A civil exchange, at least. But not a very effective performance. He treated it as an election campaign event. The opening was thoroughly partisan: his first substantive remarks were an attack on the venality of the insurance companies, a theme to which he returned repeatedly. He banged the populist drum in other ways too. If this effort fails, he said, it will be because of the resistance of special interests. (Actually, it won't.) They have blocked reform before, he said, and must not be allowed to do it again. To me, this is foolishly condescending to the voters who disagree with the proposed reforms on their merits: it says they are dupes.

Still, he successfully reset the message, as trailed earlier. He played down cost control, except when pressed by questioners to discuss the future of Medicare. (We will spend a lot less, he said, and get better results at the same time.) Moving the focus elsewhere is wise, since the bills have rather little to say on cost control, and this point is now well understood.

Instead, his main themes were the need to widen coverage and, especially, the benefits of reform for people who already have insurance--principally, that there will be new limits on out of pocket expenses (getting sick should not make you bankrupt) and that your coverage will not be denied in future because of pre-existing conditions. As I've mentioned before, this last point should have been front and center from the start, but better late than never.

Unfortunately he's still trying to argue that if you are happy with what you've got, nothing will change. This is neither true nor even plausible. For instance, services under Medicare would be affected by the new reimbursement regime. The public option would destabilize some private plans--and is intended to. People won't just migrate at their own initiative to new plans because they find them preferable. Many will be migrated by their employers, whether they like it or not. This claim that nothing will change if you're content has to go.

He was unusually clumsy now and then. What was he thinking, giving his second question to a child? And what was he thinking when he answered that question with a discussion of end-of-life counseling and an intended joke (I think) about switching off granny's life support? I didn't see many people in this overwhelmingly friendly audience laughing.

When he was asked about his earlier support in principle for single-payer, he said that the transitional difficulties would be too great. That seemed a tepid endorsement of the mostly private system that is actually being proposed. But of course the main problem is that he still cannot say with any precision what the plan is. He can assure the country of this and that, plausibly or otherwise, but there is still no finished plan to sell. Many of the questions were appeals for information. People are asking, what is going to happen? The president doesn't know. He just knows he's for it.


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