Obama Frames Healthcare Right

[ Posted Tuesday, June 23rd, 2009 – 17:58 UTC ]

President Obama had his fourth press conference today, the first one that wasn't in primetime. As expected, most of the questions were on Iran and healthcare reform. The healthcare reform battle has changed in the past few days, but Obama is still the chief spokesman so far. And he's doing a much better job of standing up for the public option than anyone else out there, so it is worth reading his words to see how other Democrats should be framing this issue.

The following are Obama's remarks and answers on healthcare reform. Because they are long, I'm presenting them with limited commentary interruptions. You can read the entire transcript of the press conference to see what Obama had to say on other subjects, as well.

From the president's opening remarks (his first two subjects were Iran and energy legislation, which is approaching a congressional vote soon), the section on healthcare:

The last issue I'd like to address is health care.

Right now, Congress is debating various health care reform proposals. This is obviously a complicated issue, but I am very optimistic about the progress that they're making.

Like energy, this is legislation that must and will be paid for. It will not add to our deficits over the next decade. We will find the money through savings and efficiencies within the health care system -- some of which we've already announced.

We will also ensure that the reform we pass brings down the crushing cost of health care. We simply can't have a system where we throw good money after bad habits. We need to control the skyrocketing costs that are driving families, businesses, and our government into greater and greater debt.

There's no doubt that we must preserve what's best about our health care system, and that means allowing Americans who like their doctors and their health care plans to keep them. But unless we fix what's broken in our current system, everyone's health care will be in jeopardy. Unless we act, premiums will climb higher, benefits will erode further, and the rolls of the uninsured will swell to include millions more Americans. Unless we act, one out of every five dollars that we earn will be spent on health care within a decade. And the amount our government spends on Medicare and Medicaid will eventually grow larger than what our government spends on everything else today.

When it comes to health care, the status quo is unsustainable and unacceptable. So reform is not a luxury, it's a necessity. And I hope that Congress will continue to make significant progress on this issue in the weeks ahead.

Obama is leading with a few strengths here. The first is "do no harm" -- in other words, if you like your healthcare, the government isn't going to force you to change it. Obama also leans heavily on "we must reduce costs," which is universally popular. The rest of it is a call to action, and a reassurance on the subject of the scope of the problem: "I get it."

His first question on healthcare came after some chitchat on Iran.

QUESTION: Thank you, Mr. President. Two of the key players in the insurance industry, America's Health Insurance Plans and Blue Cross-Blue Shield, sent a letter to the Senate this morning saying that a government health insurance plan would "dismantle" private insurers. Why are they wrong? And secondly, this public plan, is this non-negotiable? Would you sign a health care bill without it?

PRESIDENT OBAMA: Well, let's talk first of all about health care reform more broadly.

I think in this debate there's been some notion that if we just stand pat we're okay. And that's just not true. You know, there are polls out that show that 70 or 80 percent of Americans are satisfied with the health insurance that they currently have. The only problem is that premiums have been doubling every nine years, going up three times faster than wages. The U.S. government is not going to be able to afford Medicare and Medicaid on its current trajectory. Businesses are having to make very tough decisions about whether we drop coverage or we further restrict coverage.

So the notion that somehow we can just keep on doing what we're doing and that's okay, that's just not true. We have a longstanding critical problem in our health care system that is pulling down our economy, it's burdening families, it's burdening businesses, and it is the primary driver of our federal deficits. All right?

Once again, he starts by defining the scope of the problem. This may sound inane, but Republicans have painted themselves into the corner of "the problem doesn't exist," which is patent nonsense, so Obama hitting this theme repetitively is a good thing to open with.

So if we start from the premise that the status quo is unacceptable, then that means we're going to have to bring about some serious changes. What I've said is, our top priority has to be to control costs. And that means not just tinkering around the edges. It doesn't mean just lopping off reimbursements for doctors in any given year because we're trying to fix our budget. It means that we look at the kinds of incentives that exist, what our delivery system is like, why it is that some communities are spending 30 percent less than other communities but getting better health care outcomes, and figuring out how can we make sure that everybody is benefiting from lower costs and better quality by improving practices. It means health IT. It means prevention.

So all these things are the starting point, I think, for reform. And I've said very clearly: If any bill arrives from Congress that is not controlling costs, that's not a bill I can support. It's going to have to control costs. It's going to have to be paid for. So there's been a lot of talk about, well, a trillion-dollar price tag. What I've said is, if we're going to spend that much money, then it's going to be largely funded through reallocating dollars that are already in the health care system but aren't being spent well. If we're spending $177 billion over 10 years to subsidize insurance companies under Medicare Advantage, when there's no showing that people are healthier using that program than the regular Medicare program, well, that's not a good deal for taxpayers. And we're going to take that money and we're going to use it to provide better care at a cheaper cost to the American people. So that's point number one.

Obama follows up with his second theme, on getting costs down. And that Medicare Advantage is a real shot across the bow of the insurance companies. Translation of what Obama is really saying: "government can indeed provide the same service cheaper than private industry -- here is but one example of this."

Number two, while we are in the process of dealing with the cost issue, I think it's also wise policy and the right thing to do to start providing coverage for people who don't have health insurance or are underinsured, are paying a lot of money for high deductibles. I get letters -- two, three letters a day -- that I read of families who don't have health insurance, are going bankrupt, are on the brink of losing their insurance; have deductibles that are so high that even with insurance they end up with $50,000, $100,000 worth of debt; are at risk of losing their homes.

And that has to be part of reform, making sure that even if you've got health insurance now, you are not worried that when you lose your job or your employer decides to change policies that somehow you're going to be out of luck. I think about the woman who was in Wisconsin that I was with, who introduced me up in Green Bay -- 36 years old, double mastectomy; breast cancer has now moved to her bones and she's got two little kids, a husband with a job. They had health insurance, but they're still $50,000 in debt, and she's thinking, my main legacy, if I don't survive this thing, is going to be leaving $100,000 worth of debt. So those are the things that I'm prioritizing.

I've been calling for the public's voice to be included in this whole debate, and Obama does precisely this. However, he needs to get a few other examples than just one woman in Green Bay on the issue. Luckily, he's already on top of this, so expect more precise examples in the very near future.

Obama then finishes his first question by supporting the concept (without getting very specific) of a public plan.

Now, the public plan I think is a important tool to discipline insurance companies. What we've said is, under our proposal, let's have a system the same way that federal employees do, same way that members of Congress do, where -- we call it an "exchange," or you can call it a "marketplace" -- where essentially you've got a whole bunch of different plans. If you like your plan and you like your doctor, you won't have to do a thing. You keep your plan. You keep your doctor. If your employer is providing you good health insurance, terrific, we're not going to mess with it.

But if you're a small business person, if the insurance that's being offered is something you can't afford, if you want to shop for a better price, then you can go to this exchange, this marketplace, and you can look: Okay, this is how much this plan costs, this is how much that plan costs, this is what the coverage is like, this is what fits for my family. As one of those options, for us to be able to say, here's a public option that's not profit-driven, that can keep down administrative costs and that provides you good, quality care for a reasonable price -- as one of the options for you to choose, I think that makes sense.

QUESTION: Won't that drive private insurers out of business?

PRESIDENT OBAMA: Why would it drive private insurers out of business? If private insurers say that the marketplace provides the best quality health care, if they tell us that they're offering a good deal, then why is it that the government -- which they say can't run anything -- suddenly is going to drive them out of business? That's not logical.

Now, I think that there's going to be some healthy debates in Congress about the shape that this takes. I think there can be some legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly, that over time they can't compete with the government just printing money.

So there are going to be some I think legitimate debates to be had about how this private plan takes shape. But just conceptually, the notion that all these insurance companies who say they're giving consumers the best possible deal, that they can't compete against a public plan as one option, with consumers making the decision what's the best deal. That defies logic, which is why I think you've seen in the polling data overwhelming support for a public plan. All right?

QUESTION: Is that non-negotiable?

This is the best job I've seen of fighting back against the Republican talking points on the issue. "That's not logical." How can the private market be the be-all-end-all answer for everything, and not have fixed this problem by now? If government truly can't provide anything better and cheaper than private industry, why are people so worried? Does not compute.

Obama ends on a serious warning to anyone in Congress considering jettisoning the public plan -- the recent poll numbers showing overwhelming support for the public plan (three-to-one or even four-to-one support in multiple polls is nothing to sneeze at). He is bluntly telling centrist Democrats here: "the public is with me -- go against the public plan at your own peril."

He did not answer the followup question, instead taking another frivolous question on Iran. But the press corps wasn't about to let him walk away from it. Later on:

QUESTION: Thank you, Mr. President. Before I ask my question, I'm wondering if you could actually answer David's. Is the public plan non-negotiable?

Here we get a bit of the famous (for almost all presidents, it should be noted) "friendly banter" with the press corps. But I bet Leonard Nimoy would have been shocked, forty years ago, if told his character would ever come up in a presidential news conference. I'm just saying...

PRESIDENT OBAMA: That's your question. (Laughter.)

QUESTION: Well, you didn't answer --

PRESIDENT OBAMA: You think you're going to -- are you the ombudsman for the White House press corps? (Laughter.) What's your -- is that your question? (Laughter.)

QUESTION: Then I have a two-part question. (Laughter.) Is the public plan non-negotiable? And while I appreciate your Spock-like language about the logic of the health care plan, the public plan, it does seem logical to a lot of people that if the government is offering a cheaper health care plan, then lots of employers will want to have their employees covered by that cheaper plan, which will not have to be for profit, unlike private plans, and may possibly benefit from some government subsidies, who knows. And then their employees would be signed up for this public plan, which would violate what you're promising the American people, that they will not have to change health care plans if they like the plan they have.

PRESIDENT OBAMA: I got you. You're pitching, I'm catching. I got the question. First of all, was the reference to Spock -- is that a crack on my ears? (Laughter.) All right, I just want to make sure. No?

QUESTION: I would never make fun of your ears, sir. (Laughter.)

Heh heh. Kidding aside, though, the question is one of the more intelligent ones from people opposing the concept of the public plan, and can be summed up as "what about the unintended consequences?" But, while the press corps was salivating over possibly getting a veto threat, Obama dodges that, since it's really too early for such threats in the legislative process.

PRESIDENT OBAMA: In answer to David's question, which you co-opted, we are still early in this process, so we have not drawn lines in the sand other than that reform has to control costs and that it has to provide relief to people who don't have health insurance or are underinsured. Those are the broad parameters that we've discussed.

There are a whole host of other issues where ultimately I may have a strong opinion, and I will express those to members of Congress as this is shaping up. It's too early to say that. Right now I will say that our position is that a public plan makes sense.

Now, let me go to the broader question you made about the public plan. As I said before, I think that there is a legitimate concern if the public plan was simply eating off the taxpayer trough, that it would be hard for private insurers to complete. If, on the other hand, the public plan is structured in such a way where they've got to collect premiums and they've got to provide good services, then if what the insurance companies are saying is true, that they're doing their best to serve their customers, that they're in the business of keeping people well and giving them security when they get sick, they should be able to compete.

Now, if it turns out that the public plan, for example, is able to reduce administrative costs significantly, then you know what? I'd like insurance companies to take note and say, hey, if the public plan can do that, why can't we? And that's good for everybody in the system. And I don't think there should be any objection to that.

This is another shot across the bow of the health insurance industry. "Government can do administrative costs cheaper and better." Oh, and by the way, we're going to institute some new rules of the road as well:

Now, by the way, I should point out that part of the reform that we've suggested is that if you want to be a private insurer as part of the exchange, as part of this marketplace, this menu of options that people can choose from, we're going to have some different rules for all insurance companies -- one of them being that you can't preclude people from getting health insurance because of a pre-existing condition, you can't cherry pick and just take the healthiest people.

So there are going to be some ground rules that are going to apply to all insurance companies, because I think the American people understand that, too often, insurance companies have been spending more time thinking about how to take premiums and then avoid providing people coverage than they have been thinking about how can we make sure that insurance is there, health care is there when families need it.

But I'm confident that if -- I take those advocates of the free market to heart when they say that the free market is innovative and is going to compete on service and is going to compete on their ability to deliver good care to families. And if that's the case then this just becomes one more option. If it's not the case then I think that that's something that the American people should know.

Those last two paragraphs, in a sane media world, would be the soundbites excerpted for everyone to hear on tonight's evening news. I am not holding my breath that this will happen, but I do point it out for other Democrats to take note. This is the way to talk about these issues. This is the way to frame them. Democrats need to repeat this in front of a mirror until they've memorized it: "too often, insurance companies have been spending more time thinking about how to take premiums and then avoid providing people coverage than they have been thinking about how can we make sure that insurance is there, health care is there when families need it."

These two paragraphs are, for me, the highlight of the entire press conference.

Then comes another "unintended consequences" question:

QUESTION: I'm sorry, but what about keeping your promise to the American people that they won't have to change plans even if employers --

PRESIDENT OBAMA: Well, no, no, I mean -- when I say if you have your plan and you like it and your doctor has a plan, or you have a doctor and you like your doctor that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform.

Now, are there going to be employers right now -- assuming we don't do anything -- let's say that we take the advice of some folks who are out there and say, oh, this is not the time to do health care, we can't afford it, it's too complicated, let's take our time, et cetera. So let's assume that nothing happened. I can guarantee you that there's a possibility for a whole lot of Americans out there that they're not going to end up having the same health care they have, because what's going to happen is, as costs keep on going up, employers are going to start making decisions: We've got to raise premiums on our employees; in some cases, we can't provide health insurance at all.

And so there are going to be a whole set of changes out there. That's exactly why health reform is so important.

The media are already painting this as some sort of "walkback" for Obama, because he clarified his more sweeping statement of "nobody will have to change their healthcare if they don't want" to "the government is not going to make you change plans under health reform." But Obama closes with a shot across the bow of the punditocracy, who would have you believe that everyone is peachy-keen happy with their current healthcare. Obama is saying "even if we did nothing, people have to change healthcare all the time because of what their employers decide.

On the whole, this is the best thing I've heard yet from any Democratic politician on healthcare reform. It wasn't a full-throated defense (complete with details) of exactly what public option Obama prefers, but it was indeed a pretty good defense of the basic concept.

The debate in Washington is slowly changing this week (from the dismal performance last week), mostly due to all the strong poll numbers in favor of the public option.

It's early to get my hopes up too far on this, but I keep coming back to the old bumpersticker: "If the people lead, the leaders will follow." With public support extremely high for the concept, it makes it much harder for centrist Democrats to try to weasel out on offering that option. And with a few more champions of the idea to back up Obama's well-framed responses today, the whole tone of the conversation on Capitol Hill may start to change as well.


-- Chris Weigant


21 Comments on “Obama Frames Healthcare Right”

  1. [1] 
    Osborne Ink wrote:

    Let us hope that tone in Washington does change. Right now there are too many congresscritters on the insurance companies' payroll campaign contribution list for hundreds of thousands or millions of dollars.

    Another TP someone mentioned today: the US Postal Service has been in competition with FedEx, UPS, and DHL for decades. Why haven't they gone belly-up if government competition is so deadly?

  2. [2] 
    Dorkfish wrote:

    The vast majority of people claiming that the public option is a good idea don't understand basic insurance principles. The fact of the matter is that the numbers don't work. I am not coming from the position of one political party or another. I am coming from a background of disseminating risk. Every time the government has moved from "referee to player" it has not played by the very rules that it has set forth for insurance companies. In other words, the very regulations that the government places on the insurance industry to protect the public and the industry are thrown out the window. The end result is a program that is consistantly underfunded, and coverage that is rationed. This is not my opinion, it is fact. Medicare is financially failing, as is government run hurricane insurance in Florida and Cape Cod. I define failing as the inability to self sustain. It becomes a big entitlement program with the tax payers and the private sector left with the bill. The insurance industry will have to set rates based on loss ratio and government regulation, while government's rates will be artificial. In the end, the numbers are the numbers and the government will be forced into massive tax increases and/or cutting care. In the mean time, the private option cannot compete against fake rates. In the case of Medicare, doctors cannot run their offices on the pennies they are paid by the government. The end result is most doctors limiting the number of Medicare patients in the practice. On the coverage side, the care has been so badly rationed, the private sector has had to fill the holes with Medicare supplements. In order for the government to succeed in the insurance business, it will have to adhere to actuarial principles or we will be in for a lot bigger problems than we have today. IE See Canada.

  3. [3] 
    Osborne Ink wrote:

    "IE see Canada."

    My 90-year old grandmother lives in Canada. She has no complaints. She has never been denied care for a pre-existing condition, never had to wait for vital procedures, never been told that her insurance wouldn't pay above the "usual and customary rate," and never had an insurance copay raised arbitrarily without notice. She has never had to deal with the manifold ways insurance companies get between the doctor and the patient.

    Dorkfish, all your dire predictions are already happening WITHOUT a public option. Private insurers ration care and limit compensation every day. Medicare is underfunded because costs are going up far faster than inflation; that is the nature of for-profit health care. Canada -- and many other countries -- manage to have better overall health while keeping costs dramatically lower. It's got nothing to do with "actuarial principles" and everything to do with the private need for bigger and better profits.

  4. [4] 
    Chris Weigant wrote:

    Dorkfish -

    First off, welcome to the site.

    Secondly, I have to ask, for all those people who hold up Canada, Britain, and other Western countries with national healthcare as some sort of horror story, the following question:

    If national health is such a nightmare, why then has no country which provides it ever had a movement to move to the American system? If it is truly that bad, and the numbers truly don't add up, then why are we the only country to do things the way we do, and why do people in these countries never seem to demand the American system?

    Perhaps, in comparison, their systems aren't as bad as they are painted for the domestic American audience by healthcare reform opponents? I'm just saying....


  5. [5] 
    Michale wrote:

    This may sound inane, but Republicans have painted themselves into the corner of "the problem doesn't exist,"

    I haven't read much about the GOP claiming that the problem doesn't exist.

    All the complaints that I have read from the Right are that the Government doesn't have the best track record as evidenced by the mess that the Medicaid and Medicare programs are in.

    Do we really WANT or NEED a third messed up bureaucracy?? Or a fifth one, if you count GM (Government Motors) and AIG (American International Government)...

    If government truly can't provide anything better and cheaper than private industry, why are people so worried? Does not compute.

    Actually, the complaint is quite logical.

    The government CAN provide services much much cheaper than the industry simply because it can afford to LOSE money. It will always have the taxpayer tit to suckle off of so it can offer lower prices. Addressing Osborne's point is a perfect example. Does ANYONE honestly believe that the US Postal service could survive without the taxpayer's titties??

    There are many MANY examples in business whereas a company will enter a market, lose millions of dollars by undercutting the price in an effort to obtain market-share. Japan and cars, Microsoft and XBOX, etc etc etc... This would simply be more of the same. The US Government Health Care "business" will have to attract customers to justify it's existence. Since it is very unlikely that the USGHC will be able to provide superior service (come on... It's the government...) then the only way to attract business is buy much lower cost.

    Ergo, the complaint that people will leave private insurers for the lower costing plan IS a valid and logical complaint.

    If national health is such a nightmare, why then has no country which provides it ever had a movement to move to the American system?

    Probably for the same reasons that the US hasn't changed to the Canadian or British Health Care model.

    Too much hassle to totally revamp a system that is already in place.

    I'll ask the question again...

    Do ya'all REALLY want a government run auto industry, a government run banking industry AND a government run healthcare industry if Republicans are the government???

    All these government-run programs may be Utopian to Democrats with Democrats in charge. Personally, I think that the less government intervention in our daily lives the better, but that's probably just me.

    But how is the Left going to react with all these government controlled industries when it's the Republicans that are controlling them??

    When THAT happens, will ya'all still think it's a good idea??


  6. [6] 
    Michale wrote:

    Let me ask this.

    Can ANYONE give me an example of a government run program that has a private industry counter-part and is run successfully, as Dorkfish defines success, AND meets the needs of it's customers?

    Just one??


  7. [7] 
    Dorkfish wrote:

    Chris and Osborn Inc; My opinions of the Canadian system come from both the professional and personal worlds. I will start with the professional first. The Canadian system has wait times to see a specialist that far exceed America. The number of doctors that leave Canada for other places verses their American counterparts is 17 to 1. The average young adult under the age of 30 does not have a primary care physican because there simply not enough to go around. The system works wonderfully for minor issues, but anything that requires a specialist is problimatic. The tax rate in Canada far exceeds the US and continues to grow at an alarming rate to fund the cost of the care. (15% sales tax in Ontario with half going to fund healthcare). Think emergency room waits are long here? In Canada, due to the lack of pcp's, emergency room overcrowding for minor health issues is out of control. I could go on and on. On the personal front, I was on the Canadian system for three years and my former wife and my two children, (one of which is applying to med school in the US)have always been on it. My ex had been diagnosed with Lyme disease in June and was on a wait list to see a specialist until this past Feburary. When we were married, she had a cyst on her overy and we waited 7 months to see a specialist. What if if had been cancer? She now travels over 700 miles to seek treatment in New York state, as many Canadians do that live in border states. By the way, if you have been on the tube (subway) in London lately, you will see a lot of ads for private health insurance. England has very high taxes to cover its bad plan and the rich are still buying the additional coverage that they need.

    As far as the post office comparison, the analogy doesn't work because Fed Ex, UPS etc are not regulated business' like insurance. The postal service is playing on a level playing field and is forced to compete as such. In the insurance world, companies have to play by government set financial regulations, while the government doesn't compete on the same field. As Michale state, " the government plays to lose money". I would add, "our money."

    I do agree with Osborn Inc. that we are already seeing care rationed in the private sector, but currently not at a rate remotely close to Medicare. To state that business principles don't apply to runnning a business is simply silly. The big issue I have with people on the other side of this argument is that its often based on emotions rather than sound financial facts. Spewing "talking points" only works well with the uninformed. In the end, the government will have to run healthcare like a business. Their track record is dismal when it comes to business. The health insurance market is very competitive, if big profits were the root of the major problem, there is a line of competitors waitng to take those customers away. (Let me guess, there must be a big conspiracy of collusion!) The high cost of the care is not a result of health insurers, although they do play a role in the cost problem. How about the lack of competition? How about tort reform as it related to malpractice rates? How about the vast number of UNFUNDED government mandates (in our state its over 50!). The idea that profit is the issue is an uninformed and emotional position. It is a complex situation and I find it very scary the large number of Americans that have strong opinions without much research beyond political talking points. I have spend nearly 25 years understanding insurance principles. Guess what, like it or not, if the government runs it, they will be forced to adhere to those actuarial numbers as well. Sorry, Osborn, but the government trys to adhere to then now. They just do it very poorly. The govenment has a lengthy track record of actuarial failure on this subject. For the sake of arguement, take the profit margin out of the picture, the numbers still don't remotely add up. Do the math, the numbers are out there, most are publicly traded companies.

    If you want some of your questions answered, compare the average American's medical plan's coverage to Medicare, it will tell you all you need to know.

    We do agree on this point, we have a big cost problem in this country. Its not going to go away with a government run program. The government is facing the same numbers as the private sector and no where near the expertise. There are solutions to the problem, but there are a lot of sacred cows in the way, starting with the government itself.

  8. [8] 
    Elizabeth Miller wrote:


    The Ontario sales tax rate that you quote is incorrect.

    Do you have current numbers on what the comparative national tax rates are - personal and corporate - for Canada and the US?

  9. [9] 
    Chris Weigant wrote:

    OK, just a few things.

    As for the post office, I'm not sure that's a great example. I thought they were semi-privatized a few decades ago, and are off the government teat. But I could be wrong about that.

    Like I said, it's not a great example, for either side. The PO makes most of its money off bulk mail (ie., junk mail). True, UPS and FedEx and the rest of them provide a better service. They wouldn't exist if they didn't. But you pay for it. The same letter that costs you 44 cents to mail anywhere in the US costs a minimum of around ten bucks to send by FedEx, and that's only for 3-day service (overnight is pricier). Go into FedEx some day and try to convince them to mail something for 44 cents. Come to think of it, other than a parking meter, try to buy ANYTHING today for 44 cents... But, like I said, their service is undeniably better -- IF you're willing to pay the price.

    I didn't have any point vis-a-vis health care with that, but talk about an "unlevel playing field" where you're comparing $0.44 to $10.00, that was my only point.

    As for the gauntlet thrown down about govm't vs. private, I have two examples. Our military does a pretty good job. So do private contractors. The difference? Contractors make a TON of money, whereas your average grunt soldier does not. And yes, I'm speaking specifically of Iraq when I say that. "Cost plus" is an abomination.

    But a lot closer to home, what do you think of Obama's example? Medicare Advantage was passed because Republicans were CONVINCED that private companies could always do a better job (in this case, getting drugs to sick folks) and cheaper than the gummint. What has happened is that is has become a cash cow. Insurance companies make their 20% profit ON TOP of what it would cost Medicare to provide the SAME SERVICE. That is the $177 billion Obama's talking about. Taxpayers could save that money if Medicare ran the program. So there's my example.

    As for Dorkfish, you obviously have a lot of experience with the Canadian system. But let me ask you a simple question: how many Canadians go backrupt because they get sick? How many Canadians are denied health care (not delayed, denied) because they can't pay for it?

    No system is perfect. But Canada seems to have a better safety net than the US. In the US, in 1980, eight percent of all bankruptcies were due to medical bills. A few years ago, they ran the same study and came up with 50%. This year, the figure is 63%. Something is obviously wrong with this.

    It's interesting that you point out how you can buy private insurance in Britain on top of your national health. This is a big secret Americans don't realize (no matter which side of the issue they're on). Private insurance still exists in countries with "national health." Which kind of deflates the claim that even having a "public option" would kill all private insurance forever in the US.

    Part of the problem is Americans simply cannot ever believe (We're number one!!) that any other country in the world could possibly do anything (ANYthing) better than we do. It just is an impossible thing for most Americans to even contemplate -- that others could do things better than us.

    I saw a PBS show last year which looked at four or five countries with different health care schemes. Two of the ones they looked at were Switzerland and (I believe) Singapore. Both have radically changed their health care system in the past ten or twenty years. They both studied many other countries' health care, and tried to pick and choose what worked and what didn't when they set their own up. They didn't demagogue the issue to death, they sat down and studied it in a calm and sober fashion. This is what annoys me about America some times. Even though we are talking about totally revamping our health care, we (to the best of my knowledge) haven't even attempted to study how other countries do it. The Swiss, interestingly enough, had a system close to America's (all private insurance). They decided a few things: (1) everyone should have access to a "basic" level health care plan, subsidized for those who couldn't afford it, and (2) every health insurance company had to offer this -- at NO PROFIT to them. This was their "loss/leader" in advertising terms. They are all still in business, and they sell "extras" in various more expensive private plans. Things like a guarantee of a private room if you go to a hospital, or better food in the hospital -- things like that. But the medical care itself is the same for everyone. The insurance companies are still in business, still making money, they're just doing it in a different way than they used to.

    But nobody even mentions such hybrid public/private systems in this country -- not the left, and not the right. This seems to be shortsighted, to me, as there ARE things we could learn from the rest of the world, who all have "national health" but not necessarily "socialistic single payer" health. The two are not equivalent, in other words. Whereas many here think they are.

    It just seems to me that America needs to be able to provide this "safety net" level of insurance to EVERYONE, but also that there will still be plenty of money to be made on top of that providing "gold-plated" (or maybe just "gold-leaf-slightly-better-plated") health care.

    As for tort reform, I've seen figures that put it at half of one percent of the problem of rising medical costs. It might help, in other words, but not much.

    All I know is that I talk to people on Medicare who are my parents' age, and although they may have minor gripes about it, NONE OF THEM would trade it for private health insurance. NONE. Now, this may be a biased sample, but I bet you'd find most people in Medicare are pretty happy with it.

    And while it's true that it's going to cost something, Americans pay the lowest tax rates in the Western world, as far as I am aware. The country I lived in in Europe had a 22% VAT when I was there. And something like a 45% income tax rate for an average decently-paid worker. All that cradle-to-grave stuff doesn't come for free. But, at the same time, they consider the idea that someone would lose their life's savings over basic health care as a barbaric concept.

    But as for costs, please explain how other countries manage to provide health care for half or one-third of what we pay, and have measurably better health care as a result (by outcome)? How does this work out actuarily? (I probably misspelled that, sorry). Our health care, as measured against the rest of the world, is pretty dismal. We're something like 37th in the world -- right behind Cuba.

    Maybe part of the problem is drug companies charge American consumers ten times what they charge in other countries (like Canada... I bet you didn't see many Canadians taking bus trips down to the USA to buy drugs, since the traffic on that front goes the other direction). Why can they get away with this? Because the government isn't in the picture -- this is one place where national health beats our system cold.

    I'm no expert on health care, I fully admit that. And I am not scoffing at your Canadian experience. I always am willing to listen to others who have seen other ways of doing things, and what is right and wrong with them. And some of my best commenters on this site are Canadians (although I cannot make Canadian jokes right now because I promised I wouldn't for a month... I even forget why I made this promise, but I'm sticking to it).

    All I would like to see is a full discussion which includes some of the examples (both the good, the bad, and the ugly) from the rest of the world when Americans (especially American politicians) sit down to revamp our own system. Maybe we can cherry-pick and avoid some of the mistakes, who knows?

    Anyway, gotta run, this is long enough as it is...


  10. [10] 
    Michale wrote:

    The big issue I have with people on the other side of this argument is that its often based on emotions rather than sound financial facts.

    I have always said that any position based in emotion is usually the wrong position.

    In the original commentary, the polling data was mentioned.

    Here are some interesting poll numbers that paint a different picture.

    Just another point in my series of points that polls are useless and only show the bias and opinions of the Poll TAKERS. :D


  11. [11] 
    Michale wrote:

    As for the gauntlet thrown down about govm't vs. private, I have two examples. Our military does a pretty good job. So do private contractors. The difference? Contractors make a TON of money, whereas your average grunt soldier does not. And yes, I'm speaking specifically of Iraq when I say that. "Cost plus" is an abomination.

    This is not exactly an analogous situation for several reasons, but that's my fault for not phrasing the question precisely enough.

    While it's apparent that the US Military does it cheaper, there is no evidence to suggest that the US Armed Forces does it better. Of course, the US military DOES do everything better than private contractors. :D But, as a veteran of two branches of the services, I am biased and so is my opinion. :D

    Whereas one can argue that, with private contractors, political considerations are low on the priority list. On the the other hand, economic considerations are very HIGH on a contractors list. With the US Military, the priorities are reversed. So, "better" is a completely subjective term, if one were to look at the comparison logically.

    I would also point out that the issue of self-sustainability is not a factor when one looks at military operations. Self-sustaining, as Dorkfish defines (accurately), is the mark of a successful "business". In that regard, the US Military doesn't qualify as a business, but the Private Contractor does.

    However the main reason the analogy fails is because, in the military/private contractor example, it was the private contractor who entered a field that has, traditionally, been the purview of the government. IE National Security and National Defense.

    In the Healthcare issue, the government is entering a field that has, traditionally, been the purview of the private sector.

    As I said, it's my fault for not phrasing the question properly.

    So, to correct this....

    Can anyone point to ANY successful government program that has been, traditionally, the purview of the private sector.

    Given the government's track record for failure in this regard, I can't see anything good coming from the Administration's healthcare endeavor.

    It's a laudable goal. But I question whether or not it's wise to roll the dice, given the current economic climate.

    The LAST thing we need is another wasteful and bloated government bureaucracy paid for by the taxpayers of this country..


  12. [12] 
    Dorkfish wrote:

    Yopu raise some very good points about America's standing in the world in terms of quality of care. I have seen similar numbers. As far as the drug compaanies are concerned, I agree with much of your point there as well. I mention the issue briefly on my own blog. Where we continue to disagree is on the point of the cost and what entity is best at containing the cost. I believe that the private sector, while far from perfect, has done a wildly better job at cost control. The fact that we have people declaring bankruptcy is a real problem. However, it is not a problem created by insurance companies. It is problamatic of people's ability to afford the high cost of care itself. Insurance's very function is to help the individual cover those high medical costs. We have to stop confusing the cost of insurance as the cost of care. The cost of insurance is reflective, or a mirror of the care costs. Our industry has a truckload of Phd's and MBA's that understand how to set the insurance price correctly. The government has zero expertise and as a result, Medicare is financially failing as is the "Kennedy" plan in MA. You mentioned people that you know that have Medicare. Please go back to them and ask them how many one them have a Medicare Suppliment (which appears to be from the government, but is actually the private sector). I think you will find it to be the majority. Those that don't will continue to cuts in coverage because the government can't sustain the plan at the currnet coverage and tax rate.

    As far as other counties are concerned, there are always things we can learn, however, I am not interested in being a socialist country. That system over the long haul doesn't work. France and Germany have just come to grips with that by electing conservitive leaders. I would be happy to compare our tax rate to Canada or any European country and our ability to create personal wealth here verses there. the bottom line is this: the cost of the care is the issue, the governemt will face those very same costs. Insurance companies offset that cost by collecting premiums, governments do it by collecting taxes. Either way, it will be the same cost unless the system is fixed. Europe and Canada are both dealing with cost issues and tax issues. My point returns to where I started, if you think that profit is at the root of high health care costs, think again.

    One last point on Tort reform. The Med Mal cost in Virginia and West Virginia, are about 50% less in the state with the reform. Ask a doctor what his/her big costs are and its always Med Mal and insurance paperwork. (An insurance area that needs lots of cleanup). Good blog, Chris

    PS Sorry for typo's wrote this really fast!

  13. [13] 
    Michale wrote:

    Looks like the HealthCare infomercial didn't do any favors for the administration.


  14. [14] 
    Chris Weigant wrote:

    Dorkfish -

    For a new commenter, and one with an opposing viewpoint, I have to say you have added to the conversation, as I am considering things I might not have.

    I'm not answering your last post here, don't have time right now, but I did want to say "don't be afraid to post a link to your blog." It's totally allowable here, but if you post two or more links your post will be held for manual moderation (I have to do this to cut down on the comment spam). But even such multi-link comments are allowed, they just won't appear right away (just FYI).

    Anyway, just wanted to point that out. Don't be shy about plugging your own blog!


  15. [15] 
    Chris Weigant wrote:

    On a similar subject... Michale, you forgot the tags. I fixed your links, you're welcome.


    Posting links require "a href" tags, in standard html tag format with angle brackets (shift-period and shift-comma on a US keyboard).


  16. [16] 
    Michale wrote:


    On a similar subject… Michale, you forgot the tags. I fixed your links, you're welcome.

    Yea, I know, but I wanted to get the post out right aways. To lazy to wait for moderation. It's a sneaky way of doing things that borders on Moderation Evasion.. :D I'll stop it if it's a hassle for ya. :D


  17. [17] 
    Chris Weigant wrote:

    Michale -

    I can't believe I'm giving out Moderation Evasion advice on my own blog, but here goes...

    (1) You know I don't moderate for content, just to stop spam. In three years of doing this blog, I think I (I have no control over HuffPost moderators, I should clarify) have deleted precisely one comment for offensive content. Maybe two. That's a pretty good track record (for YOU GUYS, not for me, I should point out), from what I see on other blogs. And I NEVER moderate for length (which, considering the length of my posts, would be hypocritical in the extreme).

    (2) But I regularly get attacked by comment spam. My filters seem to be pretty good, as I don't think a single comment spam has ever made it through, which is why you readers have never seen this phase of the operation.

    (3) It may be awkward, but there is an easy way to avoid the automatic hold on comments -- break up your post so that there's only one link per comment (may take multiple comments to do this, of course). So, if you're looking for a workaround, there you go!

    (4) I wasn't chastising you, it was just an easy way to re-post the "how to put a link in your comment" instructions, for the benefit of new commenters (I do this periodically, and just piggybacked it onto what I wrote about yours). It's no real hassle for me to fix links, I just thought you had forgotten...

    Just to clear things up for everyone.



    PS. I simply CANNOT BELIEVE you haven't commented on the "Spock" byplay in Obama's presser. You feeling OK? Dude, a reporter just called Obama Mr. Spock! And not one word from Michale? I have to say I'm a bit disappointed, personally...


  18. [18] 
    Dorkfish wrote:

    Thanks for the kind words Chris. If anyone thinks that I am always pro-insurance, check out my blog today, "Insurance Malpractice" at

  19. [19] 
    Michale wrote:


    Yea, I kinda shocked myself that I was so blase about the "Spock" comment.

    On the other hand....

    ... I have mentioned it before. :D Even put it on a T-Shirt :D


  20. [20] 
    Michale wrote:

    HealthCare questions and answers, courtesy of Neil Cavuto.

    Question:Will I ever have to wait for vital care?

    Answer: No.

    Question: But they wait in Canada.

    Answer: But not that long.

    Question: But some, very long.

    Answer: Very overblown.

    Question: So I won't have to stand in a long line?

    Answer: Not now.

    Question: Will you pay for this taxing health benefits folks already have now?

    Answer: Everything's on the table.

    Question: Well, is that on the table?

    Answer: We're looking at a lot of things.

    Question: OK, then on that specific tax health benefit thing?

    Answer: Move on.

    Question: OK, what about sticking with my existing doctor?

    Answer: Of course, everything you have now and you like now, you can keep with this now.

    Question: But what if my doctor is thrown into a new pool of doctors. A lot more people will want to see him now will I be standing in a longer line for him now too?

    Answer: Ridiculous. Everything you love now, you keep now.

    Question: Then why the hell are we changing things now if everything is fine now.

    Answer: Because everything is not fine for everyone now. We need to think of them.

    Question: And pay for them.

    Answer: Yes.

    Question: How much?

    Answer: All things we're looking at. But in the long run it will be more efficient.

    Question: How do you know?

    Answer: We know.

    Question: Yeah, but how?

    Answer: Because we trust the government to streamline things.

    Question: The same government with the $1,000 hammers and billion dollar bridges to nowhere? That government?

    Answer: No. Different government. Better government.

    Question: But same guys in government, right?

    Answer: Kind of.

    Question: Kind of what?

    Answer: Kind of late. Gotta go. Just trust us.

    When reading this, I got the feeling that this is exactly how the Left accused the Bush Administration of sounding with regards to Iraq and the war against terrorism.

    The more things change, the more they stay the same, eh? :D


  21. [21] 
    Michale wrote:

    Interesting way to raise money for HealthCare.

    Democrats are proposing a $1000 fine for people who do NOT get the HealthCare plan...

    Anyone on board with this??


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