He has to explain exactly what problems he is trying to solve with health care reform, and persuade us that these problems warrant a wholesale revamping of our nation's health care, health insurance and health care delivery.

He has to identify exactly what his plan is. What specific law(s) does he want to see enacted?

He needs to explain how each law he wants to enact will solve the problems he says he wants to solve, without resulting in adverse consequences or worse problems.

He needs to explain what the new laws will mean to us...to our taxes, our current health plan, our relationship with our doctors, our access to services, our care at the end of our lives, our freedom to choose for ourselves, etc. If he says nothing will change, he is not to be believed.

He has to explain how his plan reconciles the seemingly mutually exclusive promises he has made to date (no tax increase on the middle class, no increase in the deficit, no reduction in benefits or quality of health care, no health care rationing, you can keep your current plan, lower overall cost of medical care, etc.). If he cannot reconcile these promises, he needs to say so candidly and explain which ones are "no longer operative."

He needs to address the concerns of his critics, with specifics. He must show a genuine willingness to modify his proposals to address these concerns.

He needs to explain how this Federal program will avoid the poor management and high overhead found throughout the rest of the Federal Government.

I will not be persuaded by the thrill of his rhetoric or by airy assurances and vague generalities.

Level with us or get off the stage, Mr. President.

I'm not sure he can do those things because I don't think he knows. Or at least up until this point he has not given any indication that he does.

Other than issues related to the number of uninsured and underinsured....the issues that have been central to the debate have been circulating for months. Access, denials for pre-existing conditions, portability and costs...all of those have been pretty much agreed by both to be the major flaws in our current system.

The republicans think that tort reform is vital to controlling costs and keep trying to move that into the bill. They also want insurance companies to be able to sell across state lines.

I have heard no proposals that change health care delivery...only the insurance coverage side of things.

The biggest problem that I see is that Obama told Congress "go write a bill" and the outcome has been the four different versions floating around (if you only count the dem versions...there are several more repub versions). I think it likely that Obama is going to take more control of the process, since congress doesn't seem to be able to get the job done.

Wait a second......healthcare insurance reform - or, from your wording, ANY Federal legislation - has to be "perfect" before you will accept it?

Does this go for the insurance companies who are dropping breast cancer coverage to women because they forgot to mention the treatment they got for acne when they were 17 years old on the insurance application?

I mean, if the Feds have to be "perfect" then so does Corporate America.

What's good for the goose....

Atlanta Bob,

I appreciate your reply and question.

No, I'm not asking for anything to be perfect before I will agree. But I need honesty about his plan and enough detail about it so I can decide whether to support or oppose some of all of it.

The problem to date has been that the President never offered a plan, and has promised more than I think he can deliver. But, I think it would be great if he could show me otherwise tonight. I will listen.

In my original post, I tried hard not to inject my own ideas and opinions, not to state what I want. To the extent you thought my points were partisan, I failed. I thought my points would be desired by everyone, regardless of political leanings! Which of my questions don't you want answered?

I don't know......answers seem clear to me.

The USA pays more than a 1/3rd for its healthcare than other industrialized nations and we still can't cover 8% (conservative estimate) of our population.

Something has to be done here.

Insurance companies are not fulfilling their end of the bargain when it comes to our (meaning the consumer's) contract with them......they deny coverage for the most insipid of reasons and have enough ligitation firepower that you will die before you reach any settlement with them.

Something has to be done here.

Insurance companies currently have a literal "monopoly" on the market and thus have no incentive to compete and lower their costs.

Something has to be done here.

The most "liberal" solution would be one like the UK's where you have to go to the government for your healthcare, doctors are employees of the state, etc.

Not one of the bills before Congress is suggesting this.

The are suggesting a "public option" which would give those uninsured an ability to help pay for their healthcare without using the local ER Dept as their "primary care giver".

This seems like an adequate, rational compromise between the UK-style system I described and their inefficient "free market" status quo. Will it be "perfect"? Hell no. But it will be better than the current path which is slowly but surely bankrupting us (soon you won't be able to afford ANY insurance and when you get sick there's no way you'll afford it......you'll become a ward of the state anyway.....let's stop that before we get there).

I guess my only question is.......why the hell are we taking so long to get this done?

He needs to address the concerns of his critics, with specifics. He must show a genuine willingness to modify his proposals to address these concerns.

Maybe you didn't mean this literally, but would you actually like for Obama to talk about "death panels" and "socialized medicine" again? There are legitimate concerns and then there are those raised by the likes of Rush and Beck. I don't care if he just blows those guys off as talking heads...their many hours of anti-reform bull shit are just that. Beck thinks the whole point of reform is to institute eugenics. I see no reason to expect Obama to address that. Sarah Palin not withstanding, there is no reason to talk about end of life counseling as if it actually amounted to death panels. Let's not waste too much time on the lunatic fringe, ok?

Middleview,

No, I'm not suggesting he respond to anything that has been raised by anyone. But there are valid concerns and fears, caused in part by things the President and his supporters have said during the campaign or since. To name just three (there are dozens):

1. His rather unguarded discussion about how "we" might want to tell an older woman that she could not get the hip replacement, but give her pain pills instead, was scary to me. (Who's "We?")

2. The argument that a public option would drive out the employer-provided plans is quite valid, economically.

3. The inability of our Federal Government to be competent and thrifty in almost everything it does raises a flag. Anyone trying to add more to the Federal Government's plate needs to explain how he will keep that from happening to health care, a sixth of our economy and a life-or-death matter to all of us.

He should focus on the substantive issues, not the slogans of a few. If he (or his supporters) do nothing except mock the "death panel" folks, he will lose me. (If I run into someone here on the Fray who just spews inflammatory slogans, half truths, vitriol, name-calling, mocking, snarky and vile rhetoric, etc., I just pass by. I don't respond.) If he thinks some of the things that have been said are untrue and unfair, he should ignore them. There are plenty of substantive concerns that have been raised during this last month which need to be addressed.

fryde67:

Middleview,

No, I'm not suggesting he respond to anything that has been raised by anyone. But there are valid concerns and fears, caused in part by things the President and his supporters have said during the campaign or since. To name just three (there are dozens):

1. His rather unguarded discussion about how "we" might want to tell an older woman that she could not get the hip replacement, but give her pain pills instead, was scary to me. (Who's "We?")

If you are talking about "rationing" then it's already happening under the current system and will get worse. Look up the term "rescission" and read the stories of people who THOUGHT they were going to be covered then get back to me.

2. The argument that a public option would drive out the employer-provided plans is quite valid, economically.

So unless the insurance companies are allowed to continue their monopoly on the market they will fail? Wow, what $hitty businesspeople they must be. I tell you what.....I'm gonna pull out this itty-bitty violin here and play them a song to make them feel better.

3. The inability of our Federal Government to be competent and thrifty in almost everything it does raises a flag. Anyone trying to add more to the Federal Government's plate needs to explain how he will keep that from happening to health care, a sixth of our economy and a life-or-death matter to all of us.

Once again, you require something "perfect" or you just won't accept it. Except you will accept the status quo and all its faults. Another interesting point.....if the insurance from the Feds is so bad you can tell your Congressperson, the President, etc and then kick them out of office if they don't do something about it. As for the CEO of Aetna or Blue Cross/Blue Shield? Meh, you don't get to vote for him or her. Think about that some.

He should focus on the substantive issues, not the slogans of a few. If he (or his supporters) do nothing except mock the "death panel" folks, he will lose me. (If I run into someone here on the Fray who just spews inflammatory slogans, half truths, vitriol, name-calling, mocking, snarky and vile rhetoric, etc., I just pass by. I don't respond.) If he thinks some of the things that have been said are untrue and unfair, he should ignore them. There are plenty of substantive concerns that have been raised during this last month which need to be addressed.

There have been substantive concerns like the effect any plan would have on the budget deficit. To these concerns I offer this.....what happens if we DON'T reform healthcare insurance? Yep, you guessed it - you're gonna pay anyway. So we might as well bite the bullet, change the system now so we're not stuck with a huge deficit because we were too afraid to act. Remember, you'll be paying regardless and won't be getting nearly as much for the money spent.

This is what I think Obama needs to focus on in the speech tonight.

Really, have you seen a Republican proposal? I haven't. Can you link me to something? I'd like to see what a Republican serious enuff about reform to actually write something up has to say. All I hear from the right is fear mongering and veiled racism. There might be some useful ideas in such a proposal.

<link>

I have read several, but each has been light on details and big on rhetoric. They all stress tort reform, as if we don't alread know that it will change nothing all by itself. The funny thing is that California has tort reform. Ask a doc. in Ca if his insurance has gone down. They all talk about allowing companies to sell across state lines....as if that won't mean that companies will find the least restrictive state to put their headquarters....like the credit card companies did with South Dakota.

I'm OK with some form of tort reform and hope the Congress finds a way to get it in there.

Former Senator Bill Bradley suggested as much recently in the NY Times......give in to the GOP on tort reform if they'll cave in on the public option.

I'd support such a bill with no reservations.

It's a way for both the specials interests of the parties (Democrat's trial lawyers, Republican's insurance lobby) to lose and the rest of us win.

Bring it!

California (and Colorado where I live) has tort reform. You are only allowed to sue for economic loss and are limited to $250k for pain and suffering. A friend of mine discovered that Kaiser had hidden that she had breast cancer for five years. What could have been resolved by a lumpectomy required a double mastectomy. The law suit she took part in was on behalf of 140 women in Southern California. They won, but only got about $150k each. Think of my friend, going through disfiguring surgery and reconstruction. Nearly a year before she was starting to return to a life. They tried to kill her and all she could do was sue them for chump change. Tort reform has had practically no effect on insurance premiums for the state of california.

middleview:

California (and Colorado where I live) has tort reform. You are only allowed to sue for economic loss and are limited to $250k for pain and suffering. A friend of mine discovered that Kaiser had hidden that she had breast cancer for five years. What could have been resolved by a lumpectomy required a double mastectomy. The law suit she took part in was on behalf of 140 women in Southern California. They won, but only got about $150k each. Think of my friend, going through disfiguring surgery and reconstruction. Nearly a year before she was starting to return to a life. They tried to kill her and all she could do was sue them for chump change. Tort reform has had practically no effect on insurance premiums for the state of california.

Fair enough. Then don't do it the way California did it.

But to shoot down the entire idea is silly.

By the way, looks like Obama might be leaning towards compromise here:

[from tonight's speech]

"Finally, many in this chamber - particularly on the Republican side of the aisle - have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today."

every instance that I know of has relied on simply limiting how much a plaintiff can get for pain and suffering. Other than that, you cold only sue for economic damages. If you were a retiree, then there would be no economic damage if you were permanently disabled, since you had no loss of future income.

I don't know what the test programs are that Obama referred to. In 2004 there was a discussion of having to go before a board to present your evidence. If your lawyer decided to go ahead with a suit, in spite of a judgement by the board that the suit had little merit, the lawyer could be on the hook for paying the costs of the lawsuit (for both sides). I thought that made sense.

Overall, what did you think of the speech?