Dearth of a Salesman: President Obama gave interviews to a number of network medical correspondents today as part of his health care push. Here is an "edited transcript" of his talk with Dr. Nancy Snyderman of NBC . As a health care sales pitch, it was awful. Why? Let's go to the videotape . [ Emphasis added .]
1) What's in it for you? Pain and discipline! Here's Obama's first big spiel, embracing a question from Snyderman:
Snyderman: I haven't heard anyone ask just for the American public to pony up here, that this is going to require some give for all the stakeholders involved.
Obama: Well, let me - let me talk about what I think the American people are going to have to do.
First of all, the American people have to recognize that there's no such thing as a free lunch. Right? So, we can't just provide care to everybody that has no cost whatsoever, you don't end up having to make any decisions.
So, obviously, we've got to have a system that controls costs, gives people choices, but makes sure that we're getting a good bang for the buck. And we've got to have the American people doing something about their own care.
Snyderman: So, self-responsibility.
Obama: So, self-responsibility is going to be critical. This is probably not going to be something that's legislated. But I tell you what, every business out there is going to be looking at their health care bottom line. And increasingly what you're going to see is that businesses are going to incentivize their employees to stop smoking, lose weight, get exercise, get regular checkups.
What we can do is we can encourage those companies that have those sorts of wellness-prevention programs. We can make sure that it's easier to find a primary care physician to get a regular checkup, that everybody has basic insurance. But the American people are going to have to participate in their own health.
Did Obama forget to highlight the part about the good things that are in the health care bills--things people might actually want that they don't have now? That failure is all the more inexplicable because the bills emerging from the House and Senate HELP committees actually do hold out the promise of a down to earth benefit that an most voters might desperately crave, namely not having to worry about where their health insurance will come from anymore! (Worst comes to worse, they can always sign up for the public plan.) Instead, in Obama's version it's time for voters to pay the bill for what they are already getting. Pony up, sinners! Everybody loves collection agents.
2) He lectures: It's also time, Obama tells his viewers, to lose weight, and stop smoking, and pull up your socks. Later on he tells people that they are foolish to prefer brand name drugs to generic drugs, and to want multiple medical tests. " If you only need one test, why do you want five tests?" Stop clinging to your tests! You're worse than those people in Pennsylvania.
Who knew we were electing a national mother-in-law? And get a chance to endure increased taxes for the privilege. Obama's supposed to be rallying support from voters, not castigating them. Outside the S& M parlor, most people do not enjoy paying to be disciplined.
3) The pain today is designed to avoid a problem that is over the horizon :
Well, I think that the most important thing for people to understand is that the system, as it is, is unsustainable. And if people understand that; if you look at the trend lines, where your premiums have doubled over the last nine years; your out-of-pocket costs have gone up 62 percent; the federal government is being bankrupt by Medicare and Medicaid - if you look at all these things, then you know that, just standing still, we are going to be overrun by health care costs.
Once the American people understand that, then it's a matter of us making intelligence choices.
As a matter of policy, maybe it makes sense to "look at the trend lines" and ward off unsustainability down the road. As a matter of politics, it's a proven loser. When was the last time we cut Social Security benefits because, sometime in the future, the "trend lines" might produce a crisis? Voters tend to say, "Thanks. Call me when the crisis actually hits." Why gratuitously make the health care bill seem like the (apparently unpopular, now-stalled) global warming bill--a costly prophylactic measure to ward off a danger that experts tell us may hit in coming decades?
FDR would never have made a pitch like this. He would have talked in simple terms about what was in it for "the people" now . Obama's arid, wonky, condescending approach might convince a majority of subscribers to the Brookings Institution email list. It's hardly going to create the kind of public demand that will push health care reform over the goal line.
Part of the problem might be Snyderman's editing. Maybe Obama gave a fabulous closer that got left on the cutting room floor. I doubt it. But even if that's true, it's still Obama's fault. He's controlling the venues in which his message gets out. He didn't have to pick the medical reporters. And he should be able to twist every question of Snyderman's into an excuse to say what he wants to say.
The likelier possibility is that he is saying what he wants to say. He's been surrounded by Orszaggy wonks for so long he thinks talking about "trend lines" and "incentivizing" is red meat. Which brings us to a final point:
4) He doesn't seem to know that much. Obama is asked why he changed his mind about a requirement that individuals purchase insurance (which he opposed in the campaign):
[M]y concern was, if we post a mandate, then people who couldn't afford it still would not have the ability to pay for the health insurance that was out there that was available, except now they were also being punished.
But I've changed my mind on this because what I've — was persuaded of was that, if we can phase this in so that we know there's affordable insurance out there — and, in fact, a lot of the uninsured are relatively young people who could be insured fairly cheaply — that that actually will drive down the cost for everybody
Huh? It was news to him that "a lot of the uninsured are relatively young people who could be insured fairly cheaply"? Even I knew that.
Obama does twist Snyderman's question--into another condescending bit of pedagogy:
So there's an example of, if the president of the United States can get educated on something and change their mind. I have confidence that the American people, when they get all the facts, will see that we can improve quality.
Yikes. If passage of health care depends on Obama's ability to educate the American people and change their mind--which, thankfully, it doesn't--we're in big trouble. The American people don't have to have their minds changed! They voted for Obama! He promised to deliver health care for everyone. Now he just has to convince them his plan will do what they wanted. Where is
James Carville when we need him? I never thought I'd say that. ... 11:22 P.M.