Health care and the inaugural address

President Barack Obama's inaugural address was impressive: a serious, well-delivered talk for our times. One sentence dealt specifically with health care:

We will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost.

Another, broader section has some implications for health care:

On this day, we come to proclaim an end to the petty grievances and false promises, the recriminations and worn out dogmas, that for far too long have strangled our politics.We remain a young nation, but in the words of Scripture, the time has come to set aside childish things.

And finally, a line intended for foreign despots also has some resonance:

To those who cling to power through corruption and deceit and the silencing of dissent, know that you are on the wrong side of history; but that we will extend a hand if you are willing to unclench your fist.

What are we to make of all this? A few thoughts:

• This speech was less about specific policies and promises than about setting out themes. I thought that was appropriate for a general audience --in this case the most general audience one could possibly imagine! The bit about "worn out dogmas" is partly aimed at some of the libertarian purists (Ralston, Pipes) who blindly push their points without regard to the real world.
• Obama's health care reform are focused on access, with cost second and quality somehow tied in. He didn't mention access at all, and he tied quality and cost to science and technology. Of course there's the science and technology of drug discovery and development, which is probably how most people will take it. But in reality the scientific approach of evidence based medicine and health care analytics hold the potential to make more impact on quality and cost during Obama's first (and possibly second) term. Expect this theme to enlarge over time as the true cost of expanding access becomes apparent. (My guess is Obama's already figured it out.)
• Obama was talking about Iran, North Korea and some others in the reference to clinging to power. There's a milder echo in some parts of the medical establishment including certain hospitals, insurers and provider groups

The collapse of Senator Kennedy today puts a bit of a damper on those who expect health care reform to spring out of the gate. Still I'm confident that health reform will be one of the top few priorities for Obama and his team.