Sep 11, 2009

Obama's Reclamation of Health Care

Wednesday night, President Obama announced a health care plan that will provide greater security to health insurance consumers and, hopefully, control costs and improve the quality of American’s care. I, for one, thought the speech was remarkably well done – and I had very high standards for such an important speech.

But before I delve into the speech, I ought to introduce myself, as the newest contributor to the IHI Open School Blog. I’m a few months out of college and a few weeks into a one-year position here at IHI. My main interest in health care is about policy and politics, so my posts will follow the health care reform debate, as it relates to all of us who are working to improve the quality of the health care system and its delivery. Just as a note, I know my opinions can be rather assertive, so I want to be clear that I am writing for myself, as myself, not on behalf of IHI as an organization.

I’m starting from a few core assumptions. First, I assume health care is a human right. That means that any reform will be unacceptable to me if it does not achieve universal coverage. It also means that reform will be unacceptable if it leaves people “underinsured.” According to 2007 data from the Commonwealth Fund, about 25 million adult Americans are underinsured—their insurance fails to cover medical costs when tested by unforeseen diagnoses or accidents. Health insurance reform means making insurance more dependable, affordable, and transparent for all. Otherwise, health care is not a right but a luxury.

My second assumption is that government is not evil. Reform will go nowhere if any steps the government take are described as a Kafkaesque “government take-over.” Let’s be real, this is America…someone will always be there to make a profit from your pain. The reality is, government policy can change the incentives that doctors and hospitals face. The government can make it worth a doctor’s time to counsel patients on the medical decisions they must make. Government policy can reverse the perverse incentives that reward hospitals for expensive care. Most important, the government is the only publicly accountable body that can make such changes.

My third assumption is not really an assumption, but in fact a challenge to a commonly held one: that the free market is the answer to health care. A purely free market for health care would in fact be catastrophic. I’ll defer to Paul Krugman on this one (as I’m sure I’ll do on a lot of these posts):

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket. This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy…The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (“I hear they’ve got a real deal on stents over at St. Mary’s!”) (

Getting back to the President’s speech, I really was very impressed that Obama rose to the challenge. He didn’t sound technocratic or boring, but he wasn’t vague or noncommittal on details either. He convinced me that the public option is not the crux of reform, and that it shouldn’t overshadow other critical consumer protections built into the law. He also chose some really great analogies to explain himself – I particularly liked how he said that a public option would provide greater choice and competition, just as public universities provide greater choice for and competition against private ones. You can read the full text here.

Some of the Republican’s reactions, though, absolutely disgusted me. I found myself screaming at the screen when Obama debunked the “death panels” lie, only for Republicans to remain seated as the rest of the audience jumped to its feet. It would have been consolation that their presence in the chamber was small--pushed to the back while Democrats took up more space than I’d ever seen--if I didn’t know that it was Democrats who have kept this reform from going forward in the past few months.

I loved the section to seniors, on Medicare: “So don't pay attention to those scary stories about how your benefits will be cut, especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program. That will not happen on my watch. I will protect Medicare.” Another moment of uncomfortable Republican seatedness. And I loved the attempt to shame Congress for their inaction: “ We did not come to fear the future. We came here to shape it.”

Whether this speech can make a difference remains to be seen. I hope it can, and I’ll be watching closely to see.

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