BREAKING: The News in the Speech

by Jonathan Cohn | September 9, 2009

Looks like there's some news in the speech after all.  Quite a bit.

On the policy front, President Obama tonight endorses, clearly and unambiguously, a requirement that everybody obtain insurance--that is, an individual mandate. He has not done that before, not this explicitly.

He also says employers will have to provide insurance or bear some of the costs. That's not news exactly; he's said that before. But it's part of the same package.

That’s why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance.  Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers.  There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements.  But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees.  Improving our health care system only works if everybody does their part.

Later, Obama makes clear that health reform should cost about $900 billion. He's put that much money on the table before, but it wasn't clear whether he would try to seek more funding. Clearly he won't. On the other hand, given the current political environment, $900 billion is--just barely--what you need to reach universal coverage, or at least put us on a trajectory to it

Obama also endorses a proposal that the Senate Finance Committee has taken up. The proposal--which, as I recall, came from Senator John Kerry--would tax insurance companies when they provide expensive insurance policies. It's an indirect way of capping the tax exclusion on health benefits, something most economists believe can help slow down health spending.

Also of interest: A promise to provide low-cost, bare-bones policies right away--merely as a stopgap, until full reforms kick in. (This is an effort to make sure Americans see at least some benefits right away.) Elsewhere, Obama talks about malpractice reform--again, more explicitly than he has before, presenting it as an effort to reach across the aisle.

And the public plan? He gives a lengthy, strong defense of the idea. It could have come straight out of the literature of groups like Health Care for America Now--or the writings of Jacob Hacker. But he also makes clear, to left as well as right, that he's open to compromise.

Those seem like the major developments on the policy front. The tone is pretty striking, too. Obama reaches out to Republicans in several places. But he also comes down hard--very hard--on opponents who are merely out to defeat reform.

More soon...

(For those following the speech, I'll be sending updates on twitter at @jcohntnr.)

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