Wednesday, July 22, 2009

POLITICO's 10 questions for Obama

By: Jonathan Martin and Josh Gerstein

For the first time in his presidency, Barack Obama is using a prime-time news conference Wednesday night to play catch-up.

With the public souring on both his handling of health-care reform and the economy, Obama is stepping to the podium for the fourth time in six months in hopes of convincing the public he’s got a plan, to get the economy back on track and a health overhaul that will expand care to all without busting the budget.

With Democrats fractured on health-care and the GOP sensing a major political opportunity, Obama is engaged in an inside-outside strategy, cajoling members of Congress in private White House sessions while using his bully pulpit to rally public support for his plan.

So it’s health care where we start with our 10 Questions for President Obama.

1) Is it still realistic that both chambers of Congress will pass health care bills before their summer recess in August? And how worried are you that missing the deadline could endanger your hopes of getting a bill this year?

A former senator himself, Obama knows Congress works best under a deadline – and he called on both houses to pass a health bill before heading off on summer vacation. So far anyway, it’s not working. Obama suggested Monday that he was willing to bend his oft-stated deadline, saying it would be OK if the legislation is “going to spill over by a few days or a week.”

But even that may not be realistic. Senators of both parties have publicly warned against rushing through the process, and rank-and-file members in both chambers have raised concerns over everything from the high costs to whether a government-run insurance option is the best way to go, as Obama has sought.

Neither the House nor the Senate has scheduled floor votes and key committees in both have yet to even approve a bill – meaning it might be see you in September time for the president’s health-care goals.

On Tuesday, House Majority Leader Steny Hoyer (D-Md.) seemed to defy Obama, saying: “If we get consensus, we'll move on it. If we don't get consensus, I don't think staying in session is necessarily necessary.”

2) Who are you referring to when you cite, as you did in your radio address last week, those “special interests” in health care who “make the same old arguments, and use the same scare tactics?” And what’s the difference between honest objections to a massive overhaul of the U.S. healthcare system, and what you consider obstructionism?

Obama has actually worked assiduously, and successfully, to court many of the stakeholders with a financial interest in healthcare – drug-makers, insurance companies and others who could strike a serious blow at his plan if they came out strongly against it.

He has hosted a variety of them at the White House, trumpeted the financial agreements struck with pharmaceutical companies and hospitals and used some of their endorsements in recent days to underline the support behind getting a bill passed.

Just on Tuesday, Obama touted such groups and others — he actually singled out the American Nurses Association and the American Medical Association — to highlight “the consensus” for legislation. So who are the bad guys that are trying to scuttle reform? Perhaps Obama will name names tonight.

3) You have sought to focus attention on Sen. Jim DeMint’s comments alluding to the political benefit for the GOP in blocking healthcare reform, but it’s mostly Democratic members of Congress that your own political apparatus is targeting in TV ads now on the air. Why haven’t you been more successful in convincing members of your own party on this issue so far, and how does DeMint figure into your effort to lobby Democrats?

Obama and his allies have been harping on DeMint’s reference to health care as Obama’s potential “Waterloo,” but the South Carolina senator is one of just 40 GOP senators.

It’s not the conservative DeMint but rather moderate Democrats and Republicans in the Senate and the conservative Blue Dog Democrats in the House who ultimately will decide health care’s fate. And right now, they’re not happy – particularly the fiscally conservative Blue Dogs who fear a deficit explosion if Obama gets his way.

It’s these members who have been brought down to the White House for meetings with the president.

So why is it DeMint who the White House is singling out? Clearly it’s part of the “Party of No” mantra the White House likes to use against Republicans. But perhaps it’s also to send a reminder to those recalcitrant members of Obma’s own party that failure on health care is what the opposition is pulling for – and that such failure would have grave political consequences for all Democrats.

4) You said during the campaign that you would negotiate the health care bill on C-SPAN. But now you won't even release the names of health care executives who visit the White House for what are closed door discussions. How do you reconcile what you said during the campaign with your approach now?

As part of his stump speech, Obama would often describe his vision for the process behind health care reform.

At a campaign stop in Virginia last summer, he said: "We'll have doctors and nurses and hospital administrators. Insurance companies, drug companies -- they'll get a seat at the table, they just won't be able to buy every chair. But what we will do is, we'll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies.”

Now, though, none of the White House negotiations are open for public consumption. And the Obama administration has rejected a request from a watchdog group to disclose the health care industry executives who have come to the White House to discuss the issue. The group, Citizens for Responsibility and Ethics, is poised to sue Obama’s administration to obtain the records.

5) On Monday you said that “folks on Wall Street don’t feel any remorse for taking all these risks; you don’t get a sense that there’s been a change of culture and behavior as a consequence of what has happened." What do you think Wall Street needs to do to show remorse and to change its culture? And isn’t the problem with the economy right now not some Wall Streeters getting bonuses, but the fact that recession is much tougher and deeper than even your administration projected?

While nothing like the AIG bonuses that fueled so much populist resentment this spring, news of Goldman Sachs’ monster second-quarter profits and subsequent billions worth of bonuses has again focused attention on Wall Street excesses.

According to a New York Times estimate, Goldman workers could earn an average of $770,000 this year, about the same as they did during the go-go boom years. Goldman paid back the $10 billion in federal bailout money they received, freeing them of compensation restrictions.
Republicans have scored points recently by pointing out that Congress approved nearly $800 billion in stimulus spending, and yet the unemployment rate is 9.5 percent and rising. Look for Obama to ask for patience from the public that his administration is focused every day on turning around the economy.

6) Attorney General Eric Holder is considering appointing an independent prosecutor to investigate alleged abuses of detainees during the Bush era. When the White House was asked about this, officials repeated your mantra that the country should look forward, not back. What’s your view about when it’s appropriate for the White House to send signals to the Justice Department about what action it should take in regarding a criminal investigation?

Holder is wrestling with the issue of whether to appoint an independent prosecutor to determine whether crimes were committed as part of the Bush administration’s “enhanced interrogation techniques”—or outside of them. While the White House has stressed Holder’s independence, it hasn’t been bashful about putting a little English on the ball. “My best guidance for you and others on this would be to look back at what the President has said over the course of the past many weeks…that our efforts are better focused looking forward than looking back,” Press Secretary Robert Gibbs said last week when asked about Holder’s dilemma.

7) In announcing the delay of up to six months in the report on detainee policy, White House officials said the issues were “hard” and “complicated” and that you wanted them to “get this right.” Weren’t they hard and complicated when you set the deadline earlier this year? What has changed? And are you still committed to closing Guantanamo Bay prison by January?

On his second full day in office, Obama held an Oval Office ceremony to sign executive orders setting a one-year deadline for closing Guantanamo and six-month deadlines for government task forces revamping detainee and interrogation policies. This week, the administration blew past the task force deadlines, even as it claims to be on track to close Gitmo.

“These are hard, complicated and consequential decisions. I mean, let’s not kid ourselves,” a senior administration official said at a White House briefing Monday. “We wanted to get this right,” another official said. However, the officials had no real explanation for how or why the issues turned out to be more complicated than they thought in January. They also insisted, though somewhat less than forcefully, that they are still working towards Obama’s goal of closing the controversial facility in January, even though an uproar in Congress has complicated his ability to bring prisoners to the U.S.

8) Your Secretary of State recently compared the North Korean regime attention-craving adolescents. Do you agree with that assessment, and either way, how do plan to proceed toward reining in North Korea’s missile program?

In an interview with ABC News earlier this week, Secretary of State Hillary Clinton offered a colorful description of Pyongyang: "What we've seen is this constant demand for attention, and maybe it's the mother in me or the experience that I've had with small children and unruly teenagers and people who are demanding attention.”

Continuing, she said: "Don't give it to them. They don't deserve it. They are acting out in a way to send a message that is not a message we're interested in receiving."

9) Harvard professor Henry Louis Gates Jr. was recently arrested by Cambridge police at his own home. Now the African-American scholar said he plans to use the experience to focus attention on racial profiling and the black experience in the criminal justice system. Do you think Gates was justified in accusing the police of being harassed for being “a black man in America?”

Obama has avoided intervening in such racially charged incidents in the past – even drawing criticism for not speaking up more about such controversies as Jena, Louisiana in two years ago – but given Gates’ prominence (and ties to Obama’s alma mater) and his intent to draw attention to the matter, it may be tough for the president to avoid weighing in on what happened in Cambridge and larger issues relating to African-Americans and law enforcement.

10) Do you still plan on joining a Washington-area church and attending services?

Six months into his presidency, Obama has attended Sunday services just once in Washington, D.C. – at St. Johns Episcopal across from Lafayette Square on Easter.

The White House knocked down a report that the president would make the non-denominational chapel at Camp David his church home, saying that the president continues to look for a congregation. Aides say the president is concerned about disrupting the worship experience of others.

Comments on CANADA vs USA HealthCare from CNN

July 6th, 2009 11:54 am ET

Just a quick note. I’m a 32 year old Canadian with hypothyroidism and rheumatoid Arthritis if I lived in the states I would be homeless not being able to afford the doctors visits or medication. Our is not perfect but it’s works for all people not just those with money.

Patti July 6th, 2009 12:13 pm ET

No system will ever be perfect, and there are always exceptions to the rule. Canada is constantly working to improve its health care system, just as the US is…but I think we have much less work to do. Dana Bash’s report seemed to only give lip service to the positive side of Canadian health care.

Yes, we sometimes have long wait periods for treatment in Canada. But everyone in this country has equal access to quality health care, and if we’re seriously ill, we get bumped to the top of the list…as it should be.

We don’t avoid the doctor as long as possible, hoping symptoms will go away because we can’t afford the bills. As a consequence, many more major illnesses are caught early, in their more treatable stages. This has got to translate into lower health care costs per capita. People shouldn’t have to lose their homes or go bankrupt because they got sick, and that’s what’s happening in the US because of your faulty healthcare “system.”

Marissa July 6th, 2009 12:20 pm ET

My 79 year old aunt is going for a Dr. requested colonoscopy but could not afford the $75.00 for the prescription needed to cleans her colon. Because her SSI benefits were reduced drastically on a technicality she’s unable to go for the necessary procedure. If we lived in Canada she would not have to worry about a $75 expense versus affording food for the month.

What option is Mitch McConnell and the Republicans offering, oh yeah non. Their option is only to criticize the Obama administration instead of helping Americans.

Jason July 6th, 2009 12:43 pm ET

Canadians may wait in the waiting room for a half hour to forty five minute. While most in the USA wait six or seven months to save up money it will cost in order to get a check up.

Blaine Norum July 6th, 2009 12:45 pm ET

I was very disturbed by this morning’s biased report on the Canadian health system. It was observed that some Canadians had to wait a long time for elective procedures. But, how does their wait compare to the lifelong wait of the 47 MILLION Americans without health insurance? You also failed to mention that the cost of the Canadian system is about 1/2 to 2/3 or ours per capita. If they spent as much per capita as we did waits would be nonexistent. You cited the fact that Canadian taxes are higher than ours but when you compare the sum of our taxes AND our health insurance premiums to their taxes then you get the real, and much different, picture. And the bottom line is this: the life expectancy in Canada is a full 2 years greater than in the US, even after you factor in variables such as murder rate, auto death rate, smoking rate, and our significantly greater propensity towards obesity.

Having lived in both countries and used the health care systems of both countries I personally prefer the Canadian system. However, I recognize that Canadians and Americans are different peoples, with different histories, priorities, and world views. Hence, I would not argue strongly that we should adopt the Canadian system outright. I just wish we could have a factual discussion of its merits and drawbacks without distortions, without focusing on non-representative isolated cases, and without meaningless ideological labels.

Rob Redfearn July 6th, 2009 2:22 pm ET

I am originally from Canada (moved here in 96)
I grew up in a doctor’s family and I also was married to one for 20 years.
I am also a business owner AND a consumer of medical care. I have a perspective from both inside and outside the the system, on both sides of the border.
I just had 2 disks removed from my neck and had the vertebrae fused. The total bill (”list price”) was $107,000 and I was in the hospital for 26 hours TOTAL.

I got the surgery quickly (under 4 weeks from diagnosis)… and had great care. My insurance covered all but the $1000 deductible. I pay $500/month for the insurance (blue cross).

In Canada I would have waited a LONG time for the surgery (not to mention getting the MRIs Xrays, etc required before hand). It may have cost me “nothing” out of pocket … but the care DOES cost.. its just paid in taxes. It would cost the same $500/month in insurance there as here.. its just coming out of tax dollars (which, make NO mistake, is STILL coming out of your pocket)

The reason Canada’s per capita cost is LESS than the US is because the average person does not get the average level of care available here in the US. … and socialized medicine is ALL ABOUT THE AVERAGE!!! And, on average, I was NOT happy with the standard of care there, nor were my father or ex-wife happy with the standard of care dictated TO them by the government bureaucrats who were making the decisions as to whom got what level of treatment.

As a business owner I am very wary of a plan imposed by government to ensure adequate care. However, I also recognize that my recent $100k surgery is one of the reasons healthcare costs (including the cost of insurance) is SO high!!!

The solution is a hybrid of private and public and TWO levels of care is going to be inevitable. As always, we are gonna get what we pay for!!!

Ed Keppel July 6th, 2009 2:24 pm ET

You talked about health care in Canada, your report made it sound like it was for free. It is not for free, they offer this free service thru higher taxes. The higher tax is not just on the wealthy, everyone in Canada is paying higher taxes because of the free health care.
The cost of living in Canada is much higher than in the U.S.

Larry July 6th, 2009 2:56 pm ET

So what is McConnell’s solution? Oh yeah, he’s Republican. He doesn’t have any solutions. Just criticism of people trying hard to fix what the Republicans have destroyed over the past eight years.

Give it up McConnell. Your connections with special interests in Washington are about to be severed.

RON TACKET July 6th, 2009 6:23 pm ET

You have to wonder at the hypocracy of congress. Each of them is covered by a Government run health care system at no cost to them. Yet Mcconnell and others oppose a similar program for the masses.

Purple Spider July 6th, 2009 6:49 pm ET

I said this once, I will say it again….Obama’s Health Care Plan could be beneficial to those who have no coverage. Obama’s Health Care Plan will not be beneficial to those who are covered and have their private doctor and have it taken away from them.
What is sad about this, is that Washington does not take time to work out details that will help everyone – THEY JUST SHOVE EVERYTHING THROUGH AND DOWN ALL AMERICANS “THROATS”! That is not a democracy and that is not America! THAT IS BEING UNDER A DICTATORSHIP!

Mark Coan July 6th, 2009 7:06 pm ET

Wolf, et al., It is not reasonable to asses and compare the Canadian Health System, or the US system, or any other, based upon anecdotal stories even if one from “each side” is revealed. And, descriptions of wait-times at a hospital are valueless, too, really. These are complex issues, immense businesses that have been studied from many perspectives analytically, and we are faced with a needed compromise, a decision which will be painful one way or t’other (and require constant adjustment / innovation)!! The present system doesn’t work, not for the patient, the physician, or the hospital.

Jacqueline July 6th, 2009 7:28 pm ET

I’m so tired of hearing biased reports on the Canadian healthcare system, that use scare tactics to frighten unknowing Americans against universal healthcare. As a Canadian RN who has lived in Florida for 17 years, I’ve seen cancer patients, who at diagnosis were at Stage IV, because they couldn’t afford to see a Dr. until their symptoms brought them to an ER. Had they had access to healthcare, they would have been diagnosed at a much earlier stage and had a shot at survival. I’ve seen the elderly make decisions about food vs. medicine, I’ve seen families financially ruined because Mom or Dad had cancer, or a devastating car accident. I’ve seen people stay in jobs they loathe, because they couldn’t afford to let their health insurance lapse. When are we going to wake up? We spend 2-3 times as much on healthcare than other industrialized nations, yet our infant mortality and overall survival numbers are lower. We have access to the best Dr’s, medicines and machinery, but outcomes aren’t any better. Wake up people, pay a little more in taxes, have cradle to grave coverage and live a happier, healthier life.
Two years ago, Canadians voted Tommy Douglas, the politician who ushered in universal healthcare, greatest Canadian of all time. What does that tell you? That despite it’s flaws, Canadians are proud of their healthcare system.

sharon July 6th, 2009 7:43 pm ET

I am a Canadian. Americans, you should consider a couple of very important points regarding the interview with Hugh Segal.
1. Our senators are not elected–they are appointed until the age of 75 and are NOT accountable to any Canadian voter.
2. Our health care system is also unaccountable to any Canadian citizen who uses it. Yes, we have universal health care but we have no idea how much a medical procedure costs –it is paid through taxes–very HIGH taxes. Nationwide, 1/2 of our total provincial budgets are health care costs.
3. We DO have long waiting lists and long emergency room line-ups-3-4 hours in Calgary Alberta seems to be the average wait time. Depending upon the time of week and year, it can be a day’s wait. We cannot see a specialist without a referral from a GP and the wait time to see a specialist is months, if not a year for some specialties.
4. Procedures ARE limited–for example, cataract surgery. You can wait for up to a year to have this surgery done. A colonoscopy has a wait list from 2-5 years!! I know this from having been on the list for 2 years. I cannot book any procedure myself, nor can I pay to have it done. I am at the mercy of the centralized system.

Don’t believe everything you read or hear about the Canadian system. Do some independent research and discover the truth.

Tina July 7th, 2009 12:43 am ET

I think that we should have a Canadian type healthcare system. It is quite obvious that our system sucks now. It is solely run by greed. Greed of insurance companies, a lot of hospitals and doctors. I am sorry, they cannot justify the high cost of premiums, medications and treatments. The same prescriptions bought in another country is 50 to 75% less than what we pay. HOW IS THAT SO? It is called GREED. So call me a socialist. If a government run insurance is cheaper and better for us then let it be so! I am so tired of these politicians claiming that it will cost millions. WELL HELLO. What do you think it is costing us now. Wake up and smell the roses. Our country is ready for big change. Do you know that our country is the only country that does not have a government run healthcare and we are also the most expensive. Wake up people. A government run medical plan will not ruin lives, it will not deminish quality of care and it would be a hell of a lot cheaper. I am so tired of hearing about insurance companies dropping people for no reason or for a reason that is ludicrus. They run our lives and for what? So the hospitals, doctors and insurance companies can live in their McMansions and take trips to other countries two or three times a year. Give me a break. I want a government runned healthcare system. Let the private sector stay, but I will guarentee that they will loose money in droves once people realize that they will get the exact same care as private.

Jason July 7th, 2009 5:04 pm ET

I hear all this talk about “oh government run health care do you want a burocrat dictating wether or not you get the procedure you need” I live in Canada and have had many medical problems and never had a politician tell me I can’t have a procedure. That is pure nonsense do not listen to those who speak such rubish.

daniel July 8th, 2009 6:59 am ET

Lets keep it simple. Let every US citizen log in to the same web site that
senators do and buy health care at the same cost they do now or when they leave office. This won’t require a new government agency. If it is good enough for them it is good enough for me.

Marc B July 12th, 2009 11:09 am ET

Being a Canadian living in the USA, I experienced both systems.
The coverage is a major problem that everybody is discussing but we have to talk about the Cost of Health Care in the US. If we increase the coverage to all Americans and the productivity is not improved, we have in front of us a big disaster.
1. We have to reduce the cost, reduce the # of medical staff that we see in a single visit.
2. Reduce the cost to educate new doctors, otherwise, we will have a shortage and foreign doctors will increase
3. Create Government insurance for doctor malpractice
4. Reduction of law suit in health care
5. Creation of a national medication insurance exactly like Quebec did few years ago where you can have the private program and if you don’t have one, you are forced to join the government one.

One element that we don’t discuss is the fact that HealthCare in Canada is a State (province) jurisdiction therefore; the Federal is not managing Healthcare but help funding the expenses. We have to ask the question if the US Federal Government is the appropriate organization to run Healthcare insurance.

Imperfect Health Reform Still Beats the Status Quo

Washington Post By Steven Pearlstein

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

So the next time you hear someone throwing a hissy fit because health reform might raise taxes on some people, or steer people into managed care, or require small businesses to contribute $2 a day for each employee's coverage, just remember to ask yourself: And that's compared with what?

In recent days, the rumors of the death of health-care reform have been greatly exaggerated. While each of the various proposals snaking their way through the legislative maze has its flaws, the outlines of a good reform plan are there -- universal coverage, insurance market reform, cost controls, computerized medical records, emphasis on effectiveness research and quality improvements. You might have to squint a bit, but they're all there.

The bigger problem now is that, in trying to build public support for reform, President Obama has made promises that will make it even more difficult to bring all the pieces together into an effective and viable reform plan.

Let's start with the promise, repeated often by the president and written explicitly into both House and Senate proposals, that if you like the insurance you have, you can keep it. But if we're aiming to fundamentally restructure the system, is it really credible to say that we can have all the good parts of the old one with none of the bad parts?

We know, for example, that people like to decide for themselves what medical care they will consume and send the bill off to their insurer. And doctors and hospitals like being paid for whatever they do, no matter whether it is needed or is the most cost-effective treatment. We also know, however, that moving away from "fee-for-service medicine," as it is called, is the key to taming runaway health spending and improving health outcomes. That will be a better system, but it will be a different one, and it won't come unless it is pushed and prodded into being by the government.

The president and legislative leaders have also put themselves in a box by promising that any health reform will not add a dime to the federal deficit, as projected by the Congressional Budget Office. The right way to think about health reform is to consider its impact on the whole economy, not just on the government.

Providing affordable health insurance to all Americans is a pretty expensive proposition, but the mechanisms set up to achieve that goal should also produce tens of billions of dollars in savings each year to workers and businesses who already buy insurance. Just looking at the government impact without also considering those private-sector savings gives an incomplete and distorted picture of the economic impact of health reform. It's not just about the deficit. One way to pay for universal coverage, of course, would be to tax those who are likely to benefit most from slowing the growth of health insurance premiums, such as workers who already get their health insurance tax-free. But Obama has also boxed himself in on that issue by reiterating his promise never to raise taxes on anyone who makes less than $250,000 a year. Having a little flexibility on that issue would go a long way to putting together a final package.

The promise of deficit "neutrality" also runs up against the natural conservatism of the CBO's budget analysts, particularly when it comes to the long-term cost savings that might come from restructuring the way doctors and hospitals are paid or moving patients from solo practitioners to clinics that make better use of nurses and coordinate care among a variety of specialists. There is a general consensus among health-care experts that these are the reforms that will finally "bend the curve" of ever-increasing health-care spending, and CBO Director Douglas Elmendorf made headlines the other day by telling Congress that lawmakers had not been aggressive enough in embracing these reforms.

Ironically, even if Congress had been more aggressive, Elmendorf and his CBO colleagues would probably not have given them very much weight in their deficit calculations. The reason: There isn't enough knowledge to say with any precision how much would be saved and when the savings would materialize. By lashing himself to the mast of CBO-certified "deficit neutrality," Capt. Obama has made it even more difficult to steer health reform through the rough political seas that lie ahead.