obamahcspeech3So, where did I leave off?

…That’s right, there was a speech Wednesday night. A pretty significant one, in fact, for reasons I described at some length.

What of it, then?

I can’t deny that it was a very, very good speech. Rhetorically powerful. And yet, what it says about the direction of health care policy, and thus about Obama and the Democratic Party itself… still remains substantially up in the air.

(Even as every pundit who can string three words together attempts to read the tea leaves and tell us otherwise.)

I’ll try to avoid that kind of divination. But opinions? Analysis? I have those.

My first impression was pretty straightforward:  there was no new information here. The speech didn’t tell me anything I didn’t already know, about the problem, the policy, the politics, or Obama’s own personal stance. Thus, I was inclined to conclude that the speech was not a “game changer,” and that Obama had failed at his goal of “resetting” the national debate.

However… the fact is that I was already up to speed on all of these matters, since I’ve been following the issue all along. It was therefore necessary to remind myself that inasmuch as I’m a well-informed and politically engaged citizen—as I and all the other attendees were repeatedly reminded at a recent DFA Campaign Training Academy—I Am Not Normal.

And most certainly, I was not the target audience for this speech, any more than were the members of the media and the blogosphere who have been following the issue obsessively and opining on it endlessly.

The actual target audience was multifaceted, in a way that made Obama’s task especially challenging. There’s a reason he called for a joint session of Congress, as opposed to speaking to a camera in the White House. As Nate Silver observed, the primary targets were both (A) dedicated liberals, who insist on the necessity of a public option, and (B) centrists and “independents,” who are often opposed to that and, at best, uncertain. Moreover, as Marc Ambinder noted in advance, the target audience was much more “in the room” than for most major televised presidential speeches—he was talking to “the American people,” yes, but first and foremost he was targeting the members of Congress on whose votes this legislation hangs. That includes both the Congressional Progressive Caucus (prominent in group “A” above) and the “Blue Dogs” (in group “B”)… but it doesn’t necessarily include the broad swath of mainstream Dems, who will be content so long as they pass something, nor does it include the GOP minority, who (despite some lip service) have frankly made themselves irrelevant to the process at this point.

What was especially tricky here, though, is that influencing members of Congress depends to a great degree on how those members think he has influenced the larger public audience. It is, unavoidably, all a game of perceptions.

With all that in mind, Obama’s skillful handling of the evening shone through in many ways. To start, he deftly positioned himself in the “center,” albeit by the somewhat sad maneuver of framing a single-payer system (as opposed to a public option) as being impractically far to the “left.” As he framed it,

I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.

The center is a sanctified place to stand—or not so much to stand, but to be perceived as standing—in today’s mainstream political and media culture. (This remains true notwithstanding the fact that most Americans actually hold fairly liberal views on most issues—they just don’t self-identify as “liberal”. And, likewise, despite my observation last night that centrism on this issue is more a stand-in for do-nothing conservatism than a signifier of independent thinking;  or, as Jonathan Chait deftly put it

…taking the middle ground between the two parties is not a way of liberating yourself from dogma. It’s simply a way of lashing your own judgment to the prevailing sentiments of the moment. … A huge proportion of self-styled “centrist” thought simply boils down to surrendering one’s own capacity to make normative judgments about politics and public policy.

…But I digress.)

Obama proceeded, explicitly and clearly, to spell out his own concept of the plan and to address the top-level concerns of every segment of the public with a stake in this issue:  those who have current coverage, those who don’t, and those on Medicare; those concerned about quality and choice, those concerned about cost, and those taken in by ominous but completely fabricated threats about reform.

Some of this was pretty basic stuff… for, again, anyone who’s been paying attention. A lot of people, regrettably but obviously, have not. Indeed, judging by some of the fundamentally confused criticism out there about the expense of reform, some people simply don’t get the concept of how insurance works, and thus fail to grasp how adding a broader population to the risk pool serves to reduce costs. Obama spelled this out with everything but diagrams.

Looking at this from the progressive side, the big question was whether Obama would take a stand on the need for a public option, or on the other hand give up on it. This is not a small matter (much less a “fetish,” as Chuck Todd at NBC would have it). A public option is necessary for very pragmatic reasons of economics, and thus (by extension) of long-term political success.

As it turned out, Obama avoided either alternative. Instead he explained the role and importance of a public option, painstakingly explaining why it’s not a “government takeover” as the paranoid fringe would have it… but refused to draw an unequivocal line in the sand (as he did, by contrast, over potential deficits), insisting that it’s just “one part” of a larger plan and that he remains open to alternatives that would serve the same ends (not that any actually exist). This is far less of a full-throated defense than one might ideally prefer, and it’s understandable why some see it as dismissive… but on the other hand, strategically speaking, it may be a clever move. By soft-pedaling the public option and painting it as if it were a small matter, he defuses some degree of misplaced public anxiety, and thus provides political cover for Congressional “moderates” not to dig in their heels against a bill that contains it. The comparison between public vs. private universities and public vs. private insurance was particularly deft, the sort of analogy that intuitively makes sense to a lot of people.

At any rate, he did at least give the public option fair treatment. Certainly this was to some extent motivated by recent activism from the left, both the grass roots and the Progressive Caucus. Whether he strategically provoked that activism, or merely reacted to it, is very much a matter of subjective perception.

What’s more unfortunate is that the public option itself, in the form that survives in current versions of the bill, is a shrunken shadow of the concept Jacob Hacker originally proposed. It’s certainly not, as some wanted from the start, something as simple and elegant as giving younger citizens an option to buy into Medicare. Instead it’s framed as a back-up plan, a coverage option available only to those who don’t already have any… an approach which, as Sen. Ron Wyden has criticized, is far from optimal. (I personally have no reservations at all about saying that if my choice is between a government bureaucrat and a profit-driven corporate bureaucrat managing my health coverage, I’d much prefer the former, and I know many people who feel the same. As now proposed, though, I—being uninsured—would be able to opt in, while my girlfriend—who’s covered through her employer—would be stuck with a private insurer. Some “choice.”)

Moreover, while insisting that a public option must be “self-sufficient,” Obama didn’t specify whether it would be allowed to use government bargaining power to set provider compensation rates—as, e.g., the original version of HR 3200 did, specifying “Medicare plus 5%”—or whether it would be prevented from doing so, as was the case with Bush’s money-pit “Medicare Part D” fiasco that was barred from negotiating drug prices with Big Pharma. This distinction makes a huge difference in terms of overall costs.

Least impressive, he threw a bone to proponents of “triggers” (one of Rahm’s pet ideas), without actually calling them by name, and likewise to “co-ops,” calling both “constructive ideas worth exploring.” They are not; they are just the opposite, destructive ideas that promise no serious cost controls, and indeed nothing more than further unnecessary delay. The private health insurance industry has had decades to demonstrate that it could contain costs and expand access on its own, and has not only declined to do so but has done precisely the opposite; at this point giving the industry yet another chance to get it right on its own is entirely unnecessarily.

Looking beyond the matter of the public option, the speech moved from strength to strength. Along the way Obama deftly offered grace notes to the GOP, in the full knowledge that they wouldn’t be reciprocated nor make a difference in the eventual voting, thus winning the public perception of who’s reasonable and who’s obstructionist. The idea (credited to McCain) of making available short-term major-medical coverage while the larger “market exchanges” are being constructed is actually a good one, and would help the public see an immediate benefit from a plan that’s otherwise frankly spread over too many years. The olive branch on “tort reform” and “defensive medicine” is less pertinent, as Obama (and everyone else in the chamber) was surely well aware that malpractice premiums and jury awards together amount to barely one percent of overall health care costs; nevertheless, it defuses one of the right’s more effective talking points. (And to the extent that there are any actual cost savings to be gleaned there, they’re most likely to be come from containing the rising premiums charged by, yes, private insurers—which would certainly be an ironic hoisting of the GOP on its own petard, wouldn’t it?)

At the same time, Obama seems finally to have given up on trying to appease those who cannot be appeased; while his rhetoric didn’t exactly evoke FDR, he wasn’t afraid to be partisan enough to call out the GOP rather pointedly for its past and present blind spots, with a touch of class consciousness thrown in. One personal favorite was this passage:

Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for – from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.

I appreciated it not because I’m a deficit hawk (far from it, especially in times like these), but because of the position in which it placed the opposition. It was (moving on from yesterday’s chess and basketball metaphors to boxing) a classic rope-a-dope maneuver. Indeed, throughout the speech the GOP side of the aisle was visibly engaged in a lot of uncomfortable squirming. They weren’t sure when they should clap and when they shouldn’t; they came across as out-of-touch and unsympathetic. Certainly it was a revealing moment when Obama said, “in the United States of America, no one should go broke because they get sick,” to rousing applause from most of the chamber… and the camera panned to show the Republicans stock-still in their seats.

And true to form, in the evening’s one unscripted (though certainly not unplanned) moment, the GOP managed to make itself look even worse. Rep. Joe Wilson’s “You lie!” outburst, as Obama was debunking various paranoid claims about reform ranging from “death panels” to (at that moment) coverage for undocumented immigrants, emphatically embodied the way today’s GOP values neither civility nor truth. The charge was, of course, a lie itself, completely unsupported by the content of the bill. The former Strom Thurmond aide has, apparently, been known for this sort of intemperate outburst in the past, though not in such a vividly public forum. Wilson has subsequently apologized and attempted to roll back the damage, but that hasn’t stopped incensed viewers from donating to his opponent in South Carolina’s 2nd District—to the tune of hundreds of thousands of dollars just since last night.

(And seriously… would anyone who actually cared about reforming health care be swayed by whether or not undocumented immigrants were eligible? If anything, including them would help further reduce costs. …But then, I’m not among the fringe cohort that so viciously despises and disparages so-called “illegals”; there’s an element of racial fear in this that leaves me utterly unsurprised at the overlap between that cohort and the “birthers” so anxious to delegitimize Obama himself.)

But perhaps Wilson just couldn’t help it. There’s lots of paranoid thinking going on out there, and as a correspondent expounds at TPM, this is exactly the sort of thing that kind of thinking leads to:

One recurrent theme of extremist assaults on the president has been the deep, visceral conviction that he’s hiding an extremist agenda. The more moderate his rhetoric, the more reasonable his tone, the more detailed and specific his claims, the deeper this conviction grows. If you start with the presumption that the president is trying to foist his socialist agenda on an unsuspecting nation, then his apparent moderation and civility is actually further evidence of his duplicity. … So when the president stood up and declared that the bills mean what they say, Wilson simply couldn’t contain himself any longer.

(Remember, it was Republicans themselves—five years ago now—who ceded the “reality-based community” to their opponents in a quixotic assertion of its irrelevance. The concession has certainly been coming back to bite them.)

The best part of the speech was judiciously saved for last, as Obama movingly described a letter from the recently deceased Ted Kennedy and segued into a resounding defense of liberalism as a philosophy of government. He unapologetically declared that “we are all in this together,” and explicitly evoked “the character of our country.” He emphasized examples of how government involvement has been essential to “the history of our progress,” pointedly referencing the battle to pass Medicare 44 years ago.

In this we got what so many critics had been urging:  a defense of health care reform as a moral imperative. In recent days journalists have spoken up, Nicholas Kristoff reminding us that government is often more effective than its critics acknowledge and Bill Moyers urging Obama to frame things in terms of “the right thing to do,” while progressive legislators like Rep. Anthony Weiner have forcefully insisted that health care is more than just another commodity to be controlled by the market… but Obama himself has too often approached the issue as if government-backed reform were at best a necessary evil. This speech changed that. The rhetorical shift was both clear and welcome.

It is far too easy, as I elaborated last night, for those of us outside the halls of power to succumb to cynicism. Certainly every presidential regime in my political lifetime has only encouraged it, each seemingly worse than the last. I was frankly depressed for months after the 2004 election, lamenting the disastrous direction our country was headed and wondering what my fellow citizens could possibly have been thinking. But clinging to that kind of cynicism ultimately bespeaks a defeatist attitude, and plays into the hands of the right. Obama explicitly rejected it last night:

[Our predecessors] knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter — that at that point we don’t merely lose our capacity to solve big challenges.  We lose something essential about ourselves. …
But that is not what the moment calls for.  That’s not what we came here to do.  We did not come to fear the future.  We came here to shape it.  I still believe we can act even when it’s hard. …  I still believe we can replace acrimony with civility, and gridlock with progress.  I still believe we can do great things, and that here and now we will meet history’s test.

It was a stirring conclusion. It was, as Andrew Sullivan put it,

a reprise of the core reason for his candidacy and presidency:  to get past the abstractions of ideology and the easy scorn of the cable circus and the cynicism that has thereby infected this country’s ability to tackle pressing problems. … And he makes sense. And this was not a cautious speech; it was a reasoned but courageous speech. He has put his presidency on the line for this.

And despite the fact (as both I and Obama’s critics have observed) that the actual policy content was nothing new, it seems to have done the trick. A CNN insta-poll reported that among people who watched the speech, support for the reform plan jumped a stunning 14 points, from 53 to 67 percent.

Combine all this with today’s breaking news that the Census Bureau reports another 680,000 people lost health coverage in 2008—a figure that would have been even worse without the government stepping in to replace eroding private coverage!—while real household income fell 3.6% in the same period (and all this before the job losses of the last eight months!), and the ground has shifted. The conventional wisdom has gone from dismissing health care reform as an almost-dead issue (despite the consistent public support) to recognizing it as politically viable. The momentum is once again on Obama’s side.

Of course, that’s not to say it still couldn’t go awry.  In truth, Obama has “put his presidency on the line” with his core supporters as much as with anyone else. Worst-case scenario, we get the exact opposite of what he offered us on the campaign trail last year:  individual mandates, but without serious cost controls, thus making us virtual captives of the private insurance industry.

(For what it’s worth, I’ve certainly communicated to my own Representative, both Senators, and the White House, that supporting any bill without a public option is not an option, and to do so would be to lose my vote in the future. Anyone who could concede that much on an issue like this and still claim to be a Democrat, is someone who richly deserves to be primaried.)

While I’m still not putting money on any particular prognostications, though, I’m not quite as fearful of a bad outcome as I had been. Remember, what’s really important is what comes out of conference committee. The worst obstacle right now is the bill coming from Max Baucus’s Senate Finance Committee—but contrary to what Baucus no doubt intended, delay has not worked in his favor. Everyone in the blogosphere (and thus certainly everyone in Washington) is well aware that Baucus and his “gang of six” are among the Senators most dependent on corporate campaign largesse, especially from the health care industry; and reports are that the bill they’ve (almost) produced is abominably bad—not only would it neither expand access nor control costs in meaningful ways, but it would ride roughshod over state laws in ways that even any self-respecting conservative should reject.

Baucus is still trying to talk a good game, but he’s clearly not in tune with the majority of his own party, never mind the public. Indeed, there’s no reason Baucus’s bill should even take any precedence over the earlier and better HELP Committee’s bill, unless Majority Leader Harry Reid has a spine made of linguine.

(Wait, we’re talking about Harry Reid. Never mind…)

But seriously… whatever hybrid versions of the bill get out of the Senate and the House (and they will; even the Blue Dog Dems understand there’s no political advantage in abject failure), once it’s in conference committee the internal pressure will be to make the bill more progressive, not regressive. (Not from Rahm, perhaps:  it’s against his very nature to put any pressure on conservative Dems. But at that stage of the game, his perspective will be considerably less relevant to most members.) Dems will own this bill, and what they need for their own political survival (never mind the public good) is a bill more likely to work as described, not less so.

So… will the uncertainty be resolved? Will Obama live up, on this huge and defining issue, to what we saw in him last year—the intellectual, independent mindset, the determination to make a difference, that inspired so much hope in so many? Will we see the Democratic party finally start to stand behind a serious, forward-looking agenda? We don’t yet know. But there’s still reason to hope.

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