Obama health speech: Enough to push reform through?

President Obama got high marks for delivery. But now that the big healthcare speech is history, it will take time for its impact – if any – to be felt. Historians note that when President Clinton delivered an address 16 years ago to a joint session of Congress promoting comprehensive health reform, he got great reviews – and no reform.

Mr. Obama did, as promised, lay out his own plan for reform, after standing back for months and allowing congressional committees to take the lead on details. In addition to repeating his goals of slowing the growth of healthcare costs and insuring the uninsured, he placed new emphasis on enhancing "security and stability" for those who already have insurance.

Obama also stressed that he was incorporating ideas from Republicans.

"Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do," Obama said.

One Republican idea that Obama is open to is malpractice reform. He instructed the secretary of Health and Human Services to launch demonstration projects in individual states to test the idea that changes to the medical malpractice system could bring down healthcare costs. Doctors have long asserted that they must practice "defensive medicine" – ordering tests and procedures that may not be necessary – to protect themselves from lawsuits.

Much of what Obama embraced as "his plan" is already on the table in congressional legislation. Insurers would no longer be allowed to deny coverage to those with preexisting conditions or take away coverage from people who get sick. Annual and lifetime caps on coverage would also be removed.

In return for insurance reform, the industry will have access to millions of new customers who will be able to shop for coverage from a new insurance "exchange," or marketplace. Individuals and families below a certain income threshold will be offered tax credits to help pay for coverage.

As promised, Obama supported the idea of starting a new government insurance plan, but did not threaten a veto if the "public option" is not in final legislation. He raised alternative proposals designed to enhance choice and competition in the insurance market, such as the idea of a nonprofit cooperative. He also alluded to the so-called "trigger," in which a public option goes into effect in markets only after it is shown that the private market is ineffective in making insurance affordable.

In essentially acknowledging he will not support the public option to the bitter end, Obama said he "will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice."

Obama also, for the first time, put a pricetag on his proposal: $900 billion over 10 years.

"Most of these costs will be paid for with money already being spent – but spent badly – in the existing healthcare system," he said. "The plan will not add to our deficit."

Obama proposed that the insurance exchange take effect in four years, to allow time to "do it right." But for people who cannot get insurance now because of preexisting medical conditions, the government would offer "low-cost coverage that will protect you against financial ruin if you become seriously ill." Obama credited his rival in the 2008 election, Sen. John McCain (R) of Arizona, with the idea.

But any feelings of bipartisan goodwill in the chamber went only so far. When Obama asserted that reforms would not insure illegal immigrants, Rep. Joe Wilson (R) of South Carolina shouted, "You lie!" He later apologized.

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