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A checklist for the President’s health care speech

Here is a checklist I will use this evening as I watch President Obama’s Address to a Joint Session of Congress (8 PM EDT). I hope you find it helpful.

  • Deadline – Does the President set any hard process deadlines? Listen for “by Thanksgiving,” “before going home,” or “before the end of this year.” Any hard process or timing statements are critical to the outcome. Soft deadlines are important but, we have learned, non-binding.
  • “Must” and its variants – There is a huge gulf between “must” and “should.” Congress will treat the first as a hard requirement and the second as friendly advice to be ignored as needed to get the votes. The brightest line is drawn by the words “I will veto.” Second is “must.” Third is “I will not sign.” In contrast, the word “should” indicates a policy preference that, if pressed, can be abandoned if that’s the only way to get a bill to the President’s desk.
  • Any new numbers – I will be surprised if the President sets any new quantitative requirements on legislation. If he does, they are important.
  • Public option language – This will be the most carefully scrutinized language in the speech. It’s not the most important. I assume he will say positive things about the substance of a public option, throwing a bone to House liberals who will likely vote before the Senate. The President and his advisors have repeatedly explained that they will chuck this policy overboard as needed to get a bill, and I see little upside to the President being explicit about that tonight. It is easiest if he talks about the policy rather than its place (or lack thereof) in legislation. He may use silent ambiguity about process to have it both ways for now. He will abandon it later after the House has voted, if that’s what is needed for a bill to pass the Senate.
  • Does he think the problem is substance or communications? – If he talks about “clarifying” and “explaining” policies or “clearing up confusion,” then he is still stuck on the premise that he is losing the public debate in spite of the policy substance, rather than because of it. I believe good policy is good politics, and bad policy is bad politics.
  • How does he characterize the opposition? – The President has characterized those who oppose this legislation as malevolent self-interested defenders of the status quo without their own reform ideas. Does he frame it this way tonight, or does he instead acknowledge that there are legitimate points of view different from his own? Sticking with demonization helps motivate his liberal base and will be the clearest signal that he has chosen a partisan tactical path. It also risks looking petty and un-Presidential.
  • What did he learn from the August town halls? – Does the President acknowledge the negative feedback, or does he instead say “we had a vigorous debate in August?” Does he characterize this feedback as pushing policy in one direction, or instead as diffuse hubbub? Did the President learn anything in August about what Americans want, and is he adapting the substance of what he wants to reflect that? This matters substantively and politically. If he says “I learned from you the people,” I think he will get a positive reaction. If he says “You were misinformed,” I think many people will be insulted and angered.
  • Does he explicitly reject bills developed in July to give nervous Democrats cover? – I imagine there are many Congressional Democrats who would like to tell their constituents, “We are doing something new this fall based on what we heard in August. This new bill is different from the one you hated last month.” The substantive changes made from July to September may be less important than the public framing – does the President signal that legislation now will be different than it was two months ago (as a result of learning from citizen feedback)? Doing so may relieve moderate Democrats but upset the bill’s authors and Congressional Democratic leaders, who would interpret it correctly as an admission of failure.
  • Medical liability / malpractice / tort reform – POLITICO is reporting the President “plans to acknowledge a problem with malpractice litigation.” If this is accurate, does he call for it to be addressed in this legislation? This is one of the few policy changes that could fundamentally change the legislative dynamic and attract Republican interest.
  • “Bend the curve” – I assume he will continue to talk about health cost growth as the underlying problem to be solved (excellent), and about the need to “bend the curve” down in the long run (also excellent). I assume he will continue to avoid proposing policies that would actually achieve this goal, and I will guess this entire topic plays a less prominent role in his speech than it did a few months ago. If he fails to mention it, that’s news.
  • What is the priority: helping the insured or insuring the uninsured? – I assume he will say both are goals. Does he signal a stronger preference for one? Pollsters say the first is more important, while the farther-left Washington health policy establishment prioritizes the latter.
  • “Universal” what? – The President has carefully linked the word “universal” to “health care” rather than to “health insurance” or “coverage.” “Universal health care” is an easier goal to accomplish than “universal coverage,” because those without pre-paid health insurance can use clinics and emergency care. If he uses words like “universal” or “every American” and links them to health care, it’s no change. If he links these words to “coverage” then he’s tacking further left. If he instead says “millions” or “more” and leaves out “universal” and “every,” then he is laying the groundwork to accept a radically scaled-back bill.
  • Tax increases – Does he explicitly signal support for any particular tax increases? Obvious candidates include the Kerry proposal to tax health insurers for high-cost health plans, the House Democrat proposal to tax high-income people, and the new Baucus proposals to tax other medical provider sectors. If the President reiterates his proposal to raise tax rates on high-income people who itemize deductions, then pack it in. Congressional Democrats (& Republicans) killed that idea six months ago.
  • Lines designed to highlight the partisan split. – Will he use specific lines designed to embarrass Republicans into standing? There will be a significant visual impact of a House Chamber clearly divided along party lines, as Congressional Democrats will stand frequently for applause lines while the Republicans remain seated. The President and his speechwriters know this, and they may try to use it to their advantage. The Machiavellian move would be to invoke Senator Kennedy’s death and link it inextricably to the need to enact the President’s desired reform this year. If Republicans stand, they look like they are supporting Kennedy-care. If they remain seated, they look like they are disrespecting the fallen Senator. If this happens, Republicans should stand. Honor the man, and disagree with his policy another day.
  • Falsely claiming that opponents have no alternative. – The President did this at Monday’s AFL-CIO Labor Day Picnic. This is false. He should not repeat it.
  • Straw men vs. valid substantive critiques – The President has used “death panels” and illegal immigrants claims as straw men to mischaracterize all substantive criticism as inaccurate. I think this tactic has backfired, but he may use it again tonight. Will he also respond to more valid substantive critiques? I doubt it.
    • CBO says no pending bill would be deficit-neutral in the short run.
    • CBO says all pending bills would increase the long-run budget deficit.
    • CBO says about three million Americans would lose the employer-sponsored health insurance they have now under the House bill.
    • CBO says about eight million uninsured Americans would remain uninsured and pay higher taxes under the House bill, violating the President’s pledge not to raise taxes on anyone making <$250K per year.
    • An independent study says health care reform done wrong (as it is in these bills) would result in lower future wages for most American workers.
  • What does his speech signal about his strategic legislative choices? My primary objective tonight will be to update my legislative scenarios based on what I hear. My pre-speech projections are unchanged from last Thursday:
    1. Cut a bipartisan deal on a comprehensive bill with 3 Senate Republicans, leading to a law this year; (5% chance)
    2. Pass a partisan comprehensive bill through the regular Senate process with 59 Senate Democrats + one Republican, leading to a law this year; (25% chance)
    3. Pass a partisan comprehensive bill through the reconciliation process with 50 of 59 Senate Democrats, leading to a law this year; (25% chance)
    4. Fall back to a much more limited bill that becomes law this year; (40% chance)
    5. No bill becomes law this year. (5% chance)

I will post tonight after the speech.

(photo credit: official White House flickr photostream)

By | 2017-05-23T19:06:35+00:00 Wednesday, 9 September 2009|