[The following comes from longhand notes by AAPS Executive Director Dr. Jane Orient, with her editorial comments in red type in brackets.]
After 15 minutes of anticipation, greetings, and applause, Obama’s address to a joint session of Congress began about 8:15 p.m. EDT on Sep 9, 2009.
I won’t rest, he said, until all Americans who are seeking work can find it, and businesses can find the capital and credit they need to thrive. But I am confident that we have managed to pull the economy back from the brink.
I wasn’t sent, however, just to clean up crises, but also to build for the future. And although I’m not the first President to try to bring Americans health care reform, I am determined to be the last.
Teddy Roosevelt tried it, and then John Dingell, Sr., in 1943. [That was when AAPS was founded for the purpose of stopping the Wagner-Murray-Dingell bill.]
Our collective failure to meet the challenge decade after decade has brought us to the breaking point. The uninsured live in fear every day that they are one accident or illness away from bankruptcy. This includes middle-class people. People who don’t get insurance through their employer have to pay three times as much for it [thanks to the federal tax code].
One man lost coverage in the middle of chemotherapy because of failure to report gallstones he didn’t know he had, and a breast cancer victim got cancelled before a bilateral mastectomy because of failure to report a history of acne. Her cancer grew before she could get new coverage. Nobody should be treated like that in the U.S.A.! [Elsewhere they will get coverage, but likely be denied treatment. See AAPS Mythbuster #16.]
Then there are the increasing costs. We spend one and a half times as much per capita as other countries and are no healthier. [See AAPS Mythbuster # 6.]
Our industries are at a competitive disadvantage because of health-care costs. [See AAPS Mythbuster #3.]
The uninsured are a burden on insured people, who pay $1,000/year for somebody else’s emergency and charity care. [See AAPS Mythbuster #12.]
There is an unsustainable burden on taxpayers. If nothing is done about rising costs, we will spend more on Medicare and Medicaid than on all other government programs combined. [See Huntoon Lampoons, Medicare Pac-Man and video “Obama Care and Medicare’s Entitlement Kids.”]
The facts are not in dispute. [See AAPS Mythbusters.] We need health care reform. The only question is how.
People on the left say the only answer is a single payer like in Canada. People on the right [such as??] say we need to end the employer-based system and leave individuals to fend for themselves. There are arguments on both sides. But either would be a radical change for most people. With one-sixth of our economy it would make more sense to build on what works than to build something entirely new from scratch. [The promised fundamental transformation will take a little time. First, the wrecking ball and the bulldozer….]
There is an unprecedented coalition backing reform: doctors [the AMA], seniors [AARP], drug companies [big PhRMA], etc.
There is 80% agreement [among the in-crowd] about what needs to be done. But some partisan elements are not engaging in honest debate but rather in scare tactics and an unyielding ideological campaign. They are focused on short-term political points and want to stop the solution to a long-term challenge.
The time for bickering and game playing is past. The time for action has come. We need to show Americans that we can do what we were sent here to do. Now is the time to deliver on health care.
There are three goals: (1) stability and security for the insured; (2) insurance for the uninsured; (3) decreasing the growth rate of costs.
Everybody, including employers and individuals, must take responsibility to meet the challenge [or else pay thousands of dollars in harsh tax penalties].
All you need to know is that if you get insurance from your job, or are on Medicare or Medicaid, or the VA, nothing in the plan will require you to change. [But nothing guarantees that your job or insurance company will survive; see AAPS Mythbuster #10.]
What the plan will do is make your insurance work better for you. It will outlaw denial of coverage for pre-existing conditions, dropping or watering down coverage when you need it most, or capping coverage in a given year or over a lifetime. The plan will have to cover preventive care and check-ups. It will place limits on out-of-pocket payments because nobody should have to go broke because of illness. All these things will happen as soon as I sign the bill. [True insurance—with pricing based on risk—is thus immediately outlawed, and replaced with collectivist third-party payment.]
If you don’t have insurance, you will finally be able to get affordable coverage through new health insurance exchanges. Insurers will have incentives to offer competitive prices because they’ll be getting millions of new customers [who will be forced to buy the product or pay a penalty]. If you still can’t afford it, there will be tax credits to help you. It will take four years to set up the exchanges to make sure we do it right. But you’ll immediately be able to get low-cost coverage to protect against financial ruin. Sen. McCain proposed this during the campaign, and it was a good idea.
Individuals will be required to carry health insurance just as many states require automobile insurance. Businesses will have to offer health care or else “chip in”—unless they get a hardship waiver, and 95% of small businesses will be exempt. But we can’t have big businesses gaming the system to avoid responsibility.
Everybody is going to have opportunities like federal employees (all of us) do.
There are significant details to be ironed out, but consensus on the main points.
The plan will benefit all Americans and the economy, but there is some nervousness owing to misinformation and bogus claims by those with an agenda to kill reform at all costs.
For example, the existence of a bureaucracy with the power to kill seniors would be laughable if it were not so cynical and irresponsible. It’s a lie plain and simple. [See AAPS Mythbuster #18. There will not be an official death bureaucracy: just incentives, penalties, guidelines, price controls, and shortages of facilities and personnel. Doctors, not officials, will be held responsible.]
Another false claim is that illegal immigrants will be covered. Reform does not apply to those who are here illegally. [There were boos and a call of “you lie” from Rep. Joe Young (R-SC). Amendments requiring citizenship checks were defeated, Wilson told Sean Hannity. And Obama favors measures to make illegals legal.]
No federal dollars would be used to fund abortions. [Nothing was said about mandates for qualified private plans to cover abortion.] Federal conscience laws are in place. [Immediately after taking office, Obama began the process of rescinding rules for protecting medical professionals from discrimination for refusing to violate their conscience.]
It is alleged that reform would be a “government takeover” of the system. As proof, the public option is offered. It would be like Medicare or Medicaid.
The guiding principle is choice and competition: that’s how markets work.
In 34 states, 75% of the insurance market place is dominated by five companies or fewer, and in Alabama one company has 90% of the business. [The role of previous “health care reform” is not mentioned.] Without competition, insurance companies treat people badly and engage in cherry-picking. I have no interest in putting insurance companies out of business; only in holding them accountable [through measures that will put a lot of them out of business.]
The not-for-profit public option would be added to the insurance exchange only for people without insurance. It would keep insurance companies honest. [See AAPS Mythbuster #9.]
The CBO estimates that only 5% of Americans would sign up for the public option. Still, insurance companies don’t like it. They think private companies could not compete. However, the public option would not receive tax funding; it would only get the premiums that it collects. It would be like public [tax-funded] and private universities. Its importance has been exaggerated by left and right [but he seems to think it is absolutely essential].
I will cooperate with my Republican friends who offer constructive suggestions, but I will not back down: if Americans cannot find affordable coverage, we will provide a choice.
And I will make sure that no government bureaucrat or insurance company bureaucrat comes between you and the care you need. [Nothing was said about between you and your doctor.]
How will we pay for the plan? I will not sign a plan that will contribute to deficits now or in the future. It will not add one dime to the deficit. [The $254 billion cost of preventing big annual pay cuts to physician is exempted from the congressional rules requiring new programs to be paid for. “In other words it doesn’t have to be paid for because they decided it doesn’t have to be paid for” (AP 9/9/09).]
There will be a provision requiring spending cuts if promised savings do not materialize. I faced a $1 trillion deficit because spending was not paid for, as in the Iraq War. I will not make the same mistake.
We will find savings within the existing system by eliminating waste and abuse [as from the purportedly very efficient Medicare program]. We do too much that does not make us healthier, in the judgment of medical professionals.
Threats to Medicare are pure demagoguery. Four decades ago we established the principle that after a lifetime of hard work people should not have to struggle with medical bills. This is a sacred trust that must be passed down to the next generation. Not one dollar from the Medicare Trust Fund will be used to pay for the plan. [The Medicare Trust Fund is an accounting fiction; all the funds have already been spent.]
In Medicare [despite its legendary efficiency], hundreds of millions are being spent on waste, fraud, abuse, and insurance company subsidies. We’ll set up a commission to identify more waste.
We will also fill in the gap that causes seniors to spend thousands of dollars out of pocket for prescription drugs.
That’s what this plan will do for you. Remember that the people spreading the tall tales opposed Medicare in the past.
I will protect Medicare. There will be no privatized system with vouchers.
Because Medicare is such a big part of the system, making it much more efficient will save costs for all.
We’ll implement common-sense measures to decrease infections and increase coordination. Decreasing the inefficiencies of Medicare [the single-payer advocates’ model of efficiency] and Medicaid will pay for the rest of the proposal.
Then there will be revenues from drug companies and insurers who benefit from new customers. There will be a fee [tax] on high-cost policies.
These modest changes will hold down costs for all.
Malpractice reform will help lower costs, say many, especially Republicans. Now I don’t think malpractice reform is a silver bullet, but I’ve talked to enough doctors to know that defensive medicine may add to costs. I’m going to move forward today on a demonstration project proposed by Bush [handing the ball to HHS Secretary Kathleen Sebelius, formerly a lobbyist for trial lawyers].
The added costs will be $900 billion over 10 years, less than the cost of Iraq and Afghanistan, and less than the Bush tax cuts for the wealthy. Most of the costs will be paid for by dollars we are already spending, but we’ll be spending them better. If we can slow growth by only 0.1% each year, it will decrease the deficit by $4 trillion in the long term.
My door is always open to serious proposals, but know this: I will not waste time with those who have made the calculation that it is better politics to kill this than to improve it. I’ll not stand by while they spread misinformation meant to keep things as they are. Those who misrepresent the plan will be called out.
We cannot accept the status quo. [See AAPS Mythbuster #14.] If we do nothing, there will be more bankruptcy, more loss of coverage leading to death. [See AAPS Mythbuster #11.]
We know these things to be true. We cannot fail because Americans are counting on us to succeed.
I received a letter from Ted Kennedy, written just after his diagnosis of terminal brain cancer in May, to be opened after his death. It calls health care reform the great unfinished business of our society….
In 1965, Medicare was called a government takeover, but Democrats and Republicans did not back down….
The problem of too much government is matched by the perils of too little….
We are not here to fear the future, but to shape it….. We need to meet the historical test. That’s who we are. That is our calling….
And we have to exchange acrimony for civility, meet the challenge, and not kick the can down the road. [Leaving debt to the grandchildren doesn’t count, nor does debasing the dollar. See: “Brother Can You Spare a FRAUD?”] An effort to help is not un-American, and we’re all in this together.
[Translator’s note: The Red Sea of deficits will part, the loaves and fishes of Medicare savings will provide care for the multitudes, divisions will cease, and every mountain and hill will be made low even if the valleys aren’t exalted.]
Additional information:
- Physicians Stand Together Rally in Washington, D.C. (AAPS President Mark Kellen’s comments on Obama’s address are near the end)
- Comments by Mark Kellen, M.D., and Kathryn Serkes on conscience clause and other features. Family Research Council 9/10/09.
- Comments by Ron Paul, AMA President David Scheiner, and AMA Past President Nancy Nielsen on Larry King Live.
- Americans for Tax Reform. Obama Bingo Card.
- Cato Institute Live Blog during the speech.
- NY Times transcript of Obama’s address to Congress (if you’d rather not go to official government site)
- Official White House site
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