Sacrifice And Change Without Sacrifice And Change

If you missed the president's news conference, you missed the president....

.... speaking from a 30,000 foot perspective: wanting Americans to buy into the notion that health care reform is imperative and won't cause much sacrifice for most Americans. If it doesn't happen, your premiums will go up, deficits will rise, quality will decline. He's arguing that even as Americans accept the status quo and don't want government to get involved, Americans ought to be angry at the status quo.  He insists that government won't dictate medical choices to people and their doctor.  Steve Thomma of Reuters asked the best question:  "Will you promise that health reform will leave medical decisions up to patients and doctors?"  Obama reframed it. "Can I guarantee that there will be no changes to the health delivery system? The answer is no."

In order for health care reform to be worthy of the name, people and their docs will have to use cheaper drugs and take fewer tests. Depending on what type of insurance they have, the insurance companies will enforce this by fiat, or the government will require this by rule.  The persuasive mechanism might be economic.

Obama's argument is that in order for doctors to do better and patients to feel better and to make all of this less expensive, government will have to change the incentive structure. That will allow doctors and patients to make better choices.

.....Lifting up out of the nitty-gritty of congressional negotiations, which are stalled, essentially, on the point of how to pay for about 30% of the cost of reforms -- about $350 billion over ten years. The White House wants Americans to interpret the loud clanging noises coming from Capitol Hill as evidence of progress and momentum; this is the president employing the bandwagon effect. Nothing chills enthusiasm on the Hill like the perception that they've already failed. (The specific point of dispute is how the structure a mechanism to set Medicare reimbursement rates and what power Congress should or shouldn't have to veto an independent agency's recommendations on those rates. )  For those following the debate, the President also suggested that the level that some House Dems want to set as the base for the tax surcharge - 1 million -- is where it will be. And he acknowledged that his August deadline was a pressure mechanism designed to get the legislative machinery moving.

......Trying to maintain a lofty tone -- "I haven't been out there blaming Republicans" -- while attempting to use the Republican GOP stratagem of the week -- kill the bill -- to set himself on the side of reform and Republicans on the side of obstructionism. He name-checks Chuck Grassley as a Republican who has good idea to contribute. He gave credit to Republicans for seeding the idea of an independent commission to set Medicare payments.

.....Putting his name on the bill. The President acknowledged it was his job to get health reform done. He portrayed himself like an editor, waiting for various drafts to come in, and implying that, when (if) the House and Senate go to conference, he will wade in with more specifics.

......Acknowledging that the early drafts of the bills he's seen don't reform the delivery system and don't change incentives for doctors and patients to experience their health care more efficiently. This is a nod to the doctors at the Mayo Clinic, who criticized the House Democratic bill (the tricom bill) for failing to link Medicare payments to the quality of health care, rather than the quantity of health care provided. 

.....Using linguistics to make subtle points: Obama in his opening statement referred to "health insurance reform," which polls better, I presume, that "health care reform." And he did not mention a public insurance option until much later on .

.....Ignoring a valid question about transparency; the reporter gave three good examples of the WH's lack thereof -- TARP being the most expensive -- and Obama simply punted. I suspect this means that he thinks such criticism is simply invalid.