Running Thoughts on the Obama Speech

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  • Saying we've been trying to do this for 100 years is an excellent tactic, though to be sure, not exactly unexpected. 
  • Saying we are the only advanced democracy on earth that has this sort of system is not a good political move:  Americans do not like arguments along the lines of "But how will we look to the French?"
  • Obama is dropping a lot of statistics about the uninsured, including a note that one in three Americans will be uninsured at some point over the course of two years.  I wonder if this isn't counterproductive.  When you get to numbers that size, people start gut checking them against their experience, and that of their neighbors.  Have one in three of the people you know gone without treatment because they were uninsured?  Not so much, particularly if you're not an immigrant, or under the age of thirty.
  • Recission is the most powerful argument Obama has.  Unless we get either comprehensive high-risk reinsurance, or a mandate/guaranteed issue/community rating, this will continue to be a problem.
  • Democrats should not have clapped for a single payer system.
  • Obama says "The plan I am announcing tonight will meet three goals.  It will provide more security and stability to those who have health care. It will provide insurance to those who don't.  And it will slow the growth of costs for our families, our businesses, and our government."  Unless he has a miracle in his pocket, this is not likely to be true.
  • Saying "Nothing in this plan will require you or your employer to change what you have" is probably the best he can do, but "trust your employer not to dump you on the private market" is not the best selling point when you're complaining about heartless companies rescinding people's coverage.
  • Preventative care may save lives, but it does not, as Obama just claimed, save money.
  • The exchange is too wonky.  It even sounds boring when Obama is talking about it, and he's a good talker.
  • Also, he's making the exchange sound voluntary.  What's the point?
  • He's offering immediate coverage for the uninsurable.  Huh?  How?  Across state lines?  Locally?  Where's the money coming from?  This is the group of people who are expensive to cover; if you move their coverage up four years, you'll bust the affordability, since part of the reason the various bills are supposed to be deficit-neutral over the next ten years is that the insurance doesn't kick in until 2013.
  • We've hit pillar numbers one, two, and three:  guaranteed issue, community rating, and an individual mandate, though he did his best to sort of tuck that one in the back where it wasn't so noticeable.  Where are the subsidies?  How much will it cost?
  • Death panels are a lie spread by "prominent politicians".  Sarah Palin's ears must be burning . . . 
  • Reforms will not insure illegal immigrants.  Democrats boo:  bad move.  What about legal immigrants, though?  Paying for their health insurance is not going to be much more popular than paying for the illegals.  Update:  They seem to have been booing a Republican rep who yelled "lie!" or "liar!" when Obama claimed illegal aliens wouldn't be covered.  This makes much more sense . . . but if I missed the shout out, so did other people.  On the other hand, they might well just think it was the Republicans.
  • No funding of abortions.
  • "Consumers do better when there is choice and competition".  As a friend tweets, why not school vouchers, then?
  • Obama says he doesn't want to demonize insurance companies--he just wants to hold them accountable.  This is the best line of the night.
  • Public option would be great, but negotiable . . . same thing he's been saying for months.
  • Public option won't be subsidized.  Claims that it will have to rely on premiums--can save money by eliminating profits, administrative costs, and flash executive salaries.  Problem #1:  most of the public insurers, like the FDIC and the PBGC, are currently underfunded.  Problem #2:  The public plan is going to have administrative costs, if it a) looks for fraud and b) collects premiums, neither of which Medicare really does--most premiums are deducted straight from social security checks. 
  • Note from a commenter:  "Blue Cross Blue Shield Alabama, the largest insurer in the state, is a non-profit." For those who didn't actually watch the speech, Obama singled out Alabama's dangerously concentrated insurance market as a huge problem.
  • The speech, overall, was dangerously wonky.  I'm guessing a lot of people tuned out well before the end, and more probably can't hold the details in their head.  The speech won't change much; this is going to be fought out in sound bites and attack ads.
  • I think the lecturing tone at the end is a mistake.  Obama's trying to evoke community and can-do spirit, but it comes off like having, well, an elite university professor lecture you on your moral obligation to provide health care to a third party.
  • The complaints about Republicans at the end also didn't sound, to me, like they'll play well.  Right now, more voters are on their side than yours.  Don't tell them they're gullible dupes, and/or mean-spirited obstructionists.
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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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