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Terrence McNally

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If I Were President: How I Would Answer the Public Option Question

Posted: 08/27/09 03:50 PM ET

I can't shake the feeling that one moment in President Obama's August 15th Town Hall captures the lost opportunities of the whole summer.

From a front page story in the Los Angeles Times, August 16, 2009:

During an otherwise placid town hall meeting in Green Junction, CO, with 1,600 people packing a high school gymnasium, one University of Colorado student challenged Obama to an "Oxford-style debate" over the so-called public option.


"How in the world can a private corporation providing insurance compete with an entity that does not have to worry about making a profit, does not have to pay local property taxes," or face local regulations? Zach Lahn asked Obama. "How can a company compete with that?"

I was watching the town hall on television, and I offered encouragement, "This one's right down the middle. Don't foul it off." But soon I was yelling at the screen in frustration, as the President complimented the questioner on his chutzpah and then launched into a wonky defense of the public option, basically bragging that if you tied both hands behind its back, it might not offer such tough competition.

Here's how I would have answered:

"You're right it might be hard for private insurance to compete with public not-for-profit health insurance. But that's really not my #1 concern. My #1 concern is the health of Americans. When I leave office, I want the American people to be healthier.

"Too many may think it's unpatriotic to say the U.S. doesn't have the best health care in the world. But that's just a way to avoid facing the problem. The dictionary defines courage as 'the willingness to face and deal with things recognized as difficult, dangerous, or painful rather than withdraw from them.'

"We spend more than other nation per person and as a percentage of GDP on health and we don't get the results. We may have the best research hospitals, medical schools, doctors, and equipment, but we do not have the best health outcomes. If we've got the best but we're not achieving the best -- then the system is broken and we have to fix it.

"My administration will do everything we can to promote prevention and education and access to early care for all, but your health care will still be up to you. I aim to improve how we pay for it, and if giving more people Medicare-type health care does that, it's worth doing. And, for those who don't want government getting its hands on Medicare, I'll let you in on a secret: Medicare is government health care.

"Medicare has 4% overhead. That means 96 cents out of every dollar goes to your health. For-profit insurance naturally has higher overhead. In addition to making a profit, they have to market, advertise, and pay thousands of people to come up with ways to cancel your policy or not pay your medical bills. Medicare doesn't have to do that, neither will a public program.

"Think of the public option as giving everyone the choice to join Medicare no matter his or her age. The difference is, you'll pay premiums until you're 65. If we can cut costs -- then maybe we can lower that age. For now it's not going to be free, but your premiums are going to be lower than private insurance. Why? Because, like Medicare, a public plan doesn't have to make a profit, doesn't have to market. We'll do public education to let people know it's available, and make it easy for them to sign up. We'll commit to cutting fraud at every turn because every dollar lost to fraud is a dollar not helping Americans get healthier. In the public plan, we won't be paying anybody to make decisions that are better for their bottom line than for your health.

"So yes, if I were a private insurer and I looked at Medicare's overhead and my overhead, and I saw a difference of 15-20 cents per dollar, I'd be concerned how I was going to compete. But remember, my goal as President is not to save private insurance and it's not to eliminate it. It's to improve the health of Americans. You know whose job it is to figure out how to compete with a simple not-for-profit alternative -- it's the insurance companies'.

"Let's look at it two ways. If a public plan, that is, something like Medicare, ends up doing all the terrible things so many are screaming it will do, then only the most desperate will sign up, and the private insurers will continue to make their profits on everyone else.

"But if the public option isn't half bad, if it's as good as Medicare, then maybe they've got something to worry about. They'll have to show that for-profit insurance is worth the extra cost. They'll have to treat patients better than the public plan. They'll have to bring down premiums, so they'll have to reduce costs without sacrificing quality -- all because now people will have a choice.

"Let me return to the issue that I brought up at the top. All other advanced countries offer a public option, and they spend less and get better results. So it is up to for-profit insurance to prove that it's got a significant role to play in providing for the health of Americans in the future. If the public option serves some people who prefer it and drives for-profit insurance to improve, we all win. And remember, my first priority is the overall health of all Americans."

That's what I would have said, but, hey, I'm just a citizen.

 
 
 
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06:24 PM on 09/02/2009
The US Post Office has the same advantage over UPS and FedEx as an expanded
MediCare plan has over the insurance companies. We have one of the best postal systems in the world. The private companies do so well because of exploiting a niche market.
03:03 PM on 08/29/2009
UNTRUE -- UNTRUE -- UNTRUE

Health insurance companies most certainly are Obama's problem, for good regulation of medical industry would reduce the excessive profit and overhead in health insurance and put 2 million of their employees out of work. For the root cause of illness is the 50% diet that most Americans enjoy, and reducing it to 10% fat would bankrupt processed food and medical industries and put an additional 10% of Americans out of work.

"We have the best research hospitals. We have the best medical schools." Untrue, as family doctors are not trained in diet, are not required to do anything about a patient's diet, and under pain of lower income virtually none say a word to anyone about diet. Amazing, as over 90% of illness being caused by said 50% fat diet, as if their highest priority was excessive wealth.

"We have the best doctors." Absolutely not, for we have the richest doctors, virtually all will retire millionaire doctors and that makes them the most corrupt on earth doctors. For doctors get a 40% referral fee, a full 40% of all money given to a specialist they recommend.

"Medicare is government health care." A lie put out by Republicans for Medicare is charity healthcare. As Medicare is funded by public charity not the government, only for the benefit of the public and not anyone in government, and only for the old public to keep them from being harmed by a Republican government.
06:54 PM on 08/28/2009
I just read Mr. Mc Nally's article on President's Abama 's weak answer to the question of "how can Private Heath Care compete with the Public Option"... It was very weak... I am angry how weak the answer was...The President and the Democratic congress need to stop tip-toeing around the issue that the current Pubic Health Care Industry is corrupt and broken...This Health Care Industry has killed millions of Americans in the last 30 yrs by denying service and /or dropping their customers when they needed most.... The Public Option is not there to make it easy for the the Private Sector ... it is there to keep them affordable and morally responsible. So start shouting "we demand the Public Option" !!!! Tom Myrdahl
03:18 PM on 08/29/2009
Yes and its most profound. For unless government finally gets to regulate the medical industry, all Republicans and the rich they represent will surely go bankrupt. Unless of course were into a global economy and their profits are enhanced by having a poor and desperate workforce, one kept fearful and insecure by having no healthcare.
06:18 PM on 08/28/2009
You know what? I have a suggestion for Mr. McNally and all of the other self-announced smart folk commenting today. Run For Office!

Yeah.

You people know it all, see it all, and have either pronounced our new President as "failed", "stupid", "soft"," a disappointment" and other truly nasty stuff all after some 8 months of taking office after the worst President in our country's history. So since you are great at turning policy and strategy differences into character flaws, I challenged you to run for office and put up.

So since you people can't bring yourselves to support the guy when he needs it the most, how about blessing us with your presence in your local, state, and federal government?

We're going to win this health care reform battle. President Obama will sign a historic, but imperfect, bill, and we'll move on. It will be little thanks to those who refused to stand unified at this critical juncture.

So, for the love of all that is good and right, Mr. McNally and the rest of you, come from behind your keyboards and put yourselves before the people. It is selfish of all of you to deprive the country of your service at this time of great need.
11:40 AM on 08/28/2009
Apart from dental care, my healthcare bill is basically zero. This is because I eat right (organic vegan whole food), exercise daily, and take great care of myself. I do not have health insurance. I was injured in November in an accident that required a couple of visits to an orthopedic surgeon, X-ray, MRI, nutritional supplements, and months of physical therapy, all of which I've paid for out of pocket. Even adding up all of the above, then dividing it by the number of months since the accident, the monthly cost was still LESS than I would pay for an individual insurance premium -- far less. Had I needed surgery, I might well have joined the ranks of the medically bankrupt. Instead, I emptied my bank account and put what I could on my credit cards, which I'm paying off. It is insane that insurance companies do not take into account my vibrant health and healthy lifestyle, but only my age and gender. I'll take the public option, please.
04:07 PM on 08/29/2009
Anyone with a 10% fat diet could have the same excellent health as you. And as most vegetarians have a high fat diet and health no better then average, if your diet is 20% fat or higher when you hit old age, health insurance will be a must.

Above you say, " I eat right (organic vegan whole food)." This leads non vegetarians astray with the false impression that the only way to have good health is with organic whole food, unprocessed food grown in pure organic soil, and fertilized with only organic matter free of chemicals.

Your position is false. For I raised a family of five on a supermarket diet, and since 1979 not one penny on medical bills or health insurance. And now 7 years on Social Security and still I refuse to pay the $100 a month for Medicare.

Eat fruit and oatmeal for breakfast, and for lunch a stew of lentils, brown rich and vegetables. Eat only two meals a day and drink a half gallon of water.
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porsche996
an inelastic scattering of photons
07:50 PM on 08/27/2009
Thanks for this blog post. It echos closely my disillusionment caused by the presidents response to a question at the first prime time town hall meeting back in June. In that instance the very first questioner asked the question foremost in my mind and I waited eagerly to hear the Presidents heartfelt adn sincere answer to what I believe is THE most important civil rights and human rights issue confronting America today. The question? "Why no consideration of single payer?"

President Obama like as in your example, answered the questioner as if he were an economist. He said that while it was clearly the best solution, it would be too disruptive to implement.

I was stunned in disbelief at his obtuse lack of understanding and insight into the needs of the American people when he had campaigned on this issue and won my support and financial support for his supposed support of this reform to drive out the profit motive from health care.

In June, he had clearly abandoned the people and made some other deal?

MY disappointment is vast and deep.
05:02 PM on 08/27/2009
After the President's meeting in Colorado I listed the following comment (in a very bad mood):

The college student asked the president how anyone could expect insurance companies to compete with a single-payer health-care provider which does not have to generate profit. The President answered that that was a legitimate point to debate. No! Mr. President, you are dead wrong! You should have said: “Young man, you do not exploit the condition of sick people to make a profit. You help them, you heal them, and sick people should pay only for what it costs to heal them. They should not go bankrupt by paying for profits providing for exorbitant unearned incomes for CEO’s and investors. If the President really thinks that it is a legitimate undertaking to squeeze profits from people in need, he should ask himself if he has a good sense of human decency.
08:22 PM on 08/27/2009
Bravo! Why is a debate on health care for citizens so focused on competition for insurance companies?

They've shown they do not care for the welfare of the people they insure.

They've put profit before everything else.
04:48 PM on 08/27/2009
If you are concerned about receiving "real" health care reform in this country, please take the time to watch a video on our current system. The video was created by Oregon physicians who are advocating for the single-payer option. The video is very informative and helped me to gain a better understanding of various aspect of health care, as we know now it.

https://www.madashelldoctorstour.com/Mad_as_Hell_Video.html

These Oregon physicians are in the process of organizing a caravan designed to inform the public about the benefits of the single-payer option. At last count they will be stopping in approximately 23 states, on their way to demonstrate in Washington. They need volunteers and our support. Please spread the word.
04:25 PM on 08/28/2009
This is fantastic. Thank you.
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tnkeating
Dyslexic agnostic insomniac
04:21 PM on 08/27/2009
If the 'public option' health care plan is so good why won't the politicians agree to have it as there plan?

Politicians are refusing to attend town hall meetings complaining, without evidence, that they are scripted. Does that mean we shouldn't come out and vote for them since every campaign stop, baby kiss and speech they give is scripted.
04:09 PM on 08/27/2009
Your 4% number for medicare overhead is wrong. Maybe the top 4% is taken for overhead, but when a medicare recipient goes to the ER for a few stitches and medicare writes a check for $5,000... I can assure you that the doctor, nurse and the equipment used cost far less than the $5,000 paid out.
09:04 PM on 08/27/2009
Yes, the actual cost is far less than the $5000 but that is the amount that the hospital will charge regardless of the type of insurance. Hospitals never consider the actual cost of anything in their billing.
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03:35 PM on 08/27/2009
Somebody put this article into Obama's prompter for his next speech!
03:06 PM on 08/27/2009
Yes!!!!