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.
