President Obama gave a nice, thematic speech Wednesday night. But that was the speech he should have given in April or May at the latest. It is now September and four congressional committees have already completed their work. The President said there is agreement on “about 80 percent of what needs to be done …”. That is probably not true because about 80 percent of what is in the current legislation is not needed in order to achieve the three basic goals outlined in the speech.

The speech is a lesson in the difference between campaigning and governing. If the Administration were truly serious about malpractice reform and attacking waste, fraud, and abuse in Medicare and Medicaid, there would have been more in the envelops he gave to the Vice-President and Speaker last night. To govern, he should have given actual legislative language (yes, the Executive Branch can and does draft legislation). If the Administration were serious, there would be a team from the Department of Health and Human Services (DHHS) on Capitol Hill all day today conducting briefings on the specifics of the President’s Plan.

For example, the President declared, “[r]educing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.” The Administration needs to provide something to back up this statement fast because the Congressional Budget Office (CBO) estimates that Title VI of the House bill dealing with Medicare program integrity will save just $1.3 billion over ten years. That is roughly how much Medicare spends in a single day. CBO estimates ZERO savings from Subtitle F in the House bill that deals with Medicaid program integrity. For the President’s statement to have any credibility, the Administrator of the Center for Medicare and Medicaid Services (CMS) that oversees more than $700 billion in Medicare and Medicaid expenditures would be presenting data from the Office of the Actuary (OACT) showing how the President’s Plan to attack fraud will work and generate those promised savings. Oops, the Administrator of CMS has not even been nominated let alone confirmed.

Congress and the Administration have no credibility on combating fraud in Medicare and Medicaid. They have rescinded regulations that would have ended abuses practices. They rescinded competitive bidding in Medicare that would have improved service for the beneficiary and lowered costs. To prevent illegal aliens from gaining access to taxpayer dollars, you have to have sufficient means of identifying them. Simply saying no funds will be used for illegal aliens is meaningless without the infrastructure and means to actually stop them from entering the programs. The President did not resolve the abortion controversy with one sentence. If he is serious to prevent taxpayer funds from being used for pay for coverage of abortion services, he needs to send the legislative language that would do so because the current Capps Amendment does not. He stated that the federal conscience laws remain in place. The Capps Amendment also impacts the conscience clause and would present a conflict with current law. Which one is he going to enforce?

The understatement of the night, which resulted in audible laughter, was, “there remain some significant details to be ironed out …”. Details? How can a Member of Congress vote on a Medicaid expansion without knowing the impact on his/her state? The Administration was asked to provide data on a state-by-state basis months ago. Why has that data not been provided?

The President tried and failed with another analogy as to how a government health plan and private health plans can compete. “They (insurance companies and their allies) (wait, do the allies include his own staff who apparently have been cutting deals with the insurance companies?) argue that these private companies can’t fairly compete with the government. And they would be right if taxpayers were subsidizing this public insurance option. But they won’t be. I’ve insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects.” If that is the President’s Plan, he needs to send the legislation to back it up because there is no such firewall in the current legislation. Compete on a level playing field? Does that mean being licensed state by state? Does it mean paying taxes to the states?

Moreover, he then compares public colleges and universities to private colleges and universities. Does he really believe that public colleges and universities operate only on the tuition paid by students and their parents and there are no subsidies from the taxpayers?

Whether the White House understands this or not, it is the source of much of the confusion and misunderstanding that has plagued the health care debate. Thus far, the White House has been following, not leading. A speech is no substitute for the hard work it takes to govern.