Does Obama Need To Be Clearer About Health Reform?

That's what Salon Editor in Chief Joan Walsh suggests today. Walsh says she considers herself a policy wonk but still doesn't quite know what the president is talking about when he talks about health reform. And it's true: as we saw in President Obama's town hall in Annandale, Virginia and in his speech yesterday at Children's Hospital in DC, his primary focus has been the unsustainability of the current system--how fast costs are rising, and how America can't afford not to overhaul the way things are currently done.

Americans seem to agree with him on this, according to a poll released today that indicates 85 percent of Americans want health care reform as part of Obama's overall package of economic fixes. Talking about health care is difficult--it's an extremely complicated arena of policy. But here's Walsh, who suggests Obama should more clearly define the public option he's pushing for:

So I'm clear about why this is a tough fight for Obama. But I think he may be making it harder than it needs to be. I realize it's difficult to define when still playing politics -- necessarily -- but I really want to know his bottom line. I know he wants to cover the uninsured, bring down the growth rate in health costs, in part by increasing preventive medicine and using evidence-based outcome studies to determine what should and shouldn't be paid for. I know he wants a public option. But what really matters in his plan? What will he fight for? He's seemed strong on support for a public option -- but Rahm Emanuel and others have gone public suggesting that's negotiable. He doesn't want to break a campaign promise not to tax healthcare benefits, which is understandable, but he hasn't fully come out for a surcharge on the country's wealthiest earners, either -- and yet he's on record saying he doesn't want his plan to bulk up the deficit to pay for the reform he's pushing. He's expressed doubt about Sen. Kent Conrad's toothless "co-op" proposal, in place of a public plan, but he hasn't ruled out going along with it.

How specific should one get when talking about health care? In the Rose Garden today, Obama talked about how "Each of these bills improves oversight while cracking down on waste.  Each will help reduce unwarranted giveaways to insurance companies in Medicare.  And each of these bills will provide incentives so that patients get the best care, not just the most expensive care." That's kind of specific--but it's not the full elocution of a public plan Walsh seeks.

Obama has built a dichotomy between "naysayers" and "powerful special interests" who oppose reform, and those who want it. This week, Obama expanded that by opening up a political fight with Sen. Jim DeMint (R-SC), responding to the senator's "Waterloo" comment. DeMint, it's safe to say, wants to defeat any kind of reform Obama would want, but there's a critical gray area here in the Blue Dogs and moderate senators who aren't completely sold on a strong public option--and it's the negotiations with those moderates that will likely determine what kind of public option, if any, gets passed.

Walsh contends that "it's going to be hard to marshal the public will he needs to get beyond the GOP and the timid Blue Dogs without laying out his core principles." That may be true--so far, he's avoided a more specific vision, taking the approach of we-need-something-as-long-as-it-gets-the-job-done, perhaps anticipating that the final plan will change in talks with moderate members.

Obama's strategy--publicly, at least--has been to rally momentum behind the necessity of health reform, within a certain range of options and producing a certain set of results, then to let Congress come to a consensus on what, specifically, is done within that range. Walsh's strategy would be to strongly define the plan before that consensus arrives, and drive the moderate members to it.

Today, Obama proclaimed that "the consensus that we've forged is not limited to Congress. Indeed, we've forged a level of consensus on health care that has never been reached in the history of this country."

The consensus he's talking about is different from what Walsh discusses--it's a general consensus, a consensus about the need for reform. The question now is: will it be the kind of reform Obama set out to achieve in the first place?