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Obama's Health Care Speech: Politics And Policy

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Obama's Health Care Speech: Politics And Policy

Health Care

Obama's Health Care Speech: Politics And Policy

Obama's Health Care Speech: Politics And Policy

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  • Transcript

GUESTS:
Mara Liasson, national political correspondent for NPR
Juan Williams, NPR news analyst
Joe Neel, science editor, NPR

President Obama addressed a joint session of Congress and laid out objectives in his health plan, including setting a price cap and suggesting that a "public option" is still negotiable. He also warned he will not accept the status quo.

NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan, in Washington.

President Obama had a number of objectives last night: to regain the initiative on health care overall, to reassure the majority of Americans who like the coverage they've got, to scold his most extreme critics, to invite conservatives and restrain progressives and to paint the campaign as necessary, reasonable, as the right thing to do. And now the speech to a joint session of Congress has generally been received as strong on presentation, somewhat lighter on specifics. But the question today is whether it has changed minds.

The question goes to Capitol Hill: Are any Republicans prepared to come along? Can Democrats resolve deep divisions between progressives and more conservative Blue Dogs? Is the public option still on the table? And the question goes to you: Did the president's address last night change your mind? How? Be specific, if you will. Our phone number: 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION. And joining us now in studio 3A is Mara Liasson, NPR's national political correspondent. Mara, nice to have you with us, as always.

MARA LIASSON: Nice to be here.

CONAN: And NPR News analyst Juan Williams is with us from his home here in Washington. Juan, always good to have you, as well.

JUAN WILLIAMS: Thank you, Neal.

CONAN: And Mara, let's start with you. We've already heard Max Baucus, the chairman of the Senate Finance Committee, saying this has breathed new life into his negotiations to come up with a bipartisan document. Speaker Pelosi had said the president will sign a health care bill this year. Has this changed the momentum on Capitol Hill?

LIASSON: I think the president's speech did help. It helped to move the ball forward. I do think that the difficulty that health care reform was in had been exaggerated. In other words, it really wasn't on life support. Now, he definitely breathed some new, you know, air into its lungs there. But I don't think it was on its deathbed before he spoke. The interesting thing about the August recess, even though there were all these acrimonious town hall meetings and the polls certainly slipped from Mr. Obama and his health care plan, the actual votes in Congress didn't change much.

People who were for a public option were still for it when they came back from recess. And people who were against it were still against it. In other words, the landscape didn't change on Capitol Hill. But I do think this was extremely important. He got involved. He said this is my plan. In my plan, this will happen, that will happen. He identified himself with something specific.

Although a lot of the things in the speech he had said before or suggested he could support, he put them together in a very orderly, clear fashion so people will actually know what's in it. There was a tremendous amount of confusion. And today, to push this forward, we are told that 17 moderate Senate Democrats are taking a bus from Capitol Hill to the White House to talk to him. And they are the key swing votes. So he's getting more involved. I think he does want to heave this over the finish line this year, and I think he has a good chance to do it.

CONAN: And Juan Williams, do you think that this is going to be - that we should look closely at what happens? Well, Mara was just talking about these moderate Democrats in the Senate, but at this bipartisan effort in the Senate Finance Committee, the so-called gang of six.

WILLIAMS: Well, it's key, Neal, because what you have there with the Senate finance chairman Max Baucus is really an intermediary link to some of these moderate Democrats. Senator Baucus has said that he will, for example, not support a public option. A public option would have a government-run alternative to health insurance programs now, and your privately run health insurance programs around the country.

President Obama went out of his way last night to make the point that this plan would not put out of business the existing insurance companies because it would not be subsidized by the government, but would have to run on premiums paid by people who were insured. And Baucus, therefore, is really setting the tone on the key question and the one that the critics have latched on to, which is: How are you going to pay for this new health care proposal? The president in his remarks yesterday said it's got to be deficit-neutral, and he introduced this idea of a trigger.

He said that if they don't have a plan in place by 2013 that would assure that there is no additional pressure put on the deficit by this plan, then they won't have the plan. Again, this is an effort, I think, to appeal, on the face of it, to the critics, specifically to the Republicans. But I think it really, if you look at who the audience was last night, it's meant to appeal to people who are independent voters.

And Mara mentioned earlier how over the summer, the president's numbers, the support for his, in general, health care proposal had slipped. It had slipped primarily among those independents. And a lot of those people said, you know, we don't even know exactly what the president's plan is. And they were concerned about the idea of government intrusion and too much spending that might lead to tax hikes. Well, all of a sudden, last night, the president's trying to reassure them, much as he was trying to reassure seniors that he's not going to take any money out of the Medicare system, not to do any damage there, as he's trying to reassure people that if they have existing health insurance plans, they will not be required to change them.

This is all part of an effort that I think, you know, some of the instant polls indicate he's had some success with the independents, and that's what he really hoped for last night.

CONAN: Let's bring another voice into the conversation: NPR science editor Joe Neel, who has also been kind enough to join us here in Studio 3A. And nice to have you back on the program, Joe.

JOE NEEL: Always a pleasure.

CONAN: And I know that one of the things we've asked each of our guests this hour to do is to pick out a part of the speech they think is critical. Juan was just mentioning that part about paying it. And well, interestingly, that's where Joe Neel picked out the cut of tape from President Bush's - excuse me...

(Soundbite of laughter)

CONAN: …President Obama's address last night to the joint session of Congress. And that has to go with, well, the seemingly magical idea that this $900 billion program will be deficit-neutral.

President BARACK OBAMA: I will not sign a plan that adds one dime to our deficits…

(Soundbite of applause)

Pres. OBAMA: …either now or in the future.

(Soundbite of applause)

Pres. OBAMA: I will not sign it if it adds one dime to the deficit, now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts, if the savings we promised don't materialize.

(Soundbite of applause)

Pres. OBAMA: Now…

(Soundbite of applause)

Pres. OBAMA: …now…

(Soundbite of applause)

Pres. OBAMA: …part of the reason I faced a trillion-dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for, from the Iraq War…

(Soundbite of applause)

Pres. OBAMA: …to tax breaks for the wealthy.

(Soundbite of applause and cheering)

Pres. OBAMA: I will not make that same mistake with health care.

CONAN: And the unfortunate part of not doing this show in stereo is you couldn't hear most of that applause - certainly to that last line - coming from the right, the Democratic side...

(Soundbite of laughter)

NEEL: That's right.

CONAN: …of the House from the - but Joe, this idea that this will be deficit neutral, how is that going to work?

NEEL: Well, it's $900 billion over 10 years. That's, I mean, it won't be 90 billion each of those 10 years, but roughly, let's think of it in those terms. So he has to come up with 90 billion each year. Half of that will be in cuts to existing federal programs, and about half comes from taxes yet to really be worked out or yet to be determined. Much is still on the table. In terms of the Medicare cuts, they want to get rid of the Medicare Advantage program, which was a program created during the Bush administration to try to encourage insurance companies to - private insurance companies to come into Medicare, offer services and to bring more competition into Medicare by bringing the private insurance industry in.

And it turned out, everyone pretty much agrees on both sides of the aisle that it's been a windfall for insurance companies. And several billion, if not 15, $20 billion there can be eliminated. They also want to reduce the amount of money spent - given to hospitals for unnecessary readmissions. A lot of people are discharged from the hospital too soon and come back in the hospital within 30 days, and they want to take a closer look at the kinds of care they get to try to minimize the back and forth to the hospital and those costs.

There's something on increasing hospital productivity. And the big thing that you hear a lot, and we heard it last night from President Obama, is he wants to eliminate waste, fraud and abuse in Medicare and Medicaid.

CONAN: Everybody does. But arithmetic, never my strong suit, Joe. Does all of this add up?

NEEL: Well, it does add up, if it all works. The waste, fraud and abuse is not what you'd simply think of as corruption, either. It's really eliminating what's called unnecessary care. This is all of the defensive medicine, the unnecessary tests, the overtreatments, the - too many procedures. If everything works the way that people are talking about, it could.

CONAN: Let me ask you another question, Joe, and that is the president kept referring to my program, my program, my program. Which of these - the various versions of the bills was he talking about?

NEEL: Well, it came closest to what we've seen from Senator Baucus out of the Senate Finance Committee.

CONAN: That's the draft, which he has not yet voted on.

NEEL: The draft that was circulated over this past weekend. It most closely parallels that.

CONAN: Mara?

LIASSON: What I thought was interesting about that, the president isn't sending legislation up to the Hill the way Hillary Clinton did. But by associating himself with various proposals that have come out of all the different committees, he's saying these are the things I want. And by calling it my plan, I think it also puts him back in the game in a way that shows strength, and it makes him look presidential, something that a lot of his supporters in his base were complaining about. He wasn't being bold enough. He wasn't out there fighting against the critics.

But, you know, something about the cost of this, which is interesting, he did give a lot of specifics last night, but this is the area where he gave the least. Yes, he said it was 90 billion over 10 years, and…

CONAN: 900 billion.

LIASSON: 900 billion over 10 years, and he said half of it would come from these cuts in Medicare. And some of it will come from this new fee on insurance companies who issue these very expensive, gold-plated plans. I don't think that's more than $10 billion a year, but he did at least name one specific thing. He didn't say whose taxes he wants to raise, and…

NEEL: But in the past, he's supported limiting the deductibility of charitable contributions.

LIASSON: Yes, but Congress doesn't like that.

NEEL: Right, no, that doesn't appear...

LIASSON: But what - when he talked about this commission, IMAC, this commission that's going to look for waste, fraud and abuse, defensive medicine, that is really difficult. In other words, getting that up and running, that's where the fears about rationing come from. They're going to decide on unnecessary care. What is that? That's a really complicated, you know, set of decisions to make. Who gets to have a hip replacement, who doesn't?

NEEL: Well, they hope to do that through these comparative effectiveness studies.

LIASSON: Right, which will take years to get...

NEEL: It would be scientifically based, but yes, it'll be several years before we get good results on that.

CONAN: We're talking about response to President Obama's speech last night to a joint session of Congress on health care. Did it change your mind? Specifically, how or how not? Give us a call: 800-989-8255. Email us: talk@npr.org.

We're also going to be talking about the atmospherics around the president's address to the joint session of Congress last night, how that played out. And well, the president said 80 percent of what he's proposed is widely agreed upon. So what's the other 20 percent? Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. The debate over health care today sounds remarkably similar to the debate over health care at this time yesterday. President Obama, of course, delivered his primetime speech last night. Even he acknowledged many details remain to be ironed out.

The night was as much about perceptions and regaining the high ground as it was about policy options. So did the president's address change your mind? How? Give us a call: 800-989-8255. Email: talk@npr.org. You can also join the conversation on our Web site at npr.org. Click on TALK OF THE NATION.

We have three of NPR's finest with us: Mara Liasson, national political correspondent, news analyst Juan Williams and science editor Joe Neel. And Juan, let me turn to you. The stage the president chose to deliver this address, he could have done it from the Oval Office, from a fireside chat. He chose, well, I guess a risky one. Nevertheless, the atmospherics of the speech last night, the Democrats, of course, understandably enthused, the Republicans shown repeatedly sitting on their hands.

WILLIAMS: Well, it's not just sitting on their hands, Neal. You know, what struck me was, of course, I think what's sort of become the story of the day, which is the remark by Congressman Joe Wilson, a Republican from South Carolina, who shouted out "you lie" to the president as the president was saying that under the plan that he wants to put in place that illegal immigrants would not get health insurance coverage.

That was really a break. I mean, obviously, we've had moments where you've had boos and hissing and mumbling about something that a president has said - not even very aggressive booing, actually. It's certainly not like the parliament, you know. But that was a real departure.

I can't think of anything like that since I've been around Washington. You can ask Mara and Joe, but - and he immediately then called the White House to apologize. Rahm Emanuel, the president's chief of staff, apparently turned to the Republicans, especially to the leader, John Boehner, and said, you know, no president's ever been treated that way. I want an apology. And he got it.

So that atmospheric, I think, really, is going to be something that marks this occasion, maybe more so than anything that President Obama said. And, of course, it works in large part to President Obama's advantage. It makes him seem to be the idealist, the rational, the adult in the room, versus people who are screaming.

The other thing that I think lots of people who may have been watching on TV noticed is that when the president spoke about if you have a plan, bring it to me, you had Republicans waving their plan out in the open, saying we do have a plan. You know, don't tell the American people there's no Republican plan, because there is one.

So last night, you had the president saying I have a plan. Here's what I believe in: the public option, mandates for people who can afford health insurance to be required to get that health insurance, employers having to provide it, talking about reaching out to Republicans by opening these medical malpractice demonstration zones to try to put limits on medical malpractice suits. But it was also, I think, the atmospherics in the room defining the opposition against him.

CONAN: I just want to pursue that last point. Joe Neel, these medical malpractice suits, that has been a hearty perennial on the Republican side for many years. What did the president exactly propose? How serious is it?

NEEL: He proposed demonstration projects, which essentially are small-scale experiments in various states that would be overseen, I am assuming, by the federal government.

Right now, a couple of states have had, for quite a number of years, limits on the awards you can get from a medical malpractice case, Texas and California being the biggest. Generally, they're limited to about $250,000 in damages, and so far - in Texas, at least - it hasn't had a lot of effect on the rise in health care spending, even though everyone says capping malpractice costs will reduce the number of unnecessary, unneeded - that defensive medicine to cover your you-know-what.

CONAN: Yeah. All right, let's get some callers in on the conversation. Did the president's address last night change your mind? Specifically, about what? 800-989-8255. Email" talk@npr.org. We'll start with Matt, Matt with us from Fort Wayne, Indiana.

MATT (Caller): Hi, Neal, how are you doing?

CONAN: I'm well, thanks.

MATT: I was not impressed with the president's speech last night. I was hoping for more specifics on what exactly the minimum acceptable plan that will meet the requirements of the mandate will be. For instance, I have catastrophic insurance right now. I pay most of my expenses out of pocket. But I was wondering: Am I still going to have to get a more expensive plan, or will I still be okay? I'll take my answer off the air, thank you.

CONAN: Okay, Mara?

LIASSON: Yeah. Those are some of the things that remain to be sketched out. I mean, he didn't say, as this caller suggested, what the basic plan would be that everybody would be required to purchase. He did say there's going to be an individual mandate. Everybody's going to have to buy something.

He also didn't say what percentage of people's - what percentage of their income should people expect to spend on health insurance. I think that's a very, very important thing for people. What people with insurance want to know is, and they're worried about their premiums rising, is, you know, how is this plan going to control my costs? And he didn't talk about that.

There are people who have lower incomes who are going to get subsidies to help them buy plans on this exchange, but what about people who are above that? You know, he said you're not going to have a lifetime limit. You're not going to be able to be dumped. You're not going to have - be barred because of a preexisting condition. But he didn't address the idea of controlling costs for people who have insurance.

WILLIAMS: Well, one of the proposals that's out there is the Senate Finance Committee draft from Senator Baucus that we were just talking about. And in there, generally the income limit is spending no more than 10 percent of your income on health insurance.

It all depends on individual circumstances, 10 to 13 percent in this bill, but this is all up for negotiation. The president didn't put a number out there last night. So I think there's a lot more to be…

LIASSON: But how would that work? I mean, if you make $200,000, an insurance company has to sell you a plan that only costs $20,000? I mean, how do you enforce that?

WILLIAMS: That's the big question.

LIASSON: Because you're too rich to get a subsidy - yeah.

CONAN: Let's get another caller in. This is Mark, Mark with us from Fort Myers in Florida.

MARK (Caller): Yes, hello. I'd like to say that I'm a Republican, lifelong, and I really wanted to hear the details. I know we need reform. I know we need something completely different from what we have, and I was really hoping to hear some good details, and I did, and I was convinced. And I think part of the problem was I was ashamed and embarrassed that my party sat there, the whole left side of the room in the screen, they sat on their hands no matter what this man said or promised or how sincere or hard he seems to be working. We're letting him fall on his face.

If we're going to push for his Waterloo, like that one senator had said a few months ago, so hard and really in the face of what this country needs, at what point does politics become treason? We need that. These people wouldn't have given him anything.

If you watch the facial expressions on these people and their habits and mannerisms, they didn't want to hear from anything. They didn't even like it when he said something they heard because they didn't want to have to react, and it was embarrassing to me. And I think that if Mr. Wilson wants to go do the prime minister's questions in England, let him. But at certain points, we're supposed to stand behind our president, whether we voted for him or not, and I don't think that was what was going on in the room.

I think it's really more of these sell-out positions, whether they're paid by the medical companies or not. They want to oppose him for the sake of opposition. That's not patriotism. That's treason to me.

The CEOs of the top 10 health care companies starting salaries start, with perks, at $900 million. It goes up to $1.6 billion for the top guy. When is somebody going to bring that up? That's where the waste is. It's at the top. Everybody above the rank of nurse in that system makes a killing. Why isn't anybody going to bring that up? I'd love to hear your guests' comments. Thank you so much.

CONAN: Thanks very much, appreciate it. Joe, can you help him out on that?

NEEL: Yes, high salaries of insurance company executive and hospital executives and the salaries of doctors are certainly a big part of the health care economy. They don't get as much attention as some say they should.

CONAN: Here's an email that we have, this from Alex in San Francisco. I've been all about a public option. I was really upset he wasn't fighting for it, but last night I was completely persuaded by his speech. I now think we need to pass reform with or without a public option. I was quite moved by his call to not do nothing.

And again, we asked our guests here today to pick out one part of the president's speech that they thought was particularly interesting. Mara Liasson picked out this: When the president addressed that right side of the room, where the Democrats were sitting.

Pres. OBAMA: To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it.

(Soundbite of applause)

Pres. OBAMA: The public option is only a means to that end, and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

(Soundbite of applause)

Pres. OBAMA: For example, some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others have proposed a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice.

(Soundbite of applause)

Pres. OBAMA: And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

(Soundbite of applause)

CONAN: And - well, that about the bureaucrats got both sides to stand up and cheer about that. Mara, I wanted to ask you about that in the context of this email we got from Mary(ph) in St. Louis: I'm a breast cancer survivor who's had to pay for her own mammograms and her yearly oncology and radiology exams, a hip replacement survivor who's had to pay for her own yearly X-rays. It's also because I'm a small business owner, can only afford catastrophic insurance with a huge deductible. No, I'm not old enough for Medicare. I'm a strong supporter of the public option. But after President Obama's speech, I am less adamant about that in the bill. What I want is affordable coverage with no pre-existing conditions with the flexibility to choose my own doctors and care. Do I still want the public option? Yes. But if I get the other benefits, I will be grateful.

LIASSON: That is exactly what he wanted to accomplish. I mean, that email and the one before it, I mean, these - that shows you that at least with these people, he hit the target right in the bull's eye. I mean, he was saying to the left, look, you know, a half a loaf is better than nothing. And in 1994, Democrats didn't believe that. They actually thought it was okay to pass nothing. Now, they understand it's not okay because that's one of the reasons they left their majority back then.

So, I think that what he did last night was really clever. He gave an incredibly full-throated, eloquent defense of the public option and then said he wasn't going to insist on it. And you don't see today an uprising from the left wing of the Democratic Party saying, oh, my goodness, he's betrayed us. Not at all.

And I think what's interesting about this, even though there are definitely some liberals in the House of Representatives who in the end will not vote for the health care bill because it doesn't have the robust Medicare-style public option they want, you're not going to - I don't think the left wing of his own party is going to sabotage this.

CONAN: Juan, do you agree?

WILLIAMS: Absolutely. I think that may be the headline out of what happened yesterday. You know, I was listening to the caller who said he was a Republican and felt ashamed of his party and all of that. And I was struck by thinking, gosh, this is exactly the guy that Barack Obama wanted to impress last night. And the whole notion that, you know, it's time to do something, that we have been stuck for too long - that's the argument that he wants to make. Now, the question is whether or not you think that he delivered enough in terms of the details. And the caller said, oh, yes. He had lots of details.

But this morning, I was on Capitol Hill and lots of the Republicans don't think that he really delivered on those details. We - earlier, we were talking about cost, we were talking about who would be required to buy what kind of insurance, or what percentage. You know, yesterday at the White House, they were saying - to pick up on what Joe was talking about - the Baucus thing is 10 to 13. They were thinking more toward the 13, maybe even a little higher. But how do you enforce that?

So, there are people who do want details and who feel that he didn't deliver those details. But nonetheless, there was this sense of President Obama going away from being on the spot - and everybody is saying, well, he's really lost the momentum - to now being on the offensive. And I think that's the big shift, and especially on the offensive with fellow Democrats. There are some people who have vote counts up there, who have a large number of moderate Democrats who would not, right now, commit to vote with this. We don't know what's going on with these bus trips up to the White House and the like, but - or down to the White House. But I think that after last night, the president has clearly put the pressure on those moderate to conservative Democrats, and maybe even a few Republicans, to get on board or to be targeted as obstructionists at a moment of crisis in the health care system - in health care reform.

CONAN: Juan Williams, Mara Liasson and Joe Neel are all with us. You're listening to TALK OF THE NATION from NPR News.

And let's get another caller in. James(ph) calling from Portland, Oregon.

JAMES (Caller): Hi. Thanks for having me on. I'm disappointed to see Obama leaning away from the public option and toward the Baucus plan, specifically because the insurance industry is a major contributor to Baucus and they're helping draft that legislation. And he actually circulated the latest draft of it on K Street before he let the White House see it, according to a White House spokesperson.

And I think that instead of focusing on nonsense like death panels, the media should be doing a little better job of showing us who the heavy hitters who are driving this debate and where the money is coming from for conservative Blue Dog Democrats and those who are - tend to drive us away from the public option, which is - polls show it's actually supported by a large number of Americans. I don't think it's a far-left idea.

CONAN: Mara, let me ask you…

LIASSON: Yeah.

CONAN: …is James right to be suspicious of K Street lobbyists?

LIASSON: Well, it was interesting that the White House said that they haven't seen the draft where there were reports that it was circulating on K Street. But it's not just Max Baucus who gets money from these so-called special interests, although nowadays, we call them stakeholders because we want them all at the table. The White House legislative strategy was to get all of those special interests - Big Pharma, the health insurance industry - at the table at the beginning, cut their deals with them and keep them there. And they've succeeded. This was the way they decided they could pass a health care plan. They didn't want the pharmaceutical industry and the health insurance industry on the other side fighting them. And they haven't gotten that. As a matter of fact, the pharmaceutical industry is spending millions of dollars on ads supporting health care reform.

So, I think that to blame all this on Max Baucus is just not fair. I mean, this was - the White House strategy was to say, we are not going to upset the applecart for the health insurance industry. We're not going to destroy the employer-provided benefit system that we have now, and even in the way he's approaching the public option. I mean, they believe this is the only way they can pass this plan. It's not Max Baucus. I mean, I think the White House has made a calculation that a robust Medicare-style public option, which is clearly what this listener would prefer, can't pass through Congress, can't get the 60 votes in the Senate that you'd need.

CONAN: Or could pass through the House of Representatives, but…

LIASSON: Yeah, but not the Senate.

CONAN: …not the Senate.

WILLIAMS: And let me just throw in there, Neal, that I think that it was a huge mistake for the White House to play it out that way. I think that there have been some major mistakes made along the way by - surprising mistakes, given the efficiency with which the Obama team ran that campaign. But they've made big mistakes here. And one of them, I think, was to try to buy into the tent very quickly Big Pharma and the insurance companies, rather than saying, you know what, we'll take you on, and point out where big money is coming from, trying to influence this debate and where the real interest of the people might lay.

CONAN: James, thanks very much for the call.

We're going to have to thank our colleague, Mara Liasson. She's got to go work for our sister program downstairs, something about ALL THINGS CONSIDERED. We appreciate her time with us today. Joe Neel and Juan Williams are going to stay with us. You, too: How has the president changed your mind if at all? Be specific please. 800-989-8255. I'm Neal Conan. TALK OF THE NATION, NPR News.

(Soundbite of music)

CONAN: President Obama made the health care pitch last night. The pundits have had their say. Now, we want to hear from you. Did the president's address last night change your minds? Specifically, how? 800-989-8255, email: talk@npr.org. You can also join the conversation on our Web site: npr.org, click on TALK OF THE NATION. With us here in Washington, our own Joe Neel, NPR science editor, and NPR News analyst, Juan Williams.

And here's an email that we have from Reed(ph) from Tempe: I am a lifelong Republican. President Obama convinced me by winning my heart. This is a moral issue. We need to level the playing field.

And again, we asked our colleagues here on the program with us today to pick one cut of tape from the president's address last night. This happens to be the cut that Juan Williams picked, about - well, it was toward the end of the address and it was really to that point about passion.

Pres. OBAMA: Ted Kennedy's passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick. And he was able to imagine what it must be like for those without insurance, what it'd be like to have to say to a wife or a child or an aging parent: There is something that could make you better, but I just can't afford it.

That large-heartedness, that concern and regard for the plight of others, is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character: Our ability to stand in other people's shoes, a recognition that we are all in this together, that when fortune turns against one of us others are there to lend a helping hand, a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play, and an acknowledgement that sometimes government has to step in to help deliver on that promise.

CONAN: And, Juan Williams, the president made the pitch: This is a moral imperative.

WILLIAMS: He really did. And it was both visual and oratorical, Neal. You heard some of the oratory and he spoke about a letter that had been written to him by former Senator Edward Kennedy just before Kennedy died - I guess that's August 25. So basically, you know, a deathbed missive to the president asking him for a long-term change. And in the audience last night was Vicki, the senator's wife. And she was sitting there almost sobbing as the president spoke about the life mission of her husband to achieve some kind of health care reform. It was a powerful, emotional note. And again, if we think about who this address was aimed at, it was aimed at independents - a lot of them women - and at Democrats in the audience in front of him in that House chamber. And again, I think both of those groups would be impacted by the thought of Senator Kennedy's legacy.

CONAN: I wonder, the president has such remarkable rhetorical gifts, why did he not unleash them earlier?

WILLIAMS: Well, I agree - if you mean earlier in the speech or earlier in this debate?

CONAN: No, earlier in the campaign. Yeah.

WILLIAMS: I wish he - I don't understand it because it seems to me, he ceded the ground and allowed critics, you know, by his own measure - I was at the White House yesterday and hearing from his top aides, and they were all saying, well, no longer are we going to do this business about looking at each individual tree or allow the critics to caricature the president's arguments. Tonight, you're going to hear of what the president - I'm thinking to myself, why didn't he do this sometime ago? Why didn't he lay ownership? Why didn't he really use the fact that the American people have so much more trust in him than they do in the Democrats in Congress or the Republicans - far more than the Republicans in Congress?

Instead, the Republicans and the critics - let me say some of them conservative Democrats - have been able to control the debate or dominate the debate with this talk of death panels and rationing and a socialized - all of that, rather than some of the elements that we heard about tonight - last night and, as you said, you know, given power by the president's oratorical skills.

CONAN: Let's go to Tracy(ph). Tracy with us from Oakland.

TRACY (Caller): Hi. I am for health reform. What I liked especially about his speech was that he said it's a moral issue and he's looking to level the playing field. And I think that's what the bill, reform, however it passes with the public option or without, that's what it should do.

CONAN: So, you were - the moral part of the argument, did that sway you, Tracy?

TRACY: Yeah. That's what swayed me.

CONAN: All right. Thank you very much.

TRACY: I believe it's a moral issue.

CONAN: All right. Thanks very much. I appreciate that.

TRACY: Thank you.

CONAN: Here's an e-mail we have from Ruth. I was against everything the president was proposing, but last night I did change my mind as he talked about collective purchasing power of the other individuals without coverage to afford low-cost health insurance. I do not support government-run health insurance. The government does not run anything correctly or cost-saving. Now, I am for parts of the plan. I think we do need to purchase our health care across state lines. That would increase low-cost options.

That's a Republican point, generally, Joe Neel, and that's not what the president was talking about last night.

NEEL: No. But he did embrace another idea of Senator McCain's from the campaign, that's high-risk insurance pools on the issue of buying insurance across state lines. It sounds, on the face of it, like a reasonable idea that if I live in high-cost New York I should be able to buy something in low-cost Texas. But the major objection that I hear out there is that people in - if the insurance company in Texas goes out of business or provides really lousy service, if you're in New York, you don't really have a lot of recourse, because the way our system is set up now is that insurance is regulated on a state by state basis.

One of the interesting things that I would bring up is the numbers came out from the Census Bureau today - Neal mentioned the poverty increase. But there were also numbers out on the uninsured today, and quite surprisingly, the number of uninsured has stayed at about 46 million, where it was in 2007 and now in 2008.

But underlying that is a very interesting phenomenon, that even though there were no more people who were left uninsured, four million more people went into government programs. So, the price of doing nothing, which is where we've been at for many years, is several million people going into public programs every year. So, we're getting a de facto government takeover, if you will…

CONAN: A creeping government take…

NEEL: Very slowly creeping, but creeping nonetheless.

CONAN: All right. Let's go to Barbara(ph). Barbara with us from Nashville.

BARBARA (Caller): Yes. My question is I have a pre-existing condition that has to do with hearing. And I was still confused about - Obama said that if you have a pre-existing condition you won't be denied insurance. But I have insurance, and nothing will ever be covered with my ears. Probably the same if I joined another insurance company even if they accepted me. So, how - I'm confused about how a public option or any option would help secure health care for me. And I'm just a college student. That's kind of an important question. So…

CONAN: Joe, can you help her out?

NEEL: Well, there are basic benefit plans that will be available. And it's true that services for people with hearing impairments and other hearing issues, even eye problems, you know, you don't - many plans will not pay for glasses. I don't - I haven't seen anything about that changing, so I'm not sure - you would be able to get insurance if you had some other pre-existing condition. But perhaps you're right that the hearing won't be covered.

CONAN: Barbara, we hope we can get that in there for you.

(Soundbite of laughter)

BARBARA: Absolutely. Thank you.

CONAN: Bye-bye. Juan Williams, it brings up a point, though: the pre-existing conditions. The president said last night we have agreement across party lines on 80 percent of this, and that would be one of the things on which there would be broad consensus. What's the 20 percent on which everybody is still fighting those - when the snickers went up, he says some details remain to be worked out?

WILLIAMS: Well, for example, the thing that Congressman Wilson said he was lying about, you know, should you cover people who are immigrants. You know, up in Massachusetts where they had a health care - statewide health care plan, the cost has risen to the point where they no longer cover illegal immigrants. So, whether or not you cover people who are not here legally, I guess President Obama says he's now off that track. But do you cover legal immigrants? Maybe there's some discussion to be had there.

The big one would be cost, though, Neal. How do you pay for this, the different plans and approaches to pay for it? Tort reform - another area of discussion and debate. Even something like, for example, the - you know, Senator Kerry had proposed and apparently, Senator - President Obama has bought into this idea of a surtax on these high-end, sort of gold-plated insurance plans. The question is, exactly what constitutes that and whether or not the unions might be upset with that. So, that would be some friction coming from the left. Because remember during the campaign, Senator McCain, during the presidential campaign, had proposed that there be a tax on your health care benefits. And then-candidate Senator Obama said that was ridiculous. Now, he's - you know, thinking, well, for some people, that might be…

(Soundbite of laughter)

WILLIAMS: …might be the case.

CONAN: That was also part of his pledge not to raise taxes on anybody making less than, what was the number, $150,000 a year?

NEEL: Two hundred fifty.

WILLIAMS: Two fifty.

CONAN: Two fifty. All right. So, that will work into that as well. So, he will be asked to uphold his pledge to tax that plan. If you're making less than $250,000 a year, that's a tax.

WILLIAMS: Well, one way the Baucus plan gets around it is the tax would, on those high-cost insurance plans - and we're talking about something in the neighborhood of 20,000, $21,000 for a family of four each year, when the average cost is about 13,000 - there would be an excise tax on the insurance company not on an individual. Therefore, he wouldn't be raising taxes on individuals.

CONAN: Individuals. I see. So…

WILLIAMS: Yeah. But they would pass that through, of course. So…

NEEL: Well, but they - yes. And they - we were talking about this today. And would they pass it through to everyone? Well, probably.

CONAN: Probably.

WILLIAMS: It remains to be seen.

CONAN: Joe Neel is NPR's science editor. Also with us, NPR News analyst Juan Williams. And you're listening to TALK OF THE NATION from NPR News.

And let's go next to Alfred(ph), who's been very patient on the line, in Oakland.

ALFRED (Caller): Hi. I wasn't convinced by Obama at all. I'm not - I'm a longtime Democrat, 40-year Democrat, and I just don't buy it. And the reason is that he didn't give any specifics about subsidies, really, about what subsidy it's going to be, who's going to get them, how are we going to pay for them, who's going to be taxed for them…

CONAN: And this would be to bring in the people who currently do not have insurance coverage.

ALFRED: Right, otherwise you can't cover them. Or they receive something so poor that you might as well not cover them at all. And the fact that the bill overall is so vague - that I really don't know what I'm getting. And I don't feel comfortable of doing that. I feel like if the bill is going to be passed and they're going to say, well, we're going to decide on some of these very important things later on, then what you're doing is saying, we don't know what's going to - what really the bill is about, but trust us. Well, I don't trust them because the forces at work upon them by the health insurance companies are overwhelming. If they don't give me some specifics that tell me I'm in a safe zone, you know, I'm getting…

CONAN: Mm-hmm.

ALFRED: ...how it's going to affect me personally, I don't trust that they're going to be able to escape the incredible influence of money campaign and -campaign money and so on that…

WILLIAMS: Well, let me ask you a question. So if I'm President Obama and I was listening to you, I would say to you: And you trust the system as it stands now and you trust the big insurance companies?

ALFRED: Well, I trust that if I'm - here's my point. If you're going to force me to buy insurance - and that's what this bill does, it forces everybody to buy insurance - you better tell me exactly what I'm getting.

WILLIAMS: Right. Well, that's a fair point.

ALFRED: That's going to be trade-off. If that's the tradeoff, you better tell me what I'm getting. I'm not getting that, so I'm going to tell my representative to vote no.

WILLIAMS: You mean, so you would stick with the status quo rather than, from the president's perspective, wait until they had a bill that was, you know, ready for final passage, let's say, some time in October or November?

ALFRED: I would say take more time, or I would say start from the beginning. Let's go back to the drawing board. I mean, in terms of the cost alone, if you start - if you just expend Medicare, my understanding is that there's 4 percent overhead in paperwork for Medicare and, what, 25 percent for most of these commercial companies.

CONAN: As much as.

ALFRED: All right? Now, you save a whole bunch of money. Now, I mean, it's things like this that make me suspicious and make me think, well, let's start over again.

CONAN: Alfred, let me follow up with Juan on that particular point. Start over again, there is a clock ticking. It's the political calendar, Juan Williams. A lot of people say if this doesn't get passed, well, this fall, it's not going to get passed.

WILLIAMS: Well, it's very - I mean, goodness gracious. You know, the political season for the 2010 midterm elections really begins in January.

CONAN: For Joe Wilson, I think it began last night, but…

(Soundbite of laughter)

WILLIAMS: Well, you've heard about all the money that his opponents down in South Carolina have raised today. But there are two big races this fall, one for the governor's race in New Jersey, another for the gubernatorial seat in Virginia. And already they're being impacted by this discussion and debate and the president's falling poll numbers. So that's potentially out there, and then you have those moderate to conservative Democrats who are fearful about how their vote will be interpreted, by people such as our caller, going towards 2010. So right now, the predictions are that Democrats are going to suffer losses in the House and Senate in 2010.

So the likelihood that anybody is going to be willing to stand up and potentially take an idealistic stand that's not related to money coming from stakeholders, as you might call them, Neal, or as others might say special interest…

CONAN: Special interest.

WILLIAMS: …or respond to attacks coming from not only conservatives but from people to their left who might say, why didn't you stand up for the public option? It's just not in the cards unless it gets done under this clock that really expires at the end of this term, and so you have to say expires at the end of December 2009.

CONAN: And are the odds better today of passage this fall than they were yesterday?

WILLIAMS: I think so. I think the president helped himself, especially in terms of consolidating those Democratic votes. Democrats control the House, they control the Senate. The question is can he wrangle them in such a way, especially that Senate Finance Committee and its influential chairman and maybe a few of the Republicans, Olympia Snowe, Voinovich, Susan Collins, just so he can claim some bipartisan - I would say that he made some progress on that front yesterday. On that basis alone, I'd say, yes, we are closer to getting a bill today than we were yesterday.

CONAN: Juan Williams, thank you very much for your time today.

WILLIAMS: Thank you very much.

CONAN: NPR News analyst Juan Williams, with us from Washington. And Joe Neel was with us here in Studio 3A, where he is NPR science editor. He's also NPR science editor when he's out of the studio…

NEEL: Outside of 3A.

CONAN: …yeah, outside of 3A. Joe, as always, thanks very much for your time.

NEEL: Sure.

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