Last night’s not-the-state-of-the-union speech covered a lot of ground, some of it rather superficially. Although health care was one of the President’s three key initiatives, he kept his comments at the proverbial thirty thousand foot level. He did take credit, and deservedly so, for his Administration’s (and Congress’) quick action on a variety of health care issues, stating: “Already, we have done more to advance the cause of health-care reform in the last 30 days than we have in the last decade,” he said. “When it was days old, this Congress passed a law to provide and protect health insurance for 11 million American children whose parents work full-time.”
Although his comments were very general there are three key takeaways.
Most significant is the sense of urgency. President Obama was quite forceful about his commitment to move on health reform quickly. He specifically noted that his 2010 budget will address health care reform, saying “This budget builds on these reforms [SCHIP etc]. It includes a historic commitment to comprehensive health care reform — a down payment on the principle that we must have quality, affordable health care for every American.”
That is the second key takeaway – this will be an incremental process, building towards universal coverage over time, not trying to cover everyone from the outset. This is consistent with Obama’s campaign platform, and also smart politically. If there are no more expansions of coverage this year, then he can point to SCHIP’s expanded coverage, COBRA subsidies, and Medicaid funding support as reforms that are resulting in more coverage and fewer uninsured.
Finally, the President explicitly acknowledged cost as the key barrier. But here he relied once again on the root out waste and inefficiency mantra as the method for reducing cost. That’s true, and comparative effectiveness research is a key weapon in that battle, Congress has already tried to blunt the impact of comparative effectiveness, demonstrating once again how tough this battle to ‘root out waste and inefficiency’ is going to be.
I’m quite sure President Obama understands the political difficulties inherent in reducing cost. And I’m also sure he is going to get what he can, and keep coming back till he gets what he wants.
What does this mean for you?
As I’ve said repeatedly, health care reform will be achieved incrementally, make lots of folks unhappy, and result in multiple bruising battles. And it will be very important for those who advocate sweeping change to reflect back on what has been accomplished. Obama is right – already this year more has been accomplished than in the previous eight.
Feb
25
