A blog about television by TIME’s TV critic James Poniewozik.

Obama's Town Hall: Open Up and Say Aaaah

ABC

ABC

Soon after ABC announced it would devote a day to covering President Obama's healthcare proposals, including a primetime townhall, Republicans began complaining that the program would be an "infomercial" for the President's plans. And the event started on an auspicious note for the President's argument that the healthcare system needed to be overhauled: in a show of hands, almost no one in the audience agreed that the system should be left as is. "Let's stop now!" Obama joked.

But what the President largely got from his questioners afterward was, in doctor's parlance, a probing examination.

While the broadcast acknowledged the problems affecting health care now—46 million uninsured, skyrocketing costs, lack of preventative care—the questions were, almost entirely, from the perspective of people with health insurance, wondering what they stood to lose.

An employed man asked if his current, top-shelf Blue Cross plan would suffer. A woman asked if the pacemaker implanted in her mother at age 100 would be rejected in a revamped system. Would doctors have to make stark decisions about end-of-life care? Would Obama spare any expense for his own wife or kids' care? Would insurance benefits be taxed? "Who decides whether we live or die?" asked a worried woman in the taped intro. "The government?"

A Bush medicare official spoke, as did the CEO of Aetna. At one point moderator Charles Gibson even asked whether insuring 46 million uninsured would be a problem—because it would be harder to make a doctor appointment. (What was mostly missing were questions from or about Americans who have no insurance at all; a self-employed man without insurance got a question in at the end of the forum.)

The skeptical (though polite) questioning wasn't surprising. The public brouhaha over the "infomercial" probably gave ABC special incentive to be tough. And after all, as the sole subject onstage, without an opposition rival, Obama was by definition the argument for change himself. (Even the townhall staging, with Gibson and Obama stationary in formal chairs, made the event look more like an audience with supplicants rather than a debate or press conference.)

In fact, I have to wonder if a debate-style forum with a Republican wouldn't have been friendlier to the President in a way, since there would have been incentive to challenge the arguments against his proposals too. As it was—even though Obama had the time for lengthy answers and defenses (he joked about Gibson checking his watch)—the dynamic created by the format left the impression of the President alone, defending his plans from a populace full of concerns and doubts. Mostly concerns from the right, although Obama took one question on single-payer health care (after primetime, around midnight).

Still, if you saw the show as an infomercial to begin with, the fact that Obama had the answers to himself probably confirmed that opinion. His style and strategy were heavy on personal charm; "I want to know what she's eating," he asked the centenarian's daughter.

But his answers were long on generalities and prepared stump points ("If we do nothing..." began several answers, to make the argument that costs re out of control in the present system as is; another refrain, "Everyone agrees that..." sought to create an impression of consensus). This President is not allergic to wonky discussions, and the talk may have gotten a little deep in the weeds of priorities, projections and hypotheticals. Americans just beginning to tune in to the debate may not have left with a concrete sense of what to expect from health care reform—largely, of course, because that's still being worked out. If anyone expected Obama to pull out some charts and simply lay out the deal, they were disappointed, if they didn't change the channel altogether.

Which means that, for all the attention given to this town hall, the act of selling, or defeating, health care reform is going to be a multi-stage process—one, you have to expect, that will involve more media pushes. (Not least because this event was blasted out of the headlines by Gov. Mark Sanford's Peccadillo in the Pampas.) Last night, Dr. Obama laid out some broad goals for treatment, but there are more procedures to come.

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  • 1

    During this whole health care reform debate, I have been very surprised a question has not been raised yet.

    "Why do we need insurance to pay for even simple every day medical check-up?"

    If you look at everything in our life, insurance is only used to deal with "extraordinary events", you don't use your house insurance to pay for your the a leaky faucet, or to have the repair man come out and take a look at it. You don't use your auto insurance to pay for your 3,000 mile oil change. Why should we have to rely on insurance to pay for our daily care?

    In the book "Undercover Economist", Tim Harford discussed the health care system they have in Singapore. It is a cross between Social Security and those medical payment plans that many employer offers now. (the one where you make monthly contribution for X amount, and you can spend against it during the year.

    If we divorce the payment of everyday check-up and small procedures from those of "catastrophic" payments, we will have a better chance to creating true competition; by allowing small niche insurance companies to create tailored products, and leaving out the middle-man between you and your doctors (Oh look, no administrative overhead from your local health insurance company).

    Another thing has been a shock to me, why has no media sources really done a break down of our actual health care costs? Where are all the money going and who is getting each cent of the money? How can we fix a problem if we don't understand the real reason for the inflated cost? For example, How much does my annual check-up really cost, and who are all the people that takes a cut of that money? I am willing to bet that the doctors only gets a very small portion of it.

    To fix this problem, we need to stop thinking in the traditional way, and look for solutions that could truly open up the market to real competition, not leaving us at the mercy of the insurance (who are for profit) companies.

  • 2

    What is most fascinating to me about the debate is the it seems to center around people's fears of the unknown. And it goes something like this:
    1. I hate the current system.
    2. I want it to be fixed.
    3. But I am afraid of it being fixed.
    So, what do we do? Go bankrupt from indecision. How about we allow the health insurance companies to rewrite the rules--since they don't seem to want to follow the rules we already have?
    See this important interview with a former health insurance PR executive who explains how the health insurance company has already come up with a plan to defeat health care reform by manipulating people's fears. And then ask your favorite news media sources why they aren't asking the tough questions of the right people.
    http://www.cjr.org/campaign_desk/excluded_voices_6.php?page=all

  • 3

    I personally thought that President Obama was superb in his presentation on the ABC program. I found his arguments convincing and inspiring. My wife has a pre-exiting condition and will be soon off COBRA. She/we have a need for the public option to "keep the insurance companies honest."
    But the President did make one huge gaff, that being that "Medicare and Medicaid are the single biggest drivers of the federal debt." Of course that is not true. Under George W. Bush, the Pentagon and the Iraq war had to be the single biggest drivers of debt. According to information before me about the 2009 budget, $542 billion is budgeted for the Pentagon and another $196 is budgeted for the Iraq War. Medicare at this point pretty much pays for itself; Medicaid is, of course, a government program shared by the federal government and the states that has no real "premium" basis. Federal debt occurs when the federal government fails to "collect" enough money to cover its spending. Blame on the "entitlement" programs is commonly misplaced.
    How nice it would be for the President to better understand that Medicare, Medicaid and, of course, Social Security, are NOT the major drivers of federal debt.

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