Just got back from President Obama's talk at Broughton HS about health care reform. Actually, it was a two-parter, with Obama focused at the outset on defending his economic record in the first six months, including a long -- very clear -- outline of the stimulus package. On health care, I think the headline should be that the President managed to go for more than an hour, right up to the end of his final answer to the final question, without ever mentioning, let alone explaining, the "public option." Finally, someone shouted from the balcony, "public option!" Obama heard it, said quickly, "I'm for the public option," and went on to finish up the point he was making, which is that he wants health care reform passed this year. Big applause, exit stage right.
In this week's Indy, I wrote that Obama was dogged by questions about 1) why a health care reform package that's supposedly about saving money has a tax increase attached to it, and 2) if the plan actually would cut costs, or at least doesn't increase them too much, doesn't it logically follow that adding the uninsured to the system will limit (i.e., "ration," a very bad word, apparently) the care available to those (the insured) already in the system?
Obama's answers, it seemed to me, boiled down to this: 1) On costs, it won't cost that much, only about $30-40 billion a year (net); and 2) You may think you're in the system now, but what happens if you lose your job? And then you can't get insurance because of some pre-existing condition, or your age, or both?
The heart of Obama's reform plan, as he described it, is that private insurance companies will be required to take all applicants without regard to prior illness and with no significant penalty for age either. It will assure that you can buy a first-rate insurance product with no caps on annual or lifetime outlays and a reasonable cap (not $10,000) on deductibles -- the amount you have to pay before your insurer pays anything. It will also assure coverage for preventive care, not just for expensive surgeries that might've been avoided if preventive steps had been taken. (This last point was made to augment his answer to No. 1 -- his plan won't cost much, and with preventive care, the rate of health insurance inflation will be reduced, if not the cost itself. Or so he said.)
(Update: The President was introduced by Sara Coleman, owner of The Cupcake Shoppe in Glenwood South. She brought him a Cupcake Shoppe T-shirt, Obama quipped, but no cupcake. Maybe all the talk about health care reform and wellness has gone too far, he said. Anyway, Coleman and the 50 or so others seated behind the President -- on-camera with him, that is -- were small business owners. Obama made a big point of saying his plan will close the gap between the rates big business pays for its employees' health-care coverage and the rates small business pays, because insurance companies won't be allowed to keep on cherry-picking the market the way they do now. So small businesses, which will be required to offer insurance to their employees or pay a penalty, should be able to buy coverage for less, Obama said.)
Obama's plan will not, however, deny anybody the same kind of health-care services they have now, he insisted, no matter how gold-plated they may be. No rationing, in other words. Not even if your services are hugely expensive or evidence of the fact that health-care costs in this country are about double what any other industrialized nation spends. Cutting costs as a driver for reform has all but disappeared from the President's pitch.
Note, too, that everything Obama said applied to the way private insurance products would be regulated. He said nothing about fielding a "strong public option" -- a public insurance product -- that would be cheaper and just as good as private insurance, forcing the private companies to pare their rates or fade away. The public option as a way to cut costs has gone the way of Obama's argument that costs should be cut. Now he'll settle for their not going up as fast.
The news from Washington, meanwhile, is that the Blue Dog Democrats in the House have reached a deal that includes a public option very similar to the one included in the bill recently approved by the Senate Health, Education, Labor and Pensions Committee (Senate HELP). The public option in the HELP committee is fairly weak, but still unacceptable, apparently, to the Senate Finance Committee, which is still pawing over a potential rival measure that would have an even weaker public option or none at all.
Obama says he wants a public option. But the argument he's making for reform, and for why reform should appeal to people with insurance as well as those without it, does not in any way hinge on the public option, strong or otherwise. If it did, Obama would be saying that it's not enough to reduce the rate of health care inflation, we need to bring the costs of the system down to be competitive in a world economy. But he's not saying that. He's saying that health care costs will keep going up, but less rapidly than if we do nothing and accept the status quo.
With reform, Obama said, we may even see the day when inflation in the health care sector isn't rising faster than wages.
Kind of a letdown. But as someone said as I was leaving, it's a start. And if a public option, regardless how weak, is included, it can be strengthened over time. If it isn't, it could be years before one is added.