Liveblogging the big speech… held a liveblog regarding the President’s health reform speech. Here are excerpts by myself and my fellow panelists: Dr. Michael Wilkes, director of global health at the University of California, Davis, who also writes a weekly column for The Bee; and Marjorie Ginsburg, executive director of the Center for Healthcare Decisions in Sacramento. It hopefully has some real-time insights into the speech…

4:59 Linda Gonzales/ Thanks to Anthony and Marge for joining us. Would you two share a little information about your organizations as we get started?
5:00 Marge Ginsburg, Center for Healthcare Decisions: Center for Helathcare Decisions is a non-profit, non-partisan organization that seeks the public’s voice in complex healthcare issues. We often focus on areas where there are no easy answers!
5:02 AnthonyWright: Health Access California is the statewide health care consumer advocacy coalition, working for the goal of quality, affordable health care for all. Our website is For more info on health reform, visit our daily blog at, or follow us on Facebook or Twitter, at @healthaccess.
5:04 AnthonyWright: It’s poignant to see Hillary Clinton coming in as a Cabinet Secretary, given her past effort at health reform

5:07 [Comment From Tyler] My child turns 1 soon and will not be eligible for mediCal due to my income. I also was recently married and my new wife is not covered. I have insurance options through my work, but it is not affordable for me to add two dependants to my health coverage at this time. Do I have any options currently besides paying more than I can afford?
5:11 AnthonyWright: Tyler: There are very limited options now. The point of health reform is to increase those options, by expanding coverage at work, through Medicaid and other safety-net programs, and to provided subsidies and help if you have to buy coverage as an individual.
5:12 [Comment From maria] Why are people so afraid of the public option? I understand people are afraid it would eliminate the private insurance companies but if they are so great why would people ditch them? I seem to hear people complaining that they would want to keep their current insurance isn’t that the meaning of the “option” part of the public option. I just don’t understand the fear behind the public option. If they are afraid of reduced quality of care I would love to tell them my mom has medicare and I buy into a high deductible health plan for myself and my mom has it so much better than me.
5:12 AnthonyWright: Tyler: If you need care or coverage, we have some resources at a nonprofit website we run, at to help people with big hospital bills, or those who seek care but are uninsured or underinsured.
5:14 [Comment From Tyler] Thanks, Anthony.
5:14 Marge Ginsburg: I think there is unwarranted but pervasive fear of ‘big government’…I think it will take a long time for many people to recognize the role the govdrnment has in healthcare today.
5:15 AnthonyWright: Maria: The public health insurance option typically gets 60-75% approval ratings. It’s a very American concept to have a public option, whether in our university system, our television stations, our mail delivery, or in other parts of American life.
5:16 AnthonyWright: Here we go…
5:17 [Comment From maria] well that is good to hear! I often keep hearing people against the idea I never knew the approval rating for it was so high. Thanks so much!
5:18 Dr. Michael Wilkes: Good evening everyone. Dr. Wilkes here!
5:19 [Comment From lite_speed] To date, I have experienced the healthcare systems in 3 countries where I have lived and worked for extended periods. The US, by far, is the most expensive. People here fear a govt bureaucrat will somehow make healthcare decisions for them. I am more afraid of an insurance company bureaucrat making that decision and being incented financially to deny coverage.
5:20 AnthonyWright: Actually, he’s not going to end the health reform conversation. Even if we pass major health reform, we will need to continue to need to adapt and move forward. But we need to get started. The conversation won’t end with the passsage of a bill.
5:22 AnthonyWright: The key point: *It can happen to anyone*

5:23 Marge Ginsburg: It’s good to see the Pres. return to why we are tying to tackle this problem in the first place!
5:23 AnthonyWright: Thank you, lite_speed. I think President Obama is making your point about the concern with the current system, including with the current insurance market.
5:26 AnthonyWright: It’s not just a slogan: The status quo isn’t an option. It’s deteriorating.
5:29 AnthonyWright: Minimize disruption, but reform. As @
consumersunion is livetweeting: Obama: #healthreform = Build on what works, and fix what doesn’t.
5:30 AnthonyWright: Obama is now going through the consumer protections in the bill. When Gov. Schwarzenegger tried health reform in 2007, stopping the denial of pre-existing conditions was his most consistent applause line. It’s working for Obama as well.
5:31 Dr. Michael Wilkes: This concept of pre-exisiting condition is crucial as it unfair and will resonate with all Americans.
5:31 AnthonyWright: The protections against “junk” insurance, capping out-of-pocket costs, is huge. “No one should go broke because they get sick.”–880,000 Facebook users made that their FB status on last Thursday.
5:33 AnthonyWright: Californians are more likely to be uninsured than residents of all but three other states. That’s why it is so critical for our state.
5:33 Dr. Michael Wilkes: Quality is key. Transportability is crucial. Empowerment of the consumer is crucial. Choice is key.
5:34 AnthonyWright: NEW IDEA: low-cost coverage for those denied for pre-existing conditions during the transition
5:34 Marge Ginsburg: These are definitely the messages that people are looking for!
5:35 Dr. Michael Wilkes: Key to see him try to tie this to Republicans! There is credit all around and it is key to let America see this problem is recognized by all.
5:35 AnthonyWright: California’s high-risk pool for those denied with pre-existing conditions now has a waiting list. It’s very sad.
5:36 AnthonyWright: Laughter at the details “to be ironed out.”
5:37 Marge Ginsburg: People hate mandates…but they also hate irresponsible behavior. It’s a real balance.
5:41 AnthonyWright: Obama references Wendell Potter. Insurers are rewarded for denying coverage.
5:41 AnthonyWright: I don’t want to put them out of business. I want to hold them accountable.
5:42 Dr. Michael Wilkes: Cherry picking is a concept that is essential understand. It implies that insurance companies choose healthy, young people wo are less likely to get sick. It also implies the similar but opposite concept of “dumping”. Dumping is the process of trying to get rid of those most like to cost money (elderly, pre-existing conditions, etc.)
5:42 AnthonyWright: Obama defends the public insurance option, says what it is and what it won’t be.
5:45 AnthonyWright: Did a member of Congress really yell out “liar” to the President? We’ve lost some decorum here…
5:46 Dr. Michael Wilkes: Yes, this issue has become very divisive.
5:46 Marge Ginsburg: Providing a choice: magic words!
5:46 Dr. Michael Wilkes: Appealing to fiscal conservatives…
5:47 AnthonyWright: New Idea: Promises spending cuts if the savings aren’t realized. (And let’s be clear, a lot of the preventative savings aren’t being scored)
5:47 Dr. Michael Wilkes: Wow… The President is also stepping into it with digs against the Bush administration. In my opinion, not a wise step.
5:47 AnthonyWright: Obama talks directly to seniors.
5:48 brogonzo: #hc09 Obama is reaching across the aisle to offer olive branches to some, and blacken the eyes of the irresponsible
5:50 AnthonyWright: Just saw CA Sac-area Congressman Tom McClintock not applauding
5:50 AnthonyWright: Obama: I will protect Medicare.
5:52 AnthonyWright: New Idea: Embraces fee on certain insurance policies that is in the Baucus plan
5:52 AnthonyWright: New idea: Obama embraces medical malpractice reform, gets standing O from both sides. Not a “silver bullet.” Patient safety first.
5:53 Dr. Michael Wilkes: Malpractice is absolutely essential to improve quality, but it needs to be kept in check to avoid this defensive medicine.
5:53 amorporchoco: Liking the trend towards the center – not sure how the finances balance out, but I do know something needs to change. #hc09
5:53 AnthonyWright: Obama: move forward on malpractice proposals by Bush Admin
5:54 AnthonyWright: $900 million cost: My concern is that it won’t provide the help that people need to actually make coverage affordable.

5:54 elleabis: #hc09 malpractice reform is necessary also
5:54 thanasipetridis: He’s making a lot of people happy so far… #hc09
5:55 Dr. Michael Wilkes: elleabis: Reform needs to happen, but MP can’t be eliminated as it is an important check on the system. Sure it also has incentives that drive to higher costs and those need to be addressed.
5:56 AnthonyWright: I am also tweeting at @healthaccess.
5:56 AnthonyWright: Important tribute to Ted Kennedy. Panning to Vicky Kennedy, sons.
5:58 AnthonyWright: He’s right: this is more than health care. It’s about the character of our country. That’s why the debate.
5:58 AnthonyWright: Wow. He is going right to the core of the issue.
5:59 Marge Ginsburg: People really do believe that the character of our country is at stake — it’s a message we need to remind them sometimes!
6:00 AnthonyWright: What does it mean to be an American? He is recognizing that the debate is really not about health policy…
6:01 AnthonyWright: “Govt cannot and should not solve every problem… the danger of too much govt is matched by the perils of too little. “

6:02 AnthonyWright: This is Professor Obama, talking to us like adults.
6:03 Marge Ginsburg: And this is what he is particualry skilled at.
6:03 AnthonyWright: “We did not come to fear the future. We came here to shape it.”
6:04 Linda Gonzales/ The president’s speech has concluded. What did you think?
6:04 AnthonyWright: He didn’t go for obvious pandering…
6:05 Dr. Michael Wilkes: Did he succeed in laying out an effective blueprint? Do you now know what his plan will entail?
6:05 Marge Ginsburg: I think he hit a home run…this is an emotional issue, not just a political one.
6:06 AnthonyWright: About five new details, and clarifications about what the President supports.
6:06 Dr. Michael Wilkes: I like the high risk pool, insurance company fees, individual mandate, public option… but the devil is still in the details. Of course he missed a few important areas, although they may opted for simplicity.
6:06 AnthonyWright: He didn’t disavow the left, but he focused on the middle,
6:07 Marge Ginsburg: He had no choice but to focus on the middle…that’s where most people are.
6:08 Linda Gonzales/ Can anyone speak to the cost of health care under reform plans?
6:08 Linda Gonzales/ The Republican response being televised now is keying on the price of health care, saying costs will rise.
6:08 AnthonyWright: The Republican response is just using talking points that have little reference to the actual bill…
6:10 AnthonyWright: Costs are $900 billion, paid for by savings from the system, employer & individuyal premiums, etc…
6:10 AnthonyWright: The idea to buy insurance across state lines is just a way to eviscerate state consumer protections. If an insurer denied you care, do you want to go to the Delware or Alabama Dept of Insurance?
6:12 [Comment From lite_speed] In a single payer system you would not be denied care. i am surprised that Americans are not embracing that single point.
6:12 AnthonyWright: The R response wasn’t truthful. Wouldn’t improve the Medicare program? I think seniors in the “donut hole” who have trouble buying Rx drugs would disagree.
6:13 AnthonyWright: KCRA-Sacramento is running a “Prescription for Change” special. I’ll be commenting later in the hour.
6:14 AnthonyWright: The President made key points how people would benefit. People get coverage through 1 of 3 ways: through employers, safety-net programs, and buying it as individuals.
6:14 Linda Gonzales/ Dr. Wilkes, along with Shannon Brownlee of the New America Foundation, wrote a column for today’s Bee. You can read it here:
6:14 Dr. Michael Wilkes: In closing the President could have mentioned more about the system being badly broken (besides malpractice). The system isn’t honest with patients, it doesn’t allow doctors or patients the information they need to make choices, it pushes for more treatment instead of better care, it allows pharmaceutical companies to push drugs and advertise treatments for diseases that don’t exist or that aren’t effective treatments. It is all about incentives pushing the system in the wrong direction. We need to re-align incentives for hospitals, doctors, pharmaceutical companies and consumers…
6:15 AnthonyWright: For those with employer-based coverage, it provides stability and security, setting some minimum standards–much like the minimum wage for pay. It would also provide help to small biz.
6:16 Marge Ginsburg: I suspect if he talked too much about improving how healthcare is delivered, it might worry people about gov’t intrusion into the doctor-pt. relationship.
6:16 AnthonyWright: For those with Medicaid & Medicare, it would improve & expand coverage: fill the donut hole, increase reimbursement rates, etc.
6:18 AnthonyWright: For those who buy coverage as individual, it would provide new consumer protections, subsidies, and an exchange to buy coverage, including a public health insurance option.
6:18 Linda Gonzales/ Thank you again to our three panelists: Dr. Michael Wilkes, director of global health at the University of California, Davis. Dr. Wilkes also writes a weekly column for The Bee. Marjorie Ginsburg, executive director of the Center for Healthcare Decisions in Sacramento. Anthony Wright, executive director of Health Access California in Sacramento.

Health Access California promotes quality, affordable health care for all Californians.
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