The President has many tasks in his speech tonight. But, the most obvious is that he must finally articulate his own plan for reforming health care. For much the past few months, people have spoken about “the President’s plan” and “Obamacare” when, in fact, what was being debated were a variety of bills being drafted by different committees in both the House and the Senate. Tonight, the President must make a compelling case for those parts of the reform effort upon which he is willing to stake the prestige and power of his office.
One problem he does not face is that set for him in this morning’s Washington Post by Michael Gerson who claims the President faces a credibility problem, specifically in terms of reducing the cost of health care. “While Obama has made cost control a centerpiece of his public message, only about 20 percent of Americans, in one poll, believe Obama will keep his promise not to increase the deficit with health reform.” There is a sleight of hand at work in that sentence. Cost control in health care will help all Americans with lower premiums, as well as the out-year projections for spending on Medicare and Medicaid. Those two programs threaten to bankrupt the government if those costs are not controlled. But, to reform the system as a whole, there are up-front expenditures that do not help the deficit projections immediately. But, cutting health care costs and cutting the deficit are different things and Gerson elides the two.
Gerson is not dumb. He knows that once health care is seen as an entitlement, there is no way the government can take it away from people. Think back to the efforts to reform Social Security put forward by the Bush administration. Those efforts were dead-on-arrival in Congress. Once health care becomes a part of the government budget, other parts of the budget will have to shrink, such as defense spending, or taxes will need to go up. The situation is the reverse of Reaganomics when the government sought to starve the government of funds by cutting taxes and use that starvation to begin a roll back of the social safety net established by the New Deal and the Great Society. Reagan’s effort failed. Obama, if he hits a homerun tonight, might succeed.