Barack Obama on Health Care Democratic nomine for President; Junior Senator (IL)

Sub-sections under Health Care:
• AIDS
• Universal Coverage
• Voting Record
• Other issues under Health Care

Health care is a right: something’s fundamentally wrong now

McCAIN: I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that I have, that will do that. But government mandates I’m always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that.

OBAMA: Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills--for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.

FactCheck: Exempts small business, but no $2,500/yr savings

McCain misstated Obama’s health care plan, claiming it would levy fines on “small businesses” that fail to provide health insurance. Actually, Obama’s plan exempts “small businesses.”

Health tax credit is bad idea; it will cost taxpayers more

OBAMA: I make sure that we have a health care system that allows for everyone to have basic coverage. McCain talked about providing a $5,000 health credit. Now, what he doesn’t tell you is that he intends to, for the first time in history, tax health benefits. So you may end up getting a $5,000 tax credit. Here’s the only problem: Your employer now has to pay taxes on the health care that you’re getting from your employer, and if you end up losing your health care from your employer, you’ve got to go out on the open market and try to buy it. It is not a good deal for the American people.

$15B subsidies to private insurers was a lobbyist giveaway

FactCheck: McCain’s plan taxes employees, not employers

Obama said, “You may end up getting a $5,000 tax credit. Here’s the only problem: Your employer now has to pay taxes on the health care that you’re getting from your employer. McCain’s plan doesn’t call for taxing employers on health care benefits; it would instead tax employees. As the law stands now, employees don’t pay taxes on the dollar value of their health insurance benefits. Under McCain’s plan, they would.

McCain also misrepresented Obama’s plan when he said that his opponent favored “handing the health care system over to the federal government.” McCain made a similar claim in his acceptance speech, when he said that Obama’s plans would “force families into a government run health care system.” We called it false then and we stand by that. Obama’s plan mandates coverage for children, but not for adults, and it does not require anyone to be covered by a nationalized system.

Give more help to those denied a life of dignity & respect

Guaranteed health care for anyone who needs it

End-of-life self-medication ok; euthanasia by others not ok

A: I believe in everybody having a living will so that their views on these issues can be factored in by family members. I don’t think that it’s appropriate to empower doctors themselves to make that decision. But I think that it is important for us to be able to allow people who are terminally ill, in excruciating pain, to get the medicine they need to relieve that pain.

Q: By “relieve that pain” you mean hasten the end of life if they choose to?

A: I think that there has to be very strict guidelines to ensure that somebody who is making a decision to relieve their pain [is acting appropriately]. That is distinguished from euthanasia in which someone else is making the decision for them.

Hillary’s plan must either be enforced, or leave out people

Source: 2008 Democratic Debate in Cleveland Feb 26, 2008

The problem with health care is about affordability

Subsidies to people who can’t afford care--not single payer

Bring GOP & Dems together to make haelthcare affordable

“I’ll be a president who finally makes health care affordable to every single American by bringing Democrats and Republicans together. I’ll be a president who ends the tax break for companies that ship our jobs overseas and put a middle class tax cut into the pockets of working Americans. And I’ll be a president who ends this war in Iraq and finally brings our troops home. We are one nation and our time for change has come.”

FactCheck: Reducing obesity would save $18B, not $1T

Obama got this claim from a “candidate briefin book” put out by the Center for American Progress, a liberal think tank run by former Clinton chief of staff John Podesta. CAP cites the CDC & the Commonwealth Fund as sources for the estimate, but representatives from both organizations told us that the claim was unfamiliar to them.

We worked up our own back-of-the-envelope estimate: The CDC officially estimates that obesity cost $75 billion in 2003; & that approximately half of the cost burden for both overweight and obese people is borne by Medicaid and Medicare; & obesity rates doubled between 1980 and 2000. So if obesity rates returned to “rates that existed in 1980” they would be cut in half, and Medicare & Medicaid would save about a quarter of $75 billion, or roughly $18.75 billion per year.

Reforms in prevention and drug price negotiation save money

Tackle insurance companies on reimbursement system

Help young people deal with the cost of medical education

Morally wrong that terminally ill must consider money

A: It shouldn’t be. And it’s wrong. You know, my mother died of ovarian cancer when she was 53 years old. And I remember in the last month of her life, she wasn’t thinking about how to get well, she wasn’t thinking about coming to terms with her own mortality, she was thinking about whether or not insurance was going to cover the medical bills and whether our family would be bankrupt as a consequence. That is morally wrong. It’s objectionable. That’s why I put forward a comprehensive legislation for universal health care so that all people could get coverage. My attitude is, that since you are paying my salary as taxpayers, you should have health care that is at least as good as mine. And the key to that is not only a good plan, but we’ve also got to overcome the drug & insurance company lobbies, that spent $1 billion over the last 10 years to block reform. As president, I am going to take them on.

FactCheck: Correct that insurance lobbying cost $1B

According to the Center for Responsive Politics, the pharmaceutical and insurance industries spent $1.2 billion and $949 million, respectively, on all lobbying efforts since 1998. Moreover, the two industries combined shelled out about $193 million in political donations and expenditures backing Republicans, about twice as much as they spent supporting Democrats. So it is reasonable to conclude that the pharmaceutical and insurance industries have indeed spent at least $1 billion combating legislation that Obama favors.

National smoking bans only after trying local bans

A: I think that local communities are making enormous strides, and I think they’re doing the right thing on this. If it turns out that we’re not seeing enough progress at the local level, then I would favor a national law. I don’t think we’ve seen the local laws play themselves out entirely, because I think you’re seeing an enormous amount of progress in Chicago, in New York, in other major cities around the country. And because I think we have been treating this as a public health problem and educating the public on the dangers of secondhand smoke, that that pressure will continue. As I said, if we can’t provide these kinds of protections at the local level, which would be my preference, I would be supportive of a national law.

Q: Have you been successful in stopping smoking?

A: I have. You know, the best cure is my wife.

Reform failed in ‘90s because of drug company lobbying

Take on insurance companies; drive down health care costs

Address minority health needs by more coverage & targeting

A: One of the biggest reasons that there are disparities is that African-Americans & Latino Americans are much more likely not to have health insurance. And so if we set up a system in which everybody’s got health insurance, some of those disparities are immediately going to be reduced. Folks who are working but don’t have health care benefits- those groups are disproportionately minority. [Covering them via their employer] would be the first step. There are some particular issues within the minority community that I think we can address in a targeted way. Lead paint may seem like an ancillary issue except for the fact that incidence of lead poisoning among African-American & Latino youths is sky high. It has huge ramifications in terms of their long-term health. Obesity and diabetes in minority communities is more severe.

Health care tied to balancing costs and taxes nation wide

Allowing seniors to bulk purchase will save taxpayers’ money

A: It was fundamentally flawed as a piece of legislation. The central premise of this prescription drug bill that was passed by Bush was that the federal government, through the Medicare program, and senior citizens could not negotiate for the best possible price with the drug companies, so that they could actually get the kinds of discounts the Canadians enjoy for the drugs that are manufactured here in the US. That was done because the drug companies didn’t let it happen. What we have is a bill that’s bad for taxpayers and bad for senior citizens. Taxpayers are hit with a half-a-trillion-dollar tab that was originally estimated at three hundred billion. And about 3 weeks later, seniors have a big donut hole in the middle of their benefits. What I would do is I would say that senior citizens, through the Medicare program they can go and negotiate the best possible price as a consequence of being bulk purchasers.

Allow prescription drug re-importation

Use whatever works with AIDS, including teaching abstinence

A: When Michelle and I were traveling in Kenya, we took an AIDS test. I compliment George Bush on the PEPFAR program [President’s Emergency Plan for AIDS Relief]. My view is that we should use whatever the best approaches are, the scientifically sound approaches are, to reduce this devastating disease. Part of that should be a strong education component and I think abstinence education is important. I also think that contraception is important; I also think that treatment is important; I also think that we have to do more to make antiviral drugs available to people who are in extreme poverty. So I don’t want to pluck out one facet of it. Now, that doesn’t mean that non-for-profit groups can’t focus on one thing while the government focuses on other things. I think we want to have a comprehensive approach.

We need condom distribution to deal with the scourge of AIDS

Homophobia prevents talking about HIV/AIDS

Got tested for AIDS, with wife, in public, in Kenya

BIDEN: You’re asking, how do we prevent these 17-year-olds from getting HIV? All the things that were said here [by other candidates] are good ideas; but they don’t prevent that. I spent last summer going through the black sections of my town, trying to get black men to understand it is not unmanly to wear a condom, getting women to understand they can say no, getting people in the position where testing matters. I got tested for AIDS. I know Barack got tested for AIDS. There’s no shame in being tested for AIDS.

OBAMA: I just got to make clear--I got tested with Michelle, when we were in Kenya in Africa. I don’t want any confusion here about what’s going on.

BIDEN: And I got tested to save my life, because I had 13 pints of blood transfusion.

OBAMA: I was tested with my wife. In public.

Curing AIDS must be all-hands-on-deck effort

Lead global fight against AIDS

Zero fines & no mandate for small business

OBAMA: Here’s your fine--zero.

McCAIN: Zero?

OBAMA: Zero, because as I said in our last debate and I’ll repeat, I exempt small businesses from the requirement for large businesses that can afford to provide health care to their employees, but are not doing it. I exempt small businesses from having to pay into a kitty. But large businesses that can afford it, we’ve got a choice. Either they provide health insurance to their employees or somebody has to. Right now, what happens is those employees get dumped into either the Medicaid system, which taxpayers pick up, or they’re going to the emergency room for uncompensated care, which everybody picks up in their premiums.

Reduce premiums and uninsured get same coverage as Congress

McCAIN: I want to give every family a $5,000 refundable tax credit. Take it and get anywhere in America the health care that you wish. [For employers], if you want to do the right thing with your employees and provide them health insurance, we’ll give you a 50% credit so that you will actually be able to afford it.

No exclusions for pre-existing conditions

A: Here’s what I would do. If you’ve got health care already, and probably the majority of you do, then you can keep your plan if you are satisfied with it. You can keep your choice of doctor. We’re going to work with your employer to lower the cost of your premiums by up to $2,500 a year. And we’re going to do it by investing in prevention. We’re going to do it by making sure that we use information technology so that medical records are actually on computers instead of you filling forms out in triplicate when you go to the hospital. That will reduce medical errors and reduce costs. If you don’t have health insurance, you’re going to be able to buy the same kind of insurance that Sen. McCain and I enjoy as federal employees. Because there’s a huge pool, we can drop the costs. And nobody will be excluded for pre-existing conditions, which is a huge problem.

Ban insurance companies from discriminating against the sick

I’ve got a health plan and a plan to get it implemented

AdWatch: My plan costs $2,500 less per family than Clinton’s

Announcer: Hillary Clinton is attacking. But what’s she not telling you about her health care plan? It forces everyone to buy insurance, even if you can’t afford it. And you pay a penalty if you don’t. Barack Obama believes it’s not that people don’t want health care. It’s that they can’t afford it. That’s why the Obama plan reduces costs more than Hillary’s, saving $2,500 for the typical family. For health care we can afford, vote for change we can believe in.

FactCheck: Unclear if Obama’s plan costs less than Clinton’s

Universal health care means anyone who wants it can get it

OBAMA: Well, look, I believe in universal health care, as does Sen. Clinton. And the point of the debate, is that Sen. Clinton repeatedly claims that I don’t stand for universal health care. And, you know, for Sen. Clinton to say that, I think, is simply not accurate. Every expert has said that anybody who wants health care under my plan will be able to obtain it. President Clinton’s own secretary of Labor has said that my plan does more to reduce costs and as a consequence makes sure that the people who need health care right now, all across America, will be able to obtain it. And we do more to reduce costs than any other plan that’s been out there.

CLINTON: [Leaving out a mandate is the same as saying] that we shouldn’t try to get everyone into health insurance.

Insurers are happy to have a mandate; issue is affordability

CLINTON: And under my plan, it is affordable because, number one, we have enough money in our plan. A comparison of the plans like the ones we’re proposing found that actually I would cover nearly everybody at a much lower cost than Sen. Obama’s plan.

Voluntary universal participation, like in Medicare Part B

CLINTON: [Obama’s plan] would be as though Franklin Roosevelt said let’s make Social Security voluntary --let’s let everybody get in it if they can afford it--or if Pres. Johnson said let’s make Medicare voluntary. Now, if you want to say that we shouldn’t try to get everyone into health insurance, that’s a big difference.

OBAMA: I believe that if we make it affordable, people will purchase it. In fact, Medicare Part B is not mandated, it is voluntary. And yet people over 65 choose to purchase it, Hillary, and the reason they choose to purchase it is because it’s a good deal. And if people end up seeing a plan that is affordable for them, I promise you they are snatching it up because they are desperate to get health care. And that’s what I intend to provide as president of the United States.

Mandating kids’ insurance ok; mandating adults has problems

OBAMA: I have no objection to Sen. Clinton thinking that her approach is superior. But we still don’t know how Sen. Clinton intends to enforce a mandate.

CLINTON: Sen. Obama would enforce the mandate by requiring parents to buy insurance for their children.

OBAMA: This is true.

CLINTON: If you have a mandate, it has to be enforceable. So there’s no difference here.

OBAMA: No, there is a difference. I do provide a mandate for children, because we have created programs in which we can have greater assurance that those children will be covered at an affordable price. But we don’t want to put adults in a situation in which, on the front end, we are mandating them, we are forcing them to purchase insurance, and if the subsidies are inadequate, the burden is on them, and they will be penalized. And that is what Sen. Clinton’s plan does.

Young adults up to age 25 can be covered under parents’ plan

OBAMA: Which is why I cover them.

CLINTON: Except when the illness or the accident strikes. And what Sen. Obama has said, that then, once you get to the hospital, you’ll be forced to buy insurance, I don’t think that’s a good idea. We ought to plan for it, and we ought to make sure we cover everyone. That is the only way to get to universal health care coverage. But if we don’t even have a plan to get there, and we start out by leaving people, you’ll never ever control costs, improve quality, and cover everyone.

OBAMA: With respect to the young people, my plan specifically says that up until the age of 25 you will be able to be covered under your parents’ insurance plan, so that cohort that Sen. Clinton is talking about will, in fact, have coverage.

My plan does more than anybody to reduce costs

My health plan does not leave 15 million people uncovered

Adults will get health care as they can afford it

AdWatch: punishing uninsured families doesn’t make sense

Hillary’s health care plan forces everyone to buy insurance, even if you can’t afford it... and you pay a penalty if you don’t.

Punishing families who can’t afford health care to begin with just doesn’t make sense. Bill Clinton’s own Secretary of Labor, Robert Reich, wrote, “I’ve compared the two plans in detail... But in my view Obama’s would insure more people, not fewer, than HRC’s.“

The Obama Health Care Plan:
• Offers health care coverage for all Americans similar to that of members of Congress, and subsidies to help those who cannot afford it.
• Reduces insurance costs more than Hillary’s plan, including capping insurance company profits in places where they have taken advantage of people.
• Saves the typical family up to $2,500 per year.

FactCheck: Hillary’s plan does mandate; but so does Obama’s

The mailer focuses on the primar difference between the two candidates’ proposals: whether they would require everyone to obtain coverage. Clinton’s plan would require all Americans to get insurance, though she hasn’t said what will happen if they don’t. Obama’s plan would require insurance for all children but not for adults.

The Obama campaign is trying to shift the focus to some unspecified “punishment” that Clinton’s plan would mete out for those who didn’t obtain coverage. It’s true that a “mandate” implies penalties for noncompliance, and Clinton’s campaign has yet to outline what those would be. But Obama’s plan, which would mandate coverage for children, would presumably also have some enforcement mechanism, and he doesn’t make explicit what that would be, either

No one turned away due to illness or pre-existing condition

The Obama Plan will have the following features:
• Guaranteed Eligibility: No American will be turned away FROM ANY INSURANCE PLAN because of illness or pre-existing conditions.
• Comprehensive Benefits: The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have.
• Affordable Premiums, Co-Pays and Deductibles.
• Subsidies: Those in need who do not qualify for Medicaid or SCHIP will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
• Simplified Paperwork and Reined in Health Costs.
• Easy Enrollment:
• Portability and Choice Participants will be able to move from job to job without jeopardizing their health care coverage.
• Quality and Efficiency: Insurance companies will be required to report data on quality.

Buy private insurance via National Health Insurance Exchange

Against enforcement mechanism for mandating insurance

OBAMA: About 95% of our plans are similar. We both set up a government plan that would [cover] pre-existing conditions. We both want to emphasize prevention. But I emphasize reducing costs. If we provide subsidies to those who can’t afford it, they will buy it. Sen. Clinton has a different approach. She believes that we have to force people who don’t have health insurance to buy it, or there will be a lot of people who don’t get it. But if you are going to mandate the purchase of insurance & it’s not affordable, then there’s going to have to be some enforcement mechanism that the government uses. And they may charge fines to people who already don’t have health care, or take it out of their paychecks. And that, I don’t think, is helping those without health insurance. That is a genuine difference.

FactCheck: Yes, Obama favored single-payer, despite denial

But Obama’s denial doesn’t hold up. In a speech in June 2003, Obama said: “I happen to be a proponent of a single-payer health care program. I see no reason why the US cannot provide basic health insurance to everybody. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see.“

After his election, Obama tempered his position, saying in May 2007, ”If you’re starting from scratch, then a single-payer system would probably make sense. But managing the transition would be difficult. So we may need a system that’s not so disruptive.

FactCheck: No, US costs are not twice as much as others

In a 2007 Kaiser Family Foundation report comparing the health care spending of Organisation for Economic Co-operation and Development member countries, the United States came in first at $5,711 per capita. But Luxembourg spent $4,611, only $1,100 less per capita than the U.S. The next biggest spender, Switzerland, spent $3,874, also far more than half of U.S. spending. KFF noted, however, that the United States’ spending was “over 90% higher than in many other countries that we would consider global competitors.”

AdWatch: Pressure insurance & drug companies to change

FactCheck: OPPORTUNITY to insure all, but no GUARANTEE

• It attributes to The Washington Post a line saying Obama’s plan would save families about $2,500. But the Post was citing the estimate of the Obama campaign and didn’t analyze the purported savings independently.
• It claims that “experts” say Obama’s plan is “the best.” “Experts” turn out to be editorial writers at the Iowa City Press-Citizen-- who, for all their talents, aren’t actual experts in the field.
• It quotes yet another newspaper saying Obama’s plan “guarantees coverage for all Americans,” neglecting to mention that, as the article makes clear, it’s only Clinton’s and Edwards’ plans that would require coverage for everyone. Obama’s plan wouldn’t guarantee that every individual HAD health insurance, just that everyone would have the OPPORUNITY to obtain it.

AdWatch: Don’t make it illegal not to have health care

[Female announcer]: Here’s what the experts say. President Clinton’s own Labor Secretary Robert Reich says, quote, “I’ve compared the plans in detail. Obama’s plan would insure more people than the others.” The Pioneer Press confirms Obama guarantees coverage for all Americans.

[Male announcer]: But here’s the real difference on health care. Senators Edwards and Clinton favor mandates which the Daily Iowan says would, quote, “force those who cannot afford health insurance to buy it, punishing those who don’t fall in line.”

[Female announcer]: Barack Obama believes the solution isn’t making it illegal not to have health care. It’s making it affordable.

[Male announcer]: And that’s why his plan cuts costs for a typical family by twenty-five hundred dollars.

[Female Announcer]: As the Concord Monitor says, when it comes to honesty about health care, Obama has the edge.

Being poor in this country is hazardous to your health

A: The president can do everything to address this and can afford it if we are able to bring people together to get it done. And this is something that I am committed to doing as president. But it is indisputable that if you are poor in this country that is hazardous to your health, if you are black or brown, too, and poor, it can be downright deadly. Right now, even when blacks or Latinos have the same health insurance as whites, they are not receiving the same quality of care. And that means that we’ve got to have more black and brown doctors and nurses; we’ve got to have studies in terms of making sure that we are eliminating these disparities; we’ve got to make sure that we are doing outreach in these communities ahead of time to prevent disease.

Problem isn’t mandating coverage, but affording it

FactCheck: Coverage plan might leave 8.5 million uninsured

Clinton uses a dubious statistic when she claims Obama’s plan would leave out 15 million of the uninsured. But Obama’s statement that his proposal provides “universal” health care is also suspect. Clinton based her claim on a column by The New Republic’s Jonathan Cohn, who loosely estimated Obama’s plan would leave 15 million uninsured. Cohn offered an estimate based on the best information available, not a hard and fast calculation. The best available information says that Obama’s plan would leave between 8.5 million uninsured, up to 18 million people uninsured if Obama has no individual mandates. The Obama plan does include limited mandates, including a requirement for employers to either provide health insurance or pay into a public fund.

Cautious incremental plan offers choice & subsidy

You can see these tendencies in Obama’s healthcare plan, which bars insurers from refusing coverage to anyone, lets people choose between private plans and a public one, and offers subsidies to those who cannot afford the rates. This approach borrows heavily from John Edward’s much-praised scheme, but it falls short of his call for universal coverage. At any rate, The New Republic estimates that Obama’s plan would leave about fifteen million American uninsured.

It can be argued that an incremental attitude is the best way to pass liberal legislation these days. Obama has said as much. “For a political leader to get things done, he or she ideally should be ahead of the curve, but not too far ahead.”

Added 20,000 children to Illinois healthcare

Government healthcare like members of Congress have

A: That’s correct. Part of the reason that you’re confused about the candidates’ differences is because the differences probably matter less than the commonalties. All of the major Democratic candidates are advocating some form of universal health care. The question is, how do we get there? My proposal says:

• We will set up a government program similar to the one that I utilize as a member of Congress, that anybody who wants to can buy into, that we will subsidize those who can’t afford it.
• That we will pay for those subsidies by imposing a set of cost-saving measures that will actually improve quality at the same time that they lower costs.
• Using health IT, information technologies, not just for billing but for maintaining medical records, for communicating between doctors and nurses and pharmacists.
• To reduce errors and reduce bureaucracy.
• Managing the chronically ill.

Increase competition in the insurance and drug markets

Obama’s plan will reduce costs and save a typical American family up to $2,500 each year:
• Driving adoption of state-of-the-art health information technology systems.
• Improving access to preventive care & chronic disease management programs.
• Requiring hospitals to collect & report cost & quality data.
• Reforming our market structure to increase competition in the insurance & drug markets
• Lowering drug costs by allowing importation of safe medicines & increasing use of generics.

National Health Insurance Exchange for private coverage

Obama’s plan will provide affordable, comprehensive and portable health coverage for all Americans by:
• Making available a new public health plan that will allow individuals and small businesses similar to that available to members of Congress. No one will be turned away or charged more due to illness, and everyone who needs it will receive a subsidy.
• Making available a National Health Insurance Exchange to help individuals purchase private coverage and to reform the private insurance market Any American could enroll in participating private plans, which would have to provide comprehensive benefits, issue every applicant a policy, and charge fair and stable premiums.
• Immediately ensuring all 9 million currently uninsured children.
• Expanding Medicaid and the State Children’s Health Insurance Program [as a] critical safety net function.
• Requiring employers to make a meaningful contribution to the health coverage of their employees.

Health plan cuts typical family’s premium by $2,500 a year

It goes further than any other proposed plan in cutting the cost of health care by investing in technology and preventive care so that children are getting regular check ups instead of having to go to the emergency room for treatable illnesses like asthma, and by breaking the stranglehold of the drug companies and the insurance industries--we are tired of them dictating our health care markets--and helping businesses and families shoulder the cost of the most expensive conditions so that an illness doesn’t lead to bankruptcy. And I promise you this: I will sign a universal health care plan that covers every American by the end of my first term as president.

Give people the choice to buy affordable health care

National insurance pool & catastrophic insurance

Employers are going to have to pay or play

Need political will to accomplish universal coverage

• that coverage has to be universal
• that we’re going to have to save costs and get more bang for our health care dollar
• that employers, government and individuals are all going to have to put up something
• and that savings that we obtain from making a more efficient system can’t be just obtained by hitting frontline workers.
• But in addition to those basic principles, we have to challenge ourselves: Do we have the political will and the sense of urgency to actually get it done? I want to be held accountable for getting it done. I will judge my first term as president based on the fact on whether we have delivered the kind of health care that every American deserves and that our system can afford. Source: SEIU Democratic Health Care Forum in Las Vegas Mar 24, 2007

  Universal health care by of first term

  Let’s be the generation that ends poverty in America. Every single person willing to work should be able to get job training that leads to a job, and earn a living wage that can pay the bills, and afford child care so their kids have a safe place to go when they work. Let’s do this. Source: Speech in Springfield, in Change We Can Believe In, p.198 Feb 10, 2007

  Healthcare system is broken without lifetime employment

  Our health-care system is broken: expensive, inefficient, and poorly adapted to an economy no longer built on lifetime employment, a system that exposes Americans to insecurity and possible destitution. But year after year, ideology and political gamesmanship result in inaction, except for 2003, when we got a prescription drug bill that managed to combine the worst aspects of the public and private sectors--price gouging and confusion, gaps in coverage and an eye-popping bill for taxpayers. Source: The Audacity of Hope, by Barack Obama, p. 22-23 Oct 1, 2006

  The market alone can’t solve our health-care woes

  President Clinton took a stab at creating a system of universal coverage, but was stymied. Since then, public debate has been deadlocked.

  Given the money we spend on health care, we should be able to provide basic coverage to everyone. But we have to contain costs, including Medicare and Medicaid.

  The market alone cannot solve the problem--in part because the market has proven incapable of creating large enough insurance pools to keep costs to individuals affordable. Overall, 20% of all patients account for 80% of the care, and if we can prevent disease or manage their effects, we can dramatically improve outcomes and save money.

  With the money saved through increased preventive care and lower administrative and malpractice costs, we would provide a subsidy to low-income families and immediately mandate coverage for all uninsured children.

  There is no easy fix, but the point is that if we commit to making sure everyone has decent care, there are ways to do it.

  Source: The Audacity of Hope, by Barack Obama, p.183-185 Oct 1, 2006

  Focus on the affordability of a broad healthcare plan

  Our medical care costs twice as much per capita as any other advanced nation. Given that half of the people are getting, already, employer-based health care, that it would be impractical for us to do so, which is why my plan says anybody can get health care that is the same as the health care that I have as a member of Congress. The problem is, they can’t afford it. As a consequence, we focus on reducing costs. This is a legitimate argument for us to have, but it’s not true that I leave them out Source: 2008 Facebook/WMUR-NH Democratic primary debate Jan 6, 2006

  Crises happen in our lives and healthcare is necessary

  The use of generics is important, as the chairman of the Health and Human Services Committee I’ve continually encouraged the use of generic drugs at the state level. Part of the problem and the reason we’re not using generic drugs as much as we should is because we have a convoluted set of patent laws that allow drug companies to change the shape or color of the tablet, and as a consequence, renew their patents and block generic drugs from coming onto the market. It does make sense for us to encourage preventative care and improve our health and lifestyles. A father in Galesburg that I met who had just lost his job, just got his pink slip, and whose son had just had a liver transplant, and he’s trying to figure out how does he pay $4,200 a month in immunosuppressant drugs in order to keep his son alive. A liver transplant is not solvable by better health. Crises happen in our lives. To the extent possible, we should control costs when we can and expand affordability and accessibility of healthcare. Source: IL Senate Debate, Illinois Radio Network Oct 12, 2004

  Believes health care is a right, not a privilege for the few

  Obama believes health care is a right for everyone, not a privilege for the few. He has made affordable health care a priority - he delivered coverage to an additional 20,000 children and 65,000 parents in Illinois and sponsored a bill to protect the uninsured from price gouging. He has proposed a detailed health plan that covers every child in America, allows those near retirement to buy into Medicare, and ensures coverage for those losing jobs through no fault of their own. Source: Campaign website, ObamaForIllinois.org, “On the Issues” Sep 28, 2004

  Will expand health coverage & allow meds to be re-imported

  Obama has proposed a detailed health plan that covers every child in America, allows those near retirement to buy into Medicare, and ensures coverage for those losing jobs through no fault of their own. He will allow re-importation of drugs from other industrialized nations and fight for a Medicare prescription drug law that allows the federal government to negotiate drug prices. Source: Campaign website, ObamaForIllinois.com, ?On The Issues? May 2, 2004

  Ensure access to basic care

  Principles that Obama supports on health care:
  • Provide tax incentives to small businesses who provide health care to their employees.
  • Ensure that citizens have access to basic health care, through managed care, insurance reforms, or state funded care where necessary.
  • Provide health care to uninsured children by expanding Medicaid.
  • Use state funds to continue some Medicaid coverage for legal immigrants.
  Source: 1998 IL State Legislative National Political Awareness Test Jul 2, 1998

  ---

  Barack Obama on Voting Record

  No need to mandate coverage; just let people afford it

  Q: [to Obama]: Sen. Edwards says your plan doesn’t really provide universal coverage. Does it?

  OBAMA: Absolutely it does. John and I have a disagreement. John thinks that the only way we get universal coverage is to mandate coverage. I think that the problem is not that people are trying to avoid getting health care coverage. It is folks like that who are desperately in desire of it, but they can can’t afford it.

  Q: [to Edwards]: Does Sen. Obama provide universal coverage

  EDWARDS: No, because the only way to provide universal coverage is to mandate that everyone be covered. Sen. Obama’s made a very serious proposal, and I’m not casting aspersions on his plan. It just doesn’t cover everybody. The only way to cover everybody is to mandate it. We have talked about it too long. We have got to stand up to the insurance companies and the drug companies. It is the only way we’re ever going to bring about real change. We should be outraged by these stories.

  Source: 2007 YouTube Democratic Primary debate, Charleston SC Jul 23, 2007

  Voted NO on means-testing to determine Medicare Part D premium.

  CONGRESSIONAL SUMMARY:To require wealthy Medicare beneficiaries to pay a greater share of their Medicare Part D premiums.

  SUPPORTER'S ARGUMENT FOR VOTING YES:Sen. ENSIGN: This amendment is to means test Medicare Part D the same way we means test Medicare Part B. An individual senior making over $82,000 a year, or a senior couple making over $164,000, would be expected to pay a little over $10 a month extra. That is all we are doing. This amendment saves a couple billion dollars over the next 5 years. It is very reasonable. There is nothing else in this budget that does anything on entitlement reform, and we all know entitlements are heading for a train wreck in this country. We ought to at least do this little bit for our children for deficit reduction. OPPONENT'S ARGUMENT FOR VOTING NO:Sen. BAUCUS: The problem with this amendment is exactly what the sponsor said: It is exactly like Part B. Medicare Part B is a premium that is paid with respect to doctors' examinations and Medicare reimbursement. Part D is the drug benefit. Part D premiums vary significantly nationwide according to geography and according to the plans offered. It is nothing like Part B.

  Second, any change in Part D is required to be in any Medicare bill if it comes up. We may want to make other Medicare changes. We don't want to be restricted to means testing.

  Third, this should be considered broad health care reform, at least Medicare reform, and not be isolated in this case. LEGISLATIVE OUTCOME:Amendment rejected, 42-56

  Reference: Bill S.Amdt.4240 to S.Con.Res.70 ; vote number 08-S063 on Mar 13, 2008

  Voted YES on requiring negotiated Rx prices for Medicare part D.

  Would require negotiating with pharmaceutical manufacturers the prices that may be charged to prescription drug plan sponsors for covered Medicare part D drugs.

  Proponents support voting YES because:

  This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.

  It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses. HR4 does not require using the Department of Veterans Affairs' price schedule.

  Opponents support voting NO because:

  Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.

  Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.
  Status: Cloture rejected Cloture vote rejected, 55-42 (3/5ths required)

  Reference: Medicare Prescription Drug Price Negotiation Act; Bill S.3 & H.R.4 ; vote number 2007-132 on Apr 18, 2007

  Voted YES on expanding enrollment period for Medicare Part D.

  To provide for necessary beneficiary protections in order to ensure access to coverage under the Medicare part D prescription drug program. Voting YES would extend the 6-month enrollment period for the Prescription Drug Benefit Program to the entire year of 2006 and allows beneficiaries to change plans once in that year, without penalty, after enrollment. Also would fully reimburse pharmacies, states and individuals for cost in 2006 for covered Medicare Part D drugs. Reference: Medicare Part D Amendment; Bill S Amdt 2730 to HR 4297 ; vote number 2006-005 on Feb 2, 2006

  Voted YES on increasing Medicaid rebate for producing generics.

  Vote on an amendment that removes an increase in the Medicaid deduction rebate for generic drugs from 11% to 17%. The effect of the amendment, according to its sponsor, is as follows: "This bill eliminates the ability of generic drugs to be sold using Medicaid. Over half the prescription drugs used in Medicaid are generic. Because we have raised the fees so dramatically on what a generic drug company must pay a pharmacy to handle the drug, pharmacies are not going to use the generic. In the long run, that will cost the Medicaid Program billions of dollars. My amendment corrects that situation." A Senator opposing the amendment said: "This bill has in it already very significant incentives for generic utilization through the way we reimburse generics. Brand drugs account for 67% of Medicaid prescriptions, but they also account for 81% of the Medicaid rebates. This is reasonable policy for us, then, to create parity between brand and generic rebates. This amendment would upset that parity." Reference: Amendment for Medicaid rebates for generic drugs; Bill S Amdt 2348 to S 1932 ; vote number 2005-299 on Nov 3, 2005

  Voted YES on negotiating bulk purchases for Medicare prescription drug.

  Vote to adopt an amendment that would allow federal government negotiations with prescription drug manufactures for the best possible prescription drug prices. Amendment details: To ensure that any savings associated with legislation that provides the Secretary of Health and Human Services with the authority to participate in the negotiation of contracts with manufacturers of covered part D drugs to achieve the best possible prices for such drugs under Medicare Part D of the Social Security Act, that requires the Secretary to negotiate contracts with manufacturers of such drugs for each fallback prescription drug plan, and that requires the Secretary to participate in the negotiation for a contract for any such drug upon the request of a prescription drug plan or an MA-PD plan, is reserved for reducing expenditures under such part. Reference: Prescription Drug Amendment; Bill S.Amdt. 214 to S.Con.Res. 18 ; vote number 2005-60 on Mar 17, 2005

  Increase funding for AIDS treatment & prevention.

  Obama adopted the CBC principles:

  HIV/AIDS Initiatives
  The CBC’s Minority HIV/AIDS Initiative will focus on those areas hardest hit by the epidemic, many of which are in districts that we represent. The initiative will focus on prevention and treatment and we will also seek to re-direct and/or increase funding levels based on a detailed review of the implementation of the initiative. In addition, the CBC recognizes the devastating impact of HIV/AIDS on the global workforce, specifically in Africa, and on the allocation of resources of developing countries. Therefore, the CBC will continue its efforts to support a comprehensive global policy aimed at ending the scourge of HIV/AIDS around the globe.

  Source: Congressional Black Caucus press release 01-CBC5 on Jan 6, 2001

  More funding for Rx benefits, community health, CHIPs.

  Obama adopted the CBC principles:
  The Congressional Black Caucus is committed to improving America’s health care system by focusing on, among other items, the following issue areas:
  • Eliminating Health Care Disparities.The CBC will emphasize the importance of eliminating health care disparities as it relates to access, treatment and availability in communities of color and other disadvantaged communities. The CBC will also ensure that America keeps its promise to our veterans, and will support funding for the best health care programs at our veterans’ hospitals.
  • Patients’ Bill of Rights. The CBC will support a strong and enforceable Patients’ Bill of Rights that puts medical decisions back in the hands of doctors, and gives patients the right to seek damages when they are harmed by decisions influenced by non-medical professionals.
  • Medicare Prescription Drug Benefit. The CBC supports a prescription benefit program for the Medicare program. The price of prescription drugs is too high for most seniors, and many seniors go without the necessary medication they need, or have to choose between conflicting priorities.
  • Support for Health Providers in Underserved Communities. The CBC will support the development of networks of providers, community hospitals and health centers in underserved communities to increase the quality of care provided to patients. We will also seek funding and technical assistance to assist Community Health Centers in developing a system of comprehensive health services in both urban and rural communities.
  • Healthy Children. The CBC will work to expand the Children’s Health Insurance Program. We will also focus on increasing immunization rates, better dietary and physical fitness programs, prevention of teenage pregnancies and anti-drug and smoking initiatives. In addition, we will support efforts to ensure that mental health is covered under basic health plans.
  Source: Congressional Black Caucus press release 01-CBC6 on Jan 6, 2001

  Improve services for people with autism & their families.

  Obama co-sponsored improving services for people with autism & their families

  Amends the Public Health Service Act to require the Secretary of Health and Human Services to:

  1. convene, on behalf of the Interagency Autism Coordinating Committee, a Treatments, Interventions, and Services Evaluation Task Force to evaluate evidence-based biomedical and behavioral treatments and services for individuals with autism;
  2. establish a multi-year demonstration grant program for states to provide evidence-based autism treatments, interventions, and services.
  3. establish planning and demonstration grant programs for adults with autism;
  4. award grants to states for access to autism services following diagnosis;
  5. award grants to University Centers of Excellence for Developmental Disabilities to provide services and address the unmet needs of individuals with autism and their families;
  6. make grants to protection and advocacy systems to address the needs of individuals with autism and other emerging populations of individuals with disabilities; and
  7. award a grant to a national nonprofit organization for the establishment and maintenance of a national technical assistance center for autism services and information dissemination.
  8. Directs the Comptroller General to issue a report on the financing of autism services and treatments.
  Source: Promise for Individuals With Autism Act (S.937 & HR.1881) 07-HR1881 on Apr 17, 2007

  Establish a national childhood cancer database.

  Obama co-sponsored establishing a national childhood cancer database

  Conquer Childhood Cancer Act of 2007 - A bill to advance medical research and treatments into pediatric cancers, ensure patients and families have access to the current treatments and information regarding pediatric cancers, establish a population-based national childhood cancer database, and promote public awareness of pediatric cancers.

  Authorizes the Secretary to award grants to childhood cancer professional and direct service organizations for the expansion and widespread implementation of:
  1. activities that provide information on treatment protocols to ensure early access to the best available therapies and clinical trials for pediatric cancers;
  2. activities that provide available information on the late effects of pediatric cancer treatment to ensure access to necessary long-term medical and psychological care; and
  3. direct resource services such as educational outreach for parents, information on school reentry and postsecondary education, and resource directories or referral services for financial assistance, psychological counseling, and other support services.
  Legislative Outcome: House version H.R.1553; became Public Law 110-285 on 7/29/2008. Source: Conquer Childhood Cancer Act (S911/HR1553) 07-S911 on Mar 19, 2007

  Preserve access to Medicaid & SCHIP during economic downturn.

  Obama co-sponsored preserving access to Medicaid & SCHIP in economic downturn

  A bill to preserve access to Medicaid and the State Children's Health Insurance Program during an economic downturn.

  • Economic Recovery in Health Care Act of 2008 - Prohibits finalizing, implementing, enforcing, or otherwise taking any action, prior to April 1, 2009, on any changes to Medicaid programs or State Children's Health Insurance Program (SCHIP).
  • Amends the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 to extend through April 1, 2009, the moratorium relating to the cost limit for providers.
  • Amends the Medicare, Medicaid, and SCHIP Extension Act of 2007 to extend through April 1, 2009, the moratorium relating to rehabilitation services, school-based administration, and school-based transportation.
  • Provides for state fiscal relief through a temporary increase of Medicaid federal medical assistance percentage (FMAP).
  Source: Economic Recovery in Health Care Act (S.2819) 2008-S2819 on Apr 7, 2008

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