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What Obama did, and didn't, say on health-care reform


I wrote yesterday that congressional Democrats were frustrated with the lack of specificity from the White House, and that the cause of their frustration was, in part, a White House that has pointedly refusing to commit to a path forward. Those offices are happier today, but not that much happier.

Here's what they got in the State of the Union: A robust defense of the concept of health-care reform. A plea for "everyone to take another look at the plan we’ve proposed." A reminder that Democrats "have the largest majority in decades, and the people expect us to solve some problems, not run for the hills." An apology for "for not explaining [health care] more clearly to the American people."

And beyond all that, they got something intangible but nevertheless important: The sense that their president can still lead, that he's not cowed or planning his retreat, that he might still be of use on the campaign trail, that things are not as bad as Politico has been telling them. Obama had some swagger last night, and so Democrats have some this morning.

But there was much they didn't get, too. For one thing, a timeline, much less a deadline. At every other juncture in the process, Obama has focused congressional efforts around a date. August, say, or the end of the year. The State of the Union, actually, was bandied about before Brown's victory. There was nothing like that last night. Given Harry Reid's recent comments that there's "no rush" on health-care reform, that's worrying.

If health-care reform dies, it will not die in a climactic vote. It will die amidst everyone pledging their continued commitment to the issue, but their aversion to doing it right this second. Obama could have quieted those fears last night. He didn't.

The second thing they didn't get was a rejection of the calls to pare back the bill. It would've been easy to insert a paragraph calling out "those who say we're doing too much. We should pare back. We should do less. Well, this problem is too big ... " etc. and so on. That wasn't there, and it was missed.

That said, many are hoping that the State of the Union was the start, not the end, of Obama's renewed sales pitch. As I write, the president is in Tampa, making many of the same arguments, in much the same way, as he did last night. He sounds like he did on the campaign. He has more events scheduled in the next few weeks. It was a good beginning, say some on the Hill, but that's not enough.

Photo credit: By Larry Downing/Reuters

By Ezra Klein  |  January 28, 2010; 2:41 PM ET
Categories:  Health Reform  
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Next: The quotable Pelosi


I've argued before that the lack of advancement of the progressive agenda in Washington, despite the majorities, doesn't have a lot to do with Obama. Obama is doing a reasonably good job of trying to lead, as the State of the Union last night should have amply demonstrated.

The reason the agenda is not advancing is the Democrats in the house and the senate (and, of course, the "All No! All the Time!" Republicans). Lack of transparency--one of the things that shows up in the polls showing the popularity of HCR declining--is not Obama's fault. Yes, he made the promise, but it's Pelosi and Reid that decided it was best not to deliver. It's the Blue Dogs and other Democrats who are more worried for their seats than healthcare--the Republicans, at least, clearly believe that this sort of healthcare reform is a bad idea. But Democrats who ostensibly support the agenda, but want a little more for their state, or want an exemption on the bad stuff for their state while still getting all the good stuff, seem to me to be the people at fault.

Obama is not flawless, and surely he could do more. If you ask me, he could stop referring to the Bush years and acting like there's nothing a Democratic president and the largest Democratic majorities in the congress in decades can do about any of that) and he could not only stop using the words "Me", "My" and "I" so much, but structure his speeches so they didn't sound like he was talking about himself quite so much of the time. As it is, I think he comes off as very charismatic, very compassionate, but also quasi-megalomaniacal. Sort of the unholy lovechild of Mother Theresa and Bill O'Rielly.

But that's not the problem with healthcare, or Cap and Tax. Does anyone think that, if the senate--the senate, with the supermajority--had delivered a Cap and Trade bill to his desk, that Obama wouldn't have signed it? That Obama didn't try to shepherd it through? What's he doing wrong--is he not cutting enough backroom deals? And if it looks like he has, to advance healthcare, then he's bad for doing that?

And I thought the conservative base demanded purity from it's politicians. It seems like liberals don't just want ideological purity, but 100% uptime. Perfect performance, all the time.

If you guys are going to keep holding your folks to those kinds of standards, I don't think Republicans have a lot to worry about.

Posted by: Kevin_Willis | January 28, 2010 2:56 PM | Report abuse

"Congressional Democrats were frustrated that Obama didn't _____ ."

There is nothing Obama can do that will prevent Congressional Democrats from possibly suffering a boo boo from actually taking their hands out of their pockets and doing some work. What a bunch of sad pathetic creatures. Especially the staffers who give anonymous quotes about how very hard it is! These sad asses sound like George W. Bush talking about all the hard work they are (not) doing.

Posted by: jamusco | January 28, 2010 3:02 PM | Report abuse

I've said, before Brown won, the Dems will sell out HCR. You'll get a tiny token to appeal to the middle class, and nothing else. I fear Ezra will keep talking about it long after that, though.

Posted by: AZProgressive | January 28, 2010 3:03 PM | Report abuse

Maybe it's up to "we the people" to push congress to finish what they started. After all they work for us, not for the President.

Posted by: tnoord | January 28, 2010 3:10 PM | Report abuse

The "Healthcare Reform's still a-comin -- in SOME form" reassurances are starting to sound like those promises that HBO kept making, after they canceled "Deadwood" that they would produce a TV movie to tie up the loose ends.

Posted by: Ronnie76 | January 28, 2010 3:11 PM | Report abuse

I can understand why Obama didn't set a date certain for health care reform last night. First, the SOTU is not the place to do it. Second, Congress has missed every deadline he's set. It makes him look ineffective when this keeps happening. So maybe (I know I'm just hoping here), the deadline is being enforced behind the scenes this time.

Posted by: JJenkins2 | January 28, 2010 3:16 PM | Report abuse

*****Obama could have quieted those fears last night.*****

This strikes me as astonishingly unnecessary. I mean, does the White House not have telephones? Can he not talk to Pelosi and Hoyer and Reid and Durbin? Why can't he say: "Hey guys, I'm not going to publicly pin you down on specific deadlines on national television, but let' all agree on the time line and strategy to get this thing over the goal line, now, please, and I'll do my part on the stump out among the people to help you push it forward in the coming days."

In other words, the fact that he didn't get specific in the SOTU speech shouldn't be synonymous with "no path forward." That's just nuts.

For all their skills in taking down the Clinton machine, beating the Republicans, and taking the White House, the Obama political operation sure doesn't seem overly effective in other things.

Posted by: Jasper99 | January 28, 2010 3:24 PM | Report abuse

Let's not forget the other thing that the President said in the SOTU last night with regard to health care:

"But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors and stop insurance company abuses, let me know. Let me know. Let me know. I'm eager to see it."

Obviously - the Republicans will have no plan that does all of these things (especially covering the uninsured). Thus, the offer to listen to anyone with a plan to do all of those things was rhetorical.

Right after the above paragraph - President Obama said:

"Here's what I ask Congress, though: Don't walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let's get it done. Let's get it done."

Keeping in mind the list of things he wants HCR to do - this can realistically mean only one thing - the House has to pass the bill. I do not think it is surprising that the President did not come out and say "Pass. The. Damn. Bill." But read in context, that is essentially the message he delivered to Congress.

I agree the next step will be for him to put some pressure on the House to pass the Senate bill and pressure on the Senate to agree to fixes (through reconciliation). But does that need to happen now? Tactically - it doesn't seem bananas for the POTUS to spend some time on jobs and the economy before returning to passage of HCR. You are right that he used to urge Congress along with deadlines -- and that has not worked out so well. Members of Congress have more at stake in failure in the short term (ie, 2010) than does the President. But some of that pressure - as a previous commenter pointed out - has to come from people calling their reps in Congress and demanding passage.

Posted by: DavidDavidovich | January 28, 2010 3:27 PM | Report abuse

I'm betting its the end. He doesn't seem to view selling as part of his job.

Posted by: pj_camp | January 28, 2010 3:35 PM | Report abuse

Maybe it's up to "we the people" to push congress to finish what they started.
We did in Mass!

Posted by: obrier2 | January 28, 2010 3:43 PM | Report abuse

I think that people who believe this can all be wrapped up with a few side deals between the House and Senate are living in an alternate universe. It's not Republicans that the Democrats need to satisfy, it's the Democratic constituency -- which is lukewarm at best about where the reform effort has gone.

Before this all began, surveys indicated that most people were satisfied with their coverage but wanted portability of coverage. The fact is, the main reason people run into the pre-existing condition dilemma is because they have lost/changed jobs and lost the coverage that paid for the treatment that disqualifies them from coverage with a new insurer. In other words, they want to break the chains that bind them to a specific job or require them to take a second job to get no- or low-cost coverage

It's notable that the bills under discussion do ZERO about that. In fact, they are designed to do the exact opposite: to strengthen the hold employers have over the medical security of their employees and deal almost entirely on those who do not have employer-paid coverage and need public subsidies to obtain insurance.

Furthermore, the whole scheme ignores increasing dissatisfaction of employers with their insurance situation. 71% of employers expect that health reform will result in higher premiums for them which will be passed on to their employees in the form of higher deductibles and co-pays . 40% of large employers are not even confident that they will still be paying for employee health coverage 10 years from now.

In their single-minded focus on the uninsured, Democrat politicians have exhibited a callous disregard for the concerns of their main constituency. Liberals/Progressives/[whomever] who think that it’s just a problem with their message getting though are wrong. It isn’t that independents and the Democratic base don’t “understand” the current bills; it’s that they know the bills don’t address their core concerns.

Posted by: Athena_news | January 28, 2010 4:21 PM | Report abuse

The fact is, the main reason people run into the pre-existing condition dilemma is because they have lost/changed jobs and lost the coverage that paid for the treatment that disqualifies them from coverage with a new insurer. In other words, they want to break the chains that bind them to a specific job or require them to take a second job to get no- or low-cost coverage.

Posted by: Athena_news | January 28, 2010 4:21 PM |

The 1996 HIPAA law addressed that issue to a large extent. You do have to ensure that you don't have more than a 63 day gap in coverage, and you have to be responsible and enroll in the new employer's coverage when you're first eligible.

Posted by: Policywonk14 | January 28, 2010 5:00 PM | Report abuse

No, HIPAA obviously doesn't "largely" address it. If it did, we wouldn't read so many sob stories about people who had insurance then lost it and ended up in dire straits.

For one thing, HIPAA assumes that the individual is going from one employer plan to another -- not from an employer with coverage to one without, or taking a job after being out of the job force for a while.

And the 63-day gap is a big problem. Just look at our current situation: how many people laid off in the past year found a new job with within 2 months? How many would be able to maintain COBRA without subsidies (even with them, the takeup rate is relatively low)

Finally HIPAA doesn't make coverage portable, it just facilitates going from one employer plan to another -- without any individual control over the composition of that coverage.

Like HIPAA, the current bills are based upon the notion employer provided insurance is the "norm" and that anyone who does not have employer-paid coverage is anomaly. We are the only country in the world with a national policy that puts individual medical security in the hands of employers.

Posted by: Athena_news | January 28, 2010 5:29 PM | Report abuse

Um, HIPAA will allow one to purchase an HIPAA health insurance plan which requires no medical underwriting within 63 days of leaving your employer or losing COBRA coverage. At least that's the deal here in California (I know, because our family has gone through this). The downside is that these HIPAA health insurance plans are costly and have crummy coverage.We ultimately switched to individual coverage and then onto another employer's plan.

Athena..I agree with your post at 4:21. Also, I think that most insured folks feel that their premiums will go much higher under Obama's proposals than they would in the absence of his plan. This is a large source of the resistance to the proposed health care changes.

Posted by: Beagle1 | January 28, 2010 7:26 PM | Report abuse

"The downside is that these HIPAA health insurance plans are costly and have crummy coverage..."

Exactly. Within 63 days of losing his job, the ex-employee has to commit to crummy, overpriced plans just to maintain his eligibility for better insurance when/if he is in a better position to buy it.

Contrast that with somewhere like Germany where insurance can't be discontinued as a result of job loss. Insurance belongs to the individual, not the company and the state recognizes that out of work people are more vulnerable to medical events.

Posted by: Athena_news | January 28, 2010 7:58 PM | Report abuse

Obama is not a king, the leaders of the House of Representatives and Senate should not meekly wait for his commands or suggestions. The founding fathers did not envision Congress being a weak, timid, deferential branch of the federal government.
Take the initiative and pass true health care reform.

Posted by: Aprogressiveindependent | January 29, 2010 12:07 AM | Report abuse

The 'ball' (HCR) is on the 6 yard line...
they need a DEADLINE??
Okay, how about this...the END ZONE, NOW.
Pass the Damn Bill! Or Run it, but do it!

Posted by: dcunning1 | January 29, 2010 1:11 AM | Report abuse

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