For those who hoped that President Obama would bring more clarity to how Congress can pass health care reform, the State of the Union address fell far short of expectations. Instead of laying a path to final passage, Obama briefly described the health care bills, urged Republicans to contribute to the process, and simply “asked” (rather than demanded) Congress to “not walk away from reform.”

Gone was his sense of urgency or commitment to passing health care reform before the end of the year. Obama spent just 6% or 5 minutes of his speech on health care (452 out of 7,077 words) and failed to connect health care reform to the economic recovery or job creation. Below is an excerpt:

But I also know this problem is not going away. By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.

As temperatures cool, I want everyone to take another look at the plan we’ve proposed. There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here’s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.

The tone was a marked departure from how Obama described reform just five months ago. Standing in that same spot in September, Obama declared that “the time for bickering is over. The time for games has passed. Now is the season for action….Now is the time to deliver on health care. Now is the time to deliver on health care.” In December, Obama even connected health care reform to the economy. “Those who’ve been accusing me of ignoring the unemployment problem haven’t been paying attention.” “Health care reform will create thousands of jobs.”

While House Speaker Nancy Pelosi (D-CA) says that the House has the votes to pass the Senate health care bill if the Senate first approves a package of changes through the reconciliation process, the White House is suggesting that the President will refrain from calling Congress into action during tonight’s State of the Union address. According to reports, Obama will reaffirm his commitment to a comprehensive bill without laying out a roadmap for how to pass the legislation.

But since Congress is so close to passing reform, Obama’s endorsement of the effort is a step backward. As the process of reform has moved forward, Obama’s rhetoric has remained in campaign mode, without a clear path forward. In tonight’s address, Obama must call on Congress to pass the Senate bill, alongside a reconciliation package of fixes, and reclaim the urgency that characterized his address in September. During that speech, Obama said, “I am not the first President to take up this cause, but I am determined to be the last” and reminded lawmakers that it is “[o]ur collective failure to meet this challenge — year after year, decade after decade — has led us to the breaking point“:

Well, the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care. Now is the time to deliver on health care. [...]

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 to improve it. (Applause.) I won’t 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 this plan, we will call you out. (Applause.) And I will not — and I will not accept the status quo as a solution. Not this time. Not now.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true. That is why we cannot fail. Because there are too many Americans counting on us to succeed — the ones who suffer silently, and the ones who shared their stories with us at town halls, in e-mails, and in letters.

Congressional leaders, health policy experts and progressive advocates have called on Democrats to quickly pass a comprehensive health care reform bill. Tonight, it’s the President’s turn to rush our lawmakers into action.

Today, Rep. Paul Ryan (R-WI), the ranking members on the Budget Committee, is re-releasing his ‘Roadmap For America’s Future‘, a Republican guide to “tackle our nation’s most pressing domestic challenges — updated to reflect the dramatic decline in our economic and fiscal condition.” The document closely resembles the GOP’s April Fools budget or a McCain-Palin 2008 press release. It relies on the traditional partisan prescription of tax credits, spending cuts and privatization of public services.

The Roadmap’s health care plan “provides a refundable tax credit—$2,300 for individuals and $5,700 for families—to purchase coverage” and establishes “state-based high risk pools will make affordable care available to those with pre-existing conditions.” Rather than strengthening the existing Medicare program, Ryan moves “those under 55″ into a private “Medicare certified plan” outside of the current Medicare system.

These polices are bad, but the overall ideology is even worse. As Ryan explains in an editorial in today’s Wall Street Journal:

The plan ensures universal access to affordable health insurance by restructuring the tax code, allowing all Americans to secure an affordable health plan that best suits their needs, and shifting the control and ownership of health coverage away from the government and employers to individuals.

It’s what Jacob Hacker calls The Great Risk Shift. Republicans are slowly dismantling the New-Deal era institutions that spread economic risks “across rich, and poor, healthy and sick, able-bodied and disabled, young and old” and shifting all of the economic costs and risks onto individuals (or as Ryan calls it, freeing Americans from the “relentless expansion of government and a new culture of dependence“).

In the wake of the Great Depression, “political and business leaders put in place new institutions designed to spread broadly the burden of key economic risks, including the risk of poverty in retirement, the risk of unemployment and disability.” “These public and private institutions did not let the individuals off the hook they required contributions and work and proof of eligibility” and they provided all Americans with a guarantee that if they paid into the system, they would later benefit from it.

But under Ryan’s alternative, the economic costs and risks of insurance are spread across a party of one — the individual. If that individual falls sick or a family loses its breadwinner, she is only empowered to lose. As Hacker explains, “The next frontier in the Great Risk Shift is the transformation of existing programs — Medicare and Social Security chief among them — from guaranteed benefits defined by law to individualized private accounts that leave workers and families shouldering more and more of the risks that these programs once covered.”

This Republicans message about personal responsibility and individual liberty resonates with the American experience and forms a powerful and convincing political narrative. But rather than creating “a nirvana of empowered owner” as Republicans would like, the Great Risk Shift leaves many Americans to face economic risks and insecurities on their own.

During last year’s health care debate, Sen. Ben Nelson (D-NE) insisted on inserting specific language into the Senate health care bill that prevented public dollars from funding abortion services and asked leadership to adopt the restrictive abortion language “that might be compatible with the Stupak language in the House.” Majority Leader Harry Reid (D-NV) refused to incorporate the House bill’s Stupak restrictions and Nelson, along with Sens. Orrin Hatch (R-UT) and Bob Casey (D-PA), introduced a similar amendment that withheld affordability credits from women enrolled in plans that offered abortion services. Once the Senate tabled the measure, Nelson held out his 60th vote until negotiators implemented a compromise that required women to write a separate check for abortion services.

But yesterday, in an interview with LifeSiteNews.com Nelson said that he agreed to the compromise to “get” the final bill into conference and planned to use his leverage as the 60th vote, to insert his original amendment into in the final conference report:

LSN: OK, so you were planning on coming back…
NELSON: Absolutely. That is what I was just trying to tell the gentleman who was arguing about the 60th vote.
LSN: What made you think that it had a shot, after conference?
NELSON: Because they needed 60 votes again.
LSN: Right, but before, you voted for it even without it –
NELSON: To get it there….But, once it went to conference, as part of the conference, there was still another 60 vote threshold, and that is when I would have insisted and that is what Christy was talking about when I mentioned this on the phone – how we would approach this in conference to say, for my last 60th vote, it has to have Nelson/Hatch/Casey.
LSN: Why didn’t you stop it right then and there and say, “No Nelson/Hatch – nothing.”
NELSON: Because, at that point and time, the leverage wasn’t as strong – you have to play it [...]
LSN: So, if we got to conference and it was just the Nelson not the Nelson/Hatch/Casey – you would say ‘yes’ because you think it was good enough.
NELSON: I could have but I was going to say – and this was all the plan – that I would insist that it be Nelson/Hatch/Casey.

Nelson also said that federal law — the so–called Hyde restrictions — already prevented federal money from funding abortions that did not result from pregnancies that threaten the life of the woman, rape or incest, and admitted that his amendment was a redundancy. “I think it was probably necessary to clear up any question about it that somebody might have – but if Hyde truly applies…It was a belt and suspenders approach … to make sure that it was clear that it didn’t… This was just to make it clear,” he said.