Healthcare Town Hall - Page 8 of 18
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Healthcare Town Hall

Now, how this debate is evolving in Washington, unfortunately sometimes kind of falls into the usual politic. So what you’ve heard is some folks on the other side saying, “I’m opposed to a public option because that’s going to lead to government running your health care system.” Now, I don’t know how clearly I can say this, but let me try to repeat it: If you’ve got health insurance that you’re happy with through the private sector, then we’re not going to force you to do anything. All we’re saying is for the 46 million people who don’t have health insurance, or for people who’ve got health insurance, like you, who are self-employed but the premiums and the deductibles are so high that you almost never get prevention services — you’ve put off going to a doctor until you’re really sick because of the out-of-pocket expenses — let’s change some of those incentives so that we get more people getting prevention, more people getting health care to keep them healthy, as opposed to just treating them when they get sick.

And I think that we can come up with a sensible, common sense way that’s not disruptive, that still has room for insurance companies and the private sector, but that does not put people in the position where they are potentially bankrupt every time they get sick.

Now, how this debate is going to evolve over the next eight weeks — I’m very open-minded. And if people can show me, here’s a good idea and here’s how we can get it done and it’s not something I’ve thought of — I’m happy to steal people’s ideas. (Laughter.) I’m not ideologically driven one way or another about it. (Applause.)

The one thing that I do think is critically important, though, is for self-employed people — because there are a lot of self-employed people here and a lot of small business people — they don’t have the ability to pool their health insurance risk. And what that means is part of the reason that — typically if you work for a big company, you get a better deal on health insurance than if you’re just working for a small company is because there’s a bigger pool. And that means that — each of us have a certain risk of getting sick, but if that’s spread around, everybody’s premiums can be lowered because the total risk for everybody is somewhat lower.

If you’re self-employed, you don’t have access to that same pool. And part of what we have to do — and that’s where a public plan potentially comes in, or at least some mechanism to allow you to join a big pool. That will help drive down your costs immediately: your out-of-pocket costs for premiums, lower your deductibles. And what I’d like to see, as I said, is that every plan includes not only prohibitions against discriminating against people with pre-existing conditions, but also every plan should have incentives for people to use preventive services and wellness programs so that they can stay healthier.


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