11/11/2009 05:12 am ET Updated May 25, 2011

Did Obama's Speech Set Stage For Death Of Change?

Wednesday, Barack Obama addressed a joint session of Congress to lay out a more specific vision for health care reform, spur compromise and shore up support within his own party for meaningful legislation.

But if the booing, heckling, legislation-waving conservatives -- let alone their pre-canned statements of opposition -- are any guide, it never mattered what the president had to say, so, one would have thought he might say something. And one would be more or less wrong.

What Obama did say tended to be as short on specifics as previous speeches on the topic have been, and high on the same reassurances he's unsuccessfully repeated in the past. It's as though, having repeated ad nauseam that his health care reform wouldn't allow employers to drop people's insurance coverage and most Americans would see no changes other than (maybe) lower costs, Obama thought that repeating it in front of Congress and with Joe Biden and Nancy Pelosi behind him might make it all more believable.

Obama told Congress tonight:

I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

"In some way" is probably an accurate description of the reforms Obama still backs.

After acknowledging that some people would prefer a single-payer system and others would prefer to leave all insurance purchases up to individuals rather than their employers, he said:

I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch.

Apparently, like certain financial institutions and car companies, health insurance companies are just too big to fail?

Sick of all the bickering, Obama presented a plan that sounds quite agreeable, even if it doesn't do much more than tinker with some of the rules of the current system.

Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies -- because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse.

Mind you, the health insurance companies already agreed to the Administration's terms on rescission and pre-existing conditions months ago in exchange for a mandate that all Americans would have some kind of insurance coverage. And, of course, covering more preventative care has been one of the major objects all along. So, there was nothing new here.

Obama also promised health insurance exchanges, to make it easier to buy health insurance companies' products once the government mandates that you must do so.

We will do this by creating a new insurance exchange -- a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers.

Exchanges are far from the much-maligned "public option," since they've nothing to do with cost or affordability. But, if someone can't afford any of the options in the exchange, it'll come with a nice steaming side of tax credit to help them along.

That said, Obama then got to the mandate.

That's why under my plan, individuals will be required to carry basic health insurance--just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements.

Of course, small businesses are 99.7 percent of all employers and half of Americans are employed by small businesses, according to the Small Business Administration. So it sounds like a significant proportion of American employers actually won't be required to offer health care or chip in for it.

After trying -- to jeers -- to debunk a couple of myths, Obama promised not to try to really hurt health insurance companies with the reform -- he just wants to hold them accountable. And, he still believes that a public option is the best way to do so. That said, he's willing to let it go.

To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end - and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

Obama says that, in lieu of the public option, he's willing to consider Senator Kent Conrad's co-ops or some kind of new non-profit health insurance company, like Blue Cross was before it was privatized.

In a blatant sop to Republicans, Obama used his speech to also announce that Health and Human Services Secretary Kathleen Sebelius would be moving forward on Bush-era medical malpractice reforms pilot programs through DHS. Republicans applauded Obama's foresight to throw them a bone despite the fact that not a one of them will even vote for the rest of the bill.

At the end of the speech, Obama acknowledged a private letter on health care reform he'd gotten from Senator Ted Kennedy, imploring him to finish the job. The end of his speech, devoted to Kennedy, Kennedy's love of country and Kennedy's bipartisan personal civility probably struck the right note for many Democrats who have told the Administration they won't accept a bill without a public option. But for the paper-waving, town-hall-loving conservatives who came not to listen but to be seen objecting, it was just another reason to block out any good and focus on being the Party of No. And if the answer's always going to be no, the question remains: why is Obama so determined to be inclusive of those people who want to take their toys and go home anyway?