Thursday, September 10, 2009

Obama's Speech: Why health care reform is pro-America

Hopefully everyone got to watch Obama’s amazing speech on health care last night. I was taking notes—not quite “live blogging,” more like a “tape-delayed” blog—and here are my takeaways:

First, Obama was wearing a red tie. Nancy Pelosi and Hillary Clinton were wearing red pantsuits. Clearly, code for all the socialists out there watching: “we’re with you comrades.”

Second, the Republicans clearly have no plan for health care other than the status quo. I was giving them the benefit of the doubt that they were saving up a surprise proposal to unveil during their response, but the response ended after five minutes and four vague principles. The most attention-grabbing part of the speech was when it ended and the abrupt shift to Wolf Blitzer’s voice jolted me out of my fantasy football draft.

Third, one genius moment was Obama’s remark that insurance companies’ immoral actions aren’t driven by evil executives, but rather by “Wall Street's relentless profit expectations.” Good job connecting the problem he’s solving to the imminently unpopular Wall Street.

Finally, as always, the key to Obama’s effectiveness is tying policies to basic American values—personal responsibility, entrepreneurship, choice, and competition. The strongest passage in the speech was:

He [Ted Kennedy] repeated the truth that health care is decisive for our future prosperity, but he also reminded me that “it concerns more than material things. What we face,” he wrote, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

I've thought about that phrase quite a bit in recent days - the character of our country… On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick; and he was able to imagine what it must be like for those without insurance; what it would be like to have to say to a wife or a child or an aging parent - there is something that could make you better, but I just can't afford it.

That large-heartedness - that concern and regard for the plight of others - is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people's shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise.

Obama is at his best not when he’s not talking about “material things,” but when he’s explaining how policies implicate the “character of our country.”

And it’s still something most liberals don’t get. Western liberalism’s basic premise holds that people are basically rational creatures—lay out the facts, fortify them with statistics, and people will be persuaded, satisfied that your policies advance their material interests.

This is rubbish. It’s not just that policies which seek only to advance the majority’s material well-being are unsustainable, as people will vote themselves both tax cuts and spending and bankrupt the country. It’s not just that people don’t have the time and mental aptitude to sort through the facts. More importantly, rational thinking is not how our brains typically process information. We don’t start from a blank slate, evaluate facts, and come to rational conclusions; judgments of value and worth are entirely subjective.

Rather, we evaluate information relative to a preexisting frame of reference. Effective persuasion is less about comparing costs and benefits, and more about establishing the frame of reference for comparison. In Sales, which is my job’s main field of research, this is a negotiation technique called “anchoring.” Start by quoting an expensive option which you never expected the prospect to buy, and you effectively “anchor” that price as the prospect’s reference point for evaluating the other options as “cheap” or “expensive.” (This is why restaurants will include expensive menu items that don’t actually sell well—the purpose is not to sell them, but to make other items appear less expensive.)

In politics, people’s values are their reference point for evaluating policies and politicians. On complicated issues like health care, it’s not particularly effective to cite studies estimating health care reform’s impact on the deficit or on premiums—the other side can tweak your model’s assumptions to produce an entirely different result. Unless the observer has the data (and the statistical training to analyze it), it’s difficult to evaluate whose numbers are right. Naturally, you accept whichever numbers confirm your worldview. Numbers are a particularly poor method for getting your point across. For that matter, so are facts.

So when President Obama says, “not a dollar of the Medicare trust fund will be used to pay for this plan,” the Republican simply asserts that the plan “cuts Medicare by $500 billion.” Who is right? Are you actually going to read the 1,000 page bill to find out? Of course not—few people know the exact text of the bill. It’s telling that when you ask Americans about “Obama’s health care plan,” a majority oppose it, but when you ask about the specifics of the plan—“the option of being covered by a government health insurance plan that would compete with private plans”—a majority supports it. People are too confused to make a rational choice.

Facts are fungible, but values endure and inspire. And that’s where President Obama excels. In one line, he was able to sum up the basic value that undergirds his policies: “A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand.” Below, I’ve broken it down further, highlighting where his speech nails why health care reform is fundamental to core American (and Judeo-Christian) values: personal responsibility, choice, and competition (today’s post), entrepreneurship, moral courage, and love for your neighbor (coming soon). And I’ve included some supporting facts for the liberals.


Now, even if we provide these affordable options, there may be those - particularly the young and healthy - who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for those people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek - especially requiring insurance companies to cover pre-existing conditions - just can't be achieved. That's why under my plan, individuals will be required to carry basic health insurance - just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers.

Beautifully said. I’ll substitute in a quote from the great socialist classical political philosopher John Stuart Mill:

Every one who receives the protection of society owes a return for the benefit, and the fact of living in society renders it indispensable that each should be bound to observe a certain line of conduct towards the rest. This conduct consists, first, in not injuring the interests of one another… and, secondly, in each person’s bearing his share (to be fixed on some equitable principle) of the labours and sacrifices incurred for defending the society or its members from injury or molestation.” (On Liberty and Other Essays. Oxford: Oxford University Press, 1991, p. 83).

I mean, if that doesn't scream socialism, what does? Obama’s genius is to recognize that personal responsibility encompasses not only taking care of yourself, but also fulfilling your duties to society. Both he and Mill recognize that the conservative ideal of self-reliance is a myth, that no matter our individual talents, Man is a social creature who relies on community for support and protection, and that we must reciprocate that support by looking out for others. Absolute liberty is balanced by duty.

Health care is a fine example. Hardcore conservatives rail that “socialists are making me pay for other people’s health care,” but in reality, that already happens. People who don’t have insurance and get seriously ill are of course not turned away by emergency rooms to die on the street. That would be evil. But those unpaid-for emergency room visits cost hospitals money, and the costs are necessarily passed through to the rest of us. Moreover, insurance risk pools with fewer health people have higher premiums because a greater percentage of the risk pool incurs health care costs. One person’s choice not to buy health insurance affect’s another person’s premiums.

In the same way that no one should be allowed to drive a car without insurance (otherwise you could wreck someone else’s car and leave them to pay for the damages), why should people be free to gamble with others’ ability to afford health care by not purchasing insurance themselves?


Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices… We will do this by creating a new insurance exchange - a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage.

Key words: choices, marketplace, shop, competitive prices, incentive, bargain. These are all words fundamentally associated with business. But even more fundamentally, they underlie the basic premise for why Americans are the most pro-business people on earth: we believe that individuals should be free to make choices that best reflect their interests. Allow people to choose from a variety of services in a free marketplace, and they will naturally select the goods and services most suited to their preferences and budgets. Whether this assumption is an accurate basis for government is another story, but this post is about messaging, and the President’s (accurate) message is clear: health care reform is about giving you more choices.


My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down. And it makes it easier for insurance companies to treat their customers badly - by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates… Now, I have no interest in putting insurance companies out of business… But 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. 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… [but] 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 have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects.

In the same way that Americans love choice, we also love competition and detest monopoly. If businesses are allowed to compete fairly, the best should rise to the top; if you can’t compete, you don’t deserve to be in business. The effectiveness of Obama’s speech is not just in highlighting the anti-competitiveness of our current system, but in his framing of the public insurance option as a little healthy competition—a challenge to insurance companies to be better. It’s a catch-22 for opponents of the public option. If you say that private insurance will be driven out of business by a public option, you’re implicitly suggesting that private insurance firms can’t compete like good capitalists and don’t deserve to be in business; but if you don’t think they’ll be driven out of business, then the “government takeover” argument makes no sense. Either you’re a socialist who believes that government runs things better than private companies, or you have no problem with the reform program.

It is late, and I can’t write anymore. Check back in the coming days for more on Obama, health care, and American values.

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