The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Obama Speech Accomplishes Much, But It’s Only a Start

Posted by Alan on September 9, 2009

Agree with him or not, President Barack Obama knows how to deliver a speech. Anyone free of Pavlovian conditioning against the man would admit his address to Congress Wednesday night was powerful and at times moving. The question is, of course, what does it mean? (For those interested in reading along, here is the prepared text of President Obama’s health care reform speech).

First, it signals President Obama’s intent to shape not just the Congressional and public debate, but health care reform legislation itself. He repeatedly sprinkled variations of “under my plan” when discussing proposals. Whereas in the past he was content to lay out general principles to guide the reform process, this phrasing signals he is now taking ownership of the legislation. That alone will change the course of the legislative process.

Second, he gave Senator Max Baucus and the Gang of Six the cover they need to negotiate bi-partisan health care reform. As discussed in earlier posts, the Senate Finance Committee Senator Baucus chairs will take up legislation next week. The path they are headed down, as outlined in the Framework for Comprehensive Health Reform, disappoints many liberals. President Obama could have left them out on a political limb. Instead he embraced several of their proposals and, by refraining from declaring a government-run health plan a necessary component of reform, gave the negotiators the space they need to deliver a moderate package. Based on the President’s speech, there is little if anything in the Framework he would not accept. What this means is that the legislation produced by the Senate Finance Committee could serve as the foundation upon which the President can build his own, detailed proposal.

Third, the President, after the requisite insurance industry bashing, focused on constraining health care costs. Whether his proposals go far enough to “bend the cost curve” as the Administration is fond of saying, is open to legitimate challenge. But by elevating the need for controlling medical costs to the top of the health care reform discussion, the President makes it more likely cost containment will be part of the final package.

Fourth, President Obama made clear he would no longer tolerate lies and half-truths about his health care reform package. He called those who claim he would establish death panels liars. He rebuked those who claim illegal aliens would be eligible for federal premium subsidies. He rejected charges that he would be cutting back on Medicare benefits. There are those who will continue to make these charges, but the President made clear their claims would be repudiated quickly, loudly and sharply.

Fifth, President Obama called for a more robust Health Insurance Exchange than some moderates have been considering. He noted an exchange available to individuals and small businesses would mean “these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. the same clout large employers enjoy when negotiating rates.” This implies the exchange would do more than simply present information to consumers, but would define benefits and seek bids from carriers wishing access to these markets. Whether or not such an exchange would be successful is open to debate. A similar approach was taken in California as part of its small group reform in the 1990’s. That legislation, AB 1672 is generally considered to have been very successful. The purchasing pool it created, however, has long been out-of-business, unable to compete with the private market.

Sixth, the President put forward his pragmatic side. He wants a government-run health plan to compete with private carriers, but he didn’t declare such a public plan was critical. Instead he said, the impact of a public option “shouldn’t be exaggerated – by the left or the right or the media. It is only one part of my plan ….” In other words, it’s a part of his plan he’d like to see in whatever legislation passes Congress, but it’s not an absolute requirement. Another example of his pragmatism trumping partisan ideology: the President reached out to Republicans by adopting some of their proposals, including those concerning malpractice reform. Yes, there was red meat for liberals, but there was plenty for moderates and even some conservatives to cheer about in his speech.

Seventh, President Obama’s speech was, well, presidential. Republican behavior was a bit childish. When President Obama stated that “the reforms I’m proposing would not apply to those who are here illegally” Representative Joe Wilson achieved a new low in politics by shouting out “You lie!” Even when President Bush was arguably shredding the Constitution and, intentionally or not, misstating the facts, Democrats still treated him with respect when he appeared before Congress. Many Americans will see Representative Wilson’s outburst as a sign of partisan passions coming to rule the GOP. (Representative Wilson later apologized for his “lack of civility,” but the damage was done). Meanwhile, Republican House members were shown on television waiving paper at the President. Apparently these were copies of the GOP health care reform plan and their presence at the speech was meant to demonstrate that the Republicans were more than just the party of “no.” Unfortunately, the television audience wasn’t in on the symbolism. It just looked strange and undignified. Again, like Representative Wilson’s behavior, these antics may play well to the base, but it does nothing to expand that base.

Eighth, the President made clear the status quo is untenable. However, this message was simply part of a 45 minute presentation, dampening the impact. Change scares people. President Obama needs to prove his message that change is needed. If the Administration wants to reposition the debate to require opponents of health care reform to defend the status quo, he will need to devote at least one political event to this topic.

President Obama accomplished a great deal in his address to Congress, but at the end of the day, it was just one speech. Now comes the tough part, tying together the elements of a package that can make it’s way through Congress, while at the same time justifying the reform effort. Given the passions surrounding the health care reform issue, this will be no easy task.


30 Responses to “Obama Speech Accomplishes Much, But It’s Only a Start”

  1. Taffy said

    I agree that Obama has taken more of a role in shaping the healthcare reform legislation but I don’t considerate it a bad move. It might help better unify the parties into supporting certain polices that where unclear before and might definitely eliminate all the negative rumors and speculations that are confusing the American public. The public is being constantly misinformed about any and all legislations concerning healthcare reform. As a result people are feeling this intense anger and hostility against a bill that is intended to help them and others. I myself have been exposed to the angry complaints about the healthcare bill when I worked for a Senator. During my time there, a majority of the callers felt extremely against the bill and most of their reasoning was based on these fabrications. One constituent wrote a letter stating the exact passage in which they found the so call “immigration coverage” but when I investigated it no such passage existed on the healthcare reform bill. When Obama addressed those rumors, to me, that was one of the more important moments in the speech because it is surprising how many people believed them and form their opinion solely on them and sadly this can be said for the majority of the American public. Now I am not saying that all the opposition are misinformed, some have their own unique reasons to not support healthcare reform but fear should not be a reason especially fear that is created by these lies and they are lies.

    • JimK said

      While proponents of Healthcare Reform are correct in asserting that the currently proposed Healthcare Reform legislation does not allow coverage for illegal immigrants, this is almost a lie by omission.
      Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat all patients regardless of their ability to pay or their status as citizens. The level of treatment varies based upon the individual circumstances.

      The following link describes a worst case scenario, the link is to a Wall Street Journal article about a woman, Nikki White, who suffered an untimely death due to complications from Lupus.

      Two points may be ascertained through Ms. White’s case:

      Ms. White suffered from Lupus and was eventually unable to work. The article details Ms. White’s struggles with the government bureacracy and these struggles may reinforce the attitudes of individuals who believe that the government is incapable of effectively administering a healthcare program.

      My second point goes to my above statement about EMTALA. Although Ms. White was not an illegal immigrant she was hospitalized for a period of 10 weeks. The hospital estimates that Ms. White’s care cost over 900K, for which they were not reimbursed. From the description in the article it would appear that under the rules of EMTALA, Ms. White did not meet the qualifications for discharge during her 10 week stay and therefore the hospital was legally obligated to continue treatment. Had Ms. White been an illegal immigrant the hospital would have also been legally required to continue treatment. I understand there is a certain amount of speculation on my part and maybe the hospital could have released her sooner under the EMTALA guidelines but the fact remains that the present Healthcare Proposals do not address this issue.

  2. glciii said

    Check out my 3 minute commenatry on the healthcare debate. Don’t forget the uninsured

    I am very saddened by the selfish tone of the healthcare debate. More people seemed worried about theorectically loosing what they have than with the reality that many don’t have any insurance at all. What do you think?

    Watch my commentary here: LTH WEEKLY

    George Cook

    • Nosedoc said

      Let’s talk honestly. If per capita healthcare expenditures weren’t through the roof in this country, the cost of health insurance would be very affordable to both employers and individuals. This is an economic issue with social consequences. Fixing the social inequities without addressing the economic cause would be misguided and likely financially disastrous to our country.

  3. Andy said

    Hi Alan,
    I know from times I have spoken with you and in meeting you that you seem to be impartial and fair in your views toward these issues. After reading your article, however I’m wondering if someone slipped you some of that Obama Kool-aid. When reading and re reading your 4th and 7th point I have concluded that for some facts are just considered opinions and what some have called a “lack of civility” others might refer to as righteous indignation.
    Abortion on demand, illegal alien coverage and an exodus of employer policies are all inevitable outcomes for this legislation if past. I don’t think this is even really questionable. Just because the President says “would not apply to” illegal’s doesn’t make it so. Representative Wilson was simply unable to contain an outrage all Americans should feel. The President of the United States is not above the facts or the truth.
    I went to see Congresswoman Capps at a meeting in San Luis Obispo last week. She stated ““This Healthcare proposal is deficit neutral.” At which point the crowd let out an audible laugh. The CBO has pointed out that this will cost between 1 and 3 Trillion dollars. Didn’t Obama say, he would “not add a single dime to the deficit?” If President Bush is wrong we should point that out and I commend those who do. Shouldn’t that hold true to the current President?
    I am a little concerned though in saying this. I was informed that the White House is requesting followers to inform on Americans who spread these exaggerations.
    I don’t mean to offend you or the President. I hope what I am saying will help in sound and sober judgment. Best wishes

    • Alan said

      Hello. And thanks for the comments and just wanted to clarify some things.

      What I meant to convey in saying the Obama Administration getting tough on lies and half-truths (#4) is that the White House would no longer sit back and let attacks go unanswered. Especially the more vile and untruthful ones (e.g., the death panels). I agree that the President is engaging in hyperbole in talking about no one being required to change their coverage. The fact is, if an employer changes coverage the workers need to come along. Also, if you change jobs you’re going to change coverage unless you happen to move to a new employer with the exact same coverage. And the stuff about exclusing pre-existing conditions is overstated, too. While that happens in the individual market many states have outlawed it in connection to group coverage. So there’s plenty of stretching being engaged in by both sides. I just think it’s interesting that, instead of passing it off as political rhetoric, the Obama Administration will now be pushing back. It should make for some lively discussions.

      As for the Rep. Wilson’s behavior, it did go beyond the norm. Democrats and Republicans alike have always engaged in booing, hissing and laughing. That’s part of the theater of it all. I suppose one could draw a line and say any of that goes too far. What I was saying is that heckling the President is dumb politics. And waiving the GOP health plans around without making it clear what they are is bad politics. As I’ve made clear in many posts and comments, I believe the battle in politics is always about who can capture the middle. The GOP, by punishing its moderates, by promoting disrespect for their opponent and for the office of the president do themselves more harm than good. I stand by that observation, although what really counts in evaluating such things is election results. Based on those, the Republican Party has suffered far more from those antics than they’ve gained.

      Again, I appreciate the comments and I hope this provides some greater detail to the points I was trying to make.

  4. npg said

    why can Obama talk about others’ lies and call other opinions lies, but opposition cannot call him out for being the liar that he is? and he IS a liar… he is trying to destroy large swaths of this industry, including mine…I have no repsect for this fraud….the “new lows” you describe Mr. Katz are those perpetrated by Barry Soetoro

    • Doug said

      I could not agree more. I would have yelled “YOU LIE!” when Obama said he would not sign a health care reform bill that increases the deficit “one dime”. What has happened to journalism in this country? Where are the hard questions?

  5. Okay, I apologize for lapsing into incivility myself. It does seem that our species has evolved in such a way as to form quick and passionate allegiance to groups (which can be defined in many ways, from high school team spirit and professional sports team allegiance, to political party affiliation and even various competitive schools of thought–physiatrists are better than orthopedic doctors for back problems, for example.)

    Once thus defined as a group member, the tag team psychological wrestlers of chauvinism and xenophobia conspire to make us thing that our group is the righteous one and the other group is subhuman.

    Result: rancor that can be unbelievably bitter and triggered by as little as a raised eyebrow.

    I would argue that Obama’s strength is that he is trying to defuse this; his weakness is that it may just be incapable of defusing.

    In any event, the comments, replies, subcomments, subreplies, etc. are–thanks to the mercy of this format–being given increasingly narrow horizontal space!

    Eventually, this argument, at least, will end for no other reason that it way have narrowed down too far to type anymore!

    Note: in the spirit of conciliation here, feel free to change the aforementioned evolution of our primate species to whatever you find to be a palatable metaphor for human nature. The last thing I want to do is to turn this into a discussion of evolutionary biology!

  6. Nosedoc said

    I strongly recommend reading the speech to anyone who hasn’t read it or listened to it last night. I believe that the President is keenly aware that health care reform is going to be a major part of his legacy, and that his ambition to achieve a great accomplishment for himself and the American public overrides his more progressive leanings. It is “too big to fail.” I share Rick’s concern about the total cost savings that will ultimately be realized by reducing fraud and abuse in the system, and just how much positive impact this will have on the overall system. I do know that the potential savings are substantial. An efficient and just tort system based on sound medical knowledge and judgment by experts, coupled with the elimination of inappropriate self-referral for personal gain by health professionals can save the system substantial sums of money, in theory enough to provide the U.S. with a cost-effective health care system, especially if the insurance and pharmaceutical industries do their part as well. Along with everyone else, I anxiously await the details in the bill being worked on by Senator Baucus and the Senate Finance Committee.

    • JimK said

      I listened to the speech today and although I would like to be optimistic nothing in Obama’s speech was new. Although he spoke of cost containment, his references to sick children receiving unaffordable “necessary care,” and the standard of care remaining strictly between you and your doctor leads me to believe we are right back to the “waste, fraud, and abuse” he plans to eliminate or as you put it “inappropriate self-referral for personal gain.”
      In addition, Obama stated that illegal immigrants would not be covered but unless EMTALA is repealed, illegal immigrants and Americans who will fall through the “mandatory” health insurance cracks in the system will still have access to medical care and the rest of us will still be paying the bill.
      Additionally, the more Obama tries to reassure the majority of Americans who currently have medical insurance that their coverage will not change, and if anything it will improve, the less credible he becomes on the issue of cost containment. We cannot continue the current level of care, or worse expand the level of care and contain costs. This is the reason for the current crisis.
      Maybe I am missing something but why not focus on eliminating the “waste, fraud, and abuse” as a first step and then proceed from there.
      I will reserve comment on Obama’s Malpractice initiative until I see more details. While I see some merit in caps, I am afraid that capping awards will just allow particularly egregious actions on the part of physicians to go unpunished.

      I have attached a link to a column in today’s NYT by David Brooks that you might find interesting. Mr. Brooks gives his take on the speech and gives mention to “malpractice courts” as a possible remedy for the “insane malpractice system.”

      • Nosedoc said

        Thank you for the link. It’s a good synopsis on the “take home” points. I agree with you on the issue of illegal immigrants. Someone is always footing the bill, whether it is the federal or state governments or the hospitals (who then pass on the costs to the private insurers).

        I’ve stated before that malpractice reform is not synonymous with caps on non-economic damages. Caps are effective at stabilizing malpractice premiums and in reversing the efflux of physicians from a given area (like Texas). The whole medical tort process needs reworking so that basic standards of care are plainly evident. That would remove much of the fear of litigation, allowing physicians to do what is necessary and not much more.

  7. Health care spending is consistently increasing each year. Which should be expected. Health care cost money. I am not sure a complete overhaul will actually benefit us in 10 years. And I think it will be too expensive. Many want a solution today or even tomorrow. I just want to make sure we don’t move to fast and miss something that will affect us in 5 years. A few good points are made in the speech by Obama and I am impressed with his abilities to get his point across.

  8. Alison said

    This is an emotional post and perhaps I will regret hitting submit. I listened to the speech last night and also several sound bites through out the day. I feel angered and frustrated by what feels like intentional “digs” at the insurance companies which I find to be suspect at best. The one story about the man who had his insurance cancelled because of gall stones he didnt know he had while he was in chemotherapy … to me insulting. He mentioned more than once scenarios in which the insurance conpanies would just cancel your coverage while you were sick. To my knowledge you only get your insurance policy canceled if you fail to pay your premium (or your employer does) of if you commit an act of fraud while filling out your application. It felt as if tales in which he warned others about in dealing with statements meant to misrepresent. Policy maximums are another issue entirely. I have in my porfolio of plans to offer policies that range from unlimited caps to specific amounts. They are selected by the insureds. Granted premiums dictate what choices people HAVE to make and that is unfortunate in itself but to phrase it as if the company sets people up to have their coverage ripped out from under them while they need it to me is misinformation.

    • GeorgeT said

      There is nothing to regret in your post.

      The “cancel you coverage” is as insane as the “death panels”.

      • So you are maintaining that recision does not occur? That health insurance companies do not have whole departments where the staff members are rewarded for finding previously undisclosed health problems and using these a grounds for canceling the policy? Alan, I trust your take on these matters. PBS had a special on healthcare abuses and specifically addressed the subject of unfair recision. If I am not mistaken, the practice has been outlawed in California unless intentional fraud can be proven.

        It would seem to me that this is a factual matter–yes or no? Could you answer the question for us, i.e., is unethical use of recision ever practiced by insurers, and are the staff who do so remunerated for their efforts?

    • Rick said

      When politicians, and especially the President, cite extremely bad examples of insurance industry pratices, is it too much to ask for all the circumstances surrounding these cases to be made public? I’m sick and tired of being called “villians” and made to look evil by the people that were elected to serve ALL OF US.

      • Doug said

        I think the president is preying on our fears. I am expecting some creative accouting coming out of the White House this month. Before you know it 50% of us will be loosing our health care coverage. Again the news media will not challenge these outrageous claims.

    • Rick said

      Op-ed in Wall Street Journal 9/14/09 “Fact-Checking the President on Health Insurance” by Scott Harrington, Professor of health-care management & insurance and risk management at U of Penn Wharton School, discredits Obama’s tales of insurance abuse.

  9. Underwriterguy said

    Further to Rick’s point: funding Obamacare with taxes on the health care and pharma industries is specious. These industries will simply be tax collectors, not payers. With the additional taxes embedded in drug costs and premiums how will overall health care costs be lowered? Wouldn’t it be ironic is these higher tax driven premiums exceed the limits for the new excise tax on “rich” plans? My sympathies to Joe Wilson for letting his indignation overcome his decorum. But I think he spoke the truth.

  10. I’m a conservative yet I’m all for completely socialized health care but that’s because I value the Christian ideal of love and don’t mind paying more taxes so that others can get treatment. Without this value, you’ll have a tough time convincing taxpayers in general that they should pay more taxes for the 5% of America that does not qualify for Medicare or some other government health aid AND is not currently covered by health insurance. Just a thought.
    -Thrive Blog Author

    • I commend your generosity of spirt, but I am not sure that your statistics are correct. I am self employed, and though I have private insurance, the cost of it is now so high I don’t think I can pay much longer. For a family of four, my premiums are now $1711.50 a month. This is for a $500 deductible on each family member, then 80 percent coverage till the first $5000 per person. Though none of us has any significant health problems, my wife and I take antidepressants and statin drugs, two of the most heavily prescribed and advertised drug categories in the nation. Because of this, we have been told that we are uninsurable if we were to shop for a more affordable deal.

      What irks me the most about the current system is the two-tier nature of it. If you work for a large company with a sense of social responsibility, you can have a myriad health problems but obtain affordable group practice without screening for preexisting conditions. If you work for yourself, you are SOL.

      It’s not a level playing field. There are different laws regulating group policies vs. individual policies. The latter lack negotiating clout. I am one of the pip squeaks that get clobbered as a result.

      It just seems so profoundly undemocratic to me that the least able to pay–sole proprieters with some debatable preexisting condition–end up being profit centers that subsidize the Fat Cats that are raking in the money and extorting the best deals for themselves.

  11. Rick said

    I didn’t read the speech, but I think Obama said his plan will be deficit neutral and the 900 billion cost will be paid for by reducing fraud and abuse from Medicare. That seems a big stretch to me. I’ve heard that fraud and abuse platitude from politicians many times before. What I continue to see is politicians attempting to transfer the high cost of health care to the tax side of expense. Am I missing something?

    Joe Wilson should be admonished for showing a total lack of respect for the office of President. However, he’s not the first. Democrats, in mass, booed George W. Bush in the 2005 State of Union Speech when he proposed solving the Social Security mess.

    • If what you say is true, there should be footage of it on YouTube or some other site. Surely the bloviator brigades would love to show that dozens of Democrats have been every bit as rude as Joe Wilson. If there is a smoking gun that shows this, provide it.

      Booing and hissing shows signs of contempt. You lie! on the other hand is an accusation of a crime. The fact that it was Wilson who was lying himself makes it all the worse.

      Wilson has some connection to the military. I am not sure if he is in active service today or not, but if he had said this to any officer with a slightly higher rank than his own, it would have been grounds of a court martial for insubordination. Obama is the Commander in Chief.

      To the brig with the scoundrel, that’s what I say.

      How did your comment warrant 9 thumbs up? At the risk of stating the obvious, are you guys all so worried about losing jobs in the dysfuntional health insurance industry that you can’t see what damage it is doing to our country?

      Or is it just a matter of feeling like you aren’t “the same kind of people” as Barrack Obama that is fueling this?

      I admit that I didn’t like Bush, his fecklessness, his total lack of curiosity, his born again Jesus freakdom that somehow answered the question WWJD? with the word torture–I found him contemptible on many levels.

      But listening to Obama, I just don’t get how anyone can hate him. He’s rational, middle of the road, a consensus builder. Where is the Manchurian Candidate that some many of his haters see?

      I am simply missing it. That’s why I find myself wondering if racism is the real subtext here.

      • Rick said

        There is footage on Youtube and I’m suprised you would post without checking that. Booing while President Bush is stating a fact that Social Security could go bankrupt if corrections are not made is essentially calling Bush a liar. Wilson did not lie, and researching the issue would be a smart thing for you to do.

        For the life of me I don’t understand why you lefties are so bitter.

        My goodness the race card!

        • Booing and hissing and the like has been part of the kabuki dance forever. You can say this is “essentially calling Bush a liar” but it’s not the same. I ask you to provide one specific example of where anyone in Congress has yelled out actual words accusing any president of a crime.

          How can you conclude that Wilson “did not lie”? It is probably true that illegal aliens will not be turned away at ERs, but this is not the same thing as saying that Obama’s health care reform will provide illegal aliens with health care insurance. What would you all on the right propose in terms of illegal aliens and ERs? Say somebody is in a car wreck bleeding to death. Would you propose having written into law that if such a person were not in the country legally, the nation’s hospitals can legally turn him or her away?

          The charge of “bitterness” seems to be yet another winger talking point you guys seem to have gotten from your daily dose of Rush McBeckreilly Larouche.

          By the way, Rick, you concede that you didn’t read (or presumably watch) Obama’s speech. But then you criticize me for not searching YouTube for this footage of Bush being booed?

          Have you ever considered some sort of remedial education so that perhaps one day you could earn that high school equivalency degree?

        • Rick said

          I just assumed one would understand I watched the speech. I have posted that Wilson should be admonished for his behavior. You are the one that doubted my post regarding Democrats booing during Bush’s 2005 State of the Union. I’m not going to get into a discussion of semantics regarding booing and speaking as that’s wasting time and this is a health blog. I’m also not going to spend time explaining why Wilson did not lie as you seem unable to grasp the core, even after I assume you researched the issue like you should have. The term bitterness is simply derived from reading your various posts.

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