RSS Feed MenuAt the beginning of their 1972 series, after the fumbled opening games, Bobby Fischer settled down and played a game so brilliant and imaginative that, at the end, even Spassky stood up and applauded.
President Obama has pulled off a staggering political win. Yes, the final vote in the House was narrow and tight, but he managed to push through his health-reform plans. Frankly, his political victory is awesome. He adds to an impressive list: wrestling the nomination away from the former First Lady, winning a landslide in 2008, championing the stimulus package.
But governance is more than simply politics and political victories. It is also about policy and ideas.
Let’s be clear, for all the hot talk about repeal and sweeping Republican victories in the fall, much of this legislation is here to stay. Sunday was a game changer. As my colleague and editor David Frum has noted, it’s difficult to see how some of the immediate benefits of the bill – think about filling in Medicare’s donut hole – would be scrapped any time soon.
But at the end of the day, Obamacare may be strong medicine – totalling almost a trillion dollars in ten years, according to CBO scoring – but it’s almost surely an unhelpful remedy.
Republicans and conservatives need to regroup and rethink. Healthcare policy is important, with huge implications on deficit spending, corporate competitiveness, and economic vitality. And, let’s not forget: it affects real people.
American healthcare faces three fundamental challenges:
1) Moving past employer-based health insurance.
Rising out of wage and price controls during the Second World War, we are straddled with a healthcare financing arrangement that the majority of us have – but no one really likes. The system needs to be modernized. Back in 2008, Senator McCain floated an alternative, but his ideas were light, and the policy prescriptions were loose. Moving forward, we need to move past employer-based health insurance.
2) Getting better value for money.
OMB Director Peter Orszag is right – we don’t get value for our money. Health insurance premiums have more than doubled since 2000, yet not even the slickest lobbyist would suggest that healthcare is twice as good. New and more aren’t necessarily better and more effective. In other sectors of the economy, prices fall with time, and quality increases. Healthcare stands as an exception, and that needs to change.
3) Improving health (not just healthcare coverage).
After the Massachusetts reforms passed, the New England Healthcare Institute noted in a paper that Boston has “lots of health care, not enough health.” The authors dubbed it the Boston Paradox: despite massive expenditures on healthcare, people in the state were no healthier, plagued by preventable illnesses. The only problem with that observation is parochialism; nationally, Americans spend more than ever on healthcare, but suffer in large numbers from basic health woes, in part because of the obesity epidemic. Americans need to be healthier, not just covered.
Obamacare flirts with a partial solution to the first challenge (it won’t work), assumes a panel of experts can solve the second challenge (it can’t), and doesn’t do much about the third.Here’s my point. They’ve scored a brilliant political win, but the challenges of reforming American healthcare largely remain. Back during his address to the joint session of Congress in September, Mr. Obama noted that he wanted to be the last President to talk about health reform. He won’t be.
For my part, I’ll be writing more on these three challenges in the coming days. And weeks. And years.
ottovbvs // Mar 24, 2010 at 3:05 pm
LFC // Mar 24, 2010 at 2:46 pm
….I also just took a look at the Douhat piece….to his credit as conservative he calls it as it is……….Keep the goodies, don’t bother paying for them, and then scream about huge deficits……this is a party that is simply not fit to govern
Churl // Mar 24, 2010 at 3:46 pm
ottovbvs // Mar 24, 2010 at 9:40 am
“Apparently we can easily afford a couple of wars costing roughly $100 billion a year but additional healthcare expenditures or around $80 billion ”
It will be easier to stop a war than an ever-growing government entitlement program.
Only $80 billion, eh? Well, its pretty to think so
For reference, here are the end-of-year Federal budget surpluses / deficits for the last while:
Year Deficit
2000 2.36E+11
2001 1.28E+11
2002 -1.58E+11
2003 -3.78E+11
2004 -4.13E+11
2005 -3.18E+11
2006 -2.48E+11
2007 -1.61E+11
2008 -4.59E+11
2009 -1.41E+12
That -1.41E+12 figure for year end 2009 is 1.4 Trillion and represents an increase of 308% over year end 2008. This without any of the new health care costs.
$100 million per year won’t eat up much of $1.4 trillion.
Obama and Company now own a huge and rapidly growing deficit which, apparently, they will manage by spending even more money.
LFC // Mar 24, 2010 at 3:59 pm
Churl, let me get something straight. Obama entered office in late Jan. of FY2009, or 5 months in to the FY. The recession was already 14 months old. The recession cratered revenue. But “Obama and Company now own a huge and rapidly growing deficit.”
Way to shirk responsibility for the complete and total failure of your party’s economic policies.
ottovbvs // Mar 24, 2010 at 4:14 pm
……What some little twit at the mooney times turns one of the greatest speeches in history into…….these folks have lost it
“What House Minority Leader John A. Boehner has called the Battle of Capitol Hill is over. I expect that the Battle of the Electorate is about to begin. Upon this battle depends the survival of a nonsocialist America. Upon it depends our own American way of life and the long continuity of our institutions and our history. The whole fury and might of the media and the Democratic party must very soon be trained on the electorate.
If they can stand up to the coming propaganda, America may be free, and the life of the wider free world may move forward into broad, sunlit uplands.
But if the voters succumb to those seven months of blandishments and deceptions, then free America — including all that we have known and cared for — will sink into the abyss of a new Dark Age made more sinister, and perhaps more protracted, by the lights of perverted science.”
Rob_654 // Mar 24, 2010 at 4:18 pm
The long and short of this whole issue is that the Republicans could have done something between 2000 and 2006 when they had control of the Congress and White House and they did nothing (except to put in Government Funded – Unfunded Medicare Prescription Drug and then the GOP has the gall to every utter the words “Socialism” and “Unfunded” ?!?).
This whole thing would be moot if the Republicans had taken care of the Health Care issues when they had power – they don’t have power – someone else took steps – what’s the problem?
Lead – Follow – Or Get Out Of The Way
When Republicans regain power (as these things go back and forth naturally) – they will once again do nothing.
They will lack the guts to scrap the whole bill because they won’t want to live up to their words and make old folks mad – well – and millions of other folks.
But they probably will strip out the funding mechanisms…
And then they will tell us all why Deficits are not a big concern – yet again….
ottovbvs // Mar 24, 2010 at 4:21 pm
Churl // Mar 24, 2010 at 3:46 pm
……Churl a little bit of misrepresentation here….the “funded” 80 billion is for HCR which according to the CBO actually reduces the deficit modestly……you already agreed with me yesterday that at least 70% of these deficits are the consequence of Bush who had a $1.3 billion shortfall in his last year of office…..”the evil that men do lives after them” Julius Caesar……Remember?……Keep this up and I’m going to start thinking you’re as intellectually dishonest as the other loopy loops posting here.
TerryF98 // Mar 24, 2010 at 4:24 pm
Churl.
I respond with the immortal words of the great Dick Cheney.
DEFICITS DON’T MATTER
ottovbvs // Mar 24, 2010 at 4:30 pm
Churl // Mar 24, 2010 at 3:46 pm
……you might also want to look at the links in LFC 24…..Does someone who claims an acquaintance with Joseph Korzenowski really find these jerks credible?
WillyP // Mar 24, 2010 at 4:35 pm
Here comes the end:
“…no profit-seeking enterprise, no matter how large, is liable to become bureaucratic provided the hands of its management are not tied by government interference. The trend toward bureaucratic rigidity is not inherent in the evolution of business. It is an outcome of government meddling with business.” [Bureaucracy (New Haven: Yale University Press, 1944)]
The bill put in place a perpetual motion machine of American decline. Stupid liberals. You’re just that – stupid.
ottovbvs // Mar 24, 2010 at 4:46 pm
WillyP // Mar 24, 2010 at 4:35 pm
“The bill put in place a perpetual motion machine of American decline. Stupid liberals. You’re just that – stupid.”
…..Well there’s a current piece of work….followed up with some profound analysis from our resident intellectual……Time to shut down the Pentagon then?…….one wonders why the socialized medicine practised in every other developed country in the world costs half what our super efficient private system does?…..what could be the explanation…..but don’t let me interrupt your intellectual musings with reality willy……carry on ……we can’t wait for more…..it’s so enlightening
WillyP // Mar 24, 2010 at 4:50 pm
Otto, this is your world now. We’re just living in it! Deficit spending to “cure” recessions, socialized medicine, “soft power” in foreign relations… all working out so well! I wish I were just that smart that I could talk my way out of omnipresent scarcity and dangerous international threats!
Obama truly is the savior. Who needs economics or philosophy or common sense? They’re all so outdated! Obama/Otto 2012.
Independent // Mar 24, 2010 at 4:51 pm
ottoBS uses the 4 most misleading words in the English language:
“… according to the CBO…. ”
Is that the CBO who’s integrity was purchased for a cup of coffee, my farLeft FrumBot boy?
Independent // Mar 24, 2010 at 4:53 pm
WillyP notes: “Obama truly is the savior. Who needs economics or philosophy or common sense? They’re all so outdated! Obama/Otto 2012.”
OK, skip the Exit Ramp off the Highway of Desperation… we’re now in the Outer Limits.
Just kidding, WillyP –great sarcasm.
kevin47 // Mar 24, 2010 at 4:55 pm
“This whole thing would be moot if the Republicans had taken care of the Health Care issues when they had power – they don’t have power – someone else took steps – what’s the problem?”
They enacted prescription drug coverage, which you dismiss out of hand before insinuating otherwise. This was a more pressing problem than health insurance.
They had a four year window within which to operate, and did not have a veto-proof majority. Bush proposed a relatively modest tweak to Social Security, and was rebuffed. SS remains a bigger mess than health care in this country, though that will change some time after 2014.
The conservative remedy for health care is difficult to defend (Barack Obama amply demonstrated its susceptibility to demagoguery). The Democratic plan is, essentially, a mish-mash of goodies designed to obscure a government take over of the system. Goodies are easy to defend, so this is an apples and oranges comparison. Simply because Republicans could not enact sensible health care reform does not mean I should be at all excited about this dimwitted excuse for same.
ottovbvs // Mar 24, 2010 at 5:00 pm
36 WillyP // Mar 24, 2010 at 4:50 pm
…..Correction…… we’re living in a world that was created over the period 2001-2008……As I point out above in 31 at least 70% of the deficit problems can be ascribed to the activities of the late and unlamented Bush admin…..but you suffer from that most common complaint of Republicans……Amnesia
ottovbvs // Mar 24, 2010 at 5:05 pm
36 WillyP // Mar 24, 2010 at 4:50 pm
And in your quest for at commonsense Willy you might care to read this:
http://www.frumforum.com/the-gop-embraces-entitlements#comments
WillyP // Mar 24, 2010 at 5:06 pm
otto, has that deficit number gone up or down since you’ve been in control?
you’ve answered that already: it was 30% less than it was now. which means you have added to the deficit. good going!
sinz54 // Mar 24, 2010 at 5:10 pm
ottovbs: one wonders why the socialized medicine practised in every other developed country in the world costs half what our super efficient private system does?
I’ve explained that to you about three times already,
but you have a tendency to ignore inconvenient truths.
I don’t want to repeat myself.
Nothing good comes from trying to teach a committed ideologue, whether it’s you on the left or Independent on the right.
Go read my other posts again and then get back to me.
WillyP // Mar 24, 2010 at 5:13 pm
lest you think this is sarcasm, you really should consider it “good going.” we are, after all, attempting to jumpstart the economy with deficit spending. so again, good going!
man, i just wish i was as foresighted as my all seeing, all knowing liberal friends. it may have taken 100 years, but i, for one, am happy that you have finally rammed socialist healthcare down the throats of 300 million prosperous, peaceful, generous people.
the stupid country bumpkins and knuckle-dragging conservatives were so near sighted… it’s the government that provides milk and honey, not hard work! how could we all have been so damn stupid! now let’s just sell out israel and let hamas set up its tents, and we can put an end to all wars, too.
ah, the life and world of the liberal!
sinz54 // Mar 24, 2010 at 5:16 pm
Rob_654: the Republicans could have done something between 2000 and 2006 when they had control of the Congress and White House and they did nothing
In the middle of a global war???
We were fighting desperate wars in two separate countries. The cost was proving far higher than originally anticipated. It was dumb enough for Bush to have enacted Medicare Part D.
As a conservative, I say that if the War on Terror was as important as Bush said it was, then it was important enough to postpone any more domestic projects until the war was won. Just as FDR shelved the New Deal after Pearl Harbor. That’s part of the sacrifice you have to make on the home front to support the war effort.
Now prior to 11 September 2001, Bush had very little political capital. Perhaps you’ve forgotten that Bush came into office on a Supreme Court ruling that broke an endless series of recounts of the very close 2000 election. Millions of Democrats were howling that Bush got the Supreme Court to steal the election.
If there was a proper time to have addressed this, it was in the 1990s when Gingrich was House Speaker and Clinton was a moderate President. As it turned out, the GOP had its chance, when the bipartisan “Patient’s Bill of Rights” was co-sponsored by McCain and the Dems. It was a modest step forward.
Unfortunately, Republican conservatives shot it down, and it never came up for a floor vote. That was the end of Republican efforts to reform health care. From then on, the only time Republicans would talk about the issue was when they were opposing some Dem initiative.
Rob_654 // Mar 24, 2010 at 5:25 pm
sinz54
We were fighting desperate wars in two separate countries.
Desperate? Hardly. Clearly not “desperate” enough to institute a draft – or raise money to actually pay for the wars…
The cost was proving far higher than originally anticipated.
Yeah – where to begin here – the Right Wing lied to us telling us that we would be out of there in 6 months and the wars would be paid for by oil revenue – and these are the same folks who told us there would be “Death Panels” if Health Care Reform passed – does anyone see any Death Panels starting up?
Sorry – sinz54 – nice try.
The Republicans had plenty of time to take care of other big things from 2000-2006 with two wars going on – they could have started the ball rolling on health care reform if they wanted to – but they simply didn’t want to…
Churl // Mar 24, 2010 at 5:27 pm
LFC, ottovbvs,
As I keep saying, Bush is gone. The deficit that his administration left behind is what it is. The annual deficit more than tripled in Obama’s first year. Blame all of that on Bush if you will, but there is a whacking great deficit remaining adding to the national debt at a growing rate of interest. Spending is going to go up (Social Security and Medicare as the population ages, added costs of Obamacare as the reputed millions of uninsured people suddenly get full coverage….)
The deficit will continue to rise unless serious new taxes are levied. These taxes will be paid by the rich, I’m sure somebody will point out, and I agree. The problem will be the unhappiness of the millions of taxpayers who will suddenly discover that they are, in fact, rich by Obamian standards.
So, I leave it to the genius of Obama, Emanuel, Axelrod, Pelosi, Reid, Krugman et al. and the rest of the Great Liberal Minds to figure out how to stop the coming fiscal and political train wreck.
Mark Rosenthal // Mar 24, 2010 at 5:30 pm
The current health care reform will do a lot, but Gratzer has a point that employer based insurance is not necessarily the way.
And if you want more bang for your buck, then the Pharma industry has to play with and not just make its billions and billions in profits.
Further, he is right: improving health, which means pre-care, is the way. It reduces costs and saves individuals a hell of a lot of sorrow. Obama has already took a step in this direction.
I will remind you that Germany has single payer, based on the so-called “Generation contract”. Their system was first created in the 1880’s, it is the oldest comprehensive Health Care System in the world, and it works. And Germany is now a fully functional Republic, based on representative democracy, just like the USA.
WillyP // Mar 24, 2010 at 5:34 pm
Mark,
Comprehensive, except when you need treatment.
Then it’s wait wait wait wait wait… just like the USSR, Canada, the UK, etc.
Socialism results in shortages. You can spread shortage and achieve “shortage equality,” just like you can spread unemployment by mandating a 4 day work week and reducing wages…
The question is, obviously, why?
Churl // Mar 24, 2010 at 5:42 pm
Mark Rosenthal has an excellent point: the German medical system is a pretty good one (I can attest to this – I just got back from working there for 14 years). The system includes competing private insurance firms with free choice of providers and facilities. Employee / employer / government have a fair stake in the system, the standard of care is very good, and there were only a few threatened provider strike threats because of low compensation.
The problem is, the system we are getting is nothing at all like the Germans have in place. I would support a German style system in one of any of my remaining heartbeats.
Unfortunately, none of the geniuses who assembled Obama’s monstrosity seemed interested in incorporating in their system any “best of breed” features from other systems. The mess we have seems to have been drafted by ignorant activists and whichever lobbyists could get the ear of legislators.
In an automotive analogy, the German system is an Audi A4 and we are getting an ox-propelled, cement-tired Edsel.
Hence my dissatisfaction.