I have several thoughts regarding President Obama’s speech to the joint session of Congress:
(1) As John King stated on CNN afterwards, “the man can certainly give a speech.” Obama’s delivery and presentation were outstanding throughout his 45 minute presentation. Obama was clear, articulate, compassionate when he needed to be and appropriately defiant when confronting the misinformation that has been directed at the bill (and him) over the last few months. In a Clarus Research poll immediately after the speech, Democrats, Independents and Republicans gave Obama high praise for his presentation.
(2) It was widely believed that President Obama needed to give specific details about what he believed was necessary for health care reform. Unfortunately, a 45 minute speech to the nation is a difficult time to explain the complex details of the House’s 1,000 plus page health care plan. Obama even said that while there was agreement on 80% of what needs to be done, that “there remain significant details to be ironed out,” which drew a laugh from members of Congress.
(3) When it came to the public option – perhaps the most contentious aspect of the proposed reforms – Obama hedged. While he said that he was in favour of such an option, he tempered his enthusiasm for it. He stated that no one would be forced to choose the public option (downplaying fears that the option would lead to a “government takeover of health care”). He also stated that Congressional Budget Office (CBO) projections indicated that fewer than 5% of Americans would sign up for it. He then repeated his stance that the public option was only one part of the plan and that he is open to other ideas that accomplish his goals of giving everyone access to affordable health care. He concluded with what seemed like a strong statement in favour of the public option, however, when he boldly asserted that “if Americans can’t find affordable insurance, we will provide you with a choice.”
(4) Another critical issue in health care reform is the issue of cost containment. While Obama pledged not to sign a bill that “adds one dime to our deficit now or in the future,” he stated that sufficient savings would come from reducing fraud and abuse in Medicare, as well as through a fee imposed on insurance companies’ most expensive coverage plans. But in July, Douglas Elmendorf, the director of the CBO stated that reducing fraud and abuse in Medicare “does not represent the sort of fundamental [cost containment], the order of magnitude that would be necessary to offset the direct increase in federal health costs that would result from insurance coverage proposals.” If Obama is serious about creating a deficit-neutral reform, the final version of the bill may not be as ambitious as he hopes.
(5) Obama took direct aim at some of the controversies and misinformation that have been spread about the reform proposal. He stated that any implication that “death panels” would be set up to determine who can and cannot receive necessary health care was “a lie, plain and simple.” Unfortunately, in my view, he did not explain where the lie came from (opponents of the plan took a proposal to provide Medicare coverage for voluntary end-of-life counseling – originally proposed by a Republican – and turned this into “death panels”) nor did he explain the value of end-of-life counseling.
(6) Obama also stated that the bill would not cover illegal immigrants, to which Representative Joe Wilson (R-SC) audibly shouted out “You Lie” at the President. As mentioned in my August 25 blog post, there is plainly no government provided health insurance coverage for illegal immigrants in the legislation. While illegal immigrants may be required to purchase health insurance under the individual mandate, illegal immigrants are specifically barred from receiving government subsidies for coverage under section 246 which forbids health insurance subsidies to “individuals who are not lawfully present in the United States.” Wilson’s outburst was disrespectful and unprofessional, but it was also patently wrong. On a side note, Wilson’s opponent in next year’s election, Democrat Rob Miller, had raised over $400,000 from 11,000 individual donors by 2:45pm on the day after the speech and Wilson’s outburst. Wilson has since apologized.
(7) Finally, many people I have talked to, including some at the Wellesley Institute, have mentioned that Obama needs to go beyond the simple economics and details of the plan to discuss the nature of America’s moral duty to care for its sick and vulnerable citizens. Obama did this in his impassioned conclusion where he discussed America’s character and values, and argued that health care is “above all, a moral issue” that affects “the fundamental principles of social justice and the character of our country.” He made this moral argument with reference to a letter he had received from the late Senator Ted Kennedy. Obama skillfully balanced using Kennedy’s memory and passion for increasing health insurance coverage, without blatantly exploiting Kennedy’s death for political gain.
(8) Unfortunately, President Obama did not mention the critical issue of reducing persistent health disparities in the U.S. Nonetheless, as I mentioned in my August 25 blog post, the proposed legislation (HR 3200) has several significant mechanisms that acknowledge and address health disparities. Hopefully, the President and Congress remain committed to including health equity provisions in the final version of the legislation.
All in all, it was a very effective speech and, predictably, poll numbers today have indicated that the President and his plan are more popular. It remains to be seen whether the speech “bump” can be sustained in the long-term to get meaningful reform passed.
There are also several critical issues that still do need to be “ironed out” as the President said. Judging by the raucous town hall meetings over the August recess, while there may be agreement on 80 percent of the issues, finding acceptable bi-partisan solutions to the remaining 20 percent may still prove to be impossible.