Tonight, Americans will get a good idea of where the urgent matter of health care reform is headed -- toward enactment or toward the trash bin.
If, in his televised address to a joint session of Congress, President Obama makes clear the need, offers a willingness to compromise and deals forthrightly with the issue of cost, then he may well save the effort. If he falls short or if he fails to answer the spin chorus ("Socialized medicine!" "Death panels!" "Rationed care!") then he will cede the debate to the people who would rather see Obama fail than to fix a health care system that, left unattended, soon will drag the country down.
And in that choice is revealed a truth that the president has not acknowledged and may not even have understood: This is a campaign. It was never going to be enough for him to say "health reform" and then leave the debate to charlatans, liars and congressmen.
Just as political candidates have learned that they must quickly answer every allegation, regardless of how untrue it is, Obama needed to be out front on this effort, explaining the reasons, going over the options, answering the critics. He hasn't done that, and the consequence has been to let the political right and the town-hall shouters dominate the discussion, if it can be called that.
We have our own problems with health reform as it has been proposed, mainly in terms of cost. While health care faces many problems in this country -- too many uninsured, too much focus on procedures rather than outcomes, too many lawsuits -- the first problem is cost. Health care is soon forecast to swallow up one-fifth of the national economy. By 2017, out of every $100 spent, $20 will be for health care. We are heading toward a crack-up.
Yet the administration's proposal will do more to expand costs than to contain them. Through its undeniably noble focus on covering the uninsured, it has failed to confront the issue that could sink health care. First, fix the costs.
Obama will be taking a political risk when he addresses Congress and the nation tonight. He plans to detail his goals on health reform, which can make it harder for him to compromise and harder to claim a victory.
But it's a calculated risk. The riskier course would be to do nothing. In this way, he can use his own substantial communication skills and political capital to regain control of the debate. If he can answer the concerns about the trillion-dollar cost (over 10 years) and make clear the price of not acting, he will have served the nation and himself very well.