President Barack Obama made his most forceful appeal yet for overhauling the nation's health-care system in a speech before a joint session of Congress on Sept. 9. It was a determined attempt to win the public—and wavering Democrats—over to his side, more so than the Republican lawmakers who have so far opposed reform efforts. Over boos and shouts from some Republicans, Obama cast many of his opponents as cynical, called some of the criticisms of reform proposals lies, pledged to keep reforms from adding to the deficit, and attempted to reassure a worried and confused public with his own determination. "I will not accept the status quo as a solution. Not this time. Not now."
Obama continued to support the controversial public plan, as well as a mandate that would require all individuals to buy insurance, and a requirement that all businesses, except for the very smallest, must offer coverage to all their employees or help pay for coverage they get elsewhere. He also gave a nod to a Republican goal, saying there should be some pilot projects on lowering malpractice costs. But mostly he called on the nation to rise to the tough challenge of solving its health-care shortcomings, as it has risen to other challenges in its history.
"I understand how difficult this health-care debate has been," Obama told Congress and a national television audience. "I understand that the politically safe move would be to kick the can further down the road—to defer reform one more year, or one more election, or one more term. But that's not what the moment calls for." Instead, he said, his voice rising, we must shape the future, not fear it. "I still believe that we can act when it's hard."
Obama's guidelines are more likely to shape what comes out of the House and Senate than to be presented as their own bill. The Senate Finance Committee, the last of the committees to come up with legislation, will meet in two weeks to draft a bill, Chairman Max Baucus (D-Mont.) said earlier Wednesday.
"The Time for Games Has Passed" The reaction to the speech in the chamber clearly broke down along partisan lines, with one Republican legislator, Representative Joe Wilson (R-South Carolina), even yelling "you lie" when Obama said the health-reform proposal offered by Congress would not cover illegal immigrants. Obama, who has sought bipartisan support for any bill he signs—an increasingly elusive goal—said in his speech that "the time for bickering is over. The time for games has passed," a passage that was met with sustained applause from the Democrats who made up the majority in the chamber. "I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it." He also insisted he would stand up to conservative rhetoric about the plan, such as that delivered this summer by some Republicans, who said reform would lead to "death panels." "If you misrepresent what's in the plan, we will call you out," Obama said.
The President made it clear that he endorsed some of the more controversial proposals on the table, but he did show a willingness to compromise over the most controversial, the creation of a public plan, which would create a government-run health-insurance option. The public plan has steadily lost support in both the House and the Senate, but Obama said such an option would keep other insurers "honest," although it would only be available to those who do not already have insurance or who don't receive it through their employer.
The National Association of Manufacturers quickly issued a statement after the speech blasting the public plan, even while supporting the concept of health-care reform. "We are concerned that many of the proposals the President outlined tonight, including a government-run plan, will increase costs and threaten economic recovery. These costs will drastically alter current plans and the coverage manufacturers already have," the lobbying group says.
The powerful lobbying group America's Health Insurance Plan, representing the nation's insurers, agreed. It issued a statement that "new health insurance reforms and consumer protections will solve the problem without creating a new government-run plan that will disrupt the quality coverage that millions of Americans rely on today." But otherwise, both industry groups repeated their support for reform and were muted in any criticism. AHIP's members have been pushing for reform for over a year, in part because mandated coverage will create millions of new customers.
Response from Grassley Senator Chuck Grassley (R-Iowa), the ranking member of the Finance Committee, said in a prepared statement after the speech: "There's support across the political spectrum for initiatives to make health insurance more affordable and accessible, and we know that legislation has to slow the rate of growth in health-care costs, or the situation will get worse instead of better. The speech could have been pivotal for bipartisanship if it had been clear-cut in ruling out the prospect of a new government-run plan. By leaving it up to Congress, where key leaders in both the House and Senate support a government-run plan and control the ultimate outcome, the President passed up a big opportunity."
Still, Obama said he is open to other ideas that would accomplish the same goals as a public plan—assuring affordable coverage for those who aren't currently covered. The public plan "is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles," Obama said. "The public option is only a means to that end—and we should remain open to other ideas that accomplish our ultimate goal." He lambasted Republicans for making "wild claims about a government takeover of health care," but he also criticized his progressive supporters who have been most adamant about a public option, saying: "I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it."
"I thought the most interesting thing in the speech is that he made the public option somewhat conditional," said Michael Thompson, principal at PricewaterhouseCoopers in charge of the health-care practice. "The business community has concerns about the cost of a public option, but what Obama described is something that would not be available to more than 5% of the population; it limits how much government-supported health care would be in play."
Obama was more determined that any bill would have an individual mandate requiring everyone to buy health coverage. He also continued to support a requirement that employers offer coverage to all their employees—except for small companies, an exemption that Obama said would cover 95% of small businesses. "We cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health-care system only works if everybody does their part," he said.
He reiterated the points he has made over and over, that those who like their current health-care coverage can keep it, that the plan will not raise the deficit, and that Medicare coverage will not get cut.
But mostly he tried to rally the public, and the moderates, with some soaring rhetoric at the end. In doing so, he also attempted to counter fears of a growing government role in health care. "We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test."
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