Thanks again to our guestbloggers for their contributions this evening. Contact info is available via our news release.
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Ben Malley
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Don McCanne, MD
He was at his best in the latter part of his speech. The American character – a recognition that we are all in this together; an acknowledgement that sometimes the government has to step in with the promise of the reward of security and fair play. What is really sad is that the collective effort on sorting out policy fell so short of what we should expect from the American character.
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Doug Henwood
Fox is running ads from PatientsUnitedNow.com which is spreading lies about the Canadian system. Boustany says Obama’s pushing government run health care. It’d be so much easier to do politics by telling sensational lies!
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Sam Husseini
Boustany claims Obama is proposing a gov plan and will cost a great deal. This mischaracterizes the Obama plan as a Medicare type plan and obscures the fact that such a plan would save money — a central point.
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Sam Husseini
Boustany, after years of heart surgery says he saw the need to cut costs, not provide better care or cover the uninsured.
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Doug Henwood
Another sign of the enduring discursive grasp of Ronald Reagan: ending the speech with “God bless America.”
Now I can’t wait to hear what Brit Hume thought of it.
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Gwendolyn Mink
It is so intellectually dishonest to cloak himself in Kennedy’s mantle of social justice, when there is little justice in this plan. If he would stop being so grandiose the conversation might be more productive. This speech says that health care reform has been defeated. What remains possible, maybe, is some regulation of health insurance practices. What has been placed on the table tonight will have to be overturned if we are ever to meet our moral obligation to provide health care as a fundamental right (Kennedy’s words). It’s so much harder to undo partial and stratified policies so we really should either insist on much more comprehensive measures or insist on redefining the President’s goals.
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Andrew Coates, MD
Again, the positive example of Medicare…
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Deborah Burger
Overall, it sounds like little has changed from his original plan, except a couple of additional sops to the Republicans, including tax credits instead of subsidies, and the attack on lawyers (medical malpractice) which is of course one of the myths about health care costs. The tax credits issue seems to me to be a huge concession. How does a one time tax credit help you with the massive costs of premiums, especially with the recent projection that premiums are expected to go up another 94% in the next decade.
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Doug Henwood
No wonder health insurance stocks were up almost 2% today….
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Doug Henwood
“Our rugged individualism”? Is that why we can’t contemplate any kind of serious reform? Isn’t that just cowardice and conformity masquerading as a virtue?
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Sam Husseini
Obama invokes Kennedy, but Himmelstein and Woolhandler have noted that the current proposal is similar to Nixon’s proposal nearly 40 years ago.
At the time, Kennedy denounced this as a “Partnership between the administration and the insurance companies” — which may well apply to the current situation.
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Andrew Coates, MD
We will find out when we knock on his door!
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Don McCanne, MD
Will he really listen when single payer is again proposed?
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Andrew Coates, MD
Part of the White House deal with PhRMA is that it will not fight for Medicare to negotiate prices with drug makers.
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Don McCanne, MD
This Medicare sounds like a great program. Why doesn’t he go ahead and include all of us in the program?
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Gwendolyn Mink
Paying for this private insurance boondoggle with Medicare savings sounds pretty scary to me.
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Doug Henwood
“I want to speak to seniors”: Medicare is pretty great, isn’t it? But we can’t let the rest of the population have it, because that would be Canadian or something.
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Andrew Coates, MD
One doesn’t know whether to laugh or cry!
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Gwendolyn Mink
This is just more stratification in a health system badly distorted by ability to pay. Ask anyone who has struggled as a Medicaid beneficiary what it’s like to be marked as unequal in the health care system because of poverty. Medicaid provides needed benefits, but it also provides stigma and permits physicians to refuse healing.
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Doug Henwood
The “waste fraud and abuse” line is a venerable load of crap. They’re not going to find it if the inscos are still running the show, since profits of the medical-industrial complex come from waste, fraud, and abuse. So that means that they’re going to squeeze Medicare, doesn’t it?
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Deborah Burger
How are you preventing the insurance bureaucrats from getting you the care you need. As our findings showed this week, in California alone, the biggest insurers have denied one fourth of claims the past seven years. Nothing in this plan changes that practice.
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Doug Henwood
This public option he’s talking about sounds absolutely ineffectual. Which seems to be one of its selling points in Obama’s market-friendly, post-ideological worldview.
You’ve got to hand it to the right. They have a firm set of principles – which are often extremely nutty, yes – and fight tirelessly for them. Admirable in some way, really.
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Deborah Burger
The problem isn’t a public option, it’s the private option. As he outlines the public option, it remains stripped of power to negotiate lower prices, and there is no guarantee to stop the insurance companies from continuing to cherry pick the healthier patients — leaving the public option for the sickest people, and thus probably bankrupting it and then under attack for proving the public option doesn’t work.
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Andrew Coates, MD
In the magical marketplace an insurer with no market share will never compete.
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Andrew Coates, MD
wait I missed that? — What legitimate service do insurance companies provide?
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Andrew Coates, MD
I agree that this is the Reaganesque “magic of the marketplace” I’ve been hearing about since high school.
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Andrew Coates, MD
In the bills in Congress if your employer offers insurance and you want to strike out on your own it is either not possible or you pay a special fine…
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Sam Husseini
“Strike out on your own” — doesn’t the employer-based plan hinder that?
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Don McCanne, MD
Hardship waivers and exempting most small businesses certainly falls short of universal.
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Doug Henwood
I don’t get where the cost control will come from? Just market competition?
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Andrew Coates, MD
Commonwealth Health Insurance Connector adds 4.5% overhead to every policy it helps sell.
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Doug Henwood
“The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal.” In other words, ciao public option, which wasn’t all that much to begin with. Will the members of the “Progressive” caucus go for this? I’m guessing they will.
We’re still in the Reaganesque universe of the “magic of the marketplace.” The problem with our current system, says the apostle of change, isn’t that it’s too market-driven, but that it’s not marketized enough. If anything, this new exchange arrangement – in four years! – will probably add a new layer of costs to what already exists.
By the same logic, shouldn’t we privatize Social Security? Or is that a project for the second term? -
Sam Husseini
“It’s time to give every American the opportunity we [congress people, etc] give ourselves.” — wouldn’t that imply a single payer type plan for all in the US?
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Gwendolyn Mink
The new, more shrivelled, public option will be one among many private insurance options in the bargain-hunters’ bazaar. So — uninsured individuals will be forced to purchase insurance, and private, for-profit insurance gets the windfall.
Sadly, to justify his narrowed vision, he misrepresents the movement for universal health coverage. He says: “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.” …Actually, ending insurance abuse has been only one piece of the struggle. Winning Medicare for all, a la Dingell, or some other form of single payer has been another key piece, which he simply defines out of history.
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Andrew Coates, MD
Caveat emptor. The insurance market is set up to allow insurers to compete for healthy and wealthy patients. That is how insurance companies succeed.
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Andrew Coates, MD
$5,000 for an individual, $10,000 for a family cap on out of pocket costs for COVERED expenses. This cap would still allow people with insurance to be driven into bankruptcy.
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Andrew Coates, MD
One important detail to start with: the changes would not begin until 2013! Four more years of worsening dysfunction.
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Sam Husseini
Re: healthcare being the deficit: A friend noted the other day — it’s good to spend money on healthcare — that would indicate a high degree of care. The problem is that alot of what’s called “healthcare spending” is profiteering by the drug and insurance companies, paper shuffleing, ads, etc. — ie, it’s not really spending on healthcare.
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Don McCanne, MD
Bringing the two parties together? He’s got to be kidding.
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Deborah Burger
But, of course, we’re not building it from scratch. More than half of Americans are already covered by government paid health care, including Medicare, Medicaid, VA, SCHIP, and the public health system. And guess what, all of those work better than the private system, have better coverage and lower administrative costs.
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Doug Henwood
“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.”
How debased. What in god’s name is he talking about?
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Sam Husseini
Going forward and going back to 1900 are both “disruptive”.
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Don McCanne, MD
Build on what works!? But it isn’t working!
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Doug Henwood
So he’s delivering a bill of indictment against the inscos – but what’s he going to do about it? Force us all to become their customers!
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Deborah Burger
And the bill Dingell has repeatedly promoted would expand Medicare. That’s what we need now.
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Andrew Coates, MD
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Sam Husseini
Determined to be last — so no further reforms, as per below.
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Sam Husseini
Bipartisanship goes out the window when Bush wants a tax cut or to invade (not that he doesn’t get substantial Democratic support).
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Andrew Coates, MD
The dream of bipartisan legislation will never die.
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Don McCanne, MD
Obama entering with McConnell and Boehner – did they work a deal?
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Deborah Burger
We hosted a national conference today at which dozens of Massachusetts nurses joined us. The plan they have been talking about looks like it is modeled after the Massachusetts plan which, the nurses relayed from their personal experience, has been a failure — it doesn’t adequately control costs, many remain uninsured, and more and more people are being cut off from coverage.
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Gwendolyn Mink
The sentence following the one Andy quotes reads: “These are not primarily people on welfare. These are middle-class Americans.” …A familiar, gratuitous put-down of families that need welfare. If the uninsured were “primarily people on welfare” — would the issue be less important, the cry for universal solutions less compelling?
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Doug Henwood
What’s with this lateness? It’s not the way to take command of the debate!
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Andrew Coates, MD
“Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy.”
This line seriously misses the mark. On the contrary, everyone understands the extraordinary hardships that are placed upon the INSURED, who live every day just one accident or illness away from bankruptcy.
This is one of the reasons why I unconvinced that, even if a bill is passed and signed, as Gwendolyn says, they will be able to declare health care “done” as we look forward to the next chapter of the effort for a national health program. Consciousness – and expectations – have been raised sky high.
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Deborah Burger
On his three basic points, the President says this plan will “provide insurance” to those who don’t have it. But, in fact, it doesn’t. It forces people to buy private insurance — a huge bailout for the insurance industry.
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Gwendolyn Mink
You’re right on all counts, Sam. But I wouldn’t lament the “end of the health reform era” — if that’s what Obama is claiming as his legacy — because it is inconceivable that the feints Andy describes could ever be the first steps toward comprehensive reform. The idea that we should settle for the shards of this year’s health care debate because the good stuff will come later is not supported by history. Contrary to centrist solipcism, no major social policy has been accomplished piecemeal in the U.S. Not the hallmarks of universal social provision, certainly — Social Security and Medicare. These policies have been perfected over time — exclusions eliminated, benefits increased, etc — but they did not become the policies their beneficiaries love by accretion.
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Sam Husseini
Obama will apparently say: “I am not the first President to take up this cause, but I am determined to be the last.” Doesn’t this seem to preclude further reform? It would seem to undermine the notion that what is now happening would be a step towards a real, national healthcare program.
Also that he “will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.” But he has shunned a single payer, enhanced Medicare for all proposal, while acknowledging it would be better than his plan.
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Andrew Coates, MD
Gwendolyn — Neither public nor an option! As Bill Moyers said, it seems straight from the founding fathers… Barnum and Bailey.
The “public option,” particularly at this point in the beltway process, is really a feint, not a punch. The most “robust” public option would still keep the private insurance industry in the driver’s seat.
Doug, I have seen the data you quote before. Do you have a thought about the profits and profitability of the insurance industry at this particular moment? – Andy
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Gwendolyn Mink
Re the pre-speech excerpts: I don’t know whether the WH released the most banal portions of the speech or the most important ones. The promise of a health insurance bazaar for bargain-hunters who don’t have insurance and don’t qualify for Medicaid or Medicare is certainly less than a public option. If that turns out to be the headline, the public option will continue to hold the gaze of progressive Democrats, which is a pity. The public option that currently exists in legislative proposals is anemic, partial, patchwork, and grossly under-inclusive. Within the terms of the current, cramped debate, the quality of the public option should be the terrain of struggle. Just because something is called a public option doesn’t mean it actually serves the public or is an option. Kind of like “change you can believe in” is not necessarily change you want to believe in.
We’ll see what he says in the speech.
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Doug Henwood
A friend pointed out to me earlier today that the market capitalization—the value of all the outstanding stock—of the publicly traded health insurers is about $150 billion. Add a little premium to sweeten the pot and you could nationalize the lot of them for about $200 billion. The total administrative costs of the U.S. healthcare system, which are greatly inflated by all the paperwork and second-guessing of docs’ decisions generated by the insurance industry, are about $400 billion a year. Those administrative costs are about three times what a Canadian-style single payer system would cost. So that means we’d save about $250 billion a year by eliminating the waste caused by our private insurance system.
In other words, the nationalization could pay for itself in well under a year.
Will Obama propose anything like that? Of course not. Instead, he’s going to propose that Americans be required to buy insurance, probably with some government subsidies. So instead of euthanizing the private insurance industry, Obama & the Dems are going to provide them with tens of millions of new customers—compelled to by their product by law, and with some degree of public subsidy. That’s lunacy.
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Ben Malley
Join us at 8:00 p.m. edt for a liveblog of President Obama’s speech on healthcare reform to a joint session of Congress.
Our guestbloggers:
Don McCanne – Senior health policy fellow with Physicians for a National Health Program. He writes a daily health policy update.
Gwendolyn Mink – Co-editor of the two-volume Poverty in the United States: An Encyclopedia of History, Politics and Policy and author of Welfare’s End.
Deborah Burger – Co-president for the California Nurses Association/National Nurses Organizing Committee.
Andrew D. Coates, MD – Teaches at Albany Medical College and practices internal medicine in Albany, NY. He recently wrote “Notes on the Eve of the President’s Address.”
Doug Henwood – Editor of Left Business Observer. He normally blogs at doughenwood.wordpress.com.
The White House released excerpts from the speech this afternoon.
Ben Malley
Sam Husseini
Gwendolyn Mink
Andrew Coates, MD
Don McCanne, MD
Doug Henwood
Deborah Burger