Line by Line Analysis of President Obama’s Healthcare Speech

I didn’t watch President Obama’s speech on health care for a very simple reason. The President is an enormously gifted rhetorician (not just a speechmaker) and he uses imagery, timing and delivery as well as or better than most modern presidents. In my opinion, only JFK and Reagan in recent times at communicating their ideas. (Note, I’m not talking about their policies and I despised Reagan’s intensely). Then there are the powerful TV images of our politicians gathered together in our beautiful national capital. All of these things sway one’s mind. I am seeking a more logical and dispassionate reading of the President’s speech to see what it portends for our country. I’m taking his speech word for word, line by line, paragraph by paragraph as presented on the New York Times website which presumably got it from the Office of the President. I’m also a lawyer so this fits in nicely with my training.To make it easy, I’ll stipulate the pages on the New York Times website and I’ll bold or blockquote (for longer passages) the President’s words.PAGE 1

:"When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month."

Fair enough, but Obama set himself up for the obvious rejoinder: has the situation really brightened that much? However, the President nimbly notes this in the next paragraph with this:

we are by no means out of the woods. A full and vibrant recovery is many months away. And I will not let up until those Americans who seek jobs can find them; until those businesses that seek capital and credit can thrive; until all responsible homeowners can stay in their homes.

Ah, yet more promises.

But thanks to the bold and decisive action we have taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink.

The reality that this ignores is that the country is slipping more and more into two societies: those with jobs, those without (or underemployed); those with health care, those without; those above the poverty line, those below (and increasing each year). For millions, we are already at "the brink" or beyond. The quotation also ignores the fact that many leading economists think the action was not bold enough (a good overall criticism of this administration).

A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point.

A nice tribute to Dingell by the President (who is an excellent politician) but it also underlines exactly how divisive this issue has been and why strong leadership is required.

Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer.

Obama segues from a very poorly laid call for the basic human need to provide health care to everyone (not articulated much at all in this speech; no moral basis laid) to insurance. Here is the tell-tale hint that what follows will be mostly about insurance and insurance reform and NOT health care reform.

We are the only advanced democracy on Earth – the only wealthy nation – that allows such hardships for millions of its people.

A nice but VERY vague statement. It may appear at first glance that Obama is talking about the moral imperative to provide health care reform to all: but what he really is talking about is the need for all to have insurance (given the placement of this statement which next talks about "coverage") which is a far different thing.

But the problem that plagues the health care system is not just a problem of the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you’ll lose your health insurance too.

This section shows why it is really necessary to READ Obama’s speeches in addition to or instead of watching them. It appears, once again with "the problem that plagues the health care system" that he is talking again about a larger moral imperative but HE IS NOT. Rather than building a strong moral basis for this, he again talks about: insurance.

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn’t reported gallstones…

First of two examples (without giving names; very impersonal here and not very effective, in my opinion) of the breakdown in the present INSURANCE system. NO EXAMPLES at all given of the need for the country, as the richest nation on the earth, to provide as a matter of course, health care to all. Again, everything is couched in terms of insurance reform. PAGE 2:

Then there’s the problem of rising costs. We spend one-and-a-half times more per person on health care than any other country, but we aren’t any healthier for it.

Obama quickly shifts to cost (which he spends more time on than human suffering by far).

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined.

More verbiage on costs and what it means to taxpayers. And a very ominous link between costs (an obvious evil) and "skyrocketing costs" of Medicare and Medicaid. Frankly, I find this appalling talk and at the age of 63, very threatening too. To me, it seems Obama is much more concerned about cost than health care treatment for all. This speech has little if no heart in it.

Put simply, our health care problem is our deficit problem. Nothing else even comes close.

Wrong, completely wrong. No mention of interest on past debts, no mention of the huge military-industrial debt and the ongoing wars that have cost trillions, no mention of bailouts to Wall St. and the banks that in the past year dwarf spending on health care. A very simplistic and misleading analysis here.

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s, where we would severely restrict the private insurance market and have the government provide coverage for everyone.

On the left? Does that make everyone in Canada a leftist? Very dismissive and misleading talk about single payer which it is clear the Obama administration never considered and NEVER WILL.

On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

An equally dismissive and simplistic painting of the "right". And obviously, Obama intends to PORTRAY himself as a centrist by demonizing both sides (but in reality, his plan seems to me to be REACTIONARY: that is, it furthers and even strengthens the hold of insurance companies on coverage as we will later see). Obama has a knack at portraying himself as a centrist when this plan will do much to enrich insurance and drug companies.

But either one ["left" or "right"] would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn’t,

Again, hugely simplistic and completely dismissive of single payer. It doesn’t work elsewhere ("it makes more sense to build on what works")–I guess he hasn’t heard about Medicare or about the UK system? Would not this plan too "disrupt" what currently exists? And if the system is as broken as he said it is, why not have a completely different approach? Neither logical or historically accurate.

During that time, we have seen Washington at its best and its worst.

True. But more worst than best, true? Note again that Obama sets everything up in terms of dichotomies: right vs. left, best vs. worst, "reform" vs. no change. This is very simplistic and misleading but allows him to come in as our savior and his false claim that he represents the center.

And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

Sorry, Mr. President, 80%? And what is the goal here: 100% agreement? You don’t need that, you need only a majority of votes (some might argue 60%).

Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.

More bad analysis and more false dichotomies (charges vs. countercharges, ideological camps). A complete failure by this President to understand there is a widespread disagreement on this issue. He also portrays those who disagree as "unyielding" as "scare tactics" and as "robbers". Obviously, Obama wants compromise and those who do not compromise are bad guys. To him, the Progressives are the worst because they stand for something.

Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.

Nice sounding fight words but what’s the fight for? It’s for compromise. It’s for more profits for big drug and insurance companies. This also ignores the political reality: the GOP does NOT HAVE to compromise, has NOT compromised and likely will not in the future.

The plan I’m announcing tonight would meet three basic goals:It will provide more security and stability to those who have health insurance. It will provide insurance to those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government.

A horrible way to introduce a plan. He did it in cold, bureaucratic, calculating "cost" terms like an insurance salesman would. And what is the plan: insurance based.

Here are the details that every American needs to know about this plan:

Very slippery statement. Not–"here are the details of my plan"– but here "are the details that EVERY AMERICAN NEEDS TO KNOW ABOUT this plan."And who judges that? Well, let’s see how detailed this is.PAGE 3:

First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

Fair and simple but is it true and accurate? Many of these plans are provided by employers and with a change in the system, there may be a change in coverage too. Here’s how one analysist looks at this:

OBAMA: "Nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: Nothing in our plan requires you to change what you have."THE FACTS: That’s correct, as far as it goes. But neither can the plan guarantee that people can keep their current coverage. Employers sponsor coverage for most families, and they’d be free to change their health plans in ways that workers may not like, or drop insurance altogether. The Congressional Budget Office analyzed the health care bill written by House Democrats and said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it.In the past Obama repeatedly said, "If you like your health care plan, you’ll be able to keep your health care plan, period." Now he’s stopping short of that unconditional guarantee by saying nothing in the plan "requires" any change.He’s dropped the "period."

SOURCE: http://hosted.ap.org/dynamic/stories/U/US_HEALTH_CARE_FACT_CHECK?SITE=WIMIL&SECTION=HOME&TEMPLATE=DEFAULTBack to the President:

And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

Sounds nice and plays into Obama’s overall cost-cutting theme. But is it true? Who’s going to be paying for these tests, and are they limited to "breast cancer and colon cancer"? What about dental exams? What about prostrate cancer exams? What about overall general health exams with follow-ups? Are these in the Obama plan? Again, very short on specifics and long on assurances. Here’s an analysis of this that demolishes the cost-cutting argument put forth by Obama:

OBAMA: Requiring insurance companies to cover preventive care like mammograms and colonoscopies "makes sense, it saves money, and it saves lives."The facts: Studies have shown that much preventive care – particularly tests like the ones Obama mentions – actually costs money instead of saving it. That’s because detecting acute diseases like breast cancer in their early stages involves testing many people who would never end up developing the disease. The costs of a large number of tests, even if they’re relatively cheap, will outweigh the costs of caring for the minority of people who would have ended up getting sick without the testing.The Congressional Budget Office wrote in August: "The evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall."That doesn’t mean preventive care doesn’t make sense or save lives. It just doesn’t save money.

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_CARE_FACT_CHECK?SITE=WIMIL&SECTION=HOME&TEMPLATE=DEFAULTBack to the President:

Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers.

Very little detail provided about this insurance exchange: who will run and regulate it? Won’t that cost money too? Will it be done on a national level? What happens to state insurance commissioners? And might this not be a step backward (since some states really do have good plans now?)? Ah, but look at this: insurance companies will have a crack at "millions of new customers." Here’s why I think this plan is REACTIONARY: it looks back, to a failed insurance industry and wants to expand it. It is an ahistorical approach that fails to come to grips with the FACT that the marketplace has failed and that the institution of insurance does not benefit the society as a whole.

This is how large companies and government employees get affordable insurance. It’s how everyone in this Congress gets affordable insurance.

Sorry Mr. President but you’re completely wrong. All 565 members of Congress get "affordable insurance" because they lump together? No, they get it because they want it and the politicians have rewarded themselves with the best coverage available at the lowest cost (like they should for the public at large). Here the President ignores the reality that single payer does work, it works for people in the government.

For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need.

No details provided at all.

And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned.

That would be denial of coverage for preexisting conditions. He talks in plurals ("protections") but in fact has listed only one protection. But what other details? And who/what is going to oversee insurance company compliance? What if any, will the penalties be for noncompliance? Max Baucus will set the penalties?

This exchange will take effect in four years, which will give us time to do it right.

NOTE: This is so outrageous I bolded it. In other words, no real change for 4 years making nothing effective, no change until 2014 (well after the President’s relection campaign is over). Translation: Nothing happens until I’m outta here. And why does it take 4 years to do this, to "do it right"? Medicare could be extended now, it’s simple and it’s affordable. It could be done in STAGES for the timid.

In the meantime, for those Americans who can’t get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it’s a good idea now, and we should embrace it.

Very short on specifics. Where is the line drawn? What does "low-cost" mean here? What does "if you become seriously ill" and what an odd placement of this phrase for a lawyer. And John McCain’s ideas are the "change we believe in"? PAGE 4:

That’s why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance.

A complete flip-flop from Obama embracing a position he campaigned against. I guess he forgot all the reasons he adduced to rebut Hillary who had made this argument hers. Here’s some analysis of Obama’s 180 degree change on this:

In his speech, Obama endorsed mandatory coverage for individuals, an approach he did not embrace as a candidate.He proposed during the campaign – as he does now – that larger businesses be required to offer insurance to workers or else pay into a fund. But he rejected the idea of requiring individuals to obtain insurance. He said people would get insurance without being forced to do so by the law, if coverage were made affordable. And he repeatedly criticized his Democratic primary rival, Hillary Rodham Clinton, for proposing to mandate coverage."To force people to get health insurance, you’ve got to have a very harsh penalty," he said in a February 2008 debate.Now, he says, "individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance."

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_CARE_FACT_CHECK?SITE=WIMIL&SECTION=HOME&TEMPLATE=DEFAULTYet another indicator that the president will say and do anything, that promises really don’t seem to mean much to him.

While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined:

The understatement of the century about details but now he claims "a broad consensus" while a minute ago it was 80%. And if the "broad consensus" exists why so much opposition? Why put everything off for 4 years?

The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.

Including some of the politicians that you mention warmly in this speech (like Grassly).

And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

I guess health "insurance" reform doesn’t extend to "deviants" who might need abortions. Yet another capitulation to the right-wing and what a horrible way to frame this argument. Here Obama politicizes health care.

So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies.

And how exactly will this bill stimulate more insurance competition? Will Joe Blow tomorrow be able to compete with Prudential? The president doesn’t seem to get that consolidation in insurance is the watchword (as it is in banking, airlines, newspapers etc.). A completely myopic read on the American economy.

Insurance executives don’t do this because they are bad people.

Oh really? Where have you been Mr. President? Have you seen Sicko? What about those two examples of denial of coverage you gave in page 1? Again you see things in false dichotomies: good people vs. bad people. Could it be that the entire insurance business, based as it is on profits, leads to people acting in selfish "bad" ways? And isn’t that a great reason for abandoning (and not embracing) an insurance based system of health care?

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable.

Obviously true. And insurance companies have been Rahm’s good friend, and provide money to Blue Dog Democrats and to the administration. What would your good friends Max Baucus and Tom Daschle do without them?

But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

Obama approaches the public option as if it was venereal disease. Why only 5% when polls show more than 50% of the people support it. This number also doesn’t square with Obama’s 30% or so without insurance–wouldn’t they also naturally turn to the public option? Obviously, Obama pulled this number out of a hat.PAGE 5:

Despite all this, the insurance companies and their allies don’t like this idea. They argue that these private companies can’t fairly compete with the government. And they’d be right if taxpayers were subsidizing this public insurance option. But they won’t be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers.

Wrong analysis, Mr. President. Insurance companies and their allies oppose a public option because it will show they are no longer necessary. A good public option will force them from the field. And very short on specifics on finance. If the present system is so wasteful, why not scrap it?

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight.

Wow! What a dismissive statement, "it’s worth noting" that your administration has done nothing to bolster this.

To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it.

A patronizing and false statement. Progressives’ goals have been to extend health coverage (not insurance coverage) to all. It is not only clear that Obama is not a progressive, he does not understand what progressives stand for or their history.

The public option is only a means to that end [make coverage affordable] – and we should remain open to other ideas that accomplish our ultimate goal. And we should remain open to other ideas that accomplish our ultimate goal.

Ugh! The watered down public option is seen only in terms of insurance coverage. And Obama’s "ultimate goal" is unclear. It should be affordable health care for all but this is not something Obama talks about, for him it’s all about insurance reform.

And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

More evidence that the president is not reality-based and clings to the false hope of bipartisanship.

But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

Pure political pap. In legal terms, an unenforceable promise. And given Obama’s history with promises, what’s it really worth?

Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for – from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.

But you added to the deficit with a $2 trillion bailout of banks and Wall St. and by expanding the wars. Notice Obama is not holding health care reform to the same standards as the defense budget, which he has never questioned, ever.

Second, we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse.

Pure pie-in-the-sky. And if the present system is so wasteful, why not scrap it?

That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.

Fine, but why not an outright pledge that benefits will not be reduced too?PAGE 6:

And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

And on the 7th day… . A biblical ring here but what bullshit! After all, such a commission would cost money too! Or will these people serve gratus?

Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody.

Coming after a pledge to "protect Medicare" this sounds ominous.

We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system – everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.

A sales pitch for coops without using the term? They haven’t worked, Mr. President, do your homework.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.

Even scarier. Hold on to your benefits, Seniors!

Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers.

An admission that this plan is a bonanza for insurance & drug companies. And just imagine how hefty the fees Max Baucu$ & friends are likely to impose. And this idea furthers the powers of lobbyists like Tom Da$chle. Kosacks, if you cannot see that the Obama "plan" is a sellout to the powers that be, you need new glasses.

Finally, many in this chamber – particularly on the Republican side of the aisle – have long insisted that reforming our medical malpractice laws can help bring down the cost of health care.

Tort reform? Now the question is not whether Obama is a Progressive, it’s whether he’s a Democrat. Here Obama is embracing McCain’s brand of right-wing Republicanism, again.NOTE: This post was written in a slightly different form earlier as a diary over at DailyKos. Page references and text are to New York Times publication on their website:http://www.nytimes.com/2009/09/10/us/politics/10obama.text.html?pagewanted=7&_r=1

Obama’s view of where the United States belongs

Per President Obama:

We are the only advanced democracy on Earth – the only wealthy nation – that allows such hardships for millions of its people. There are now more than thirty million American citizens who cannot get coverage. In just a two year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.

Veterans and those over 65 are the only Americans who can be sure they have health insurance.

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s, where we would severely restrict the private insurance market and have the government provide coverage for everyone.

Which is the way of the other advanced democracies.

On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

Which is the way of the third world.

I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.

According to its bipartisan centrist president, the United States is and belongs somewhere in the center between these two "radical shifts."

We will miss you Palmetto State.
You and your delicious Charleston Chews

Don’t say you weren’t warned, bitchez

Tonight while leading Congress in a rousing sing-a-long of "I am stuck on Big Insurance, because Big Insurance is stuck on me" President Obama Selassie was interrupted by South Carolina Congressman Joe Wilson who yelled "You lie" and then totally ran out of the place when Obama started going "Who said that? Who said that? I pity the fool…" and all of the other Congressmen and Senators were all "Ooooooooo, muthafucka goin’ down".

We’ve never heard of South Carolina’s Joe Wilson, but since we already know who the South of the Border humper, closeted  gay guy, really closeted gay guy, and the cum slut are, we assume that Wilson must be the double-wetsuit & dildo ensemble guy. Or maybe a furry; we’re not sure. But since all  of the politicians in South Carolina have some kind of secret kink, we’re pretty sure that Wilson’s is fairly disgusting and involves either dead animals or live libertarians.

Not that it makes any difference since Obama had Wilson disappeared (screen cap below)

screen-shot-2009-09-09-at-95215-pm.jpg

….and then he renamed the state Vanjonesland.

Um. All you white people? You need to be out by Saturday.

Sorry.

Obama States Overhead Advantage of Public Option is Key to Choice and Competition

There’s no competition in the health insurance marketplace without a public plan, president Obama implied in his address to the joint session of Congress this evening.

The key to there being competition is the White House reform measure to introduce a public insurance plan with projected enrollments of under 5% of the population — well-short of Jacob Hacker’s estimates. (Even though every citizen would be mandated to buy health insurance, the public plan would an option among several Hobson’s choices in the private insurance not-so-free market.)

The president said that the public plan would maintain a low administrative overhead, presumably modeled after Medicare. From the speech:

Despite all this, the insurance companies and their allies don’t like this idea. They argue that these private companies can’t fairly compete with the government, and they’d be right if taxpayers were subsidizing this public insurance option, but they won’t be. I’ve insisted that, like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums its collects.

But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers and would also keep pressure on private insurers to keep their policies affordable and treat their customers better

As a corollary, without this public plan, competition in the multi-payer marketplace would be unsustainable — as it is today through segmentation, oligarchy, price-fixing, etc. Since, at the moment, there’s no public plan of the type envisioned by the White House, we may safely assume there is currently no competition in the health insurance marketplace.

It should be pointed out the administrative cost of Medicare was not brought up in the speech, but it seemed the perfect example in this country of the gold standard. In Kip Sullivan’s Bait and Switch public option article of last July, it was noted in passing,

Medicare is the nation’s largest health insurance program, public or private. It pays doctors and hospitals about 20 percent less than the insurance industry does, and its administrative costs account for only 2 percent of its expenditures compared with 20 percent for the insurance industry.

It’s a shame the president didn’t point these things out while he had the chance, but there it is.

As we saw earlier, the president said in his speech that the public plan would be self-sufficient and (quite unlike warmaking and banking bailouts) deficit neutral as part of the overall reform package. At another point, reassuring the elderly, needlessly alarmed by the wingnuttery mob, Medicare was deemed by Obama a sacred trust as long as he could help it. If only the proposed public plan were so lucky as to be in such good graces.

What follows is the portion of the president’s speech related to this topic.

And one more misunderstanding I want to clear up: under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

Now, my health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system.

Now, as proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly sponsored insurance option, administered by the government, just like Medicaid or Medicare.

So let me set the record straight here.

My guiding principle is, and always has been, that consumers do better when there’s choice and competition. That’s how the market works.

Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company.

And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly — by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates.

Insurance executives don’t do this because they’re bad people. They do it because it’s profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it.

All of this is in service of meeting what this former executive called "Wall Street’s relentless profit expectations."

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service and employ a lot of our friends and neighbors. I just want to hold them accountable.

And the insurance reforms that I’ve already mentioned would do just that, but an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange.

Now, let me — let me be clear.

Let me be clear, it would only be an option for those who don’t have insurance. No one would be forced to choose it and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

Despite all this, the insurance companies and their allies don’t like this idea. They argue that these private companies can’t fairly compete with the government, and they’d be right if taxpayers were subsidizing this public insurance option, but they won’t be. I’ve insisted that, like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums its collects.

But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers and would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

Now, it is…

It’s — it’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated by the left or the right or the media. It is only one part of my plan, and shouldn’t be used as a handy excuse for the usual Washington ideological battles.

To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it.

The public option — the public option is only a means to that end, and we should remain open to other ideas that accomplish our ultimate goal.

And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example — for example, some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others have proposed a co-op or another nonprofit entity to administer the plan.

These are all constructive ideas worth exploring. But I will not back down on the basic principle that, if Americans can’t find affordable coverage, we will provide you with a choice.

And — and I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

Can someone, anyone, explain why the President described health insurance companies as providing a “legitimate service?”

What "legitimate service" do these rent-seeking bloodsuckers provide?

If the risk spreading function is what is being referenced, the government does that job far better and cheaper. Certainly that function is not worth 35% profit as health insurers currently enjoy.

Why was it necessary for Barry to slurp these market manipulating monopolists?

I get the need to reward pharmaceutical companies when (but only when) they risk hundreds of millions of dollars to find a cure or treatment for some malady. (I intend to omit drug companies who game the patent laws by, e.g. adding an antacid to highblodd pressure medicine) Same for the medical devise companies and the health care providers who pay tuition and spend years learning their craft.

But what in hell do health insurers do to improve the efficacy of healthcare that entitles them to a 35% profit?

Somebody, anybody, Bueller? [crickets]

Rep. Joe Wilson yells "You Lie" at the President during address to Congress

This low-clash trashy behavior of Rep. Joe Wilson (R-SC)  during tonight's address is outlandish. While the President was dispelling the  lies by the right regarding whether undocumented people in this country would be  covered under health reform (they are not), Wilson took it upon himself to  scream out:

"YOU LIE"

…at the President of the United States. You can let your feelings be known  about Wilson's behavior by doing this:

petition @CongJoeWilson to apologize  for yelling "LIAR" during Obama speech, and lying about #hcr http://act.ly/iq RT to sign #p2

Even better than that — drop some scratch in the kitty for his opponent Rob Miller at Act Blue: http://www.actblue.com/entity/fundraisers/19079

You should check out the Wikipedia entry for Wilson before it is edited again:

The other Bush-league behavior seen in the chambers was by Eric Cantor, who  texted while sitting in the front row in full view of cameras for the entire  speech. One has to wonder why he couldn't for one damn hour, put the  thing away. I was wondering if he was fervently texting about adulterous  spanking, dripping, sex.

UPDATE: John McCain on CNN called for Wilson to "apologize immediately." So what does the rest of the GOP leadership have to say? And does censure await Wilson?

THE APOLOGY, from CNN’s Politicker: GOP Rep. Joe Wilson of South Carolina issued a statement Wednesday night apologizing for his outburst during President Obama’s speech to Congress:    

“This evening I let my emotions get the best of me when listening to the President’s remarks regarding the coverage of illegal immigrants in the health care bill. While I disagree with the President’s statement, my comments were inappropriate and regrettable. I extend sincere apologies to the President for this lack of civility.”

See if his behavior qualifies for censure…below the fold.

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Beware of the Public Cost Option

Today, RE a public option, Obama said to Congress:
"Let me be clear – it would only be an option for those who don’t have insurance."

And then later, to downplay its importance:
"To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal."

What about prices charged by insurance companies? Aside from a rehashed argument about price competition, there’s no mention of how or why a health insurance company would be motivated to lower the price of anything.

But wouldn’t a public option force private insurance to compete with lower prices? Maybe it would somewhat; but why would they want to? As they say, the truth is in the details.

If a public option is only an option for the un-insured, the next question is who are these un-insured people? They’re probably an assorted combination, not only of people who can’t afford insurance in the first place, but also those driven out of the insurance marketplace by having to pay out-of-pocket, for procedures that coverage was denied for.

What happens if these people become the dominant customer base of the public option? It seems likely that this customer base would overall, be a higher overhead cost group than the public at large. Correspondingly then, the private insured group would be a lower overhead cost group.

In other words, depending on the final form of passed legislation, it’s possible to end up with a scenario where insurance companies are able to keep their lower-overhead/higher-profit customers, and dump the higher-overhead/lower-profit customers on the government’s public option.

If this came to pass, it would essentially amount to government subsidized profit for private insurance companies.

Personally I would prefer single payer. But as that seems to be virtually off the table at the moment, the un-insured really need a health coverage option. A public option would be arguably the best way to provide it for them.

However, I think we should beware of the kind of public option that ignores any requirement for private companies to provide more affordable insurance. This along with outright denial of coverage, should never be off the table.

A Brief History of Communism, from Race Mixing to the Public Option

little_rock_integration_protest-small.jpgThis bit of hypocrisy shouldn’t surprise anyone:

A Texas school which refused to air President Barack Obama’s live classroom address is planning to bus students to see the president.

Did school officials reverse course after realizing Obama’s speech wasn’t political, as conservatives had claimed?

Nope. They’re sending fifth graders to see another president: former President George W. Bush, and his wife, Laura. Bush is speaking alongside several Dallas Cowboys players and prominent Texas business leaders.

The people who pushed to censor President Obama’s speech, and who habitually call him a Communist or Socialist (and who call the public option "communism") are not only the same ones who approve of Bush and Reagan speaking to our kids, they (or their parents) were running around in the 1960s calling Dr. Martin Luther King Jr. a Commie, and holding up signs at anti-civil-rights protests that read "RACE MIXING IS COMMUNISM".

Oh, you say, that was forty-plus years ago! Surely nobody exists today who believes that?!

Why, yes they do, and as Lean Left points out, they write for "respectable" conservative magazines like the National Review, and emit (as Lisa Schiffren did back in 2008) things like this concerning President Obama’s white mother and black father: (more…)