Watching Obama on health care last night on ABC was painful during the 9:00 hour. I think he had a real opportunity to lay the issues on the table and speak clearly to the people in a way that would have prompted them to pressure their congressman for change. Instead, I think he just muddled through it and repeated what he did on the campaign trail.
I think he’s out of practice. Perhaps it’s an ego thing, where he doesn’t feel he needs to do his homework. Michelle did say he needs to be reminded once in a while to keep in check. Either way, I think he disappointed the folks (like me) who really thought he would come out fighting. Throughout the show I found myself answering the questions much better, simpler – and faster. Why didn’t he?
Here we go:
The first questions was really stupid: “Can you promise that if you wife or kids get sick, you’ll not seek extra care not approved by government plan?” In other words, would you just accept the system given to you and watch your wife or kids die? What a stupid, loaded question. Of course, Obama defelcted it and spun off in another direction, adding that “”it’s my family member, if it’s my wife, if it’s my children, if it’s my grandmother, I always want them to get the very best care.”
Me: Of course I want any care that will improve my famiy’s health. What do we do today in that same circumstance? If the insurance company does not approve the treatment, we can pay for it ourselves or we can not do the treatment. The government, like insurance companies today, are not going to let you go bananas, getting every treatment available. But I will tell you this: The government is not making decisions based on making a profit – but insurance companies do.
Insurance companies are out to make as large a profit as possible. If it were entirely up to them, they would insure only healthy people. That’s why, when you get sick they move quickly to reduce the long-term cost of taking care of you. You’ll get a huge premium increase at the end of the year – or you’ll get dumped. After the termination, which insurance company do you think will pick you up? None. The government won’t be able to do this. Bottom line? You get covered.
Gibson asked the president if it doesn’t make sense to decide what the limitations will be on options in any reform bill before voting on it. “That’s what people are afraid of,” Gibson said. The president said he understood the American people “know they’re living with the devil, but the devil they know instead of the devil they don’t.”
Me: Don’t just highlight it, defend it. First, there are many options to consider when creating a reform bill. They won’t all be perfect, and they won’t all be implemented immediately – this is a gradual implementation. Second, the closest thing we have to a public option today is Medicare, so you may know the devil better than you think. Now, I realize Medicare is not perfect, but let’s consider the ease of which a Medicare patient is processed. They simply go into a hospital or make an appointment with their doctor. No bills, no credit cards, no anything. This may be an option for those who select a public plan.
Now that I’ve formally mentioned “Public Plan”, let me add this: Despite the 72% of Americans who want a public health care option, opponents will compare it to long lines at the DMV, or some rare cases in Britain or Canada in order to scare you. I believe our government does some things very well and we should be proud of these institutions. Does Medicare work well? Perhaps not perfectly, but it’s a heck of a lot better than the for profit insurance companies. Does the Military work well? This is one of the most complex organizations in the world and we do pretty darn good. Does Nasa do well? I don’t think anyone can argue that.
A public option will be just that – an option. Should t perform badly, insurance companies will win. SHould it perform well, insurance companies will have to compete to survive. That’s who you make change.
Another dumb question: How can we get general practitioners instead of specialists out of Med school? BO said he would provide incentives like loan forgiveness, etc. Ughhh. Boring. No one cares.
Me: Doctors go where patients are. Today, patients don’t go to regular checkups with a general practitioner. They don’t work on preventative care with a family doctor. Instead, you wait until you get sick and you go to the emergency room. That’s where the patients are and that’s where the doctors will be. We need to create programs that help patients reduce the number of circumstances that put them in the emergency room. These programs will be run by doctors and nurses who will benefit financially by their participation. Specialists, who make lots of money today, will run into fewer patients with emergency needs and will make less money. Supply and Demand people.
Another stupid question: Some lady’s 105 year old mom was originally denied a pacemaker by her physician, but a second physician went for it because her mother was vibrant, etc. Will decisions be made based on a person’s livelihood and energy? Obama ran on, into a dicusssion about his grandmother and the importantce of her care, but the reality of her likelihood of survival after breaking her hip. Tough decisions had to be made.
Me: Congratulations on being one of the 30-40 people in America who’ve reached that age. (OK, I’ll assume she gets that point) People, please understand that our promise is to give people the care they need in order to cure their ills, or in those rare cases where it’s near the end, make the person as comfortable as possible. It’s no different than today – except that the government will stick around while the insurance companies will drop you.
OK, on the to nightline section of the show where the President started to kick a little butt. Problem was, no one tuned back in.
Gibson read a letter from GOP Senators: “At a time when major government programs like Medicare and Medicaid are already on a path to fiscal insolvency, creating a brand new government program will not only worsen our long-term financial outlook but also negatively impact American families who enjoy the private coverage of their choice,” the senators wrote. “The end result would be a federal government takeover of our health care system, taking decisions out of the hands of doctors and patients and placing them in the hands of a Washington bureaucracy.”
“They’re wrong,” the president said. YES! He’s beginning to warm up…arguing that in a Health Insurance Exchange, the public plan would be “one option among multiple options.” Ok, he petered out a bit there.
Me: They’re wrong. The GOP and insurance companies want you to think the decisions are between you and your doctor, but they are not. They are between you and an approval board measuring risk within the insurance company. This is as bureaucratic as it gets. These people are making decisions based on profitability, not your health. No ask yourself this: Why is the GOP so defensive about a public option – one you don’t have to select over your current plan? I would remind them that they work for you, not the lobbyists.
The concern, Gibson articulated, is that such a plan wouldn’t be offered on a level playing field.
Here’s where Obama started to get hot: “We can set up a public option where they’re collecting premiums just like any private insurer and doctors can collect rates,” but because the public plan will have lower administrative costs “we can keep them honest.” Obama said he didn’t understand those advocates of the free market who constantly say the private sector can do things better and are yet worried about this plan. (Right on!)
“If that’s the case, no one will choose the public option,” the president said. He also suggested, however, that the private sector might not necessarily be better, point out that users of Medicare and Veterans Administration hospitals constantly rate “pretty high satisfaction.” (YES! Now he has our attention, except it’s like, midnight)
OK – Obvious this guy is a lobbyist: John Sheils, senior vice president of The Lewin Group, a health care policy research and management consulting firm, estimated that up to 70 percent of those with private insurance would end up on the public plan.
Obama: “There are a whole series of ways that we could design this,” the president said, arguing that employers would be given a “disincentive” to shift their employees to the public plan. Wrong answer.
Me: As we’ve stated before, the health care situation in this country has a significant impact and relationship on the economy. Some of these businesses might find it attractive to move to the public option. Like others, however, they too will be paying premiums, feeding the system. Companies that save money, can in turn hire more people. That is how this can help the economy. Secondly, smaller businesses who can’t afford to hire employees or offer health care to those they hire, may now afford to do so. That is another way to improve the economic condition in this country.
Loaded question: “What can you do to convince the American public that there actually are limits to what we can pay for with our American health care system and if there are going to be limits, who’s going to design the system and who’s going to enforce the rules for a system like that?”
Obama: “If we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that make sure that necessary treatment is provided but we don’t have a huge amount of waste in the system.” Then he cited the Mayo Clinic and said more doctors and hospitals should be like them. Shot and a miss. Snoooooooze.
Me: Let’s clarify this question for you. You are asking us to limit the cost of such a system and ensure everyone that the cost is fixed and we’ll have the guards in place to control those costs. However, we just spent the past 30 minutes discussing how tests and care should not be limited in any way as to provide the maximum quality care. Control costs, but don’t limit my care. With technology and today’s generation, I have confidence that we can add enough efficiency to the system to control costs over the long term, wtihout affecting quality of care. For God’s sake we put a man on the moon when we had absolutely no clue what was up there. (nice touch)
A lady asked about a single-payer, medicare-for-all system. President said he is agaisnt it now because it would be disruptive to the economy, stating that health care is 1/6th of the economy. OK, makes sense for now. I approve.
“How and who will pay for a national health care system,” was next. Obama said we’d pay for it. He went on to criticize the budget office estimate, saying they did not credit the cost with savings from technology, elimination of administration stuff, fat trimming, etc. He mentioned the $177B subsidy that goes to insurance companies. I bet a lot of folks didn’t know that.
Finally, I’d add that he should have focused on the fact that the private insurance option is in real trouble. Earlier he mentioned that premiums are going up every year and eventually the cost will be too high. My only complaint is that he wasn’t forceful enough on this point, and he didn’t use this point throughout his discussion.
Me: Private insurance will die if we don’t fix this system. Why? Because as your premiums grow and become more unaffordable, so do the premiums of employers, who will evventually have to drop the benefit. In addition, premiums for healthy people will begin to rise to cover unhealthy people. Unhealthy people will cost more and eventually fall out of the plan due to their inability to pay the high premiums.
Once that happens we’ll have insured healthy people and uninsured sick people. Then where will we be?
Folks this is a high priority issue and if you, the constituency are not being vocal enough with your congressman or senator, get on with it. The only way we’ll get things accomplished is if you can outgun the lobbyists.
Here’s a link to find and contact your congressman or senator: http://www.usa.gov/Contact/Elected.shtml
