President Barack Obama addressed the nation early in September to propose his plan for health care reform, but according to Dr. Mark Rushefsky, professor of political science at Missouri State University, the speech was “more a presentation of ideals,” primarily due to the reaction to a similar speech by President Bill Clinton in 1993.

Rushefsky, co-author of “Health Policy and Politics in America,” is familiar with each of the speeches since he teaches a graduate seminar in health policy and shows these videos as points of discussion for the course.

In President Clinton’s case, the administration lead the health care reform, not Congress, Rushefsky said. When President Clinton made his speech, “He didn’t have it in legislative form, but there was a book that came out that was essentially the Clinton plan, so there was something physical you could hold on to.”

With President Clinton’s plan, specifics were outlined and Congress had that as a starting point, according to Rushefsky. Many critics found flaws in both the strategy and the specific plan.

President Obama went about his health care plan a different way. “Instead, (President) Obama said, ‘this is what I think health care reform should look like, but you guys do the details,’” said Rushefsky. “That has been a little bit of a problem for (President) Obama because it’s been suggested that he hasn’t exercised sufficient leadership in pushing the bill in a particular direction.”

This is the first comprehensive health care reform plan to get to this stage – to be voted on the floor of the House and the Senate – but Rushefsky believes the structure of the Senate and the rule of 60 (necessary number of votes needed to end a filibuster) will slow down the process, unless the plan is pared down considerably. The bill has stalled in the Senate finance committee, and Rushefsky said there is still the possibility to overcome the rule of 60 with the budget reconciliation process. However, the plan would have to be budget neutral, which could be difficult with such a comprehensive plan.

To Rushefsky, there is not a perfect way to address the problems of the health care system. “If we had originally just sat down and said, ‘this is what we want the health care system to look like,’ it would have never come out the way that we have now. It’s something that has evolved accidentally without any sort of planning.”

Because it took the health care system many years to become what it is today, and due to the entrenched interests, he added, it will be extremely difficult to change.

For example, Rushefsky cites a recent study showing the increases in health care costs. While inflation decreased over the last year, health premiums increased five percent, which is a fairly low number, he noted. If insurance premiums were an average of $13,000 per year for a family, and health care costs continue to rise at five percent over a ten-year period, premiums would be $24,000 or closer to $30,000 (if inflation had increased).

“I think what we need to do is to get back to what the problems are, and I think we are losing sight of that,” Rushefsky said. “Again, what counts is if we are actually addressing the problems.”

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