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Obama On Healthcare: A Strong Start Raises Expectations

Where so many proposals attack healthcare piecemeal he laid out a definition of the problem that was thorough, and that also raises expectations for the plan he's developing.
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Host of 'The Zero Hour'; Writer; Senior Advisor, Social Security Works

Host of 'The Zero Hour'; Writer; Senior Advisor, Social Security Works
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I've been hard on Barack Obama in the past but, unlike some of my colleagues, I was very impressed with today's speech on healthcare. I've posted most of the speech's text on The Sentinel Effect with running commentary, but here's why I think it's such a strong start - both in the context it sets and in the rhetoric it employs:

First, he defined the problem in a comprehensive way. Where so many proposals attack healthcare piecemeal - universal coverage, or out-of-pocket costs, or health IT - he laid out a definition of the problem that was thorough, and that also raises expectations for the plan he's developing.

Here's what he emphasized:

  • Universal coverage -- it's "morally repugnant" that Americans can't afford their own healthcare, says Sen. Obama, and universal coverage must be a priority.

  • Out-of-pocket expenses -- He was explicit in describing the rise in the out-of-pocket costs for healthcare experienced by insured Americans. By including this issue in his definition of the problem, Obama's going where Gov. Schwarzenegger and Sen. Wyden have not. He's implying that healthcare reform can't place unfair burdens on working Americans.

  • The high cost of healthcare -- He included remarks about the impact healthcare costs are having on American business. By doing that, he's also raising the issue of runaway cost inflation, which many of the reform plans currently on the table don't directly address.

  • Drug company profits -- The Senator directly raised the issue of record drug-company profits. His proposed response could range from the mild (e.g. continued price negotiation for Medicare) to the strong (direct price intervention.) It will be interesting to see what he proposes.

  • Health IT -- Like others, he cites our lack of health IT development as a critical need - and he's right.

  • Employer-Based Health Insurance -- He also raises questions about using employers to provide healthcare, although in a very general way. I've long maintained that Americans made a tacet decision to use business as a distribution network for socially-needed insurance, and have resented the inevitable results of that decision ever since. Can Sen. Obama address this fundamental issue? It will be interesting to see.

    • Sen. Obama knows words, and he knows how to use them. I don't think it's an accident that he uses language to raise very high expectations for his coming healthcare plan. Here are some of the things he says in his speech:

    • ""Plans that tinker and halfway measures now belong to yesterday."
    • "In the 2008 campaign, affordable, universal health care for every single American must not be a question of whether, it must be a question of how."
    • "For too long, this debate has been stunted by what I call the smallness of our politics - the idea that there isn't much we can agree on or do about the major challenges facing our country."
    • "Caution is what's costly."

    The Senator closes with an impassioned description of the fight to create Medicare, and the political courage that was needed to overcome resistance to change. That's raising the stakes very high for his own proposal.

    I fail to understand Kevin Drum's criticism. "Maybe in a little while," writes Kevin, "he'll give a major speech in which he really does endorse universal healthcare rather than fiddling around the edges of the debate." I think Obama's endorsement of universal coverage was unequivocal.

    If you're looking for areas of concern from the left, you might concentrate on the Senator's definition of what constitutes "affordable" care. The greatest flaw with both Gov. Schwarzenegger's plan and Sen. Ron Wyden's, in my opinion, is that they could both prove very costly to middle and lower-income people.

    The Senator's use of the phrases "socialized medicine" and "burdensome taxes" suggest that he's not pushing a single-payer solution, and some won't like that. Nevertheless, he's setting goals and expectations in a way that strongly implies he will come up with a compelling and interesting plan.

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