Thursday, September 10, 2009

President Obama delivered on specifics

"The time for bickering is over" – The Boston Globe

"Now is the time to deliver" – Star Tribune

"President heckled during speech" – Chicago Tribune

"Time for games has passed, Obama says" – Houston Chronicle

"On healthcare, Obama juggles losses and gains" – LA times

"Obama makes pitch" – Wall Street Journal

"President moves to reframe debate" – The Washington Post

"Aim of Obama health speech: Reigniting a presidency" – The New York Times


These are just some of the headlines around the nation this morning after President Obama speech to a joint session of Congress. President Obama vowed last night that "I am not the first president to take up this cause but I am determined to be the last." During the speech President Obama laid out a plan on what he wants to see health care reform to look like.

"We know we must reform this system. The question is how. Now, there are those on the left who believe that they only way to fix the system is through a single-payer system like Canada's, where we would – where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own. I have to say that there are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have," the president summed up the extreme positions that are the undercurrent of the health care debate. The president claimed that Congress is in agreement with 80% of the type of health care reform is needed.

The goal of President Obama's health care reform is to meet "three basic goals".

  1. Provide more security and stability to those who have health insurance.
  2. Will provide insurance for those who don't.
  3. Slow the growth of health care costs.

Thankfully the president went on to elaborate these points.

In regards to providing more security and stability for those who have insurance the president went on to explain that his plan:

  • No change to current plan offered by one's employer
  • Insurance companies cannot deny coverage for preexisting conditions
  • Insurance companies cannot drop coverage due to illness or "water down" coverage
  • Eliminate arbitrary caps on year and lifetime insurance benefits
  • Limit the out of pocket expenses
  • Require insurance companies to provide cover for routine and preventive care at no cost

For those without insurance, President Obama's plan will:

  • Create a new exchange to purchase insurance from – similar to the one that Congress uses
  • Tax credits for individuals and small businesses that cannot afford insurance on the exchange
  • Required Insurance companies on the exchange to abide by the same consumer protections enacted to protect those that currently have insurance
  • Exchange will be established in four years after enactment of health care reform
  • Interim low-cost coverage will be provided for those who cannot get insurance today due to preexisting conditions

The third part of this plan is to slow the growth of health care costs. This part of his plan may be the most controversial and possibly unconstitutional.

  • Basic health insurance mandate established on individuals
  • Businesses will be required to offer insurance or chip in to help cover the cost of their workers
  • Hardship waiver established for those individuals and businesses that cannot afford to provide health care insurance

While I am pleased that President Obama laid out specifics the devil will be in the details. I am troubled by the mandate on health care and how illegal immigrants will be affected by the reform. President Obama mentioned that "If there are affordable options and people still don't sign up for health insurance, it means we pay for these people's expensive emergency room visits." Now what if one wants to pay cash for their services received? How does the illegal immigrant visit get paid for? "Now, there are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms – the reforms I'm proposing would not apply to those who are here illegally," stated President Obama. The claim drew groans from the Republicans and even an audible "You lie" from Rep. Joe Wilson (R-S.Car).

If the presidents claim that people who opt to not purchase health care insurance, doesn't that claim apply to illegal immigrants who by their very nature of being illegal do not posses health care insurance? It has to. To claim that costs are out of control because of emergency room visits, who does he think is more likely to go there – a 20-something American or an illegal immigrant? Now if reform does not cover illegal immigrants will hospital and clinics have to deny health care? If illegal immigrants are not turned away the rest of us will be covering the tab.

The president went on to mention that "My guiding principle is, and always has been, that consumers do better when there's choice and competition. That's how the market works." No kidding Mr. President, yet the majority of your progressive base does not understand this concept. One of the Republican ideas is to allow people from one state to purchase insurance from another state. Based on what was stated last night, "in 34 states, 75 percent of insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company." That being said, open up competition by eliminating the stranglehold insurance companies have in these situations. Instead the president continues to push for a public option.

"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. If fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up," stated President Obama in regards to the establishment of a public option. While the president is correct with the assessment of the number of Americans that would sign up, where his logic falls short is the long term enrollment of the public option. Companies, large and small, will assess the cost of providing coverage versus the cost of "chipping in". Plus, under the hardship clause of the president plan, he acknowledges that 95% of small businesses would be eligible. It is small business that is the backbone of our society and will push up that 5 percent estimate.

President Obama pledged that "I will not sign it if it adds one dime to the deficit now or in the future – period." How is he going to prove that nothing will be added to the future deficits? Especially in light of an aging society and Medicare is near bankruptcy. To pay for part of his $900B plan, that will be over ten years, will come from "reducing the waste and inefficiency in Medicare and Medicaid." The rest of the money will come from charging "insurance companies a fee for their most expensive policies." Now what happens if insurance companies decide to no longer provide "Cadillac" plans? Will the next plan down the line be hit with a fee? Are we naïve enough to believe that this extra fee will not be passed onto those being covered? I think not. Insurance companies will pass along the fee.

While the president was specific to many ideas in his plan, he fell short on one; tort reform. "Now, 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 costs of health care. Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs." The only direction given in regards to tort reform is to authorize the Secretary of Health and Human Services to move forward with the Bush administrations "demonstration projects in individual states to test these ideas." Even though the compromise is a nice gesture, why does the president fall short to include it in a health care reform bill?

Overall I was pleased with the specificity that the president spoke. Had he stopped after talking about how he'd pay for his plan the speech would have been great. Instead he went on to invoke Ted Kennedy. Ted Kennedy did have a lifetime goal of universal health care but for the president, or anybody, to use his death to promote their agenda is pathetic and cowardice. I look forward to the debates moving forward and to see if the president's door is truly open.