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Wednesday, March 3, 2010

The non-starter-over in chief

If you had any doubt that President Obama means to, uh, stay the course in his pursuit of health care reform this year, you can rest a little easier. Today in an address from the East Room of the White House, flanked by doctors, nurses and other health-care professionals, the president threw the gauntlet upside the heads of the gradualists on Capitol Hill, the tabula rasa crowd who insist on starting the health-care reform process all over again on the proverbial Clean Sheet of Paper.

Obama’s message couldn’t be simpler: No do-overs. Two weeks, give or take. “Let’s get it done.”

“The insurance companies aren’t starting over. They’re continuing to raise premiums and deny coverage as we speak.

“For us to start over now could simply lead to delay that could last for another decade, or even more,. The American people and the U.S. economy just can’t wait that long.”

“I believe the United States Congress owes the American people a final vote on health care reform. We have debated this issue thoroughly, not just for a year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of sixty votes. And now it deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program [S-CHIP], COBRA health coverage for the unemployed, and both Bush tax cuts – all of which had to pass Congress with nothing more than a simple majority.”

In a speech that exhibited a pitch-perfect balance of rhetorical loft and rhetorical heft, the president indicated he’s had enough of the congressional kabuki do-si-do bullshit that has characterized this debate in the halls of Congress for the past 13 months (to say nothing of the prolonged debate among street activists, netroots organizers, and the blogosphere in general).

And just as important, Obama gave the speech the necessary sense of mission, of purpose. It might be fair to say health-care reform could be to Obama what the Interstate highway system was to Eisenhower, what the moon shot was to JFK: an opportunity to apply national principles to the pressing and immediate task at hand.

“In the end, that’s what this debate is about: It’s about what kind of country we want to be. It’s about the millions of lives that would be touched — and in some cases, saved—by making private health insurance more secure and more affordable.”

“What’s at stake right now is not just our ability to solve this problem, but our ability to solve any problem.”

“The American people want to know if it’s still possible for Washington to look out for their interests and their future,” Mr. Obama said. “They are waiting for us to act. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership. I don’t know how this plays politically, but I know it’s right.”

“And so I ask Congress to finish its work, and I look forward to signing this reform into law. Thank you. Let’s get it done.”

The Republican response was swift and utterly predictable. House Minority Leader John Boehner of Ohio said “well, it’s pretty clear that the Obama administration and my colleagues in Congress are going to continue on their march to shove this government-run health care plan down the throats of the American people,” Boehner said, using the word “shove,” one of the GOP’s hot verbs of the moment (others invoked recently by the Republican leadership include “ram” and “jam”).

Rep. Marsha Blackburn, of Tennessee, condemning Democratic attempts to “push through” health care, said, “This is a bill that is too expensive to afford. It is something that will restrict access to health care, and it will cause us to continue to lose jobs in this country.”

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So much of the health care debate has centered on its estimated out-of-pocket cost; the president’s plan has been estimated at $900 billion over 10 years. Hardly chump change by any estimation.

But look at it another way:

According to a Harvard Medical School analysis released on Sept. 17, almost 45,000 Americans die every year as a result of having inadequate medical care and/or no health insurance. Extrapolating from that estimate, then: if those 45,000 Americans’ lives could be saved, what would be the cumulative annual effect on the economy?

It’s fair to assume that not all of those 45,000 Americans are of or past retirement age, or facing end-of-life issues like terminal diseases that would prevent them from making an extended contribution to the work force. Many, maybe even most of them, could be expected to return to some productive work once their health issues were resolved.

For the sake of a workable scenario, let’s assume that 70 percent of those 45,000 Americans — 31,500 of them — had been ordinary working people.

According to the Statistical Abstract of the United States 2010, wage earners of all races and both genders earn an average of $27,059 a year. Multiplied across the 31,500 people saved from early death in our hypothetical, that puts $852.3 million into their pockets, which, ultimately, means putting most of that money into the national economy.

Add to that the vast financial benefit that arises because hundreds of thousands of other Americans aren't forced into bankruptcy by ruinous medical bills — Americans who are able to route that money into various sectors of the wider economy, such as construction, small businesses and consumer products. The benefit would be billions more.

And there’s the other unknown unknown: just how big a financial impact their incomes would have on other businesses whose income depends on their income ... and on and on, the ripple effect of American capitalism at work.

Admittedly, such gains would be a drop in the bucket compared to the conservatively estimated $90 billion a year the Obama plan is expected to cost, to insure another 31 million Americans. But surely, there’s an obvious financial benefit to bringin’ em’ back alive. Any money is good money when the alternative is no money. A live contributor to the American workforce beats a dead statistic any day.

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We don’t know if anything like that entered the president’s consideration, and since it’s just a back-of-the napkin conjecture, maybe it doesn’t matter.

What does matter is the fact that in May 2002, the Institute of Medicine estimated that 18,314 Americans died every year because they lacked health insurance coverage.

In less than eight years, that number’s more than doubled.

"The report documents the immense consequence of having 40 million uninsured people out there," said Ray Werntz, a consumer health expert with the Employee Benefit Research Institute, to USA Today in 2002. "We need to elevate the problem in the national conscience."

The president’s throwdown to Congress does just that. Finally.

It’s still to be seen if Congress can meet his admittedly ambitious two-week deadline. Congress is as unwieldy an institution as there ever was, and the Republicans on Capitol Hill and their cheerleaders in talk radio and the punditburo will do everything they can to slow down a process that’s already taken too long.

But more and more, there’s a sense that we’re near the endgame, maybe closer to this goal line than ever before. And when you’re on the 10-yard line, or even the 20, you damn well don’t start the game over.

Image credits: Obama: Pete Souza/The White House. Operating room: Detail of photo by Piotr Bodzek, MD, republished under GNU Free Documentation License version 1.2 or later.

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