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Examination of Obama's health care speech

10 09 09 - 18:56

Check Point: Examining Obama’s Assertions
By DAVID M. HERSZENHORN - The New York Times

WASHINGTON — In what may become the most talked-about moment of President Obama’s speech to Congress on health care, Representative Joe Wilson, Republican of South Carolina, pointed his finger and shouted, “You lie!”

It was an angry retort to Mr. Obama’s statement that illegal immigrants would not benefit from proposed health care legislation. And while other points in Mr. Obama’s speech were debatable, this one was not.

The legislation approved by three House committees clearly states that only lawful residents will qualify for new health insurance subsidies. “Nothing in this subtitle,” it says, “shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

But Mr. Obama did repeat some assertions he had made about the proposed health care overhaul that are not so easily defended.

For instance, the president said that “if you are among the hundreds of millions of Americans who already have health insurance” through an employer or the government “nothing in our plan requires you to change what you have.”

That is technically true. But there is a real possibility that existing policies could change as a result of the legislation. The government, for instance, would set new standards, and employers that already offer insurance would have to bring their plans into compliance.

Some existing policies might not be sustainable given the new requirements. Doctors, for example, could end up refusing to accept insurance plans patients now use.

The Congressional Budget Office predicts that far more people will obtain health insurance as a result of the legislation, but whether existing benefits will remain the same for everyone who is now covered is far from certain.

Mr. Obama also seemed to stretch things a bit when he declared: “Not a dollar of the Medicare trust fund will be used to pay for this plan. The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud as well as unwarranted subsidies in Medicare that go to insurance companies.”

Critics of the president’s plan have said Americans ages 65 and over could find their Medicare benefits reduced as a result of the health care overhaul. Congressional Democrats certainly do not intend to cut benefits, but they are proposing big cuts in government spending on Medicare and not all of it would come from eliminating waste.

The legislation seeks to trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. Other cuts would come from reduced payments to drug makers. Such cutbacks could inadvertently reduce access to some types of care.

The changes could also create new co-payments for services, including some laboratory tests that are now provided without charge.

Mr. Obama, in his speech, forcefully rejected contentions that the legislation would limit end-of-life care or even encourage euthanasia. Both of those claims are indeed false.

But his assertion that “no federal dollars will be used to fund abortions” is not so clear-cut.

Abortion opponents say tax dollars could be used to subsidize insurance that could pay for abortion. The legislation approved in the House committees seeks to avoid this by requiring that only money from premiums paid by beneficiaries be used to cover abortion.

Existing restrictions on the use of federal money for abortion would remain in place, as Mr. Obama stated. But in practice, the public and private money would all go into the same pot, and the source of money for any single procedure is largely a technicality.

At one point, Mr. Obama made future health benefits seem more generous than they may actually turn out to be. “Insurance companies,” he declared, “will be required to cover, with no extra charge, routine checkups and preventive care like mammograms and colonoscopies.”

The president’s plan would establish a minimum package of benefits that all private insurers would have to provide as a condition for participating in new government-regulated insurance markets or “exchanges” where consumers could shop for plans.

Insurers would have to include the cost of minimum benefits, including preventive care in their basic premiums. So while there might not be an “extra” charge, the services would not be free.

On some major points, Mr. Obama’s speech recounted irrefutable truths.

He stated, for instance, that for nearly a century presidents and the Congress have tried and failed to address major gaps in the health care system. And he accurately stated that the United States is the only developed democracy with millions of uninsured citizens with little or no access to anything but emergency care.

He truthfully stated that nearly all Americans with insurance are at risk of losing it if they lose or change their jobs or run afoul of obscure technical rules. Mr. Obama also accurately stated that Americans spend more per person on health care than residents of any other country but often get worse results and that health care costs are spiraling out of control.

Of course, it is far from certain that Mr. Obama will succeed in overcoming partisanship and achieve a sweeping health care overhaul as he predicted in the speech.

But there is little disagreement that without government action, things stand to get worse.

“Everyone in this room knows what will happen if we do nothing,” Mr. Obama said. “Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.”




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