Live Blog: Obama's Health Care Townhall

I'm watching Obama's health care reform town hall on C-Span. The White House and Facebook sites had very choppy audio. So far it looks like an HCANned rally or an OFA house party, heavy on health care horror stories, light on explanations of the reform bills that are on the table. The only difference is that if you told your horror story here, you got a hug from Obama together with his promise of immediate help, not a small difference to the one person, but not all that helpful to the rest of us. According to the American Cancer Society, in 2006 there were 559,888 cancer deaths. According to Cancer.org, there were an estimated 1,372,910 new cancer cases in 2005. Lots of these people are uninsured or underinsured. As sweet a guy as he is, Barack cannot hug and help all of these people. Health care cannot be looked at in this piecemeal, throw a charity bake sale way we tend to look at it in this country.

Single payer? He says it's too disruptive. Yawn. Thats been his latest buzzphrase. It's misleading because changing the payer does not change the provider. What changes ones provider? It's the currently disruptive concept of plan networks. Insurance plans have networks of providers and the networks are a moving target, providers move in and out of them. Every single time I go to my doctor, there is a new note on the wall saying that such and such plan is no longer accepted. Plan networks are undisturbed by any of the legislation on the table, but no longer exist under a single payer system.

Also, President Obama forgets to explain how the US implemented Medicare long before the technology revolution. That worked out pretty well without any longterm aches from disruption. What could be disruptive under the currently proposed legislation? Providers refusing to accept those covered by the public option. There's nothing in currently proposed legislation to stop that from happening.

Why exchanges? I'm not really sure what he's saying. Help people find plans, increase buyer's leverage. That's what they said about mortgage brokers and we've seen how well that worked out. Why doesn't the industry pay for the exchanges if they want a better way to sell their products.

Healthcare-Now just missed a good opportunity to ask a question going back to single payer. Their question was too vague about costs and it basically left President Obama answering republican and industry claims, not answering the real cost question why not save the money that single payer would save?

Taxation of health benefits. Obama opposed during the campaign. The current proposal calls for a cap on the exclusion so high priced health care only get a deduction up to a certain point. The question is does it lower costs by creating only sensible plans. Obama prefers to cap itemized deductions, ensure those with health care do not see costs go up as other people's costs go down. His bottom line is to prevent costs from going up.

A Texas doctor is saying that defensive medicine is what increases costs. It's a tort reform argument, but before we even get to that let's examine his statement that they know what works in Texas. Isn't the most expensive health care town a town in Texas? Yes it is, McAllen, Texas. Obama is talking about real medical mistakes and the very severe damage that can be caused, he wants to cover people medical costs and pain and suffering. He wants to reduce costs when they actually perform effectively. He'll work with the AMA on that, but didn't we learn that only about 20% of the AMA is made up of practicing doctors. Ahhh, Obama mentioned McAllen! Good for him. Better than what they do to cap lawsuits in Texas would be what they do at Mayo, develop a team at the outset of a case and coordinating care.

It's looking like the crowd is filled with advocates and not average Americans. Now, he's talking to an SEIU member, previously there was someone from Healthcare-Now.

So, what does he want these advocates to do. Stop the old arguments that this is a government takeover of health care. Wants to make sure that we get our money's worth, doesn't want to provide $x in subsidies (but that's what the bills actually do). He wants a private plan to compete. They argue against it but if their plans are giving such a great deal, why are they worried about competing with the public plan. Not rationing, being sensible.

Obama wants people to pay attention to the argument and not let people scare you into keeping a system that is not working.

Now he's explaining that the process Congress goes through is to keep stability, but this is one of the times we need to build the will to make a change.

Blasting band music, now it really looks like an HCAN rally.

The dialogue is still at a high level with few specifics about the pending bills being discussed. While they did discuss the exchanges a bit--for the first time I've ever heard any discussion about the exchanges, he never really explained why that is a cost for the government and not the industry. He also didn't explain how they lower costs. The basic idea of an exchange (or gateway under the Senate bill) is to put out all the information on the Internet to help individuals and small employers shop for plans. They use an exchange in Massachusetts and costs have not gone down there. Another problem in Mass. is that the lower priced plans on the connector board are deceptive in that low premiums mask lots of other out-of-pocket costs such as copays, deductibles and co-insurance. The bottom line is the old line, you get what you pay for. We need to lower total costs, not just play with premiums to sell a product and why the taxpayers should fund a misleading marketplace like that is beyond me.

To me, the best value of the exchange would be some of the other reasons listed by the Kaiser Family Foundation, increase portability and move people off employer plans. However, that only benefits people if we take the next step and create a single payer. Without that, you have the shopping mechanism, but no one to pay the bill or control costs. Portability, but everyone's on an individual plan, more ownership society as in you're on your own.