Obama's speech - Workmanlike and strong

All in all, I thought it was a good speech. Ironically enough, I think Joe Wilson's outburst was one of the best things that could have happened. The speech was largely to the undecided middle. Anything that makes the opponents of this reform look wild eyed and uncivil is helpful. Wilson stepped up and fit that bill perfectly.

Excerpts from the speech and my thoughts:

Text - Obama’s Health Care Speech to Congress - NYTimes.com:

I am not the first President to take up this cause, but I am determined to be the last.

I love this line. You couldn't ask for a clearer or more eloquent statement of executive resolve. He has doubled down here, and that is good news.

Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies . . . .

Good reforms, all. And very, very expensive. I look at this list and can't help thinking "what are the insurance companies going to charge for all that?" These are needed and necessary, but we will need the other elements to bend the cost curve a LOT to make up for how much these are going to cost.

That's why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.

Here's the first part of the answer. The risk pool will be enlarged a lot, to include a fair number of people who are fairly young and healthy, but will nevertheless be required to pay for insurance. I think this is a good idea, and the auto insurance analogy is a good one. So, part of the way you control premiums is by increasing the number of insured and spreading the risk more.

It's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

This is exactly true. The real issue is not that a public option in a private market is so crucial. The real issue is that many of us believe that the only way to really get the costs and stuctural deficiencies of our health care system under control is to go to a single payer system. Bluntly, the more people we get on to government plans, the closer we get to that system and it's benefits. I am not one, however, to let perfect be the enemy of good. We need to get a significant portion of this done, and sooner rather than later. If the public option will get in the way of that, we should jettison it and come back later when it's still needed. Which it will be.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.

Uhhmm. Lost me here, Mr. President. (1) Every president since Johnson has talked about reducing the waste and fraud in Medicare and Medicaid. Why do we have any reason to think we'll be better at it now? (2) Who in the world thinks that the "fees" that will be charged to insurance companies and drug companies will stay there? They pass through and increase our costs, pure and simple. Fine, it needs to be done. We are better off for it. But this is sleight of hand talking.

Finally, many in this chamber – particularly on the Republican side of the aisle – have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.

Agreed. The tort system and medical malpractice claims are a stupid and inefficient way to control doctors' behavior and to compensate those harmed by medical negligence. Ditch them.

That large-heartedness – that concern and regard for the plight of others – is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people's shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise.

This has always been the history of our progress. In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped way, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress, Democrats and Republicans, did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

This is great leadership here. It is appealing to the better nature of everyone, asking them to step up and be good citizens. In particular, he chooses to give Republicans a share of the credit for Social Security and Medicare, which he need not have done. This is excellent. People who care about the good of our country, rather than political points, will recognize it and step up. The rest, well, I guess they'll keep wallowing in their own offal, like always.