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.
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