health care--Obama trapped

As he pushed through the stimulus package so quickly Congress did not have a chance to read it, Obama is now trying to push through changes in health care, which the pundits are saying makes up 1/6th of the nation's budget.  It's been pretty interesting watching the knots he's tying himself in to satisfy all his constituents.  So far, he's not succeeding very well.

In a speech to the AMA, he said he "understands" the constraints put on doctors by concerns about malpractice suits, and acknowledges that they do a lot of testing they might not otherwise do as "defensive medicine", one of the practices that makes our system so cumbersome and expensive.  As the doctors started to cheer, though, he stopped them and, without really saying so, also hinted that tort reform is off of the table.  So Obama is trapped between the doctors represented by the AMA (about 1/3 of US doctors, and arguably the more liberal 1/3) and trial lawyers.  How can he satisfy both?

At the same time, many members of his own party are digging in their heels because of the cost.  He's promising to have the CBO estimated $1T paid for with cost-savings by increasing efficiencies (i.e., less defensive medicine, among other things), but, well, see the previous paragraph for how that's working out.

Another idea he's thrown out is to pay for it by taxing health benefits above a certain minimum, i.e., targeting employer supported health insurance.  But some of the richest such plans are the ones the unions benefit from, and Sen. Dodd, for one, has pretty well scotched that idea.  

Then there are the hospitals--yet another idea he's thrown out is reduced payments to hospitals.  They are already stressed, having already faced cuts from Medicare and HMOs.

So, hospitals, doctors, unions, lawyers, other Democrats:  all pulling in different directions.

Gee, what a surprise!

CAVU

I don't know about you, but I like to try to go to original sources before listening to the pundits, so I searched for a transcript of Obama's speech (no way was I getting up at 0300 to hear it live). I found a transcript on a Muslim blog, here. I didn't agree with everything, but it was a pretty good speech; my biggest concern was the part about Israel and the Palestinians, but that has been/is/will be such quagmire that I don't think anyone can really say anything sensible about it.  

He mentions 9/11 at the beginning, and I don't think he pulled his punches in presenting the effect of that event on this country. I didn't see a hint of apology anywhere, and he never mentioned Bush or even the previous administration. The closest he came was a very oblique reference to the mistakes in Iraq, but that was adjacent to a statement that the Iraqis are better off without Saddam Hussein, which surprised me. He defended democracy.  

All in all, it was a very pretty speech. I just wish I were convinced that he will be as strong an advocate for some of the principles as he sounded. And I was put off by the kumbaya-one world bits, but that probably plays well elsewhere and I would have been shocked if that weren't a strong theme.