In his speech to Congress tonight, President Obama has to juggle many objectives, some of them seemingly contradictory. For example, he must continue to reach out to Republicans, cite one or two of the ideas they brought to the table that he is endorsing himself, and hold out the hope that the eventual reform will be bipartisan. But, at the same time, he must rally the Democratic Party, the liberals in safe districts as well as the Blue Dogs from conservative, swing districts.
The primary way – no, the only way – to achieve this rallying of the Democratic Party’s different ideological components is to state the moral argument for health care reform and, specifically, for government involvement in that reform. This argument is only partly about insuring those who currently lack health insurance, although the moral argument for the reform’s universality is the most accessible. The problem politically is that plenty of Americans who have insurance and are happy with it think they are going to end up paying to insure those currently uninsured through higher taxes. He must state again that those with insurance pay for those without it today, they just pay for it in an irrational manner, through the hidden costs and rising premiums of unnecessary visits to the emergency room by the uninsured. This fiscal dynamic points to a deeper moral reality: We are Americans and we are all in this together, whether the issue is fixing health care, prosecuting the war in Afghanistan, or coping with the out-year budget deficits. During the campaign, when candidate Obama gave voice to such sentiments, he received the loudest and most sustained applause of any applause lines.
The rationale for government intervention in the health care insurance market has many moral attributes. It is immoral, albeit profitable, to deny people coverage because of pre-existing conditions. It is immoral, albeit profitable, for insurance companies to hire teams of lawyers to help them avoid paying benefits because of some loophole in the fine print. But, at a deeper level, the mistrust of government, while healthy in some regards is also immoral. These latter-day patriots who worry about the Second Amendment and show up with guns at events where the President is scheduled to speak have nothing in common with the Minutemen who assembled on the Green at Lexington on a chill April morning. Government is not some alien force and our government is not a foreign monarchy, unanswerable to the will of the people. Medicare may or may not be "socialized medicine" but it has lengthened the life expectancy of the citizenry and immeasurably improved the final years of millions of Americans. Medicare is government-run health care.
If anything, the problem with Congress is that it is too malleable in the face of popular opinion and instead of shaping it, they allow themselves to be terrified by it. August was not, as some have said, an exercise in democracy. Town hall meetings were disrupted by organized conservative groups who had every right to disrupt those meetings. But, say every member of Congress had five town hall meetings and each meeting had 300 people. (I think those estimates are generous.) And, let us stipulate that every single person who attended those meetings was opposed to any further government involvement in health care. That would mean that 1,337,500 people showed up in August to tell their congressman to vote against health care reform. Last autumn, 69,498,952 citizens voted for Barack Obama.
The President tonight must connect the health care reform provisions he will be advocating in the days and weeks ahead with the call for change the voters endorsed last year. And, he must especially re-assure the centrist swing voters that while change is often scary, nothing is scarier than maintaining the status quo in health care. He must also re-assure Catholic swing voters that he is committed to keeping health care reform neutral on the issue of access to abortion. The President faces a tall order tonight, but the only way to hit a homerun in his address is to return to the great moral themes of his campaign. That is why he won last year and it is how he can win this year.