What Andy, publius, Paul, Terrence, Sully & Jane and Josh said . . .

This YouTube by Andy Lubershane is simply terrific.

publius: #MoreLikeThis

Rescission -- i.e., canceling coverage when you get sick -- is arguably the most outrageous action that health insurance companies take. So kudos to the Post for putting a rescission story on A1. There's more to this debate than town halls. This is what's really at stake in our once-in-a-generation opportunity for reform:

In a pending case, Blue Shield searched in vain for an inconsistency in the health records of the wife of a dairy farmer after she filed a claim for emergency gallbladder surgery, according to attorneys for the family. Turning to her husband's questionnaire, the company discovered he had not mentioned his high cholesterol and dropped them both. Blue Shield officials said they would not comment on a pending case.

Officials from three insurance companies told a House Energy and Commerce subcommittee this summer they had saved $300 million by canceling about 20,000 policies over five years.

It doesn't get much better before or after this excerpt.

Krugman: Hoping for audacity

President Obama will give his big health-care speech tomorrow. Let’s hope he does it right.

What does that mean? It means not playing professor; it means not having the speech read as if it were written by a committee (like that woefully weak op-ed in the Times a couple of weeks back); it means showing real passion about health care, which has been sadly lacking so far.

I, for one, won’t be obsessing about exactly which pieces of proposed reform he emphasizes — because that’s not what’s driving the politics. Americans haven’t become skeptical about Obamacare because they’d rather shave an extra $30 billion a year off the cost; they have not, contrary to “centrist” fantasies, been turned off by the details of the stimulus plan or cap-and-trade. What has been missing is a vision. And this is probably the last chance to supply that vision.

So what should Obama do? I am not a speechwriter, but here’s my view:

1. Make it personal: In general, I’m not big on the personal anecdotes. But right now, Obama really needs to make it clear that the horrors of our health care system can lead to nightmarish outcomes — and that those nightmares can happen to you, or someone like you. This is the time for “Lois Lane, of Smallville, Kansas, lost her coverage when her employer went bankrupt. When she tried to get individual coverage, she was turned down because she once had a rash in college. Then she got cancer …”

2. Talk about Medicare: Incredibly, the Obama administration has let conservatives — conservatives! — position themselves as the defenders of Medicare. Obama needs to remind viewers that Medicare was a deeply controversial program, that there were dire warnings about what the program would do, and that the people who tried to prevent the creation of Medicare (and keep trying to dismantle it) are the very same people now opposing health-care reform. Talk about how many Republicans voted for a resolution calling for Medicare privatization just months ago!

3. Talk about the system’s troubles: Obama really needs to convey the urgency of reform; he should talk about the doubling of premiums over the past decade and, crucially, the way ever fewer employers are offering coverage. The message should be, even if you think your insurance is OK now, it could well be gone in a few years.

4. Explain the plan in as few words as possible: Here’s my stab at it — one hopes the speechwriters can do better, but it gets at the essence. “We’re going to make sure that every American has access to the same insurance deals big employers get. We’re going make sure that no American can be denied coverage at a reasonable rate because of previous medical history. And for those Americans who find it hard to afford essential insurance, we’ll provide financial aid.

“Now, there are a few things we’ll need to do to make this work. We’ll have to require that all large employers either offer coverage to their workers or pay into a fund that helps them get their own insurance. We’ll sign people up for insurance now, even if they’re healthy, because it’s not fair to others if you wait until you’re sick to join the system. And we’ll keep the insurance companies honest by offering people the choice of buying their insurance directly from a public plan.

“Let me be honest: this won’t come free. But this plan will give Americans the fundamental security of knowing that for the rest of their lives they and their families will have the health insurance they need, insurance that they can’t lose.”

That’s the main thrust.

Oh, and about the public option: yes, it should be in the speech — and not just because it will lower costs. From personal discussions I know that the individual mandate really gets peoples’ hackles up,because they see it as a giveaway to the insurance industry (you may recall that many Obama supporters made precisely that case during the primary). Yet the individual mandate is necessary — so it’s crucial to have the counter-argument that look, people can choose the public option. Yes, some senators will fight against that option tooth and nail — but that’s for later.

What I hope Obama realizes is that this speech should not be aimed at Kent Conrad or Susan Collins. A national address is not where you do your backroom deals. This speech has to be aimed at regaining the trust of the American people. It needs to be something with vision and sweep, not an item-by-item detailing of what the administration is prepared to concede.

This is a time for Obama to show real leadership — not to uplift the nation with vague generalities, not to sound like a technocrat, but to persuade America that it needs to change. Can he do it? Let’s see.

Terrence Samuel: Barack Obama, Explainer-in-Chief
Republicans have been able to confuse the issue, but their chances of killing health-care reform remain slim. All Obama has to do is lay out the facts.

Mr. President: You're right; they're wrong, and don't you forget it.

There is some good news for President Barack Obama on health-care reform: No one of consequence is seriously arguing to kill it outright. Despite all the sound and fury of the summer town halls, to be against health-care reform is still not a winning position with the American people.

It is important for the president to keep this bottom-line calculus -- that he is on the right side of this issue both morally and politically -- at the top of his mind when he returns from vacation to a chorus of depressing reviews about how badly August turned out for him and the prospects of health reform.

Health-care reform is an issue that won him the election, and it is one that is worth the good fight, one to which he should not just bring a megaphone but a baseball bat.

One strategic consideration going forward is how much ammunition the other side has in its possession, measured against the White House arsenal. In this, the opponents to reform come up short. What they have, and have used to great effect, is confusion. But we should not misread the confusion of the American people as opposition. The other side, with no alternative plan, no coherent critique of the existing ones, and no argument that we're better off without reforms, has resorted to a strategy of distortion and distraction and demagoguery aimed at undermining Obama's credibility. And, sadly, to great effect: Two-thirds of Americans say they are confused by the plans under consideration by the Congress.

In Oklahoma this week, a Republican United States senator told a supportive crowd that the president was dismantling America. "I never dreamed I would see an administration try to disavow all the things that have made this country different from all others," Sen. James Inhofe said. Even if you had any idea what he meant by that, you'd know that he was not even remotely addressing the specifics of the health-care debate. While the right's tactics can be infuriatingly effective at shifting the debate, they point to the huge disadvantage at which the Republicans find themselves; they have been able to confuse the issue, but their chances of killing reform remain slim.

Indeed, a more dangerous threat comes from the president's own party, split between those who are demanding a controversial public option and those worried that a far-reaching bill will hurt them at the polls. This is where the baseball bat will come in.

But first Obama will try his megaphone trick. On Wednesday, he will pull out his explainer-in-chief cape for a speech before a joint session of Congress. It is a speech the White House hopes will cut through the fog, clear up the confusion, and close the deal. A health-care analogue to his Philadelphia race speech, when he used the trouble caused by comments made by the Rev. Jeremiah Wright to talk about how race is really lived in America.

The White House's lack of full engagement on health care may have as much to do with the confusion as the Republican misinformation campaign.

But after all the explanations, clarifications, and the corrections of fact and context, it will be up to Democrats to pass a bill. Obama should not allow either political cowardice or ideological intransigence to kill reform.

To the wobbly legged he needs to explain that this is: 1) not so politically damaging as is being made out, and 2) even if it were, this is the kind of issue that is worth losing an election for. To those demanding a public option, or nothing, he ought to explain that the public option is worth fighting for and that he intends to fight for it all the way to the end. But the fight should be one to win, not to lose. If the public option means no bill at this juncture, then it will have to wait. If we've learned anything from all the recent Ted Kennedy tributes, it is that there is no dishonor in incremental victories.

The real disgrace would be to lose a political fight when you're right and the other side is so poorly armed. August is over.

Sully: My Take On The Healthcare Debate

I wrote my column on it. I don't find the opposition to reform somehow illegitimate. There are many reasons to criticize the plans now congealing; and the end-result looks to me more and more like a simple extension of healthcare security to a lot of people without any real or strong mechanisms to curtail the soaring costs that are bankrupting the country and putting so much strain on US business. Of course, I belong in that archaic camp that believes it is the job of a liberal president to expand such coverage and the job of a conservative opposition to propose ways to afford it. Instead, the chairman of the GOP is making the Republican position on Medicare indistinguishable from the most cynical Democratic scare tactics, and complaining about any attempt to curtail costs. If you have to strip out of a bill a mere conversation with seniors about powers-of-attorney for end-of-life decisions, you are not interested in a serious conversation about curtailing healthcare costs.

I agree with most everything David Brooks has written on this subject. If we had a functional and serious conservative movement in this country - instead of a Poujadist mob of cynical know-nothings - we would be talking about the kind of questions David Goldhill discusses in the best single piece on the debate I have yet read - the cover-story in the current Atlantic. We'd be talking about re-thinking the insurance model for large parts of medical care, we'd be cutting subsidies for employers, we'd be empowering patients to seek better coverage with better value and providing the tools to help them make informed decisions. Instead, we're talking Hitler and Oligarhy and "taking the country back".

Anyway, my column is here. It's bullish on Obama, as I remain.

Ben Nelson tipped his hand in a way today that suggests what I think we'll end up with - which will be a huge step forward on the accessibility front, if not on costs. (But we can come back on costs, and must, in a broader context of fundamental fiscal reform). My view of the president remains what it was two years ago: We're still lucky to have this small voice of reason in this nutty time. And if he becomes the first Democratic president to initiate universal healthcare access in his first year, he will indeed be transformational on a core domestic question.

Hang in there, Mr President. I have a feeling that the forces that elected you are re-grouping now we know exactly how determined and incoherent the opponents of change on all fronts have become. Above all, remember the discipline you showed in your campaign. You won through a combination of persistence, strategy and a refusal to take the bait. Don't take the bait, Mr President. The degenerate right (a better one will come along in time) only knows Rovian cultural warfare. They want you to fight back on their terrain. Don't. Just move forward. Talk to the country as a serious president should - about the problems we face and the debate we need to have to confront them.

Josh Marshall: On Offense

The last 8 weeks has demonstrated nothing more clearly than the fact that in politics as in most other things nothing is won on defense. The fact impressed itself on me again when I saw this opinion column by Reps. Shadegg and Hoekstra (R) in the Wall Street Journal. Piece through the rhetoric and the essential message is true to what the Republican leadership believes about health care and health insurance policy.

In short, the problem isn't that your insurance costs too much or that you might lose it or anything like that. The problem is that you have insurance, especially insurance through your employer. Ideally you wouldn't have insurance at all or at least you'd have much less of it.

That's the essence of where Republicans want to go. And why Democrats aren't making that a lot more clear is a very good question without any good answers. The problem is that you go to the doctor and agree to take the tests the doctor recommends. Shadegg and Hoekstra want a system where if your doctor suggests a biopsy for a suspicious lump you think about the pros and cons. Is it worth the money? Do you have the money? How suspicious is the lump anyway? Maybe you get the first one. But not necessarily the follow up scan six months later.

This is the essence of the Republican plan: the fact that you're insured and aren't directly feeling the cost of individual tests and procedures is the problem and getting rid of the insurance concept is the solution. Give you a structure where you can save money for future procedures and medications (the more money you have the better) and you decide how much medical care you think you can afford. That's what HSAs are about (google it). That's the gist of the column and it's not surprising because that's what most conservative policy ideas are about.

To be clear, such an approach probably would cut costs because most people just couldn't afford to get a lot of care, which is a great way of cutting costs. But remember, the problem according to most Republicans in Congress isn't that there's not enough insurance or that it's not good enough. It's that there's too much. The problem is that you have insurance. And good policy will take it away from you.