Speaking, Plainly

I'd love to say I have a strong feeling about anything Barack Obama said last night... but frankly, I don't think he said all that much: most of the ideas were vague, and mostly boilerplate rehashing of points he's made already, which, in the abstract, are basically left-wing notions about governing that we all pretty much agree on. Who doesn't want smarter, more efficiently run government (well, aside from Bobby Jindal... but let's get to that in a moment)? Who doesn't want major improvements to our health care systems? Better schools? What kept jumping out at me last night was... all the jumping up for standing ovations, the race to see who could applaud soonest, loudest, and longest. Yes, Republicans deliberately sat on their hands at moments... but those seemed fleeting compared to the times that everyone seemed to be enthusiastically supportive of the big ideas... like people need jobs. Or we need better schools and better healthcare. Or the military is great, and honorable. Anyone opposed?

I didn't think so.

Much of the speech was simply content-free; Ezra's been kind of spear-heading the "theater of healthcare nonspecifics as if they were substantive details" type of posting, but even Tim Foley over at Change.org fell into similar mode today, arguing that lack of substance and details was, you know, reassuring. I don't know what it is... I'd kind of have to have, you know, details or something, to make that out.

In general, it seems that Obama is likely to propose a universal insurance mandate, presumably on the Massachusetts model of a gradual imposition of fees (tied to tax returns) for people without coverage. That, in theory, means that some new form of individual insurance would be made available to people without coverage, probably the "Federal worker" option of allowing average citizens to buy into the same set of options offered to federal employees, in some form. There's almost no other way to achieve any kind of reasonable goal of universality otherwise.

After that, things are pretty murky: there's suggestions that the next move would be to develop some kind of new approach in Medicare to cost controls, probably something about testing various outcome/delivery approaches to paying for care. A larger question is what Medicare is going to do overall about reimbursement rates, since they have been frozen for the past few years (partly by design and partly because Congress and President Bush never reached budget agreements in the past two years). The failure to increase Medicare reimbursements is a huge issue that's set to explode if nothing is done this year - doctors and hospitals have been screaming that they can't afford to continue to provide coverage at these rates, and have suggested they will drop services, or patients. Obama offered no kind of insight into how his Administration is thinking about this (which is probably not helped by - still - not having a Secretary for Health and Human Services).

I mention health care questions because I think the lack of detail and specificity is indicative of the larger questions raised, and not answered, by the speech. Obama made clear, last night, and much of this week, that "health care reform" is the big push for his legislative agenda. Yet, there's been little to no preparation of the public to explain what's under consideration or why. This, I maintain, has been a problem with "health care reform" since at least the 1993 Clinton plan went down in flames: it's clear that much of the public has only a hazy idea of all the issues involved, and while they're concerned, in a general sense, with "the uninsured" and "rising costs", they're also too trained to doing things in the current environment to accept major change. People expect to be able to "go to their doctor", and to access almost any service or prescription if it's "crucial" to their care (this, usually, is expected to be the thoughts of that doctor they like so much).

Those expectations - much of them unrealistic, and untethered to actual current approaches to care - are why the public can be swayed by Republican scare tactics about "socialized medicine" or "government-run healthcare." As Americans, we are leery of notions that health care will have to be "rationed", when few fully appreciate that rationing is already happening, and really in ways mostly unfair to needy people, and at a cost to many people's good health.

Like many who've looked closely at this issue, I tend to believe in a general idea of insurance reform that would offer more coverage to more people, probably through expanding government supported options (like the Federal employee plan)  to more people. I think we'd be in even better shape if we adopted a model where a "base" insurance - that covered standard things like checkups and a number of good preventive types of care we already know work - was offered at a fixed rate to everyone, and could be supplemented by other plans at an individual's discretion. This would, probably, mean a gradual shift to including Medicare as part of the "base plan", since that would sync up younger people with a plan that could apply across a lifetime, and probably gradually push reforms of Medicare's out of date approach to fee for service payments to a better model of paying for care that improves outcomes, and reducing payment for care that's unnecessary or extraneous.

But in order to get there... you have to explain it. You have to explain where we are, and why we're here... and why it doesn't work.  Almost none of that has happened; and where it has (like Michael Moore's Sicko, for example), it's been polemical, and more in search of someone to blame than focused on identifying what works... and what doesn't, in what we already have.

There are plenty of questions to be asked about Obama's plans for healthcare reform; few are really being asked, and little is being spelled out. There's particularly plenty to be asked about how all of this will be paid for, and in the context of Obama's plans to "halve the deficit" by 2012 and to have "honest budgeting," that's especially germane... since Medicare alone is expected to account for hundreds of billions of the growing deficit issues we face.

And so the speech last night - for me, anyway - was a wash; the President's exceptional skill as a speaker, and his gift for evoking a general sense of upbeat hopefulness while embracing liberal concepts was impressive. His refocusing of the national agenda, in ways that play to Democratic strengths, was very well done.  But with little, really, to go on about specifics... it's hard to say how all of the big ideas get translated into practical realities. And it's hard to say that our practical realities - so filled with clear indications of upcoming hardships - can embrace all of the big ideas.

It's depressing then, to see how lackluster the Republican response was, and how little they have to offer as any kind of thoughtful alternative. Already conservatives are blaming the "liberal media" for knocking Bobby Jindal's poor response last night... but that's ignoring the obvious. On almost every level - the ideas, the reflexive embrace of old (and failed) talking points, the impressively weak delivery - Jindal delivered so little that I have to agree with Rachel Maddow, it left one pretty much speechless. More telling was that Jindal, a health policy wonk himself, had to admit the obvious - that healthcare needs reforms, that better coverage and better care have to be paramount, and we have to work together to figure this out. Almost all of which pretty much means that Democrats are well ahead of where any Republican is in offering what actually gets healthcare reform moving. And beyond healthcare, that's true of most of the big issues we face: Republicans are nowhere, and showing few signs of getting anywhere soon. At a time when we need more ideas - not less - we've got very little... and much of it is very vague. And Republicans are poised to do little more than obstruct, complain, and resist. That may have worked, barely, as a unifying moment when dealing with the stimulus... but over time it's bound to fail; opposition will just be meaningless without a credible alternative.

As much as anything, what left me disheartened last night were two glaring things, one he said, and one he didn't. What Obama didn't say was anything meaningful about addressing poverty in a comprehensive way; so much of what we face in terms of economic disaster will just be worse if we don't admit that more people are headed into poverty... and we're not looking fully at how to stop it... or get them out. But just as unsettling was what Obama left in - a definition of the "credit crisis" that insisted that "we have to get lending again." Car loans, student loans, mortgages... here Obama was encouraging (even modestly) a mindset that refuses to see how debt got us into the mess we're in - banks aren't just not lending because they're being overly tight; they're not lending because it doesn't make sense. All those things we got loans for - the cars we couldn't afford, the tuition that was way too high, the home that was priced beyond our reach - were unsustainable. And now, we can't just have them back.

Together, I think these two ideas - the poverty we don't talk about, and the old way of life we still want back - suggest that for all his brave words, Obama didn't speak to us plainly enough last night. Because plainly, we can't go back; and by simply casting "going back" as a return to, or extension of, failed Republican policies, he ignored what was also in the past - a heady, free spending, damn the consequences notion of everyday life lived by credit card and ever expanding debt ("People bought homes they knew they couldn't afford from banks and lenders who pushed those bad loans anyway" - is not a sentence where all the problems lie with the banks).

The way forward needs more definition, more specificity than he's willing to give... and it needs to be more honest about the things we can't have, that we have to give up, that have to be sacrificed. It's not "un-hopeful" or even depressing, to face the need for sacrifice and hard work... but it can be, if we try to hide from it, if we try to hide - and we still are, as a nation, in active denial about all of what's happening, and what it means about the lives we face. If we avoid the specific sacrifices and changes we have to make for too long... we're just likely to make it more painful when we actually have to face the realities. And that's just speaking plainly about where we are.

Comments

[Leigh]

I don't find this post depressing at all (per your email). In large part because it offers some specific suggestions for what could happen w/healthcare. It reads more like a helpful critique to me. I enjoyed it.

I also think there's a philosophical difference among pp over what that speech was supposed to accomplish. If you expected general uplift and a broad outline of his domestic agenda, you got that. If you expected details, which I guess you did, you didn't get that.

I'm not wedded to which works better, but I do think there's a time and place for details, and a pomp-and-circumstance opportunity like that is probably not the time or place. So I'm generally satisfied with his speech. That said, I did assume I'd missed a lot of it during live blogging, but when I went and re-read it yesterday, not so much. So either my expectations were subconciously higher...I don't know.

As for the debt piece, this is an intriguing case you make. Bob Kuttner, the founder of TAP, spoke on campus on Tues night and reassured us that BO had no plans to return us to the economy of 2 yrs ago. NO KIDDING, BOB. But when I asked if he planned to take us back to the late '90s or towards a more balanced economy like the 1950s and 1960s, I didn't get an answer. I also think that Obama's economic team is the weakest link in his Cabinet and the most revealing about where his economic philosophies probably lie, and that's extremely troubling.

As for poverty, I had zero expectations that he'd address it - it's up there w/immigration in terms of things no pol wants to go near. There's also a case to be made, one I don't agree with obviously, that if 10-15% of our country lives in poverty, pretty consistently over the decades, is it really a pressing problem? Compared to a full 25% of the 2/3 of homeowners in the US now being underwater, for instance. The absolute # of people affected in those 2 pools might be similar, but the latter issue is unprecedented and we like to believe we've at least got our national homeownership rates to be proud of, so everyone's legitimately freaking out.

I think a more useful conversation that addressing poverty itself would be addressing inequality, and BO did that a bit, but could obviously go much further on that. As a nation we should really face that. But sort of like w/the debt piece, it requires some internal awareness that we're not all better off or one of the privileged few, and though the time is right for that kind of realization, as you keep pointing out, we're not quite there yet.

I liked his speech, but you know that, and you know it's because it was erudite more than anything. Bush really did a # on me, I guess! :)

[weboy]

I don't know what I expected... or that I expected anything; I hadn't even planned on listening to the whole speech, but tehre he was, captivating as usual... and I got drawn in. Honestly, it took me half a day to realize... there wasn't much there. Was it the "right time" for specifics? I think the better question with Obama is... when is the right time? It's always later, it's always coming in some white paper or at some strategy session... but so far, we don't see the details, or get much sense of the actual ways he'd like to see "good government" (a term I frankly despise, never mind how I loathe "goo-goo") actually get implemented. It's all broad temes, big ideas... and as someone who majors in "big picture", I now understand why people say "nice, in theory... but how does that play out?"

As for poverty, it seems to me we are headed toward the situation you describe - where the percentage of people in poverty is about to sail past historic norms... what then? As you and I talked about during the campaign, there's a class question with Obama and his economic team (who I don't necessarily think are his "weakest link" so much as his most Establishment Concession) about whether they "get" the issues facing poor people. Nothing, so far, has made me more confident about that, even, and especially, that speech. And that's beyond the plain speaking I think we still need to get more people to face up to the problems we face.

[Leigh]

Why do you hate that term? Just curious. I only knew it as a formal political ideology (more or less) so had some trouble finding plainly written explanations of it, other than in newspaper articles where it was used as a descriptive w/o any clarification. It's awfully vague without some historical clarification.