As we watch …
The Night of A Million Zillion Slowly Clapping Congress-critters.
Watching CSPAN. Cannot stand the media talking heads elsewhere.
Interesting start to the speech, to address the economy.
Serious looks. Obama has his business face on.
“I am not the first president to take up this cause, but I am determined to be the last.” I hope that’s a good thing.
Invoking TR. Nice.
Huzzahs and standing ovations. Okay, guys, we don’t want to watch you.
The burden on the uninsured. Middle-class Americans. Can’t get it on the job. Can’t afford their own. Previous illnesses or conditions. “The only advanced democracy on Earth, the only wealthy nation, that allows such hardship on its people.”
“It can happen to anyone.”
“Those who do have insurance have had less security than they do today.” Changing jobs. Insurance companies dropping coverage or bumping up payments. Rescision.
Standard litany of horror stories.
“And no one should be treated that way in the United States of America.”
Rising costs. We spend 1.5x more per person on HC than any other company. Premiums rising 3x faster than wages. Employers dropping coverage or passing on costs. American businesses cannot compete. And hidden / growing tax on people with insurance to take care of charitable / ER care. Pressure on Medicare / Medicaid.
“Our health care problem *is* our deficit problem.”
Nobody disputes the facts. We know we must reform. How?
On the Left – the only way is through a Single Payer System like Canada. On the Right, end employer-based and leave individuals to buy on their own. Arguments to be made for both approaches — but either would be a radical shift that would disrupt most folks health care. It makes more sense to build on what works, and fix what doesn’t, then to build a new system from scratch.
Washington at its best … and its worst. We’ve never come so far before. Supported by doctors, nurses, even insurance companies. Agreement on about 80% on what needs to be done. We are close.
But we’ve also seen partisan spectacle. Scare tactics. Unyielding ideological camps. Scoring short-term political points. Charges, counter-charges, confusion.
“The time for bickering is over. The time for games has passed. Now is the season for action.”
Now is the time to deliver on Health Care.
Three basic goals:
- More stability and security to those with insurance
- Provide insurance for those who don’t.
- Slow the growth of HC costs.
Everyone takes responsibility, including employers and individuals. Senators and Congressmen, Dems and GOP.
One: More stability and security. If you have health insurance through your job, etc., nothing will require you to change coverage or your doctor. Against the law to deny coverage for a pre-existing condition. (standing ovation) Against the law to drop or water down coverage when you are sick. No arbitrary cap on annual or lifetime coverage. Limit on out-of-pocket expenses. “In the United States of America, no one should go broke because they get sick.” And insurance companies will be required to cover check-ups and preventive care.
Two: Quality, affordable choices for those without insurance. If you lose/change job you can get coverage. New businesses, too. Insurance exchange. That’s how big companies, the government, and Congress get affordable insurance. If anyone still can’t afford – tax credits. Exchange will take effect in 4 years. For those without insurance today, immediately offer catastrophic insurance now (as McCain suggested). Some might want to go without coverage, or companies that want to duck giving insurance. But that costs everyone money – we all pick up the tab (and give them an unfair advantage), and it prevents the other reforms. So individuals will be required to carry basic HC coverage, just like states require you to have car insurance, and businesses will be required to offer HC or chip in to help cover. Hardship waver, and 95% of small businesses will be exempt because of that — but large businesses and those who can afford can’t be allowed to game the system. Only if everyone does their part.
Significant details to work out (group chuckle) … we can do consumer protection, exchange, requirement to buy coverage.
Given all the mis-information of the past few months, folks are nervous.
Bogus claims from those who want to kill reform. Claims by talk show hosts and politicians, that we’re going to have bureaucratic panels killing people. “It is a lie, plain and simple.” (S/O from the Dems, GOP stays seated.)
Illegal immigrants. “This, too, is false.” Someone shouts “Lie.” Boos.
No federal dollars used to fund abortions. Federal conscience laws remain in place.
Government takeover of the health care system. They point to the “public option.” Guiding principle is consumers do better in cases of choice and competition — “that’s how the market works.” But in 34 states, most of the market is controlled by only a few or one company. No competition. Cherry-picking. Overcharging those without leverage, and jacking up rates. They do it because it’s profitable. Insurance companies are rewarded for doing so by Wall Street. No interest in putting insurance companies out of business — we just want to hold them accountable.
Insurance reforms mentioned to that. But an additional step we can take is to have a not-for-profit public option in the insurance exchange. (wild huzzahs) It would only be an option for those w/o insurance, and nobody would be forced to choose it. CBO, less than 5% of Americans would sign up. Insurance companies claim they can’t compete — but taxpayers will not be subsidizing. The public option would have to be self-sufficient, but by avoiding profit overhead, it could provide a deal for consumers, and give pressure to insurance companies, just like public universities.
A strong majority of Americans still back the public option. But it shouldn’t be exagerrated by the left, right, or center. It’s only one part of the plan, not the whole thing. Progressives — the drive is to make sure that all have insurance that is not abusive; the PO is a means to that end, and we should remain open to all options. To GOP — rather than making wild claims, let’s work together to address any legit concerns you have.
Trigger? Co-op? Explore the ideas. But must not back down that if Americans can’t get affordable coverage, they will be provided with a choice.
(GOP pointedly stays seated)
I will make sure no government OR insurance company bureaucrat gets between you and teh care you need. (s/o)
Issue of concern to all: how we pay.
Will not sign a plan that “adds one dime” to deficits, now or in the future. (Repeats.) Will require spending cuts if savings don’t materialize. Too many initiatives “have NOT been paid for in the past, from the Iraq War to tax breaks for the wealthy.”
Estimated that most of plan can be paid for with savings in current system. Waste and abuse. To much spending on stuff that doesn’t make us healthier. Also true in Medicare and Medicaid.
Medicare another issue of demagoguery and distortion. Four decades ago. It remains a sacred trust between generations. Not a dollar of the trust fund will go to this — the only thing this plan would eliminate is waste / fraud / subsidies in Medicare that only pad insurance company profits. Independent commission of doctors and experts to find more waste in years ahead. Seniors will get the benefits they are promised, and Medicare will be there in the future — plus cover gaps in prescription drugs. “Don’t pay attention to the scary stories … esp. since some of these folks have in the past have been against Medicare itself” or have tried to turn it into a privitized system.
Because Medicare is a big part of the HC system, making it more efficient, we can save lots of money and can adopt common sense ideas that Medicare regions have developed. That will pay for most of this plan. Much of the rest — revenues from the same drug and insurance companies that will benefit from millions of new customers.
Many in the chamber have insisted malpractice reform can bring down the cost. (partial s/o from GOP). It’s not a silver bullet, and defensive medicine may be adding to some costs. So let’s move forward with ideas on patient safety first and let doctors practice medicine. Bush wanted pilot programs — HHS will move forward on that today.
Plan will cost $900B over 10 years. Less than Iran/Afghan wars, and less than Dubya’s tax cuts for the wealthiest Americans. Most costs will be paid for by efficiencies — if we can slow HC costs 1/10%, will reduce the deficit by $12T.
Will continue to seek common ground. Come to me with serious proposals — I will be there to listen. BUT KNOW THIS – “I will not waste time on those who have made the calculation that it is better politics to kill this plan than to improve it.” If you misrepresent what’s in the plan, we will call you out. I will not accept the status quo as a solution.
Everyone in this room knows what will happen if we do nothing. Deficits grow, more families and businesses bankrupt. People will lose coverage, and will die. We cannot fail because too many are counting on us.
Appeal to Kennedy. “A moral issue … fundamental principles of social justice and the character of our country.” Our self-reliance, and our healthy skepticism of government — and rigorous even angry debate over the appropriate size of government. Some Kennedy critics found his passions an affront to American liberty — but folks who worked him knew that what drove him was something more — Hatch, McCain, Grassley, folks he worked with — Kennedy’s passion was not ideological, but his own experience of children stricken with cancer, imagining what it was like for those without insurance. That is not a partisan feeling. Part of the American character — standing in others shoes, lending a helping hand — security and fair play, and sometimes government has to step in to deliver on that promise.
In 1935, Social Security did not lead to socialism. In 1965, Medicare did not mean a government takeover of health care. Our predecessors understood that government cannot solve every problem … but the danger of too much government is matched by the perils of too little. Markets crash, monopolies, vulnerable exploited. When facts and reason are thrown overboard and we cannot engage in a civil conversation over the things that matter, we lose something essential about ourselves.
Debate has been difficult. People skeptical that govt looking for them. Safe to kick the can down the road another year, term, election. Not what this moment calls for. We did not come here to fear the future, we came here to shape it. We can act, even when it’s hard. We can replace acrimony with civility, and gridlock with progress. We can do great things, and here and now we will meet history’s test, because that is our calling. That is our character.