Obama’s health care stand

by David Safier
Below is the full text of a letter Obama sent to Senators Kennedy and Baucus laying out his stand on health care legislation. Here is the paragraph that had the items I care most about: no denial of care for preexisting conditions and a public health care insurance option.

The plans you are discussing embody my core belief that Americans should
have better choices for health insurance, building on the principle that if
they like the coverage they have now, they can keep it, while seeing their
costs lowered as our reforms take hold. But for those who don't have such
options, I agree that we should create a health insurance exchange — a
market where Americans can one-stop shop for a health care plan, compare
benefits and prices, and choose the plan that's best for them, in the same
way that Members of Congress and their families can. None of these plans
should deny coverage on the basis of a preexisting condition, and all of
these plans should include an affordable basic benefit package that includes
prevention, and protection against catastrophic costs. I strongly believe
that Americans should have the choice of a public health insurance option
operating alongside private plans. This will give them a better range of
choices, make the health care market more competitive, and keep insurance
companies honest.

I'm a single payer guy myself, but if I can't have that, these are the items we have to preserve.

Here's the whole letter.

June 2, 2009

The Honorable Edward M. Kennedy

The Honorable Max Baucus

United States Senate

Washington, D.C. 20510

Dear Senator Kennedy and Senator Baucus:

The meeting that we held today was very productive and I want to commend you
for your leadership — and the hard work your Committees are doing on health
care reform, one of the most urgent and important challenges confronting us
as a Nation.

In 2009, health care reform is not a luxury. It's a necessity we cannot
defer. Soaring health care costs make our current course unsustainable. It
is unsustainable for our families, whose spiraling premiums and
out-of-pocket expenses are pushing them into bankruptcy and forcing them to
go without the checkups and prescriptions they need. It is unsustainable for
businesses, forcing more and more of them to choose between keeping their
doors open or covering their workers. And the ever-increasing cost of
Medicare and Medicaid are among the main drivers of enormous budget deficits
that are threatening our economic future.

In short, the status quo is broken, and pouring money into a broken system
only perpetuates its inefficiencies. Doing nothing would only put our entire
health care system at risk. Without meaningful reform, one fifth of our
economy is projected to be tied up in our health care system in 10 years;
millions more Americans are expected to go without insurance; and outside of
what they are receiving for health care, workers are projected to see their
take-home pay actually fall over time.

We simply cannot afford to postpone health care reform any longer. This
recognition has led an unprecedented coalition to emerge on behalf of reform
— hospitals, physicians, and health insurers, labor and business, Democrats
and Republicans. These groups, adversaries in past efforts, are now standing
as partners on the same side of this debate.

At this historic juncture, we share the goal of quality, affordable health
care for all Americans. But I want to stress that reform cannot mean
focusing on expanded coverage alone. Indeed, without a serious, sustained
effort to reduce the growth rate of health care costs, affordable health
care coverage will remain out of reach. So we must attack the root causes of
the inflation in health care. That means promoting the best practices, not
simply the most expensive. We should ask why places like the Mayo Clinic in
Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer
the highest quality care at costs well below the national norm. We need to
learn from their successes and replicate those best practices across our
country. That's how we can achieve reform that preserves and strengthens
what's best about our health care system, while fixing what is broken.

The plans you are discussing embody my core belief that Americans should
have better choices for health insurance, building on the principle that if
they like the coverage they have now, they can keep it, while seeing their
costs lowered as our reforms take hold. But for those who don't have such
options, I agree that we should create a health insurance exchange — a
market where Americans can one-stop shop for a health care plan, compare
benefits and prices, and choose the plan that's best for them, in the same
way that Members of Congress and their families can. None of these plans
should deny coverage on the basis of a preexisting condition, and all of
these plans should include an affordable basic benefit package that includes
prevention, and protection against catastrophic costs. I strongly believe
that Americans should have the choice of a public health insurance option
operating alongside private plans. This will give them a better range of
choices, make the health care market more competitive, and keep insurance
companies honest.

I understand the Committees are moving towards a principle of shared
responsibility — making every American responsible for having health
insurance coverage, and asking that employers share in the cost. I share the
goal of ending lapses and gaps in coverage that make us less healthy and
drive up everyone's costs, and I am open to your ideas on shared
responsibility. But I believe if we are going to make people responsible for
owning health insurance, we must make health care affordable. If we do end
up with a system where people are responsible for their own insurance, we
need to provide a hardship waiver to exempt Americans who cannot afford it.
In addition, while I believe that employers have a responsibility to support
health insurance for their employees, small businesses face a number of
special challenges in affording health benefits and should be exempted.

Health care reform must not add to our deficits over the next 10 years — it
must be at least deficit neutral and put America on a path to reducing its
deficit over time. To fulfill this promise, I have set aside $635 billion in
a health reserve fund as a down payment on reform. This reserve fund
includes a number of proposals to cut spending by $309 billion over

10 years –reducing overpayments to Medicare Advantage private insurers;
strengthening Medicare and Medicaid payment accuracy by cutting waste, fraud
and abuse; improving care for Medicare patients after hospitalizations; and
encouraging physicians to form "accountable care organizations" to improve
the quality of care for Medicare patients. The reserve fund also includes a
proposal to limit the tax rate at which high-income taxpayers can take
itemized deductions to 28 percent, which, together with other steps to close
loopholes, would raise $326 billion over 10 years.

I am committed to working with the Congress to fully offset the cost of
health care reform by reducing Medicare and Medicaid spending by another
$200 to $300 billion over the next 10 years, and by enacting appropriate
proposals to generate additional revenues. These savings will come not only
by adopting new technologies and addressing the vastly different costs of
care, but from going after the key drivers of skyrocketing health care
costs, including unmanaged chronic diseases, duplicated tests, and
unnecessary hospital readmissions.

To identify and achieve additional savings, I am also open to your ideas
about giving special consideration to the recommendations of the Medicare
Payment Advisory Commission (MedPAC), a commission created by a Republican
Congress. Under this approach, MedPAC's recommendations on cost reductions
would be adopted unless opposed by a joint resolution of the Congress. This
is similar to a process that has been used effectively by a commission
charged with closing military bases, and could be a valuable tool to help
achieve health care reform in a fiscally responsible way.

These are some of the issues I look forward to discussing with you in
greater detail in the weeks and months ahead. But this year, we must do more
than discuss. We must act. The American people and America's future demand
it.

I know that you have reached out to Republican colleagues, as I have, and
that you have worked hard to reach a bipartisan consensus about many of
these issues. I remain hopeful that many Republicans will join us in
enacting this historic legislation that will lower health care costs for
families, businesses, and governments, and improve the lives of millions of
Americans. So, I appreciate your efforts, and look forward to working with
you so that the Congress can complete health care reform by October.

Sincerely,

BARACK OBAMA


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