Anticipation for Obama's health care speech to Congress tonight is high, with dozens of pundits weighing in
on what Obama should and should not do. But Steve Coll, New Yorker
writer and head of the New America Foundation, argued that one of the
most important aspects of health care reform is already in the bag.
With a reform bill not even yet solidified to vote on, the health
insurance industry has agreed to "guaranteed issue," which means people
with a preexisting condition cannot be refused coverage.
In a historical sense, this represents an enormous shift of political
and economic will within the insurance industry—and it is a shift that
has held firm throughout the rancor and political fear-mongering this
year. It also promises real change in the lives of some American
families; right now, it is estimated that more than twenty thousand
people die each year in this country because they do not have health
insurance. Obama will probably make pointed reference to this emerging
policy consensus in his speech tonight; rather than using the wonky
terms above, he will likely use the language of "security" to remind
Americans what will be achieved if a bill can be passed that enacts the
bargain to which the insurance industry has, essentially, already
For all of the flaws and unfinished work in the health-reform
legislation now pending—and there are big problems involving cost
controls and delivery-system incentives that likely will go unaddressed
by whatever bill finally passes this fall (and one will pass, sayeth
me)—this is nonetheless a big and important change in the American
system of social insurance, one that only awaits the passage of an
Coll wins the day for avoiding speculation over what will happen,
pointing out what has already happened, and making the case that the
most important reforms have already been secured even before tonight's
speech. While everyone had their eyes on the political speech that will
be this evening's address, Coll looked for the substance.
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