Joint Session
Some immediate thoughts on the President's speech on healthcare reform before a joint session of Congress:
- The speech was well-constructed. It should be reasonably well-received by the target audience—those without insurance, those worried about their insurance, and seniors—particularly if they're not interested in the details.
- It's too bad this wasn't the starting point several months ago; the debate could have been much more constructive.
- I am an insurance exchange proponent and was glad to see it proposed by the President. If implemented properly, it can promote competition, particularly across state lines.
- It is still very unclear to me how the government can force insurance companies to not consider pre-existing conditions without significantly driving up premiums. Insurance relies on actuarial science. If more risk/costs is/are foisted on insurers, they'll have to raise prices in order to ensure their viability.
- It's possible that all those with pre-existing conditions will end up in the non-profit, public option provider, but that then virtually makes certain that entity's ultimate insolvency and/or need for government support.
- It is impractical to expect the non-profit, public option insurer to be self-sustaining, as the President guaranteed. How can it be when the users of the option will almost certainly be those priced out of the exchange? They will have been priced out because they'll be the riskiest and most expensive to insure. So, the non-profit cannot possibly be viable when it has to provide care for persons who will cost orders of magnitude more than those in a typical, actuarially sound risk pool. Therefore, the non-profit will assuredly go broke and/or require government subsidy.
- The only way the aforementioned might not be a guaranteed outcome would be if the non-profit was comprised of much more than 5% (the President's number) of the populace. That way, it would have a chance to spread the risk. However, in order to make that happen, it would have to undercut the private insurers on price; thereby crippling that market.
- The malpractice reform proposal was weak and will be unacceptable to Republicans. It's difficult for Obama to argue that we can do all the heavy lifting necessary for healthcare reform, but ostensibly eviscerate tort reform with drawn out state trials.
- The case was not made regarding how this will be paid for. It has always been laughable when either party claims their program is going to be paid for by eliminating waste, fraud, and abuse. Even if there is a slim chance that this might be the one time it's true, we've all been conditioned to dismiss such a rationale.
I can't understand it. If there is enough waste fraud and abuse to pay for 47 million peoples health insurance why don't they eliminate it now, so everyone's health insurance would be cheaper? I agree there is much waste, largely driven by doctors who order excessive testing and procedures hoping to avoid the emotional and financial shit storm that comes with malpractice law suits. But tort reform won't happen under this administration. Even Howard Dean admitted they don't want to make enemies of the trial lawyers. After all, they donate 95% to democrats, and they donate lots of loot.
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