We all know that Obama gives a good speech, and last night’s health care address to a joint session of Congress was no exception. While I’m still one of those who think that the President’s team ought to have made single-payer the opening debate position, and then compromised on the “public option” idea, I think that the now somewhat codified “Obama Plan” is on the right track toward doing something positive; a good first step to getting the mess that is US health care cleaned up and organized, a first step that should lead to further reforms down the road, and eventually put an American system on the same quality level as the rest of the industrialized world.

There were a lot of ideas in the speech I really liked; such as a new regulatory structure for the insurance industry that eliminates a lot of the stuff (rejection of claims, unreasonable limits on coverage, refusal based on pre-existing conditions, etc) that does a lot to make the health care insurance industry a real provider, rather than denier of health care.

I was also glad to see amongst the proposals to insure as many people as possible a “public option” which would be operated in a not-for-profit way; serving as a counterbalance to the for-profit public companies. I don’t see the existence of a public option in the insurance marketplace as in violation of free market principles at all; more competition leads to better deals for consumers. and healthy customers who pay less for health care have more time, energy and money to contribute to the economy as a whole. This makes us all better off, which is one of the things a government ought to be trying to do.

Related to this, an analogy in the speech I did like (as opposed to the one I didn’t below) was the comparison to the public vs private university model. Public universities offer a quality education at a (traditionally) affordable price, and create opportunities for a greater number of people for a quality education than if only private universities existed, creating a larger educated and skilled workforce to contribute to our economy, which helps improve the quality of life for all. An affordable public health care option would provide a greater opportunity for more people who can’t otherwise get basic health care to do so, creating a more healthy population, resulting in, for example, fewer sick days for workers, increasing overall productivity in the economy; again, improving things for all of us. And just as my public alma mater hasn’t put it’s private rival down the road out of business in the last 150 years, a public health care option probably won’t drive the for-profit companies out of business either.

I also saw what I figured would end up being coming to pass was mentioned (which is a nice bit of whuffie for me for the prediction, if nothing else); the large-population “health care marketplace” idea. This is essentially what the federal government does to provide health care to it’s employees – the Federal Employee Health Benefits System offers the choice of many different packages from various commercial providers from which employees choose the option that’s best for them. These plans are, apparently, often less expensive than those offered by private employers, mostly because of the large pool of insured across which the risk is spread. This is the famous “same health care program members of congress get”, and overall, it’s not bad; letting individuals and small businesses buy into this system is certainly better than the option many people currently have, and a positive step in a longer process of reform.

One thing that almost worries me, is the requirement for everyone to have health insurance. Ideally, this is a great thing; everyone having basic coverage is the ideal. However, if it’s merely a mandate without provisions to make sure that everyone can actually afford to get health coverage, this is a problem. An affordable non-profit public option for those without the means does a great deal to mitigate this, as does the federal system marketplace model, which could make good coverage a lot more affordable (especially if employers are given greater incentives to provide assistance to employees to purchase good plans). The problem, of course, is that in mandating universal coverage without offering honestly affordable and accessible options for everyone according to their ability to pay, the government is at the same time setting many people up for serious financial hardship, and perhaps unduly rewarding for-profit insurance companies without necessarily giving them proper motivation to play by the rules in order to benefit from the manditory coverage requirements.

In many places, including by the President in last night’s speech, the comparison is floated between manditory health care coverage and many states’ requirements for manditory auto insurance coverage. In the sense of it being everyone’s responsibility for public safety/health, this is apt, but beyond that, the comparison breaks down. First of all, one can choose to not own a car (at least in regions with good, affordable public transportation), and avoid paying the premiums. You can’t not own a body. Additionally, auto insurance is designed to provide coverage in the event of an accident, not for routine maintenance and regular wear and tear (I know my auto policy doesn’t cover oil changes or a bum alternator). Health coverage is assumed to kick in for both routine maintenance (preventive care, regular check-ups) and unexpected accidents. Also, last time I checked, you don’t have the option to trade your body in for a better one when it becomes a rattle-trap money pit; not that your car insurance pays for replacement when your car wears out from normal use. So, beyond the philosophical, the car insurance analogy isn’t really apt; and in order to meet the “responsibility for public health” test, the government’s got to back up the universal care mandate with effective mechanisms to make sure everyone can actually meet them.

Of the five proposed health care bills floating around congress, most of these address the issue to some degree. however, the so-called Baucus Plan (read the white paper here) coming out of the Senate Finance Committee, which has gotten a lot of attention recently, mostly doesn’t. It mandates universal coverage, but includes no public option provisions, which is going to leave a lot of people in trouble, both in terms of health coverage access, and financially (particularly given the proposed fines for not being covered; which, while scaled somewhat towards income, are still very high). In short, it does more harm than good, both for individual health care, and for the overall economy.

The positive side here, is that the Baucus plan is one of many plans circulating, and the final bill that’s voted on will be a fusion of all the proposals, ideally in line with the guidelines the President laid out last night. To make sure that the final health care bill does incorporate proper mechanisms (such as a strong public option) to make sure that a universal coverage mandate is actually workable, it’s imperative that the people let their Representative and Senators know that they support this kind of solution. I know that’s what I’m planning to do; I strongly suggest everyone else do the same, in the interest of all of us.