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Obama seizes the moment but did he change the game

Paul Jay speaks with Roger Hickey at the Tides Foundations’ Momentum Conference in San Francisco about the importance of Obama’s congressional speech.

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PAUL JAY, SENIOR EDITOR, TRNN: Welcome to The Real News Network. I’m Paul Jay in San Francisco. We’re at the Momentum Conference. Now joining us is Roger Hickey, one of the cofounders and leaders of Campaign for America’s Future. Thanks for joining us.

ROGER HICKEY, COFOUNDER, CAMPAIGN FOR AMERICA’S FUTURE: Good to be here.

JAY: So we just heard President Obama’s speech. He made an inspired ending, called for shaping the future, not being scared of it. I guess it’s the sort of statement one could make in a war and many other places; it wasn’t inspiring. But the truth about this health-care reform is that it’s going to be in rather boring, banal detail that we find out whether this is real reform or not. So give some of your impressions of the speech. You couldn’t have helped but be excited, but [inaudible] banal.

HICKEY: You and I both watched the speech in a large crowd of progressives here in San Francisco.

JAY: Well, I was up in my room. I was being a journalist. I stayed clear of it.

HICKEY: Alright. Well, let me tell you, this was one of the best crowds to watch the speech I could have found. They were very, very enthusiastic. And some of the people in that crowd are strong single-payer people, very progressive folks, and they were delighted with their president today, and I am too. As you say, the banal details of health-care reform are important, but we were in danger of being swamped by those details, we were in danger of being just discouraged in the political system from ever finding a strong way forward. And what the president did today is that he clearly stated what he was for and how he was going to achieve health reform with the Congress. He said he’s going to take charge of this debate now. And he did probably the best job that I’ve heard in explaining the basics, the basic elements of a mixed system that he is proposing, and he didn’t shy away from explaining that the insurance companies and their business practices are part of the problem. The insurance companies, I think he said, are not jacking up prices and denying people coverage because they’re bad people; they are doing it because it’s profitable to them.

JAY: But if that was all it is, the regulating of the private insurance companies and let’s put the public option over here, that first part of it, the insurance companies were ready to buy into that practically four, five months ago when [Max] Baucus had his hearings.

HICKEY: I tell you something: this process has gone forward in the Congress in a very abstracted away that did not—very few of the leaders of the Congress, some of them but not all, have really fingered the insurance companies as the key part of the problem. The president did that today. It’s very important that the American people understand this is not just some policy equation designed to improve things in America; this is a moral crusade to create a system that makes sure that the profit-making motive doesn’t get in the way of people getting real health care. Now, will he achieve all of that in one bill? No, but he’s defined the problem and he’s defined what needs to be done in order to go forward in a way that motivates people to understand what we’re up against and to understand why we need something like, quote, a "public option," which too many times in the press just sounds like some lefty idea. We need a public option to keep the insurance companies under pressure to perform. We need a public option, because if we’re going to force people to buy insurance—and that’s what we’re planning to do—you’ve got to give people an option that they can buy into that doesn’t involve profit. And so the important thing to me is that he didn’t just talk policy; he talked about why the health-care system is failing America, and he went into a long argument about why on some occasions Americans triumph over our instinctive distrust of government and understand that the character of our nation is often determined by public action. That was a powerful statement. And he also put the Republicans pretty much on the defensive most of the speech.

JAY: I thought it was a brilliant political speech. My guess is he can more or less pass what he talked about tonight and he will come out of this with a political victory. But I think—it’s partly my job, but I also believe it to be true—I watched the Baucus hearings, and I heard the representative of the insurance companies very early on say, "We can live with your regulations. Just give us all the same regulated playing field, and, you know, we can live with all of this." In fact, they actually asked for it. And as we said off camera, it’s even possible that a more regulated environment will favor the biggest companies, and even lead to more consolidation, because the bigger companies will be able to have that much bigger of a user base. So that part of it—and I’m not suggesting it’s not an advancement. I mean, it’s a hell of a lot better to have a regulated insurance environment where you don’t get excluded ’cause of pre-existing conditions and you don’t get thrown off when you get sick, it’s a real achievement. That being said, without that public option, which is the thing the insurance companies were absolutely against from the beginning—you know better than me, a more monopolized market, what leverage you’re going to have with it. So what should we be looking for as the banal detail about public option comes out? Does he open the door here to what this—he didn’t use the word "trigger", but he opened the door to the possibility that you could have a market which is all private insurance companies, and if they are competitive—and I’m not sure who defines that, what’s competitive—the public option may not even be there.

HICKEY: Paul, I’m going to answer all those questions, but it’s important to know that prior to giving this speech, it was very much an open question, really a knife’s edge moment where all reform might—was seen as possibly failing. This president, maybe he just let all the crazies take the summer, knowing that he could be could give a brilliant speech [inaudible]

JAY: I’m saying that it’s look like rope-a-dope: you can hit me in the stomach for a few months and—.

HICKEY: Perhaps it was intentional. I don’t think it was. I think that they, the Democrats in the Congress, were losing heart, and even some of the best of them. So this speech, putting the president firmly in charge of advancing the argument and making the case and moving votes, that’s a sea change in the environment around the health-care debate. So it’s important that he gave the speech, and it’s important that he gave the speech in the masterful way that he did. You can’t take that for granted. And yes, in fact, it’s possible that after all the compromises are made, we will end up with some hypothetical trigger on the public insurance plan. It is possible that that will happen. But it’s important that the president made the judgment that he wanted to go out there and defend the public plan, despite the fact that it has been made controversial by the insurance companies, despite the fact that some of his own advisers were advising him to give up on it. And he made the case in a very clear way so that the American people understand that it is an option for them to choose. So I think he gave new life to the public insurance plans. And, of course, those of us who believe in it are fighting like crazy every day and every congressional district to pass a bill with a public plan in it. And, yes, there is the possibility that if we do not do our job in mobilizing the American people, we could end up with a compromise. Obama needs a victory. And we could end up with a compromise in which there is a politicized question of we’re going to throw this money at the private insurance companies, and if they can’t do the job, then we will invoke a public plan. That, in fact, even raising that in the way that he did, means that there is now a debate that we can take advantage of, of just making it clear how badly the insurance companies are doing in meeting even basic standards. Obama knows that he’s got to win a majority in the Senate, maybe 60 votes in the Senate, for a plan that really can work. And what I’m impressed by is that he’s going to make the fight for a structural element in his plan that can have a lot of leverage on the whole health-care [inaudible]

JAY: Okay. Now, you and I have done interviews for the last few months about this. And I’m not disputing that he has changed the momentum. I mean, we are at the "Momentum" Conference. He changed the momentum on this issue with this speech. But in the specifics of what that public option would be, you’ve said up until tonight it needs to be robust to be meaningful, and without meaningful public option the rest is—becomes unaccountable.

HICKEY: For sure.

JAY: So for people watching, they’re going to watch this process, the negotiations over the next few weeks. What are the litmus tests, for you, for you to decide this is a real public option?

HICKEY: Listen, first of all, I think he set up the notion that if we don’t get a public option, it’s going to be because of the greedy insurance companies. He set up that idea. It’s important for the president of the United States to say that. It may be that we are in a 10-year battle to improve what gets passed this year and to politicize the role of the insurance companies in America and to put them under a microscope and to—. If, hypothetically, we don’t get a robust public plan immediately, it is the job of the progressive movement to shine the light of public scrutiny on the horrors of the private insurance system. We’re doing it now. We’re going to have to do it continually.

JAY: He’s the one that said, "The time’s now, and I want to be the last president to do this." He’s not talking about a 10-year process; he’s talking about—.

HICKEY: Hey, he wants to be the guy that signs the first bill. When we passed Social Security, it didn’t cover everybody. It wasn’t as rich a benefit package as it is now. But Franklin Roosevelt got credit for starting that ball rolling and passing legislation against the opposition of the far right and the Republican Party. I’m sure Obama knows that life is a constant struggle, and I know that he knows that whatever he passes is going to be improved and refined and changed again and again. I’m hoping that what we can do is to make the public plan, the public option, that toehold into a real competition and a real debate, a public plan that actually gets put into functioning and put into being. And even if we do that, it’s going to be a huge job ahead of us making sure that that public plan is robust, able to produce good benefits for people at a decent price. And we’re going to fight off all kinds of critics who say that it’s ineffective, bureaucratic, etcetera. All of those charges were made against Medicare. Ronald Reagan, the great communicator, was hired by the AMA [American Medical Association] to call it socialism, and Medicare is now a beloved part of American life after many decades.

JAY: The other piece of this is going to be—and it’s the piece of it—how much is it really going to cost, and who’s really going to pay for it? So one of the biggest pieces of cost has been taken off the table—the deal with PhRMA. And most of the economists I’ve talked to and health economists I’ve talked to said that the real elephant in the room of cost is the cost of PhRMA. And the White House has made a deal more or less saying we won’t use this collective juggernaut to drive down the price of PhRMA, as they are in Canada and Europe and such. So you’ve taken that off the table. So we’re told it’s most of this $900 billion that’s going to—health care’s going to cost has come through efficiencies.

HICKEY: Not most; about half.

JAY: And then, if you can’t get tax reform through the Senate, which seems to be the dynamic, how do you pay for all the uninsured people? Where does all this tax credit going to come from for small business? This whole thing’s still murky to me.

HICKEY: We’re going to have to raise taxes, no doubt about it, and we’re going to have to raise taxes on the rich, which has been the explicit plan of the three House bills and the Senate Health Committee bill. We are going to have to make the argument, as the president made today, that people who are wealthy should pay for a large part of this. So, for example, most Americans who get a majority of their income from clipping coupons and investments do not pay a tax on that into Medicare. They do not pay—you know, somebody’s paying—earns $34,000 a year, they pay a portion of that entire income into Medicare. Taxing that kind of income stream under the Medicare tax rates would produce an enormous amount of money, and simply doing a surtax on the wealthy, which has been proposed and passed in the House, would produce a lot of money, too. So this can’t be separated. How you pay for it has got to be progressive, and you’ve got to raise enough revenue so that the package is a package that can subsidize people so that the insurance that they have to buy is affordable. If it’s not affordable and if there’s no pressure on the insurance companies to keep their prices down, this thing is going to blow up, ’cause the working class of America is going to say, "I’m not buying that insurance." But the thing that encourages me is that this president made those arguments today. He tied together the business practices of the industry with the unaffordability and unavailability of health insurance.

JAY: So as we judge this going forward, we’re going to look: is it tied to tax reform? And is the public option has some teeth? And whether it’s trigger or no trigger, even if it’s trigger, is that trigger real, or is it the kind of trigger that you can just imagine the sigh in the White House, "Oh, geez, do we actually have to start this all over again now by starting the trigger?" So there has to be some mechanism that’s objective and not going to be subject to the political whim of the day.

HICKEY: Yeah. The good news is that even if we’re into that—I hope we’re not; I hope we pass a public plan—there’s a strong number of members of Congress who have staked their reputation on the public plan, and they want to work really hard to make sure that the legislation, if it is a trigger, is a trigger that actually shoots the gun.

JAY: And that is the other wild card is that the 60 progressive Democrats in the House have have said "robust"—not "trigger"—"robust" public plan or they’re going to vote no. And they’re going to be pretty embarrassed, even in spite of a great speech, if they have to back up on that.

HICKEY: And the president just met with those progressive members of the House yesterday. I mean, there’s a reason why Obama has stuck with the public option: it’s because it’s very popular with the public. And then there’s a big chunk of his party that is insisting on it. So this is popular, and he understands that it’s popular, and he did not want to disappoint a huge portion of his constituency. The people in that room that we watched the speech with today in San Francisco would have been really deflated, and those are the people that he’s counting on all around the country to push this thing through to completion.

JAY: Okay. So as we go forward, we’ll talk again.

HICKEY: Absolutely.

JAY: And we will judge: is this real or not? Thanks for joining us.

HICKEY: Good to be with you.

JAY: Thank you for joining us on The Real News Network.

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