There have always been two sides to the health care debate: The insurance industry and their allies, and everyone else.

It has not always been clear, however, that there have been these two sides. We’ve found ourselves talking about death panels, socialism, and a myriad of other things that have nothing to do with the essential division in this fight.

In his speech, President Obama refocused the debate, and this is perhaps the speech’s most important effect.

The President firmly stated that insurance companies put profits over people, and that it’s in their very nature to do so:

Insurance executives don’t do this because they are bad people. They do it because it’s profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill; they are rewarded for it. All of this is in service of meeting what this former executive called “Wall Street’s relentless profit expectations.”

After quoting Wendell Potter, CIGNA whistleblower, and touching on stories of Americans hurt by the industry, he outlined how we keep the industry honest, and mythbusted misinformation about the public option, something that he’s never done before to my knowledge:

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I’ve already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

Despite all this, the insurance companies and their allies don’t like this idea. They argue that these private companies can’t fairly compete with the government. And they’d be right if taxpayers were subsidizing this public insurance option. But they won’t be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

Obama then called out his opponents in no uncertain terms:

But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

This is the essential question: Do we get reform that works for us, or do we get reform that works for the insurance industry? Do we get reform that caps our out-of-pocket expenses, so people no longer go bankrupt so insurance executives can get bigger golden parachutes? Do we get reform that makes it against the law to discriminate for things like pre-existing conditions and firmly puts our health before their profits? And will we get the choice of a real public health insurance option – not a trigger or a co-op – that lowers cost and keep the insurance industry honest?

Obama defined the two sides and issued what I’d call a challenge to reformers to make sure reform is done right.

The opposition – the insurance industry and their allies – also showed their hand.

AHIP, the insurance industry’s spokesman, immediately released a statement reiterating falsehoods the President had just debunked about a "government takeover of health care" and going against a policy proposal he unveiled:

"New health insurance reforms and consumer protections will solve the problem without creating a new government-run plan that will disrupt the quality coverage that millions of Americans rely on today. We share the concerns that hospitals, doctors, employers, and patients have all raised about the significant unintended consequences of a government-run plan. "Health care reform must also include a serious commitment to cost containment to ensure coverage is more affordable and to put our health care system on a sustainable and fiscally responsible path. New taxes on health care coverage will have the opposite effect by making coverage less affordable for families and small businesses across the country.

The industry’s allies, Republicans in Congress, went further, with Congressman Joe Wilson calling the President a liar, a breach of House decorum rules:

Wilson exemplifies the mindset of the opposition to health reform. Facts are not important, and shouting replaces civil debate:

We’ve spent the entire summer watching the teabaggers drag our public discourse into the mud, spreading fear and lies, calling Obama a Nazi and describing the public option as a communist plot. We’ve seen them accuse us of wanting to kill their grandmothers, and they hysterically fought to "protect" their children from Obama’s "stay in school" speech to students, as if he were a child molester. And last night, during a Joint Session of Congress, Rep. Joe Wilson adopted the Teabagger tactics and bizarrely thought it a good idea to try and disrupt the President’s address.

Will Republican leadership repudiate this outburst?

Either way, this is a reminder what we’ve come to and what we face. The insurance industry and their allies will stop at nothing to get reform that works for them, or kill reform altogether. And in the face of the news that 600,000 more people have lost their insurance [pdf] due to the industry’s relentless drive for profits, they must be stopped.

They are the enemy, and it is our job to deliver to the President a reform bill that works for us, not them.

(also posted at the NOW! blog)

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