Motley Moose – Archive

Since 2008 – Progress Through Politics

Health Care Reform the Obama Way – The Real ObamaCare

The dog days of August have long been known as “the silly season” in the media. Most people are busy enjoying the summer and the media has to stretch to find stories of interest. This is the time for “man bites dog” stories. It has been this way in this country for a long time.

Tonight, the silly season officially came to an end.

Anyone who is not blinded by hatred or ideology will admit that Barack Obama is one of the most skilled political orators to ever hold the office of President of the United States. He reaffirmed that status in a speech tonight to the joint houses of Congress.

The timing of the speech couldn’t have been better. During August, the health care debate seemed to be reaching an impasse. Opponents were twisting reasonable proposals into “death panels” and “government takeovers”. Supporters were complaining about lack of leadership, focus, and messaging. It was time to get the reform effort back on track.

President Obama addressed both sides tonight, as well as the huge number of people who were on neither side so far.

Some time ago, I had a discussion with my son who asked me what reform would do for people like him and his family. I couldn’t give him a full answer then. I sent an email to the White House asking for an answer to that question. Many other Americans with insurance are asking the same question. It was answered in this speech tonight.

For those who have insurance: (my emphasis)

  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.  More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care.  It happens every day.

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.  This is one of the reasons that insurance premiums have gone up three times faster than wages.  It’s why so many employers – especially small businesses – are forcing their employees to pay more for insurance, or are dropping their coverage entirely.  It’s why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally – like our automakers – are at a huge disadvantage.  And it’s why those of us with health insurance are also paying a hidden and growing tax for those without it – about $1000 per year that pays for somebody else’s emergency room and charitable care.

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

These are the facts.  Nobody disputes them.  We know we must reform this system.  The question is how.

  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.

What this plan will do is to make the insurance you have work better for you.  Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition.  As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most.  They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime.  We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick.  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.

That’s what Americans who have health insurance can expect from this plan – more security and stability.

But what of the uninsured?

The biggest part of the plan for the uninsured and one of the best cost controls in the bill for rising premiums can be found in the health insurance exchange. Some form of the exchange can be found in all versions of the bill currently in Congress.

I was planning on making the case for the value of an insurance exchange, but I’ll let the President do that.

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.  As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage.  This is how large companies and government employees get affordable insurance.  It’s how everyone in this Congress gets affordable insurance.  And it’s time to give every American the same opportunity that we’ve given ourselves.

An exchange is a very good way to foster competition and control standards for minimum benefit packages. However, an exchange is useless for those who still won’t be able to afford the premiums. The President also addressed this concern.

  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.  And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right.  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.

One of the most politically sensitive issues is the question of mandates. John McCain and Hillary Clinton both proposed mandates during the campaign season. President Obama opposed those except for children. He has apparently come around to the same position that Secretary Clinton first proposed, although he did not go into details in this speech. In fact, I thought it was one of the weakest parts of the speech, because of that lack of detail.

  Now, ev
en if we provide these affordable options, there may be those – particularly the young and healthy – who still want to take the risk and go without coverage.  There may still be companies that refuse to do right by their workers.  The problem is, such irresponsible behavior costs all the rest of us money.  If there are affordable options and people still don’t sign up for health insurance, it means we pay for those people’s expensive emergency room visits.  If some businesses don’t provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors.  And unless everybody does their part, many of the insurance reforms we seek – especially requiring insurance companies to cover pre-existing conditions – just can’t be achieved.

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.  Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers.  There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements.  But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees.  Improving our health care system only works if everybody does their part.

The portions of the speech I’ve quoted here covered the main parts of his proposal. But he did more than outline the plan he wants to see passed by Congress. Speaking to those who have distorted parts of the plan and outright lied about other parts, the President addressed the bogus hysteria about “death panels”, illegal aliens, abortions, and the claims of a government takeover of health care.

Speaking to what he called the ” bogus claims spread by those whose only agenda is to kill reform at any cost” the President had this to say about the “death panels”.

Such a charge would be laughable if it weren’t so cynical and irresponsible.  It is a lie, plain and simple.

He addressed the issue of coverage for illegal aliens thusly:

   There are also those who claim that our reform effort will insure illegal immigrants.  This, too, is false – the reforms I’m proposing would not apply to those who are here illegally.

One Republican representative shouted out, “Liar” or something similar. He has since apologized for the lack of decorum, but has not backed down from his claim that the President was lying when he said this even though the bill in question, H.R.3200, actually addresses this issue and specifically prohibits coverage for illegal aliens.

The President also addressed the issue of federal funding for abortions by saying:

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.

While the controversies over end of life counseling, abortions, and illegal aliens are really about minor portions of the bill, the fight over the public plan option has sparked a furor about “government takeovers”.

The President spent some time covering this part of the plan and I urge you to read the entire part of the speech that covers this in detail. In summary, he did not rule out the possibility that the final bill will not have a public plan. He opened the door for the possibility of a co-op or other non-profit entity, but he spoke strongly in favor of offering people a choice.

This portion of the speech will not sit well with many on the left.

   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, the right, or the media.  It is only one part of my plan, and should not 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 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.  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.

I say to those who will be upset about this, do not be disheartened. I believe the President is still in our corner on this.

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.

One concern that is shared by most Americans, whether they are on the left, right, or in the middle, is how we are going to pay for this. The President spent a large part of his speech dealing with that concern.

President Obama made it clear that no funds from the Medicare Trust Fund will be used for this reform. He also made it abundantly clear that the bill must not increase the deficit.  How this will be accomplished will be two-fold.

The first method of paying for health care reform will come through savings. The second will be through increased revenues. Apparently, the preferred method of raising new revenues will be based on the Senate Finance Committee’s plan to tax insurance companies for high-benefit health plans.

One additional method of savings mentioned by the President may have surprised both his supporters on the left and his opponents on the right, and that was his acknowledgement that tort reform of malpractice law suits may have a place in the plan. I think he surprised Republicans with this part of the speech.

   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.  I don’t believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.  So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine.  I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It’s a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.

After presenting his plan, the President laid down a gauntlet.

But know this:  I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it.  I will not stand by while the special interests use the same old tactics to keep things exactly the way they are.  If you misrepresent what’s in the plan, we will call you out.  And I will not accept the status quo as a solution.  Not this time.  Not now.

He went on to talk about the late Senator Ted Kennedy and a letter that the Senator had written him to be delivered upon his death.

And he expressed confidence that this would be the year that health care reform – “that great unfinished business of our society,” he called it – would finally pass.  He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that “it concerns more than material things.” “What we face,” he wrote, “is above all a moral issue; at st
ake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

While the entire speech was a tour de force, he closed very strong.

But that’s not what the moment calls for.  That’s not what we came here to do.  We did not come to fear the future.  We came here to shape it.  I still believe we can act even when it’s hard.  I still believe we can replace acrimony with civility, and gridlock with progress.  I still believe we can do great things, and that here and now we will meet history’s test.

Because that is who we are.  That is our calling.  That is our character.  Thank you, God Bless You, and may God Bless the United States of America.

This speech may end up being only a footnote in the long battle for health care reform, but I believe it served several purposes.

In the first place, it gave the President a chance to rebut the lies and disinformation spread by opponents to reform. Tens of millions of Americans watched this speech. Many of them will have heard these lies rebutted for the first time. This should go some ways towards reining in the craziness that was rampant in August.

The second and perhaps most important benefit of the speech may have been the boost the President will get for his performance. Many people will be reminded that he is indeed a strong leader.

This speech should also swing quite a few independents and undecided people to the reform side of the debate. This could give reform a huge boost in the polls. While Congress routinely ignores polls, the effect this will have cannot be discounted.

Lastly, this speech may well energize the President’s base. I know that some progressives have been losing heart. I didn’t have to read progressive blogs or listen to Air America to realize this. I know, because I was one of those who were getting worried about the way the reform effort was getting off-track. I no longer feel that way. I’m betting that many others will react the same way.

There was one part of this speech that got to me more than any other part. It came at the end after more than thirty minutes of listening to the President speak. It was as moving in its own way as “Yes, we can” was during the campaign.

Like the campaign slogan, it was only three words. Three powerful words. He repeated them three times. “I still believe…”

Tonight, at this moment in the battle, I do.

I still believe.


  1. spacemanspiff

    I’ve been waiting for this diary to drop all night.

    May I just say this…

    I believe that health care in America should be provided as an unalienable right to anyone and everyone in our country, illegal or otherwise. They keep talking about “Judeo-Christian values” in this country, but they want to just let people suffer without care when they are ill or injured? Sure, OK, bill their government or something, but don’t deny a single person needed care. Act like all of the grown-up countries in this world.


    The reality is there would never be reform passed without it as the insurance companies wouldn’t stand for it.

    However, it’s one of those things (like raising taxes) that is political suicide.  It would have been Hillary’s undoing in the general election.  There is just no way to get people to vote for you if you tell them it will cost them money.  

  3. summary of the speech. He was live-blogging the whole thing.

    (my bold)

    9.04 pm. A masterful speech, somehow a blend of governance and also campaigning. He has Clinton’s mastery of policy detail with Bush’s under-rated ability to give a great speech. But above all, it is a reprise of the core reason for his candidacy and presidency: to get past the abstractions of ideology and the easy scorn of the cable circus and the cynicism that has thereby infected this country’s ability to tackle pressing problems. This was why he was elected, and we should not be swayed by the old Washington and the old ideologies and the old politics. He stands at the center urging a small shift to more government because the times demand it.

    And he makes sense. And this was not a cautious speech; it was a reasoned but courageous speech. He has put his presidency on the line for this. And that is a hard thing to do.

  4. HappyinVT

    I’ve gotten most of the Joe Wilson stuff out of my system.  I can focus more on the speech, specifically the policy part.

    Bear with me here; I’ve got several questions all tied together trying to come out coherently.

    The president said that if you like your current insurance you’ll keep it.  He also said that if you have insurance you would not be eligible for the public option.  But, would you be eligible for the exchange?  Does your employer have a say over what plan(s) you get to choose from?  Which then brings up the question of insurance companies operating in certain states.  What if your state only has one or two insurance companies that operate in it.  My BC/BS is actually out of New York because Vermont has such a low population.  There will have to be companies willing to do business in this state.

    What happens if your employer stops offering health insurance?  Presumably you are then eligible for the public option as one part of the exchange.  How likely is it that employers will dump health insurance en masse?  I don’t really care if they drop coverage or not.  I’d rather they did, actually.  I have a co-worker who is on her husband’s insurance and loves it.  She’s concerned, because it happened in Canada(?), that her husband’s employer will dump coverage and she’ll have to settle for something crappy.

    Okay, I’m done for now.  Any clarification would be appreciated.

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