It’s a truism that health care reform is so hard in large part because so few people actually understand the stuff. Well, President Obama is working mightily to frame this year’s debate simply: It’s a tug-of-war between those who want to fix a self-evident problem and a few flat-Earthers who thrive off its dysfunction. So the president held fast last night to the simple message he’s articulated repeatedly in recent days: American health care costs both consumers and taxpayers way too much money, yet still offers lousy service to most and none at all to millions. As David Corn points out over at MOTHER JONES, Obama’s rhetorical game plan is to mesmerize folks with his calm, confident mastery of both the policy details and that simple big picture. Sound familiar? Yes, it does.

Which is crucial. Ultimately—and maybe very soon—Obama is going to have to sell a health care reform package as his plan. [snip] Obama will essentially have to say, Take it from me, this is good legislation that the country needs now. And to do so, he will have to have a boatload of credibility. That's what he displayed in the East Room of the White House.

Forcefully, Obama talked us back to the halcyon days of 2008, when huge majorities agreed that we must wade out of our old quagmires, from Iraq to health care. He’s betting that, despite Congress’ daily twists and turns, he can keep Americans rooted in the consensus from which this all began—that the current system is broken. It costs too much:

Right now, premiums for families that have health insurance have doubled over the last 10 years. They’ve gone up three times faster than wages. So what we know is that, if the current trends continue, more and more families are going to lose health care.

It’s draining taxpayers:

We also know that health care inflation on the curve that it’s on, we’re guaranteed to see Medicare and Medicaid basically break the federal budget.

And it’s not even providing the best care:

On average we, here in the United States, are spending about $6,000 more than other advanced countries where they’re just as healthy. And I’ve said this before, if you found out that your neighbor had gotten the same car for $6,000 less, you’d want to figure out how to get that deal.


This last point is both the most salient and the most elusive for reform advocates. A growing, but too easy conceit is that the president is hiding the pain of reform. As ABC’s Jake Tapper offered in questioning Obama, “You don’t talk about the sacrifices that Americans might have to make.” Yes and no. If the public plan does its job, there’s plenty of reason to believe that employers will migrate to it. Which means people will in fact be forced to give up their current coverage. But it also means they’ll be getting cheaper, better care. And here’s where Obama was at his best last night. “They’re going to have to give up paying for things that don’t make them healthier,” he told Tapper, before launching into an all-too-relatable scenario in which needless, repeated tests waste not just time but money.

You may not see it, because if you have health insurance right now, it’s just being sent to the insurance company. But that’s raising your premiums. It’s raising everybody’s premiums. And that money, one way or another, is coming out of your pocket. Although we are also subsidizing some of that because there are tax breaks for health care. So, not only is it costing you money in terms of higher premiums, it’s also costing you as a taxpayer. Now, I want to change that. Every American should want to change that. Why would we want to pay for things that don’t work?

The fact is that all of our beloved choice in the health care market is hurting us. Obama was also refreshingly frank in describing who benefits from the status quo—Republicans groping for a political win and an insurance industry that’s making a killing. (“Right now, at the time when everybody’s getting hammered, they’re making record profits and premiums are going up.”) But he was much less direct about those in his own party who are trying to run out the clock. House Speaker Nancy Pelosi insisted yesterday she’s got at least her caucus under control. Chris Hayes over at THE NATION joined a group interview of Pelosi and reports,

She seemed confident about the House being able to pass a healthcare bill with a "strong" public option, the importance of which she repeatedly stressed. "That's gonna happen," she said flatly. She also said that for all the stories about Democrats rebelling over the Ways and Means proposed surtax on the rich, she's gotten very little push back from members of her caucus. [snip] While she suggested the house would pass their version of the bill before August recess, she stopped short of promising it. She clearly feels the urgency, however. "Ideas can melt in the sun," she said, "especially in August."


That’s a nice line, but it’s likely at this point Obama and Pelosi nonetheless will have to figure out how to keep reform cool through August.