Thoughts On Obama’s Health Care Speech
By Justin Gardner | Related entries in Barack, Health Care, Obama
First off, my takeaways about the policy in the speech…
- You can’t be dropped because of pre-existing conditions. No surprise there, but to me this is the most important reform. Also, no more yearly or lifetime caps. For catastrophic illness, this is a must.
- Stressing that nobody will be forced to change doctors or insurance providers, he’s not in favor of wholesale changes in how health insurance is delivered. And he specifically called a single payer system unrealistic. This should reassured most independents.
- Health insurance will now be mandated under this plan. That’s a tricky one, and it goes against what he said in the campaign. My guess is that this will be the new target for Republicans, “This is a health tax on everybody” etc.
- He wants a public option, but he’s not tied to it as the end all be all. That means that we’ll most likely get a localized co-op public option instead of a centralized system. Again, this should appeal to independents.
- He’s open to testing tort reform…which should be big for Republicans.
Now to the politics…
- Somehow Obama was able to dismiss the most strident elements of health reform opposition while bringing moderate Republicans closer to the table. Basically he gave them a choice: do you really want to take cues from Sarah Palin and Glenn Beck or do you want to solve this problem? It was an impressive bit of framing and he could get a couple more Rs on his side.
- This was by far the biggest bipartisan speech of his Presidential career and it could prove to be the most important. In fact, most of what he talked about Republicans had to agree with. They were standing up and clapping A LOT. And when they weren’t clapping, well, they cut their own legs out from under themselves.
- As for Dems, Obama put enough out there for them to like without promising the moon. He clearly didn’t commit to the specific federal public option they wanted, just that some type of non-profit public option should be part of the plan. So now Obama should be able to shape exactly what that is since he’s saying, “Uber-liberals, don’t blow this for us.” I think that message came through loud and clear and all Dems should now fall in line.
In the end, this speech was a gamble but I honestly think it’ll pay off. In fact, his defense of Medicare as bipartisan legislation was spot on and reminded voters who’s really for Medicare and who wants to slash it. Of course I hesitate to say this one is historic, but have you heard a better defense of government helping the weak and wounded? I certainly haven’t.
You thoughts are welcome and appreciated.
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September 10th, 2009 at 10:57 am
President Obama has ALWAYS given us a bipartisan speech…. Then he invites the other side in and slams the door on them afterward.
I can not help but believe nothing will change with him… Nancy or Harry! In the end it will be pretty much Their Way or the Highway…
AubreyJ………
September 10th, 2009 at 11:12 am
On Who and when has he slammed the door?
September 10th, 2009 at 11:25 am
Nicely written, Justin.
Jake
September 10th, 2009 at 11:55 am
AubreyJ:
WHAT?? President Obama is basicly using some of John McCain health Care plan mix with Bacus’s plan. It’s the GOP that is slamming the door on President Obama because they want him to fail and are listening to idiots like Rush, Glenn Beck and Sarah Palin.
September 10th, 2009 at 12:24 pm
Here’s a thought: why does this have to be all one bill? There’s a set of insurance reforms (the items under #1, plus an end to rescission) that are so broadly popular they would sail through. Can we get those in one bipartisan bill, independent of the thornier issues of exchanges and mandates?
September 10th, 2009 at 12:29 pm
Aubreyj,
When the minority party chooses to define “bipartisanship” very narrowly as something along the lines of: “the only acceptable plan is one that we either weren’t able to, or chose not to, try to pass while we were in power” … it’s hardly surprising that they are going to run around protesting about how the “door is being slammed in their face”.
The real problem for Republicans, is that they are not “allowed” to vote for anything resembling a compromise, even if they wanted to … Limbaugh, Beck and Hannity would quickly declare them RINOs, and then the rest of you would start attacking them with the same vigor that you attack the Democrats.
I hate to disappoint people like MW (because I too am a fan of divided government and compromise), but the sad truth is that divided government only works if BOTH sides are truly interested in governing … as opposed to simply “winning” the news cycle of the day.
Just my opinion of course.
September 10th, 2009 at 1:09 pm
Right now, the closest thing to an actual republican party are the blue dog dems, who are actually proposing ideas and trying to negotiate with their more liberal friends to find some sort of accommodation that would satisfy both. The GOP has essentially been AWOL on this debate, unless you count screaming, whining and lying as debate.
September 10th, 2009 at 2:26 pm
Here’s a thought: why does this have to be all one bill? There’s a set of insurance reforms (the items under #1, plus an end to rescission) that are so broadly popular they would sail through. Can we get those in one bipartisan bill, independent of the thornier issues of exchanges and mandates?
The problem with breaking up the proposal is that most of it’s parts depend on other parts to work. If we only end recision, and pre-existing conditions clauses all the unhealthy people in the country will buy insurance. paying for all their treatments is expensive, so premiums will have to go up. We’re talking $800-$900 a month. So we also have to include an individual mandate, and an employer mandate.
But it’s unreasonable to expect small businesses and individuals to buy on the individual market, because the individual market is ridiculously inefficient. Thus the Exchange. And, given that insurers have totally screwed up the individual market, a public option to keep them honest.
The Senate may actually try something like this. Ideas Senators don’t like would go to reconciliation, and they’d only need 50 votes. More popular ideas go in a normal bill, which needs 60 votes.
September 10th, 2009 at 3:35 pm
My guess is that you will hear, “This is unconstitutional.” And they may have a point. This will certainly be challenged in the courts, all the way up to the supreme court if necessary who will inevitably make the decision. Can the government force the citizenry to buy consumer products? Does this violate the commerce clause? Sure, there is the example of car insurance, but you only need it if you are driving on a public road.
Did you ever wonder why it is ridiculously inefficient? Its because there are too many government regulations regarding taxes and licensing. Remove those regulations and efficiency will improve.
Milo has a point. Why doesn’t Obama try to reform medicare first, and then move on to universal care. Why do we need to wait until 2013 to reform medicare if it is so full of “fraud and waste” right now?
September 10th, 2009 at 5:45 pm
The promise to consider tort reform is bull. Can anyone picture the House passing a bill that even mentions reform of the plaintiff’s bar? Obama can promise to sign such a bill, and even be truthful when he promises it, because he’ll never have the opportunity to actually do it.
September 10th, 2009 at 8:28 pm
I’m glad that Obama decided to get out front and try to lead, to focus the efforts of congress and reinvigorate sagging public support. It made sense to me in the beginning that Obama let Congress try to shape things. But they were at an impasse.
I do question whether, in the end, the outcome of this effort will really rest on Obama and his ability to lead and inspire. Seems to me there are still plenty of folks whose current healthcare and insurance are very good. Quite possibly enough folks to yield insufficient desire for wide-ranging change.
I don’t really believe that this reform won’t add money to fed’l budget obligations. I also take it for granted that to whatever extent money is sought to pay for the reform, that money will come from the pockets of 1) young people who will be required to subscribe to something and 2) people who have extremely good benefits at little out of pocket cost to them.
And while I don’t think either of those two money grabs is wrong per se, I think that the people belonging to those pockets are largely smart enough to see through whatever rhetoric and promises are being floated. “Don’t tax me, don’t tax thee, tax the man behind the tree.”
Long story short, I wonder whether there are enough Americans truly worried about what happens to their healthcare costs if they lose their job, they get too sick to work, their business fails, they retire, and so on.
I also agree with Cal that the tort reform thing is BS. Obama says he’s open to it to make some folks think he is extending an olive branch. But it just has no chance of happening in any meaningful form with this congress, so it’s a non-starter, a bone with no meat or marrow.
September 11th, 2009 at 12:21 pm
Did you ever wonder why it is ridiculously inefficient? Its because there are too many government regulations regarding taxes and licensing. Remove those regulations and efficiency will improve.
Yes I did wonder. So I did actual research on the matter. One problem is that none of these companies are big enough to negotiate discounts, or take advantage of the economies of scale large plans have. Most of them have administrative costs of around 7%, but the little guys are doing great if they have costs of 14%.
Another problem is that many of the people on the individual market are very sick. Healthy folks who don’t get health care through their jobs, or the VA, just don’t buy policies. The break-even point on those policies is $10,000.
As for the constitutionality, you have to remember the Interstate Commerce clause exists. This means Congress can regulate what you buy. Period. End of story. Do not pass go. Do not collect $200. This means they can make you buy things.
Moreover the mandate is enforced via the Income Tax. You buy insurance, or you pay a tax penalty roughly the same as insurance costs. In other words Congress is using it’s taxation power to penalize anyone who does things it doesn’t like. Given that Congress is clearly allowed to reward people for doing things it likes with their money through tax deductions it’s fairly ridiculous to claim they can’t do this.
September 11th, 2009 at 12:45 pm
kk,
I don’t really believe that this reform won’t add money to fed’l budget obligations.
You got reform ideas you think will save money?
Without them all these deficits you worry about will look like pocket change.
In theory killing Medicare, and all other government health programs, including the VA, could work. But you have to keep in mind people with federal health benefits, particularly Medicare-eligible seniors, vote. Healthy young people don’t, and they are the ones who will have the most to gain by killing Medicare.
I’d say we don’t have much choice but to try something, and see if it works, while we still have time to try something else.
Long story short, I wonder whether there are enough Americans truly worried about what happens to their healthcare costs if they lose their job, they get too sick to work, their business fails, they retire, and so on.
There have been plenty of protests, but they only managed to start the relevant people posturing about the public option vs. co-ops vs. a trigger.
Before Kenneddy died we were a few votes short of passage in the Senate. His death means we need Olympia Snowe. And she is strongly signaling she’ll support a bill with a public option as long as there’s a trigger. In policy terms there’s no reason for a Progressive to oppose that because Progressives believe insurance companies won’t be able to contain costs, and the trigger will be pulled. With her aboard it becomes much harder for Kent Conrad, Ben Nelson, and Blanche Lincoln to filibuster the bill.
This speech was supposed to remind the people (and Congress) why they elected health-care reformers. It was also supposed to show so-called “deficit hawks” were guaranteeing massive deficits if the bill wasn’t passed, as health costs are constantly increasing. While there are other ideas that might work (and, IMO, would work better) none of them could get through this Congress.
September 11th, 2009 at 12:52 pm
The promise to consider tort reform is bull. Can anyone picture the House passing a bill that even mentions reform of the plaintiff’s bar? Obama can promise to sign such a bill, and even be truthful when he promises it, because he’ll never have the opportunity to actually do it.
Hell yes.
They probably won’t pass a bill that satisfies the most enthusiastic tort reform people, because no politician is gonna cap actual damages, but they could easily cap punitive damages at $350,000. That sounds like a lot of money, but if a Doctor actually kills somebody there’s no actual damages because dead people don’t get better.
They may be close to the trial lawyers, but reforming health care is literally a life’s mission for many of them.
September 11th, 2009 at 1:32 pm
Health care or not, I’m partisan to a president that can lower my taxes and fix what the housing market “greed” created… Just get the job market back up and avoid more scams…
September 11th, 2009 at 7:18 pm
I hope that this health care bill is as good as the president says it is.
September 12th, 2009 at 4:32 pm
Care to place any bets on whether punitive damages get capped in this bill? You know, to make it interesting.
Nick, if I hear you right, you are suggesting that if a reform bill passes, this will lead to lower federal liabilities related to health care costs.
I have NO reason to believe this is true. It sounds nice, but I am deeply skeptical that 30 million folk will be added to healthcare rolls while the feds save money, even if revenue is captured from the young healthy.
One would be to mandate a maximum price for each prescription drug based on an average of what other modern nations are paying.
Another would be to bolster co-pays/patient obligations for medicare on a means-tested basis.
A third would be to verify citizenship for eligibility for a host of federally-subsidized services, including but not limited to healthcare.
September 12th, 2009 at 6:32 pm
Nick, if I hear you right, you are suggesting that if a reform bill passes, this will lead to lower federal liabilities related to health care costs.
I’m not at all certain it will work. I believe it will bend the curve somewhat, but that it won’t do enough, and in two years we’ll be debating more tweaks.
What I am absolutely certain of is that we have to do something soon, and that the current bill is the least ineffective proposal we can get through Congress.
As for your ideas:
One would be to mandate a maximum price for each prescription drug based on an average of what other modern nations are paying.
I’d actually go further than you do. They get their discounts because they do bulk buying. We’re a lot bigger than Sweden, so we should be able to pay less.
But I doubt we can get that through while getting these other reforms through, and while prescription drug costs are ridiculous they aren’t the biggest driver of cost growth in health care.
BTW, Obama’s deal with the drug companies only applies to this bill. He probably intends to push through more drug price reforms in the near future, or he would have offered them a 100-1 return on their $150 million in ads.
Another would be to bolster co-pays/patient obligations for medicare on a means-tested basis.
I dislike means-testing on principle.
I also dislike it because it requires paperwork. Forms for people to declare their incomes, forms for them to fill out if the get fired, forms to fill out if their entire life savings was in the hands of Bernie Madoff, etc. And a whole new bureaucracy to make sure the papers are in order.
More to the point this cannot be more than a temporary stop-gap measure. If implemented perfectly it would save money today, but it does nothing to contain cost increases. Which means in three years we’re back to 2009’s ginormous costs, and they’re still increasing at a ridiculous rate.
A third would be to verify citizenship for eligibility for a host of federally-subsidized services, including but not limited to healthcare.
Again, this does not solve the core problem of cost increases. Non-citizens are not a reason our health care cost are ridiculous. Most of them (even half of illegals) are on the same employer-sponsored plans the rest of us use.
That’s the real problem with health care reform economics. There are plenty of one-time fixes that would save money immediately, but none of them actually solve the problem.
ObamaCare won’t completely solve the problem. But it will help a bit.
The exchange will cut administrative costs in the Individual Market from 15-30% to 6%. It will also limit the problems 20-40-somethings cause by not seeking treatment until they’re really sick. Hopefully this means that they’ll get blood pressure medication before they get heart attacks.
If there’s a robust public option insurance companies will have to negotiate a lot harder with providers. Which will be very good as most US Health providers a inefficient. Mayo, the Cleveland Clinic, etc. all manage to be be the best in in their fields while spending less than their competitors.
I assume the medical community’s response will be respond by turning into McAllan, TX and every Doctor will open hi own lab so he can make million$ off useless tests, but if they do that it’ll be a lot easier to move over to capitation payments. Or simply convince the AMA to pull the license of any Doctor who profits from tests he orders.