Good Speech, Muddled Politics

Many people in Washington sadly have come to the conclusion that the moment for health care reform has come and gone. In short, that Obama’s inspiring speech was too little and too late.

What’s left is a dim possibility of limited reform. And many critics believe Obama can’t even get that.

However, it may just be that Obama, using the Democratic majority as a hammer, can achieve some limited change for the better. If so, that most likely will come from a base set forth by the Baucus plan announced yesterday, embellished and compromised during the joint House-Senate conference that will settle the issue.

As for the public option, that’s pretty clearly gone down the drain. Obama said the public option is “only one part of my plan.” He added, “If you can’t find affordable coverage, we will provide you with a choice.’’ The choice, of course, could be any one of a number of things—expanded Medicaid, tax breaks, coops, special subsidy programs. One thing is clear, it won’t be a challenge to the private insurance industry. Obama said, “I have no interest in putting insurance companies out of business.’’

The speech was brave. But the politics remains a muddle. The problem here is the Obama administration’s inability to project a vision for real change. Instead, it has dawdled in a swamp of technocratic mumbo jumbo.

The relevant model here is not Theodore Roosevelt, John Dingell’s father, Harry Truman, or LBJ—it is the wishy washy credit card legislation enacted earlier this year which in many ways has become the stamp of this administration. As I have written previously,

Under a propaganda blitz heralding sweeping reform, we get legislation that reins in some of the very worst abuses, while making no significant change at all to the underlying flawed system. So, for example, we may see insurance companies required to provide coverage in spite of pre-existing conditions–something Obama referred to in his AMA speech, with moving references to his mother’s own battle with cancer. We might see what the President called “more efficient purchasing of prescription drugs,” which presumably means more power to haggle with Big Pharma over drug costs, as well as speeding up approval of generics. We will see health care providers given incentives for more cost-effectiv–and, we can hope, better–treatment. These things are not meaningless, and they will provide a modicum of help to some struggling Americans. But they do virtually nothing to strike at the basic American system of health care for profit. And at the same time, they offer only a fraction of the savings a single-payer system could offer.