Obama town hall transcript

[DrToast]

http://www.cqpolitics.com/wmspage.cfm?docID=news-000003117832

Here's the bit on single-payer.

Q: Oh, thank you. Thank you, Mr. President. I work for one of the large corporations here. But I talk to a lot of people about health care. My question is, so many people go bankrupt using their credit cards to pay for health care. Why have they taken single-payer off the plate? (Applause.) And why is Senator Baucus on the Finance Committee discussing health care when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest? (Applause.)

THE PRESIDENT: Well, as you know, I campaigned vigorously on health care reform, and I think that we have a better chance of getting it done this year than we’ve had in decades. I am optimistic about us getting health care reform done.

Now, health care is one-sixth of our economy, so it is a complicated, difficult task. And Congress is going to have to work hard. And everybody is going to have to come at this with a practical perspective, as opposed to trying to be ideologically pure in getting it done.

Here are my principles in terms of health care: Number one, we’ve got to control costs across the system, because if we simply insured everybody under the current system, we couldn’t afford it -- we’d go broke. The fact of the matter is, is that families are seeing their premiums go up -- skyrocket each and every year. Businesses are getting crushed by the rising costs of their employees’ health care. And the federal government -- Medicare and Medicaid -- is going broke. That’s the single biggest driver, by the way, of our deficits.

I want everybody to be clear about this, because driving in I saw some folks who were saying, what are you going to do about debt, et cetera. Listen, by far the biggest contributor to our national debt and our annual deficit is the costs of Medicare and Medicaid -- as well as the other entitlement, Social Security -- defense, and interest on the national debt. That’s the lion’s share of the federal budget.

The things you read about in the newspapers and you see on TV about earmarks -- I want to get rid of earmarks, but the truth of the matter, they’re only 1 percent of the entire budget. Most of what’s driving us into debt is health care. And so we’ve got to drive down costs.

Now, here is some good news. There are ways that we can drive down costs, because we just have an inefficient system. If we emphasize prevention and wellness programs; if we help -- (applause) -- if we -- so that we’re reimbursing doctors and providers not just for treating people after they get sick but for helping people stay well if we use medical technology to reduce error rates and ensure electronic medical billing so when you go to the hospital, you don’t have 15, 20 forms that you have to fill out over and over and over again.

There are simple things that we can do that will save us money, so we need to focus on cost, that’s number one.

Number two, I think that it is very important that we provide coverage for all people, because if everybody’s got coverage then they’re not going to the emergency room for treatment. (Applause.) And right now, if you’ve got health insurance, the average family is paying about $900 a year in additional hidden costs because you’re subsidizing the folks who are going to the emergency room.

And so you’d be better off with a system that might cost the federal government overall a little bit more -- and we do have to pay for that -- but that would lower your premiums so that you don’t have these hidden costs, because it’s cheaper to treat a child for asthma with an inhaler than it is to have them go to the emergency room and take up a hospital bed. So that’s the second principle.

Now, this brings to the last principle, and so this touches on your point, and that is, why not do a single-payer system. (Applause.) Got the little single-payer advocates up here. (Applause.) All right. For those of you who don’t know, a single-payer system is like -- Medicare is sort of a single-payer system, but it’s only for people over 65, and the way it works is, the idea is that you don’t have insurance companies as middlemen. The government goes directly -- (applause) -- and pays doctors or nurses.

If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That’s the kind of system that you have in most industrialized countries around the world.

The only problem is that we’re not starting from scratch. We have historically a tradition of employer-based health care. And although there are a lot of people who are not satisfied with their health care, the truth is, is that the vast majority of people currently get health care from their employers and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.

So what I’ve said is, let’s set up a system where if you already have health care through your employer and you’re happy with it, you don’t have to change doctors, you don’t have to change plans -- nothing changes. If you don’t have health care or you’re highly unsatisfied with your health care, then let’s give you choices, let’s give you options, including a public plan that you could enroll in and sign up for. That’s been my proposal. (Applause.)

Now, obviously as President I’ve got to work with Congress to get this done and -- (laughter.) There are folks in Congress who are doing terrific work, they’re working hard. They’ve been having a series of hearings. I’m confident that both the House and the Senate are going to produce a bill before the August recess. And it may not have everything I want in there or everything you want in there, but it will be a vast improvement over what we currently have.

We’ll then have to reconcile the two bills, but I’m confident that we are going to get health care reform this year and start putting us on a path that’s sustainable over the long term. (Applause.) That’s a commitment I made during the campaign; I intend to keep it.

[snowdays]

1. Gawd--Obama is so lame with his excuse for not even putting Single-

payer on the table.

Be bold Obama--start from scratch instead of feeding the insurance industry--and them feeding campaigns.

[dflprincess]

2. Health and wellness programs will not work if people have insurance

that's so crappy they still can't afford to go in for routine maintenance and those are the kinds of policies more and more employers are opting for.

There's a lot of wiggle room and weasel words in this statement. He never addressed why single payer advocates aren't even being allowed to speak and he didn't answer the question about that crook Baucus. He used to tell us how he wanted to do something about the influence lobbyists have.

He can't expect us to trust us on this issue when he appears to have crawled in bed with the insureres.

[NYC_SKP]

3. Gawd--Obama is so honest and logical in describing a Single Payer option if you want it.

You see, I actually read the entire piece.

I think it's genius.

"If you don’t have health care or you’re highly unsatisfied with your health care, then let’s give you choices, let’s give you options, including a public plan that you could enroll in and sign up for. That’s been my proposal." (Applause.)

Sounds like single-payer if you want it, to me.

[snowdays]

5. If you believe what he says about SP--then you are taken in by the RW who

are spouting the same crap.

[Cha]

6. Thanks for reading the whole thing..

and highlighting that, NYCSKP!

[snowdays]

11. I did and I 'get it" even if you read with rose colored glasses

[snowdays]

4. Obama is scaring people--just like the RW--saying that they

will have to change doctors. That is NOT true. What a farce!!


see this.

http://www.youtube.com/watch?v=9dq4UyCvmoo

[NYC_SKP]

7. Please indicate where he said you'd have to change doctors, I'm not seeing it.

I don't think he said it, ever.

You cannot from this:

"So what I’ve said is, let’s set up a system where if you already have health care through your employer and you’re happy with it, you don’t have to change doctors, you don’t have to change plans -- nothing changes."

Assume that an SP plan would necessarily cause you to change doctors, that's an imaginary leap.

I'm certain that my personal doctor would stay with me, he is a strong advocate for SP and has been for years.

:patriot:

[snowdays]

10. and by implication--if SP comes into play--then everything changes.

[NYC_SKP]

13. Yep, one thing that changes is that EVERYONE has health care, that's cool!!!

And I'd argue that people with NO doctor might not have the problem of CHANGING DOCTORS, eh?

And I maintain that it's quite possible that most people with a doctor could keep that doctor.

Why on earth would that not be a possibility?

[Phoebe Loosinhouse]

8. The crux of the matter is how the public option is designed.

That will be the whole ball of wax when the final product is revealed. If the plan is not subsidized with taxpayer money aside from premiums, it will fail- the reason being that it will be a loser from the get go since a great many of the initial enrollees will be people with pre-existing conditions who have been denied insurance up to this point. The plan will run deficits immediately. There are some people who are trying to design a non-subsidized plan because they WANT it to fail.

Over time, if the plan is subsidized, well-designed and affordable, people who are disatisfied with their employer plans may migrate. This is what the insurance companies fear the most.

So, the vested interests want a poorly designed plan doomed to fail so they can bury public healthcare for the next twenty years and say, "but we tried and it didn't work!"

Be vigilant everyone about the design of the public plan.

[DrToast]

9. What I think is going to happen...

The public plan is going to serve as benchmark for the plans the private insurers need to offer.

It's there to keep the private insurers honest. If the private insurers don't reduce the costs as they claim, then people will start flocking to the public plan.

[grantcart]

12. You are correct that the design will determine whether or not the system succeeds or not.

But you are incorrect that the subsidy will determine whether or not it succeeds;

1) European single payer systems offer more coverage at 30% less cost because

a) they do not have a useless profit center
b) they don't waste a lot of money deciding coverage
c) greater economies of scale
d) other efficiencies


2) If the design of the system requires that private companies take people with pre exisiting conditions then some of the uninsured are even more likely to take private insurance -- these would be people of means who cannot purchase insurance at this time because of pre-existing conditions


3) As the public option becomes available many of their customers will go to the public option and their base of numbers will decline and they will sustain a loss on economies of scale.


Now it is possible that the design would be done in such a way as to create "an even playing field" for private companies. If this is what is done (and that is the phrase that you are hearing) then you are correct - a subsidy will determine the outcome.

[Boomerang Diddle]

14. Thanks for posting this.

Obama makes perfect sense to me on this issue and I agree with him.

[Phoebe Loosinhouse]

15. "Got the little single payer advocates up here" ? And he didn't answer the Baucus question nt.

[DrToast]

16. He can be condescending sometimes.

[cooolandrew]

17. As long as he's talking to the people we've got a good thing here. We should honor that at least.>

Remember the Bush years listening was off the table out the dining hall even. It's easy to get cynical after the last 8 years but no other candidate offered to actively listen as far as I recall. We should always encourage more of this democracy in motion.