Obama Tepid on Public Option
By Matthew Rothschild, September 9, 2009
The sadness is that almost Obama’s entire speech could be read as a splendid brief for universal single-payer health care, or at least Medicare for all who want it.
But when Obama got down to specifics, he gave only tepid support to the public option.
He laid out clearly the problems with the current system, in economic but also—and especially—moral terms, but then stepped back from the fundamental changes that are necessary to meet that economic and moral crisis.
The speech was by turns thoughtful and impassioned, conciliatory and tough, dry and moving, ingenious and disingenuous, naïve and nobody’s fool.
He appealed to reason and to our values—to the “character of our country.” It was a term he borrowed from a letter he received from Ted Kennedy, which was delivered posthumously. Obama used it and Kennedy’s memory in an affecting way toward the end of the speech. He talked of Kennedy’s “large heartedness,” and noted that because of this trait, Kennedy saw a role for government to help the needy and those without health care.
Obama also begged for civility even after one Republican shouted out that he was a liar, and while Obama urged a bipartisan approach, he finally showed some steel.
“Know this,” he told the Republican side. “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.”
But he could have stiffened his spine several months earlier, and for a bill that would have allowed anybody to join Medicare at any time.
That’s not this bill.
Hell, from the sounds of his speech, the public option is a goner.
When he finally got around to discussing the concept, he used the word “can” instead of “must”: “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.”
And after he went on defending the virtues of his diluted public option (the only people who could join would be the uninsured), he then tiptoed away from it.
“Its impact shouldn't be exaggerated – by the left, the right, or the media,” he said. “It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles.” He called it “only a means” to an end.
He then suggested he’d be open to co-ops instead, or a trigger later on for a public option if the private insurers don’t behave themselves.
You could almost see the white flag in his suit coat pocket.
Actually, the only time he put his foot down on a specific detail of the legislation was when he said: “I will not sign a plan that adds one dime to our deficits, either now or in the future.” And then he repeated the line in case we weren’t listening. He added that that the bill would require more spending cuts if the savings he proposed don’t materialize.
Chances are they won’t, since the Congressional Budget Office already estimated that Obama’s plan would not be revenue neutral but would cost hundreds of billions of dollars more.
The only way to really reduce health care costs across the board is by single payer, since it would wipe out profits, advertising, and immense systemic waste that occurs when doctors and hospitals have to fill out forms for a myriad of different insurers.
And one of the best ways to reduce the costs in Medicare is to allow the government to bargain for bulk drug discounts, but Obama already gave that store away. (In his speech, he bragged about how the drug companies are backing his bill, but he didn’t reveal why.)
So now Obama has embedded into the health care bill a recessionary device—the automatic slashing of federal spending when health care costs inevitably go up.
Obama also exaggerated the budgetary problem of health care when he said, “Our health care problem is our deficit problem.”
Actually, war is our deficit problem—$3 trillion for Iraq, and more for Afghanistan.
Actually, bailing out banks is our deficit problem—several trillion more, when you count the guarantees.
Obama himself waved at the cost of the Iraq War and the Bush tax cuts to the rich, which belied his earlier simplification.
And Obama misled the country when he said single-payer would require us to “build an entirely new system from scratch.”
No, it wouldn’t.
The system is in place.
It’s called Medicare.
And it works very well.
It’s a pity that a President with such intelligence and such eloquence and, yes, “large heartedness” has not used his attributes—along with his power and popularity—in service of the most sensible and profound solution to the health care problem.
Instead, he’s left the private insurance companies and the drug companies running the show.
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ABC 20/20
Below is a complete transcript of the segment from the Friday, July 31, 20/20 on ABC:
JOHN STOSSEL: Some in Congress say they’re moving closer to a plan that will make health care cheaper and better. Sounds great. But when government takes charge, it can also mean innovation stops, and you may not get the breakthroughs and care that you need to save your life.
BARACK OBAMA IN FRONT OF AUDIENCE: -affordable health care for every single American, that’s what we’re called upon to do.
STOSSEL: Care for everyone, for less money. Critics say that just isn’t possible.
SALLY PIPES, PACIFIC RESEARCH INSTITUTE: The only way they can get costs down under a government-run system is to control the amount of money that is spent on health care. But there is much more of a demand for health care than the government is willing to pay for. We will have long waits for care just like they do in Canada and in Great Britain.
STOSSEL: Those countries do have problems.
UNIDENTIFIED REPORTER: The nationwide shortage of NHS dentists-
STOSSEL: In England, people wait just to register for a dentist. Waits are so long, some people do it themselves. He used superglue. Some pull their own teeth. Dental tools – pliers and Vodka. Patients protest because the health service won’t pay for drugs they say they need. The President says he doesn’t want that.
OBAMA: -you hear the naysayers claim that I’m trying to bring about government-run health care, know this: They’re not telling the truth.
STOSSEL: But once, he did say that if he were starting from scratch-
OBAMA, FROM DEMOCRATIC PRIMARY DEBATE: I would probably go with a single-payer system.STOSSEL: He says he doesn’t want government-run health care.
PIPES: He does want government health care. He just wants to go about it in a slow way so people don’t realize what’s happening to them.
STOSSEL: Many pundits and economists agree, saying Obama’s plan will build “a bridge to government-run health care.”
PIPES: -and we’re all going to face long waiting lists and have lack of access to the latest care.
DOCTOR DAVID GRATZER, AUTHOR OF THE CURE: People line up for care, some of them die, that’s what happens.
STOSSEL: Canadian Doctor David Gratzer thought Canada’s government health care was great until he started treating patients.
GRATZER; The more time I spent in the Canadian system, the more I came across people waiting for radiation therapy, waiting for the knee replacement so they could finally walk up to the second floor of their house-
STOSSEL: People wait in line?
GRATZER: You want to see your neurologist because of your stress headache? No problem. You just have to wait six months. You want an MRI? No problem. Free as the air. You just got to wait six months.
STOSSEL: But Canadian doctors told us their system is cracking. This man had a heart attack.
UNIDENTIFIED MALE DOCTOR: What did they tell you about when an ICU bed might become available?
UNIDENTIFIED MALE PATIENT: They’re waiting for the chance that somebody may be transferred so that I can get that spot.
STOSSEL: In America, people wait in emergency rooms, too, but in Canada, if you’re sick enough to be admitted, you wait an average 23 hours.
UNIDENTIFIED MALE DOCTOR: You can’t send these patients to other hospitals that have capacity because there is no other hospital in the area that has capacity.
STOSSEL: There was no bed for this little girl, and she had no pediatrician that her parents could take her to to monitor her seizures. In fact, 1.7 million Canadians say they can’t get a family doctor. Some towns, like this one outside Toronto, hold a lottery. Once a month, the town clerk gets this box out of the closet. Inside are names of everyone who wants a family doctor. She pulls out four slips and then calls the lucky winners.
UNIDENTIFIED WOMAN ON PHONE: I just wanted to let you know that your name has been drawn for Dr. Keel’s patient list. Oh, you’re quite welcome.
STOSSEL: Others in town must wait. Businessman Rick Baker makes money from Canadian rationing. People stuck on waiting lists like Shirley Healy pay him to get them to America for treatment. Healy had a blocked artery that kept her from digesting her food.
RICK BAKER, CANADIAN BUSINESSMAN: She was starving to death. She’d lost 50 pounds.
STOSSEL: She hired Rick to help her get to this hospital in Washington state where she saw an American doctor.
HEALY: The doctor said that I would have had only a very few weeks to live.STOSSEL: Yet the Canadian government calls her surgery elective.
HEALY: The only thing elective about this surgery was I elected to live.
STOSSEL: When this Canadian woman was about to give birth to quadruplets, she was told, “Sorry, all the neonatal units are too crowded.” She had to fly to Montana.
UNIDENTIFIED FEMALE ANCHOR: Actress Natasha Richardson is said to be in critical condition-
STOSSEL: After Natasha Richardson fell while skiing in Montreal, she needed a high-tech trauma center but there wasn’t one within hundreds of miles. And there were no med evac helicopters to take her to one.
STOSSEL: So, yes, our profit-driven system is expensive and sometimes wasteful. But it’s that pursuit of profit that’s given us inventions that save lives.
GRATZER: This is the country of medical innovation. This is where people come when they need treatment.
STOSSEL: Thousands come here from countries with government health care. When this Spanish tenor got cancer, he came to America. So did this sheikh from the United Arab Emirates, Italy’s prime minister, and Archbishop Desmond Tutu.
GRATER: Literally, we’re surrounded by medical miracles. Death by cardiovascular disease has dropped by two-thirds in the last 50 years. You got to pay a price for that type of advancement.
STOSSEL: Breakthroughs like birth control pills and robotic limbs wouldn’t have happened without the possibility of big profit, says Grace Marie Turner of the Galen Institute.
GRACE MARIE TURNER, GALEN INSTITUTE: I want companies to come up with cures for Parkinson’s, cures for cancer, cures for Alzheimer’s. And unless there is a reward for them to do that, we’re not going to have those new medicines.
STOSSEL: Well, government has researchers. We have the NIH.
TURNER: Government is responsible for four percent of the drugs on the market today.
STOSSEL: She’s right. You want innovation and fast treatment? That often comes from people pursuing profit. And you see that in Canada because, even here, there is one area where they do offer easy access to cutting edge technology-
UNIDENTIFIED FEMALE VETERINARIAN: -CT Scan, endoscopy, thoracoscopy, laporoscopy-
STOSSEL: -available all the time.
UNIDENTIFIED FEMALE VETERINARIAN: -24 hours, seven days a week-
STOSSEL: Patients rarely wait.
UNIDENTIFIED FEMALE VETERINARIAN: If I see a patient that’s torn a crusciate ligament in that patient’s knee, we can generally have that patient scheduled within probably a week.
STOSSEL: But you have to bark or meow to get that kind of treatment. Want a CT Scan in Canada? Private vet clinics say they can get a dog in the next day. For people, the waiting list is a month.