Did Obama's speech succeed in recasting the debate over health care reform?

Did Obama's speech succeed in recasting the debate over health care reform?

Did Obama's speech succeed in recasting the debate over health care reform?

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Sept. 9 2009 11:09 PM

Obamacare 2.0

Did Obama's speech succeed in recasting the debate over health care reform?

Barack Obama. Click image to expand.
President Obama

Barack Obama must envy Steve Jobs. In a speech Wednesday afternoon, Apple's CEO unveiled several spiffy new product updates, and within hours, on millions of computer screens across the country, little windows popped up asking users if they wanted Apple's new software. If they did, it was seamlessly a part of their lives in just minutes.

John Dickerson John Dickerson

John Dickerson is a Slate political columnist, the moderator of CBS’s Face the Nation, and author of On Her Trail. Read his series on the presidency and on risk.

Several hours later, President Obama spoke to a joint session of Congress promising his own painless overhaul: a retrofitting of the American health care system with no changes for those who like their coverage, coverage for those who don't have any, and all of it paid for.

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Unfortunately for the president, installation is a nightmare. To make his case, Obama drew from a wide palette. At times he sounded like he was on the campaign trail. Knocking down claims about "death panels," he said, "It is a lie, plain and simple." To opponents who might distort his plans, he promised, "We will call you out." He dove deep into the details of insurance coverage as if he were presenting to a policy roundtable. He ended with high speechifying that included a celebration of the life of Sen. Ted Kennedy.

As for the substance, there were some new nuggets. But mostly the president sought to reiterate what he's been saying for months. "Nothing in our plan requires you to change what you have," said Obama in the first of what he described as three main principles of his reform. For the insured, he promised, "as soon as I sign this bill," their lives would be better. It would be illegal to deny coverage because of a pre-existing condition or lose it because of illness. For those without insurance he promised quality and affordable choices.

Obama's goal was not to present some perfect plan but to support the best plan that can get the votes. "There is a path here to get this done," a senior administration adviser said before the speech. Obama tried to lay out that path both in detail but also in manner: He played the middleman.

He talked about those on the left who want a single-payer plan and those on the right who prefer to leave things pretty much as they are. (This will no doubt infuriate the left more than the right, who will not only claim false equivalence but who might remind the president that before he was using them as a foil, he was courting their support by saying he supported a single-payer plan, too.) He was reminding those independent voters who tell pollsters they disapprove of his handling of the health care issue that he's the reasonable, unradical guy they liked during the election. "I believe it makes sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch."

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Twice Obama referred to Republican ideas. He praised John McCain's idea of providing catastrophic care for those who've been denied insurance because of a pre-existing condition. He also said he was looking into medical malpractice reforms considered by George Bush. He made a detailed appeal for the public option, a favorite of liberals, but then downplayed it, saying it would cover only 5 percent of the uninsured.

The president was not met with a similar considered tone. Rep. Joe Wilson, a Republican from South Carolina, shouted out "You lie" when Obama suggested illegal immigrants would not be covered. (Which still doesn't make him the most unruly South Carolina congressman in history). Wilson later apologized.

White House aides hope that merely by describing his plan, Obama will see a bump in public support. Previewing Obama's remarks, a senior administration official cited polls in which support for health care reform increases by 20 points to a sizable majority when voters simply see details of the president's plan. Said a senior administration aide: "This is about providing clarity."

As allies had hoped, Obama portrayed insurance companies as the villains of this tale. He did it in every way possible. In the box of seats reserved for first lady Michelle Obama sat Nathan from Colorado, Katie from Montana, and Laura from Green Bay, whose stories of suffering at the hands of insurance companies have provided the emotional punch for his health care speeches on the road. For the home audience, the White House made heartbreaking videos. Obama told his own tales of brutal, deadly insurance company malpractice. A man from Illinois lost coverage in the middle of chemotherapy because his insurer found he hadn't reported gall stones that he didn't even know about. A woman from Texas saw her policy canceled because she forgot to declare a case of acne. "That is wrong and no one should be treated that way in America," said the president.

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Obama offered a new plan—sort of. He isn't offering legislative language, but on a Web site put up in conjunction with the speech, there were some new details. Obama's plan will cost $900 billion (though oddly the Web site doesn't say so). That's less than the $1 trillion-plus experts say is necessary for comprehensive reform, but also less than the $1 trillion opponents have said is too much. "In the end this is about getting this passed, " a senior administration official said, explaining how the administration reached the figure.

Another new idea was what aides are calling a "fiscal trigger." Obama pledged that he will provide additional spending cuts if the savings he's promised don't materialize. The details of the trigger are still fuzzy. To have teeth, a trigger should initiate mandatory action. The one offered by the bipartisan policy center plan's calls for automatic policies that would achieve savings. On Obama's trigger, the discipline is not automatic but left in the president's hands. We just have to take the president's word that he won't wiggle out of the pledge. (Of course, since the budget window we're talking about is 10 years, Obama won't be around to face some of the potential overruns.)

The trigger is aimed at those who worry that expanding health coverage will increase the deficit. It's also an attempt to address one of the fundamental problems Obama and other reform advocates have faced selling reforms. "They may like what we're offering," said one senior Democratic aide on the Hill. "But they don't believe we can actually deliver." The trigger makes it seem like Obama is not just promising but locking himself into the promise.

People want change in the health care system but also fear the change of reform. Obama made the careful case that reform will be incremental, safe, and effective. After months of Congressional back and forth, it was a sweeping effort to take control of the substance and the politics of a debate that has been slipping away from him. Now he'll have to see if his plan and his speech can survive the congressional process to come, where each of his carefully worded sentences and balanced middle-way approach will get buffeted about by competing interests.

Obama ended his speech with a flight of rhetoric. He read from a letter written by Ted Kennedy that the Massachusetts senator asked be released after his death, in which Kennedy argued that health care was "above all a moral issue." Obama argued that Kennedy's passion for the issue had grown not from his ideology but from his big-heartedness and concern for others. It was the opening chords of what would become Obama's full-organ-music rendering of the American character. He called on the country and the legislators before him to keep faith with America's principles of tolerance, limited government, and fellow-feeling. A speech that had been so specific, so incremental, and so earthbound headed to such rhetorical heights that when the president concluded with the traditional "God bless you and may God bless the United States of America," it sounded like a drop in altitude.