President Barack Obama’s health care reform speech to Congress Wednesday night was impassioned. But the real tip-off on the shape of a final bill could be found on Page A15 of the morning’s Wall Street Journal in an advertisement by insurance industry giants Blue Cross and Blue Shield.

The ad, “Healthcare Reform That Works for Everyone,” was placed by the BlueCross BlueShield Association, an organization of 45 insurance companies around the country with more than 80 million customers. The association is a major player in the Capitol., part of the reformist Center for Responsive Politics, says that in 2008 and 2010 the association gave $3.16 million to congressional candidates, $1.64 million to Democrats and $1.53 million to Republicans.

I read the ad in the morning and put it aside along with my other health care materials. Maybe I’m paranoid about insurance companies, but something about it prompted me to think that some of it would be echoed in the presidential speech. And sure enough, it was.

Take for example the hyped-up “public option,” in which a government plan would join private plans in an exchange or marketplace where consumers could shop for the best deal. This option, now limited by compromises, has become an article of faith for Democratic liberals. These are the liberals who have abandoned what I consider the best alternative, Medicare for all, or “single payer.”

Obama kissed off universal government-run health insurance in his speech. “There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s where we would severely restrict the private insurance market and have the government provide coverage for everyone.” He went on to say such a plan “would represent a radical shift that would disrupt the health care most people currently have.”

As for the public option, the insurance industry is inalterably opposed to it. So are Republicans and conservative Democrats. In perhaps the most significant part of his speech, Obama left the door open to dropping it from his plan. He said “its public impact shouldn’t be exaggerated — by the left, the right or the media. It is only one part of my plan. …

“To my progressive friends, I would remind you that for decades the driving force behind reform has been to end insurance company abuses and make coverage affordable to those without it,” he said. “The public option is only a means to that end — and we should remain open to other ideas that accomplish that goal.”

That’s not too far from the Blue Cross Blue Shield ad, which advocated a system in which “it is easier for individuals and small businesses to shop, compare and enroll in coverage.”

It’s easy to see how the White House, congressional Democrats and insurance lobbyists can find common ground on this one.

On another important issue, Obama said that under his plan “it will be against the law for insurance companies to deny you coverage because of a pre-existing condition.” Blue Cross Blue Shield advocates that “[a]ll Americans have health coverage regardless of pre-existing conditions.” Not much disagreement there.

The insurance association is calling for mandatory coverage, another matter of vital importance to the insurance companies. Think of the additional huge profits if almost everyone is required to have health insurance.

In his speech Obama, too, favored mandatory coverage. He criticized as “irresponsible” any individuals who after reform was passed would fail to get health insurance and any companies that would fail to provide it to their employees. He said that “unless everybody does their part, many of the insurance reforms we seek — especially requiring insurance companies to cover pre-existing conditions — just can’t be achieved.”

The Blue Cross Blue Shield ad said much the same, advocating “a personal responsibility requirement to obtain and maintain health coverage.” Like Obama, the insurance companies supported government aid for those who couldn’t afford policies.

Mandatory health insurance is fine. But make no mistake, it would be a huge bonanza for the insurance companies.

There were excellent moments in the speech, as is usually the case when Obama takes the podium in a moment of crisis. His story is full of such moments when he rises to the occasion and confounds critics with his wonderful words and style.

“I am not the first president to take up this cause, but I am determined to be the last,” he said.

And there was, of course, his presentation of the unexpected letter from the late Sen. Edward M. Kennedy. “He asked that it be delivered upon his death,” said the president. Kennedy wrote that “what we face is above all a moral issue; … at stake are not just the details of policy, but fundamental principles of justice and the character of our country.”

That tugged at every heart, including mine. Ronald Reagan couldn’t have done it better.

Obama’s memorable speeches, it should be noted, were given during the presidential campaign. After a campaign speech, the candidate moves on to something else, as do the journalists with their short attention spans.

Health care reform is different. It now disappears into the pit of congressional-White House, campaign-contributing insurance company deal-making. Days and nights will be devoted to small details, which will hurt or help Americans.

This is where the insurance companies operate best. Judging from the goals of the Blue Cross Blue Shield ad, they have mapped out a path to victory.

Obama’s plan is better than nothing. But he’s got a chance to strengthen it in the negotiations ahead. He’s tougher and smarter than the insurance companies. Let’s see him show it.

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