President Obama's speech last night was hailed as a potential game changer. And it was a Hail Mary pass down the middle of the country-- but with precious little time left on the clock to deliver the kind of reforms the president says he really wants.
Eloquent, centrist, and more detailed on specifics than he has been up to this point, the president delivered the kind of speech he should have given back in May or June. Instead, he let Congress fritter months away passing partisan bills in the House and Senate to meet an August deadline that he imposed and that led to support for reform plummeting as details emerged.
One laugh line from his speech summed up his predicament: "some details" have yet to be worked out -- and these are critical. The Congressional Budget Office has said that none of the Democrats' bills (to date) in the House or the Senate, bend the curve of government health care spending. A national health care exchange, heavily regulated, would drive up the cost of coverage, not make it more affordable. Deficits would rise, not fall, under these bills.
Expectations for last night's speech were too high to satisfy. Would he save the "public option," a rallying cry for liberals, or dismiss it, because it infuriates moderates and conservatives? He did neither. Talk of principles predominated, and the president said that as long as they were met the public option was a means to an end, not an end in itself. Killing it entirely would've infuriated liberals, but stupefied Republicans, who've spent so much time fighting it. Without a line in the sand, the public option will continue to be a flashpoint in the debate.
President Obama conceded that tort reform was a good idea, but in the form of a few demonstration projects run by the Department of Health and Human Services. Demonstration projects are where good ideas go to die. Republicans won't see this as a concession but as a ploy.
The genius of the president's 2008 campaign was that he wrapped his proposals in the conservative themes of choice and competition sprinkled with liberal aspirations of universal coverage. He was long on rhetoric and short on details. But with the economy souring, and Republicans floundering, his cool competence and steady message won the day.
Much of the same was on display last night: Everyone with private insurance would get to keep the coverage they have, except that it would be cheaper and better. Government would balance its budget by taming entitlement spending for Medicare and Medicaid-- primarily by cutting waste, fraud, and abuse. Insurers took a beating for excluding Americans with preexisting conditions. The uninsured would be given affordable health care options, and no one would ever have to worry about health care ever again.
Everything would be the same, only better – the president's persistent message. But the political landscape has changed, even if the president's tactics haven't.
Congress has helped squander the president's political capital with a nearly $800 billion stimulus bill that has garnered widespread contempt, an unpopular bailout of the automobile industry and lavish spending in general. While the administration moves on to its next big idea (health care reform), the economy remains fragile and unemployment stands at just under ten percent. Add to this volatile mix the fact that the administration has just announced deficit projections $2 trillion higher than its own previous estimate and the public has little appetite for sweeping new programs.
What to do now? The president needs to do more than signal he's open to new ideas. He needs to embrace them: Pull the plug on the public option. It's on life support anyway, and it deserves to go. Put tort reform provisions with teeth into any final bill; the only group that hasn't been asked to sacrifice anything so far is the plaintiff's bar. A good place to start would be expert health courts to hear medical malpractice claims. Scrap proposals for new taxes on insurers, drug companies, and diagnostic makers. Taxes only get passed along to customers, driving up health care prices, not lowering them. Scrap the "deficit neutral" argument. The aim should be to lower government spending, not increase it.
Bring Republican leadership in the House and Senate into the discussion and invite specific proposals on areas of agreement-- like covering Americans with preexisting conditions and ensuring that competition and choice drive health care costs down. The current strategy-- picking off a Republican Senator here or there and calling it bipartisanship-- doesn't build credibility with anyone.
"Misinformation" isn't the main reason why health care reform is floundering-- and the president's speech last night won't change that. But there's still time for a game changer-- if the president changes how he plays the game.
Paul Howard is a senior fellow and director of the Center for Medical Progress at the Manhattan Institute
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