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Analysis: Obama laid out his case, but didn't convert opponents, say experts

This article first appeared in the St. Louis Beacon, Sept. 10, 2009 - Throughout the presidential campaign, Barack Obama relied on his oratorical flair to excite a crowd (take his acceptance speech from the Democratic National Convention) or rescue himself from a politically damaging situation (see his speech on race in the midst of the controversy over the Rev. Jeremiah Wright.)

In his televised address Wednesday to the joint session of Congress, President Obama waxed poetic about lessons in bipartisanship learned from the late Sen. Edward Kennedy. But for the most part, the president concentrated on the latter objective: taking charge of the health-care conversation that had largely spun out of his control this summer.

"The time for bickering is over," Obama said in his address. "The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do."

With Wednesday's speech, did Obama accomplish what he set out to do? The politicians have weighed in -- in some cases immediately after the speech was over. Among public-policy experts, and ordinary citizens, opinion is also divided. Depends on whom you ask and how you measure success.

Robert Cropf, an associate professor and chair of the department of public policy studies at Saint Louis University, said Obama might have won over political independents already leaning toward Democratic versions of health-care legislation, as well as viewers who were tuning into the health-care conversation in a serious way for the first time. But, he said, the speech wasn't intended to change the minds of those vehemently opposed to the plan broadly outlined by the president.

"Overall it was a strong speech for him," Cropf said. "You have to judge it by its intention, and if you do, it's clear that it helped his cause, even if he's not going to convince his enemies at this point."

Cropf said Obama was more specific about what he'd like to see in a health-care reform package than he had been in the past. In the speech, the president said that his plan would help the uninsured, give more security and stability to those with insurance, and help bring down health-care costs.

Barbara Martin, a retired school teacher, said she thought Obama clearly and concisely explained his goals for health-care legislation. "The way he broke it down and spoke about the major parts of his plan made the speech very understandable," Martin said. "The thing that sticks out in my mind is his point that everyone takes responsibility for insuring people in this country."

The president attempted to present himself as a pragmatist and centrist. "I believe it makes more sense to build on what works and fix what doesn't rather than try to build an entirely new system from scratch," Obama said.

Bob Knowles, board president of the St. Louis Area Business Health Coalition and team leader for health and welfare benefits at Monsanto, said he is pleased that Obama spoke about wanting to slow the growth of health-care costs, protect Medicare and refrain from adding to the national debt.

Knowles said he wanted to hear more from the president about how best practices in health care could be implemented across the country. He said he also would have liked more detail about improving the quality of care.

"Like many people, I have concerns about the details that will be worked out later," Knowles said. "My concern is that Congress takes enough time to understand the legislation proposed without rushing to approve something."

Tim McBride, a health-policy analyst and associate dean for public health at Washington University, said Obama was clearer about what he wanted in health-care legislation than he had been in previous speeches and was as specific as he could be in an hourlong address. McBride said he wasn't surprised by the elements that Obama focused on because they have been major parts of existing Democratic proposals.

McBride said it was striking how little time Obama spent explaining how the bill would help the uninsured. He said he also was surprised that the president didn't focus more of the speech on what the elderly have to gain from a health-care overhaul.

While Obama broadly mentioned how the plan would be paid for, McBride said the president made a political calculation not to go into too much detail. "When you get into cutting things, you open yourself up to criticism and you become a target," he said.

McBride added that he didn't consider the speech bipartisan.

"He was really sending a message that it's time to move on this debate," McBride said. "He did suggest that if any Republicans are ready to come along he's willing to listen, and you could read into the speech certain places where he was reaching out. But he said directly that there were politicians who had misrepresented the plan, and if they continue to do that he'll call them out on it."

Obama told Republican lawmakers that he is willing to listen to "serious" health-care proposals. But he said he wanted to steer the debate away from what he described as distortions that were repeated during testy town hall meetings last month. "What we've ... seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government," the president said.

Cropf, the SLU professor, said Obama did well to debunk some of the accusations that had been floated in recent weeks, including the idea that the bill would set up "death panels," to which the president said "it's a lie, plain and simple."

"In some ways," Cropf said, "this is the speech he should have given earlier. But no one knew at the start of summer the kind of rancor that would be displayed at town hall meetings. And I don't think it's too late for this message."

William Fogarty, a retired physician, agreed that Obama was able to direct the conversation away from talk of death panels and toward his agenda. "Whether he changed anyone's mind is another question. I'm not sure he did. I'm not sure he can."

Fogarty said he wishes Obama would have dedicated more time to speaking in detail about cost control measures and how to respond to the shortage of primary care physicians who provide much of the preventative care.

Jason Vander Weele, who works for BJC HealthCare in the school outreach and youth development department, said he was impressed by Obama's ability to address the politicians the president accused of fear-mongering. "It set a higher standard for the entire Congress and the nation," Vander Weele said. "He was taking on the fact that politics have gotten in the way of most things lately."

Obama also addressed perhaps the most controversial part of the plan -- the so-called "public option." The president said that while he favors the option for people who don't have insurance, "It's only one part of my plan ... it shouldn't be used as a handy excuse for the usual Washington ideological battles."

Vander Weele said he got a better understanding of how the public option piece of the plan would work. Knowles said he wanted to hear more detail about how the public option would be managed.

Added Cropf: "If anything, he more strongly embraced the public option than he has in the past. But if you're strongly opposed to more government intervention in health care, you're not going to support the bill because the president said what he did."

Still, McBride said Obama seemed to leave the door open to other proposals that reach the goal of covering the uninsured. "Reading the tea leaves on this one, he was saying go ahead and vote for the public option, but I'm willing to look at others," McBride said. "He didn't lay down the gauntlet and say, 'I'll veto it if it's not in there.'"

Rep. Charles Boustany, R-La., a heart surgeon who delivered the official Republican response to Obama's speech, said Republicans agree with the president on certain aspects of the plan, including the idea that people should have access to health-care coverage regardless of preexisting conditions. But he questioned the need for a public option.

"It's clear that people want health-care reform," Boustany said. "Replacing your family's current health care with government-run health care is not the answer. In fact it'll make health care much more expensive."

Obama said in his speech that he won't sign any legislation that adds to the federal deficit. Ken Schafermeyer, a health-care economist and professor of pharmacy administration at St. Louis College of Pharmacy, said it was important for Obama to repeat the promise of any proposal being budget neutral. He also said Obama likely quelled some fears about government playing an increasing role in health care.

Several observers said Obama was strongest toward the end of the speech, when he praised Sen. Kennedy's ability to reach across the aisle, underscored the importance of finally reaching a deal on health care after decades of misses, and struck a tone that was reminiscent of his campaign stump speeches.

"It's classic Obama in the sense that he combined the policy wonk with the evangelist," Cropf said. "Health care has become the centerpiece of his young administration. For (health-care legislation) to pass, he has to operate in campaign mode from this point on."