The media has been promoting Obama’s Wednesday speech to a joint session of Congress as a major event that could shift the momentum in the health care debate, but I think it’s important not to get too carried away. I have no doubt that Obama has the ability to make a great speech that could momentarily boost support for health care legislation just as Bill Clinton’s speech did in September 1993, but no amount of rhetoric can change the fundamentals of the debate. The reason is that Americans may favor action on health care in the abstract, but get cold feet when they learn more about the details.

Once the pageantry of a major presidential address fades, lawmakers will still be stuck with the same set of problems that have plagued health care over the past few months. Liberals say that a bill can’t get through the House without a government plan, while moderate Democrats say a bill can’t get through the Senate with one. Any bill is likely to cost in the neighborhood of $1 trillion or more at a time of already unprecedented long-term debt, meaning paying for it will require a combination of tax increases and cuts to existing government programs. The major cost saving measures — electronic medical records, preventive care, a Medicare advisory commission — will not put a dent in health care spending, and in some instances, may exacerbate the problem. If you expand Medicaid, the governors will be up in arms about the cost to states unless the federal government picks up the tab — but either way we’d be adding to our massive entitlement burden. As much as Obama says people can keep their health care if they like it, there’s no way he can offer that guarantee, and some of the proposals actually would encourage businesses to change the coverage they currently offer. And all of this is playing out with the economy still weak and unemployment up to 9.7 percent despite Obama’s promises during the stimulus debate. I can go on and on, but the point is that whatever Obama says tomorrow night, and no matter how grand it is, it won’t change the big picture.