Well, that's done, and it was done well. But except for a Republican's moronic outburst -- I guess it's true, these people really can't help themselves, like fidgety toddlers in church or incoherently yakkety old guys in nursing homes -- in general we heard nothing new; no new, major delineations, which in any event Congress can and likely will mutilate in conference.
That's what had me puzzled days before his speech to the joint session of Congress. We were told the president would swoop into chambers and for the first time get "specific" and lay down markers, since merely one of health-care reform's many immense problems was that the public knew not what the president wanted. And, it's true, he gave us plenty of what he wants. For the already insured:
Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. [I]t will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses.... And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care.
Marvelous. Yet you may recall that way back in July the president announced an equally specific eight-point plan designed to persuade the presently insured of reform's advisability. He called for outlawing the imposition of exclusionary preexisting conditions; for outlawing the dropping of the ill's coverage; for outlawing arbitrary caps on coverage; for outlawing extravagant out-of-pocket expenses; and for guaranteeing inexpensive preventive care.
Filling out his eight-plan plan were "guaranteed insurance renewal," "no gender discrimination," and "extended coverage for young adults."
OK. Again, all quite marvelous. But these are specifics the public already knew -- rather, specifics they would have known if they'd been paying attention. Will they pay any more attention this time? Will they even be permitted? Which is to say, What fresh Republican hells will the media obsessively cover as September's equivalents to August's disgraceful town halls?
The public, by and large, wants jolly-good entertainment and low drama and partisan food-fights, not dry information. And the media are nothing if not willing to please.
So next, one imagines, will come endless speculations about jackbooted government-"mandate" goons descending on rugged American individualists who only wish to be left alone with their flag, mother, and her special Sunday pie. Yet more Congressional Democrats will then run for cover, and actuarial benefits of risk-spreading and cost-containment will be apocalyptically excised.
That, anyway, is my guess. A Congressional rumble over mandated coverage could very well dwarf its internal bickering over a public option. The latter would be statutorily restricted to less than five percent of the American population, while the former would be statutorily required of virtually all the vastly more sizable balance.
And as for that public option, once again, we heard nothing new. Rather, what we heard was a reiteration of Obama's famous pragmatic progressivism, or, as some would prefer to reverse it, his notorious progressive pragmatism. Accordingly, the key passage was this:
"[The public option] should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, 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."
Those words transcended mere rhetoric; and they betrayed far more than just self-defensiveness. They were, instead, a statement of plain, simple, empirical and indisputable American historical fact.
In our roughly free-market society, universal coverage has dominated for a century as the progressive ideal. Many -- and I'm one of them -- have strongly preferred a single-payer system, but universal coverage has always loomed as the more critical objective. You can scour every progressive speech ever delivered on the subject of American health care and nine times out of 10 that's what you'll find.
So again, nothing new. (If any part of that objective, as stated last night, is to be legitmately attacked, it's the likely insufficient $900 billion price tag which Obama attached.)
What will be new, however, what we do have to look forward to, is more ingenious right-wing and Blue Dog and New Democrat inventiveness in assaulting that monstrous socialistic wraith of egalitarianism: universal health-care coverage. My fingers tremble just typing those words: Oh, the horror of it all.
"Public Option" and the Risk of Reform through Regulation
In health insurance reform, what congress and the president are trying to achieve, i.e., (nearly) universal coverage while lowering costs and equaling or improving outcomes, has never been accomplished before, anywhere in the world, using primarily for-profit private insurance. What is sought isn’t a slam-dunk with this approach; nobody can point to an example that shows this approach even works. We are trying to regulate a private for-profit insurance system into having the attributes previously known only among public (or highly regulated non-profit) healthcare financing systems.
Thus there is a significant risk that regulating a for-profit system into the attributes of a non-profit or public system will fail. If the president and congress are serious about really wanting to fix the problems this time, they are taking by far the most risky approach.
Having a “public option” available mitigates this risk. We know that public healthcare financing can lower costs, provide universal coverage, and improve outcomes. It has been demonstrated not only around the world but in our Medicare and VA systems (themselves quite different from each other). If we want to avoid the suggested “disruption” of conversion to a completely public system, then an eminently reasonable alternative is to include a robust, available to all Americans, “public option”.
By having a robust “public option” – I would suggest simply extending Medicare to buy-in by all Americans (in a cost-neutral way, perhaps on a sliding scale to make it accessible to lowest incomes) – we have a fallback in case the attempt to change the very nature of for-profit insurance through regulation proves to be difficult or impossible.
Unfortunately, the president’s proposal isn’t to “build on what works”. His proposal is to rebuild what doesn’t work. This is a risky proposition. Medicare – our well-established “public option” – works! If congress and the president insist upon rebuilding what doesn’t work, at the minimum they must also have the “public option” as a model and a fallback.
The “public option” is far more than competition for the private insurers to keep them honest. It is an alternative model, one that is known to work, which would immediately fill in any cracks and which eventually could be called upon to serve all if the “rebuild the private system through regulation” approach fails. It is the safety net’s safety net.
We talk about the “abuses” of the current insurance system, but practices such as excluding pre-existing conditions and coverage and rates based upon risk estimates are simply standard business practices similar to practices in all kinds of insurance. The for-profit insurance companies are simply behaving the way even the most ethical for-profit insurance companies would behave. One has to admire the optimism of those who think that this behavior can be changed through regulation or that if these practices are changed, there won’t be compensating unintended consequences.
We need the “public option” – a robust, available-to-all public program available soon if not now (Medicare took one year to implement) – to ensure that we really do get health insurance reform that works. If all we get is an attempt to rebuild the current system through regulation, there is a high probability that some future president will need to come back to congress for “health care reform” again. President Obama says that he doesn’t want that.
What were they waving?
Earlier this week, when railing against the President's school speech, one airhead at Fox likened him to Chairman Mao. Yet last night, during the President's health care speech, the Repugs waving those white papers reminded me of those long-ago images of the Chinese people waving Quotations From Chairman Mao little red books. Is there anyone else of my generation who registered the same memories?
You know what?
I'm beginning to think Obama wants single-payer universal health care, after all. He proved himself to be even more shrewd than I'd previously thought at last night's speech. His gradualist approach, although tedious and exasperating at times, is serving to expose those who take their sworn responsibilities seriously as well as those who would betray our trust and side with the corporate racketeers.
The Centerpiece
Let's see, single payer just tossed out the window without a glance. The anemic public option restricted to only those who the insurance corporations reject. And even at that Obama show a willingness to "work together" and toss that little scrap overboard. What is the centerpiece of Obama's "plan?"
The mandate that citizens must purchase health insurance policies from the same corporations that have created the health care mess in the first place is the centerpiece of Obama's "plan." Everything else is small potatoes. Everything else is window dressing and distraction from the elephant in the room. The insurances corporations know it. It represents an enormous transfer of wealth to them.
The insurance corporations are besides themselves with joy. They have acquired the power of taxation in all but name. A law that uses the power of the state to force you to pay money or else be punished is a tax. There is no other name for it. A tax is a tax.
These corporations now have the power collect taxes directly without the interference caused by democracy and our elected representatives with the only role for government is as the enforcer.
The power to tax. What a plum! What a reward! I guess because these corporations have done such a fine job giving us the wonderful efficient healthcare system we now enjoy they deserve this new power. We can all be assured they will be responsible with it. Why wouldn't they be? They are deeply concerned with our well being. It says so right in their ads.
Nothing has changed
Obama retains his abiliity to inspire. But after watching him operate behind the scenes for the last 8 months, I'm afraid I am now somewhat immune to his words. Because that's all they are.
Words.
I heard this from Bill Moyers who heard it from Josh Marshall at TPM...what if the president had posed this question to the American people:
"Would you like the opportunity to buy into Medicare before you reach the age of 65?"
Simple. Direct. Effective. Easy to understand. I'll bet 80% would say yes.
But we can't have that.
As a card-carrying member of the left of the "left of the left," I simply cannot sign on to a piece of legislation that mandates under law that poor people buy insurance (junk is all they can possibly afford) with inadequate subsidies and no guarentees that premiums will not be jacked up. If we don't get a public option then the insurance companies must have further, stricter regulations on profits and CEO bonuses or some other way to protect the poor.
If you want to get liberals to sign onto this turkey then regulate the insurance companies to point of nationalizing them. I'm not a fool, I recognize that Obama proposes some worthwhile things that I would very much like to see happen. But the insurance companies are getting way too much out of this deal as it is currently constructed and the poor are left with little or no protection.
Okay, you're going to jettison the public option? And you still want liberals on board? You better start throwing some more scratch our way and get much tougher on insurance companies. That's my bottom line for a compromise that does not contain a public option.
You're up.
I liked the question Rep.
I liked the question Rep. Weiner stumped Scarborough with: What do private insurance companies offer relative to a medicare-for-all option? After hearing a rightie try to come up with something - anything- for five minutes, its clear that they are entirely superfluous and detrimental to health care.
It is hard ...
... to come up with anything so completely worthless as the health insurance "industry" ......... except maybe telephone sanitizers or the B Ark?
Obama speech review:
The phrase Obama didn't use...
is universal coverage. It's gone or as they in New Yawk, foget about it.
Insurance exchanges is a sell out, regardless of a public option.
Tort reform? Another sell out.
And we're going to finance it all from uncovering waste and fraud? Wasn't that one of Reagan's overused lies back in the eighties?
At the same time some new regulation of health insurance providers is an improvement, unless that too is given away in the final package.
Other than that it is was a great speech. Really, except for what the President said and what he didn't say, it really was a great speech. The man is cool.
Keep It Civil - Please
An adult just walked into the room.
Can we keep this discussion civil - Please?
As for the four year time frame -- IT IS TOO LONG.
If we could trust insurance companies to do the right thing in four, two, or ten years.... we wouldn't be having this discussion.
As for the "bullying" - "arm twisting" -- call it what you will -- the last President who effected any change in the arena of health care, was Lyndon Baines Johnson.
He did not --- (as did Obama, Clinton, and Kennedy-- none of whom were successful at changing anything relating to health care) -- make his case before a joint session of Congress.
LBJ, bullied, he cajoled, he twisted arms. He had the will. It was important to the American people. He got the job done. We now have Medicare.
And..... to the best of my knowledge.... nobody ever tried to shout him down in the chamber of the House of Representatives.
People knew there would be consequences to an action as unethical as that.
We will just have to wait and see what happens to Representative Wilson.
We will either have a censure, or we will have mob rule.
There is a time and place for "bullying", for "arm twisting" and for cajoling.
Now is the time for all three. For the good of the American people, and for the memory of Ted Kennedy, Obama will have no choice but to do whatever it takes to get this done.
You Lie!!
Obama should have called Wilson up to the podium to elaborate on his dispute with the presidents speech. The utter humiliation would have been good for the Yahoo. I thought for a second he was going to - for crying out loud, it was in his speech! He said he would "call out" preposterous allegations and behavior, and there it was; his first opportunity....like so many; rejected.
leaning toward good, but weak, weak, weak.
So I, who currently have health insurance from my employer, will not be given the option to buy into the possible, future private option? This option - the whole "marketplace" idea, in fact, seems to be only for the uninsured. I will be forced by law to continue buying my unchosen policy, but the only cost-control posed to the insurance companies appears to be this totally separate market for uninsured people. How is the one to effect the other, with two such mutually exclusive groups of consumers bidding for mutually exclusive packages of policies?
How do I prove that I've complied with this new obligation I've recieved? How much more paperwork and enforcement costs will this engender? What if an uninsured person gets a job that offers insurance? Will that person be forced to drop his chosen "marketplace" plan and buy the one offered by his employer? If so - more onerous paperwork and bureaucratic costs. If not - what makes him so special?
This is stupid. Obama should have expanded on his spanking of the Republicans, ending with their utter humiliation - the mood was right. Then he should have said "This is stupid. We're going single-payer Medicare for All. Ask your Grandpa what that means; goodnight."
...and four years before
...and four years before implementation? That's ridiculous. Obama is simply thinking "can't get re-elected after I pay for this". He needs to forget about 2112 for a while and do the right thing - roll back tax-cuts to the 1970's, and pay for whatever.
The taste of being forced to make the insurance industry parasites filty rich is really getting vile.
Ken -
"Weak?" Despite your no doubt HEROIC Citizen Activism right?
Keep up that verbal masturbation man!
As opposed to .....
.... your Obama-cheerleader, circle-jerk?
Good one.
Down with civility! Down with respect. Down with inclusion!
Obama, we want change! Not REAL change, but simply our Progressive version of Bush / Cheney THUGGERY!
They bullied, now WE bully!
They strong armed, now YOU strong arm!
Gandhi was WRONG. Don't "be the change you wish to see."
IMPOSE the change you wish to see!
Stop Leading and Start DICTATING!!!!
What, do you wanna be the re-incarnation of Lincoln or something?
Progressives are NOT like Bush/Cheney Thuggery!
You have progressives confused with Blue Dog DINO-Fascists. Their leader, of course, is the big Blue Dog bully of them all, Rahm.
Also, what is Obama going to do besides sign or veto the bill? You want a dictator? Well you have one in the form of the upper 1% plutocracy who insure that their K Street lobbyist pimps bribe enough members of Congress so they always get their way.
Get your facts straight next time before you embarrass yourself, again.
So the BIG. EPOCHAL "Speech"?
Just more boiler-plate bullshit, nest paw?
Nothing new: appeasing the corpoRats and spinning to the people?
Sooo-prahs...sooo-prahs...
konopelli
Lincoln prevailed despite slugs like you. Maybe, with the
help of some REAL citizens, Pres. Obama will too.
Start Loving, when will you actually start loving?
Virtually every single one of your posts is an uncivil, ad hominem attack.
Your name is false advertising. You still don't see the irony in it either.
You should be banned from this website.