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On Health Care, the Messenger Changes, But Questions Remain the Same

By Dan Balz
The repeated applause President Obama received from members of the American Medical Association as he laid out his case for health care reform today illustrated anew why many people believe the political climate for action has rarely been better.

But as the president was speaking in Chicago, a leading Democratic polling firm was releasing the details of a new survey that underscored how divided the country remains over some of the basic choices in the reform package and why the president will need to do more before he can expect to see legislation on his desk for signature.

Though congressional committees have been working steadily for months on health care, Obama's speech marked the true opening of this health care debate. The speech represented his most comprehensive argument for acting now to reform the health care system.

At its heart, the speech was a rallying cry for political leaders to come together to fix a system whose costs continue to spiral upward and which leaves 46 million people without insurance. The current system is an unsustainable burden on the U.S. economy and, as Obama put it, "a ticking time bomb for the federal budget.

The president used the address not only to advance his case for change but to answer specific charges by critics, foremost among them his advocacy for a public health insurance plan as an option for consumers, a potential deal-breaker on Capitol Hill.

Obama cited repeated past failures by previous presidents and Congresses. Teddy Roosevelt, Harry Truman, Richard Nixon, Jimmy Carter and Bill Clinton all called for comprehensive reform. Though there seemed to be public support for previous efforts to reform the system, particularly in 1993, strong opposition and effective lobbying by many of the stakeholders and infighting among the advocates helped sink those previous efforts.

Obama said he believes this year can be different. As evidence he cited the Senate passage of legislation to allow the Food and Drug Administration to regulate the tobacco industry, a measure that died a quick death when proponents pushed it forward a decade ago.

"What makes this moment different is that this time -- for the first time -- key stakeholders are aligning not against but in favor of reform," he said. "They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit."

There certainly appears to be a different mood among the stakeholders this year than there was when Bill and Hillary Clinton tried to reform the system in the early 1990s. One sign of change came last month when leaders of the health care industry visited the White House to pledge $2 trillion in reductions in the cost of care.

While the pledges may prove illusory and lack any enforcement mechanism, as political theater, the event suggested that, for now, major players are reluctant to look like they're leading the effort to deep-six this president's effort to change the system.

At the same time, public opinion appears to strongly favor reform. Public dissatisfaction with the current health insurance system is high and sizable majorities believe the system needs either a total overhaul or significant reforms. But there are important caveats to the conclusion that the conditions today are significantly better for health care reform than they were in 1993.

The Democratic firm of Greenberg Quinlan Rosner Research, it its new survey, found that public opinion appears almost identical to where it was in that period, both in the overall support for reform and the reservations that Americans still have about just how reform might be accomplished. Some of the findings were summarized in a New Republic article.

Obama makes the case that the costs of health care threaten the economy and the budget. But roughly as many Americans are concerned that the government will make changes that reduce the quality of care, raise taxes, hurt small business or limit choices as worry about whether rising costs will cause even more people to lose insurance.

In other words, the debate over change versus status quo has not yet been decided. People see as much risk in change as in maintaining the current system. They worry as much about the federal government assuming too much control over health care as much as they worry that, without change, insurance companies will have too much control.

The Greenberg survey found support for Obama's plan, but not a majority behind it, and when broken down by parties, only Democrats offered strong backing. Two in three Republicans said they opposed the plan and among independents, 49 percent said they opposed it (to 32 percent who favored it). The survey also found a significant difference among age groups, with those over 65 far more opposed than those under 65.

The survey then tested arguments for and against the broad principles at the heart of Obama's plan and the authors of the poll asserted that, after real debate, support for the plan increases, though not dramatically. Their conclusion was that advocates for reform must make the case for change more effectively than they have.

Obama began the public side of the campaign Monday in Chicago and effectively marshaled the arguments in his favor. But the path to success will require a continuous campaign of public advocacy by the president, attention to legislative details and a willingness to cut some deals. The climate may look favorable, but if the past is any guide, Obama still has a difficult fight on his hands.

Posted at 2:51 PM ET on Jun 15, 2009  | Category:  Dan Balz's Take
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Are you a healthcare professional who is committed to a robust public health plan option? Please join us in petitioning Congress!

www.docsforapublicplanoption.org

We are a diverse group of healthcare professionals and students of the health professions that support the choice of a public health insurance plan as an essential component of comprehensive health care reform this year.

Posted by: NPAlliance | June 17, 2009 8:45 AM

After all is said ... I just want to hear what comes out of Congress and the White House that addresses the needs of the majority of Americans. President Obama was once Senator Obama, he knows fullyu what to expect so I suggest he's just got to keep on plugging away at it. http://www.youtube.com/watch?v=vN5PbSvFFAE

Posted by: Victoria5 | June 17, 2009 12:51 AM

Health Care is an item for purchase not a right. Health care was much cheaper and better when competition was evident. Socialized health care is the pits and most from those systems say so or they pay for it outside of the system. Healthcare was much more affordable before the governement started getting involved trying to "improve" it. Far as I'm concerned government outside of security services pretty much sucks at everything it does. Government does almost everything very poorly, it is better to let the free market and competition improve and make cheaper health care. Government will never ever do it. It can only screw up things in a much worse manner.

Posted by: keithp1 | June 16, 2009 2:09 PM

I think our entire country is incredibly backwards and a bizillion steps behind every other civilized nation on Earth regarding the issue of health care justice and the continuation of legally sanctioned discrimination against sick people here by the private, profit-before-people and money-before-morality health coverage industry.

The Cruelest Lie perpetrated on the American public is that uniting everyone into one reliable, comprehensive, transparent public plan would cost us more money than we're spending now. In fact it would save us at least $400 Billion year after year in health unsurer administrative costs alone, plus hundreds of thousands of wasted lives and destroyed families. United health coverage protection for our people is a moral and fiscal "no brainer". Everyone who has done their homework, as well as almost everyone in every other civilized nation on Earth (but ours) knows it.

How stupid can we continue to be, and for how long? Tens of millions of innocent Americans are unnecessarily dieing, becoming disabled, bankrupted and terrorized as I type.

Posted by: bspoons | June 16, 2009 11:49 AM

AMERICA’S NATIONAL HEALTHCARE EMERGENCY!

It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

Contact congress and your representatives NOW! AND SPREAD THE WORD!

God Bless You

Jacksmith – WORKING CLASS

Posted by: JackSmith1 | June 16, 2009 3:14 AM

I think perhaps Obama and Congress are one or two steps ahead of where they ought to be right now.

Instead of trying to craft legislation to achieve health care reform, perhaps The President, Democratic, and any Republican leaders inclined to work with them, and health care experts ought to be crafting a legislatable set of principles on which to base a health care plan. Perhaps a health care bill of rights.

SORT of an RFP or RFQ for all interested parties to bid on. Properly parsed, it would call for, for instance, a built in ten to twenty percent excess of health care facilities, workers, and technical support, so that when disaster strikes, like Spanish Influenze or tha New Madrid earthquakes, the massive excess of people needing medical care would stand some chance of being treated when it makes a difference. This is one aspect of a sound medical policy that private, for profit approaches to health care can't begin to address.

Having reached a mostly unarguable set of principles to be implemented, the system can be bid piecemeal if necessary. Where private and for profit can successfully compete give them the bid. Where they decline to compete because the return on investment isn't high enough, (like the Southern Power Companies refusing to electrify Appalachia but opposing TVA because it would be competing against them in electrifying Appalachia...) then government will have to satisfy the lack.

It is easy for the republicans to scream about how poorly the government runs programs, until they have to oppose a program we need that no one else will run.

Get the principles down on paper.

THEN implement them.

Posted by: ceflynline | June 15, 2009 8:22 PM

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