Friday, August 14, 2009

The "Wide Open" Town Hall on Obama-care

Obama is on now. He is doing his initial talk and unctuously going on about how he wants to have a civil dialogue, a “civil” dialogue. “That is what democracy is about.” Now this is rich given that the Obamanoids wanted to have this all done and passed before the August break and has passed bills out of committee before the members of the committee had read them, before they had been printed.

Now he is giving his reasons: preventing insurance companies from dropping people after they get sick. He has some nice anecdotes. Who could disagree? Then again, even his number of 20,000 a year unjustly dropped does not seem a reason for a government takeover and a trillion dollar plan.

Then there is the discrimination against people with pre-existing conditions and caps on coverage. Well, insurance companies are not dead set against the pre-existing conditions reform as long as the burden is spread evenly among them. After all, insurance for a pre-existing condition is not insurance. And an end to caps is simply making it illegal to buy a cheaper policy. It is like ending the evil practice of selling non-Cadallacs. Moreover, isn’t it an argument for making the insurance market national? I should think that the regulations that make these practices possible are based on state laws?

Then he says that all of this has to be done because otherwise costs will spin out of control. And how does this happen? Why experts will get rid of care that you don’t need.

He makes the argument that we have an inefficient system because we pay more and yet we are not healthier than people in other industrialized countries. He proposes a uniquely American solution (though from his remarks it is clear that he would prefer a single payer system but those poor gun/religion clingers are too attached to their employer based health system), which has the advantage of being able to deflect any criticism based on bad outcomes in those countries by saying “Well, that is not what we are proposing.” It is like Communism—the countries where it was actually tried are never really communism.

Now he is brining back the 70s: pay hospitals for outcomes, not procedures. It is an incentive to get the procedure right the first time, it is also an incentive to make sure that the really sick people go to another hospital. And is it really the case that a major driver of cost inflation in the system is hospitals botching things to increase their bottom line?

Now his Oneness proposes that they will save money by instead of doing 5 tests doing one test and emailing the results to 5 specialists. Email? Thanks, Your Oneness. And thank you Al for inventing the internet too.

Quite interesting that he often bases his arguments on incentives and yet proposes more government command and control.

NRA guy asks a good question. Where are you going to get the money?

Obama cops to 80-90 billion a year cost for insuring 47 million but claims that he can get 2/3s from the evil insurance companies who are making record corporate profits (applause), or “wastes and inefficiencies.” The remainder will come from simply decreasing the rate of deductions for those making over 250,000 grand from 37% to 28%.

He gets a lot of applause on purely partisan remarks. That seems to be an indication that this is not a random draw even of a state like Montana that is tending Democratic.

NGO type begins by thanking Obama for the stimulus money that He gave her. It is not his money.

Question is about COBRA and portability. It seems that his argument for portability is really John McCain’s.

Wants to create an exchange to help small businesses. Isn’t that an argument for letting people buy insurance nationally rather than within their state?

Describes the public option as simply another option that may be better because it has no profit motive or lower overhead. Obama accepts that the public option would possibly drive out private insurance if it were subsidized but that it is not going to be subsidized. Well, fair enough, but if it is not subsidized what is the point? How is it different from the many non-profit insurance companies out there now?

Guy points out that medicare/caid are already under reimbursing the costs of hospitals. Now this raises the point that if they are already under paying how much more money is there to be saved? Obama answers the question very well pivoting to the point that you are already paying for the uninsured.

Small business woman’s question. Obama brings up the exchange.

I find this boy-girl thing a bit tedious.

Guy who sells insurance asks a question. Gutsy guy. “My intent is not to vilify private insurance companies, if that were my intent we wouldn’t be proposing to keep them.” (missed something) I am not anti-insurance—we after all allow them to exist.

Makes a really cleaver (and fallacious, I suspect) argument that he is doing insurance reform and expanding coverage at the same time is that the reason companies are unwilling to change some of these practices is that they are not large enough.

This is the first time I have ever been impressed by Obama. He seems to be able to answer succinctly when he gets a good, challenging question. Was this there all the time or was it something that adversity has brought out in the man? What ever else you can say the man is confident.

I think that he does great at this but I think for a lot of people a point has been passed. They have decided that he is a good talker and that if what he says seems to make sense at the moment there is always some clause or definition or fine print that you aren’t catching but that will come out once he has want he wants.

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