You are precisely right that Obama tried to portray health care reform as a modest, centrist set of reforms, and that his goal is to attract the support of Blue Dog Democrats (and perhaps a handful of moderate Republicans) without losing his left flank. The question is whether he did so effectively. I argue that he did not, and for the reasons I spelled out: the speech lacked an even emotional keel; instead, he was both combative and conciliatory, partisan and above partisanship. More importantly, he fudged on precisely the details that his target audience needs to know before they will put themselves on the line for this bill. In this regard, he has already gone on record as supporting the House version of the bill that includes higher taxes on wealthy income earners, and a penalty for those who opt not to buy insurance, and on employers who don’t offer plans that meet the government’s standards. This isn’t a secret, but in his speech it suddenly seemed as if the bill would be funded entirely by wringing waste and fraud out of existing programs. This obfuscation for political reasons was at odds with the conclusion of his speech, which tried to rise above politics and instead justify the policy on the basis of more principled standards.

As for what constitutes radical or significant reform, I thought I spelled it out pretty clearly: that would include mandates that force all consumers to buy insurance and a public option for insurance, at a CBO-projected cost that increases by some $1 billion or more. That’s radical. If, on the other hand, the final bill is essentially deficit neutral insurance reform – forcing insurance companies to include certain coverages in their base package, no denial for preexisting illnesses, incentives to expand coverage perhaps by expanding Medicaid eligibility – I think he could get a few Republican votes. His Left would scream bloody murder, of course. In the end, I think that’s what we’ll see: insurance market reform and modest expansion in coverage through subsidies, but no mandates and no public option. Radical? Given where this debate started, I don’t think anyone would say this is fundamental health care reform. But my point is that it would nonetheless be a significant accomplishment.

Jack – If only more Democrats had your common sense! Many moderates have said all along that it is far better to take half a loaf than hold out for more, with the understanding that there’s always tomorrow. Whether you view this as the came’s nose, or a flea’s nose, under the tent, it can be sold as progress. Obama could (and would) claim victory. Of course, victory is in the eye of the beholder, and the Pelosi wing of the party would argue that Obama folded. But that’s the nature of politics today.

Fred (from your question to my previous post): Obviously presidents prior to Obama have received their share of hissing and grumbling from a Congressional audience, but I’ve never seen such a direct affront from a single person. I think it crossed a boundary, which is why even Republicans pressured Wilson to apologize, which he did. The problem, of course, is that contributions to Wilson’s reelection campaign skyrocketed, and he’s used his comments as a springboard for publicity (see his website). Once again, it is a reminder that Obama’s election has done nothing to mute the partisan polarization characterizing discourse in politics today.

Marty – Your question suggests that it would be useful to lay out the specific provisions in the various health care reform bills to see which get support and from whom. But I think moderates are very worried about getting hung out to dry by supporting a bill that will leave them vulnerable to consumer backlash come 2010, particularly if it’s a bill that passes with only Democratic votes. On the other hand, they do want to produce something. It would be very hard, in my view, for Republicans not to sign on to a bill that is essentially insurance reform – hating insurance companies is a bipartisan issue. But when reform spills over into employer mandates and the public option, moderates get nervous and Republicans bail.

Passing a bill will 1) be the camel’s nose under the tent and 2) reduce the Democrats losses in Congress next year.

No bill equals a blood letting for the donkeys in 2010.

Can you boil it down even more: Are most lawmakers just deer-in-the-headlights on this issue, or is this an issue that does jeopardize reelection? Is health care destined to be a significant factor in reelecting representatives next year (and in 2012) or not? Would it be feasible for many members to “do the right thing” here — with more forward-looking measures, though it would cut against current opinion?

And the usual response to this is: “Define ‘radically.’”

Republicans in the House and Senate have publicly indicated support for:

1) Prohibiting insurance companies from denying coverage of preexisting conditions
2) Strengthening “portability” (from job to job, or more critically from job to no-job, or job to job-that-doesn’t-come-with-health-care)
3) Opening up the insurance market to expand purchases across state lines.

The Devil is in the details, of course, but some of this stuff could really reshape the way Americans pay for health care. But you should take my point here with a grain of salt since I’m far from a health care expert.

On the speech, you know, Obama doesn’t need to sway “national” views. He needs to win over a fairly small percentage of the electorate — wavering voters in at-risk Democrats’ districts, for instance, or people on the left-flank of the Democratic party who may be growing disaffected, or voters in the districts of the handful of ‘gettable’ Republicans.

I tend to view this fight as a repeat of the 2004 election more than the 1993 health care feud (happy to expound on this over drinks in Middlebury in a few weeks). But I thought the speech was an effort to position Obama as speaking for the people in the rough middle of US politics who worry about whether they would still be able to choose their doctors, or whether there would be rationing — very, very fundamental worries about Obama’s plan.

That’s because something funny happend while “We In The Media” gave over August to the raucous town halls, the Obama-Is-A-Nazi, His Government Is Coming To Kill Granny fringe arguments: Poll after poll found the bulk of the objections (especially among “gettable” voters) to be more down-to-earth. The Obama White House spent an enormous amount of energy trying to fend off the “Obama = Hitler” folks.

And that left the concerns of independent voters mostly unaddressed — on either side.

To my ears, Obama was trying to stake out a claim to the middle. He made several points meant to distance himself from the left of the party (Vermont Senator Bernie Sanders was basically a lone clapper when Obama mentioned how some want the Canada model), then he defined his opposition as the “death panel” crowd (rank and file House GOP happily obliged him throughout the speech) and finally he said “here are legitimate complaints and my answer to them.”

Others have fact-checked him so I won’t repeat the process here, but that was, I think, the strategic thinking.

Let me quickly say that advising the President to tell the American people that their taxes will go up to pay for the overhaul of US health care = immediately dooming the reform effort.