Thoughts on Obama's speech

These are my off-the-cuff, as I read the text, reactions to Obama's health care speech.

"Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer."
If you are lucky. We found that buying coverage on our own was cheaper for at least my husband and daughters, and these days I'm wondering if there might have been a cheaper option for me as well. But I can accept this as an average.

"More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care."
Yep, this is what I worry about. Pre-existing conditions and job loss.

"Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most."
Okay, this is something I want to see . . . I think. A little clarification might be nice, though. But it sounds like something I think we need.

"We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick."
I think I disagree with this. People should be allowed to take higher deductibles and pay more out of pocket if they choose. A person can reasonably save $20K in their life, and choose to take a $20K deductible to lower their health insurance costs. A person who works hard might be able to save $100K, and some people would rather depend on home equity they've built up than pay for a low-deductible plan. There should not be such a limit, IMO.

"And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives."
"With no extra charge" worries me. Are they saying that insurance companies shouldn't be reimbursed for this care? That doesn't make sense to me. But I do want to see incentives of SOME kind for people to get preventative care, so this might be something I agree with . . . more clarification is needed.


"the second part of this plan will finally offer you quality, affordable choices. . . . We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices."

How is this different from eHealthInsurance.com? That's what we used to shop around for competitively priced insurance. And it worked GREAT for us! I guess I don't see why the government is doing this, what it is adding. Visibility of choice, at least, I guess. There is something to be said for that.

"In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it."
A public option for catastrophic care? Is that what this is? If so, I support it whole-heartedly. And also if it is just for those w/ pre-existing conditions.

"That's why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance."
I call bullshit. I don't think a single state has this requirement. I know lots of people who don't carry auto-insurance. The consequence, of course, is that they aren't legally allowed to drive - but there is a way to avoid it. I have used this option in the past to save money. I know people who never bothered to get their license. Sorry, the analogy proves your opponents' points.

Also, what is the definiton of "basic" health isurance? Catasrophic + preventative care makes more sense. Anything else should NOT be required for sure - there are ways to handle more normal expenses, like savings. And we need to be careful not to over-cover care so that market forces continue to apply.

"And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place."
This had better be true.

"But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange."
I support this, with some misgivings.
"based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up."
I find this plausible. I really don't know that a public option would be able to offer anything better than a private option - unless it's subsidized (duh duh duhhhhhh).
"[Insurance companies] argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects."
Yep, I support this. That's my main misgiving.

"And if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term."
Boy, "the long term" - is that ever vague! Ten years? One hundred? Infinity, approaching 4 trillion as an asymptote?

Hrm . . . other than mandated health insurance and possibly limits on out-of-pocket expenses, it actually sounds pretty good to me. I really don't like the insurance mandate, unless it's basically catastrophic care and maybe a little preventative care that gets insured, but I do want to see a non-subsidized public option. And I don't believe we're going to get all this for free, either.