Obama's latest attempt to reshape the health care debate.

Who's winning, who's losing, and why.
Sept. 8 2009 7:17 PM

Situation Almost Critical

Obama's latest attempt to reshape the health care debate.

President Obama. Click image to expand.
President Obama

In his back-to-school remarks Tuesday, President Obama told America's schoolchildren to pay attention. By Wednesday, when he speaks to a joint session of Congress about health care reform, he hopes the message will have trickled up to their parents. Cutting through the fog surrounding the issue may be the president's biggest challenge of the evening. In a Pew poll taken in early September, 67 percent of Americans say the health care debate remains hard to understand. That's about the same as the 63 percent that said the issue was hard to understand in mid-July.

John Dickerson John Dickerson

John Dickerson is Slate's chief political correspondent and author of On Her Trail. Read his series on the presidency and on risk.

Despite August's carnival (and sometimes gothic) atmosphere, the president has not lost the public. It increasingly disapproves of his handling of the health care issue, but in general it still supports reform. According to a recent CBS poll, more than 70 percent say the system needs a major change.

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As Obama put the final touches on his speech, the president appears to have already achieved one goal. He's spurred the Senate finance committee to quicken its pace. Chairman Max Baucus provided an 18-page framework to the other members of the "Gang of Six" trying to find a bipartisan basis for agreement. Last week, a senior administration official said of the committee's long process of coming to consensus, "If there's a thing in this process that deserves to be called a death panel the [Senate] Finance Committee is it." But this new development has caused a slight reappraisal. Maybe the committee's work might be useful in forging a compromise after all.

The president's aides say he will get specific Wednesday about the areas of common agreement—from insurance reform and regulation to measures for controlling health care's skyrocketing costs. The argument will be simple: We're so close on so much of this, and the public wants it. We can't turn back now.

The more specific the president gets, the better he'll be able to clear up public confusion. The White House hopes that once people hear the facts, they'll start believing that the big changes they say they want won't harm their individual health care. Clarity also helps supporters in search of political cover. If Obama backs it, it's safer for them to back it. When health care reform is associated with Congress, the public has a less-favorable view. Fifty-five percent of Americans say they have either a great deal or fair amount of confidence in the president when it comes to dealing with health reform, about 10 percentage points more than those who say they trust Congress on it, according to a recent Pew poll.

The president has actually been pretty specific, as he argued in a July interview with Karen Tumulty of Time. It's very possible it won't seem like there's much new in his remarks. But even if he repeats himself, he will be repeating himself in a highly charged moment at which people are paying more attention. According to a recent Pew poll, 56 percent of Americans say they plan to watch the speech.

We saw an example of how the old can seem new on Monday when the president spoke to the AFL-CIO. He used his campaign voice, and the speech was heralded for its emotional tone. Obama gave a nearly identical speech, lending the same emotion to the cause and calling out his critics, more than two months ago at a campaign rally for New Jersey Gov. John Corzine. The DNC mailed a clip of it to supporters to fire them up for the August fight.

The question is whether the president will now keep using that same tone not only to rally supporters to the cause but to also warn opponents about the political consequences of doing so.

The mere notion that the president is willing to put the weight of his office and his rhetoric behind the cause is what made Monday's speech so appealing to supporters. It's why they're optimistic when they hear that he's going to get more specific Wednesday. On Monday, he sharpened his remarks about insurance companies "raking in the profits" while denying people coverage. He suggested they benefited from a fundamental unfairness in the current system. This heartened reform proponents, who believe that Obama has to make insurance companies more obvious villains in order to explain the value of reform for those who already have insurance. "Right now the fear of the unknown is trumping the fear of insurance companies," says one strategist involved with a third-party group advocating for reform.

The other key question for supporters is whether the president will really get more specific about his support for an increased government role in health care—the so-called "public option." At the Labor Day rally, after using all of the flashes of campaign style that worked so well in his race against McCain, Obama then said this about his support for a government role in the insurance market: "I continue to believe that public option within the basket of insurance choices would help improve quality and bring down costs." That's a statement of belief, not a commitment of energy. 

The debate has reached the point at which Obama needs to "draw lines in the sand," to use one of the official clichés of the 2009 Health Care Reform Debate, because after he leaves the Capitol, Congress will go back to its messy work of making legislation. The president has to be clear enough to avoid having the public debate hijacked by the day-to-day congressional process as it was during June and July. If he merely explains and describes rather than advocates the clear contours of what he supports, he'll merely be drawing pictures in the sand. Those might be pretty, but they don't demand attention.