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Obama Misses the Point on Health Care Debate

08/23/2009 05:12 am ET | Updated May 25, 2011

My wife is an economist -- and I study politics. But on President Obama, she has been right all along. From the start she understood that he was speaking to the nation in a way that resonated uniquely with voters; I was skeptical.

Now, she understands that his lofty rhetoric is missing the point on the health care debate. And again she is right.

In one amazing presidential campaign and six short months in office, President Obama has established himself as one of the greatest public orators in American history. That makes it even more perplexing how he has missed opportunity after opportunity to stir the nation to support major health care reform.

Wednesday night's press conference might have been the low point. We witnessed Professor Obama explaining the intricacies of the policy options in sonorous tones; he made the economic argument in a way that made every listener understand why economics is "the dismal science." I was screaming at the television set every time he launched into the litany of cost savings from effective use of technology, saving two-thirds of the cost by efficiencies within the system, not allowing the health care reform to add to the deficit, the excessive cost of U.S. health care, and the undeniable problem of 46 million uninsured Americans. We get that. He did not need to pound it into our heads.

What was missing was the very simple concept that health care is a public good.

If an uninsured family does not take a child with symptoms of swine flu to the doctor because of the cost of health care, swine flu will spread. Other children and adults will be infected. And we will all lose. We need to fix the system so this does not happen--not just for that uninsured family's sake but for all of our sakes.

The debate has been framed in terms of winners and losers. The Obama strategy has been to pick off interest group after interest group--the doctors, the nurses, the pharmaceutical industry, the AARP--in order to get a majority behind the bill. The opposition has taken the opposite tack. Poke holes in the specific proposals, raise fears, play to the claims of those who might not benefit from a specific part of the whole.

That is old school, interest group politics, the kind of politics that is flooding our airwaves on this issue

What is needed is the Obama of the campaign. Raise the aspirations of a great nation. Let the nation know that we, the American people, we, the nation to whose standards every other nation in the world aspires, can do better. And in doing better, we do so not just for the less privileged among us, but for all of us.

The public good argument is clear. A reformed health care policy will make us a stronger nation and--and this is the key--will benefit everyone. That argument can be made in economic terms. When an uninsured person does not get treated early on for a wound because of fears of the cost, the wound may become infected. Eventually he goes to a hospital emergency room and is treated. When the bill is unpaid, the hospital writes it off. But that write-off goes into other fees; and insured people end up paying higher fees for services and consequently insurance premiums. Those costs are real; they are just less apparent than others. But people are treated--and those costs are paid.

The President came close to making the public good argument only once during his press
conference, when he outlined the cost of the current system. "If somebody told you that there is a plan out there that is guaranteed to double your health care costs over the next 10 years, that's guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that."

Then he left that argument. I cannot believe I am saying this, but Ronald Reagan would have made the point, in simple homespun language, probably with a couple of human examples as props. The health care debate is a human debate, not an economic one. And it is a debate about what is best for all Americans, not just the underserved.

This President, every bit the Great Communicator that Reagan was, must make this argument in terms of what is best for every American, not financially, but in terms of our health. His plan--even with lots of compromises--recognizes that health care is an American problem, not a special interest problem. His plan--even with lots of compromises--improves markedly on the current system, in a way that should be reassuring, not frightening.

He has to sell it in that way.

L. Sandy Maisel is director of the Goldfarb Center for Public Affairs and Civic Engagement at Colby College.