Obama's Big Health Care Speech - SALE or NO SALE?
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OBAMA ADDRESSES THE CONGRESS: THE SPEECH THAT ALMOST WORKED
It was crystal clear to me that the president has failed to make the sale. He has left his most ardent supporters worried that he might compromise too much to save face, while seeming to offer his opponents almost nothing in exchange for a grand compromise. And the morning after fact checks will further undermine the presidential credibility....
The cause needed less eloquence and more heavy lifting, the kind of backroom compromises that this president so far has considered unnecessary and inappropriate.
A presidential teaching moment soon begins when it is revealed: “Mr. President, the votes just aren’t there...”
Tonight’s speech was too long, and its rhetorical close, invoking the “Teddy” legacy seemed unpersuasive, almost detached. The president's most palpable passion surfaced when he complained – with undisguised petulance – about partisan bickering and misrepresentations.
Ironically, the Associated Press was quick to call attention to some of the president's own rhetorical and lawyerly misdirection and dissimulation. I reproduce most of the AP piece. Then I add the major substantive excerpts from the president's speech, with my own commentary and observations.
The bottom line: The president must be content with modest reforms, spending far, far less money without threatening the quality of care now provided the currently insured, particularly Medicare recipients. This is a core democratic constituency that simply cannot be rolled....
AN EARLY FACT CHECK....
By CALVIN WOODWARD, ERICA WERNER, Associated Press Writers
“WASHINGTON – The change was subtle, but significant. In his speech to Congress on Wednesday night, President Barack Obama gave a more accurate — and less reassuring — account of the impact of his proposed health care overall than he has done in the past. It went by in a blink.
“He told Americans...that nothing he is proposing will force businesses or consumers to change their existing insurance coverage. That much is true.
“It's also true that nothing in his plan guarantees that policies people have now will continue to be available in the same form. In earlier accounts, he spoke with unmerited certainty in saying people who are happy with their current insurance can simply keep it.
‘Other parts of his speech repeated some of the oversimplified claims that have marked his salesmanship. A look at some of his assertions Wednesday night:
“OBAMA: ‘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.’
“THE FACTS: That's correct, as far as it goes. But neither can the plan guarantee that people can keep their current coverage. Employers sponsor coverage for most families, and they'd be free to change their health plans in ways that workers may not like, or drop insurance altogether. ….
In the past Obama made repeated statements such as, ‘If you like your health care plan, you'll be able to keep your health care plan, period.’ Now he's stopping short of that unconditional guarantee by saying nothing in the plan ‘requires’ any change.
He's dropped the ‘period.’
“OBAMA: ‘Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage.’
“THE FACTS: Left unsaid is that the Democratic proposals in Congress could, in fact, require all individuals and families to buy insurance, including many who want it but can't now afford it and many who choose not to get it. Waivers or discounts would be available to lower-income Americans.
“That requirement, called the individual mandate, is designed to increase the size of the insurance pool and, by including younger and healthier Americans, reduce overall costs.
“If a mandate becomes law, the claim that ‘you will be able’ to get coverage will be misleading. People will have to get it.”
Associated Press writer Jim Kuhnhenn contributed to this report.
Copyright 2009, the Associated Press
Here is the Full Text of the most substantive parts of the president's address, as released by the White House just before he gave it. I watched the speech live in its entirety an hour ago, and can attest that Mr. Obama stayed faithful to the script. I have omitted some well known arguments, the president’s introductory remarks and his closing passages, including those relating to the late Senator Teddy Kennedy.
My own comments are interlineated in [BOLD] throughout.
We know we must reform this system. The question is how.
There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, 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 to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months.
[THIS WAS THE PRESIDENT'S BEST LINE AND IT EARNED APPLAUSE FROM BOTH SIDES OF THE AISLE. REGRETTABLY, IT BECAME APPARENT LATER IN HIS SPEECH THAT MR. OBAMA HAS NOT MOVED VERY FAR, IF AT ALL, TOWARDS THE CENTER, PRESUMABLY BECAUSE HE DOESN'T THINK HE HAS TO.]
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.
The plan I'm announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government. It's a plan that asks everyone to take responsibility for meeting this challenge – not just government and insurance companies, but employers and individuals. And it's a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans – and yes, from some of my opponents in both the primary and general election.
Here are the details that every American needs to know about this plan:
First, 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.
What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime.
We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.
That's what Americans who have health insurance can expect from this plan – more security and stability.
Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage.
[THE DEVIL HERE IS IN THE DETAILS. THE PRESIDENT'S USE OF THE 'FREE MARKET' NOTION IS MISLEADING BECAUSE CONTROLS, TAXES AND SUBSIDIES IN THE CURRENT PROPOSAL ACTUALLY PRODUCE A RIGGED MARKET THAT SQUEEZES OUT PROMISING NON-BUREAUCRATIC HEALTH CARE SOLUTIONS IN FAVOR OR MORE OF THE SAME, ULTIMATELY LEAVING THE GOVERNMENT PROMOTED OPTION THE LAST CHOICE STANDING..]
This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we've given ourselves.
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
[CAMERAS ZOOMED IN ON SENATOR MCCAIN WHO PROPOSED A RATIONAL PLAN TO EXPAND GROUP COVERAGE IN ORDER TO MAKE IT ECONOMICALLY POSSIBLE FOR INSURERS TO OFFER INSURANCE TO THOSE WITH PRE-EXISTING CONDITIONS. BUT MCCAIN OPPOSES MOST OF THE REST OF THE PRESIDENT'S PLANS AS UNWORKABLE AND UNAFFORDABLE.]
Now, even if we provide these affordable options, there may be those – particularly the young and healthy – who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for those people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek – especially requiring insurance companies to cover pre-existing conditions – just can't be achieved.
That's why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.
While there remain some significant details to be ironed out...
[HERE, A ROAR OF LAUGHTER SEEMED TO SURPRISE THE PRESIDENT.]
...I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.
And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. Still, given all the misinformation that's been spread over the past few months, I realize that many Americans have grown nervous about reform. So tonight I'd like to address some of the key controversies that are still out there.
Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple.
There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I'm proposing would not apply to those who are here illegally....
[HERE THERE WAS A SHOUT OF DISSENT FROM A MEMBER.]
...And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.
My health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly-sponsored insurance option, administered by the government just like Medicaid or Medicare.
So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition.
Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down. And it makes it easier for insurance companies to treat their customers badly – by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates.
Insurance executives don't do this because they are bad people. They do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill; they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."
Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.
[NOTE A GLARING OMISSION HERE: BECAUSE OF THE BURDENS IMPOSED ON EMPLOYERS AND PRIVATE INSURANCE PROVIDERS, MOST PRIVATE OPTIONS WOULD BE UNDER WATER AND OUT OF THE MARKET WITHIN SIX YEARS, LEAVING THE GOVERNMENT PREFERRED OPTION THE ONLY SOURCE OF COVERAGE LEFT STANDING FOR ALMOST EVERYONE.]
Despite all this, the insurance companies and their allies don't like this idea. They argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. \
[THIS IS MISLEADING BECAUSE THE PRIVATE EMPLOYERS AND INSURERS WILL BE SADDLED WITH INCREASED COVERAGE OBLIGATIONS, HELD NOT TO RAISE PREMIUMS AND TAXES TO BOOT. THIS AMOUNTS TO A DE FACTO SUBSIDY FOR THE GOVERNMENT PREFERRED ALTERNATIVE, MAKING THE PRESIDENT'S ASSERTION MISLEADING, EVEN DISINGENUOUS.]
I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.
It's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight.
[THE POLLS DEMONSTRATE THE OPPOSITE IS TRUE – MOST AMERICANS DO NOT FAVOR A GOVERNMENT SUPPORTED AND CONTROLLED OPTION.]
But its impact shouldn't be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.
[THIS IS AS CLOSE AS THE PRESIDENT GETS TO ABANDONING THE GOVERNMENT OPTION, A SINE QUA NON, FOR REPUBLICAN AND BLUE DOG DEMOCRAT VOTES.]
For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.
Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public – and that is how we pay for this plan.
Here's what you need to know. First, I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize. Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for – from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.
[THIS STATEMENT, IF THE PRESIDENT IS ACTUALLY SERIOUS, MEANS ONLY THAT THE REFORM INITIATIVE WILL BE SUPPORTED PRIMARILY BY TAX INCREASES.]
Second, we've estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment – it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.
In fact, I want to speak directly to America's seniors for a moment, because Medicare is another issue that's been subjected to demagoguery and distortion during the course of this debate.
More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.
[UNCLEAR IF THIS REPRESENTS A PRESIDENTIAL DEPARTURE FROM THE HOUSE BILL, WHICH WAS TO MOVE HALF A TRILLION DOLLARS OUT OF MEDICARE TO HELP FUND THE 'REFORM' LEGISLATION.]
The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies – subsidies that do everything to pad their profits and nothing to improve your care.
[WE CAN REASONABLY ASSUME THAT 500 MILLION WILL BE TAKEN FROM MEDICARE UNDER THIS PRETEXT.]
And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.
These steps will ensure that you – America's seniors – get the benefits you've been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pocket for prescription drugs. That's what this plan will do for you. So don't pay attention to those scary stories about how your benefits will be cut – especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.
Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system – everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.
Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.
Finally, many in this chamber – particularly on the Republican side of the aisle – have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.
[INTERESTING THAT THE PRESIDENT PROPOSES ONLY A SMALL PILOT PROGRAM TO SAVE MONEY, AGAINST A VAST PROGRAM THAT WILL CERTAINLY SPEND MORE THAN A TRILLION DOLLARS. IN THE CURRENT FISCAL CRISIS, WOULD IT NOT BE MORE PRUDENT TO IMPLEMENT THE REFORM PROPOSALS IN A SMALL PILOT PROGRAM TO SEE WHETHER THEY WILL ACTUALLY SAVE THE MONEY?]
Add it all up, and the plan I'm proposing will cost around $900 billion over ten years....
[The president's closing remarks are omitted.]
“Susan Davis reports on the president’s address on health care.”Associated Press
“President Barack Obama’s address to Congress this evening was moving along fairly smoothly until he pledged that there was nothing in the legislation that would provide health care to the millions of illegal immigrants residing in the nation.
“A cry of ‘You lie!’ was audible from the Republican side of the aisle. The Associated Press reports that the heckler was South Carolina Republican Rep. Joe Wilson.
“It’s not true,” the president responded to the outburst....
Copyright 2009, the Associated Press