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Analysis: Obama Addresses Congress About Health Care

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Robert G. Kaiser
Washington Post Associate Editor
Wednesday, September 9, 2009; 9:00 PM

Washington Post Associate Editor Robert G. Kaiser was online Wednesday, Sept. 9, at 9 p.m. ET to discuss and analyze President Obama's address to Congress about health-care reform.

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Robert G. Kaiser: Hello everyone. This is an interesting moment in the Obama presidency, in American history. I hope we can have a lively discussion and look forward to the next hour or so.

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Seattle: As I'm heading home to watch the speech live, I have only one question to ask: how many times do you think our President will bring up single payer national health care in the context of the speech?

Since that's what three quarters of American citizens want.

Robert G. Kaiser: This question came in early, and obviously was posted before the president spoke, but it offers a good place to start, at least in my opinion. It has long seemed to me that as a country we have avoided looking straight and hard at the medical care system we have. It is a profoundly inefficient system. It generates huge profits for a great many corporations, and pays by far the highest salaries to doctors (though by no means all doctors) that are paid anywhere in the world. It is a wildly extravagant system. But as Obama said tonight, trying now to start over again would be incredibly disruptive, not least because of what I just mentioned. Sixteen percent of the economy is our health care system. If we cut its cost by a third, say -- a reasonable expectation if we had a system like Japan, or Finland, or nearly every other industrialized country -- that would have a profound economic impact.

I think this is why, Seattle, we are not seriously debating a single-payer alternative now.

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Philadelphia, Pa,: What were the Republican members of Congress holding and waving during the speech? Also, what did the sign (I saw one, I don't know if there were more) read that a member of Congress held up? Is this generally acceptable behavior in Congress?

Robert G. Kaiser: I saw one piece of paper that said "What Bill?", a legitimate question I thought. Obama talked all evening about a plan that in fact doesn't yet exist. Implicitly he was describing the contents of a bill he would like to sign, obviously, but none of the versions approved by committees of the House and Senate so far include all the elements of his "plan," which he too has not reduced to a draft bill.

But other Republican behavior tonight was more problematic, I thought, particularly the shout of "You lie!" that apparently came from Rep. Joe Wilson of South Carolina when Obama said his plan would not cover illegal immigrants. I thought that was way, way out of bounds, and a sad demonstration of something really ugly that has come into our politics.

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Indianapolis: From what I've seen, the biggest problem with the health care "debate" is us (Americans). Our congress has serious people doing serious work and others who will say damn near anything--most of it inflamatory and nonproductive but get all the attention in part because we tune in for their antics. Until we (as a nation) learn to talk about these issues seriously and with respect we will get NOWHERE. I don't know if we even remember how.

I remember when Alan Simpson left the Senate and gave his exit speech. He said: one of these days you guys are gonna miss people like me because there won't be anybody left to do the heavy lifting.

He was dead-on accurate!

Robert G. Kaiser: Thanks for this. Of course you are absolutely right. It is a dismaying fact of American life that so many of our fellow citizens are prepared to offer the strongest imaginable opinions about issues like this without much or any serious knowledge of what they are talking about. Emotion prevails over intellect time and again, as it has in this debate. It is not an admirable national trait, is it?

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Richmond VA: Boehner, Cantor and other Republicans sat on their hands a lot. Do you think the President "moved the needle" with them at all?

Robert G. Kaiser: We'll never know, because they are too dug in now to change their positions.

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Rock Hill, SC: From the president's speech I got the impression that he is not pushing as hard as expected for the public option. Is this your take as well, and how will the Dems react in your opinion. Thanks.

Robert G. Kaiser: I thought he did a good job on the public option, on several levels. He pointed out how few people it would affect, if it is offered. He pointed out that it won't solve any of the biggest problems with health care. I was impressed earlier in the summer by a Steve Pearlstein column that I thought debunked the importance of the public option very effectively. My producer Paul Williams has created a link to it which I hope we can give you right here.

washingtonpost.com: Steven Pearlstein - Time to Give Up on the Public Option

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Bridgewater, Mass.: How much good will - or more importantly, votes for the eventual bill - do you think his "so you want tort reform? ok, then, you've got it" will get him?

Robert G. Kaiser: This was a powerful speech. I think its greatest impact, probably, will be on nervous Democrats who haven't been comfortable with supporting a sweeping plan. I think Obama may have shamed a lot of them tonight. He couched the tort reform idea in the context of Republican opposition, as though he hoped it might win some GOP support for a reform plan. I think the Republicans are firmly committed to opposing whatever plan may finally emerge here, just as most Republicans opposed Social Security and Medicare in their day. So my answer is, not many, probably not any Republican votes will be swayed by this proposal.

However, I think it's a really good idea. Talk to any doctor you know about the cost of medical malpractice suits. They have added a great deal to the cost of American medical care. We ought to be able to contain those costs a lot better than we do.

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San Francisco, CA: Has any President ever been greeted by a House member shouting "You lie!" as Joe Wilson, GOP of South Carolina, did tonight to President Obama?

Is this grounds for censure by his fellow House members?

Robert G. Kaiser: Not to my knowledge, and yes.

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Sewickley, Pa: A bone to pick with the Republican response-- the statement that we are piling debt on our grandchildren. President Reagan ran up huge deficits that sunk President George H W Bush's chances for reelection but were paid off just a few years later by the Clinton administration working with both Democratic and Republican legislatures. If the current crop of Republicans were in office during WWII perhaps we would not have run up deficits to conduct the war. My dad fought in WWII and I'm pretty sure that was paid off before my neice was born in 1978. Has the Obama administration been sunk on this issue by emotion and fear mongering? His logic seems impeccable but is that enough?

Robert G. Kaiser: Thanks for this. For Republicans to complain that Democrats are piling up debt is, after the eight years of balooning debt under George W. Bush, cynical in the extreme.

Can emotion sink logic? Of course; sadly, it often does.

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D.C.: Now is not the time to fear the future, but to shape the future seemed to me to be a pointed line for moderate Dems who have heard anxiety from their constituents who worry they will be harmed by change, or who worry that the country can't afford it.

Does such a message have any impact on Congressmen and women who want to save their own jobs, and who believe public sentiment is not in line with big reforms?

Robert G. Kaiser: We live in an age of political cowardice. Personally I hold the modern political poll responsible for this. When politicians have to read polls that tell them just what their constituents are thinking, it makes it vastly more difficult for them to take contrary positions, and most of them don't do it. Fear is, I'm afraid, the strongest single influence on Capitol Hill today.

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Pittsburgh: Re Indianapolis assertion that "we" are the problem-- amen. One of the media watchdogs reports that coverage of the town hall protests outstrips coverage of the actual issue of health reform and what's in the various bills is four to one. I feel like we're watching the crappy coverage that led to Iraq war.

Robert G. Kaiser: Thanks for this. The problem is more profound, even. The groups that helped organize some of those town-hall protests did so secure in the knowledge that they would be providing precisely what our television networks are looking for in the way of "news." And that, of course, isn't news at all. It's conflict.

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Philadelphia, PA : He's great at these. The one touch he could use is the witty Reagan spontaneous one-liner, for someone like the idiot from SC. Something like: And my plan will even help you with your anger management issues, but it may not help with your hallucinations.

Okay, maybe I should keep my day job!

Robert G. Kaiser: Not sure about your day-job, but your idea is certainly worth posting.

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Gaithersburg: How do we know the savings of tort reform would be realized by patient-consumers? The politicians advocating for it are the same free-market advocates who think it's not government's role to interfere in the right to make a buck.

Robert G. Kaiser: thanks for this.

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Pennsylvania: Wasn't the REAL purpose of Obama's speech to move constituents of wavering Democratic Senators and Representatives (and maybe a handful of moderate Republicans) to contact them to urge to support the health plan?

Robert G. Kaiser: Yes--and also to woo public opinion of course.

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D.C.: President Obama is without a doubt a great orator. But, tonight, he seemed to "feel" this speech more than usual. I have to come expect a casually calm demeanor from him. This speech certainly brought a more aggressive, defiant tone that I wasn't expecting, but I appreciated.

Robert G. Kaiser: I was referring to this in my initial comment about what an interesting moment this is in the Obama presidency. My own hunch (worth exactly what you'll pay for it) is that this will be seen as one of the most effective speeches this considerable orator has yet given, for exactly the reason you put your finger on. The combination of mind and heart that went into this speech was unusual.

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Ft Campbell Ky.: To respond to Indianapolis. Could it be that politics is one of the few things left to divide us. Racism, sexism, these things linger but for the most part we have beat these biases. All that remains is political division and the people who make money keeping us divided: Limbaugh, Michael Moore, etc. The more we hate each other the more they get paid. We allow ourselves to get caught up and so it's hard to put the anger aside to talk about serious things. It's off topic. But I agree Americans don't know how to talk about things anymore.

Robert G. Kaiser: Thanks for this insightful comment.

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Alexandria, Virginia: My wife, who is suffering terribly from Multiple Sclerosis, was moved to tears when President Obama spoke of the unfairness of a system that punishes those who become ill. We had lost our health care plan when my employer went bankrupt several years ago and have gone without medical coverage for over four years because every insurance company rejected her under the pre-existing condition rule. We hope and pray that members of Congress will find it in their heart to help those of us in need. Do you think our prayers will be answered? Many thanks.

Robert G. Kaiser: Thank you for this. If I had to bet (luckily I don't), I would bet on some reform passing this year, particularly one covering insurance companies' abuses. But I wouldn't bet the farm.

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Washington, DC: I agree with you that a Congressman shouldn't be shouting from the floor during a president's speech, but I am still not convinced that any bill that merely states that illegal aliens are not eligible for "affordability" credits is enough to prevent them from receiving health insurance. They're not supposed to receive a lot of government benefits, but millions and millions of them manage to do so, but please forgive me for being skeptical about this until such time as I see PRECISELY how this is going to be ENFORCED. As a long-time federal employee, I know that enforcement is where the action is. The bill's provisions are completely toothless.

Robert G. Kaiser: Personally I cannot pretend to be sympathetic to your implied position that those dreadful illegals should not be given any medical care. America would grind to a halt without our illegal immigrant workers, and I suspect we all know it. But in fact studies show again and again that illegals avoid trying to take advantage of government programs for fear they'll be caught and deported. Sending kids to school is an exception, but most states have decided long ago that it makes more sense to take the kids into their schools than try to exclude them. Could a program be enacted that guaranteed no ineligible immigrants would benefit from it? Of course not. But it would surely be possible to draft a health care reform that explicitly excluded illegals and made it both risky and difficult for them to try to participate in it.

We simply cannot keep everyone out of this country that doesn't have a visa. The idea is wildly impractical, which is why of course we have never really tried to do it.

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Fairfax, Virginia: Good Evening Mr. Kaiser, Did the President's remarks debunking death panels for senior citizens finally put an end to these hysterical outbursts, at least among mainstream politicians? Or are we likely to continue hearing this type of rhetoric, rather than reasoned debate about health care options?

Robert G. Kaiser: Don't you think some of our politicians aren't interested in facts?

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Sewickley, Pa: You are the professional and if you say political cowardice is due to polls I will ponder and research it. My instinct tells me it is cable TV schlock news. The Tea Partiers and Town Hall health reform protesters have gotten a disproportionate amount of coverage. The Obama administration was slow on the uptake when the hotheads got a hold of the debate during the recess. How do you assess the admins ability to get an effective bill?

Robert G. Kaiser: Well, all the players on my Washington Nationals are professionals too; that doesn't seem to help.

I like your theory too, but I don't think it is adequate to the task of explaining political cowardice, which is a fundamental disorder.

As I said above, I think there is a real chance that a plan will pass, but that's certainly not the only possibility.

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Baltimore: Strategically, I think the speech was just right. Mr. Obama had avoided writing a bill so that Congress could draft several; then we'd all debate and see what good ideas surface.

I think the plan as described is a masterful marriage of a private-sector system with market incentives, with government guarantees that people won't be left out for profit motive.

Robert G. Kaiser: thanks. of course something incorporating the "Obama plan" still has to get written as a bill and brought to the floor of the House and Senate.

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Censure?: So what if the House censures Joe Wilson. Isn't it a totally toothless action, that costs him nothing (while simultaneously making him a hero to the likeminded)?

Robert G. Kaiser: thanks for posting.

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Chicago: Don't you think the president risks his own credibility when he makes a blanket statement that those who have insurance will not be required to change it, when in fact many employers will have a strong incentive to move their employees onto different plans, or even the public option?

Robert G. Kaiser: The wording of what he said was important--and you picked it up. "Required" was the key word. Of course lots of peoples' situations could change in a new world ordered by a new health insurance law.

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Washington, DC: I have to congratulate the President for one thing: he's managed to finish the job started by Bill Clinton and finally kill off any hope I had for this nation. It's unconscionable that he isn't pushing for real, sustainable, effective health care reform. I feel completely betrayed.

Robert G. Kaiser: Hey, where have you been, on a long vacation? Obama's position hasn't changed much at all since the campaign. Were you paying attention then? He didn't offer what I take it you would like to have when he was a candidate.

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Ft Campbell KY: Doesn't everyone know that illegals get humanitarian care in the country today and I can't imagine we'd want that to change. Who among us wants a child hit by a car to die because she was here illegally.

Robert G. Kaiser: Thanks for this.

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Washington, DC: Interesting, in Obama's speech, how all of a suddent healthcare reform has shifted to insurance reform! And what about the issue of not extending insurance to the 12 million illegal aliens? We're simply supposed to "trust" gov't to enforce this? Yeah, right.

Robert G. Kaiser: Has there really been a shift beyond the rhetorical emphasis? I don't think so.

As to the illegals, see above.

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Overland Park, Kan.: What will be the extent of the "bureaucracy" to administer the program and are those costs inherent in the program costs?

Robert G. Kaiser: No big new bureaucracy is envisioned by any of the bills passed by committees so far, and I wouldn't expect that to change. Of course we already have more medical bureaucrats in this country than any other nation on earth can claim. But they work for private insurance companies, not the government.

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Ames, IA: Will the Post please (or any media) report on the mechanics of the health care proposals at least as much as you do on commentary. That is what America needs, reporting.

washingtonpost.com: Health-Care Reform 2009 - Tracking the National Health-Care Debate

Robert G. Kaiser: Thanks. Paul Davidson has given you a link to the wonderful, detailed, rich coverage of the substance that The Washington Post has been providing its readers, on-line and on paper. You may wallow in it for many hours!

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Austin, TX: To Chicago: I work for a company that provides me with health insurance, yet I'm "required" to change almost every year when my company finds a plan that's cheaper for them to offer. That's status-quo in the insurance game.

Robert G. Kaiser: thanks.

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st paul : David Gergen said on CNN tonight that Obama gave a very good speech, but one that should have been given three months ago. What do you think?

Robert G. Kaiser: I agree with David, my old colleague on the college paper, that it was a good speech, but I don't think it would have made sense or fit the situation three months ago. Context means a lot in politics. This was a very good speech for this moment, I thought.

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Lyme, Conn.: One of the reasons it is hard to find support from Republicans is that so many Republicans have been replaced by Democrats. Even though people like Chris Shays are no longer in office, I wonder what these former Republicans have to say on health care. If they were still in Congress, would they have supported seeking bipartisan cooperation on health care?

Robert G. Kaiser: Good comment, thanks. The Republican moderate, of which Chris Shays was a good example, is worse off than the average endangered species; in the House of Representatives he/she is virtually extinct. Interestingly, the last two elections, '06 and '08, have made the House Democrats a much less homogenous, much more conservative bunch than they were for some years before 2006. The same elections have made the Republicans still more conservative.

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Indian Head, Md.: Bob, I really enjoy your chats. I am retired military, cancer survivor, and with free health care for the rest of my life. I never, in my wildest dreams, thought how vicious the conservatives can be about this issue. I know people, family and friends alike, that are paying an outrageous premium on health care insurance...and they are the ones screaming in the town hall meetings against reform. Huh? I know others that lost their health insurance after turning 22 and therefore are losing their cancer treatment. It is a shame that the most powerful nation on Earth can't take care of their own.

Robert G. Kaiser: Thanks for this. I really enjoy the chats too, but your approval means more to me than my own!

You and I both have a huge advantage; you've got military health care, and I'm newly on Medicare and enjoying it--much better than the Aetna plans the Washington Post was providing.

I think when Obama spoke tonight about the character of our nation, a lot of people nodded in agreement who did not vote for him last November. We do think of ourselves as a compassionate, fair-minded, generous people, and I think it is indisputably true that the health insurance horror stories that all of us have heard from friends and relations somehow contradict our image of ourselves. I don't know how that plays out politically here, however.

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Chicago: Now that the president has given his speech, what happens next? Does much of what has been done need to be rewritten? I am unsure of whether this will have any substantive impact on where both sides are on the issue.

Robert G. Kaiser: A very good question, and it will be the last one this time. Thanks to all for a very lively hour.

As I've indicated earlier, yes, these ideas that now really do constitute an "Obama plan" need to be incorporated somehow into legislation. I suspect that the strength of this speech was to shame Democratic members of both houses into the realization that there really is no avoiding doing something now. I could be wrong--I often am!

But stay tuned. This is a very big issue, and a huge test for our new president--and for the Democratic majorities in both houses.

Good night.

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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