Setting the Record Straight

The president, the press, and the public option

In an interview with The Washington Post yesterday, President Barack Obama rejected criticism that he had compromised too much just so he could get some health bill passed this year. The president challenged his critics to identify any “gap” between what he campaigned on last year and what Congress is on the verge of passing. He told the paper:

Nowhere has there been a bigger gap between the perceptions of compromise and the realities of compromise than in the health-care bill. Every single criteria for reform I put forward is in this bill.

The conversation with reporter Scott Wilson inevitably turned to the most contentious issue of all: the public plan option, which the president has not forcefully advocated. In September, he said it was not an essential ingredient for reform. He was still saying that Monday, when Politico reported that if progressives were relying on the president to push hard for a public option in a House-Senate conference committee, their hopes were dashed when the president again downplayed the importance of the public option in an interview on American Urban Radio. There, he argued only “a few million people” would have benefited from the plan.

Obama told the Post the public option “has become a source of ideological contention between the left and the right,” adding “I didn’t campaign on the public option.”

Really? If that’s true, Mr. President, that is not what the public was led to believe. Obama saying he didn’t campaign on the public option is a little like Bill Clinton quibbling during the Monica Lewinsky scandal about the meaning of sexual relations. “It depends upon what the meaning of the word is is,” Clinton declared. It’s all dodgy lawyers’ talk.

If Obama didn’t “campaign” on a public option, his campaign certainly embraced it. The Kaiser Family Foundation, the definitive source on such matters, reported during the campaign and still notes on its Web site that he would create:

the National Health Insurance Exchange through which small businesses and individuals without access to other public programs or employer-based coverage could enroll in a new public plan, like Medicare, or in a range of approved private plans.

Obama did, however, make clear from the get-go that not everyone would be able to use the public plan, and that those who had other coverage could not benefit from whatever advantages such a plan would offer. Still, until late this summer, the public—which generally supported the public option—held out hope that they would get cheaper and more comprehensive coverage through such an animal. This morning I reread a piece by Minnesota single payer activist Kip Sullivan, who dissected the bait-and-switch of the public plan. By the time the idea got worked over by the pols and the special interests, it’s no wonder that it was toothless, making it easier to dump in the end and allowing the president to say it wouldn’t have helped that many people anyway.

In the Post interview, Obama said that the Senate legislation accomplishes “95 percent” of what he called for during the campaign and in his September speech. Without toting up the score, it does provide for some of the proposals he advocated, like investments in electronic medical records, the CLASS Act, cutting the fat out of Medicare Advantage plans, and making insurers cover sick people—although companies will have ways of getting around that prohibition.

In reality, a gap does exist on the big stuff. During the campaign, the president did not support the individual mandate and the penalties that come with failure to buy coverage. He and Hillary Clinton sparred mightily over that one. He wanted to require only kids to have insurance; she wanted to make everyone have a policy. Both Senate and House bills call for the mandate, which by September the administration supported, although Obama and other pols didn’t make a big deal about it. Most likely they didn’t want to alarm the voters who will have to cough up money for coverage.

Then there’s the matter of lowering prescription drug prices, using the power of the federal government to negotiate prices under the Medicare program and allowing the reimportation of less expensive drugs from other countries. Those two proposals, at one time dear to liberals, were washed away in the deals the White House made with drug makers, arguably reform’s biggest winners.

And, of course, there’s the affordability issue. How many times did the stump speech promise that Obama was going to make insurance affordable and cut premiums $2,500, on average? That talk vanished early on when it was clear that even with reform, millions of Americans would have to dig deep into their pockets to pay the thousands of dollars for coverage they’d be penalized for not buying.

How affordable policies will be under legislation with weak or non-existent cost containment won’t be known until Barack Obama leaves office, because the legislation doesn’t take effect for several years. The affordability question yesterday prompted Physicians for a National Health Program to urge the Senate to kill the bill, arguing that it would leave “hundreds of millions of Americans with inadequate insurance. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care.”

Politicians say things all the time to get elected. The voters know that on some level. But in the last election, millions thought and hoped that this time was different. How different is the story the press will have to tell.

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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.