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rosco 357

Senator: Democrats 'baffled' by president's health care stance
Posted: 10:46 PM ET
July 21, 2009

From CNN Senior Congressional Correspondent Dana Bash

WASHINGTON (CNN) – As the prospects for passing health reform by the time Congress leaves for its August recess look bleaker, Democratic grumbling about President Obama is growing louder. One Democratic senator tells CNN congressional Democrats are “baffled,” and another senior Democratic source tells CNN members of the president’s own party are still “frustrated” that they’re not getting more specific direction from him on health care. “We appreciate the rhetoric and his willingness to ratchet up the pressure but what most Democrats on the Hill are looking for is for the president to weigh in and make decisions on outstanding issues. Instead of sending out his people and saying the president isn’t ruling anything out, members would like a little bit of clarity on what he would support – especially on how to pay for his health reform bill,” a senior Democratic congressional source tells CNN. The Democratic leadership had hoped the work going on behind closed doors for months could bear fruit in time for the president’s news conference Wednesday night. But multiple Democratic sources tell CNN that’s looking very unlikely, and one senior Democratic source tells CNN there is some frustration among Democratic leaders that Senate negotiators have, "repeatedly missed deadlines."


Hopefully someone is realizing Obama is pushing to hard to fast and slow down and read this plan from cover to cover. I have my doubts this is going to be the quick fix just a huge expense on tax payers.
Is there really enough millionaires to support this , or again will the taxes on the rest of us sky rocket. Obama is in a might big hurry for some reason.


I think what they want is for Obama to be more specific about his plan, they want answers so they can start thinking about how it will work, so they can judge it and analyze it. Right now they don't have any details and they want Obama to explain to them the entire plan and how it will work. The scary part his he may not know, or worse yet, no one knows, and the plan may not be very well thought through.

That's what I got out of that article anyway.


I watched the press conference, he laid it out pretty clear,I can't go into details too lengthy, i~ it sounds good to me,what is in the bill and how it works.
45 million people without health care that shouldn't be. not in America!!
here i hope is the conference


gypsy wrote:I watched the press conference, he laid it out pretty clear,I can't go into details too lengthy, but it is here on line by now I am sure~ it sounds good to me,what is in the bill and how it works.
45 million people without health care that shouldn't be. not in America!!
Well obviously you know the plan better than they do in that article, becuase people are complaining that they need more details. I think they need details you can't see, its a complex issue and professional's need to analyze it. What you see is from the surface, they know how Health systems work and need more details.


very true on seeing the bill,but dems/repubs are working to clarify and to improve is my understanding,.and to weed out. the video wasn't complete, that was mostly towards the end.


gypsy wrote:very true on seeing the bill,but dems/repubs are working to clarify and to improve is my understanding,.and to weed out. the video wasn't complete, that was mostly towards the end.
What needs to happen is for everything to be explained, not the speeches he makes where he is speaking broadly, but extreme details they need answers. He can talk about how it will work, but the details are on paper and need to add up. They need more details. There are many unanswered questions that have not been addressed. They need the entire plan in detail, as to how it will work and how to implement it.

Of course they are working to "improve" that's the whole point. And I see no rational explanation for talking about "weed out" that doesn't apply to anything about this subject that I can see.


Well in my opinion, an for politicians especially there is always a weed out LOL
here is another discussion video,i agree in laying out the complete scenerio it is right there for the congress/senate to see .


gypsy wrote:the complete scenerio it is right there for the congress/senate to see
Oh you think so do you? Obviously professional people in the field don't agree. I happen to believe they have many unanswered questions.


Maybe, Tyler, but if they are professional my answer is quit putting it on back burner, just as Dodd says for 70 years this has happened exactly what is transpiring now~ I say use that professionalism find out what they don't like about the bill, it is right there for them to read/study I say" Get er done"! not just 47million americans who need it, our economy does. if they continue this course it will be shelved again



here is Kennedy's
don't know if this is the same as Obama's or not | HuffPost Reporting
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Kennedy Health Care Reform Bill Released -- Help Us Read Through It
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First Posted: 06- 9-09 08:25 PM | Updated: 06-10-09 09:06 PM
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Read More: Health Care, Health Care Bill, Help Committee, Help Health Care, Kennedy Health Care Bill, Senate Health Care, Senate Health Care Bill, Ted Kennedy, Politics News

Dropping in at 615 pages is the Senate Health, Education, Labor and Pensions Committee's attempt to fix the broken health care system. The HELP Committee is chaired by Sen. Ted Kennedy (D-Mass.). The second-ranking Democrat, Sen. Chris Dodd of Connecticut, had a large hand in drafting the bill as well, given Kennedy's absence from the committee while he battles brain cancer.

If you want to help read through the committee's offering, sign up here to be part of the research team! Or, if you can't wait that long, give it a read now and write me at

The bill can be read here. A HELP Committee aide cautioned that the bill is not in its final form and that part of the reason for filing it is to meet a committee rule that requires a bill to be filed seven days before a vote can be held.

Committee Democrats will be meeting with their Republican counterparts Wednesday and Thursday to hash out the bill's details.

"On the legislation we'll introduce later today, there are some gaps in it and done so intentionally," said Dodd at a press conference earlier Tuesday. "There are no gaps in our determination, in my determination and that of my colleagues to have a public option, to have something done with the pay or play and deal with the follow on biologics. But I left those areas open for discussion, not because they're open for some sort of decision about whether or not we ought to move in that direction. But I want my Republican colleagues to know, I want their ideas, I want to hear what they have to say. This is a bill, it's an opening step."

Kennedy's bill will get its first hearing on Thursday and is scheduled for a committee vote on Tuesday, June 16th.

Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, said Tuesday that a committee vote on a health care bill could come as early as the week after next. The battle over the future of health care in America now enters a span of several months as important as any in a generation.

Below is a statement released by Kennedy and further down is the health care bill itself.

For the past year, Chairman Edward M. Kennedy and Democratic Members and staff of the Senate Committee on Health, Education, Labor and Pensions (HELP) have been working to develop legislation that reduces health care costs, allows Americans to keep the coverage they have if they want it, and makes health insurance affordable to those who do not have it today.
Story continues below

Today, while discussions between HELP Committee Democrats and Republicans on key outstanding issues continue, Chairman Kennedy released the landmark "Affordable Health Choices Act." Click here for a copy of the bill,

"Our health care system is a crisis for American families and President Obama and members of Congress of both parties recognize the urgency of the problem. Our goal is to strengthen what works and fix what doesn't. Over the next few days, we will continue working with our Republican colleagues on common sense solutions that reduce skyrocketing health care costs, assure quality care for all and provide affordable health insurance choices. Much work remains, and the coming days and weeks won't be easy. But we have a unique opportunity to give the American people, at long last, the health care they need and deserve," said Senator Kennedy.

Earlier this year, Kennedy and Senator Max Baucus, Chairman of the Finance Committee, which shares jurisdiction of health care reform with HELP, established a joint process that will lead to complementary legislation being marked-up in June and on the Senate floor by July. The HELP Committee is on track to meet that goal. On Wednesday, June 10 and Thursday, June 11, Democrats and Republicans on the Committee will meet to discuss outstanding legislative options such as the public option and employer mandate.

A public hearing is scheduled for Thursday, June 11 at 3 p.m. in Dirksen 430. Mark-up will begin Tuesday, June 16 at 2:30 p.m. in Russell 325.

Last year, Kennedy asked Senator Christopher J. Dodd, vice chair of the HELP Committee, to be his chief deputy on health reform to help lead the overall effort. In addition, Senators Tom Harkin, Barbara A. Mikulski, Jeff Bingaman and Patty Murray have also assumed leadership roles on key aspects of reform within the Committee. Since January, the Committee has held over a dozen public hearings on improving the quality of care, prevention and wellness, and expanding insurance coverage.

"Health care reform cannot and must not wait. Today, we will introduce legislation that will strengthen what works and fix what doesn't. If you like the insurance you have today, you can keep it. If you don't like what you have today, we'll give you better choices, including a public option for health care. This does not symbolize the end of the game or even the end of the first quarter. We still have a lot of work ahead of us and are looking forward to working with our colleagues on a bipartisan basis to resolve the remaining issues and move forward with a mark-up of this legislation next week," Senator Dodd said.

"All stakeholders in the health reform debate agree one of the keys to reining in the rising costs of health care in this country is to reduce chronic disease. Data shows that with an investment of $10 per person per year, community prevention programs could yield net savings of more than $18 billion annually within 10 to 20 years," said Senator Harkin. "This reform provides one of the largest investments in prevention and wellness initiatives, offering choices throughout the health care system. At the federal level, it creates a new inter-agency council to develop a national health strategy and a dedicated funding stream to support these efforts; at the clinical level, it provides coverage of preventive services and the elimination of co-pays and deductibles for these services; and at the grassroots level offers grants for community initiatives. It short, it realigns incentives to make it easier to be healthy and removes the barriers to preventive services like screenings for diabetes, depression, tobacco cessation, and nutrition counseling - to name just a few."

"We can't fix the economy without fixing health care so families can afford it and businesses can afford it. We can't afford not to fix health care," said Senator Mikulski, who was asked by Chairman Kennedy to lead the Senate effort on improving health care quality. "A national health care quality strategy will provide solutions to the biggest problems - medical errors, preventable hospital readmissions and failure to manage chronic disease - that severely impact people, their lives, their checkbooks and national health care costs. Emphasizing quality improves lives, saves lives and helps pay for reform by saving money."

"This bill introduction marks a very important step toward fixing our nation's broken health care system. As we continue developing this measure in the coming days and weeks, our primary goal will be to ensure that all Americans have access to affordable and quality health care," Senator Bingaman said.

"Our health care reform bill is a step toward ensuring all Americans can see a doctor when they need one and that our long term economic strength is not held captive by the skyrocketing cost of care," Senator Murray said. "I applaud my colleagues for the hours of work they have all put in and thank Senators Kennedy and Dodd for their leadership in moving this forward. I am particularly proud that as we work to offer quality, affordable coverage to all Americans that we have included a plan to ensure we have enough health care professionals to provide that care. We still have work to do, but this bill is a good step forward on protecting patient choice, lowering costs and providing coverage for the millions of Americans who currently have none."

A Quick Summary of the Affordable Health Choices Act

Senator Edward M. Kennedy, Chairman of the Health, Education, Labor and Pensions Committee (HELP), today released The Affordable Health Choices Act, legislation that aims to reduce health care costs, protect individuals' choices of doctors, hospitals and insurance plans and guarantee, quality and affordable health care for all Americans.

The Affordable Health Choices Act includes the following five major elements:

CHOICE: An important foundation of The Affordable Health Choices Act is the following principle: If you like the coverage you have now, you keep it. But if you don't have health insurance or don't like the insurance you have, our bill will give you new, more affordable options.

COST REDUCTION: The Affordable Health Choices Act will reduce health care costs through stronger prevention, better quality of care and use of information technology. It will also root out fraud and abuse and reduce unnecessary procedures.

PREVENTION: The best way to treat a disease is to prevent it from ever striking, which is exactly why The Affordable Health Choices Act will give citizens the information they need to take charge of their own health. The bill will make information widely available in medical settings, schools and communities. It will also promote early screening for heart disease, cancer and depression and give citizens more information on healthy nutrition and the dangers of smoking.

HEALTH SYSTEM MODERNIZATION: The Affordable Health Choices Act will take strong steps to see that America has a 21st-century workforce for a modern and responsive healthcare system. America must make sound investments in training the doctors, nurses, and other health professionals who will serve the needs of patients in the years to come. It will make sure that patients' care is better coordinated so they see the right doctors, nurses and other health practitioners to address their individual health needs.

LONG TERM CARE AND SERVICES: The Affordable Health Choices Act will also make it possible for the elderly and disabled to live at home and function independently. It will help them afford to put ramps in their homes, pay someone to check in on them regularly, or any of an array of supports that will enable them to stay in their communities instead of in nursing homes


gypsy wrote:if they are professional my answer is quit putting it on back burner
How can people proceed to make an important decision as Health care without all the facts? You seem to think they have all the facts they need, and they are putting the issue on the "back burner" I'm suggesting (as many other 'Americans' are, with questions) they have not answered questions that need answering to make a rational decision. They need more facts than what is being presented to them.


don't know if these help or not

Protesters march through downtown Seattle.
Protesters march through downtown Seattle in support of health care reform. Democrats and Republicans may be able to reach a health care compromise by their August deadline.

If Congress were to take a vote on a health reform bill today, Democrats and Republicans would find a surprising level of agreement — so much so that the broad outlines of a consensus plan already are taking shape.

Sick or healthy, rich or poor, all Americans would be guaranteed access to health insurance.

In fact, they’d probably be required to purchase it — perhaps through mandates in the law that would include stiff tax penalties for anyone who tried to opt out.

Newly created insurance marketplaces would make finding a plan as easy as shopping for cheap airfare. People could keep their coverage, even if they switched jobs. And they might be able to choose between private insurers and a government-backed plan.

But here’s the catch — none of this would come free, with the wealthiest Americans likely to face higher taxes to help pay for coverage for all.

It’s hard to believe that only three months ago, health care advocates worried that President Barack Obama would drop the health reform issue from his first-year agenda. Now, with an August deadline to pass a bill, a compromise that once seemed unimaginable is considered quite possible, both sides say.

Congress this week begins a two-month sprint to pass legislation overhauling the health care system — an aspiration that has eluded generations of American politicians. The task is exceedingly complex and faces the legislative equivalent of an Ironman triathlon, tested at every stage by monied interests, political alliances and an estimated 13-figure price tag.

So there’s no guarantee every piece is going to fall into place just like this or even that a final compromise will be forged. But here’s a look at what could be expected in a bill — and what details have yet to be resolved:

Everybody gets in and stays in. The guiding principle of congressional efforts remains universal coverage, or something close to it. This means not just finding a way to cover 50 million uninsured Americans but also making the system more stable and affordable for those who already have insurance through their employer. Now, losing a job means losing coverage.

Why it looks likely: Lawmakers view universal coverage not as much as a moral imperative but as an economic issue. If the aim is to lower insurance premiums for everyone, then the young and the old, the sick and the healthy must be funneled into the system as a way to spread the costs of high-risk patients.

The unresolved fight: how to compel participation in the system and how to pay for it. Last month, Senate Finance Committee Chairman Max Baucus (D-Mont.) said “we’re going to try to get as close as we can” to universal coverage, and the Congressional Budget Office estimates the proposals would reach about 95 percent of Americans. But the package of options for achieving even near-universal coverage requires lawmakers to find hundreds of billions of dollars in new tax revenue and spending cuts — money that it hasn’t found yet.

Orbitz for insurance. If there was such a thing as a sure bet in the bill, this would be it: the creation of an insurance marketplace, or “exchange,” where individuals and small employers could compare plans side by side, find options with a minimum benefits package and buy coverage. Insurers would be required to take all comers, regardless of pre-existing conditions. Proponents say it would give individuals a place to find affordable insurance that could go with them from job to job.

Why it looks likely: It is the cornerstone of Democratic and Republican health care proposals. Experts from the conservative Heritage Foundation and the liberal Center for American Progress endorse it. Federal lawmakers already participate in an exchange called the Federal Employees Health Benefits Program — and they have been promising for years to provide the same choices to voters.

“That has to be the one thing that is close enough to a guarantee as you can find,” said David Merritt, a health policy expert at Newt Gingrich’s Center for Health Transformation

Read more:


runawayhorses wrote:
gypsy wrote:if they are professional my answer is quit putting it on back burner
How can people proceed to make an important decision as Health care without all the facts? You seem to think they have all the facts they need, and they are putting the issue on the "back burner" I'm suggesting (as many other 'Americans' are, with questions) they have not answered questions that need answering to make a rational decision. They need more facts than what is being presented to them.
I believe the facts are there for congress/senate to see,how can you work on something,if they aren't there, my point is the issues has always come up the same way it is now~ politics is the biggest culprit.facts are there is my belief, yes .


Oh, so now I'm being bombarded with copy & Paste replies? Ok, whatever.


gypsy wrote:I believe the facts are there for congress/senate to see,how can you work on something,if they aren't there, my point is the issues has always come up the same way it is now~ politics is the biggest culprit.facts are there is my belief, yes .
I don't understand what makes you think or believe people are getting all the details and facts they need to make a good and rational judgment decision, I don't understand why you believe that they have all the info they need. But whatever, if you want to ignore the questions professional people ask and their reasons for asking them, that's your deal. I believe more questions need answers, as does many other Americans..


Tyler, I am not talking about you or me having the bill for us to evaluate, I am saying the bill is there for congress/senate to do this,my question is are they acting on this or again putting it on back burner? I understand what your saying, can someone explain break the bill down to our level, last night Obama did go into how it would be payed for,and certain other aspects of it~I agree on questions, like i said the congress/senate have the info. I do believe a break down in layman terms would help for all of us to understand it,, as with anything to do with government,but the important part is it is there to be worked out an needs to be done as quick as they can.


don't know if this helps still questions there, to be answered

Tuesday, June 10, 2008
A Detailed Analysis of Barack Obama's Health Care Reform Plan

Access the daily updates as the Congress and President debate health care reform here.

February 26, 2009: The Obama Health Care Budget Proposal, Mr. President, Aren’t You Just Kicking the Can Down the Road?

A Review of the Obama Campaign Health Plan

Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.

The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.

That the Obama health care reform plan would cost between $50 and $65 billion a year is highly doubtful. Obama claimed his plan was nearly identical to Hillary Clinton's and her plan was projected by her to cost more than $100 billion a year.

By contrast, the McCain Republican strategy for health care reform would first emphasize market reforms aimed at making the system affordable so more Americans can be part of the system and he claims that there would be no additional upfront cost.

Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”

The three parts are:

1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health

Obama claims that his health care reform plan will save the typical family up to $2,500 every year through:

* Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems.
* Improving prevention and management of chronic conditions.
* Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead.
* Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
* Making health insurance universal which will reduce spending on uncompensated care.

Will Obama be able to cut the typical family’s health care costs by $2,500 a year?

Well, yes and no.

All of the candidates, Republican and Democratic, called for most of what is on the Obama cost containment list; expanding health information technology, improving prevention and better management of chronic conditions, and a more vibrant health insurance market.

Obama is unique in calling for catastrophic reinsurance coverage in order to reduce the cost of family health insurance. Really, this is not a cost reduction but a cost shift. This idea, first proposed by Senator Kerry in his failed bid for the presidency, would have the federal government absorb a large portion of the highest cost claims thereby taking these costs out of the price of health insurance. That would reduce the price of family health insurance but would also increase federal spending by the same amount. It would also water down the incentive for insurers and employers to manage these claims since most of these costs would be transferred to the government.

Obama’s assertion that covering more people would reduce the overall cost of insurance is likely correct because it would mean less uncompensated care that would have to be shifted onto the rest of the system. Since the McCain health plan emphasizes making the insurance system affordable before ensuring widespread coverage as the first priority, one could argue that Obama would make gains toward near universal care well before McCain.

In the end, Obama’s claim that he would save families $2,500 every year are based upon a number of initiatives that McCain also argues he would undertake. More, these ideas, such as health IT and prevention, are under way in the market anyway.

Obama’s claim that he would save $2,500 per family beyond a simple cost shift to the federal government of large claims is unsubstantiated and highly doubtful.

Let’s take a look at the three main parts of the Obama health plan:

1. “Quality, Affordable & Portable Health Coverage For All”

Obama follows the Democratic health care template by building on existing private and public programs such as employer health insurance, private individual health insurance, Medicare, and Medicaid. This is unlike the Republican approach that would refashion the private market by providing incentives to encourage a reinvigorated individual health insurance platform focused on personal choice and responsibility (see McCain post).

Obama’s key components here include:

* Establishing a new public program that would look a lot like Medicare for those under age-65 that would be available to those who do not have access to an employer plan or qualify for existing government programs like Medicaid or SCHIP. This would also be open to small employers who do not offer a private plan.
* Creating a “National Health Insurance Exchange.” This would be a government-run marketing organization that would sell insurance plans directly to those who did not have an employer plan or public coverage.
* An employer “pay or play” provision that would require an employer to either provide health insurance or contribute toward the cost of a public plan.
* Mandating that families cover all children through either a private or public health insurance plan.
* Expanding eligibility for government programs, like Medicaid and SCHIP.
* Allow flexibility in embracing state health reform initiatives.

Obama would also mandate guaranteed insurability, a generous minimum comprehensive benefits package such as that required for federal workers, the ability to take their policy from one job to another (portability) when it is purchased through the new Medicare-like public plan or the "National Health Insurance Exchange," and he would require providers to participate in a new plan to collect and report data about standards of care, the use of health information technology, and administration.

Obama would provide premium subsidies to individuals and families who are not eligible for employer-based care or a government program. Just how much these subsidies would be is not indicated. In Massachusetts, thousands of families have been exempted from that state's mandate to buy coverage because subsidies are inadequate for those making too much to qualify or too little to still afford coverage.

How would Senator Obama do on improving coverage for all?

This is the section that separates him most from Senator McCain.

In Europe they have a way of explaining the general philosophy toward universal health care for all. You often here the term, “solidarity.” The concept implies that everyone is in it together—all are covered in the same pool and share the burden equally.

Democrats, like Obama, tend to make an Americanized attempt at health care solidarity by crafting a structure that ensures everyone will be covered, not by a single government-run plan but by guaranteeing access to a mix of government and private plans. Obama understands that the vast majority of Americans are not ready to give up their private health insurance plans and that creates a political imperative to continue making private health insurance a part of any “unique American solution.”

Republicans, like McCain, on the other hand, build their health reform plans on the classic American foundation of “rugged individualism” promoting choice and personal responsibility.


herefore, Obama puts as his first priority getting everyone in the system by spending lots of money up front to ensure that everyone can afford a benefit rich traditional private plan—or have access to a public plan.

McCain argues that we already spend too much on health care and says his plan will not cost more than that since he will rearrange existing tax benefits to provide the incentives and support necessary for a more efficient system. It is hard to see how McCain can rearrange the existing employer tax benefits those who are insured now get, reapply them on an individual basis to those same people and also have extra money to provide assistance for the millions of uninsured who don't get these employer tax benefits today.

Obama sets as his goal quality, affordable, and portable coverage for all.

Let’s take them one at a time:

* Quality- Obama’s quality initiatives look a lot like McCain’s as well as those things that are going on in the market anyway. All good points—but no advantage here or expectation there will be quick savings.
* Affordability – Affordability is more about shifting the cost of insurance to the government then it is making a more efficient U.S. health care system. Health insurance is more affordable for people because he spends many billions of dollars subsidizing access for everyone.
* Portable Health Coverage For All: While Obama does not have an individual mandate to purchase health insurance; it is likely that he would cover most of those who are uninsured today because of his generous subsidies for low-income Americans. Compared to McCain, he puts far more emphasis on getting people covered upfront.

Obama would be successful in getting most of the uninsured covered and securing coverage for those that now have it. But when it comes to crafting a system that will not continue to outstrip the rest of the economy in what it costs, I see no evidence that he has tackled the drivers in health care costs—in fact he has likely poured some highly inflationary “gas on the fire” by adding tens of billions more to the system with no effective cost containment features to offset the new inflationary pressures.

The Obama health care reform plan is very similar to the new Massachusetts health care reform plan that was first implemented a year ago. The Massachusetts plan is proving to be falling short of covering everyone for an affordable cost. It's second-year costs look to be coming in 50% higher than were projected when the plan became law in 2006 and its insurance is still unaffordable for most families making between $60,000 a year and $110,000 a year. See: First Year Results in Massachusetts' Health Care Reform Undercut Barack Obama's Health Care Reform Strategy

2. Modernizing The U.S. Health Care System To Lower Costs and Improve Quality

Obama would argue that I am wrong about the notion that he has no effective cost containment ideas. In this section of his plan he argues he will contain, if not reduce costs, with a long list of proposals.

He would reinsure employer plans for a portion of their catastrophic costs. This would reduce employer costs but it would do so by simply shifting them onto the government. He runs the risk of shifting these costs away from a market that now has incentives to manage them to a big government program that likely will not have the same incentives to confront and manage them. I don’t see this as cost saving as much as just cost shifting.

Obama goes on to outline a long list of quality initiatives that include disease management programs, coordinated care, transparency about cost and quality of care, improved patient safety, aligning incentives for excellence, comparative effectiveness reviews, and reducing disparities in health care treatments for the same illness.

McCain has virtually the same list—all good ideas and all things the market has been tackling for years with only incremental success. The notion that Obama will suddenly make any or all of these more successful than others have with all the billions spent on such programs in recent years constitutes a leap of faith. Why will Obama be any more successful in this area than any other candidate or than those who have been tackling these things for years—no new ideas here and no cost containment “silver bullet?”

Obama would also reform the medical malpractice system by strengthening “antitrust laws to prevent insurers from overcharging physicians for malpractice insurance.” Clearly a malpractice reform strategy supported by the trial bar! He also makes a vague pledge to “promote new models for addressing physician errors that improve patient safety.”

Obama makes investments in health information technology an important part of his cost containment strategy. This is something every other candidate supports and is generally regarded at the heart of what’s needed to improve both cost and quality. And it is something the market has been spending billions at for many years and has shown only slow but steady progress on.

Obama would make the insurance markets more competitive and efficient by creating the “National Health Insurance Exchange” to promote more efficient competition and he would set a minimum health cost ratio for insurers—not defined in detail. Reducing insurance company overhead is important but constitutes only a small percentage of costs and those overhead costs have been increasing at the rate of general inflation while health care costs have been increasing by two to four times the basic inflation rate in recent years. The biggest cost containment challenge is in the fundamental cost of health care itself.

He would legalize drug reimportation. However, the amount of drugs imported from Canada, for example, has fallen by half in recent years, as this once popular scheme hasn’t produced the savings to even maintain itself at past levels. Somewhat surprisingly, even Republican McCain favors drug reimportation.

He would emphasize the use of generics by making it harder for drug companies to payoff generic makers to stay out of their markets—a good idea that also has bipartisan support.

He proposes lifting the ban on Medicare being able to negotiate drug prices—including those for the senior Part D program. However, recent Democratic proposals to do so do not allow Medicare to take a drug off the Medicare formulary when the manufacturer is not willing to reduce its prices. If Medicare doesn’t have the power to walk away from a drug maker, its power to negotiate is a hollow one. Obama does not tell us if he would give Medicare the leverage it would need to get real results.

When the day is done, Obama gives us a list of generally good cost containment ideas that are more often than not also in Senator McCain’s health proposal and have been part of a market struggling to bring costs under control—nothing really new and nothing that promises to get better results than each of these cost containment ideas are going to be able to get us anyway.

What would it take to really contain costs?

McCain would say a more robust market and more reliance on personal responsibility and consumer choice to make the market work better.

Obama, like McCain, has come up with the same generally good list of things that are underway in the market anyway with only a limited success to point to so far.

To really get at costs you have to gore some very powerful political oxen among all of the key stakeholders.

McCain won’t do it because he simply doesn’t believe that a direct assault on the market players is the right thing to do—put market incentives in place and it will encourage and reward efficient behavior.

Obama won’t do it, not because he doesn't like government intervention, but because he doesn't want to offend key stakeholders who could derail any meaningful health care reform effort.

The Democrats learned a very powerful lesson in 1994 when many of the special interests all united in opposition to the Clinton Health Plan.

Capping or even reducing costs means you have to cap or reduce costs. There are no magic bullets that reduce payments without doctors, hospitals, insurers, and lawyers getting less than they would have gotten. All of the health IT, prevention, wellness, and the like will not reduce costs by any big amount at least in the short term.

McCain avoids the notion that aggressive cost containment is important because he just doesn’t believe in it—a vibrant market will do the job.

Obama avoids the notion that their cost containment list will be inadequate because it is politically expedient to do so—they aren’t going to risk their health care reform proposals by taking on the big stakeholders head-on.

I have been convinced for some time that we will actually do health care reform in two parts—access first and cost containment second.

This Democratic proposal is all about access—getting just about everyone covered. Getting everyone into this unsustainable system will then make things even more unsustainable creating an imperative for a second wave of real cost containment when the feel good list of cost containment proposals now in their plans falls short. My sense is that most Democratic health policy experts already know this but see no other political alternative.

3. Promoting Prevention & Strengthening Public Health

At the core of this Obama health care proposal is the notion that, “Each must do their part…to create the conditions and opportunities that allow and encourage Americans to adopt healthy lifestyles.”

Obama lists employer wellness programs, attacking childhood obesity in the schools, expanding the number of primary care providers, and disease prevention programs as part of his effort.

Again, his emphasis on healthier lifestyles is embraced by all of the other candidates and doesn’t give him an advantage.

Perhaps the most important thing a new president can do in this regard is to use the “bully pulpit” to place far more emphasis on just how unhealthy Americans are becoming. We can pass all of the health care reform proposals we like and spend many more billions of dollars each year but that will do little as we watch our youngest generation on its way to becoming the first in American history to be less healthy than the prior generation.

Will the Obama health reform plan work?

The Obama health reform plan would get most of those who are now uninsured covered.

The Obama plan focus is on access by making it possible for everyone to have coverage in an existing private or public plan and by making a Medicare-like program also available for those who don’t have private coverage.

The Obama plan is not really a universal health care plan. A universal plan, like those in Europe and Canada, start out by including everyone in a plan they are automatically enrolled in and that is paid for by various mandatory taxes. While people in these truly universal systems can sometimes opt out for a private plan, as in Britain, they are in one on day one. As the Massachusetts plan is showing us, Obama's plan structure will still leave a significant number of the uninsured without coverage.

Obama builds on the American tradition of people having to buy their coverage. He claims to make it affordable to buy—but the consumer must make the purchase. Obama makes that an option for adults. In the end what matters is not the mandate but whether coverage is in fact affordable to everyone.

McCain takes a completely different view continuing to build on options and choices and relying upon the market to do the work in creating an affordable system.

Would the Obama health care system work?

It would clearly get most of the unisured covered sooner rather than later.

The real question is how would it be sustained. Are his cost containment strategies going to support a system that is affordable in the long run?


As the Massachusetts plan is showing us, the Obama health care reform plan would likely have an incomplete result for an unsustainable cost.

The Obama cost containment proposals are only incremental cost containment proposals that are layered over $100 billion of upfront spending to cover tens of millions of more people—far too little cost containment for the new massive injection of money, almost overnight, into the health care system.

Obama offers us a long list of good cost containment ideas—most of which he shares with McCain. Most have been underway in the market for many years with limited success. Undoubtedly, a government infusion of resources or requirements aimed at a more efficient system would have a positive impact but it is hard to see how they would be enough fundamentally alter things and bring the system under real control.

More likely, a $100 billion infusion of new health care spending by an Obama health plan would actually increase the rate of health care inflation and ultimately create an imperative for more draconian government intervention in the health care markets Obama would preserve.

Cost containment is the big missing link here.

The big question John McCain has to answer is how will his health care program cover everyone—particularly the older and sicker—and how will he be able to provide enough assistance to those who are now uninsured by simply redistributing the tax breaks now only enjoyed by those currently covered?

The big question for Obama is not in how he will get almost everyone covered—his plan spends enough money up front to likely do that—the question for Obama is how he will create an affordable and sustainable health care system with only minor incremental cost containment ideas?


gypsy wrote:Tyler, I am not talking about you or me having the bill for us to evaluate, I am saying the bill is there for congress/senate to do this,my question is are they acting on this or again putting it on back burner? I understand what your saying, can someone explain break the bill down to our level, last night Obama did go into how it would be payed for,and certain other aspects of it~I agree on questions, like i said the congress/senate have the info. I do believe a break down in layman terms would help for all of us to understand it,, as with anything to do with government,but the important part is it is there to be worked out an needs to be done as quick as they can.
You missed my point entirely, its not about ME understanding it or any other citizen that is not knowledgeable enough about it to make a rational judgment call on the plan itself, its about the 'professionals' understanding it and getting their questions answered. Its not about me or my understanding of it, its about them and their questions. I don't pretend to understand the complexity of the Health Care issues and would never attempt to make a decision along those lines, however, I appreciate people that are knowledgeable in the field, and I can certainly understand they have questions, questions that need answering to make a rational judgment as to the Health care plans validity.


no I didn't intend to bombard you, i don't have answers to your questions, but i was trying to provide some~ sorry you can delete them if you like. I think they have been answered,

Last edited by gypsy on Thu Jul 23, 2009 12:08 pm; edited 1 time in total


More paste, beautiful.. cheers


ok I was just trying to help, delete them I don't mind~sorry .my point if they are professionals they should understand it


No I'm not going to delete them, no reason under the sun to do that, its not offensive or vulgar, its just how you like to post sometimes, I don't mind at all.

I'm not intimidated by copy and pasted material, all it does is show they need another outlet to make there point, they choose not to use their own words, no, I don't mind at all. I usually 99% of the time always speak my own words, it more Interesting that way, people would rather read what the "poster" has to say, as opposed to someone elses they don't know from a C&P. Do what you feel, it doesn't matter to me.

The copy and paste news reports in my opinion are to get the convo started, not meant to replace your opinion. But that's just me.


My opinion,I gave you, from the conference last night, Obamas plan will work.. you question was more answers needed., and professionals analysis ,I believe our people in the house/senate are professionals so what is the problem with them?
if one did not watch the news conference, then I was trying to provide what it is about, i see no professionals not understanding the concept, i see the politics senators and representative 's not wanting to act on this, elections are coming up so they are playing politics, not all but some~ I see the concept is workable i think obama pushing, has put dems/repubs in a stalling mode for more time~ which may not be all bad, but if they recess, and come back to handle this problem then good, but to recover from this meltdown all aspects of this problem has to be addressed, especially the health reform..
if the question is can i provide the answers no but the professionals can i was shedding light on that with my pastes

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