Do, or do not. There is no 'try'. - Yoda
Here’s the fisk. I couldn’t wait until morning. It’s not as bad as I’d feared. But the idea that this was a land-breaking speech is overblown. There was little we hadn’t heard before. For all the President’s soaring rhetoric (someone administer smelling salts to Sullivan, please), he still does not understand how healthcare or insurance works.
And his metaphor for the public option is now public universities. Think about that.
I think there’s room to maneuver here toward a good plan—if we had a competent GOP. But I fear the most likely result is that the Conservative Clown Car that has taken over the dialogue will get increasingly shrill and increasing steam-rolled.
Update: Quote of the Day:
He said,
Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.
And if we don’t pass this plan, does he intend to keep the waste and inefficiency, out of spite?
I said this below, but it’s worth repeating over the fold—if reducing waste is so easy, why not do it now? That should be uncontroversial and pass both houses unanimously, no?
I did like this kickoff.
When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month, credit was frozen, and our financial system was on the verge of collapse.
Thank God that’s all over. Oh, wait.
It has now been nearly a century since Theodore Roosevelt first called for health care reform.
And ever since, nearly every president and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell, Sr., in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.
This is one meme I have grown increasingly tired of. That we have wanted to do something for a very long time does not necessarily make it a good idea (people wanted to “finish the job” in Iraq for a long time too). The reality of a legislation is almost always very different from the delusional vision of its authors. I’m disinclined to make policy because Teddy Roosevelt and John Dinghell were unable to impose their fantasies on the nation.
Ideas have to stand on their own merit. “We’ve wanted to do this for soooo long” is not an argument ... it’s adolescent whining.
Some can’t get insurance on the job. Others are self-employed and can’t afford it since buying insurance on your own costs you three times as much as the coverage you get from your employer.
And also, because they don’t have the tax advantage big corporations do.
Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or too expensive to cover.
There’s a reason for this. Some conditions are too risky to cover. Insurance companies are not a public service. They are businesses who intend to make money for their investors. They don’t deny coverage because they are evil; they deny it because it makes no sense for them to take on hundreds of thousands of dollars in costs in exchange for thousands of dollars in premiums. That reality will not change.
We are the only democracy, the only advanced democracy on Earth, the only wealthy nation that allows such hardship for millions of its people.
I’ve never understood the Democrat desire to be like every other country on Earth. But I would point out that we are also the only advanced democracy on Earth that can treat illness as rapidly and effectively as we do. I’ve used the example of breast cancer—in which a woman can get a biopsy and mastectomy in the same surgical setting—many times. No other country does that.
Making us like France will slow the pace of innovation, possibly to a crawl. Is that really a good idea? (And lefties, please do not come at me with ‘we’ll get government to fund research’. You can’t pay for healthcare and research simultaneously).
More and more Americans worry that if you move, lose your job or change your job, you’ll lose your health insurance, too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care. It happens every day.
And it was a nitwit Democrat—Roosevelt—who created the system that manacles health insurance to employment. We call this “unintended consequences”. Insurance portability could be fixed with COBRA reform. Rescission is something that needs to be addressed, preferably at the federal level since the states have proven toothless in forcing insurance companies to honor their God-damned contracts. But I see no need for massive government intrusion.
Then there’s the problem of rising costs. We spend one- and-a-half times more per person on health care than any other country, but we aren’t any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages.
To the extent that this is true, it is mostly our own fault. The health care system is doing an outstanding job of caring for us, considering how drunk, drugged, violent and fat we are.
If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined.
I look forward tot your proposals to control spending on these programs. Hello? Echo ... echo.
Our overall efforts have been supported by an unprecedented coalition of doctors and nurses, hospitals, seniors’ groups, and even drug companies—many of whom opposed reform in the past.
These would be the special interests that you have bribed with hundreds of billions of dollars in promised spending.
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 for those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government.
These goals are incompatible, as Massachusetts is finding out. If you previously uninsured people insurance, they will use it. Now that might be a laudable goal. But don’t sit here and tell me we can also control spending without making major changes in how service is provided. You are going to have to control costs someday. You would think that this “conservative” “pragmatic” “thoughtful” leader who treats us like adults would ... treat us like adults and admit that there will have to be tradeoffs.
First, if you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the V.A., nothing in this plan will require you or your employer to change the coverage or the doctor you have.
When my brother and I were kids, we would sometimes say, “I’m not going to hit you; I’m just to swing my arms around and if you get in the way, it’s your own fault.” Obama is giving us the semantic equivalent. He’s not going to require that your employer change your coverage, he’s just going to make it almost impossible for him not to.
Under this plan, it will be against the law for insurance companies to deny you coverage because of a preexisting condition.
Without a mandate to buy insurance, this is a recipe for disaster. Democrats simply do not understand how insurance works. Insurance is not some magic bean factory that produces free healthcare. It is a way for a person to disperse his healthcare costs over his entire life or his fellow insurees. If people are able to hold off buying insurance until they need it, the industry will go bankrupt. (Addendum—Obama does get into mandates later).
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 the most.
I don’t oppose this, in principle.
They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime.
I’m sorry. You were saying something about reducing costs?
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.
This would be fine—if it were mated to a system that mandated that people be responsible for the first few thousand dollars of costs. There has to be some consumer incentive to control costs, doesn’t there?
And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies.
At no extra chage? Where is the money coming from then? These things are not free. And recent research has shown that having consumers in control of those costs result in far less spending and far more efficient spending.
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.
Preventative medicine saves lives, but does not save money. This isn’t really debatable anymore.
If you lose your job or you change your job, you’ll be able to get coverage. If you strike out on your own and start a small business, you’ll be able to get coverage. We’ll 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.
You could also give insurance tax breaks to the self-employed. You could also reform Cobra so that people can downgrade their insurance when they leave their employer and transfer it to a new employer without losing coverage or having to be re-approved.
It’s how everyone in this Congress gets affordable insurance. And it’s time to give every American the same opportunity that we give ourselves.
There is no way that the public insurance exchange will be as generous as the one Congress enjoys. Such cadillac insurance would be way beyond the means of most people. They would have a choice, all right, between various forms of crummy insurance.
Once again, we are seeing Obama’s appeal to magical thinking—the idea that just creating an exchange will create the utopia our Congressional millionaires enjoy. The insurance exchange does not create Congress’ wonderful healthcare benefits—massive taxpayers spending does.
This exchange will take effect in four years, which will give us time to do it right.
Also, to conceal the costs, since CBO projections only go for ten years.
Now, even if we provide these affordable options, there may be those, and especially the young and the 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 by giving them coverage. ... 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—likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers.
Finally.
There will be a hardship waiver for those individuals who still can’t afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements.
Oh. So ... there won’t be mandate. You can’t call it a mandate when you exempt such a large slice of the populace, can you?
Here’s one part I loved.
Still, given all the misinformation that’s been spread over the past few months, I realize—I realize that many Americans have grown nervous about reform. So tonight, I want 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 by prominent politicians that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie plain and simple.
In other words, “suck my dick, Sarah Palin”. One of these days, people will wonder how on Earth someone so willfully ignorant became the face of the GOP. It’s like we’re picking spokespeople by bra size.
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.
This is actually highly debatable and not something I want to get into.
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.
Again, something I like. I’m pro-choice, which means I think the government should stay the fuck out of abortion—on both sides.
But now we get stupid again:
My guiding principle is, and always has been, that consumers do better when there’s choice and competition. That’s how the market works.
Except in education, apparently. At least that’s what I have to think from the people who murdered the highly successful DC voucher program.
Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down ... 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.
Now, let me be clear. You won’t allow insurance companies to compete across state lines and create real competition. But you will create a subsidized Fannie Med that will “compete”, with massive political and financial advantage, across the nation. The assurance that Fannie Med will not be subsidized rings very hollow. Medicare and Medicaid are allowed to conceal much of their administrative costs in other branches of government. Even without that, a public option will have the implicit backing of the US government. There is simply no way to create a public option without some kind of backdoor subsidy.
On the other hand, allowing competition across state lines costs nothing and involves no subsidies.
But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers and 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.
First, I’m sure that the political appointees running Fannie Med will draw the same miniscule salaries the ones running Fannie Mae and Freddie Mac did. Oh, wait.
Second, do you really want to cite universities this way? Public universities are subsidized! And even with that subsidy, higher ed costs have been soaring far far faster than healthcare costs. It was hard to imagine that Barack Obama could make a worse case for the public option than comparing it to the post office. But he just did.
I will not sign it if it adds one dime to the deficit now or in the future—period.
As we found out with Bush, talk is not cheap—it’s hideously expensive. Spell out your cost control mechanisms. Spell out tax hikes. Treat us like adults, for once.
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 promise don’t materialize.
Like the Sustainable Growth Rate cuts to Medicare that Congress defers every year? Or the Gramm-Rudman-Hollings Amendment of the 80’s that Congress ignored? Or the PAYGO that you have ignored? Those requirements?
Now, 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.
True enough. But both the tax cuts and the Iraq War will be gone before your plan takes effect.
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.
If waste, fraud and abuse are so easy to get rid, why don’t you get rid of them now and then we’ll talk about plowing all that savings into healthcare
I also like what McArdle said about this. To hear politicians talk, you’d think 113% of our budget is waste. To come up with $1 trillion in savings, you’re going to have to cut some meat.
That is why not a dollar of the Medicare trust fund will be used to pay for this plan.
Well, that’s easy to say since the trust fund doesn’t have any money.
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. So 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.
This is classic government idiocy. Small programs do not necessarily work when applied over the nation at large. And top-down costs savings would not be nearly as effective as the bottom-up savings of having consumers more in charge of spending.
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.
So ... the insurance companies and drug companies will get paid by ... taxing the insurance and drug companies. OK.
And 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.
This is the charge on high-end insurance. As long as unions aren’t exempt, I don’t have much of a problem with it. I would prefer simply capping the tax break for insurance (or eliminating it) rather than charging “fees”.
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. ... I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it’s a good idea, and I’m directing my secretary of health and human services to move forward on this initiative today.
We’ll see what comes of this. I have no faith in the ability of the Democrats to stand up to lawyers.
The speech ends with empty fiscal promises and a rather crass reading of Ted Kennedy’s death letter. An appeal to Social Security, Medicare, American War Dead, God, the Flying Spaghetti Monster. Liberals are in a tizzy about the closing paragraphs. But I find myself increasingly unmoved by lofty rhetoric. I spent eight years hearing about fiscal discipline and humility from one of the most arrogant spendthrift Administrations in American history. So you’ll understand if I don’t wet my pants because the President acknowledges that government can’t solve all our problems. Because, as we’ve seen, this President has yet to see a problem he doesn’t think government can solve. He’s sure that somewhere there’s a problem government can’t solve; but he just hasn’t found it yet.
I do think this speech represent a step forward in that we could find some compromises and room to maneuver. The government exchange combined with inter-state competition, for example. But the President’s ideas still show a shocking disregard for basic economics and a stunning ignorance of how the healthcare system really works. And again, no mention of tradeoff, no mention of the tax hikes or benefits cuts which will be necessary to make this work.
When you combine that with a useless GOP, I remain pessimistic.
Just slightly less so.
Posted by
Hal_10000 on 09/09/09 at 06:47 PM (
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Hal,
I’ll read through your post tomorrow when it’s not so late at night, but the AP did a basic fisking of its own, and it’s pretty devastating in that it gets right to the point and doesn’t waste time on Obama’s extraneous campaign-rhetorical flourishes.