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It's Not Universal Health Care, but…

Josh Gerstein

Two people walk inside a Medicare Services office in New York City in 2006. President Barack Obama announced Monday a bipartisan summit next week for policymakers and legislators to discuss reforms to fix the nation's ailing health care system. (AFP/Getty Images/File/Spencer Platt)

To the casual listener, President Barack Obama's promises on health care Tuesday may have sounded like an unequivocal vow to get all Americans health insurance coverage by the end of 2009.

But in reality, that's not exactly what he pledged Tuesday night.

Obama stressed the importance of "quality, affordable health care for every American" and struck an urgent tone. "Let there be no doubt: health care reform cannot wait, it must not wait and it will not wait another year," Obama said.

But in truth, Obama's speech contained several caveats and deliberately avoided language that could box in Obama as he turns swiftly toward health reform in coming weeks.

For one thing, Obama spoke of making a "down payment on the principle" of getting affordable health care for every American. It's a phrase that shows Obama believes that it could take some time to get everyone on board, and that helping everyone is a goal rather than a reality that will be achieved in the near future.

Parsing his statements even more closely, Obama never actually said he would get insurance coverage for all, just "quality, affordable health care."

And he stopped well short of setting any final timetable on broad-based healthcare - and also avoided the sweeping notion of providing "universal health care" to Americans, a phrase Obama himself largely avoids.

During his campaign, he was more specific than he was last night. ''We can have universal health care by the end of the next president's first term, by the end of my first term,'' Obama told a union convention in March 2007.

But if Obama left himself some wiggle room on the timing and particulars of a plan, he made clear he'll tackle it soon - even amidst the economic meltdown.

In fact, Obama said he believes solving the health-care crunch is an integral part to solving the recession - that he must do one to accomplish the other. In fact, Obama's talk on health-care often seems to spring more from the brain of an economist than the heart of a caregiver, as he often paints the solution in budgetary terms rather than in humanitarian ones.


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"It's a step we must take if we hope to bring down our deficit in the years to come," Obama said.

Obama pledged to convene a health-summit next week that will bring together "businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue."

And advocates on both sides at the issue will get a clearer picture of what Obama has in mind when he releases his first budget Thursday.

Already some who favor universal coverage are watching Obama's words - and actions - very closely.

Ron Pollack of Families USA said he would accept a bill that phased in universal coverage. But he said before Obama's address that "piecemeal" legislation that covered some people now and left others to be dealt with later would be "truly troublesome."

Obama's delicate dance on health care reform is made more difficult by the fight he had with Hillary Clinton over the issue during the Democratic primary contest last year. Clinton favored requiring all Americans to get insurance-in policy parlance, a mandate.

Obama rejected that approach, saying he expected that most uninsured people would buy coverage if it was cheap enough. Obama isn't expected to endorse the mandate many experts say is essential to achieve "universal" coverage - but he's also expected to go along in the likely event that Congress includes one in health reform legislation.

A blogger with the American Prospect, Ezra Klein, reported Tuesday that Obama's new budget will strike an aspirational tone, by urging Congress to "aim for universality." White House spokesmen declined to confirm that language, though one top budget official did take issue with a portion of the Prospect report that said the budget's wording on health care "is changing hourly."

"The budget overview has been at the printer since Friday," said the official, who asked not to be named.

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