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Did Obama’s Speech Change Your Mind?

[1]The President of The United States, the Leader of The Free World, The Hope and Change for our nation, sounds tonight like a hero to some, a potential suitor to others, and a charlatan to the rest.

President Barack Obama’s speech (video [1]/text [2]) was somewhat predictable.  And yet, the core principles are honorable and should be agreeable to all parties:

  1. Provide more security and stability to those who have health insurance
  2. Provide insurance to those who don’t
  3. Slow the growth of health care costs for our families, our businesses, and our government

These words are verbatim from the President.  And I agree with them.

Unfortunately, the President began falling flat with the very next paragraph when he stated:

“…if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.”

This is a promise that Obama simply cannot keep.  Why?  The first principle of security and stability will require changes in the business model of insurance companies.  This will quickly lead to changes in premium costs and the structure of policies.  What any of us with insurance currently has will simply have to change, and to the financial disadvantage of the majority.

Frankly, I’m not worried about how my insurance will change yet.  I think there are changes needed.  Not all of the changes outlined by the President, but some are needed.  There needs to be a solution to the issue of preexisting conditions.  There needs to be more responsibility on the part of consumers to help keep costs down (co-pays are intended to accomplish this, but are not always structured effectively) without compromising appropriate treatment.  Portability would be a valuable improvement, but will require some kind of pooling among companies.

The President wants to provide affordable insurance to those who can’t afford it.  He presents a public option as what appears to be a “temporary” solution until a permanent tax-credit based solution with insurance exchanges can be implemented (in four years, supposedly).  No government take-over.  Mind you, Social Security started with similar promises (yes, you guessed it, I would favor eliminating Social Security as well).  I also want to see those who can’t afford insurance have a reasonable option.  Tax-credits sound like a good start… why can’t we do that right now?

The President wants everyone to be covered because that’s the only way to make it all work.  But even then, it only works if everyone is covered and the entire system is pooled.  That’s what “single-payer” means, right?  And we’re not going to do that, right?  If we’re going to force insurance companies to cover preexisting conditions, then raise the premiums for everyone.  Oh, wait, can’t change the current plans for those who have insurance.  Like I said earlier, that’s just a bad promise to make.

And finally, the President wants to reduce health care costs.  As do most of us.  The President says that by reforming Medicare to eliminate waste and fraud (no information on how this will be done, and we’ve all known it’s been a problem for a long time), and use the system to encourage “best practices” that would benefit everyone… he cites a couple of facilities that are running more efficiently, but provides no real substance regarding how the Government will make this happen.  It’s vapor-legislation at the moment.

He also made a move toward addressing “malpractice reform” (we refer to this commonly as “tort reform”), but only went so far as to direct his administration to test out the theory (based on plans formed by the Bush Administration… he should be commended on clearly giving Bush credit).  I’m actually hopeful, but even if he comes up with good results, pressuring Congress to address this may be difficult.  Keep in mind, malpractice insurance usually pays out damages, so the doctor is not generally hindered by these awards, but the cost is just passed on to you and me.

The one area of cost savings that he has overlooked is consumer cost visibility.  If patients could see and compare options, it would drive down artificially inflated costs (already proven in Florida with pharmaceuticals).

I believe that President Obama is sincere in his desire to see Americans get the health care they need.  And I think this is an issue that needs attention within the current Congress.  I question, however, the following statement:

“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 most. And more will die as a result. We know these things to be true.”

I’m not convinced these are true… and ironic that the same man that criticizes others for fear mongering would make statements like this that just aren’t supportable.

I think the current state of affairs, however, is bad enough that it is important for us as a country to act.  The issues of preexisting conditions have existed since the beginning of the industry, and should be addressed, but I question that it constitutes a sudden crisis that requires immediate action.

The crisis in my opinion is around costs, tied to waste, inappropriately high punitive damages (leading to higher malpractice insurance premiums and excessive test practices) and fraud.  Addressing tort laws and fraud in Medicare would likely create a huge lift in a short amount of time.  As the President stated,

“…if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.”

I’m convinced that the President’s plan, as outlined in tonight’s speech, will deepen our deficit and create a new level of waste and fraud.  The current House bill creates 53 new government bureaucracies.  I agree that both parties need to work together toward a solution, but the starting point seems dramatically flawed.

Republicans have presented a plan [3] that seems to make sense.  Here’s an overview:

Pillar #1: Access to Coverage for All Americans
Makes the purchase of health care financially feasible for all – Extends the income tax deduction (above the line) on health care
premiums to those who purchase coverage in the non-group / individual market. And, there is an advanceable, refundable tax credit (on a sliding scale) for low-income individuals to purchase coverage in the non-group / individual market.
Covers pre-existing conditions – Grants states incentives to establish high-risk / reinsurance pools. Federal block grants for qualified pools are expanded.
Protects employer-sponsored insurance – Individuals can be automatically enrolled in an employer-sponsored plan. Small businesses are given tax incentives for adoption of auto-enrollment.
Shines sunlight on health plans – Establishes health plan and provider portals in each state, and these portals act to supply greater information, rather than acting as a purchasing mechanism.

Pillar #2: Coverage Is Truly Owned by the Patient
Grants greater choice and portability – Gives patients the power to own and control their own health care coverage by allowing for a defined contribution in employer-sponsored plans. This also gives employers more flexibility in the benefits offered.
Expands the individual market – Creates pooling mechanisms, such as association health plans and individual membership accounts.  Individuals are also allowed to shop for health insurance across state lines.
Reforms the safety net – Medicaid and SCHIP beneficiaries are given the option of a voucher to purchase private insurance. And states must cover 90% of those below 200% of the federal poverty level before they can expand eligibility levels under Medicaid and SCHIP.

Pillar #3: Improve the Health Care Delivery Structure
Institutes doctor-led quality measures – Nothing suggested by the Council for Comparative Effectiveness Research can be finalized unless done in consultation with and approved by medical specialty societies. It also establishes performance-based quality measures endorsed by the Physician Consortium for Performance Improvement (PCPI) and physician specialty organizations.
Reimburses physicians to ensure continuity of care – Rebases the Sustainable Growth Rate (SGR) and establishes two separate
conversion factors (baskets) for primary care and all other services.
Promotes healthier lifestyles – Allows for employers to offer discounts for healthy habits through wellness and prevention programs.

Pillar #4: Rein in Out-of-Control Costs
Reforms the medical liability system – Establishes administrative health care tribunals, also known as health courts, in each state, and adds affirmative defense through provider-established best practice measures. It also encourages the speedy resolution of claims and caps non-economic damages.
Pays for the plan – The cost of the plan is completely offset through decreasing defensive medicine, savings from health care
efficiencies (reduce DSH payments), ferreting out waste, fraud, and abuse, plus an annual one-percent non-defense discretionary
spending step down.

~ ~ ~ ~ ~

The President, in the beginning of his speech, mentioned a perspective from the right of:

“there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.”

I have never heard this argument before.  Can someone point me to the source for this?  It just seems really odd, and not at all anyone in my circle has ever proposed.

~ ~ ~ ~ ~

During post-speech conversations on Facebook, I made the following observation:

The government never provides competition that a business can compete with… they never have to deal with the silly requirements like maintaining actuarial integrity or adequate cash reserves. The government doesn’t mind working with a deficit, and doesn’t care that it can’t run it’s operations efficiently or prevent more than 10 times the fraud that exists in comparable private sector industries. Calling that “competition” is ludicrous.

Another writer, dead-set on a government-run option, responded with:

Well then start a revolution! If you hate it, change it. Or don’t you want to give up your Hummer and DirectTV?

I don’t like to generalize too much, but it seems that whenever one provides a cogent position to someone on the left who lacks a reasoned counterpoint, it seems that personal attacks are inevitable.  And, unfortunately, the same can come from folks on the right who lack a meaningful argument.   At any rate, I responded to the writer with:

I don’t have either, and I try to live frugally. I don’t have any reason to start a revolution, I just won’t support government entering the business world as a player. It’s not necessary, [it’s] counter-intuitive, and economically destructive.

~ ~ ~ ~ ~

Shane Vander Hart provides a great roundup [4] from folks much more eloquent than I.  I hope you’ll check it out.

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Comments Disabled To "Did Obama’s Speech Change Your Mind?"

#1 Comment By John Marshall On September 10, 2009 @ 1:18 am

My mind is certainly not changed.

It used to be that two things you absolutely HAD TO DO was 1) die, and 2) pay taxes. Obama is on track to add third thing: 3) buy health insurance.

Land of the free… Where is that?

#2 Comment By Jill On September 10, 2009 @ 2:28 pm

I consider myself moderate, and I’m still reading the various sides of the argument to determine where I fall in the whole health care debate. But I don’t really understand why people jump to the conclusion that we are ‘losing freedoms’ if health insurance were to be required. We’re required to have an SSN, an ID, car insurance if we drive, etc, and I don’t feel like any of that takes away from my personal freedoms – maybe others disagree. Most people will need health care at some point. If they don’t have insurance because they simply don’t want it, they will still need to seek help and where will they go? The ER. We will all pay for those trips to the ER if that person cannot, and I would rather not have our emergency room full of patients that could have gone to the doctor instead if they had the appropriate coverage.

I’m sure I also don’t understand what a public option would do to private industry, but it seems that we have a public school system and private schools still exist. We have a government run postal system and private mail carriers still exist. Why would a public insurance option drive private insurance companies out of business (at least that is one of the arguments I hear)? Yes, they would likely have to change, but that could be a good thing, right?

I’m not trying to start a fight, I’m just trying to understand that issue in the debate. I totally agree that pre-existing condition clauses need to be corrected and tort law needs reform, but I’m just trying to understand what is so unbearable about a public option.

I agree with the article that both sides need to stop immediately jumping to the name calling and personal attacks as soon as they disagree. I don’t even think many people are listening to the other side or taking the time to truly educate themselves – they’re just choosing their corner and refusing to come out of it. It makes it hard for us all to learn the true facts and form educated opinions when what makes the news is the wild statements/accusations/conspiracy theories from both ends of the spectrum. It gives it the appearance that there is absolutely no middle ground to be found, and that frustrates me.

#3 Trackback By Caffeinated Thoughts On September 10, 2009 @ 5:57 pm

More Reaction to Obama’s Speech Last Night…

Additional reaction to Obama’s speech last night on healthcare to Congress.
Dan Perrin over at Red State:
Obama is living in fiscal fantasy land. The last “spending trigger” for Medicare was simply ignored by Congress and then the law that contained th…

#4 Comment By Art Smith On September 13, 2009 @ 10:51 pm

Jill: Thanks for the great comments!

There is a lot different criticisms flying around about the public option, some that are a bit knee-jerk, others that seems warranted. I hope to get into this topic in more depth in the coming weeks, but here’s the key concerns on my mind:

1) With the understanding that a “public option” means that the government will provide some level of administration of insurance-like benefits for those that are not financially equipped to purchase health-insurance, similar to the current Medicare system and the Veterans Administration, the biggest concern is the cost of such an enterprise. Not just in the raw expense of financing insurance benefits for the needy, but of the administrative overhead of such a program. If what is needed is money to insure folks that are less fortunate, it would seem a great deal less costly to simply provide the funding so that these folks can buy their health insurance. I think the simplest approach would be tax credits, since it would require less administrative overhead than a new office to pay out premiums and such, but either way is better than the government creating a new insurance business.
2) The strongest statement I keep hearing from congressmen is that a public option would create more competition. Government never creates legitimate competition because it never has to abide by the rules it sets up for free-market businesses. Such competition is not only unfair, but similar in nature and potential impact to monopolies, which we all abhor.
3) A public option becomes an excuse for insurance companies to be even less responsible than they are perceived to be today.
4) A public option puts the government in the position of forcing providers to accept substandard compensation. This is one of the biggest issues with the current Medicare system, and one of the reasons it is becoming harder and harder for Medicare recipients to find providers.
5) The government expects to pay for a public option by cleaning up waste and fraud in Medicare. This kind of clean up has been promised over and over again over the years and it has only gotten worse. The government has proven itself incapable of such clean up, within Medicare and throughout the rest of it’s administrations… the problem is insipid because it comes from inside and out. Money lost to fraud in the Medicare system is significantly worse than the Credit Card industry, which is comparable in size and risk of fraud. More on this in future postings.
6) It’s just not needed. There is no problem statement in the midst of the current health care “crisis” that is screaming for the government to create a new insurance company of its own. If there are problems with the health insurance industry itself, we should be looking at how to fix those issues (and I agree there are many). If there are problems with people being able to afford insurance, then lets looks at how we can remedy that financial challenge. But multiplying the problem by trying to make a new government bureaucracy to act like a business is just wasteful in my opinion.

I hope that helps a little. This discussion will get better as we focus on the very questions you asked and continue to discuss them rationally. I really appreciate your input!