A big part of his political game as President is to fake left and go right. He did this once again in his big speech on health care on September 9th. In this speech he pleased rank and file Democrats by flirting with the "l" word. That's "L" for liar. He finally struck back at a few of the blatant lies that the Republican noise machine has been telling about the various health care reform bills that are circulating in Congress. In particular he responded to the baloney around "death panels", though not as strongly as he could have, in my opinion. He made a good faith attempt to repudiate the charge the health insurance bills would provide health care for undocumented aliens. He threw a sop to the Progressives by noting that the cost to the government of health care reform was dwarfed by the costs that the Bush administration had run up with the wars in Iraq and Afghanistan. He rhetorically positioned himself as a populist by ticking off the flaming abuses that he wanted to do away with, such as denying insurance due to pre-existing conditions, canceling insurance for people who get sick, and the other host of flagrant abuses that everyone can agree need to be addressed. He also somewhat resolved the drama of the days leading up to the speech by saying that he supported the public option.
Having half-heartedly faked a move to the left, he then proceeded to go right. He tried to set himself up as being in the center by saying that he had rejected a fanciful right-wing notion to do away with employer-based health care and the "far-left" idea of a single-payer plan. While the mythical go-it-alone against the big insurance company plan was never taken seriously by anyone, single-payer national health care is the system of choice throughout the industrial world. In fact, the plan that leaves for-profit health insurers basically intact that he so enthusiastically backs would be the odd man out among national health care systems. The no-brainer reforms that he so strongly enumerated have such widespread support that even Republicans can agree to them. He even brought up the traditional Republican red herring of "tort reform" as part of health care reform.
On closer scrutiny, it appears that Obama wants to help preserve the profits of the private health insurance oligopoly. The requirement that people be required to buy health insurance has been decried by many critics for many months as a vast bonanza to the health insurance oligopoly. The version of the public option that he described in his speech, where it would be available only to those who couldn't get insurance elsewhere, does little if anything to restrain the premiums charged by the big health insurers. The only effective public option would be one freely available to anyone. The Obama version shields the health insurance oligopoly against competition. The health insurance exchange that is a keystone of the Obama proposal is the hackneyed creation of Blue Dog Democrats and Republicans that gives the appearance of providing a health insurance market that crosses state lines. When these "reforms" were instituted for banks and financial institutions it resulted in the creation of a few mega-banks and helped set the stage for the current financial crisis. While the exchange might provide some short-term relief in states where there is virtually no competition among health insurers, there is nothing in it that, in the long term, prevents further insurance company consolidation and nothing to constrain the health insurance oligopoly that in fact easily traverses state lines at present.
Progressives have to fight for a reform bill that actually improves the situation. A bill that requires people to buy health insurance, does little or nothing to restrain premium increases, and places increased burdens on small business and consumers forced to make choices about complicated plans that they cannot understand will soon be seen as oppressive and will help the Republicans in 2010 and 2012. The requirement that everyone buy health insurance should be revisited. As it stands, this requirement could actually create a grain of truth to the Republican narrative of "Obama as oppressor." At the very minimum, progressives must agitate for a public option that is available to anyone. Others who are better versed in the various proposals floating through Congress can no doubt point out other "must haves" and "must not haves" for which progressives should agitate.
The importance of this speech lies in the widespread perception that it was a "good" speech even though it offered little in the way of new content or direction. Blue Dog Democrat Ben Nelson, who has opposed the public option, called it a "game changer." Polls showed a gain of 14 points in public support for health care reform after his speech. Many pundits and commentators, even including some who are considered progressive, were highly impressed. While those of us who looked at the content with eyes open were not particularly pleased, we should realize that a public shift away from the Republican narrative and in favor of health insurance reform may help make it possible to advance the cause of meaningful health insurance reform.
To use a different sports metaphor, the opinion that Obama hit a home run with this speech is widespread. I submit that he just reached base. The rest of us will have to work to get him and real health insurance reform home. While Obama deserves credit for bringing the issue front and center, he has left it up to the Congress and the public to push it through. I submit that so long as he doesn't get the most efficient, economical, tried-and-true, and user-friendly plan, namely single-payer,he will not be the last president to deal with this issue, as he said he wanted to be in his speech. It will be up to progressives such as Dennis Kucinich, Progressive Democrats of America, Democracy for America, organized labor, and the many other progressive organizations that have been campaigning tirelessly for this to make real health care reform that really works for ordinary people and health care providers happen.