RSS Feed MenuIn opposing the Democratic urge to corral Americans into a government-operated healthcare monopoly, let’s not overlook: The administration is right about the wastefulness of the present system and the need for changes in the status quo. From Friday’s Wall Street Journal:
The battle heated up in June, when Mr. Orszag visited Capitol Hill to discuss health care with a small group of House Democrats. The meeting started well, with one lawmaker after another echoing his message that spending controls were critical to any health-care overhaul, according to two administration officials.
Then one member said her top priority was winning higher payments for oxygen suppliers, the officials say. Mr. Orszag was taken aback. Officials had been trying for years to cut payments to suppliers of oxygen and other medical equipment, which critics say are inflated. Yet when a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan. They are still fighting to block changes.
Healthcare is a game with many, many players. The present rules favor some over others.
Among the losers:
- Taxpayers, who must pay the rapidly rising costs of Medicare and Medicaid.
- Small business owners, increasingly priced out of the health insurance market.
- The basically healthy (especially the basically healthy with children), who must pay astounding prices via lower wages and higher out-of-pocket costs for routine care that is not very much better than what Europeans get for half the price.
The winners may not appreciate the term, because after all many of them are in what would otherwise be considered unfortunate circumstances. Still, from an economic point of view, they receive more consideration under the present system than do the losers. Some signal examples:
- The acutely and extremely ill, especially the very young and the very old.
- Retirees covered by Medicare
- Providers of equipment and services
- Insurers and health maintenance organizations.
The problem for Republicans is that the 7 groups I’ve mentioned are all groups for whom Republicans feel special solicitude, either because they form an important constituency within the GOP, or because they give money, or because (as with the very ill) the party rallies to them out of pro-life conviction. Yet we cannot serve all 7 – there have to be choices made. The Obama administration is at least recognizing the inescapability of choice. And face it: many of their choices are the ones that need to be made, especially choices aimed at relieving small businesses of the crushing cost of healthcare. The health plan being drafted in the House currently offers small businesses the option of shedding their healthcare plans altogether in exchange for a tax equal to 8% of payroll. Many businesses will regard that as a very attractive proposition. And even many of those businesses that do not currently offer health coverage may be glad to know that they have relieved their employees of this concern for as little as 8% – buying into a plan would probably cost more. Republicans don’t like this option because the plan on offer is a government-run plan. But we ought to take seriously the need to provide small business some better answer than the current stark alternative of costly and remorselessly rising health insurance – or else no employee coverage at all.
gblittle // Jul 27, 2009 at 12:17 pm
Sorry but I fail to see one thing that the current Administration or Congress “gets” about healthcare. The only thing they do get is what “sound bite” they wish to shove at the American public that attempts to make us feel good that someone is in charge. Observation by our leaders is not the same at getting it “right on”. For years we have heard that Medicare and Medicaid are problems and would only get worse. The VA Healthcare system, about as close as one can get to government run healthcare, too has been tagged as a failure. What has been done so far? Observations of the problem versus fixing the problem. If the government can’t run these programs effectively what makes anyone think that a national or government run program covering all American will be a success. I would be much more encouraged on the latest government venture if it has a record of success behind it. Sadly, which much taxpayer money behind it, it does not. If they cannot cut the waste with current programs, or run them effectively now would be a good time to start — after all I’m still waiting for “change” — the constructive change and not the change of one bad program for another.
Spartacus // Jul 27, 2009 at 1:23 pm
Wow!!! I’m impressed.
I’ve been very quick to criticize the lack of honesty from the Right in the healthcare debate, so I will try to be just as quick in commending Frum’s heavy dose of honesty in correctly stating that there will necessarily be winners and losers and in honestly identifying who those winners and losers are likely to be.
“But we ought to take seriously the need to provide small business some better answer than the current stark alternative of costly and remorselessly rising health insurance – or else no employee coverage at all.” In this one sentence, we finally have an acknowledgement from Frum that reform of some sort is necessary.
For far too long, the country has gotten nowhere with healthcare reform, in large part, because those opposed to reform have been unwilling to concede that the status quo is unsustainable. Whatever aspects of the current system that each particular interest group covets are going to go away unless there is reform.
The next step for the Right is to devise a viable plan that addresses the need for (1) cost containment, (2) universal coverage, and (3) better outcomes for the services we consume.
Oneon1isto // Jul 27, 2009 at 1:29 pm
Good thoughts in general.
In the policy battle there will be winners, users, and shifted costs. One thing that the Obama-ites are getting right is a focus on actually paying for the program. Whether or not you agree with the math, at least they’re not ramming through another Medicaire part (D?). That’s why we’re actually seeing the sausage get made–because they at least recognize that programs must be paid for. It’s odd, coming from the Dems, but there you go.
sinz54 // Jul 28, 2009 at 9:56 am
Spartacus sez: “The next step for the Right is to devise a viable plan that addresses the need for (1) cost containment, (2) universal coverage, and (3) better outcomes for the services we consume.”
The GOP Right rejects universal coverage, and with good reason: It’s impossible to cover everybody in America, whether they want to be covered or not, without a government mandate that they must do so. And the Right is opposed to wholesale government unfunded mandates that override personal and corporate decisions.
So the proposals you’ve seen coming out of the GOP Right are intended to reduce costs and improve services (though so far, they haven’t bothered to ask the CBO to score them). But they don’t require everybody to have insurance.
barker13 // Jul 28, 2009 at 7:15 pm
Yeah, yeah… let me acknowledge the WSJ’s honesty also – as well as offer David a nod for reprinting a portion of the op-ed and commenting (intelligently) upon it.
One thing though…
NOTICE…
“Mr. Orszag visited Capitol Hill to discuss health care with a small group of House Democrats.”
President Obama’s OMB Director – Democrat – met with a small group of House DEMOCRATS…
(Right? We’re all on the same page?)
“Then one member said her top priority was winning higher payments for oxygen suppliers…”
One DEMOCRATIC member.. right? (Since they were ALL Democrats… right…???)
(BTW, who was it I wonder; which Congresswoman should we “credit” when we consider this tale?)
NEXT…
“Officials had been trying for years to cut payments to suppliers of oxygen and other medical equipment, which critics say are inflated.”
OFFICIALS, huh? Trying for YEARS, huh? By “officials” we’re talking ADMINISTRATION officials… right? BUSH ADMINISTRATION officials… right…???
(I mean if this goes back more than EIGHT YEARS I’ll gladly give Clinton a slice of the credit…)
(*GRIN*)
“Yet when a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan.”
Hmm… let’s examine this carefully.
LAST year… hmm… 2008… right? Which Party controlled Congress in 2008…??? If memory serves, hasn’t Nancy Pelosi been Speaker since January 2007 with Harry Reid as Majority Leader of the Senate from that same date…???
Also, while for whatever reason the writer chose to identify “industry supporters” as the inferred “bad guys,” in fact isn’t it… er… ELECTED MEMBERS OF CONGRESS – the DEMOCRAT MAJORITY in this case – that actually does the… er… voting and/or blocking…???
Anyway… (*SHRUG*)… just some points to ponder.
(Hmm… I wonder how they escaped David’s attention…??? Oh… nevermind…) (*CHUCKLE*)
BILL
Michael Reinemer // Aug 1, 2009 at 11:21 am
This entire thread is uninformed and way off kilter, starting with Meckler’s article in the WSJ and Orszag’s comments. There is zero context, no numbers, no history.
First, oxygen reimbursement rates have been cut by 27 percent in 2009 alone. Those rates were cut in 2003 (MMA), 2005 (DRA), and 2008 (MIPPA). The most fervent wish of the oxygen provider community is to get through one year without more cuts, which are reducing access to care. This benefit needs to be changed in order to recognize the services that go along with equipment. There are champions for better oxygen therapy policy in both parties, including Tom Price (R-Ga.) and Mike Ross (D-Ark.)
Second, in order to delay the competitive bidding program to make that program less of a job killer, the home medical equipment sector (durable medical equipment sector) took a 9.5 percent cut to PAY FOR the billions in savings that the bid program would have reaped. Is that the “victory” for “industry supporters” that Meckler is referring to, and which Orszag is talking about?
Finally, Medicare spending growth for this sector, home medical equipment and services, is 0.75 percent annually per the most recent NHE data from CMS. Compare that to more than 6 percent for Medicare as a whole. The sector is about 1.6 percent of Medicare spending. And THIS sector is “Exhibit A” in a story about the problems with healthcare spending? Someone explain that to me, please.
Seriously, you guys — starting with Frum — should do some research before going on and on about topics on which you don’t have even the basic information.
Yeah, I work for this sector. http://www.aahomecare.org/athaome
Michael Reinemer // Aug 1, 2009 at 11:21 am
http://www.aahomecare.org/athome