Public Option: Obama Speaks Loudly But Carries a Small Stick

The "public option" was positioned as something akin to a consumer-protection initiative. Robust? Not hardly.

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.

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.

Another, 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 for all of its rhetorical flourishes, this was not a to-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 disturbingly 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 corporate 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 provide quality care to all while 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 has failed so miserably to deliver universal care 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 offered mainly by insurance companies that would be enjoy "incentives" -- i.e., new streams of taxpayer dollars--if they agree to abide by consumer-friendly regulations and come up with strategies for covering more of the uninsured.

The government might step in to help, Obama suggested, but he painted such interventions 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 as something akin to 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.


John Nichols writes about politics for The Nation magazine as its Washington correspondent.