What Obama's Speech Did Right and Wrong

I agree with Matthew Cooper that it's way too early to say whether last night's health care speech reset the debate or whether it was essentially a Roosevelt Room speech to Congress that some of my blogger friends happened to watch on television. My guess (and that subject has a way of jinxing whatever goes in the predicate) is that we'll see a bit of a bump in health care support next week, when Americans tune in to cable news and see pundits praising the rhetoric or wincing at the mention of Rep. Joe Wilson's bizarre efforts to import British (socialist?) parliamentary decorum.

Anyway, the most effective parts of the speech, I think, were the parts that dealt with fairness.

It's not fair when an American has his coverage rescinded when he gets cancer. It's not fair that in the richest country in the world, health care -- which is, you could argue, a right -- can make you bankrupt when you need it the most. The moral case for health care is extremely moving, and when Obama combined it with an allusion to Ted Kennedy, the decade-long mission to care for our nation's poorest and the character of our country, I'll admit he had me at "this cause."

Where he didn't have me was "at costs." The president made some -- but no too many -- allusions to health care reform as fiscal hawkery. Rhetoric aside, the plans being considered in Congress make this approach problematic. There are two ways that health care reform aims to make up money. The first is short term -- finding "waste" in Medicare and possibly taxing the rich to pay off the $900 billion of reform over 10 years. The second is long term -- bending the curve of health care inflation down over the next few generations. In the short term, cutting $500 billion over 10 years from Medicare is unlikely to merely cut fat around patients and doctors and leave care completely untouched. Perhaps eliminating all that waste and fraud will make care significantly better. Perhaps $50 billion of cuts every year will change services in ways that seniors find worrying. I don't know, and I don't know that it's possible to know. In the long term, there is no plan that has come out of the House or Senate that the non-partisan CBO has scored as seriously reducing health care inflation in the long term. There is too much ambiguity in the realm of cost-cuts to make for soaring rhetoric, and that's why Obama was wise to scrub out most of the facts and make this speech a principled cri de coeur for the public and a procedural blueprint for the Congress.