Thursday, September 10, 2009

Obama's Speech - B+ for politics, D+ for content 
There was enough in President Obama's speech last night, but only barely. There was a bit of red meat and some tugged heartstrings, but I'll say this - his health plan is far too considerate of Big Insurance & Big Pharma and not nearly considerate enough of what is needed to truly reform the system.

In the President's proposal it would be illegal for people not to buy insurance from a private insurance company. In effect, he's adding a new tax, to be paid not to the government but to private, for-profit companies. Equating this mandate to the requirement to carry automobile insurance, as Obama did last night, is bogus because you can choose not to own a car but you can't simply choose not to get sick. This makes Aetna, Wellpoint, United Healthcare et al. into latter-day publicans, who've purchased the right to squeeze the populace for as much as they can. What the President laid out last night is a giveaway to insurance companies - the profits from the 30-50 million new, mandated "customers" will far outstrip any reduction in their profits due to restrictions on policy rescission and rejections for pre-existing conditions.

As the President described it, the public plan option will be there only for people who are otherwise unable to get insurance - i.e. only for those without an employer plan available to them. But what if the health insurance an employer provides sucks ass? Apparently it's "too bad, Charlie" because you can't opt out of employer insurance in favor of the public plan. It was not clear, but it appears that employers will be unable to choose the public plan when shopping for group health insurance for their employees - it will be for uninsured individuals only. This undercuts the raison d'etre of a public insurance option - to provide real, lower overhead/lower cost plans that will force insurers to keep internal costs down and innovate on the services they offer.

The health insurance "Exchanges" won't go into effect until 2013 (Why not? The Feds set up the Department of Homeland Security in mere months, and it has well over 100,000 employees) - leaving the uninsured still uninsured (except by a so-far-hypothetical assigned-risk pool that is likely to be very expensive to buy in to) for the next 4 years. In the meantime, insurers will almost certainly be raising premiums to cover the reduction in revenue from having to cover pre-existing conditions and rescinding the policies of sick people.

The President did not mention one of the most serious problems facing healthcare consumers today - the cost of prescription drugs. There's still no provision for negotiating lower prices. No re-visiting Medicare Part D to allow price negotiations. No elimination of the Part D "donut hole." And nothing that addresses the price disparity between what Americans pay for drugs and what the rest of the world pays (Canadian prescription drugs cost 35-90% less than they do here in the U.S.).

What also went completely unmentioned and unaddressed by the President was the massive waste of money on paper-pushing. Hospitals and physicians alike spend hundreds of billions each year on filing claims, requesting pre-certifications, issuing referrals - none of which add a single iota of value to the system. Health exchanges will only make that aspect worse.

The only viable solution for most of what really ails American healthcare is a single-payer plan. Despite his public support for it in the past, the President went out of his way last night to sneer at single-payer and its supporters, in what has lately become the Democratic Party modus vivendi - i.e. throw your most avid supporters under the bus while bending over backwards to try to satisfy your opposition, who will never support you anyway.

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