Highs and Lows

The President was exceptionally eloquent in his grounding of health-care reform on moral arguments. He did many things very well:

• He made a persuasive case that, while the percentage of Americans completely without insurance coverage is relatively small, the percentage of Americans persistent insecure about health insurance is very high.
• He also made a cogent argument that when health care costs grow fast and crowd out other spending, we lose economic competitiveness.
• He stated his goals with great clarity. While I am disappointed that he did not focus on health improvement and health-care quality, his prioritization was a welcome contrast to his muddled messages over the last several months.
• His outreach to opponents on issues such as medical malpractice and low-cost coverage for the seriously ill were also welcome.

The proposed prohibitions on lifetime and annual coverage limitations, on denials of coverage for pre-existing conditions, and on terminations of coverage after someone becomes ill and the requirements for individuals to buy health insurance made sense, although an unintended consequence of a badly-designed employer mandate could be the destruction of even great employer-based health plans.

His case for the public option was flawed. State government regulation is the cause of lack of insurance competition. A public option does not create fair competition; it either creates unfair competition or it is ineffective. Nevertheless, I appreciated his message that achieving affordable coverage and care were more important than the litmus test of a public option.

He tread on dangerous ground when he spoke about financing. It's easy to talk about spending cuts, but brutally difficult to make them happen. When he speaks about "waste and abuse," he does not mention that one person's waste is another person's livelihood. There is a way to achieve these cuts, but the political challenges are enormous. The lack of specificity on how to pay for his proposals is the most serious issue in the speech.

Only time will tell whether his speech succeeded, but it was well-crafted and well-delivered.

By Michael Critelli  |  September 9, 2009; 10:29 PM ET  | Category:  Health Care Reform , Health costs , Individual mandate , Insurance , Presidential leadership , Public option
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