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Obama Vows to Keep Fighting for Health Care Overhaul

By DAVID M. HERSZENHORN
January 22, 2010, 5:40 pm
Update | 6:00 p.m.

During a town hall meeting in Ohio on Friday, President Obama made an impassioned pitch for a broad overhaul of the American health care system. He acknowledged that the legislative process on Capitol Hill was ugly — “it starts looking like just this monstrosity,” he said — but also said he was resolved to finish the job.

“There are things that have to get done,” Mr. Obama said, toward the end of the town hall meeting in Elyria, Ohio. “This is our best chance to do it. We can’t keep on putting this off.”

After discussing his health care efforts in his opening remarks, Mr. Obama returned to the issue following the question-and-answer session.

Here’s what he said:

Now, I’m out of time, but I want to say one last thing. First of all, because there’s been so much attention focused on this health care issue this week, I just want to emphasize not the myths but the reality of what is trying to — that both the House and the Senate bill were trying to accomplish, because it’s actually very simple. There are a bunch of provisions in it, but it’s pretty simple.

Number one, for those of you who have health insurance, we are trying to get in place reforms that make sure you are getting your money’s worth for the insurance that you pay for. That means, for example, that they can’t impose a lifetime cap where if you really get sick and suddenly there’s some fine print in there that says you’re not completely covered. We’re trying to make sure that there is a cap on out-of-pocket expenses, so that you don’t find out, when you read the fine print, that you’ve got to pay a huge amount that you thought you were covered for. We’re trying to make sure that if you’ve got a pre-existing condition, you can actually still get health insurance, because a lot of people have been banned from getting health insurance because of a pre-existing condition. One of the provisions — one of the reforms we want is to make sure that your 26- or 27-year-old could, up until that age, could stay on your insurance, so that once they get out of high school and college, they can stay on their parents’ insurance for a few years until they’ve got a more stable job.

The line about pre-existing medical conditions drew applause from the crowd, which is not surprising given that denial of coverage for that reason is one of the most unpopular insurance industry practices. But Mr. Obama also went on to explain why the health care bill cannot easily be pared back into component parts, with Congress only adopting the most popular provisions

So you’ve got all these insurance reforms that we’re trying to get passed. Now, some people ask, well, why don’t you just pass that and forget everything else? Here’s the problem. Let’s just take the example of pre-existing conditions. We can’t prohibit insurance companies from preventing people with pre-existing conditions getting insurance unless everybody essentially has insurance. And the reason for that is otherwise what would happen is people would just — just wouldn’t get insurance until they were sick, and then they’d go and buy insurance and they couldn’t be prohibited. And that would drive everybody else’s premiums up. So a lot of these insurance reforms are connected to some other things we have to do to make sure that everybody has some access to coverage. All right?

But Mr. Obama did not stop there. He went on to make a pitch for the sweeping overhaul that Democrats have championed on Capitol Hill, including a new government-regulated insurance exchange and subsidies to help millions of moderate-income Americans afford private coverage.

So the second thing we’ve been trying to do is to make sure that we’re setting up an exchange, which is just a big pool so that people who are individuals, who are self-employed, who are small business owners, they can essentially join a big pool of millions of people all across the country, which means that when you go to negotiate with your insurance company, you’ve got the purchasing power of a Ford or a GM or Wal-Mart or a Xerox or the federal employees. That’s why federal employees have good insurance, and county employees and state employees have good insurance, in part is because they’re part of this big pool. And our attitude is, can we make sure that everybody is part of a big pool to drive down costs? That’s the second thing we’re trying to do.

Third thing we’re trying to do is to try to reduce costs overall because the system — how many of you, you go into the doctor’s office, you fill out a form, you get a checkup, you go fill out another form, somebody else asks you for the form you just filled out. Then the doctor fills out a form, you got to take it to the pharmacist. The pharmacist can’t read the doctor’s — this is the only industry in the country that still does that, that still operates on paper systems, that still orders all kinds of unnecessary tests.

In one of the more personal aspects of his pitch, Mr. Obama described himself as patient-in-chief, relying on the advice of his doctors just like everybody else, not quite sure if or when medical tests are necessary or if and how treatment might be obtained at a cheaper cost. That personal approach drew more applause — as did his acknowledgment that the legislative process in Congress has been especially ugly and possibly offputting for many Americans.

Because a lot of times, I walk in the doctor, I just do what I’m told — I don’t know what he’s doing. I don’t know whether this test was necessary, or whether we could have had the test that I took six months ago e-mailed to the doctor so I wouldn’t have to take another test and pay for another test. Right? So there are all these methods of trying to reduce costs. And that’s what we’ve been trying to institute.

Now, I just want to say, as I said in my opening remarks, the process has been less than pretty. When you deal with 535 members of Congress, it’s going to be a somewhat ugly process — not necessarily because any individual member of Congress is trying to do something wrong, it’s just they may have different ideas, they have different interests, they’ve got a particular issue of a hospital in their district that they want to see if they can kind of get dealt with and this may be the best vehicle for doing it. They’re looking out for their constituents a lot of times.

But when you put it all together, it starts looking like just this monstrosity. And it makes people fearful. And it makes people afraid. And they start thinking, you know what, this looks like something that is going to cost me tax dollars and I already have insurance, so why should I support this.

So I just want to be clear that there are things that have to get done. This is our best chance to do it. We can’t keep on putting this off. Even if you’ve got health insurance right now, look at what’s happening with your premiums and look at the trend. It is going to gobble up more and more of your paycheck. Ask a chunk of you folks in here who have seen your employers say you’ve got to pick up more of your payments in terms of higher deductibles or higher co-payments. Some of you, your employers just said, we can’t afford health insurance at all. That’s going to happen to more and more people.

You asked about Social Security. Let me talk about Medicare. Medicare will be broke in eight years if we do nothing. Right now we give — we give about $17 billion in subsidies to insurance companies through the Medicare system — your tax dollars. But when we tried to eliminate them, suddenly there were ads on TV —

“Oh, Obama is trying to cut Medicare.” I get all these seniors writing letters: “Why are you trying to cut my Medicare benefits?” I’m not trying to cut your Medicare benefits. I’m trying to stop paying these insurance companies all this money so I can give you a more stable program.

And then came the grand finale, where Mr. Obama seemed to say he was committed to continuing an ambitious agenda, despite the loss of a Democratic Senate seat in Massachusetts this week and the perception that his administration suddenly is on the ropes.

The point is this: None of the big issues that we face in this country are simple. Everybody wants to act like they’re simple. Everybody wants to say that they can be done easily. But they’re complicated. They’re tough. The health care system is a big, complicated system, and doing it right is hard.

Energy. If we want to be energy independent — I’m for more oil production. I am for — I am for new forms of energy. I’m for a safe nuclear industry. I’m not ideological about this. But we also have to acknowledge that if we’re going to actually have a energy-independent economy, that we’ve got to make some changes. We can’t just keep on doing business the same way. And that’s going to be a big, complicated discussion.

We can’t shy away from it, though. We can’t sort of start suddenly saying to ourselves, America or Congress can’t do big things, that we should only do the things that are non-controversial, we should only do the stuff that’s safe. Because if that’s what happens, then we’re not going to meet the challenges of the 21st century. And that’s not who we are. That’s not how we used to operate, and that’s not how I intend us to operate going forward.

We are going to take these big things on, and I’m going to do it, and you’re going to do it, because you know that we want to leave a better America for our children and our grandchildren. And that doesn’t mean standing still; that means marching forward.

I want to march forward with you. I want to work with you. I want to fight for you. I hope you’re willing to stand by me, even during these tough times, because I believe in a brighter future for America.

http://prescriptions.blogs.nytimes.com/2010/01/22/obama-vows-to-keep-fighting-for-health-care-overhaul/