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Health care reform – a scan of various sources

Editor’s note: Here is a series of articles and opinions collected from various sources, worth a scan…

The Left Gets Anxious

Don’t Confuse Me with the Facts.

Of course, advocates of Big Government hate this stuff. Writing in Politico Princeton history professor Julian Zelizar says the CBO is, “the most potent threat to the Obama administration’s fledgling health care plan.” He adds, “if the long-term CBO cost estimates climb too high, Republicans might be able to prevent Democrats from using the budget reconciliation process to protect health care from a filibuster in the fall.” But he recommends that the president ignore all such gloom and doom – “Obama can’t get trapped into a dry debate that is just about the numbers. Whatever form his final proposal takes, his best bet will be to keep public attention focused on the major objectives behind health care reform.”

That’s the ticket – just keep whistling past the graveyard.


Jonathan Cohn is Worried

This is all worrying the Big Government crowd.  Writing on his New Republic blog, Jonathan Cohn says, “Attention fellow liberals who want health care reform: You are in danger of losing the fight for universal health insurance. And it’s not only–or even primarily–because of the public plan. It’s because of the money.”

He cites the two estimates from CBO that the Finance bill would lower the uninsured by two-thirds and cost $1.6 trillion and the HELP bill would lower the uninsured by one-third and cost $1 trillion, and the reaction from Senate Dems that the price has to be lowered. “This is a problem,” says Mr. Cohn. “My suspicion–based on what I’ve heard and seen over the last few months–is that knocking the price tag all the way down to $1 trillion will mean a lot less money to subsidize insurance for people who can’t afford it and far fewer guarantees that insurance would be adequate.”

He figures paying for all this should be easy – raise taxes and pay providers less, and damn the consequences.

The New Republic Blog

So is Ezra Klein

In his Washington Post blog, Mr. Klein writes, “Health reform is, I think it fair to say, in danger right now. The news out of the Senate Health, Education, Labor, and Pensions Committee was bad. The Congressional Budget Office had scored a partial bill and the result was a total fiasco. But the news out of the Finance Committee is much, much worse.”

Like Mr. Cohn, Mr. Klein figures these estimates shouldn’t be an obstacle, because the answer is more reform, not less – putting everyone in a public plan, or passing a new Value Added Tax (VAT), or completely ending the employer exclusion But, alas, “The hope that we could expand the current system while holding costs down appears to have been just that: a hope. And CBO doesn’t score hopes. It only scores plans.”

Don’t you hate it when that happens? After all, we elected a president on nothing more than hope, why can’t we enact health reform on the same basis?

Washington Post Blog

Other Fallout

Falling into the VAT

David Hogberg writes in Investors Business Daily that, “Democratic lawmakers, scrambling to find a way to finance a trillion-dollar expansion of government health care, are mulling the creation of a value-added tax.” He says, “A VAT would be a major headache for President Obama, who has consistently pledged not to raise taxes on 95% of Americans. Republicans are sure to portray a VAT as a violation of his vow.”

He goes on to cite the National Association of Manufacturers and  the national Retain Federation as being extremely concerned about imposition of a new federal sales tax, especially in this economy, because it would further depress consumer spending. He writes, “Both groups voice support for the idea of health care reform, but have opposed specific components, including an employer mandate and a public plan.”

Mr. Hogberg goes on to say, “the fact that Democrats are even considering the idea reflects a growing concern about health reform’s cost.” Plus, “Public opinion may be souring. A new N.Y. Times/CBS poll shows only 44% approve of Obama’s handling of health care vs. 34% who disapprove.”

The article concludes, “Democrats could try to pass health care reform that isn’t fully financed. But they need a deficit-neutral bill to be able to use budget reconciliation to allow Senate passage with 51 votes. Otherwise, they would need 60 votes to overcome any GOP-led filibuster.”

Investors Business Daily

But, Be Careful

The Associated Press reports that, “Majority Democrats running the Finance Committee have told lobbyists that their views will be taken into account as long as their groups don’t mount public campaigns against the legislation.”  Ooooops! There goes that “seat at the table” again — we will listen to (and ignore) what you have to say as long as you shut up in public.

Will it work to silence the interest groups?  The article says, “We have a lot of sweat equity in this process,” said E. Neil Trautwein, chief health care lobbyist for the National Retail Federation, referring to hundreds of hours his group has spent with lawmakers as they prepared legislation. He predicted the bill would prove too costly and force lawmakers to pare it down – or else. “We need cost relief,” he said. “But if comes to the point where we have to cut and run and build a coalition” to oppose the bill, “we’ll take that step.”

On the other hand, the AMA is more compliant – “The American Medical Association backed off from a confrontation with the Obama administration over a government-run plan to compete with private insurance, declining to take a firm position at a Chicago meeting Wednesday.”

Associated Press

To the Rescue?

Meanwhile, writing for Bloomberg, Edwin Chen says, “Former Senate majority leaders, including Democrat Tom Daschle and Republican Robert Dole (along with Howard Baker), are promoting a healthcare overhaul plan aimed at bridging differences between the two political parties and overcoming objections by doctors, hospitals, and insurers.” He says it would, “tax some employer-provided health insurance premiums, require individuals and large employers to buy health insurance, and create public insurance pools run by states instead of the federal government.”

While the article goes on to cite numerous Administration and Congresional sources thanking the former Senators for their contribution, it is hard to see how this plan is much of an improvement over the ones already on the table.

Bloomberg News

Medicaid for All?

New York and California Collapsing

In the Wall Street Journal, Daniel Henninger says we should pay attention to the experience of Medicaid, because it is a model for what the President wants to do. But, “after 45 years, the health-care reform called Medicaid has crushed state budgets. A study by the National Governors Association said a decade ago that because of new requirements imposed by federal law, ‘Medicaid has evolved into a program whose size, cost and significance are far beyond the original vision of its creators.'”

Although, “Mr. Obama makes the original vision of his public option insurance plan sound about as simple as driving through toll booths with an electronic pass on your windshield.” In fact, “why shouldn’t one think that, as with Medicare and Medicaid, the Obama Public Option in time will become an impossible fog for patients to navigate?”

Both New York and California are in the process of collapsing under the weight of the program and the elected legislatures in those states, “are essentially falling apart as governing bodies.”

Wall Street Journal


June 19, 2009 - Posted by | Accountability, Affordability, Economics of Health care, Federal Government, healthcare | , , ,


  1. People are missing the point about this health care issue. It is not a matter of “us” vs. “them” – smart, hard-working people footing the bill for lazy, goof-offs . It’s a question of a broken down, non-funcitioning system.

    Our problem is threefold: 1) Health care has become big business. A few have gotten incredibly rich (insurance and pharmaceutical companies), while the majority of Americans are spending way too much money just to get the bare minimum health care, and a significant segment of the population is going without care altogether, 2) Our system rewards quantity and intensity of care, but not quality, prevention, and patient satisfaction, and 3) the population as a whole is clinging to a “Marcus Welby, M.D.” paternalistic health care paradigm that is was out-moded two decades ago. We, as health care consumers cannot afford to be passive recipients of care any longer; we need to learn to be active partners in the management and maintenance our health.

    This false choice between the government being in charge of health decisions versus the doctor is nothing but a worn-out attempt to distract us from the fact that insurance companies have been dictating care for decades, profiting at the cost of escalating premiums, declining quality and deteriorating health of the American population.

    Do we really want to listen to the Republicans go on and on about the perils of government involvement, or do we want to get serious and fix this problem and put good, quality health care within reach of every American. I think a little government influence would be a refreshing change from the fat-cat CEO approach to running things. Instead of crying “socialism”, let’s take a careful, considered look at other models, like Canada’s and France’s health care systems. Maybe we could learn something.

    Comment by klgrider | June 19, 2009 | Reply

    • You make three good points.
      1) It is a good business. More than a few have gotten rich. In fact, one of the major barriers to reform is that there is so much money in the system, change of any sort gores someone’s ox.
      2) The current system is one that pays for services not care. The original intent of HMOs was to manage care not cost, but it went awry and become only a cost conversation at a time when the process and measurement technology was so immature as to be impractical to utilize to deliver improvements in care.
      3) Consumers must get into the fray. However, most people still want someone else to pay for their health care. As long as someone else is paying the majority of the cost, we will have an insatiable appetite for services. We need a real system where people are real consumers with data on what works and what doesn’t, the relative outcomes of providers and they have a real stake in the cost of the services being delivered.

      As to your solution, this isn’t a republican or democrat, this is about reforming a system first and then figuring out how to deliver it within our ability to afford it. What appears to be going on is that there is a move to FIRST give people access and coverage. The fear is that our government officials will claim victory and not focus on the hard work of comparative effectiveness, efficiency and productivity so that all of this is affordable.

      As to your assertion that we should look at Canada or France — go ahead take a good look. We can debate the delivery system pros and cons, but the bottom line is that the health care costs in these nations is choking their governments and the people as well.

      I agree there needs to be ‘little’ as you said, government influence, but the emphasis here should be on little.

      Comment by Health care -- how do we move forward | June 19, 2009 | Reply

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