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A spur to health care reform Obama delivers strong message, but clarity on costs still needed

Wednesday, President Obama provided what had been missing from the health care debate: his leadership.

With his televised address to Congress, the president was able to reset the debate by offering a combination of his own eloquence and passion and several hard facts. Obama did the nation the favor of making clear that with the rapid growth of health care costs, the price of doing nothing is simply too high to accept. The nation has to make changes, and the president pledged to achieve that long-sought goal, which he traced to President Theodore Roosevelt.

TR left office in 1909 -- a century ago.

Importantly, Obama also pledged to listen to serious Republican proposals and specifically opened the door to two: Sen. John McCain's campaign proposal for insuring the poor against catastrophic medical expenses and the enduring and, importantly, Republican demands to place limits on malpractice litigation.

The latter, although delivered vaguely, can only be seen as the president extending a hand to conservatives, inviting them to join in the work of achieving a crucial national priority. So, for that matter, did his call to "build on what works and fix what doesn't, rather than try to build an entirely new system from scratch."

Such approaches may work to break down Republican resistance and help to produce a plan with some level of bipartisan support. The startling boorishness of a South Carolina Republican may also help the cause by, once again, causing the country to wonder what the opposition party has to offer the country these days if it doesn't want to compromise.

The speech was necessarily short on specifics, as it had to be, given the complexity of the subject and the need to be open to compromise. Details still must be delivered -- and debated. With health care impacting a sixth of the American economy, Congress should do that job thoroughly and not just quickly.

Still, while we agree that now is the time to accomplish this goal, we remain concerned about the costs of reform. At a potential cost of $900 billion over 10 years, Obama's approach remains a huge undertaking, even if it does cost less than the Bush tax cuts or the wars in Iraq and Afghanistan, as Obama pointed out in one of the more strongly partisan moments of his address.

Obama evidently understands the broad-based concern about costs, because he promised not to sign any plan that increases the budget deficit and insisted that any legislation must require cuts in other areas in the event that it does balloon the deficit. That was good to hear, but Washington has a way of keeping its fingers crossed when making promises. This debate needs to proceed to a responsible and productive conclusion, but achieving that will require oversight -- preferably of the responsible and productive sort, as opposed to the town-hall-screaming or the lying-about-death-panels sort.

Also good to avoid is the "You lie!" kind of oversight, as practiced Wednesday night by Rep. Joe Wilson, R-S.C. Wilson claims his remarkably rude breach of protocol was spontaneous, but we're sure his mother taught him something about common courtesy.

Wilson's outburst could only have created sympathy for the president, and perhaps for his program. It certainly did nothing to rehabilitate Republicans in the eyes of swing voters, to say nothing of the party's own despairing moderates.

The test now will be to see if Democrats in Congress follow up on Obama's approach by reaching out to Republicans and if Republicans respond with proposals meant to advance the cause of reform. In such exchanges will Americans be able to take the measure of their government and know if the president's leadership truly made the difference.

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