Obama's Tactical Retreat is Key to Victory

On September 9, President Obama delivered his second address to a joint session of Congress and his 29th speech on the topic of health care reform. The speech was perhaps one of his best – and I say that as someone who is not a big fan of Obama the orator (I tend to think of him as Obama the teleprompter reader). But this speech was on target – he did an excellent job of explaining why the American health care system is in need of reform. Costs are rising at twice the rate of inflation, insurance premiums have doubled in the last 10 years as our wages have stagnated, the rising costs of Medicare and Medicaid threaten to consume our entire budget – all true.

After a blistering August, Obama needed to reclaim the debate – needed to reframe the debate. To use a tired expression, he needed a game changer. Reactions to the speech have been mixed (John Dickerson, Slate, Janet Hook, Los Angeles Times, James Fallows, The Atlantic, Ezra Klein, Washington Post). That mixed reaction is probably bad news for the President – he needed an undisputed homerun to truly reframe the debate. As for the specifics – the President has clearly retreated from his lofty goals of comprehensive system-wide reform. What he endorsed last night amounted to insurance reform. Needed reforms to be sure – but scaled back from what he had hoped for. In many ways the President endorsed the proposal just released by Senator Max Baucus – leading Blue Dog (details here). Coupling new regulations on insurers with individual and employer mandates, the President, and Baucus, would expand coverage. But lacking any system-wide reform we are unlikely to realize substantial cost savings or improved efficiency and care coordination. Still, by retreating on the call for comprehensive reform, the President will likely win incremental change that takes us a step closer to real reform.

Just my take…