A Path out of the Health Care Mess?

Still no guidance from the president

As readers of Campaign Desk know, we have long questioned the president’s leadership on health care, his number one domestic priority last year. Those questions remain relevant in 2010, especially since it appears that his domestic priority has now shifted to jobs and economic help for the middle class. Health care surfaced some thirty minutes into Wednesday night’s State of the Union speech, and seemed more like a throw-away line than the stirring call for action for which some reform supporters had hoped. As Politico put it, the president offered Congressional Democrats:

words of encouragement but little else—no concrete plan to jump-start progress on a bill, no timeline for getting it done and no guidance on what he wants to see in what was once his top legislative initiative.

Specifically, supporters were looking for direction. Are the Dems still going to press for the Big Enchilada, or will they settle for tidbits that might have some chance of passing through both houses? Are they going to ram something through under the reconciliation process, or work through more normal channels? The White House had warned that Obama was not going to dictate particular legislative tactics to move the stalled bills. But then again, he hasn’t dictated much so far, waiting instead for Congress to take the lead. Witness his equivocation on the public plan.

Throughout last year he said he was open to other ideas, and he made that point again Wednesday night:

If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.

Obama still glossed over what he wanted from health reform, a tactic which allowed pols to hear what they wanted to hear in the speech. Rep. Jan Schakowsky, a liberal Democrat from Illinois, said people were waiting to hear that health care was not off the table just because it’s hard and politically difficult, and “he made it very clear that that is not the case.” Pennsylvania Democrat Jason Altmire said “It was near dead. I think the president brought it back to life. But I don’t know that the Congress has the appetite to continue the fight.”

Obama took some of the blame for “not explaining it more clearly to the American people.” But last night he still didn’t explain much, repeating the same focus-group tested themes he had used before. He told Americans that his approach would “preserve the right of Americans who have insurance to keep their doctor and their plan”—the standard Democratic boilerplate for the last two years. How can they keep their doctor if the doctor is no longer in the health plan their employer chooses? What happens when a plan they like is no longer offered by the employer? What rights do people have then? What are older people who heard the phrase “strengthen Medicare for seniors” supposed to think when all they’ve been hearing about are cuts to doctors and hospitals participating in Medicare? How does the word “strengthen” square with the word “cuts” in the average beneficiary’s mind? How exactly will his plan reduce costs and premiums for millions of families and businesses when its cost containment provisions are problematic? This is the kind of explaining the president has not done and still needs to do if he is to bring the public along.

The media should not wait for the president. Too often the press has based its health care stories on what newsmakers say, not on what the public needs to know. That partly explains the widespread public unease and misapprehension over health reform. Those following health care are confused by what’s going on—all that talk about reconciliation, ramming a bill through, wooing Olympia Snowe, and so on. If this thing is resurrected, there’s still much work for the press to do. A first step might be to look closely at the parts of Obama’s plan he so briefly mentioned on Wednesday night.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.