As imagined by Dave Lindorff

My Fellow Americans.

I stand before you a chastened president. I made a mistake. Two mistakes really. (wild applause from Republican side)

I thought that Congress could do its job and through the
deliberative process, produce a health care reform plan that would win
broad support across the aisle and among all of you. But I’m afraid
that I was wrong. Health care is an enormous industry—maybe the biggest
and most powerful industry in the country—and it has far too much power
in Washington. Literally thousands of lobbyists, carrying tens of
billions of dollars in campaign contributions—have invaded these halls (and my house!) (relieved laughter)
and distorted the process, and in the end have stymied reform. (some hissing)

Meanwhile, I have realized that the answer has been staring us in the face all along.

And that was my second mistake. I told the American Medical
Association that while single-payer medical plans, where the government
is the insurer, might work well in other countries, the idea of
government running health care was not part of our American tradition.
In fact, it is, and has been since 1965, when President Lyndon Johnson
signed into law the Medicare program. Medicare is a single-payer
program, and polls and surveys show it is enormously popular with older
and disabled Americans. Medicare has relieved our parents and
grandparents from the fear that they will not get medical care when
they stop working, and it has lifted the enormous burden and worry off
of younger Americans over how to pay for the care of their elders, and
it has done this with enormous efficiency, all while allowing
recipients to choose their own doctors and hospitals. (applause)

So we really don’t need to re-invent the wheel here. There is no
point in members of Congress having to hold endless hearings, and to
sit and listen to the pitches of lobbyists from the medical
establishment. We can just expand Medicare to cover everyone. (applause)

How much would that cost? Well, we know that 10% of the elderly—the
oldest and sickest among us--account for 50% of total Medicare costs,
so that means the other 90% only cost some $200 billion a year. Even if
we assumed that the rest of the population’s medical bills were as high
as those 90% or older Americans, it would mean that expanding Medicare
to cover them would cost less than $1 trillion a year, and probably
closer to $750 billion. So roughly speaking, we’re talking about adding
$750 billion a year to the cost of Medicare.

Now that’s a big number, and I know that some of you—a lot of
you—worry about higher taxes. But let me assure you, expanding Medicare
to cover everyone is going to save you money—virtually
everyone. Let’s look at why that is, and why you cannot just look at
the federal tax when you consider those savings.

Today, the United States spends nearly 20 percent of GDP on health
care. That is more than double what any other country in the world
spends on health care. And you know what? We don’t get our moneys’
worth for all that dough. Canadians, who spend half that percentage of
their GDP on health care, and who have what amounts to Medicare for all
with their single-payer system (they call it Medicare too), have longer
lifespans and better infant mortality statistics than we do. In fact,
Cuba and Mexico have better child health statistics than we do!

By the way, I want to introduce, in the gallery, Shirley Jean
Douglass, whose father, Tommy Douglass, was the founder of Canada’s
Medicare program. We will be consulting closely with experts and
administrators of Canada’s Medicare program as we move forward with our
own reform. (applause)

Now I've been accused of lecturing (laughs and applause),
and I don’t want to sound like a college professor here, but let me
just highlight a few reasons why simply expanding Medicare to cover all
of us makes not just moral, but also economic sense. If we were to make
that change, we could immediately eliminate the Medicaid program, which
as you know is funded by the states, and costs them (and you) about
$400 billion a year, mostly to cover low-income families and
individuals. Now that money would not be totally eliminated, because
Medicare currently doesn’t cover all health care costs—just 80%. And
Medicaid covers the remaining 20% for those elderly and disabled people
who cannot afford to pay for Medi-Gap private plans--something the government would continue to do with an expanded plan. Even so,
eliminating Medicaid for the poor, who would be switched to Medicare,
would save at least $300 billion. We could also eliminate the Veterans
Administration—which incidentally is an excellent example of true
government healthcare, with publicly owned hospitals and doctors on
salary, and it runs very well and very efficiently.

Something those folks at last month’s town meetings who were saying government can’t do anything right should think about. (wild applause from Democratic side)

Sorry. I just had to say that. (more applause)

Anyhow, eliminating the VA would save another $100 billion so we’ve
already saved more than half the amount that was added to the cost of
Medicare in order to cover everyone. (applause)

But there are far more savings.

One of the biggest would be the elimination of about $300 billion
that is spent each year by hospitals and doctors to provide care to
people with no insurance who end up in hospital emergency rooms. The
cost of this “charity care” is factored into higher hospital and
physician bills, and ultimately into higher insurance premiums paid by
the rest of us. Since all those people would now be covered by
Medicare, that expense would vanish.

American companies currently pay about $25 billion a year in workers
compensation insurance—money that ultimately comes out of workers’
paychecks. That would no longer be necessary, because people injured on
the job would be covered by Medicare. (smattering of applause, mostly from Republican side)

Car insurance rates would be dramatically lower, because car
insurance would no longer have to pay for medical costs following an
accident. The same is true for homeowners insurance, which would no
longer have to cover the costs of someone being injured on your
property. (applause from Pennsylvania delegation, with among highest car insurance rates in the nation)

And of course, the biggest savings of all—about $3000 per person or
$12,000 per family every year—namely the cost of private insurance
premiums paid by you and/or your employer, would be gone. Think about
that a minute: no more co-pays, no more annual deductibles, no more
employee share of insurance premiums for yourself or your family. And
for businesses that provide health care coverage, a huge savings that
will make them more competitive in the global marketplace, and that
will also allow them to pay higher wages to their employees. (prolonged applause)

Oh, and there is one other huge, if unquantifiable savings to
consider. If everyone has Medicare, the total cost of health care will
go down dramatically, because everyone will be getting timely
treatment, instead of having to put of exams and early treatment of
illness or injury. And no one will suffer the terrible anxiety or
worrying about whether they can pay for health care for themselves and
their families.

So yes, your Medicare withholding will be perhaps 25% higher if we
expand Medicare to cover everyone. That tax is currently set at 2.9%
for you and 2.9% for your employer, so it would go up to about 0.75% of
your paycheck. For someone earning $600 a week, that would represent an
increased deduction of about $4.50 a week. For someone earning $1200 a
week, it would be an increased deduction of $9. That is a pretty good
deal for not having to pay for insurance coverage any more, wouldn’t
you agree? (applause, plus some boos from largely silent Republican side)

Now for you folks already receiving Medicare, there have been a lot
of scare stories out there, some of them being promoted by some
irresponsible people right in this chamber (pause for applause and nervous laughter), suggesting that if we expand health care coverage, it will come off of your benefits. Don’t you believe it! (applause)

We live in a democracy, and when a lot of people want something, or
benefit from something, they collectively defend that particular thing.
In the case of Medicare, if everyone is receiving it, and receiving it
in the same manner as everyone else, that creates a huge voting bloc in
favor of defending that benefit, so by expanding Medicare to all, we
would be creating a powerful political force that will defend Medicare
from attack, just as the universality of Social Security has made that
program bullet-proof (something my predecessor learned when he tried to
promote the idea of privatizing it). (wild applause from Democratic side)

So here’s the deal.

I’m admitting it was the wrong move to try to lay it on your poor
folks in Congress come up with some completely new, complicated reform
our existing health care system—if you can even call it that. My good
friend and former colleague in this building, Chairman John Conyers,
had it right all along: We have a great system that we just need to
expand to cover everyone.

So to get it started, I’m going to send Congress a couple of bills.
One would immediately shift everyone eligible for Medicaid over to
Medicare. I’m calling this the States' Medical Cost Relief and Medicare
Expansion Act. It will not only begin the process of expanding
Medicare, but will provide badly needed financial relief to states that
are suffering from declining tax revenues and rising health care costs
because of the recession. (applause)

I will also send Congress a bill that will expand Medicare coverage to all Americans and to legal residents. (applause, some boos from Republicans)

I am sure that as financially sound as this change is, there will
be opposition from the medical industry, so let me add that this is,
for me, a moral imperative too. For too long, this great country has
allowed health care to be a matter of whether or not you had a job with
health benefits, or enough money to pay for insurance yourself. That is
unacceptable. We are our brothers’ and sisters’ keepers, and just as we
believe that every child needs an education, we believe that everyone
deserves to have access to quality medical care. (loud applause)

So let me add this: If Congress does not pass these two bills by
the end of the current session, in time for the holiday recess in
December, I will declare a national emergency because of the recession
and the huge rise in the uninsured that it has caused, and will issue
executive orders implementing both these measures. It’s not the way I
would prefer to see things done, but if Congress cannot act, I promise
you and the American people, I will. (applause and boos)

Let me also say that this program is a priority for me and for all
Americans, and anyone—Republican or Democrat—who gets in the way can
expect to hear from me, and from the American people, in this coming
election year. (applause)

Thank you and good night. (applause)
_______________
DAVE LINDORFF is not a speechwriter for the president. He is,
however, the author of “Marketplace Medicine: The Rise of the
For-Profit Hospital Chains” (Bantam Books, 1992). His work is available
at www.thiscantbehappening.net