Wednesday, September 09, 2009

Writing As It Happens

I thought I would try something different tonight. I wanted to catch Obama's speech on Health Care because I have a vested interest, what with being a newbie old fart, on what happens to Health Care over the next decade. In an attempt to understand his stand better I wrote a running commentary as the speech unfolded. Impressions, interpretations, and how I saw it in a nutshell. The result was interesting. To me anyway.

So Obama Man just walked in. I could hear the Sargent at Arms announcing his arrival in the background of the NPR commentary trying to keep us placated because the Prez is running late. Apparently Obama will spell out his views on what we should do with Health Care. He will one more time try to bridge the differences and sift out the rhetoric that means nothing and only causes emotions to get fired up.

Over what is obviously loud and boisterous applause, Obama - several times, "Thank You...clap clap clap......thank you......clap hoot holler...." Pelosi in charge starts pounding the podium with that massive mallet. She introduces the President. More applause. He begins.

He starts in with an overview of what he talked about the last time. How he won't give up until all Americans who have lost their jobs have found new employment. He won't give up until all who lost their homes have moved into new ones. He goes on saying through all our efforts we have indeed pulled our collective asses away from the brink. But there is more work to do. He is setting a grand tone.

I left for a moment. Parched, needed a drink of water.

Seems Obama is now jumping right in on the Health Care issue. Several examples of egregious and poor treatment at the hands of an indifferent Health Care Insurance Industry. Care denied for arbitrary and specious reasons. Costs have more than tripled in some period of recent memory. In other words, he tells us what almost all of us already knew. The system we have now sucks.

He proposes not to build from scratch, but work with the system we have and make it better. Now he begins to stroke Congressional egos by telling them how pleased he is with their efforts. On both sides. But we are only 80% there and that partisanship has been utilized to hamstring the efforts. Scare tactics using blatant untruths. He utters the word "Lies" and "Liars" I think. (That's gonna piss off some folks and ruffle feathers) He calls for action. The games are over. He calls on the Leadership to "deliver on Health Care".

His plan with substantial gaps because I ain't no stenographer.
~Nothing in our plan requires those who have insurance already to change providers. What it will do is clean up some of the rules.
~No pre-existing condition refusals
~No arbitrary caps on amounts of money
~Insurance policies will be required to cover pre-emptive measures - Mammograms, Physicals, blood work, etc.
~Instilling a plan that will include every American not covered to go to a new insurance market place and buy insurance as part of a bigger pool of people. Will make rates more competitive and cheaper.
~Interim Catastrophic Plan - The same plan McCain proposed back during the election
~Require some kind of "basic Insurance" for all Americans who can afford at least the basic coverage. We all need to work together.

Obama says he has no interest in putting the insurance companies out of business. He wants to hold them accountable. He is of the opinion that consumers do best when there is competition. Fair competition. The way it is set up now is not fair and often exploits the insured.

Calls both the Right and the Left out to stop the partisan crap. To the Left - Don't overstate the impact of the plan. To the Right - Stop the fear mongering of government takeover.

Paying the freight - Won't sign any bill that increases the deficit. Must be deficit neutral. Will cost about 900 billion dollars over the next ten years. Cheaper than the War in Iraq. Cheaper than the Tax cuts to the rich.

He feels that much of the cost can be born by making the system we have work more efficiently. Too much waste. Too much inefficiency. Not one dollar of the Medicare plan will be used to pay for this. Then he outlines some the measures his plan will utilize to protect and even enhance the coverage Seniors have and will have in the future.

Another water break.....I'm back ......clapping - guess I did not miss much.

He lays down the gauntlet. Lets everyone know that he is serious and will call out anyone who uses unfounded claims to misrepresent the plan he laid out. Killing the idea of Health care reform is not an option. Settling on the "status quo" again was not an option.

Then it gets mushy as Obama begins a tribute to Ted. Ted was not being ideological or partisan with his focus on Health Care. He just cared. Then a brief history of Social Security. 1935 - fears of Socialism were unfounded as Social Security came into existence. The stupid fear that this country will ever be socialist. That over the years, our leaders have ultimately understood that too much government is no better than too little government. A balance must be found and so far we seem to find it. Eventually.

And finally a rah, rah rah closing moment as he performs a "I still believe" and "We Can" moment - that we can still act when it is hard. We can bury the acrimony. We can do the right thing. See ya and thanks for your time.

Charles Boustany - Republican Hack Response

Republicans are pleased Obama came to Congress. The Republicans are ready to find ways to make Health Care more affordable. Republicans understand Americans want reform. Then it is onto their standard bullshit about it being nothing but Government Health Care. Faults Obama for not taking it off the table. What a maroon. Just because it is on the table does not mean it "has" to be part of the solution. Obama said as much.

Then ole Chuck starts beating the favorite Republican straw dog, er man - Tort Reform and how without it, the cost of Health Care will remain high. Standard crap from the Right. But somewhat muted because Obama was so very clear about the what, where, and how his plan would really work. Why has the party of my youth become such a cast of clowns?

I give Obama a B+ or maybe even an A- for this speech. I would give him an A but well, he was a tad kinder than I would have been to the boneheads in Congress. I'm way more disgusted I guess with the lot of them than he is. But President Obama spoke strongly, clearly and he did strike a line in the sand to a degree. And not just one between himself and the Republicans, but one between himself and Congress. He continues to do the job I envisioned he would. I just hope to see his success rate pick up some in the near future.

I am not sure why I even did this. I have to say though, writing my impressions and my take as I thought them was quite...... well shit, it was cool to do this. I have re-read the previous narration and decided that after some spelling corrections and straightening of a few (okay, more than a few) awkward phrases and such, I will let it go to post.


(1274 / 2773)


El Cerdo Ignatius said...

Just wondering on one point: why is the call for tort reform dismissed as the "standard crap from the right"? Seems to me that overly litigious individuals and their lawyers are doing more than their share to help keep costs high, both in the health care system and in the insurance sector.

Demeur said...

Anything they come up with must be better than what we have now. I'm guessing you have a plan for your business Crum that barely covers anything. I've been there myself. You can afford to have the plan but can't afford to really use it. What good is that?

Tort reform? That's a miniscule part of health care costs. The real problem is greed. Insurance companies posted a $146 billion profit. How many people's lives would that have saved?

Middle Ditch said...

Yeah it's always greed. Money makes the world go round.

At least you've got someone talking about it. Here it's just shoved under the carpet.

El Cerdo Ignatius said...

Wouldn't permitting individuals and companies to buy insurance policies from companies in other states help the greed problem? Nothing like a bit more competition to take a bite out of profits and bring revenue down closer to costs. And some transparency might be nice, if it were legislated at the same time. And by transparency, I mean laws that require the government to publish performance ratings on doctors, hospitals, and insurance companies. The insurers should be required to disclose the percentage of their revenue that goes toward medical benefits. They should also have to disclose rescission rates, claims approved/declined rates, and they should have to disclose which doctors and hospitals they cover. Finally, medical care providers should be required to publish prices for procedures for uninsured patients.

The best way to cure greed is to change the existing situation, which is basically 50 oligopolies or near monopolies, and add some competition. If we face a monopolist, we are at his mercy.

As for the citation of the problem of greed, one need look no further than the legal profession. I believe tort misuse is more than just a minuscule part of the cost problem.

MRMacrum said...

El Cerdo Ignatius - Tort reform serves the purpose of deflecting attention from what is really wrong with our Health Care system to something that may need some changing but is hardly worth all the fuss being made out of it. First it was the Insurance Companies using it to justify their rate hikes on us and doctors. Then the Right got hold of it and now you'd think it was the main reason things are screwed up. Not even close. In my opinion, if the insurance companies would show some balls and actually fight some of the stupid and sleazy cases that come their way, maybe we wouldn't need Tort Reform. But the bottom line always wins out over the ehtics or doing the right thing. As Demeur & Middle Ditch say, it's about greed. Or to put it a nicer framework, profitability.

Demeur - Yeah, it would seem it couldn't get much worse. But I remember back in 2000 or so and thinking the same thing after my deductible had to be raised just to keep my family premium under $1000/month. Now we are well over $1000/month with an even higher deductible and there is one less person on the policy. I hate to sound self serving, but All I want out of this is for my Health Care to get cheaper or better without paying more for it.

Middle Ditch - Interesting that you Brits have your own peculiar problems with Health Care. No system is perfect. It would seem though that all of them could be better.

El Cerdo Ignatius - Allowing more competition across state lines is exactly one of the improvements Obama mentioned when he talked about an open Insurance marketplace. The system is rigged now with the country having been divided up among the various carriers insuring them almost monopolistic power over the states they operate in.

I am not for anything but better Health Care for all of us at reasonable prices. Re-evaluating the rules under which the current system works seems like the logical place to start. It also seems like that would have the biggest over all immediate effect without dishing out huge Federal dollars to do it.

As to the overall cost of malpractice - from Wiki "Including legal fees, insurance costs, and payouts, the cost of all US malpractice suits comes to less than one-half of 1 percent of health-care spending". This of course does not consider the amount of "defensive medicine" practiced by many in the medical profession. But even if we take that into account, I am sure it would not raise the cost more than a few percentage points.

El Cerdo Ignatius said...

For obvious reasons, I'm going to wait until the weekend or later to continue participating in this discussion.

Have a good day, everyone.

BBC said...

I know that it's just me but I could pretty much care less about any health care system overhaul.

I'm getting old, have been here at least 30 years longer than I ever expected to be and I don't need any fucking body trying to save my sorry old ass.

Ain't no way I'm dying in a hospital or care center shitting in a bed if I can help it, that's for fools that are afraid to die.

Anything they come up with must be better than what we have now.

I've never had any complaints, until that bitch doctor last year, but that's just a single event and not about the system. And I stopped her from sending me bills after just two of them.

My hernia should still be fixed but I guess I'm not too concerned about it being as I haven't looked for another doctor that isn't the bitch she was.

There are doctors in this town that will fix it for just what my medicare will pay but I don't get around to getting to one.

I just made my own support belt to keep it from getting worse, something else is likely to get me before it does.

Just who do you think is going to pay for a better plan? The rich damn sure isn't, if they get stuck with it they'll just pass the cost on to everyone else they can get the money out of, hey, that's you.

El Cerdo Ignatius said...

I have heard zany estimates, too, about the potential savings from tort reform. I don't agree that the US would save $500 billion per year by enacting it, which is a number I've heard thrown around by some commentators (I'm assuming that's some of the "standard crap from the right" that you cite). I do think, based on reading I've done and discussions with family members who work in the US health care sector, that tort reform could lower insurance and health care costs by something in the range of 5%. And if you can save 5%, why not give it a try? Why does every single issue have to be dismissed as the usual stuff from the usual suspects on one side or the other?

Anyway, we might not be too far apart in other areas here - if President Obama is serious about creating a more open marketplace for insurers, which (as I've written and you've written) would bust up these near-monopolies, then the Congress ought to get on the stick. A better approach might be to chop up the health care reforms into several bills and pass them one at a time - progress could quickly be made on areas where both parties agree.

And despite my position in the VRWC, I don't shriek and gasp at the public health insurance option. I would say that, though, that neither party is speaking or acting honestly or from an informed position when they debate it. The Democrats emphasize that "no one would be forced away from their current insurer or doctor", without ever considering the after-effects of introducing another insurer into the market, the mandate of which is to insure the currently uninsured (or those considered uninsurable by conventional standards), to ignore generally-accepted risk management practices, and to do all of this while charging premiums that result in a revenue-neutral outcome for the government. If they charge too little, employers will have incentive to dump their current group plans and let their workers get coverage through the public option. If they charge too much, they are not meeting their mandate of providing affordable insurance. (One big complaint levied at private insurers is cost of coverage.) And if they somehow manage to price the public plan so that it matches prices in the private market, I cannot see how they can do this without losing money, because they would be covering too large a pool of people currently not insurable, who pose a higher risk of incurring claims, and ignoring other high-risk factors. It is possible that coverage purchased by the 18-34 crowd might offset these costs, but no one knows. It's a crapshoot.

There are a handful of Republican Congresscritters who actually read these bills and debate the content of them as they are written. The rest, and most of the rest of the commentators on the right, are ignoring the elephant in the room; e.g., a 15-minute visit to the doctor's office should not cost $500; a bill from a hospital who treated a patient for 12 hours before the patient died should not read "TOTAL: $125,000, but we'll settle for $13,000 if you pay within 30 days"; and the fact that the insurance market, because of the way it has been set up, is actually prone to [gasp] market failure. (Anyone remember how badly insurance companies and their clients suffered after 9/11?) And screeching that this reform proposal is nothing more than an evil plot to gain control of as many people's lives as possible is downright wacky. I might not agree with too much that comes from the Democratic Party's leadership, but I will, at a minimum, grant them an assumption of good faith. Even if I think they're dead wrong on everything, I'm committed to ascribing it only to intellectual error. The Republicans demand the same thing, and whine when they don't get it. And the whole chicken-or-egg debate over which side started the extreme vitriol during which decade in whose administration is irrelevant. There's nothing wrong with disagreement, but when you heave and groan that the public option - however badly designed and promoted - is a Communist plot, you lose me.

MRMacrum said...

El Cerdo Ignatius - Once again a very reasoned comment without the emotional garbage I often bring to the table.

I am actually for tort reform. I have personally felt the sting of a system that rewards accusations without proving liability. My bike shop was involved in a lawsuit about twenty years ago. The insurance company knew the claim was off the charts, yet they chose to settle anyway. I just do not think tort reform is the first and most important issue of Health Care to be addressed.

I am with you here about the lack of objective and calm reasoning coming from the loudmouths of both sides. Our system is broken and it needs fixing. And as you say, maybe the pill would be less bitter if it was broken down into smaller bites. That might also help to insure legislation that is better thought out.