At a critical moment in the tense health care debate -- when the U.S. House and Senate are scrambling to forge compromise reform plans that might be passed before the Congress embarks upon its traditional August recess -- President Obama is retooling his health-care reform message.
Instead of the bold rhetoric of last year's campaign, or even of last month's press conferences, the president is now pitching reform as more of a consumer-protection gambit.
"No one is talking about some government takeover of health care," Obama explained to the crowd at his latest town hall meeting in North Carolina on Wednesday.
Rather, the president argued that his reform vision would make insurance companies more responsible.
"We have a system today that works well for the insurance industry, but it doesn't always work well for you," Obama told 2,000 people gathered in a Raleigh high school gymnasium. "What we need, and what we will have when we pass these reforms, are health insurance consumer protections to make sure that those who have insurance are treated fairly and insurance companies are held accountable."
Obama wants to do this by:
* requiring insurers to set annual caps on how much they can charge for out-of-pocket expenses,
* requiring insurers to fully cover routine tests to help prevent illness,
* requiring insurers to renew any policy as long as the policyholder paid the premium in full,
* barring insurers from refusing coverage because of pre-existing conditions, scaling back insurance for people who fall very ill, charging more for services based on gender and/or placing limits on coverage,
* barring insurers from denying children family coverage through age 26.
These are pretty good ideas.
Unfortunately, they tinker around the issue of affordability -- the great challenge for tens of millions of Americans who have access to health care but lack the resources to pay for the coverage they need.
For those who would seek to control costs in a responsible manner, the dangerous trend in the health-care debate at this point is toward schemes that would see the federal government providing money to low-income families so that they can buy care from high-income insurance companies.
That's nothing more than a giveaway to insurance companies. And it will not control costs.
In fact, if the Medicare "reform" experience of recent years is an indicator, the likelihood is that costs will skyrocket as insurers hike prices to pay for advertising and maintain excessive profits. And how much does anyone want to bet that the advertising will highlight the "services" they are required to provide by Obama's consumer protections?
Whenever anyone talks about controlling health-care costs, the important thing to remember is that private, for-profit insurers drive costs up in order to make money.
That's what's maddening about the focus of so much of the congressional negotiation that is currently going on.
As Obama's message illustrates, some attention is being paid to the problem of insurance companies that collect money from healthy people and then refuse to care for sick people.
But scant attention is being paid to the problem of insurance companies that charge Americans -- be they well or ill -- too much.
Instead, in order to draw support from conservative "Blue Dogs" and corporatist "New Democrats," congressional leaders are talking about putting the screws to Medicare -- a public program that is popular and that actually delivers care to tens of millions of Americans.
Congressional officials tell the Associated Press that Senate Finance Committee chair Max Baucus, D-Montana, has reportedly forged a tentative agreement with wavering Democrats and supposedly moderate Republicans in the Senate to cut "squeeze an additional $35 billion out of Medicare over the next decade and larger sums in the years beyond."
"Under the plan," AP is reporting, "an independent commission would be empowered to recommend changes in Medicare annually, to take effect automatically unless Congress enacted an alternative... The commission would be required to recommend $35 billion in savings over a decade from Medicare."
When used by Washington insiders to describe changes in how a safety-net program, the word "savings" usually translates as "cuts."
So, as of today, health care "reform" is shaping up as scheme to impose consumer protections on insurers while squeezing Medicare with cost controls that will be implemented not by Congress but by an "independent commission."
Honest reform must include consumer protections. But that's just a starting step.
The question remains: What will be done to make coverage affordable?
Here's a notion: Instead of setting up an independent commission to squeeze Medicaid and Medicare, how about an independent commission to squeeze insurance company profits?
Here's an even better notion: Instead of trying to make insurance companies do the right thing, why not set establish a single-payer program that takes as its mandate the coverage of all Americans in a system that controls costs by operating on a not-for-profit model?
After all, that's what a wise legislator said when he was asked about controlling costs while delivering health care to all Americans.
Here's what he said.
"I happen to be a proponent of a single payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody. And that's what [single-payer advocates are] talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that's what I'd like to see."
The legislator's name was Barack Obama.