THE TREATMENT SEPTEMBER 1, 2009
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David Frum was just on CNN, explaining that President Obama had blown it on health care by embracing the "hyper-ideological" House bill. He's not the first one to make this argument. But I don't really see it.
A single-payer plan might qualify as hyper-ideological. A plan like the one Congressman Pete Stark once proposed, in which everybody without employer-sponsored coverage ended up in Medicare, might also qualify as hyper-ideological.
But the House bill? It leaves the employer system largely in place, then creates a marketplace in which people without employer coverage can choose from among a selection of private plans.
In other words, it's nothing more than a fleshed out version of what Obama and the other Democraitc candidates proposed during the presidential campaign. It's also what Max Baucus outlined in a white paper he issued shortly after the presidential election. And Baucus is not exactly the first name that leaps to mind when you think "hyper-liberalism."
Yes, the House bill has a public insurance plan to compete with private plans in the exchange. But the the public plan itself is a compromise for lawmakers who'd prefer a true single-payer plan. And the House version is actually weaker than many proponents would prefer.
No, the plan doesn't entirely pay for itself, depending on how you count an adjustment in Medicare physician payments; beyond the ten-year budget window, most experts seem to believe, it doesn't move that aggressively on controlling costs. But I'm not sure that makes the bill particulalry ideological. After all, it's far more fiscally responsible than legislation that centrists championed during the tenure of the last presidential campaign.
Of course, Frum's argument is of a piece with the claim David Brooks made today, that Obama's political struggles reflect his decision to lurch left. But I agree with Kevin Drum, who suggests this is a strange reading of history:
You'd think that Obama had been working in a vacuum or something. There's not even the briefest mention of the primary cause for all this: the deliberate decision by the Republican Party to hand over the reins to its most extreme wing and adopt a scorched earth counterattack to Obama's entire agenda. He agreed to cut the stimulus package by $100 billion and put 40% of it into tax cuts. That cut no ice. Democrats proposed a cap-and-trade proposal for reducing greenhouse gas emissions because it uses market mechanisms instead of crude command-and-control directives — and then adopted hundreds of compromises to water it down. Didn't matter. Max Baucus has been "negotiating" over healthcare reform with Republicans in the Senate for months and Obama has been careful not to criticize. But that turned out to be a charade. Tim Geithner's financial bailout plan was limited and business friendly. No matter.
Believe me, I'd like nothing more than if Obama would sell out to the left. But it's not happening.
For the record, I think Brooks' interest in health care reform is sincere. I just think he's wrong about why it's not working out so far. Noam has more on this.
Update: And so does the other Jonathan C.
1 comments
Is the Tri Committee Bill "hyper ideological"? Yes, it is -- it was drafted behind closed doors primarily by the staffs of two committees -- ways and means and energy and commerce. You need the read the bill, however, and weave in the various cbo letters which have been issued about the bill to place it in some type of context. First, it has a huge Medicaid expansion of 11 million individuals at the cost 438 billion over ten years. The cost is so high because the tri committee bill pays 100 percent of the cost for this Medicaid expansion, while attempting to freeze states into their current eligibility levels. This Federalization of this new Medicaid expansion is a Federal budget disaster of the first magnitude because the States will have no incentive to control or monitor costs because they no longer have any financial exposure. The key to Medicaid since its inception was that it was financed by matching payments from the States and the Federal government (known technically as the FMAP). Ask any ex CBO Director or CMS Administrator about this, and I bet everyone of them, regardless of their political affliation will tell you this a budgetary time bomb. Secondly, before you get to the insurance connector or the public program, you need to understand that private health insurance plans are grandfathered under certain conditions for only five years. After the five year period or sooner if you change your plan, you must be in total compliance with the Federal benefits package and other rules concerning cost sharing and actuarial value of the benefit and cost sharing. There are also Federal requirements on employer contributions and a complete undoing of ERISA preemption which governs most self insured plans. Thirdly, the private individual market for health insurance is abolished because the only place to purchase in the future will be the Federal insurance connector. In the connector insurers would have to function under: (a) new Federal insurance regulation; (b) current state insurance regulation which is not preempted; (c) the new Commission on Benefit Design. Fourth, you have the public option paying Medicare rates which are according to CBO 25 to 30 percent less than private payment rates because of statutory price controls. The number of those in the public option is open to debate. But the Lewin model which has been used by both Heritage and the Commonwealth Fund project at least 35 million based on the lower premiums that the public option could charge based on price controls. The public opiton would grow rapidly and significantly. It is the reason that Pete Stark and Jacob Hacker did another press conference last week arguing that it is the hear and soul of their type of health care reform. READ the BILL. Stop spinning like a top and try to be a little objective.
- lawphd
September 2, 2009 at 12:00am