Health Care

5 Thoughts About Obama's Speech at the Health Care Summit

Published March 05, 2009 @ 11:31AM PT

Quick notes on President Obama's kickoff speech to today's White House summit on health care (while I'm watching the session hosted by Nancy DeParle, where Twitter and Facebook were just mentioned -- by a House Republican!)

  1. This was not a meek call to arms.  Throughout the campaign, Obama always gave a more modest and cautious (though still seen as ambitious) goal of universal health care by the end of his first term.  Lately, the president has been talking about urgency to address health care now, but it wasn't clear if he meant to start along the road to reform -- maybe by focusing on cost control -- or go for the grand slam and achieve comprehensive reform this year?  Well, Operation Grand Slam appears to be the marching order:  "The purpose of this forum is to start answering that question – to determine how we lower costs for everyone, improve quality for everyone, and expand coverage to all Americans.  And our goal will be to enact comprehensive health care reform by the end of this year."
  2. The president somewhat soft-pedals the moral questions of health care reform and the uninsured compared to how much he ramps up the financial concerns for those with insurance.  "And that is why today's forum is so important. Because health care reform is no longer just a moral imperative, it is a fiscal imperative."  This is his key argument -- we have to tackle health care not for the benefit for some, but the economic necessity of all.
  3. An ad lib in his speech:  "In fact, this [health care summit] was the hottest ticket in town."  A health care reform summit is the hottest ticket in town!  Could you have imagined that statement being said a year ago?
  4. Although the president give us the "every option must be on the table" line, his follow up to it is perhaps more accurate:  "Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect."  Tnis Mick Jagger-like focus on getting what you need, not what you want is striking.  You don't normally hear that level of honesty from a politician.
  5. By the same token, Obama has drawn one line in the sand:  "The status quo is the one option that is not on the table.  And those who seek to block any reform at any cost will not prevail this time around."  It's great to reach for bipartisanship, but it's more important to actually make the reform.  From what I've heard, the president gets it.

You can watch this summit live at http://healthreform.gov/.  Full text of the president's speech after the jump.

Remarks of President Barack Obama – As Prepared for Delivery
White House Forum on Health Reform
Washington, DC
March 5, 2009

We are here today to discuss one of the greatest threats not just to the well-being of our families and the prosperity of our businesses, but to the very foundation of our economy – and that is the exploding cost of health care in America today.

In the last eight years, premiums have grown four times faster than wages, and an additional nine million Americans have joined the ranks of the uninsured.  The cost of health care now causes a bankruptcy in America every thirty seconds.  By the end of the year, it could cause 1.5 million Americans to lose their homes.  And even for folks who are weathering this economic storm, and have health care now, all it takes is one stroke of bad luck – an accident or illness; a divorce or lost job – to become one of the nearly 46 million uninsured or the millions who have health care, but can't afford it.

We did not get here by accident.  The problems we face today are a direct consequence of actions we failed to take yesterday.  Since Teddy Roosevelt first called for reform nearly a century ago, we have talked and tinkered.  We have tried and fallen short, stalled time and again by failures of will, or Washington politics, or industry lobbying.

And today, there are those who say we should defer health care reform once again – that at a time of economic crisis, we simply cannot afford to fix our health care system as well.

Well, let's be clear: the same soaring costs that are straining our families' budgets are sinking our businesses and eating up our government's budget too.  Too many small businesses can't insure their employees.  Major American corporations are struggling to compete with their foreign counterparts. And companies of all sizes are shipping their jobs overseas or shutting their doors for good.

Medicare costs are consuming our federal budget.  Medicaid is overwhelming our state budgets.
And at the Fiscal Summit we held here last week, the one thing on which everyone agreed was that the greatest threat to America's fiscal health is not Social Security, though that is a significant challenge; and it is not the investments we've made to rescue our economy; it is the skyrocketing cost of health care.

That is why we cannot delay this discussion any longer.  And that is why today's forum is so important. Because health care reform is no longer just a moral imperative, it is a fiscal imperative.  If we want to create jobs and rebuild our economy, then we must address the crushing cost of health care this year, in this Administration.  Making investments in reform now, investments that will dramatically lower costs, won't add to our budget deficits in the long-term – rather, it is one of the best ways to reduce them.

Now I know people are skeptical about whether Washington can bring about this change.  Our inability to reform health care in the past is just one example of how special interests have had their way, and the public interest has fallen by the wayside.  And I know people are afraid we'll draw the same old lines in the sand, give in to the same entrenched interests, and arrive back at the same stalemate we've been stuck in for decades.

But I am here today because I believe that this time is different.  This time, the call for reform is coming from the bottom up, from all across the spectrum – from doctors, nurses and patients; unions and businesses; hospitals, health care providers and community groups.  It's coming from mayors, governors and legislatures – Democrats and Republicans – who are racing ahead of Washington to pass bold health care initiatives on their own.  This time, there is no debate about whether all Americans should have quality, affordable health care – the only question is, how?

The purpose of this forum is to start answering that question – to determine how we lower costs for everyone, improve quality for everyone, and expand coverage to all Americans.  And our goal will be to enact comprehensive health care reform by the end of this year.

In the past month alone, we have done more to advance that goal than we have in the past decade.  We've provided and protected coverage for eleven million children from working families, and for seven million Americans who've lost their jobs in this downturn.  We've made the largest investment in history in preventive care; invested in electronic medical records that will save money, ensure privacy, and save lives; and launched a new effort to find a cure for cancer in our time.  We have also set aside in our budget a health care reserve fund to finance comprehensive reform.  I know that more will be required, but this is a significant down-payment that is fully paid for and does not add one penny to our deficit.  And I look forward to working with Congress and the American people to get this budget passed.

Now, as we work to determine the details of health care reform, we won't always see eye to eye.  We may disagree – and disagree strongly – about particular measures.  But we know that there are plenty of areas of agreement as well, and those will serve as the starting point for our work.

We can agree that if we want to bring down skyrocketing costs, we'll need to modernize our system and invest in prevention.  We can agree that if we want greater accountability and responsibility, we must ensure that people aren't overcharged for prescription drugs, or discriminated against for pre-existing conditions – and we need to eliminate fraud, waste and abuse in government programs.  We can agree that if we want to cover all Americans, we cannot make the mistake of trying to fix what isn't broken.  So if you have insurance you like, you'll be able to keep that insurance.  If you have a doctor you like, you can keep that doctor.  You'll just pay less for the care that you receive.

Finally, we can all agree that if we want to translate these goals into policies, we need a process that is as transparent and inclusive as possible.  That is why I have asked all of you – representatives of organizations, interests, and parties from across the spectrum – to join us here today.  And that is why we asked concerned citizens like the folks on this stage to organize open meetings across America where people could air their views.  More than 3,000 meetings were held in all 50 states and DC, and more than 30,000 people attended.  I thank them for their input and ideas, and I look forward to reading the report that Travis has presented to me.

In this effort, every voice must be heard.  Every idea must be considered.  Every option must be on the table.  There will be no sacred cows in this discussion.  Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect.  But when it comes to addressing our health care challenge, we can no longer let the perfect be the enemy of the essential.

Finally, I want to be very clear at the outset that while everyone has a right to take part in this discussion, no one has the right to take it over.  The status quo is the one option that is not on the table.  And those who seek to block any reform at any cost will not prevail this time around.

I did not come here to Washington to work for those interests.  I came to work for the American people – the folks I met on the campaign trail, and who I hear from every day in the White House. Folks who work hard and make all the right decisions, but still face choices that no one in this country should have to make: how long to put off that doctor's appointment; whether to fill that prescription; when to give up and head to the emergency room because there are no other options.

I have read some of the many letters they've sent asking me for help.  They're usually not looking for much.  They don't want a handout or a free ride.  Some are embarrassed about their situation and start by saying they've never written a letter like this before.  Some end by apologizing -- saying they've written to me because they have nowhere else to turn; asking me not to forget about them and their families.

Today, I want them, and people like them across this country, to know that I have not forgotten them.  They are why we are here today – to start delivering the change they demanded at the polls in November.  And if we are successful, if we can pass comprehensive reform, these folks will see their costs come down and get the care they need, and we'll help our businesses create jobs again so our economy can grow again.

It will not be easy.  There will be false starts and set-backs and mistakes along the way.  But I am confident that if we come together, and work together, we will finally achieve what generations of Americans have fought for and fulfill the promise of health care in our time.

(Photo credit:  SEIU International on Flickr.)

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Comments (16)

  1. Linda Galve

    Sure the idea of this healthcare package sounds great.But if you think about it and read between the lines on what pres.obama wants in this plan is totally un-acceptable. It's not the answer the american people need to hear.What he's saying is that it would be more socialized healthcare and not for everyone.. tht means our government would regulate your health care.. Is that what you want??? Weigh the differances yourself.. National Healthcare is not going to work..If this goes through then everyone suffers... thousands of americans including seniors would have a harder time trying to get their healthcare options..
    Speak out against this National Healthcare

    Linda Galve

    Posted by Linda Galve on 03/06/2009 @ 12:23PM PT

  2. Timothy Foley

    Linda, I can't help but think you're not reading between the lines, you're reading what you want to read. 

    He is saying he wants a market driven solution to health care that builds on public and private.  Government would regulate insurance -- by the way, like states do not -- but not your health care.  Seniors would be in a system that DOES NOT CHANGE because they're already in Medicare.

    We can debate whether that's a good idea or not, but you can't debate what the man's plan is.  It's there in black and white.

    Posted by Timothy Foley on 03/06/2009 @ 02:51PM PT

  3. Sally Gellert

    Linda, I read the speech just the opposite of the way you did; NOT as an endorsement of a single-payer proposal (which you refer to as "socialized  medicine", but which is not that in fact: the providers remain private practices and businesses, not government employees as they would be in a socialist system; the major difference between an American single-payer system and what we have now is that there would be just one (public) payer rather than hundreds of for-profit insurance companies).
    Do I want the government to "regulate [my] health care"?  Not especially, but rather the government, which works for the public, than the insurance industry, which works for its own profits and does everything possible to avoid paying claim, which they consider a "medical loss", not the reason that one has insurance.
    At a town hall meeting a friend attended, our Representative (Rothman, D-NJ) asked "Who here has Medicare?", and when a number of hands went up, Rep. Rothman followed up with "Who has problems with it?"  Almost none.
    Obama says that "if you like your insurance plan you can keep it", but that's a promise he can't keep: people who lose their jobs are routinely dropped from employer-paid insurance.  It is time to sever employment and insurance, and find a new way.
    What I like about what the president said is that he is considering all options, which is the only way, IMHO, to make a rational decision.  I still think the problem is moral as well as fiscal, but the fiscal component has risen to a point at which a greater proportion of the population feels the pinch, and that could be an impetus for real reform.  I certainly hope so.  Check out www.kff.org and www.pnhp.org for information about the savings of a publicly funded single-payer system with private health-care providers.

    Posted by Sally Gellert on 03/06/2009 @ 08:54PM PT

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  5. Elizabeth Robechek

    I am opposed to the market driven DISEASE REIMBURSEMENT system we now have and am disappointed that a universal, single payer HEALTH CARE systemappears to NOT be part of this important conversation.  The single payer does not have to be the Federal Government, but could be a organization associated with the goverment i.e. the Federal Reserve....or some other institution.  I have family members and friends who have lived in Europe with socialized medicine---and found it tremendously positive. Health care and prevention of several common life threatening diseases, which are part of the rising costs, needs to be a right for all citizens.  

    I am pleased that the Obama administration seeks to operate from a whole systems approach.  The environment, agriculture, jobs and the economy etc. affect health  There is not effective way to solve these problems as isolated from one arena to another.   

    Posted by Elizabeth Robechek on 03/06/2009 @ 05:36PM PT

  6. Nancy Miller

    That is exactly the point. All the current plan proposes is in the end is: more money for insurance companies by forcing lower income people (who can't afford insurance as it is) to do just that. If you think for one moment that the people who take the lower-tier insurance will get adequate health care, you are deluded. I've been a RN for 33 years, watched HMOs destroy the medical profession, and have NO interest in helping them bury it completely. Do you realize that HMOs and their ilk are practicing medicine without a license? Do you know that they tell your MD what drugs he/she can and cannot prescribe for your condition? Even when the med they are 'pushing' is not the best for you (but it's cheaper)? Or that they will tell your surgeon/oncologist/other specialist what he/she can and cannot do to treat an illess or condition? It's medical care by oligarchy, not by doctors. Oh of course, you can have the 'unapproved' treatment or medication, but you'll have to pay up front for that, so you effectively cannot have it.
    And do not even *think* about well-care - it isn't a money-maker so our insurance overlords will never allow it. Thanks, Dems.
    Bah, HUMBUG! Universal, single-payer healthcare is the only rational answer. Folks here wail about the problems with Europe and Canada's solution, but they get far better care, for far less cost. Check the UN health stats, for general populace health, cost for care, etc. Put Universal Single Payer Health Care on the table. If you really meant what you promised.

    Posted by Nancy Miller on 03/07/2009 @ 08:04AM PT

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  7. Sally Gellert

    A single-payer system is not socialism in any form; the providers are not government employees but private practitioners/hospitals, etc., that contract with one payer rather than dealing with hundreds of insurance companies, thus allowing them to concentrate on health care, not "flying paper airplanes".  It puts the treatment-option discussion back to the patient and provider, and cuts out lots of wasted time and paper.

    Posted by Sally Gellert on 03/08/2009 @ 10:05PM PT

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  9. Rebecca S

    President Obama needs to make sure to include Registered Nurses in advising regarding policy... for example the California Nurses are strong Obama supporters, but also are proponents of a single payer health care system, akin to Medicare. This would still allow MDs and other providers to be fairly reimbursed, but would ease out the For Profit motive of insurance companies. As someone who has worked in all facets of healthcare, I believe single payer is the best way to go. Thank you. 

    Posted by Rebecca S on 03/06/2009 @ 09:02PM PT

  10. Sally Gellert

    Definitely true; the RNs are the ones who care for hospitalized patients on a daily basis and know the practicalities.  I would also like to see prevention (nutritional education, good health practices) and so-called alternative practitioners included (e.g., acupunturists and midwives/birthing centers [We had a few birthing centers in northern N.J. back in the early 90s, but one center had its insurance rate raised from $30,000 to $300,000 in one year, with nothing unusual during that year to explain it.  That sort of "medicine by fiscal fiat" MUST GO!])

    Posted by Sally Gellert on 03/08/2009 @ 10:12PM PT

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  11. Taguhi Arakelian

    I whole-heartedly agree that the single payer system is what we need.  However, considering the blow this would be to the insurance companies, who seem to have us by the throats, I am rather pessimistic if we will ever get there.  Still, hope springs eternal....

    Posted by Taguhi Arakelian on 03/10/2009 @ 09:37AM PT

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  12. Sally Gellert

    Taguhi,

    Hope springs eternal, but action has brought an HR-676 amendment to the House Energy and Commerce Committee for a vote! :)  Check out healthcare-now(dot)org for info.

    Posted by Sally Gellert on 07/14/2009 @ 02:53PM PT

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  14. Andrew Heugel

    I feel that changing to a single payer system is a necessity, if we wish to provide health care for all at a reasonable price. President Obama didn't mention it, but the current HMO system is at the root of the problem and is broken and does desperately need to be fixed. Almost every year, the non-profit I work for changes HMO's in a search for the best deal. This means that every insured employee must then go to an enrollment meeting to fill out paperwork and learn the new rules on company time and then fill out new paperwork at every health care provider. And, when we're not doing this, we need to be checked for eligibility every time we go to a health care provider and that provider has to have their medical billers check to see if the procedure or service is covered and what the reimbursement rate is. And, at the HMO's there is an incentive to deny benefits. Many thousands are employed in this eleigibity part of the business, rather than providing actual health care and this slows delivery of services, adds to the patients' and service providers' confusion and costs billions that could be spent on insuring the uninsured.

    Another area of waste is the current Medicaid system of providing reimbursement for the agencies that provide services to the various populations of people with disabilities. In services for the develomentally disabled, there are the ubiquitous check boxes for the providing of residential, pre-vocational or day hab services that along with attendance documents that a service was delivered. But, rather than improving services for the consumers served by these agencies, this has changed the focus of the service providers to keeping what is in some cases virtual nonsense data and killing trees. And, none of these services are billable, unless they are in the consumer's ISP, which was described by one Medicaid Service Coordinator as an invoice for billing Medicaid. So, endless agency hours are spent making sure that the data on the ISP, such as enrollment dates, match the data on the other documents and every agency has a quality assurance department (often headed by a lawyer) to assure that the paper, facility, and appearance of services is audit ready. The focus has taken the emphasis away from providing actual services to making it look like services are provided.

    Also, in the world of the disabled, there are the people with multiple disabilities or mild disabilities that fall through the cracks. In New York State, someone whose primary diagnosis is psychiatric is expected to graduate to either independent or supported OMH housing, with the latter being one case manager for 15-20 clients. I have seen people with IQ's in the seventies and psychiatric diagnoses fail time and time again due to lack of support. And, when I worked in a homeless shelter, I encountered someone who was developmentally disabled with a psychiatric diagnosis and a history of substance abuse who was severely underweight and had full blown AIDS. What service provider is equipped to deal with a person with that range of problems? THese kinds of issues need to be addressed.

    And, health care providers need to be better reimbursed for preventative medicine and therapies and for getting disabled clients to higher levels of independence. The current system is reactive in that it rewards health care providers for providing services, medications and therapies for chronic conditions and disabilities, rather than being proactive and enabling the patient to be healthier or the person with a disability to be more independent.

    The current American health care system is such a confusing and unnecessarily complicated mess that it will be a long, detailed process to make it simple as it is in such countries as France, Great Britain and Cuba and put the health care providers back in charge. And, many thosands of workers who are employed due to the current billing system will need to seek new and more useful employment, and their transition needs to be provided for. In the meantime, we could run the lobbyists for the Axis of Evil (HMO's, drug companies, ambulance chasing lawyers) out of town, so our elected representatives can focus on creating a system that provides quality, affordable health care for all. 

    Posted by Andrew Heugel on 03/07/2009 @ 12:18AM PT

  15. Sally Gellert

    I'm with you 100%.  PPOs are just as bad as HMOs, and there are very few "traditional" insurance policies around anywhere.  The use of company time for so much inefficient health-care-related paperwork is one obvious reason to divorce employment and health care, as no company can afford that much downtime and remain competitive.  A possibly more important reason is that as unemployment goes up, so does the number of the uninsured, especially as the cost of COBRA insurance has risen dramatically.  For those lucky enough to have a job, even one they hate, fear of losing employer-provided coverage is a great factor in life decisions such as where to live, looking for another job, starting a business, ability to stay home with children of the parent with the better insurance plan, etc.  Is this anyway to run a health care system?  You know it's not.

    Posted by Sally Gellert on 03/08/2009 @ 10:18PM PT

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  17. Lucien Beauley

    There's only one obvious way to solve this nation's health-care crisis and that is "Disease Prevention" using natural foods. It must be taught in our schools and this will not require substantial investment on the government's part and we would save billions[with a "B"]. The U.S. would soon become the healthiest nation once again and would in a short period balance the budget and produce a surplus. It is the "common sense" solution. It is dollars spent in the most effective way. You don't have to be a math genius to figure this out. Of course, the big corporations now involved in providing the present health care would not make the profits they do now while not helping us "prevent illness",  but it is the people we should be serving.

    Posted by Lucien Beauley on 03/08/2009 @ 01:45PM PT

  18. Sally Gellert

    You are absolutely right, but even with the healthiest life style and diet, some people will become sick, have major accidents, etc, and need professional health care.  A single-payer program including prevention education seems to me to be the best option.

    Posted by Sally Gellert on 03/08/2009 @ 10:20PM PT

  19. Joe  Ward

    Foods (and other prevention measures that are learned) are very important. I Agree.

     However,Traumatic Brain injuries (the only one that I am familiar with) top the list according to the CDC statistics. Most are not logically preventable,while some in fact are. Most of what the doctors want isn't paid for for long term health care by the insurance. If  The doctors say that my wife NEEDS 8 weeks of Rehab, The case worker might get 4 out of insurance after a rebuttal. They say that she NEEDS further cognitive therapy at a specialized level (which she does) My insurance pays 0%. Medicaid would pay 100% if she could qualify. I make too much money, so that screws her over. Divorce is an option that will give her a shot, but It costs a whole lot in legal fees due to me being her guardian. (cannot get a simple uncontested divorce if you are the caregiver).She has to be with someone 24 hours a day. Insurance does not pay for a sitter while I go to work. Yes , I could turn her over to the state, but I would have no legal say-so on her care or how she was treated, or even where she will end up.These companies are telling the docs what to do and they are not even there to see what is going on. That is what made me think," Who is in charge of our health care?!" I would rather leave it to the government, rather than corporate bean counters. At least you have a bit of a voice to be heard there. I don't want anyone to go through what we have been (Even people I hate).

    Something just has to be done soon. It is out of control. Lines in the sand, a show of force, and Party loyalty does not help my wife any. Now we are at stand still, for what? There are millions of people out there waiting and hoping for some headway. I can't speak for them. Right now I am feeling we are  let down and sold out. Eighty-seven percent want a change and somehow the 13 percent is standing fast. Things are kind of quiet now about it and I guess I don't understand, as to why.

    Posted by Joe Ward on 06/28/2009 @ 01:14AM PT

  20. Sally Gellert

    Joe,

    I was out of town and just read your message.  Myy heart goes out to you and your wife, my voice goes out (usually as e-mails) to support REAL reform, single-payer universal health care.  Nobody should have to go through what you two are.  Part of being a civilized, advanced nation (I consider us an adolescent nation) is taking responsibility to provide on a society level for those with needs for access to treatment and therapy, home care, and so forth, as a group, not leaving the less fortunate to fend for his- or himself.  I really consider this the civil rights issue of our time.  Best.

    Posted by Sally Gellert on 07/14/2009 @ 02:59PM PT

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Timothy Foley

Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.

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