An Open Letter to President Obama

August 20, 2009

Dear Mr. President:

As a strong (financial and volunteer) supporter of yours throughout the primary and general election periods in 2008, I feel compelled to convey my profound disappointment in your job performance to date. Like many progressives, who constitute your primary source of support, I supported you for one simple reason: I honestly believed (and continue to believe despite the preponderance of evidence to the contrary) that you had the best chance to be the next FDR. Your performance to date, however, indicates to me that you are really blowing your opportunity. I don’t know whether it’s just your nature to attempt to achieve bipartisanship at all costs, if you are more concerned with your preservation of a majority regardless of its effectiveness, or if your primary concern is your re-election in four years. Whatever your motivation, if you don’t change course soon, you risk the failure of your presidency.

The most urgent area in which you are quite frankly failing is in health care reform. Senator Obama once quite clearly stated that he was in favor of a single-payer system. Candidate Obama once quite clearly stated that he favored a health care system in which universal coverage is the end result. President Obama, in an effort to compromise with those who will never support his agenda and satisfy those that will never vote for him, has consistently shifted positions, presumably in a genuine effort to build a consensus behind his agenda. Unfortunately, it seems that this strategy is, at this point in time, a colossal failure. I share your indignation at the innumerable lies being promoted by the right, including but not limited to your intention of establishing a socialized medicine system and establishing government death panels. Unfortunately, I believe that you must take at least some of the responsibility by virtue of the fact that your apparent waffling has made you an easy target.

As a physician, I see each and every day unfortunate Americans who are at best bankrupted and at worst suffer permanent injury or death because of the lack of health care coverage. In what we like to refer to as “The greatest country in the world” it is unconscionable that Millions of Americans lack what should a basic human right, and may continue to lack this right for the foreseeable future. In spite of this crisis of epic proportion, you have allowed the argument to be concentrated on peripheral issues, largely ignoring the core problem: 50 million Americans without access to a healthcare system that is as good as any on earth. Over the past week, I was appalled to hear you refer to the public option as “A sliver of health care reform.” You and I know that without a robust public option, there is no meaningful health care reform. Over the course of the past few years, you have evolved from the greatest agent of change in America to just another politician.

Unfortunately, the shortcomings of your administration are not limited to health care. Millions voted for you over Hillary Clinton because of your opposition to foolish wars while she refused to admit that she made a mistake in supporting a war based on the lies of George Bush. Seven months into your first term, there is no end in site to the occupation of Iraq and you have doubled down on our other unwinnable war in Afghanistan.
The one bright spot was your bail out of GM and Chrysler, saving millions of jobs and, despite considerable resistance from the right, changing leadership at GM. The bank bailout is more of a mixed bag. There is room for disagreement regarding the bailout of those institutions that were “Too large to fail.” However, when the taxpayers bail out the very companies that caused the financial melt down of our system, it seems that a temporary government takeover would have prevented the outrageous bonuses paid to these failed managers while ensuring a reasonable return on investment if and when these entities returned to profitability.

Regardless of your performance in your first term, I am sure you realize that there is a very real chance that you will be a one term president. I don’t believe that your re-election will be determined as much by your performance as the state of the economy in three short years. The presence of more than one moron showing up at a presidential event toting a loaded assault weapon points to the direction of social mood in this country; a mood that will undoubtedly deteriorate further before improving. At the same time, the economy is likely headed for rougher times, and may not improve in time to save your presidency. Faced with this scenario, I sincerely hope that you capitalize on the opportunity that you have been given, and govern as if there is no tomorrow.

I believe I speak for the great majority of the 69 million people that put you in office when I implore you to remember those of us who gave you this opportunity. I understand that you are the president of all people, but you were elected by an impressive margin as an agent of change. While many of us are justifiably disappointed by your performance to date, I believe that many of us still support you and believe that you will ultimately be that agent of change that we elected. History reveals that FDR himself was initially dragged kicking and screaming into the new deal; in spite of resistance to deficit spending and support for social programs that largely eliminated poverty in this country for decades, he eventually changed our society for the better permanently. I hope that you will follow his lead, and be the president we elected.


Health Care Reform – Managing the Real Cost of Living

March 31, 2009

(updated below)

Fifteen years ago, Harry and Louise sat at their kitchen table and worried about the possibility of a national health care plan. “They choose, and we lose,” was the theme of their widely-viewed political advertisement. By 2008, the now middle-aged couple acknowledged that “Whoever the next president is, health care should be at the top of his agenda.”

CEOs Urge Reform – Health Care Costs “A Significant Competitive Disadvantage in the Global Marketplace”

Reuters news service reported on a Business Roundtable study released this month:

U.S. business leaders urged lawmakers on Thursday to act quickly on healthcare reform, saying American companies were losing out to other countries with cheaper healthcare and healthier workers. […]

Ivan Seidenberg, chairman and chief executive of Verizon Communications, said an overhaul of the U.S. healthcare system ‘should have been done yesterday’.

Quoting from the study summary (PDF):

According to the Business Roundtable Health Care Value Comparability Study, a new measure of the “value” (cost and performance) of the U.S. health care system relative to our competitors’ systems on a weighted scale, the workers and employers of the United States face a 23 percent “value gap” relative to five leading economic competitors – Canada, Japan, Germany, the United Kingdom and France (the “G-5 group”) – and a 46 percent “value gap” compared with emerging competitors Brazil, India and China (“the BIC group”).

Media Ignores Single-Payer Option

A study by the media watchdog group Fairness & Accuracy in Reporting (FAIR) concluded that:

Major newspaper, broadcast and cable stories mentioning healthcare reform in the week leading up to President Barack Obama’s March 5 healthcare summit rarely mentioned the idea of a single-payer national health insurance program … advocates of such a system – two of whom participated in yesterday’s summit – were almost entirely shut out. (03-06-09)

What is Single-Payer?

The publicly funded organization Single Payer Central supplies a succinct definition:

Single payer health insurance is a system by which the health care expenditures of an entire population are paid for through one source.

Distinctly different from socialized medicine (where the government owns and operates health care facilities) a “single payer system” is simply a financing mechanism. The government collects and allocates money for health care but has little to no involvement in the actual delivery of services. Care is provided privately at hospitals and clinics but paid for publicly.

Who Wants It?

Recent polls have established that substantial health care reform is a high priority for the majority of Americans. When asked, most favor the single-payer option.

In June of 2008, the U.S. Conference of Mayors resolved to back single-payer health insurance.

An Indiana University School of Medicine’s Center for Health Policy and Professionalism Research survey found that a majority of American physicians support national health insurance. Roger Bybee explains why.

The cost of health care insurance administration is a significant portion of the fee paid for a doctor’s office visit. A family practice physician recorded a typical day at his office to show the resources devoted to dealing with “an insidious bureaucratic monster, the health care insurance system.”

Physicians For A National Health Program (PNHP) predicts that a single-payer system “would eliminate the wasteful spending and high administrative costs of private insurance, saving almost $400 billion annually.”

Single-payer advocate Dr. Oliver Fein chronicled his first-hand experience at the White House Health Care Summit.

KDKA radio host Chris Moore interviewed Russell Mokhiber, an organizer of the activist group, Single Payer Action. Mr. Mokhiber talked about mobilizing support for H.R. 676, The United States National Health Insurance Act. You can listen to a podcast of their conversation.

Despite widespread support, single-payer faces formidable opposition from the health care insurance industry. According to Consumer Reports, “In 2006, the nation’s six biggest private health insurers collectively earned almost $11 billion in profits.” But, there are indications that health insurers might not have as many business allies as in 1993. John F. Wasik of Bloomberg News comments that there is “No Reason to Demonize U.S. Single-Payer.”

Our confidence in American financial institutions has diminished. The only thing they’ve earned recently is outrage. The health insurance industry is in danger of catching the spillover of that anger. President Obama and Congress might want to consider that as they negotiate a solution to the real cost of living.

Update: On Tuesday, March 31, the PBS program FRONTLINE presents “Sick Around America,” a report on the failures of the American health care system. From the PBS Pressroom:

As President Obama launches his plan for reforming healthcare, Kaiser Family Foundation president Drew Altman tells FRONTLINE, “This is the first big opportunity for health reform since … [the] early 1990s. And a question is again, pointedly, whether we will blow the opportunity again this time or [whether] we will actually get it all done or get something significant done.” Consultant Laszewski wonders if Americans have the will to make it happen. “Every doctor I meet says he’s underpaid. I’ve yet to meet a hospital executive who thinks he or she can operate on less. I have yet to meet a patient who is willing to sacrifice care. So we have this $2.2 trillion system, and I haven’t met anybody in any of the stakeholders that’s willing to take less. And until we’re willing to have that conversation, we’re just sort of nibbling around the edges.”

FRONTLINE airs from 9:00 p.m. – 10:00 p.m. EDT. View a preview of “Sick Around America.”

Steve Sikora blogs about governance, media, business and community at Art of Angles.