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Vidhya Alakeson on President Obama’s healthcare speech

11 Sep, 09 | by BMJ

It is a peculiar trait of American politics: long presidential speeches broadcast at prime time. Just as Bill Clinton did thirteen years ago, yesterday, for an hour, President Obama tried to convince the American people that they had more to gain from healthcare reform than they had to lose. After a summer in which the opponents of reform have dominated the debate and public support has waned, the president was under pressure to regain the upper hand.

There was no mistaking the careful craftsmanship of the speech, designed to distance healthcare reform from a big government takeover. “Choice” was mentioned frequently. The insurance exchange was deliberately recast as a “marketplace” and government became an enabler of the market. Strip away the rhetorical flourishes and heartfelt tribute to Senator Ted Kennedy and the speech had three basic aims: to reassure the majority of Americans that they have nothing to lose; to rebuild bi-partisan support for reform; and to dispel myths that have dominated the debate over the last few months.

Eighty four percent of Americans have healthcare and most of them are happy with what they have. As in the past, insured Americans have become a major barrier to reform, fearful that covering more people will inevitably mean that their coverage gets worse. The president addressed them first, offering reassurance that the only change for those with insurance would be greater consumer protections. Insurance companies would no longer be able to turn away people with pre-existing conditions or drop people from coverage when they became sick. He focused in particular on the over sixty fives who have become his harshest critics, reassuring them that he would protect the Medicare program and that they would lose nothing.

To stifle the intensely partisan tone that has infused the healthcare debate of late, the speech contained some very deliberate attempts to adopt ideas initially put forward by Republican members of Congress. Obama proposed providing young people with catastrophic coverage in case of a serious accident or illness, giving credit for the idea to John McCain’s election campaign. He saved his boldest bipartisan move for close to the end of his speech, committing to medical malpractice reforms initially proposed by the Bush Administration. The Republican side of the chamber obliged with a rare standing ovation.

Obama quickly dismissed the three most common myths about his reform proposals. Death panels were a lie, he said. Suggestions that his plan would cover illegal immigrants were false and there would be no federal funding for abortions. He dwelt longer on the subject of a public insurance option, the most politically controversial part of his proposal. He tried to take the heat out of the issue, arguing that it was not as important as either side contends. But that is wishful thinking. The left wing of the Democratic party, including the leader of the House Nancy Pelosi, has said that there will be no reform without a public option. Many on the right of the Democratic party face Congressional elections next year in traditionally Republican states. They will not risk their electoral future on a public plan many of their constituents are against. And the Republicans are universally opposed to a public plan.

Today, Bill Clinton’s healthcare speech is remembered only because his aides loaded the wrong speech onto the teleprompter and he was forced to ad lib for the first ten minutes. Obama’s speech will also not be decisive in the healthcare debate. But each time he stakes his presidency on passing healthcare reform by the end of 2009, as he did again last night, the political imperative to pass some something, however incomplete, grows. It is this political imperative, not the moral imperative that everyone should have healthcare in the richest country in the world, that could make Obama successful where Clinton failed.

Vidhya Alakeson is a former Harkness Fellow in Healthcare Policy based in Washington DC.

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  • Dr Anthony Papagiannis

    Having trained and worked in the NHS, where equality and free care at the point of delivery are the paramount values, and now tasting a free market system, where every suggestion of a required procedure is met by the questions “How much will it cost?” and/or “Is it not covered by my insurance?”, I hope President Obama will be given the go-ahead for his proposed reform. Given the worldwide financial crisis people cannot expect the complacent stability of the status quo, especially when resistance to reform is driven by the profit-hungry private sector. I find especially galling the fact that the example of the NHS is being used as a scarecrow to drive Americans away from reform. Those who have lived with the system know better, I’m sure.

  • http://www.bmj.com Duncan
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