My Eight Point Plan

by Nick Stone of Drawnlines Politics.
This is the speech that would have won me over

As we gather here tonight, Americans are tuning in to watch the closing arguments on a conversation about the issue of health care. They’ve seen the ads and heard the talking points. They’ve heard the ideas and the name-calling. They’ve heard us characterize each others’ plans, and they know we don’t necessarily see eye to eye. They also know that even if they are satisfied with the care they currently receive, the system is on an unsustainable path with no end in sight.

Many are concerned that those of us in this room are going to intrude on the relationship between them and their doctor. Rather than improving the quality of their care, they fear we will make it worse by piling a massive bureaucracy on top of the greed they already face from their insurance company. Rather than making their health care cheaper, families watching at home fear that we will make it more expensive by offering free care to others on their backs. Let’s make them proud by avoiding those mistakes and having an honest conversation about how we move forward with improving our health care system in this country.

If you believe as I do, then you feel strongly that health care is a basic right. Though the constitution does not specifically enumerate this right, the founding fathers did leave us with the basic fundamentals of life, liberty, and the pursuit of happiness. It’s awfully hard to have those three endowments if you are sick or dead because of a lack of adequate medical attention. No doubt health care is an increasingly expensive right, and the costs are rising rapidly. And we know that we are losing the battle to keep Americans healthy by practicing reactive medicine rather than the much less expensive and much more effective proactive medicine.

Healthcare reform is a difficult issue that has been discussed since the days of Teddy Roosevelt. President Harry S. Truman suggested a need in our nation for universal health coverage, though it has never materialized. And as you know, I ran for this job on the premise of covering every single American. This pledge was a cornerstone of my campaign for president and it is one I will keep.

But while many changes have been made to the way we cover sick Americans, no comprehensive reform has yet taken place. Our elected officials have passed legislation to cover a few more people here, or expand treatments or prescriptions there, but a thorough reform has been kicked down the road by both parties for decades. Congress after Congress has failed to enact a comprehensive change to the way we treat our sick or maintain our healthy.

The time to pass reform is now.

Many of you watching tonight are well aware of the difficulties of tackling comprehensive reform, no matter which party has control of Congress. Right now, I’ve got a lot of folks in the House telling me they’ll never vote for a bill that doesn’t include a “robust” public option, and a lot of folks in the Senate telling me they’ll never support a bill that does include one. That’s obviously a problem. I come before you tonight to map out a path forward with a solution to this complex problem. We must find a smart solution – one that is both Republican and Democratic, because this issue affects every single one of us – no exceptions.

From my days as a community organizer on through my days in the US Senate, I met thousands of people with concerns over the health care treatment they receive or don’t receive. On the campaign trail I met thousands more families on the rope line and at my events – people who are rightly concerned that they might not be able to afford enough coverage to provide for their families if they become ill. As president, I’ve read letters and fielded questions at town halls that have made even clearer the pressing urgency of finding solutions to the problems in our health care system today.

I don’t need to recite polls or statistics to tell you that there are problems with our health care system today. We know that too many families are forced to reduce their medical visits to true emergencies. They receive little or no care, even if they have insurance coverage. Scared away from their doctor’s office by high co-pays and high deductibles, these families aren’t getting the treatments they need or the checkups that would prevent greater problems down the road. These families are everywhere. If it isn’t your family I’m talking about, then it’s probably your next door neighbor. They are everywhere. The lack of adequate care for these families is costing us all more money, and it is making us all sicker. There is no doubt about it.

Instead of pointing fingers, let me be forthright with you about the nature of our problems - so that we can tackle them together, head-on, with smart solutions. First let me point out that there is a difference between health care and health insurance. Both have problems, both need reform.

Specifically, the cost of actual health care in this country is too high. Because it is too expensive, adequate care is not being received by tens of millions of American families. Because it is too expensive, many families are unable to pay - either out of pocket or through an insurance company - to see a doctor when they need one. They aren’t receiving care for their sicknesses or injuries – they aren’t even receiving checkups to prevent further sickness or injury. They are, in effect living in a third world, right here in America. That fact is a disgrace, and it is one we are going to turn around starting with this session of Congress.

Bringing down the costs of care is the first domino that must fall if we are to provide adequate care to every American. To bring down these costs over the long run, we are going to have to make a few up-front investments which will bear fruit over the long term. We will also have to sacrifice in small ways which will pay dividends as the reform takes root. Many approaches will be taken, thorough assessments will be made, and both large and small changes will come in the way we administer care to our people.

To bring down the cost of care, some doctors are going to have to make less money. That’s not a fact that many aspiring medical professionals want to hear, but it is true. But while some doctors will have less money coming in to their offices, they will also be spending less money on overhead. That is news I would think everyone would like to hear. There are several ways we can accomplish this:

First, we will completely reform the way doctors are paid. Instead of a pay-for-service system, we will transform doctors’ offices across the land to a salary system with bonuses for better outcomes and higher quality, rather than quantity. Proactive care will be the focus, rather than reactive care. Doctors will spend more time with patients; they will better counsel their patients on good health habits such as hygiene and a proper diet and exercise regimen. They will order tests and perform procedures which are likely to enhance the quality of life of the patient, rather than taking shots in the dark which are unlikely to improve health. These changes will improve both the relationship between doctors and clients, and the overall health of our citizens by fundamentally changing the role of the doctor from pencil pusher to caregiver.

Second, we will reform the way medical liability insurance is structured by pushing dramatic tort reform. A good doctor cannot provide a high level of care while looking over his shoulder for someone to say “gotcha”. Many good doctors have closed their practices completely because they cannot afford the hundreds of thousands of dollars yearly that it costs to carry liability insurance. Besides the cost of the malpractice insurance itself, doctors are increasing the cost of health care by ordering so-called defensive medical tests in order to cover their liabilities. These duplicative and unnecessary tests are inflating costs while failing to make Americans healthier. The cycle must be stopped. Though it is imperative that a patient can sue for damages if they undergo a botched operation or receive poor care, there must be a reasonable limit to what can be recovered so that a few poor examples don’t escalate the cost of care for those who need it most. This change will be good for everyone, not just doctors.

Third, we will streamline the way medical information is acquired and processed. We will dramatically enhance the way online health records are kept so that duplicate information is unnecessary and a comprehensive health history is available for everyone without delay. We will make data from your throat culture from last fall and your immunizations from the seventh grade talk to each other so that doctors will be assisted in drawing parallels and trends in individual medical histories. By turning paper records into smart information, the doctor can provide better care for his or her patient, spend more time providing actual care rather than performing paperwork, and reduce costs and errors dramatically over the long run.

Fourth, we will recruit an army of new doctors and nurses to administer the care that will be needed by all of the newly insured families across America. We will assist with college tuition for the most skilled up-and-coming medical professionals in our country, and we will keep them here to treat our sick right here in America. We will provide incentives to doctors to open a new rural practice, or take a job at an urgent care center in a poor neighborhood or inner city. We will make it affordable for skilled men and women who care about treating the sick to go to school and become doctors and nurses if they go to a public institution and go to work in that state. We will assist these young people, we will subsidize their training, and we will keep them here in America. We will fight with all of our resources to have the best health care in the world administered by the best and brightest medical professionals in the world. Importantly, we will still save the American taxpayers untold trillions of dollars to do it. That will be the legacy of health care reform in our time.

Reducing the cost of care, like I said, is only the first domino to fall. But if we are going to increase quality and access of health care for every American, it is the first domino that must fall. After implementing these key changes to reduce costs, many other changes can and must be made to ensure that quality continues to improve while costs are kept in check. Primarily, we must completely transform health insurance itself. These next insurance reforms, like the previous four care reforms I’ve outlined, won’t be easy. They will come with significant pushback and they will require both compromise and innovative ideas.

First, most health insurance is administered by for-profit companies. Many of them have shareholders, which legally makes them bound to turn a profit. Anyone who has ever paid a premium knows that making a profit is something insurance companies are good at. The obscene profits made by insurance companies each year often come at the sacrifice of care for the patients who need their coverage most. This profit could be going back to the insured in the form of lower premiums and co-pays, it could be going back into hospital rooms in the form of better reimbursements to doctors and nurses, and it could be going back to the universities and laboratories to invest in more innovative treatments. In order to take profit considerations out of the decision making process, we will transform our health insurance industry into a field of non-profit companies and co-ops. We will make it illegal for health insurance companies to remain for-profit entities by the year 2015 under the new laws we pass with this Congress. No more will a sick person suffer in order to pad the earnings of an insurance company or its CEO.

Second, we will fundamentally transform the way Americans purchase their health insurance. Rather than staying at a crummy job because it provides your family health insurance you couldn’t otherwise afford, we will even the playing field so that the tax burden on individual insurance purchasers is no greater than that on employer-based purchasers. An individual must be free to choose the best insurance for their family without it affecting their career path. This is an inequity we will tackle immediately. Many employers will choose to continue to offer health care to their employees, and those employers will continue to enjoy tax breaks for doing so. But no longer will an individual be pressured into taking his employer’s coverage for fear that he or she cannot provide any better for their families. The days of the employer-based health insurance monopoly are over.

Third, we will reduce the geographical barriers to coverage. Insurance purchased in your home town of Cedar Rapids must also cover you if you get sick while on vacation in Orlando. If you purchase coverage that you like while living in Maine, you should be able to take that insurance with you when you take a new job in Minnesota. Likewise, families in New Jersey pay three times as much as they would pay in Pennsylvania (apples to apples) because the state of New Jersey mandates that any insurance purchased in the state must include several specific procedures that aren’t mandated in Pennsylvania. But maybe you’ve decided that you’re family doesn’t need vasectomy coverage or laser eye correction coverage. You should be free to call a company in Pennsylvania and get on board with their insurance plan if you so choose. This is a simple and obvious reform that we must make.

Fourth, and fundamental to our overhaul of the nation’s health insurance overhaul is the inclusion of every American in basic health insurance coverage by law. We will begin this process with the outlaw of the pre-existing condition clause for any and all insurance carriers, period. Then, we will mandate that all individuals purchase a minimum standard of health coverage to provide a backstop against catastrophic medical bills. For those individuals requiring financial assistance to purchase basic coverage, we will provide assistance to you. If you choose to purchase a plan that includes more coverage or lower deductibles, then that is a choice you can make for your family. We will make sure that plentiful and affordable options are there before you by instituting the previous principles I have outlined. But at a minimum, every American man, woman and child must be covered by a basic insurance which covers routine medical checkups, blood work, and common procedures to promote good health. On this principle there shall be no compromise.

When this Congress enacts into law the eight reforms I have detailed for you tonight, this nation will have taken a giant leap down the path toward stable, quality, affordable health care in our country. Rather than a tweak or a nudge, the state of care of our citizens is in desperate need of a fundamental transformation – and that is what we will achieve together, starting on this day. America has a responsibility to her citizens and the world to be a leader in all areas she can, and on health care we face a golden opportunity to leap ahead of the rest of the globe. We have the resources, we have the need, and we surely have the ideas to create a forward-looking health care system that will be the envy of the world.

While the road through comprehensive health care reform will be long and winding, all of us know in our hearts that it is a road we must travel. Rather than watch quality of life deteriorate while costs skyrocket, we must stop current trends in their tracks and fundamentally restructure the way care is administered in our nation. We owe it to our grandparents, our spouses and our children to take this journey in the spirit of a better tomorrow for all Americans. With your support, we take the first step on this journey forward tonight.

Thank you, and God Bless America.

Posted by Nick Stone on 9:23 AM. Filed under . You can follow any responses to this entry through the RSS 2.0