I watched the speech tonight and afterwards I participated in a conference call with the White House. Dan Pfeiffer, the White House deputy communications director, fielded our questions. So, what did I learn?
Number one, I learned that the South Carolinian GOP’s problems don’t end with their philandering governor, Mark Sanford. Rep. Joe Wilson (whose government website is loading very sloooowly) had the temerity to interrupt the president mid-speech and yell, “You lie.” Actually, the president wasn’t lying. He was correcting a lie about the health care reforms providing insurance coverage to illegal immigrants. They won’t. Wilson has now apologized and groveled before Rahm Emanuel. But Joe Wilson wasn’t alone in his rudeness and disrespect. Other Republican congressmen made heckling noises and some were even waving what appeared to be sheafs of paper.
Number two, I learned that Obama is willing to compromise on the public option to get the larger reform bill passed, but he isn’t willing to compromise on providing for some affordable option if people cannot afford mandated coverage.
It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.
For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice.
Number three, I learned that the primary focus of the White House push (as always in this center-right country) is to reassure the vast majority of people who already have health insurance that they aren’t going to get screwed in this deal. The key phrase is “security and stability,” and you’ll hear White House flaks repeat that phrase endlessly as if it came out of Paul Rosenberg’s magic framing hat. What does it mean? It means that you won’t lose your health insurance if you lose or change your job. You won’t be denied coverage for a preexisting condition. You won’t have your coverage denied on a technicality if you become sick or get injured. You won’t go bankrupt if you get sick because your annual and lifetime coverage will not be capped. And your premiums will hopefully go down. That is a lot of injustice cured in one bill.
Number Four, I learned that Obama has a disconcerting penchant for giving away goodies before he has locked down anything in return. He instructed his Health & Human Services secretary to begin implementing a Bush demonstration project to address ‘defensive medicine’ caused by fear of lawsuits. It’s a shot at the trial lawyers, a critical Democratic constituency. I don’t have a problem with taking some skin out of the trial lawyers, but did he win one Republican vote before he made this friendly gesture? I hope so, but I’ll believe it when I see it.
So, did the speech change anything? Maybe. He’s clearly trying to get something passed without having to resort to any parliamentary tricks. He definitely added pressure on anyone who is considering holding up the bill with a filibuster. The Republicans brought their townhall antics to the well of the House of Representatives, which won’t win them any sympathy from swing voters. But I don’t honestly know if he made any progress on moving the critical Senate at all.
It looks like he thinks the sweet middle spot is to make progressives cave on a public option from day one and make the centrists cave on not having any option at all. He can get a worthwhile bill out of this, but just barely. If he has to move much at all to the right, the whole thing won’t work to bring down costs, won’t provide an affordable option, and will be a political albatross if combined with a mandate.
Wait a second, you know that the speech wasn’t going to change minds in Congress. Didn’t you say that beforehand?
In my mind, the speech was designed largely to change the conversation in the media, which had been harping on town-hall meetings, death panels and all sorts of relatively trivial stuff. And I think he has accomplished that goal. The conversation and tone of the coverage should be different for a while.
And perhaps that changed tone of coverage will help shore up support among those who’ve been wavering, even if additional “yes” votes are not found.
It’s true that I doubted it would change any minds in Congress, but that was part of their goal, as confirmed to me by the White House after the speech.
While we’re on the topic, can you clarify the purpose of the conference call?
Was this the equivalent of a press conference for bloggers?
Or was it an attempt to rally support?
pretty much a press conference for bloggers.
Unfortunately Booman, I think you are right. I wonder if the progressive caucus will cave or continue to standup? Really, I would rather have no bill than one requiring mandates with no cost containment measure. There may have been a cost containment measure in the speech but I could not pick it up. If Obama gets a bill passed that hits the middle class in the pocket book, we are finished.
agreed. the progressive caucus is going to have to stay together to sink a bad bill, and that will be difficult.
on the other hand, with people like nyceve, slinklerwink, and jane hamsher whipping the crap out of the progressive caucus, it might not be as difficult as it has been in the past. susie has a link to larry o’donnell from last night, and he says much the same:
i think it could get quite ugly indeed for the democratic party.
Good speech, the pulpit was used to good effect, to reframe the issues.
I now see the public option as a tender plant, which may be able to grow into something worthwhile. Sneaky, backdoor, fine with me, just get it into the ground.
Still a little BS though. I don’t see how you can require health insurance the way you require auto insurance. What are they going to do, take your shoes away ? And are we going to tie up a Federal Court to try a healthy young refusenik ?
“Illegal” coverage ? Suppose a guy shows up at the ER with H1N1, or with a serious injury. The hospital is not going to refuse to treat, but the government is going to refuse to pay ?
Via email
The tort reform talk may be an insult to trial lawyers but basically Obama is negotiating away what little protection remains for victims of medical torts. Blaming the victims’ lawyers has always been the excuse. It’s really about not caring about justice for average people and saying screw off to innocent victims so that corporations can make a little more profit.
Ah, bipartisanship. Where no corporation gets left behind.
I don’t agree. We have room to negotiate on medical malpractice jurisprudence. We ought to make good reforms, but make the GOP make concessions to get them. Make one or two of them a hero in return for sensible reforms. I don’t have a problem with that.
What “reform” is needed? Tort law has been eroded over the last few decades and it’s one of the few ways for average people to be compensated for wrongs done to them. Don’t get me wrong. I’ve worked on some mass medical torts and I can see some ‘reform’ is needed, but what the conservative reformers want is not a fix but to make it impossible for victims to be compensated.
There would be NO tort liability for corporations if conservatives (and many Democrats, like Obama) had their way.
Just look at how our legislators sold out victims of torts in this very area of health care with ERISA. ERISA covers the plans that are employer-based and since the feds sort of regulated it, they took away some tort rights. So, if you were on an employer provided plan and your insurer denied coverage IN BAD FAITH, for no reason other than they don’t want to pay for instance, there is no punitive damages or other damages that have been traditionally awarded for bad faith insurers. What other force will require insurers to honor their contracts? You don’t think bad faith insurers should be punished? You don’t think tortfeasors should be held responsible?
Anyway, we’ve been whittling away at one of the few consumer protections we have left, tort reform, for awhile. In our new Feudal economy I guess it doesn’t surprise me Obama is willing to give it away. Just like our usury laws or allowing credit card companies to rape the innocent it’s just another fact of life in the ownership society.
I wish I could say I was surprised he’s willing to give it away for nothing. But I’m not. His shit eating grin as he gave it away kind of made me mad though. Could you imagine Reagan or Bush advertising to the opposition party he was willing to cave so readily and publicly on a long-held party position?
I may have been willing to give tort reform for single payer. Dude gave it away for nothin’ What a joke.
given the fact that the citizen has to go up against the insurer with a rubber band and a very small stone, i have alot of trouble with a plan to water down in any way the last refuge of the simple folk. unless and until we are truly offered some form of guarantee that if we have been harmed we will have true recourse, then throwng the goopers even a sliver of a bone is a disgrace – and such a change should be be a deal breaker for anyone who gives a damn about true health security.
I think we need to get lawyers and judges out of it completely, and have a no fault system like France and Scandinavia. Of course, if one doesn’t think their settlement is enough they can go to court instead of taking the settlement, but if done properly, this would no doubt result in less money than the settlement. Least that’s the way it’s structured over there.
And Obama and Clinton both proposed such a system in 2006, and it didn’t make it out of committee.
I agree, SFHawkguy, with you precisely. Why is Obama giving away this goodie with no counter offer at all from the Republicans? I am afraid we have a president with a spine like a chocolate eclair. In the face of naked self interest by the corporation owned Republican Party he is willing, apparently, to offer up the last remnants of tort protection for ordinary folks. How utterly and profoundly pathetic.
I don’t think this president will be able to arrest America’s downward arc. The rancor builds, the dollar crumbles, the frustration increases. I wonder when the nut jobs will bring out their guns.
the focus isn’t on insurers. It’s on doctors who have to buy their own malpractice insurance, and who may in many cases decide to order tests just to protect themselves from the threat of a lawsuit.
If Obama wants to take away the right to sue your doctor, then I’d obviously be against it. If he wants to place some reasonable caps on damages and find other ways to improve the situation for doctors, I am willing to listen.
There’s a difference between consumer protection and being the most sue-happy country on earth.
Let’s see — you answer a comment about malpractice reform by talking about taking away the right to sue insurance companies. I didn’t hear anything about that issue in the speech. I absolutely agree that there should be nothing to impede suing insurancecos for their characteristic fraud, but near as I can tell that was not the issue. If you have reason to think otherwise please explain.
On malpractice torts, I don’t see how anyone can argue that major reform isn’t needed. It has become a cash cow for lawyers and professional litigants and seriously impedes the practice of good medicine. The med students and interns I’ve heard from are mostly willing to give up the excess compensation if they can be left alone to try and heal people, free from interference by insuranceco vultures and malpractice tort entrepreneurs.
Unfortunately it looks like the debate will center on capping awards, which does take away patient rights, and not on limiting liability to genuine cases of fraud, incompetence, or negligence.
Well, both involve weakening the few remaining remedies victims of torts have. One involves coverage of health care the other involves health care malpractice–both are health care consumer protections the GOP and even Democrats have weakened over the last couple of decades.
Please describe who these “professional litigants” are that are abusing the system. They’re just not there. They are called victims of medical error and there are millions of medical errors each year and the vast majority do not result in litigation or even compensation.
And punitive damages or other non-economic damages are integral to our tort system because it is one of the few ways we prevent abuse and torts happenig in the future. The threat of damages is one of the few things that keeps insurance companies and big actors honest (and yes, using a “stick” is probably less effective on doctors than companies so some reform I could see is limiting Dr.’s personal liability as opposed to what the insurer chips in).
I’ve taken and defended many a deposition of a doctor and know that it is conventional wisdom among doctors that lawsuits are increasing and overly burndensome (a conventional wisdom spread by the GOP and centrist Dems like Obama) but this does not make it so. I don’t have time to go into it now but the little money saved on litigation, through tort reform, will simply mean doctors, insurance companies (professional liability companies–not health insurance), and the for-profit health care system in general will get to keep their money while injured victims of America’s system have even less recompense for the wrongs done to them. C’est la vie in America I guess. Take from the poor, the defenseless, the victims, and give to the powerful.
Now if there was a fully funded insurance program for victims of medical errors that really looked out for consumers I would be willing to give up our traditional tort approach for single payor. But this is not the deal proposed.
And while I have some sympathy for doctors I don’t buy this story they are selling; doctors do very well in modern-day America. They do much better than in other countries and they did in the past. They get a far greater share of the health care pie and one of the few downsides is they will probably get sued at some point and yes, even though America’s system is skewed to the powerful and against the powerless, there is still the semblance of a tort system and the occasional victim will get compensated plus punitive damages to punish the wrongdoer and to act as a warning to future wrongdoers.
And people do not recover unless there has been incompetence or negligence–by definition–as opposed to what you state. If a litigant filed a fraudulent claim against a doctor he would be in big trouble. There are millions of medical mistakes a year and just because they seek compensation for the damage done to them does not make them “professional litigants”.
Look, take, for instance, asbestos (I know it’s not med malpractice but it’s analogous). I’m positive there are a lot of people without asbestos-related diseases that are getting compensated. Part of the problem occurs when we don’t know why exactly this worker has a lung disease and maybe it’s from asbestos? So his recovery is less because we are not certain or are unclear about how he got his disease and how much his work with asbestos causes this. But are these people frauds because they got sick and think it might be because of their work with a toxic and deadly product? Maybe some people that got sick from smoking, for instance, and not asbestos are being compensated. But surely you think a worker who is losing his life because his company didn’t heed the warnings that others around the world heeded and required him to take a risk for the company’s profit. Now that many workers are dying from the risk their employers agreed to take they have sued for compensation. I would be willing to “reform” our system to deal with the large number of claims and take away punitive or big awards so that everyone will get a little compensation and the court’s won’t be clogged righting all the wrongs done to this many people. But we need worker and consumer protections in place that do just as good a job as tort reform before we “reform”.
Republicans and evidently many Democrats now want to take away that last remaining protection for victims. Not good.
Incompetence and negligence are not cut and dried standards. The squeakiest wheel gets the grease in this area, too. Doctors are sued all the time because they used their best judgement and the case went bad anyway. Most of the time the hospital/doctor/insurer will settle for a relatively small amount rather than go through the costs of litigation and the likelihood of a jury that just wants to make it better for the “victim” without understanding whether what the doctor did was reasonable or negligent.
I have no problem with high awards, including punitive damages, where there was real negligence or bad practice involved, as opposed simply to a bad outcome. Such cases would be relatively rare — probably rare enough that the offending doctor would become unemployable and hence no longer a danger to patients.
As I understand it, the mega-jackpots are not the real cause of unsustainable malpractice insurance rates. It’s the smaller “sympathy” awards that cause the trouble. When doctors are forced into CYA medicine, it’s pretty obvious that the costs of unneeded tests and procedures are going to raise the costs for everybody and degrade the practice of medicine.
To me, reform would center on proving real negligence, not just bad outcomes. It would probably have to give more weight to medical experts than just the hired witnesses produced by lawyers. The current malpractice system drives out the best, most dedicated, doctors while it’s just another cost of doing business for the worst. You seem to think doctors are the villains in the medical mess. I think the good ones are as much the victims of our shameful healthcare system as the patients.
No system that is designed to determine the truth is perfect. What you are suggesting is basically tinkering with our court system (and of course most cases settle out of court after the parties have examined the evidence and been able to analyze the probability of success at trial). It’s rough justice but no justice is perfect. And what the tort reformers are proposing is worse; an inherently unjust system that leaves victims under protected and puts a big fat thumb on the corporate side of the judicial scale.
Here is part of the Wiki entry on “medical malpractice” which estimates the number of people that are victims of medical malpractice (and no one is saying doctors are acting maliciously; everyone makes mistakes):
Statistics
Main article: Medical error
A 2004 study of medical malpractice claims in the United States examining primary care malpractice found that though incidence of negligence in hospitals produced a greater proportion of severe outcomes, the total number of errors and deaths due to errors were greater for outpatient settings. No single medical condition was associated with more than five percent of all negligence claims, and one-third of all claims were the result of misdiagnosis.[6]
A recent study by Healthgrades found that an average of 195,000 hospital deaths in each of the years 2000, 2001 and 2002 in the U.S. were due to potentially preventable medical errors. Researchers examined 37 million patient records and applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a study published in the Journal of the American Medical Association (JAMA) in October 2003. The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic.[7] Some researchers questioned the accuracy of the 1999 IOM study, reporting both significant subjectivity in determining which deaths were “avoidable” or due to medical error and an erroneous assumption that 100% of patients would have survived if optimal care had been provided. A 2001 study in JAMA estimated that only 1 in 10,000 patients admitted to the hospital would have lived for 3 months or more had “optimal” care been provided.[8]
A 2006 follow-up to the 1999 Institute of Medicine study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. The report stated that these are likely to be conservative estimates. In 2000 alone, the extra medical costs incurred by preventable drug related injuries approximated $887 million – and the study looked only at injuries sustained by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs.[9]
Most (73%) settled malpractice claims involve medical error. A 2006 study published in the New England Journal of Medicine concluded that claims without evidence of error “are not uncommon, but most [72%] are denied compensation. The vast majority of expenditures [54%] go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant.” Physicians examined the records of 1452 closed malpractice claims. Ninety-seven percent were associated with injury; of them, 73% got compensation. Three percent of the claims were not associated with injuries; of them, 16% got compensation. 63% were associated with errors; of them, 73% got compensation (average $521,560). Thirty-seven percent were not associated with errors; of them, 28% got compensation (average $313,205). Claims not associated with errors accounted for 13 to 16% percent of the total costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including lawyers, experts, and courts). Claims involving errors accounted for 78 percent of administrative costs.[10][11]
But you’re right that Dr.’s and medical professionals are trying their best and should not be treated like criminals. I would be fine if we set up a fair compensation system with real protections for the many victims each year.
One thing I was thinking about and is really not acknowledged is that single payer health care WOULD BE TORT REFORM. If you take away compensatory damages for medical care, because the government pays for basic medical care anyway, plaintiffs would not be able to get awarded these damages. Lawyers would have less of a reason to take these cases and pursue punitive damages or other damages.
So, if we had single payor and a well-funded insurance program to compensate victims of accident, and a tort system for the grossly negligent, or something like that, I would be all for it.
Couldn’t agree more. As it stands, the court system is a bad substitute for universal health care.
In the meantime, maybe requiring hospitals to provide treatment for physician-caused medical problems would be a step in the right direction. Wouldn’t work with independent practitioners and wouldn’t stop the litigious from trying to collect just because a treatment didn’t work but it seems like it would significantly lower the cost of malpractice insurance.
It really bears repeating though: Single Payer Health Care IS TORT REFORM. We wouldn’t have to litigate the damages for medical expenses because it’s covered for all citizens! Well, there would be still be some reason to litigate that issue–but it would be limited. How much is wasted over litigating who should pay for health care?
If you took away compensatory damages for medical expenses there would be far fewer lawsuits, far fewer in damages awarded, etc. Malpractice premiums would presumably come down (if one buys the canard that high premiums are a result of malpractice claims). This may apply to automobile accidents as well. It would cost less to cover auto policies under single payer (whether this will be passed on to the policy holders I don’t know). If you really want to reduce litigation enact single payer!
As this diary explains, http://www.dailykos.com/story/2009/9/8/778839/-Tort-Reform-for-%28Doctors-Who-Are%29-Dummies , we’ve already limited “pain and suffering” damages in many states, and already have enacted tort reform in many states, and there just simply isn’t the evidence of a wave of runaway juries awarding high awards for nonexistent injuries.
none of the republicans want to be that hero.
even “reasonable” olympia snowe has said she’s 100% against the public option.
so why make any concessions to these kooks at all? none of them are going to support the final bill anyway.
On a side note, thank GOD for Rep. Joe Wilson, who demonstrated on national television that the GOP has been reduced to drooling nutjobs.
Apparently Wilson apologized through Rahm. Now, i have no love for Rahm, but i would have LOVED to have been the fly on that wall.
that’s my point. Why give something of value away, even if it is worth doing, before you have secured something in exchange for it?
My kid and I watched the speech and I thought it was brilliant. Did his plan go as far as I wanted? No. Hell No. But, it may be as far as the envelope can be pushed.
For me, the highlight was when the republicans booed the president and my daughter said to me, “Can they do that?
Didn’t they learn basic respect?” “This is our congress! That is just wrong”.
Yeah, even our kids know that booing in a place like that and a time like that is just poor taste and tacky.
bdetween this comment
and this one:
…I get the distinct impression you are not impressed.
I’m not particularly excited.
I think the speech massively upped the pressure on legislators to go along with the plan. Despite all the “reaching out”, the scene Obama painted was a stark comparison between a rational and decent vision of a fair and just healthcare system and the childish tantrums and lies of the other side. He let the wrong side take their shots and then defanged them by making everything they said an embarrassment. It will be very hard for members of Congress to justify further obstruction, at least in districts and states without an insane majority. As persuasion I think the speech was brilliant and the timing perfect. It changed the terms of debate for the immediate struggle and future policymaking.
The guts of the plan remain pretty open. Lefties and liberals will still have to fight like hell to keep Congress from trying to get by with mere windowdressing. Personally I think we’ve focused too much on the public option instead of the broader imperative of preventing the “reform” from becoming just another tax on the middle class in the form of a mandate without real affordability. I have to think that even the dumbest blue dogs would be aware that such an outcome would be political poison for the Democratic Party, starting with themselves.
I had thought that this bill had to be the comprehensive end-all be-all for all time — that this would be the one chance in a generation. Now that’s looking a little different. I think whatever bill is passed — as long as it eliminates discrimination against sick people and people who once were sick, and takes away the fear that losing/changing jobs means playing russian roulette — can be exactly what terrifies the GOP and their industry sponsors: a sea change in how we look at what health care is supposed to be. Until now, the current predatory system has been the default that every effort at change has had to try to knock down before even getting to the details of a new regime. With the new bill the game will be irreversibly changed. We will no longer have to argue about what a medical system should be about, but how to make the system do what its enablers said it’s for. That changes everything.