Obama Speaks Loudly But Carries a Small Stick

President Obama spoke loudly but carried a small stick Wednesday night, when he outlined what's left of his health-care reform agenda in a rare address to a joint session of the Congress.

Noting that "it has now been nearly a century since Theodore Roosevelt
first called for health care reform," the president told skeptical
legislators from both sides of the political aisle. "I am not the first
president to take up this cause, but I am determined to be the last."

That was one of several takeaway lines of the night.

The other, delivered to members of the House and Senate who have
just returned to Washington after an August of brutal town-hall
meetings, was: "The time for bickering has passed. The time for games
has passed. Now is the season for action. Now is the time when we must
bring the best ideas of both parties together... Now is the time to
deliver on health care."

The president was equally muscular when it came to addressing "scary
stories" and "bogus claims" about "death panels" and threats to
Medicare that have been spun up by insurance-industry front groups in
order to thwart meaningful reform. Democrats loved it when Obama told
the spin doctors -- in the House and Senate Republican caucuses and
their media echo chambers -- that: "If you misrepresent what's in the
plan, we will call you out."

But this was not a too-the-barricades address by a president who was
prepared to battle not just the lies about his plan but the compromises
that would make universal health care the dream deferred.

When it came to the task of offering the explanations, arguments and
details that have been so hard to come by during a frustratingly
unfocused debate about how to develop a functional health-care system
for a country where tens of millions of Americans have no insurance
coverage and tens of millions more are under-insured, Obama remained
unsettlingly vague.

He restated his determination to prevent insurance companies from
denying coverage to Americans with preexisting conditions. He proposed
portability and flexibility. He pledged to bar insurance-company caps
on the amount of care that is provided the sick. And he decried
insurance company abuses that even Republicans seemed to agree -- at
least if applause is any measure -- are "heartbreaking" and "wrong."

These consumer-protection initiatives could well form the foundation
for the legislation that Obama says he is determined to sign this year,
since it certainly did not sound Wednesday night like the president was
going to fight for the sort of broad reforms that really would
guarantee health-care for all and control costs.

"It makes more sense to build on what works... rather than to build
an entirely new system from scratch," Obama said, making all-too-clear
his determination to retain the private for-profit system that failed
so miserably to deliver health care for all but that has succeeded so
monumentally in delivering profits to insurance and pharmaceutical
corporation stockholders.

Obama still talked about "options" and "choices," but he suggested
that they would be provided mainly by insurance companies that would be
given "incentives" -- i.e., streams of taxpayer dollars -- to abide by
consumer-protection regulations and come up with strategies for
covering the uninsured.

The government might step in to help, Obama suggested, but he
painted the initiative as temporary rather than permanent. When he
spoke of a "public option," as he had to in order to keep progressive
Democrats on board, the president still said: "I have no interest in
putting insurance companies out of business."

The "public option" was positioned more as a consumer-protection
initiative for "those without insurance," a sort of welfare program
that would attract only about five percent of Americans and that would
be funded by premiums rather than tax dollars.

Robust? Not hardly.

The president's language, so strong at the start, went soft when he
talked about talked about the public option. He even suggested that he
was open to alternatives favored by Republicans and some moderate
Democrats.

The president kept talking about "the plan" he was presenting. But a
lack of clarity or line-in-the-sand commitments when it came to genuine
reform of a system he described as "full of waste and abuse" created
the most amusing moment of the night.

Obama was not going for laughs when he uttered the line "while there
remain some significant details to be ironed out..." But he got them.

What the president was headed toward was a suggestion that he was still
searching for some kind of middle-ground that will satisfy "those on
the left" and "those on the right" -- even if that means supporting
medical-malpractice "reforms" that would make it harder for those who
are injured by bad doctors, nurses and hospitals to hold the wrongdoers
to account.

What Americans who have waited "nearly a century" for reform were
left with was a sense that the "great unfinished business of our
society" -- as the late Edward Kennedy described the work of pursuit of
universal health care in a last letter to Obama -- might remain
unfinished.