Must read: Health care in danger

charley-on-the-mta   |   Thu, Jun 18, 2009 7:35 AM EST

Ezra's got a critical post in understanding the bad news we've gotten on health care reform recently. Essentially, the plans that the Senators Kennedy and Dodd wanted to pass are judged to be too expensive. That's because they didn't include enough reform. So we could be in trouble.

But there's another path. This CBO estimate could be the first step towards making health reform better rather than worse. Rather than capping the employer tax exclusion, the Finance Committee could end it entirely and convert it, as Ron Wyden does, to a progressive standard deduction. Wyden's plan, incidentally, was scored by CBO as being revenue neutral in two years and revenue positive in four. Rather than protecting the private insurance system, the Finance Committee could include a public plan with the ability to bargain to Medicare rates, thus saving, according to the Commonwealth Fund, 20 percent to 30 percent against traditional private insurance. Ezekiel Emmanuel, brother to Rahm and health-care adviser to Peter Orszag, has a proposal for a universal voucher system funded by a value-added tax. All these ideas would make health reform better, cheaper, and more sustainable. None of them, so far as I know, are under serious consideration.

So, as Ezra says, the more reform you put into health care reform, the more affordable it will be. And that's a political problem. But progressive priorities — quality of care and universal coverage — should not bear the brunt of making a law affordable. Rather, we should operate under the assumption that the public demands health care reform; and it's the drivers of cost in the medical-industrial complex that have to justify their existence.

It ain't no how impossible. Failure will be because of timidity, not a fundamentally unworkable problem. Politics and organization now become very, very important.

Jon Cohn's got more.

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  1. Paradox...

    ... pointed out by Yglesias:

    On the one hand, insofar as your plan is "big government" that's left-wing. But insofar as your plan is expensive, that's also left-wing. Which is because people normally think of big government programs as expensive. But when it comes to health care, heavy-handed government intervention is actually way cheaper than private sector alternatives. Consequently, every time you try to make the plan more "moderate" by, for example, curbing the influence of a public option you actually wind up making the plan more "left wing" by needing to raise more taxes. And if you want to make the plan cheaper, while still actually achieving its goals, then you need to make it more left-wing not more moderate. But in the United States, ideological correctness and special interest politics prevents us from admitting this.
    mr-lynne   @   Tue 4 Dec 7:00 PM

  2. CBPP says CBO report incomplete.......

    The Center for Budget and Policy Priorities says .........

    The news media are widely reporting that, according to a partial and preliminary Congressional Budget Office (CBO) analysis, health reform legislation that the Senate Committee on Health, Education, Labor, and Pensions (HELP) is developing would cut the number of uninsured by only 16 million people while costing $1 trillion over ten years. That conclusion, however, is incorrect. The CBO analysis covers only a part of the HELP plan (the parts for which the Committee gave CBO detailed specifications) and does not include major elements of the plan that would further substantially reduce the number of uninsured.

    Consequently, the CBO analysis is highly incomplete; it does not show, nor does it purport to show, the effects that the full HELP plan would have on either health insurance coverage or the federal budget. As CBO itself noted, the provisions of the HELP plan that it did not cover "could also have substantial effects on our analysis."

    So I'm not pushing the Jon Cohn's panic button.......yet.  

    judy-meredith   @   Tue 4 Dec 7:00 PM

  3. Another good...

    ... Ezra (emphasis mine):

    The Question of Bipartisanship

    You know who wrote a smart column today? EJ Dionne. Read him. I'd put it a slightly different way, though: How many lives, and how many taxpayer dollars, is Chuck Grassley's vote worth?

    mr-lynne   @   Tue 4 Dec 7:00 PM

  4. $quot;timidity$quot; isn't why real reform with cost controls isn't being discussed

    The word I'd use is more akin to "corruption". In more expansive terms, what we are witnessing is not timidity but instead is "the corruption of crony capitalism, a compromised congress using taxpayer's money to enrich entrenched interests." (This phrase used by Robert Borsage over at CAF in his health reform piece June 17 09 http://www.ourfuture.org/blog-...  It's worth a read.)

    Don't go all alarmist on us C-MTA; what's happening now is to be expected. We've got to pace ourselves for the long haul fight. For a better understanding of the phases of reform we're likely to experience, check out the post excerpts below (and go read the full post, too) from one of the most valuable health plicy blogs out there, Health Beat.

    June 17, 2009 Health Beat blog by Maggie Mahar

    David Brooks on the President's Strategy: Who Exactly Is MedPac ? - Part I http://www.healthbeatblog.com/...

    I cannot recall an occasion when I have praised New York Times' columnist David Brooks. And I'm not quite ready to start today.

    But I would draw your attention to yesterday's column.  In some ways Brooks understands Obama's strategy for passing health care reform better than many more liberal pundits.

    Brooks describes the first-step as "table-setting: You will spend the first several months of your administration talking grandly about the need for reform. You will invite all interested parties to the table.... [too bad they excluded the least timid reform, improved Medicare-for-All aka Medicare Part E - Everybody in, nobody out]

    The second step is simple: "In stage two, you pass everything over to Congress."  Obama did just that when he submitted his budget and said, in essence: "I've found $600 billion to finance reform. If you don't like my ideas please come up with some alternatives. And we'll need roughly another $300 Billion-so perhaps you could think about that too. I'll be happy to listen to your ideas."

    "This brings you to the final stage, the scrum. This is the set of all-night meetings at the end of the Congressional summer session when all the different pieces actually get put together....

    read full post and comments at http://www.healthbeatblog.com/...

    For the not-timid among us, please take a moment to sign Senator Bernie Sanders Petition for a single-payer improved Medicare-for-All national reform bill. Bernie lays out the issues and the argument for this reform clearly and succinctly, and he asks for your healthcare story to read into the Congressional Record--click here  http://sanders.senate.gov/peti...

    Thanks

    annem   @   Tue 4 Dec 7:00 PM

  5. Here's what I don't get

    Every Democratic candidate in 2008, from Sara Orozco to Barack Obama, ran (in part) on changing healthcare.

    As it happened, after a mountain of work and a galaxy of money, we retained both houses of Congress and won the presidency too.

    So why are we having a debate with the GOP, which ran on not changing healthcare? Why have we already taken single payer off the table?

    Why do we have to call reps? We can pass this without a single Republican vote.

    WHY?

    Are you really telling me every Democratic campaign last year -- every Democratic campaign -- meant nothing at all? Because that's what I'm hearing.

    jimc   @   Tue 4 Dec 7:00 PM

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