Obama's (non) response
Can Obama calm public qualms about government insurance?
Obama's (non) response
Dick Polman, Inquirer National Political Columnist
President Obama's sales pitch for major health care reform will not be easy. A key exchange at his press conference yesterday underscored the challenge.
Notwithstanding his general popularity (the latest New York Times-CBS poll puts his job approval rating at 63 percent), and notwithstanding strong majority support for the concept of a government-administered health insurance plan that would compete with private insurers (nicknamed the "public option"), Americans are generally wary of expanding government's role. National surveys, during the past week, report that only 34 percent think Washington should do more to tackle national problems, while, in response to a separate question, 69 percent voice "quite a bit" or "a great deal" of concern about an enhanced government role on issues such as health care.
Those stats came to mind as I watched Obama pitch the public option during the press conference. Here's how he framed it early in the hour: "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,' but 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 later in the hour, Jake Tapper of ABC News spotted the potential flaw in Obama's pitch. What happens, he asked, if an employer who provides good health insurance decides instead to dump that coverage and go with the public option - even if the workers like their private plan and want to keep it?
Tapper told Obama: "It does seem logical to a lot of people that if the government is offering a cheaper health care plan, then lots of employers will want to have their employees covered by that cheaper plan, which will not have to be for-profit, unlike private plans - and may, possibly, benefit from some government subsidies, who knows. And then their employees would be signed up for this public plan, which would violate what you're promising the American people, that they will not have to change health care plans if they like the plan they have."
They bantered for a few moments, sparking much faux laughter in the room, as reporters sought to lighten the vibes, because Obama did seem particularly testy yesterday. Then Obama tried a general response. Which was actually a non-response:
"We are still early in this process. So, you know, we have not drawn lines in the sand, other than that reform has to control costs and that it has to provide relief to people who don't have health insurance or are under-insured. You know, those are the broad parameters that we've discussed. There are a whole host of other issues where ultimately I may have a strong opinion, and I will express those to members of Congress as this is shaping up. It's too early to say that. Right now, I will say that our position is that a public plan makes sense."
His filibuster continued: "Now, let me go to the - the broader question you made about the public plan. As I said before, I think that there is a legitimate concern, if the public plan was simply eating off the taxpayer trough, that it would be hard for private insurers to compete. If, on the other hand, the public plan is structured in such a way where they've got to collect premiums and they've got to provide good services, then, if what the insurance companies are saying is true, that they're doing their best to serve their customers, that they're in the business of keeping people well and giving them security when they get sick, they should be able to compete. Now, if it turns out that the public plan, for example, is able to reduce administrative costs significantly, then you know what, I'd like the insurance companies to take note and say, hey, if the public plan can do that, why can't we? And that's good for everybody in the system. And I don't think there should be any objection to that."
The president kept going - I'll spare you the next 300 words - yet he never addressed Tapper's specific concern. The reporter's question was, what if employers dumped a private health plan that the workers liked and wanted to keep?
When Obama finally stopped talking, Tapper sought to follow up: "I'm sorry, but what about keeping your promise to the American people that they won't have to change plans even if employers - "
Obama interrupted with another lengthy non-response: "Well, all right - 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 the 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."
Note how, in the first sentence, Obama declared that "the government is not going to make you change plans under health reform." Again, that's not what Tapper was asking about. The question was whether the private employer would compel you to change plans. Again, Obama didn't address it.
Obama went on to make a few decent points - under our burdensome status quo, there's nothing to prevent employers from switching private plans with even greater frequency, and thereby messing with coverage that their workers like - but he never addressed the core concern raised by Tapper: That if the federal government gets involved, it might screw things up and compound the health coverage woes we already have.
Obama's core theme, gleaned from his second long reply, is that the status quo can no longer be tolerated and that government-driven reform would surely be an improvement. But, as I noted earlier, there is considerable public nervousness about an expanded government role - in the latest Washington Post-ABC News survey, 61 percent of swing-voting independents favor a smaller government with fewer services, rather than a larger government with more services - and Obama will likely need to leverage every percentage point of his personal popularity to calm those public qualms. Assuming that he can. His signature domestic proposal may well depend on it.
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Hypocrisy update:
More woes for the party that prides itself on conservative "family values." John Ensign, the Nevada senator whose dreams of a 2012 GOP presidential bid were dashed when he 'fessed up to canoodling for nine months with the wife of a senior aide, has now been joined on sin row by fiscal conservative champion Mark Sanford - who, until now was probably best known for rejecting Obama's stimulus money until ordered by the courts to take it.
The married South Carolina governor and father of three, who had nurtured dreams of a 2012 GOP presidential bid, basically blew up that scenario this afternoon when he 'fessed up to visiting an extramarital lover on the sly in Argentina. Over Father's Day weekend, no less. After his staff had told South Carolinians that Sanford was off communing with nature on the Appalachian Trail. After driving to the airport in a state car.
Turned out he was working on his own stimulus package.
tom: you can get the cheap tests whenever you want (blood work, Xray, even MRI). I have Aetna, and can go to Quest with nothing more than my doctor's script. However, the expensive tests, such as a CT scan, are not nearly the way you describe them. And no, this was a standard HMO.— still_independent- Vandy: I'm FOR what safeway is doing. Of course cutting back on smoking, losing weight, eating right, and exercising are all important. We should reward healthy behavior and punish unhealthy behavior through premiums. The point that you seem to be (intentionally?) avoiding is the "uninsurable". Lots of cancer patients are not smokers (I believe the majority). Many people have high cholesterol due to heredity. My sister runs several marathons a year yet has mild hypertension. All of these people would be prohibitively expensive or even uninsurable (especially the cancer ones) without goverment mandates. In the "let the market decide" solution to health care costs, how do you address this?— still_independent
- "What you still haven't addressed is the uninsurable." Good! We've taken care of 99% of the population and whittled it down to the 1% that are truly medically uninsurable because of pre-existing conditions. On the one hand, charging different premiums based on health will encourage more young, healthy people (especially single young adults who believe they are invincible and would rather buy a Wii than insurance) to obtain bare-bones plans to protect against catastrophe, and putting premiums from people who are unlikely to utilize services into the risk pool will help absorb the others to a degree. And for those 2.5-3.0 million people, I don't have a problem with government subsidies at all, while recognizing that it is not inappropriate for those who utilize more insurance services to be asked to pay higher premiums.— Vandy
- Let's face it. Employer-sponsored Health & Welfare coverage is just another benefit of the labor movement that Businesses have been trying to roll back since the first collective bargaining agreement was signed. Not counting the "golden parachutes" offered to CEO's and other highly compensated employees, how many non-union firms offer a company paid pension? Once the gov't started taking care of retirees, the private sector didn't have too. Plus, by paying Social Security taxes, private firms ARE contributing toward a "pension" plan. Employer based plans are destined to fade away as they become too expensive to be offered. Wasn't the pensioners' H&W plan the albatross hanging around GM's neck that dragged GM into insolvency? The model is broken. Maybe we could ALL enroll in Tricare? There's no fee if you're under 65 (SOURCE: http://www.military.com/benefits/tricare/tricare-prime/tricare-prime-overview#cost) and it seems to be single payer administered. «SNIP» TRICARE For Life is administered nationally by a single contractor «SNIP» (SOURCE: Page 3 on http://www.tricare.mil/mybenefit/Download/Forms/TFL_Handbook_rev_08.pdf) Nahhh. That's too much like Socialism???— Phrossty
- Vandy: have you ever dealt with a "pre-existing conditions" clause with an insurer? It's nowhere near 1%. Let's just start with cancer (all stats from ACS). There are over 1,000,000 diagnosed a year. It's estimated that in 2005, over ten million people were living with cancer. A male has an almost 50-50 chance of developing cancer in his lifetime. Granted much of that is in older patients, but anyone with a cancer history, without government mandates, would be either uninsurable or close to it. Move on to cardiovascular disease. As of 2004 (last data I could find), over 17,000,000 Americans were living with a cardio vascular disease diagnosis (from HHS). You can count them out, too. 1% starting to seem a little optimistic, isn't it. Did you know that until certain laws were changed (and some lawsuits), some insurers considered pregnancy a pre-existing condition? Jaundice as a baby? Pneumonia? ... Sorry, but a very significant percentage of Americans would be uninsurable in an actual free market system.— still_independent
- "Sorry, but a very significant percentage of Americans would be uninsurable in an actual free market system." Says who? So you're saying that private insurance companies don't cover oncology drugs? Nonsense. Many of those persons in your post do, in fact, have private insurance right now.— Vandy
- A straight answer from Barack Obama? Now there's any oxymoron, if ever there was one.— Jack_Davis
- We seem to be forgetting that insurance companies do not exist to provide healthcare benefits. They exist (like all businesses) to make money. It is a gross corruption of the principles of a free market system to primarily provide a benefit to the general population. Yet, somehow, the free marketeers on the right have gussied up the preservation of the for-profit model in that gown. It's nonsensical. All of the propaganda naysaying a healthcare plan that benefits the people is designed to distract us from the point that the insurers and the lawyers don't want to lose their pieces of eight. Nothing to see here, people. Move along. Any talk of providing quality healthcare to people in our advanced, civilized society regardless of ability to pay will cause the downfall of capitalism. Don'tchya know. I mean, really. If we can't view illnesses and injuries as entrepreneurial opportunities, where can we hustle a buck? Injured? Call Allen Rothenberg. He won't get paid until you get paid.— Phrossty
- Vandy: yes, they do have private insurance - because states mandate that they cover these conditions if they want a license to offer any insurance in their state, and they don't allow out of state shopping.— still_independent
- Still, I'll go up to 5 million medically uninsurable (1.5-2% of the population), with a citation: "The 47 million Americans without health-care coverage include 5 million uninsurables such as Kendra -- people locked out by private insurers because they have costly ailments." http://www.bloomberg.com/apps/news?pid=newsarchive&sid=a4BEIIi_OauQ— Vandy
- "and they don't allow out of state shopping." Again, they should remove those inter-state boundaries.— Vandy
- Vandy: is they allow out of state shopping, then the number of "uninsurables" goes up. Again, much of what's covered is mandated by the state. Now if you were an insurer, would you cover whole classes of people with expensive ailments? No. You only do it because it's a cost of doing business in that state, which you want to do to make a profit on the young and healthy. .. If your sole goal is to lower insurance premiums, by all means allow out of state shopping. This will, however, come at the cost of MORE uninsured.— still_independent
- Vandy - are you pulling a Tom here? From your article "A majority of Americans, about 160 million, get insurance through the workplace, where health plans must cover everyone regardless of medical background. It's not the same for the estimated 15 million people who buy their own coverage. Most states let insurers reject applicants because of pre-existing conditions. " So that 5 million uninsurable number is only out of those who DON'T have employer-sponsored health coverage. Again, it's state mandates that make them cover everyone in these plans.— still_independent
- Still, you seem to be accusing me of something I don't support. To be clear, I'm NOT opposed to government regulations of private health insurers; never have been. Quite the opposite, which is why I cited the auto insurance area. What I am opposed to is government getting into the business of PROVIDING health insurance.— Vandy
- "If your sole goal is to lower insurance premiums, by all means allow out of state shopping. This will, however, come at the cost of MORE uninsured." Why? Prove it. If it's a cost of doing business in the USA instead of a cost of doing business in a given state, what's the difference? If anything, you'd increase the risk pool from 50 smaller ones into a much larger one. Moreover, people who live in states where policies are forced to carry tons of (for them) needless benefits that come with a higher price can instead find policies from states, still regulated, that fit their specific needs.— Vandy
Cited by the Columbia Journalism Review as one of the nation's top political reporters, and lauded by the ABC News political website as "one of the finest political journalists of his generation," Dick Polman is a national political columnist at the Philadelphia Inquirer. He is on the full-time faculty at the University of Pennsylvania, as "writer in residence." Dick has been a frequent guest on C-Span, MSNBC, CNN, NPR and the BBC. He covered the 1992, 1996, 2000, and 2004 presidential campaigns.
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