President Obama went all-in on health reform tonight (September 9, 2009) with his win-one-for-the-late-senator pitch to the assembled houses of Congress. Beyond his always-inspiring rhetoric, his actual proposals offered virtually nothing we haven’t heard before. His essential message: when it comes to health reform, I’m asking the American public to accept hope over experience, faith over fact.

Have Faith that the government will provide a public insurance option that is more competitive, efficient, fair, and effective than anything you can get from a private insurer. Subtext: Ignore the man behind the curtain who has already given you the unmatched fairness and effectiveness of FEMA, Fannie, Freddie, Medicare ($74 Trillion in the hole), Social Security ($17.5 Trillion under water), the national debt ($11.7 Trillion and counting), the sex-offender registry, and the SEC’s crack enforcement of Bernie Madoff’s Ponzi scheme.

Have Faith that we’ll pay the majority of the trillion dollar cost of health reform by cutting hundreds of millions in fraud and waste from Medicare. Subtext: Why didn’t the eight presidents before you (Johnson through Bush II) think of this? Indeed, Medicare has been conspicuous by its presence on the GAO’s watch list of government programs “at high risk for fraud, waste, abuse, and mismanagement” every year since 1990.

Have Faith that making insurance companies provide more preventive services—for free—will save billions on the diseases thus prevented. Subtext: But please ignore the fact that more than three decades of Health “Maintenance” Organizations doing just that have failed to produce any net savings from prevention. The hard, cold, incontrovertible fact is that preventing diseases almost always costs more than it saves.

Have Faith that a new bureaucracy called the Health Insurance Exchange will bring competitive, affordable health insurance to 46 million uninsured Americans. Subtext: How will (1) requiring coverage for even more unnecessary and cost-ineffective services, (2) starving insurers of the funds necessary to control costs, (3) charging insurers a 3% Exchange administration fee (more than insurance company profits in 2006), (4) requiring efficient, well-managed private insurers to pay a portion of their revenues to support poorly-run ones, (5) making private insurers compete against a government player that is also the game’s referee, and (6) taxing insurance benefits going to improve availability, affordability, competitiveness, or anything else?

Have Faith that those hordes of uninsured younger Americans who are just beginning their college, families, and careers will see the light (or at least the mandates) and finally sign up for health insurance. Subtext: But we’re also going to increase the premiums they have to pay by 45-60% so they’ll help pay for their older colleagues who consume four times more medical care and have more wealth, higher incomes, and AARP.

Have Faith that we need to fix only the parts of our health care system that are broken, while leaving intact the parts that have been proven to work. Subtext: Employer-based health insurance is out of control and utterly unsustainable. Medicare is a bankrupt Ponzi scheme. Medicaid is tearing apart states’ budgets. And these are the parts that work?

The American public is wisely and rapidly reaching a conclusion that yet eludes one of the most articulate, intelligent Presidents we’ve seen in generations: Our health care financing and delivery system is irretrievably broken. It needs nothing less than root-and-branch reform. And that reform must honor the fundamental American values of individual responsibility, relentless innovation, freedom of choice, and social justice.

That’s really not all that hard to do—once we have the collective political will to make it happen. For that, I fear we’ll have to first suffer a health care version of 9/11 or the Great Financial Meltdown of 2008.

This entry was posted in Health Costs, Health Insurance, Health Reform Goals, Myths and Bad Ideas, Prevention and tagged , , , , . Bookmark the permalink.


  1. D. A. Duke says:


    Thanks for you comments and your newsletters. My intuition leads me to the same conclusions, but….

    I read the Wall Street Journal, New York Times and Economist articles about health care every day, but I still feel like I have an inadequate understanding of the real problems. I’m feeling the need to better understand the issues in a more tangible, brass-tack, non-ideological way. (Kind of like – how would I approach a complex problem if I were running a business?) What should I be reading to get a better grasp of the issues without all the bickering and ideological crap seeping in from ever angle?

    Thanks again, Steve.


  2. jun huangpu says:


    What are needed to make the real healthcare reform to take place?

    Are there a detailed to do list?

    Enjoyed reading your writing


  3. Dr. Bob Browne says:

    Folks, read Steve’s new book. (I haven;t seen it at Half Price Books yet but Amazon has it! – JUST KIDDING. IT IS A BARGAIN). It will help you understand what those of us suffering through the health care system of the last 30 years have learned. It also proposes some common sense solutions. Bwana Bob

  4. p little says:

    In order to frame the issue, first ask “What is wrong with the current system?” (Lots)
    Then ask “What would success look like after we change the system?”
    What I find is that Steve’s answers to these questions look a lot smarter than the majority of Congress and The Administration.

  5. Dennis says:

    COME ON, do the math folks!

    RE: “…the trillion dollar cost of health reform by cutting hundreds of millions in…”

    In the most favorable light: round “the trillion” down to one trillion, and round the “hundreds of millions” up to one billion; That is one tenth of one percent.

    Obama insinuates that the American people are so dumb that he can convince them that they can pay of a debt with one dollar per thousand. Loaves & Fishes??

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