I know it has been a while since we talked, but after listening to your healthcare speech the other night I have a few concerns and questions. Being familiar with HR3200, the plan you are moving through Congress I find this statement "I am not the first President to take up this cause, but I am determined to be the last". pretty optimistic. If this plan passes, I think we will be back, but you probably won't be. In fact it seems to me that a lot of Republicans had to work pretty damn hard to look pretty damn stupid in order to make this plan seem reasonable.
One concern of mine come from this statement you made, "And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize". I am pretty sure you have not promised us an actual savings as opposed to slower cost increases. Call it nit-picking if you will, but I feel more like I am saving money when I am actually spending less. But in order to give you the benefit of the doubt, can we judge "savings" to be accomplished when half of the countries without a "uniquely American" healthcare delivery system are more expensive than ours? I would like to be in first place again someday, but I know the first step is getting back in the race. In order to keep it simple for me, can we judge this health plan a failure if it does not get within 10% of the costs paid by an average of developed countries with universal coverage, within say, 5 years while keeping our life expectancies as high as theirs? And then to satisfy the free market guys can we give their complete deregulation plan a 5 year chance? And if that fails could we then finally try one of the existing European or Canadian models that is doing so much better than either of these? I realize that could mean ten to fifteen years of more suffering Americans but you are the leader of the free world, I just fix broken stuff for a living.
"And that's why under my plan, individuals will be required to carry basic health insurance". Then please make sure there is an option so I do not have to buy insurance from UNH. It is morally reprehensible to me to pay an executive $100mil per year to do a job that is less difficult than those done by many public servants for $250 thousand. I also have issues with supporting lavish lifestyles for people whose sales pitches promise healthcare and then do not deliver. You said "Insurance executives don't do this because they're bad people; they do it because it's profitable". I am a car mechanic and business owner. I could promise you a new engine and then put in a used one. It would be "profitable" and I would be a "bad person", do you get my point?
I would also like to talk about the "public option". I know you identified the problems when you said insurance companies cherry-picking the healthiest individuals and trying to drop the sickest", and "insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it". Then you said "I just want to hold them accountable. And the insurance reforms that I've already mentioned would do just that" What makes you think that our Gov't is up to that task? And do you really want to spend years in court deciding if someone was dropped because they got sick or for some other reason? The gap between this idea succeeding and "Not F'n Likely" is a chasm. Already gov't insurers pick up a much higher percentage of chronic illness's than the private insurers do so I am not sure why the privates are complaining. The conspiracy theorist in me thinks the Republicans played at looking healthcare stupid, so this dumping ground gift to insurers idea would look good going through. Maybe I'm just afraid we'll elect leaders who say Gov't is the problem and then set out to prove themselves right. It already happened once.
Down near the end of your speech you said "My guiding principle is, and always has been, that consumers do better when there is choice and competition". That's kind of cute and charming, in an innocent but Devoish gets screwed, kind of way.
Generally I like choice too, so it sounds good on the surface. A long time ago you could only get vanilla ice cream. Then someone made strawberry, chocolate, pistachio, chunkey monkey, chocolate chip cookie dough, added sprinkles, m&m's, whipped cream, butterscotch, chocolate and marshmallow topping. I know what I want and choice is good.
Healthcare is like that too. A long time ago if I got sick my choice was whether or not I got a wet towel on my forehead while my family waited to see if I lived or died. In fact people would get insurance to cover their bills while they missed work and tried to get better, but no-one bought insurance to pay a Doctor who could barely help you at all. Then someone added cleanliness, vaccines, anti-biotics, painkillers, blood transfusions, cat scans, mri's, organ transplants, prosthetic legs and arms, then better ones.
Now I might want a pistachio ice cream without sprinkles, but I assure you, I don't want an organ transplant without cleanliness. The problelm is, I can afford ice cream, but I cannot afford a surgery. There are some real costs involved with delivering a surgery. I have seen surgery with it's teams of well trained people, in disinfected rooms with bright lights and equipment for every emergency that might occur. It is an entirely different look than my local Carvel with it's team of high school kids and perpetually inoperative milkshake dispenser. Surgery is not expensive just because people do not shop around.
Because healthcare is expensive and I don't make in a year what a bone marrow transplant costs ($200,000 plus $50,000 to screen donors), I buy insurance. And here I get more choices, and not easy ones like ice cream flavors and toppings. These choices are a little tougher. Because the professional risk assessors at my insurance company find the job too tough, they want to leave it up to me. Hopefully my expertise in rebuilding engines and choosing ice cream will get me through this. If not, perhaps you will tell me if Wellcare's Gold Plus insurance plans includes bone marrow transplants and the cost of screening or not, how many days of hospital recovery time it covers, unlimited or capped, what your costs are if the cap runs out and you are not ready to leave, and how much less your insurance should cost if you are taking this portion of risk and/or the cost of screening donors. If you are like me, I am guessing you cannot answer those questions about your insurance either. After we figure this out we can go to work on what percentage of erbitux we should pick up, and how much less our insurance should cost us for each thousand dollars/month we are picking up.
You said your plan "would supply more security and stability to those who have health insurance" but I guess I would feel more secure if my plan covered anything my Doctor says is Medically neccessary, because the truth is, I cannot choose what should be in my plan. I do not know whether I am going to get hit by a bus or a car, or what sickness I might get, what the associated costs are, or what the best treatment for me is. Now I know the Canadians get medically neccessary as in Germany and France. And I know their costs are much less.
So after all this talk I guess the answer that matters most to me is, under your plan, can I get insurance for whatever my Doctor says is medically neccessary, and if so, how much will that policy cost?
And let's not forget, there are real life, good healthcare payment models that cost 50% less.