Last night was a very strange evening of political theater. President Obama pretended that the last eight weeks never happened and gave essentially the speech he has been giving to no avail around the country all summer, in favor of the same general outline the Democrats have been pushing, without more detail, and without any real changes.
As Bill Kristol points out, Obama actually began by suggesting that there was not a health care crisis in America. “We did not come here just to clean up crises,” he said after speaking about the economic crisis. “We came to build a future. So tonight, I return to speak to all of you about an issue that is central to that future — and that is the issue of health care.” And he suggested that by engineering and designing things just right, the Democrats would indeed give American health care its correct ultimate shape, and render it permanently unproblematic. “I am not the first president to take up this cause, but I am determined to be the last.” The last?
Permanent perfection, in this kind of technocratic vision, would surely require getting every fine detail just right. Yet Obama did not seem to be advancing a very detailed plan, but rather championing some vague generalities. And when you line these generalities up, they form a very peculiar and implausible picture. It will cost $900 billion, involve no tax increases for the middle class and no Medicare benefit cuts for the elderly, but not add a dime to the deficit. The basic prerequisites for risk-based insurance will be rendered illegal, but the public is assured that insurance arrangements need not change–or rather that they will only improve.
To try to sneak these glaring contradictions past his listeners, the president engaged in some familiar misdirection. He said the government would not force people to lose their existing insurance. But the question of displacement is not about force: employers currently provide insurance not because they are forced to do so (they are not) but because a combination of policy and labor market pressures lead them to choose to do so. Change those pressures and coverage arrangements will change for millions.
He insisted that “no federal dollars will be used to fund abortions,” but those dollars would be used to fund insurance that would pay for abortion, and new rules would require more insurers to pay for it. He insisted the public plan would not be subsidized by the public (though he then compared it to public universities, which are subsidized by the public). But the problem with that plan is that it would have regulatory advantages and negotiating power that would allow it to price private insurers out of the market, not that it would be directly subsidized in ways its competitors were not.
To pass off this misdirection (not to say dishonesty), he accused his opponents of dishonesty. There won’t actually literally be panels of people deciding that elderly patients should die, he said. That’s a relief. To argue that cutting hundreds of billions of dollars from Medicare will in any way reduce benefits is just plain lying, he insisted.
And in the face of these liars, the president offered himself up as a moderate. Again and again he presented two extremes and described his position as a golden mean between them. Some people want a single-payer system (yes, some people do), and others want to abruptly end the employer-based insurance system, while he is the centrist taking good ideas from both sides. But his support for medical liability reform amounted to an argument against including it in the bill (since he said he would pursue very modest executive branch action alone). His support for lower-cost options for people with pre-existing conditions, which he attributed to John McCain, was just unclear: what exactly is he arguing for there?
The president made a spirited case for a public insurance plan, yet somehow the news is supposed to be that he didn’t demand it as adamantly as he might have or threaten a veto if it is not in the final bill. That’s true, but he argued for it, and it’s a very bad idea. Are we supposed to walk away impressed that he’s not really for it?
And finally, Obama concluded with a painfully inappropriate abuse of the memory of the late Sen. Ted Kennedy-calling by name on several Republican friends of Kennedy’s, as if to shame them into voting for a bill they do not support because failing to do so would be a failure of friendship. Is this how a president behaves? Using the memory of the recently deceased as a club with which to pound upon the man’s friends?
Steppping back, it is striking how partisan this speech was — both in its offense and its defense. There’s nothing necessarily wrong with that, of course. But it’s telling. It suggests the White House and the Democratic leaders have decided that the Democrats must go it alone, and therefore needed a pep talk to give them the courage to push against public unease and Republican opposition. This speech may well serve them on that front. But it is hard to imagine that it will persuade independent voters who are worried about the plan, and that kind of persuasion is what moderate Democrats needed.
On the whole, it is hard to see how this speech moved the ball much. But it certainly revealed more clearly some of Obama’s priorities and premises — a peculiar combination of technocratic ambition and wariness of particulars.