RSS Feed MenuAs President Obama’s health care reform founders, he and Congressional Democrats are attempting to shift blame to the ‘do-nothing Republicans.’
Democrats need to be reminded that in truth they have no one to blame but themselves for the collapse of their health care agenda.
President-elect Obama promoted a “grand bargain” that would ask all Americans to compromise in the interest of tax reform, health care reform, and entitlement reform.
Everyone’s going to have to give. Everyone’s going to have to have some skin in the game.
Americans were likely willing to give quite a bit for expanded coverage, greater portability, lower costs, and increased transparency. But for all the Progressive talk of ‘shared sacrifice,’ Obamacare promises to secure the interests of the politically connected – by industrial heft or ideological affinity – while taxpaying suburbanites (including many Obama voters) get caught in the crossfire.
Stakeholder industries, threatened with becoming pay-fors, have cut their own bargains.
The pharmaceutical industry has its deal, kicking in $80 billion (a steal compared to the $130 billion Congress hoped to get) to fill the “doughnut hole” in the hope that the 50% branded-drug discount will keep more seniors from switching to cheaper generics.
The American Medical Association has its deal, apparently accepting the public plan it previously rejected and an $18,900 loss per-physician, in return for repeal of the dreaded Sustainable Growth Rate Formula.
Health insurers will swallow additional government regulations in return for the promise of insuring those forced by the individual mandate to purchase coverage.
Even Wal-Mart, the bogey of the unions for its reluctance to provide rich health benefits to its employees, now supports Obamacare, trusting that the legislation will help it to undercut the competition.
And those are just the stakeholders supporting Obamacare out of economic self-interest.
Next up are the standard-issue liberal groups that need to get theirs.
The abortion lobby will benefit through requirements that private insurers and any government plan provide for elective abortions.
Trial lawyers will be protected from medical malpractice reform.
And through pork in the name of wellness, the politicians responsible for Obamacare are attempting to shore up their own reelection.
The business community and liberal interest groups get quite a bit out of this deal. But what about those who are supposedly the beneficiaries of Obamacare? As it turns out, these ordinary middle class citizens will be doing most of the giving.
Channeling President Kennedy, Obamacare asks them to pay all the price and bear every burden.
Elderly citizens face rationed care. In the event of unfunded Medicaid liabilities state tax bills will increase. Republican Finance Committee staff contends that the 5.4% “surtax” will be paid for in large measure by small businesses, the same small businesses that will be hit by an 8% tax if they cannot rewrite the laws of economics and provide health care to their employees without lowering wages (see p. 147, line 14 of the Tri-Committee bill). For the millions ineligible for Medicaid or insurance subsidies, non-compliance with the individual mandate will lead to a tax penalty.
And in Obamacare’s coup de grace, 83 million individuals will lose their private health coverage.
Could this toxic formula have been avoided? Could the middle class have been asked to bear its burden without the accelerated inflation in health care costs and loss of choice associated with Obamacare?
The answer is yes. The President could have demanded that health care benefits be treated as ordinary income. A majority on the Senate Finance Committee would likely support some taxation of benefits as a means of financing reform, while bending the growth curve. Sure, had Obama demanded inclusion of this bipartisan policy, he might have faced some uncomfortable questions about his campaign’s mischaracterization of John McCain’s “Health Insurance Tax.” But some minor embarrassment is not what holds the President back from promoting changes to the tax treatment of health care. The real challenge for Obama is standing up to the unions (and their liberal patrons in the House and Senate), who are among the chief beneficiaries of the inflationary exclusion of employer-provided health care from income.
As he earlier demonstrated with the auto bailouts, crossing the unions – asking them to share in the sacrifices necessary for health care reform – is apparently a bridge too far for the President.
If Obama’s hopes for a “Grand Bargain” collapse less than 9 months into his presidency, he and Congressional Democrats will not be able to pin blame on lack of industry or interest-group support. Rather, it is their own lack of will – their failure to demand real sacrifice from political allies like the unions – that will be the true source of Obamacare’s undoing.
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ottovbvs // Jul 23, 2009 at 7:11 am
Chekote // Jul 22, 2009 at 10:26 pm
“Otto
The regular checkups are not that expensive.”
………..You are ignoring a host of non catastrophic tests and conditions that are extremely expensive…..take prostate biopsies for example
Chekote // Jul 23, 2009 at 9:13 am
Otto
I SAID that insurance will be only to cover catastrophic events. What I meant is that for preventitive care, it is cheaper to deal directly with the doctor than to go through insurance. I pay about $400/month. I have a $3,000/year deductible. No copays except for ER. So I am paying basically out of pocket for routine/preventive care and pay premiums. That is what happening to most people. No wonder there is a lot of frustration out there.
barker13 // Jul 23, 2009 at 9:21 am
Re: Liv&win // Jul 22, 2009 at 5:19 pm –
“We all want reasonable access to quality healthcare at an affordable price.”
True. But as we’re both well aware, price is a function of cost-plus.
“Further, we can all agree, or we can after some rangling, that health care is currently not affordable.”
And yet… we DO afford it. (*SHRUG*)
I afford it. I don’t like to pay for it, I believe I’m overpaying, but I afford it.
Bear with me, L&W, I’m not trying to pick a fight with you – just the opposite! Here we are, two conservatives… “rangling.” (*GRIN*)
Our health insurance (mine and my wife’s) cost us roughly the equivalent of both of our monthly car payments plus our monthly food shopping. Is it pleasant for us to pay so much? No. Do we want to pay so much? No. But we afford it… just as we afford our car payments and groceries, etc.
HERE’S A DIFFERENCE THOUGH: As with our other expenses, we pay for our health insurance out of pocket – out of our earnings – financial compensation for work performed. Millions and millions of our fellow Americans have large chunks of their health insurance bills paid for by their employers. This non-direct-financial compensation is NOT taxed as income to the employee. The employer gets to write it off as a “business expense.” Government “makes up” the unrealized taxes in those two circumstances by increasing taxes elsewhere to make up for the “shortfall.” To add insult to injury, my wife and I get hit with both receiving no tax subsidy while paying for others’ tax subidies.
*** Ahh… but I digress… point is, healthcare is “affordable” – even to folks like us who don’t get the subsidy union types and corporate types get.
Are lawyers “affordable?” Legal services… are they “affordable?” Say you’re in the wrong place at the wrong time and everything goes wrong, events conspire in such a way as to enmesh you or a family member in the legal system. Imagine you have to hire a top flight criminal attorney who will end up billing you for many dozens of hours of work – perhaps more – anyone think that will be “affordable?”
L&W. Again… I’m not trying to play word games or muddy the waters, I’m simply trying to make a point. Society affords the poor (“if you cannot afford an attorney one will be provided for you”) legal services, but you have to be really poor. What some seem to believe is that when it comes to medical care we should just assume that the entire middle class is “unable to afford” insurance or ultimately care so that (the false logic implies) society must therefore step in to “provide” – to provide not just for the poor, but for the middle class.
My point? There’s a difference between “expensive” and “unaffordable.” My other point, the costs are the costs and there are only so many ways of lowering them. (*SHRUG*) “The devil is in the detail…” “the cure is often worse than the disease…” Pick whatever cliche you choose, but beware… there’s a reason these phrases BECAME cliches. (*SHRUG*)
“We should also be able to recognize that health care is not health insurance. While they are interrelated, they are not the same. Health care is a service or supply provided by a health care practioner. Health insurance is a method of financing health care. It is an important distinction.”
EXACTLY…!!! Right on the mark! Dead on!
“Health insurance can be reformed tomorrow.”
By King Bill or Emperor Liv&Win. (*GRIN*) By Obama and Congress… not so fast. (Protect us from evil and deliver us from our tresspasses…) (*CHUCKLE*)
“No pre-exisiting conditions…”
…means we’re no longer talking about “insurance.” We’re now talking entitlement. (*SHRUG*)
Hey… I’m not against talking entitlement… I’m just saying let’s not confuse the two concepts. Let’s not pretend that if my auto insurance allowed me to keep the most bare boned of bare bones policies and ADD full collision with ALL the bells and whistles only AFTER an accident that my insurance company would be able to stay in business very long.
(Yes, L&W, I realize that YOU know all this… I’m just laying it out for those who believe in the “free lunch” concept.) (*SMILE*)
“…no denial of coverage…”
Again. Fine as an entitlement to CARE, but let’s not fool ourselves… if the “coverage” we’re talking about is CARE which is GUARANTEED to cost far more than any premiums collected then we’re simply NOT talking about “insurance;” we’re talking about entitlement spending.
“…regulated costs and spending targets…”
Which brings us right back to “the devil is in the details.” (*SHRUG*)
“Health Care Reform, on the other hand is a hugely complicated matter.”
Yep! Which is what we’re trying to get across to the folks who what “change now” without necessarily thinking ahead to “what sort of change” we’ll get. (*NOD*)
“If one were ambitious, you would realize that health care is not just doctors and hospitals, but oral and mental health, too.”
Yep. There have been years when BESIDES paying $13K-$14K a year (out of pocket) for straight medical health insurance we were also paying THOUSANDS OF DOLLARS OUT OF POCKET for dental care as needed.
“You really couldn’t do a complete job of health care reform without tackling Workers Compensation.”
(*THUMBS UP*) Good point! (I didn’t even consider that aspect!)
“Pretty quick you would also need to start planning to avoid huge job losses. there are more insurance agents than auto workers, yet your plan might put the agents out of business or worse, reduce their incomes by a substantial amount. Insurance companies employee hundreds of thousands who could also be unemployed if your plan wasn’t carefully crafted.”
(*SHRUG*) L&W is right.
Outstanding post, L&W; simply outstanding!
BILL
barker13 // Jul 23, 2009 at 9:30 am
Re: Chekote // Jul 22, 2009 at 6:49 pm –
“Nothing in Obama’s bill reduces costs. Actually, it raises costs. Overnight 47 millions will be added with no overnight increase in doctors, nurses facilities.”
(*SHRUG*) (*NOD*)
Of course.
(*THUMBS UP*)
BILL
barker13 // Jul 23, 2009 at 9:36 am
Sinz54 // Jul 22, 2009 at 7:08 pm –
Sinz. (*SIGH*) What you’re saying is that you gamed the system and won.
Sinz. (*SIGH*) What you like is that you gambled, lost, and now “the house” has to cover your “losses” plus.
I mean I understand the human nature of your reaction… but do you understand MY reaction…??? Do you understand why I’d like to smack the $hit out of you and rumage through your belongings taking what I want (sharing with L&W, Mid, Brutus, Franco, and Mike of course) in order to make up just a little for YOUR “theft” of MY taxes?
BILL
sinz54 // Jul 23, 2009 at 10:00 am
barker13 sez: “I mean I understand the human nature of your reaction… but do you understand MY reaction…??? Do you understand why I’d like to smack the $hit out of you”
Perfectly.
And it illustrates an important point, which I’ve made before:
A completely free market in health care (which is what you prefer) inexorably leads to Social Darwinism: The poor and the less fortunate (those who fall ill through no fault of their own, like me) are left to die. Unless, of course, they can go begging to private charities and get some handouts.
The RomneyCare experience shows that you can design a health care system with substantial private sector involvement. It doesn’t have to devolve into single-payer.
But if you want your society to be humane, and take care of those who fall sick through no fault of their own, the free market can’t deal with that. Because the free market assumes that
a) transactions are the result of conscious rational choice; and
b) the supply-demand curve intersescts at a price point that won’t bankrupt the society.
Neither of those is true.
I didn’t consciously choose to get kidney failure.
And because everybody thinks THEIR life is worth a lot, the demand for health care will always max out.
sinz54 // Jul 23, 2009 at 10:07 am
barker13: One more thing.
I made the conscious, rational choice, which is exactly what any participant in a free market should do:
I took a high-deductible plan, recommended for the healthy; and I did everything I could to stay healthy: Normal weight, high fiber, low fat diet, normal cholesterol levels, exercised regularly.
It didn’t work. I got sick anyway.
And the reaction from free market purists is: “Too bad! You lost at the game of life! Not my problem!”
Which is exactly what Ebenezer Scrooge said in the 19th century.
We economic conservatives will never win elections again if we sound like Ebenezer Scrooge.
I remember what Ronald Reagan promised in 1980: “We’ll move ahead, but we won’t leave anyone behind.”
When I joined the conservative movement back then, it didn’t talk like Ebenezer Scrooge. That old model had been jettisoned. Now, in the bitterness after the 2006 and 2o08 elections, it’s back.
barker13 // Jul 23, 2009 at 10:27 am
Re: Sinz54 // Jul 22, 2009 at 7:12 pm –
Funny thing, Sinz… I just received an issue of “National Journal” yesterday; the cover story is “Lessons of Massachusetts.”
Allow me to provide a few excerpts…
“…in MA, healthcare costs are about 25% higher than the U.S. average…”
Oh, wait… there’s a “boxed” statement! Here…
“MA has the lowest uninsured rate in the nation. Per capita costs for personal health care were higher there than in any other state in 2004, the most recent year for which data are available.”
Hmm… more numbers…
Government spending on Commonwealth Care was six hundred million in 2007. In 2008 it went to $1.1 billion. 2009…? Budgeted for $1.3 billion.
So… six hundred million to $1.3 billion in two years… great… just great.
More quotes? Sure!
“The price of the four insurance plans offered under Commonwealth Care rose 9.4% in 2009…”
More? Why not!
“…more than half of the residents newly enrolled in health coverage in MA are in free or heavily subsidized plans.”
(Nah… no “trend towards socialism” here, right…?) (*SNORT*) (Oh… sorry… we don’t use the “S” word. It’s… er… “social justice.”) (*SMIRK*)
Oh… and get this…
There’s a chart marked “Boston Medical Center Costs and Payments from Medicaid and Commonwealth Care.” For the year 2009: Costs – $600,000; Payments – $300,000.
(Hmm… I think next time I go food shopping if the bill comes to $60 I’ll just hand the cashier $30 and say “close enough.”) (*SMIRK*)
Hey… Sinz… “In the state budget for fiscal 2010, the Legislature voted to eliminate health care coverage for 30,000 LEGAL immigrants. Lawmakers are considering halting dental care for people on Medicaid.”
(But, hey, Sinz… as long as YOU are getting YOUR “fair share” of the Peoples’ tax subsidies all is well in the World of Sinz.) (*SHRUG*)
Oh… oh… oh…! Read this…
“…one in five adults in 2008 was turned away from a doctor’s office or clinic because it was not accepting new patients or their type of insurance. The problem was worse for low-income people: 29% reported problems.”
Hey… did you know that in Massachusetts “two thirds of (MA Hospital Assoc.) member hospitals say their community has two few primary care clinicians. The trouble has become severe, according to the MA Medical society. A 2008 report found 12 of the 18 physician supported specialties had critical or severe shortages?”
(Perhaps government will simply “mandate” the creation of more doctors… say just grab a few thousand folks from the stands at Fenway during the next home game and “pronounce” them “By the Grace of Government… thou art physicians!”)
Hey… Sinz… in MA…
“The percentage of family-medicine physicians who no longer accept new patients rose from 25% in 2006 to 35% in 2008.”
Furthermore…
“Existing patients had to wait an average of 18 days for a routine doctor’s appointment or regular office visit in 2008, up from 15 days a year earlier.”
(Oh, what a year can do…) (*SMIRK*)
Anyway, Sinz… just a timely bit of added perspective.
BILL
barker13 // Jul 23, 2009 at 10:34 am
Re: Chekote // Jul 22, 2009 at 7:47 pm –
“Eventually, I think doctors and patients will deal directly and cut out insurance except for catastrophic coverage.”
From your keyboard to God’s (Obama’s?) eyes and ears! That’s what I keep on calling for… CATASTROPHIC COVERAGE!
Re: Chekote // Jul 23, 2009 at 9:13 am –
“I pay about $400/month. I have a $3,000/year deductible. No copays except for ER. So I am paying basically out of pocket for routine/preventive care and pay premiums. That is what happening to most people. No wonder there is a lot of frustration out there.”
We can’t get such a plan in New York State. (*SHRUG*)
See, this is the problem – it’s not that there’s not ENOUGH government “regulation” and “oversight,” it’s that there’s too much! 50 states… all with their own rules and regulation… no ability for a consumer such as myself to “shop around” out of state and as we all realize, “shopping around” within a state is a joke because each insurance company is straightjacketed by state regs to basically offer only slight variations on the same basic plans.
BILL
barker13 // Jul 23, 2009 at 10:43 am
Re: Sinz54 // Jul 23, 2009 at 10:00 am –
“The poor and the less fortunate (those who fall ill through no fault of their own, like me)…”
Sinz. Seriously. Doesn’t being full of shit leave a bad taste in your mouth?
YOU WEREN’T POOR!!!
YOU WERE A GAMBLER!!!
YOU GAMED THE SYSTEM!!!
As to being “unfortunate…”
Yeah. I feel your pain and sympathize that you have kidney disease. But in terms of the health INSURANCE debate we’re having… the health CARE debate we’re engaging in… YOU WERE EXTREMELY FORTUNATE…!!!
YOU WERE ABLE TO GAME THE SYSTEM!
YOU WERE ABLE TO AVOID PAYING “YOUR FAIR SHARE” IN TERMS OF PREMIUMS while BEING ALLOWED TO SHARE EQUALLY IN THE BENEFITS OF THOSE WHO SUBSIDIZED THEIR OWN PLANS PLUS SUBSIDIZED YOUR GREED!!!
My God… sorry for all the “shouting”… but this is ridiculous. You’re a frigg’n leech, Sinz.
“But if you want your society to be humane…”
Sinz. You confuse “humane” with a society which allows itself to be EXPLOITED by people like you. You confuse “humane” for you gaming the system and the rest of us paying the freight.
Now I don’t know if anyone else will have the balls to call it like it is… but your self-serving actual personal history in contrast with your high minded talk makes me gag.
BILL
barker13 // Jul 23, 2009 at 10:45 am
Re: Sinz54 // Jul 23, 2009 at 10:07 am –
Sinz. You’re delusional. I just don’t know what else to tell you.
(*SHRUG*)
BILL
Washington Planner » Thursday Required Reading // Jul 23, 2009 at 11:04 am
[...] *except for the biggest supporters of health care reform. [...]
sinz54 // Jul 23, 2009 at 12:46 pm
barker13: We’re all “gamblers,” at the Game of Life.
Many of us try our best to live a long, healthy life, and we try our best to do the same for our children. But stuff happens. It could happen to you someday.
And I did *NOT* “game the system,” as you call it.
In Massachusetts, insurance companies, who own the casino and try to maximize the house take, agreed to accept guaranteed issue–accept anyone regardless of pre-existing condition. They did that in exchange for the Commonwealth mandating universal coverage. With millions more young healthy policyholders, the insurance companies come out ahead despite policyholders like me.
That is the “system”: In Massachusetts, all the healthy people pay the claims of all the sick people. And there’s no revolt against this, because most folks in Massachusetts recognize that stuff happens, and “there but for the grace of God go I.” That’s a sensible ethical policy for any society. Not “To hell with losers.”
I made a mistake by purchasing a high-deductible plan. Should I be sentenced to death by kidney failure for that mistake?
barker13 // Jul 23, 2009 at 2:30 pm
Re: Sinz54 // Jul 23, 2009 at 12:46 pm –
“barker13: We’re all “gamblers,” at the Game of Life.”
Sinz… (*SNORT*)
‘Nuf said.
“And I did *NOT* “game the system,” as you call it.”
(*ROLLING MY EYES*)
Keep telling yourself that.
“I made a mistake by purchasing a high-deductible plan. Should I be sentenced to death by kidney failure for that mistake?”
No… you should be sentenced to death for that “game of life” crack.
(*SNORT*)
BILL
Spartacus // Jul 23, 2009 at 4:31 pm
barker13 // Jul 23, 2009 at 2:30 pm
Down, boy, down!!! Who let the barking dogs out this morning?
barker13 // Jul 23, 2009 at 11:30 pm
Re: Spartacus // Jul 23, 2009 at 4:31 pm ==
http://www.youtube.com/watch?v=He82NBjJqf8
(*WINK*)
BILL
Spartacus // Jul 24, 2009 at 12:09 am
barker13 // Jul 23, 2009 at 11:30 pm
Very funny. I would not have expected that from a conservative. Although, you’re more of a libertarian so that makes more sense.