From Our 2009 Archives

Obama's Health Plan: The Debate Goes On

Experts React to the President's Speech on Health Reform

By Andy Miller
WebMD Health News

Reviewed By Louise Chang, MD

Sept. 10, 2009 -- Declaring that "the time for bickering is over," a passionate President Barack Obama took a forceful stand for health care reform Wednesday night, explaining his objectives for change while denouncing distortions made by opponents.

But was his speech a "game changer"? Did it wipe out a month of slipping polls and town hall criticism of reform?

A single speech can't change the debate by itself, says Julius Hobson, a health policy adviser for the law firm Bryan Cave. "We're in a marathon that will run till Christmas."

"I think he succeeded in delivering the message," Hobson says. "Did he succeed in changing the minds of the American people? Time will tell."

It had been a rough August for supporters of the Democrats' initiatives. An AP-GfK survey released before the speech showed that public disapproval of Obama's handling of health care had jumped to 52%, an increase of 9 percentage points since July.

Clearly addressing the public as much as Congress, Obama touched on several areas of agreement on health reform, both past and present. "I am not the first president to take up this cause, but I am determined to be the last," he said.

He drew strong applause from the joint session of Congress when attacking insurance company discrimination against people with pre-existing medical conditions, citing a woman with breast cancer having her policy canceled because, he said, "she forgot to declare a case of acne."

"That is heartbreaking, it is wrong, and no one should be treated that way in the United States of America," Obama said.

Ending such insurance practices has gained broad political support, says E. Richard Brown, director of the UCLA Center for Health Policy Research.

The Public Option

On perhaps the most divisive issue of reform, though, Obama again backed a proposal for a "public option," run like Medicare, to compete with private insurance companies in a health insurance exchange or marketplace. Republicans say the public option would eventually lead to the demise of private insurance.

But Obama also said he was receptive to other ideas to foster competition, such as a nonprofit co-op run by consumers. That openness to alternatives "will disappoint many progressives," says Brown, a supporter of the public option.

Greg D'Angelo of the Heritage Foundation, which opposes a government-run public option, says if Obama had scrapped it, "people on the left would have revolted."

The speech basically "repackaged" what Obama has already said on reform, D'Angelo says.

Still, the president reached out at times to Republicans, citing Sen. John McCain's idea to provide immediate insurance reform for helping people with pre-existing conditions.

He also said he would back changes of the medical malpractice insurance market, a topic that drove many Republicans to their feet in applause. Obama said he would pursue pilot projects on malpractice reform proposed by the Bush administration.

But D'Angelo says if the president truly wanted to be bipartisan, he would start over on a new health reform bill. "He didn't find the middle ground."

Obama was perhaps at his most forceful when he singled out rumors that health reform would lead to government encouraging euthanasia -- "that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."

That rebuke was "probably something he needed to say," Hobson says.

Obama also denied that reform would give insurance to illegal immigrants -- a statement that was greeted by a shout of "you lie" from Rep. Joe Wilson, R-S.C.

The president later said he would continue to seek common ground. "If you come to me with a serious set of proposals, I will be there to listen. My door is always open."

But not to people who misrepresent his plan, he added.

It's encouraging that Obama is open to any ideas, D'Angelo says, but he notes that Republicans already had introduced alternative bills. "I don't think he made any progress. I don't think he'll get bipartisan support."

Though reform will achieve savings in Medicare, Obama also said he would protect the program for people 65 and older and the disabled. The aim was to shore up support from a wavering audience, seniors, who have shown increasing worry over health reform. A recent Kaiser Family Foundation poll found seniors are more likely to see Medicare as worse off than better off under health care reform (37% to 20%).

Rising Health Care Costs

The speech acknowledged the enormous problem of rising health care costs. "We will eventually be spending more on Medicare and Medicaid than every other government program combined," Obama said. "Put simply, our health care problem is our deficit problem. Nothing else even comes close."

But the address didn't lay out many details on how it would restrain those costs, which have risen much faster than inflation.

There wasn't much, if anything, surprising in Obama's speech, experts say. Even the malpractice proposal he's hinted at before, Brown says.

"What was new was his very passionate commitment to getting it done," Brown says. "What he cannot do is back off and let others lead this debate. The test will come in the days ahead."

This is still the beginning of the debate on health reform, adds D'Angelo.

If you have questions or comments about speech or health care reform in general, please visit the WebMD Health Reform board.

SOURCES: Julius Hobson, senior policy adviser, Bryan Cave LLP. E. Richard Brown, director, UCLA Center for Health Policy Research. Greg D''''''''''''''''Angelo, policy analyst, Center for Health Policy Studies, Heritage Foundation. Kaiser Health News, transcript before President Obama''''''''''''''''s speech. Kaiser Family Foundation: "Kaiser Health Tracking Poll," August 2009. Associated Press. AP-GfK survey.

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