health care reform

Jagadeesh Gokhale and Mark Warshawsky speculate on the reasons why this year's Social Security Trustees Report has been delayed from its usual spring release:

Given the lead times necessary to prepare the trustees' report, it is highly likely that a final draft report was readied by early March to meet the April 1 legal deadline. But the trustees' decision to table that report was clearly unopposed because Social Security currently has no confirmed public trustees. All of its current trustees are ex officio members of the Obama administration, leaving no one to register concern that delay would prevent the public from knowing how rapidly Social Security's finances are deteriorating.

The excuse for the delay is to take account of the effects of the new health care laws, passed at the end of March, on Social Security's finances--with the expectation that ObamaCare will restore a semblance of financial viability to the program. The new health care laws create the possibility of offsetting the recession-induced decline in payroll tax revenues if many employers substitute higher taxable wages in place of health insurance coverage for their employees.

Eleven months ago, I wrote a post with the same name as this one reflecting on why the Political Right's fortunes were sagging in the wake of Tedisco's win in the NY special election and Specter's defection.  With health care reform now passed, I thought it worthwhile to revisit the idea I raised in the post:

[T]he Political Right has a problem in addressing policy issues in which people are fundamentally connected to each other.  Leaving aside the recent challenges of the financial crisis, the big issues in domestic public policy are health care, education, and the environment.  In each one, the choices that one group of people make affect the opportunities available to other people in a fundamental way -- beyond simply changing relative prices as people interact in free markets.  The connections come in different ways for each of the issues, but they are always related to basic notions of fairness. 

In health care, the connection comes through the formation of the insurance pool.  In our current setup, the pooling occurs largely around employment, which advantages some and not others and can in extreme cases leave out the sickest entirely. 

My column from today's The Fiscal Times explains why last Sunday's debate between Karl Rove and David Plouffe over health care reform really should have been aired somewhere other than This Week on ABC.

The column is below.

Health Care Budget Projections Spark Political ‘Food Fight’

The big news story today seems to be that more than a dozen state attorney generals are putting together a legal challenge to the individual mandate in the recently passed health care reform.  Here's what Bill McCollum of Florida said:

"It forces people to do something -- in the sense of buying a health care policy or paying a penalty, a tax or a fine -- that simply the constitution does not allow Congress to do," McCollum said at a news conference in Tallahassee.

McCollum, who is seeking the Republican nomination to run for Florida governor, said the healthcare reforms would add $1.6 billion to Florida's spending on the Medicaid health program for poor people.

I'm no legal scholar, but I cannot see how handling the mandate through the 1040 tax form is any less constitutional than, say, tax deductibility of IRA contributions.  Start from a baseline where everyone is presumed to have contributed to the maximum amount to an IRA.  The IRA deduction operates as:

I was distressed to read this post by Megan McArdle about "The Future after Health Care," particularly this part:

There seem to be three complaints here.  The first is that the American people don't want health care reform, or at least this version of health care reform.  I don't think anyone will hold up the bill that will pass as exemplary, but it does reflect elements of health care reform that Democrats campaigned on and won on in 2008.  So I have a hard time seeing this as doing violence to the will of the people as it is typically expressed in our electoral system.  Elections matter.  This is how they matter.

UPDATE (3:05 p.m.): The authenticity of the memo referred to below is being challenged.  Do we have "Fake but Accurate" II?

John Hinderaker at Powerline produces confirmation of my biggest concern about the so-called financing of the health care reform legislation -- banking on cost-saving in Medicare that I believe will be undone after this bill passes.  John has posted a copy of a memo distributed to Democratic staffers.  Here's the key excerpt:

One of the many dishonest features of the Democrats' effort to conceal the fact that their plan is a budget-buster is the assumption that reimbursements to physicians under Medicare will decline. This accounts for a large chunk of the Democrats' "savings." In fact, all knowledgeable observers understand that this alleged savings will be illusory because Congress will, in separate legislation, raise those reimbursement levels as in the past. The Democrats' memo acknowledges the party's dishonesty on this point, and urges its staffers to continue misleading the public:

Second, most health staff are already aware that our health proposal does not contain a "doc fix." Some Republicans have repeated CBO's November 18 letter that says "the sustainable growth rate (SGR) mechanism governing Medicare's payments to physicians has frequently been modified ... to avoid reduction in those payments, and legislation to do so again is currently under consideration in the Congress." The inclusion of a full SGR repeal would undermine reform's budget neutrality. So, again, do not allow yourself (or your boss) to get into a discussion of the details of CBO scores and textual narrative. ...

As most health staff knows, Leadership and the White House are working with the AMA to rally physicians support for a full SGR repeal later this spring. However, both health and communications staff should understand we do not want that policy discussion discussed at this time, lest it complicate the last critical push to health care reform.

My column from today's Roll Call explains why, contrary to what some may think, the fact that health care reform meets the Paygo rules of the congressional budget process is a reason to vote for rather than against the bill.

PAYGO Is Not a Reason to Oppose Health Care Reform

March 16, 2010

Pay-as-you-go, or PAYGO, is what supposedly forces Congress to offset the cost of doing something new so that it doesn’t make the deficit worse. For the past two decades, PAYGO either was a formal part of the Congressional budget process or, when it expired, was something many immediately and vehemently insisted be reinstated. Editorials promoted it. Budget hawks demanded it. Political parties tried to show it was one of their basic tenets. Democrats and Republicans both supported it.

My column from this morning's Roll Call explains why reconciliation, a subpart of the congressional budget process, and a sub-subpart of the legislative process, isn't what we should be arguing about.

Can We Please Stop Talking About Reconciliation?

My fellow Roll Call columnist Norman Ornstein was one of the authors of a truly excellent chart on reconciliation that appeared in the New York Times on Sunday.

Pete's post below on reconciliation and healthcare reform takes a far too strict look at what could and could not be included in a health care reform bill considered under reconciliation rules.

Pete's correct that the primary consideration is whether a provision would have an impact on the federal budget.  He's also absolutely, positively, no-doubt-about-it correct that the Byrd Rule was created to prevent "extraneous" (that is, having no impact on the budget whatsoever) provisions from being included.  I recall one of the things that got Senator Byrd (D-WV) so exercised was the inclusion of a major change in the broadcast fairness doctrine, which had no budget implications of any kind, in a reconciliation bill.

But Pete's very strict interpretation of the rules for what qualifies as an extraneous provision is..well...far too strict.

Leave aside the broader health care reform debate and what the Democrats want out of this process.  Why are the Republicans not using their elected offices to advance policies that serve their own supporters?

Their main voting constituency is middle class (or higher) white families in the suburbs, particularly the husbands and fathers in that constituency.  They don't face the raft of problems that others do in our society.  But one big problem that they do face is that something beyond their control happens to someone in their family.  Medical catastrophes have to rank high on that list -- they certainly do for me.  If a member of my family were to be afflicted with an expensive medical condition, then I am financialy viable only for as long as I stay insured with my current employer.  Put simply, there are gaps in private insurance markets that leave such families exposed.  This is plain to see and should be the focus of Republican efforts on health care reform, along the lines that I have discussed over the past six months (most recently here).