Tuesday, June 23, 2009

Howard Dean, President Obama, and Sen. Schumer step up to the plate

by Phil E. Benjamin

In front of a packed house at the Hunter College of Social Work in NYC, former Governor of Vermont and former head of the Democratic National Committee, Howard Dean made it clear: "Without a Public Health Insurance Option; Health Reform Legislation is not Supportable."

He said that the 2008 elections gave the Democrats the largest control of the House of Representatives since the 1940s and also a 60/40 split in the Senate. And, most important a President of the United States who has wide popularity. He said that there is not a separation between the Single Payer advocates and the need for a strong public health insurance option. Dean is bringing 300,000 petitions to the June 25th Washington, D.C. Demonstration taking place in the part in front of the U.S. Senate.

He said that the American people sent the strongest message possible and its time for the Democrats to do the right thing.

He pointed out what President Obama pointed out in his press conference today [see below], the Republications are for choice; well here is a choice.

On the delivery side of the health issue, keeping in mind that Dean is a physician; he is calling for far more Primary Care Physicians. He said that the AMA doesn't speak for these physicians since they are mostly specialists. Interestingly, Dean said that salaries of primary care physicians in the United Kingdom with Socialized Medicine get paid more than then the same doctors in the U.S.

Dean cited the recent NY Times polls where 72% polled called for a public, government run system option. This is a historic finding, Dean said.

In the question and answer period, Dean pointed out that the Massachusetts and Vermont plans are good as far as they go, but both need a public health insurance option to make them financially feasible.

Co-Ops and Triggers

Dr. Dean opposed both the Co-Op options being proposed by Senator Kent Conrad and those called for a trigger to kick in the public option.

In terms of delivery of health care, Dean pushing for more Community Health Centers.

A recurring theme of Dr. Dean in his formal presentation and in the answers to questions is that the problem this time is NOT the Republicans and the Insurance Carriers, is the Democrats who must vote by the people voted for them.

Tuesday, June 23, 2009

The last issue I'd like to address is health care.

Right now, Congress is debating various health care reform proposals. This is obviously a complicated issue, but I am very optimistic about the progress that they're making.

Like energy, this is legislation that must and will be paid for. It will not add to our deficits over the next decade. We will find the money through savings and efficiencies within the health care system -- some of which we've already announced.

We will also ensure that the reform we pass brings down the crushing cost of health care. We simply can't have a system where we throw good money after bad habits. We need to control the skyrocketing costs that are driving families, businesses, and our government into greater and greater debt.

There's no doubt that we must preserve what's best about our health care system, and that means allowing Americans who like their doctors and their health care plans to keep them. But unless we fix what's broken in our current system, everyone's health care will be in jeopardy. Unless we act, premiums will climb higher, benefits will erode further, and the rolls of the uninsured will swell to include millions more Americans. Unless we act, one out of every five dollars that we earn will be spent on health care within a decade. And the amount our government spends on Medicare and Medicaid will eventually grow larger than what our government spends on everything else today.

When it comes to health care, the status quo is unsustainable and unacceptable. So reform is not a luxury, it's a necessity. And I hope that Congress will continue to make significant progress on this issue in the weeks ahead.

THE PRESIDENT: Well, let's talk first of all about health care reform more broadly.

I think in this debate there's been some notion that if we just stand pat we're okay. And that's just not true. You know, there are polls out that show that 70 or 80 percent of Americans are satisfied with the health insurance that they currently have. The only problem is that premiums have been doubling every nine years, going up three times faster than wages. The U.S. government is not going to be able to afford Medicare and Medicaid on its current trajectory. Businesses are having to make very tough decisions about whether we drop coverage or we further restrict coverage.

So the notion that somehow we can just keep on doing what we're doing and that's okay, that's just not true. We have a longstanding critical problem in our health care system that is pulling down our economy, it's burdening families, it's burdening businesses, and it is the primary driver of our federal deficits. All right?

So if we start from the premise that the status quo is unacceptable, then that means we're going to have to bring about some serious changes. What I've said is, our top priority has to be to control costs. And that means not just tinkering around the edges. It doesn't mean just lopping off reimbursements for doctors in any given year because we're trying to fix our budget. It means that we look at the kinds of incentives that exist, what our delivery system is like, why it is that some communities are spending 30 percent less than other communities but getting better health care outcomes, and figuring out how can we make sure that everybody is benefiting from lower costs and better quality by improving practices. It means health IT. It means prevention.

So all these things are the starting point, I think, for reform. And I've said very clearly: If any bill arrives from Congress that is not controlling costs, that's not a bill I can support. It's going to have to control costs. It's going to have to be paid for. So there's been a lot of talk about, well, a trillion-dollar price tag. What I've said is, if we're going to spend that much money, then it's going to be largely funded through reallocating dollars that are already in the health care system but aren't being spent well. If we're spending $177 billion over 10 years to subsidize insurance companies under Medicare Advantage, when there's no showing that people are healthier using that program than the regular Medicare program, well, that's not a good deal for taxpayers. And we're going to take that money and we're going to use it to provide better care at a cheaper cost to the American people. So that's point number one.

Number two, while we are in the process of dealing with the cost issue, I think it's also wise policy and the right thing to do to start providing coverage for people who don't have health insurance or are underinsured, are paying a lot of money for high deductibles. I get letters -- two, three letters a day -- that I read of families who don't have health insurance, are going bankrupt, are on the brink of losing their insurance; have deductibles that are so high that even with insurance they end up with $50,000, $100,000 worth of debt; are at risk of losing their homes.

And that has to be part of reform, making sure that even if you've got health insurance now, you are not worried that when you lose your job or your employer decides to change policies that somehow you're going to be out of luck. I think about the woman who was in Wisconsin that I was with, who introduced me up in Green Bay -- 36 years old, double mastectomy; breast cancer has now moved to her bones and she's got two little kids, a husband with a job. They had health insurance, but they're still $50,000 in debt, and she's thinking, my main legacy, if I don't survive this thing, is going to be leaving $100,000 worth of debt. So those are the things that I'm prioritizing.

Now, the public plan I think is an important tool to discipline insurance companies. What we've said is, under our proposal, let's have a system the same way that federal employees do, same way that members of Congress do, where -- we call it an "exchange," or you can call it a "marketplace" -- where essentially you've got a whole bunch of different plans. If you like your plan and you like your doctor, you won't have to do a thing. You keep your plan. You keep your doctor. If your employer is providing you good health insurance, terrific, we're not going to mess with it.

But if you're a small business person, if the insurance that's being offered is something you can't afford, if you want to shop for a better price, then you can go to this exchange, this marketplace, and you can look: Okay, this is how much this plan costs, this is how much that plan costs, this is what the coverage is like, this is what fits for my family. As one of those options, for us to be able to say, here's a public option that's not profit-driven, that can keep down administrative costs and that provides you good, quality care for a reasonable price -- as one of the options for you to choose, I think that makes sense.

Q Won't that drive private insurers out of business?

THE PRESIDENT: Why would it drive private insurers out of business? If private insurers say that the marketplace provides the best quality health care, if they tell us that they're offering a good deal, then why is it that the government -- which they say can't run anything -- suddenly is going to drive them out of business? That's not logical.

Now, I think that there's going to be some healthy debates in Congress about the shape that this takes. I think there can be some legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly, that over time they can't compete with the government just printing money.

So there are going to be some I think legitimate debates to be had about how this private plan takes shape. But just conceptually, the notion that all these insurance companies who say they're giving consumers the best possible deal, that they can't compete against a public plan as one option, with consumers making the decision what's the best deal. That defies logic, which is why I think you've seen in the polling data overwhelming support for a public plan. All right?

Q I'm sorry, but what about keeping your promise to the American people that they won't have to change plans even if employers --

THE PRESIDENT: Well, no, no, I mean -- when I say if you have your plan and you like it and your doctor has a plan, or you have a doctor and you like your doctor that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform.

Now, are there going to be employers right now -- assuming we don't do anything -- let's say that we take the advice of some folks who are out there and say, oh, this is not the time to do health care, we can't afford it, it's too complicated, let's take our time, et cetera. So let's assume that nothing happened. I can guarantee you that there's a possibility for a whole lot of Americans out there that they're not going to end up having the same health care they have, because what's going to happen is, as costs keep on going up, employers are going to start making decisions: We've got to raise premiums on our employees; in some cases, we can't provide health insurance at all.

And so there are going to be a whole set of changes out there. That's exactly why health reform is so important.

Senator Chuck Schumer's Floor Speech - Public Option in Health Care:

[Senator Schumer is charged by the House and Senate to Develop a Public Health Insurance Option plan.]

Mr. President, I rise today to discuss the necessity of including a public option in the health care legislation Congress is currently drafting.

One of our top priories as we undertake health care reform must be increasing competition among health insurance companies in order to get costs under control and give consumers better choices.

A recent NY Times/CBS poll clearly shows that a large majority of the American people, 72% in fact, want a government-sponsored health care option that would compete with private health insurance companies. 72%!

What is even more incredible is that 50% of Republicans want a public option.

Do you know why so many Americans want a public plan? Because, despite what many of my colleagues on the other side of the aisle would have you believe, they don’t feel that they have affordable choices.

And fundamentally, this is what lies at the heart of our public plan proposal. We want to ensure all Americans have a guaranteed affordable choice when it comes to health insurance. And right now, too many of them don’t.

In many areas of the country, one or two insurers have a stranglehold on the entire market, which produces costly premiums and health care decisions that often serve the interests of the insurer, not the patient.

In fact, according to a study According to the American Medical Association, 94 percent of insurance markets are highly concentrated. That’s right, 94 percent.

This is why a public health insurance plan is absolutely critical: to ensure the greatest amount of choice possible for consumers, and provide at least one option that is patientâ€"not profitâ€"focused.

The public plan option is not about government controlled health care, socialism, or any of the other buzz words that have been tossed around as part of this debate. The public plan option is about offering Americans a choice in a market that far too often offers them none.

I’ll tell you the choices too many Americans do face â€" whether to pay for health insurance and healthcare or to pay for the other necessities of life. That’s not a choice anyone should have to make.

And maybe that explains why the American people don’t agree with the critics of the public plan. 50% of Americans think the government plan will provide better healthcare coverage than private insurance companies.

Let us be clear, a public plan need not have special built-in advantages. It would be a coverage option that would compete on an equal footing alongside private insurance plans in the market for individual and small business coverage.

If a level playing field exists, then private insurers will have to compete based on quality of care and pricing, instead of just competing for the healthiest consumers.

In this way, a public plan will accomplish many of our most important goals.

It will not waste money on costs incidental to providing healthcare. It will not focus on profits at the expense of the best health outcomes. Instead, it will spend money on improving health delivery, and on trying innovative technologies and systems in order to SAVE money.

It will force many insurers that have been shielded and protected from competition for far too long to compete with a plan that provides comprehensive care at an affordable rate.

It will, most importantly, give Americans a choice.

In fact, I think the thing that really scares opponents of the public plan option is choice â€" that Americans might choose the public plan. Because then the curtain might be pulled back on their friends at the insurance companies.

Americans will finally see the hidden costs that have caused their premiums to skyrocket; the wasteful spending that does not improve health outcomes, but fattens bottom lines; and the protection from competition that has been offered to private insurers over the last decade.

To truly reform our health care system, Congress must pass legislation that includes a public option. And a watered-down public plan is no public plan at all.