Deconstructing a lengthy presidential reply
At the risk of making you nod off, let us revisit President Obama's eight (?!)-minute response to the first question that was asked last night at his less than scintillating news conference on health care.
Q: "Congress, as you alluded to, is trying to figure out how to pay for all of this reform. Have you told House and Senate leaders which of their ideas are acceptable to you? If so, are you willing to share that stand of yours with the American people? And if you haven't given that kind of direction to congressional leaders, are you willing to - are you willing to explain why you're not stepping in to get a deal done, since you're the one setting a deadline?"
(Bear with me. Obama's answer will take awhile.)
Obama: "Well, before we talk about how to pay for it, let's talk about what exactly needs to be done. And the reason I want to emphasize this is because there's been a lot of misinformation out there. Right now, premiums for families that have health insurance have doubled over the last 10 years. They've gone up three times faster than wages. So what we know is that, if the current trends continue, more and more families are going to lose health care, more and more families are going to be in a position where they keep their health care but it takes a bigger biting out of their budget. Employers are going to put more and more costs on employees or they're just going to stop providing health care altogether.
"We also know that health care inflation on the curve that it's on, we're guaranteed to see Medicare and Medicaid basically break the federal budget. And we know that we're spending - on average we, here in the United States, are spending about $6,000 more than other advanced countries where they're just as healthy. And I've said this before, if you found out that your neighbor had gotten the same car for $6,000 less, you'd want to figure out how to get that deal. And that's what reform is all about. How can we make sure that we are getting the best bang for our health care dollar.
"Now, what we did very early on was say two-thirds of the costs of health care reform, which includes providing coverage for people who don't have it, making it more affordable for folks who do, and making sure that we're, over the long term, creating the kinds of systems where prevention and wellness and information technologies make the system more efficient. That the entire cost of that has to be paid for and it has got to be deficit-neutral. And we identified two-thirds of those costs to be paid for by tax dollars that are already being spent right now..."
(Let's take a breather. I'll just note that Obama hasn't yet begun to address the question.)
Obama continues: "...So taxpayers are already putting this money into the kitty. The problem is, they're not getting a good deal for the money they're spending. That takes care of about two-thirds of the cost. The remaining one-third is about what the argument has been about of late. What I've said is that there may be a number of different ways to raise money. I put forward what I thought was the best proposal, which was to limit the deductions, the itemized deductions, for the wealthiest Americans. People like myself could take the same percentage deduction that middle class families do. And that would raise sufficient funds for that final one-third.
"Now so far we haven't seen any of the bills adopt that. There are other ideas that are out there. I continue to think my idea is the best one. But I'm not foreclosing some of these other ideas as the committees are working them through. The one commitment that I've been clear about is I don't want that final one-third of the cost of health care to be completely shouldered on the backs of middle class families who are already struggling in a difficult economy. And so, if I see a proposal that is primarily funded through taxing middle class families, I'm going to be opposed to that because I think there are better ideas to do it..."
(OK, that's a little something. Obama wants to broadly ensure that middle-class taxpayers won't be forced to bear the costs of reform. But rather than get too specific - and a lot of people would like him to lead by getting more specific - he cast himself as a spectator who is still awaiting the committee bills, without "foreclosing" whatever other ideas the committees might come up with.)
Obama continues: "...Now there are - you know, I have not yet seen what the Senate Finance Committee is producing. They've got a number of ideas. But we haven't seen a final draft. The House suggested a surcharge on wealthy Americans. And my understanding, although I haven't seen the final versions, is that there has been talk about making that basically only apply to families whose joint income is $1 million. To me, that meets my principle that it's not being shouldered by families who are already having a tough time..."
(Ah, a smidgen of news - or so it is being ballyhooed this morning. News stories are trumpeting Obama's "support" for a House Democratic proposal to make the rich shoulder the costs of health care reform. But wait, let's continue.)
Obama continues: "But what I want do is to see what emerges from these committees, continuing to work to find more savings, because I actually think that it's possible for us to fund even more of this process through identifying waste in the system. Try to narrow as much as possible the new revenue that's needed on the front end. And then see how we can piece this thing together in a way that's acceptable to both Democrats and I hope some Republicans."
(See the wiggle room? He actually didn't commit to the taxing-the-rich idea, or to any other. He wants to wait and "see what emerges," and then he shifted to the topic of eradicating waste in the health care system.)
Obama continues: "...Absolutely, it's my job. I'm the president. And I think this has to get done. You know, just a broader point..."
(Uh oh. Whenever Obama prefaces something with "just a broader point" - as he did frequently during the early presidential primary debates, back when his aides would warn him about the pitfalls of giving long answers - you know that he's going off at length in a new direction. And getting farther and farther away from actually answering the original question that was posed. For a refresher, scroll back to the question.)
Obama continues: "If somebody told you that there is a plan out there that is guaranteed to double your health care costs over the next 10 years, that's guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that. Well, that's status quo. That's what we have right now. So if we don't change, we can't expect a different result. And that's why I think this is so important, not only for those families out there who are struggling, and who need some protection from abuses in the insurance industry, or need some protection from skyrocketing costs, but it's also important for our economy.
"And, by the way, it's important for a family's wages and incomes. One of the things that doesn't get talked about is the fact that, when premiums are going up and the cost to employers are going up, that's money that could be going into people's wages and incomes. And over the last decade, we basically saw middle-class families, their income and wages flat-lined. Part of the reason is because health care costs are gobbling that up. And that's why I say, if we can -- even if we don't reduce our health care costs by the $6,000 that we're paying more than any other country on Earth, if we just reduced it by $2,000 or $3,000, that would mean money in people's pockets, and that's possible to do.
"But we're going to have to make some changes. We've got to change how health care is delivered to -- the health care delivery system works so that doctors are being paid for the quality of care, not the quantity of care. We've got to make information technology more effective. We've got to have the medical system work in teams so that people don't go through five different tests. Those are all critical to do, and we can do them.
"Now, I understand that people are feeling uncertain about this. They feel anxious, partly because we've just become so cynical about what government can accomplish that people's attitudes are, you know, even though I don't like this devil, at least I know it, and I like that more than the devil I don't know. So folks are skeptical. And that is entirely legitimate because they haven't seen a lot of laws coming out of Washington lately that helped them. But my hope is -- and I'm confident that, when people look at the cost of doing nothing, they're going to say, "We can make this happen." We've made big changes before that end up resulting in a better life for the American people.
(Still with me? That concluded his answer to the first question.)
That first answer epitomized what was good and bad about the entire news coference. Obama as always is verbally deft about defining the grand stakes of a critical problem, and explaining them in relatively simple language. He did it again last night, at this crucial moment in the health care debate on Capitol Hill. But I doubt that he managed to sway skeptical lawmakers or wary citizens. Most people, by this point, have already heard him speak at length about the health care stakes, and about the dysfunction of the status quo. Saying it all again isn't likely to move the needle his way.
That first question was an attempt to prod Obama into offering up some specificity. Beyond the broad goals that he has established - he wants to promote health care choice, extend coverage to roughly 97 percent of Americans, and he wants it done without adding to the deficit - what are his specific proposals for achieving those goals? He still wouldn't say. It's tough to rally the public aroubnd health care reform by merely saying that he awaits to see what ideas the committees come up with.
Granted, he's in the midst of complex negotiations with Capitol Hill, and doesn't want to show his hand. But if that's the case, why conduct another news conference and plow old ground at great length? Health care is a tough issue to sell in a talking-head format anyway, so he might have been better off going in a totally different direction; for instance, instead of repeatedly referring to the letters he has received from citizens aggrieved about their health care, perhaps he could have read directly from those letters, or arranged to have some of those citizens share the podium - anything to put more of a human face on the issue.
Indeed, the sole moment of human spontaneity came at the end of the news conference. Obama said that the Cambridge, Mass. police had "acted stupidly" earlier this week when they arrested a famous black scholar who was trying to gain entrance to his own home. That prompted a tart presidential discourse on racial profiling. He seemed to welcome the opportunity to take on an entirely new topic, to leave behind, however briefly, his cautious rhetorical calibrations. Given the way he seemed physically stirred by the plight of Henry Louis Gates, it's clear that the signature reform issue of his young presidency has become hazardous to his political health.