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in 2009 there is no bigger issue

Fictional Conversation with Obama

In this fictitious conversation with Obama, to explore any common ground, and propose a next step:

Editor:  thank you for taking the time, Mr. President.  I wanted to ask you a few questions.

Obama:  fire away.

Editor:  So the focus is now on insurance reform.  You do see the need for more competition, but how is this best achieved?

Obama:  The notion of a public option to provide an alternative to the private sector will increase efficiency and give citizens another option.  They can of course keep their current doctor and healthcare plan if they wish.

Editor:   So the government can create a plan that increases competition in the private sector, without disrupting or destroying the private sector?

Obama:  That would be a good alternative, the one intended.

Editor:   Is there any precedence in history for such a competitive occurrence?  And did you consider just removing the government mandated anti-competitive practices in the insurance industry?

Obama:  I am glad you asked.  We took a long look at how Medicare programs work, and how the Advantage program is a subsidy for insurance companies, and decided that the cleanest approach was to create a public option.

Editor:  So the notion that Medicare is overall a good plan, despite its overwhelming future deficits, and just needs some tweaking, and that the government will make a competitive entry into a market already with many players, and this will solve the healthcare issues?

Obama:   I see it as a strong push into solving the issues, yes.

Editor:  Was the option of opening up the insurance market and freeing the companies from anti-competitive mandates considered, thereby giving the citizens more choices?  You want more choices for the citizens, correct?

Obama:  That option was not seen as viable or beneficial, and yes we want more choices for the citizens.

Editor:  So the public option, which allows the government to continue to dictate treatment charges, as it does in Medicare and Medicaid, operate with no profit and even incur a loss, be driven by political processes, both to drive down costs at any cost to the patient and doctor, and also operate as Medicare does today - does not constitute monopolistic practice with a bad hook?

Obama:  I think that there are a good many things to work out on this front, and I am confident that we will succeed to serve the people well.  It is imperative to the future of America that this occur.

Editor:  Are you not concerned that the government will operate more like the Post Office than Fed-EX or UPS in your model, as y0u mentioned the Post Office is the one to criticize of these three?   Is there not a great risk to how much this is going to cost? 

Obama:  We have to do something, for the status quo is not an option.

Editor:  Is there not a risk in all of this that is concerning a lot of Americans that the government is entering an area, an industry with no apparent advantage, a great risk to the future of healthcare and to the economy at a cost that is really not in control nor will it be?  Do you not see that the centrist control of the healthcare of 300 million people is impossible?

Obama:  As I said we have work to do, but reform must occur for us to move through this economic recovery successfully.   We need to be sure to provide coverage for all Americans and allow for healthcare to be contained in costs.

Editor:  It would also seem that if rationing had to occur, and it always does in medicine to some degree, that this would best be done by the patient, perhaps even with the approach embedded in the HSA buyer approach.  Are you familiar with the great success that Singapore has had with this idea of a decision on healthcare including cost at the patient-doctor decision point?

Obama:  I think that there a number of ways to increase competition and insure choices, and we intend to do just that.

Editor:  Mr. President, you also seem to shy away from placing any credence on government being a strong factor in getting us to this point.  Would you care to comment and to elaborate, given that government is responsible for a lot of the drivers on cost and nearly 50% of the totals?

Obama:  I think that blaming government is not constructive.  It is a big part of how we will make the big step in reform that we need.

Editor:  Have you seen the website "Liberate Healthcare", Mr. President

Obama:  No I have not yet, no. 

Editor:  thank you for your time, Mr. President.