The speech: What he said, what he meant

President Barack Obama on Wednesday night tried to portray health care reform – potentially the most sweeping overhaul to American society in some 40 years – as something as nonthreatening as buying auto insurance.

health insurance, covering their doctor bills the way they would pay for a car accident. A government-run health insurance option would be akin to the way private colleges battle with state universities for students.

And a government takeover of health care? Hardly, said Obama. Only 5 percent of Americans would use the public option even if it existed.

But behind that rhetoric, Obama was laying out massive changes to the health insurance system that have raised concerns that one high-stakes speech to Congress seem unlikely to quiet – and highlighting divisions in his own party that seem certain to continue.

He set out to speak with average Americans and call for a new era of civility, but he also laced his speech with jabs at Republicans and lines directed at a handful of lawmakers sitting in the House chamber.

And in the end, a speech meant to reset the health care debate ended up sounding in large parts like speeches Obama gave before, raising the question of whether the public heard anything Wednesday night to calm their nerves. But they would have had to listen closely to what Obama was really saying, so here’s the POLITICO translation:

What he said: This is the plan I’m proposing. It’s a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.
What he meant: Hey, Republicans – you know I won’t bite on your version of reform. So I’m not exactly worried about a GOP stampede to the Oval. But that doesn’t mean I won’t call my plan bipartisan. . . I’m extending my hand, and I’ll include a few GOP-sounding ideas here and there, like medical malpractice fixes. Voila, it’s bipartisan!

Obama is trying to argue that the process can be considered bipartisan even though no GOP lawmakers voted for the bills in committee, and it’s possible none will support it on final passage (except maybe Olympia SnoweOlympia Snowe of Maine). Some Democrats, particularly those in GOP—heavy districts, are dreading the prospect of aparty-line vote, because it would play in to the Republican argument that Obama is ramming it through. So Obama is determined to call his bill bipartisan, whether it truly is or not.

What he said: But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it.

What he meant: I can pass this bill with 51 votes in the Senate, and don’t think I won’t do it.

This is a lesson learned from the economic stimulus fight. The White House publicized its hopes of winning significant Republican support, only to be spurned. Obama is willing to talk with Republicans, and dial up Olympia Snowe or Chuck GrassleyChuck Grassley when necessary, but he will not allow their tepid support to scare him away from passing a bill this year. And he certainly doesn’t plan to take the advice of Senate Minority Leader Mitch McConnellMitch McConnell (R-Ky.) to start the process from scratch. He is moving ahead – even if it means using reconciliation, a last-ditch procedural maneuver that allows him to pass legislation with a simple majority rather than a filibuster-proof majority.

What he said: That is why we cannot fail.

What he meant: Did I say we? That is why I cannot fail. I saw what happened to the last guy who dropped the ball on health care – President ClintonPresident Clinton, meet Speaker Gingrich.

Make no mistake: Obama’s failure to achieve health reform this year – after investing so much time and energy in it – would severely weaken his hand for other big fights, like energy legislation, and embolden the GOP heading into 2010 and even 2012. Despite the setbacks, all signs suggest Obama will be able to pass some reform legislation this year – seriously watered down, perhaps – but the prospect of outright failure has to rattle even the normally cool-headed Obama.

What he said: Well the time for bickering is over. The time for games has passed.

What he meant: I sure am glad August is over.

Obama was trying to mark a clear break from the angry recess, when YouTube clips of irate voters dominated the conversation. Unfortunately, for Obama, his hopes for a new season of civility were dashed within minutes as Rep. Joe WilsonJoe Wilson (R-S.C.) yelled from the House floor, “You lie!” Wilson took issue with Obama’s statement that the reform would not cover illegal immigrants. In an unusual exchange for such a setting, Obama shot back: “That’s not true.”

What he said: There are now more than thirty million American citizens who cannot get coverage.

What he meant: I know I said as recently as last month that there 47 million uninsured, but I’m changing the baseline.

Nope, 17 million people did not just find insurance in the last month. The adjusted figure is part of the White House’s effort to distance itself from claims that health reform will cover illegal immigrants. Census figures, which will be updated Thursday, show there are 47 million uninsured – but about 10 million are illegal immigrants. Another five to seven million are people who could go on Medicaid, but have not. That leaves about 30 million that the president needs to cover under the bill. Expect to hear this number instead of the larger figure from now on, according to White House aides.

What he said: To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal.

What he meant: Ease up already on the public option.

Democrats have pushed for health care reform for decades – and it was only after the 2004 presidential election that public option became an element of the overhaul debate. Obama was trying to remind Democrats who have made it a do-or-die issue that health care reform has long been about so much more. And he was trying to let them down gently – giving a pretty full-throated defense of the idea and trying to talk down Republicans who say it’s “socialized medicine” by pointing out only 5 percent of Americans would even use it.

But in trying to give a spoonful of sugar to progressives, Obama probably bought himself many more weeks of “is the public option in or out?” talk, in his own party and in the media – crucial weeks that could be better spent negotiating stuff that will end up in the bill, like how much to cut costs in Medicare or what insurance co-ops might look like. Or even negotiating whether there should be a trigger to the public option.

What he said: In the meantime, for those Americans who can’t get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCainJohn McCain proposed it in the campaign, it’s a good idea now, and we should embrace it.

What he meant: Look, Republicans, I am championing an idea that one of your own – heck, your presidential nominee in 2008 – supports. So how long can you continue to say I don’t listen to you?
For a speech meant to speak to average Americans, there were plenty of insidery winks – and jabs – targeted at the 535 members of Congress sitting in the chamber. He chided Republicans – twice – for going to war in Iraq and enacting tax cuts without paying for them. He reminded Sen. Orrin HatchSen. Orrin Hatch (R-Utah) and Sen. Chuck Grassley (R-Iowa) – two Republicans who have been open to a reform bill – about their willingness to work with the late Sen. Ted KennedyTed Kennedy (D-Mass.). Obama was counting noses Wednesday night, not merely laying out a grand vision for America.

What he said: 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.

What he meant: So easy, a caveman can do it.

If Obama sounded a little like a GEICO insurance salesman, there was a reason for that. He wants it to sound simple and non-threatening. But with this one single sentence, Obama probably bought himself a whole new series of conservative talking points about Big Brother telling individual Americans how to live – by forcing them to buy health insurance.

Obama did not favor the individual mandate during the campaign, in part because he did not want to mandate insurance and penalize people until coverage was made more affordable. But the insurance industry said it cannot agree to the market reforms, such as ending their practice of denying or dropping coverage for people with preexisting conditions, unless every American is required to buy coverage. Republicans are now seizing on a plan released by Senate Finance Committee Chairman Max BaucusMax Baucus (D-Mont.) that would fine families as much $3,800 for not buying coverage.

What he said: I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. . . . I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It’s a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.

What he meant: See, I’m not so bad – I’ll even do something George W. BushGeorge W. Bush wanted to do, right here, right now.

This was another proposal aimed at Republicans, some of whom say the lack of attention to medical malpractice is a reason to oppose the health care overhaul. Obama made an explicit bid for their support, but take note of what he didn’t say: The president did not suggest he add malpractice measures to the bill. Republicans are unlikely to budge. A senior GOP aide said Wednesday that the opposition to the public insurance option is so strong that a sop to liability reform can’t make up for it.