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Obama's Moment: Keeping it Simple

Bill Moyers, in his Journal, offers an interesting suggestion (Alternet transcript here) for President Obama for his big health care reform speech on Wednesday:

Here's a suggestion, Mr. President: ask Josh Marshall to draft your speech. Josh is the founder of the website talkingpointsmemo.com. He's a journalist and historian, not a politician. He doesn't split things down the middle and call it a victory for the masses. He's offered the simplest and most accurate description yet of a public insurance plan -- one that essentially asks people: would you like the option — the voluntary option -- of buying into Medicare before you're 65? Check it out, Mr. President.

Moyers' suggestion, made on Friday, will probably not be followed, since the President knows he has a great speechwriter in Jon Favreau. But there is something to be said for Moyers' comment about there being value in the "simplest and most acurate description yet" of a credible public option. Moyers links to Marshall's TPM post on the topic, in which he wonders:

...why the advocates of a public option and just reform in general have not simply explained this as allowing people to buy into Medicare at any age. Because, essentially, that's what it is. And I think I could pretty much guarantee you that if the question in the public mind was "Would you like the option of buying into Medicare before you turn 65?" the opposition would be vastly diminished.

This isn't just rhetoric. This is the most accurate and graspable explanation of what's being proposed. Indeed, the big secret not many people are discussing is that in the current iterations of the 'public option' in most of the bills in committee that 'option' isn't given as an option to many people. Most people aren't allowed to access it. And it's designed that way in order to put a crimp on any competition it might provide to private sector insurers.

Moyers isn't the only one with speechwriting advice for the President. Here's Robert Reich, from his blog, urging the President to hold firm to three key principles and say something like:

1. I will not stand for a bill that leaves millions of Americans without health care. It's vitally important to cover all Americans, not only for their and their childrens' sakes and not only because it's a moral imperative, but because doing so will be good for all of us. One out of three Americans will experience job loss and potential loss of health insurance for themselves and their families at some point. One out of four of us who have health insurance is underinsured --unable to afford the preventive care we and our kids need on an ongoing basis. And those of us who don't get preventive care can get walloped with diabetes, heart disease, and other major illnesses that wipe us out financially, or force us into emergency rooms that all of us end up paying for.

2. The only way to cover all Americans without causing deficits to rise is to require that the wealthiest Americans pay a bit extra. The wealthy can afford to make sure all Americans are healthy. The top 1 percent of earners now take home 23 percent of total national income, the highest percentage since 1928. Their tax burden is not excessive. Even as income and wealth have become more concentrated than at any time in the past 80 years, those at the top are now taxed at lower rates than rich Americans have been taxed since before the start of World War II. Indeed, many managers of hedge funds, private-equity partners, and investment bankers -- including those who have been bailed out by taxpayers over the last year -- are paying 15 percent of their income in taxes because their earnings are, absurdly, treated as capital gains. We should eliminate this loophole as well, and use it to guarantee the health of all.

3. Finally, I want a true public insurance option -- not a "cooperative," and not something that's triggered if certain goals aren't met. A public option is critical for lowering health-care costs. Today, private insurers don't face enough competition to guarantee low prices and high service. In 36 states, three or fewer insurers account for 65 percent of the insurance market. A public insurance option would also have the scale and authority needed to negotiate low drug prices and low prices from medical providers. Commercial insurers now pay about 30 higher rates to providers than the government pays through Medicare, because Medicare has the scale to get those lower rates. A nationwide public option could get similar savings. And those savings would mean lower premiums, deductibles and co-payments for Americans who can barely afford health insurance right now.

And the L.A. Times has an unsigned editorial calling on President Obama to recognize that,

With so many people feeling as if they have no stake in the reform effort, Obama's opponents have been able to tar the House and Senate versions of the bill with hyperbolic and sometimes nonsensical attacks, such as the fear-mongering references to "death panels" and "socialized medicine." And as with the proposals to help troubled borrowers, the push for universal insurance has led some consumers to grumble about "responsible" people being forced by Washington to aid the “irresponsible” ones who don't lead healthy lifestyles. In other words, healthcare reform looks to this group like yet another government bailout.

In laying out his plan, Obama's first goal should be to offer clear gains for the insured as well as the uninsured. One example would be specific proposals to improve quality and control the runaway costs that threaten to double insurance premiums over the next decade. Those two efforts go hand in hand. The president's plan should also include measures aimed specifically at chronic diseases, including incentives for prevention and, for those with such diseases, better coordination of care. The bills already moving through Congress offer some good ideas on many of these fronts, but they're not as aggressive as they should be in combating costs.

Obama should also use his plan to spark a debate over the central principles of healthcare reform -- namely, whether to extend insurance coverage to all Americans and whether it's desirable to slow the growth in healthcare spending. Universal health insurance is an expensive proposition...We think the choices are clear. Health insurance should be universal -- it's not only humane and better for public health, it's crucial to stopping costs from being shifted from the uninsured to the insured. And unless medical inflation is tamed, healthcare spending will come to dominate the federal budget and the economy as a whole.

No doubt, you can find more unsolicited speech advice for the President on numerous other blogs, much of it good. As is often the case with speechwriting, the hardest decisions are what to omit, and how to best simplify what is included. Obama is a great speaker, and experience suggests he will do the best possible job with the speech his staff puts together. They know that not just politics, but the health security of millions are at stake. Much depends on their efforts.