Published on Wednesday, September 9, 2009 by The Nation

Obama Speaks Loudly But Carries a Small Stick

by John Nichols

President Obama spoke loudly but carried a small stick Wednesday night, when he outlined what's left of his health-care reform agenda in a rare address to a joint session of the Congress.

U.S. President Barack Obama delivers a speech on healthcare before a joint session of Congress in Washington, September 9, 2009. (REUTERS/Jason Reed)

Noting that "it has now been nearly a century since Theodore Roosevelt first called for health care reform," the president told skeptical legislators from both sides of the political aisle. "I am not the first president to take up this cause, but I am determined to be the last."

That was one of several takeaway lines of the night.

The other, delivered to members of the House and Senate who have just returned to Washington after an August of brutal town-hall meetings, was: "The time for bickering has passed. The time for games has passed. Now is the season for action. Now is the time when we must bring the best ideas of both parties together... Now is the time to deliver on health care."

The president was equally muscular when it came to addressing "scary stories" and "bogus claims" about "death panels" and threats to Medicare that have been spun up by insurance-industry front groups in order to thwart meaningful reform. Democrats loved it when Obama told the spin doctors -- in the House and Senate Republican caucuses and their media echo chambers -- that: "If you misrepresent what's in the plan, we will call you out."

But this was not a too-the-barricades address by a president who was prepared to battle not just the lies about his plan but the compromises that would make universal health care the dream deferred.

When it came to the task of offering the explanations, arguments and details that have been so hard to come by during a frustratingly unfocused debate about how to develop a functional health-care system for a country where tens of millions of Americans have no insurance coverage and tens of millions more are under-insured, Obama remained unsettlingly vague.

He restated his determination to prevent insurance companies from denying coverage to Americans with preexisting conditions. He proposed portability and flexibility. He pledged to bar insurance-company caps on the amount of care that is provided the sick. And he decried insurance company abuses that even Republicans seemed to agree -- at least if applause is any measure -- are "heartbreaking" and "wrong."

These consumer-protection initiatives could well form the foundation for the legislation that Obama says he is determined to sign this year, since it certainly did not sound Wednesday night like the president was going to fight for the sort of broad reforms that really would guarantee health-care for all and control costs.

"It makes more sense to build on what works... rather than to build an entirely new system from scratch," Obama said, making all-too-clear his determination to retain the private for-profit system that failed so miserably to deliver health care for all but that has succeeded so monumentally in delivering profits to insurance and pharmaceutical corporation stockholders.

Obama still talked about "options" and "choices," but he suggested that they would be provided mainly by insurance companies that would be given "incentives" -- i.e., streams of taxpayer dollars -- to abide by consumer-protection regulations and come up with strategies for covering the uninsured.

The government might step in to help, Obama suggested, but he painted the initiative as temporary rather than permanent. When he spoke of a "public option," as he had to in order to keep progressive Democrats on board, the president still said: "I have no interest in putting insurance companies out of business."

The "public option" was positioned more as a consumer-protection initiative for "those without insurance," a sort of welfare program that would attract only about five percent of Americans and that would be funded by premiums rather than tax dollars.

Robust? Not hardly.

The president's language, so strong at the start, went soft when he talked about talked about the public option. He even suggested that he was open to alternatives favored by Republicans and some moderate Democrats.

The president kept talking about "the plan" he was presenting. But a lack of clarity or line-in-the-sand commitments when it came to genuine reform of a system he described as "full of waste and abuse" created the most amusing moment of the night.

Obama was not going for laughs when he uttered the line "while there remain some significant details to be ironed out..." But he got them.

What the president was headed toward was a suggestion that he was still searching for some kind of middle-ground that will satisfy "those on the left" and "those on the right" -- even if that means supporting medical-malpractice "reforms" that would make it harder for those who are injured by bad doctors, nurses and hospitals to hold the wrongdoers to account.

What Americans who have waited "nearly a century" for reform were left with was a sense that the "great unfinished business of our society" -- as the late Edward Kennedy described the work of pursuit of universal health care in a last letter to Obama -- might remain unfinished.

© 2009 The Nation