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Obama on Health Care: Polishing the Policy

6 years ago
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Barack Obama may be the greatest Democratic orator in half a century, but until now his rhetorical gifts have deserted him when the topic turned to health care. His May 2007 speech unveiling his health-care plan for the primaries was tepid and – believe it or not – Obama only devoted three sentences to the issue in his acceptance speech at the Democratic National Convention in Denver last summer. There was merely a fleeting reference to health care in Obama's Inaugural Address and even in his policy-laden speech to Congress in February, the president seemed mostly concerned about "the crushing cost of health care."
All that changed Wednesday night when Obama delivered what I believe (as a long-ago presidential ghostwriter) was probably his best speech since the 2004 Convention keynote address that put this little-known Illinois state senator on the staircase to the stars.
There were many of Obama's familiar rhetorical tricks such as his self-conscious effort to walk a middle path between those on the left who want "a single-payer system like Canada's" and those on the right who believe that individuals should fend for themselves in the marketplace. The president was forceful in ridiculing "bogus claims" about Medicare death panels and supposedly free health care for illegal immigrants. He also occasionally played fast and loose with logic as he vigorously defended giving the uninsured the right to buy coverage from the federal government (the public option), but moments later disingenuously claimed that "its impact shouldn't be exaggerated by the left, the right or the media."
But Obama soared when he invoked Ted Kennedy – not in a mawkish "Win this one for Teddy" way, but rather by reading aloud from the senator's final send-only-upon-my-death letter. Kennedy's last testament employed passionate language seemingly at odds with Obama's detached public persona: "What we face is above all a moral issue; at stake are...fundamental principles of social justice and the character of our country."
A lesser speaker would have left things there. But instead Obama mused aloud about the concept of the "character of our country" as he played off the American tradition of "rugged individualism" with the national belief that hard work should be rewarded "by some measure of security and fair play." To hear Obama tell it, health-care reform seemed analogous in spirit to an old-fashioned community barn-raising.
When Obama formally declared his candidacy for president in February 2007, he pledged "we will have universal health care in by the end of the next president's first term." But although it is hard to remember now, both Hillary Clinton and John Edwards went after Obama from the left in the primaries, arguing that the Illinois senator's plan did not really provide universal coverage. The reason: Both Clinton's and Edwards' proposals mandated that individuals must obtain health insurance (with heavy government subsidies if needed) while Obama's plan did not. Yes, it seems abstruse in retrospect, but this policy dispute received center-stage billing in several debates.
That is why it was so intriguing to hear Obama come out for – yes – individual mandates Wednesday night. "Under my plan," Obama declared, "individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance." Sitting in the front of the House chamber, Secretary of State Hillary Clinton might have been allowed a quiet moment of long-delayed vindication. The mandate to have insurance (which Obama had never before explicitly endorsed) is the only way to prevent the young and the foolhardy from gaming the system by depending on hospital emergency rooms for their health care.
It was not too long ago that Obama seemed embarrassed to talk overly much about the millions of Americans without insurance for fear that health care reform would be dismissed as a social welfare program. During his late July prime-time health-care press conference, Obama began with a prepared statement that stressed, "This is not just about the 47 million Americans who don't have any health insurance at all." But in his speech to Congress Wednesday night, Obama was far more explicit about the plight of the uninsured: "We are the only advanced democracy on Earth – the only wealthy nation – that allows such hardships for millions of its people." But even then, the president was careful to point out, "These are not primarily people on welfare. These are middle-class Americans."

Obama's stirring speech does not guarantee that the polls will swing in his direction nor is it likely that congressional naysayers will surrender to the force of his oratory. A strong address to Congress by Bill Clinton in 1993 did not save his health-care plan from a quick trip to the legislative rendering plant. But if health-care reform goes down to defeat this time around, it will not be because Obama failed to find the poetry to put a polish on the policy.

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