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Obama's Conversation-starter On Health

Standing before a packed audience in the East Room, President Obama just finished his opening remarks at the White House health care forum. For the next two hours, invited attendees--members of Congress and their top staff members, plus representatives for various interest groups with a stake in health care--will participate in breakout sessions on different dimensions of the health care crisis. Afterwards, the entire group will reconvene for a larger discussion.

This event, to be clear, is primarily for show. This is not the place where Obama and his advisors will hash out the details of their proposal for comprehensive health reform. It is, instead, a chance for players in this debate to get together, in one place, and pay homage to the idea they can get along. And, of course, this is a chance to build political momentum for reform. None of this is any great secret. In fact, after months of speaking of this event as a "summit," the White House decided to call this gathering a "forum." Which is just fine. This is how the policy-making progress begins.

But it was revealing, all the same, to hear Obama's remarks--and not just because, as a friend standing next to me noted, it's stirring when the president of the Untied States, as opposed to a candidate seeking that office, dwells on the problems of our health care system and pledges to enact "comprehensive" reform "by the end of the year." The noteworthy part was the language and the context.

Throughout the presidential campaign and now his young presidency, Obama has focused relentlessly on the issue of "cost." And it reflects a key, undoubtedly accurate, political judgment. Speaking about health care reform primarily in terms of those who lack insurance--that is, the uninsured--doesn't necessarily register with the vast majority of Americans, who still have coverage. But everybody, not just individuals but businesses too, feel the pinch of rising health care costs.

But in the reform debate, there are plenty of people who are argue that focusing on costs necessarily means putting off action on expanding insurance coverage. In other words, "cost" must come before "access." Some do this in good faith, suggesting that it's simply too expensive (measured either in dollars, political capital, or both) to handle both costs and access at the same time. Others use this more as a dodge, because they're not particularly interested in government doing what it takes in order to make health insurance available to everybody (i.e., meddling with private insurance or creating public alternatives to it, plus finding the money to do it).

Which brings us back to what Obama said--and why I found it encouraging. Demonstrating good discipline, he didn't dwell on the uninsured and pitched his remarks, clearly, to people who already have insurance. And he pointedly stressed the extent to which high spending on health care cripples individual businesses, hinders American competitiveness in the global economy, and threatens to overwhelm our resources in the coming decades.

But Obama also presented the cost problem as a problem for individuals--one that was crushing the insured as well as the uninsured, and in many cases transforming the insured into the uninsured:

In the last eight years, premiums have grown four times faster than wages. An addition 9 million Americans have joined the ranks of the uninsured. The cost of health care now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. Even for folks who are weathering this economic storm, and heave health care right now, all it takes is one stroke of bad luck--an accident or an illness, a divorce, a lost job--to become one of the nearly 46 million uninsured or the millions who have health care, but really can't afford what they've got."

The emphasis is mine, because that's the argument Obama and other reformers need to make. Pollsters will tell you, accurately, that the phrase "universal health care" does not play that well with the voters. That's because, when it's phrased that way, middle-class voters thinks that simply means paying more taxes so that people without insurance now can get it. What Obama is trying to do here is to suggest that everybody--the uninsured and insured--are vulnerable today, and that neither will be totally secure until we do something to guarantee coverage and make health care less expensive.

Obama understands this. His advisers understand this. The rest of the reform movement understands this. Now they have to convince the rest of the country. That conversation begins today.

--Jonathan Cohn