Tuesday, September 08, 2009

Obama: It's Time To Act On Health Care

"It's time to act on health care" is the message that President Obama is going to deliver tomorrow after giving a nondescript speech to school kids today. That speech to kids got a whole lot of blustery attention from GOPers over the weekend, but I'm rather mystified over why. The need for educated kids is acute - and getting kids to focus on science and math has been a battle for decades. Then again, that's the problem, isn't it- no matter what the President says, the situation remains the same because the education system is governed by inertia and not on sound education principles that put the kids first.

It's not like he's going to say anything out of the ordinary for a speech of this type. People complained about what the Department of Education suggested for teachers to do in accompanying the speech, but that too was adjusted before the speech ran. The speech includes references to AIDS research and homelessness, but they're nothing but buzzwords that show sympathy to a particular interest group in and among Democrats, but no more.

Moreover, many students simply aren't in school as yet (they start tomorrow in NYC and on the 10th in Boston and Los Angeles for instance). Other schools are simply ignoring the speech altogether, including one in Chicago.

No, if you want reasons to complain, perhaps it's the fact that this speech will put the kids to sleep. It's 10 times longer than the Gettysburg Address, arguably the most important speech ever given by a President. There is something to be said for brevity and conciseness, but that doesn't appear to be a trait that this President has. He's hoping for a grand sweeping gesture, and the speech to kids simply isn't it. You write a speech for the audience, and on those grounds this speech fails. This is a speech by him, and about him, rather than the kids (at least those who are around to listen to it).

Note too that the Democrats slammed President George HW Bush's speech in 1991, and sought to investigate it for the improper use of funds (the investigation turned up nothing, but to claim that Democrats haven't done this tit-for-tat complaining over Presidential speeches is disingenuous). The GOP needs to pick and choose its fights, and the speech to kids is the sideshow compared to where the real action.

The real speech to watch is tomorrow's joint speech to Congress.
A "fired-up" President Obama declared that it's finally "time to act" on overhauling the nation's health care system.

"Every debate, at some point, comes to an end. At some point, it's time to decide. At some point, it's time to act," he told labor leaders in Cincinnati on Monday afternoon.

"It's time to act and get this thing done," he insisted.

Obama dusted off his "fired-up, ready-to-go" campaign chant during the speech in hopes of recapturing his mojo and setting the tone for what could be a make-or-break week for his presidency.

Lawmakers return to Capitol Hill Tuesday following a turbulent summer.

Obama and Democrats in his corner were repeatedly attacked by conservatives and constituents angry or confused over plans to revamp the nation's health care system. Republican support evaporated.

The President's poll numbers plummeted.

To wrestle the debate back onto his turf - and on his terms - Obama is delivering a prime-time speech tomorrow to Congress. If his call to action fails to motivate lawmakers, experts say, it could damage him politically.
Obama still has Democrats control the agenda in both the House and Senate. If he fails to get any kind of health care proposal through, it would damage him politically going into the 2010 election.

The problem is that the public has soured on the Administration and Democrats' attempts to claim that there's a crisis of health care in this country. People have realized that there's a difference between access to health care (which is universal - see how illegal aliens can obtain health care without any health insurance, much to the detriment of the hospitals that expend vast sums to provide such care), and the cost for such care - whether it's through private insurance and/or out-of-pocket costs, which include higher costs to offset the provision of care to illegal aliens and lower reimbursement rates provided under state and federal health care programs.

Obama's problem isn't that he hasn't been forceful. It's that he's not being persuasive. He called for a health care overhaul, and then left the details up to Congress, which turned it into a ill-understood and unread 1,000+ page behemoth. He hasn't made the case to justifiably overhaul a system that provides health insurance to 85% of Americans (based on the widely used 50 million uninsured (which itself is a dubious figure that includes millions of illegal aliens and those who are transitioning between insurance plans or who are eligible for various programs but choose not to use them and a US population of 300 million). People who are already satisfied with their health insurance aren't keen on a proposal that will change how things are done, and while the President has said that you'll be able to keep your existing insurance, the problem is various versions making their way through Congress have phase-in dates that allow for employers to shift employees to the proposed plans.

Then, there's the mother of all problems for the President.


There's no way that his proposals are revenue neutral, which means tax hikes are inevitable (above the tax hikes and surcharges indicated in the existing bills).
As expected, Baucus’ proposal does not include a public insurance option, but instead features insurance cooperatives that could appeal to moderate Democrats and perhaps some Republicans. That’s a major difference from bills approved by three House committees and the Senate Health, Education, Labor and Pensions committee.

Baucus’ plan also is expected to be less generous in terms of subsidies and coverage than those bills – which, along with the absence of the public option, is sure to rankle more liberal Democrats.

The bipartisan group also is considering a tax on insurance companies
that provide expensive coverage plans. And one feature that might help satisfy the more liberal members of the committee is that insurance companies could face a separate new fee to help pay for the plan. It would be determined based on market share, and could raise $6 billion a year starting in 2010, the sources said.
The Baucus proposal doesn't quite get the fact that if you raise taxes on those insurance companies, they will pass through the costs to the consumer in the form of higher premiums and/or lower benefits. The companies aren't going to eat those costs.

President Obama has repeatedly attempted to claim that his proposals will save money over the first 10 years of implementation, but the CBO has already shot down that claim, finding that it will be in deficit, and will never save money. Preventative care is far more costly than the Administration was willing to countenance, and cost savings aren't likely to be there. Moreover, there's the problems with existing health care systems operated by the government such as the Veterans Administration and the Indian Health Service, both of which provide substandard care far too often to be seen as a model for all Americans.

Then, there's the question of who's going to provide all this care if there's 50 million people who aren't receiving this care. If you assume the 50 million (which I think is overblown based on various figures, but which works wonders to highlight the fact that at least 85% of Americans have insurance coverage), who is going to be there to provide the care without lowering the quality for everyone else. As it is, health care providers are already overburdened and there are shortages of nurses and general practitioners in various parts of the country. The proposals do nothing to address those concerns. They aren't going to be created out of thin air - in fact, it would take years to produce a crop of doctors to cover that many new patients into the system, which means quality is sure to drop in the short run.

The fact is that if the President dropped the current Democrats' plans (HR 3200 or the Baucus proposal in the Senate), he could find a plan that would reform the system and expand coverage to more Americans without scrapping a system that works for 85% of Americans. It would involve expanding insurance coverage regionally and nationally, as well as reduce costs to those Americans looking for cheaper insurance options. The problem is that the President would run into a roadblock from Democrats who want the public option, which means that he risks running afoul of Congressional Democrats.

It's a real test of leadership to see if he does what he says (call for bipartisanship) or kowtows to Congressional Democrats who have largely frozen Republicans out of input on the crafting of the bills.

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