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August 22nd, 2009
06:49 AM ET

Dear President Obama #215: Fighting from the ropes

Reporter's Note: President Obama, in a poll late this week, has found more Americans disapproving than approving of how he is handling health care reform. I’m writing a letter each day to the White House, whether anyone approves or not.

Tom Foreman | Bio
AC360° Correspondent

Dear Mr. President,

This is gut check time. Time to back yourself into a corner, rally your team around you, and prepare to defend the castle. This letter is not about whether your health care reform plan is good, bad, wise or silly. That’s for you and others to decide. Polls are running against you now on this issue; people who voted for you are raising questions about your abilities. So this letter is about tenacity.

When I was a kid, we moved from South Dakota to Illinois and I tried to settle into a new neighborhood over the summer. Champaign was much bigger than the town I’d known, and I was more than a little nervous. One day my brother and I were throwing a football in a field across from our house. An errant throw landed near a kid on a passing bicycle. He hopped off, and punted it as far as he could for me to chase.

“Now, go get it!” I ordered, with all the toughness of a third grader with something to prove. (Bear in mind, back then transferring schools was like going to a new prison; you had to establish your credentials up front.) He walked right up, stared me in the eye, and said, “Are you going to make me?”

The fight was fast and decisive. He took a swing, I pounced, and with the luck of the Irish and a weight advantage I took him down, grinding him into the dirt and pinning his arms beneath us.

“Give up,” I commanded, in the timeless tradition of back yard fights.

“No,” he responded.

“Give up!” I urged.

“No.”

“Punch him,” my brother said.

“No,” we both responded.

That’s how it went until my mother pulled us apart. I later found out, the kid was named Ken and was renowned for never, ever, under any circumstances surrendering. His insistence on fighting out to the very end any dispute was not the model of diplomacy to be sure. But it made him a force to be reckoned with. Even in defeat, he commanded a strange respect because he showed no fear, and you knew he would fight you the next day, the next, and the next.

Being President, of course, is not like being a schoolyard tough, but sometimes some of the same rules apply. This is something I can tell you about this town with certainty: Presidents can lose fights, but if they appear weak, indecisive, or beaten they effectively lose their presidencies. So I’ll give you the same advice I’d give to any President in such a situation.

One: Don’t let anyone tell you the fight is lost. That is a decision only you can make. Hillary Clinton won many admirers, even among Republicans, for her toughness in the campaign; for fighting on, and making you prove your stuff, even when the math said she could not win.

Two: Win, lose or draw, stand up and face the music with a steely eye. When I was coaching one of my daughter’s soccer teams, I always said, “We don’t have to win every game, but we have to play hard every time, no matter the score. Losing is not the end of the world. But losing your self-respect comes pretty close.”

And three: Keep your perspective. No matter what happens in this fight, it is only one battle. The victory does not go to the faint heart or the easily dissuaded. Often it goes to the person who just hangs in and keeps swinging.

Call if you need more encouragement. Like I said, this is not about health care; this is about the kind of character we expect in our leaders, no matter what policies they pursue.

Regards,

Tom

Find more of the Foreman Letters here.

soundoff (72 Responses)
  1. Medicare Patient/Satinder

    Tom;
    First let me tell you that I have listened to you.You are one of the best like AC.
    I am going to be in Illinois and Calif.travelling leaving NY State health care problems behind.But let me tell you that an issue that everyone seems to just skim thru is SUPPLY of Primary Care doctors and Staffing of ER.
    People say -our health system is great.Yes it was great in 80's-when the primary care doctors provided 24/7 service at their office/telephone or hospital.COSTS were much lower in 80's.
    Go to an ER on Sunday afternoon in Johnson City's hospital and you will get true picture of what went wrong.
    1) Primary care doctors do not offer service on weekends.
    2)ER do not enough Staff.Waiting time is around 5 hours and then you get to see a Nurse–who takes 3 hours to diagnose the problems as she /he runs from one patient to another and consults COMPUTER for treatment/prescriptions as she/he has 2 years training. ER doctors only see life threatening cases.
    3) If you are insured-which our family is–pay 150$ Co-Pay and rest paid by the best insurance from a top co.
    4) Problem in Central NY–started when IBM shrank.Higher Mix of medicaid to others created problems for doctors and hospitals reimbursement mix.
    5) Paperwork increased a lot-adding 5-10 min. of doctor's time.
    6) Electronic Medical records are the answer for lower costs by cutting back on duplicate tests.–DO YOU REALIZE that someone has to enter the information.One member was supposed to find about a test within 24-36 hours–has not found it in 5 days.
    7) The Electronic Records have a package that includes entering history/symptoms,which then walks you thru various questions–a great teaching tool for nurses and fresh MD's–but wastes 5-10 minutes of experienced doctors time.Yes-it may be a nice way to blame the Computer if sued.Well the lawyers and Judge will not blame the Computer–but hold a doctor responsible if he/she did not do the MRI to detect 0.01% chance of some problem.
    TOM–please send a reporter on SUNDAY to Johnson City hospital.Why Sunday–that is the day–primary care doctors are closed and some one who is sick on Friday night or Saturday decides that they can not wait till Monday.So the overload from 80% who have a primary care doctor. TEST an ER at Peak Time–like you do for a Toll line or any other service line.
    If not,pass this message to AC. Thanks.

    August 24, 2009 at 11:04 am |
  2. David - TN

    My BIG idea,

    By attaching a small tax to all tickets sold for sporting events such as baseball, football, basketball, and hockey…And by attaching a small tax to all movie tickets, theater tickets, concert tickets, and movie rentals. And by attaching a small tax to all lottery tickets sold, we could pay for health care reform and make it deficit neutral! As you can see, these are all non-necessity items. So what do you think America?

    August 24, 2009 at 9:31 am |
  3. Greg f

    Yes President Obama, ignore the critisism, the majority opposition, and good old common sense and just go ahead and bankrupt the country. Our enemies will thank you for it.

    August 24, 2009 at 9:08 am |
  4. Randy Mahan

    Please give media coverage to HR2962. I truly believe one of the number one reasons health care costs have risen at such rapid rates is the increased use of expensive imaging such as CT,MRI, and PET scans. This is why I support HR2962. What is the major cause of increased utilization? Study after study has shown that self referral by doctors is behind much of the rapid increase.

    More and more internists are buying CT scanners. Whether consciously or not these internists start ordering more expensive CT’s once they own the equipment. If you have new toy, why not use it? Do you have mild abdominal pain which is probably gastritis or heart burn? Do you have mild diarrhea that is probably viral enterocolitis? In most cases, as long as there were not any serious signs, the internist would use conservative therapy for a few days and in most people it would pass. If the symptoms failed to pass then he or she would think about expensive imaging/workup. Now a days, since the internist owns the scanner, they may scan on day 1. Light excuses can be used for justification such as “My patient is elderly, I would not want to miss something life threatening." Deep inside they know nothing is wrong. Other times it is just plain conscious greed. Even if the scan is negative he or she makes his money. As an added bonus patients often feel better because they feel something is being done to address their complaint. In fact patients often request a scan.

    Orthopedic surgeons, neurosurgeons, and neurologists are buying their own MRI machines and ordering more and more MRI’s. Oncologists are buying PET scanners and ordering more and more PET scans. Studies have shown that when these doctors order much fewer tests when they do not own the scanners and do not have the financial incentive. They actually only order the tests when they feel it is necessary.

    Overutilization is causing a big strain on the healthcare system. HR2962 is supposed to close the loophole in the Stark law for in office imaging such as CT,MRI, and PET. Please try to give media attention to this bill as it would greatly reduce the unnecessary spending that goes on today. I understand many physicians will not support this bill because their pocket books will be effected. The only physicians who will support this will be radiologists who see day and day the countless pointless studies being performed. However passage of this bill is paramount to slowing down healthcare costs.

    As one example as to how ridiculous self referral has become I offer this example. There is a group of neurologists in our town who previously made 200-250k a year, which is slightly above average for that field. They recently bought 2 MRI scanners and are now making 500 to 700k a year. They are doing chart reviews and ordering MRI’s every 6 months even if not needed just to keep the revenue stream alive. This is the kind of behavior that is bankrupting our system. Please give media attention to HR2962.

    August 24, 2009 at 7:58 am |
  5. Mark from Saint Louis

    Oh Tom, that was so great, I think the President will greatly benefit from your advice. Keep fighting and don't listen to what the critics say to you, even if it's true.

    August 24, 2009 at 12:29 am |
  6. david oklahoma

    On Democrat and Repulican...... If we the people want bipartisianship then we don't need a two party system.. lets have a king and his servants then.. I love freedom and i hope partisianship will still deliver the debate that made this country great not two partys giving and taking to get deals done by stealing the taxpayers money.... to buy votes

    August 23, 2009 at 9:27 pm |
  7. Karin Connolly

    Everyone,
    There is no reason to re-invent the wheel. We have health care cooperative models out there already that work.
    We don't have to be crazy blaming anyone or any entity. There are cooperative rural and city HMO's models already in place.
    In Wilmington,Ohio (yes as seen on 60 minutes) we have and I'm sure all across the country there great models already there both rural city that have proven excellence in care and outcomes It is far more fiscally responsible to fund existing models and emulate them with public option funds.It is not cost-effective to re-invent everything all over again. I am going to describe the models we have in our rural farming community.
    – DHL had a new and cutting edge innovative model for delivering health care at a cost-effective way. They opened a clinic right in the companies, hired physicians,nurse practitioners,nurses and ancillary personnel. They not only performed employment physicals,worker's compensation, but also chronic illness care.They saw the employees,their husbands,wives and children including their children in college at no charge. They practiced and taught disease prevention with weight loss and fitness,high blood pressure,cholesterol and diabetic teaching,etc.
    -Clinton Memorial Hospital in Wilmington,Ohio, a rural hospital participated in a cooporative HMO with seven other rural hospitals. Claims were processed and paid at the small CHPO HMO in Newark,Ohio, The individual hospitals managed the day to day referrals and utilization review when referrals were required. It worked; however, this small HMO didn't have the huge billions dollars in premiums,10 million dollar CEO salaries or lobbyist in congress. This is a great HMO model, it just needs to be funded by the federal government. We have to create competition against the out of control big insurance companies. The federal government doesn't want to manage our healthcare; there are models out there that work already.
    -Kaiser Permante has had a program that has been there for many years that works.They provide health insurance and hospital care ,outpatient treatments,primary care physicians and specialist. Their model and center for excellence should be looked by the president and congress.Not only can the employees pay premiums and get the healthcare, it is also open to the community companies big and small and self-employed businesses. It works!

    Nurse Practitoner

    August 23, 2009 at 9:19 pm |
  8. Stephen J Dunston

    Regarding Healthcare: The numbers are important. The French have the best system in the world for everyone in their country and they spend in money that is the equivalent of $3374.00 per person. In America we don't cover everyone spend an average of $6402.00 per person and our healthcare system is ranked a very poor 37th in the world. To fix our system, let's play COPYCAT and create a system just like the French system for everyone in America

    August 23, 2009 at 7:06 pm |
  9. JR

    I wonder how Tom would have advised President Bush? He was roundly criticized for his stubborness by his detractors. So is a vice in one president now a virtue in another?

    August 23, 2009 at 5:43 pm |
  10. Mrs. McCray

    Love you Pres Obama! Enjoy your vacation and Family! MR Pres it is time to show everyone that you have try to do it with both parties. I knew when McCain said, " he will go across the stand and help, I knew he was not telling the truth! Mr Pres. O, just keep your eyes towards the hill and keep the the faith God wants you to have. They all wants to sit back and judge you, when God said, " let no man judge or you will be judge. They have this report card on you, but God have a better report. Don't listen to the negative of any man, because if they have a plan to get all of us out of this mess, they would of step up to the issues, and lay it out to someone to see how much anyone was willing to paid. Jesus paid a price for our sins, now I pray that you stay force, because God will see you through this. US needs to get over the color of a man skin. Let us all work together for the good. TOM leave the dog alone, try Jesus instead of man or animals! Pres. O, the US should now that you are trying. Why, no one did a report card on the Bush run office, he did not know gas was 4.00 dollars.

    August 23, 2009 at 4:15 pm |
  11. Richard Remington

    Absent from the discourse is the 60% bite the health insurance companies are taking out of the total expenditure. A public company working 10% could offer the same care and give a 50%rate cut to all insured citizens. A substantial 10% reduction to all insured citizens would seem to leave sufficient revenues to give health care to all the others. We had health care before we had insurance. It should only exist to lower overall costs by spreading the risk. It clearly does not . This spring the small company I work for was hit with a 30% premium increase. In searching for a better option we found that all the companies had raised their prices at the same time. There is no reason to believe that this will not happen again and again unless there is true competition.

    August 23, 2009 at 3:52 pm |
  12. Vicki

    Enjoy the vacation 1000's of grandmothers are paying for it. Whne you go to dinner I will be going to 2nd job. Oh yea I knew I couldn't get a goverment job I pay my taxes

    August 23, 2009 at 2:07 pm |
  13. Holly Waddles

    Hey Tom I really liked your witty letter! I agree with what you said and thought you put it into words very well. Let's face it the President has a job that none of us probably would want to take on especially in this crazy economic times, but do not under estimate Obama. He is clear spoken and speaks from the heart with much conviction. He will not make everybody happy because that's just a cold hard fact, however I for one am between jobs and not quite retirement age, and without health care. I believe that we are in the state we are in because there has not been the regulations in effect to have kept healthcare costs down, and affordable for everyone. I was highly disappointed to see today US Chamber of Commerce opposing the Presidents plan to make healthcare better for all. Do they really think things are great the way they have been for the last 8 years? They truly do not have the best interests of the American people as they claim. What are they afraid of? Could things be possible worse? And why do people keep saying slow down & take your time? These cannot be people with inflated hospital bills or routine office visit doctor bills in front of them with 30 days to pay. So Tom please keep encouraging not only the President to press on in this fight, but also your friends, neighbors, and relatives, and I will do the same.

    August 23, 2009 at 1:12 pm |
  14. 4Told

    Pretty soon people are going to turn to medicaid, so prepareing a plan now is one of the few options to consider to avoid health care chaos is how i see it.

    August 23, 2009 at 12:01 pm |
  15. 4Told

    With 250 plus jobs lost every month along with that health coverage how can the house not reconize that healthcare form is needed now.

    August 23, 2009 at 11:54 am |
  16. Marlene Axe

    Mark,

    Just wanted wanted to reassure you forever, even if you cant find me til afer the summer of '69, and I'm not home when when you get there, I'l always be kibbutzing always with my mother wither ny mother on her front porch, where you can always find me, and sh'll get up and go check on the stove from another Jewish dish you never tried before and you can take her place until dinner's ready, but don't tell your mother ever where you are going while your spreading out your arms to fly there from Grosvenor.

    Love,

    Eve

    August 23, 2009 at 12:36 am |
  17. maggi jacks

    Re your report on government subsidised healthcare

    re your report on the America healthcare system: I am a happy, fit, and healthy 60 yr. old Canadian, living with government medicare. I believe that the U.S. should have a serious look at our system.....namely the one in place in the province of British Columbia, which is the best place on earth! Our system requires every resident to pay into healthcare (max $74. monthly for a single person), and then it is indexed according to the number of people in your family, and your annual income. If your annual income is below $18K , your medicare is free. This includes ALL aspects of medical care, except for optional plastic surgery and such, and some prescription drugs, as well as some prothsesis and eyeglasses, where healthcare professionals and government agencies can make exceptions. This even includes counselling and treatments for obesity, which is an escalating problem in the U.S., as well as in Canada. My cousin, who lives in Arizona, is an American by birth, and a former Canadian, is self employed, and she and her self employed husband, do not have any healthcare whatsoever. They both earn well, but because they are self employed, and still provide jobs for others, are penalized. I believe that the U.S., and her ciitzens, and President Obama should study our system well, and perhaps mimick it, and if not, learn by it. I had emergency neck (spine) surgery last year for a herniated disc (my left side became paralyzed within 36 hrs.) My doctor had me in the hospital and in the O.R. within 24 hrs. of diagnosis, and it did not cost me a dime, even tho' my annual income is over $75K. It does not get better than that! Please look at the Canadian model, and ask your elected representatives to lobby congress to vote YES for universal healthcare. Another good model to look at is Germany....even better than our Canadian one! I hope that you will consider my comments in your next discussions.
    Thank-you!
    Maggi Jacks North Vancouver, B.C. Canada

    ;

    August 23, 2009 at 12:33 am |
  18. Janet

    I should not be on Social Security Disability and Medicare. I should not be a government problem. The worker's compensation insurance company, my employer paid should be taking care of me.

    The government allows these insurance companies to have their own rules. A Social Security Judge, Lawyer, and 3+ spine sugerons all said I would never work again. The fall caused too much damage. I had already had spine surgery 2 years prior to the fall. But the insurance company said you can go back to work. My employer said "Do not come on the property until I had a release from a doctor." The insurance company sent me to 3 of their doctors. 1 in Texas, Louisiana, and Mississippi. One finally said I could work, but would not provide me with a written excuse. I lost my job, benefits, and my health. everything. I worked hard and slipped and fell in water at work @ 7:00 pm doing overtime. I've been victimized by the insurance company, their doctor, my former employer, and yes our government. Yes our government for allowing them to have these rules. They will send you to their list of doctors until one writes the report they want to see. Then you are screwed no matter what your doctors say.

    Again, I should not be a government problem. 48 years old and forced to retire.

    August 23, 2009 at 12:31 am |
  19. Patricia Young

    I am currently on Disability. Due to a life-changing presciption medication I am now healthy enough to return to work and I prepared myself with the necessary degree to get a job.
    The trouble is a job will cause me to lose my healthcare and the ability to pay for the medication that has given me my life back.

    August 23, 2009 at 12:14 am |
  20. Janet

    Tom this isexcellent advice. Our President must, must stand up tall and strong, no matter if fellow Democrates are behind him or not. We elected him and expects him to stand up for what the American people are demanding. Don't be a sellout to the insurance companies and allow them to keep, keeping all of the money. They deny billions of dollars worth of healthcare every year. All of these people end up beaten, and on Medicare/Medicade or Social Security Disability/Social Security Insurance because they are too sick to work. This is what is making the government healthcare system stay in the red. We need healthcare reform now. Too many of us are counting on him to get this Bill passed.

    I hope he reads these or someone in his cabinet does.
    Even if they hate you in Washington Mr. President, you can always come to your loyal supporters for lunch.

    August 23, 2009 at 12:11 am |
  21. mary lee

    What a great concept to devote your time and effort in a town known for moving on when there's not an easy solution. Perhaps the President needs to reread some of his stump speeches that touch on the subject of persevering. Maybe he ought to check out the quote from President Calvin Coolidge.

    August 23, 2009 at 12:10 am |
  22. Mariam

    Currently our Health Care System is a joke. So why are people fussing about? For example in California the inmates receive better medical care than most of us.

    August 23, 2009 at 12:06 am |
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