President Obama is trying to bring about the largest change in social policy in more than 75 years. To do that, he has to get consensus among 300 million Americans who fall into two basic categories: those worried that change will not go far enough, and those worried they will be worse off when the process is done.
The President tried to allay the fears of those who already have health insurance by assuring them that they could stay where they were. At the same time he promised to create a health insurance system for all 300 million. It would be as though you were living in a house and the president came and said he was going to build a new one that would house everyone on your block, perhaps even you.
The President is trying to build a house of health in which all Americans can live without fear of losing their coverage or being threatened by bankruptcy. In the process of building this house he is promising the American people that it will be a better place to live and will not cost more than it presently does.
Congress has shaped the president's vision into legislation that includes major provisions like a public option, prevention and wellness, increased competition and assistance for small business. Together, the president and the Congress have started to pour the foundation and build the structural supports. Much of the argument that is going on today is over the details of what the house will look like, what will be included, and at what cost.
From the beginning, the President clearly understood that not every detail could be worked out before construction started. This house of health is a work in progress that will be created over the next three years. There are those who feel that if we can't know all the details of the construction then we should not begin to build the house. Their plan is to do nothing until everything is decided in final form. People who feel this way don't want a house of health.
The President has succeeded in convincing the majority of the Congress that the most effective way to provide both access to health care and control the cost of health care is to have everyone living in the same house that is universal coverage. No one can be excluded from the house because of where they lived before (pre-existing condition) and no one can be thrown out of the house because of problems they develop while living in a house. Today in the United States some 50 million people do not have a roof over their head and another equal number have a leaky roof that does not protect them when the storms come. Every other industrialized nation in the world has built a house of health for their people. It is inconceivable that the richest democracy on earth cannot provide a house of health to cover everyone.
When one builds a house there is not unlimited money available, so choices have to be made. None of these decisions are simple or easy, but they will be made over the course of the next three years as we build the house of health. Cost estimates will be made, but anyone who has done home construction knows that unexpected things come up which require decisions.
In 1965 when we built the house of health for senior citizens called Medicare, we could not anticipate all the changes that would occur in health care delivery since then. Congress has changed Medicare many times since it was created to keep up with the times and the needs of older Americans. This compassionate flexibility is at the heart of Medicare's popularity and success. The same process will go on as we build the house of health for the American people.
The President and the Congress are about to lay the foundation so that all Americans can live securely in the house of health, unafraid of the consequences of an illness or injury. This house will protect the American people from the weather they cannot predict. We must begin now.