Friday, September 11, 2009

Obama's Speech on Health Care

President Obama’s speech to the joint houses of Congress last evening highlighted his considerable strengths and a couple of his inconsistencies. In it he demonstrated his great skills in oration. He also exposed his pragmatic approach to politics. For what it’s worth, I thought it was an excellent speech and I agreed with most of the points he raised.

I agree “it makes more sense to build on what works and fix what doesn’t…” I appreciate his even handed assessment of the political wrangling in congress. ”Some have dug into unyielding ideological camps that offer no hope of compromise… a blizzard of charges and counter charges…”

His stated goals are laudable: provide security and stability for those who have health insurance, provide insurance for those who don’t, and slow the growth of healthcare costs.

His proposals for laws to protect the insured from unjust practices by the insurance companies are long overdue. I would like to see him add a law to ensure that once someone has insurance they can remain a member of that group for as long as they wish (and pay the premiums), i.e, once they get a policy with a group they can never be expelled from that group even if they loose their job.

However, in addressing those who have insurance it is misleading for him to say, “Nothing in our plan requires you to change what you have.” The contents of the plan might not require a change but the fruit of the plan might make it inevitable. However healthcare is overhauled it will result in major changes for most Americans. His plan may well create an environment where companies cannot afford to compete with a government sponsored program.

To the degree I understand the concept an “insurance exchange” it sounds great. As a conservative, I would prefer such a program be run as a non-government, non-profit co-op (love those hyphenated words). In fact there could be multiple co-ops, sort of like credit unions. The articles of incorporation for these non-profits could require them to accept any applicant fitting their demographic/geographic designation. The government could provide vouchers for the poor.

And as I wrote last year, I agree with Obama that it is time we move to mandatory health insurance. Persons without insurance create an unnecessary risk to society, warranting this intrusion on our personal freedoms. [If they get sick or have an accident they will be treated and the rest will pay for it.] The only exception I could imagine would be for those who for reasons of religious faith refuse medical care. However, I would prefer the individual states be incentivized to pass such legislation.

My difficulties with the speech are two fold: the fiscal viability of the plan and the occasional combative tone. The nebulous numbers just don’t add up. I don’t believe this plan will only cost a trillion dollars over ten years. I don’t believe the projected savings will be as great as he promises. I don’t believe once programs are put in place Congress will live within the financial restraints the President wants put into place.

Concerning the tone, I am referring both to his presentation and the content. He was at times a little too forceful in his presentation but that may just be me. Certainly his delivery was effective in communicating his passion for this project. In content he stepped over the line on at least one occasion. As I noted last fall in a discussion on negative political advertisements, Obama has mastered the art of making his opponents look guilty while his practices are the same as theirs. I am referring to his denunciation of those prominent politicians [a.k.a. Sarah Palin] who he said have lied in saying his plan would “set up panels of bureaucrats with the power to kill off senior citizens.” I have no need to defend Sara Palin; I find her guilty of fear mongering (not always a bad thing). The language I have heard her use is “creation of death panels” which will determine who gets treatment. The argument is that these panels will determine whether grandma gets treatment to prolong life at the expense of others who might be able to live longer, more productive lives. My point is I have not heard a prominent politician say the plan will create a bureaucracy with power to “kill off senior citizens.” The distinction may seem insignificant but I find it troubling. Obama is calling for civilized discussion that avoids lies and distortions. His reframing of the language of others exaggerates their statements in a pejorative way. In short, he is misrepresenting their misrepresentation of him. At the very least it calls into question his commitment to an open and civil dialogue.

I offer some final observations. The speech skillfully incorporated concepts and proposals from persons across the political spectrum creating an illusion of compromise and cooperation. It is interesting to me that one of the least specific of his proposals was a gratuitous reference to tort reform. As I re-read the paragraph it hit me he made no real commitment for change. I also find his appeal to the character of America revealing; our history is one of fierce commitment to freedom and compassion. This tension thrusts us into a quest for the proper balance for government control and personal freedom. It demands we change by solving our problems or we will “loose something essential about ourselves.” He is a true pragmatist with a nod toward Hegel’s dialectic. The most revealing paragraph of his speech (I think) is here given in entirety.

“You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter -- that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.”

Finally, having listened to and read the speech I am struck with how little I know about the details of the various bills bouncing around Congress. Will the bureaucracies be enlarged? What powers to control our personal medical options will be delegated to boards and commissions? I would that this was simply a debate about whether to provide health insurance to those who can not afford it; I could support that (but then again we already have Medicaid). If it was simply about insurance reform I might could get a better handel on the debate. But this is about all aspects of our healthcare system and no one seems to know everything that is being proposed. How can I endorse this plan when I don't even know what is in it? How can I not be leery of an unknown plan that might drastically change our society in undetemined ways? What I need now is not a speech to convince me to trust the President and Congress to implement the appropriate change for our times; what I need is a good, open, honest description of the changes being proposed. I am not getting it from the left or the right.


Phil Hoover, Chicago said...

Again, you made me stop and think about this tremendous speech by the President. I am very concerned about this whole healthcare debate...because I see the problems GROWING...not slowing down. But one HUGE ELEPHANT IN THE ROOM (that no one has even admitted to being there) is the personal behaviours of the American consuming public.

Regardless of what we do in the healthcare reform arena, until the "consumers" stops abusing their bodies, their own health, and the "healthcare systems" already in place, then ANY change will be of little consequence. Having worked in two different hospitals (Cleveland, TN and Chicago, IL), I have witnessed, firsthand, the abuse of the healthcare systems.

There is a fine distinction between "using" the systems in place, and "abusing" the systems in place. The toenail that aches is not an EMERGENCY ROOM visit "illness"....and neither is the headache that you've had for two hours--about 99% of the time.

We must "reorient ourselves" to use the system when we need it....and only when we need it. We must INSIST on this as a starting point.

We must INSIST on preventative care---diet, up unhealthy habits...

Jackie Johns said...

I agree we need to educate our citizens on the care of their own health and on how to use, not abuse, the system. But how do we "insist" they practice preventative care? Fines? Incarceration at a fat farm? Perhaps we can find a way to reward healthy life styles.

Phil Hoover, Chicago said...

We should be rewarding healthier lifestyles...but a HEALTHY LIFESTYLE is almost it's own reward. GREAT post.