Barack Obama Has a Plan (But Not Much of One)


Watching Obama's big health-care speech tonight, I was reminded of the recent remake of Battlestar Galactica: For a long time, the show opened with a foreboding note about the series' robotic villains, the Cylons: "They have a plan." But when their mysterious plan finally materialized, it was underwhelming, and not terribly consequential to the larger arc of the series. So my basic reaction to the speech tonight was the same as my reaction to the non-plan explained by Cylons: This is it?

Despite what Jon Cohn says, there just wasn't much news. As expected, Obama waffled on the public plan in the exact same way he's been waffling for months: Expressing clear support, and refusing to say it's a deal-breaker one way or the other. And as expected, he cleverly avoided explaining why some people might end up shifted off their current health-care plans.

If there was any real news tonight, it's that Obama expects his proposal will cost about $900 billion over ten years. But who knows how the CBO, whose judgment will be a key factor in the ongoing debate, will actually score the plan? After all, Obama also claimed that preventive care saves money. But the CBO (like the New England Journal of Medicine) says otherwise. Indeed, if Obama really wanted to incentivize prevention and save money, he might take a much closer look at consumer-driven health-care plans, which strong evidence suggests bring down costs and result in greater use of preventive care services than traditional insurance plans. Meanwhile, he argued that a public plan would save money by avoiding some of the "overhead" of private insurance. But Medicare doesn't really avoid overhead costs; it hides them. And what administrative activity it does cut out results in massive waste, fraud, and abuse.

A quick scan of the blogosphere and the cable chatter suggests reform advocates are reasonably happy with the speech, but I'm skeptical that it will prove significant. Sure, the final section, after Obama finished listing out the policy details, was surprisingly elegant, but it was also strangely disconnected from what came before it. This wasn't a great speech; it was a policy paper hog-tied to a Jon Favreau jam session.

Maybe I'm wrong, but I just don't think it will be enough. At this point, I'm not sure reform has much going for it: At least when they Cylons disappointed, they looked like this.