As the summer has waned in an atmosphere of misinformation and recrimination, so too have hopes for real health care reform. Many people have by now sadly come to the conclusion that the moment for such reform has come and gone. In this context, Obama’s inspiring speech tonight was simply too little and too late.
It may just be that Obama, using the Democratic majority as a hammer, can achieve some limited change for the better. If so, that change most likely will be built on a base set forth by the Baucus plan announced yesterday, further embellished and/or weakened in the joint House-Senate conference that will draft a final bill. That final bill will be such a study in compromises that most people in America won’t notice any change at all–which is pretty much the point, as Obama himself admitted tonight.
Obama tonight eloquently defended the need for a public option, only to kick it to the curb, insisting that it is “only one part of my plan”–and one open to further tinkering and dilution. He promised the American people: “If you can’t find affordable coverage, we will provide you with a choice.’’ The “choice,’’ however, could be any one of a number of things—co-ops or exchanges accompanied by tax breaks, with special subsidy programs or perhaps expanded Medicaid to pick up the slack for the poor. One thing is clear: It won’t be a challenge to the private insurance industry. Obama said flatly, “I have no interest in putting insurance companies out of business.”
Giving the speech was brave. But its politics remains a muddle. The core problem here is the Obama administration’s inability to project a vision for real change or take an ideological stance that might have some populist appeal. The only time Obama reached toward that ground tonight was when he quoted Teddy Kennedy’s belief that health care is a human right–something the president himself apparently couldn’t bring himself to say in his own words. Instead, the administration has dawdled in a swamp of tehnocratic mumbo jumbo, leaving ideology, once again, to the Right.
In the end, the model here is not the lawmaking carried out by Teddy Kennedy–or Teddy Roosevelt, John Dingell’s father, Harry Truman, LBJ, or anyone else Obama cited tonight. The model is Obama’s own wishy-washy credit card legislation enacted earlier this year, which sands down some of the freemarket’s hard edges by outlawing its most outrageous abuses, and otherwise lets business go on as usual. This approach seems destined to become the hallmark of the Obama administration–and as I predicted months ago, the final health care reform bill will undoubtedly bear this stamp:
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.