Dollars and sense

President Obama took care of the easy tasks Wednesday in his much-anticipated speech to Congress on healthcare reform. He laid out the main provisions he’s looking for in a comprehensive bill, and provided a clear and powerful rationale for fundamental change. But the steps he endorsed -- including new regulations on insurers and help for the uninsured to obtain coverage -- already have broad support from industry lobbyists and lawmakers. The hard part, in terms of both policy and politics, is finding a way to pay for the expansion in coverage. And on that most contentious issue, unfortunately, Obama argued that Congress could cover most of the cost by attacking waste, fraud and abuse in Medicare and Medicaid -- a pain-free path that’s as unrealistic as it is alluring.

Advocates of a healthcare overhaul, including this page, had been urging Obama to provide more details about the measures he would support and why they were necessary. The president delivered Wednesday night in stirring terms, outlining a plan to give the insured a more secure hold on their coverage and the uninsured access to more affordable policies. The plan would require the vast majority of Americans to obtain coverage, while mandating that large employers provide insurance benefits or contribute to the cost of their employees’ individual policies.

As Obama noted, though, healthcare reform wasn’t about to be derailed by those proposals. The challenge for those who want a comprehensive bill is more in the politics -- in particular, the allegation that “Obama-care” is a government takeover of the healthcare system, burdening taxpayers with a ruinously expensive new obligation. The president offered a persuasive response to part of that critique, making the case that the flaws in the current system threaten all Americans. He soft-pedaled the controversial“public option” plan, and portrayed his plan as a melding of Republican and Democratic ideas with the same moral underpinning as Social Security and Medicare. Those initiatives were also branded “socialism” or a “government takeover,” Obama noted, subtly warning opponents that they risk being on the wrong side of history.

Still, the president’s comments about the savings available in Medicare were disingenuous, as was his assertion that a new tax on insurers would lead them to “provide greater value for the money” instead of simply passing the cost on to policyholders. Obama will have to come up with a more complete approach to paying for reform as the legislation moves forward. He claimed the plan as his own with this speech, but he left some of the hardest questions unanswered.