The ABCs of Health Care Reform

By ObamaNerd June 26, 2009

[caption id="attachment_7998" align="alignright" width="361" caption="Grumpy health care town hall attendees ready to stick it to Obama."]Grumpy health care town hall attendees ready to stick it to Obama.[/caption]

Wednesday night, ABC broadcast a town hall featuring President Obama laying out his vision for health care reform. The town hall was called "Questions for President Obama: Prescription for America." Very creative.

ABC's armchair quarterbacking: "Obama struggled to answer questions." I agree. He wasn't tight on the answers like we saw during the stimulus town halls a few months back. Did he sell it or did he blow it?

This was a meaty townhall. Too long for the play-by-play. Here is the ObamaNerd breakdown (analytical, not mental) of the 8-part video archive of the town hall. Let's go right to the gutter, shall we?


Lead in: Very dramatic music, booming male voiceover: "The President calls for sweeping reforms."  "Who decides what doctors you can see?" Cut to crying cancer survivor.  Cut to X-rays. Cut to stodgy conservative to give "balanced" counter-viewpoint: "Who should decide whether you live or die?  The government?"

Who put together this montage, FoxNews?

Cut to the 164 people, from all walks of life, all over the country, brought to the White House to help with the dialogue. Um, what a sour looking bunch of people. This won't be going well. I can tell already.  Not a fucking smile in the crowd. Abort partially staged town hall!  Abort!

ABC's "resident doctor,"  Tim Johnson, paraphrasing key questions and does a very broad overview of Obama's plan.  And what "critics" (also known as Republicans and insurance companies) say the problem is with Obama's plan.

Charles asks the group:  "How many of you think health care system needs to be changed?" Looks like nearly all hands go up. Anyone who thinks the system should be left unchanged?  One hand maybe.

Now for audience questions.

Q:  Dr. Orrin Devinsky (oh a doctor, this must be valid!) asks the first question and sets the stage: "Some politicians who take a crack at health care reform often push a limiting of testing and evaluations and access to specialists as way of saving on costs. If a national health care plan was approved and you participated and your wife or your daughters became seriously ill, would you let them die in agony under your 3rd world national health care plan because some of those advanced tests aren't allowed under your plan or would you be a total hypocrite and seek out a far superior private plan that would allow for such tests and save your wife or daughters' life?"

A: "'Terrific' question. Remember when my grandma died?  Yeah, that kinda sucked.  She was terminal, if you remember, so I have been through some of this. Therefore, I'd appreciate it if you didn't lump me into some category where you insinuate that I am too elitist to relate. But nice gotcha question...

"But seriously  'the status quo is untenable.' Just a heads up: I will say this 100 more times over the summer while this debate rages through Congress.  Also, we seem to favor a system that pushes for quantity of health care rather than quality. That's why costs are so high...more and more tests ain't making you healthier, dog."

Q. Dr. John Corboy (yea, another doctor!): "Let me first say—there is a significant amount of provided care that isn't necessary or appropriate.  But let me get to MY loaded question now—and with this question, let me see if I can conjure up some images of the 1994 Health Care debate: What can you do to convince the public that there actually are limits to what we can pay for with our health care system?  And if you are going to be limited in your tax-and-spend ways, who's going to design that system and who's going to enforce the rules?"

O:  "You are totally asking the right questions.  And by right...I mean right of the political spectrum, not right as in 'correct.'  We need to move away from these 'doctor incentives' where the doctors make more money with the more care they provide...regardless of how it improves your health. But I believe doctors will do the right thing. I ain't no doctor hater.  Oh, and did I mention the Mayo Clinic—they in the house?  No, fact checking then.

"Mayo provides outstanding care—so good in fact that people fly all over the country to go to Minnesota to receive it. Oftentimes it's one third the cost of other health care or treatment. Why?  They are streamlined. Specialists actually talk to primary care physicians and each person involved in a health care issue don't order the same test 3 different times.  Imagine that.  Communication and efficiency.  Chew on that for a minute cuz I think I just blew your mind."

Diane Sawyer asks a question (seems totally fair to have Diane Sawyer ask a question—who can afford any health care she wants—when you have 162 other people who might want to):  "Well that's the point, Mr. President.  The Mayo Clinic is private and they are doing these things already (for people like me who can afford and arrange to go there). Why get the government involved and with the right initiative replicate it more in the private sector?"

O: "Right wing critics have been squawking about letting the free market drive down costs or incentivizing the private sector to make efficiencies and such. Look around you.  See that taking off?  Me either.  Why don't you go back to sticking the microphone in someone's face who flew to be here?

Oh and by the way: Government is already running parts of health care, and more cheaply and more effectively than you're insinuating a national plan would.  Hear of Medicare?  Children's Health Insurance Program?  Yeah, pipe down Sawyer."

Part 2

Q:  From nurse practitioner. "How do we re-orient a new system around primary care and get better primary care with all the shortages of trained primary health practitioners out there?"

O: "Change the incentives!  See a recurrent theme here?  It is more lucrative to be a specialist. No hate to specialists. But medical students are making decisions based on student loan debt.  They go into the higher paying jobs.  They don't do primary care because of the crushing debt.  We need better incentives for these students."

Q: Cut to Mary Vigil, also known as "Town Hall Hail Mary."

O: "Mary, you're a medical student. How much debt will you face when you get out of school?"

A: Mary:  "About $300,000.  I would love to do primary care—it's why I got into medical school in the first place" (wink to Obama).

Q: Charles Gibson Question #2 (screw you town hall attendees!) "So, we have 46 million uninsured.  Your goal is to get them insured.  With such a shortage of primary care doctors, how are you going to get an appointment to meet a doctor to get a physical?  It's impossible now.  Imagine all those newly insured competing for the same doctor."

O: "Are you fucking kidding me?  Really?  This is the best argument you have against insuring those 46 million uninsured?  You're a fucking moron."


Q:  "How are we going to deal with the elderly. Extending end of life and the cost of treatment for terminal illness is an enormous expense. How do we deal with it?"

O: "I am not really going to address the cost part other than to say that I think a living will is necessary so families know how to deal with end of life issues."


Q: "How far will Big Brother (aka government) go into looking my personal life as it relates to my health (gay alert!) and how will this get paid for?"

O:  "We want to put some restrictions on insurers. No doubt, girlfriend.  Like nixing coverage for pre-existing conditions. Fuck that noise.  Also, if we do nothing, costs will continue to rise 6-8% each year. Also, a lot of money you taxpayers already cover as it relates to health care can be moved around.  Like $188 billion in subsidies to insurers. Fuck that noise x 2. We need to change that. We think we can do health care reform in a deficit-neutral way and lead to big savings across the system in the long term.  Big Brother ain't looking so bad now, is he?"


Q: Now a question from a former Bush policy advisor: "Your numbers are missing $300-$600 billion from cost savings, moving money and coverage for everyone.  How do we get there?"

O: "That's Congress' shitbag to hold.  They'll figure it out."


Q: Public option question!  "What do you say to your critics when say this: "When Medicare and Medicaid are on the path to fiscal insolvency, we can't afford to negatively impact families who enjoy private coverage with this new program?"

O: "I say they are fucking wrong.  What's wrong with setting up an insurer that isn't profit driven and works to compete to drive costs down.  Answer me that."

Q:  Interesting twist! Diane takes a moment to ask a question to the CEO of Aetna: "When we see insurance companies claiming billions and billions in profits—even in lean years—is the President right when he says we need to keep you honest?"

A:  Republican sound bite from CEO of Aetna:  "It's hard to play fairly when the person playing is also the referee. That is an unlevel playing field."

A:  Obama answer:  "It's not an unlevel playing field.  Government would have to abide by the same rules. And since when have insurance companies played fair?  They play for profits, not for equity."

Part 7

Q:  "Will my taxes go up?"

O:  "The first thing I'd say: Would you be willing to pay a little more in taxes to be healthy and have access to health care when you need it, you fucktard?  Part two of my response: Most of this is a shell game. We are moving money out of this shell and putting it under this other health care shell.  Keep up.  I've talked about this before. And no, I am not in favor of taxing health care benefits."

Part 8

Q:  Finally a question from somebody uninsured and not a health care professional or policy maker: I make too much money to qualify for Mass government's health care, but as a small business owner I can't afford a private plan.  How are you going to make sure people like me don't fall through the cracks?

O:  "That's where the public option would work for you."
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