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Reporting from Washington -
The challenge facing President Obama's effort to revamp healthcare can be summed up with these words from Nobel Prize-winning economist Daniel Kahneman: Losses loom larger than gains.
Obama's speech to a joint session of Congress on Wednesday night was an effort to shift the balance between Americans' fear of loss and their hope of gain from changing a healthcare system that reaches deep into their personal lives.
For months, the often-vociferous debate has been dominated by fears of what might be lost if Democrats succeeded in overhauling what even critics agree is a troubled system -- loss in the quality of individual care, in people's ability to choose doctors, in their freedom from new government rules and mandates.
Those anxieties, underlined and reinforced by Republicans and other opponents of Democratic proposals, seemed to eclipse the possible gains -- more affordable healthcare, less dependence on keeping one's job, less vulnerability to punitive insurance company rules and more accessibility to healthcare for all.
Obama may have succeeded in bringing the possibility of such improvements back into the spotlight. President Clinton got a substantial boost in public support after delivering a similar address more than a decade ago, though he let the gain slip away over time.
But Obama's speech also illustrated another, more durable obstacle to overhauling the healthcare system: the difficulty in packaging solutions to such complex problems in a simple way.
"You can kill it with sound bites like 'death panels' and 'socialized medicine,' " said Sen. Ben Nelson of Nebraska, a skeptical Democrat being wooed by the White House. Nelson was wowed by the speech but said that "it is hard to put the sell out there on the basis of sound bites."
For months, the White House focus has swung from moral arguments for helping the needy to pragmatic appeals to the self-interests of more fortunate Americans. It has moved from a strong defense of a government-run health insurance option to a willingness to negotiate away that most dearly held goal of his political base.
Ambiguity about his commitment to a public plan as an alternative for the uninsured was underlined again in his speech, signifying Obama's willingness to rankle his political base if that's what it takes to allay fears that big government would take away people's autonomy.
But after months of stumbling from one policy rationale to another, Obama came closer than ever to distilling his message to simple principles: stability for those who have health insurance, affordable coverage for those who don't, and cost controls for all.
Still, it took 45 minutes in the glare and grandeur of a joint-session Congress for Obama to begin to recast the debate and respond to critics.
If he succeeds in reversing the public's declining confidence in his handling of the issue, Obama may also shift the balance of hope and fear among the handful of swing votes in Congress.
The lawmakers in the middle -- centrist and conservative Democrats and a tiny number of moderate Republicans -- were an important target of Obama's speech.
Whether their votes are won or lost will be depend, in part, on the details that emerge during the intense legislative deal-making that is expected in coming months.
But the swing votes will also be influenced by what they see as the effect of Obama's arguments on voters back home -- whether he succeeded in shifting the balance between hope of gain and fear of loss, and whether he managed to cast his arguments in the sharp, uncomplicated forms that tend to stick in people's minds.
Only time will tell, but the White House might take comfort from one conservative House Democrat's reaction to Obama's pledge not to let a healthcare overhaul blow up the federal deficit.
"I come away from that with new hope that maybe we can reach agreement," said Rep. Earl Pomeroy (D-N.D.), a member of the fiscally conservative Blue Dog Democrats. "I think progress was made tonight."
janet.hook@latimes.com
Obama's speech to a joint session of Congress on Wednesday night was an effort to shift the balance between Americans' fear of loss and their hope of gain from changing a healthcare system that reaches deep into their personal lives.
For months, the often-vociferous debate has been dominated by fears of what might be lost if Democrats succeeded in overhauling what even critics agree is a troubled system -- loss in the quality of individual care, in people's ability to choose doctors, in their freedom from new government rules and mandates.
Those anxieties, underlined and reinforced by Republicans and other opponents of Democratic proposals, seemed to eclipse the possible gains -- more affordable healthcare, less dependence on keeping one's job, less vulnerability to punitive insurance company rules and more accessibility to healthcare for all.
Obama may have succeeded in bringing the possibility of such improvements back into the spotlight. President Clinton got a substantial boost in public support after delivering a similar address more than a decade ago, though he let the gain slip away over time.
But Obama's speech also illustrated another, more durable obstacle to overhauling the healthcare system: the difficulty in packaging solutions to such complex problems in a simple way.
"You can kill it with sound bites like 'death panels' and 'socialized medicine,' " said Sen. Ben Nelson of Nebraska, a skeptical Democrat being wooed by the White House. Nelson was wowed by the speech but said that "it is hard to put the sell out there on the basis of sound bites."
For months, the White House focus has swung from moral arguments for helping the needy to pragmatic appeals to the self-interests of more fortunate Americans. It has moved from a strong defense of a government-run health insurance option to a willingness to negotiate away that most dearly held goal of his political base.
Ambiguity about his commitment to a public plan as an alternative for the uninsured was underlined again in his speech, signifying Obama's willingness to rankle his political base if that's what it takes to allay fears that big government would take away people's autonomy.
But after months of stumbling from one policy rationale to another, Obama came closer than ever to distilling his message to simple principles: stability for those who have health insurance, affordable coverage for those who don't, and cost controls for all.
Still, it took 45 minutes in the glare and grandeur of a joint-session Congress for Obama to begin to recast the debate and respond to critics.
If he succeeds in reversing the public's declining confidence in his handling of the issue, Obama may also shift the balance of hope and fear among the handful of swing votes in Congress.
The lawmakers in the middle -- centrist and conservative Democrats and a tiny number of moderate Republicans -- were an important target of Obama's speech.
Whether their votes are won or lost will be depend, in part, on the details that emerge during the intense legislative deal-making that is expected in coming months.
But the swing votes will also be influenced by what they see as the effect of Obama's arguments on voters back home -- whether he succeeded in shifting the balance between hope of gain and fear of loss, and whether he managed to cast his arguments in the sharp, uncomplicated forms that tend to stick in people's minds.
Only time will tell, but the White House might take comfort from one conservative House Democrat's reaction to Obama's pledge not to let a healthcare overhaul blow up the federal deficit.
"I come away from that with new hope that maybe we can reach agreement," said Rep. Earl Pomeroy (D-N.D.), a member of the fiscally conservative Blue Dog Democrats. "I think progress was made tonight."
janet.hook@latimes.com
