With Obama seemingly making his firmest stance on health care reform last night in his address to a joint session of Congress, not all media sources were as impressed with the content or the accuracy of his speech. While his tone and delivery were par with his normal speaking ability, his attempts at unifying Democrats, and getting any bipartisan support from Republicans is at best, hopeful. Accordingly, below is a brief analysis of what Obama said in his speech, and how some sources measured the truthfulness. A copy of his plan can also be found here Read Obama's health care plan (PDF).
Obama asserted, as do all versions of the health care bill available now, that all Americans would be required by law to have health insurance under his proposal, a requirement he noted would be similar to mandatory auto insurance in most states. His plan also includes a mandate for businesses to either offer health care coverage to workers or contribute to covering their costs of obtaining coverage.
There will also be a hardship waiver for those individuals who still cannot afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements.
The President “defended his proposal for government-run public health insurance as an option for consumers, saying it would force private insurers to lower costs.” He noted that the public option be one alternative for increasing competition for health insurance.
He also addressed critics of the public option by clarifying that the public option would “only be an option for those who don't have insurance … No one would be forced to choose it, and it would not impact those of you who already have insurance.” He even cited from the Congressional Budget Office (CBO) “that less than 5 percent of Americans would sign up."
One of the most controversial statements Obama made last night was that “any health care bill approved by Congress would not increase the federal deficit ,… and that savings in the existing health care system would cover most of the cost of an overhaul bill.” Contrary to the President’s statements, the Associated Press reported that “although there's no final plan yet, the “House Democrats offered a bill that the CBO said would add $220 billion to the deficit over 10 years.”
The same article noted that “Democrats and Obama administration officials claim the bill actually was deficit-neutral because they simply didn't have to count $245 billion of it — the cost of adjusting Medicare reimbursement rates so physicians don't face big annual pay cuts.” As the author from AP put it, Obama and Democrats feel the $220 billion the bill would add “doesn't have to be paid for because they decided it doesn't have to be paid for.” Consequently, even CBO Director Douglas Elmendorf said this July: "We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."
By speaking directly to seniors, the President “also sought to assure the elderly that cutting costs and finding savings in the Medicare program for senior citizens won't diminish the level of service currently provided” … and "not a dollar of the Medicare trust fund" would pay for the bill. While he did not offer any specifics of how the bill would do this, Obama asserted that the plan would eliminate "unwarranted subsidies in Medicare that go to insurance companies" and create an independent commission of doctors and medical experts to identify further waste.
The President also got bipartisan support in response to his comments about setting up demonstration projects in states for ways to reform medical malpractice. Obama noted that he had “talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.”
Obama invoked the late Senator Edward Kennedy by citing a letter in which the senator called providing health care to all Americans "above all a moral issue." Read what Sen. Ted Kennedy wrote to Obama about health care in May.
Focusing on coverage, Obama reiterated that "Nothing in his plan will require Americans or employers to change the coverage or the doctor you have." While this assertion is true on its face, the plan cannot guarantee that people actually do keep their current coverage. “Employers sponsor coverage for most families, and they'd be free to change their health plans in ways that workers may not like, or drop insurance altogether.”
The CBO analysis of the health care bill written by House Democrats “said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it.”
Obama did clarify that nothing in the bill would apply illegal immigrants however, keeping them out of emergency rooms, and stopping them from buying private health insurance was not addressed.
In reference once again to how Obama and congressional Democrats want to pay for their health care plans, they will do it in part by reducing Medicare payments to providers by more than $500 billion over 10 years. “The cuts would largely hit hospitals and Medicare Advantage, the part of the Medicare program operated through private insurance companies. “Many experts believe some seniors almost certainly would see reduced benefits from the cuts, particularly for the 25 percent of Medicare users covered through Medicare Advantage.
The President also talked about “requiring insurance companies to cover preventive care like mammograms and colonoscopies because it saves money, and it saves lives." Once again, the truth of this statement is misguided. The CBO wrote in August: "The evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall." While preventive care certainly would save lives, it would cost more “because detecting acute diseases like breast cancer in their early stages involves testing many people who would never end up developing the disease. The costs of a large number of tests, even if they're relatively cheap, will outweigh the costs of caring for the minority of people who would have ended up getting sick without the testing.”
Interestingly, Obama also changed his normal number of uninsured from 46 million to 30 million in last night’s speech, to reflect “an analysis by the Kaiser Commission on Medicaid and the Uninsured, which concluded that about two-thirds of Americans without insurance are poor or near poor. “By using the new figure, Obama avoids criticism that he is including individuals, particularly healthy young people, who choose not to obtain health insurance.”
With the President putting his entire future and administration on health care he is certainly taking a risk, while probalby worth it, that Americans are still unsure of. His attempts to clarify myths and rebut scare tactics may have worked for an hour, but the recent memories of angry Americans at town halls is still fresh in the minds of many Americans.
The next step is to wait for the Senate Finance Bill to be published and marked up, and then consolidated with the Senate HELP bill. With a new chairman for the HELP Committee (Senator Harkin, D-IA), the outcome will be heavily scrutinized.