Delivering a brilliant healthcare speech

Tonight we saw a brilliant performance from Barack Obama. It was Obama at his best, using his command of the English language to inspire and connect on a grand stage as only few politicians can. For sceptics like myself, he surprised. For his base, he reaffirmed. For his adversaries he reached out with an open hand but with the credible threat of a clenched fist.  Obama delivered the goods.

And judging from the initial reactions of the American public, I am not alone in this assessment.

More reactions here via Andrew Sullivan.

Look, I have said I see this in stark terms. No other advanced society would permit tens of millions of its citizens to live without insurance against a basic 21st century need, which healthcare clearly is.  No other advanced society sees thousands of its workers bankrupted due to health issues. Forget about the politics and posturing. This issue goes to the very core of who we are as a nation and our values as a society.

That was also the message Obama delivered.

Here are some of the basic points the President covered:

  1. Obama wants an evolutionary change, not a revolutionary one. The present basic healthcare system will remain. For the majority of Americans, this means there will be no change of doctor or insurance provider.
  2. He is strongly in favour of a public option to promote competition and reduce cost.
  3. Obama is advocating coverage mandates for everyone like for car insurance.
  4. He wants to ban pre-existing condition dropped coverage.
  5. The President wants to ban yearly and lifetime spend caps.

A few other thoughts:

  • From my perspective, the most important thing Obama did was stay true to his conciliatory self while still somehow projecting the willingness to show the iron fist. He said “I will not waste time” with those playing political games. Misrepresent and we will call you out. My favourite line was when he called Sarah Palin out, saying “it is a lie plain and simple.” Apparently, Obama has learned when to talk tough.
  • Obama did an excellent job of throwing enough red meat to progressives while covering all the bases on fiscal responsibility to make it difficult to criticize the outline he gave. He gave lip service to his change agent status by quipping “I will not accept the status quo.”  I suspect the only potentially effective points of attack will be on the lack of specifics or on the feasibility of cost cuts.
  • Obama’s line about illegal immigrants caused a bit of an uproar. I don’t have a view here, but it was one of the more negatively received lines – there were boos to the reaction.  See the CNN coverage here.
  • Obama threw a bone regarding malpractice insurance into the fray. Smart move.  This was more of a political ploy than a plan to actually do anything, in my opinion. But, it did cover that flank, if just.
  • The Republicans overreached.  Sensing a populist backlash against Obama, they really miscalculated in the school lunch speech brouhaha. These missteps were furthered during the speech.  The lack of civility by members of Congress was cringe-worthy. They often refused to stand and clap and one even heckled. This will cost the Republicans politically.  See the picture on Andrew Sullivan’s site.
  • The choice of venue was important.  It certainly worked well for Obama, lending him a statesman-like aura and putting him in a large speaking venue where he excels.  It was like a state of the union address with Congress rising to its feet and clapping in orchestrated approval. The contrast to the Republican rebuttal, done from some non-descript room, was enormous.
  • The Republican rebuttal was flat. Charles Boustany spoke mostly about costs and the evils of government-run healthcare. It rang hollow because the President’s speech covered those bases fairly well. Boustany was at his best when he gave his four specific proposals on what to do to reform healthcare. He was at his worst in trying to label the President’s plan as government-run healthcare, a claim that seemed at odds with the facts. Yes, he was at a huge disadvantage because of venue. But I’m sorry, he was just not a good public speaker.
  • There was some ‘class warfare’ rhetoric which I found distasteful and it also sounds like the plan will be paid for in part through taxes on the wealthy. Moreover, I am no liberal and the big defense of liberalism and big government at the end was a turn-off for me personally. Others will like him for taking a stand. It will certainly help brand him as far left of center.
  • The Ted Kennedy story he told was a clear political prop that I felt was somewhat risky. But, it was generally well done.  I liked the ” character of our country” phrase.
  • The speech did go on for maybe 5 or 10 minutes too long.

Fallows sums it best:

There will come a time when Barack Obama cannot pull himself out of pinch with a big speech. And obviously we don’t know how this debate will turn out yet. But he hasn’t fallen short on the big-speech front yet. More tomorrow.

Let’s see what kind of legislation comes of this.  If I get video, I will post.  Feel free to comment.

Full text of speech here.

Here is the video:


  1. CMY says

    Did you get a complimentary set of kneepads with that review?

    You’re talking about a speech on subject matter that has some pretty serious implications to our economy and isn’t particularly “sexy”. Obama could read the phone book and make it sound good- what about the specifics?

    Oh yeah. None.

  2. Anonymous says

    “Great speech”? It was pretty moving when he spoke of the need for reform of some sort, but pretty deceptive and unsatisfactory when it came to details. Let’s see what he left out:

    1. The fact that a government-sponsored and operated plan (the “public option”) would have a very good chance, if not a certainty, of killing off all competition when the purported purpose is to provide some competition where there is little now. Ineed, he trumpeted why this would happen: no need to make a profit and no need to pay high executive salaries. Did he even nod in the direction of acknowledging that this is what each and every competing company must do in a captialist soceity? No. Did he offer to open up the field for insurance companies, permitting them to offer healthcare insurance across state lines, with the thought that this might provide competition where there is none (his example was Alabama, where, apparently, a single provider has some huge percentage of all of the business) without the need to put a U.S. government plan into the mix? No.

    2. Did he really say — yes, he did — that fining people for not having health insurnace was analogous to forcing those who drive automobiles (which for some reason I have trouble understanding is viewed as a privilege awarded by the state rather than a right) to buy accident insurance? Let’s see if I get this. Now we are to be fined for not getting health insurance because we are alive and walking around as if being alive and walking around in America is a government awarded privilege? What? Can it be that this will pass Constitutional muster?

    3. Refusing insurance on the basis of prior condition was addressed as was capping benefits and watering down benefits for those who trigger them because of an illness or medical need. But nothing was said about premium levels based on age or prior condition. One supposes that these factors can still be taken into account by insurance companies and charged out at a different level than what is charged to those with no medical history and who are young instead of old.

    4. Nothing was said about increasing Medicare reimbursement rates to something like a local average payout by insurance companies, requring health care providers to report their prices to some central authority (like, say, the Comptroller General) and published on the internet for all to see and analyze, and the need to incent doctors to stop dropping out of having Medicare patients at all.

    6. Nothing true was said about carving into benefits now provided by Medicare to the tune of a half a trillion or the curtailments of benefits under Medicare to conform to some nuttty committee’s idea of “best practices” — read by rationing care and curtailing this or that treatment for this or that beneficiary.

    7. The truth was not told about the number of Americans needing all this and the grant of benefits to illegals unless the President actually meant to confess that this number is not even close to 47 million people, as advertised.

    8. Nothing was said about capping medical lawsuit damage awards against doctors and hospitals (e.g., limiting recovery to, say, $1 million per plaintiff, including as a single plaintiff any group of similarly situated plaintinff involved in a single law suit) and lawyers’ split of any damage award (to, say, 20% or something like that).

    9. The promise not to increase the deficit when all this goes into effect
    was flat-out preposterous.

    10. Nothing was said about reducing the text of the plan to a single page or two, which seems eminantly possible to me, when this ought to be easy to do unless the whole thing is larded with new government agencies of one sort ofr another and special carve outs for those whose support is being bought.

    So, a “great speech”? Maybe for a college debate, but, as for great policy, too much was twisted or left unsaid and undone in the plan being proposed.

    1. Edward Harrison says

      I sense partisanship. Look, you can criticize the policy points all you want. But when it comes to the actual speech and its effectiveness in helping drive a political agenda, Obama got it done.

      His numbers among independents are up enormously in the polls I am reading. Remember, this is politics and that’s what counts.

  3. Anonymous says

    what a bunch of non-sense. The country is near broke and this guy along with his buddy politicians can’t stop spending recklessly.

  4. dansecrest says

    Excellent review of an excellent speech. Thanks.

  5. Anonymous says

    Uh….take a look at the sample used in the poll. 2 to 1 Demo vs. Rep. Not exactly representative of the nation. Good speach, not great. Echo the fact that there were many details left out. Oh..and by the way, if the Almighty thinks this is such a good idea, why is He proposing kicking this down the road to implement in 2013? Perhaps it’s because it won’t be until after the next Pres election cycle is over the full effects won’t be felt (i.e. higher taxes, less services). Come on and take the blinders off and stop drinking the cool aide.

    1. Edward Harrison says

      Fair enough on the poll sample. On the whole, the speech did what it was designed to do: give a temporary boost to Obama to aide him in pushing this piece of legislation through. And on that measure it was a resounding success as I have said.

      For more critical pieces regarding policy or the effects on Obama’s future political fortunes, take a look at a few other commentaries. Here are three:

  6. Sobers says

    As someone who lives under the monolithic NHS in the UK, I suggest most strongly that the USA does not travel down the road of such a system. Yes in the UK everyone gets ‘free’ treatment. And yes you CAN get very good treatment here. But whether you get it is entirely out of the control of the individual. It comes down to what area you live in, what some bureaucrat decides on which drugs are to be made available and if you are lucky enought to get consciencious individuals treating you.

    Socialised medical care suffers from producer capture. That is the system ceases to focus on the needs of the patient, and instead focuses on making life easier for the people running it. Thus when I go to see my GP (General Practitioner – the gateway to NHS care) he has little incentive to listen to me, and investigate my problems. His salary is the same whether I get better or die. His sole interest is how to get through his appointments in as fast a time as possible so he can go home. The same goes throughout the whole NHS. You are entirely at the mercy of the conscience of individuals throughout. And while the majority do a reasonable job, a significant minority are there to collect their salary for doing as little as possible. And being employed by the State they are almost impossible to sack.

    As a patient I have no power over the providers of my medical care. I have no defined rights to care. I cannot take my custom elsewhere as I can when I spend my own money on something and get bad service. And because the NHS is so monolithic the private sector is entirely crowded out, and is thus even less competitive. Though how you can compete with ‘free’ is open to question.

    My Grandfather was a GP before WW2, and left the UK to practice privately in Ireland because he disagreed with the introduction of the NHS. He said the NHS would destroy the independence of doctors, and reduce their focus on helping patients. Anyone looking at the NHS now couldn’t help but agree with him.

    It is not for me to say whether the US should reform its medical system. The fact that a proportion of the population of the US has no cover at all is hard to swallow. But be under no illusion – providing cover for free for the people at the bottom has to be paid for somehow by the rest. That will either be in cash terms (extra taxation) or by the rationing of the care available for all. There is no free lunch. For Obama to claim otherwise is nonsense. But then he’s politician. They tell us what we want to hear, not the unpalatable truth.

    1. Edward Harrison says

      Sobers, the NHS system is not being considered here. So it is somewhat
      irrelevant. I would like the comments to reflect the true options in this
      debate which do not include single payer or government run healthcare

      1. Sobers says

        Once you provide medical treatment for free to some of the population, its rather hard to prevent everyone wanting it for free as well. My prediction is that the ‘govt option’ will slowly suffocate the private options, and you will end up with a system similar to that in the UK. We had many private medical care systems in 1945 prior to the NHS. Now we have very few, for the ultra wealthy only. That was my point in describing what happens here.

        The govt will always ‘out compete’ the private sector, because its pockets are deeper, and it can rely on compulsion to get its tax income, compared to the voluntary purchasing of goods and services from private companies.

        1. Edward Harrison says

          That’s preposterous because the NHS is government run medicine. That is not
          a consideration here. The public option only allows for non profit insurance
          not hospitals. A completely government run insurance scheme is single payer
          which is what they have in Canada not the UK.

  7. Anonymous says

    Are you in support of Obama’s healthcare plans? I’m out of touch with the healthcare debate but am curious to know whether you support it.

    1. Edward Harrison says

      That’s a hard question to answer because Obama has yet to make any specific healthcare proposal. His speech was an outline of things he wants, but he did not give any specifics nor did he put a stake in the ground over those specifics.

      I do support his larger aims like: covering all Americans with adequate insurance and reducing cost. But there are a lot of ways to get from here to there. So, there are a lot of options I would support.

      What I would not support is the status quo. Nor would I support an expansion to cover the uninsured without identifiable cost reduction mechanisms. One last issue that I think is very important is closing insurance loopholes like: denying or capping coverage. If you have insurance, you have insurance – full stop. If provisions are not there to stop insurance companies from denying and capping coverage, you should consider this effort a failure.

      1. Anonymous says

        Thanks for sharing. I’m still trying to play catchup with the healthcare debate and familiarize myself with the different options and benefits/drawbacks of each.

  8. Vangel says

    I guess this is another example of the claim that we see what we are rather than the way things really are. Sorry but if one is objective one has to be a lot more critical of the speech than you seem to be. Obama seemed a bit off and not as consistent as he should have been. Of course, it is difficult to really give a good speech when some obvious emissions (tort reform, the removal of state barriers) are left out for political reasons.

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