Obama's Evolving Health Care Pitch

In his press conference yesterday the President talked about this goals in reforming our health care system which demonstrated a clear evolution of thinking and narrative.  Take a look:

During our meeting we also touched briefly on how we can move forward on health reform.  I've already announced that in two weeks I'll be holding a meeting with people from both parties, and as I told the congressional leadership, I'm looking forward to a constructive debate with plans that need to be measured against this test.  Does it bring down costs for all Americans as well as for the federal government, which spends a huge amount on health care?  Does it provide adequate protection against abuses by the insurance industry?  Does it make coverage affordable and available to the tens of millions of working Americans who don't have it right now?  And does it help us get on a path of fiscal sustainability?

What is encouraging about this langauge is that as NDN has suggested for some time the true test of any proposed health care reform is whether it can get costs down over time while maintaining quality and accelerating innovation.  It makes sense that to achieve another important goal - creating universal coverage - that one must first figure out how to make the system less expensive.  For as President Obama said repeatedly during the 2008 campaign, people do not have health insurance today because of its high cost.  Creating a more competitive, intelligent, effecient, less expensive and patient-driven system needs to be the primary goal of health care reform, and there is no way to do this without sacrificing one of the other stated goals of the 2009 debate - making sure everyone can keep what they have. 

My own take is that the adoption of that rhetorical goal - letting everyone keep what they have - was a critical moment in driving health care reform off the political rails.   For how can one have "reform" if everyone gets to keep what you already have? Where is the reform in that? And if your basic argument is that the system is terribly broken, and needs to be fixed - in fact it is an urgent national priority - then how can you then say but you, the American people, get to stay in the old broken system and not join the effort to reform?

In fact what is required for true reform and the construction of a 21st century health care system in the US is for everyone to in fact leave behind the current, inadequate system and move to a better system.  Rhetorically the President needs to tell those who are satisfied with their insurance today that in fact the new system will actually not allow them to keep what they have, but will offer them something fundamentally better (the idea you get to keep what you have was also dramatically undermined by the idea of the excise tax on "cadillac plans").

As the President's language suggests above, he is rhetorically and intellectually moving beyond the theory of the bills which passed in 2009.  I am not sure how this evolution of the President's thinking will effect what happens with health reform in 2010, but the tests the President offered yesterday are the right tests which all reform must be measured.  At the core of this new pitch must be that the new system will be better for everyone, and that everyone has a stake in making it happen.