Three Things About Obama's Health Care Speech

Give President Obama credit for a little truth-telling in his big health care speech, even if the conclusions did not quite match the analysis.

He spoke relatively frankly of the national embarrassment of the US being the highest per-capita health care-spending nation in the world, with results that don't match the cost, and of being the only wealthy nation with millions without health insurance and many others with insurance that's not all that great anyhow. The speech has proven to be something of a national Rorschach test - the Obama plan's lovers, haters, and the lukewarm generally found it inspiring, appalling, and blah, respectively, treating it as confirmation of what they already thought. Yet at least three of the president's remarks may deserve a closer look, certainly for those who think health care is a right. In one instance, the President's probably right, when his supporters may hope he isn't; in the second, we can only hope he's wrong; and in the third, he's so wrong that it's hard not to call to mind what that Congressman from South Carolina said about a different part of his speech.

Where Obama is right on the money is on just how important the "public option" probably isn't. "We believe that less than five percent of Americans would sign up," he said and "its impact shouldn't be exaggerated - by the left, the right, or the media." Now 10-11 million people purchasing a public policy, as the Congressional Budget Office (CBO) estimates, "administered by the government just like Medicaid or Medicare," as the President describes it, is a lot of people and certainly better than nothing, but his caution about making too much of it gets to the ambiguity at the heart of the plan.

"The insurance companies and their allies ... argue that these private companies can't fairly compete with the government," he said. And, apart from their judgement that it is somehow unfair for the government to provide a service more efficiently than the private sector does - or even can, they are largely right, for reasons Obama went on to explain: a government plan can avoid "some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries."

Certainly the Heritage Foundation, which describes its purpose as formulating and promoting "conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense," seems to agree. They funded a study that put the number of people who would ultimately sign on for a public plan at 103 million. So, in other words, each side is claiming that the public option will ultimately play out the way the other side would prefer. If the program were good, the Heritage Foundation's numbers ought to be right; if the President is right, then there's probably something wrong with the program.

Why do I suspect that it is Obama who is right? Ultimately because it is his proposal - although arguing details of a program that doesn't yet have any is admittedly a pretty speculative proposition. And because Obama, Rahm Emmanuel, etc. are prodigious fundraisers among the insurance industry precisely because they've made it clear that they don't intend to harm its bottom line. (The announcement subsequent to Obama's speech that a lobbyist for UnitedHealth, the nation's largest health insurer, would be hosting a fundraising party at his home for House Speaker Nancy Pelosi serves as a useful reminder of the realities of the situation.)

The reason that many on the left may be making more of the program than it merits is that, having been told from the get-go that the Administration has no stomach for a fight with the insurance industry, they hope it might be possible to still achieve their goal of universal coverage by some type of technical solution - in other words, "back door single payer," as the opposition claims. But outsmarting the industry seems a pretty unlikely outcome and, at this point, the CBO estimate itself seems quite optimistic.

Which brings us to the second point, Obama's statement that "I am not the first President to take up this cause, but I am determined to be the last." Whether or not he really thinks that, let's hope no one else supporting universal health insurance does. For even if the President should accomplish everything he said he wants in his speech, there are going to be people who are not covered - a lot of them. And regardless of what any Senator might say, single payer will be on the table until they are covered.

And so, to the third point. The President said: "There are those on the left who believe that the only way to fix the system is through a single payer system like Canada's," but he claimed that this "would represent a radical shift that would disrupt the health care most people currently have." Now, there are many things he might legitimately have said about the fight for a single payer system and the difficulty of achieving it. First off, there's nothing inherently shameful about compromise - it's a part of politics, just as it is a part of everyday life. What gives political compromise a bad name, however, is politicians claiming that a compromise between competing interests is not really a compromise at all, but a wonderful and better idea that they don't know why they hadn't thought of in the first place.

So Obama might legitimately have raised the point that there are powerful forces lined up against a single payer system, (and mentioned, if he wanted to be blunt, that the health insurance industry would go apoplectic - before going defunct.) And he could have spoken of how, if he were to seriously promote such a system, a lot of powerful people would turn their efforts to defeating him next time around and that they might even succeed, thereby jeopardizing other goals of his Administration. And it certainly would have been accurate to note that many people currently employed in the duplicative and wasteful private health insurance industry would no longer be needed and might have to be retrained for work in other fields, so their lives would be disrupted. (Provision for such retraining was actually written into the unsuccessful 1994 California single payer referendum.)

Unfortunately, Obama, who has in the past demonstrated a good understanding of what a single payer system would actually do, chose instead to make a statement he knows not to be true. Such a system would not change "the health care most people currently have," but only the address where the health care provider would send the bill afterwards - just as many people whose bills are now sent to Medicare once had them paid by UnitedHealth or Aetna.

After Obama's speech, George McGovern, probably the last Democratic presidential candidate to actually hold many of the views currently imputed to Obama - by supporters and detractors alike - succinctly summed the actual situation up in the title of an editorial he wrote for the Washington Post: "It's Simple: Medicare for All."