Friday, December 18, 2009

Healthcare Bait-and-Switch

Former DNC chair and medical doctor Howard Dean came out against the draft Senate healthcare bill this week, giving his reasons in a Thursday WaPo op-ed. Much of Dean's disgust arises from Harry Reid's dropping of the "public option" and the now apparently dead plan to lower Medicare eligibility to age 55, amid teeth-gnashing about "private insurers' monopoly over health care" (he's wrong about that). Yet Dean also complains about eliding controlling costs, predicting that "the American taxpayer is about to be fleeced." So Dean's half right.

Lowering healthcare spending was the original impetus for the Administration's health reform advocacy. Yet, as MaxedOutMama concludes, "none of these bills do anything but accelerate our budget problems." This explains Senator Lieberman's defection -- leaving Senate Democrats short of the 60 votes required to end debate and bring a bill to the floor.

This has left reform proponents such as Atul Gawande defending the proposed plethora of pilot projects. But, as Critical Condition's Paul Howard says:
If that were all the debate was about, they could've done that easily, with bipartisan support from Republicans -- and for a lot less money than the trillions Democrats plan to spend. Instead, they wanted to create a new government-run entitlement program to cover the uninsured.
The good news is that the Senate won't pass a bill this year: on Thursday, Senator Reid's office released a "Possible Path to Adjournment," a proposed legislative timeline, including:
Thursday (12/24) (30hrs) (note that this vote could occur on 12/25, depending on when each 30 hour period begins to run):
• After 30 hours has expired or been yielded back after the cloture vote on the underlying bill, final passage vote on the Patient Protection and Affordable Care Act, as amended
I don't have a hyperlink, but based on my 30 years in Washington, there's no way the Senate stays in session 'till Christmas eve (much less Christmas day). Meaning that healthcare legislation will be delayed beyond recess to early next year.

By then, be sure to read the excellent editorial in the December 14th Wall Street Journal:
ObamaCare's core promise--better quality care for everyone at lower costs--is being exposed as an illusion as it degenerates into the raw exercise of political power. Naturally, the White House and its media booster club are working furiously to prop up this fiasco, especially on cost control.

As Obama budget director Peter Orszag put it at a revealing media breakfast earlier this month, the Senate bill does everything the experts recommend to "get at the underlying drivers of health-care costs." While he admitted that "we don't know enough" to produce results right away, the key is to encourage "continuous improvement" through pilot programs and demonstration projects. Cost containment will actually take "years to decades," Mr. Orszag conceded.

The torch was then passed to Ron Brownstein of the Atlantic Monthly, David Leonhardt of the New York Times and editorial writers for the New England Journal of Medicine, among others. Last week the New Yorker ran a 5,000-word apologia from Atul Gawande, who likewise owned up to the fact that there is "no master plan for dealing with the problem of soaring medical costs," only "a battery of small scale experiments." Keep in mind, this is an argument in favor of ObamaCare.

They might have piped up earlier: What they're finally admitting is that all the grandiose talk about "bending the curve" used for months to sell ObamaCare really comes down to their hope that bureaucratic improvisation will make a difference over the long term. Yet the liabilities of the greatest social spending program in American history will be added to the budget almost immediately, and what happens if Mr. Orszag's technocratic revolution doesn't work as promised? Or rather, when it doesn't? . . .

The new cost-control apologists concede that there isn't any actual plan for controlling costs: Throw enough speculative policies against the wall, they say, and some breakthrough will stick. Yet Mr. Orszag's no-less-confident predecessors spent decades trying to pull down Medicare spending with little to no success. Technocracy rarely if ever works as intended. Mr. Gawande points to the case study of U.S. farm policy, and if politically sacrosanct agriculture subsidies and rural price-supports are the best to hope for, then what's the worst? . . .

One liberal sage noted in a 2007 paper that "four decades of empirical research" have shown that insulating people through third-party insurance coverage "from the full cost of health care has been responsible for anywhere from 10% to 50% of the large increase in health expenditures." Ultimately, he concluded, increasing cost-sharing would give individuals a direct stake in more prudent purchasing, as opposed to today's invisible health dollars that vanish as more expensive premiums, foregone wages and higher taxes.

Those are the words of Jason Furman, now the White House deputy economic director who seems to have been put into witness protection. Every serious health economist in the country recommends reforming the tax exclusion for employer-sponsored insurance, perhaps by converting it to a deduction or credit. Cost control will never stick unless it is extricated from politics and transferred to individuals to make their own trade-offs. . .

The White House hawked a permanent entitlement expansion on flimsy and speculative theories that its own partisans now admit--albeit when it is nearly too late--aren't more substantive than the triumph of hope over experience, while simultaneously writing off the one policy that has been effective in the real world. The cost control mantra of ObamaCare was always a political bill of goods, and its result will be the opposite of its claims: poorer quality care at higher costs.
In sum: Medicare starts running short of money in just six years, and many complain about increased medical expenditures, while private insurance still sheds most incentives toward cost control. So we respond with bills spending at least $500 billion more -- likely well more than that -- freighted with racially discriminatory provisions, while jettisoning cost-cutting targets, to the detriment of the middle class. Sounds great!

Told ya so. No wonder it won't be wrapped by Christmas: bait-and-switch requires more salesmanship.

(via reader Thai, EconLog, The Corner, Berman Post)

1 comment:

A_Nonny_Mouse said...

I hope you are correct that there's no way this will come to a vote before Christmas.

In "normal" times, I'd agree with you.

But this Administration seems willing and able to use every dirty tactic up to and including "Nice Air Force Base youse gots there, be a shame if anything was ta happen to it, yaknowwhadImean?"

Call me paranoid --I hope it's only that-- but this abomination of a bill seems SO DAMN IMPORTANT to the Really Truly Left that I'm betting Obama/Reid/Pelosi are readying one or two more out-of-left-field-never-saw-it-coming attempts at finalizing this thing before the Senate breaks for Christmas.