An Open Letter to My President on Health Insurance Reform

(I will be on the Nicole Sandler Show to discuss President Obama's speech on health insurance reform tonight at 12 ET/9 PT Please check it out…)

Dear Mr. President:


Have you noticed
that every time you're absent from the scene for even a short time, like taking a week of vacation, the health insurance reform
debate gets out of hand, and more than a little nuts? There's a very good
reason for this, you know; it's because this country needs leadership. We
haven't had that for a while, and we're in deep trouble right now because of that. But you know that; it's why you ran for president in the first place.


I know what you're
trying to do with the public. You're trying to get people fired up to
participate in the system,  throwing out trial balloons designed to activate
certain groups. Unfortunately, that doesn't work as well as you might think. If
you want to find out what people want from you, ask them. If you want people to
get behind you, then show leadership. If you show strong leadership on any
issue, the people will get behind you and tell you how they want you to proceed.


One of the reasons I
supported you in the last election was because you were absolutely unflappable. You were less inclined to say the politically expedient thing, and more likely
to say what needed to be said.  You were
a refreshing change from what we had become used to.  We need a leader in the White House who
cares about people and was willing to take on the neoconservative
establishment.  Seriously, the only two
presidents to  demonstrate leadership since Kennedy were Johnson and Reagan, and
Johnson's leadership was tainted by his obsession with Vietnam, and Reagan
didn’t care about the people as much as he cared about political power, and his "leadership" did a lot of damage. It's time to return the government to the people who own it, and we, your biggest supporters, are looking to you to see that happen.  


We used to be able
to rightfully lay claim to the title of "greatest country in the
world." As imperfect as we were at times in the past, we strove to be greater and more
benevolent than any other nation. But now, after 30 years of neocon rule, we no longer even seem to try to be the greatest; just the brattiest. We've traded action for jingoism, and whereas we used to be
a world leader in human rights, at least rhetorically and in principle, we now seem to be fighting  against ourselves on that front. We need a leader who will do the
right thing for once, just because it's the right thing to do. I thought then,
and still think, that you have the gravitas to finally deliver leadership to
this country, and begin to lead this country out of the huge chasm we find ourselves in thanks to neocon policies. 


But leadership is
more than making speeches and holding press conferences; it's about taking a principled stand and sticking to that. That means getting the
entire White House on message and fighting for the same thing. I understand the appeal of being surrounded by diverse opinions, and it's admirable. I like the same thing.
But all but one of those opinions belongs behind closed doors. Your clearly stated opinion should dominate the debate, and that simply isn't happening.


This country needs a
major reform movement, and believe me when I tell you, that reform movement will
happen, either with or without you. This country has to become a productive,
responsible nation once more, or it will cease to exist in any significant way
within a relatively short time. I envision our reign as a world superpower will be
all but over within 20 years if we don't get our act together. We deserve better, and we can be better, with good solid leadership.


I think you know all
of this. I know you love this country as much as I do, and I know you ran for
president with the intention of being its leader, and not simply to occupy the
White House and enjoy the power inherent in the position. That is quite the change from what we've become used to.

I also think you have the potential to be a visionary. But the key
to real leadership in a democracy lies in the ability to articulate to the
people what THEY need to do in order to move us forward as a society. We're all in this together; if the people
don't know the plan, they can't help you enact the plan. Franklin Delano Roosevelt didn't pass the New
Deal by trying to finesse Congress. He told them what he wanted, he told the people what he wanted and he made them
pass it. He didn't appeal for bipartisan support; he put the plan out there and
put them in the position to have to pass it. Some of the New Deal was
unconstitutional, and he probably knew that going in. But he put Congress in
the position of having to pass his agenda or else. he shamed them into having to pass it, and helped them by taking all of the heat himself, and taking a lot of the heat off them. That's what a government
leader does; he puts the other elements of the government on notice that he
wants something, gets the people behind him on it, and makes Congress support him.


You chose wisely
when you chose health insurance as the linchpin of the reform that must occur
in the post-Bush world. If we're to move forward as a society, socially and
economically, we must recognize that human beings are happier and more
productive when they can count on certain things, such as a roof over their
heads, food in their bellies, and that everything they work for will not be
taken away arbitrarily, especially a reason out of their control. 


The most massive
economic problem our country faces right now comes courtesy our health care
financing system, which is inarguably the stupidest system in the world.  Note that I said our health care financing
system. We still have some of the best medical professionals in the world, and
to those who can afford it, the care is the best. One thing the right sometimes gets right is that people from all over the world come here for the best health care. But only the rich ones.

The problem is isn't the health care delivery system. The problem is the system we use to
finance the health care delivery system is designed to fail. The current insurance system makes
money by denying health care coverage to all but the healthiest people in the
country, leaving doctors and hospitals holding the bag, and forcing them to increase prices to make up the difference. The higher the prices go, the higher insurance companies raise premiums, and the more people are denied coverage. As premiums go up, and more people are left uninsured, the higher the unpaid bills go. There is no way that model is sustainable in the long run, and its
very existence threatens to bankrupt us within a generation or so, just as it
bankrupts three quarters of a million individuals every year.


We recognize health care as a basic
fundamental right under the law — if we show up at the emergency room with our
arm falling off, they must treat us — but when it comes to paying for it, we
attempt to treat health insurance as a consumer commodity, like cheese or milk,
or high fructose corn syrup.


This system has
needed reform for a long time.  The first
bills requiring an employer mandate were put forward 40 years ago. The first
attempts to expand Medicare beyond the elderly were attempted in the late 1970s. Fifteen years ago, the
Clinton Health Care plan attempted to combine an employer mandate and an
insurance exchange system that would have put us in a position to simply make a
tiny little jump, instead of the huge leap we have to make to reform the system


Now is not the time
for political gamesmanship. We passed that threshold a long time ago. A problem
that was irritating in 1969 was allowed to become chronic by 1994, and now
needs life support. According to the CBO, without any changes to the system, the
average family insurance premium will top $30,000 per year within ten years,
even as the number of uninsured tops 60 million, and health insurance costs top
$4 trillion per year.


And that's just the
economic toll. How many American citizens are we losing to illness and injury,
because they weren't able to get health care when they needed it? How many
families are forced into absolute financial devastation because a family member
is sick? Just as importantly, how many people are we coming in contact with
every day, who are walking around sick, and possibly contagious to the rest of
us, because they can't see a doctor and be diagnosed and/or cured?


And what does it say
about our country that we are the only industrialized nation in the world in
which a citizen can work and pay taxes all of his or her life, and either die
or lose everything based on an injury or an illness?


Mr. President, it's time for you to pull
out all the stops and lead this country into a new health care financing system. It's
time to put all of the cards on the table and rally the troops behind you.
Summer vacation is over, and people are ready to invest time and energy in
getting this done.

Meaningful health insurance must contain all of the following:

  • It must cover everyone.
    Period. There can be no "freedom of choice" with this. We will
    all need health care at some point, and if we allow some bozo to "choose"
    to go without it,  or ro choose "catastrophic" care, the rest of us will end up paying for that choice.
    Therefore, this issue is about individual responsibility. The system must cover everyone.  Let the cranks whine about being
    "forced;" they've pretty well proven they'll whine, no matter
    what happens, anyway.
  • It has to cover all medically
    necessary procedures. If someone is diagnosed with a medical problem, they must
    receive the care necessary to restore their health, to the extent
    possible. Insurance carriers should not be allowed to deny a claim for any reason
    other than non-payment of premiums.
  • There must be an employer
    mandate, as well as a mandate for self-employed individuals (and I'm self-employed; I know what I'm talking about) and
    accommodations for those who work for small businesses.
  • There must be a component of
    the system that can absorb risk in a way that private insurance companies
    cannot. That likely means a public insurance system, or an expansion of
    Medicare, but regardless, it must be set up to cover every single person
    and every single necessary medical
    procedure, because it's obvious that private insurance alone simply cannot handle the risk involved in the current system.
  • There must be an openly
    competitive market, if we're to even attempt to keep private insurance in
    the mix.
  • There must be cost controls,
    period. We'll save money by covering everyone, and we'll save money by paying every bill and allowing more preventive care, but there must be controls on costs, as well. It must be as maddening to you as it is for me to hear
    journalists and pundits cry and whine how Congress can't do certain
    things, because "health care represents one-seventh of our
    economy." That's exactly the problem. If we take all of the above
    measures, one-seventh of the economy could become one-tenth of the economy within a few years. But if we do nothing, "one-seventh of the economy" will become
    one-fifth in a decade and one-fourth a decade or so after that.

No one is asking you
to dictate terms to Congress; we all know, or should know, that is the quickest
way to kill a bill. But you should be out there on the stump, rallying people
behind the above principles, to the point that every single Representative and
Senator should actually be afraid to NOT support the above concepts.  That is how a reform movement happens.


It's time to give up
on the whole "bipartisanship" concept, mainly because it's never going to happen. There are
still a handful of decent Republicans out there, but they're being held hostage, politically speaking,
by the right wing elements that took over their party years ago, and as they
see things, the only way they can save face is to make sure you don't succeed
at anything. The rhetoric is nice, and makes some folks feel good, but the
bottom line is, just as happened with most of the New Deal, the Civil Rights
and Voting Rights Acts, Medicare, CHIP and countless other major reforms, we
have to do this on our own. A true leader knows when to cut bait and go it
alone, and your time to do so was a while ago. 
Put them on the defensive; you're right and they're wrong. If they had
any ideas to put forth, they would have presented them long before now.There have been no alternative proposals; everything they say about the current reform proposals has been proven to be lies.


But there's another
factor here. One of the reasons the so-called "Blue Dogs" have been
so vocal, and coming out against you is because they're trying to save face,
and save their jobs in states where re-election is not a certainty. By taking this
on yourself, and making this a White House mandate, and demonstrating strong
leadership, you take a lot of the pressure off them, and make it easier to
support you.  Make them follow you; if we
can create a truly workable health insurance system out of this mess, they'll
be the ones who have to face voters having been against it all along. 


I truly hope your
speech before Congress Wednesday night marks the beginning of a strong
leadership phase on this issue because, of all of the reforms that are needed
in this country, this is the most crucial to the survival of this nation.  Lives are at stake, and we need a leader who
will take charge, and take the bull by the horns.  Be the leader we elected last November. Be
the man you were during the last campaign. Make this happen, Mr. President. The
American people are behind you; do the right thing.


Your friend and a proud American,


Milt Shook