The President's State of the Union Address: Rhetoric or Reality?
By Roger Forsyth, MDJanuary 28, 2010
In his State of the Union speech, many of the statements President Obama made about the pending health care legislation were at variance with the facts.
The most egregious comment he made was his statement that the non-partisan Congressional Budget Office (CBO) found that the legislation would reduce the deficit by one trillion dollars over 20 years. Readers should recall that the CBO estimates are based on the information given to them by Congress. If faulty information is put in, faulty estimates will result. The President must have forgotten that shortly after issuing an estimate that there would be a small deficit reduction over 10 years, the CBO pointed out that the Congress was double counting the savings from Medicare cuts. Moreover, based on prior history, they doubted that these cuts would be achieved.
This doubt should have been reinforced by the recent statement from the Mayo Clinic that they were collecting only 50% of the true cost of the care rendered to Medicare patients—even before the adoption of the new cuts. Creative accounting resulted in benefits being provided for only six years while taxes and cuts covered ten years.
Also, some of the “savings” were dependent on taxing high-cost insurance policies—an option that had been rescinded to court the favor of labor unions.
Finally, the proposal sent to the CBO did not include $240 million to cover the shortage in payments to physicians. Given all of these facts, it would have been prudent to avoid claiming that the pending legislation could reduce the national debt.
The President also extolled the fact that the legislation would prevent insurers from canceling a policy because of the development of an illness or the revelation of a pre-existing condition. This ignores the fact that the adoption of this provision in Massachusetts has led to an escalation in the cost of premiums because many high-risk individuals game the system and delay the purchase of a policy until they become ill. In their haste to provide the public with a needed benefit, Congress opened the door to new abuses by patients that replaced the abuses by insurers.
The President chastised Republicans for obstructing reform and stated that they had been given a seat at the table. He neglected to mention that the seat did not lead to the adoption of any of the major Republican suggestions—tort reform, insurance across state lines, and tax-deductibility for individual policyholders. Bipartisanship should mean the adoption of something from your opponent’s wish list in order to get them to support something from your wish list. That was never done.
The President stated that he undertook healthcare reform to protect the public from excessive healthcare costs. He neglected to point out that when he eliminates Medicare Advantage, this passes the cost onto the public. When he cuts Medicare payments and drives physicians out of primary care, he adversely affects patients. When he adds any new taxes, he raises overall costs. Optimistically, the legislation adds $ 900 billion to the ten-year cost of healthcare. Realistically, the cost will be closer to $ 2.4 trillion.
The rhetoric was admirable—he painted a picture of lower costs, the elimination of bankruptcy and cancelled policies, a reduction in the national deficit, etc. The reality is that some of the positives are accompanied by significant negatives and his glowing references to deficit reduction were highly inaccurate.
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