The Economist: "His is a bold ambition indeed; but this week the president looked a bit closer to fulfilling it."

I've posted an article once before ("4 emails debating health reform!") from the magazine, The Economist.  Their editorials are (I believe) usually thoughtful and objective, and here's what they had to say this week about Obama's health-care speech.  For the wonkier/wonkiest, below that are snippets from a 2nd article that goes into much more detail explaining the significance of this speech where "Mr Obama also unveiled the main elements of his own centrist reform plan for the first time." Click on the link to read the full article at economist.com. 

The art of the possible

A fine, measured piece of oratory from the president. But there is still tough work to do

“I AM not the first president to take up this cause, but I am determined to be the last.” Thus Barack Obama, late in the day, took his quest to reform America’s expensive and flawed health-care system to the floor of Congress with a mighty speech that will surely stand as one of the defining moments of his presidency, whether it leads to eventual triumph or disaster. His is a bold ambition indeed; but this week the president looked a bit closer to fulfilling it.

Politics, as everyone knows, is the art of the possible; and there have been times over this ill-tempered summer when the idea of tackling a system that costs almost twice as much as any other rich country’s, yet yields substandard results and leaves tens of millions of people with no health insurance at all, has seemed simply impossible. Mr Obama has to find a package of policies that is fiscally and politically moderate enough to win over a vital few Republicans to his side (and also prevent the defection of nervous conservative Democrats). But at the same time he has to keep the support of the leftish Democratic Party base, which wants to see a more expansive and costly set of reforms. He may well fail. But on September 9th the president for the first time laid out in some detail what such a plan might look like. Cleverly borrowing good ideas from both sides of the party divide, his proposals at least look like a plausible basis for agreement (see article).

The plan obliges everyone to take out health insurance while creating a tapering subsidy for poorer families to help them afford it. It also requires insurance companies to end various nefarious practices, such as refusing to insure people with existing conditions or cancelling their coverage just when they need it most. To pay for these long-held liberal goals (the cost is put at $900 billion over ten years), the president has committed himself to several policies that Republicans, if only they could remove their partisan spectacles, should applaud.

There is, for instance, a tax on insurance companies that offer “Cadillac” plans to richer individuals; since this will inevitably be passed on to consumers, it is a useful step towards making individuals aware of the cost of their coverage. He has made a cast-iron pledge that he will not sign a health bill that increases the deficit, and has promised automatic spending cuts if savings do not materialise. He wants to set up a new technocratic committee that could mandate changes to the hugely expensive Medicare system of health care for the elderly (an idea that cleverly takes such difficult decisions out of the hands of politicians, who have displayed a lamentable failure to grapple with them). And the president also promised conservatives reform of America’s mad tort system. The risk of being sued pushes up costs, obliging doctors to practise “defensive medicine” in the shape of needless tests and procedures.

Give me public options, but not now

Still up in the air is the trickiest question of all: whether the government should create a “public option”, its own insurance provider, which people could use if they dislike what the free market has to offer. Medical insurers and most Republicans say a public plan would enjoy unfair advantages and destroy competition. Liberal Democrats say the insurers will not cut prices without it. Both sides have a point. This newspaper still thinks the best solution would be to keep the public option as a threat: to set up a formal provision in the bill whereby a public plan would be introduced in, say, five years’ time if certain targets were not met. In his speech Mr Obama hedged his bets, sticking with the public option but signalling a willingness to compromise. This may come back to haunt him. But overall, this performance was a big step forward.

Fired up and ready to go

As Congress returns to work, two big bills before it may determine the fate of Barack Obama’s presidency—and he knows it. First, health care

“THE time for bickering is over. Now is the time for action.” With those fiery words, delivered to a special joint session of Congress on September 9th, Barack Obama made his case for reforming America’s troubled health system....

The speech was a success on several measures. It was passionate, which is essential if he is to win over a sceptical American public and energise his liberal base....

....Reading from a letter he had received from [Senator Edward Kennedy] posthumously, as his widow listened from the gallery, Mr Obama made the moral case for change: “At stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

During this passage, he cleverly reminded Americans that leading Republicans currently hostile to Democratic efforts at health reform—including Senators Orrin Hatch and John McCain—had worked hand-in-hand with Mr Kennedy on earlier, smaller efforts at health reform. That points to the second reason to think that Mr Obama’s speech may yet succeed in kick-starting reform this autumn: it managed to position the president as a reasonable and moderate adult in a room full of petty and partisan ideologues....

...He also announced a surprising idea to use executive authority to encourage state-level experiments in curbing malpractice abuses.

Mr Obama also unveiled the main elements of his own centrist reform plan for the first time. He wants to expand coverage to some 30m Americans without insurance, principally by introducing an individual mandate for cover, insurance exchanges, subsidies for the less well-off and heavy regulation of insurers. He also accepted an important proposal to tax the most lavish of insurance plans.

Crucially, he made it plain that he would not accept a health-reform bill from Congress that raises the deficit—not now, not ever. He also vowed that most of the $900 billion his plan will cost—again, the first time he has given a firm figure for his initiative—will come not from taxes on the rich, as the current bills in the House envision, but from internal savings to be realised within the health system.

He offers two reasons to suppose that this claim is not complete bunk. The first is the White House’s support for empowering an independent panel of experts to cut costs in Medicare and other government health schemes. This matters, because Congress has shown it is incapable of making such difficult cuts. More impressive is his vow this week that any final bill must include provisions for mandatory spending cuts that would kick in if budgeted cost savings do not materialise.

Will this speech be enough to get the president’s reform agenda back on track? It just might be. One reason to think so is the deft way Mr Obama signalled a willingness to compromise on the “public option” this week. The left has insisted on a government-run insurance scheme, but this ill-founded idea is strongly opposed by the health-care industry and by Republicans. It also has no hope of passing the Senate, as Max Baucus, the head of its Finance Committee, confirmed this week. Mr Obama voiced theoretical support for the idea, but by also supporting other options—including, crucially, the idea that such a plan could be triggered only if necessary later—he has, in effect, dealt it a death blow.

Several committees in the House have already passed versions of health bills, but all contain the public option and are seen as too far to the left of the Senate—and now, it is clear, of where Mr Obama stands. So all eyes are now on the Senate Finance Committee, where a “Gang of Six” led by Mr Baucus has been working to forge a moderate bill that could provide the backbone for any final health law this year. Mr Baucus this week unveiled his own $900 billion proposal (also a moderate approach without the public option), and announced plans to finalise a bill next week.

Earlier this week that effort seemed to be flagging, as two of the Republicans in the gang, Charles Grassley and Mike Enzi, appeared to be undermining its efforts. That leaves Olympia Snowe, the free-spirited Republican from Maine, as the most courted legislator in recent memory. Mr Obama’s speech and sensible proposals, which are similar to those drafted by Mr Baucus, and his openness to the trigger option favoured by Ms Snowe, can only boost efforts at compromise.

Whether it is enough to keep Ms Snowe and perhaps one or two other Republicans firmly on board remains to be seen. But even if it does not, the next few weeks could yet produce a bill that is better than anything seen thus far and which would be worth passing. He was not the first president, Mr Obama said, to take up health-care reform; but he was determined to be the last.