Outside editorial: Obama must be more direct on health care

Posted: Tuesday, July 28, 2009

If you have followed many of President Barack Obama's health care comments and speeches, you know that he pretty much reiterated his views during his prime-time news conference Wednesday. And that wasn't necessarily bad.

We didn't expect him to negotiate with Capitol Hill on national TV, and he was using the White House bully pulpit to explain to Americans why their system needs changing.

He did a good job in a macro way of making clear why reform is necessary. His best moment came when he outlined why Washington needs to overhaul health care financing, control costs and expand coverage. The president correctly reminded Americans that the status quo will lead to a doubling of personal health costs and upward pressure on the deficit because of rising Medicaid and Medicare expenses. He spoke plainly and directly, just as he did yesterday in Cleveland. Both addresses should help people get the point.

He also did a good job in both appearances embracing and explaining the kinds of reforms the country needs to rein in costs. That includes more preventive care and creating incentives for patients to become more discriminating consumers.

And he made clear Wednesday that he would veto any bill that is not deficit-neutral and does not control costs, which was good to hear. Without both elements, other reforms would be meaningless. Less satisfying was his argument that all of these changes could happen without higher costs. Too many questions remain for this claim to have credibility.

Unfortunately, Obama only waded into a few legislative particulars during his question-and-answer session Wednesday; we doubt he moved the needle much with Congress.

And if he wants reform as much as he says he does, that's what he must start doing.

To now, he has remained mostly above the fray, largely letting his aides participate in legislative discussions while Congress works out the details. After the Clinton administration got too deep into policy details back in 1994, this was the sensible course for Obama.

But now it's time for him to be more direct about where he thinks the House and Senate should head with their reform bills. He did some of that yesterday, but if he sits back too much, he could end up getting rolled again. Recall that in the first weeks of his term, the House took his stimulus idea and stuffed the bill with seemingly every wish-list program it couldn't get past a Republican president.

One area where the president has been specific is in his preference for an independent panel to set Medicare rates. We like that because it's more likely than Congress to change how providers are paid.

Obama probably helped himself with the American public with his news conference and his Cleveland speech, making the point that the health care status quo could eat us alive.

Next, he needs to get the details right. And that means being straight - and publicly so - with lawmakers and even reconciling divisions within his White House. Doing this massive reform wrong could create a problem that would rival doing nothing at all.

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