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

A friend asked what I was hoping to hear tonight from President Obama. It’s surprisingly hard to answer this simple question.

Like many advocates and political junkies, I listening for implicit and explicit signals concerning particular matters—a strong national insurance exchange, affordability credits up to 400% of the poverty line, and more. I admit these are dry and mechanical things. It’s ironic but true that government shows its humanity by getting such arcane matters right. The public option is one such matter. I strongly favor it, for both human and for policy reasons. The President better get something good if he backs down on this one.

Of course this is the wrong moment to put too much stock in the policy details. This is a historic occasion. It arrives not a moment too soon, after a month of tawdry misrepresentations, screaming matches at town halls, Facebook screeds about death panels for the elderly and the infirm. Watching the President specifically call out this stuff was viscerally satisfying. It was richly deserved, as was calling out Republicans for unfunded tax and foreign policies.


The speech began with a bang—“I am not the first President to take up this cause, but I am determined to be the last.” This promissory note is unlikely to be fully paid. Whatever provisions become law, much would remain undone in the effort to provide universal, affordable health care. President Obama was right to mark the largeness of the occasion. We’ve had a month of small people making small distractions. President Obama has a fighting chance to leave office providing affordable, secure health coverage to every American who needs it. That would indeed be historic.

The occasion is large in other ways, too. The United States Congress--particularly the United States Senate—has a legacy at stake. Can these bodies tackle large issues with the seriousness but also with the decisive action this moment demands? Senate rules properly favor the defense over the offense. Large policy change should be difficult. It should still be possible. President Obama has faced heated criticism for his strategic decisions—some wise, some less so. Yet the real problems reside on Capital Hill. If this reform fails, Americans will quite properly ask some harsh questions about our legislative institutions, why Democrats appear so disorganized as a majority legislative party, and why Republicans are so captured by their reactionary wing.

The United States citizenry also has a legacy at stake. Are we focused and patient enough to tackle large problems? Can we have a civil and informed discussion of complicated intimate matters? Mark Schmidt has wisely noted that Republicans “have gone where the fear is, not where the bill is,” in attacking health reform. So they have, with scary lies about death panels and the rest.

In viewing this dismaying spectacle, advocates on all sides often deny two accompanying uncomfortable truths. First, these scare tactics would not work if millions of Americans were either unwilling or unable to seriously confront these issues on the real merits. Second, these tactics would not work if Americans had a stronger sense of collective solidarity about our fellow citizens. The President mentioned that we are the only wealthy society that allows millions of people to go without health coverage, and millions of others to suffer financial hardship because they or a loved one gets sick or injured.

Two years ago, I became involved in the Democratic primaries and participated in briefings by political experts about effective talking points. An early lesson—presented by a political pro as liberal as I am—was that covering the uninsured is not a winning political argument. Everyone cares about this issue. Too few people care enough about this issue to expend real resources to fix the problem. Our regard for each other seems not to extend that far. That too is a gut-check aspect of the current debate.

Over the past few months, I’ve met many people who say: “I have good insurance. Why should I support a change?” I’ve met seniors who receive care financed by Medicare and the VA who don’t want others to have the same chance. Politicians debase themselves by pandering to such sentiment; they are a symptom of the underlying problem. Right after the speech, CNN ran political advertisements claiming that Democrats will “finance health reform on the backs of seniors.”

President Obama closed in bravura fashion, evoking the memory of Senator Edward Kennedy, and the Senator’s lifelong passion for universal coverage. This was more than a tug on the heartstrings. President Obama unmistakably reminded America that conservatives called Social Security socialism in 1935. Conservatives called Medicare socialism in 1965. They are calling health reform socialism today. This was the opposite of triangulation. President Obama placed himself firmly in the camp of Franklin Roosevelt, Lyndon Johnson in providing a leavening hand of wise policy to intervene when markets crash or when individuals need help.

In his final months, Senator Kennedy noted that the character of our country is at stake. Is our heart large enough to embrace people who need help? President Obama closed by saying: “We did not come to fear the future. We came here to shape it.”  He added: “I still believe we can act even when it's hard.”

He has staked his presidency on this final point. That’s exactly what I wanted to hear.