Obama Healthcare speech :update 7/21/09

President Obama appears to be giving daily updates on Healthcare legislation and progress.   Here is a bullet point review of some of his noon statements today with  and fact checks.     

  • Objections (to reform) are Politically based –  Doesn’t pan out.  This isn’t about $30 million for the Harvest Mouse in Nancy Pelosi’s district that was essential in the economic stimulus bill in 2/2009.   This is about a $2.5 Trillion threat to scrap a healthcare system that, right or wrong, has existed for 60 years and, with all it’s flaws, does currently cover over 250 million people.  The Auto Industry has been nationalized,  The banking system has been nationalized, now the healthcare system is in the sights.   (*note to union bosses-  if you got one I can join, please add me now, I need to be protected)
  • People will be able to keep their plan if they like it –     Not really.   If your employer plan is changed, and you have employer insurance, you get what your employer decides.   There is no provision that allow you to go rouge.   Since there appears to be little or no ability for a private insurer to remain in business, and since the mandates will change the plans and coverage, it’s a stretch to even imply that you can keep your plan.    Sort of reminds me of being 16 and asking my parents if I can buy something superfluous .    The old “it’s your choice, your 16 now” rings in my head.   I might be able to do it, but I will pay for it in ways that I couldn’t imagine.   
  • If you like your provider you can keep them – FALSE –   Anyone who has ever gone into an HMO knows that your provider must be in the HMO.    The government HMO will NOT include all providers.  
  • Mandated will include Out of Pocket Limits with each policy: –  Probably a good thing – Call it agree  We consistently see people buy insurance for no other apparent reason that to “have” insurance.  If things don’t go right, they can’t afford to pay their share.   Insurance should protect you from catastrophe, not take $10 off your Rx bill.   Having standardized guidelines for Medicare supplements for seniors has been a very good thing.   It protects the seniors and lets carriers truly compete.  
  • Waiver of Preexisting condition clause for all: Definitely Agree –  Without mandates to carry coverage, only those that need coverage today would have it.   With mandates for coverage,  and even if the government kept out of the competition altogether, added taxes, and provided subsidies for insurance based on income, all insurance companies would be glad to compete on that level and offer guarantee to issue coverage with no pre-ex clause.  Please note “insurance carriers would love that”.   That would not be a great thing for consumers.   If you add that the federal government mandated that providers charge the same amount to all members, it would create a private system of competition that would most definitely lower the cost of healthcare for all.    I don’t think this would ever happen because it would mean that Medicare would no longer get private subsidies.     
  • Quoting Here : “Incentive that you get the best care, not just the most expensive”:  What does that mean??  Time for a history lesson from the 1980’s.  During the 1980’s Aetna HMO actuaries concluded that if they could promote preventive care for it’s members that the cost of preventive care for all would reduce the likelihood of major claims later.   A bonus based system to reward their physicians was set up that paid bonuses to doctors who promoted well care and had a healthier group of patients.   What the actuaries couldn’t believe is metaphorically similar to the financial meltdown we nearly had in 2008.   In 2008, financial institutions made loans that they did not believe could be paid back.  In the 1980’s Primary care doctors withheld tests and treatment to their members to meet the “healthy bonus” criteria as defined by Aetna’s HMO bonus program.  Massive litigation found Aetna guilty of conspiratorial actions to incent doctors to present false data.     I don’t how or why the government thinks that they can formulate incentives with adequate protections for patients.   
  • The cost of benefits has risen 3x the rate in the growth of wages  –  it’s true.   What is implied is that existing government policies haven’t  demanded more from private system subsidies.   When Medicare cuts it’s reimbursements to providers, the provider turns around and raises the cost to private patients to offset the loss of revenue from Medicare.    You may be reading how Drug companies have agreed to cut the cost of drugs by 50% to Medicare Part D patients who are in their donut hole of coverage.   The end result will be an increase in costs to the private sector to offset that revenue loss.    The government is critical of private insurers denial of claims, yet somehow, omnipresently will be able to reduce costs without rationing healthcare even though a public system would have no profit motive.  This is contrary to logic or sound business principals.   

The tone of rhetoric today was more focused on constructive advances with highlights of several points that the majority of reasonable people agree on, Republican and Democrat.   A thoughtful and purposeful advance of the principals we agree on:  No preex clause, guaranteed access to coverage, and reasonable mandates will make it if we can all keep our wits.   Change can happen.   Not everyone will be thrilled, but the bills, as they stand, are still today unacceptable.  

Special thanks to Mayo Clinic who posted this rebuke of HR 3200 and the current bills under consideration :  
The Clinics Health Policy Blog, one of the most respected medical institutions in the nation said: “The proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.”

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