Wednesday, September 09, 2009

So the President spoke ...

And before I read anybody else's analysis, I thought I would venture my own. First I will say I realize that Chad Hermann (and his minions) will pick apart the President’s speech line by line, finding it wanting piece meal and as a whole. And any one who says anything positive about the President’s speech is a dupe in thrall to the mystique of Obama the messiah. But anyone who criticizes him is part of a persecuted minority (of people with common sense), who are being accused of racism by the actual racists, the liberals (actually closet communists) whose arguments are so weak they have to resort to name calling and twisting the facts.

And so you should ignore anything I say here, because it will all be useless drivel.

Anyhoo, I thought the President gave a good speech. He continues to walk a fine line, between reinforcing his base, trying to include the Republicans in on things and actually do something to achieve health care reform. He started by introducing the problem, citing the costs in lives and dollars. He then stated he is going to give Congress a bill (that’s the way I understood it) and he outlined what will be in it, including an insurance exchange for the uninsured. Then he spent some time correcting (attacking?) the misinformation we have had forced on us in the last month. Only then did he mention the public option. He waited so long I thought he had dropped the public option. He did specify the limitation that only people who don’t have insurance now will be able to use it. He said that only 5% of Americans might sign up for it (according to the CBO). But I will say the public option could, in fact, be a powerhouse in health insurance. The private companies keep as much as 20% of premiums for overhead (mostly for profit). The public option might only keep 3%. So they might be able to pay somewhat more for medical claims and still have lower premiums. This cold affect the bottom line of private insurers, and cause them to either keep less of premiums and lower costs to consumers, or to lobby the Republicans hard to block the plan. On the other hand, if the public option really is only for the currently uninsured, well, they weren’t buying private insurance before anyway, so how much have the private companies lost?

Back to the President’s speech, it went on. And on. He said finally at least three times, I think, yet it kept on not being finally. He said we wouldn’t insure illegal aliens, which yielded a yelled “lie” from the Republican side (Nancy Pelosi glared for some time over that way), and some other dubious noises, some I think from Democrats. He pointedly did not mention a tax on those making over $250,000, although Obama did mention the Bush tax cuts for the wealthy, as well as the two wars Obama inherited, as adding to the deficit Obama inherited (to enthusiastic Democratic only applause). And Obama did pointedly reassure senior citizens that he was not going to make them suffer any hardship.

He finished with an extended discussion that started with a letter Teddy Kennedy wrote in May but somehow was delivered to Obama only recently (that’s the way I understood what Obama said). He focused on a phrase Kennedy used, the American character. And Obama drew out his analysis, talking about the tension between individual liberty and having government step in when either the free market has failed or maybe when some problem, natural disaster or man made, has occurred. Obama stressed the importance of individual liberty, but came down particularly in this situation on a greater role for government.

Now, if you think about it, bringing up the issue of individual liberty with reference to health insurance is entirely silly. Most of us experience health insurance through our employer, where we are either offered one plan, period, or perhaps a cafeteria of plans. My employer has six or maybe seven or eight plans, each with different costs depending on family size. Despite that fairly impressive variety, I don’t thing there is a true High Deductible/Health Savings Account plan in there (the plan has to meet certain deductible levels to qualify for the tax benefits, which are key). By the way, I have decided now that HD/HAS plans are only good for young people (preferably just out of college) who plan to never have children. That’s means pushing HD/HSA’s means having your country shrink.

Anyway, my point is that even for me, my choices are pretty limited. But I am steered toward those limited choices because my employer will pay some 70% of my premiums. Even if I were to buy my own health insurance, my choices would be pretty limited to what is available around here. And if I try to shop around for doctors, I quickly find I am pushed toward health insurance options where I choose from a limited pool of doctors, ones heavily affiliated with my health insurance company. Plus, for shopping either for health insurance companies or doctors, the rates they charge are largely concealed. So any shopping will be made that much more difficult, and if you (and you spouse if you are married) work, it will be even more difficult since your work would have to tolerate your calling health insurance companies and/or doctors during work hours, and staying on the phone for a pretty long time.

So any sense that the free market of health insurance and health care actually gives you choices is in practice simply wrong. Despite that, Obama is trying to maintain part of the status quo (despite what he says) because it works for a majority of Americans. The majority doesn’t have to think too hard about their health insurance, and doesn’t want to.

I think Obama is taking a wise approach, and I think he made that clear in his (long) speech tonight (clearer than in my long post here). But I think the day is coming when we will decide to take the single payer route. And the longer we delay, the more suffering that will occur along the way.

No comments: