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Truman Show

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

There must be 100 smart analyses of last week's State of the Union speech. Many of my blogosphere friends were happy with it. I was pretty dismayed. I thought the President needed to push much harder and with greater specificity for a comprehensive bill. A week later, I feel even worse.

The origin of my disquiet was ably expressed by Brown University professor James Morone in Wednesday morning's Los Angeles Times. Morone provided the best analysis of that address, even though his essay went to print before word one was spoken. Morone is a gifted scholar who works at the interface between history and political science. If you haven't read him, stop reading this column and do so.

His op-ed "Seeking their inner Trumans" identifies a crucial political problem.

The Democratic leaders have not gotten credit for running this difficult reform through the daunting congressional gantlet. It hasn't been pretty -- Democratic leaders are talking ruefully about sausage-making -- but they played the inside game brilliantly.

But they forgot to tell their story to the people…. The Republicans told their story with exquisite skill. "Death panels," socialism and "government takeover" were all colorful ways to opt for private markets over government policy.

What is remarkable -- given the eloquent man in the White House -- is that Democrats were too busy dealing to come up with a counter story…. Not just once, in a complicated speech, but every day and in ways that connect….

Part of the President's task was to place that inside game in broader perspective, to remind voters that there was an honorable purpose to all that sausage-making. Clawing for 60 votes is sordid when the goal is to pass another bloated agriculture or a fighter jet the Pentagon doesn't want. It's quite another thing when the goal is providing health insurance coverage for 30 million people.

Majority Leader Reid and Speaker Pelosi deserve great credit for winning passage of the two bills. For all the sausage-making and disappointment, the Senate and House bills surpassed the outer limits of what I thought possible trudging through the Indiana snow distributing Obama leaflets two years ago.

These bills required backroom deals. Some deals were laudable—efforts to secure money for community health centers, for example. Others were straight pork. Still others--say favorable treatment for rural hospitals—fall in-between. Legislative acts between consenting adults are generally best done in private. Still, I see nothing wrong—indeed a lot right--in Senator Reid's willingness to cut the required deals to win landmark legislation. The same holds for reconciliation. I wish the President had made this case with passion and some precision from the podium. Every health policy expert I know believes that reconciliation will be essential to passing a comprehensive reform.

Republicans' newfound fastidiousness over "cornhusker kickbacks" is especially rich. To take one random example among many, Senator Lindsey Graham protested that Senate debate had "turned into a pretty sleazy process." That same Senator, when questioned about a $950,000 earmark for a South Carolina convention center, replied, "I should have the ability as a United States Senator to direct money back to my state as long as it's transparent and it makes sense."

Even more important, President Obama needed to embed his comments within a broader narrative that rebuts the poisonous anti-government narrative offered by Republicans. He needed to do this in his own defense, and to defend his political base and the Democratic Party. His State of the Union address didn't surrender to that Republican narrative, but it didn't offer a powerful alternative, either.

There are many good arguments to be made for health reform. Many of these arguments are technocratic. Despite massive spending, our health care and private health insurance systems are visibly dysfunctional in so many ways that would be improved through provisions in the House and Senate bills.

To my mind, the most powerful arguments go beyond valuable technical adjustments. These come down to what kind of country we really want to be. I want to live in a country where I know 300 million fellow citizens have my back if my daughter is struck by cancer, if my mother fades into dementia, if I am paralyzed in a freak fall.

I've thought a lot about these questions because my own life has included freak accidents of its own. Not long ago, I sat bored and scared in a hospital waiting room, wondering how it was that my aerobicized 40-something wife came to be there, connected to myriad monitors and lines in the cardiac ICU. I spent much of my time there watching the throng of tight-lipped people sitting alongside me, some reading mystery novels, some playing cards and making small talk, some wandering down to the cafeteria loading up on junk food, some quietly crying, many sitting quietly waiting for good or bad news. I spent a lot of time wondering how our family's life would change as a result of this illness. I worried how we would pay for an unfolding and uncertain package of expensive care.

The story had a happy ending. After a wild medical ride, my wife came home one week later. She's back to her old self doing 90-minute workouts at the gym. In due course we received a $50,000 hospital bill. Thanks to our generous and costly university health plan (annual premiums to me and my employer: $17,000), our out-of-pocket costs were less than $5,000. That was a burden, but hardly life-changing for us.

I doubt my waiting-room companions had the luxury of making that choice. That hospital is located within a gritty working-class Chicago suburb. The lady next to me sat pensively while her husband's chest was being cracked open for surgery in the adjoining operating room suite. Local data (and heartrending accounts in Jonathan Cohn's Sick) suggest that many similarly-located Chicagoland families fall into medical bankruptcy. Given my nice job and health coverage, I'm spared that situation. Maybe my family doesn't need health reform at all. I can see how easy it is for millions of us to just leave things there. We might feel badly for that lady if she's in a financial jam, just not quite bad enough to pay higher taxes or to change our own healthcare deal.

I might feel that way myself, except for the fact that I know something that lady doesn't. She and millions of others have already stepped up to help me, when my mother-in-law died without warning, leaving my wife and I suddenly responsible for a medically challenged, cognitively disabled man. Without Social Security, Medicare, and Medicaid, we could never have paid the six-figure bills that accumulate in his care. Taxpayers footed the bill so that he could lead a healthier and more productive life in our community, and spared our family the need to warehouse him in an affordable but awful institution as families were once routinely forced to do.

Our nation opened its heart, and thus its wallet, to help families such as ours. Now, through a different accident of fate, some of the people who helped us now need our help after they or a loved-one have become seriously ill. Our society is failing to help them, although their need is scarcely less profound. We can do better. If some added sliver of my six-figure paycheck is required to help that lady, I think she's earned it. She had my back when I needed her. I should have hers.

I was hoping that the State of the Union address would include the simplest argument for social insurance: Acting together, we can protect ourselves and our neighbors against burdens that would crush any one of us if we were forced to bear it alone.

President Obama has not made this case (though he made some of it Friday in a brilliant question-time with House Republicans). That was an opportunity lost.

Now three Jonathans (Chait, Cohn, and Zasloff) note Rahm Emanuel's belief that health care can wait awhile. Allowing this thing to die after it has passed both houses would be an even bigger opportunity lost. We just can't do that.

Note: Due to an editor's error, the original posting of this article was missing the first three paragraphs. It's now been corrected.

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