Checking the speech

As Larry Jacobs told Gary Eichten after Saturday’s speech at Target Center by President Barack Obama, it was a rally speech, not a policy speech. By design, it should have capitalized on the momentum from his speech to a joint session of Congress on Wednesday night, except that most of the discussion afterwards was about a guy who yelled something stupid, rather than the issue. So the president needed to use Saturday’s speech to jumpstart things… again.

There usually isn’t a great deal of meat in a rally speech, but that’s not to say there weren’t many interesting parts. Let’s look at a few segments of his speech.

In the last twelve months alone, six million more Americans lost their health insurance. And today, we received more disturbing news. A new report from the Treasury Department found that nearly half of all Americans under 65 will lose their health coverage at some point over the next ten years. More than one-third will go without coverage for longer than one year. In other words, it can happen to anyone. There but for the grace of God go I.

The president used this on his Saturday radio address. We’ll have to take his word for it; the report isn’t online. But it makes sense because health insurance is tied to employment in this country and we know in the last 12 months, people have lost their jobs. It’s interesting that only 6 million lost their health insurance, because nearly 15 million are currently unemployed. COBRA allows people to keep health insurance for a few months — until they can figure out how to pay for private insurance when they don’t have income.

At some point, opponents are going to have to acknowledge the validity of this aspect of the problem. Many of them did in the last campaign.

Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer more than doubled in size.

Her name is Robin Beaton of Waxahachie, Texas. Obama mentioned her situation in his speech on Wednesday.

It has now been nearly a century since Teddy Roosevelt first called for health care reform.

I was alive during the debate over Lyndon Johnson’s Great Society. Trust me, plenty has been done to help provide it since Teddy Roosevelt. The suggestion that nothing has been done since Teddy Roosevelt is, of course, wrong.

If we do nothing, we will eventually spend more on Medicare and Medicaid than every other government program combined. That is not an option for the United States of America.

On this Republicans agree. The comment mirrors Gov. Tim Pawlenty’s comments in recent years about health care in Minnesota. His view is the state shouldn’t provide health care to the extent it does. Obama’s is that someone should. That’s really the issue here.

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.

This, of course, is the “money quote” and has been for some time. But the concern of opponents is that employers — if there is a cheaper option available via public option — will drop their private-insurer coverage and force their employees to go on whatever public “exchange” is available. Why should employers pay for something that would be provided directly to their employees via this option?

We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for an affordable health insurance plan that works for them.

Lacking details as almost every plan does, what would you consider affordable when it comes to health insurance premiums?

And it would require changes for those who have Medicare. The Congressional Budget Office says the provisions currently in the House version of the health care bill will add 5 percent to Medicare premiums in 2001 and 20 percent in 2019 (although spending on prescriptions would fall. Is this a wash? It depends on whether you buy a lot of prescriptions).

Now, if you still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits so that you can. And in the few years it takes us to set up the exchange, we will immediately offer Americans with pre-existing conditions low-cost coverage that will protect you from financial ruin if you become seriously ill.

Again, these are the details we don’t have. What does low cost mean?

I have also said that one of the options in the insurance exchange should be a public insurance option. Let me be clear – it would only be an option. No one would be forced to choose it, and no one with insurance would be affected by it. What it would do is provide more choice and more competition. It would keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting private colleges and universities.

We know by experience how insurance companies lower their costs. So if the public option is intended to apply pressure on private insurers to keep their policies affordable, how does that likely square with the claim that having such a public option wouldn’t affect anyone with insurance now? I’m not saying it will. I’m not saying it won’t. I’m not inviting another round of T-shirt slogans. I’m asking how the theory works in detail?

And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the coverage that you need.

There seems to be almost no way to provide a public option without a bureaucrat working on administering it. But giving Obama the benefit of the doubt that what he means is a bureaucrat won’t deny “the coverage you need,” it invites the question, “who decides what coverage you need?” We know who does now. The insurance companies. But the promise is a bureaucrat won’t be involved in this. Suppose your health care provider — however you define that — suggests laetrile to treat cancer. Who’s going to be the one to say that’s not an acceptable treatment?

First, I will not sign a plan that adds one dime to our deficits – either now or in the future.

According to the “Congressional Budget Office”:″ target=”_blank:

According to CBO’s and JCT’s assessment, enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period. That estimate reflects a projected 10-year cost of the bill’s insurance coverage provisions of $1,042 billion, partly offset by net spending changes that CBO estimates would save $219 billion over the same period, and by revenue provisions that JCT estimates would increase federal revenues by about $583 billion over those 10 years.

By the end of the 10-year period, in 2019, the coverage provisions would add $202 billion to the federal deficit, CBO and JCT estimate. That increase would be partially offset by net cost savings of $50 billion and additional revenues of $86 billion, resulting in a net increase in the deficit of an estimated $65 billion.

Keep in mind, that refers to the House version of the bill, which nobody thinks is ever going to be enacted in its present form.

Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn’t make us healthier. That’s not my judgment – it’s the judgment of medical professionals across this country.

And it’s also true that this isn’t a serious point of debate.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies – subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

This also mirrors what the president said Wednesday. The New York Times said the president overreached.

Critics of the president’s plan have said Americans ages 65 and over could find their Medicare benefits reduced as a result of the health care overhaul. Congressional Democrats certainly do not intend to cut benefits, but they are proposing big cuts in government spending on Medicare and not all of it would come from eliminating waste.

The legislation seeks to trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. Other cuts would come from reduced payments to drug makers. Such cutbacks could inadvertently reduce access to some types of care.

The changes could also create new co-payments for services, including some laboratory tests that are now provided without charge.

So don’t pay attention to those scary stories about how your benefits will be cut. That will never happen on my watch. I will protect Medicare.

Even if he’s re-elected president, Medicare isn’t expected to run out of money until 2017, right after his term would expire.

  • Joanna

    The devil’s in the details, of course. But since opponents of reform are suggesting that Obama wants to kill your grandmother with a “death panel” maybe the first step is to get people to not reject all change out of hand?

  • Bob Collins

    The death panel has been pretty much discredited now and was such an over the top allegation, actually, that it’s making it more difficult for opponents to gain traction on issues that actually are worth talking about.

    It’s a pretty interesting strategy, this notion that Americans can’t or won’t be interested in intelligent debate over legitimate differences — and there are legitimate reasons to be concerned about the proposals, so they must be bludgeoned with hysteria instead.

    So, in many ways, the death panel allegation has helped proponents of the legislation, too. It makes it much easier to marginalize opponents as all being, well, crazy.

  • Joanna

    I don’t think I was arguing that Americans can’t or won’t engage in rational discussion, but I’ve been observing that rational discussion does not make headlines for news organizations that sell ads (unlike MPR) and that these diversionary topics do confuse and alarm people. So, while I would also prefer to hear Obama give us a professorial public lecture about specifics– much in the way Al Franken did in that conversation at the State Fair that you blogged about– that was not the political function of this particular event, which instead is designed to reassert theatrically and visually some measure of public support for the agenda of reform itself. I appreciate your role in clarifying the details; that’s an important journalistic function that this event make possible.