Questions from a Medical Student for President Obama regarding his Health Care plan

Some of you who know me personally might be aware that in April I graduated Cum Laude from Brigham Young University with a degree in Chemistry. My family and I are moving in a few days to Temple, TX where I will attend Texas A&M College of Medicine (pause for cheers and applause).

Since I have chosen medicine as my career, I have paid close attention to the ongoing debate on single-payer nationalized systems vs. private healthcare systems. I will have to save my personal opinions on what our health care policy should be for a later post, but I will say that Obama's plan is among the worst. At least socialized health care has the potential of cutting cost (though it furthers the advance of the nanny state and will completely and utterly stiffle inovation in the field). Obama crosses his fingers and swears up and down that his plan will cut costs, though when faced with questions on specifics, as in specifically how the plan will save money, Obama goes into 20 minute long diatribes on how Health care is important for the little guy, and how too many people can't afford health insurance, and how the greedy SOB doctors are gaming the system trying to take advantage of the people. All the while, the press and the rest of His adoring fans, their Obama T-shirts sweaty with anticipation and lustfull zeal, look up to the Dear Leader with tearfilled eyes and sing paeans of eternal love to the Sun God. Meanwhile I am left to pondering specific points of his plan. Yesterday, my Mother-in-law informed me that she would be hearing somebody (probably not Obama himself) talk up the Dear Leader's health care plan for us plain regular folks. She asked me for some questions that she could ask. I obliged and jotted down a small list, but then I realized that she would only get to ask one, if any, and so I will post them here and if anyone else gets a similar opportunity feel free to use them.

If you happen to get an answer (or a non-answer) please let us know what Obama the beloved has to say on the matter. If you have some other question, leave it for the rest of us.

1. One of the central features of this plan is the "public option" health insurance plan. You have stated that the purpose of this plan is to provide a low-cost option to the American public and to maintain a competative atmosphere with private heath insurance companies. I have 3 questions regarding this aspect of your plan: First, what types of deregulation do you propose to allow private companies (which are currently under various state and federal mandates) to compete directly with your "public option"? Second, will the "public option" be subsidized at all by tax payer dollars, or will it be funded entirely by premiums paid by policy holders? And Finally, what is your plan for keeping the "public option" in the black? Specifically, when health care costs rise, who will take the hit financially? Will policy holders see an increase in premiums, or will physicians see a decrease in reimbursements, or a combination of the two?

2. You have repeatedly called for cessation of the "pay for service" mode of compensating doctors and instead called for a "pay for performance" modality? First of all, how do you propose to measure "performance"? Second of all, will pay for performance be applied only to compensation that comes from a government source, or will it apply to all compensation. And finally, where does the government get the authority to dictate how a private citizen is renumerated for a service he or she provides?

3. It is reasonable to assume (based on the performance of other federal programs) that the "public option" will require additional subsidy from the tax payer to cover its expenses. This combined with the practice of cutting physician's compensations will enable the public option to operate at a loss, thus enabling it to undercut any other private plan. Two questions, how are private companies supposed to "compete" with a federal entity that can opperate at a loss? Second, how do you propose to handle the influx of people who will enroll in the public option once their preimiums start to rise?

4. It has been estimated that between 15 to 20 million of the oft-quoted 45 million uninsured are people who are in this country illegally. Will your public option be available to them?