This is my recent letter to the editor of the Wall Street Journal.
What would columnist Gerald Seib have the Republicans do? According to polls, Americans are against most of President Barack Obama's policies: his version of health-care reform, the cap-and-tax bill, the bailouts of the auto unions, wasting money in the stimulus package and out-of-control spending. When Republicans fight against these policies, are they being partisan or responsible?
We need to shrink government, lower the tax burden on individuals and companies, and take national security more seriously. Outside of that, I think gridlock is good. Do we really want either party to have a free ride in passing legislation?
Here is the link to the article (I hope it works)
http://online.wsj.com/article/SB10001424052748704194504575031033202535438.html
Friday, March 5, 2010
The President's Health Plan Won’t Cut the Budget Deficit
I have tried to move away from posting other people's work on my blog, but I think this commetary is worth sharing as it cuts the heart out of Obama's budget spin on his "Reform" proposal. This will equally apply to the CBO score (they can only score what they are given and have limited ability to acknowledge the "gimmicks" that are used by Obama & Team). The author of this piece is James Capretta, a Fellow at the Ethics and Public Policy Center. He served as an associate director at the White House Office of Management and Budget from 2001 to 2004.
One of the central arguments President Barack Obama has made on behalf of the health care plan he wants Congress to approve in coming weeks is that it would begin to address the problem of rising costs and thus also begin to bring down future federal budget deficits.
But will it?
The president’s plan has not yet been assessed by the Congressional Budget Office. But CBO has provided a cost estimate for the Senate-passed bill, upon which the president’s proposal is built. That estimate shows the Senate bill would reduce the budget deficit by $132 billion through 2019. CBO also says that the Senate bill would likely reduce projected deficits even more during the second decade of implementation.
But, as Republican Rep. Paul Ryan of Wisconsin noted at last week’s Blair House meeting, there are a number of reasons to be skeptical about this claim.
For starters, the Senate bill omits the president’s proposal to permanently restore a 21 percent reduction in Medicare’s fees for physician services, now in effect as of March 1. The administration estimates that overriding this cut will cost $371 billion through 2020. Last summer, the House planned to include a permanent repeal of the cut in its health reform bill. But when the president imposed a 10-year budget of $900 billion on the reform legislation, Democratic leaders decided to pull the physician fee spending out of it and pass it separately.
The health bill includes scores of Medicare provisions, touching on just about every aspect of the program. The only major Medicare provision not in the bill is the costly “doc fix.” And the only reason for the omission is to make the total cost of the health reform bill appear lower. But passing the “doc fix” in a separate bill doesn’t make the cost go away. When the president’s entire health care agenda, including the “doc fix,” is tallied up, there is no deficit reduction over the next 10 years.
Ryan noted in his remarks at Blair House that the Senate bill would start up a new long-term care insurance program for the disabled. Participants would be required to pay in premiums for a number of years before becoming eligible for any benefits. Consequently, in the new program’s early years, there would a surplus, which CBO estimates at $73 billion over 10 years. The president’s claim of deficit reduction depends on double-counting these funds, first as an offset for the larger health care bill and then as a revenue source for long-term care insurance benefits beyond the 10-year window of the CBO estimate. Not only that, but it also creates a new entitlement program where, like Social Security and Medicaid, the premiums collected are spent rather than accumulating so that future service can be paid with the accumulated reserves rather than growing debt.
Over the long run, what matters in terms of the budget in the president’s health plan are the entitlement expansions, the effectiveness of “bending-the-cost-curve” measures, and the tax increases and spending cuts used to pay for broadened insurance coverage.
CBO expects the cost of the new entitlement spending aimed at coverage expansion in the Senate bill – the premium subsidies in the exchanges and the expansion of Medicaid -- to reach about $200 billion by 2019 and then grow at a rate of 8 percent every year thereafter. 8% per year means that it will DOUBLE every 9 years. In other words, this new health entitlement spending is expected to escalate just as rapidly as Medicare and Medicaid have in the past. CBO does not expect the “delivery system reforms” in the Senate bill, which are mainly small initiatives and pilot programs, to amount to much of anything in terms of cost control.
So how would the president pay for another expensive and rapidly growing entitlement? First, he would try to slow the rate of growth in the Medicare program, but not with new measures to weed out wasteful spending. His claim of long-term deficit reduction comes mainly from across-the-board payment rate reductions for hospitals, nursing homes and other providers of Medicare services. They would get a lower inflation update every year, in perpetuity. But these kinds of cuts do nothing to improve the efficiency of patient care or reward quality.
The chief actuary of the Medicare program has said repeatedly that these cuts are unrealistic because they would continuously cut reimbursements without touching the actual costs of providing care. He expects many facilities would be driven into serious financial distress. And without these Medicare cuts, the Senate bill is almost certainly a long-term budget buster.
The Senate bill also includes the so-called “Cadillac tax,” a new fee imposed on insurers and employers offering high-cost plans. As passed, this provision would generate substantial revenue in the second decade of implementation because the threshold for what constitutes “high cost” would rise much more slowly than medical inflation. Eventually, virtually the entire country would be in plans deemed “high cost.”
The president is relying heavily on the large, second-decade revenue increase associated with this tax for his claim of long-term deficit reduction. But just last week, under heavy pressure from union leaders, the president proposed to delay the tax from 2014 to 2018, well past the point when he will have left office. It will now raise almost nothing over the next 10 years, but the administration still claims credit for the sizeable revenue that would come in a second decade. That revenue would materialize, however, only if future officeholders were more willing than their counterparts today to impose large new taxes on a broad cross-section of the American middle class. They care less about the middle class, it's members of organized labor that they care about.
The federal government is piling up new debt at rates not seen since World War II. As Warren Buffett said recently, what the country desperately needs is a serious plan to slow the pace of rising health care costs.
What the president’s plan would deliver, however, is dead-certain entitlement spending, financed with speculative revenue and spending cuts that almost certainly will not work as advertised. The president says Congress should pass his plan to improve the budget outlook. In fact, Congress should reject it to protect the budget from more unfunded entitlement obligations.
One of the central arguments President Barack Obama has made on behalf of the health care plan he wants Congress to approve in coming weeks is that it would begin to address the problem of rising costs and thus also begin to bring down future federal budget deficits.
But will it?
The president’s plan has not yet been assessed by the Congressional Budget Office. But CBO has provided a cost estimate for the Senate-passed bill, upon which the president’s proposal is built. That estimate shows the Senate bill would reduce the budget deficit by $132 billion through 2019. CBO also says that the Senate bill would likely reduce projected deficits even more during the second decade of implementation.
But, as Republican Rep. Paul Ryan of Wisconsin noted at last week’s Blair House meeting, there are a number of reasons to be skeptical about this claim.
For starters, the Senate bill omits the president’s proposal to permanently restore a 21 percent reduction in Medicare’s fees for physician services, now in effect as of March 1. The administration estimates that overriding this cut will cost $371 billion through 2020. Last summer, the House planned to include a permanent repeal of the cut in its health reform bill. But when the president imposed a 10-year budget of $900 billion on the reform legislation, Democratic leaders decided to pull the physician fee spending out of it and pass it separately.
The health bill includes scores of Medicare provisions, touching on just about every aspect of the program. The only major Medicare provision not in the bill is the costly “doc fix.” And the only reason for the omission is to make the total cost of the health reform bill appear lower. But passing the “doc fix” in a separate bill doesn’t make the cost go away. When the president’s entire health care agenda, including the “doc fix,” is tallied up, there is no deficit reduction over the next 10 years.
Ryan noted in his remarks at Blair House that the Senate bill would start up a new long-term care insurance program for the disabled. Participants would be required to pay in premiums for a number of years before becoming eligible for any benefits. Consequently, in the new program’s early years, there would a surplus, which CBO estimates at $73 billion over 10 years. The president’s claim of deficit reduction depends on double-counting these funds, first as an offset for the larger health care bill and then as a revenue source for long-term care insurance benefits beyond the 10-year window of the CBO estimate. Not only that, but it also creates a new entitlement program where, like Social Security and Medicaid, the premiums collected are spent rather than accumulating so that future service can be paid with the accumulated reserves rather than growing debt.
Over the long run, what matters in terms of the budget in the president’s health plan are the entitlement expansions, the effectiveness of “bending-the-cost-curve” measures, and the tax increases and spending cuts used to pay for broadened insurance coverage.
CBO expects the cost of the new entitlement spending aimed at coverage expansion in the Senate bill – the premium subsidies in the exchanges and the expansion of Medicaid -- to reach about $200 billion by 2019 and then grow at a rate of 8 percent every year thereafter. 8% per year means that it will DOUBLE every 9 years. In other words, this new health entitlement spending is expected to escalate just as rapidly as Medicare and Medicaid have in the past. CBO does not expect the “delivery system reforms” in the Senate bill, which are mainly small initiatives and pilot programs, to amount to much of anything in terms of cost control.
So how would the president pay for another expensive and rapidly growing entitlement? First, he would try to slow the rate of growth in the Medicare program, but not with new measures to weed out wasteful spending. His claim of long-term deficit reduction comes mainly from across-the-board payment rate reductions for hospitals, nursing homes and other providers of Medicare services. They would get a lower inflation update every year, in perpetuity. But these kinds of cuts do nothing to improve the efficiency of patient care or reward quality.
The chief actuary of the Medicare program has said repeatedly that these cuts are unrealistic because they would continuously cut reimbursements without touching the actual costs of providing care. He expects many facilities would be driven into serious financial distress. And without these Medicare cuts, the Senate bill is almost certainly a long-term budget buster.
The Senate bill also includes the so-called “Cadillac tax,” a new fee imposed on insurers and employers offering high-cost plans. As passed, this provision would generate substantial revenue in the second decade of implementation because the threshold for what constitutes “high cost” would rise much more slowly than medical inflation. Eventually, virtually the entire country would be in plans deemed “high cost.”
The president is relying heavily on the large, second-decade revenue increase associated with this tax for his claim of long-term deficit reduction. But just last week, under heavy pressure from union leaders, the president proposed to delay the tax from 2014 to 2018, well past the point when he will have left office. It will now raise almost nothing over the next 10 years, but the administration still claims credit for the sizeable revenue that would come in a second decade. That revenue would materialize, however, only if future officeholders were more willing than their counterparts today to impose large new taxes on a broad cross-section of the American middle class. They care less about the middle class, it's members of organized labor that they care about.
The federal government is piling up new debt at rates not seen since World War II. As Warren Buffett said recently, what the country desperately needs is a serious plan to slow the pace of rising health care costs.
What the president’s plan would deliver, however, is dead-certain entitlement spending, financed with speculative revenue and spending cuts that almost certainly will not work as advertised. The president says Congress should pass his plan to improve the budget outlook. In fact, Congress should reject it to protect the budget from more unfunded entitlement obligations.
Wednesday, March 3, 2010
Remarks by the President on Health Care "Reform" and My Comments
For Immediate Release March 3, 2010
REMARKS BY THE PRESIDENT
ON HEALTH CARE REFORM
East Room
1:50 P.M. EST
THE PRESIDENT: Thank you so much, all of you, for joining us today. And I want to thank Julie, Barbara, Roland, Stephen, Renee, and Christopher, standing behind me -- physicians, physicians assistants, and nurses who understand how important it is for us to make much needed changes in our health care system. Thanks for coming even though you were hand picked to be there and applaud my comments!
I want to thank all of you who are here today. I want to specially recognize two people who have been working tirelessly on that -- on this effort, my Secretary of Health and Human Services, Kathleen Sebelius -- (applause) -- as well as our quarterback for health reform out of the White House, Nancy-Ann DeParle. (Applause.) You've made multiple revisions to my "Reform" bills. I would also like to thank the Republican Party and the American people. If it were not for their steadfast opposition of the prior versions of my "Reform" bills, I wouldn't be able to tout this bill
We began our push to reform health insurance last March, in this room, with doctors and nurses who know the system best. And so it’s fitting to be joined by all of you as we bring this journey to a close.
Last Thursday, I spent seven hours at a summit where Democrats and Republicans engaged in a public and very substantive discussion about health care. This meeting capped off a debate that began with a similar summit nearly one year ago. And since then, every idea has been put on the table. Every argument has been made. Everything there is to say about health care has been said -- (laughter) -- and just about everybody has said it. (Laughter.) So now is the time to make a decision about how to finally reform health care so that it works, not just for the insurance companies, but for America’s families and America’s businesses. I have to bash insurance companies because I think people hate insurers more than they hate me.
Now, where both sides say they agree is that the status quo is not working for the American people. Health insurance is becoming more expensive by the day. Families can’t afford it. Businesses can’t afford it. The federal government can’t afford it. Smaller businesses and individuals who don’t get coverage at work are squeezed especially hard. And insurance companies freely ration health care You talk about controlling costs, but that is what insurers do. You may not like it, but it's better than one of your czars deciding what is covered. based on who’s sick and who’s healthy; who can pay and who can’t. That's the status quo. That's the system we have right now. Bullshit! Per the "conservative" Washington Post, "Although polls have consistently shown that just over half of Americans think the health-care system is in need of reform, a substantial majority say they are satisfied with their own insurance and care."
Democrats and Republicans agree that this is a serious problem for America. And we agree that if we do nothing -– if we throw up our hands and walk away -– it’s a problem that will only grow worse. Nobody disputes that. More Americans will lose their family's health insurance if they switch jobs or lose their job. More small businesses will be forced to choose between health care and hiring. More insurance companies will deny people coverage who have preexisting conditions, or they'll drop people's coverage when they get sick and need it most. And the rising cost of Medicare and Medicaid will sink our government deeper and deeper and deeper into debt. On all of this we agree. So the question is, what do we do about it? So, he finally recognized that Medicare and Medicaid are sinking the government. Wasn't it that long ago, that Medicare and Medicaid expansions were the savior de jour for Obamacare?
On one end of the spectrum, there are some who've suggested scrapping our system of private insurance and replacing it with a government-run health care system. Yeah, that was you! And though many other countries have such a system, in America it would be neither practical nor realistic. Yeah, the Republicans and the American people taught you that lesson.
On the other end of the spectrum, there are those, and this includes most Republicans in Congress, who believe the answer is to loosen regulations on the insurance industry -- whether it's state consumer protections or minimum standards for the kind of insurance they can sell. The argument is, is that that will somehow lower costs. I disagree with that approach. I'm concerned that this would only give the insurance industry even freer rein to raise premiums and deny care. So, you recognize the fact that healthcare costs are rising, yet magically, insurance companies are not able to raise premiums? Do you think managed care companies are public utilities? There are few ways to control costs - ration care (you tried that and failed), institute price controls (you're going to try that with drug companies), or shift some of the burden of healthcare costs paid by healthcare consumers (currently 12-13 cents per dollar of hearlthcare spending). While that would be the best way to control costs, you know it would be a hard sell, so you ignore that option.
So I don't believe we should give government bureaucrats or insurance company bureaucrats more control over health care in America. I believe it's time to give the American people more control over their health care and their health insurance. I don't believe we can afford to leave life-and-death decisions about health care to the discretion of insurance company executives alone. I believe that doctors and nurses and physician assistants like the ones in this room should be free to decide what's best for their patients. Will this also apply to Medicare and Medicaid? If so, then seniors could get the virtual colonoscopies that Obama is allowed to get now, but Medicare will not allow seniors to have this option. You act like Medicare and Medicaid don't tell doctors, nurses and physician assistants what they can and cannot do?
Now, the proposal I put forward gives Americans more control over their health insurance and their health care by holding insurance companies more accountable. It builds on the current system where most Americans get their health insurance from their employer. If you like your plan, you can keep your plan. Heard that before. I'll reserve judgment until we see the bill. If you like your doctor, you can keep your doctor. Heard that before. I'll reserve judgment until we see the bill. I can tell you as the father of two young girls, I would not want any plan that interferes with the relationship between a family and their doctor. Yet, not too long ago you were advocating an entire government bureaucracy to do that very thing!
Essentially, my proposal would change three things about the current health care system. First, it would end the worst practices of insurance companies. No longer would they be able to deny your coverage because of a preexisting condition. Which, in isolation will drive up insurance premiums in the absence of an individual mandate. No longer would they be able to drop your coverage because you got sick. No longer would they be able to force you to pay unlimited amounts of money out of your own pocket. No longer would they be able to arbitrarily and massively raise premiums like Anthem Blue Cross recently tried to do in California Arbitrary? The Insurance Commissioner of California approved those rate increases as a result of rising costs incurred by Wellpoint -- up to 39 percent increases in one year in the individual market. Those practices would end.
Second, my proposal would give uninsured individuals and small business owners the same kind of choice of private health insurance that members of Congress get for themselves -- because if it’s good enough for members of Congress, it’s good enough for the people who pay their salaries. And yet, this is the first version of Obamacare to acknowledge this.
The reason federal employees get a good deal on health insurance is that we all participate in an insurance market where insurance companies give better coverage and better rates, because they get more customers. It's an idea that many Republicans have embraced in the past, before politics intruded.
And my proposal says that if you still can’t afford the insurance in this new marketplace, even though it's going to provide better deals for people than they can get right now in the individual marketplace, then we'll offer you tax credits to do so -- tax credits that add up to the largest middle-class tax cut for health care in history. After all, the wealthiest among us can already buy the best insurance there is, and the least well off are able to get coverage through Medicaid. So it's the middle class that gets squeezed, and that’s who we have to help.
Now, it is absolutely true that all of this will cost some money -- about $100 billion per year. $100 billion, that's "Walking around" money for Obama. But most of this comes from the nearly $2 trillion a year that America already spends on health care -- but a lot of it is not spent wisely. And who is to blame for this unwise spending? Patients? Doctors? Nurses? Physician Assistants? Your suggest you know better? A lot of that money is being wasted or spent badly. So within this plan, we’re going to make sure the dollars we spend go towards making insurance more affordable and more secure. We’re going to eliminate wasteful taxpayer subsidies that currently go to insurance and pharmaceutical companies; Will this be more industry taxes that will be passed on to the ultimate consumer? set a new fee on insurance companies that stand to gain a lot of money and a lot of profits as millions of Americans are able to buy insurance; and we're going to make sure that the wealthiest Americans pay their fair share on Medicare No downside to taxing the rich, so long as they are not members of the AFL-CIO, SEIU or UAW.
The bottom line is our proposal is paid for. And all the new money generated in this plan goes back to small businesses and middle-class families who can't afford health insurance. It would also lower prescription drug prices for seniors. Because the Pharmaceutical Industry thought it was better to offer that concession rather than risk the rath of the the Chicago Cosa Nostra. And it would help train new doctors and nurses and physician assistants to provide care for American families.
Finally, my proposal would bring down the cost of health care for millions -- families, businesses, and the federal government. We have now incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care --- ideas that go after the waste and abuse in our system, especially in programs like Medicare. But we do this while protecting Medicare benefits, and extending the financial stability of the program by nearly a decade. By ripping off "rich" beneficaries!
Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people's premiums and brings down our deficit by up to a trillion dollars over the next two decades -- brings down our deficit. We'll see what the CBO has to say. Those aren't my numbers; those are the savings determined by the Congressional Budget Office, which is the Washington acronym for the nonpartisan, independent referee of Congress in terms of how much stuff costs. Is he talking about the Senate Bill or this version?
So that's our proposal. This is where we've ended up. It's an approach that has been debated and changed and I believe improved over the last year. This is as close to a "Thank You" as our fellow "Obstructionists" will get. It incorporates the best ideas from Democrats and Republicans --- including some of the ideas that Republicans offered during the health care summit, like funding state grants on medical malpractice reform, and curbing waste and fraud and abuse in the health care system. My proposal also gets rid of many of the provisions that had no place in health care reform -- provisions that were more about winning individual votes in Congress than improving health care for all Americans. And you had nothing to do with those back room deals?
Now, despite all that we agree on and all the Republican ideas we've incorporated, many -- probably most -- Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies. And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I've put forward. A childish "I dare you."
Now, some also believe that we should, instead of doing what I'm proposing, pursue a piecemeal approach to health insurance reform, where we tinker around the edges of this challenge for the next few years. Even those who acknowledge the problem of the uninsured say we just can't afford to help them right now --- which is why the Republican proposal only covers 3 million uninsured Americans while we cover over 31 million.
The problem with that approach is that unless everyone has access to affordable coverage, you can't prevent insurance companies from denying coverage based on preexisting conditions; you can't limit the amount families are forced to pay out of their own pockets. The insurance reforms rest on everybody having access to coverage. And you also don't do anything about the fact that taxpayers currently end up subsidizing the uninsured when they're forced to go to the emergency room for care, to the tune of about a thousand bucks per family. You can't get those savings if those people are still going to the emergency room. So the fact is, health reform only works if you take care of all of these problems at once.
Now, both during and after last week's summit, Republicans in Congress insisted that the only acceptable course on health care reform is to start over. But given these honest and substantial differences between the parties about the need to regulate the insurance industry and the need to help millions of middle-class families get insurance, I don't see how another year of negotiations would help. Well the last year (against your will) has resulted in a better bill.
Moreover, the insurance companies aren't starting over. They're continuing to raise premiums and deny coverage as we speak. For us to start over now could simply lead to delay that could last for another decade, or even more. The American people, and the U.S. economy, just can't wait that long. A majority of American want your to either start over or scrap the effort alltogether, So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on health care reform. Excluding members of Organized labor, since when do you or Congress give a shit about the American people?
We have debated this issue thoroughly, not just for the past year but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of 60 votes. And now it deserves the same kind of up or down vote that was cast on welfare reform, that was cast on the Children's Health Insurance Program, that was used for COBRA health coverage for the unemployed, and, by the way, for both Bush tax cuts --- all of which had to pass Congress with nothing more than a simple majority. Have you forgotten all the times you labeled reconcilation as an "Abuse of Power?"
I, therefore, ask leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. (Applause.) And I urge every American who wants this reform to make their voice heard as well --- every family, every business, every patient, every doctor, every nurse, every physician’s assistant. Make your voice heard. What would you have the rest of us do?
This has been a long and wrenching debate. It has stoked great passions among the American people and their representatives. And that's because health care is a difficult issue. It is a complicated issue. If it was easy, it would have been solved long ago. As all of you know from experience, health care can literally be an issue of life or death. And as a result, it easily lends itself to demagoguery and political gamesmanship, and misrepresentation and misunderstanding. I think we would all agree that you are the king of "political gamesmanship, and misrepresentation and misunderstanding."
But that’s not an excuse for those of us who were sent here to lead. That's not an excuse for us to walk away. We can’t just give up because the politics are hard. I know there’s been a fascination, bordering on obsession, in this media town about what passing health insurance reform would mean for the next election and the one after that. How will this play? What will happen with the polls? I will leave it to others to sift through the politics, because that’s not what this is about. That’s not why we’re here. But it will be the reason you are sent packing!
This is about what reform would mean for the mother with breast cancer whose insurance company will finally have to pay for her chemotherapy. This is about what reform would mean for the small business owner who will no longer have to choose between hiring more workers or offering coverage to the employees she has. This is about what reform would mean for middle-class families who will be able to afford health insurance for the very first time in their lives and get a regular checkup once in a while, and have some security about their children if they get sick.
This is about what reform would mean for all those men and women I’ve met over the last few years who’ve been brave enough to share their stories. When we started our push for reform last year, I talked to a young mother in Wisconsin named Laura Klitzka. She has two young children. She thought she had beaten her breast cancer but then later discovered it had spread to her bones. She and her husband were working and had insurance, but their medical bills still landed them in debt. And now she spends time worrying about that debt when all she wants to do is spend time with her children and focus on getting well.
This should not happen in the United States of America. And it doesn’t have to. (Applause.)
In the end, that's what this debate is about. It's about what kind of country we want to be. The founding fathers have already defined what this country is. It's been that way for nearly 234 years. We don't need you to redefine America. To the extent that that has not dawned on you is disturbing. It's about the millions of lives that would be touched and, in some cases, saved by making private health insurance more secure and more affordable.
So at stake right now is not just our ability to solve this problem, but our ability to solve any problem. The American people want to know if it's still possible for Washington to look out for their interests and their future. They are waiting for us to act. They are waiting for you to raise the white flag. Do not pretent that you are acting with the interests of the American people. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership. I do not know how this plays politically, but I know it's right. (Applause.) And so I ask Congress to finish its work, and I look forward to signing this reform into law.
Thank you very much, everybody. Let's get it done. (Applause.) To my fellow Americans, we have to wait nearly 3 years before Obama runs for reelection. We have a lot of work to do to further weaken this far left President. It starts with the 2010 elections. Let's get it done (no applause expected)!!!
"It is the duty of every patriot to protect his country from its government." -- Thomas Paine
REMARKS BY THE PRESIDENT
ON HEALTH CARE REFORM
East Room
1:50 P.M. EST
THE PRESIDENT: Thank you so much, all of you, for joining us today. And I want to thank Julie, Barbara, Roland, Stephen, Renee, and Christopher, standing behind me -- physicians, physicians assistants, and nurses who understand how important it is for us to make much needed changes in our health care system. Thanks for coming even though you were hand picked to be there and applaud my comments!
I want to thank all of you who are here today. I want to specially recognize two people who have been working tirelessly on that -- on this effort, my Secretary of Health and Human Services, Kathleen Sebelius -- (applause) -- as well as our quarterback for health reform out of the White House, Nancy-Ann DeParle. (Applause.) You've made multiple revisions to my "Reform" bills. I would also like to thank the Republican Party and the American people. If it were not for their steadfast opposition of the prior versions of my "Reform" bills, I wouldn't be able to tout this bill
We began our push to reform health insurance last March, in this room, with doctors and nurses who know the system best. And so it’s fitting to be joined by all of you as we bring this journey to a close.
Last Thursday, I spent seven hours at a summit where Democrats and Republicans engaged in a public and very substantive discussion about health care. This meeting capped off a debate that began with a similar summit nearly one year ago. And since then, every idea has been put on the table. Every argument has been made. Everything there is to say about health care has been said -- (laughter) -- and just about everybody has said it. (Laughter.) So now is the time to make a decision about how to finally reform health care so that it works, not just for the insurance companies, but for America’s families and America’s businesses. I have to bash insurance companies because I think people hate insurers more than they hate me.
Now, where both sides say they agree is that the status quo is not working for the American people. Health insurance is becoming more expensive by the day. Families can’t afford it. Businesses can’t afford it. The federal government can’t afford it. Smaller businesses and individuals who don’t get coverage at work are squeezed especially hard. And insurance companies freely ration health care You talk about controlling costs, but that is what insurers do. You may not like it, but it's better than one of your czars deciding what is covered. based on who’s sick and who’s healthy; who can pay and who can’t. That's the status quo. That's the system we have right now. Bullshit! Per the "conservative" Washington Post, "Although polls have consistently shown that just over half of Americans think the health-care system is in need of reform, a substantial majority say they are satisfied with their own insurance and care."
Democrats and Republicans agree that this is a serious problem for America. And we agree that if we do nothing -– if we throw up our hands and walk away -– it’s a problem that will only grow worse. Nobody disputes that. More Americans will lose their family's health insurance if they switch jobs or lose their job. More small businesses will be forced to choose between health care and hiring. More insurance companies will deny people coverage who have preexisting conditions, or they'll drop people's coverage when they get sick and need it most. And the rising cost of Medicare and Medicaid will sink our government deeper and deeper and deeper into debt. On all of this we agree. So the question is, what do we do about it? So, he finally recognized that Medicare and Medicaid are sinking the government. Wasn't it that long ago, that Medicare and Medicaid expansions were the savior de jour for Obamacare?
On one end of the spectrum, there are some who've suggested scrapping our system of private insurance and replacing it with a government-run health care system. Yeah, that was you! And though many other countries have such a system, in America it would be neither practical nor realistic. Yeah, the Republicans and the American people taught you that lesson.
On the other end of the spectrum, there are those, and this includes most Republicans in Congress, who believe the answer is to loosen regulations on the insurance industry -- whether it's state consumer protections or minimum standards for the kind of insurance they can sell. The argument is, is that that will somehow lower costs. I disagree with that approach. I'm concerned that this would only give the insurance industry even freer rein to raise premiums and deny care. So, you recognize the fact that healthcare costs are rising, yet magically, insurance companies are not able to raise premiums? Do you think managed care companies are public utilities? There are few ways to control costs - ration care (you tried that and failed), institute price controls (you're going to try that with drug companies), or shift some of the burden of healthcare costs paid by healthcare consumers (currently 12-13 cents per dollar of hearlthcare spending). While that would be the best way to control costs, you know it would be a hard sell, so you ignore that option.
So I don't believe we should give government bureaucrats or insurance company bureaucrats more control over health care in America. I believe it's time to give the American people more control over their health care and their health insurance. I don't believe we can afford to leave life-and-death decisions about health care to the discretion of insurance company executives alone. I believe that doctors and nurses and physician assistants like the ones in this room should be free to decide what's best for their patients. Will this also apply to Medicare and Medicaid? If so, then seniors could get the virtual colonoscopies that Obama is allowed to get now, but Medicare will not allow seniors to have this option. You act like Medicare and Medicaid don't tell doctors, nurses and physician assistants what they can and cannot do?
Now, the proposal I put forward gives Americans more control over their health insurance and their health care by holding insurance companies more accountable. It builds on the current system where most Americans get their health insurance from their employer. If you like your plan, you can keep your plan. Heard that before. I'll reserve judgment until we see the bill. If you like your doctor, you can keep your doctor. Heard that before. I'll reserve judgment until we see the bill. I can tell you as the father of two young girls, I would not want any plan that interferes with the relationship between a family and their doctor. Yet, not too long ago you were advocating an entire government bureaucracy to do that very thing!
Essentially, my proposal would change three things about the current health care system. First, it would end the worst practices of insurance companies. No longer would they be able to deny your coverage because of a preexisting condition. Which, in isolation will drive up insurance premiums in the absence of an individual mandate. No longer would they be able to drop your coverage because you got sick. No longer would they be able to force you to pay unlimited amounts of money out of your own pocket. No longer would they be able to arbitrarily and massively raise premiums like Anthem Blue Cross recently tried to do in California Arbitrary? The Insurance Commissioner of California approved those rate increases as a result of rising costs incurred by Wellpoint -- up to 39 percent increases in one year in the individual market. Those practices would end.
Second, my proposal would give uninsured individuals and small business owners the same kind of choice of private health insurance that members of Congress get for themselves -- because if it’s good enough for members of Congress, it’s good enough for the people who pay their salaries. And yet, this is the first version of Obamacare to acknowledge this.
The reason federal employees get a good deal on health insurance is that we all participate in an insurance market where insurance companies give better coverage and better rates, because they get more customers. It's an idea that many Republicans have embraced in the past, before politics intruded.
And my proposal says that if you still can’t afford the insurance in this new marketplace, even though it's going to provide better deals for people than they can get right now in the individual marketplace, then we'll offer you tax credits to do so -- tax credits that add up to the largest middle-class tax cut for health care in history. After all, the wealthiest among us can already buy the best insurance there is, and the least well off are able to get coverage through Medicaid. So it's the middle class that gets squeezed, and that’s who we have to help.
Now, it is absolutely true that all of this will cost some money -- about $100 billion per year. $100 billion, that's "Walking around" money for Obama. But most of this comes from the nearly $2 trillion a year that America already spends on health care -- but a lot of it is not spent wisely. And who is to blame for this unwise spending? Patients? Doctors? Nurses? Physician Assistants? Your suggest you know better? A lot of that money is being wasted or spent badly. So within this plan, we’re going to make sure the dollars we spend go towards making insurance more affordable and more secure. We’re going to eliminate wasteful taxpayer subsidies that currently go to insurance and pharmaceutical companies; Will this be more industry taxes that will be passed on to the ultimate consumer? set a new fee on insurance companies that stand to gain a lot of money and a lot of profits as millions of Americans are able to buy insurance; and we're going to make sure that the wealthiest Americans pay their fair share on Medicare No downside to taxing the rich, so long as they are not members of the AFL-CIO, SEIU or UAW.
The bottom line is our proposal is paid for. And all the new money generated in this plan goes back to small businesses and middle-class families who can't afford health insurance. It would also lower prescription drug prices for seniors. Because the Pharmaceutical Industry thought it was better to offer that concession rather than risk the rath of the the Chicago Cosa Nostra. And it would help train new doctors and nurses and physician assistants to provide care for American families.
Finally, my proposal would bring down the cost of health care for millions -- families, businesses, and the federal government. We have now incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care --- ideas that go after the waste and abuse in our system, especially in programs like Medicare. But we do this while protecting Medicare benefits, and extending the financial stability of the program by nearly a decade. By ripping off "rich" beneficaries!
Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people's premiums and brings down our deficit by up to a trillion dollars over the next two decades -- brings down our deficit. We'll see what the CBO has to say. Those aren't my numbers; those are the savings determined by the Congressional Budget Office, which is the Washington acronym for the nonpartisan, independent referee of Congress in terms of how much stuff costs. Is he talking about the Senate Bill or this version?
So that's our proposal. This is where we've ended up. It's an approach that has been debated and changed and I believe improved over the last year. This is as close to a "Thank You" as our fellow "Obstructionists" will get. It incorporates the best ideas from Democrats and Republicans --- including some of the ideas that Republicans offered during the health care summit, like funding state grants on medical malpractice reform, and curbing waste and fraud and abuse in the health care system. My proposal also gets rid of many of the provisions that had no place in health care reform -- provisions that were more about winning individual votes in Congress than improving health care for all Americans. And you had nothing to do with those back room deals?
Now, despite all that we agree on and all the Republican ideas we've incorporated, many -- probably most -- Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies. And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I've put forward. A childish "I dare you."
Now, some also believe that we should, instead of doing what I'm proposing, pursue a piecemeal approach to health insurance reform, where we tinker around the edges of this challenge for the next few years. Even those who acknowledge the problem of the uninsured say we just can't afford to help them right now --- which is why the Republican proposal only covers 3 million uninsured Americans while we cover over 31 million.
The problem with that approach is that unless everyone has access to affordable coverage, you can't prevent insurance companies from denying coverage based on preexisting conditions; you can't limit the amount families are forced to pay out of their own pockets. The insurance reforms rest on everybody having access to coverage. And you also don't do anything about the fact that taxpayers currently end up subsidizing the uninsured when they're forced to go to the emergency room for care, to the tune of about a thousand bucks per family. You can't get those savings if those people are still going to the emergency room. So the fact is, health reform only works if you take care of all of these problems at once.
Now, both during and after last week's summit, Republicans in Congress insisted that the only acceptable course on health care reform is to start over. But given these honest and substantial differences between the parties about the need to regulate the insurance industry and the need to help millions of middle-class families get insurance, I don't see how another year of negotiations would help. Well the last year (against your will) has resulted in a better bill.
Moreover, the insurance companies aren't starting over. They're continuing to raise premiums and deny coverage as we speak. For us to start over now could simply lead to delay that could last for another decade, or even more. The American people, and the U.S. economy, just can't wait that long. A majority of American want your to either start over or scrap the effort alltogether, So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on health care reform. Excluding members of Organized labor, since when do you or Congress give a shit about the American people?
We have debated this issue thoroughly, not just for the past year but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of 60 votes. And now it deserves the same kind of up or down vote that was cast on welfare reform, that was cast on the Children's Health Insurance Program, that was used for COBRA health coverage for the unemployed, and, by the way, for both Bush tax cuts --- all of which had to pass Congress with nothing more than a simple majority. Have you forgotten all the times you labeled reconcilation as an "Abuse of Power?"
I, therefore, ask leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. (Applause.) And I urge every American who wants this reform to make their voice heard as well --- every family, every business, every patient, every doctor, every nurse, every physician’s assistant. Make your voice heard. What would you have the rest of us do?
This has been a long and wrenching debate. It has stoked great passions among the American people and their representatives. And that's because health care is a difficult issue. It is a complicated issue. If it was easy, it would have been solved long ago. As all of you know from experience, health care can literally be an issue of life or death. And as a result, it easily lends itself to demagoguery and political gamesmanship, and misrepresentation and misunderstanding. I think we would all agree that you are the king of "political gamesmanship, and misrepresentation and misunderstanding."
But that’s not an excuse for those of us who were sent here to lead. That's not an excuse for us to walk away. We can’t just give up because the politics are hard. I know there’s been a fascination, bordering on obsession, in this media town about what passing health insurance reform would mean for the next election and the one after that. How will this play? What will happen with the polls? I will leave it to others to sift through the politics, because that’s not what this is about. That’s not why we’re here. But it will be the reason you are sent packing!
This is about what reform would mean for the mother with breast cancer whose insurance company will finally have to pay for her chemotherapy. This is about what reform would mean for the small business owner who will no longer have to choose between hiring more workers or offering coverage to the employees she has. This is about what reform would mean for middle-class families who will be able to afford health insurance for the very first time in their lives and get a regular checkup once in a while, and have some security about their children if they get sick.
This is about what reform would mean for all those men and women I’ve met over the last few years who’ve been brave enough to share their stories. When we started our push for reform last year, I talked to a young mother in Wisconsin named Laura Klitzka. She has two young children. She thought she had beaten her breast cancer but then later discovered it had spread to her bones. She and her husband were working and had insurance, but their medical bills still landed them in debt. And now she spends time worrying about that debt when all she wants to do is spend time with her children and focus on getting well.
This should not happen in the United States of America. And it doesn’t have to. (Applause.)
In the end, that's what this debate is about. It's about what kind of country we want to be. The founding fathers have already defined what this country is. It's been that way for nearly 234 years. We don't need you to redefine America. To the extent that that has not dawned on you is disturbing. It's about the millions of lives that would be touched and, in some cases, saved by making private health insurance more secure and more affordable.
So at stake right now is not just our ability to solve this problem, but our ability to solve any problem. The American people want to know if it's still possible for Washington to look out for their interests and their future. They are waiting for us to act. They are waiting for you to raise the white flag. Do not pretent that you are acting with the interests of the American people. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership. I do not know how this plays politically, but I know it's right. (Applause.) And so I ask Congress to finish its work, and I look forward to signing this reform into law.
Thank you very much, everybody. Let's get it done. (Applause.) To my fellow Americans, we have to wait nearly 3 years before Obama runs for reelection. We have a lot of work to do to further weaken this far left President. It starts with the 2010 elections. Let's get it done (no applause expected)!!!
"It is the duty of every patriot to protect his country from its government." -- Thomas Paine
Tuesday, March 2, 2010
A modest (by his standards) proposal for Obamacare we can support
One of the biggest obstacles to Obama's preferred version of Health Care Reform is the push back from private, for profit entities. They correctly view Obamacare as a threat to their growth and profits. If they were not profit seeking entities focused on growing their businesses (an unfortunate necessity of shareholder owned entities), they could go along with the Presidents reform package. That's the rub; They are profit seeking and they have a duty to maximize the value of the company for the benefit of shareholders. To the extent that the profit motive stands between the healthcare products and services and patients in need, my modest proposal for the President is as follows. There are 173 Health Care companies in the S&P 1500 (500 Large Cap, 400 Mid Cap and 600 Small Cap companies). Of these 173 companies, 162 generate profits. In fact, the total profits of these 162 companies is $115.6 billion dollars. The market capitalization of these companies is $1.4 trillion. I would think that Mr. Obama could buy all of these companies if he offered a healthy premium of 20%. Now, spending $1.7 trillion is a lot of money, but I'm sure Uncle Ben could order some more paper and ink. Now, with the profit motive no longer serving as an obstacle to getting the health care products and services to those who need them, it would seem like the stars would be aligned for Progressive nirvana. Just think of the things the government could do with complete ownership of the Health Care complex. They could:
- Stop seeking approval of products that have no proven clinical benefits
- No more needless tests and procedures
- No uncompensated care
- Use comparative research to decide what products to sell and which to kill
- Cut compensation of the government officials running these entities
- You could immediately eliminate direct-to-consumer advertising
- You could eliminate your sales force, as you would be selling products to yourself
- You could lower, if not eliminate price increases for your products and services
- In fact, you could sell your products at cost!
- You could eliminate the cost and distractions of patent challenges, as you own everybody
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