Wednesday, February 24, 2010

The Same Gov’t Takeover You Still Don’t Want - Now with Price Controls!

Democrats have spent the last year trying to sell a government takeover of health care to an American public that just isn’t buying. After failing for so long, it looks like the White House has decided to add a new wrinkle to its marketing scheme. It’s the same government takeover of health care you still don’t want…(drum roll)…now with price controls!

The plan unveiled by the White House earlier today is basically the Senate bill with a few changes. Let’s take a look to see what the Obama administration still mistakenly thinks health care reform should look like. The White House plan:

o Still levies mandates on individuals and employers.

o Still leaves $650 billion in savings on the table every year by ignoring real medical liability reform.

o Still puts Washington bureaucrats in charge of defining “quality” health care. Still cuts Medicare Advantage.

But wait, there’s more! For an unlimited time only, the White House plan also:

* Still raises taxes to pay for new entitlement programs (only this time the Medicare payroll tax increase is even higher).

* Still gives the government-run plan a beachhead to eliminate the private insurance market.

You see, it really is the same government takeover you still don’t want. Only now the Obama administration has included a “Health Insurance Rate Authority” to make sure that insurance premiums aren’t any higher than Uncle Sam says they should be. After all, price controls are as American as apple pie.


CBO: Obama health bill too sketchy to rate

President Obama tried to woo the GOP with sweeteners and threw out the controversial "cornhusker kickback," but the White House's first stab at resurrecting the health care overhaul was so bare-bones that Congress' budget scorekeeper couldn't put a price tag on it. In a nod to Republicans, Mr. Obama's proposal calls for a centralized database where government officials can document Medicare and Medicaid abuses — an idea from the conservative House Republican Study Committee.

The president also culled a provision from a centrist House Republican bill that would require background checks for those who provide health care services under Medicare. The plan also adds stronger sanctions such as jail time for those who purchase, sell or distribute Medicare-beneficiary information numbers.

Republicans were not impressed and continued to take aim at Mr. Obama's decision to release a plan before Thursdays televised White House summit with Capitol Hill lawmakers. "The president has crippled the credibility of this week's summit by proposing the same massive government takeover of health care based on a partisan bill the American people have already rejected," said House Minority Leader John A. Boehner, Ohio Republican.

Saying it "doesn't make sense" to start from scratch, the administration ignored calls from the Republican minority to scrap the Democratic health care bills and instead released a detailed outline based on the Senate version. At the same time, advisers insisted that Mr. Obama is heading into the summit with an "open mind." The administration did not post the bill's text on the White House Web site but outlined what the legislation would do. It said the measure would cost $950 billion over 10 years.

The information wasn't enough for the nonpartisan Congressional Budget Office, the official keeper of budget costs, to even venture an estimate of the bill's price tag. "Although the proposal reflects many elements that were included in the health care bills passed by the House and the Senate last year, it modifies many of those elements and also includes new ones," CBO Director Douglas Elmendorf said in a blog post. "Preparing a cost estimate requires very detailed specifications of numerous provisions, and the materials that were released this morning do not provide sufficient detail on all of the provisions."

Republicans and Democrats have blamed each other for the lack of bipartisanship on health care, but the pressure has been on Democrats to reach out now that they have lost their filibuster-proof majority in the Senate. While Republicans have said that true bipartisanship requires writing bills together, Mr. Obama has argued that it means the minority party must accept some things it doesn't like.

After letting Capitol Hill take the lead for the past year, Monday's proposal was Mr. Obama's first effort at a comprehensive bill. His moves are designed to answer some of the harshest criticisms of the House and Senate bills. In addition to addressing a couple of Republican ideas, Mr. Obama's version removes one of the flash points of the Senate health care bill — Nebraska's special Medicaid arrangement that guaranteed it more federal dollars than other states, which Republicans derided as the "cornhusker kickback."

The Senate bill expanded eligibility for Medicaid so that more people would qualify. But Medicaid is a shared state and federal responsibility, which means that states eventually would have to pay more to cover the new enrollees. Sen. Ben Nelson, a moderate Nebraska Democrat and a last holdout in the Senate vote last year, negotiated a deal under which his state's increased payments would be funded by the federal government in perpetuity. Although the White House removed the Nebraska provision, it left other special exemptions, even after Mr. Obama called the deals "ugly" in an ABC News interview last month. He lamented that the deals undermined public support for the bill. Mr. Obama's bill, for example, kept the $300 million in Medicaid funds that Sen. Mary L. Landrieu secured for Louisiana, according to her office. It has become known as the "Louisiana Purchase."

But White House press secretary Robert Gibbs noted that Mr. Obama's bill would allow any state in which a major disaster occurred to be eligible for additional federal Medicaid funding. "So it's not a carve-out," he said. Mr. Gibbs on Monday called on Republicans to post their own proposal online. House Republicans responded by pointing out that the text of their bill has been posted on their Web site for months.

"Mr. Gibbs needs to talk with his boss. Our health care alternative — the full text of the legislation — has been available at for months, which President Obama knows, since he discussed it with us in Baltimore a few weeks ago," said Michael Steel, a spokesman for Mr. Boehner.

Mr. Obama's proposal appeared to leave untouched the special treatment that Sen. Bill Nelson, Florida Democrat, and other senators helped negotiate for Medicare Advantage customers in their states, though Mr. Nelson's office said it couldn't be sure until the CBO scores the bill.


Premature Schadenfreude

Jonathan Chait is enjoying what you might call "pre-schadenfreude" about health care's apparent revival. One can understand the urge, given how little opportunity liberals have had to actually revel in GOP despair over the past few weeks. But I think it's more wishful than warranted.

Despite having declared the death of the health care bill before almost anything else, I don't want to say that the thing's impossible. But the House has lost three of the votes it used to pass their bill 220-215 . . . which means that you have to persuade someone (probably a Blue Dog) to vote for it, who already voted against it. Progressives have been making the almost-plausible argument that the public is going to treat a vote for the House or Senate bill as a vote for final passage, so Democrats might as well go ahead and pass the thing. But their best argument totally falls apart for those who originally voted no.

And that's the best case scenario. It assumes that you can keep Bart Stupak's pro-life caucus, even though it's unlikely that they'll be able to "fix" the Senate's more liberal abortion language in reconciliation. This is a pretty heroic assumption. If you lose many of the Stupak folks, then the bill's done; there is not a snowball's chance in hell that you are going to persuade any significant number of the prior "no" votes in the Democratic caucus to throw their careers on the pyre of Democratic health care ambitions.

Meanwhile, it's not clear how many senators are nervous. Are we sure they have 51 Democrats for reconciliation? Reid has made these sorts of claims before, only to slip another deadline.

And deadlines are yet another big problem. Reid says they'll be ready to do reconciliation within 60 days. Really? Democrats are going to pass a mongo, costly new entitlement right around tax day? The caucus might as well pass the hat for the GOP election fund. But if you delay it, you're leaving an unpopular bill very fresh in peoples' minds as they go into the 2010 elections. You're also eating up air time that senators and congressmen would presumably like to have for initiatives that are actually, y'know, popular.

I'm not seeing it. And neither are any of the people I know who opposed the bill. They're worried, but at about the level of worry you give toe fungus, not stage-three metastatic cancer. Mr Chait is going to have to wait a little while for his freak-out. Unless that's one hell of a health summit Obama puts on, he'll probably have to wait forever.


Cool reception for Obama health plan in Congress

President Obama's latest health care reform proposal has received a lukewarm response among House Democrats and a scathing review from Republicans three days ahead of a bipartisan summit on the issue.

The plan includes many of the elements of the Senate-passed plan the GOP opposes, but it adds a few more provisions that will stir even more Republican opposition, including language that could be used to give the government control over private insurance premiums.

House Minority Leader John Boehner, R-Ohio, put out a statement condemning the new plan, going so far as to say it jeopardizes the summit planned for Feb. 25 at Blair House

"The president has crippled the credibility of this week's summit by proposing the same massive government takeover of health care based on a partisan bill the American people have already rejected," Boehner said. "This new Democrats-only backroom deal doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits."

Boehner goes on to say the summit, "has all the makings of a Democratic informercial."

The latest version is aimed at appeasing House Democrats who did not like the bill's tax on expensive insurance plans. The new plan delays the tax for union workers and raises the threshold of those who would have to pay it.

House Speaker Nancy Pelosi, D-Calif., however, did not appear thrilled with the plan. She said in a statement that it "contains positive elements from the House and Senate-passed bills."

The proposal lacks the public health insurance option House liberals are demanding and it is not clear whether the House Democratic leaders will be able to come up with the 217 votes needed to pass it. The House will be short three members who voted "yes" on a previous health care reform bill that barely passed the House, including Rep. Neil Abercrombie, D-Hawaii, who is resigning at the end of the month to run for governor.

Democrats in the Senate were more enthusiastic of the bill, which includes most of the provision they already passed in December.

"The president needs to say, 'This is what I'm for,' and it sounds like he has done that," Sen. Tom Carper, D-Del. said. "We need to ask Republicans, 'What are you for?' And hope that they will present their ideas and we won't be dismissive of them."


Health Care and Hubris

Scott Brown didn’t derail health-care reform. Bad politics and policy choices did

President Obama is making a last-ditch effort to salvage health-care reform at a bipartisan meeting Thursday at Blair House in Washington, D.C. Democrats may still try and ram their unpopular bill through Congress using a budget tactic known as “reconciliation” in the Senate, but make no mistake: it’s a sign of desperation, not strength. The Democrats’ 2,000-page, $1 trillion legislation may not be dead yet, but it’s on life support.

What a difference a year makes. In November 2008, Democrats trounced Republicans. President Obama swept into office with a powerful majority in Congress and a determination to enact sweeping liberal reforms. Democrats’ long-held dream of universal health care seemed on the verge of fruition. Feeling invincible, the White House quickly strong-armed the hospital, insurance, and pharmaceutical sectors into supporting Democratic health-care reform proposals. The drug industry’s trade association even promised $100 million in advertising support. An eventual Rose Garden signing looked all but certain.

With Obamacare now in shambles, the White House and its allies are trying to shift blame to the Republicans as the “Party of No.” But the Democrats helped derail themselves. The administration made poor political decisions that resulted in a bad legislative process and even worse policy outcomes. Obamacare ultimately collapsed beneath the weight of its own contradictions.

From the start, the president set broad goals for health-care reform but left the drafting of legislation to the congressional committee heads. In the House, this meant that the most liberal members wrote the bill, lurching the whole process leftward. The House liberals produced a massively expensive and convoluted bill and ignited a public debate about a new government insurance plan—the “public option”—that predictably raised red flags for moderates and conservatives in both parties. The White House, in short, opted for a “majority only” approach to health-care reform, disdaining broad bipartisan support in favor of (potentially) picking off one or two Senate Republicans.

The legislation that congressional Democrats produced is a dog’s breakfast. Democrats can claim that it’s “deficit neutral” (a terrible standard, since current deficit projections are unsustainable) only because it’s loaded with fiscal gimmicks and across-the-board reimbursement cuts to doctors, hospitals, and nursing homes. No one really believes that these will play out as advertised. The legislation’s projected costs over its first decade are almost willfully misleading. Provisions on taxes and reimbursement cuts (to Medicare and Medicaid) kick in immediately, while outlays on coverage subsidies (including a Medicaid expansion) don’t go into effect until 2013. The legislation also includes $200 billion in Medicare physician cuts that will be rescinded once a bill is signed by the president. And union pressure gutted a “Cadillac Plan” tax that was supposed to slow the rate of health-care inflation, costing another $60 billion.

After the Senate version passed on Christmas Eve, many supporters admitted that it didn’t do nearly enough to control costs and was tarred with too many backroom deals to buy off Senate moderates, like the Cornhusker Kickback and the Louisiana Purchase. Scott Brown’s victory in Massachusetts simply reflected public unhappiness with the Democrats’ efforts to ram lousy legislation down the country’s throat.

A more sensible approach would have been to pursue reforms that enjoyed bipartisan support, such as tax-code reforms to make insurance more affordable for the uninsured, increased federal funding for high-risk pools offering guaranteed access to people with preexisting conditions, reformed medical-malpractice laws to lower health-care costs, and preventing insurance-industry abuses (like dropping policyholders after they’ve become sick). These measures would have focused scarce tax dollars on the most vulnerable uninsured Americans without exploding the deficit.

Can bipartisanship work? It has before. Someone should remind President Obama that 83 House and Senate Republicans voted for Medicare in 1965. One hundred and twenty-three Democrats voted for welfare reform in 1996. Two hundred and forty-four Democrats voted for President Bush’s No Child Left Behind legislation in 2001.

Still, the outlook for bipartisanship is currently grim. Today, just days before the bipartisan summit, the president has issued his “own” plan for health reform—basically the Senate version of the legislation, with more regulations and subsidies tacked on to make it more acceptable to House Democrats. (The Washington Post reports that the president’s changes could add $200 billion to the cost estimate for the original Senate bill.) This is clearly a prelude to a reconciliation push in the Senate, even though the underlying legislation remains deeply unpopular.

The summit will probably turn out to be to be an exercise in administration spin. But moderates and conservatives in both parties must call the president’s bluff and present their own agenda for reform. Wiping the slate clean and starting over is highly unlikely at this point. Then again, Obamacare seemed all but certain just a few months ago.


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