From the September 10, 2009 National Review Online
September 10, 2009
by Tevi Troy
[EDITOR’S NOTE: The material in italics actually appeared in President Obama’s speech of Sept. 9, 2009. The other material is an improvement suggested by health-care-policy expert Tevi Troy.]
Madam Speaker, Vice President Biden, Members of Congress, and the American people: . . .
Tonight, I return to speak to all of you about an issue that is central to [our] future — and that is the issue of health care.
Our health-care system faces many challenges, and we as a society need to address these challenges for both moral and financial reasons. In reviewing this issue during our national conversation over the last few months, I have learned that we face two main problems in health care: first, our government faces long-term insolvency due to high costs; and second, millions of Americans lack access to care.
We have tried over the last few months to have the majority party in Congress craft a series of bills to address these challenges. Unfortunately, the bills produced under this approach would not solve the main problems we are facing.
I recognize that the bills produced so far cost a trillion dollars, and fail to provide universal coverage. I recognize that the nonpartisan Congressional Budget Office has consistently found that the bills crafted by the majority party do not do what I have asked, and do not achieve what I promised the American people that we would accomplish.
For this reason, I propose that tonight we begin from scratch. We should proceed with a process that will be bipartisan, and bicameral, and that will not be beholden to the status quo or interest-group politics. We should bring Republicans to the table and hammer out an agreement that Americans from both parties can support.
I have asked in the past what the critics would do to fix the system, and in the last few days I have looked at the variety of ideas Republicans have offered to fix our health-care system. Many of them are good ideas, and I would like to incorporate them into this new, reset version of health-care reform.
To improve access, increase portability, and reduce cost, I would like to allow Americans to be able to purchase health insurance across state lines, an idea long promoted by Congressman John Shadegg, Republican of Arizona. The fact that there are 2,100 different mandates out there increases costs and makes it harder for individuals to find insurance plans that work for them. Allowing Americans to reach across state lines in purchasing health insurance will provide more options — and more affordable options — to Americans seeking health insurance.
Another cost driver is medical-malpractice lawsuits, which have three kinds of devastating impacts on our health-care system. First, they cost doctors, hospitals, and suppliers billions of dollars in lawsuits without improving patient care at all. Second, frivolous lawsuits encourage doctors to practice defensive medicine to protect themselves from lawsuits, which increases costs for everyone, without providing benefits for patients. Third, the high cost of malpractice insurance drives doctors out of practice areas and increases patient costs, once again without providing benefits.
To address this problem, we should embrace real tort reform. I propose immediately adopting a Bush administration idea to authorize demonstration projects in individual states to test alternatives to lawsuits to resolve disputes. In addition, I recognize that this problem needs a legislative solution. Therefore, I will ask Congress to pass the medical-malpractice-reform bill passed by the House in 2005, which would have placed caps on noneconomic and punitive damages and limited contingency fees for tort lawyers, among other good ideas.
We should also look at the shape of the problem of the uninsured. Although I have talked about the number of the uninsured being 47 million, I now recognize that the number is lower than that, perhaps in the range of 30 million people. But it is important to recognize that those 30 million are uninsured for different reasons, and that we should target our solutions to the reasons that they are uninsured. One significant segment — approximately 12 million people — are already eligible for forms of public health-care assistance such as Medicaid, but are not taking advantage of them. I therefore endorse a provision in the bicameral Burr-Coburn/Ryan-Nunes bill, which calls for auto-enrollment of individuals eligible for but not taking advantage of public health assistance.
I also recognize that there are areas of agreement between the parties, and we should take advantage of that agreement to nail down specific improvements to our system. For example, Democrats and Republicans alike support making sure that all Americans can purchase insurance, regardless of preexisting conditions. In addition, both Democrats and Republicans would like to see increased portability, so that Americans who leave their jobs could take their insurance with them. It should be relatively easy to craft mutually acceptable language in these areas, and we should not let some of the more contentious issues in the debate get in the way of forging agreements where we can.
One person who would have understood this was the late Ted Kennedy. Senator Kennedy was committed to health reform, but he was also committed to the art of compromise with those with whom he disagreed. He was a tough negotiator, but once you came to agreement with him, his word was his bond, and as a result he was able to establish trusting relationships with his Republican colleagues. Like Senator Kennedy, I recognize that something as important as health reform will require working across the aisle with Republicans. Threats, insults, and dismissive comments will not bring us closer to the agreements we will need to craft in order to fix our broken system.
We did not come to fear the future. We came here to shape it. I still believe we can act even when it’s hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history’s test.
Because that is who we are. That is our calling. That is our character. Thank you, God bless you, and may God bless the United States of America.
Tevi Troy is a Visiting Fellow at Hudson Institute and served as the Deputy Secretary of the U.S. Department of Health and Human Services from 2007 until 2009.
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