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