Excerpts From Tonight’s Speech on Health Care

The White House has released some excerpts from tonight’s speech. I will wait until I have the full speech to comment.


Office of the Press Secretary


September 9, 2009


I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.


During that time, we have seen Washington at its best and its worst.

We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors’ groups and even drug companies – many of whom opposed reform in the past. And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.

Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.

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 to those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government. It’s a plan that asks everyone to take responsibility for meeting this challenge – not just government and insurance companies, but employers and individuals. And it’s a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans – and yes, from some of my opponents in both the primary and general election.


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, Medicare, 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.

What this plan will do is to 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 pre-existing 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 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 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.

That’s what Americans who have health insurance can expect from this plan – more security and stability.

Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It’s how everyone in this Congress gets affordable insurance. And it’s time to give every American the same opportunity that we’ve given ourselves.


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 improve it. I will not 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 the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

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 most. And more will die as a result. We know these things to be true.

That is why we cannot fail. Because there are too many Americans counting on us to succeed – the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in emails, and in letters.

Some Conservatives Regret Smear Campaign Against Cass Sunstein


If conservatives really were concerned about principles as opposed to just opposing Obama, they would have been happy about the appointment of Cass Sunstein to head the Office of Information and Regulatory Affairs. Unfortunately, just as many conservatives use the language of limited government and fiscal responsibility while promoting the opposite, they also use the language of libertarianism while having no regard for actually supporting liberty. Rather than supporting Sunstein for his libertarian-leaning views on regulation, many conservatives have subjected him to a smear campaign.  As is typical of right wing smear campaigns, they take selections from his writings out of context and apply totally different meanings to them. The ditto heads who follow the right, but never actually read the views which are being distorted, then repeat the smears.

While such smear campaigns based upon misinformation are a common strategy of the right, David Weigel found that a handful of conservatives have considered Sunstein’s views and are frustrated by the attacks on him. Many independents such as myself, who oppose the policies of the Republicans but do not necessarily support the typical Democratic agenda, saw the influence of people such as Sunstein on Obama as a welcome change from typical Democratic views. Some conservatives realize that, even if they don’t completely agree with Sunstein’s views, his views are far friendlier to libertarian beliefs than those of many other liberal Democrats:

In January, the libertarian blogger and law professor Glenn Reynolds wrote a hearty endorsement of Sunstein, telling readers that the nomination “shows that the Obama Administration is perhaps willing to look at new and less intrusive approaches to regulation.” Today, he sees the lengthy campaign against Sunstein as an unflattering example of “how the messed-up appointments process works.”

“I think he should be confirmed,” Reynolds told TWI. “Do I think Sunstein will push a hunting ban? No. Do I think he’s sympathetic to hunting, particularly? No. But what Obama appointee is likely to be? As the Van Jones affair indicates, there are a lot of people worthy of more concern than Sunstein. If I were advising Republicans, I’d tell them to focus their attentions elsewhere.”

That advice was echoed by Ed Morrissey, a conservative blogger at HotAir.com, which published dozens of posts about Jones until he finally withdrew. “I’d prefer to see someone more conservative or moderate in [Sunstein’s] position,” said Morrissey, “if it should exist at all. I’m not going to endorse Sunstein, but don’t think that he presents a good target for Republicans to attack. I think that there is a big problem with lumping the ‘czars’ in with those like Sunstein who need Senate approval and have Congressional oversight.”

Ilya Somin, a libertarian law professor at George Mason University, has written at the popular Volokh Conspiracy lawblog that “the czar system does circumvent the regular appointment and confirmation process.” Like Morrissey and Reynolds, he was critical of Beck and other Sunstein critics.

“Sunstein has nothing to do with the ‘czars’ or the problems with the ‘czars,’” said Somin. “The ironic thing is that anybody else who might be appointed to this job would be less qualified, and more liberal. I disagree with what Sunstein writes in ‘Nudge.’ But what he advocates is not as bad as the views likely to be held by other people who could run [the Office of Information and Regulatory Affairs].”

Ed Morrissey responds to the article here.

Much of the article also deals with the appointment of a variety of “czars” in the executive branch who do not need to be confirmed by the Senate. The manner in which a single Senator can block an appointment based upon fallacious arguments demonstrates why, right or wrong, there is such a desire to circumvent the confirmation process. Possibly frustration over not being able to block some appointees in the Senate has led to a greater desire to block Obama appointees who do require Senate confimation such as Sunstein.This includes the usual false attacks from the totally irrational Glenn Beck:

In the face of that criticism, hardened by the “czars” controversy, Sunstein’s supporters remain frustrated by their lack of progress. Richard Epstein, a libertarian-leaning law professor at the University of Chicago who edited a book about the 2000 election with Sunstein, told TWI that he supported Sunstein’s nomination “notwithstanding the many substantive disagreements between us.”

“The Beck stuff,” said Epstein, “is well over the top.”

Thomas Friedman Is Right About The Problems In Our System But Wrong In His Comparisons to China

I could never apply a simple classification of those I agree with vs. those I disagree with to Thomas Friedman. He is certainly worth reading for the insights he often expresses, but sometimes he also comes up with things which are totally off the wall. I do sympathize with his objections to the Republicans who  simply say “no” without any coherent policy ideas of their own, as expressed in this column. Still, as bad as our “one party Democracy” is, it remains far better than a one-party oligarchy as in China. Sure there have been a number of abuses of civil liberties by the United States government, but freedom of expression is not suppressed in the way it is in a one party state such as China.

There might be some areas where the Chinese government can bring about modernization more efficiently than we can in the United States, just as Mussolini might have kept the trains running on time. That does not mean that overall their systems are preferable.

That said, if we can ignore any thought that the Chinese system might be better than our flawed system, Friedman is right in his assessment of the Republicans:

With a few notable exceptions, the Republican Party is standing, arms folded and saying “no.” Many of them just want President Obama to fail. Such a waste. Mr. Obama is not a socialist; he’s a centrist.

Friedman also has a few words about the Republicans blocking health care reform:

“The central mechanism through which Obama seeks to extend coverage and restrain costs is via new ‘exchanges,’ insurance clearinghouses, modeled on the plan Mitt Romney enacted when he was governor of Massachusetts,” noted Matt Miller, a former Clinton budget official and author of “The Tyranny of Dead Ideas.” “The idea is to let individuals access group coverage from private insurers, with subsidies for low earners.”

And it is possible the president will seek to fund those subsidies, at least in part, with the idea John McCain ran on — by reducing the tax exemption for employer-provided health care. Can the Republicans even say yes to their own ideas, if they are absorbed by Obama? Without Obama being able to leverage some Republican votes, it is going to be very hard to get a good plan to cover all Americans with health care.

“Just because Obama is on a path to give America the Romney health plan with McCain-style financing, does not mean the Republicans will embrace it — if it seems politically more attractive to scream ‘socialist,’ ” said Miller.

Republicans Not The Party of Fiscal Responsibility

Republicans hope to capitalize on any dissatisfaction with Obama, and place the blame on him for problems created by the Republicans, in order to return to power. Andrew Sullivan explains the absurdity of this:

Charlie Cook and others are predicting a sea-change in public mood, with support for the GOP rising because of deficits. This strikes me as an amazing thing. It makes Charlie Brown, the football and Lucy look like the model of intelligent interaction. If you believe in fiscal conservatism, the last place on earth you should look for salvation is the GOP. They have single-handedly destroyed America’s finances since the 1980s, with the sole exception of George H W Bush, who was rejected by his own party precisely because of his fiscal sobriety. The current debt is overwhelmingly inherited by Obama, and it would have been nuts to enter office in the downdraft of the sharp recession and set about cutting spending. Bush had eight years to restrain it and he didn’t. He let it rip. Think of the GOP’s phony concerns about the cost of the current healthcare bill and compare it with the GOP’s prescription drug entitlement that Rove rammed through the Congress when the GOP held total power. The costs then were about eight times as great as the proposed costs now. But that was a Republican measure and so it doesn’t somehow count as evidence of fiscal irresponsibility. But Nancy Pelosi only has to raise an eye-brow and the alarms go off.

Sullivan also notes this comment to a column by Bruce Bartlett:

The last Republican who left the office of the presidency with the federal public debt as a percentage of GDP less than when he entered was Richard Nixon (FY 1975). The last Republican who left the office of the presidency with a federal deficit less than 2.7% of GDP was Dwight Eisenhower (FY 1961). Since WW II no Democratic president has ever left office with the federal public debt as a percentage of GDP more than when he entered. And since WW II no Democratic president has ever left office with a federal deficit more than 2.6% of GDP.

We already have at least one party of fiscal responsibility. It’s called the Democratic Party.

John Cole comments:

I find it amazing when I read the right-wing blogs and they talk about fiscal conservatism and fiscal responsibility. It is just too damned funny. But what is kind of creepy is that they sincerely believe their own bullshit- it is like the last several decades never happened. In their minds, the Republicans really are responsible stewards of the nation’s finances. It is mind-boggling.

Joe Klein adds:

…there are only two presidents in the past 50 years who took the national debt seriously after it exploded when Lyndon Johnson refused to fund the Vietnam war–George H.W. Bush and Bill Clinton. The Clinton experience is particularly important: he raised taxes to address the deficit. The Republicans said it would throw the economy into recession. It didn’t.  Clinton’s 1993 economic plan threw the economy into…a massive expansion and budget surpluses that reduced the national debt significantly.  (I remember reading pieces at the turn of the 21st century about the consequences of eliminating the national debt.)

George W. Bush wiped out all that. His tax cuts, overwhelmingly for wealthy Americans were bad enough. Then he passed a major entitlement–prescription drugs for the elderly–without paying for it. That’s what created the hole we were in when President Obama, acting to ameliorate a major economic meltdown, widened the deficit with his stimulus package…which, by the way, deserves some credit for preventing us from going off an economic cliff last winter.

Furthermore, Obama has promised that the health care reform plan will be revenue neutral. It may cost $1 trillion over 10 years, but he will raise $1 trillion to pay for it. Of course, Republicans are blocking most of the pathways to raising the revenue…and Democrats are blocking one important revenue sour (eliminating the employer-provided health care deduction), which, ironically, is the surest

But make no mistake: If you believe the national debt is a big problem, don’t blame the Democrats. Without question, they have been far more responsible–and, dare I say, conservative–party when it comes to balanced budgets for the past 30 years.

There is one necessary correction to Klein’s post. Bush’s Medicare D plan did provide some benefits for the elderly, and certainly was fiscally irresponsible, but it was primarily a program of corporate welfare for the insurance and pharmaceutical industries to reward them for their support.

The Real Problem

My initial thought upon reading about the planned Republican response to Barack Obama’s speech on heath care reform:

Why don’t Republicans ever show any concern about the insurance company executives who come between you and your doctor?

Robert Reich Explains The Public Option

Posted in Health Care. Tags: . 3 Comments »

Dionne Responds to Wild Charges Which Media Accepts

E.J. Dionne notes that the media is far too willing to repeat nonsense attacks from the right without demanding that those who make the attacks can back them up:

Upon Barack Obama’s election, even my most conservative friends who supported John McCain said Obama could do a world of good for poor children in the country by stressing the importance of education, hard work, staying in school and taking responsibility. Yes, those are often thought of as conservative values.

But when Obama proposed to do just that on the first day of school, the far right — without asking any questions or seeking any information — decided to pounce, on the theory that everything Obama did should be attacked relentlessly as part of some secret and dangerous ideological agenda.

Out popped Jim Greer, the Florida Republican chairman, who accused the president of trying to “indoctrinate America’s children to his socialist agenda.”

In a normal world, the media would have asked Greer for proof of such a wild charge and, since he didn’t have any, his press release would have gone into the circular file.

But, no, the media is so petrified of being criticized for being “liberal” that it chose to take a lunatic charge seriously and helped gin up this phony controversy.

Of course there is noting socialist in either Obama’s views or in his speech to school children. Comparing Obama’s speech to those given by other presidents, Dionne concludes:

If that’s “socialist,” then Barry Goldwater, Ronald Reagan and just about every parent in America are “socialists.”

Modern conservatives might have spent a little more time in school learning what “socialism” means.

Dionne also responds to the false right wing meme that their treatment of Obama is justified by the way in which Democrats treated Bush after his election:

Defenders of the right-wing argue that the left said terrible things about George W. Bush. That’s true. What the apologists miss is that the deep anger at Bush did not set in until he had been president for several years. Despite the rage over Florida and the Supreme Court’s Bush v. Gore decision, Bush did not face until much later in his administration anything like the hostility that Obama already confronts. Liberals, staunch liberals, were even willing to work with Bush on some issues — remember, for example, Ted Kennedy’s work on the “No Child Left Behind” Act.

And the entire country, including almost all of the left, united behind Bush after the attacks of Sept. 11, 2001. (Here, to provide a personal example, is my own column of Oct. 12, 2001. Yes, what I wrote looks naive now, but I’m still glad I gave Bush the benefit of the doubt at that moment.) The far, far left that trashed Bush immediately after 9/11 was isolated and treated as cranky and even subversive by the mainstream media. Note how quickly Van Jones was driven from his administration job for singing that wacky post-9/11 petition. The far left faces much tougher public and media discipline than the far right.

The right-wing decided almost from Day One that a president elected with 53 percent of the vote (and 365 electoral votes) was illegitimate. They are trashing a moderate liberal as a socialist propagandist. They are getting a lot of press coverage for doing so. Where is the accountability?

Am I continuing to be naive in believing that, one of these days, a phalanx of responsible conservatives will stand up to the extremists? Boy, do I miss William F. Buckley Jr.

Sarah Palin’s Lack of Understanding of Health Care

Sarah Palin was an “expert” on foreign policy because she can see Russia from parts of Alaska. She is now an “expert” on health care policy–perhaps because she once saw a hospital or a sick person. Palin has an op-ed in The Wall Street Journal which is nothing more than a long string of empty talking points from the far right. If Republicans had any actual arguments against health care reform, the last thing they need is to have Sarah Palin once again show her lack of understanding of national issues.

Palin writes, “Common sense also tells us that a top-down, one-size-fits-all plan will not improve the workings of a nationwide health-care system that accounts for one-sixth of our economy.” Perhaps, but that is not what is being proposed at all, and from reading the op-ed it becomes clear that Palin, like most conservative critics of health care reform, hasn’t the slightest idea of what is actually being proposed.

Palin next shows her ignorance of the problems in the Medicare program:

In his Times op-ed, the president argues that the Democrats’ proposals “will finally bring skyrocketing health-care costs under control” by “cutting . . . waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies . . . .”

First, ask yourself whether the government that brought us such “waste and inefficiency” and “unwarranted subsidies” in the first place can be believed when it says that this time it will get things right.

Palin apparently does not realize that the waste and unwarranted subsidies which Obama referred to come from George Bush’s Medicare Advantage plans. This is yet one more example of Republicans governing incompetently and then using this history to make their argument that government is always incompetent.

The problem is not “the government that brought us” this waste but the Republican Party which brought us this waste. Without these Republican policies Medicare is far more efficient than private insurance at providing health care. The Republican policy of paying subsidies to private insurance companies costs 13% to 19% more to care for Medicare patients through private companies than it costs to care for them thorough the government Medicare program.

Palin then proceeds to distort the meaning of the report of the Congressional Budget Office on potential cost savings, ignoring the fact that the methodology used by the CBO prevents them from even considering most of the future cost savings. Note that conservatives rely upon the CBO here, even if distorting the meaning of the report, while ignoring the CBO’s report that show that the public plan would not be a threat to private insurance companies or that tort reform would not significantly reduce health care costs. They certainly had no regard for the CBO when they warned about the costs of the Iraq war.

Palin distorts the idea of an Independet Medicare Advisory Council despite the fact that Republicans have supported this in the past. Palin calls this “an unelected, largely unaccountable group of experts charged with containing Medicare costs” but their recommendations would still be voted upon by Congress. In contrast, many medical decisions are now being made by unelected insurance company executives whose decisions are based upon maximizing their profits. The Mayo Clinic’s blog has a different view on this proposal than Palin:

Late yesterday, Mayo Clinic became aware of the concept of development of an Independent Medicare Advisory Council. We applaud the direction of this proposal. We view favorably the concept of an independent body that can move Medicare to a “value- based payment” model.  An independent Medicare advisory commission focused on defining value, measuring it, and finding ways to pay for value could have significant, positive impact on health care for the long term.  While we think the proposal’s timeline of 2014 is too long to wait to see value-based reforms, we look forward to working with the administration on refining and strengthening their new proposal. This, and other, bold concepts have the potential to “bend the cost curve” in U.S. health spending without compromising health.

Palin moves from her misinterpretation of the Independent Medicare Advisory Council to repeat her totally untrue scare stories about “death panels.” Some fact checking of Palin’s misinformation has previously been posted here, here, and here. Palin’s false statements about “death panels” originally came from provisions to fund voluntary counseling for patients regarding end of life care–an idea which Sarah Palin has supported in the past.

Palin provides more warnings:

“A new study for Watson Wyatt Worldwide by Steven Nyce and Syl Schieber concludes that if the government expands health-care coverage while health-care inflation continues…”

Yet it is Palin and the Republicans who object to any measures which would actually reduce health-care inflation such as the public option and the Independent Medicare Advisory Council.

Palin ends by providing meaningless solutions:

As the Cato Institute’s Michael Cannon and others have argued, such policies include giving all individuals the same tax benefits received by those who get coverage through their employers; providing Medicare recipients with vouchers that allow them to purchase their own coverage; reforming tort laws to potentially save billions each year in wasteful spending; and changing costly state regulations to allow people to buy insurance across state lines.

Providing more tax benefits or vouchers will not help when the private market has collapsed due to insurance companies finding it more profitable to deny coverage and drop the sick than to cover health care expenses. Tort reform would provide some minor savings, but I’ve already noted that the Congressional Budget Office, which Palin loves to cite when she can distort their reports to appear that they are supporting her arguments, has already contradicted Palin on this. Allowing people to buy insurance across state lines will not help when there is no longer a meaningful individual market. Besides, giving the insurance industry yet another way to evade regulation is the last thing we need.

Republicans such as Palin repeatedly respond to health care reform by distorting what is being proposed. They neither offer any serious proposals of their own or respond to what is actually being proposed. Their lack of response to the actual proposals suggest that they are unable to come up with any meaningful objections to what is actually being proposed.

Update: The White House has responded to Palin’s claims.

Update II: My response to Obama’s speech.