September 10, 2009

A cold look at the text of Obama's speech.

I watched the big speech last night, but didn't live-blog. But now that the text is available, let me locate the few things that I felt at the time I would have live-blogged if I'd been live-blogging and see how they strike me in the cool light of day:
Well the time for bickering is over. The time for games has passed. Now is the season for action. 
Why? This is just a raw pronouncement, and he's tried to call time before, including back when the hot debate was only beginning. What I hear is: Shut up. It irks me. It makes me want to make trouble for him. He never encouraged debate. But the debate grew in spite of that. He keeps looking back on what he didn't want at all and says now, that's enough of that.
[I]f 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.
I get it. Nothing will require anything of me if I have what I like (and I do). But if you change the structure of the insurance market, my insurance company may not survive or it may be forced to change. Then how do I keep what I have? What I have now may not exist in the future. This is why I do not feel secure.
What this plan will do is to make the insurance you have work better for you. 
But I like my plan now. You admit you're going to change it.
Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. 
Not just me, but anybody. The health insurance business will have to change.  I understand the good of helping people with medical conditions, but I wonder what it will do to the private business to suddenly change this.
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.
And that will change the economics of insurance. Why will that work? What if companies go out of business when you deprive them of the ways they've come up with to be profitable? I'm afraid making the insurance business unprofitable is completely acceptable to you, because you don't mind if in the end government takes over everything. It's what you would do now if you could, isn't it?
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.
It will cost less? I just don't believe that prevention and early detection will perform the necessary magic. And who will provide all this extra care?
That's what Americans who have health insurance can expect from this plan – more security and stability.
Security and stability? That sounds nice, but I don't feel... secure about it.

Obama goes on to describe the insurance exchange that will improve the market for people who don't now have health insurance and the tax credits that will help "individuals and small businesses who still cannot afford" insurance. I don't know who qualifies for these credits, but that is a loss of tax revenue, and the burden must fall on the rest of us, some of whom are going to be forced to buy something we haven't been buying yet. There is some kind of a squeeze on people in the middle. But presumably, we are already paying for these people when they do go to emergency rooms, and getting everyone covered, even if some don't pay, will spread the costs more widely.
[The] exchange will take effect in four years, which will give us time to do it right.
And him time to get re-elected.

Next, Obama explains why everyone will be required to buy health insurance. It's "irresponsible" not to. So all-encompassing care is recast as personal responsibility. But the real point is economic: The new system — requiring insurance companies to cover pre-existing conditions and not to charge different rates even for those who begin with very expensive medical needs — won't work unless all the healthy people are forced to join and pay in much more than they are taking out. They can't be allowed to game the system, keep all their money, and then opt in to cheap insurance when they start needing reimbursements.

Where will all these people get the money to buy insurance? We're told that some people and businesses will get "a hardship waiver," but we aren't told where the cut-off point is.
While there remain some significant details to be ironed out... 
This got a huge laugh at the time. It was the biggest laugh of the night,  I think.
... I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. 
At this point, last night, I felt some hope, but not knowing what the details are going to be, I was also pretty suspicious. The next part of the speech, however, attacked his critics and felt like nasty attack on ordinary people who have legitimate doubts and whose criticisms were what pushed him into the more moderate position that was giving me hope.
Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. 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.
Ugh. He says nothing more about the genuine concern that there will need to be rationing, that lines will be drawn, and that he himself has said things that suggest that someone will be deciding when older and disabled persons will get "the blue pill" instead of vigorous treatment.
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. 
An important promise.
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.
But insurers will have cover abortions, and people will have to do business with insurers.
My health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system.... Now, I have no interest in putting insurance companies out of business... 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. 
Why is something more needed to keep them "honest"? You're imposing new regulations on them. Enforce those regulations. Why is more competition needed to make them "honest"? I'm saying "more competition," because Obama is clear that the public option will be a separate entity that must operate solely on the premiums it collects and free of any taxpayer subsidy. Won't that coverage be expensive too, then? He claims that "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." But private companies try to control costs to compete, and government entities tend to get bloated too. It's hard to see what this is for.
... I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize.
How will this promise be enforced?
This is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.
Am I allowed to shout "You lie" at the TV?

Now comes the sentimental, inspirational stuff that I don't need to spend time on.
... Ted Kennedy....
Zzzzz.... Then my ears perk up:
One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate.
Words for conservatives. Obama then concedes that Teddy seemed to be the opposite off all of that to conservatives. But somehow he really wasn't. Why? I scan the text for a reason. He had conservative allies in some of his political ventures? There's a list of friends — John McCain, etc. Eh. Not enough. Obama goes on about problems Teddy saw, kids with cancer, and it seems as if the idea is just to make us forget about the questions he'd just raised.
You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. 
That's the kind of moderation I like, so that worked on me, but I'm sure it's a disappointment to those who got really excited by those words for conservatives.

Finally, he bemoans the lack of civil conversation again. I hear echoes of the "shut up" I heard at the beginning of the speech. He says we need to act now, not be timid. We need to do "great things" and "meet history's test." We need to do it because it's "our calling." He's entitled to end his speech with a call to action.

I'd say he did pretty well with what he had, but some of us still have questions and don't appreciate being called louts and liars.

224 comments:

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bagoh20 said...

Thanks all, great discussion. Need to get outside a little.

Bender R said...

I'm late to the game here, and no way I'm going to read through 200 comments to see if someone beat me to it, but just a question for Dr. Obama --

Which is it? (a) everyone will be forced to buy insurance, or (b) illegals won't be covered?

They can't both be true.

If "everyone" is forced to buy insurance, well, "everyone" includes illegals, so they will be covered in the plan after all.

If that "everyone" does not include illegals, well then that would be penalizing and treating lawful American citizens far worse than the illegals by imposing a far greater burden on Americans than on the illegals. And meanwhile, the illegals will still show up in the emergency rooms for medical care.

How about instead of some dictatorial system, we try a little bit of freedom? Let's try increasing freedom, rather than eliminating it.

Anonymous said...

We cannot have the luxury of expensive life saving treatments if we don't make the private insurance system work, which requires all to pitch in.

I pick this statement out among all your bizarre statements as the most bizarre. People who have private insurance will be the most likely candidates for such treatments, second only to those who can pay in cash.

The private insurance system works fine. Everyone does not pitch in. Therefore, everyone does not need to pitch in.

Finally, it sounds to me like you've got some guilt complex, Bag, about some health care provider writing off some bills you failed to pay. That's not society's problem, dude. That's your problem.

Hector Owen said...

The problem with your thinking, bagoh20, is that you omit the possibility of charity. At 4:03 pm, you state that there are only three possibilities: 1) Balfegor's question, does [our] choosing to provide a service to someone, knowing he is unwilling to pay for it, create a moral responsibility in him to repay. 2)we choose not to treat him. 3)we make someone else pay.

I offer 4) we treat him out of the goodness of our hearts, knowing he cannot or will not pay, because we think that it is the right thing to do, and we do not expect to be repaid.

bagoh20 said...

One more thing: People really have to read what they are arguing about. I have been arguing against this health care bill and for our current system with minor changes, but some people assume I'm in favor of the bill. No way, no how. If not for our current system I would have died 3 years ago. Just relax and discuss. We are not at war, and we learn more when we listen. I've learned here, thanks.

Balfegor said...

Which is it? (a) everyone will be forced to buy insurance, or (b) illegals won't be covered?

They can't both be true.

If "everyone" is forced to buy insurance, well, "everyone" includes illegals, so they will be covered in the plan after all
.

Mechanically, I think there are two pieces to this puzzle, and I'm actually not sure where it ends up, as far as illegals being covered.

First, if you're in the country illegally, do you pay tax? If you're invisible to the taxation authorities, you're not going to be forced to buy insurance, because the mechanism for that is through the tax code -- the government will levy a penalty tax against you if you don't buy health insurance that's compliance with government mandated standards.

Second, will hospitals have a legal obligation to provide full care for people who aren't enrolled in an insurance plan? I don't think they will. If that's correct, and illegals aren't subject to the health insurance penalty tax, then they won't get insurance, and they won't get regular care (just emergency care, I suppose).

The thornier question, I suppose, is whether, when they do choose to buy health insurance, they become eligible for the subsidies. The house bill contemplates subsidies for purchase of insurance for households making up to -- as I understand -- four times the poverty level (something like $80,000/year), so I'd imagine that a majority of illegal immigrants will be eligible for the subsidy. And whether, as a practical matter, they can get it would depend on how eligibility for the subsidy is determined. (I don't know how it is). If it's through the tax code, and they've been evading tax by virtue of their illegality, then they won't be able to collect the subsidy. If you get proof of need some other way, then they will.

So it's a technical question, and I'm pretty sure the President doesn't know what the answer is.

X said...
This comment has been removed by the author.
bagoh20 said...

"I try to get out and they pull me back in."

C'mon Seven, You venture that I got guilt issues about not paying some bills? And, I'm bizarre?

Speaking of bizarre: you say: "The private insurance system works fine. Everyone does not pitch in. Therefore, everyone does not need to pitch in."

I guess if your one of the non-payers then yea, it works great.

The care is great, but the insurance system rips off those who pay for insurance by charging them for the rest who don't. I guess we could all refuse to pay, but then what do we have?

Hector, Charity is fine, and the extra that us insurance buyers put in to cover the indigent is just that, but when people refuse to pay, because they would prefer to spend it on a vacation, then it's not charity I want to give. When you take someone's money to pay for someone else, without their agreement, it's not charity, it socialism.

Anonymous said...

the insurance system rips off those who pay for insurance by charging them for the rest who don't

No. This is not true. People with insurance get much better care than people without insurance.

Even if this were not true, it's better morally to have the private sector rip people off than the government.

Still further, the very fact that this discussion is occurring demonstrates that we are dealing with a largely intractable problem. It's best to attack these organically and at the margins, not with a wholesale revolution that changes everything.

I have just described the basis of conservatism. You are welcome.

amba said...

The Dems on their pet cable "news" channel MSNBC are rolling out the "race" canard big-time -- if you disagree with Obama's policies you must be a racist. Nothing could make me sicker -- it's the flip side of Birtherism but with a whole lot more proponents -- and I wonder if the totally dishonest convenience of it isn't one of the reasons Obama was elected.

bagoh20 said...

"it's better morally to have the private sector rip people off than the government."

Seven, dude, I completely agree. Trust me, I'm more conservative than..., well, anybody.

But we are way past ideology now. The real world is about to take away our choice permanently. Purity, is like fighting clean in a bar fight.

Obama has a chance at making this shit happen for two reasons:
1) Health insurance is too expensive for a lot of people.
2) 30 million people aren't covered.

Take away those two things and this would have never had a chance. As long as those 2 things exist it will keep coming up. To put this socialist power grab in the coffin for good is gonna require that we:

1) Get the cost of insurance down.
2) Get most of those people on it.

They go hand in hand and it's all we gotta do to kill this.

So, we:
1) Lower cost through: competition by allowing interstate insurance, and getting some tort reform.
2) Somehow get everyone to pay for insurance, even if by force, because the alternative is socialism.

Of course I hate forcing insurance, but as you guys are arguing, you won't pay for it until you need it,
which is too late.

If you think this plan sucks, wait till we get the alternative from DC.

I'm forced to have car insurance and it's not the end of the world, especially if the alternative was a government bus pass.

Hector Owen said...

Bagoh20, "Charity is fine, and the extra that us insurance buyers put in to cover the indigent is just that, but when people refuse to pay, because they would prefer to spend it on a vacation, then it's not charity I want to give. When you take someone's money to pay for someone else, without their agreement, it's not charity, it socialism."

But when you donate your time and resources, that's charity. Like the provision of prosthetic hands for victims of Saddam Hussein:

The Methodist Hospital, the Institute for Rehabilitation and Research, and Dynamic Orthotics and Prosthetics in Houston donated the operating rooms, rehab and training; Houston-based Continental Airlines paid for the seven Iraqis' flight; the Marriott and Warwick hotel chains housed them; and the Minneapolis branch of a German prosthetics company, Otto Bock, provided the artificial hands.

Or for that matter, the old custom of Christmas baskets for the poor.

If "the extra that us insurance buyers put in to cover the indigent" is not voluntary, but part of your premium that you must pay, that's not charity. When you take your own money to pay for someone else, because you want to do it, that's charity.

bagoh20 said...

Hector, I absolutely agree with all of that, and stand corrected. All my extra premium for indigents is taken, but I agree with it use for that purpose. I don't care if it's called charity of not: it's my money, gladly given and it's used for a good purpose. That's all that matters. Thanks for the link.

bagoh20 said...

wow 213 comments and Palin was only mentioned 4 times.

Hector Owen said...

All right then, bagoh20. That line of argument you were pursuing didn't really sound like you.

Democrats don't like charity because it involves individuals rather than groups, and choices rather than obligations. I can choose to donate to a cause, an organization, or an individual. That makes the whole thing less systematic. The Marxist view of history as dominated by impersonal forces leads leftists to view voluntary interactions among individuals as chaotic and undesirable; better if those interactions were replaced with state programs which, however inefficient or bureaucratic, are predictable. So private charity is replaced by state programs, and comes to be regarded as less worthy. "You have a right to these benefits! No need to ask some old biddy from the church if you can get some help." So then taxes must be imposed to fund the benefits, and the people at the church stop contributing, since their help is no longer wanted.

Bruce Hayden said...

Obama has a chance at making this shit happen for two reasons:
1) Health insurance is too expensive for a lot of people.
2) 30 million people aren't covered
.

I still don't see why it wouldn't be better to go after those 30 million or so (assuming that that number is accurate, which I really question).

1) Get the cost of insurance down.
2) Get most of those people on it
.

The problem with the first one is that there is really only one way of doing that - rationing. And the first dollar coverage that Obama is pushing is just going to make things worse, since there is nothing else controlling demand. Part of the current plans all seem to be getting ready to dump high deductible plans, like I have with my HSA, which provide a small modicum of demand constraint.

The idea that expenses can be lowered by eliminating fraud and waste is just not plausible, esp. without a significantly greater enforcement effort by the feds.

1) Lower cost through: competition by allowing interstate insurance, and getting some tort reform.
2) Somehow get everyone to pay for insurance, even if by force, because the alternative is socialism
.

I would argue that forcing everyone to pay for insurance, regardless of need, is closer to socialism than I think advisable. Not communism style socialism, but closer to the Fascist or Nazi model.

As I noted earlier, making health insurance available interstate sounds really good - until you stop to ask why there is such a difference state to state.

And, even Dr. Dean admits that tort reform ain't going to happen because of the trial lawyers who backed Obama with so much money. (Yes, the same Dr. Dean who was DNC chair).

Rich said...

Balfegor said:

The thornier question, I suppose, is whether, when they do choose to buy health insurance, they become eligible for the subsidies. The house bill contemplates subsidies for purchase of insurance for households making up to -- as I understand -- four times the poverty level (something like $80,000/year), so I'd imagine that a majority of illegal immigrants will be eligible for the subsidy.

Well, not that it matters with many people, but HR 3200, at section 246, provides: “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

I really think this is part of the problem, that people continue to talk at cross-purposes. The president says his plan (which is not necessarily HR 3200 in the first place) doesn’t apply to people in the country illegally. That’s true – his plan doesn’t. But then someone says “You lie!” because they presume that whether the plan by its terms applies to them or not they’ll get something we’d rather they not have. And so because the plan does not affirmatively prohibit something we’re afraid of we call someone a liar for saying, accurately, that it “doesn’t apply” to those people.

Any health care benefits that are extended will probably be accessed by illegal immigrants the same way they access other benefits – illegally. But does that mean we can pass no law which does not say in so many words “By the way no illegal immigrants allowed,” on pain of being called a liar if we say – accurately – that the law doesn’t address them at all?

Same thing happened in re “death panels.” The fact is the bill does not provide for “death panels” or anything close. Many people are concerned that a very likely, even necessary, effect of the bill will be that we will have to have them (i.e. rationing) anyway (as if we don't now under the rubric of, say, United Health Care). There is a difference between what the bill explicitly addresses and concerns about its likely ramifications. I am not suggesting these concerns are not valid or ought not be addressed. I am saying that the proposition the “bills establishes death panels” is simply not true.

Bruce Hayden said...



Same thing happened in re “death panels.” The fact is the bill does not provide for “death panels” or anything close. Many people are concerned that a very likely, even necessary, effect of the bill will be that we will have to have them (i.e. rationing) anyway (as if we don't now under the rubric of, say, United Health Care). There is a difference between what the bill explicitly addresses and concerns about its likely ramifications. I am not suggesting these concerns are not valid or ought not be addressed. I am saying that the proposition the “bills establishes death panels” is simply not true
.

Maybe, maybe not. It does provide for or augment panels, boards, etc. that could be used for rationing through, for example, "best practices" (whatever they decide that means).

As for your suggestion that the plans don't provide for illegals, keep in mind that the Democrats have rejected each time that the Republicans have proposed amendments that would police this issue.

Kirk Parker said...

"Who was the candidate in the last election who was not going to be irksome?"

Fred Thompson? Oh, wait, he irked me by not really running...


Aaron (@ 11:15am),

Sorry, that's not covered. Here's a blue pill...

Shanna said...

The president says his plan (which is not necessarily HR 3200 in the first place) doesn’t apply to people in the country illegally. That’s true – his plan doesn’t.

Part of the problem here is that the President doesn't really have a plan. He has a magical, in his head plan that doesn't exist on paper for people to read. That makes it really easy to for him to say what he wants, and then turn around and say "that's not in my plan".

mrs whatsit said...

garage, you can't have it both ways. Illegal aliens do get health care now, because, as you appear to have noticed in spite of yourself, we don't actually make the destitute do without basic health care in this country. What illegal aliens don't get is health care COVERAGE paid for by taxpayers who live here legally. The debate is whether they should -- not whether we should let them die in the streets.

Ironically, of course, we're already paying for their coverage. I pay for it and you do too, in higher insurance premiums, higher taxes, whatever it takes to defray the costs of hospitals who, right now, must take care of illegal aliens and other poor people without reimbursement. Perhaps it would be more honest to just pay for their care directly by covering them, rather than indirectly by pretending not to cover them as we do now -- but that would require a level of political courage that our President clearly doesn't have (does he have any? Not that I've noticed so far), as well as a level of discernment with regard to the difference between "health care" and "health insurance" that you've shown that you don't have.

bagoh20 said...

Shanna,
I can actually see his people sitting around and deciding to do exactly that, and thinking it's cleaver. It may actually be in political terms, but it is not leadership and it is not worthy of an issue this important. He just is not presidential caliber in terms of character.

Balfegor said...

But does that mean we can pass no law which does not say in so many words “By the way no illegal immigrants allowed,” on pain of being called a liar if we say – accurately – that the law doesn’t address them at all?

I think that would be a fair criticism in the absence of an eligibility verification mechanism. It's not like this issue isn't on the radar, after all -- like it's something unforeseen. You can draft all the laws you like saying this applies and this doesn't. What matters is the enforcement mechanism. Otherwise it's just empty words.

SH said...

Robin said...

"Right, I'll take his word for it because the federal government has an excellent record when it comes to streamlining massive undertakings."

It’s the old progressive talking point about the 'low administration costs of Medicare'. It’s mostly a lie / myth... of course... Medicare is part of the executive branch so it shares resources with other departments (which don't make it into its accounting as a cost). They cook the figures by judging the number about administration by 'per person percentage' and Medicare serves people at the end of life... ergo, their admin costs per person as a percentage spent... are low... because they spend so much per person compared to insurance for general population. Then there is the problem that Medicare is out control / not administered well. This might also have something to do with its 'low' administration costs (as high as it actually is, maybe it is too low / should be even higher!). :)

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