What case did the president make for reform Wednesday night? Not a very persuasive one, in my view. For me, the big takeaway from President Obama’s press conference was that finally—finally—he revealed what this year-long exercise has been about. Whether viewers caught it among all the rhetoric was another matter. For the most part, learning anything specific took a lot of listening between the lines of his sometimes long, rambling, and off-point answers. They left viewers in the dark about most major issues.
In his opening remarks, the president let slip that health reform at its core was about health insurance reform. After a few words about his Recovery Act, the president said “we must rebuild it (the economy) stronger than before. And health insurance reform is central to that effort.” He did not say reform was fundamentally about covering the growing ranks of the uninsured, or making certain that insured people have enough coverage when serious illness strikes, or guaranteeing health care as a right without having to buy an insurance policy to pay for it.
For those who like their coverage, the president promised “more security and more stability.” But employers provide the security and stability through the benefits they choose to offer. The government doesn’t have control over that. He promised that reform “will keep government out of health care decisions.” But insurance companies make those decisions now, and they will continue to do so under Obamacare.
For those without coverage and for small businesses, Obama said they could choose a “quality, affordable health plan” through a health insurance exchange, which he said was a marketplace that promoted choice and competition. Those Celinda Lake words again. No insurance company would be able to deny coverage for preexisting conditions, he noted, but he didn’t mention that companies still might be able to charge older (and presumably sicker) people more money.
The individual mandate is central to health insurance reform efforts that would make carriers cover sick people. Insurers insist on a mandate which will require all Americans to have some kind of insurance, either through a government program, their employers, or policies bought on their own. But hardly anyone has mentioned the mandate, or how it would force cash-strapped citizens to either buy insurance or pay a tax penalty. Wednesday night the president did not tell ordinary Americans why the individual mandate was a good idea. There was only a cursory reference to it in response to a question from NBC’s Chuck Todd, who asked how the president planned to expand coverage. The president said that the bill estimates that 97 or 98 percent of people would be covered, adding:
There might still be people left out there who, even though there’s an individual mandate, even though they are required to purchase health insurance might still not get it or, despite a lot of subsidies, are still in such dire straits that it’s still hard for them to afford it and we may end up giving them some sort of hardship exemption.
One thing the president did make clear was that his plan would not add to the deficit, and must also slow the growth of health care costs in the long run. His recipe for doing that: change payment incentives, so doctors and nurses can give the best care rather than the most expensive care, and transfer some authority for setting doctor fees to an independent agency, in order to help eliminate some of the politics that inevitably surround payment decisions. It’s hard to say whether people really understood what all that meant. His pledge to refrain from increasing the deficit raised the thorny problem of paying for subsidies needed to help the uninsured buy insurance. (About 85 percent of uninsured people will need them.) Here, there was little clarity.
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Maybe I'd agree with you that "employers provide security and stability" if people weren't losing their jobs at an alarming rate. Wouldn't it be nice if you wouldn't have to also worry about paying outrageous monthly rates for COBRA insurance on top of having lost your job?
#1 Posted by Thalia, CJR on Fri 24 Jul 2009 at 05:15 PM
I thought the President's press conference was interesting and informative, and I think he made the case well. And I think he was talking to me, and not to you.
You should criticize your colleagues if you didn't like the questions; that aspect is hardly the President's fault. Evidently your colleagues in th White House Press Corps are too bored to stay awake that late.. You and your colleagues bemoan the lack of exact details, at the same time dropping yourselves upon the fainting couch at the "long answers." How bo-o-o-o-o-oring!
Well, which is it? You want long detailed answers? Then suck it up and stay awake. You want short, snappy sound bites? Then STFU about the lack of detail.
POLICY IS HARD WORK. Your vapid colleagues are in the wrong business if they can't follow along. Maybe theater criticism would better suit their shortcomings.
#2 Posted by Tom, CJR on Sat 25 Jul 2009 at 01:56 PM
Recessions inevitably deliver capitalism a bad rap.
History shouts that dependence on government becomes dangerously habitual, and leads to loss of liberty. That goes for individuals, as well as for businesses.
http://pacificgatepost.blogspot.com/2009/07/government-vs-capitalism.html
#3 Posted by James Raider, CJR on Sun 26 Jul 2009 at 04:08 AM
Trudy, there used to be an article on this site called "The Selling of Clinton-lite" or something like that which detailed the history of health reform in 1993. It was an excellent article, but the URL I had for it doesn't work any more. Was it moved?
The exact same process that denied us any change in 1993 seems to be being repeated now. Many people don't seem to be old enough to realize that, maybe they need some kind of recap. Please write another article on the co-opting and subsequent destruction of our hopes in 1993 comparing it to now.
#4 Posted by Alex Gossett, CJR on Sun 26 Jul 2009 at 02:59 PM
Alex, I wrote the "Selling of Clinton Lite" which appeared in the March/April 1994 issue of CJR. That story told of the marketing efforts surrounding a bill introduced by Rep. Jim Cooper of Tennessee, which was to be an alternative to the Clinton plan. Our archives are currently being reconfigured, but you should be able to access the piece soon. Thanks for writing.
#5 Posted by Trudy Lieberman, CJR on Mon 27 Jul 2009 at 11:43 AM
The Democrats need to ask some sacrifices of their political base if they want to expand coverage for the poor. They should roll back the increase in the minium wage and eliminate the refundable tax credits. Those two actions alone would provide almost all of the funding needed for Obamacare.
#6 Posted by Les Horowitz, CJR on Wed 29 Jul 2009 at 03:21 PM