Deciphering President Obama’s Health Care Speech

Last night President Obama delivered a powerful speech on health reform to a joint session of Congress. The President was able to articulate the reasons so many of us put our time, our passion, and our heart into changing this health care system, which needlessly harms so many. We share the President’s vision, but we write to you with real concern about the road-map laid out in the President’s speech, as all too often in the United States our policy has proven inadequate to meet our ambitions.  Below: the good and the bad in President Obama’s address.

THE GOOD: INSURANCE MARKET REFORM. If a bill passes Congress it is likely to eliminate some of the most heinous practices of the private health insurance industry. Most of these practices – exclusion of enrollees with pre-existing conditions, recisions (dropping patients after they get sick), charging higher premiums to women – are already illegal in Massachusetts. Some, such as banning annual or lifetime caps on benefits, would be extremely welcome in Massachusetts. However, most of these reforms – as well as requiring coverage of basic preventive services – have the effect of increasing premiums, and they are one of the reasons that Massachusetts has the highest premium costs in the country.

THE GOOD: SUBSIDIZED COVERAGE FOR LOW-INCOME FAMILIES.  Like the Massachusetts reform law of 2006, the President and Congress are likely to subsidize health coverage for low-income people. Also like in Massachusetts, these subsidies are almost certain to leave middle-income people in the lurch, and will by no means make insurance affordable even for those qualifying for reduced premiums. They will, however, be a great improvement over the status quo.

THE BAD: NO ROBUST PUBLIC OPTION OR EFFECTIVE COST CONTROL. The President made clear in his speech that any public option in his plan would be limited to those who are uninsured, and very few would enroll, making it impossible for such a proposal to reduce costs for most businesses and households. What will a public option for the uninsured do for struggling auto-makers, whose health care costs have rendered them internationally uncompetitive? Or for municipalities rolling back services to continue covering city workers? Worst of all: without effective cost control, states that have tried to extend subsidized care to the uninsured have been forced by sky-rocketing costs to slash benefits and limit enrollment – such as Massachusetts is doing now – and have not succeeded in keeping the numbers of uninsured down over time. We seem on track to repeat these failed experiments nationally.

THE BAD: THE PRESIDENT FLIP-FLOPPED ON INDIVIDUAL MANDATES. You may remember that during his presidential campaign Obama opposed forcing the uninsured to purchase health insurance. During his speech, the President not only backed individual mandates but used the same “blame the victim” language as Mitt Romney, claiming that middle-income uninsured people are somehow irresponsible free-riders, forcing society to pay for their emergency room visits. Every country with universal health care requires residents to pay into the system, but in those countries you pay a percentage of your income or your wages, which is fair, you don’t pay an extraordinarily high, flat premium regardless of your income, which is what individual mandates do. Mandates are regressive and punitive, and in Massachusetts they have forced residents to purchase plans with premiums they can afford but high deductibles and copayments that make actually accessing care unaffordable. This proposal is unfair, it is straight out of the Newt Gingrich playbook, and the President is wrong to have supported it.

THE BAD: OBAMA WAS DISMISSIVE OF SINGLE-PAYER REFORM
. The President admonished “the left” that establishing health care as a right through a single-payer system, much like the right’s proposal to abolish employer-based insurance and leave individuals to purchase care on their own, “would represent a radical shift that would disrupt the health care most people currently have.” Single-payer is not a leftist position: ask the leader of any conservative party in a country that has it, or witness the Republican Party’s recent defense of Medicare, our single payer plan for seniors. It is simply not true that single payer would disrupt the health care that people currently have – everyone would be allowed to keep their doctor and have free choice of all providers, but the gaps in their coverage would be filled. None of the horror stories the President described would have been possible in a country with single-payer, and to lump such a proposal in with efforts to shift costs onto patients is absurd.

At Mass-Care we hope that you will be inspired by President Obama’s speech, the good and the bad, to get more involved with health reform over the next few, crucial weeks. Please call your members of Congress and tell them that a public option only available to the uninsured is not going to do anything to bring down costs for the nation. Ask them to vote yes for single payer reform, which will be coming up for a vote in both the House and the Senate, as this vote will be extremely important for advancing the movement for comprehensive reform.

Click here to read or view the full text of President Obama’s speech.