Getting to the heart of the craaaaaazy US health care debate

I've done it. I have finally got some sort of clue about the health care debate in America. After months of looking foggy-eyed across the pond at the angry debates over labyrinthine health policies, I've cracked it.

The heart of the debate is this - in the words of Barack Obama as delivered to a joint meeting of Congress this week:

...an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

Despite all this, the insurance companies and their allies don't like this idea. They argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I've insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects.

Fairly harmless hey? Hardly plucked from the pages of 'Das Kapital'. But this is what is causing him to be called a "socialist" by his opponents.

It is interesting to hear the Republican response to Obama's speech from Rep. Boustany (transcript here, video here), who is a former heart surgeon. It includes this:

Replacing your family's current health care with government-run health care is not the answer.

From what I can make out, the only thing in Obama's plan which Boustany could be describing there is the option described in the quote from Obama at the top of this post. But how on earth could this be described as "replacing your family's current health care with government-run health care"? It's a marginal non-subsidised voluntary option. But old Boustany uses a sweeping statement as if the whole Obama plan is set to forcibly remove all families from their insurance policies and force them to take a government scheme.

Boustany's précis is precisely ludicrous. It is staggering that such a modest proposed solution (from Obama) for such a monumental moral and economic problem is being met with such an utterly stupid characterisation from the right wing. As Obama said twice:

...I will not sign a plan that adds one dime to our deficits -- either now or in the future.

I've watched the full video of the speech. As usual, there's great entertainment value from watching the Human Performing Seal, Nancy Pelosi, jumping up and down and clapping behind Obama. And watching the reluctant standing ovations from the Republicans, and when they are not quite sure whether to stand or sit, is fun. In an interesting example of anti-partisanship, Obama even gets a standing ovation from the Republicans (while most of the Democrats remain seated) for one point (his proposal to reform medical malpractice laws).

The moment when Rep Joe Wilson shouts out "You lie" is quite breathtaking. You can see it at 27:05 on the video below. Those two words may turn out to be fairly significant both in the health care debate and the career of Rep Wilson. His South Carolinan seat has now gone from relatively safe to very close overnight and his Democrat opponent has raised $700,000 in the couple of days since Wilson uttered those words.

Overall, the speech was in two halves. First, Obama very clearly and comprehensively outlined the plan in very attractive terms. Second, he did one of his oratorical soarings, invoking the words of the late Senator Ted Kennedy, whose prehumous letter he received recently. This bit towards the end is just sensational:

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter -- that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves. That was true then. It remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road -- to defer reform one more year, or one more election, or one more term. But that is not what the moment calls for. That's not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. (Applause.) I still believe -- I still believe that we can act when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test.

All in all, a stunning speech which has met with significant improvements in both Obama's ratings and the public's perception of his health care plan.

Here is the full transcript of the Obama address and click below to see it in full on C-Span via YouTube: