A warning, this is a long post.
From Obama’s health care speech last night:
“But thanks to the bold and decisive action we’ve taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink. ”
Really? This doesn’t pass the smell test. Unemployment malingers on at 9.7%, higher than any of the administration’s worst-case scenarios and far, far worse than their projected numbers. We face a $56 trillion unfunded liability in Medicare/Medicaid/Social Security, we’re $12 trillion in debt and will need to raise the “debt cap.” (While a member of the opposition party in the Senate, Obama voted against raising the debt cap.)
“I am not the first President to take up this cause, but I am determined to be the last. ”
Really? The last? This is just sophomoric delusion. Politics is a battle of ideas, of principles and law. The arguments cycle and the debate rages on. That’s the point, people. The only way anything is ever “finally decided” is with a bullet. more than anything, this comment indicates that the administration is already–in its first year–caught up in its own hagiography.
“Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer.”
That’s because of the absurdist tax code! Nothing in the administration’s proposals would do anything to change this. Extend the tax deduction!
“We are the only democracy — the only advanced democracy on Earth — the only wealthy nation — that allows such hardship for millions of its people.”
All the cool kids are doing it! Really, we can be just like France! Or Sweden! They have great health care, fantastic rates of growth and thriving economies! Except they ration their health care, their growth is absymal and their debt is completely crippling and utterly unsustainable. I know, I know, facts will be in short supply in this speech.
“There are now more than 30 million American citizens who cannot get coverage. In just a two-year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.”
Do the math. These numbers make no sense. If one in three “goes without” (for how long?) that’s 100 million over two years or 50 million a year. if 14,000 lose their coverage every day that’s only 5 million a year. He’s making it up.
“One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn’t reported gallstones that he didn’t even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America. ”
I’m guessing that both anecdotes will turn out to be slightly more complicated than presented here, but assuming we take the President at his word, these are examples of breach of contract and are the proper subject of litigation. If they do represent legitimate issues that could be addressed with regulation, then do that.
“Then there’s the problem of rising cost. We spend one and a half times more per person on health care than any other country, but we aren’t any healthier for it. ”
So let the government run it! It’ll be like the Post Office of Health Care!
“And it’s why those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for somebody else’s emergency room and charitable care. ”
OK… wait a minute… he wants to increase that hidden tax!
“Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else. ”
That’s true. But his answer to that is to increase government liability without increasing funding. If he wants to control spending in Medicare and Medicaid, then do that! But adding an entirely new government entitlement does not lower costs.
“Now, these are the facts. Nobody disputes them. ”
“There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s — (applause) — where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own. I’ve said — I have to say that there are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have.”
Well… no. Extending the tax deduction would allow individuals to purchase health insurance. Allowing insurance companies to sell products across state lines would increase choice and opportunity. I’m not entirely sure how either proposal would disrupt anyone’s health care, unless they wanted it disrupted.
“Well, the time for bickering is over. The time for games has passed.”
Nice partisanship. Expressing deep reservations about a policy proposal is not “bickering.” Expressing deep reservations about a policy proposal is not “bickering,” it’s democracy. Perhaps the President is as confused as Friedman.
“Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Rob the people blind, cheat on our own taxes, and ruin the economy for the benefit of politically connected cronies! (Sustained, rapturous applause)”
OK… I added that last bit. He didn’t actually say that.
“Let me repeat this: Nothing in our plan requires you to change what you have. ”
That’s substantially different than his old line, “If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period.” Notice the shift? Nothing requires you to lose the coverage you now have, but if it’s priced out of existence and the insurance company goes bankrupt…
” Under this plan, it will be against the law for insurance companies to deny you coverage because of a preexisting condition.”
That will increase premiums.
“They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime.”
That will substantially increase both premiums and costs.
“We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick.”
That will increase premiums and increase costs.
“And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies”
Increase premiums again! (The “no extra charge” thing is a lie, lie lie. It’s like saying that he’ll make your teeth white by smiling at you; it’s magical thinking.)
“Now, that’s what Americans who have health insurance can expect from this plan — more security and more stability.”
And increased premiums and increased costs and increased taxes.
Then he goes on to explain how he wants to set up this “exchange” where health insurance can be sold to individuals. Because a government run “exchange” is so much better than, say… letting people just buy their freaking insurance. It sounds like a market, but it’s not. The government controls pricing, access, sales volume, and competition. In the long run, sustained lobbying from the insurance industry will mean that the exchange will transform from an agency that artificially lowers the price for consumers into an agency that artificially raises the price for consumers. That will happen.
The tax credit stuff is fine, but why not EXTEND THE TAX DEDUCTION?
“And that’s why under my plan, individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance.”
Anyone who’s ever been in an accident knows how fantastic no-fault laws are. Requiring everyone to buy insurance (or face a tax penalty) is… wait for it… going to increase costs. It’s a direct wealth transfer from the young to the old, the healthy to the sick. His line about how the young and the healthy cost us more by going to the emergency rooms is pure hokum. The old and the frail cost the most, the only reason to require the young and the healthy to pay for care they neither need nor want is to subsidize care for the elderly.
“The reforms — the reforms I’m proposing would not apply to those who are here illegally. ”
At this point a Republican congressman shouts out “You lie!” Which is tacky and uncivil. But… Congress has so weakened the enforcement provisions that Obama’s statement is… well, it’s kind of a lie.
“And one more misunderstanding I want to clear up — under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.”
See, the federal money will have sparkles and hearts on it and will smell all fresh and tangy, like mountain mist on a mid-summer day. We won’t use the pretty money on abortions, we’ll use other money! Say your kid has two dollars and wants to buy a sandwich and candy. Each costs two dollars. You give him another two dollars and tell him that he can only buy the sandwich with the money you gave him and he has to use his own money on the candy. You just bought your kid candy. The money’s all the same, people. If you don’t want the feds to fund abortions, then you’ve got to keep the feds from funding health care. If they fund health care, they’ll fund abortions. It’s like pretending that because you can’t use WIC coupons on cigarettes that WIC money doesn’t ultimately support tobacco companies; it’s a fiction.
“Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. … But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. ”
If the public option can offer a lower premium due to goverment subsidy and if private insurance sales are criminalized (as the plan in the House does), then private insurers will go out of business.
“I’ve insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers…”
Since when has government beauracracy ever been able to compete witht the private sector? This is more magical thinking. Think of the union contracts and severance packages employees of the public option will enjoy.
“…the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.”
And look at how those costs have been contained! And it’s not like we subsid… Oh… wait….
“And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need. ”
And how is he going to reduce spending? Where’s the pixie dust?
“First, I will not sign a plan that adds one dime to our deficits — either now or in the future. ”
“I will not sign it if it adds one dime to the deficit, now or in the future, period.”
Sure. This is just laughable blather. It’s a promise he knows he’ll break as he makes it. And you know, I find it interesting. He’s been willing to sign anything and everything that adds to the deficit so far, why not this one?
“And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize.”
“Now, part of the reason I faced a trillion-dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for — from the Iraq war to tax breaks for the wealthy.”
So, when faced with a trillion dollar deficit, Obama stared it down and did the most courageous thing he could; he doubled it. In six months.
“I will not make that same mistake with health care. ”
Like I made with the stimulus bill. And the cap and trade bill.
“Second, we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care don’t make us any healthier.”
That’s rationing. If he wants to cut spending by eliminating “waste” then he’s talking about rationing. Some of it will be good rationing, but a lot of it won’t be. Also, remember that he’s made this exact same promise before. He found $100 million in savings and increased spending by $1 trillion.
“And that is why not a dollar of the Medicare trust fund will be used to pay for this plan.”
There is no trust fund. That’s why it won’t be used. Cause it’s not there.
“And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pockets for prescription drugs.”
“So the commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system — everything from reducing hospital infection rates to encouraging better coordination between teams of doctors. ”
Yes, of course! That’s what the doctors have been missing! A congressional committee to help them communicate and coordinate complex medical care!
“And this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money…”
Oy. That “fee” (tax) will simply be passed on to their subscribers (do you think the gas station pays the gas tax?), further increasing premiums. How the tax is supposed to “encourage them to provide greater value” is a mystery. If you tax the most expensive (comprehensive) plans, then insurance companies will reduce the value of those plans. You get less of things you tax, not more.
“Now, add it all up, and the plan I’m proposing will cost around $900 billion over 10 years…”
Good rule of thumb: double that.
“The plan will not add to our deficit.”
Uh huh. I’ll wait for the CBO and the GAO to confirm that.
“What we face,” he wrote, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”
Which we don’t agree on. So stop pretending like we do.
“In 1935, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism, but the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress — Democrats and Republicans — did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind. ”
$56 trillion unfunded liability. That’s not peace of mind; that’s unsustainable insanity.
Lest I be accused of just throwing stones, I’ll quote Greg Conko, from CEI:
President Barack Obama and congressional Democrats have proposed a major restructuring of the American health care system. They argue that Americans spend too much for health care of often dubious quality and that tens of millions of Americans lack meaningful access to health insurance. In turn, they have proposed structural reforms to the existing private and public health care financing systems that are intended to increase coverage, lower costs, and improve health care quality.
Most Americans agree that our health care system is broken and must be fixed. But it is increasingly clear that what ails health care is not too little, but too much government intervention. Federal and state tax preferences for employer-sponsored health insurance distort the market in a way that limits choices for individuals, reduces competition among insurers, and artificially inflates costs for health care services. For most working Americans, switching jobs often entails switching health plans and doctors or losing coverage altogether, while many others find non-employer-sponsored insurance unaffordable or difficult to obtain.
Efforts by federal and state governments over the past few decades to solve these problems have generated additional burdens and distortions, leading to increasingly bigger problems. To ensure affordable coverage for those in poor health or with potentially expensive medical conditions, governments have implemented guaranteed renewability, guaranteed issue, and community rating laws that force healthy individuals to subsidize those with higher health care costs. Many states require insurance policies to pay for niche specialists, including acupuncturists, pastoral counselors, and massage therapists, or to cover alcoholism and substance abuse treatment, smoking cessation, and in vitro fertilization. But these regulations further raise the price of insurance coverage, leading many healthy individuals to forgo insurance altogether.
Similarly, numerous state and federal restrictions on who may provide medical services and how they must be delivered have hindered the development of innovative ways for medical professionals to offer more convenient and lower-cost health services to consumers. A combination of government and medical professional lobbying has restricted the supply of new doctors, creating an artificial scarcity and contributing to rising prices. And medical products regulation substantially raises the cost of producing new drugs and medical devices, often without increasing their safety.
Instead of reducing these burdens, Democratic health reform proposals would impose more regulations on insurers, place mandates on individuals and employers to purchase health insurance, provide subsidies for individuals to pay for health care coverage, expand Medicaid, and create a new government-run “exchange” through which individuals and businesses could purchase strictly defined coverage from private insurers. But more government intervention will only add cost and complexity to the health care system; without solving the underlying problems.
As an alternative, policy makers should eliminate the many layers of market-distorting government regulation that have produced our current crisis. To truly reform America’s health care system, policy makers should:
- Modify tax policy to eliminate the disincentives for individual purchase of health insurance and health care.
- Eliminate regulatory barriers that prevent small businesses from cooperatively pooling and self-insuring their health risks by liberalizing the rules that govern voluntary health care purchasing cooperatives.
- Eliminate laws that prevent interstate purchase of health insurance by individuals and businesses.
- Eliminate rules that prevent individuals and group purchasers from tailoring health insurance plans to their needs, including federal and state benefit mandates and community rating requirements.
- Eliminate artificial restrictions on the supply of health care services and products, such as the overregulation of drugs and medical devices, as well as state and federal restrictions on who may provide medical services and how they must be delivered.
- Improve the availability of provider and procedure-specific cost and quality data for use by individual health consumers.
- Reform the jackpot malpractice liability system that delivers windfall punitive damage awards to small numbers of injured patients while it raises malpractice insurance costs for doctors and incentivizes the practice of defensive medicine.
Each of these changes would help to fix our broken health care system by reducing costs and enabling better informed, cost-conscious decision making. By themselves, they will not guarantee access to health insurance among those with chronic preexisting conditions. But if we reform the existing maze of federal and state regulation, we will then be able to address the problem of the truly chronically uninsured. Because they are a fraction of the 46 million individuals who now lack insurance or government health coverage, it would then be possible to create targeted programs to help subsidize their health insurance costs without breaking the bank and without distorting the rest of the health care and health insurance markets.