How big was the big speech?

The cable TV channels fired their screeching engines hours in advance. A “Health Care Make or Break Moment” screamed a CNN headline. Countdown clocks at Fox and MSNBC ticked inexorably toward 00:00, the moment when President Obama would face down a joint session of Congress.

This had to be really, really big, I learned all day Wednesday from the excitable people on cable TV -- a speech that likely would determine the fate of healthcare reform and, perhaps, the Obama presidency.

Unless it didn’t. Unless it merely rejoined the debate over an intensely complicated set of proposals and set the stage for months of politicking, with the outcome far from certain. In which case the noise makers who must fill 24 hours of cable news time would be back Thursday doing what they do best -- following what’s on fire, on video or on the way to next week’s tabloids.

So less than 24 hours after their Day That Will Live in History proclamations, the cable television giants focused a good hunk of their coverage on Joe Wilson, the South Carolina congressman who shouted, “You lie!” in the midst of Obama’s address.

Since even Hollerin’ Joe couldn’t fill their whole dance card, Fox also found time for sex-scandalized South Carolina Gov. Mark Sanford and a camel that predicts NFL winners. CNN interviewed celebrity blogger Perez Hilton about the newest “American Idol” judge, Ellen DeGeneres. And MSNBC joined the others in serial parsing of the video showing California Assemblyman Michael Duvall boasting about the naughty spankings he gave one woman as he looked after the people’s business.

What’s a TV producer to do, when those killjoys on Capitol Hill insist on following Obama’s speech with endless closed-door meetings, insisting (sheesh!) this could take months, with the results only likely to emerge from a House-Senate conference?

Hadn’t they heard that this speech had been declared a watershed, a game changer?

Newspapers were, by and large, the repository of the dreary details about the prolonged length and scope of the negotiations.

Wondering just why better and broader national healthcare has eluded us for so many years, I stumbled away from the glowing screen and phoned someone who’s gotten the job done himself.

My friend Howard Kahn is CEO of the L.A. Care Health Plan, which bills itself as “the largest public health plan in America.”

Kahn’s nonprofit HMO has nearly 800,000 enrollees -- supported by Medi-Cal and other public programs -- and supports the kind of care for the poor that is in short supply across much of America.

“I think a lot of this debate really gets to a conflict we have had since the founding of the country, over the idea of liberty versus the idea of community,” said Kahn.

“It’s a core disagreement around our social contract,” he said. “We’ve never resolved it in our minds the way they have come to a resolution in Europe. That’s the debate we are actually having right now.”

Agreed. But what’s been complicating the debate is the public’s sense, fueled by simplistic media coverage, that the only alternatives are the private insurance status quo or a future of government medicine, with bureaucrats hovering over every doctor’s examination table.

Kahn might disappoint some of the bleeding hearts who support a single monolithic, national “public option” to compete with private insurers. In an essay for the Huffington Post he advocated that states offer incentives to create regional plans that are either public, not-for-profits or cooperatives.

L.A. Care has managed to coexist in Southern California without threatening private insurers, and Kahn is respected enough among his peers, including private health insurance providers, that he chairs the state association of health plans.

He believes that public programs structured like his could be required, in the reform legislation, to plow their “profits” back into the “safety net” of hospitals and clinics that serve the public. L.A. Care has installed new medical record systems at public clinics and helped redesign the outpatient facility at UCLA-Harbor Medical Center.

Kahn suggests that a public option can be realized in this “third way” that is neither the wholesale government takeover conservative commentators keep warning about nor the continuation of private insurance near-monopolies that liberals so disdain.

Consumer cooperatives in Minnesota and Washington state have shown that private insurance need not be the only means of delivering healthcare.

Though such a concept has been proposed by some key Senate Republicans, among others, the idea gets little attention in much of the media.

Just as they like to obsess on big events (the “deadline” of the August legislative recess, the do-or-die Obama address to Congress) and the noisiest voices in the rooms (see August’s town hall meetings), so talk radio and cable television fixate on a single government insurance plan as the irreplaceable core of the healthcare debate.

Obama’s unwillingness to reveal his bottom line (in order to maintain maximum flexibility in negotiations) has freed the opposition -- both on Capitol Hill and in the media -- to pick apart this fuzzy notion of “government healthcare.”

That’s not to say that the plans on the table don’t raise serious questions. When the president suggests that ridding healthcare of waste and inefficiency will, by itself, save enough money to insure millions more Americans without any new taxes, that strains credulity.

The consolidation of records online and elimination of duplicate care promise to save billions of dollars over time, to be sure. But the full savings would take years to realize, and the exact dollar value remains impossible to measure.

Even loyal liberal foot soldier Barney Frank conceded to CNN’s Larry King after Wednesday’s speech that he was “not convinced that we will find all of the savings that we want.”

The Massachusetts congressman suggested that the Medicare Advantage plan (which offers premium services, sometimes including services such as transportation to medical appointments) might be one area to cut. He also conceded that the government might have to look elsewhere in the federal budget -- as Obama suggested -- to find additional savings to expand healthcare.

The ground rules for those kinds of discussions and the true cost of health reform won’t be easy to agree on. Something close to a solution will come, if at all, after painstaking weeks of negotiation.

Don’t expect a cable TV crawl or a countdown clock to tell you when it’s coming, if it’s coming at all.

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james.rainey@latimes.com

Follow Rainey on Twitter at latimesrainey.