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Wednesday, September 09, 2009

The Speech We Needed

President Obama's speech of September 9, 2009 had three crucial goals:

1) replace the current sense of paralysis for one of momentum and progress
2) outline a core set of principles that justify the structure of the proposals he's promoting
3) recast the core of the debate from a partisan political battle to a moral reflection of our collective American character -- an appeal to our "better angels"

At this point, any debate about whether the speech achieved those goals may be moot (or "mute" if yous ignert).

The more appropriate question would be -- What was the speech we needed?

Answering that question requires an understanding of the portion of the voting public that's still capable of moving the debate. Based upon most news stories over the past month of "town hall meetings", that audience is actually the large percentage of workers who actually have insurance coverage right now. To date, this group hasn't become terribly concerned or involved with the debate because even though they may not be thrilled with their employer-provided coverage, they have concluded

1) unemployment is high but I still have a job
2) my job provides coverage
3) I may not like the terms of my coverage but I've covered for the big stuff

In short, I got mine, I don't understand all this stuff, so just leave it alone.

Obama's speech ended with a fabulous rhetorical flourish related to goal #3 -- We did not come to fear the future. We came here to shape it. None of that is going to click with the "I got mine" crowd.

What would click?

Here's an abbreviated speech that would have made the appropriate point to the appropriate subset of Americans that could really drive their elected officials to ensure substantive change is made to both health care and health insurance.

My fellow Americans, on the issue of healthcare, we Americans are divided into several distinct camps based on a combination of long-held ideological views and short-term indifference. Frankly, for those of you out on the fringes of the left or right of this issue, nothing I say here will convince you of the merit of any change in your views. We already know how many don't have insurance. We already know the costs of emergency care for those without insurance is being subsidized by those of us with coverage or by taxpayers. We already know insurance companies want to be free to cherry pick low-risk customers yet at the same time preventing lower-cost alternatives from being provided to those excluded from coverage.

For those who have been comfortably indifferent to this issue, it is you who need to listen to what I'm going to state here. I'm talking about you out there with jobs, with families, with employer-paid healthcare insurance who are still ambivalent about the dangers posed by our current insurance and care delivery systems. I'm talking about those of you out there comfortably retired with a pension and retiree health care coverage and a 401k.

Wake up.

You have a job now, but we have fifteen percent real unemployment. Your wages have been flat but you haven't aggressively sought higher paying jobs because at least you have healthcare coverage. Even if you have a job you may not like or sub-par pay, you worry about changing employers because you worry about taking a chance with a new employer who might lay you off with no way to come back to your prior job and resume coverage. Even if you don't worry about the employer change, you worry about whether the new employer's insurance will exclude coverage for a pre-existing condition for you or a family member. The feeling of healthcare coverage limbo between jobs isn't the real issue though.

The real issue you need to understand is the very real chance you don't actually have the coverage you think you do. You've been tolerating a possibly crappy job, possibly crappy pay, a possibly crappy corporate employer to hang on to dear life for insurance coverage that when you REALLY need it may turn out to be a phantom -- an very expensive illusion. The minute you file a claim for a serious (expensive) condition, you encounter a giant corporation bent on finding rules allowing them to exclude payment or allowing them to drop you entirely. After you've paid thousands in premiums for years. After being diagnosed with a condition that will now likely allow any other insurance company to exclude you leaving you completely alone.

The real issue you need to understand is that any healthcare coverage you may enjoy as a retiree of any large company faces grave dangers in the current financial climate. The financial contraction is not over, tighter credit markets will continue to squeeze weak financial institutions including banks and insurance companies and investment firms, further squeezing company pension plans, 401k balances, and reserves for employee / retiree healthcare coverage. If your former employer goes bankrupt, obligations for retiree healthcare are the first to be jettisoned in any bankruptcy.

The current system of healthcare insurance and providers is acting as a growing drag on EVERY sector of the American economy and has reached critical mass in its ability to kill jobs, bankrupt firms and bankrupt families. The only way to break the downward spiral, stabilize the economy and begin re-orienting the delivery of care is to

1) force insurance companies to compete without exclusions or retroactive denial of coverage
2) provide alternate sources of coverage to break the death grip of employers on insurance pricing
3) combine meaningful tort reform with objective, public reporting on care quality to eliminate defensive medicine

That's what the American people deserve, that's what I aim to deliver and that's what you should demand from your Representatives and Senators in this chamber.


THAT'S the speech I would have preferred hearing to kick-start reform.