This is what comes before what I already typed:
As vital as it may be to raise the wages of American workers abd improve their retirement security, perhaps our most pressing task is to fix our broken health-care system. Unlike Social Security, the two main government-funded health-care programs -- Medicare and Medicaid -- really are broken; without any changes, by 2050 these two entitlements, along with Social Security, could grow to consume as large a share of our national economy as the entire federal budget does today. The addition of a hugely expensive precription drug benefit that provides limited coverage and does nothing to control the cost of drugs has only made the problem worse. ANd the provate system has evolved into a patchwork of inefficient bureaucracies, endless paperwork, overburdened providers, and dissatisfied patients.
In 1993, President Clinton took a stab at creating a system of universal coverage, but was stymied. Since then, the public debate has been deadlocked, with some on the right arguing for a strong dose of market discipline through Health Savings Accounts, others on the left arguing for a single-payer national health-care plan similar to those that exist in Europe and Canada, and experts across the political spectrum recommending a series of sensible but incremental reforms to the existing system.
It's time we broke this impasse by acknowledging a few simple truths.
Given the amount of money we spend on health care (more per capita than any other nation), we should be able to provide basic coverage to every single American. But we can't sustain current rates of health-care inflation every year; we have to contain costs for the entire system, including Medicare and Medicaid.
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With Americans changing jobs more frequently, more likely to go through spells of unemployment, and more likely to work part-time or be self-employed, health insurance can't just run through employers anymore. It needs to be portable.
The market alone can't solve our health-care woes -- in part because the market has proven incapable of creating large enough insurance pools to keep costs to individuals affordable, in part because health care is not like other products or services (when your child gets sick, you don't go shopping for the best bargain).
And finally, whatever reforms we implement should provide strong incentives for improved quality, prevention, and more efficient delivery of care.
With these principles in mind, let me offer just one example of what a serious health-care reform plan might look like. We could start by having a nonpartisan group like the National Academy of Science's Institute of Medicine (IOM) determine what a basic, high-quality health care plan should look like and what it should cost. In designing this model plan, the IOM would examine what which existing health-care programs deliver the best care in the most cost-effective manner. In particular, the model plan would emphasize coverage of primary care, prevention, catastrophic care, and management of chronic conditions like asthma and diabetes. Overall, 20 percent of patients account for 80 percent of the care, and if we can prevent diseases from occurring or manage their effects through simple interventions like making sure patients control their diets or take their medicines regularly, we can dramatically improve patient outcomes and save the system a great deal of money.
Next, we would allow...
to continue:
Next, we would allow anyone to purchase this model health care plan either through an existing insurance pool like the one set up for federal employees, or through a series of new pools set up in every state. Private ensurers like Blue Cross Blue Shield and Aetna would compete to provide coverage to participants in these pools, but whatever plan they offered would have to meet the criteria for high quality and cost controls set forth by IOM.
To further drive down costs, we would require that insurers and providers who participate in Medicare, Medicaid, or the new health plans that have electronic claims, electronic records, and up-to-date patient error reporting systems -- all of which would dramatically cut down on administrative costs, and the number of medical errors and adverse events (which in turn would reduce costly medical malpractice lawsuits). This simple step alone would cut overall health-care costs by up to 10 percent, with some experts pointing to even greater savings.
With the money we save through increased preventive care and lower administrative and malpractice costs, we would provide a subsidy to low-income families who wanted to purchase the model plan through their state pool, and immediately mandate coverage for all uninsured children. If necessary, we could also help pay for those subsidies by restructuring the tax break that employers use to provide health care to their employees: They would continue to get a tax break for the plans typically offered to workers, but we could examine a tax break for fancy, gold-plated executive health-care plans that fail to provide any additional health benefits.
[b]The point of this exercise is not to suggest that there's an easy formula for fixing our health-care system -- there isn't. Many details would have to be addressed before we moved forward on a plan like the one outlined above[/b]; in particular we would have to make sure the creation of a new state pool does not cause employers to drop the health-care plans that they are already providing their employees. [b]And, there may be other more cost-effective and elegant ways to improve the health-care system.[/b]
[b]The point is that if we commit ourselves to making sure everybody has decent health care, there are ways to accomplish it without breaking the federal treasury or resorting to rationalizing.[/b]
If we want Americans to accept the rigors of globalization, then we will need to make that commitment.
[transcriber note -- this section personal not wonky per se, can skip]
One night five years ago, Michelle and I were awakened by the sound of our younger daughter, Sasha, crying in her room. Sasha was only three months old at the time, so it wasn't unusual for her to wake up in the middle of the night. But there was something about the way she was crying, and her refusal to be comforted, that concerned us. Evenutally we called our pediatrician, who agreed to meet us at his office at the crack of dawn. After examining her, he told us that she might have meningitis and sent us immediately to the emergency room.
It turned out that Sasha did have meningitis, although a form that responded to intravenous antibiotics. Had she not been diagnosed in time, she could have lost her hearing or possibly even died. As it was, Michelle and I spent three days with our baby in the hospital, watching nurses hold her down while a doctor performed a spinal tap, listening to her scream, praying she didn't take a turn for the worse.
Sasha is fine now, as healthy and happy as a five-year-old should be. But I still shudder when I think of those three days; how my world narrowed to a single point, and how I was not interested in anything or anybody outside of the four walls of that hospital room -- not my work, not my schedule, not my future. And I am reminded that unlike Tim Wheeler, the steelworker I met in Galesburg whose son needed a liver transplant, unlike millions of AMericans who've gone through a similar ordeal, I had a job and insurance at the time.
[end of that section]
Americans are willing to compete with the world. We work harder than the people of any other wealthy nation. We are willing to tolerate more economic instability and are willing to take more personal risks to get ahead. But we can only compete if our government makes the investments that give us a fighting chance -- and if we know that our families have some net beneath which they cannot fall.
That's a bargain with the American people worth making.
pp. 183-187, "The Audacity of Hope."
Whew.
OK, this came up when Obama was being accused of trafficking exclusively in uplifting generalities. I don't consider the above to be uplifting generalities.
I also don't consider it to be a detailed policy position. I bolded the part that indicates what he was doing with it -- just an "exercise."
I find it a pretty wonky exercise, especially from someone who apparently actually and at least officially wasn't considering running for president at the time.
This section leads me to think that, in presidential candidate mode, he's going to research the heck out of this and come up with something that he thinks will work -- but that it will take some time for him to do so.
