What Obama Should Say Tonight

By David Brooks and Gail Collins

Josh Haner/The New York Times President Obama’s first address to a joint session of Congress, on Feb. 24, 2009. Tonight, in his second address, he will press his case for major health care legislation.

Gail Collins: David. So. About President Obama’s health care speech …

In our last conversation, you made so many important policy points that I was inspired to spend part of Labor Day weekend reading serious articles about how to fix the health care system. I made my husband read them too. So if you detect a little coolness next time you see him, don’t take it personally.

One thing is certain. Washington is now swimming with really attractive red herrings — ideas that Obama can’t propose and Congress won’t pass.

Washington is swimming with health care ideas that Obama can’t propose and Congress won’t pass.

We’ve spent months now watching Congress struggling with this issue, and if we’ve learned anything it’s that these people will not pass a bill that takes anything away from their constituents. That’s too bad. Their constituents would be better off if their representatives were willing to take away a little in order to get a big reform.

But here we are, where we are.

The Republican leadership is now saying: “Scrap the whole thing and start over.” This translates into: “Scrap the whole thing.”

David Goldhill, whose article in the Atlantic you’ve been touting, wants to give every American catastrophic insurance and a health safety account to pay for everyday medical expenses. This presumes that consumers can make reasoned decisions on how to use their health care dollars, the way they can when they’re looking for a new blender. But let’s pretend he’s right. That would still require a sweeping, top-to-bottom transformation of the current structure of the health industry.

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If we’re going to go for something that radical, I want to go back to the beloved single-payer option. Which we don’t talk about because it can’t pass.

From what you’ve written, it sounds like you’d like Obama to break loose, stride out to the podium Wednesday night and endorse the bipartisan Wyden-Bennett bill.

Wyden-Bennett is almost as hard to explain as the big health care hairball Congress is currently rolling around. It involves universal coverage, health insurance exchanges and vouchers. It might make the whole system much more rational, tidier, and very possibly cheaper.

And it, too, would be about as hard to pass as the single-payer system we’re not supposed to discuss because it’s impractical.

True, Wyden-Bennett has bipartisan roots. But if Obama actually embraced it, those roots would dry up fast. The right is already attacking it for having too much federal control. The Democrats don’t like the idea of getting rid of Medicaid and employer-based insurance. There’s plenty in it that the talking heads could demonize.

As soon as Wyden-Bennett became possible, it would become impossible.

Obama should ask Congress for the strongest bill he thinks he can get.

You can see this now in the debate over a cap-and-trade bill to control global warming. Republicans like John McCain supported cap-and-trade before. Now they’re running away as fast as their little legs can carry them because A.) the Democrats have added stuff they don’t like and B.) the sucker might actually pass.

I hope Obama asks Congress for the strongest bill he thinks he can get, one that greatly expands medical coverage, protects people from the worst abuses of the insurance industry, and at least sets up some structures that will make it easier to move toward cost control in the future, even if it doesn’t do much right now.

Then, I’d like him to say something like this:

Over the summer, we’ve seen how difficult it’s become for Americans to talk sensibly about big, serious subjects like health care. There are some people in our news media, and some people sitting in this very chamber, who have lost interest in doing anything except whipping the public into hysteria and going in for the kill. Shame on them.

So far, my biggest failure as a president is that I haven’t brought the country the kind of civil politics I promised. So while I’m going to be working very hard with Congress to give you health care reform this year, I also am going to start preparing the ground for the much harder work on this subject in the future. Getting there will require us to talk to each other like adults.

To set an example, I’m going to tell my own party to stop running brain-dead scare ads like the one we’ve got up now in several states saying the Republicans want to end Medicare.

After that, every time a politician or a TV commentator says something that’s both incorrect and insanely divisive, I’m going to hold a five-minute press conference and denounce it. I’m going to be like a stern parent, making the kids put a quarter in a jar every time they say a swear word.

The American people are confused about health care, but they’re very clear about the kind of political discourse they want to see. And it doesn’t look like anything they saw this summer. We’re going to do better, beginning now.

David Brooks: Gail, far be it from me to offer anyone marital advice, but forcing one’s spouse to read serious articles on health care reform strikes me as a very risky move. My own spouse has managed to preserve her self-respect by ignoring the Op-Ed Page on Tuesdays and Fridays and telling her friends that I sell refrigerator warranties.

Whether it’s a single-payer system or a consumer-driven one, both options are better than the status quo.

Starting with your Obama speech, it would be great if he gave it but I’m not sure anybody would believe it. In this case, actions have to precede words. During the 2008 campaign, John McCain proposed a very serious health care reform plan with a risky central plank — cutting the employer tax exemption on health care benefits. Obama proceeded to demagogue the hell out of that, despite the fact that many of his major advisers were on record supporting the idea.

It’s hard to behave opportunistically when it suits you and then once in office call for an all-clear.

On the broader legislative landscape, I’ve become similarly disenchanted with the health debate. The impression one gets is that the country will never accept any benefit cuts. I don’t know if that’s true, but the politicians are acting as if it is. If they are right we are on a one-way ride to Spengler-land because great nations decline when they get buried under their own debt.

That said, I think there are some things that are practical that we can do today. In a recent column I mentioned a Brookings report called “Bending the Curve.” That report took a lot of ideas that are floating around in miniature in the current bills and it implemented them. That proposal would get us a big step toward real cost restraint. I am told, by the way, that the president has read that report and he will be pushing harder on many of the ideas. The crucial test there is whether he is willing to cap the tax exemption on benefits.

Over the long term, I’ve become more and more convinced that we have to make a choice. We either have to go down the road to single payer, as you’d like, or we have to go down the road to a consumer-driven system, as I’d prefer. I like the latter because I think the health care economy is simply too dynamic and complicated to be regulated and driven from the center. Nonetheless, I’ve lived in Europe and I don’t regard single-payer as a civilization-ending disaster.

Both of these options are better than the status quo. And I’m afraid the status quo (in obese form) is where we are headed.
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