The horizon is not so far as we can see, but as far as we can imagine

The Compromised President and Congress: Why this health care bill probably won’t reduce costs

Ok, I’ve tried to keep an open mind on this. I prefer single payor, but a properly done public option could, indeed, drive down costs and help some people get care.

But I’m no longer sure I can maintain benefit of the doubt.  First it was the AMA endorsement, which was bought by a promise not to reduce medicare rates as much as initially planned.  Now I read from Robert Reich that the price of pharma not killing it is:

  • Not allowing drug reimportation from Canada
  • Not allowing the government to negotiate drug prices

The 80 billion pharma promised last month is a small price to pay for that, and I’ll tell you right now that that 80 billion won’t appear anyway.  As soon as the pharma companies can betray, they will.

The mandate, as Reich points out, can easily lead to insurance companies earning more money than they’ll lose, which since the insurance companies are the problem, means that costs won’t go down much, if at all.

All in all, I don’t think any bill that’s going to come out of this Congress is going to be strong enough to drive down costs or even significantly reduce the growth rate.  The mandates, combined with insufficient subsidies mean that many people are going to be hurt by being forced to buy insurance.  The Massachussets plan, which this is based on, has not worked well.  This isn’t going to either.

This bill is turning into a pork-fest.  Buy-in is being achieved by making it clear that stakeholders will make more money once it’s done, not less.

My biggest weakness this year in doing analysis has been hope.  I have let hope that the Obama administration and a Democratic Congress will do the right thing, and that they aren’t corrupt and incompetent, get in the way of clear thinking.  Enough.  Hope isn’t a plan, and hope isn’t policy.  Hope without good policy is a con-job.

There hasn’t been a good, major, bill come out of this Congress this year.  They have all been fatally compromised, from the stimulus bill (larded up with useless tax cuts and without necessary State relief) to the global warming bill, which is so far from doing enough that it’s a joke.

At this point I see no reason to believe this bill won’t be the same.  Yes, a few people may get health care who wouldn’t otherwise and that matters, but it won’t contain costs to any significant degree and it will put a huge burden on Americans who can’t afford it.  The likelihood that a surtax on the rich to pay for it won’t happen just makes this even more clear.

This is not the Bush administration, but the primary assumption of the Bush years that nothing would get through Congress that wasn’t bought and paid for; that wasn’t fatally compromised at very best still holds in only a mildly mitigated form.  Yes, Obama and the Democrats sometimes try to do the right thing while Bush almost never bothered, but  the bills that come out at the end are still awful.

This year is effectively over.  Obama’s ratings are dropping and will continue to drop as the economy doesn’t improve for ordinary people.  In future years he will reap what he has sown: bad policy will lead to bad real results, and Obama and the Democratic Congress will be blamed for that.  They will deserve it.

Hope I’m wrong about this.

But I wouldn’t bet on it.  Even hope wears thin over time.


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  1. senecal

    I have read that another doleful effect of the health care reform bill is a planned reduction in medicare payments to doctors and hospitals who perform/prescribe “unnecessary” treatments. The NY Times is the main voice of the myth that our health care system is too expensive because we expect too much of it, and we’re willing to pay for it. Guess which segment of the population will be most impacted by cuts to medicare doctors and hospitals?

  2. Sadly, I don’t think you’re wrong about this. Nothing I’ve seen these people do gives me hope that they’ll actually follow through and do the right thing, even on the rare occasions when they start out trying to. Does this sound optimistic? Comparing how DC works now with how it worked forty years ago is anything but encouraging – not that things were going great back then, either.

  3. gtash

    Somebody at Talking Points Memo (Josh?) referred to the long list of organizations who “signed on” to work on the reform plan and he called it a list of “fair-weather friends”. That’s the feeling I have as well. It is politically correct to acknowledge the status quo is awful no matter what you really thing about it. It gives a space for temporizing discourse. I think it was on Here & Now a spokeswoman for Big Health Insurance offered a “plan” that had free choice of providers, no denial because of pre-existing conditions, universal coverage, portability—-everything except a public option. She wasn’t questioned closely, but the moderator did suggest skepticism. The spokeswoman turned around and said “we all recognize the present system is no longer workable and we want to do our part to put things right” (paraphrase) and then went from there to how the US is not Canada or France and has to find its own way without public options because, well, that is just the only American thing to do.

    And that is precisely where I feel the Congressional reform package is going to end up. American exceptionalism.

    Lately you see the remark: this is not about health insurance for everyone, it is about health care for everyone. That observation hasn’t sunk in. One of my 60 yr old colleagues at work fretted about how public options would permit abortions and (as a Catholic) he was worried about that. But then he said, people should plan their lives to include the cost of health insurance from the time they become teenagers and enter the job market. He said he wrote our state Senator to tell that story. Health insurance is a privilege that you have to earn and you have to plan for it as surely as you plan for a car and driver’s license. He wrote his Senator about the duty of teenagers to plan for health coverage, not “right to life”.

    Is this American exceptionalism?

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