The sadness is that almost Obama’s entire speech could be read as a splendid brief for universal single-payer health care, or at least Medicare for all who want it.
But when Obama got down to specifics, he gave only tepid support to the public option.
He laid out clearly the problems with the current system, in economic but also—and especially—moral terms, but then stepped back from the fundamental changes that are necessary to meet that economic and moral crisis.
The speech was by turns thoughtful and impassioned, conciliatory and tough, dry and moving, ingenious and disingenuous, naïve and nobody’s fool.
He appealed to reason and to our values—to the “character of our country.” It was a term he borrowed from a letter he received from Ted Kennedy, which was delivered posthumously. Obama used it and Kennedy’s memory in an affecting way toward the end of the speech. He talked of Kennedy’s “large heartedness,” and noted that because of this trait, Kennedy saw a role for government to help the needy and those without health care.
Obama also begged for civility even after one Republican shouted out that he was a liar, and while Obama urged a bipartisan approach, he finally showed some steel.
“Know this,” he told the Republican side. “I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.”
But he could have stiffened his spine several months earlier, and for a bill that would have allowed anybody to join Medicare at any time.
That’s not this bill.
Hell, from the sounds of his speech, the public option is a goner.
When he finally got around to discussing the concept, he used the word “can” instead of “must”: “An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange.”
And after he went on defending the virtues of his diluted public option (the only people who could join would be the uninsured), he then tiptoed away from it.
“Its impact shouldn't be exaggerated – by the left, the right, or the media,” he said. “It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles.” He called it “only a means” to an end.
He then suggested he’d be open to co-ops instead, or a trigger later on for a public option if the private insurers don’t behave themselves.
You could almost see the white flag in his suit coat pocket.
Actually, the only time he put his foot down on a specific detail of the legislation was when he said: “I will not sign a plan that adds one dime to our deficits, either now or in the future.” And then he repeated the line in case we weren’t listening. He added that that the bill would require more spending cuts if the savings he proposed don’t materialize.
Chances are they won’t, since the Congressional Budget Office already estimated that Obama’s plan would not be revenue neutral but would cost hundreds of billions of dollars more.
The only way to really reduce health care costs across the board is by single payer, since it would wipe out profits, advertising, and immense systemic waste that occurs when doctors and hospitals have to fill out forms for a myriad of different insurers.
And one of the best ways to reduce the costs in Medicare is to allow the government to bargain for bulk drug discounts, but Obama already gave that store away. (In his speech, he bragged about how the drug companies are backing his bill, but he didn’t reveal why.)
So now Obama has embedded into the health care bill a recessionary device—the automatic slashing of federal spending when health care costs inevitably go up.
Obama also exaggerated the budgetary problem of health care when he said, “Our health care problem is our deficit problem.”
Actually, war is our deficit problem—$3 trillion for Iraq, and more for Afghanistan.
Actually, bailing out banks is our deficit problem—several trillion more, when you count the guarantees.
Obama himself waved at the cost of the Iraq War and the Bush tax cuts to the rich, which belied his earlier simplification.
And Obama misled the country when he said single-payer would require us to “build an entirely new system from scratch.”
No, it wouldn’t.
The system is in place.
It’s called Medicare.
And it works very well.
It’s a pity that a President with such intelligence and such eloquence and, yes, “large heartedness” has not used his attributes—along with his power and popularity—in service of the most sensible and profound solution to the health care problem.
Instead, he’s left the private insurance companies and the drug companies running the show.