The Plank

For Obama, Just What The Doctor Ordered


Health care has been conspicuously absent from the presidential
campaign in the last few months. But Barack Obama is trying to change
that. He's got the right idea--and, more important, the right message.

On Saturday, Obama gave a major health care speech in North Carolina.
For the next few days, his surrogates will be fanning out to carry his
message to local constituencies and to the media. The campaign is also
running new ads, distributing a series of mailers, and organizing local
events including a series of "Docs for Barack" gatherings.

The primary focus of the push is on the perils of John McCain's health care plan, by now familiar to readers of this publication and other sites that  feature health care wonkery.
The gist is this: McCain's health care plan, which changes the tax
treatment of health insurance, would shift more people from
employer-based insurance into indivdiual coverage. But individual
coverage provides much weaker protection: You get fewer benefits for
the money, the benefits themselves are more inconsistent, and the
potential for fraud much higher. Plus, of course, people with
pre-existing conditions can't get decent coverage at anything
resembling affordable prices.

What struck me most about Obama's
speeech, though, was the political telegraphing. The question about
Obama has never been whether, broadly speaking, he was on the right
(er, left) side of the health care debate. He's always been a proponent
of using government to make medical care affordable for everybody. Nor
was the issue his record. As a state legislator in Illinois, he really
was instrumental in passing coverage expansions.

question, insead, has been his poiltical commitment to the issue. Just
how badly did he want universal coverage? How hard would he push? Among
the reasons to be skeptical: During the primaries, Obama didn't
identify himself with the issue as closely as his two rivals, Hillary
Clinton and John Edwards. And in the general election, with issues like
rising gas prices and the collapse of Wall Street soaking up so much
attention, Obama just hasn't focused on the issue much.

now. On Saturday, after Obama explained how he hoped to reduce the cost
of medical care, he made clear that simply reducing costs was "not
enough"--that it's essential to make sure everybody has insurance. And
while he said it was an economic imperative, because the costs of
caring for the uninsured imposes a "hidden tax" on everybody else, he
also described the presence of 45 million uninsured Americans as "one
of the great moral crises of our time."

"This is not who we are," Obama said, "and this is not who we have to be."

the end, Obama offerd some rhetoric conspicuously reminsicent of what
his rivals were using in the primaries. After describing the story of a
Florida woman named Robyn, whose son Devon needed a procedure that his
insurance company wouldn't cover, Obama made a vow:

I want to say to Robyn and Devon and everyone like them across America, you have my word that I will never back down, I will never give up, I will never stop fighting
until we have fixed our health care system and no family ever has to go
through what you’re going through, and my mother went through, and so
many people go through every day in this country. That is my promise to

(Empahsis mine.)

I'd be lying if I said I liked everything about the way this new health care pitch is shaping up. As Ezra Klein noted on Friday, the first of the four ads, which you can see here, seems unnecessarily defensive. The empahsis was on what Obama wouldn't do, rather than what he would.

The Obama campaign has also chosen to focus on the fact that McCain's plan, if enacted, would raise taxes on some people.

is a complicated issue I hope to address shortly, in a separate post.
But I'm not wild about this argument, in part because changing the tax
treatment of health benefits has some merit. McCain would accomplish
this in a reckless, ill-conceived way that would actually deprive
people of health security--so it's right to call him on it. But, done
properly and with some complementary reforms, a cap on the tax
exclusion for health benefits makes sense.

In other words, I'd
rather Obama not demonize the idea, much as I'd rather he not demonize
"government-run health care" (which actually works pretty well in a lot
of cases).

But the bigger story here is that Obama is
promoting health care. And while second-guessers like me were calling
for him to do this a while ago, the timing may actually be perfect. In
a week when McCain is trying to distract voters with absurd charges
that Obama has been "palling around with terrorists," the health care offensive puts McCain on the defensive. See, for example, this new ad.

The McCain campaign has, in fact, spent much of the past few days
trying to answer charges like these, with memos and conference calls. 

course, aggressively defining the health care issue now has one more
advantage for Obama. It will let him use the waning stages of the campaign to
build a mandate for reform. If he wins in November--and, to be clear, I
don't assume he will--the time he spends promoting health care reform
now will pay political dividends come 2009.

--Jonathan Cohn

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