What Obama Must Demand from Congress on Health Care

Picture 11 Congress returns this week to one of the fiercest and most important debates in recent memory — whether and to what extent the nation will provide health care to all Americans, and how we will reign in the soaring costs of health care overall. But do not expect unusual courage from this Congress in standing up to demagogic lies and money-toting lobbyists. An unusually large portion is facing close races in 2010, both in primaries and in the general election. Republicans have many primary challenges from the right. A record number of Democrats, who took over Congress in 2006, hail from traditionally Republican or swing states and districts.

In order to get anything meaningful through this session of Congress, then, the President will have to give congressional Democrats far more leadership and more cover. Doing so is harder now than before the recess, when he was still basking in the afterglow of a honeymoon and 60 percent favorabilities.Yet it’s not too late. Addressing a joint session of Congress next Wednesday is a good idea but Obama can’t rely solely on his exceptional rhetorical skills. He’ll need to twist arms, cajole, force recalcitrant members to join him, threaten retribution if they don’t come along.

Most importantly, he’ll need to be specific about what he wants — especially about three things. I hope says the following next Wednesday, and makes clear to individual members that he means business.

1. I will not stand for a bill that leaves millions of Americans without health care. It’s vitally important to cover all Americans, not only for their and their childrens’ sakes and not only because it’s a moral imperitive, but because doing so will be good for all of us. One out of three Americans will experience job loss and potential loss of health insurance for themselves and their families at some point. One out of four of us who have health insurance is underinsured –unable to afford the preventive care we and our kids need on an ongoing basis. And those of us who don’t get preventive care can get walloped with diabetes, heart disease, and other major illnesses that wipe us out financially, or force us into emergency rooms that all of us end up paying for.

2. The only way to cover all Americans without causing deficits to rise is to require that the wealthiest Americans pay a bit extra. The wealthy can afford to make sure all Americans are healthy. The top 1 percent of earners now take home 23 percent of total national income, the highest percentage since 1928. Their tax burden is not excessive. Even as income and wealth have become more concentrated than at any time in the past 80 years, those at the top are now taxed at lower rates than rich Americans have been taxed since before the start of World War II. Indeed, many managers of hedge funds, private-equity partners, and investment bankers — including those who have been bailed out by taxpayers over the last year — are paying 15 percent of their income in taxes because their earnings are, absurdly, treated as capital gains. We should eliminate this loophole as well, and use it to guarantee the health of all.

3. Finally, I want a true public insurance option — not a “cooperative,” and not something that’s triggered if certain goals aren’t met. A public option is critical for lowering health-care costs. Today, private insurers don’t face enough competition to guarantee low prices and high service. In 36 states, three or fewer insurers account for 65 percent of the insurance market. A public insurance option would also have the scale and authority needed to negotiate low drug prices and low prices from medical providers. Commercial insurers now pay about 30 higher rates to providers than the government pays through Medicare, because Medicare has the scale to get those lower rates. A nationwide public option could get similar savings. And those savings would mean lower premiums, deductibles and co-payments for Americans who can barely afford health insurance right now.We’ll see.

Robert Reich served as the 22nd United States Secretary of Labor under President William Jefferson Clinton from 1992 to 1997.  He blogs regularly at robertreich.blogspot.com, where this post first appeared.

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23 replies »

  1. Yes.
    It is not the job of the federal government.
    Sounds cruel, but it is not. There are other ways to care for these deserving people, but not by the federal government.
    That is the slippery slope of never saying “no” to a worthy cause. The federal gov’t must say “no” to all special causes.
    It is not their job.

  2. One has to be really skilled in drawing the line between general welfare of the nation and benefits for individuals. Most of us are blessed to be able-bodied. Should we withhold the portion of our taxes that finance the Rehabilitation Services Administration, on the premises that the activities of the agency benefit certain individuals?
    As I said before, our society keeps evolving, together with our views on the role of the government in our lives.

  3. Mr. Saip,
    If you are taxed by the federal government for a service provided to individuals rather than for the general welfare of the country, then, yes, it is tyranny to be forced to pay such a tax.
    The feds have overreached their authority and no one is standing in their wasy

  4. No one will force care on you, but you will be forced to pay for it whether or not you use it. That is the tyranny.
    I can only care for one person at a time…who will decide who is first, and then second, and then…?
    When the line stretches all the way to Washington, maybe the last person in line can turn around and ask the government for a fast pass. I am sure there will be a loophole for the priveleged elite and their lapdogs to get VIP treatment.

  5. A state politician isn’t hiding 2000 miles away for starters. Second they answer to the states population not the nations.
    There is and has been far more coruption by Democrats then republicans ever have committed.
    States rights was closer to ideal then the centralized power/planing system road we are headed down. ANy such experiments should be undertaken by individual states.

  6. Nate:
    “…I want my taxes paid to a government that is accountable to me, not DC 2000 miles away to a handful of crooks that don’t know I am alive.”
    What makes you think that your Senator or House Representative in DC are less accountable to you than their State counterparts? After all, they all receive political contributions…
    “…Democracy doesn’t win when you have political machines like Daly in Chicago, Tamney Hall in NY and the corruption of NJ, CT, and MA.”
    Do you mean there is no corruption in TX, SC or AK? The color of the state doesn’t make it more susceptible or immune to corruption.
    “…There is no reason or allowing law for federal involvement and taxation for the purpose of education, retirement, healthcare, on and on. All of those services if taxed for at all should be done at the County and State level.”
    There is no ideal political system, which could remain immutable forever. Ours is no exception. It is still evolving based on changing public perception of what they want our government to be. Some push for changes they believe in, others resist.
    MD as HELL:
    “…Therein lies the problem with “”helping” people: Freedom to live and die as one chooses or as someone who loves you chooses for you IS the central concept in The United States of America.”
    There is no choice if care is a service we buy and one has no money to pay for it. On the other hand, nobody will force care upon you if you can receive it, but choose not to do so. Advance directives are honored too, as far as I am aware. BTW, are you for or against assisted suicide for terminally ill patients?
    ”… It is better to be free and illiterate rather than indoctrinated and educated.”
    In my view, uneducated people are easier to indoctrinate.

  7. Mr. Reich,
    Given a 2.5X variance in healthcare costs from region-to-region (www.dartmouthatlas.org), why wouldn’t we find ways to change the system delivery first before we add tax burdens? This is not to defend wealth accumulation, but instead to drive change…as soon as we have a way to finance access for the uninsured, i.e., by an additional tax, we relieve the pressure that is so important in a change process.
    The numbers associated with the over-supply of care (too many tests, too many specialist visits, etc) are really big. Estimated by a number of analyses to be about 30% of the total spend in healthcare, this would not only fund important initiatives (e.g.,universal access), but it would improve quality too (fewer distractions, fewer harms from tests, etc).
    Yes, there is a very well researched argument to be made about the effect of a social gradient (differences between those with wealth, education and status compared to those with less) on health status, but it is a different argument.
    Keep the pressure up… to drive change in the system.

  8. MD as Hell wrote: “This eliminates freedom from government, which was the dream and vision of our Founders.”
    It’s not even possible for anything to be further from the truth. It’s barely possible to carry on a substantive conversation with anyone whose thinking actually proceeds from such obvious nonsense.
    “Freedom from government”? Really? There was not one Founder who imagined, let alone proposed, that anything they were up to would “free” people from “government”.
    Please, your ability to compose entire legible words and post them on the internet indicates you have sufficient intelligence to sit down and actually learn something about your own land’s history. You’d be doing yourself a favor. And it’s you that matters most, right? Because your conception of “freedom” is all. about. you.

  9. MD as HELL: I do agree with almost every word you wrote. The problem is that if you have no means, you cannot exercise that freedom. If you cannot afford health care when you are seriously ill, you cannot freely decide that you want to live.
    And yes, it is the government’s role to make sure that you have the freedom to decide if you want to live in sickness or receive treatment. I am not suggesting that government forces you to undergo heart surgery, only that it allows poor folks the same freedom to choose as the more fortunate citizens.
    Some of us need help in order to be truly free to choose.
    As to those QALYs, I said it before and I’ll I say it again, it’s a preposterous notion that does not belong in a free country.

  10. Margalit,
    Theirin lies the problem with “”helping” people: Freedom to live and die as one chooses or as someone who loves you chooses for you IS the cenral concept in The United States of America. Having the government choose for you is anathema to the continuation of the country under the Constitution.
    It is better to be free and sick than QALY’d and sick. It is better to be free and illiterate rather than indoctrinated and educated.
    This is the basic difference between liberal and conservative: Who chooses your life?
    The United States was founded to protect the individual from the tyranny of the majority. Benevalent tyranny is still tyranny.

  11. are we foreign to Hawaii?
    We are surly foreign to guam then?
    you need to seperate the word taxes into its legal taxing entities.
    I am willing to pay federal taxes for the defence of our nation and its borders.
    I am willing to pay state taxes for for the regulation of commerace and some consumer saftey
    I am willing to pay county & Local taxes for my police, fire, and some utilities.
    I want my taxes paid to a government that is accountable to me, not DC 2000 miles away to a handful of crooks that don’t know I am alive.
    The real question is how much of my money are you really planning to steal at the federal level to force your political ideals on me? You need someone else to fund your fail ideals of socialism so you enact your laws at the federal level to force everyone to contribute. There is no reason or allowing law for federal involvement and taxation for the purpose of education, retirement, healthcare, on and on. All of those services if taxed for at all should be done at the County and State level.
    Democracy doesn’t win when you have politicial machines like Daly in Chicago, Tamney Hall in NY and the corruption of NJ, CT, and MA. Democrats haven’t known Democracy in 100 years.

  12. Howdy Nate! A government that resides an ocean away and collects taxes but allows no representation of the ones taxed is a foreign government. I don’t know which one is the left coast, but I believe everybody has the right to vote and send their representatives to Washington. Sometimes yous opinion wins, sometimes you get clobbered. That’s how democracy works.
    So Nate, what is your vision of government? What are you willing to pay taxes for? Anything at all?

  13. In 1776 it was a foreign government. What we fought off them is no different then the left coast we are trying to fight off now. It was about 1 set of people living off the work and labor of another against their will. The confiscation of property today is exactly the same as the tea and other taxes back then.
    If harm from disease is not a stretch then how about hunger? Then the elements, then the social pain of your neighbor having a nicer car. Where do you stop Margalit? At one time a modest income tax was seen as a strecth of the federal governments rights, now look where we are. The left justr keeps taking and taking, it never stops.
    This has nothing to do with the down trodden, that is misleading to downright dishonest. 87% of seniors had sufficent assets to cover their medical expenses, how was Medicare helping the down trodden? Social Security covers all retirees, are you claiming they are all down trodden? You keep trying to claim you want to help the down trodden but your measures always go way past that and don’t accomplish helping those you claim to.

  14. MD as HELL: I agree with you on terminology. Let’s stop talking about insurance. Let’s talk about health care. The word “insurance” invokes terms like industry and market and profits and loss. Health care, the two word variety, invokes compassion and community and people caring for each other.
    I think citizens of this country assume that the government, as evil as it may be, is obligated to protect them form harm; be it external enemies or internal criminal elements or fires or natural disasters. Protection from harm caused by disease is not such a big stretch. It’s hard to pursue happiness when you are ill or your child is ill and there is nothing you can do about it.
    The war in 1776 was fought against a foreign, oppressive government and a government by the people, for the people was installed. The founding fathers did not advocate anarchy. In 1865, the war was fought for freedom from slavery (more or less) and in 1945 a cruel dictator that tried to enslave other nations was destroyed. This country never fought a war to prevent a government from providing a helping hand to the downtrodden.
    The freedom to not be covered by anything means nothing but the freedom to have others pay for your care when you need it, and you will need it.
    How about the freedom to not have an education, or the freedom to not have fire protection. Maybe get a tax deduction for opting out.
    Freedom is a great thing, but I don’t think that the freedom to suffer or die from disease is one to be cherished anymore than the freedom to be illiterate.

  15. Is it true that doctors will not be permitted to decline to treat “public option” patients? I don’t suppose they will mind, though, since (as I understand it) they will be compensated 5% more than the Medicare rate.
    I think the reason group health pricing varies so much from state to state has a lot to do with state “mandates.” By way of example, using some of the mandates included in HR 3200, these might include dental and vision for offspring up to age 21, “substance use disorder,” and “intensive counseling” and “behavioral intervention” for the obese. Infertility treatment and in-vitro fertilization are “mandated” by some states. I understand that Rhode Island leads the pack, with 70 such mandates.

  16. Mr. Reich, I believe, is a very intelligent person who also is a master politician. There are terms in this entire discussion that have different meanings to different people. This is very useful when separate ideologies clash. Both can be duped with their own words, with different meanings for each.
    Let’s stop using the word “insurance”. None of us have insurance anymore. None of the government programs are insurance. None of the managed care plans are insurance.
    If we can get rid of the word “insurance” then we can talk more clearly about what is proposed. What is proposed is mandatory payment into a system that provides coverage for government approved and/or mandated services.
    There is no insurance for preventive care. There is coverage for some of it, but not all of it. Right now Medicare will pay for an old tetanus diphtheria shot, but not the new Tdap shot. Medicare covers one physical with your new doctor, but not subsequent ones.
    Everyone can have healthcare in America today. Most of you do not need it today. Not everyone wants it at all. But you will be buying it, so why would you not use it? Today those not buying it but receiving it are using it like there is no tomorrow and no limit.
    This present healthcare bill eliminates the freedom to not be covered by anything. This eliminates freedom from government, which was the dream and vision of our Founders. Just as the general welfare clause has been the excuse for the federal government to get its tenticles into everything that should be up to the states, healthcare will be the excuse to tell you what you can and cannot eat, drink, smoke, climb, dare, challenge, attempt, achieve.
    There will be no tolerance for costing more than you should cost. There will be fines and other sanctions. This is the government opening to tell you how much money you can make.
    Most of you will not believe this, and it will not happen on day one. But it will happen by day 3650 or by day 7300.
    This is what we got rid of in 1776 and in 1865 and in 1945. We should not hand our freedom back to political hacks masquerading as saviors.

  17. I have no issues with the desire to cover all Americans in health reform. I have issues with first looking to tax the wealthy to achieve these goals financially, rather than first looking for the efficiencies in fraud abuse/protections. Why not start there?
    Second, why is it that the way to promote competition is through the use of a government process, instead of allowing the free market create competition, through allowing insurance companies to reach across state lines?
    Doesn’t it seem like these are achievable goals that the federal government can easily tackle, that both parties should be able to agree upon?

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