President Barack Obama will hold a prime-time news conference tonight to sell health care reform to Americans, as support for his trillion-dollar measure is wilting. Health reform is a tricky political sell for a couple reasons; 1) Most voters have health care already; 2) It costs more than a trillion dollars on the back of tax increases; 3) Obama doesn't have a strong enough case that a trillion spent today will bend the cost of health care. So what's Obama's pitch? Here -- with graphs! -- are three ideas Obama should put forth and three ways reporters should push back against his arguments.
I side with Mickey Kaus and Kevin Drum that Obama is going to have act the part of a concerned fearmonger. If he wants to remain above the fray, without endorsing any particular health care bill, the alternative is to highlight, in neon clarity, the breaking cresting tsunami wave that is the health care crisis. Here's how he could do it -- and how reporters should push back.
1) Emphasize the Federal Cost Crisis
Of course we're going to hear a lot about the price tag of health care. But the most effective rejoinder to the cost of reform is the argument that doing nothing to health care will cost us, too. Obama could demonstrate that fact clearly with two graphs, both from the CBO. The first estimates future government spending as a percentage share of GDP. It shows, very clearly, that our long-term budget crisis is fundamentally a health care crisis.
And if you think that Medicare and Medicaid spending is driving America toward a cliff, look at the tailwind provided by all other health care.
Obama could say: "Here's what that sharp, machete curve of "All Other Health Care" means for America's future. It mean higher premiums, and higher co-payments for your family. It means that when you get a job, your employer will constantly tempted to switch to a cheaper, worse coverage plan for you and your family. And if you lose your job, it means the free market health care system threatens to price you out of coverage. That is the cost of doing nothing."
Reporter's rebuttal: First, this graph has health care spending approaching 100 percent, which is absurd, because that would mean that in 70 years, Americans would be subsisting off of band-aids and Nyquil. Also, we hear you talking about the cost of doing nothing. But doesn't Doug Elmendorf's testimony to Congress last week suggest that the trillion-dollar House bill won't make any practical difference to long term costs? Why should "the cost of doing nothing" be cover for any sort of expensive health care reform?
2) Tell Americans Health Care is Stealing Their Pay Check
Of course, government spending arguments are pretty impersonal. If Americans care about money, they care about the money in their pocket. So how about the money in their pocket? We can already feel the depressing impact of health care costs on wages. Obama could brandish this graph:
The hard blue line above is the expected growth in average wages. The dashed-purple line is what's actually appearing in workers' wallets when you account for premiums. Health care is stealing our paychecks. Every year, Americans are paying for the cost of doing nothing, to the tune of about $5,000 per worker per year.
Reporter's rebuttal: But if Americans are going to have to pay higher taxes to extend health care, will that offset whatever benefit they eventually get even if a public option is capable of negotiating down the cost of care? Also, we've heard mumblings that some senators are considering capping the tax deduction for employer-based care. How would the savings from eliminating that tax deduction compare to the increased cost for employers to insure their workers?
3) Tell Americans Health Care is Stealing Their Services
As most politicians like to note every so often, we're in an educational crisis, and we're not adequately preparing our kids for the jobs of a new millennium. What does that have to do with health care? A lot, according to Peter Orszag, Obama's health care budget person, who has argued that health care spending is crowding out education spending across the country. State appropriations on higher education have declined by 15 percent in the last three decades and salaries for public school professors have also declined:
In a nutshell, Obama could use this anecdote as part of a larger argument that rising heath care costs necessitate trade offs and budget cuts that have a negative effect on policies that have nothing to do with health care. Our ability to control health costs is directly feeding our inability to field, among other things, an effective, competitive public education system.
Reporter's rebuttal: But Mr. President, Democratic governors have already said that your health care plan would cripple them with "unfunded mandates" to spend more money on the uninsured through Medicaid. How can you argue that you're reforming health care to save state budgets when the Democratic governors in charge of those state budgets say your plan isn't saving them at all?