Free Markets, Free People


Health Care Speech – The Morning After

As I think about last night’s speech by President Obama, two words kept coming to mind: partisan and combative. The speech was highly partisan, even though he gave lip-service to bi-partisanship. And I thought he was needlessly combative – calling people liars and describing those who disagree in less than flattering terms.

It was not his finest hour. Nor was it a particularly good speech. It seemed to go on forever and that is usually a sign that it isn’t holding the attention of the audience.

As I figured, since I was at a loss as to what else he could do, he attempted to repackage the same old proposals that the country has been rejecting and called it “new and improved”. He promised details, but there were scant few. And that was particularly true in his attempt to describe how he’d pay for the mess.

Let’s look at some quotes:

There are now more than thirty million American citizens who cannot get coverage.

I’m wondering what happened to the 17 million “Americans” that Democrats and Obama have consistently claimed were uninsured. Where did the 47 million uninsured go? Is this an acknowledgment that they’ve been purposely pumping the numbers up for quite some time?

Well the time for bickering is over. The time for games has passed. Now is the season for action.

This is what I mean about needlessly combative. Those who attended townhalls and other gatherings to voice their opinions and protest what the Democrats were trying to pass do not consider what they did to be “bickering” nor do they feel they were engaged in “games”. Those gaming this were the Democrats who tried their hardest to pass this monstrosity without the benefit of debate, without anyone being able to read and digest it and without Republican participation.

That is gaming the system. There’s no rush to do this and pretending there is also falls under “gaming”.

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.

But it has never been Obama’s guiding principle – not when he insists that “choice” and “competition” can only be achieved by introducing a government run entity into the mix while declining to consider other options.

Remove the regulation that prohibits health care insurance providers from selling across state lines, remove the mandates that require the insured to buy coverage they don’t want or need and facilitate the removal of health care insurance from under employers into the open market. All of those moves – which would require little in the way of tax dollars and government intrusion – would actually deliver choice and competition while driving insurance costs down.

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.

And most experts say that 5% would not be enough to keep such a system fiscally sound and it would eventually have to turn to the government for subsidy. Want a real insurance exchange? See my comments above.

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.

Mandatory health insurance – something he said he didn’t believe in during his campaign. So a young person who would prefer to pay for his health care as needed now no longer has a choice.

Key word – choice. Remember Obama’s “guiding principle”. Well he violates it right there. You no longer have a choice. And remember, in the bill now on the House floor, this will involve the IRS fining you if you fail to comply.

Companies are left with no choice as well.

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.

Certainly there are aren’t any literal panels called “death panels” in the pending legislation, but within the structure of the bill (HR 3200) there are certainly plenty of panels which will be determining what constitutes “best care”. The obvious logical argument then says, if they are there to determine what constitutes “best care” and are using the reimbursement mechanism to encourage their recommendations be followed and the refusal to reimburse if they aren’t, then it isn’t at all incorrect to logically conclude that “best care” when it comes to the elderly may conflict with the desired care the family and doctor want to render the patient.

That argument gets to Obama’s claim that he would prevent any bureaucrat, government or insurance, from getting in between you and your doctor.

So is what those are saying about “death-panels” “a lie, plain and simple”? Or is the lie to be found in the entrails of HR 3200 and in the glib assurances of Obama?

As an aside – is a president calling for “civility” really being civil when he calls those who disagree with him liars in a speech before a joint session of Congress?

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.

See my post on Joe Wilson. He yelled “you lie” for a reason.

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.

Once again the combative and dismissive of the right. This was not a speech that really welcomed Republicans into the process. And, I found it amusing when he tried to imply the Republicans weren’t a part of the process because they’d refused to participate, Republican members of Congress waved the three bills they’ve submitted in the House for all to see.

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.

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.

The stated cost is $900 billion. That’s before the CBO looks at it. But of course the CBO can’t look at it until it is written legislation. But the CBO has already dismissed claims that saving of the amount Obama is claiming can be achieved by “finding savings” in “waste and abuse”.

And isn’t it telling that Obama admits that the system he now runs – Medicare – is “currently full of waste and abuse”. If eliminating fraud and abuse is so easy, one would assume a) there’d be none now or b) he could direct waste and abuse be ended now and those savings accrued immediately.

This is a hand-wave at fiscal responsibility. It is a glib nothing which he can stretch into a claim the cost of his proposal is “covered”.

Also remember that the front end of all these plans are loaded with collections, but no health care reform. Reform doesn’t kick in until 2013 – after Obama hopes to be safely reelected. But in the intervening years, we’ll begin to pay for it. Consequently we’ll have 10 years of money and only 7 or 8 years of reformed health care to pay for in that time frame. That means costs will explode after the 10th year and add to the deficit. Point? His proposal will add heavily to the deficit but not until he’s well out of office.

Knowing seniors were very wary of his plans, and he was losing their support, he attempted to win them back:

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.

And in his next breath he says:

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. 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.

Well, first, Medicare part D is the Medicare prescription drug plan, so I have no idea who all these seniors are paying “thousands of dollars a year” for drugs.

As I recall, what Obama is primarily targeting, though he is very careful not to actually mention it, is doing away with Medicare Advantage.

If you’re wondering what Medicare Advantage plans are, you can read about them here. One of the things Advantage plans pay for is prescription drugs.

And, as the website points out, “In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

I guess the Advantage plans must be considered one of those “gold-plated” plans.

Also note the promise of yet another bureaucratic panel – so, could continuing care on grandma at some point in time be considered “waste” and a different form of “care” be encouraged? Is it possible that could conflict with what you and your doctor prefer?

Again, nebulous language that can be interpreted and logically extended to mean precisely what Obama denies is in his proposal.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.

This is the oldest claim in politics and the most bald-faced of its lies.

Obama mentioned demonstration projects for tort reform (and I am glad to see tort reform at least on the edge of the table). I’ve got an idea for a real demonstration project – if it is so easy to reduce the “waste and inefficiency” in Medicare and Medicaid, you have 3 years in which to do it. And once you’ve been successful and that success is unequivocally documented, then come back to us and we’ll talk about further reform.

Overall, as mentioned, not his finest speech. In fact, probably one of his poorer speechs. There was a measure of arrogance that was unattractive. There was a feeling that he wasn’t trying to convince but instead dictate. Nothing I heard last night was new. Nothing I heard last night was particularly compelling in terms of making a convincing argument for doing what he contends we must do.

Instead I heard frustration voiced in surly combativeness. That’s not the way to convince your opposition to see things your way. Leadership was again missing in a speech and moment that practically begged for it.

~McQ

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31 Responses to Health Care Speech – The Morning After

  • “Leadership was again missing in a speech and moment that practically begged for it.”

    I agree. Leadership – Not Observed!

  • I’m wondering what happened to the 17 million “Americans” that Democrats and Obama have consistently claimed were uninsured. Where did the 47 million uninsured go?

    One of two possiblities, that 47 million included illegal aliens and Obama didn’t want to contradict himself within the same speech. Or, they’re starting to acknowledge a lot of the 47 million is actually people who can afford it, but choose to risk going without it.

  • Here is the most important point you guys miss:

    “First is a health care system that is utterly unsustainable. If the Republicans win and nothing gets done, it will be a Pyrrhic victory, as the system will continue to collapse until so many lose coverage and get denied claims that people will scream for an even stronger government plan.”

    You are not coping with the reality that the system as it stands is unsustainable, and even if reform is halted, more and more people will lose coverage, have expanding costs, and bloat the deficit. Even if you manage through fear, misinformation and bluster stop this, it’ll come back in an even more government-intrusive form in the future. This is a battle you ultimately will lose; all you can do is delay defeat. Or, you can work with the Democrats, find compromises, focus on holding the administration to promises about deficit and bureaucratic inefficiencies, and be part of the solution.

    I also think you’re going to be sorely disappointed when your predictions of Obama’s leadership failing are going to collapse. The speech is widely seen not only as a success, but just the opening shot in a PR the Obama team is very good at. Don’t say you haven’t been warned!

    • For the speech to be judged a success, it would have to change minds. I see no evidence of that. In fact, I saw little evidence this speech was much different than the previous 112 speeches he gave on the topic.

      Rick

    • “You are not coping with the reality that the system as it stands is unsustainable, and even if reform is halted, more and more people will lose coverage, have expanding costs, and bloat the deficit. ”

      Mr Erbb you are a Fool of the highest order. This line alone makes you a fool. Noone here has EVER said not to change things, in this very damn post Bruce talks about things needing to change, but not a complete reform like this, we want market changes that will have real effect and reduce prices. The left thinks they can say the right has no answer till they are blue in the face and STILL it will be false and foolish. Your a clown.

      • I wouldn’t say that line proves Erb is a fool, but it is increased evidence that anyone who believes Erb is a fool. There’s a chance Erb doesn’t believe it himself, but any program that looks like it will hamper the chances America uses military force is worth supporting in his book.

        Tying up a huge portion of GDP for a program that will never shrink or go away certainly fits that description. A speculative plus to Erb’s approach here: if Obama-worshippers can spin this to look like a moderate solution, there’s a chance he can cut and run from Afghanistan without giving the appearance that he always leans to the far left.

    • The Democrats (and frankly, the Republicans as well) are proposing to reform a broken system by breaking it even more. Working together won’t magically produce a viable health care system when both the current system and the ones being proposed continue to promise that we’ll provide health care that someone else is going to pay for. That someone else is US. And we can’t afford it.

      I’d like for the President and both his supporters and detractors to put the speeches and rhetoric away and invest in a calculator. And by the way, that little “dash” that keeps appearing before your figures? It’s a minus sign.

    • First is a social security and entitlement system that is utterly unsustainable. If the Democrats win and nothing gets done, it will be a Pyrrhic victory, as the system will continue to collapse until so many lose coverage and get denied claims that people will scream for an even stronger government plan.”

      ***

      Anything else you want to opine about?

      And again- if you have the votes for your precious health plan, ram it through.

      TODAY.

  • “Mandatory health insurance – something he said he didn’t believe in during his campaign. So a young person who would prefer to pay for his health care as needed now no longer has a choice.”

    It’s fine to call this out, but lets not pretend that the free rider problem doesn’t exists with these liberty minded young people. I wonder how many of these pay-as-needed twenty-something males end up in car accidents and someone else ends up footing their bills?

    • Of course the free rider problem exists. It always will. It exists in every welfare state. But I don’t see that as a basis for further limiting the liberty of choice for everyone. The real reason for mandatory insurance is to pull young people into the pool and help pay for the “insurance reform” (no pre-existing conditions, no denial of coverage, no caps on payout) he’s pushing.

      Don’t the young, then, end up paying someone else’s bills under that scheme?

      • “Don’t the young, then, end up paying someone else’s bills under that scheme?”

        Yeah, just like insurance works, since a portion of my premiums pays for the medical needs of someone else to the extent my claims are less than my premiums, which is true for most people. Except that those people have been paying risk-based premiums too, whereas the free rider has paid nothing.

        The “young person who would prefer to pay for his health care as needed” is not a particularly good basis for making counter arguments against any increased government intrusions. Though I’m generally for maximizing individual freedoms, I’m not going to go out of my way for those who maximize their freedoms while failing to take corresponding responsibilities. In short, don’t impose your externalities on me; bear the cost of your own existence.

        • Let’s not pretend they don’t get billed for it when they use the medical services they aren’t insured for.

          They may, or may not PAY that bill and may get ‘charity’ on it, but they GET the bill. Some of them will man up and pay it, some of them won’t.

          • Yeah, I’m sure they get the bill. But if it’s for anything significant (I don’t know, let’s say more than 10k) I’ll bet anything they never pay the full amount and the costs are spread over those that do pay in the form of higher prices.

        • I have no problem with your point and in a free country that’s how we’d operate. In fact, until we became a welfare state, that’s how we operated – people paid their own way.

          As far as I’m concerned, anyone who takes more out of a system than they put in is as much a free rider as someone who doesn’t participate but uses the system. There’s no question that a good portion of those who will be put into this system they’re cobbling together won’t pay a penny. We all know that. That person is just as much a free rider as the person you’re talking about. And you’ll be paying for their care. I really don’t see the difference.

          I believe what you’re really saying is you want everyone in the system, regardless, so that when free riders are treated their treatment won’t cost you as much as if theose people were not in the system. OK – but that still doesn’t solve the free rider problem.

          • All I’m saying is that a critique of the current ‘reform’ proposals on the grounds that Johnny Pay As Needed has his freedom curtailed is a critique that won’t have resonance with many people, including, I daresay, libertarians. I don’t care that the high risk twenty-something might lose his ability to role the dice and increase costs for the rest of us, indirectly through higher prices. I’m not saying I’m for mandatory insurance either, but I think this line of attack is one of the worst that can be offered up in light of the target rich environment the pols have offered up.

          • Johnny Pay As Needed is more likely to actually pay than the free riders already in the system wouldn’t you say?

            So, if the “libertarian” with whom this has no resonance has accepted the welfare state we live in as unchangeable and therefore something to accept and support, I’d say they’re really not much of a libertarian to begin with.

            The only way to eliminate a free rider problem is to make everyone pay their own way. I simply refuse to discourage those who want to do that in favor of the demands of the welfare state.

          • There may be numbers out there on uninsured young risk takers at least attempting to pay vs the ‘free riders’ who never have any intention of doing so in the first place.

            There are still people to whom an acquired debt has meaning (although the plethora of adds to ‘reduce your credit card debt for pennies on the dollar!’ leads me to believe we’re trying to kill THAT class off as quickly as possible).
            Some people understand that their credit history DOES mean something and failure to pay your health care provider(s) is certainly not ignored by the credit rating industry.

            Just as the deadbeats exist, a fact no one will argue, so too does Johnny Pay as Needed. I’m not sure why people think these young folks will pay to have their car repaired, for example, but will try and slip out from under a debt to a hospital.

          • “I’m not sure why people think these young folks will pay to have their car repaired, for example, but will try and slip out from under a debt to a hospital.”

            Do you really think these two are the same thing?! Please! To be perfectly clear here, I’m not talking about the guy who has a couple of thousand in debt to the hospital because he did something stupid while drunk. I’m talking about the idiot without coverage in a car accident or who is stricken with a major disease. The kind of thing that can easily run into the tens of thousands and beyond. Yeah, I don’t think that’s the same thing as the guy who will drop a couple of thou to fix his car.

          • The young single types don’t need coverage for office visits, sex changes, and males don’t need OB-GYN/maternity coverage, yet this is mandatory coverage on insurance policies.

            How much coverage is to pay, for example, free-loader transvestites?

            Young people need only catastrophic coverage. Even those polices are overloaded rather than customized.

          • Bruce, honestly, you’re missing my point. I take full responsibility that I wasn’t being clear in the beginning, but my last comment, in reply to you, was clear.

    • No. If the goal were simply to catch free riders who end up in car crashes, then mandatory *catastrophic* insurance would suffice — but that’s not what the statists are calling for. They want universal HMO coverage, IOW not just insurance for the young & healthy, but over-insurance to subsidize the chronically ill and elderly. Go shop around — you’ll see that HDHP to cover catastrophic injuries are an order of magnitude less expensive than HMO (pre-paid care) plans. There’s a reason for that.

      • Titus, I have a HDHP, I know all about it’s relative cheapness. See my last comment before this for the gist of my argument. I wasn’t particularly clear earlier.

        • The point is total inside baseball. The closest anyone else is going to get is to note that Barry is now endorsing the individual mandate, a point he once chewed-out Hilary over!

  • Once, just once, I’d like to see a politician describe why the health care system in this country is broken.

    You don’t hire someone to do body work on your car after you just watched him take a sledge hammer to it.

  • Scott Erb

    “You are not coping with the reality that the system as it stands is unsustainable”

    yet we can keep our health care if we want it. nothing has to change.

    Obama will protect Medicare too right.

    Once he cuts $500b in payments then providers will do one of 3 things to make up for the loss in revenue

    a. Stop accepting medicare

    b. cut down on the number of medicare procedures to offset costs.

    c. Continue to accept medicare and charge people who pay (either personally or through insurance) more thus increasing their costs even more.

    Liberal logic = Not logical.

  • Scott erb

    “I also think you’re going to be sorely disappointed when your predictions of Obama’s leadership failing are going to collapse.”

    He has to display leadership first which usually entails DOING SOMETHING OTHER THAN TALKING.

    ” The speech is widely seen not only as a success,”

    By the gullible masses awaiting to listen to the words of the Annointed one.

    ” but just the opening shot in a PR the Obama team is very good at’”

    PR works when you dont have to show anything afterwards. PR doesnt do so good if you cant back up what you are saying.

    1st rule of war – No plan (or PR) survives first contact with the enemy.

    Go back to that joint you were smoking.

  • “The speech is widely seen not only as a success”

    Based on the Erb poll at the U of M Farmington Faculty lounge.

    A second poll was taken at another psychiatric institution near by, the results from that poll have not yet been tabulated, largely because “Napoleon” and “Ghengis Khan” were unable to reach agreement on who should be in charge of said tabulation.

  • And the comment replies are all over the d*mn place! It’s hard to follow what’s going on here. For what it’s worth, I’m using Firefox 3.5.2 on a Mac.

  • After the speech, there are still some questions that I know I am not the only one to raise. It seems that people’s biggest problem with this new reform bill is that they don’t know much about it. There are no clear lines and no points that more than one group of people could understand at once. From seniors and medicare, to employers and public policies, even to health professionals and who or who not to treat. There is no clarity.

  • I hope that this health care bill is as good as the president says it is.