Belatedly weighing in on the dominant issue of health reform, President Obama used his congressional address Wednesday to argue forcefully for overhaul of a patchwork system that excludes millions of Americans and whose ever-rising cost are unsustainable.
His speech was partly a tutorial -- a clear explanation of the status quo, including how the plight of the uninsured impacts those with insurance by inflating premiums and how perverse incentives encourage expensive and often needless procedures and skimp on cheaper, more effective preventive care.
But mostly it was a summons to action, to provide Americans the "security and stability" of health care that is satisfactory, dependable and efficient and exempt from the vagaries of cold-hearted insurance company practices.
After being content to let Congress thrash out the details, a deference that fed public confusion and unease, exacerbated by misinformation and outright lies of reform foes, Obama spelled out his "plan."
The key is a mandate for everyone to carry health insurance, which minimizes cost-shifting and spreads the risks for insurance companies, eliminating their penchant for dropping sick people or refusing to cover pre-existing conditions. Businesses would be required to provide insurance or help cover their employees' costs. Subsidies would help poorer Americans obtain coverage and insurance exchanges would offer a choice of plans.
While he made a strong case for a public insurance option to compete with private plans in the exchanges, he also said its importance had been exaggerated and declined to insist on its inclusion in the final bill.
He was more vague on cost controls although he insisted on provisions for spending cuts if expected savings don't materialize.
After so ably framing the issue and delineating his priorities, Obama must follow through, prodding Congress, including ideally some constructive-minded Republicans, to enact legislation that fixes a badly flawed, economically unsustainable system.