And – The Response to the 090909 Obama Speech…

Last weekend, in the run-up to The 090909 Obama Speech, I was clearing away my collection of stuff in my home office randomly collected from two years of living in London.  After completing the disposal of a lot of miscellaneous items, Sandi and I decided to take Sunday afternoon off and visit the British Museum.  There are so many options at the Museum.  After some discussion, we decided to visit “Living and Dying,” an exhibit which highlights the responses of cultures to our lives through ritual, perspectives, and habits.  Hidden amongst the materials was this great quote from Carl Sandburg (1978 – 1967) which read, “The single clenched fist lifted and ready?  Or, the open asking hand held out and waiting?  Choose: For we meet by one or the other.”  I think that Sandburg’s poem captured the essence of the Obama speech far better than any other analysis I’ve seen. 

As President Obama stepped into the House chamber Wednesday night you could feel the anticipation hanging in the air over the joint session of Congress.  While the dreadful summer was over, Obama faced a drop in approval ratings and an ambitious healthcare overhaul effort which had fallen off the tracks.  As I said last week, Obama needed a Brett Favre-like moment with a long successful pass down the field. An Associated Press-GfK poll released just hours before the speech showed a 52 percent public disapproval of President Obama’s handling of healthcare – a record spike in disapproval.  It was clear that the President was looking to land the long ball.  My sense is that he put healthcare reform up field, but the goal line is still out there a ways…

The speech was intended to provide greater detail on his healthcare agenda.  He started by reassuring the American people that if they already had health insurance, nothing in his plan would require them or their employer to change coverage.  He went further in proposing a limit on how much individuals can be charged for out of pocket expenses and a requirement to cover preventive-care measures such as mammograms and colonoscopies without an extra charge.

But the most sweeping reform of the night was the call for a mandate that all Americans carry some form of health insurance.  Obama proposed the creation of a new insurance exchange within four years – a marketplace of sorts where both individuals and small businesses would be able to shop for insurance at competitive prices.  Within the exchange, he proposed that government would offer a non-profit public option only for those who do not have insurance. Speaking to one of the key controversies in the healthcare debate, the Obama public option would not be subsidized by taxpayers.  Rather, like any other private insurance company, the President’s public option would be self-sufficient and rely solely on the collected premiums for maintenance of the program.  The intent of setting the exchange as a non-profit organization is to avoid excessive overhead and compensation costs. 

Speaking to both sides of the aisle, Obama’s sharpest tone of the night came when he discussed the many misconceptions about his healthcare agenda.  He directly rebutted the rumors which spread like wildfire during the summer recess that his plan included  support for supposed “death panels” where bureaucrats would decide which senior citizens are kept alive, and that his plan would fund abortions.  Obama was direct and clear – a resounding NO!   The most controversial moment of the night though came when President Obama declared that his proposed healthcare agenda would not cover illegal immigrants. Shouting from his seat “You lie!” Representative Joe Wilson of South Carolina instantly received his 15 minutes of fame for all the wrong reasons. A visibly stunned Nancy Pelosi (D-CA) and Vice President Joe Biden, who sat behind the President, were seen scowling at Wilson after Obama continued speaking. Shortly after the address, Wilson telephoned The White House and apologized to Chief of Staff Rham Emmanuel. On Thursday President Obama formally accepted Wilson’s apology.

So, long and short – none of the three controversial rumors are true, and the facts can be checked on multiple Web sites.  Consider www.PolitiFact.com, a truth-squad venture run by the St. Petersburg Times newspaper which concurs with Obama’s position.  No subsidy for illegal immigrants.  No "death panels," either.  And, no public money for abortion. Despite the clarity of response, there continued to be ongoing rumors of hidden support for these areas late in the week.

On the issue of price, Obama did not shy away from facing his critics.  He explained that his plan will cost roughly $900 billion over ten years and went a step further by promising that he would not to sign any bill that increased the federal deficit “even by a single penny.”  Instead, Obama’s plan would be paid by cutting waste, reducing unnecessary medical spending, and collecting taxes from the drug and insurance companies where profits will spike due to the government’s mandate that all citizens buy insurance.  He also proposed a fee on insurance companies as a type of surtax on their most expensive policies which is intended to encourage consumers to seek more value for the money paid in insurance premiums.   Arnold Relman, MD, former Editor of the New England Journal of Medicine, captured it best when he said, “It was a terrific political speech.  But eloquence, clarity, and passion do not by themselves provide the means to achieve [his] ends.”

I continue to believe that this is the area where the debate needs to be revved up.  The focus over the last several months clearly shifted to insurance reform.  Without concurrent delivery reform, however, a newly expanded insurance plan will simply not yield the results we all want.  In particular, as I talk with many of my colleagues in the healthcare community – the approach to delivery reform is one of the greatest concerns.  I anticipate that this issue, if not included in the initial initiative, will become the major area of focus after the first of the year.  From my perspective, it must be considered…

Finally, in an attempt to appease both wary senior citizens and Republicans – two constituencies whose support is crucial – Obama stated that “not a single dollar from the Medicare trust fund” will be used for the new program. Instead, he called for the elimination of billions in Medicare subsides that go to insurance companies for management services.  He also called for an independent panel of doctors and medical experts to identify the wasteful spending.  And, as an olive branch to the Republicans, Obama proposed testing medical malpractice reform in states – an olive branch that was rejected by many Republicans as too little and too weak. 

My sense is that President Obama extended both an open hand and a clenched fist to his opponents. Signaling that he was willing to work together with both sides of the aisle, the president also made it clear he would not accept the partisan bickering and stalling that plagued the efforts throughout the summer months. Giving praise to Republican John McCain (R-Arizona), who Obama ran against last November and to Chuck Grassley (R-Iowa) was a clear and forceful gesture toward bi-partisan support in an effort to stimulate passage of a healthcare reform package.   But, as I noted – it may not have worked.  On Friday, McCain described the Obama plan as “an egregiously expense and expansive form of government-run healthcare” and was purported to be circulating a petition in opposition to the plan…

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.