Speak, Obama

Well, we’ve gotten to and almost through this day and a good thing to have done so. About the only thing that is a matter of public policy that I know a lot about is health care and so, in honor of the new President, I’d like to offer him the speech that I wish he’d give on health care.

‘My Fellow Citizens and Health Care Users,

There are many difficult problems facing us all--and especially me--today, but fortunately, there is one problem whose solution is clear. It is clear because we have a lot of experience, a lot of research, a lot of history, and a lot of examples from other countries. In fact, it is hard to think of any other policy discussion where there is so little disagreement among those who have seriously looked at the issue as to what needs to be done. And that is health care.

The health care system we want should be efficient, equitable, effective, and affordable. To achieve that requires that everyone be in the system and that there be a single payer. That is a simple truth, though what some might consider an inconvenient truth. A single payer system is required because if there are multiple payers (as in multiple insurance companies), those companies will be compelled to try to provide insurance for people who are healthy, and deny insurance, coverage, and reimbursement to people who are sick. That is the nature of insurance. If you are ensuring health care, however, you cannot have multiple payers competing for patients on the basis of price and health-risk.



The system that my administration and the Congress will be working on is not a universal, single-payer system, however. Americans can not have the best health care system, one that works for everyone now and in the long run, for two reasons. First, because the Congress and I cannot stand up to the power of the health care industry; and, second, because many of you fear change, and fear that if something is different, it might be bad.

So, if you want a system that is able to control costs, that is able to include everyone, that will be available to you when you need it without bankrupting you, that will be a background not a foreground issue in all your life decisions, then you will have to demand from your legislators a national, single-payer health care program, and you will have to prepare yourselves for change. Otherwise, you’re going to get stuck with what you already have, and with its getting worse as the years go by, even while we tinker with it.

The choice is yours. Make us do the right thing.”

[I was inspired to write this by an article in the February 2009 Harper’s by Luke Mitchell, which explains the issue much more expansively.]