RSS Feed MenuLet’s quickly review the Democratic setbacks of the last week: infighting so harsh that the DNC is now taking out ads against some of its own congressmen; a devastating CBO report that shoots down the latest White House plan to save money; a press conference in which the president not only sounded completely unpersuasive and simplistic, but managed to step into a culture war with his musings on a police incident (in which no charges are laid).
The White House will fall short of its goal of the House and the Senate passing health-reform bills by the August recess. And at this point, it’s possible that even in the House – where Democrats have a huge majority – no bill will be passed.
But conservatives and Republicans need to hold back on the celebration. This isn’t 1994.
Writing over at the Enterprise blog, Norm Ornstein makes some solid observations:
Certainly, the odds of a sweeping health plan that turns our current system on its head are near zero. But they have always been near nil. The odds of a major change that does everything candidate Obama asked for during the campaign—and more, since he did not ask for mandated universal coverage—were also never very high, since the cost is simply too much for a debt-strapped, overloaded government to bear right now.
He continues:
But the odds remain high of a significant bill—one that does move towards universal insurance coverage, albeit more slowly; expands the concept of exchanges; finds a credible way, through an enhanced Medicare Commission, to change the cost structure and payment mechanism in that huge program; and also moves toward more emphasis on prevention and coordinated treatment of chronic diseases.
He goes on to note that we shouldn’t be distracted by the drama:
Don’t get too distracted by the sturm und drang of the legislative process—members storming out of negotiating sessions, declaring that it is all over, denouncing their negotiating counterparts, etc. That is typical when the stakes are so high and the time is so compressed. The question is whether Obama and his congressional leaders can find a formula to keep Blue Dogs and liberals inside the tent. He is far better equipped, with a much better political climate, to do so than was Bill Clinton.
What emerges will not be a full loaf, or even a half loaf. But it will be enough to enable the president and his allies to declare victory.
I suspect that Mr. Ornstein is right.
President Obama has faced a series of setbacks, but he still has many advantages. Start with the fact that votes count, and he has plenty of them in the House and the Senate. Don’t forget that many elements of reform – like expanding coverage – remain popular. His opposition – though enjoying a run of good luck – still lacks in the leadership department. And, as AP reports, the lobbyists are on side, big time.
Indeed, the makings of a Senate compromise may already be taking shape.
The debate in the fall will be different. The most controversial aspects of the White House proposals will be jettisoned – is it a coincidence that at last Wednesday’s press conference the President barely mentioned a public plan option, let alone defended the idea? – and we’ll be left with a leaner, meaner proposal.
The odds are the President and his party will find a way to declare victory. In other words, despite the recent setbacks, 2009 will still probably be the year of health reform.
This makes it all the more important for conservatives to think not just about today’s debate, but next year’s, and the year after that. Democrats did just this after 1994, regrouping to expand Medicaid and create SCHIP, as well as honing their arguments – including co-opting conservative rhetoric, as President Obama has done so brilliantly.
Losing this battle doesn’t mean conceding the war and a competitive health-care market –the only meaningful alternative to the rationing found in every other Western country – remains the road less travelled.
sinz54 // Jul 28, 2009 at 12:57 pm
The news that the Senate may be dropping the public option, and dropping the employer mandate, is good news indeed for us worried conservatives. The Senate plan is much less likely to ever evolve into a single-payer system, thank goodness!
And it seems to have had a salutary effect on our very own “ottovbs” poster. Namely, he seems to have fled.
The thought of having to admit to me he was wrong is so intolerable to him, that he’s probably going back to MyDD or one of those lefty blogs.
Bulldoglover100 // Jul 28, 2009 at 1:18 pm
Inless we are reading different CBO reports david then your inability to discern the written word is lacking.
The CBO report I read? Supports the White House and no amount of twisting is going to change it…unless your just looking to incite people? if so? Go away, we have enough nutters out there now lying and hurting the party.
Bulldoglover100 // Jul 28, 2009 at 1:29 pm
In case there is ANY regarding my above post, here is the url for the AP Story regarding the CBO report and the White House:
http://news.yahoo.com/s/nm/20090728/pl_nm/us_usa_healthcare
Spartacus // Jul 28, 2009 at 1:42 pm
Bulldoglover100 // Jul 28, 2009 at 1:29 pm
You should not expect Sinz to be persuaded by facts. Repeatedly, he’s been presented with actual evidence of private insurers competing alongside a public option and he’s been asked for evidence that a public option will drive private insurers out of business. He simply disappears. He’s an ideologue and facts are largely irrelevant to him.
sinz54 // Jul 28, 2009 at 2:39 pm
Spartacus: The evidence is all over the left-wing blogosphere and other left-wing media. They are openly saying that the public option is just the first step on a long, 10 or 15 year long, road to single-payer. I’m not saying that, they are the ones saying that.
This is very reminiscent of the way the City of New York took over the subway lines and bus lines, which used to be privately owned. They started running their own lines to take business away from the private lines, which eventually went out of business. Then the City of New York took them over, and we ended up with a government-run mass transit system.
Obama himself is on record as favoring a single-payer system.
http://www.youtube.com/watch?v=fpAyan1fXCE
So you’ll understand when I say I don’t trust him one little bit.
The academician at Berkeley who came up with the idea of a public option, openly ADMITS it’s the first step to single-payer.
http://www.youtube.com/watch?v=ryKGqF28d34
So you’ll understand when I call deception on the public option idea.
My advice: If you liberals want to sneak single-payer past the American public, don’t be so stupid as to openly discuss your plans on TmpCafe and HuffPo and DailyKOS and YouTube. You make very poor conspirators indeed.
And if you want the support of center-rightists like myself, I want you liberals to go ON THE RECORD that you have PERMANENTLY abandoned your dreams of single-payer. And I mean PERMANENTLY. And I want OBAMA to say so too–publicly.
Spartacus // Jul 28, 2009 at 3:59 pm
sinz54 // Jul 28, 2009 at 2:39 pm
Whether certain groups in this country favor a single payer system or even believe that a public option is the first step toward a single-payer system is completely irrelevant to whether or not a public option will drive private insurers out of the market. The facts that Bulldoglover presented you, which are consistent with all of the other facts you’ve been presented with, clearly show that a public option will not drive private insurers from the market. Nevertheless, you’ve ignored these facts and continue to falsely claim that private insurers will be driven from the market. So, again, I maintain that you, as an ideologue, are impervious to facts.
As for an on-the-record, permanent abandonment of aspirations for a single-payer system, I personally am not committed to a single-payer system. I am, however, committed to achieving (1) cost containment, (2) universal coverage, and (3) better outcomes for the healthcare services we consume, and a single-payer system and a public option are the only systems in the history of the world that have demonstrated their capability of achieving these goals on a large-scale sustainable way. So, I would never abandon any path with demonstrated success.
Why, in the face of emirical evidence regarding a public option or single-payer system, do you maintain an ideological adherence to a mythical system that has not shown itself capable of providing (1) cost containment, (2) universal coverage, and (3) better outcomes for the healthcare services we consume?
You have repeatedly failed to actually demonstrate that there is a way to achieve these goals without a public option or some other large-scale government intervention. Your oppostion to a public option or single-payer is not based on real-world facts. Instead, it’s ideological; you are ideologically opposed to this kind of government intervention despite the fact that it is the only demonstrated way of achieving the goals I’ve described.
We simply have different values. You value adherence to an ideology and I value the goals I described above.
ottovbvs // Jul 28, 2009 at 4:26 pm
sinz54 // Jul 28, 2009 at 12:57 pm
“The news that the Senate may be dropping the public option, and dropping the employer mandate, is good news indeed for us worried conservatives.”
………..Sinz since I’ve explained it several times I can only assume you don’t read anyone’s postings than your own………..There will be five bills coming from congress committees…….three from the house and two from the senate……..once out of their respective committees and voted on the floor the bills go into the process called conference at which the final bill is hammered out by the congressional leadership and white house……….just because there isn’t a public option in Baucus’s committee’s bill does not mean there will not be one in the final bill…….once in conference the leadership and white house have much more control over the process……..depending on the final bill looks like and reactions will determine whether the white house passes it on reconciliation or not…… I think Ornstein couldn’t be more wrong………the final bill will be 90% plus of the loaf………the issue will then be whether it has to be passed without GOP votes which I don’t think will be there for any sort of bill so the president might as well be hung for a sheep as a lamb and go for what will make Democrats very happy
ottovbvs // Jul 28, 2009 at 4:30 pm
Spartacus // Jul 28, 2009 at 3:59 pm
sinz54 // Jul 28, 2009 at 2:39 pm
………the supreme irony of all this is that Sinz is in a universal healthcare system in the state MA…….And has health problems the nature of which would have made it next to impossible to obtain insurance in another state and thus he would either be dead or bankrupt
Spartacus // Jul 28, 2009 at 4:47 pm
ottovbvs // Jul 28, 2009 at 4:30 pm
“the supreme irony of all this is that Sinz is in a universal healthcare system in the state MA”
He would probably relinquish his ideological opposition to a public plan or single-payer system if he lived in another state . . . so it may not be so ironic after all.
ottovbvs // Jul 28, 2009 at 4:57 pm
Spartacus // Jul 28, 2009 at 4:47 pm
…………These guys make me laugh……..I remember having a big argument in a restaurant in LV with an executive of a vendor of our sabout seven years ago and he was going nuts about the idea of universal healthcare, govt programs, etc etc he made DeMint look like a moderate……later in the conversation his family comes up and he mentions that his father has serious health problems, emphysema I think, then he says something like “but he gets fantastic care at the VA”………..so I pointed out this was pure socialized medicine and he deny’s it……..amazing …..they just don’t get it.
ottovbvs // Jul 28, 2009 at 5:20 pm
……….Reality check from Bloomberg:
” Soaring Costs
Health-insurance premiums for families have risen 119 percent since 1999, according to the Kaiser Family Foundation, a Menlo Park, California-based policy-research firm. Inflation has risen 28.5 percent over that period, according to the Labor Department.
Premium costs are projected to rise another 9 percent next year, an increase that 42 percent of employers plan to pass on to their workers, according to a report last month by PricewaterhouseCoopers. That’s likely to further squeeze millions of Americans who find themselves in high-deductible insurance plans as wages stagnate because of the recession.
Earnings per hour climbed by a 0.7 percent pace on average over the last three months, the Labor Department said earlier this month, the smallest gain since the agency began keeping records in 1964. Meanwhile, the share of insured workers with at least a $1,000 deductible has almost doubled since 2006 to 18 percent, according to Kaiser.
Wal-Mart Weighs In
For companies, the cost of health care “appears to be borne by the employees in the form of forgone wage increases and by consumers in the form of higher prices,” according to an October 2007 research paper by economists Victor Fuchs and John Shoven of Stanford University.
Some companies say the rising costs are also hurting them.
“Health reform could not be more critical,” Mike Duke, president of Wal-Mart Stores Inc., the nation’s largest private employer, said in a letter last month to Obama. “Reforming health care is necessary not just to improve the health of all Americans, but also to remove the burden that is crushing America’s businesses.”
For Louis Gerstner, former head of International Business Machines Corp., failure to curb medical-care costs will have a devastating, ripple effect.
‘Destructive Impact’
“If we don’t fix the spiraling cost of health care, it will have such a destructive impact on our economy that every sector of the economy will deteriorate,” Gerstner said in an interview last month with Bloomberg Television’s “Conversations with Judy Woodruff.”
Health-care spending will account for 20 percent of U.S. gross domestic product in 2018, or $1 in $5 spent, compared with 16 percent of GDP, $1 of $6 spent, in 2008.”
dragonlady // Jul 28, 2009 at 8:17 pm
“Spartacus: The facts that Bulldoglover presented you, which are consistent with all of the other facts you’ve been presented with, clearly show that a public option will not drive private insurers from the market.”
This defies macro and micro ECON 101. It’s called the “crowding out” effect. There is no level playing field in the market when gov’t is a provider since it does not play by market rules but instead dictates prices and mandates. It will shift costs and private insurers simply won’t be able to compete. And as far you citing that single payer systems/public options being the only way to extend universal coverage and contain costs, it may do the former but consider the measures for the latter. Everyone has to pay punitive tax rates. Costs are contained by rationing, especially for the most expensive forms of care. So even though we have a dysfunctional, patchwork health care system, we still have enough innovation and speedier access to care that we have higher forms of cancer surival than countries with single payer systems. If you want everyone to be covered and for gov’t to guarantee this, the health system will be mediocore. It will do okay at run of the mill ailments. But I’d rather not have the gov’t tell me what type of care I’m entitled too–that is my decision, not anyone else’s.
barker13 // Jul 28, 2009 at 9:06 pm
Re: Dragonlady // Jul 28, 2009 at 8:17 pm –
“There is no level playing field in the market when gov’t is a provider since it does not play by market rules but instead dictates prices and mandates. It will shift costs and private insurers simply won’t be able to compete.”
Exactly.
BILL
sinz54 // Jul 29, 2009 at 8:54 am
Spartacus sez: “He would probably relinquish his ideological opposition to a public plan or single-payer system if he lived in another state . . . so it may not be so ironic after all.”
First of all, I’m not in a public plan. I didn’t quality for it, because the Massachusetts plan is strictly means tested, which the ObamaCare plan is not.
I’m with Blue Cross/Blue Shield, which has been with my family now for FOUR generations. And we’re all very satisfied with it. We don’t want Blue Cross to go out of business, just because YOU LIBERALS think you know what’s best for US.
Secondly, this won’t be the first time I’ve faced supreme financial adversity in my life. I know what it means to go without. (During the Carter years, I was drowning financially, having to withdraw savings from my meager bank account just to pay the rent on my apartment, which had doubled in three years thanks to the Carter inflation. If Reagan hadn’t won the election and set the economy on track, I would have been broke in short order.)
When I’m deciding a national issue, what happens to me personally is far less important than what is best for the nation as a whole.
I thought you liberals believed that Americans had to “sacrifice” for a greater good. But now you try to defend ObamaCare on the basis of my individual self interest???
Make up your minds already!
sinz54 // Jul 29, 2009 at 8:55 am
Oops, I should have written: I didn’t QUALIFY for the Mass public plan, because it’s strictly means tested.
ottovbvs // Jul 29, 2009 at 10:27 am
sinz54 // Jul 29, 2009 at 8:54 am
……….Sinz you’re denying reality old boy……with your condition in most other states you’d have been in deep doo doo.
“(During the Carter years, I was drowning financially, having to withdraw savings from my meager bank account just to pay the rent on my apartment”
………OMG he had to draw on his savings to pay the rent………this was tragic
ottovbvs // Jul 29, 2009 at 10:33 am
sinz54 // Jul 29, 2009 at 8:54 am
“I thought you liberals believed that Americans had to “sacrifice” for a greater good. But now you try to defend ObamaCare on the basis of my individual self interest???”
……………Just because you’re blinded by ideology (although sitting in a state where your interests are protected very nicely thank you) that’s no reason why one should be thinking about the greater good of all those people who may be in a similar situation but without the same privileges
……………I’m not sure Sinz what I find more distasteful……..your racism which emerges whenever racial issues arise or your narcissism whenever healthcare is discussed
Spartacus // Jul 29, 2009 at 2:36 pm
dragonlady // Jul 28, 2009 at 8:17 pm wrote: “This defies macro and micro ECON 101. It’s called the “crowding out” effect. There is no level playing field in the market when gov’t is a provider since it does not play by market rules but instead dictates prices and mandates. ”
barker13 // Jul 28, 2009 at 9:06 pm wrote: “Exactly.”
Can either of you provide any real world examples of the crowding out and the absence of a level playing field that you wrote about? I’m willing to be persuaded if there is actual empirical evidence of the harms you describe, and if those harms are greater than the benefits that would be relinquished.
Spartacus // Jul 29, 2009 at 2:54 pm
sinz54 // Jul 29, 2009 at 8:54 am
I never said you were in a public plan. I said that if you weren’t in a state that made it possible for you to obtain the medical services you need, you would probably relinquish your ideological opposition to a national plan that would make it possible for you to remain alive notwithstanding the fact that it included a public plan to which you are ONLY ideologically opposed.
You also wrote: “When I’m deciding a national issue, what happens to me personally is far less important than what is best for the nation as a whole.”
I’m sure you really mean this, but neither of us will ever know if it is actually true because you didn’t have to face a choice between dying or entering a plan that you believe is not best for the nation as a whole. And, by the way, the RomneyCare that you think should be expanded to the entire nation would actually be far worse for the country because it does not pay for itself nor does it contain costs, two objectives that Obama has insisted upon.
Incidentally, I’ve noticed that when your positions are debunked you increase your use of the phrase “you liberals.” Is that your substitute for clear thought and persuasive argument?
You still haven’t refuted any of the substantive points in my post at Spartacus // Jul 28, 2009 at 3:59 pm (#6 above). I can only conclude that, once again, you have no rational response.
barker13 // Jul 29, 2009 at 4:16 pm
Re: Spartacus // Jul 29, 2009 at 2:36 pm –
“Can either of you provide any real world examples of the crowding out and the absence of a level playing field that you wrote about?”
Public vs. private K-12 education.
NASA.
Fannie/Freddie.
We’re talking “crowding out,” not completely eliminating, right?
Does “distorting” count towards “crowding out?”
As to a “level playing field,” we’re constantly talking about Medicare/Medicaid where payment scales are “negotiated” mainly by a combination of extortion and fiat. (*SHRUG*)
Just off the top of my head I can point you to how “our” Pharmaceutical companies are basically “forced” to sell drugs cheaper to foreigners (through foreign governments) as compared to direct sales to American consumers. (You’re aware of this… OBVIOUSLY you’re aware of this or else the whole “reimporting” concept wouldn’t make any economic sense.)
BILL
Spartacus // Jul 29, 2009 at 5:02 pm
barker13 // Jul 29, 2009 at 4:16 pm
Public vs. private K-12 education is a very good example. I even cited this in one of my earlier posts on a different NM thread. The first schools in this country were almost certainly private schools and the arguments for/against the creation of free public schools were probably quite similar to the arguments regarding a public option for healthcare. I do, however, believe the harm of fewer private schools was greatly outweighed by the benefit of guaranteed universal free public K-12 education. There’s lots to complain about public schools today, but if you look back over this country’s history and consider its rapid ascent and its economic dominance (alas, mostly historical), I think a large part of that success is attributable to high literacy rates and a large, fairly well-educated population.
No one can retrospectively prove that the same successes could not have been attained if we had relied solely on private education, but the fact that the opponents of the creation of public schools lost the debate suggests to me that their case was not more compelling than that of the advocates for public schools. That is, there was a reason why the people at that time collectively decided it was better to have public schools even if it meant many private schools would go out of business. I think there’s lots of wisdom in that experience. I think it’s better to achieve the goals I described above even if it results in some crowding out, but there are plenty of examples to show that crowding out is not inevitable.
I’m not as familiar with NASA and Fannie/Freddie so I can’t compare/contrast those. I can, however, point to state workers compensation insurance markets as well as the Medicare Advantage program of Medicare. There are public options for both, and in each circumstance private insurers are competing and thriving despite the presence of the public option. In fact, the Medicare Advantage program has been so profitable for insurers that many people in Congress are complaining about the large profits insurers make in the program and they’re seeking changes to the program.
As for the level playing field aspect of Medicare/Medicaid payments, it is true that, because of its large volume purchasing, Medicare is able to extract lower prices from doctors and other providers than is the case for most private insurers, but (1) that has not prevented insurers from earning large profits in the Medicare Advantage program, and (2) the government makes lots of large purchases of all kinds of goods/services and it always gets better pricing than you and I will ever see so I don’t see this as particularly problematic.
I’ve said many times that achieving the goals I’m after will necessarily result in lower profits for some stakeholders (this is a point Frum also made yesterday). It will also result in some limitations on the type/amount of care, although not necessarily the outcomes or quality of care. (The Gulwande article in the New Yorker proved that point.) I’m perfectly fine with those effects because I believe it is more valuable to contain rising healthcare costs and to achieve universal coverage.
Again, I’m not ideologically committed to a public option or a single-payer system, and I know those paths have their own problems, but I know of no way of achieving the goals that I described above without a public option, single-payer or some other kind of large-scale government intervention. There’s just no other demonstrated way of containing costs that I’m aware of.
Spartacus // Jul 29, 2009 at 5:04 pm
P.S. Just in case I wasn’t clear in my last post, I absolutely do agree that private education was crowded out by public schools.
ottovbvs // Jul 29, 2009 at 6:05 pm
Spartacus // Jul 29, 2009 at 5:04 pm
………He’s also wrong about Fannie and Freddie because basicaly he’s financially illiterate……apart from a brief period in 2006/2007 when congress was desperate to find someone to prop up the housing market Fannie/Freddie never had a majority of the mortgage securitization market……..Republicans never liked F/F because they were impinging on the private sectors activities in this market and that’s why they traditioanally tried to restrain them……this all changed when the housing market hit the skid in late 06
barker13 // Jul 29, 2009 at 9:31 pm
* Responding in reverse order…
Re: Spartacus // Jul 29, 2009 at 5:04 pm –
(*WINK*)
Re: Spartacus // Jul 29, 2009 at 5:02 pm –
Glad that I could answer your question to your satisfaction.
(*NOD*)
BILL