According to Laurent Bouvet, professor of political science at the University of Nice, Barack Obama has recovered his lead in determining the main principles of his reform of the United States’ health care system. But important concessions to private insurers will be required for the plan to pass.

After the much anticipated speech by Barack Obama to the U.S. Congress, which met in special session, Bouvent assessed the challenges facing the far-reaching reform of the Democratic president.

At both symbolic and substantive levels, how would you analyze the speech made by Barack Obama to Congress?

Barack Obama’s performance met the standards of his great speeches with affirmed oratory skill. Symbolically, it did not miss the mark. Substantively, one notes that never before had he spoken so clearly about health care reform. Henceforth, one knows better what to expect than before – it was confusing. During the summer, many addressed the issue. Barack Obama solemnly explained and clarified its main objectives.


I see three: improving health insurance for those who already have it, creating coverage for the 47 million people who are destitute, and reducing the rate of increase in health spending. He did not emphasize it, but there is another goal: that of improving prevention.

Which strategy does he appear to want to adopt?

Obama’s main objective is to give Americans choice between private and public insurance. In his speech, he rejected “the completely public option,” like that of Canada, which he sees as the option of the left; and the option of leaving insurance up to the individual, the option of the right. In this context, “the public option” truly is at the heart of the Obama program. If there were doubts about this aspect over the summer, yesterday Obama reaffirmed this to be the paramount objective.

What concessions must he make to pass the heart of his reform?

I think the deal will be as follows: private insurers will have to show goodwill on the public option, limit their quest for profit and stop denying some patients. However, in exchange, they keep the grip on much of American health. That is to say, they retain the most profitable patients, those who are the least expensive. The others (the poor and old) will be integrated into the public system.

To this extent, we may consider Obama's speech to be bipartisan?

Obama did not deliver the speech of a liberal Democrat. He knows that if he is too far to the left, the reform will never happen. Clinton made that mistake in 1993, when he declared that if the project did not meet his requirements, he would veto it. In being open, Obama leaves some points negotiable, mainly in the margin it leaves for private insurers. Obama will have to concede on some points to pass the public option. For example, he said he was ready to negotiate on the "waste and inefficiency" of Medicare and Medicaid, including the streamlining of care pathways. This appears to be a concession to the right and the Republicans. Another point of negotiation is the financing of the reform. Obama’s gamble is that the new system will be cheaper.

What is the timetable for the weeks ahead?

Obama has set his objectives, with implicit agreement that he is ready. He has placed himself in the balance. Now Congress will write the bill. Obama did not say what he would do if some major principles were not accepted. By threatening to veto, he would limit himself. In my opinion, Congress will introduce a bill by the end of September. We will then have an idea of the level of the course chosen. If there is something for the private sector (the insurers, the lobbyists), the public option will be accepted.