Obama’s Health Care Speech

by philg

Thursday, September 10, 2009 at 06:17 PM EDT

I’m reviewing the transcript of Barack Obama’s health care speech to Congress yesterday. I’m confused by a couple of points.

Obama was careful to stress that there will be no health insurance for illegal immigrants. Why does this matter? If a very sick illegal immigrant shows up at a hospital, the hospital has to provide him with emergency care. If a very sick and very old illegal immigrant shows up at a hospital, he will have the same $250,000 death in the ICU as an American citizen. The current standard of care does not consider costs and does not consider citizenship. Why would people get excited over whether an illegal immigrant gets a free flu shot or not? As far as the expensive stuff goes, we’re already paying for it (where “we” includes the illegal immigrant, of course, since, as I pointed out in my own health care reform plan, illegal immigrants pay most of the taxes that citizens pay).

Another point that struck me as bizarre is “most of this [multi-trillion dollar] plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse. … The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies … Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan”.

The proposed changes to our health care system would start to be phased in during the year 2013, according to H.R. 3200. If we’re wasting hundreds of billions of dollars a year right now in Medicare and Medicaid, why aren’t we taking immediate steps to stop the waste? Why would we wait until 2013? Why would we say that we’re only going to stop this waste if we implement some unrelated changes to the U.S. health care system?

Speaking of immediate fixes, Obama says that the insurance market is not very competitive: “Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down.” The federal government pays for more than half the cost of health care in the U.S. The Feds regulate all sorts of other things whose connection to “interstate commerce” is more tenuous. If the 50 state insurance commissions and licensing procedures are reducing competition and raising pricings to consumers, why not get rid of them tomorrow? Why wait until 2013 and predicate the efficiency improvement on implementing unrelated new schemes?

The speech constantly equated health insurance with health care, as though it were not possible to have health care without insurance companies, despite the fact that a person’s routine health care is predictable and therefore classically would not be considered something to be insured at all (except against catastrophic accidents or rare disorders). Food is even more important than health care. Without food, an American would be dead within just a few months. Why don’t we have food insurance if it is so much more important than health care?

Nowhere did the speech mention the most obvious reason that our spending is so high: Medicare, Medicaid, and private insurers pay providers more if they do more and fancier procedures and tests. Nowhere did the speech mention any proposed change to this practice, only that the government would spend more money and hire more people to crack down on “fraud” and “abuse” by providers. Given that medicine is not a science and doctors often disagree on how to treat a patient, how is this ever going to work? Someone at a desk in Washington didn’t think the doctor in Texas should have ordered an MRI, perhaps done at a MRI clinic partially owned by that doctor? Did the desk jockey talk to the patient? Is the desk jockey an MD? If not, how is he going to be able to say with authority that the MRI wasn’t necessary? Some of the words in the speech are fine, but when one puts forward a specific example it is impossible to understand how it could work in practice.

“For some of Ted Kennedy’s critics, his brand of liberalism represented an affront to American liberty.” Finally a part of the speech with which I can agree, as there is no doubt that Ted Kennedy’s brand of liberalism deprived Mary Jo Kopechne of her liberty.

This article originally appeared on Philip Greenspun's Weblog.