Search DC's Musings

Wednesday, August 12, 2009

Dear President Obama

Dear President Obama,

I have never written a President before; I might have written President Nixon in Mrs. Tacker’s First Grade class at Paul Revere Elementary in Tulsa, Oklahoma in 1968 but if so I do not remember. I have chosen this time of my life as a 47 year old man to write you due to a request on the White House website,“If you get an email or see something on the web about health insurance reform that seems fishy, send it to” Rather than have someone else go through the hassle of forwarding my opinions and postings to you, I thought I would do the stand up thing and send it myself. In the interest of full disclosure this letter is also posted on my blog at and will also be linked to my Facebook page and emailed to others including some members of the media. Since one of your campaign positions was transparency I thought you would be okay with my making this communication public and transparent.

As I stated, I am 47, married and have two children in elementary school, for more than twenty years I have been a mortgage broker, for the past ten have been partners in a successful brokerage that has helped thousands of Americans purchase homes—very few of whom have faced foreclosures due to our diligence in matching finances to prices. I am a college graduate from a small liberal arts college with a degree in Economics and Political Studies. Very active in my community, I have served on the boards and in leadership positions for several non-profit organizations; most recently serving the past two years as Chair of the Board of Community Hospital of Long Beach. There are a million or more Americans like me across this great land, parents, small business owners, active in their communities, while this communication is from me perhaps it speaks for many of them as well.

Now to the heart of the matter: Health Care Reform (HR3200). In my role as parent, business owner, patient and board member of a non-profit community hospital I have seen our health care industry from practically every angle except that of practitioner—unless removing a splinter from the tiny finger of a crying daughter qualifies. I have paid the co-pays, have settled the disputes between doctor’s office billing and insurance coverage, I have negotiated payment of health benefits for employees, I have waited anxiously for test results and I have poured over financials of a hospital where many months up to half the visitors to its Emergency Room are classified as “self-pay” which in the hospital business usually means “no-pay.”

From these experiences I am very aware that some reform is necessary as there are billions of dollars wasted in our current health care system and the waste impacts the two most important parties in the transaction: the patient and the provider. Between my insurance premiums, co-pays, taxes for MediCal and Medicare for my self, plus premiums and taxes paid by our company, I am paying thousands and thousands of dollars every year into health care, and most of what I am paying goes to administrators, bureaucrats and other premiums to cover the malpractice insurance the providers must carry.

I know from the provider side billions are spent on bureaucratic minefields whenever they wish to add a washroom, create a new program, or remodel a hospital room. In California state law will force the closure of many hospitals who do not have the hundreds of millions of dollars, each, to retrofit their buildings to the codes set by politicians. In California state law creates millions of dollars per year for every hospital to constantly maintain minimum nurse staffing levels set by politicians with heavy influence from groups like your friends at Service Employees International. I know that payments from MediCal are uneven throughout the state and that Medicare is cutting payments for services provided. And I know that hospitals must treat every person who walks through the door, whether insured or not, whether a citizen or not, if they need medical assistance from removing lice to cardiac arrest they are treated, by moral law and government statute, and often receive no reimbursement for the care.

Central to HR3200 is the “public option” insurance that will be the blanket coverage for all Americans without insurance. The number that is used appears to be 48 million uninsured Americans who will be covered by this private option. Currently over 45 million Americans are enrolled in Medicare, it costs us $425 billion per year and accounts for sixteen cents of every dollar spent by our Federal government. As you have stated, it is inefficient. It is estimated that 10% of the program is lost to fraud and theft. Under HR3200 the number of Medicare patients, would essentially double, and the cost of HR3200 is $1.6 trillion. If the current system of federal insurance does not work well why are people so eager to add more individuals to the system? Medicare is paid for by working Americans and mostly covers Americans who are not working. Under HR3200 the uninsured, whether working or not, will be covered and the cost will be paid for once again by working Americans. How will my taxes not go up if I am already paying a Medicare tax that is still not enough to cover 45 million Americans health care needs and the intention is to add another 45 million to be covered?

In your press conference last month you said that a doctor treating a child for a sore throat would prescribe that the child’s tonsils be taken out just to make more money. Despite the fact that the child’s pediatrician would not make more money since another doctor would perform the tonsillectomy, have you considered that the doctor may be prescribing the treatment to avoid a lawsuit later on? What if the doctor did not prescribe the tonsillectomy and the tonsillitis worsened and became a worse condition? Almost 30% of babies delivered in the United States are done so by caesarian section, the main reason the percentage is so high is to avoid possible lawsuits for malpractice; former Presidential candidate John Edwards made his fortune on C-Section lawsuits and settlements—an indication of not only a major problem in our current healthcare system but also the incestuous relationship between trial lawyers and members of the Democratic Party.

Our health care system needs to be reformed. HR3200 does not reform our health care system it creates a new health care system. House Speaker Nancy Pelosi and others have attacked and slandered Americans who are questioning and opposing HR3200, but have admittedly not read the legislation. Mr. President you are on the campaign trail urging Americans to support HR3200 but I, and many others, are skeptical that you have read the entire bill. How can our elected leaders ask us to support something they have not read?

Rather than asking us to support a brand new health care system that costs trillions and trillions of dollars, rather than asking us to support a new health care system that will change how our children and grandchildren, how our parents and grandparents, will be treated, rather than asking us to support a new health care system that will create enormous debt for our children and grandchildren, why not work within the existing framework of our health care system to preserve what works and fix was does not?

My health care insurance works great. It is costly, but that is mainly due to the costs created throughout the entire system. Work on those costs and create more competition, not from the government, and my premiums will come down.

Any health care reform that does not include tort reform is useless in lowering costs for the medical community and therefore for patients and insurance companies. Instead of creating a new health care system, create tort reform that protects patients but as importantly is not punitive to good doctors who treat us with care and concern.

Any health care reform that does not create an environment that allows insurance companies to compete for my premiums is useless in lowering costs for health insurance. Currently my most competitive option for insuring my family is through my company. My company selects, once a year, from a few options for a company to cover everyone in the company. Our premiums are set by the condition of the least healthy amongst us. As well we are only able to obtain quotes from companies in California. Remove the borders for insurance companies and let them compete for business in Long Beach, California, Tulsa, Oklahoma and Albany, New York. Competition creates lower prices and more efficient delivery of services—consumers can choose between cost and service and often end up with both.

Create an environment where employers are not responsible for insuring workers and their families. It limits the options for families and ties them to their employers for benefits not for the quality of their job or work environment. It would eliminate COBRA costs which drive up health care costs. With more individuals seeking insurance, companies can reward healthy families and drive costs down.

Yes I am against HR3200. I have not read all 1000 pages which may make me a hypocrite for deriding those in Washington who have not read it, but I am not obligated to since I am not voting on it. What I have read however does not make sense. It does not seem to solve our heath care system’s problems but rather seems to add more problems in the future. As can been seen by the reaction of Americans across the country, most of us like our doctors, like our insurance companies and like our health care system. We know we have the best health care in the world, with the best doctors, the best hospitals and the best nurses. However since approximately 10% of Americans are not covered by insurance, not by choice, your Administration and some Democrats in Washington want to tear down our current system and create a new health care system.

Yes, this worries some of us. Yes, this scares some of us. Yes, we are concerned for the type of care we will receive, our children will receive and our grandchildren will receive. These are legitimate concerns and the reaction from you and others only increases our concerns. It is difficult to trust leaders who tell us to “get out of the way” say we are “carrying swastikas to meetings” and tell us to “stop talking.” It makes us wonder what are they trying to hide, what do they not want us to know?

Your employee asked for any letters or emails that seem “fishy.” I do not know if this qualifies, but I am sending it anyway because I think HR3200 is fishy. I think there is so much hidden in 1000 pages of legislation that no one has read but are pushing onto us that there is reason for concern and opposition. I think the trust you gained from the majority of Americans in November 2008 is evaporating the more you insist we stop talking and support radical changes that will affect how we will live our lives in good health or bad.

Please stop trying to create a new health care system and instead look at what simple but minor changes can be made to our existing system to enable continued quality care to be provided to over 300 million Americans every year.

Dennis C Smith
Long Beach, CA


poolman said...


that is an awesome, well thought out, well articulated argument against the house bill on health care reform. i think you should consider some minor modifications to make it applicable as a letter to sen. feinstein, madam boxer, and your congressperson. also i think this piece is entirely worthy as a reader's column in the press telegram.

Bob Schilling said...

Your objections to the House bill are cogent. It seems evident in your argument, however, that health care reform is urgent. You seem satisfied with the current insurance system, arguing that what we really need is tort reform and better Medicare oversight. Do you also believe that we should extend care to all, or virtually all of our population?

I agree with you on stronger Medicare audits and tort reform. It does not seem to me, however, that current insurance arrangements are adequate. I would add to your list of needed reforms a prohibition on cancellation and refusal to renew. We'll need a government-backed reinsurance program to make this work, but I think we can do that. I think we also need a mechanism to make health insurance portable between employers and for those not employed.

I'm sure you know that the issue of competition by health insurers is largely illusory. The major providers offer programs nationally. The heart of this argument is that, like all insurance companies, they are subject to state-by-state regulation. Many states require insurance companies to hold liquid reserves within the jurisdiction. Would you support federalization of those requirements?

I also think we should stablish a marketplace in which any individual could opt for any health insurance policy or direct provider (e.g., Kaiser) at any time, as we can with other kinds of insurance. We do this now with automobile insurance, and it seems to work pretty well.

We should allow employers to reimburse individuals for some or all of the costs of this coverage, with limits similar to those now in place for life insurance. We should also allow companies to offer health care as a benefit if they believe it will help them attract more or better people. We should provide a public subsidy to individuals who are unemployed or whose work does not include health care, based on income.

Finally, we should establish a customer protection agency, using the SEC or the old version of NASDAQ as a model. And we should ensure that there are robust systems to investigate and resolve customer complaints.

Absent all the hysteria, I don't think that conservatives and moderates are all that far apart on this. And I think enough liberals can be brought into the fold with consumer protections and increased oversight that we could reform the system, lower costs, and avoid the inevitable added costs of a parallel public system.

Just don't tell all my liberal friends.....