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Hitting His Stride In Montana

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

Given the boorishness and insanity unfolding at town halls across the country, yesterday's Montana event was a pleasant surprise. President Obama presented his vision as simply and as well as anyone can:

First, health insurance reform will mean a set of common-sense consumer protections for folks with health insurance. Insurance companies will no longer be able to cancel your coverage because you get sick. ... Think about this. You do the responsible thing. You pay your premiums each month so that you are covered in case of a crisis. And then that crisis comes... And at your most vulnerable--at your most frightened--you get a phone call from your insurance company. Your coverage is revoked. It turns out, once you got sick, they scoured your records looking for a reason to cancel your policy, and they found a minor mistake on an insurance form you submitted years ago. ...

Insurance companies will also be prohibited from denying coverage because of your medical history. A recent report found that in the past three years, more than 12 million Americans were discriminated against by insurance companies because of a preexisting condition. ...

And insurance companies will no longer be able to place an arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. That will help 3,700 households in Montana. We will place a limit on how much you can be charged for out-of-pocket expenses, too, because no one in America should go broke because they get sick. ...

Now, if you're one of the nearly 46 million people who don't have health insurance, you will finally have quality, affordable options. If you do have health insurance, we will help make that insurance more affordable and more secure. If you like your health care plan, you can keep your health plan. If you like your doctor, you can keep seeing your doctor.

As the White House variously puts it: Protect what works. Fix what's broken. Help people of modest means to buy and keep decent insurance coverage.

Today's town hall won't be confused with a mini-conference at the Brookings Institution. Yet President Obama didn't conceal his commanding grasp of policy detail. His political advisors may wonder if he went too far, as when he fluently described differences between the British and the Dutch national health insurance systems.

The meeting sustained a dignified and substantive conversation at which ordinary citizens had the chance to ask their president apparently unscreened questions about what health reform--oops, health insurance reform--would actually mean for them. The questions were serious, and moved past legitimate but all-consuming political matters to the actual substance of proposed legislation.

Here is one question:

I think most of us know that Medicare is one of the best social programs this nation has ever put together. (Applause.) It works extremely well and helps the people who need it the most. But money doesn't grow on trees. How can we be assured that increasing coverage to others is not going to make Medicare more expensive or less effective?

There is a refreshing directness that cuts to the heart of many seniors' anxieties about health reform.

Or consider this:

I've learned that Medicare pays about 94 percent of hospital cost. And I've learned that Medicaid pays about 84 percent of hospital cost. And I've learned this from a reputable source, my brother who is a chief administrative officer at a large hospital group ... his hospital collects about 135 percent of cost from private insurers, and that makes up the difference. So if the public option is out there, will it pay for its way, or will it be under-funded like Medicare and Medicaid?

And how about this:

Mr. President, I make a living selling individual health insurance. Obviously I've paid very close attention to this insurance debate. As you know, the health insurance companies are in favor of health care reform and have a number of very good proposals before Congress to work with government to provide insurance for the uninsured and cover individuals with preexisting conditions. Why is it that you've changed your strategy from talking about health care reform to health insurance reform and decided to vilify the insurance companies?

These aren't softballs. And since they were asked by polite ordinary citizens rather than by preening television reporters, the president had to give a respectable answer. With simplicity and a commanding grasp of policy detail, the President's answers took on greater credibility than they would have had as prepackaged sound bites, or as responses to some ignorant critic ranting about death panels.

I didn't like everything he said. As in New Hampshire, the president was asked about the impact of health reform for families caring for disabled children:

I'm a single mother of two children. ... I have a son that suffers from many disabilities. He's disabled for the rest of his life. He's 11 years old. He suffers from autism. He's non-verbal. He suffers from extremely hard to control epilepsy, and he's Type I diabetic. He has been sick with these ailments ever since he was nine months old. ... I rely heavily on his Medicaid to support good health care for him. What, with this reform, would happen with his [Medicaid coverage]?

The president answered, correctly, that health reform would not alter her son's eligibility for services. A more humane society would free persons with disabilities from the tyranny of means-tested benefits. That's an issue best left for another day.

A Washington Post story suggests that today's friendly event was a missed political opportunity for President Obama. He is apparently seeking opportunities to confront crazy critics. The president might have enjoyed shredding a Teabagger or two on national television. In the end, though, he came off best providing genuine responses to legitimate critical questions.

The president should do this more often. In communicating the human realities that necessitate health reform, and in manning up to answer whatever questions citizens lob at him, he has a decent shot to return this debate to the reality-based community, and to defeat the Swiftboating efforts that have so marred our democracy this summer.