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Obama's Health Plan: The Debate Goes On

Experts React to the President's Speech on Health Reform

By Andy Miller
WebMD Health News

Reviewed by Louise Chang, MD

Sept. 10, 2009 -- Declaring that ''the time for bickering is over,'' a passionate President Barack Obama took a forceful stand for health care reform Wednesday night, explaining his objectives for change while denouncing distortions made by opponents.

But was his speech a ''game changer"? Did it wipe out a month of slipping polls and town hall criticism of reform?

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A single speech can't change the debate by itself, says Julius Hobson, a health policy adviser for the law firm Bryan Cave. "We're in a marathon that will run till Christmas.''

"I think he succeeded in delivering the message,'' Hobson says. "Did he succeed in changing the minds of the American people? Time will tell.''

It had been a rough August for supporters of the Democrats' initiatives. An AP-GfK survey released before the speech showed that public disapproval of Obama's handling of health care had jumped to 52%, an increase of 9 percentage points since July.

Clearly addressing the public as much as Congress, Obama touched on several areas of agreement on health reform, both past and present. "I am not the first president to take up this cause, but I am determined to be the last,'' he said.

He drew strong applause from the joint session of Congress when attacking insurance company discrimination against people with pre-existing medical conditions, citing a woman with breast cancer having her policy canceled because, he said, ''she forgot to declare a case of acne.''

''That is heartbreaking, it is wrong, and no one should be treated that way in the United States of America,'' Obama said.

Ending such insurance practices has gained broad political support, says E. Richard Brown, director of the UCLA Center for Health Policy Research.

The Public Option

On perhaps the most divisive issue of reform, though, Obama again backed a proposal for a ''public option,'' run like Medicare, to compete with private insurance companies in a health insurance exchange or marketplace. Republicans say the public option would eventually lead to the demise of private insurance.

But Obama also said he was receptive to other ideas to foster competition, such as a nonprofit co-op run by consumers. That openness to alternatives ''will disappoint many progressives,'' says Brown, a supporter of the public option.

Greg D'Angelo of the Heritage Foundation, which opposes a government-run public option, says if Obama had scrapped it, "people on the left would have revolted.''

The speech basically ''repackaged'' what Obama has already said on reform, D'Angelo says.

Still, the president reached out at times to Republicans, citing Sen. John McCain's idea to provide immediate insurance reform for helping people with pre-existing conditions.

He also said he would back changes of the medical malpractice insurance market, a topic that drove many Republicans to their feet in applause. Obama said he would pursue pilot projects on malpractice reform proposed by the Bush administration.

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