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Obama Speaks About Speaking


Time's Karen Tumulty has a very nice interview with Barack Obama. This bit was especially striking:

I will say that this has been the most difficult test for me so far in public life, trying to describe in clear, simple terms how important it is that we reform this system. The case is so clear to me. And when I sit with our policy advisors — we had somebody here sitting right there this morning who is a medical expert, worked at McKinsey for a while, he's now working on our health care team — and he just ran through: We pay 77 percent more on prescription drugs, we're paying $6,000 more per individual on health care than any other industrialized nation; here's all the failures in the delivery system that account for it. It's not just because we are somehow more obese or more unhealthy. It turns out actually we're a little bit healthier than most of these other countries because our smoking rates are lower and we're younger. So we should actually be paying less than they are.

And when you just start hearing the litany of facts, what you say to yourself is this shouldn't be such a hard case to make, because the American consumer is really not getting a good deal.

And so when I see polls saying that it's 50-50 and people are still worried about whether this is going to somehow increase their costs when every bill that's out there would lower them, or that this is going to mean that they lose their doctors, or their health care is rationed, or, you know, all the other things that they're worried about, it leads me to spend a lot of time thinking about how can I describe this in clearer terms so that we can get the health care that the American people deserve.

I'm loath to be an armchair political strategist. But I do know a little something about trying to explain McKinsey reports to people. In fact, I know a little something about trying to explain this specific McKinsey report to people. And you can't really do it.

In a weird way, it would be easier to make this argument if the situation wasn't so dire. If our health-care system was a little bit better, and the median system in Europe a little bit worse, you could probably convince people of this stuff. But to say that Britain gets comparable results while spending 41 cents for every dollar we spend? To say that the French system spends a bit over half what we do per person and is the best system in the world? Or, closer to home, to say that the Veteran's Administration is, on measure after measure, one of the best health care providers in America?

It's not intuitive. It sounds like trickery. The lived experience of most Americans is that health care is too expensive, but not so bad. Similarly, it's that Europe might do a bit better than us on some things and quite a bit worse on others, but they're not very far ahead on anything. And the Veteran's Administration is terrible -- didn't you hear about Walter Reed (which most people don't realize is an army, not VA, hospital)?

I don't think the problem for health-care reform is how it's being sold. The problem is the congressional process, and maybe the fact that it's hard to say what this bill gives the median American because it's trying so hard to leave the median American alone. But insofar as health-care reform is going to be sold, I don't think it can be done through McKinsey reports and cross-national comparisons.

Towards the beginning of his interview with Tumulty, Obama talks about studying Lyndon Johnson's success at passing Medicare. It's worth going back and reading Johnson's remarks upon signing Medicare. McKinsey reports don't figure into the speech.

Photo credit: AP Photo/Haraz N. Ghanbari.

By Ezra Klein  |  July 30, 2009; 10:57 AM ET
Categories:  Health Reform  
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Next: Give Congress a Fish and it Will Eat for a Day...


Here is what I don't get. Why is it never brought up that other countries don't tie health insurance to your job. So you can leave a crappy job, if you don't like it, and not worry about if you'll be covered in an emergency? Is that because it's "Un-American" in a BillO/Glenn Beck kind of way? Why is it that the DC Democrats never seem to have a clue about advertising?

Posted by: Calvin_Jones_and_the_13th_Apostle | July 30, 2009 11:02 AM | Report abuse

It is interesting that Obama is now thinking about how LBJ did it. I wonder which version of that story he will internalize as a guide for current action.

My faulty memory says LBJ did it the good old fashioned way: he twisted arms, hard. Threats, favors, and every variety of carrots and sticks. (And, he didn't face the increased amount of lying, wacko GOP opposition of today).

But that is not O's style, and I bet he doesn't do it because he has no visible experience of doing it and it runs completely counter to his well-tended garden of public images.

It is very hard to alter the outcome in a three-act theatrical play when you are in the third act. The playbill says it is a tragedy, and that's what we will get.

Posted by: JimPortlandOR | July 30, 2009 11:09 AM | Report abuse

The problem is that Democrats are petrified of the conversation saying "I know that you are happy with your current healthcare- but we can give you better care for less money if you just trust us to get it right". Politicians are petrified of change overall- Obama obviously likes talking about change but actually proposing change is a massive difference. So democrats are trying to change the system in a way that people don't know that its being changed while also trying to talk about how badly the system needs to be changed.

If there is a system that you think would clearly be better than what we have now- then come out for that plan in detail and convince people that its the best way to go.

Posted by: spotatl | July 30, 2009 11:17 AM | Report abuse

This quote from LBJ: " is so clear indeed that we marvel not simply at the passage of this bill, but what we marvel at is that it took so many years to pass it."

I trust that we will pass some kind of reform this year. And this will be the start of more to come. It all takes time.

And btw I love Calvin Jones's point about health care being tied to a job - what a damper on an efficient labor market this has been.

Posted by: wapomadness | July 30, 2009 11:19 AM | Report abuse

The problem is that speaking about universal coverage and speaking about cost control are very different.

When you base the need for reform on cost control, you're committed to a purely practical path, and you're done for if that cost control does not materialize. Or even just if people don't believe that it will materialize, which is where a lot of people are today.

Universal coverage is a moral ideal that could have been presented in much more high-flown, aspirational terms.

Posted by: tomtildrum | July 30, 2009 11:24 AM | Report abuse

and getting back to the point of Ezra's post - I fully expect Obama to figure out how to communicate all this to the nation, clearly, cleanly, and in a time of subverted and corrupt media communications.

First, I'm in awe of his desire to do it, and second, this is one of the greatest tests so far of the reach of his abilities.

Posted by: wapomadness | July 30, 2009 11:26 AM | Report abuse

I don't think the problem for health-care reform is how it's being sold. The problem is the congressional process, and maybe the fact that it's hard to say what this bill gives the median American

Looking across from the other side of the Atlantic, I'd say your biggest problem is that you have prominent political leaders and media figures who are prepared to lie outrageously to sabotage healthcare reform (as well as a whole slew of other thing). Why this is, or how you change it, I don't know, but the difference in honesty of public discourse is palpable.

Posted by: vagueofgodalming | July 30, 2009 1:26 PM | Report abuse

Great point Calvin Jones. Hope Obama takes it and runs with it. What I can't understand is why can't we just have a system of vouchers where your employer gives you a voucher and that allows you to buy coverage on the health care exchange. Republicans love vouchers don't they?

Posted by: KDID | July 30, 2009 2:20 PM | Report abuse

So then what about a web site, which:
- gives details to Americans where these bills stand and what WH wants there; and
- how would it affect an individual family.

It is like the way people had websites during election, telling people how much would it tax or tax reduction with Obama proposals.

Not a great thing, but that is White House and Congress can do to educate Americans more.

Will Congress be scared of exposing their under belly? A bill of 1000 pages when legislative strategy at times seems like fellow lawmakers really do not read those pages; then what chance is there for a common person? A fat chance?

Regardless, it will be a nice tool for public to understand how these bills are structured and how they impact individuals or 'use cases' and how those use cases are handled under different versions.

Can it be 'crowd sourced'? Any 'wikipedia' equivalent? Can media big houses like WaPo / NYT / WSJ / Politico / Bloomber pull resources for the same?

Ezra - talk, talk about this.

Posted by: umesh409 | July 30, 2009 3:11 PM | Report abuse

"If our health-care system was a little bit better"

LOL. Dude, it's the best system in the world. For now, anyway.

Posted by: whoisjohngaltcom | July 30, 2009 11:41 PM | Report abuse

Thankfully, the Health Care Reform Process is going on vacation. The Blew Dogs can go home and sit in the lap of the Industry for another 5 weeks of paydays. As reported here, the Progressives are mounting an attack against the Blew It's which spells opportunity for them now to get on the Big-Med, Pharma, Labor gravy train too. Unfortunately, Big Media and their pundits are also on point to keep the airwaves filled with the various points of view all at a serious profit. The name of this game is four corners, running up the influence tab. Business as usual, fiddling as Rome grows more ill, obese, and irrelevant. At least until November 2010....

Posted by: freesmilesinc | July 31, 2009 10:14 AM | Report abuse

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