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Healthcare Efficiency
Explore the delicate balance of efficiency and quality care.
The Speech
Posted by: Robert Burney on September 13, 2009 at 1:40PM CST

Gotta do it. The President's speech was the most significant event in the health reform debate and the most talked about event in town for the past quarter. (The Triathlon didn't even make the sports page.)

Whatever your politics, you've got to admit President Obama is a great orator. You may not agree with his ideas, but even critics admit they are well organized and well presented.

In case anyone missed it, here is a link to a transcript of the speech, so you can check out exactly what he did say. This is necessary, because there are various opinions about what he said. "Selective hearing" is a good term. In fact, one columnist stated that polarized positions were not changed. Perhaps the intent was really to solidify his team and convince them to support the existing bills. Someone described the speech as "aggressively pragmatic."

Many have criticized the talk for not providing sufficient details, chiefly on payment. He declared again that the reform plan must be self-financing but didn't say how that would be done. There were vague references to savings from eliminating fraud and abuse (standard political rhetoric) and more from prevention (clearly shown NOT to produce any savings). Medicare Advantage plans would take a well deserved hit, and there's still talk about taxing overly generous health insurance benefits. All of this will not be enough, and no one has mentioned promoting greater efficiency in healthcare services.

Kaiser Health News assembled opinions from several "experts" (whatever that means). Beth Kilbreth saw the speech as an attempt to "reestablish debate as political discourse rather than mud wrestling" and an attempt to "defuse the anti-reform campaign based on falsehoods and inuendos." Subsequent events suggest that he failed on both counts.

Interestingly, the most commonly quoted phrase of the evening was uttered not by Mr. Obama but by Congressman Wilson from SC when he interrupted the President by shouting, "You lie!" Wilson, widely regarded as a jerk both before and after his remark, was unrepentant. He made the perfunctory phone apology to the White House press secretary but put a video on his web site saying essentially, "If you agree with me, send money." And many did.

The most cogent assessment of Wilson's outburst came from Gail Collins of the NY Times: "it is not a good plan to heckle the president of the United States when he's making a speech about replacing acrimony with civility." The Republicans were caught in a tough spot-not wanting to endorse his behavior but not wanting to deny it either. So they did nothing.


But what about the issue? Wilson challenged the President's statement that illegal aliens would not be eligible for healthcare. Facts say otherwise. There is text in both bills that clearly state that no money will be used to pay for healthcare for those who are in this country illegally. Period. So, he was wrong in his behavior and wrong in his facts, but that didn't stop many from endorsing him. Oh well.

Consensus is that it was a good speech, maybe the best he has made since the campaign. Those who are against everything were not moved. Reasonable people may have been convinced to think about the larger goals of caring for the uninsured and reducing the costs of healthcare. That's what leadership is all about: "Here's where we're going. You can come along and help or you can be left behind."

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