Power Line Blog: John Hinderaker, Scott Johnson, Paul Mirengoff
http://www.powerlineblog.com
From a policy standpoint, there was nothing new in President Obama's speech to a joint session of Congress tonight. It can only be assessed, therefore, in political terms. I read the transcript rather than watching it, but the speech struck me as reasonably effective. I assume the delivery was standard Obama--smooth, generally flat, occasionally a bit whiny. One striking aspect of the speech was that Obama kept talking about the "plan" that he "announced" tonight--but there is no plan; not in writing, anyway. Not unless Obama meant Nancy Pelosi's House bill, but he didn't seem to, since he made a point of saying that details remain to be filled in, referred to work still going on in committee, and said that "his plan" is open to alternatives to the public option. This vagueness gives him a sort of deniability: what he was describing was more his concept of the qualities health care legislation should have, rather than a specific bill. Whether that was politically smart remains to be seen. So far, vagueness hasn't seemed to be the President's friend on this issue.
Here are some excerpts from the speech that I thought were noteworthy:
Instead of honest debate, we have seen scare tactics.
Then, a few minutes later:
Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result.
By far the biggest scaremonger on this issue has been Obama himself.
Well the time for bickering is over. The time for games has passed.
I'm not sure whether Obama and his handlers understand how this sort of talk grates on those of us who are not liberal Democrats (a large majority of the country). Debating public policy issues is not "bickering." Disagreeing with a proposal to radically change one of the largest sectors of our economy is not a "game." This kind of gratuitous insult--something we never heard from President Bush, for example--is one of the reasons why many consider Obama to be mean-spirited.
I assume most people noticed how, in tonight's speech, Obama's assurance that we will not lose our present insurance coverage has been scaled back. This was after thousands of critics pointed out that under the Democrats' proposals, many people (more than 100 million according to some estimates) will in fact lose the insurance coverage they now have:
[I]f you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.
That's true, of course. No one ever said it did. What the Democrats' plan does do, however, is give employers the opportunity and, depending on pricing, the incentive to terminate their employees' plans and dump them into the public system. And whether private insurance companies can compete with the public "option" depends on whether Obama keeps his pledge that the public program won't be subsidized.
[I]nsurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse.
How does that work? Better coverage for more people at less cost. Does anyone actually believe that is possible? I don't think so.
Obama described his plan for an insurance exchange where those who are not part of a larger plan will be able to buy coverage. He then added:
This exchange will take effect in four years, which will give us time to do it right.
But wait! Aren't people dying? The Democrats tried to ram their bill through Congress before the August recess, with essentially no debate and with virtually no one having read it. Their theory was that we are facing such a dire emergency that there is not a moment to lose. If, in fact, we have four years to spare, could we maybe stop trying to cram the bill down Americans' throats?
Now, even if we provide these affordable options, there may be those - particularly the young and healthy - who still want to take the risk and go without coverage.
That's true, of course. There are millions of people, mostly young and single, who choose not to buy health insurance or take a job where compensation comes largely in the form of benefits (same thing) because they have made a rational decision that for them, health insurance isn't worth the money. As Americans, they should have that right. The problem is that, in the unlikely event they do get sick, they know they will be treated anyway.
That's why under my plan, individuals will be required to carry basic health insurance - just as most states require you to carry auto insurance.
Traditionally, it was liability insurance that drivers were required to carry, not to protect themselves, but to protect others from their possible negligence. It is only because of no-fault laws that most states now require drivers to carry insurance that includes first-party coverage. There are some similarities, but many differences, between automobile and health insurance.
[U]nless everybody does their part, many of the insurance reforms we seek - especially requiring insurance companies to cover pre-existing conditions - just can't be achieved.
This is a key point that many will overlook. One of the central purposes of nearly all health care "reform" proposals is to force young people into the system to help pay older peoples' bills. Why is it that you can't force insurance companies to cover pre-existing conditions--i.e., "insure" against something that has already happened, a logical impossibility--unless you force young people to "do their part"? Insurance companies, and, eventually, the government as single payer, need young people to pay premiums that far exceed any actual risk to subsidize the known losses that will come from being forced to "insure" people whose medical conditions are not risks but certainties.
Consider the analogy to life insurance: could a dying, 90-year-old person expect an insurance company to issue him a million dollar life insurance policy? Maybe, but it would cost close to a million dollars. Why can life insurance companies sell policies at rates that people consider reasonable? Only because they are insuring against premature death, and the insured has been paying premiums for many years, during most of which time there was little risk of his dying. The same principle applies, pretty closely, to health insurance.
Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple.
No, it isn't. The Democrats' bill doesn't call the agencies it sets up "death panels," it says they will decide on "best practices." But any socialized medicine scheme saves money by rationing care. Who gets shorted, the politically powerful? No, of course not; the elderly and those who are otherwise helpless. In the United Kingdom, the death panel goes by the Orwellian acronym "NICE."
There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false - the reforms I'm proposing would not apply to those who are here illegally.
This is an outright lie, as Congressman Joe Wilson couldn't resist blurting out during Obama's speech. The Democrats defeated Republican-sponsored amendments that would have attempted, at least, to prevent illegals from being treated under the House version of Obama's plan. I think everyone expects that if Obamacare becomes law, illegals will receive benefits on an equal basis with citizens.
And one more misunderstanding I want to clear up - under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.
More oily language from the master of the half-truth. Under Obama's plan, it won't be necessary for federal dollars to fund abortions, at least not until socialized medicine actually arrives. Insurance dollars will fund abortions. The House bill sets up a nameless, unaccountable committee that will decide what coverages must be included in any approved private insurance policy. Those required coverages, you can be 100 percent certain, will include the costs of abortions. But Obama will take no responsibility; those are just "best practices."
This seems to me to be the most critical moment in Obama's speech:
My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down.
In fact, Obama and Congressional Democrats have zero interest in increasing choice and competition. If they did, there is an easy solution. There are over 1,000 health insurance companies in the United States; why do you think it is that in Alabama, one company has 90 percent of the business? It is because there are major legal obstacles to insurance companies operating across state lines. State legislatures, and lots of the companies, like it this way. Competition is hard. But if Obama really wanted to expand "choice and competition" in health care, all he would have to do is go along with the Republican proposal to allow health insurance companies to sell on a national basis. Like, say, computer companies, beer companies, automobile companies, law firms, and pretty much everyone else. The Democrats' refusal to allow existing health insurance companies to compete against each other nationwide, more than anything else, puts the lie to their nonsense about "choice and competition."
Now, I have no interest in putting insurance companies out of business.
Really? We've all seen the YouTube video where Obama says that under his plan, private health insurance will be driven into extinction over a period of ten to twenty years. Has he changed his mind? When? Why? Does President Obama fail to understand the ubiquity of YouTube? Does he not understand that many millions of Americans consider him a liar when he says things like this?
President Obama talked about the "public option" and assured listeners that it would not be subsidized by the government:
I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers.
Is it churlish to point out that profits are not overhead? It might be if this were just a slip of the tongue on the stump. But this was a speech that was carefully crafted by Obama and his top advisers. They really do not know the first thing about business or economics. So why should we put them in charge of our economy?
I want to speak directly to America's seniors for a moment, because Medicare is another issue that's been subjected to demagoguery and distortion during the course of this debate.
Actually, the administration has said that around half the cost of the plan, $500 billion, would be paid for by cuts in Medicare. So it isn't exactly "demagoguery and distortion" to suggest that there might be cuts in Medicare.
[N]ot a dollar of the Medicare trust fund will be used to pay for this plan.
I should hope not, since there isn't any Medicare trust fund, just like there isn't any Social Security trust fund.
The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud...Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.
But wait! If we can identify hundreds of billions of dollars in waste and fraud in Medicare and Medicaid and we know how to eliminate it, why haven't we done so already? Why don't we do so--right now!--regardless of the administration's highly controversial health care bill?
There is no possible answer to these questions. The Obama plan--whatever it is, once reduced to writing--depends for most of its financing on the bare assertion that we are currently wasting hundreds of billions of dollars, and that we will stop wasting that money only if taxpayers knuckle under to Obamacare.
This was not, to put it kindly, a speech that was directed at thinking people.
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http://www.washingtonpost.com/wp-dyn/content/article/2009/08/17/AR2009081702965.html?wpisrc=newsletter&wpisrc=newsletter&wpisrc=newsletter
Cooperatives Being Pushed as an Alternative to a Government Plan
By David S. Hilzenrath and Alec MacGillis
Washington Post Staff Writers
Tuesday, August 18, 2009
As prospects fade for a public, or government-run, option as part of health-care reform, key senators are considering another model to create competition for private insurers: member-owned, nonprofit health cooperatives.
Sen. Kent Conrad (D-N.D.), the chief advocate for including cooperatives in reform legislation, has cited examples as disparate as the Land O'Lakes dairy concern, rural electricity cooperatives and Ace Hardware.
But so far, cooperatives have been defined in the health-care debate primarily in terms of what they are not: They would not be run by the government.
That may make the cooperatives more politically palatable to conservatives, as well as to some Democrats such as Conrad, who fear that the public option may be a bridge too far. But it also presents new challenges: Cooperatives would face potentially greater difficulty getting off the ground and obtaining discounted rates from doctors and hospitals, observers say.
"It's very difficult to start up a new insurance company and break into markets where insurers are very established," said Paul B. Ginsburg, president of the Center for Studying Health System Change. "I don't see how they're going to obtain a large enough market share . . . to make a difference."
Karen Davis, president of the Commonwealth Fund, a foundation focused on health care and social policy research, said co-ops may not enroll enough people to negotiate favorable rates with health-care providers.
Dennis G. Smith, a senior fellow at the Heritage Foundation, a conservative policy research group, said he cannot yet tell whether co-ops would amount to government-run health plans by another name.
There are at least two major health-care organizations that could serve as models for Congress: HealthPartners in Minnesota and Group Health Cooperative, based in Seattle. They employ physicians and own health-care facilities, giving them greater power to control the delivery of care.
A major question Congress would have to decide is whether the new cooperatives would be integrated medical systems, like HealthPartners and Group Health. Or, would they simply negotiate reimbursement contracts with health-care providers, as conventional insurers do?
According to Conrad's Web site, co-ops would contract with providers and act as insurers. That could make them more like mutual life insurance companies, which are owned by their policyholders and are therefore somewhat insulated from the pressures and temptations of Wall Street.
Like the proposed public option, state or regional co-ops would be among the choices offered through a new regulated marketplace, in which eligible individuals could more easily comparison-shop for insurance.
However, co-ops would lack perhaps the main advantage of the public option: reimbursement rates for doctors and hospitals set by federal law, like those paid by Medicare, the program for older Americans. Federally determined reimbursement rates were central to the cost-saving promise of a government-run health plan and a potentially powerful competitive advantage. They were also a lightning rod for intense opposition from health-care providers and private insurers, who denounced the public option as a threat to their financial survival.
Co-ops would lack the ability to piggyback onto existing government institutions, like the ones that help administer Medicare.
President Obama championed a government-run health plan as a way to generate competition for private insurers and keep them honest, but the administration over the weekend signaled that it is willing to accept reform legislation without a public option.
As nonprofit enterprises, cooperatives would not have to worry about generating returns for shareholders. They could use that freedom to reduce members' premiums or put more money into improving care. HealthPartners aims for a 2 percent profit margin, said Mary Brainerd, the group's chief executive.
Being owned by members could make them more accountable to consumers, Brainerd said. Although HealthPartners is not owned by members, policyholders elect its board, and candidates for board seats have run campaign ads on local cable television, Brainerd said.
"It's not a magic answer, but I think it has a lot of the incentives that you would want to see that are pro-consumer," she said.
How the co-ops would spring to life is an open question. As start-ups, they could have a hard time competing with insurers that already dominate local markets. It is possible that existing health care organizations could try to convert themselves into co-ops.
There is a danger that co-ops could someday try to turn themselves into something else. Many non-profit health-care institutions, including CareFirst in the Washington area, have tried to convert themselves into for-profit corporations listed on the stock markets. CareFirst's attempt foundered amid criticism that it would generate huge financial windfalls for the company's executives and convert years of tax advantages into private gain.
Most Blue Cross and Blue Shield plans have a history as consumer cooperatives in the sense that they were nonprofit and owned by their members, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania's Wharton School.
"The history here is that they did bargain aggressively with hospitals because they often had (and still have) the largest market share of any private insurer. But there is little evidence that they held down spending growth, and a lot of evidence that they were captured by their professional management and not really controlled by consumers or by the public," Pauly said by e-mail.
Conrad envisions the co-ops receiving seed money from the government.
"The hard reality is, the reason I was asked to see if I could come up with [an alternative] is that the public option does not have enough support in the Senate to pass," Conrad said in a recent interview. "It's an alternative that would accomplish much of what's appealing [in the public option] and not have the fierce opposition of virtually every Republican and some Democrats."
It remains to be seen whether the co-op alternative would win any support for the legislation in Congress.
Sen. John D. Rockefeller IV (D-W.Va.), a leading proponent of the public option, isn't sold on Conrad's substitute.
"The co-op approach is very weak," he said in a recent interview.
Apparently, the proposed health co-ops would differ from another form of co-operative, the real estate version. Unlike, say, Manhattan's exclusive co-ops, whose boards decide who can move into the building, health co-ops would have to admit anyone willing to pay the premium, according to Conrad's Web site.
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OPINION
* AUGUST 18, 2009, 7:16 P.M. ET
ObamaCare Is All About Rationing
Overspending is far preferable to artificially limiting the availability of new procedures and technologies.
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* Comments (310)
By MARTIN FELDSTEIN
Although administration officials are eager to deny it, rationing health care is central to President Barack Obama's health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.
The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating "high cost, low-value treatments," by "implementing a set of performance measures that all providers would adopt," and by "directly targeting individual providers . . . (and other) high-end outliers."
The president has emphasized the importance of limiting services to "health care that works." To identify such care, he provided more than $1 billion in the fiscal stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. That could morph over time into a cost-control mechanism of the sort proposed by former Sen. Tom Daschle, Mr. Obama's original choice for White House health czar. Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost.
In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as "too expensive."
One reason the Obama administration is prepared to use rationing to limit health care is to rein in the government's exploding health-care budget. Government now pays for nearly half of all health care in the U.S., primarily through the Medicare and Medicaid programs. The White House predicts that the aging of the population and the current trend in health-care spending per beneficiary would cause government outlays for Medicare and Medicaid to rise to 15% of GDP by 2040 from 6% now. Paying those bills without raising taxes would require cutting other existing social spending programs and shelving the administration's plans for new government transfers and spending programs.
The rising cost of medical treatments would not be such a large burden on future budgets if the government reduced its share in the financing of health services. Raising the existing Medicare and Medicaid deductibles and coinsurance would slow the growth of these programs without resorting to rationing. Physicians and their patients would continue to decide which tests and other services they believe are worth the cost.
There is, of course, no reason why limiting outlays on Medicare and Medicaid requires cutting health services for the rest of the population. The idea that they must be cut in parallel is just an example of misplaced medical egalitarianism.
But budget considerations aside, health-economics experts agree that private health spending is too high because our tax rules lead to the wrong kind of insurance. Under existing law, employer payments for health insurance are deductible by the employer but are not included in the taxable income of the employee. While an extra $100 paid to someone who earns $45,000 a year will provide only about $60 of after-tax spendable cash, the employer could instead use that $100 to pay $100 of health-insurance premiums for that same individual. It is therefore not surprising that employers and employees have opted for very generous health insurance with very low copayment rates.
Since a typical 20% copayment rate means that an extra dollar of health services costs the patient only 20 cents at the time of care, patients and their doctors opt for excessive tests and other inappropriately expensive forms of care. The evidence on health-care demand implies that the current tax rules raise private health-care spending by as much as 35%.
The best solution to this problem of private overconsumption of health services would be to eliminate the tax rule that is causing the excessive insurance and the resulting rise in health spending. Alternatively, Congress could strengthen the incentives in the existing law for health savings accounts with high insurance copayments. Either way, the result would be more cost-conscious behavior that would lower health-care spending.
But unlike reductions in care achieved by government rationing, individuals with different preferences about health and about risk could buy the care that best suits their preferences. While we all want better health, the different choices that people make about such things as smoking, weight and exercise show that there are substantial differences in the priority that different people attach to health.
Although there has been some talk in Congress about limiting the current health-insurance exclusion, the administration has not supported the idea. The unions are particularly vehement in their opposition to any reduction in the tax subsidy for health insurance, since they regard their ability to negotiate comprehensive health insurance for their members as a major part of their raison d'ĂȘtre.
If changing the tax rule that leads to excessive health insurance is not going to happen, the relevant political choice is between government rationing and continued high levels of health-care spending. Rationing is bad policy. It forces individuals with different preferences to accept the same care. It also imposes an arbitrary cap on the future growth of spending instead of letting it evolve in response to changes in technology, tastes and income. In my judgment, rationing would be much worse than excessive care.
Those who worry about too much health care cite the Congressional Budget Office's prediction that health-care spending could rise to 30% of GDP in 2035 from 16% now. But during that 25-year period, GDP will rise to about $24 trillion from $14 trillion, implying that the GDP not spent on health will rise to $17 billion in 2035 from $12 billion now. So even if nothing else comes along to slow the growth of health spending during the next 25 years, there would still be a nearly 50% rise in income to spend on other things.
Like virtually every economist I know, I believe the right approach to limiting health spending is by reforming the tax rules. But if that is not going to happen, let's not destroy the high quality of the best of American health care by government rationing and misplaced egalitarianism.
Mr. Feldstein, chairman of the Council of Economic Advisers under President Ronald Reagan, is a professor at Harvard and a member of The Wall Street Journal's board of contributors.
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http://www.washingtonpost.com/wp-dyn/content/article/2009/08/18/AR2009081803652.html?wpisrc=newsletter&wpisrc=newsletter
The President and the Public Option
Wednesday, August 19, 2009
White House press secretary Robert Gibbs says President Obama's support for a government-run -- or public -- insurance option has not changed. Here is a sampling of what the president has said about the public option.
March 26 And to say we are going to allow anybody to get health insurance -- and if you've got a preexisting condition you're not going to be excluded, but you're going to be able to obtain health insurance; and if you can't obtain it through a private plan, there is going to be a public plan that is available in some way to give you insurance, or insurers are obligated to provide you with insurance in some way -- now, that's a principle.
June 15 Let me also address an illegitimate concern that's being put forward by those who are claiming that a public option is somehow a Trojan horse for a single-payer system.
Now, I'll be honest. There are countries where a single-payer system works pretty well. But I believe -- and I've even taken some flak from members of my own party for this belief -- that it's important for our reform efforts to build on our traditions here in the United States.
So when you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth.
June 24 A lot of the objection to the public option idea is not practical, it's ideological. People don't like the idea of government being involved. But keep in mind that the two areas where government is involved . . . in health care -- Medicare and the VA -- actually, there's pretty high satisfaction among the people who participate.
July 7 I am pleased by the progress we're making on health-care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices and ensure quality is a public option that will force the insurance companies to compete and keep them honest.
July 18 Any plan I sign must include an insurance exchange -- a one-stop-shopping marketplace where you can compare the benefits, costs and track records of a variety of plans, including a public option to increase competition and keep insurance companies honest, and choose what's best for your family. And that's why we'll put an end to the worst practices of the insurance industry. No more yearly caps or lifetime caps. No more denying people care because of preexisting conditions. And no more dropping people from a plan when they get too sick. No longer will you be without health insurance, even if you lose your job or change your job.
Aug. 15 Now, the insurance companies have come back and said, "Well, that's not fair, because nobody can compete against the government." They have a legitimate point if, if what's being done is the government is . . . subsidizing that government plan -- essentially taking taxpayer money and saying, "Here, we'll just keep on spending money regardless of whether you run a good operation or not," then it's hard for insurance companies to compete against that. And by the way, it would be wildly expensive for taxpayers.
So I've already said a public option can only work if they have to collect premiums just like a private insurer and compete on a level playing field.
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# The Wall Street Journal
* AUGUST 18, 2009, 6:08 A.M. ET
The Public Option Goes Over
The big fight over ObamaCare is far from finished.
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* Comments (138)
So it looks as if the public option has been sent to the death panel—so to speak. Over the weekend President Obama and other White House officials throttled back their demands for a new health-care entitlement program that looked like Medicare for the middle class. Liberals are in a furor and more than a few conservatives are popping champagne corks. But dumping one of the most radical and destructive features of ObamaCare is best viewed as a tactical political retreat, not a surrender.
The Administration had to toss something overboard, considering the rising swell of voter opposition and the fact that many Democrats are getting queasy in the current health-care squall, especially in the Senate. Jettisoning the public option is supposed to quiet the public's main worry about government control of medical decision-making—not to mention neutralizing the insurance industry's main objection. The issue now is whether Mr. Obama's fall-back is merely to pass the public option on the installment plan.
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Associated Press
whiteflag
To pose the question is to answer it. "All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health-care reform," Mr. Obama said Saturday in Colorado. "This is just one sliver of it, one aspect of it."
Yet the public option wasn't some afterthought, or merely the obsession of Congress's leftward fringe. A new government-run program would crowd out private insurers by undercutting them on consumer prices, courtesy of an intravenous drip of taxpayer dollars and its monopsony power to force doctors and hospitals to accept sub-market rates. As millions of people gravitated toward "free" coverage, the public option would also vastly expand federal management of the practice of medicine, shaping the treatments and care patients can receive to save on costs.
Some liberals were honest, or used to be honest, about where all this would lead. Barney Frank noted the main reason Democrats were not backing a total government takeover: "We don't have the votes for it. I wish we did. I think if we had a good public option it would lead to single payer." Then there's Mr. Obama's now famous 2003 remarks: "I happen to be a proponent of a single payer universal health-care program. . . . But as all of you know, we may not get there immediately."
There are plenty of other ways of "getting there" without a public option—namely, through the federally chartered insurance cooperatives now gathering momentum in the Senate. The idea of creating member-owned co-ops in the states, as Senator Kent Conrad originally proposed, isn't necessarily harmful. But if regulated as advertised by Democrats like Chuck Schumer and Harry Reid, they'd be satellites of Washington and have 50 open checks drawn on the Treasury, creating the insurance industry equivalents of Fannie Mae. "We're going to have some type of public option, call it 'co-op,' call it what you want," Mr. Reid said in July. From the start, the Administration has always held that "the goal is non-negotiable; the path is," as Chief of Staff Rahm Emanuel put it.
Another path may be to convert private insurance companies into public utilities outright. In a New York Times op-ed on Sunday, Mr. Obama reiterated his plan to regulate who the insurers must cover, how generous the benefits must be and how much they can charge, including a limit on out-of-pocket spending. If Democrats decide to centrally plan the insurance market, in what sense is that different from a public option?
The most dangerous outcome of this weekend's ostensible concession would be if ObamaCare acquires a "moderate" gloss and the public comes to think the rest is innocuous. Cashiering the public option doesn't eliminate the plan's many other problems: The federal fisc is already a shambles because of our current health entitlements, and a new $1 trillion liability is unsustainable given the deficits and tax burden required to finance them. Democrats plan to subsidize insurance up to 300% of the poverty level, which for a family of four is about $66,000. That commitment will only grow, as do all government health programs. ObamaCare would still impose costly new mandates on individuals and businesses and dismantle even the parts of the health-care system that are working well now.
The real goal this year is to create enough of the architecture for government-run health care; eliminating the public option merely slows the march. Still, that Mr. Obama has been forced to publicly repudiate one of his main ideas shows how much he over-interpreted his 2008 mandate. His election was not a call for larger government or a return to 1970s-era entitlement liberalism a la Henry Waxman or Pete Stark. Rather, it was in favor of the amorphous change—"change we can believe in"—to clean up the Beltway mess and toss out an exhausted GOP.
The best health-care option now is to attempt a truly bipartisan reform, likely one built on individual tax credits for private health insurance. Or drop the scheme entirely and focus on improving the economy. The Democratic walk-back on the public option is just a few steps. This fight is a long way from over.
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http://www.washingtonpost.com/wp-dyn/content/article/2009/08/17/AR2009081702178.html?wpisrc=newsletter
Where's Mr. Transformer?
By Eugene Robinson
Tuesday, August 18, 2009
It's true that politics is the art of the possible, but it's also true that great leaders expand the scope of possibility. Barack Obama took office pledging to be a transformational president. The fate of a government-run public health insurance option will be an early test of his ability to end the way Washington's big-money, special-interest politics suffocates true reform.
Without that option, what Obama now calls "health insurance reform" still would be better than no reform at all. But frankly it's becoming hard to tell. So many genuine reforms have been taken off the table -- fully universal coverage, the ability to negotiate prices with the drug companies -- that expectations are ratcheted down almost daily.
Giving up the public option would send many of Obama's progressive supporters into apoplexy, yet the administration has sent clear signals that this is the path of less resistance it's prepared to take.
"The public option, whether we have it or we don't have it, is not the entirety of health-care reform. This is just one sliver of it, one aspect of it," Obama said Saturday at a town hall in Grand Junction, Colo. Kathleen Sebelius, the secretary of health and human services, told CNN that a public option is "not the essential element" of comprehensive reform.
But what is the "essential element"? Where, if anywhere, does Obama draw a line in the sand? For reform to be meaningful, there must be some components that a final package absolutely should include. What on Earth might they be?
Obama was wise to avoid the central mistake of Bill Clinton's failed attempt at health reform, which was to hand Congress a fully elaborated package and say "take it or leave it." Instead, Obama set broad -- and awfully fuzzy -- policy outlines and let Congress fill in the details. He has followed this strategy to a fault, allowing the effort to be hijacked by special-interest lobbies determined to thwart genuine reform.
The let-Congress-do-it approach meant that multiple bills would be written in committees on both sides of the Capitol, which gave the lobbyists for health insurance and drug companies a target-rich environment. They could nibble a little here, gnaw a little there, find the weak points and exploit them. Republicans could find opportunities for demagoguery -- the proposal to have Medicare pay for end-of-life counseling, for example, which was twisted into euthanizing the elderly and infirm. Opponents could write a script for chaos at town-hall meetings, designed to create the impression that Americans love their health-care system just the way it is.
Clearly, the White House feels itself on the defensive. But why?
Consider the political landscape. Democrats control the White House and both houses of Congress. No matter how disciplined Republicans are in opposing any reforms -- even if Republican objections are accommodated -- they don't have the votes to kill a final bill.
If conservative "Blue Dog" Democrats are successful in nixing a public health insurance option and watering down other reforms, progressive voters have a right to ask why they went to such trouble to elect Democratic majorities and a Democratic president. But the Senate can still resort to a parliamentary maneuver that would require only 51 votes, rendering most objections irrelevant. Historical trends indicate that it's unlikely the Democrats will expand their majorities in 2010. Politically, therefore, there's not likely to be a better moment for health reform than right now.
It's also true, politically, that failure to get any health reform measure passed and signed would be a severe blow to Obama -- and a bad omen for the rest of his ambitious agenda to revolutionize U.S. policy on energy and education. It would be understandable if the White House decided that the important thing, at this point, was to get a "win" at all costs. Is this what the apparent retreat on the public option signals?
If so, that would be not only wrong but also -- even at this point -- unnecessary, or at least premature. What the president hasn't done is the obvious: Tell Congress and the American public, clearly and forcefully, what has to be done and why. Take control of the debate. Consult less and insist more. Remind the Blue Dogs who's president and who's not.
Giving up on the public option might be expedient. But we didn't elect Obama to be an expedient president. We elected him to be a great one.
eugenerobinson@washpost.com
_____________________________
AUGUST 17, 2009, 11:04 P.M. ET
The Panel
What death by bureaucratic fiat might look like.
* Article
y ANDREW KLAVAN
It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance.
—President Barack Obama in a New York Times interview on how costly medical decisions should be made.
The people behind the long table do not know what they've become. The drug of power has been sugared over in their mouths with a flavoring of righteousness. Someone has to make these decisions, they tell their friends at dinner parties. It's all very difficult for us. But you can see it in their eyes: It isn't really difficult at all. It feels good to them to be the ones who decide.
"Well, we have your doctor's recommendation," says the chairwoman in a friendly tone. She peers over the top of her glasses as she pages through your file.
You have to clear your throat before you can answer. "He says the operation is my only chance."
"But not really very much of a chance, is it?" she says sympathetically. Over time, she's become expert at sounding sympathetic.
"Seventy percent!" you object.
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"Seventy percent chance of survival for five years—five years at the outside—and even that only amounts to about 18 months in QALYs: quality-adjusted life years."
"But without this procedure, I'll be dead before Christmas."
You try to keep the anger out of your voice. The last thing you want to do is offend them. But the politicians promised you—they promised everyone—there would never be panels like this. They made fun of anyone who said there would. "What do they think we're going to do? Pull the plug on grandma?" they chuckled. The media ran news stories calling all rumors of such things "false" or "misleading." But of course by then the media had become apologists for the state rather than watchdogs for the people.
In fact, the logic of this moment was inevitable. Once government got its fingers on the health-care system, it was only a matter of time before it took it over completely. Now there's one limited pool of dollars while the costs are endless.
"You have the luxury of thinking only of yourself, but we have to think about everyone," says the professor of ethics. He's a celebrity and waxes eloquent every Tuesday and Thursday on Bill Maher Tonight. "This isn't the free market, after all. We can't just leave fairness to chance. We have to use reason. Is it better for society as a whole that we allocate limited resources for your operation when we might use the same dollars to bring many more high quality years to someone, say, younger?"
"I'm only 62."
He smiles politely.
"Look, it's not just about me," you argue desperately. "My daughter's engaged to get married next year. She'll be heartbroken if I'm not there for it."
"Maybe you should have thought of that before you put on so much weight," says the medical officer. "I mean, you people have been told time and again . . ."
But the chairwoman is uncomfortable with his censorious tone and cuts him off, saying more gently, "Perhaps your daughter could move the wedding up a little."
The member in charge of "stakeholder" exceptions shakes her head sadly as she studies your file. "If only you could have checked off one of the boxes. It would be awful if you were penalized just because of a clerical oversight."
It begins to occur to you that this is how you are going to die: by the fiat of fatuous ideologues—that is to say, by the considered judgment of a government committee. They are going to snuff you out and never lose a minute's sleep over it, because it's only fair, after all.
That logic is implacable too. Free people can treat each other justly, but they can't make life fair. To get rid of the unfairness among individuals, you have to exercise power over them. The more fairness you want, the more power you need. Thus, all dreams of fairness become dreams of tyranny in the end.
You know you should keep your mouth shut. Be humble—they like that. But you speak before you can stop yourself.
"What you're doing here is evil," you cry out. "You're trying to take the place of God!"
"Sir, this is a government building!" says the chairwoman, shocked. "There's no God here."
Mr. Klavan is a contributing editor to City Journal. His latest novel is "Empire of Lies" (Harcourt, 2008).
________________________________________
WASHINGTON, August 17, 2009
Thousands Quit AARP Over Health Reform
Tens of Thousands Don't Like the Health Care Overhaul
(CBS) CBS News has learned that up to 60,000 people have cancelled their AARP memberships since July 1, angered over the group's position on health care.
Elaine Guardiani has been with AARP for 14 years, and said, "I'm extremely disappointed in AARP."
Retired nurse Dale Anderson has 12 years with AARP and said, "I don't wanna be connected with AARP."
Many are switching to the American Seniors Association, a group that calls itself the conservative alternative as CBS News Investigative Correspondent Sharyl Attkisson reports.
Watch Extended AARP Interview Here
Last week alone, they added more than 5,000 new members. Our camera was there Friday when the mail came.
Letters were filled with cut-up AARP cards.
"I think that probably the seniors are most upset with cuts in Medicare," said ASA President Stuart Barton.
The American Seniors Association is flat-out against President Obama's plan, which calls for $313 billion dollars in Medicare cuts over ten years. The AARP is widely viewed as supporting the President.
Last week, Obama told a town meeting in Portsmouth, NH, "We have the AARP on board because they know this is a good deal for our seniors."
The AARP called the President's statements "inaccurate," saying it hasn't endorsed any plan or bill.
Some were left with the feeling that AARP was waffling.
"I feel they're supporting it through the backdoor, and telling members that they're not through the front door," said Guardiani.
"AARP has not endorsed any plan at this point," said Cheryl Matheis, AARP VP for Social Impact.
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