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State-of-the-Healthcare Speech: Final Thoughts

Reactions from Tom and I:

Nate Silver: As Marc Ambinder outlined this afternoon, this was a difficult speech because it was going for a bit of a two-fer. On the one hand, Obama needed to appeal to liberals — both the 60 or so members of the House who have threatened to vote against a watered-down bill, and the much broader, activist community who has grown wary of what they perceive as a Clintonian president who is too willing to compromise. On the other hand, he needed to appeal to independent voters and their brethren, among whom Obama’s approval ratings and sentiment toward his health care package have fallen significantly. He could afford to skip over the broad mainstream of the Democratic Party, who are going to be happy with more or less anything the that he does on health care, and the quarter or so of country who disapproved of Obama from Day One and won’t care for what he has to say no matter what.

I think Obama accomplished both of those things — with some margin to spare. On the one hand, there was no absence of red meat for the liberals. Lies were called out as lies. The Republicans, who seemed to lack an understanding of the theatrics in the room, were at several points made to look petty and stupid. And Obama made the moral case for health care reform, something many liberals — including yours truly — have been urging him to do for a long time.

On the other hand, there was a lot of the “bipartisan” pivoting of the sort that made Obama very popular during his 2004 DNC convention speech. He made himself look like the reasonable party in the room. He got a smile out of John McCain, and a golf clap out of John Boehner. At the end of the day, he probably acknowledged the sacrifice of the “robust” public option (although a version with a trigger remains possible, and perhaps even likely). But he got some mileage out of it: using it as the left goalpost by which he’d confidently kick the field goal through.

I called the speech a triple, because I think it was about 10 minutes too long. Andrew Sullivan’s readers call it a home run. FOX News, I’m sure, will call it a long fly-out to the warning track. The bottom line: it was a well-delivered speech, and a very, very smart speech. It will remind people of what they liked about Obama. It won’t do miracles. But it will increase, perhaps substantially, the odds of meaningful health care reform passing.

Tom Schaller: This was classic Obama, both from a policy conceit and rhetorical framing. Anyone who read The Audacity of Hope knows how Obama works through issues—he sets up how one side conceives it and how the other side does and then, after admitting he is inclined toward progressive/Democratic side of the ledger, he humbly suggests the best solution is probably somewhere in between.

Obama did that again tonight with his juxtaposition of liberals’ desire for single-payer and conservatives’ desire for ending employer-based insurance and a fully privatized market. He was also clear about setting out the three overall goals of reform: lowering growth rate of total cost, adding stability to those who have insurance, and extending coverage to those without. And then he proceeded to argue for those goals and demonstrate a desire for split-the-difference pragmatism: On the one hand standing behind a public option but not laying down an absolute ultimatum; and on the other saying that, while tort reform is not a silver bullet, he’s willing to negotiate to help alleviate the costs associated with defensive medicine practices.

As for raw politics, unsurprisingly the lion’s share of attention was directed at seniors, about whom I’ve written on this site as both the biggest complainers about “socialized” medicine and its largest beneficiaries. The politics of health care have always been about convincing the insured—who by definition are both more powerful and less inclined toward change—and specifically the elderly who are insured, that something needs to be done. This speech was designed to convince the reluctant insured to get behind the White House plan.

I have no doubt the speech can’t hurt this effort. But I wonder just how many of the insured, regardless of age, are persuadable at all—whatever the merits of the plan or the audacity of the speech. Obama’s key line—that the health care problem is our deficit problem—is essentially (if incompletely) true. But the nature of health and health care makes it very difficult to get people to conceiving of health care as a budgetary problem for the federal government, or least conceiving of it primarily and forebodingly that way.

And frankly, the notion that Americans of the current and previous governing generations care about the government’s fiscal solvency is belied by the fact that most cannot remember the government balancing the budget in their adult lifetimes. They have shown a willingness to let the country spend inefficiently and beyond its means for years, on policies (as Obama pointed out) both domestic and foreign. I’d like to believe that rationality and long-term planning governed the thinking of politicians and voters. But there’s too much evidence to the contrary. I know this sounds cynical, and I hope I’m wrong.

That said, Obama is trying to win an argument on its merits, on logic, and statistics and projections. In an ideal world, that sort of pragmatic rationality would be enough. But we don’t live in such a world.

Nate Silver founded and was the editor in chief of FiveThirtyEight.