Obama's Health Care Plan. Where is it? Who has it? And how can it come to a vote when it doesn't exist?

Obama claimed during his address on 09/09/2009 that his/the health care reform bill will achieve the following:

The plan I'm announcing tonight would meet three basic goals. It will provide more security and stability to those who have health insurance. It will provide insurance for those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government.

First off, the CBO disagrees with the president about "slowing the growth of health care costs".

PDF file: 06-16-HealthReformAndFederalBudget from the CBO website

■ Currently, a significant share of the population moves in and out of insurance
coverage during a year, which complicates efforts to provide effective
prevention and wellness services. As discussed later, though, those services
are less broadly effective at reducing health care spending than might be
expected, and in any event, expansion proposals would not eliminate all of the
churning that makes it harder to maintain continuity of care.

■ Most expansions of insurance coverage that are under consideration would
leave a moderate number of people uninsured, in part because some people
would be ineligible for subsidies or would choose not to buy insurance even
with large subsidies. Therefore, any current problems arising from the lack of
insurance could be reduced but not eliminated.

It also bears emphasizing that if a reform package achieved “budget neutrality”
during its first 10 years, budgetary savings in the long run would not be
guaranteed—even if the package included initial steps toward transforming the
delivery and financing of health care that would gain momentum over time.
Different reform plans would have different effects, of course, but two general
phenomena could make the long-run budgetary impact less favorable than the
short-run impact:

■ First, an expansion of insurance coverage would be phased in over time to
allow for the creation of new administrative structures such as insurance
exchanges. As a result, the cost of an expansion during the 2010–2019 period
could be a poor indicator of its ultimate cost.

■ Second, savings generated by policy actions outside of the health care system
would probably not grow as fast as health care spending. Such would be the
case for revenues stemming from the Administration’s proposal to limit the
tax rate applied to itemized deductions and from proposals to tax sugar-sweetened
soda or alcohol, for example.

Some policy options under consideration would yield savings that grew in tandem
with health care spending—reducing the level of federal spending on health care
but not affecting the measured rate of spending growth after the first few years.
For example, the largest savings proposed in the President’s budget would arise
from a decrease in payments to private health insurance plans operating under the
Medicare Advantage program. If enacted, that change would permanently lower
the level of Medicare spending, but it would probably not offset a noticeably
larger share of the cost of an expansion of insurance coverage in the second
10 years than in the first.

To put it all together the non partisan Congressional Budget Office -- the authority when it comes to the financial impact of legislation -- says the Obama plan is not going to achieve it's goals.

Now to dissect part of the speech. The following quotes are from the address on 09/09/2009

http://www.npr.org/templates/story/story.php?storyId=112695048

There are now more than 30 million American citizens who cannot get coverage.

I thought the number was 46 million. Oh that's right 46 million Americans, not American citizens. Don't forget about those non-citizen Americans (illegal aliens).

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.

Shortly after giving these strange examples, Obama goes on to mention Republican "scare tactics".

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else.

Now, these are the facts. Nobody disputes them. We know we must reform this system. The question is how.

Why must we reform the system this year? Wouldn't it make more sense to look at all of the options? Does it not make more sense, given the stated importance of the situation, to think this through with a little more scrutiny?

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's, where we would severely restrict the private insurance market and have the government provide coverage for everybody.

Obama is "one of those on the left" who has advocated a single payer system on multiple occasions.

And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

That is why about half of the chamber stood and clapped throughout the majority of the address. The other, nearly half, were sitting in opposition.

Some have dug into unyielding ideological camps that offer no hope of compromise.

That's what people with core values do. It's because of an "unyielding ideological camp" that the United States was founded. Besides compromising in and of itself is not always a good thing.

Here are the details that every American needs to know about this plan. First, if you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: Nothing in our plan requires you to change what you have.

This is not true. After five years every plan will have to meet the standards of the exchange. Also nearly every part of the legislation is adjustable by means of the Health Insurance Commissioner. As I pointed out in a previous post, the word commissioner is in the health care legislation 203 times. There is a legal definition, or value set nearly every time the commissioner is mentioned. The legislation is intentionally ambiguous when it comes to definitions.

What this plan will do is make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a preexisting condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it the most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies, because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

I thought that there was a separate plan from the White House. What happened to Obama's plan? Obama said, "his plan" many times already, now during the speech he says, "this bill." This is a ridiculous idea anyway. Mandate that insurance companies have unlimited liability, and cannot increase their premiums. Can anybody explain to me how a business with unlimited liability is going to run?

Now, even if we provide these affordable options, there may be those — especially the young and the healthy — who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers by giving them coverage. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for these people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek — especially requiring insurance companies to cover preexisting conditions — just can't be achieved.

And that's why under my plan, individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance. Likewise — likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still can't afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we can't have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.

Where is this responsibility to society coming from? I thought this was a free country. I thought that if you decided that you didn't want to participate in something you had a choice not to. After all is that not one of the most simple freedoms. If you don't want it, don't pay for it.

The next part is absurd. Car insurance is the most ridiculous analogy I've heard so far. Even if a state requires you to carry car insurance, the state doesn't mandate that you own a car! For this mandate to take exist, you only have to be alive.

The idea of chipping in to cover the cost is also absurd. What does chip in mean? I'll give you a hint, it rhymes with TAX.

Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple.

There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms — the reforms I'm proposing would not apply to those who are here illegally.

(Rep. Joe Wilson, R-S.C., shouts, "You lie!")

There are two things wrong here. First of all where are those who are trying to kill reform at any cost? People want to kill this bill, but there is nobody advocating that we do nothing.

Illegal immigrants were indeed going to receive government benefits under the proposed legislation. There were two times that republicans tried to add a measure that would require individuals to prove their citizenship. Both times the measures were voted down with a near party-line democratic vote.

Now, my health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly sponsored insurance option, administered by the government just like Medicaid or Medicare.

Obama said this earlier in the speech, "I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months." If congress were to building an entirely new system from scratch, would that not be a government takeover? Last time I checked congress was part of the government.

So let me set the record straight here. My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly — by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates.

So if we add just one more insurance option, a public option (government run plan), this problem will go away. So Obama says that monopolies are bad. So the plan is to give the government a monopoly on health care, that should fix it. O.k. sure.

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. And the insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

The public option plan would only be an option for those who don't have insurance. This is right after he said that everyone will be required to have insurance. Obama says, "less than 5 percent of Americans would sign up." Who else would sign up? Is there anyone other than Americans allowed to sign up? Take note: earlier in the speech Obama said "American citizens" not simply Americans.

For example — for example, some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others have proposed a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

I find it interesting how Obama states that "no government bureaucrat or insurance company gets between you and the care that you need." This entire plan is between you and your doctor! Otherwise what would the plan do? Think about it for a moment. If insurance companies are between you and your doctor now, how would a government insurance option be any different?

And here's what you need to know. First, I will not sign a plan that adds one dime to our deficits — either now or in the future. I will not sign it if it adds one dime to the deficit, now or in the future, period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize. Now, part of the reason I faced a trillion-dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for — from the Iraq war to tax breaks for the wealthy. I will not make that same mistake with health care.

This would be the first government plan ever that has not required additional funding. Does anyone actually believe this?

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies — subsidies that do everything to pad their profits but don't improve the care of seniors. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

This must be very reassuring to seniors. We have a plan to do stuff... There is absolutely no specificity in this statement what so ever. Also you have to pay close attention to what he says. Obama says, "And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead." Note: Obama does not say that they will do anything about the waste, only that they will identify it.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Now, much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. And this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money — an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long run.

So the private insurance companies are going to have to shell out to their competition, the government plan, and this is somehow not going to hurt them in the long run? This will do nothing but charge the insurance companies out of business. When private companies are reduced to offering low quality plans, the legislation will still tax the most expensive plan, which at that point will not be expensive comparatively. Setting the value based on that companies most expensive plan, sets a sliding scale that can never be removed.

Now, finally, many in this chamber — particularly on the Republican side of the aisle — have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. Now — there you go. There you go. Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today.

Notice no mention of Tort reform, only an admission that there is something possibly there.

Now, add it all up, and the plan I'm proposing will cost around $900 billion over 10 years — less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration. Now, most of these costs will be paid for with money already being spent — but spent badly — in the existing health care system. The plan will not add to our deficit. The middle class will realize greater security, not higher taxes. And if we are able to slow the growth of health care costs by just one-tenth of 1 percent each year — one-tenth of 1 percent — it will actually reduce the deficit by $4 trillion over the long term.

Obama and his administration are the only people alive who believe that by spending money, we are going to save somehow. The Chinese sure don't believe it.

Now, this is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight — Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.

But know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it. I won't stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in this plan, we will call you out. And I will not — and I will not accept the status quo as a solution. Not this time. Not now.

The president says, my door is always open. He then follows that with, "I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it." Sorry, but killing the plan would be an improvement. The president is making the case to kill his plan with this speech. Again he mentions those who oppose reform. There is nobody who opposes reform. There are only those who oppose this reform.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true.

Again, who is advocating that we do nothing? Where are all of these people who think that we have a perfect health care system? Name some people, if you are going to make accusations.

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