The President's Health Care Speech: A Quick Reaction
I broke in a new plasma television on the President's speech this evening, so I couldn't help but think that he looked and sounded great. The line that jumped out at me was, "there is agreement in this chamber on about eighty percent of what needs to be done." If that is really the case, then why not pass the legislation that specified exactly that eighty percent? Everyone could declare victory and go home. What is in the other twenty percent that is essential to the President but on which there is not broad agreement in Congress?
Either the statement is not true, or some of what the President is pushing for -- the individual mandate, the employer pay-or-play, the measures to cut costs in Medicare, or the Medicare-for-a-premium public option -- is not subject to that broad agreement. I think the public option and employer pay-or-play are the most contentious, and I did not hear anything in this speech that set the stage for easier negotiations on those topics. That is still to come, and it will likely happen in a conference committee, complete with all of the backroom deals that we've come to expect from Capitol Hill.
It depends on how you count, doesn't it?
If it's by ideas, then maybe passing the 80% makes some sense politically. But I rather thing it's weighed by the word, which means there's a lot of agreement on massive regulation, but no agreement on the important but easy to specify part--how to pay for it.
But why is it that the
But why is it that the Republicans do not think getting 80% of what they want is a reasonable outcome for a minority party? We all know that their strategy is not about health care reform. It is about bringing down the President so they can get back in power. Period.
"the individual mandate, the employer pay-or-play, the measures to cut costs in Medicare, or the Medicare-for-a-premium public option -- is not subject to that broad agreement."
If there is no pay or play then won't employer have an incentive to dump all their employees into the public option, which is your biggest nightmare?
Do you really think measures to cut costs in Medicare are that controversial? Republicans talk about pay for value all the time too which is mostly what we are talking about (unless you think the medicare advantage subsidies are a good idea) I am surprised you don't refer more often tot he excellent work of your Dartmouth colleagues John Wennberg, Jon Skinner and Elliot Fisher on the extent of over-utilization of care (and thus spending) in Medicare.
Re: "But why is it that the", politics, politics...
But why is it that the Republicans do not think getting 80% of what they want is a reasonable outcome for a minority party?
Obama didn't say: "We, Nancy Pelosi, Henry Waxman, et al, propose to give Republicans 80% of what they want." Nothing like it.
We all know that their strategy is not about health care reform. It is about bringing down the President so they can get back in power. Period.
Of course. Exactly as was the Democrats' strategy of demagouging all Republican proposals for Social Security reform.
As Disraeli put it upon leading the opposition to a political reform he personally favored, "The duty of the opposition party is to oppose." That was 150-odd years ago, so this is not a new development in how the politics of democracy works.
But it might have been different this time, if Obama had kept his campaign promises and actually negotitiated in some kind of bipartisan, postpartisan manner, giving something to the Repubs -- instead of handing the whole bill over to Pelosi, Waxman and a bunch of committee leaders who are left even of the Dems in Congress.
With the Repubs lying flat on their back after the election, thinking they were going to get steamrolled as Obama got whatever he wanted, if he had offered them some real input and say 30% of the credit for a health care reform, keeping 70% for himself, they might very well have gone along to try to restore their political credibility from its then level of zilch. And reform would be done today.
But instead Obama broke his promises about how he was going to negotiate -- transparently and "On C-SPAN" -- and Pelosi & all tried to roll through these 1000-page bills that are totally opaque and make plainly contradictory promises, and which no Democrat can explain or reconcile to the public.
When the Repubs realized they could stymie things on those grounds, hey, they were up off their backs and politically credible again. Why compromise now? They're just like the Dems were on Social Security reform.
FDR and LBJ had Congressional majorities probably like will never be seen again, yet always went across the aisle on big issues to make sure they had some Repubs on their side.
But today's politics is so hyperpartisan, forget that. Whoever gets elected -- Clinton with 43%, Dubya by half a vote, Obama just now -- that guy and his party go shooting off like they won some super-mandate to roll up the other side. Maybe their own most partisan, activist wing, forces them to do that, so they have no choice, whatever. But they overreach, then it blows up on them.
Six months ago major liberal political publications were running big articles about the Permanent Democratic Majority and the New Liberal America, and assuming all this stuff was already done.
They always forget that "reversion to the mean" applies as powerfully to political popularity as to anything else.
Do you really think measures to cut costs in Medicare are that controversial?
Pretty obviously they are -- just look at the poll numbers.
If cutting all that "30% waste" wasn't controversial, why hasn't it been done already? Why does it exist now?
Why is cutting that waste conditional on getting health reform enacted? If the bill doesn't pass, are the Democrats going to leave that waste in the system?
If it isn't controversial, why doesn't Obama come up with some specific proposals for now cutting the waste that exists now?
Why is the best he can do to propose a new commission of experts that will come up with ideas to "bend the curve" later, a lot later, long after he is out of office?
("I'll cut costs after I'm out of office" is a very convincing promise from any politician.)
I am glad you believe you own
I am glad you believe you own BS, because no one in Washington does. Were you not cc'd on Bill Kristol's memo. Or Jim Demint's or the revelation of Mr Enzi and Mr. Grassley that they were never really negotiating in good faith.
I am glad Mr. Disraeli thought pith was more important than human lives. If opposition means more people suffer, and more people die, and more people are put through the terror of economic insecurity then you can shove your opposition for opposition sake up your arse (that's how they say that in Britain)
And how is it that the democrats so dissed the Republicans and yet still would up with something that Andrew seems to agree is about 80% OK. The truth, revealed by your adolescent tit-for-tat imperative, is that you refuse to say yes.
President Bush's "plan" for Social Security was not to fix the financing, it was to change the very nature of the program. That's what he spent all his time barnstorming for. Since he ruled out any revenue increases what was the opposition supposed to do debate about cutting benefits versus cutting benefits?
President Obama has in fact put most every issue on the table in this health care debate. Things he agrees with and things he does not. Just because you do not prevail does not mean that you have no chance to propose solutions.
If this was an argument in good faith over policy differences then would would not have had to deal with demagoging death panels, killing grandma, government takeover, getting between you and your doctor, rationing care. All the BS scare tactics that aremenat to shed heat not light.
AsS for cutting waste from Medicare, the idea is to reform the health care delivery system to look much more like Intermountain Health care or Geisinger, or Mayo Clinic, etc... that's why the President mentioned them in his speech. that's why he proposes major investments in IT and comparative effectiveness research, and an independent version of MedPAC which every one who knows what's what would be expected to propose major changes to Medicare's payment system away from fee-for-service and more toward supporting better value. There is a pretty broad consensus about this, frankly. It's one of the least partisan issues albeit perhaps hard for the average lay person to grasp.
Of course, they wanna kill grandma is what you say when you are not interested in effecting meaningful change but just want political victory.
Unfortunately, the 80% we all
Unfortunately, the 80% we all agree on is actually 84% - the percentage of Americans who already have health insurance, and who everyone agrees shouldn't see a reduction in coverage. It is the other 16% we are arguing over.
why we can't just do the 80% that's agreed upon
there are real reasons why we can't just do the 80% that people are willing to agree upon... because policy choices interact with one another... 80% of the choices are the easy stuff, but in order for the 80% to work, we need to make hard choices on the remaining 20% that will ensure the policy as a whole does not fall apart...
for example, part of the 80% that we can agree on is that insurance companies should not be able to discriminate against pre-existing conditions... we've all heard the horror stories of people who are sick, but can't afford healthcare or insurance because no insurance company will take them on... it's easy to say that they should not discriminate against pre-existing conditions...
however, if we make that condition, we also must have an individual mandate to buy insurance! why? because without such a mandate, we would all just not pay for health insurance at all until we happen to get really sick or injured, and then we quickly purchase insurance to cover our illness/injury... then exit the insurance after all major healthcare has been paid for...
and then, if we have an individual mandate, we must provide subsidies so that low and middle-class families can actually afford their health insurance (or provide, in extreme cases, a hardship exception)... current proposals provide subsidies up to 300 or 400 percent of poverty levels... because you can't mandate families pay for health insurance if they have a hard enough time paying for most of the other stuff they have to just to live...
ultimately, if we want to make america healthier and overcome a system that's incentivized to discriminate against old people or people with pre-existing conditions and that leaves up to 50 million people in america without health insurance (and that number growing daily)... we have to not only do the easy things, but the hard choices as well...
this is why the healthcare debate is difficult... we all want america to be healthier, people to have access to healthcare, and to try to curb costs... but in order to fix the obvious problems, we also need to make difficult choices that may "grow" government or require more "spending"... this is what, generally speaking, healthcare reform is trying to do...
but opponents of healthcare reform either ignore the difficult questions that arise or pretend that there is nothing wrong with the current system as is... they want to fix healthcare without any "growth" of government or additional "spending"... it can't be done... or at least any legitimately workable proposals have not been made... the opponents just scream of bigger government and spending and death panels and government bureaucracies, without an alternative proposal to fix the gigantic problems staring us in the face...