The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Obama: Don’t Bet Against Health Care Reform This Year

Posted by Alan on July 17, 2009

A few hours ago I wrote about how President Barack Obama was ratcheting up the heat and pressure on Congress to pass comprehensive health care reform in August. Today he turned down the heat a bit, but kept the pressure on. In a skillful speech he laid out to the American people the benefits they will gain from health care reform, described the substantial areas of agreement already achieved by negotiators, reinforced his reasons for seeking reform, and pledged that reform will be enacted this year.

Some highlights from his speech.

Existing common ground: “We’re now at a point where most everyone agrees we need that we need to invest in preventive and wellness programs that save us money and help [us] lead healthier lives.We have an agreement on the need to simplify the insurance forms and paperwork that patients have to fill out every time they go to a hospital or see a doctor. We have an agreement on the need to reform our health insurance system so that if you lose your job, change your job or start a small business. you can still get affordable health insurance. We have an agreement on the need to prevent insurance companies from denying coverage to Americans with pre-existing medical conditions. And we have agreement on the need for a health insurance exchange, a marketplace where people can compare prices and quality and choose the health care plan that best suits their needs.”

On the benefits reform: “This is what health insurance reform will mean for the average American. It will mean lower costs, more choices and coverage you can count on. It will save you and your family money. You won’t have to worry about being priced out of the market. You won’t have to worry about one illness leading to your family going into financial ruin. Americans will have coverage that finally has stability and security. And Americans who don’t have health insurance will finally have affordable quality options.”

Impact on the deficit: “Health insurance reform cannot add to our deficit over the next decade. And I mean it.”

On cost containment: “Our proposal would change incentives so that providers will give patients the best care, not just the most expensive care, which will mean big savings over time. This is what we mean when we say that we need ‘delivery system reform.’ I’ve proposed to Congress .. that an independent group of doctors and medical experts will oversee long term cost saving measures. Every year there’s a new report that details how much waste and inefficiency there is in Medicare, how best practices are not always used, and how many billions of dollars could be saved. Unfortunately, this report ends up sitting on a shelf. And what we want to do is force Congress to make sure that they are acting on these recommendations to bend the cost curve each and every year.”

What’s at stake and the timing of reform: “Now is not the time to slow down. And now is certainly not the time to lose heart. Make no mistake, if we step back from this challenge at this moment we are consigning our children to a future of skyrocketing premiums and crushing deficits. There is no argument about that. If we don’t achieve health care reform we cannot control the costs of Medicare and Medicaid and we can not control our long term debt and our long term deficits … If we don’t get health care reform done now then no one’s health insurance is going to be secure because you’re going to continue to see premiums going up at astronomical rates,  out-of-pocket costs going up at astronomical rates and people who lose their job or have a pre-existing medical condition or changing their jobs finding themselves in a situation where they cannot get health care. And that is not a future that I accept for the United States of America. And that’s why those who are betting against this happening this year are badly mistaken. We are going to get this done. We will reform health care. It will happen this year.”

A few observations:

The President referred to his effort as “health insurance reform” on more than one occasion. Every drama needs a bad guy. With hospitals and doctors supporting key elements of reform, prepare for a lot of the rhetoric to turn against the insurance and pharmaceutical industries.

President Obama did not mention the month of August even once. As I wrote earlier today, he had been hammering at Congress to pass legislation next month. If the House and Senate were each to pass legislation that quickly it would still need to go to a conference committee, which means final passage would still be in the Fall. By emphasizing when the bill will get to his desk (“this year”) as opposed to when milestones are achieved in Congress, he shifts attention away from the inside baseball of the legislative schedule and returns it to the benefits of reform (“It will save you and your family money.”). That’s smart politics – it focuses on the benefits, not the features, and avoids appearing like he’s jamming reform through an unwilling Congress.

In his list of areas of agreement, the President included Exchanges, but did not mention a government-run health plan. Exchanges, as noted in a previous post, Exchanges can be a force for good or for not so good. Watching what kind of exchange emerges from the debate will be important. One should not read too much into his failure to mention public plans. He was simply being accurate – there’s no consensus on them. This doesn’t mean he’s giving up on the idea, just that the issue is still open.

President Obama also did not use his statement to threaten Republicans with an expedited process that would prevent them from filibustering on health care reform. This public restraint contrasts with the comments of his top aides. Coupled with his recent meetings with Senate moderates it indicates the Administration has not completely given up on the finding common ground critical for a bi-partisan solution.

The Obama Administration is deep into campaign mode on the health care reform issue. As he proved over the past two-plus years, it’s risky to bet against Barack Obama in a campaign. As the man said, “We are going to get this done. We will reform health care. It will happen this year.” If there’s any way to deliver on this promise, President Obama will find it.


15 Responses to “Obama: Don’t Bet Against Health Care Reform This Year”

  1. Joe Novy said

    Health care
    Senate, Republicans, some mainly the moderate democrats are to dumb in trying fix the health care based on Obama principal and guidelines. Health care should not be Casino or Wall Street.
    Try to fix system that is ruined by greed and stupidity of American culture, idiotic government rules and regulations, patient, doctors drug and Insurance Company, and some hospitals is naive.
    What is amazing the brainless party followers and they empty suggestion based on what mess or under falls pretences the democrat, Obama pushing for changes and some of the racist NO party portending go along, only with some obvious improvements, but really try to stop democrats.
    You either set up medical like in Canada, England, or other civil country. Or you cancel all the government run Health care like Medicare or VA, senate and government employees. In any event you have to start from scratch if you do not want to come back over and over to the sixty year old adjusted mess. If you like do not like the foreign style of Health Care and you would like to develop unique American system you can ask me I will give you some ideas.
    P.S I live and work on four continents, where by the way he people refers to us stupid Americans and there is not problem with healthcare.

  2. cynthia said

    How can the Congress pass a valid and workable universal health care plan when it cannot run a decent health plan for the members and veterans of our armed services? Health care is deplorable for those who have risked their lives for our nation. Veterans hospitals are sorely underfunded and poorly run. What can the rest of us expect from a government health plan if Congress cannot even fund and run those hospitals and cannot provide decent health benefits to our veterans?

    Some reform is needed, however the plan passed by the House will lead to cuts in Medicare spending and rationing of health care services. It will burden small businesses and individuals who will be forced to buy health insurance. People with insurance now may be locked into their present policies, whether or not they can continue to afford to pay, and their premiums are certain to rise. Medical research will be stunted and advances in treatments will not be funded.

    The U.S. health care industry has been responsible for a large proportion of the advances in medical care and treatment for the entire world for the past 50 years. All of that will be lost with any of the proposed health plans either passed by the House or on the table in the Senate.

  3. FRANK M CROWE said

    having spent 45 years in the health field.

  4. Doug said

    President Obama has a big problem with numbers. First, he promised a more open and transparent government and then he increased the national debt 10% in a stimulus bill that was passed in a late hour. What ever happen to the promise to post any bill forty eight hours before a vote? Second, he promised a new era of politics in Washington by getting pass bipartisanship. While he invited Republicans to the White House there was not a single vote for the stimulus bill in the House. Third, he indicated that we have to act immediately on the stimulus or unemployment will go over 8%.

    The long and short of it is that President Obama makes bold claims and the press does not call him out on it. He claims that health care reform will reduce cost and the Congressional Budget Office indicated that cost will go up. He claims that by spending 1.8 Trillion dollars that this plan will be budget neutral. He critized Hillary for requiring everyont to have health insurance and John McCain for taxing insurance benefits, however, Congress is flirting with both of these ideas.

    Why should I trust his claims, Congress, on the Federal government with health care?

  5. Joe said

    Re: Healthcare Reform.
    Healthcare is human right no business with peoples life on stock market.
    Are majority people in US greedy and selfish and stupid? Or is it senate? Or is it lobbyists? Stop playing politics and using public in the process.
    Get this reform out of senate they working on wrong proposal and playing politics. Appoint Reform health care committee to change and reform the broken system; apply new methodology for them to develop new structure and principles. When new structures and principals are developed than give that to senate to apply new laws, regulations and finances.
    Just small changes the existing system won’t work.
    From existing Insurance Company no meter what package you buy just to give you peace of mind when you are healthy. This package price is increased yearly and you buy different package and majority people never know what they have until they get sick and bills start coming.
    When you get really sick the system with co-payments, drugs and other additional hidden charges, only Insurance company know about, will ruins your credit and life.
    You need to develop one type of coverage to provide the mandatory Basic Healthcare package. This Basic Healthcare package should cover the one who is sick for100% including all doctor services, tests, drugs and hospitals care (all basic care).
    The cost for the package can be arrived from past records and should be established by Government newly appointed group. With name like Health Regulatory Agency it could be public Co-op or give this new mandate to some other existing non profit associated with health care. Health Regulatory Agency will reform the system, reinforce, regulate and adjust the medical professions, insurance company, the basic Health care services, the billing and other laws and regulations.
    Any collection for basic health care coverage doctors billing to patients should not exist period.
    The rules have to be that every family physician has to recognize this basic healthcare coverage in all states and treat all patients.
    Let the Insurance company sale and administer the basic coverage where the price is fixed by the new Health Regulatory Agency and senate. Health services not included in basic healthcare (for example hip replacement) let the private insurance company come up with product and make money on these services.
    The double or triple billing by doctors for same diagnostics is result of this Wild West private enterprise policy and big part of large medical cost. Some of the reasons are doctor’s investment in medical industries and to get round the limitations in insurance coverage.
    Doctors should be accountable if they order duplicate unnecessary tests on costly equipment or prescribe unnecessary drugs.
    If you have one electronic record for each patient accessible by Health Regulatory agency if there is report of abuse they will think twice before they try to misuse the system.
    Family doctor has to make decisions for his patients, coordinate all drug prescriptions, visits to hospitals and specialist, have all the records on computer and all billing should go trough his office. He would pay the others specialist hospitals, clinics covered under the basic package.
    Change the law suing doctors for malpractices and expand it if they provide unnecessarily duplication of test and drugs prescriptions.
    Have one electronic record for each individual patient kept with his latest physician. Each individual should be able to transfer it (all records) if he moves to other state to the new family doctor of his choice or if he changes his Family doctor locally. If you have one transferable electronic record for each person you can easy detect cost per person, ordering the unnecessary procedures prescribing excessive amount of drugs and the overcharging by greedy individuals.
    Every one has to have the basic insurance. Reason is simple there should not be freebee in Emergency rooms. And the healthy will pay for the sick as they never know when they get sick.
    Every one who is working or filing taxes should pay percentage base on the income. Employers should be out of insurance deals. Basic insurance should be personal to be fully portable.
    Healthcare is human right no business with peoples life on stock market based health Insurance company.

    I’m 10 years on my own and your senate policies last 10 years help me in to bankruptcy last year. I lost everything give me at list my affordable health care service. You should learn that monopoly will ruin our democratic system. You are still helping to create the monopoly with existing system of healthcare delivery by Insurance Company. Like the Help you give to the large banks and now the Health care Insurance.

    • Paul said

      You’re basically arguing *for* a monopoly, administered by the government. It is the opposite of a free and liberal society. Your suggestions would increase services and cost, not to mention cripple the economy. Central price controls cause shortages of desired things and abundance of undesired things.

    • Doug said

      Wow, taken your logic everything is a human right. Why not have government provided food, clothing, and shelter?

      Back to the point of the “public plan” providing choice and competition…..There is one thing that the government can do that no insurance company can do and that is PRINT MONEY. A private insurer is required to have capital reserves to underwrite risk. The federal government just prints money, sells bonds, and runs up debt. How is that fair competition?

      • Joe said

        I did not try to say federally centralize healthcare. I try to improve on it.
        Let have the Co-op extensions offices in each state. I improve it you some more.
        Get priced the Basic insurance by this state based Co-op agency and ask the private insurance do the same based on same coverage.
        I guess you did answer my first question in my Health care reform write up.
        You do not believe in Basic package with 100% coverage and the principal that money paid for the basic packages by the healthier should be in reserve to pay for the sick.
        I did not suggest government run health care I mean to say Co-Op to set up the services cover under the basic package and federal and senate to change the laws to support the package. If you like to think the private Insurance would do better job let them to price the same basic package.
        I give you example why the Insurance Company have bad product now apart of the obvious the unrealistic price increases each year.
        Let see what you have to say to this:
        My mother paid Private Insurance for 30 years with Kaiser Permanente one of the largest Health care insurance company with own hospitals in CA. On top of this coverage she did have Medicare and Medicate. She did get Sick and with in two month in and out of hospital 5 times. Her Kaiser Physician family doctor did not know how many specialists performing the same tests on her in the different hospitals. Than they sent finally sent her home and she had to take 11 different medications and drugs. She had bills totaling $26,000.00. The second month she was in and out of hospital she was 3 weeks late with the payment and Kaiser cut her off. They wouldn’t reinstate the coverage.
        Let me tell you about me I was republican until last year. I live and work on four continents and in six countries belongs to G8. Generally people in that country have any problem with basic healthcare services or the cost. I’m on my own for 35 years 20 years in electrical engineering and 10 years as land developer.
        We are so limited to except this status quo. We have such bad name every where you go and we are paranoid from the words like socialism. We are arrogant, racists, selfish, greedy, Neo-conservatives with narcissistic behavior. This is why I left republicans.
        Let me know what you think about Kaiser. I hope you do not get sick one day.

        • Paul said

          Kaiser is an uncommon design. At best it’s probably a cheaper model with some problems.

          Status quo is not being argued for by any significant interest.

          The suggestion of a minimum package already exists today, per state regulaion. Creating a single central package does not address the problem of rising costs. Rising costs must be tackled by increasing efficiency in a smart way, improving health, or in ways that I would not advocate such as blunt price controls (medicare).

  6. Echoing911 said

    For those of us who are concerned about Health care in this country, we need tot ask the following three questions of our President, United States Senate and our Congress.

    Why should you have a different and much more comprehensive health and pension plan than your constituents?
    Regarding the current health care legislation that is being worked on; will you and your family go on this plan? If not, why?
    If it is good enough for the American people, why is it not good enough for you (please remember we are also paying for all your benefits too)?

    I encourage you to pick up the phone and call your representatives to ask these questions.

  7. The House Health Care Bill, 1,018-page document, released this week (July 14th, 2009) reveals some concerns as noted by and Mike Oliphant serves as health care consultant with these two popular websites in Utah. He also is a serving board member with Utah Association of Health Underwriters. A provision within this bill would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

    “Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.
    This translates into those who currently have private individual coverage won’t be able to change it. It is likely that those same people will suffer abnormally high rate increases over time which would force them out of coverage. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
    From the beginning, and warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington’s coverage. The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, “fizzle out altogether.”
    What wasn’t known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law. The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs. With HSAs out of the way, a key obstacle to the left’s expansion of the welfare state will be removed. states that the public option won’t be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny. Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn’t be killing business opportunities, or limiting choices, or legislating major changes in Americans’ lives.

    • Paul said

      Indeed – some big concerns over the House language. Anyone with a current individual policy will see that policy unchanged, meaning the premiums will go up beyond what the average is today since cost sharing cannot be increased. Therefore the exchange policies (public option and private options) will look more and more attractive. The current individual policies will die off. Moreover, this represents a new federal ability to regulate, whereas states do it now. The feds will determine the minimum benefit package acceptible. For employer sponsored plans, they are allowed to continue, and enroll new people, but must within 5 years abide by the exchange (i.e. federal) regulations. So, with this legislation, the govt will call the shots for the whole marketplace for insurance. This is all set up to ensure that the exchange (federally regulated) new policies will rule the day, and with a public option that is of course advantaged over private plans (for many reasons) one cannot project anything but eventual government plan domination.

      I sincerly hope that the debate will contemplate these truths.

  8. disinter said

    Why Obamacare Can’t Work: The Calculation Argument

  9. Mark Goodman said

    Driving back to New Hampshire this evening I heard the President speak and was surprised when he choose to say health insurance reform rather than health care reform. I don’t think this was a slip and suspect the tenor of the debate is thus changing. Unfortunately I don’t think it’s for the better.

    The public’s biggest gripes with the insurance industry seem to center around being declined and pre-existing conditions. Both easily solved legislatively. If you can’t; you can’t! Now the cost of that is an issue. Or thee issue. No one in Washington is really able to get their hands around why all this medicine costs what it does. Several good ideas get discussed but no one really is signing on.

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