Faced with sagging job approval ratings and drooping public support for health reform, President Barack Obama gave a widely televised speech to rejuvenate what's become his signature domestic policy item. The nearly hour-long speech, delivered Wednesday night before a rare joint session of Congress, was Obama's most vigorous defense of health reform as he blasted critics for distorting the facts and sowing fear. But what did he say about Medicare, and what details did he deliver on the specifics for reform?
Here's my take on a few key points, based on the exact words of the speech itself (speech text in blue font).
- The reform bill would be partly funded by money recovered from eliminating waste and fraud. Draft legislation already contains language about identifying "overvalued services" and you're already dealing with Recovery Audit Contractors (RACs). Health reform would probably increase the intensity of such efforts.
"That is why 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."
- Bonus payments to Medicare Advantage (MA) plans would be slashed -- something Democrats have long been planning. Expect this to affect how much you're paid by MA plans.
"[The plan also would eliminate] unwarranted subsidies in Medicare that go to insurance companies - subsidies that do everything to pad their profits and nothing to improve your care."
- An independent commission of experts will be created to target more fraud and waste.
"And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead."
- This commission will "help encourage" you and your peers to follow best practices culled from areas of the country identified as providing the most efficient care. It's not clear if the commission will have the authority to mandate adoption of best practices, or what Congressional oversight will exist over such authority.
"Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system -- everything from reducing hospital infection rates to encouraging better coordination between teams of doctors."
- HHS will authorize state-level pilot programs aimed at curbing malpractice costs and reforming medical malpractice law. Politically, it seems unlikely that malpractice or tort reform will pass under a Democratic administration. We'll know whether Obama is serious about tort reform or just throwing the Republicans a bone once more details emerge on the scale and timeframe of these pilot programs.
- "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."
You can watch the full, 48-minute speech via this streaming YouTube video. Obama's final point was that his plan -- which appears very similar to the draft proposal put out by the Senate Finance Committee -- will cost less than the wars in Iraq and Afghanistan, and less than the tax cuts passed by President George W. Bush. The total price tag? $900 billion over ten years. So far, the political reaction has been predictable, with Democrats offering unblinking praise and Republicans largely unmoved. Most of the media coverage has been dominated by commentary on Rep. Joe Wilson (R-S.C.), who shouted "You lie!" at Obama when the president said his reform plan won't cover illegal immigrants. NOTE: You can watch this happen by skipping to time index 21:33 in the YouTube video. Indeed, traffic to Wilson's official House website is so high that the page has been overloaded and is no longer accessible (as of this post).
For the record, not a single piece of reform legislation anywhere in Congress states it will pay for services to illegal immigrants and the draft House bill explicitly states that it won't. At the same time, none of these bills require citizenship to be verified before treatment is administered. Those are the facts -- decide for yourself whether that makes President Obama a liar. Rep. Wilson has since apologized for his outburst, though his Democratic challenger in 2010 received more than $200,000 in donations in the 24 hours following the speech.