Wednesday, July 22, 2009

A Modest Healthcare Proposal

"This isn't about me. I have great health insurance,
and so does every Member of Congress."

- President Barack Obama, July 22, 2009*

UPDATE, 10:oo pm: *The exact quote above was taken from the President's opening remarks at his Press conference earlier this evening. But during the conference, he was specifically asked about whether his healthcare plan would be good enough for his family. He would not directly address the question. We'll post video, and his specific response when it is available.

UPDATE II, 1:15 pm, 7:45 pm 07/23: [Corrected] Reporter Steven Thomma of McClatchy [and not Steve Koff of the Cleveland Plain Dealer as was indicated in the CBS transcript, and on the video] asked the question, and a follow-up when the President ducked the question the first time. The President apparently thought he was calling on Koff but Thomma, hearing "Steve" jumped right up and fired off his question when the President pointed to him. The personal reference to the Cleveland Mayo Clinic in his answer, and his reaction to Lynn Sweet's subsequent interjection makes it very clear Obama still thought he was speaking to Koff during his answer as well.

Gee, was Koff's question supposed to be a "set-up" question? Sure looks like it might have been. After Lynn Sweet spoke, Koff was then given an opportunity to ask a quick question, and he promptly asked the question about the Mayo Clinic that President Obama had essentially just answered in responding to Thomma!

The transcript of the full exchange with Thomma is below. And here is Steven Thomma's story from the press conference.

(Original post) 07/22/09 Watch, if you will, the short and informative embeded video below,(ht, Reboot Congress, here. The clip is quite entertaining, and what can only be described as the clutch move is given voice by an unseen questioner in the audience. It suddenly crops up, right at the very end.

I think you'll enjoy it! The video contains a few key portions of a healthcare forum held by Russ Carnahan (D-MO), a first term Missouri Congressman, just as his forum was beginning to show a few signs of going south on him. Check the expressions on the faces of some of his staff at the end. Tango down!

While I was watching it, an idea struck me. If this healthcare overhaul is good enough for all Americans -- to have it be required for all of us to have it as a minimum, then it's good enough to be required for everyone, including everyone in the federal government, no?

Here is the clip:

President Obama was reportedly asked a similar question quite recently. Something like, "Are you going to be covered by this plan?" or words to that effect. And he largely ignored the question. Not hard to figure out why!

So, why not make a condition of the passage of any healthcare legislation, a specific statutory requirement that all Congressmen and Congresswomen, all of their staffs and employees, all United States Senators, and all of their staffs and employees, the President and his staff, all members of his Administration, in other words all officers and public employees of the Executive Branch of our government, and all members of the Federal Judiciary, and their staff officers and employees, are all subject to the same requirements of law that the promoters of the healthcare are now proposing to be required for the rest of us, you know . . . "We the People ..."

Of course, like any of us, they would be free to seek any private or supplemental coverage they want or desire, but not on our dime. Realistically, if they are certain such additional coverage will be readily available, then they could hardly have a beef placing themselves in the same situation they want the rest of us to be subject to. Of course, the law should require that they would also have to pay for any of that additional coverage entirely on their own, just as we would. But if they are going to require all the rest of us to be in a basic system that they tell us is so good, then it should be good enough for them as well.

The requirement would have to be in the form of an amendment to any bill that is proposed to overhaul the healthcare system. If a sufficient number of Americans make it clear that they want that amendment included in any provision to overhaul the healthcare system, then the Members of Congress would he hard-pressed not to include it, especially if it was offered as an amendment, and they had to vote yes or no on that particular provision.

An amendment to the healthcare bill might look something like this:

"(1). The provisions of any law to the contrary notwithstanding, all officers and employees of the United States of America, including, but not limited to all Members of Congress in either House, and their staffs and employees, the President of the United States, all of his staff, all appointed or ex officio members of his Administration, all officers and public employees of the Executive Branch of the federal government, and all members of the Federal Judiciary, constitutional or otherwise, and all staff officers and employees of the federal judiciary, shall be hereafter subject to the provisions of this law.

(2.) In no event shall any federal funds pay for any healthcare coverage beyond the basic coverage mandated herein [public option], provided however, that nothing shall prevent any federal officer or employee, as specified in paragraph (1.) of this provision, to contract for purchase of any additional healthcare coverage as said person or persons shall deem appropriate for themselves, and, or, their families, as the case may be.

Here is the transcript from CBS News, containing the exchange between Steven Thomma of McClatchy and President Obama on whether he and the Congress would abide by the terms of the "public option." At one point on a follow-up he says he would abide by the terms of the public option, and immediately notes why that could not possibly work! He ducked the question about Congress entirely, except to falsely suggest at one point that the plan they want to put in place somehow matches up with the federal plan. (my emphasis added)

[Steve Koff, the Cleveland Plain Dealer.] Correction: Steven Thomma, McClatchy

Q: Thank you. To follow up on Jake's question earlier, sir, so many Americans are concerned that this plan, particularly the government insurance, the public option, would lead to reduced benefits or reduced coverage.

Two questions. One, can you guarantee that this legislation will lock in and say the government will never deny any services; that that's going to be decided by the doctor and the patient, and the government will not deny any coverage? And secondarily, can you, as a symbolic gesture, say that you and the Congress will abide by the same benefits in that public option?

THE PRESIDENT: Well, number one, not only the public option but the insurance regulation that we want to put in place will largely match up with what members of Congress are getting through the federal employee plan. That's a good example of what we're trying to build for the American people -- the same thing that Congress enjoys, which is they go -- there is a marketplace of different plans that they can access, depending on what's best for their families.

Now, one of the plans that we've talked about is a public option. And part of the reason we want to have a public option is just to help keep the insurance companies honest. If the insurance companies are providing good care -- and as it is, they're going to be more regulated so that they can't deny you care because of a preexisting condition or because you change jobs or because they've decided you're too sick and not a good risk -- with regulation there's already going to be some improvement in the insurance industry.

But having a public plan out there that also shows that maybe if you take some of the profit motive out, maybe if you are reducing some of the administrative costs, that you can get an even better deal, that's going to incentivize the private sector to do even better. And that's a good thing. That's a good thing.

Now, there have been reports just over the last couple of days of insurance companies making record profits -- right now. At a time when everybody is getting hammered, they're making record profits, and premiums are going up. What's the constraint on that? How can you ensure that those costs aren't being passed on to employers or passed on to employees, the American people, ordinary middle-class families, in a way that over time is going to make them broke? Well, part of the way is to make sure that there's some competition out there. So that's the idea.

Now, to get to your original question, can I guarantee that there are going to be no changes in the health care delivery system? No. The whole point of this is to try to encourage changes that work for the American people and make them healthier. The government already is making some of these decisions. More importantly, insurance companies right now are making those decisions.

And part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works -- because that's not how it's working right now. That's not how it's working right now.

Right now doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there.

So if they're looking -- and you come in and you've got a bad sore throat, or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, you know what, I make a lot more money if I take this kid's tonsils out. Now that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies, maybe they have something else that would make a difference.

So part of what we want to do is to free doctors, patients, hospitals to make decisions based on what's best for patient care -- and that's the whole idea behind Mayo, that's the whole idea behind the Cleveland Clinic. I'm going to be visiting your hometown tomorrow to go to the Cleveland Clinic to show -- to show why their system works so well. And part of the reason it works well is because they've set up a system where patient care is the number-one concern, not bureaucracy, what forms have to be filled out, what do we get reimbursed for. Those are changes that I think the American people want to see.

Q: And what about yourself and Congress? Would you abide by the same benefits package?

THE PRESIDENT: You know, I would be happy to abide by the same benefit package. I will just be honest with you -- I'm the President of the United States so I've got a doctor following me every minute. (Laughter.) Which is why I say this is not about me.

I've got the best health care in the world. I'm trying to make sure that everybody has good health care -- and they don't right now.

Lynn Sweet. Oh. (Laughter.) Well, I said Steve Koff -- but he just stood up, huh?

Q: Yes.

THE PRESIDENT: Well, that's not fair. Shame on you. (Laughter.) All right, get in there real quick.

He can say that bit about it not being about him again . . actually, he did say it, twice . . . it is not about him. Nor is it about the Members of Congress! They will just be the ones imposing it on the rest of us; not the ones who have to live with it.

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