Remarks made by Nicole Kurokawa at the
Patients First Ladies Tea Party
Saturday, September 12, 2009

(Remarks as Prepared for Delivery)

Thank you to Patients First for putting on such a wonderful event, and thank you Betsy/ Tracy/ Kristan for your very moving comments.

I am now going to report you all to the White House for sedition.

Funny, isn’t it, that in the same breath we’re told that the system is totally broken and we need to “change” everything – but that you don’t have to change if you don’t want to, and that you can keep your current health plans and doctors. You know, and I know, that this plan is a wolf in sheep’s clothing.

And we also know that this battle is not just about health care. It’s about an individual’s relationship to the government. And this “health care reform” that’s being shoved down our throats is one step along the way to fundamentally redefining that relationship.

It didn’t have to come to this. This is your fault, though. You have not been making good decisions, according to the President, Madam Speaker, and all the rest. So now you don’t get to make those decisions for yourself anymore. That’s fine though, because Washington, in its infinite wisdom, knows better than you do how to spend your money.

And spend they will. If the government’s good at anything, it is spending your money. Someone told me that saying the government spends like drunken sailors is an insult to drunken sailors.

Conservative estimates – not you “evil” conservatives, it’s just an adjective – price this plan at $1.6 trillion over 10 years, and have it adding $239 billion to the deficit. Of course, 10-year deficit projections were recently revised from $7 trillion to $9 trillion, too. What kind of a legacy is that for our children?

But of course, this plan will do what no health plan has ever done. It will cover more people. It will give better care. And it will cost less. Remember the term “voodoo economics?” Well, there you go. It’s not mathematically impossible. We’re changing the laws of mathematics! How’s that for change?

So what do we want? According to the President, if you’re not with him, you’re against him. You don’t want change. You favor the status quo. You hate poor people. You hate women.

Obviously, that’s not true. We want choice. We want competition. And the President’s plan won’t give us either.

I was always under the impression that defining the problem helps you find the best solution. This health plan we’ve been given has started with the solution – one-size-fits-all government redistributing your money – and defined the problem for us. But for the sake of argument, let’s do it the old-fashioned way.

Who are the uninsured?

June O’Neill put out a great study a few months ago through the Employment Policies Institute that went largely unnoticed by the government because it didn’t fit their narrative. Here are some of her findings:

  • 1/4 of those counted as uninsured – 12 million- are eligible for Medicaid and SCHIP but haven’t enrolled

  • Another 10 million uninsured “Americans” are, at least technically, not Americans. ~5.6 million are illegal immigrants, and another 4.4 million are legal immigrants but not citizens

  • 43 percent of the uninsured have incomes higher than 250 percent of the poverty level ($55,125 for a family of four). And slightly more than a third have incomes in excess of $66,000

  • Most of the uninsured are young and in good health: CBO reports roughly 60 percent are under 35, and 86 percent report that they are in good or excellent health

  • Most people without health insurance are uninsured for a relatively short period of time

  • Only about 30 percent of the uninsured remain so for more than a year, approximately 16 percent for two years, and less than 2.5 percent for three years or longer. About half are uninsured for six months or less

The problem is much smaller than it initially looked. And doesn’t require a wholesale restructuring of the U.S. economy. But who am I to let the facts get in the way?

We know there are smaller changes that can be made that would make a huge impact. In his speech on Wednesday, the President acknowledged that we would partially fund his plan through cutting out waste. How about we start there? Let’s cut out the waste before we get down to business.

Our big picture principles are affordability, access, quality, innovation, and choice. We want a system that protects the best part of our system while assisting those who truly need help.

The U.S. has been the birthplace of numerous innovative medical treatments that have been used throughout the world, saving countless lives. Italian PM Silvio Berlusconi came to the U.S. for treatment – if Italian health care was so phenomenal, why not patronize a local specialist?

Some strategies for reform:

  • Allow for the purchase of affordable health insurance over state lines.

    • The federal McCarran-Ferguson Act permits states to create their own health insurance mandates and shields them from interstate competition. Some of the mandates include requiring coverage for acupuncture, marriage counseling, and hairpieces, all of which drive up the cost of health insurance, and as a result cost of coverage varies from state to state. A family purchasing a health insurance policy in WI would pay about $3,087, but that policy would cost $10,398 in NJ. If states are forced to compete with each other on price and services offered, consumers will benefit; at the moment, they are held hostage by geography.

  • Let individual citizens control their health care dollars.

    • Expand the use of Health Savings Accounts so that patients can use their own money to pay for non-catastrophic medical care

    • Reveal true costs – demand quality:  if patients use their own money, they will demand quality services and will only use medical treatments that are necessary and sensible investments in their health (and individuals know better than anyone what is a sensible investment and what is not) Patients would vote with their dollars; reward providers that meet the needs of their consumers; penalize those that do not

  • Reform tax treatment of health care

    • The current system of employer-based health insurance began under wage and price controls during WWII

    • Equalizing the tax treatment between employer-based and individual health insurance will provide much needed mobility, as well as help part-time workers, by making individual health insurance more affordable and competitive.  Decoupling health insurance from your place of employment not only allows for better, continuous health care, by allowing for continuity, but will also help the economy in general, by making the workplace more dynamic and freeing workers from “job lock” or the desire to  keep a job solely to maintain their insurance.

    • Presently, tax rules raise private health-care spending by as much as 35%. Like the housing bubble – special tax treatment led to overconsumption as employers have had an incentive to provide generous health insurance benefits because of the tax benefits, which has distorted demand, and increased prices

  • Reform medical licensing laws

    • Allow practitioners to expand their scope of practice

    • Allow for the portability of medical licenses across state lines

    • Encourage the expansion of minute clinics to provide basic services to people at a low upfront cost, rather than tying up primary care physicians with simple requests

  • Encourage state experimentation in high-risk pools and Medicare/ Medicaid vouchers

    • Target money to those who truly need help

    • Create and/ or expand programs to support the purchase of insurance for those who are high risk or have preexisting conditions

    • Provide subsidies (ideally vouchers so that individuals are still in control of and vested in  the quality of their care and service) to those who are genuinely impoverished

    • Dems’ bill defines “low income” family of 4 at $88,200 

  • Tort reform

    • Fear of lawsuits leads to lots of unnecessary tests “just in case”

    • Capping awards for punitive damages would help discourage counterproductive “defensive” medicine

    • Texas is a great example: In 2003 and in 2005, the state enacted a series of reforms to the state’s civil justice system. Medical malpractice insurance companies have slashed premiums, saving doctors millions; the state has been flooded with doctors wanting to practice there.

  • Reform Medicare and Medicaid

    • Implement means-testing, so those patients who are able to pay more for deductibles shoulder a greater burden

    • Slow the growth of these programs without resorting to rationing by encouraging individuals to purchase insurance through a competitive process.

    • Physicians and their patients would continue to decide which tests and other services they believe are worth the cost

A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care-with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.

Car insurance would cost too much if it paid for oil changes or your new tires, or if it didn’t differentiate between good drivers and dangerous ones, and home insurance would be through the roof if it paid for air conditioning and plumber visits.  Health insurance needs to return to being health insurance.

We cannot compromise on this bill. The Founders enshrined “Life, Liberty, and the Pursuit of Happiness” as our rights in the Declaration of Independence. Making decisions about your health and welfare and that of your loved ones is inextricably linked to those rights. This health care reform plan kicks those rights to the curb.

You should be free to make contractual agreements with others, and you should be able to control your own life choices. Women on the left proudly proclaim “Your body, your choice.” Let’s hold them to that.