Thursday, August 20, 2009

Please be Clearer, Mr. President

Though I have no illusion that he will ever see it, I have sent off the following letter to President Obama:

Mr. President, if you want to know why your health care reform program is drawing so much flak, you might find at least some of the reasons in the Op-Ed piece that appeared under your name in last Sunday’s New York Times.

To begin, the title of the piece was Why We Need Health Care Reform. But by the third paragraph, you referred to the subject under discussion as health insurance reform. Health care and health insurance are not the same, Mr. President. Which is it you want to reform?

You went on to discuss the four main ways that reform would make things better.

The first was that your health insurance would offer high-quality, affordable coverage. How can you assure affordability when health care represents seventeen percent of the economy? In those conditions, can health insurance be made “affordable” without a government subsidy? Is that what you have in mind? How would it be paid for without increasing the federal deficit, which you have sworn not to do?

You also said that the coverage would “stay with you whether you move, change your job, or lose your job.” Just how would you do that, Mr. President? What if my new employer uses a different insurance company that offers different benefits? If I lose my job, who will pay my insurance premiums?

The second was that “reform will finally bring skyrocketing health care costs under control.” Again, Mr. President, just how would you go about doing that? You speak later about cutting “hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid.” These are programs you administer, Mr. President, and if there is waste and inefficiency why don’t you just go ahead and do something about it?

The third was that the money saved by making Medicare more efficient would be used to make its benefits more generous, including paying a larger portion of drug costs. That would all be very nice, Mr. President, but it doesn’t do anything to reduce overall costs, which you have said on a number of occasions are already too high.

The fourth was to provide consumer protection, such as prohibiting the denial of coverage for pre-existing conditions and limiting co-pays and deductibles. That would also be nice, Mr. President, but it surely will make health insurance more expensive. Also, if I don’t have to worry about pre-existing conditions, what is to prevent me from just doing without insurance until I get sick, knowing that I can get it when I need it?

These uncertainties make people nervous, even frightened. If you want people to support your reform efforts, Mr. President, I suggest that you be clearer on points like these.

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