This time, the President is going to be specific. Next week, President Obama is going to give Democrats a health care plan they can begin to sell.
He plans to list specific goals that any health insurance reform plan that arrives at his desk must achieve, according to Democratic strategists familiar with the plan. Some of these "goals" have already been agreed to, including new anti-discrimination restrictions on insurance companies. Others will be new, including the level of subsidies he expects to give the uninsured so they can buy into the system.
Obama will also specify a "pay for" mechanism he prefers, and will
specify an income level below which he does not want to see taxed.
He
will insist upon a mechanism to cut costs and increase competition
among insurance companies -- and perhaps will even specify a percentage
rate -- and he will say that his preferred mechanism remains a
government-subsidized public health insurance option, but he will
remain agnostic about whether the plan must include a robust public
option. Officials won't say whether the president intends to endorse a
specific "trigger" mechanism if the competition mechanism fails, but
they say he will make it clear that the final bill must contain
language that increases competition.
Though officials would
not provide the numbers Obama plans to use, they say that the goal is
to give his side -- Democrats -- a true presidential plan that they can
sell. That includes the rebranding of several consensus initiatives,
like the insurance reforms, as his own. The effect of this sales job,
if it works, will be to associate the president with parts of the
reform bills that are almost certainly likely to pass -- assuming the
Senate doesn't bog down.
The White House hopes the specifics
will be specific enough to gradually soothe the concerns of the
Democratic caucus. The budget reconciliation process remains a cudgel
-- it's still the weapon of last resort, and President Obama has told
his advisers that he does not want to ask Congress to use the mechanism
until it becomes necessary, politically -- that is, until the public
understands that the popular elements of reform will not pass without
using it.
I think the key will be putting numbers against the "plan." When you do so, it become clear that a plan with a robust public option is actually cheaper and more effectively bends the cost curve than one with a diluted public option or one without the public option.
"and he will say that his preferred mechanism remains a government-subsidized public health insurance option"
That's an unfortunate way to frame the issue; outside of the first few years, the public option is funded by individual premiums and subsidies, but the same subsidies are available to private insurers as well. Overcoming this misperception that Obama will take money in taxes, general revenue, etc from people in private insurance to pay for people in public insurance is vital to winning public approval.
well shit folks ('cuse the salty language) seems like President Obama is finally gonna get his other foot off the dock and in the boat.
about damned time.
This look like another trial balloon. Throw something at the wall, see what sticks. What's it gonna be: a prime time presser? A speach to cancer patients?
And I swear, the way he ran around for 18 months talking about his health care plan, you would have thought he had a health care plan.
i feel the same way. but then to have beleived in the guy SOOO wholeheartedly just taught mt about politics the hard way.
As it stands, the Health Care debate has undoubtedly had a negative affect on the potential of the Obama presidency. However, it seems to me that this might work well for Obama. The Republicans have spent a lot of a ammo shooting at the multitude of bills and have not gained the trust of the American people. People are scared of change but want a better system. Meanwhile the Obama administration has been able to watch what works and what does not. Further, they are not tied to any specifics.
Everything has quieted a bit. Now the administration may be better able to choose those specifics and forcefully articulate a clear plan. In other words, if Obama had a clear plan earlier in the game we could be at the same place we are currently at--with Republicans laying out its downfalls and Obama basically stuck with a plan that would have been difficult to change politically. The ball is in Obama's court. If he can't follow through the Dems are toast in 2010.
The problem that I have and many Americans have is that the problem the President keeps referring to is health insurance. He has used the "50 million uninsured" line and the "evil insurance companies" line hundreds of times. What the media forgets to inform the people is Americans and illegals are never denied medical services. They can go to any hospital and receive the best medical treatment on the planet.
The way I think health insurance works in this country is that the doctors and hospitals petition the insurance companies evry year to increase the amount they get paid. The increases are requested each year to compensate them for two huge business consequences - non-payment of services and medical malpractice insurance. What people need to understand is that the insured people are getting hit with the insurance increases, while the poor and the illegal immigrants are getting free care.
There was a study done about 3 years ago how Parkland Hospital in Dallas was losing millions of dollars because of illegal immigrant births. They weren't getting paid for the services performed. They couldn't refuse treatment either.
So why is the government looking to take over health care when our problem is health insurance? If someone could give me a straight answer on that, I will rethink my position on the whole reform bill.
There was a proposed amendment to specifically exclude illegals from coverage under the new bill. Naturally, the Democrats voted it down just as they voted down requiring photo IDs for elections (ironically some of the same Dems required photo ID for their town halls). They need those illegal votes.
It doesn't matter that much anyway. If they're here, they're going to be treated.
Another falsehood. None of the health care proposals mention anything at all about "illegals". They are silent about it. Finally, my dear sir, "illegals' do not vote.
well i spoke to my senator dick durbin who claims illegals will not be covered, since the senate has no bill you are tecnically right. in the house, my congresswoman jan schawkowsky also said at her town hall that illegals would not be covered. two amendments were defeated to use a verification system so i have no idea how they will enforce who this provison. as far a illegals not voting who knows since most states don't require an id.
Good point, the Heller Amendment which would have required proof of citizenship or lawful immigration status (since the bill expressly provides coverage to non-citizens) as a requirement to receiving taxpayer-funded subsidies through the “public option” or to employers buying insurance through the “exchanges” was defeated on a straight party-line vote.
It doesn’t matter whether they say the bill doesn’t expressly provide subsidies to illegal aliens or even if they have toothless language in there saying that nothing in the bill is intended to provide subsidies to illegal aliens.
If they make the program available to non-citizens but don’t require verification of lawful immigration status or provide a method of verification, it’s essentially an open invitation to commit fraud.
Obama is not honest in his rhetoric.
- 61% of major health plans are non-profit. NON-PROFIT
- The other 39% earn a WHOPPING 3.2% profit margin, same as Wal-Mart. Google earns 25%. Google CEOs get invited to appear in Obama campaign ads. Insurance company CEOs, including non-profits, get villainized.
- 82% of hospitals are non-profit are government run. About half of nursing homes are as well.
Health care insurance and provision of services is one of the least profit-oriented sectors in the economy, given the widespread participation of non-profits.
Pharmaceutical and Medical Device Companies make 15% profit margins, roughly. That is real money. However, other innovation-oriented technology companies often make more. Apple earns 15%. Google earns 25%. Microsoft earns closer to 30%. Pharma is not out of line with other R&D lead industries.
As for the uninsured, it is actually 46 million PEOPLE.
- 9 million are illegal immigrants
- 2 million are legal residents who can return to their home country if they get too sick, so they do not insure themselves
- 12 million are actually covered by Medicaid but have not signed up because they are not sick
- 15 million are uninsured, yet make more than $75,000 and CHOOSE not to purchase coverage
When you get down to it, the number of people who fall through the cracks because of economic reasons amounts to...
8 million people.
That is about 3% of the population.
Keep in mind another important factor. This data is collected by the US Census every year and they ask the following question.
"In the last year, were you without health insurance coverage?"
What that means is that anyone who was between jobs or failed to re-up their policy for any reason gets included.
This probably overstates the actual level gap in coverage significantly because lots of people may go for a month without coverage between jobs, even in a good economy.
Obama is not interested in educating people on this topic. That is a shame, and wholly unlike the candidate who ran for the job.
"What the media forgets to inform the people is Americans and illegals are never denied medical services. They can go to any hospital and receive the best medical treatment on the planet."
The naivete of the statements is apalling. First of all, there is universal consensus that American health care system is far from the best. It ranks 37th among industrialized nations judging by results like life expectancy, cost and other parameters.
Secondly, those without health insurance do get health care, if you may call it so, at the emergency room, only when it is life threatening or such.
Finally, who pays for this "uncompensated care"? Those of us who do have health insurance. The hospitals and providers simply factor it in the rates they negotiate with insurance companies, who in turn recover from us in the form of higher premium.
Wall Street Journal clarified that "37th among industrialized nations" myth yesterday.
It makes for nice red meat rhetoric, but it isn't true.
"universal consensus"?? Do you even know what the words you type mean?
Life expectancy is based on things other than health care. For example auto accidents and murder. Infant mortality and birth weight are more a function of culture and poverty than the health care system. Cost? WTF does that have to do with measuring outcomes? Are we overpaying for human life? Is that the argument? Take out those factors related to poverty and the US life expectancy is as high as anywhere in the world. Compare a state like Vermont, which has similar demographics to Canada or Scandinavian countries as a basis for comparison.
Re: Infant mortality rates
The United States has an infant mortality rate of 0.626 percent while Singapore reports the lowest infant mortality rate of 0.231 percent. Any difference in infant mortality rates among countries whose rates are already so low that they’re less than one percent is so statistically insignificant that it barely qualifies as a rounding error.
"So why is the government looking to take over health care when our problem is health insurance? If someone could give me a straight answer on that, I will rethink my position on the whole reform bill."
Good lord.
The government is not looking to take over healthcare. Other than VA centers, the government has very little role in the delivery of healthcare.
They are looking to intervene in the insurance market.
Reading: Try it!
23% of Hospitals are government-run
Many of them are city hospitals or state hospitals. Most major cities above 100,000 residents operate at least 1 city-owned hospital.
States run hospitals for the disabled and mentally ill as well. Also, keep in mind that any public university-run hospital technically operates off of state funding.
Most major public universities with medical programs run at least one hospital.
The data is at www.nonprofithealthcare.org.
The problem is not health insurance either. 61% of major health plans are non-profits. For-profit insurers earn a 3.2% profit margin.
That amounts to around $12-15 Billion in insurance company profits a year.
We spend $2.6 TRILLION on health care annually.
Do the math. That is half of a penny of every health care dollar spent going to insurance company profit.
1/2 of 1%. That is your big savings if you wipe out 100% of insurance company profits.
I think you need to get a calculator and do some reading yourself, no offense intended.
This reconciliation nuclear option is a dangerous road to hoe. If you start ignoring the rules, the minority can shut down the Senate by withholding unanimous consent.
Ah, those quaint old-fashioned days of 2005, when the filibuster was Right and Just and Necessary.
Other than VA centers, the government has very little role in the delivery of healthcare
And mandates. And community rating laws. And Medicare monopsony pricing. And medical torts. And the thousand pages of new rules for health insurance in the current bill.
Dave, no need to willfully misread the VirginiaCentrist's point. He/She's obviously responding to the earlier person who is mistaken in thinking that the current healthcare proposals somehow mean the government will take over the direct delivery of healthcare, i.e. doctors on government payroll treating patients like in the U.K. No one except left-wing think tankers are proposing anything resembling that. As VirginiaCentrist points out, this only happens in veteran's hospitals. (I'd add hospitals for the active military, but same essential point.) And that wouldn't change if this legislation were to pass.
Filibuster was never the rule for centuries, it is recently created exception. Absence of filibuster, also called simple majority rule has always been the rule.
So, remind me: What is the plan Obama has been stumping for over the past several weeks? Obama is a complete con man. What a joke.
There will be numbers put on whatever Obama claims to be beholden to. Rest assured, this is a retreat in view of the town hall outbursts. But superficial cost controls mean health care rationing based on a government panel of (politically oriented) health care "geniuses."
Thanks for your venomous outburst. It makes it neasier for us to understand your argument, which is nothing.
On all of the blogs I read, I'm having trouble sorting out the Righty trolls from the Lefty trolls.
Does that bother anyone else?
If Obama really wanted to promote competition, why does he not make it so insurers have to compete with one another across state lines? On the left they decry these "local cartels" where only 3-4 insurers serve certain regions, yet when the GOP says "let's have them compete across state lines so you can get a plan from anywhere" the left freaks out.
Obama says that there might be shady companies in Delaware who will rip us off. Well, as a constitutional scholar I would think that he understands that interstate commerce is subject to federal consumer protection regulation. Apparently he has no faith in the federal government to perform its duty in this case, yet seems to believe it will do much better in the insurance market. Anyone see the contradiction here?
All of this proves how tremendously unserious Obama is about promoting competition. He knows what any educated observer should know. Insurance company profits are actually quite miniscule.
- 61% of major health plans are already non-profit, which cover about half of the population.
- The other 39% earn a profit margin of 3.2%. That is lower than Wal-Mart.
- 82% of all hospitals are non-profit or government run. 82%!
By way of comparison, Google earns a 25% profit margin.
Maybe we should tax Google to pay for health care?
Bottom line...squeezing insurance company profits to ZERO would save about 1/2 of 1% (.5%) of total health care spending. That would take us back to what we spent...in June. June 2009. WOW!
Is it me or is a 3.2% profit margin a pretty honest profit margin? Obama actually suggests that insurance companies are gouging people, yet he does not seem to understand the math at play.
He likes to make convenient villains for the left to hate and demagogue on, but he is not really interested in an educated debate. He is turning out to be a completely unserious president.
That is a shame.
FYI: the stats on non-profits are available at www.nonprofithealthcare.org. I wish more columnists knew these facts.
Insurance companies earned $13 billion if profit after paying $100-200 million to company executives and several hundrel millon dollars in campaign contributions and advertisements to buy out the politicians, while denying citizens insurance and dropping those with insurance as soon as they start needing it. They make a business out of playing with people's lives.
That is a shame.
I like the idea of enabling interstate competition the same way we have for pretty much every other good and service that we buy. If Obama’s “public option” was really intended to introduce competition into the marketplace rather than a backdoor attempt to displace private insurance, then there would be no reason to opt for just allowing consumers and employers to buy health insurance policies across State lines.
So he is going to take all of the things he could have had in January, portability, pre-existing conditions, subsidized insurance for the poor who can't, for some reason qualify for Medicaid, oh, and don't forget tort reform which would have a huge effect on the cost of defensive medicine, beyond the dollar amounts of payouts. All of those... wait a minute, I didn't see tort reform in the list... Oh well. Anyway, he is going to put all of them as sugar on top of the obamanation of a bill that he wants to ram through reconciliation, which I presume will contain the proposed cuts to Medicare, which will force rationing to the elderly.
But I give him props, it almost seems like he has figured out that he is president, and not Professor Harold Hill, coming to sell us all band paraphernalia, which we will all learn to use by the "Think System", and march down Main Street playing Seventy Six Trombones the whole way to Utopia. Err, no he hasn't. I think America will give him another chance. He just better cut out the blatant lying.
Well said. Brilliant rhetoric, total absence of argument.
Can you really graduate from Columbia and Harvard Law without knowing that when you make an argument, it is not enough to just state your conclusion? For example, he tells us that we can "keep our insurance", but he never supports that claim with evidence and logic. He uses the weasel words that "there is no mandate to make you change your coverage." So what? There are incentives to get other people to kick you off your coverage. There are dozens of similar examples. It is as if he thinks he can just mesmerize the country with his good looks and pretty voice, without presenting any substance.
It is the same with you lefty commenters. You say that the plan is not a camel's nose under the tent for single payer, but you never explain why an employer wouldn't dump their employees, en mass, onto a public option, if all they had to do was pay and 8% tax, and the headache of administering employee health care went away. Either the President and you lefies are really stupid, or you think the American people are stupid, but wait, that makes you stupid too.
It's like the old Simpson's episode where Bart and Lisa are walking along swinging their fists, and claim that if the other person "happens to walk into them, it isn't their fault."
Obama has been playing waiting game…SO THIS BIG MESS is close to what he and his staff have planned, where they could walk in and dictate OBAMAS’S PLAN, what Orzag, Rahm and Ezekiel Emanuel, and United Health Care Alumnus De Parle advised—–predicted by Christine Romer, who reassured the wealthy last spring the deficit would be tamed, not by tax increases of the rich, but by health care reform (AKA as big Medicare and Social Security cuts).
And Obama’s plan will be the sum of his staffs’ values and dreams. It has been spread sheet jockey Orzag’s life’s dream to cut the Medicare budget, It has been Ezekiel Emanuel’s dream, as expressed to epidemiologists at the NIH/CDC in 2006 during the bird flu scare, to ration care to the over 50 crowd for the good of the state and it may be no longer be “premature” to put this rationing plan in place for “health care as a whole “(as E. Emanuel summed up in the Jan. Lancet) for those over 50, in the next 5 years as the deficit deepens partially thanks to Obamacare.
Ezekiel Emanuel wrote a book outlining a plan very close to what Obama will propose as a pragmatic solution…
So here will be THE OBAMA PLAN:
1. No public plan. Both Emmanuels never wanted this…weakens the rest of THE PLAN.
2. Emphasis on private insurance plans so there is enough embedded administration to force centralized planning. Medicare, and therefore ‘Medicare for all’ have insufficient overhead for this massive control that Obama and his team want over the health care system.
3. Centralized decision making over all new insurance plan benefits and the “effectiveness” of drugs and procedures, with doctors being rewarded for the “right” answer, doctors will be either explicitly or implicitly indemnified against liability, even if the “right” treatment hurts the patient.
4. Rationing (AKA cost savings) results from the vast policy power(IMAC) that the executive branch will be able execute without any democratic input(no pesky voters and Congress needed) and rationing will also occur because of less access to doctors and health facilities, i.e. not enough doctors and nurses for the growing population and added new beneficiaries of government subsidies. There have been no added dollars for medical school slots or residencies, so no added doctors. There have been no residencies added in USA since 1996 except a few philanthropist funded slots.
So now we citizens will get a regressive, pork laden bill, a bill that is predicted to hurt the working poor, middleclass, the disabled and single women, a bill that is filled with Obama/Baucus giveaways to special interests like big PhRMA and insurance companies that preempts true cost savings, instead. Obama is using the handy Medicare budget “waste” as a piggy bank for offsets…( when Obama mentions waste in Medicare it is sometimes not clear if he believes the seniors are the “waste” or its really some Medicare administrative failure)
“Accepting the complete lives system for health care as a whole would be premature.” is the conclusion by Ezekiel Emanuel in “Principles for allocation of scarce medical interventions” published in the January Lancet.
single women? have i missed something?
Ah, our dear logical, President! Sadly, the rabid opposition to health-care reform is not driven by logic (if it were, we'd all have health insurance by now) but by primitive fears and perverse distortions of the Obama proposals. As a physician in practice for over 30 years, I believe these fears go back to our days as "Hunter-Gatherers", and that resistance to real reform will persist until the fears of the right-wing extremists are understood, exposed and confronted. For more on "Health Care and the Hunter-Gatherers", please see my blog on etalkinghead.com
http://www.etalkinghead.com/archives/health-care-and-the-huntergatherers-2009-08-28.html
Ronald Pies MD