I worked hard for Barack Obama last year largely because I believed he was sincere about fixing our very broken health care system. When the economy started going south and so many other problems arose shortly after his election, I started to wonder if healthcare reform would be pushed down on his to-do list.
I shouldn’t have worried. The most striking aspect of the first 100 days of President Obama’s presidency has been the tirelessness with which he attacks problems and promises alike. He understands that our economy will not recover and jobs will not be created or restored until the system undergoes a serious overhaul. He gets it.
During the campaign, he promised that there would be open and transparent discussion of the issues with all interested parties. The dialogue began with house parties to share ideas for reform before he was inaugurated, and continued with the first Healthcare Summit convened at the White House. He has kept his promise and held healthcare reform as a high priority in his administration despite the intervention of other pressing issues. On March 5, 2009, elected representatives from both parties as well as representatives from all interested parties and sectors touching health care reform came together to begin the process of brainstorming issues and generating ideas. In his opening remarks, he made it clear that healthcare reform was going to be at the front of our economic recovery:
You know, we’re here to discuss one of the greatest threats, not just to the well-being of our families and the prosperity of our businesses, but to the very foundation of our economy. And that’s the exploding cost of health care in America today.
In the last eight years, premiums have grown four times faster than wages. An additional 9 million Americans have joined the ranks of the uninsured. The cost of health care now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cost 1.5 million Americans to lose their homes.
Even for folks who are weathering this economic storm and have health care right now, all it takes is one stroke of bad luck, an accident or an illness, a divorce, a lost job — to become one of the nearly 46 million uninsured, or the millions who have health care but really can’t afford what they’ve got.
What’s happened so far
In the first 100 days, two incredibly significant pieces of legislation have come from the White House. The first is the ARRA, aka the Stimulus package, which provides federal subsidies for workers unemployed in late 2008 forward. As one of those laid-off workers, I can attest to the amazing relief I felt at not figuring out how I was going to afford $1500/month premiums for our family on the $1,700/month unemployment benefit I wouldn’t receive until March. In addition to the subsidy, it extended the pre-existing conditions provisions (which is a huge concern for many), and offered an extension of time for workers to opt into COBRA (or reinstate COBRA if it has lapsed).
The second legislative initiative is the 2010 budget sent to Congress from the White House, which calls for expansion of health insurance to the uninsured, and a more inclusive government-subsidized healthcare option. The budget has not been passed, is still under debate, but it’s pretty clear that Congress intends to go forward with the healthcare provisions intact.
But is it enough?
It’s enough for the first 100 days. He gets an A+ from me for pushing the dialogue and the legislative activity forward. More has been done on this issue in 100 days than in the last 10 years.
However, there is much more to be done. And it must be done soon, and it must be done without the intervention of lobbyists. Make no mistake, the insurance lobby is the second most powerful lobbying power in Washington. Only the gun lobby wields more power. Combine the insurance lobby with the AMA, lobbyists for liability lawyers, pharma, and other powerful interests, and the task is daunting. Here are just a few of the issues.
- A public insurance option available to all
Insurance companies are looking for the bottom line, not the health or well-being of the citizens of this country. In the words of Richard Kirsch, they are killing our economy. No individual or corporation can continue to pay the extortion they call premiums.
One reason that private insurers have gotten away with skyrocketing premium increases is that they have a near monopoly across the nation. According to data from the American Medical Association, in virtually every metropolitan area in the country (96%) the insurance market is dominated by so few insurers so as to be considered “highly-concentrated.” A public health insurance option coupled with a regulated private insurance market will break the stranglehold a handful of companies have on the insurance market. Most importantly, under these reforms consumers will be able to vote with their feet when their health care plan — public or private — doesn’t work for them.
Until recently, I have not been a supporter of the public health plan option. I am now. There has to be an option that allows us to sleep at night knowing that if one of our family becomes ill, we are not going to lose our house. We cannot afford the cost of a private insurer without the federal subsidy, and employers can’t continue to absorb the rising costs and still hire workers over the age of 30 or so. A public option has to be part of the overall reform effort.
- Limits on damage awards
This has to be part of the package. Doctors are practicing defensive medicine to avoid being sued, prescribing unnecessary clinical tests or just bailing out entirely, because the reward is no longer worth the risk. There is no incentive to practice medicine, other than possibly an altruistic desire which few of us in general have and which the threat of a lawsuit will kill. Trial lawyers will squawk, but this needs to be part of the landscape. - Incentives for students to go to medical school
I’ve heard lots of suggestions around this, but the one that makes the most sense came from @kylesellers, who suggested that the government assist with the costs of medical school in exchange for a commitment to general practice for a certain number of years. I would only augment that by also expanding the use of Physicians Assistants and Nurse Practitioners, who are trained and able to treat many general practice patients at a lower entry cost in terms of time spent in education and training. - Mental health services
The Reagan administration destroyed what little this country had in the way of public mental health resources. Any reform of the system needs to include this aspect. It is morally wrong to leave our mentally ill on streets and in homeless shelters. It’s also dangerous for them and for us.
The fact President Obama has managed to get much of anything accomplished astounds and impresses me, given the obstinate entrenchment of the Republicans, who seem to think stonewalling is effective politicking, and the “ConservaDems”, who want to delay health care reform rather than understand how closely it is related to jobs and economic recovery. Yet, he has managed and continues to push forward.
What may be most striking though, is this: He communicates and he listens. This is not a man sitting in an ivory tower deciding on his own what is best for us. He has opened a channel of two-way communication with the people who elected him and those who did not, and is asking us to speak to one another and to him. That is an amazing and exciting way to lead.
RJ Eskow sums it up nicely:
You’d think that the economic crisis might lead people to conclude “we can’t afford health reform right now.” While that’s a familiar refrain in Congress, the public’s singing another tune. An April poll by the Kaiser Foundation shows that “59% of U.S. residents believe health care reform is now more important than ever,” while only 37% say that “reform would be too costly to attempt during the current economic climate.”
That’s a home run for the President.
Yes, yes it is. It’s a home run, the winning touchdown, and the nose across the finish line of the qualifying heats. But the real win will be when comprehensive, carefully considered, full-package reform emerges from Congress and finds its way to President Obama’s desk for his signature.
I look forward to writing about it here when it happens. There is no doubt in my mind that it will happen. Yes, we can.
(cross-posted to The Bipartisan Report’s 100 Days feature
