The Speech

The SpeechWell I listened to President Obama’s speech on NPR last night whilst playing with my daughter and Curious George.  Suffice to say, I didn’t catch the entire thing, though what I did catch sounded pretty good.  A few thoughts:

CNN says it boosted support for Obamacare.  We’ll see if it lasts.  Speeches, especially those of masterful orators like Obama, can certainly sway us – but is it sustainable?

If reforms to the health care industry do not cover illegal immigrants (I hate the term “alien”) then who will cover the costs of their medical care?  It’s beyond wishful thinking to believe the immigration problem will simply fade away regardless of which side of the debate you fall on.  And until then, illegal immigrants will need medical care, as will their children.  Either the brunt of that expense will fall on local community emergency rooms or we can talk about spreading out those costs.  This is the same problem we have with legal, low-income uninsured.  Ignoring it will not make it go away.

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That outburst from Joe Wilson…what can one say?  My favorite reaction was this from Yglesias.  I’m all for heckling.  I think we should institutionalize it.  Then again, Ezra Klein writes:

If we’re going to adopt British norms of political behavior, we should also adopt British norms of governance. It’s fine to have a polarized system when the majority can wield power. You just can’t have it when you need a supermajority — which is to say, a high level of consensus — to get anything done. So if we’re going to move toward British-style heckling, lets also move toward British-style majority rule. Deal?

Yes, then we could have Britain’s lovely health care system, high taxes, high unemployment, high cost of living, and endless rain.

Flashback

Also from Yglesias:

Would Obama seriously veto an otherwise good health plan on the grounds that it adds literally one dime to the deficit?

Right?  I have a hard time believing this.

I also wonder why Obama hasn’t moved more seriously to pull out of Iraq and Afghanistan in conjunction with his health care push.  Not that I’m entirely sold on rushing out of either conflict, but it certainly would add fuel to this debate.  Save money by ending the war!  Bring health care to citizens and veterans alike through the cost-saving measure of peace!

I wonder if half-baked reform plus an individual mandate won’t be too much of a burden on the young and on lower-middle-income people?  How much will insurance cost on the private market after reforms?  How much cost-assistance will people be eligible for?  How will this effect consumer spending in other areas?

***

I hate the heartstrings stories.  Every anecdotal story of woe is just another version of Joe the Plumber.  Little Suzy in Maine whose school is made from cardboard boxes.  Bob, the carpenter from Tuscaloosa who lost both legs in a fight with his BCBS billing rep.  My eyes fog over, the sound of the sea fills my ears.  I drift…..  I’m glad we didn’t have to suffer much of this in last night’s address.  The Ted Kennedy reference was appropriate.

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The bone thrown to Republicans – tort reform – is probably the least appealing bone from where I stand.  I would prefer some more robust market reforms, insurance across state lines, and so forth.  I would be fine and happy with a public option if these reforms were included, especially if vouchers were a part of the mix.  Tort reform is small potatoes.

I do like the idea of providing catastrophic coverage right away.  Why didn’t we do this decades ago?  McCain seemed pleased with the shout-out.

***

Did Obama say that the public option would have to be self-sufficient based on premiums and not public tax dollars?  Really?  Or am I mistaken?

How will this work exactly?  Wouldn’t it just make more sense to expand Medicaid to say – 200% of the poverty line and institute some cost-saving reforms?  I wonder, for instance, if letting each state implement Medicaid is the right approach….  Perhaps a national Medicaid, easily accessible in one online location as well as at Medicaid offices (not state-run offices) might make more administrative sense.  Maybe even make Medicaid cost something on a sliding scale as you rise above the poverty line.  This just seems like a simpler idea than adding a non-profit public option that is somehow totally self-sufficient to the mix.

Indeed, the one thing that I thought lacking from what was a fairly decent speech, was any semblance of simplicity.  What is your plan Mr. President?  Which of the many circulating plans is it?  Can I tick the reforms off on my fingers?  I do like some of what I hear, but I come away with cobwebs – shaky on details but also on the broader vision.

Also:

Keith Hennessey lays out his predictions for health care reform:

  1. Cut a bipartisan deal on a comprehensive bill with 3 Senate Republicans, leading to a law this year; (5% chance)
  2. Pass a partisan comprehensive bill through the regular Senate process with 59 Senate Democrats + one Republican, leading to a law this year; (25% chance)
  3. Pass a partisan comprehensive bill through the reconciliation process with 50 of 59 Senate Democrats, leading to a law this year; (25% chance)
  4. Fall back to a much more limited bill that becomes law this year; (40% chance)
  5. No bill becomes law this year. (5% chance)

See also: Jonathan Cohn and Kevin Drum.

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36 thoughts on “The Speech

  1. One thing is for sure. If the Dems don’t get something they can at least plausibly claim to be significant out of their control of Congress then come 2010 their own base will grill them like hamburger on the White House lawn. Obama will probably survive since the Republicans currently seem set on not fielding an opponent to his re-election but their congressional majorities will likely get flattened.

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  2. My money is on #4. It will allow everyone to feel good and allow everybody to say “See? We did what you sent us to Washington to do!” Democrats can point to the neutered bill and call it “American Universal Health Care”. Republicans can point to the bill and how it was neutered.

    And everybody gets re-elected +/- 2%.

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  3. “Speeches, especially those of masterful orators like Obama, can certainly sway us – but is it sustainable?”
    I doubt it will create the overwhelming support that might actually scare politicians into supporting the legislation. However, as Yglesias noted yesterday public opinion is pretty damn nebulous, so the decision lies with the politicians themselves.

    “Yes, then we could have Britain’s lovely health care system, high taxes, high unemployment, high cost of living, and endless rain.”
    I’m pretty sure we have a higher unemployment rate than Britain right now… but we should really aim to be more like Scandinavian countries :-)

    “Bring health care to citizens and veterans alike through the cost-saving measure of peace!”
    I really like this idea. I also thought it was a great move on Obama’s part to explain that reform will cost less than the Bush wars and the tax cuts.

    “I hate the heartstrings stories.”
    I hate them too, but who doesn’t have a horror story to share about our current health care system? The horror stories are real and help create the moral foundation for reform.

    “Did Obama say that the public option would have to be self-sufficient based on premiums and not public tax dollars? “
    Democrats have been saying this for months. I think there is supposed to be an exemption for the startup/infrastructure costs.

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  4. The undocumented immigrant thing is interesting too.

    For the record, I can totally see the argument that people who played by the rules (and people who happened to be born here) shouldn’t be paying for health care for people who broke laws to get here (and who cannot effectively be demonstrated to have paid into the health care fund that they are now taking out of… the freest of free riders). I can seriously see how someone might say “I am already shelling out for me and mine… I was willing to expand my definition of who qualifies as “me and mine”… now you’re going to force me (AT THE POINT OF A GUN) to shell out for people who aren’t even here legally?”

    That said, if your justification for universal health care is that no one should be denied care that they need, you can’t really follow that up with “English Only” or whatever. Come one, come all.

    I think that the whole “no illegals” thing has a *HUGE* amount of resonance, though. Those who are on the fence regarding health care all pretty much oppose giving it to people who aren’t “us”. I don’t see it as anything but a loser on a political level to include it.

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    • I get why people are upset about the issue but I can’t help but laugh/be disappointed at the irony of the Religious right opposing health care coverage for illegal immigrants. It’s as if they missed the part of the New Testament when Jesus went over to criminals and impoverished people and loved them. And by loved them I mean provided free health care with his hands.

      I’m not terribly religious but it’s an inescapable thought.

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      • They were the same during the Schiavo incident. I found myself saying some variant of “you people finally found someone you want free healthcare for.”

        However, I’d like to point out that Jesus wasn’t being forced to pony up himself. Even when he had to pay taxes, he made the fish do the dirty work. The guy is the Son of friggin’ *GOD* and so, of course, he gives out health care only when there’s a photo op and, meanwhile, people in Egypt are dropping like flies. Didn’t he have a responsibility to save Egyptians? Apart from the eternal soul bullshit, I mean.

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  5. I think some facts are needed here rather than opinions. Sure the British health care system is poor on responsiveness but it only spends less than half per capita than the US system and still manages to beat the US on Infant Mortality Rate, Disability Adjusted Life Expectancy and Rank plus nobody is left to die because of inability to afford insurance cover, or refusal of cover, and nobody goes bankrupt. Here is the OECD and WHO data in Table One:-

    http://dll.umaine.edu/ble/U.S.%20HCweb.pdf

    Even on a crude columns ranking from this table it comes out 6th best as opposed to the American 14th and with double the per capita spending would no doubt improve on this.

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  6. I have mixed feelings about the heckling. On one hand, I watch PMQ enviously. On the other, the rising tide of disrespect for the President of the Free World United States is somewhat disconcerting. I feel like the GOP should have a new rule. If you wouldn’t have done it to President Reagan…don’t do it to President Obama.

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      • Disrespect our Marxists president…oh my! The man’s an embarrassment! Joe Wilson’ s two simple words nailed it all!
        HC reform is needed but this Steve Erkle isn’t interested in that, he and his dem friends are interested in political power…you kids are naive, your hearts are right but you are so naive…gummint isn’t your friend.

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  7. If we can legislate endless rain, I’m down with anything else he wants to put in the bill. Rain is easily the best weather available. LOVE IT.

    Also, I would take the NHS over our system any day of the week. I would take literally any major Western democracy’s health care system over ours any day of the week.

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      • I am not suggesting it as a tactic but simply we are all in this together and if we leave someone out of it, it will still have costs. I look at so much of this debate over the costs as simply ignorance of the costs being dumped unevenly and “off the books” of the federal budget. When a person shows up in an emergency room it still costs, and indeed costs more, than proper care would.

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  8. Perhaps a national Medicaid, easily accessible in one online location as well as at Medicaid offices (not state-run offices) might make more administrative sense.

    Yes, perhaps… and perhaps the Republicans will jollily board that excellent Democratic bus so that we can do it with the gleaming imprimatur of ‘bipartisanship.’ I’m sure Joe Wilson would sign up. [Newsflash: that would essentially be a federal public option, if just a somewhat means-tested one, and it would be awesome.] Aren’t you the big localizer, though?

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    • That being said, I still think there is a great deal of merit to the simple argument that if a majority of the country wants the option to buy health insurance from the federal government and hence wants the federal government to try its hand at that business, and their representatives agree, they should have that option. That is not on the table now however, as a person has to be uninsured to begin with to be eligible for the public option that is proposed.

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    • First off – yes, it would be similar to a public option. The big, and I’d say essential, difference is that it would not add a public option on top of an existing program. I can’t see how more programs = lower costs. Medicaid is means-tested already, which is one thing that other entitlements don’t have going for them.

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      • According to Obama, the public option would go out of business if it’s not self-sustainable. I don’t purport to tell you not to be skeptical of that, but that’s the claim. Initially of course, as in any new business, there would be start-up costs.

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        • (And see above for what to me is a still-not convincingly refuted rationale for a public option along Obama’s lines — if people want that option — government as health-insurance seller, they should have it, regardless of means, as long as it is sustainable as a business.)

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          • So basically I’m all for what you propose in expanding Medicare, and then for a public insurance purchasing option for more well-off uninsured. And then maybe for everyone when we break the employer-insurance link down the road.

            At the same time, however, you also want to do away with Medicaid (or is it just Medicare?) via vouchers.

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  9. For the record, that 2005 video is a perfect illustration of the fine line between appropriate and inappropriate reaction in a joint session address, which the Dems there were close to but clearly on the acceptable side of, and which Wilson was way, way on the other side of.

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  10. Also: “vouchers,” ie pixie dust. I realize this has been discussed here before, but what does that phrase even mean in this context? It’s as if any initiative associated with that word can be assumed to have magical properties. What’s the deal? Where are they from? What are they for? Is this different from the subsidies that will be given to help low-income people buy insurance?

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    • It boils down to choice and monopoly. When you create a monopoly either in the private sector (as we have down with many of our health insurance providers) or in the government (the threat of single-payer for instance) or by some collusion of the two (the laws limiting interstate competition in the insurance industry – read jfxgillis’s article on this) then you hurt taxpayers/consumers/citizens/individuals – whatever you want to call them. The act of limiting their choice generally has the effect of raising costs and lowering quality. This is why so many conservatives (and liberals actually) want to do away with the employer-based health insurance status quo and establish a system in which individuals choose and insurance companies can sell across state lines. Vouchers, then, are government grants which allow poor people to buy the same insurance that more well-to-do people buy. This avoids subsidizing companies or industries directly and instead gives people choice. So insurance companies still have to compete for those dollars – they can’t merely lobby the government for subsidies or protections. Theoretically, this leads to higher competition, lower prices, and better quality of service.

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          • Zounds. This is something that this site seems to have trademarked, namely raising objections (if this is one) to what are explicitly and openly incremental reforms (which reality was the basis for heartfelt dismay at the president’s absurd, ostentatious claim to want to be ‘the last’ one to reform health care) that are essentially saying “because we can’t have this totally radical, politically non-starting, third-rail-attacking revolution in the issue, we can’t get behind lesser reforms or even forthrightly address whether they have more merit than cost.” (That’s the form of the argument — punched up for clarity. I’m not saying you’re saying all of that.)

            But are you seriously suggesting that the fact that the prez/Dems haven’t proposed dissolving Medicare into a voucher program should really affect this debate in any way? ‘Cuz that’s crazy talk, even if there is a concrete proposal on the table somewhere to answer the thousands of inevitable questions (I’m open to links).

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  11. Last thing, E.D., can you direct me to a detailed precis on the exact hows and wherefores of what stops insurance companies from operating in different states. I’ve seen it so often, but I’m not clear where that is written. Also, do you favor the nationalization of all the types of insurance regulation that states currently do in conjunction with any lifting of the interstate restriction in order to avoid races to the bottom, as David Frum and now, I believe, your colleague Mark Thompson have?

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