Ask the President: Can we afford health care reform?

April 5, 2010 at 12:51 pm | Posted in health, Obama Speaks, Presidential Picture of the Day | Leave a comment
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On April 2, 2010, President Obama met with employees of Celgard, a manufacturer of lithium battery components in Charlotte, N.C., and extemporaneously answered a question that is of concern to many Americans:

In the economy times that we have now, is it a wise decision to add more taxes to us with the health care, because it — we are over-taxed as it is?

The President’s response was comprehensive, clear and coherent:

U.S. President Barack Obama speaks during a town hall meeting at Green Valley High School February 19, 2010 in Henderson, Nevada.

OBAMA: Well, let’s talk about this, you know, because this is an area where there’s been just a whole lot of misinformation. And I’m going to have to work hard over the next several months to clean up a lot of the misapprehensions that people have.

Here’s the bottom line. Number one is that we are the only — we have been, up until last week, the only advanced country that allows 15 million of its citizens to not have any health insurance. And the vast majority of those folks work; it’s just that they don’t happen to work for a company that is either big enough or generous enough to provide them any coverage.

So that’s point number one: There is a moral imperative that is important.

Number two: You don’t know who might end up being in that situation. See, those of us who have health care right now ask ourselves, “Well, is this something that should be a priority right now?” But anybody here who lost their job and then COBRA ran out, or COBRA wasn’t subsidized the way the Recovery Act made sure COBRA — paid 65 percent of the cost of COBRA, and you had somebody at home who was sick or you had a child who got sick, you’d suddenly say to yourself, “Well, now I see the need.”

(LAUGHTER)

And so part of what we have to do is always say to ourselves, “There but for the grace of God go I,” and have a basic — basic safety net.

So that’s point number two.

Point number three is that the way insurance companies have been operating, even if you’ve got health insurance, you don’t always know what you’ve got. Because what has been increasingly the practice is that if you’re not lucky enough to work for a big company that is a big pool, that essentially is almost a self-insurer, then what’s happening is is that you’re going out on the marketplace, you may be buying insurance, you think you’re covered, but then when you get sick, they decide to drop the insurance right when you need it; or when you get sick, they try to find what’s (sic) they consider to be a pre-existing condition that would justify them canceling your policy; or there’s some fine print in there where you’ve got a lifetime limit and it turns out you thought you had coverage but it turns out the coverage only goes up to a certain point and then after wards you have to start paying out of pocket, and even after paying all those premiums, you’re now in the hole for $100,000 or $200,000 and you’re going bankrupt or losing your house.

And the final point is that the cost of health care, setting aside anything we did in reform, I mean, if we just allowed the current trajectory to go on, is out of control.

Now, I haven’t talked to Bob about what his costs are looking like for Celgard employees, but I can tell you that health care costs have gone up, the price of health care has gone up three times faster than wages. So either the company is having to swallow those costs, which means that’s less money that they could use for hiring new workers or investing in new plants and equipment, or they’re passing on those costs to their employees in the form of higher premiums, higher deductibles, higher co-payments.

And what’s happening federally is, because the costs are so out of control, all the programs that we already have — Medicare, Medicaid, the Children’s Health Insurance Program — all those things are completely out of control.

So if you’re concerned about the deficit, what you’re really concerned about is the cost of Medicare, Medicaid and all the other programs that are already in place.

So here’s what we did. What we said is, number one, we’ll have the basic principle that everybody gets coverage. And the way we’re going to do that is to say that most people individually shouldn’t buy health insurance on their own because they have no leverage and the insurance companies take advantage of them.

Instead, what we’re going to do is we’re going to set up a big pool, a marketplace, that allows everybody to buy into this pool — that members of Congress, by the way, will be a part of, so you know it’s going to be a good deal, because members of Congress, you know, they’ve got to look out for their own families. They wouldn’t vote for it if it wasn’t going to be a good deal.

And just like Wal-Mart is able to leverage a really good price from its suppliers for everything, because they’re such a big purchaser, well, this pool will be a big purchaser and it will be able to get a better deal from insurance companies.

So that’s point number one. That will drive down the prices for people who are participating and it will allow everybody to get a decent deal on insurance. And what we do is we provide tax credits to people who still can’t afford it, so that they can afford it. That’s point number one.

Point number two is we’ve got the strongest insurance reforms in history. So all those things I told you about, you not being able to get insurance because of a preexisting condition, you finding yourself getting dropped even though you’ve been paying premiums for 15 years and suddenly they just decide, “Sorry, we don’t want you because you’re getting sick,” those policies will be over.

And so you will be protected as a consumer to make sure you’ve got security and protection if you’ve got insurance already. That’s the second thing we do.

The third thing we do is we actually put in place a whole bunch of mechanisms to start reducing the actual cost of health care. So for example, one of the things that we do is to say, “We’re going to start encouraging paying doctors not based on how many tests they take, but based on the quality of the outcome, does somebody end up healthy?”

And it turns out that a lot of times, you know, if you go to the doctor, you get one test, then you go referred to a specialist, you get another test. Then maybe you go to a third person, the surgeon, you get a third test. It’s all the same test, but you’re paying three times. So what we’re trying to say is, we’ll pay you for the first test, and then e-mail the test to everybody.

(LAUGHTER)

(APPLAUSE)

Right? Or…

(APPLAUSE)

… or have all three doctors in the room when the test is being taken. But — but that’s an example of the kinds of things that save money and will start reducing costs over the long term. So what we’ve done is we’ve embedded in how Medicare reimburses, how Medicaid reimburses — all these ideas to actually reduce the costs of care.

So our hope is that over time, over the next three, four, five, six years, because of all these changes, that we’ve actually saved money from this even though more people are covered.

And so now you’ll — you’ll hear the critics and the Republicans say, “Now, that just defies common sense. If you’re adding 30 — 30 million more people, then it’s got to cost more money. And it — you know, you can’t pretend like somehow that’s going to help us on the deficit.”

I’ve heard this criticism. I understand it. But let me give you an example.

If you’ve got a house and you’ve got a big hole in your roof, and it’s raining and snowing through that roof, and there’s some people who are inside the rooms where the roof’s OK and they’re nice and warm, and then you’ve got a few — you know, your family members in that room where there’s a big hole in the roof and they’re shivering and they’re cold, if you repair the roof, that’s going to cost some money. But if all the water damage from your floors and all the heat that’s going out of the roof and all — you count all those savings over time, it may turn out that it actually is saving you money and, by the way, all those family members now are warm, too. You’re not the only one who’s warm, right?

That’s essentially what we’re trying to set up.

Now, the last point I want to make: All those savings that we’re anticipating, we don’t even count those when it comes to making sure that this is deficit-neutral. Here are the two ways that we’re pay for this thing.

Number one, we are eliminating a whole bunch of waste, fraud and — and insurance subsidies that were being paid out under Medicare that aren’t making our seniors any healthier. I mean, you’ve got a pretty sweet deal from insurance companies right now in a program called Medicare Advantage where they get $18 billion a year paid to them to manage a Medicare program that about 80 percent of seniors are getting directly from the government and it’s working just fine. It’s just a subsidy to them that doesn’t make anybody healthier. So what we’re saying is, “Well, let’s eliminate the subsidy.”

So that’s about how we pay for half of this thing.

The other half of it, it is true that we have identified some additional taxes that we think are fair. And let me describe, just to give you an example. I don’t think this will affect you, but I don’t know — you know, I don’t know your family’s circumstances.

Right now if you’re on salary, you get your salary from Celgard or any of the — any of the companies around here, you’re paying your Medicare tax on all of that, right? You see it on your — as part of your FICA. But if you’re Warren Buffett and you get most of your money from dividends and capital gains, you don’t pay Medicare tax on that.

You’re eligible for it. You’re going to get the same Medicare benefits as anybody else. But because your source of income is what’s called unearned income, capital gains and dividends, you don’t have to pay this.

Well, I’m thinking to myself, how is it that the guy who’s cleaning up the office is paying the Medicare tax and the guy who’s making capital gains isn’t.

So what we said was, look, if you make more than $200,000 and $250,000 a year, then that money that you make over $200,000 and $250,000 a year that’s unearned, that’s from capital gains and dividends, you should have to pitch in to Medicare just like everybody else because you’re going to be using it like everybody else. So it’s a concept of fairness.

(APPLAUSE)

Now, what the Congressional Budget Office has said — I’m sorry, by the way, these questions sometimes are — or these answers are long. But I want to be sure, you guys, that I’m really answering your question. I hope you feel like I really want to respect the importance of your question.

What the Congressional Budget Office has said is that as a consequence of the savings from the waste and fraud, combined with the new revenue sources I just mentioned, that this thing is going to actually reduce our deficit by over a trillion dollars. Over a trillion dollars. We’re actually saving money for the government because we closed the roof, the house is now insulated, it’s warm. And by the way, in the meantime we’ve got a whole bunch of people who were left out in the cold who are now being taken care of.

That’s — that’s the concept. But I know that for a lot of people they’ve got a legitimate concern about, gosh, it just seems like government spending is out of control. I understand that. I feel that.

But understand what happened. When I walked in, we already had a $1.3 trillion deficit. That’s an annual deficit of $1.3 trillion. That’s the day I got sworn in, before I did a thing.

We had $8 trillion in accumulated debt from the war in Iraq, not paid for; the prescription drug plan, Medicare Part D, not paid for; Bush tax cuts, not paid for. So we already had all this debt that had just been piled up, but nobody had noticed because things were going kind of good. Just like a lot of folks didn’t notice their credit card was going up or that their home equity loans were going up because when things are going good, you tend not to notice. So all that debt had already accumulated.

We then had to spend $787 billion on the Recovery Act to do all the things — unemployment insurance, COBRA, what’s called FMAP, which is essentially helping states to keep their budgets afloat so they didn’t have to lay off teachers and cops and firefighters — all of which, if that had happened, would have further depressed the economy and we would have recovered a lot later. The investments we’re making in clean energy and things like Celgard to help spur economic growth, so we had to spend that.

But that’s only a fraction of what our debt was. And in addition, what happens is when the economy goes south, there are fewer tax revenues. And so you’re putting more money out to help people with unemployment insurance and things like that, but you’re getting less money in because folks are out of work and businesses aren’t making money.

Bottom line is, we now have a significant debt that has to be paid down. That’s why I’m freezing government spending. That’s why we re-instituted what is called “pay as you go.” You can’t start a program without paying for it. Our health care program is paid for.

But the big thing if you’re really worried about leaving debt to the next generation, which I know you are, the most important thing we’re going to have to tackle is our health care costs because Medicare is by far — Medicare and Medicaid — are the biggest things that are looming in the horizon in terms of what our debt’s going to be. Nothing else comes close.

If this health care bill never existed, if I didn’t do anything about it, we’d actually be a trillion dollars worse off over the long term. But even with what — the savings we’re getting from health care, we’re still going to have to do more. And if you don’t believe that, you know, go on our Web site, www.whitehouse.gov, and you can look at where — at how the federal budget works.

A lot of people think if you just eliminated foreign aid, we could balance the budget. Or if you just eliminated earmarks, you could balance the budget. Earmarks, you know, pork projects, what everybody calls pork, those account for about 1 percent of the budget, less than 1 percent. Foreign aid accounts for about 1.5 percent to 2 percent of the budget.

Most of the budget is Medicare, Social Security, Medicaid, defense spending and interest on the national debt. That — that accounts for about 70 percent of the budget. And so all this other stuff that sometimes we argue about, that’s not the big stuff. We’re going to have to tackle the big stuff if we’re going to get our budget under control.

Boy, that was a long answer. I’m sorry, but I hope everybody — but I hope I answered her question.

Nothing silly about it

March 31, 2010 at 5:32 pm | Posted in Uncategorized | Leave a comment
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Native Texan farmer on relief. Goodliet, Hardeman County, Texas. "Tractored out" in late 1937. Now living in town, and on the verge of relief. Wife and two children. "Well, I know I've got to make a move but I don't know where to. I can stay off relief until the first of the year. After that I don't know. I've eat up two cows and a pair of horses this past year. Neither drink nor gamble, so I must have eat'n 'em up. I've got left two horses and two cows and some farm tools. Owe a grocery bill. If had gradutated land tax on big farms, that would put the little man back again. "One man had six renters last year. Kept one. Of the five, one went to Oklahoma, one got a farm south of town and three got no place. They're on WPA (Works Progress Administration). Another man put fifteen families off this year. Amother had twenty-eight renters and now has two. In the Progressive Farmer it said that relief had spoiled the renters so they had to get tractors. But them men that's doing the talking for the community is the big landowners. They got money to go to Washington. That's what keeps us from writing. A letter I would write would sound silly up there." 1938 June. Dorothea Lange, photographer. (Library of CongressO

You have to read this.

War: What is it good for? Absolutely nothing.

March 27, 2010 at 3:23 am | Posted in environment, Foreign Affairs, Historical, Obama!, politics straight up, senate | Leave a comment
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President Obama and Russian President Dmitry Medvedev have agreed to sign a new nuclear arms treaty on April 8 in Prague, Czech Republic. Great news, right?

Well, it should be, except that it requires ratification by 67 out of 100 United States senators. It can take some time.

(NYT) According to the White House, the agreement would require both Russia and the United States to reduce their long-range warheads to 1,500. This is 74% lower that the START number in 1991 and 30% lower than the limit of the 2002 Moscow Treaty.

START (Strategic Arms Reduction Treaty) I was signed by President George H. W. Bush and Russian President Boris Yeltsin on July 31, 1991.  The U.S. Senate ratified the treaty on October 1, 1992.  START II took a bit longer.  Signed by Bush and Yeltsin on January 3, 1993, it was not ratified until January 26, 1996. In other words, let’s not get our panties in a twist if the new treaty is not ratified this year.

That being said, there are very good reasons why the United States should embrace this treaty and renew its commitment to reducing its nuclear weapons arsenal. Here is a short film to demonstrate how absurdly overstocked we are with weapons that benefit no one.

‘The Status Quo Is Good For The Insurance Industry And Bad For America’

February 20, 2010 at 5:15 pm | Posted in health, Obama!, television | Leave a comment
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How to destroy a presidency, a political party and a country in a few easy steps

January 26, 2010 at 12:02 pm | Posted in Economy, environment, health, House of Representatives, Obama!, Reality Bites, senate, Uncategorized | Leave a comment
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Cincinnati ; New York : Strobridge Litho. Co., c1900. (Library of Congress)

Apparently Barack Obama does not understand the job of president, because he has refused to avail himself of the most basic tool that office holds: power.

He has allowed the Republicans — the failed and disgraced minority party whose policies got us where we are today — to continue to set the agenda and determine our direction forward.

In How to Squander the Presidency in One Year, or Hey, Conan Obama: How About Now? Can You Hear Us Now?, David Michael Green of CommonDreams.org summarizes Obama’s failure of leadership.

Why are we headed for failure again on health care reform?

Could there possibly be a greater prescription for failure than allowing a bunch of the most venal people on the planet [“those dickheads on the Hill,” i.e., Congress] to cobble together a 2,000 page monstrosity that entirely serves their interests and those of the people whose campaign bribes put them in office?

You would think in a country of over 300 million people, that claims to be the awesomest country on the planet, we could find a president better than this.

UPDATE (8/21/11): Yeah, I was right peeved back in June 2010. Although I still wish President Obama would bitch slap Republicans more and the health care reform didn’t go far enough, given the circumstances, the ACA is an improvement over what we had.

Presidential Pardon: Thanksgiving Edition

November 25, 2009 at 6:16 pm | Posted in Obama! | Leave a comment
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President Obama today pardoned Courage, the turkey and sent him off to Disney Land. At this light-hearted ceremony the President took time out to remember and recognize the military and their families.

And in between enjoying your Thanksgiving dinner and snacks, give a read to this Thanksgiving reminder from Bitch PhD.

Peace President

October 9, 2009 at 2:51 pm | Posted in Historical, International Affairs, Obama! | Leave a comment
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President Barack Obama and his daughter Malia read an excerpt from the Declaration of Independence at the Jefferson Memorial, Sept. 27, 2009. (Official White House photo by Pete Souza)

President Barack Obama and his daughter Malia read an excerpt from the Declaration of Independence at the Jefferson Memorial, Sept. 27, 2009. (Official White House photo by Pete Souza)

Congratulations to President Barack Obama, and the citizens of the United States, on the auspicious occasion of his being awarded the Nobel Peace Prize. Being awarded the prize and earning it are two different things. President Obama is going to have to do more than engender hope in order to have it be said that he did indeed earn it. That being said, I do indeed hope that he does.

(Reuters) The Norwegian Nobel Committee praised Obama for “his extraordinary efforts to strengthen international diplomacy and cooperation between peoples,” citing his fledgling push for nuclear disarmament and his outreach to the Muslim world.

Obama has been widely credited with improving America’s global image after the eight-year presidency of George W. Bush, who alienated both friends and foes with go-it-alone policies like the 2003 U.S.-led invasion of Iraq.

The Nobel Foundation keeps secret the names of nominees for 50 years. Visit the Nobel Prize website to read about past award winners and nominees in all categories.

Steve Benen has links to relevant commentary.

Glenn Greenwald says what a lot of people are thinking on the subject.

It’s as if instead of a nice present, we open the box to find a dead parakeet.

“It is so cold in here. So fucking cold.”

October 7, 2009 at 11:19 am | Posted in Miscellany, Reality Bites | Leave a comment
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The first part of the headline to the story — Obama is “incompetent — annoyed me but the second part — and the U.S. is a Madhouse — made me curious, so I trotted over to HuffPo to read Johann Hari’s “exclusive interview” with Gore Vidal. I can’t say I particularly disagree with Vidal’s assessment.

Yuki yanagi ni karasu (Blackbird in snow) Koson Ikeda, artist.   (Library of Congress)

Yuki yanagi ni karasu (Blackbird in snow) Koson Ikeda, artist. (Library of Congress)

Gore Vidal is not only grieving for his own dead circle and his own fading life, but for his country. At 83, he has lived through one third of the lifespan of the United States. If anyone incarnates the American century that has ended, it is him. He was America’s greatest essayist, one of its best-selling novelists, and the wit at every party. He holidayed with the Kennedys, cruised for men with Tennessee Williams, was urged to run for Congress by Eleanor Roosevelt, co-wrote some of the most iconic Hollywood films, damned US foreign policy from within, sued Truman Capote, got felated by Jack Kerouac, watched his cousin Al Gore get elected President and still lose the White House, and – finally, bizarrely – befriended and championed the Oklahoma bomber, Timothy McVeigh.

Yet now, he says, it is clear the American experiment has been “a failure.” It was all for nothing. Soon the country will be ranked “somewhere between Brazil and Argentina, where it belongs.” The Empire will collapse militarily in Afghanistan; the nation will collapse internally when Obama is broken “by the madhouse” and the Chinese call in the country’s debts. A ruined United States will then be “the Yellow Man’s Burden,” and “they’ll have us running the coolie cars, or whatever it is they have in the way of transport.”

Are you listening, President Obama?

September 7, 2009 at 10:51 am | Posted in politics straight up | Leave a comment
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Mr. Znamenski, holding stuffed head of a wolf in his lap.  Znamenskii was the district chief of police in the Siberian town of Minusinsk when (George) Kennan visited in January, 1886.  Kennan found Znamenskii to be a petty Russian bureaucrat who obeyed the rules with a stupid and brutish disregard of all the circumstances.  Photo by Fidlerman in Tobolsk.

Mr. Znamenski, holding stuffed head of a wolf in his lap. Znamenskii was the district chief of police in the Siberian town of Minusinsk when (George) Kennan visited in January, 1886. Kennan found Znamenskii to be a petty Russian bureaucrat who "obeyed the rules with a stupid and brutish disregard of all the circumstances". Photo by Fidlerman in Tobolsk.

Baratunde Thurston (aka Jack Turner) sums up my questions to the President very nicely:

How do you expect folks to continue to go to the mat for your agenda, when you so easily sacrifice our best and brightest at the whim of an illegitimate lynch mob? How do you expect the next generation to invest themselves in the political process when they see that despite their good works, they can be taken out over nonsense, especially when the double standard is so abundantly clear? How can you ask from us what you won’t do for us? And when will you realize that you cannot negotiate with terrorists?

Happy Independence Day

July 4, 2009 at 11:46 am | Posted in Obama Speaks | Leave a comment
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