“If not now, when? If not us, who?”

At last, Obama is back in campaign mode.

I wondered when Barack Obama was going to get back into campaign mode around health care. The answer seems to be: now. And he’s still pretty good at it. From Obama’s Arcadia University speech today (Video here.):

The insurance companies continue to ration health care based on who’s sick and who’s healthy; on who can pay and who can’t pay. That’s the status quo in America, and it is a status quo that is unsustainable for this country. We can’t have a system that works better for the insurance companies than it does for the American people. (Applause.) We need to give families and businesses more control over their own health insurance. And that’s why we need to pass health care reform — not next year, not five years from now, not 10 years from now, but now.

Now, since we took this issue on a year ago, there have been plenty of folks in Washington who’ve said that the politics is just too hard. They’ve warned us we may not win. They’ve argued now is not the time for reform. It’s going to hurt your poll numbers. How is it going to affect Democrats in November? Don’t do it now.
My question to them is: When is the right time? (Applause.) If not now, when? If not us, who?

Think about it. We’ve been talking about health care for nearly a century. I’m reading a biography of Teddy Roosevelt right now. He was talking about it. Teddy Roosevelt!

We have failed to meet this challenge during periods of prosperity and also during periods of decline. Some people say, well, don’t do it right now because the economy is weak. When the economy was strong, we didn’t do it. We’ve talked about it during Democratic administrations and Republican administrations. I got all my Republican colleagues out there saying, well, no, no, no, we want to focus on things like cost. You had 10 years. What happened? What were you doing?

Every year, the problem gets worse. Every year, insurance companies deny more people coverage because they’ve got preexisting conditions. Every year, they drop more people’s coverage when they get sick right when they need it most. Every year, they raise premiums higher and higher and higher.

Just last month, Anthem Blue Cross in California tried to jack up rates by nearly 40 percent — 40 percent. Anybody’s paycheck gone up 40 percent?


Yes, it’s hard. It is hard. That’s because health care is complicated. Health care is a hard issue. It’s easily misrepresented. It’s easily misunderstood. So it’s hard for some members of Congress to make this vote. There’s no doubt about that. But you know what else is hard? What Leslie and her family are going through — that’s hard. The possibility that Natoma Canfield might lose her house because she’s about to lose her health insurance — that’s hard. Laura Klitzka in Green Bay having to worry about her cancer and her debt at the same time, trying to explain that to her kids — that’s hard. What’s hard is what millions of families and small businesses are going through because we allow the insurance industry to run wild in this country.

So let me remind everybody: Those of us in public office were not sent to Washington to do what’s easy. We weren’t sent there because of the big fancy title. … We weren’t sent there just so everybody can say how wonderful we are. We were sent there to do what was hard. We were sent there to take on the tough issues. We were sent there to solve the big challenges. And that’s why we’re there.

And at this moment — at this moment, we are being called upon to fulfill our duty to the citizens of this nation and to future generations.

So I’ll be honest with you. I don’t know how passing health care will play politically, but I do know that it’s the right thing to do. It’s right for our families. It’s right for our businesses. It’s right for the United States of America. And if you share that belief, I want you to stand with me and fight with me. And I ask you to help us get us over the finish line these next few weeks.

The need is great. The opportunity is here. Let’s seize reform. It’s within our grasp.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

24 thoughts on ““If not now, when? If not us, who?””

  1. Great speech, but Obama's plan leaves me with no policy until 2014. It's wrong, and it's also stupid politically. I donated $2000 to Obama last time – this time I'm not even going to walk down the street to vote for the spineless corporate patsy unless I have a policy in place. Likewise my many donations to democratic candidates around the country. Multiply me by a million and then tell me how smart Rahm Emanuel is.

  2. If not this plan, then what?

    How about something that focuses on actual cost drivers? The insurance industry is a mess of bad incentives, but like med-mal, it's not the cost driver.

    How about a guaranteed basic coverage, government-provided? Basic–as in "the most valuable 1/2 of healthcare" free to everybody, replacing all the current government programs? (Doesn't require any new funding.)

  3. Mark, let's hope that Obama has some fire in his belly this time, and understands that he's in a zero-sum game with the GOP (at best; IMHO they're happily playing negative-sum games).

  4. SamChevre: nice but no cigar. The plan on the table is the second- or third-best one that has passed both houses of Congress, with slight differences that can be quickly reconciled by a process amazingly called reconciliation. If it fails, it will not be replaced by your clever plan. In fact, health care reform will be off the table for 10 years, during which half a million Americans will die earlier than necessary, the US government will slide close to bankruptcy, and a discredited Democratic party will be unable to get anything serious done on climate change or jobs.

  5. James has it about right. And this isn't about Republicans – this is about the battle between the democratic spectrum. The bill is better than nothing. The bill is better than nothing. (Once more?) And if you think we're getting another crack at it before 2014, or 2020 for that matter you're smoking something great.

  6. What I want in a reconciled bill:

    1. An explicit guarantee that States can decide to do the right thing and institute some form of single-payer. The Senate bill doesn't allow this.

    2. Either the mandates come out or a public-run insurance option goes in. At this point, I don't care which.

    What I'd really like to happen is that I wake up tomorrow morning and discover this has all been a really bad dream induced by general anesthesia. George Dubya was never President of these United States, and we have a good single-payer system in place. As an alternative, I'd settle for a substitute bill a la the so-called USA PATRIOT Act that institutes single-payer nationally. Those worthless b******s in Congress never bothered to read that piece of legislation before they passed it. The least they can do is to give a substitute health care bill similar (lack of) scrutiny.

  7. James, your argument against a better bill seems to be that it is too hard… I take it from your agreement with the tone of the speech that you think we should only do things that are just hard enough? I'm going to change tack on my position on this bill, however, and say that if Dennis gets what he wants I may not vote against all of my representation in Congress that votes for this bill.

  8. Mr. Obama and the Democrats should have been using the real world examples of people and families months ago.

    I swear they really did believe the GOP would come around and compromise.

  9. I have a suggestion for Obama: Don't make jokes about people's paychecks not increasing.

    The idiot has forgotten that he's not running for president, he is president now.

  10. Why, exactly, should anyone pay the slightest attention to the President, when he is only just now noticing what has been as plain as the nose on his face to everyone else since January 20, 2009? One thing Obama has taught me once and for all time, talk is cheap. Not only that, this half-assed "reform" doesn't even take place, for the most part, for four more years. What are people like "obessed" supposed to do in the mean time? Oh, yeah. Don't get sick. And that also applies to many of us who think we are taken care of by these same goddam companies through our employers.

    Oh, and btw, this presidentin'? "Yes, it’s hard. It is hard." No sh*t, Sherlock. Try to avoid sounding so much like your immediate predecessor. It's very unappealing.

  11. I see in the comments of people like Sam a strong demand for A Pony. Their comments are pure pony effluent. The bill's flawed, but it's a huge improvement and – incredibly – has chance in Congress.

  12. Ahhh, nice speech. Imbues one with complete confidence that HCR will pass, right after the closure of Guantanamo and Khalid Shaikh Mohammed's trial in a real court of law. Because President Obama does not make promises that he can't, or won't, live up to.

  13. KLG – Obama is saying it's hard for everyone – the public, congress, etc. – whereas Dubya was saying that it was hard for himself. There's an enormous difference. Obama, as he often does, is invoking the spirit of self-sacrifice, hard work and perseverance for all people and parties to come together and pass healthcare. Dubya was just complaining.

    If we do pass reform and you get sick after 2014 you will be glad. If we don't and you get sick after 2014 you will wonder what you were thinking on days like today. I don't see why a four year delay in implementation of reform (if it is passed) should kill our best chance to pass it in a century.

  14. DW – Obama has been a complete and utter failure, given his campaign based on "change we can believe in." There has been no change on anything we thought we were electing him to do after the long dark night of the Reagan-Bush Descendancy (including the Clinton-Gore Interregnum). No one expected victory after victory for the forces of light, so to speak, but we expected real effort. There was none. After his election the President completely "forgot" who it was that elected him. Period. Yeah, I know. Some things have been accomplished and we are better off with Bible Spice giving speeches in Canada. But here is the thing: Obama had a real mandate and he totally blew it. Yeah, it's hard. Especially if you are not willing to fight for what you believe in (if you actually believe in anything other than your own grandiloquence – and the jury is out on that as far as Obama is concerned). Bipartisanship is fine, before about 1980. Since then, not so much, and every sentient political being knows this. Except for the President, apparently. And the 4-year delay in implementation of HCR (sic)? Total bullsh*t. And if I get really sick? I expect to go bankrupt. I have been paying health insurance premiums through my employers (mostly academic institutions) for myself and then my family for 35 years. Except for the birth of two children we have never taxed they system very much. But my premiums have increased and increased while my coverage has shrunk and shrunk. When the time comes for one of us to really need health care it won't be there in any form to keep us from losing much of the so-called wealth we have accumulated. Nothing in this insurance company rescue scheme seems to be designed to prevent that. Not really. There are ways to fix the system, however, but Obama has not even tried. Yes, it might have taken something like the LBJ effort on civil rights and voting rights and economic opportunity, with consequences for Democrats similar to those foreseen by LBJ himself (but I doubt that since there would be no (mis)perceived winners and losers in a new, legitimate health care system…only winners. Except for a vanishingly small number of misanthropes (The multitudes of insurance company clerks? Well, they would have to find other jobs, just as have steelworkers, textile workers, autoworkers, longshoremen, small retailers, tool-and-die makers). And Obama may well have failed. But we will never know. Pity.

    Finally, you speak of "…the spirit of self-sacrifice, hard work and perseverance for all people and parties to come together and pass healthcare." None of this applies to the GOP as it is currently constituted and especially its wingnut appurtenances. Not one goddam thing on that list…and it is as plain to see now as it was a year ago. For everyone not in the West Wing anyway. That is all.

  15. Sorry–I thought that was a serious "what would be a better plan" question. What's a better ACHIEVABLE plan is a different and harder question.

    But President Obama's campaign was based on a "no mandate" promise. That puts limits on what kinds of reform are possible. What's being proposed now isn't compatible with that promise; it will help some, maybe, but as far as I can see, it's not really going to do much about the underlying costs issue. (IF it introduces a standard claim form, that will probably do more about real problems than the whole rest of the bill.)

  16. SamChevre, Obama's "no mandate" promise was always an awful and dishonest political calculation – and so far as I can recall, it was received as and derided as such by everyone who thought seriously about these issues, including Obama-friendly people like Matt Yglesias and Ezra Klein (though I was otherwise about as Obot as they come, that and his railing against taxing health care benefits were a couple of my biggest disappointments in his campaign stances – overall, not just in health care). Apparently mandates scare people and even conjure accusations of unconstitutionality and even tyranny, so campaigning against them was maybe the clever move. But the simple fact is that if you're going to have guaranteed issue and community rating (and we need these things, and a public option or single-payer would also have them, only more so) then you've got to have a mandate; otherwise people don't get insurance until they're really sick and premiums skyrocket accordingly. So, yes, he's dropped his "no mandate" pledge – but it's about the only dropped pledge whose abandonment I've celebrated.

  17. I agree with James and Eli in the end.

    I too was disappointed with what we're getting. I don't know why the Prez ever said the words "public option" if he didn't mean them. I dearly wish he hadn't. What I learned from President Clinton, bless his soul for trying, is that flowery language bugs the hooey out of me. I'd rather have Gray eff'g Davis every single day of the week. At least you know where you stand! Boring is the new black for me.

    But, this bill would still be better than what we have now. I am in the individual market, I got one of those Anthem BC MoFos letters and there's not a darned thing I can do except dump my coverage. Such a tempting thought! My UI is about to run out, maybe I will have to anyway. And I'm lucky, I'm healthy.

    Let's face it, we live in a dumb country. We don't use the IQ we have. I'm surprised we got this far. And remember, the problem is Congress and the Democrats, *not* the President. I still like him a lot.

  18. Wow. I see stuff like KLG's post above – and wonder where on Earth he's getting his information. A bill with community ratings (rather than allowing insurance companies to charge at risk people more money) and no bans for pre-existing conditions; one that allows young adults to stay on their parent's insurance until 26; one that outlaws recission (hunting for bogus reasons to cancel insurance when someone gets sick); etc. These are real achievements, not nothing. And the sweeping dismissal of everything that Obama has done? Myopic is the kindest word that I can think of.

  19. Actually, Marc, can't the insurance companies charge older people more money for their coverage? You know, like me…one of those at higher risk for any number of things. And the fact that a child may have to remain essentially a dependent until the age of 26 is simply absurd; my daughter will be 26 this summer, so what good would that do her, since she will be 30 before HCR (sic) kicks in? If you want to run down the list of all the things Obama has done, I'm all years. Seriously. But start with the things he promised during the campaign I and millions of others supported with time and money because we believed him. For example: Public option, Gitmo, restoring the rule of law (instead of "looking forward"), winding down the wars…BTW, I know the RBC isn't particularly used to DFHs showing up, so I do apologize for being shrill.

  20. KLG, I'm at a loss to understand what you would have had Obama do to get the public option into a bill that could pass. The clearest answer I've heard from those taking your position is that he should have been "tougher" or worked "harder". But by what metric are you judging him? I mean, he obviously hasn't done nothing. He and his cabinet have been working with congress on this for a year now. For instance, how much harder could Obama have worked on Ben Nelson?

    It all just sounds premised a totally unrealistic understanding of the limits of the executive branch.

  21. Eli: Yeah, probably. Incremental is obviously the way to go, unless you actually want to get somewhere. In my field "incremental" is the kiss of death from a reviewer, but that's neither here nor there. Still, I am unaware of when Obama actually worked, other than through such leading lights as Max Baucus, for what he said during the campaign that he wanted on HCR (sic). Until fairly recently that is or unless he just lied. Private deals and/or negotiations don't count, because there is no reason to believe that the Administration will tell the truth (what was in that agreement with Big Pharma anyway?). But I'm still waiting for a reality-based explanation of why it was reasonable for the President to hold out for a bipartisan solution that he was never, ever going to get. This is a battle he may well have lost this time, but had he defined his opposition as would have been ridiculously easy to do, he would have been able to come back stronger, with re-invigorated support from the majority of us who elected him in the first place. There are worse things than losing, but when you have the upper hand you absolutely must press it as far as you can rather than negotiate in public with yourself in the face of an implacable foe. And the latter-day GOP in its various manifestations is nothing if not implacable. One other thing. I am not in the private health insurance market, but I fail to see how the federal government can legitimately prescribe, under penalty of law, that certain citizens must buy a product from a private vendor. Automobile insurance is not a good example; people don't have to drive.

    And, btw, I never said that Obama has done nothing. As you put it he "obviously hasn't done nothing." But your double negative doesn't inspire much confidence that he has actually done something to be remembered for, except for the Lily Ledbetter Act. A reality-based explanation of why HCR (sic) won't kick in completely until 2014 would also be nice to hear ("it's complicated and it's hard" is not an acceptable explanation absent a few details). The crisis is now, not in 2014. If I am wrong on community rating and older people will not be charged more, as much as 4X more, than young people, the RBC answer to that question would be appreciated, too. Doesn't sound much like pooling the risk to me. Ditto for the "26-year-old still on the parents' health insurance." This is a good idea how? What if the parents don't have insurance? What if they die? Oh yeah, the tender mercies of Anthem Blue Cross for the next 4 years, I forgot. Finally, as for my "totally unrealistic understanding of the limits of the executive branch" run it by me again how this mattered during the previous Administration. Until now I have followed my late but longstanding mentor, Michael Harrington, and practiced my politics on the left wing of the possible. No more though. The left wing of the possible has become nothing but corporatist co-dependence across the spectrum of civil society. There is no future in that. Pity.

  22. Oops. Forgot this: "how much harder could Obama have worked on Ben Nelson?" I don't know, but Obama is the political genius. Not me. Obviously. Cheers!

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