How the President Can Reboot Health Care in the State of the Union Address

Let’s be realistic about our expectations for the State of the Union. We’re unlikely to see a newly-energized President trailing clouds of progressive glory, ascending the podium while the PA blares anthemic 70’s stadium-rock. That’s not his style. (If I’m wrong about that 70's rock, however, I recommend Alice Cooper’s “No More Mr. Nice Guy.”) Still, he can recapture the health debate and stay true to himself by saying something like this:

“When 3,000 Americans died on September 11, our nation came together as one. Studies tell us more than ten times that many people have died in from a lack of health insurance since we began this debate last year. This is not a liberal issue or a conservative issue; not a Democratic issue or a Republican issue; it is an American issue. The American people will not tolerate any further delay in fixing this problem.

"I respect the legislative process, but we’ve gotten lost in the details. We need to remind ourselves of the big picture – why we need health reform, and why everybody will benefit when we do.

“People talk about changing the health care system - but we don't have a 'system.' We have lots of different parties acting independently, funded by for-profit insurance companies who too often fail to consider what is best for the country as a whole. That must stop, and it will stop.

“To the people listening at home, what does reform mean for you? If you don’t have insurance now, it means you will have it – at prices you can afford. If you have insurance, it means that runaway costs will stop eating away at your family’s budget. It means that your health insurance will be just what that name implies: something that insures your financial health, as well as your physical health, because when you need it, it will be there.

"Here are four changes we must make, and we will make, starting today:

“One: A guarantee that you’ll be able to purchase affordable health insurance, even if you have a pre-existing condition, and that it can’t be revoked if you get sick. I am asking Congress to pass a bill immediately, separately from any other initiatives, providing all Americans with these assurances.

“Two: Meaningful cost containment. That includes finding out what works and what doesn’t – not to deny you and your doctor the right to choose your care, but to make sure that the best information is available to make that decision. So I’m convening a Presidential Commission on Medical Cost Containment comprised of physicians, economists, policy makers, and leaders from all walks of life – business executives, working people, even moms and dads.

“Three: Ways of handling paperwork and delivering care using the technology we already use in the rest of our lives. Health care should be at least as efficient as making a plane reservation or buying movie tickets. That’s why we’re investing in health information systems. They’ll make your life easier. They’ll also make you healthier, by connecting all your information in ways that will help spot problems before they happen. I’m pleased to report that we’re expanding our efforts in this area.

“Four: Real competition. That means a public option, or something very much like it. Economists tell us insurance companies can’t make a profit unless everybody’s insured. But it’s not fair or politically feasible to make everyone buy insurance at these prices without competition to drive costs down. So I am again asking Congress to create a public option or its equivalent. I invite the insurance companies to support this effort. After all, without it there will be no mandate, and they’ll have a problem on their hands. But what they do is up to them.

“Now, I know some politicians and some special interests are going to be unhappy with these proposals. They’re going to tell us it’s too hard, or they’ll want to ask someone else to sacrifice. But we have never run from hard work as a nation before.

“Let’s be clear: the American people want results, not scare tactics or politics as usual. So let’s have no more talk of ‘death panels’ or ‘government-run medicine.’ We’re going to debate these issues freely and openly, without getting cute or misleading the public. If you have a better idea, I want to hear it. If we can work together to improve these proposals, I want to do it. But if anybody tries to stall progress, if anyone plays the games of fear and deception or pushes only for their own interests, I will stand up and call them out on it in front of the American people.

“And if anybody in this chamber plans to filibuster these badly-needed measures, if you plan to filibuster against the mother and child in Texas who need health care, or the middle-aged man in Ohio whose coverage was cancelled when he got cancer, or the families all across this nation who struggle to pay their medical bills, know this: the American people will be watching.

“But I don’t expect that to happen. I expect all of us to rise to the occasion and do what needs to be done. That is what we’ve always done when we’ve been confronted with a crisis, and that is what we will do now.”
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Well, okay, maybe there are a couple “clouds of progressive glory” in there. And even if we’re not hearing Alice Cooper, there is a faint echo of “We Will Rock You.” But this is essentially a centrist speech, pushing for popular initiatives that have broad bipartisan support. 51% of Republicans polled support a public option, for example, while Newt Gingrich is a leading advocate for effectiveness studies. And the speech doesn’t oppose mandates, it just creates a precondition for them, putting the ball back in the insurers’ court.

Words like these are very much in line with what this President has said in the past, and how he has said it. If he were to take this kind of stand on Thursday night, the political rewards could be enormous. The human rewards would be even greater.

Views expressed on this page are those of the authors and not necessarily those of Campaign for America's Future or Institute for America's Future