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Somebody Forgot to Tell Obama It's Over (Updated)

Now that's more like it.

President Obama on Wednesday addressed a meeting of Senate Democrats. It wasn't nearly as dramatic as his visit to a House Republican retreat last week. The question-and-answer period mostly featured vulnerable Democrats, like Evan Bayh and Blanche Lincoln, who used the opportunity to grandstand about the perils of liberalism and importance of fiscal discipline--or, at least, their own very curious brand of it. But Obama used the occasion to send another strong message about health care reform--and the need to push ahead with comprehensive reform, despite the loss of the Massachusetts Senate seat.

You look at an issue right now like health care.  So many of us campaigned on the idea that we were going to change this health care system.  So many of us looked people in the eye who had been denied because of a preexisting condition, or just didn't have health insurance at all, or small business owners in our communities who told us that their premiums had gone up 25 percent or 30 percent.  And we said we were going to change it.
Well, here we are with a chance to change it.  And all of you put extraordinary work last year into making serious changes that would not only reform the insurance industry, not only cover 30 million Americans, but would also bend the cost curve, and save a trillion dollars on our deficits, according to the Congressional Budget Office.  There's a direct link between the work that you guys did on that and the reason that you got into public office in the first place.
And so as we think about moving forward, I hope we don't lose sight of why we're here.  We've got to finish the job on health care.

Obama was doing more than appealing to the senators' sense of moral obligation, I think.

He was also reminding them that, by abandoning health care reform, they'd be abandoning one of their central campaign promises--a decision that's not likely to play well with the voters, for reasons that Nate Silver explains over at Five-Thirty-Eight:

...this is the equivalent of a Republican saying: "You know what, my opponent is right--lower taxes are a bad idea on principle." It's a stake in the heart of the liberal/progressive value system. ... If you've conceded that one of your ideas--one of your most important ideas is a bad one--why should the public trust any of the other ideas that you have? Instead, they're going to say: Well, thank you Mr. Blue Dog--I'm glad you've come around to my way of thinking on this. Now I'm going to vote for the guy who didn't have the bad idea in the first place.

Of course, Obama didn't say anything about exactly how the Senate should proceed. And even if he had, rhetoric can do only so much. But it appears he and his advisers have been more specific privately. Greg Sargent reported at Plum Line on Wednesday that the administration has been urging the Senate to take up amendments to its bill through the reconciliation process, so that the House will then feel comfortable voting for the Senate bill.*

(The administration would prefer, I'm sure, to have the House just pass the Senate bill. But Speaker Nancy Pelosi has said repeatedly that House Democrats wouldn't go for that.)

All of this is consistent with what Obama said on Tuesday, during a town hall in New Hampshire. After a fairly straightforward endorsement of health care reform in his prepared remarks, he gave a far more passionate argument for it in response to the first question. He explained the bill, defended its complexity, and then he challenged the Republicans--as he's been doing lately-- to come up with something better.

The response is long, so I'm reprinting it at the end of this item. But suffice to say that it's not the kind of language you would use if you were trying, very carefully, to let the issue fade away. In fact, something about the way he said it--the body language, the fact that he gave such an extended defense once he was off his prepared text--made me think this is something that's really gotten to him, whether out of principle or mere pique.

I can't be sure, of course. I have no idea what goes on in his head--or his heart. But, whatever his calculus and motives, it certainly appears he's not finished yet. Let's just hope Congress isn't either.

Here's that excerpt from the New Hampshire town hall:

In our health care bill, one of the most important components was the idea, the basic principle that nobody should have to go without health insurance because of a preexisting condition.  Nobody should have to go after--go without health insurance without--because of a preexisting condition. Now, this is something that's very popular if you just say it in isolation, but when you start explaining what is required to make that happen, then sometimes some people get a little nervous. You can't have insurance companies have to take somebody who's sick, who's got a preexisting condition, if you don't have everybody covered, or at least almost everybody covered.

And the reason, if you think about it, is simple. If you had a situation where not everybody was covered but an insurance company had to take you because you were sick, what everybody would do is they'd just wait till they got sick and then they'd go buy insurance. Right? And so the potential would be there to game the system.

The reason I point that out is because a lot of the reforms that we've proposed fit together.  So we want insurance reforms that make sure that a cancer survivor can still get health insurance.  But to do that, we want to make sure that everybody has health insurance, which in turn allows us to cut back on some wasteful spending and help upgrade hospitals and doctors and how they perform medicine because now they're not dealing with as many emergency room patients.

So the cost control aspects of it, the coverage aspects of it, and the insurance reform aspects of it all fit together.

Here's the problem, though, is when you've got all those things fitting together it ends up being a big, complicated bill and it's very easy to scare the daylights out of people.  And that's basically what happened during the course of this year's debate.  But here's the good news:  We're essentially on the five-yard line--for those who like football analogies.  So we've had to go into overtime, but we are now in the red zone, that's exactly right.  We're in the red zone.  We've got to punch it through.

What I have said is that both the House bill and the Senate bill were 90 percent there. Ten percent of each bill, people had some problems with, and legitimately so.  So we were just about to clean those up, and then Massachusetts’ election happened. Suddenly everybody says, oh, oh, it's over.  Well, no, it's not over.  We just have to make sure that we move methodically and that the American people understand exactly what's in the bill.

And what I've done is I've said to the Republicans, show me what you've got.  You've been sitting on the sidelines criticizing what we're proposing.  I'm happy to defend insurance reforms; I'm happy to defend the fact that we need to provide 30 million people with access to coverage; I'm happy to defend the need to provide small businesses an ability to pool so that they can have the same purchasing power that the big companies have and drive down their premiums and drive down their rates for their employees.  I'm happy to have these debates.  I just want to see what else you got.  And if you've got a good idea, great.

At the Republican caucus, they held up--they said, we've got a plan; it's going to provide everybody coverage at no cost. And I said, well, if that were true, why wouldn't I take it? My wife Michelle thinks I'm stubborn sometimes, but I'm not that stubborn. Okay, let me think. I could have everybody get health care coverage that's high quality, and it's free, which I'll bet is really popular.  But I'm not going to do that. I'm going to go through the pain of really working through this hard process in Congress, getting yelled at and called a socialist, because I just--that's how I roll. I'm a glutton for punishment.

No, look, if this were easy and simple, first of all, somebody would have done it before.  Seven Presidents have failed at this; seven Congresses have failed at this.  If this was simple, it would have already been done.  It's not.

This is one-sixth of our economy; it's extremely complex.  But I want everybody to understand here:  The health care proposal we put forward is basically the same shape as the proposal that was put forward by Tom Daschle, former Senate Democratic Majority Leader; Bob Dole and Howard Baker, two Republican Senate leaders.

So it can't be that radical.  It's a very straightforward principle that says we're going to set up an exchange, a pool, where people who don't have health insurance and small businesses who can't afford it right now can buy into the pool.  If even after we've driven premiums down because of increased competition and choice, you still can't afford it, we're going to give you a subsidy, depending on your income.  We're going to ask that everybody get health insurance, but if you still can't afford it we'll exempt you, we'll give you a hardship exemption, because there are some folks, you know, that it's just too tough.

We are going to insist that the insurance companies all abide by certain practices like making sure that you take people with preexisting conditions, that you don't drop people just because they get sick.

We then say that we have to control the costs of medicine, so we're going to set up a panel of experts -- doctors and health care economists -- who are going to scrutinize how we reimburse things like Medicare to make sure that doctors are encouraged to work as teams -- don't order five tests if you could just do one test and then e-mail it to five different doctors.  Pretty straightforward.

Now, what I just described is the essence of what we're doing.  And according to the Congressional Budget Office, it would save $1 trillion in our deficits, which is the single most important thing we can do, by the way, to reduce our deficit over the long term.

Almost all the growth in deficit has nothing to do with my Recovery Act, and has everything to do with the growing costs of Medicare and Medicaid.  Almost all of it.  You project out 20-30 years -- almost all the growth is because health care costs are just going out of control and we've got an older population that's going to need more care.  And if we can't figure out how to get a better bang for the buck, we're going to lose.

So here's my thing:  You got a better idea?  Bring it on.  But what I will not do is to stop working on this issue -- because it is the right thing to do for America and you need to let your members of Congress know they shouldn't give up, they should keep on pushing to make it happen. 

Update: It remains an open question whether Obama is doing enough on the inside to close the deal. Ohio Senator Sherrod Brown tells Huffington Post's Sam Stein that White House engagement on the issue has "dried up" in the last few days. And he's not the only one complaining that the White House should be doing more.