I am disheartened and disgusted with the current state of play with the healthcare bill. They are so close, and yet the Democrats manage to confirm all the worst suspicions about their cravenness, cowardice, and incompetence. Of course, the nihilists in the Republican party are dancing with glee, as nothing makes them happier than the failure of healthcare reform.
If I were a nihilist myself, I would say – take a lesson from the Republicans. Forget good policy. Focus only on winning and scoring political points. Pass the parts of the healthcare bill that are simple to understand, universally popular, and difficult for the Republicans to oppose. In other words, restrict insurance companies from discriminating based on pre-existing conditions, denying coverage, or tying premia to health status. That would be good, right?
Wrong. On its own, it would be horrible. Without an individual mandate, the healthy would flee from the insurance market, weakening the risk pool dramatically. Costs would rise, and without subsidies, healthcare would become rapidly unaffordable to those most in need. If I were a nihilist, I would relish such an outcome, as it would fatally wound the private insurance system and edge the country closer to single-payer, a system I regard as superior on cost and equity grounds.
But I am not a nihilist. I cannot embrace this cynical position. There is a reason healthcare is complicated. There is a reason why it takes so long to put together, why it runs to thousands of pages of legislation. The Senate bill is now the last best chance for healthcare reform in this country. It is indeed the last best chance for the future of private health insurance. The status quo is untenable. The alternatives are untenable. It is for this reason that 45 leading healthcare experts (including people like Henry Aaron, David Cutler, Jonathan Gruber, and Jacob Hacker) are imploring the House to pass this legislation now, as this legislation would “provide health coverage to tens of millions of Americans, begin to control health care costs that seriously threaten our economy, and improve the quality of health care for every American”. This is not about gamesmanship or politics or point scoring, it is about people’s lives.
I have heard a number of highly placed Democrats (e.g., David Axelrod) acknowledge that the poll number for the health care reform bills are bad, but they say, “If you ask the people about the bills, they disapprove. But if you ask them about the things that are in the bill, they like them.” SO WHY HASN’T THERE BEEN A CAMPAIGN TO EDUCATE THE AMERICAN PEOPLE ABOUT WHAT’S IN THE BILL???
My partner said yesterday that Obama should have made an appearance every day and said, “I got a letter from Rose in Oklahoma whose daughter has cancer and whose insurance company ended their coverage . . . etc. etc.”
It may be a lot easier to scare people about death panels and pulling the plug on grandma than it is to explain what is actually in the health care reform bills, but it seems to me the Democrats scarcely tried. I was going to say, “The best lack all conviction, while the worst are full of passionate intensity.” But I see somebody on the Huffington Post beat me to it.
“This is not about gamesmanship or politics or point scoring, it is about people’s lives.”
Except when it comes to the unborn, I guess. Until you reconcile thsi huge gaping hole in your logic MM, healthcare reform will continue to be DOA.
Americans dont’ like this bill. No one likes this bill. Which is why Reid had to schedule the vote at 1 in the morning.
It is time to dump this bill and start over with real reform.
The issue is finally extending health insurance to 30 million Americans. It is something we cannot give up on.
Colin, can you tell us what “real reform” would be?
I do not trust politicians to run healthcare for the benefit of people.
I do trust them to try to manipulate the healthcare system to reward their political allies and punish those who oppose them.
At least if we left the healthcare system to various states, they could only corrupt the portion of the US that they have control in. If the politicians really mess things up, people can leave for another state. For example, see the flow of people and business from California. When the Federal Govt messes things up, you have to go to a foreign country.
I’m Bipolar 1 and can’t get insurance coverage for my “preexisting condition.” Recently I was taken to the emergency room after four days straight of suicidal thoughts. Despite not being admitted for lack of insurance, I’ve was billed $1,260. In addition to this, the medication I’ve been prescribed costs $850 a month. Suffice it to say, I can’t afford this for long, as I am unemployed and have a small amount of savings. Without medication, I will either become so depressed as to become suicidal, or so manic that I blow whatever money I have left. I didn’t ask to be made severely bipolar. I did not bring any of this onto myself. I did well in college (ranked number 10 out of 1000), tried to join the the Army but was kicked out when my illness surfaced, and am now trying to become a teacher. My Father is a mail carrier and can only help me so much with my medical expenses since some of my siblings are young and still need to be taken care of.
I was a Republican in high school and college but now I see what a fool I was believing that smaller government is what this nation needs. What is even more tragic is that I am one of the lucky ones, because I have a great family and support system. What of the poor and needy who have nowhere to go, nowhere to turn to?
I know that this is only one piece of anecdotal evidence, but it is perhaps the best evidence I have to offer.
“Except when it comes to the unborn, I guess. Until you reconcile thsi huge gaping hole in your logic MM, healthcare reform will continue to be DOA.”
No. Once again, abortion is being used as a stick to beat liberals.
The republicans are not offering any alternative to the democrats health care reform. They are motivated primarily by “stopping socialism” whatever that means.
If preventing abortion were the motivating factor, then the RTL movement could have suported a pro-life democrat against Coakley, rather than a pro-abortion republican, as was pointed out in the comments of a previous post here.
The republicans do NOT want a modifed health care bill, and they do not want to stop abortion.
They want to oppose the democrats, period.
I also agree that it is not about games and points. The American people are fighting for their way of life against this administration. This post is treating the healthcare debate as a game.
(BTW, the expert Jonathan Gruber supported Obama’s position while receiving significant funds from the Department of Health and Human Services. I would not refer to him as an independent expert.)
Right now it looks like one of the main obstacles to the House passing the Senate is union opposition. Are they nihilists?
Navy Vet writes:
I do not trust politicians to run healthcare for the benefit of people.
How’s your TRICARE?
More importantly, can we review the Democratic legislation.
1. There are very mild incentives for employers to continue providing health insurance to their employees or to start. Because this is being done with such a light touch, a mere 2 million would be added to the rolls from this an from the individual/family mandate encouraging coverage by workers who have employer provided insurance but decline it. The insurnace is not run by the government.
2. There would be a slight expansion of Medicaid eligibility for the poor.
3. There would be exchanges were private firms would offer insurance to those still without and families below a certain income would get tax credits or vocuchers to partially pay for it (on a sliding scale).
“Colin, can you tell us what “real reform” would be?”
Reform that respects the right to life of all humans, regardless of stage of development. That would be a good starting point.
“No. Once again, abortion is being used as a stick to beat liberals.”
If liberals continue to support abortion then they need to be hit with a stick. :-)
Seriously though, as long as advocates of health reform insist on abortion funding (or those who don’t like the abortion funding but defend the bill anyway) introduce a huge contradiction in principle.
The left says: “No support for the fetus”
The right says: “No support for the illegals”
Different targets, same hole in thinking.
“I also agree that it is not about games and points. The American people are fighting for their way of life against this administration. This post is treating the healthcare debate as a game.”
Their way of life? Does that “way of life” include Medicare and Medicaid, which was denounced as socialism by Ronald Reagan, but is now a key element of republican resistance to Obamacare. . . since the GOP has persuaded people that they will “keep the government’s hands off their Medicare.”
When a republican runs on an anti-Medicare -Medicaid platform I will believe they are being anything other than obstructionist.
“Colin, can you tell us what “real reform” would be?”
Reform that respects the right to life of all humans, regardless of stage of development. That would be a good starting point.
And would that be the bill passed by the House?
It is for this reason that 45 leading healthcare experts (including people like Henry Aaron, David Cutler, Jonathan Gruber, and Jacob Hacker)
Would this be the same Gruber who was paid around $300,000 to provide consultation on the bill, and whom the Administration quoted tirelessly as an independent expert without disclosing the connection?
http://voices.washingtonpost.com/ezra-klein/2010/01/jon_gruber.html
If your “argument” is that anyone who opposes the current health care reform bill is nihilistic, there has been a sudden and startling spike in nihilism recently. It’s the new black, in fact. Which begs the question: is over 50% of the American public comprised of nihilists (or pawns of nihilists), or are you abusing the word to express your frustration that people disagree with you about a much-disputed matter of public policy?
phosphorious:
Each of these government programs has become a money pit. A government-run public option would also be a money pit. Politicians from both parties have proven that they cannot manage resources, and maybe we should rethink substitutes for Medicare and Medicaid.
As far as the current process, it has been monopolized by Democrats who do not want to allow any opposing viewpoints. It is not about helping people. It is about power and control. Pelosi, Reid, Obama (and his Chicago cronies) need to stop telling the American people how to live their lives. In fact, Pelosi and Obama should clean up her/his respective home state and home town before they attempt to experiment on the entire country.
The situation that Aegis was generous enough to share with us encapsulates very succinctly why health care reform is essential. Aegis is correct that (s)he is very fortunate in having a familial support system able to provide some help; millions of others are not so fortunate. With every day that passes I personally grow more and more discouraged about the direction in which this nation is headed. We have become a selfish, grasping, non-empathetic people, more attuned to the ravings of the rightwind hate mongers than we are to the Beatitudes.
We can lose it all. Believe it.
The situation that Aegis was generous enough to share with us encapsulates very succinctly why health care reform is essential. Aegis is correct that (s)he is very fortunate in having a familial support system able to provide some help; millions of others are not so fortunate. With every day that passes I personally grow more and more discouraged about the direction in which this nation is headed. We have become a selfish, grasping, non-empathetic people, more attuned to the ravings of the rightwing hate mongers than we are to the Beatitudes.
We can lose it all. Believe it.
I see a couple of people are attacking Jonathan Gruber. Yes, he has been advising the healthcare reform, but sorry folks, I’ve been reading Gruber’s work for years now — he’s one of the leading healthcare economists in the country (along with David Cutler, who also signed the letter).
As for its unpopularity with the public, that is quite obvious. It’s not nihilism, it’s a lack of understanding. Instead of deferring to authority, the mob must rule. If you look at the “populist” crictisms of the healthcare bill you will find them contradictory and confused. Instead of seeking to understand, or deferring to those who do, they instead resort to meaningless slogans about “big government” (except if they themselves are the beneficiaries of “big governmment” such as medicare). They complain about the length of the bill, or what they think is in it.
The ignorance is wilfil, and reflects a very American populist tradition that is (once again) the antithesis of conservatism.
The nihilists are the people who prey on this ignorance, and encourage the mob – and this is the Republican party.
“Each of these government programs has become a money pit. A government-run public option would also be a money pit. Politicians from both parties have proven that they cannot manage resources, and maybe we should rethink substitutes for Medicare and Medicaid.”
Then republicans should say this: “We are opposed to Medicare and Medicaid, and we will work to abolish them.” They don’t because they know peopel wouldn’t stand for it. It’s fundamentally dishonest of them
“As far as the current process, it has been monopolized by Democrats who do not want to allow any opposing viewpoints. ”
This is fundamentally dishonest of you. 1) yes the process is dominated by democrats. . . they won the last election by a wide margin. 2) If they do not allow opposing viewpoints, if they do not value or respond to republican input, then why was Brown’s victory widely seen as enough to scuttle the bill? democrats still have a wide majority, but they have so far refrained from forcing anything through. Republicans believe BOTH that Obama is a rabid partisan that ignores republicans AND that he is a weak leader who can’t get anything past a republican minority.
Pick a stiry and stick with it.
Sorry about the double posting. The one on top has a typo in it that the bottom one corrects. Didn’t mean to post twice, ‘tho.
Aegis, thanks for offering us your pespective. It is important in this debate to hear the stories of people who simply want the medical care they need, without having to go broke to get it. I’m adding your intentions to my evening prayer, that you’ll be granted mental and financial health, and that soon you’ll live in a more compassionate nation.
In other words, no legitimate criticism of the bill is possible. Bart Stupak: nihilist. I think this post calls into question your judgment at least as much as that of the American public.
Cathy.
It is not about helping people. It is about power and control. Pelosi, Reid, Obama (and his Chicago cronies) need to stop telling the American people how to live their lives.
It is not about human life. It is about power and control. Brownback, Santorum, Chaput (and their Christian Right cronies) need to stop telling American women how to live their lives.
See the similarity? Probably not.
John,
I was half expecting somebody would respond along these lines. But really, can you not see the difference between legitimate policy debate and emotional populist know-nothingism?
Let me begin with an analogy. When I was in Ireland last year, I watched a prime time current affairs program on the main public TV station (RTE). The topic of debate was the Irish government’s solution to the banking crisis by using public funds to remove toxic assets from troubled Irish banks. These are complicated issues. And yet, the dabte was sober. There were a number of experts with a variety of views, some supportive, some against. The host actually tried to delve into the policy issues.
Why is this kind of debate seemingly impossible in the US, when it is the norm in most of the world? Why must debate in the US degenerate into ideological talking points? Why must authority and expertise be mocked and derided?
In such an environment, it is possible for a cynical political actor to exploit this “hyper-charged ignorance” to his own advantage.
That is what the GOP is doing. This is nihilism. In a country used to sober debate, it simply is not possible for a party that spent the last two decades trying to chop medicare could suddenly position itself as the savior of medicare. It would not be possible to make false sweeping generalizations about healthcare that go unchallenged.
But debate in the US is quite divorced from the “reality-based community”, a fact the Republicans have brilliantly exploited to their own advantage in recent years (it was not always so). Truth doesn’t matter. Facts don’t matter. Reality is malleable. Truth is relative. Shouldn’t all Catholics have a major problem with this?
Well said, Mark, and I also want to thank Aegis for commenting.
“In other words, no legitimate criticism of the bill is possible. Bart Stupak: nihilist. ”
Absolutely not.
You will notice that it is called the “Stupak Amendment”, because it “amends” the bill, in order to address legitimate concerns about abortion.
It is not called the “Stupak Let’s Stop The Evil Socialists from Sending Grandma Before The Death Panel, And Smash The Obama Presidency Once And For All Bill.”
A subtle difference, but importnat nonetheless.
MM
What happened in Massachusetts though was very much about independents not republicans in a state where 97% of people are covered already for health care. Why would they elect a spoiler aside from the fact of the Democrat involved going on vacation during her campaign? Probably because they do feel they will get billed for the rest of the country (remember the Harry Reid back room Nebraska deal which confirms that and against which tactics Obama ran his campaign as he said that all discussions would be on cspan rather than back room deals) but they will not get (commensurate with paying for others)
a reduction in the cost of health insurance that is certain through mandate rather than projected as the result of largesse…. nor a reduction in the cost of medicine through government control of prices or allowing importation…. which should obtain in areas like medicine which are a necessity not a luxury and not a discretionary item as in Aegis’ situation.
Aegis
In the long run, research those countries in which medicine in your case would be low cost or no cost and don’t rule out moving and living there if it is attractive in general terms also though it is awful in terms of leaving family. It is simply awful what you are up against but keep in mind that this life is but a grain of sand compared to the next one where you will be compensated for anything uneven here as long as you keep close to God. I will pray for you throughout the month of February.
But really, can you not see the difference between legitimate policy debate and emotional populist know-nothingism?
Well, sure. But I also can spot the difference between legitimate policy debate and name-calling masquerading as an argument (e.g. this post).
Why is this kind of debate seemingly impossible in the US, when it is the norm in most of the world? Why must debate in the US degenerate into ideological talking points…Truth doesn’t matter. Facts don’t matter. Reality is malleable. Truth is relative. Shouldn’t all Catholics have a major problem with this?
So, just to be clear:
1) You wrote a post calling anyone who opposes the current health reform bill a nihilist (a popular ideological talking point on the left).
2) I point out that you’re substituting ideological name-calling for argument.
3) You respond with a lament about ideology and the erosion of public discourse.
Well, at least we agree that the erosion of public discourse is a bad thing, and that it occurs with depressing frequency in U.S. politics. I suppose our disagreement is about whether it’s possible to have legitimate criticisms of the current health insurance bill; but since you’ve assumed (nihilists!) rather than argued that point, I suppose we’re past the point of ‘sober’ debate.
You wrote a post calling anyone who opposes the current health reform bill a nihilist (a popular ideological talking point on the left).
I most certainly did not. But when a Republican like John McCain issues a statement decrying this bill as a “government take-over of healthcare”, playing on ignorance, without any attempt to address the substantive issues, then I most certainly call it nihilism.
If giving folks tax credits and partial subsidies to buy private health insurance is a government take over of health care, then is the letter I received from Archbishop Wuerl asking for support for the DC Opportunity Scholarship Program, a demand by him for a government take-over of the Catholic schools?
Just wondering.
And what shall we call it when the Supreme Court renders a decision that will allow the executives of the insurance industry, and few of their closest friends, to take over the government?
If lack of transparent and reasoned debate on HCR is a problem you should be pointing your fingers at the Obama and the Dems. In spite of campaigning on having open negotiations and trying to engage the public, Obama and the Dem leadership kept it all behind locked doors. Friendly special interest groups were given a seat at the table while any dissenters were locked out while they tried to steamroll through a massive and (and in your own words, complicated) legislative effort. Even to get buy-in from friendlies, political bribes were made using the public treasury. If there are any merits to the substance of the current HCR efforts they’re all legitimately called into question by the irresponsible and unethical manner they were derived coupled with the grave consequences if it goes wrong.
I didn’t like Bush’s plan to partially privatize social security, but I also didn’t agree with the Dems’ all-out opposition to him and total unwillingness to work towards a compromise. I wouldn’t characterize it as nihilism though – just politics, combined with ideological opposition to aspects of the president’s plan. Sounds familar…
Also, people keep saying you need a mandate to if you’re going to ban discrimination on the basis of preexisting conditions. But the Dems’ plan has such a weak mandate that it would be unlikely to work anyway.
MM,
Here, again, you’re simply choosing to avoid the substantive issue. McCain’s claim isn’t that the current bill is single payer; it’s that it vastly increases government involvement in health care, which, in time, will lead to something like single payer. And many progressives agree with him, which is one reason among many why they support the bill. To call pointing out the likely long-term results of a bill ‘nihilism’ or ‘playing on ignorance,’ is simply to avoid the issue altogether.
Rick,
I’ve heard this argument a lot, and I just don’t get it. Over the past year, there was a vigorous debate in policy circles over the merits of the various proposals in various bills. Where were the locked doors? I followed the debate closely, and knew exactly what was being proposed by each bill at each time.
The problem is, the Republicans decided from day 1 to play no part in this debate (Specter has come clean). Had they joined the debate, I’m almost certain they could have put something to their liking, such as tort reform in there (this doesn’t affect healthcare costs much at all, but reform wouldn’t exactly hurt either). Plenty of old-school moderates like Max Baucus were incredibly frustrated by this cynical nihilism. Most Democrats were desperate for the “bipartisan” label and tried to bend over backwards to accomodate.
Yes, it is massive, and yes, it is complicated. But that’s how good policy works. The Republicans really need to get beyond the simplistic Reaganite mantras, roll up their sleeves, and get their hands dirty.
As for political bribes, well, yes, that’s what happens in such a democracy. Then again, I am becoming less enchanted with democracy by the day! And it was not that bad – the only real egregious example is Nelson’s Nebraska deal. Far worse was Bush’s Medicare part D deal, which amounted to a massive transfer from the Treasury to the drug companies, and was in fact written by the drug company lobbyists. At that time, the GOP rallied to this bill, even though it amounted to a massive new entitlement that was not paid for. You can quibble with the cost savings of the current bill, but at least they are trying.
This country is as hopeless as the San Diego Chargers. At least the latter only figuratively torture people.
I asked my Ohio-born wife, “Wtf is wrong with this country ?” she said that healthcare subsidies smack of socialism which is coterminous with communism to the average person. She added that brainwashing starts at an early age.
There must be millions on Medicare, Tricare etc who don’t see the irony of their position. I guess stupidity, too is a pre-existing condition.
It also didn’t help that first a woman and then a black (half black, but that doesn’t count I guess) man proposed it.
The entire civilized world has subsidized healthcare, where employment change doesn’t result in pre/existing conditions and unemployment in no coverage. It’d seem that especially the fattest country in the world should worry about healthcare. There IS a weight limit for rapture, after all.
There has been an open and reasoned debate between the progressives and centerist elements of our society. The centerists pretty much won in the drafting of the legislation.
Despite initial optimistic hopes, there really is no possibility of discussion on HCR with the conservatives who affirmatively seek to keep 30 million Americans without health insurnace so that they have a scared, docile and insecure lower middle class in order to advance corporate profits.
Gerald – I agree with you. Its the very notion of subsidizing the healthcare of others, and this pertains not only to obvious government subsidies but to the very notion of community rating (not charging premia depending on individual risk). Community rating is what makes healthcare work all over the world, whether by government or by private sector.
John: “McCain’s claim isn’t that the current bill is single payer; it’s that it vastly increases government involvement in health care, which, in time, will lead to something like single payer.”
If that is indeed McCain’s point, he should try to make it. In fact, it is more likely that this bill represents the last effort to save private health insurance.
But here is what McCain actually said: “I remain committed to opposing any bill that puts your health care decisions in the hands of government bureaucrats while adding more than a trillion dollars to our country’s deficit. Taxpayers simply cannot afford this government takeover of our health care system and this is our opportunity to put an end to it.”
As you well know, McCain is bending the truth. The Senate bil leaves healthcare decisions exactly where they are, and reduces the deficit. McCain knows this. He also knows that the know-nothing element of his base automatically assume a “socialist” “big government” take-over of healthcare, because that is the nonsense they have been sold at least since the Reagan years. In short, McCain is a nihilist.
The Senate bil leaves healthcare decisions exactly where they are, and reduces the deficit.
Well, apparently bending the truth is a bipartisan sport. No one actually thinks this bill would reduce the deficit; that’s why most of the coverage doesn’t start until 2013 and revenue collection begins several years in advance.
You don’t extend coverage to thirty million people and reduce the deficit, promises of magical curve-bending free lunches notwithstanding. The CBO does the best they can, but anyone can game a model. Moreover, to the extent you accept the curve-bending cost-savings argument (and, presumably, the existence of unicorns), you undermine the argument about decision-making.
If cost-savings are achieved, it will have to be by making deliberate decisions affecting the quality and availability of care. There are no free lunches – either you’re reducing the deficit through deliberate cuts (making decisions about care and it’s availability) or you’re not reducing costs and the deficit isn’t being reduced. My view is that it would both centralize decision-making and not reduce the deficit (rising costs + expanding coverage would trump dwarf whatever cost savings were achieved). In any case, and back to the post, there’s nothing nihilistic about stating that the Senate gamed the CBO accounting process for this bill, and that it will lead to centralized decision-making about health care in the future.
Yes, I’ve heard this argument too and beyond the tautological “inability to project with certainty” point, I also don’t get it. The CBO has always been regarded as independent, which is why all sides have always trusted their analyses. In fact, it is set up in a way so that its assumptions are as conservative as possible, which again makes sense given its non-partisan position. Remember when Republicans were trying to force it to “dynamically score” tax cuts (i.e. you get revenue for free?).
I’m certainly not an expert on healthcare delivery systems, but I follow those who are. I was initially quite skeptical of the delivery system reforms in this bill, well aware that this (and not the insurance companies) is the real problem on the cost side. Right now, reimbursement is based on quantity of treatment, thus creating the incentive to overtreat.
That said, I was genuinely surprised by the excitement amont the experts on the delivery system reforms. These issues are not a matter of public debate, and people really don’t understand them, but they are real nonetheless. The main ones include the Medicare Commission, bundled payments, prudent purchasing (control over entry to exchanges), the excise tax on high-value health insurance, comparative effectiveness review, better health information technology, and the individual mandate. The experts claim that the CBO is being too conservative in some of its costings, which might be right.
Everybody keeps noting this is a complicated bill, and there is a reason for that. The healthcare system is complicated. Fixing it is complicated.
Ironically, this is private sector solution. Beyond the modest expansion in Medicaid, the newly insured will come under the auspices of private insurance. It is a nudge in the direction of Germany, France, and Switzerland – private health insurance combining the individual mandate and community rating. If this fails, and health care costs keep rising as they do, and employer-sponsored insurance diminishes, then the only solution will be to expand government programs. This is really the last best chance for private insurance.
Why would anyone trust corporate bureaucrats more ? Ask my Austrian parents I’d they’ve ever heard of “pre-existing” conditions – or a limit on sick leave.
Yes, I’ve heard this argument too…I also don’t get it.
Excellent. We’ve dispensed with the nihilism nonsense; you’ve heard the arguments, you just either disagree or ‘don’t get’ them. That’s politics, not nihilism.
The CBO has always been regarded as independent, which is why all sides have always trusted their analyses. In fact, it is set up in a way so that its assumptions are as conservative as possible, which again makes sense given its non-partisan position.
The CBO is independent, and, as I said, they do their best. But they adhere to certain guidelines that are fairly easy to game. The most obvious of which I alluded to earlier. They evaluate bills on a ten-year time horizon; in order to achieve ‘savings’ the bill starts significant spending in 2014, but collects revenues for several years before that. So during the ten-year time horizon, there are ‘savings’ or its ‘revenue neutral’. But, of course, really the budget will be increasing as soon as expenditures start occurring in 2014. The extra revenue from 2010 through 2013 will be spent by then, and so the deficit will increase. Here’s a chart which shows the CBO’s estimates for the spending on the healthcare reform bill:
http://twitpic.com/qol1i
That said, I was genuinely surprised by the excitement among the experts on the delivery system reforms.
That said, I was genuinely surprised by the excitement among the experts on the delivery system reforms. These issues are not a matter of public debate, and people really don’t understand them, but they are real nonetheless…The experts claim that the CBO is being too conservative in some of its costings, which might be right.
In other words, you have no idea how the ‘savings’ are achieved, but you trust people like Gruber, who received several hundred thousand dollars and didn’t disclose it, that the savings will appear. Well, you can call it nihilistic, but I’d say there’s a reasonable case for skepticism that the cost savings will be 1) as large as advertised 2) large enough to make the program fiscally sustainable(post 2014, that is).
Now, I’d like to see coverage expanded, and I’m happy with some of the smaller reform proposals that have been floated since Brown’s election. But I thought the Senate bill as proposed was a fiscal version of Russian roulette (again, once costs started in 2014), and I shared the Stupak type objections to the abortion funding in the bill. Hopefully a more modest bill will pass soon (and help people before 2014). In the mean time, again, I don’t think opposing the Senate bill was an act of nihilism.
In any case, and back to the post, there’s nothing nihilistic about stating that the Senate gamed the CBO accounting process for this bill, and that it will lead to centralized decision-making about health care in the future.
Nihilistic or not, there is something very ugly about saying contrary to the most widely accepted measure, one has theories that an initiatve may cost somewhat more than projected and therefore you would block the extention of health insurance to 30 million people without offering an alternative means to that end.
Kurt,
Take a look at the spending chart I linked to above based on the CBO projections. It’s quite clear that the bill was gamed to look like it would fiscally responsible, when, of course, the savings are a mirage. Now, I have no sympathy for the ‘I’ve got mine’ brand of resistance to the bill. But there were legitimate reasons to think it was fiscally irresponsible – and that the liabilities being created could do more harm than good.
For instance, here’s Mickey Kaus (no conservative), criticizing the ‘this will save money’ line:
Obama’s the one who fell for Orszag’s Laffer-curve-like, win-win, ‘this will save money’ line, and who raised the issue at every opportunity in the middle of 2009. It’s Obama who became infatuated with–and ordered his staff to read–Atul Gawande’s amorphous New Yorker curve-bending argument and Ron Brownstein’s even-less-convincing-than-it-seemed-at-the-time cheerleading piece. It was Obama who eagerly let himself get suckered into discussing end-of-life rationing in the pages of the New York Times.
http://www.slate.com/blogs/blogs/kausfiles/archive/2010/01/22/it-s-not-rahm-s-fault.aspx
Here’s Jerome Groopman in the New York Review of Books shredding (with actual data, rather than hopeful projections) the ‘comparative effectiveness research,’ which formed the basis of Orszag’s curve-bending cost-savings analysis:
http://www.nybooks.com/articles/23590
It’s not ugly to object to a bill that one thinks is 1) unlikely to significantly approve care (rather than a promise of care); 2) irresponsible from a financial perspective (and being advocated with obviously gamed analysis).
How can it not improve care? 30 million people who are not insured today will have insurance. People will be protected from dying or facing financial ruin because they cannot afford healthcare. The worst that can be said is that those with healthcare today will see no change (and this is largely true). But we should judge policy by how it affects the poor, the marginalized, the underpriviliged, the least among us.
The philosophy of this reform is rather simple, and it really is the only viable solution to the health care crisis. It’s something pretty much every country with the resources and capacity has figured out – healthcare provision must combine community rating with an individual mandate. Community rating guarantees solidarity, and the individual mandate makes it viable. Once this is accepted, it can be done with either the public or private sectors. Without this, millions will be left behind and at the mercy of powerful insurance companies, which is a violation not only of solidarity but subsidiarity.
So far, we have the guts of the Massachsetts reform. The federal reform goes quite a bit further by trying to “bend the curve” and contain cost growth. Naturally, this is murkier territory, but I have already listed a number of items in the bill that could make a significant impact (and I believe Atul Gawande is supportive, no?). The worst you can say is that these reforms have no significant impact and are just window dressing. But how could they possibly be worse than the status quo where not only is medicare going bankrupt but private health costs are rising at an ever faster clip, and being paid for by wage stagnation?
That is overall costs. Budgetary costs are rather easier to project, which is why I don’t get your skepticism. OK, you might think $100 billion in savings is optimistic, but it is still a stretch to think it would be worse than the status quo.
On this point, I will take you back to medicare part D – the Bush bill that increased federal spending more than proposed by the current Senate bill, and – to add insult to injury – without even the pretense of paying for it. Why was it that so many Republicans supported this but balk at a bill that is more modest fiscally, but will actually do far more good? Could it possibly be….nihilism? Occam’s razor suggests so.
On this point, I will take you back to medicare part D – the Bush bill that increased federal spending more than proposed by the current Senate bill
That’s simply not true, as any honest reading of the data would suggest. Here are the CBO estimates for the first ten years of Medicare Part D at the time it was passed (ah, the rose-colored glasses of bill passage). Total spending for the first ten years(once the spending actually starts) is around $550 billion.
http://www.cbo.gov/doc.cfm?index=6076&type=0#table1
Here is the projected spending under the health care reform bill at the time it was supposed to be past. Once the spending gets started (in 2014!), the first ten years cost $1.8 trillion.
http://twitpic.com/qol1i
Now, you’ll reply that there will be all sorts of cost-savings mechanisms in place that (really!) will reduce the costs, so that insuring 30 million people will save money. If you honestly believe that, and think it will cost less than Medicare Part D, well, there’s not really much more to say. I’d rather buy a bridge from a kindly man coming door-to-door than bet on that actually happening. And the more honest of the reformers, like Kaus above, admit as much.
Why was it that so many Republicans supported this but balk at a bill that is more modest fiscally, but will actually do far more good? Could it possibly be….nihilism? Occam’s razor suggests so.
Well, a starting point could be that the financial condition of the country was a lot different in 2005 than it is in 2010. Currently, we’re in the worst recession since the Great Depression, and the federal deficit is growing at an alarming rate. Now, deficit spending is good as a counter-cyclical measure, but expanding entitlements in 2014 is hardly counter-cyclical (at least, Obama better hope it’s not still counter-cyclical at that point). Republicans may have grudgingly accepted slightly higher deficits for Medicare Part D prior to the housing crash (and Democrats, you’ll recall, wanted a larger bill with even higher deficits), but it’s perfectly reasonable to be ok with x size deficit in prosperous times, but concerned about signing up for 5 times x in the worst recession in eighty years.
I don’t think the Senate bill is likely to pass at this point, so I’m disinclined to keep arguing about it. My original point was simply that calling people who oppose the health care reform bill ‘nihilists,’ particularly when that group includes a majority of the country, is not particularly persuasive.
Kurt,
“And would that be the bill passed by the House?”
My point being that the advocates of the Senate bill on this site have tried to get folks to look past the abotion support, despite the obvious contradiction between universal health care and the funding of the murder of the unborn.
And for the record IF the Democrats had been willing to drop abortion funding the House wouldn’t be such an issue and we probably would have had a bill passed. Instead the authors on this site seem more interested in bashing Republicans who have (until Brown’s election) no real power to block this bill. The opposition has come from the Blue Dogs and the Pro-life Democrats, who right recognize the contradiction pointed out earlier.
It may be salve for the wound to bash Republicans on this site, but until MM and the others actually hold the Democrats feet to the fire about abortion, no progress can be made on social justice since any advancement of aboriton will only undermine the inherint dignity of the human being. And any supposed gains in health care reform will be false and hollow.
As far as my ideas for healthcare go, not funding the murder of unborn children woudl be a good “starting point.” Then we can talk specifics.
A number of points.
First, the latest estimate of medicare part d is $964 billion over the first 10 years. And when you create a new entitlement, it’s a little myopic to look at only 10 years. The medicare trustees themselves declared that this new program would create a $9.4 trillion unfunded liability over the next 75 years. That is quite staggering.
Remember, you quibble with the cost savings, and seem to think this is worse than having no cost savings or revenue offsets whatsoever. On other words, this new entitlement is 100 percent deficit financed.
We should also be clear on another difference – the current reform is not a new government entitlement. The big expansion in health insurance is funded thorugh private premia. If anything, you can consider the subsidies to those below a certain income threshold to be an entitlement, but this is of a different order.
I simply don’t get you argument about Republicans changing their mind. You are stretching beyond the boundaries of reason. Yes, this is the worst downturn since the Great Depression (and would have been far worse had the Republicans been at the steering wheel). The problem is, the government did not have enouigh fiscal space to deal with such a problem, coming into it with a deficit that was far too high for normal times. This limited room for action and it also pushed debt into territory that might yet prove dangerous (it isn’t yet, not close).
The big spike in the deficit can be nearly fully explained by 2 factors – the recession, and the legacy of past policies. And here, there were 3 big ones – war, tax cuts, and medicare part d. All cost at least as much as the current healthcare proposals, none of them were offset, and all received big Republican support. And yet, when the recession arrived, they suddenly became fiscal hawks, which is the exact opposite of economic logic!
How can you possibly argue for fiscal prudence when you support increasing the largest item in the federal budget (military), resist any cuts to the largest entitlement (medicare), and actually support tax cuts, not increases?
Colin,
Again I ask since you say that we start with no abortion funding, are you supporting the House bill?
You keep pretending this major piece of legislation passed by one of two chambers of Congress doesn’t exist. You have on the table an actually existing piece of legislation that meets your criteria, yet you, the NRTLC and the March for Life are celebrating its possible demise.
Could you tell me who the advocates of the Senate bill are on this site? I don’t know a single one. On this site there are people like you who seems to oppose both the Senate and House bill, there are those like me who advocate the House bill and there are others who advocate something with the Stuapk language but even more robust than the House bill including a single payer system. I have not found a single poster advocating the Senate bill, though folks have made various comments about it.
The House bill DID drop any abortion coverage. The House Demcorats DID pass a bill without abortion coverage. You and the rest of the Right-Wing say that nothing can be done on social justice until the abortion issue is addressed. And when a health care bill is passed that is pro-life you just pretend it didn’t happen.
The Right-to-Life Movement has not only lost all moral authortiy and is affirmatively a force against justice. No one is obligated to support a movement so based on dishonesty and unjust political manipulation.
Kurt,
You misrepresent me completely and assume that I am simply a drone for your boogeymen (Right to Life, NRTLC, etc.).
I said simply that not funding the murder of children is a starting point. The House bill was passed yet Pelosi et al assured her constituents that abortion funding will be covered.
Several authors here have advocated that we should look past the abortion funding since it is only “material cooperation” (we are only sinning a little). See http://vox-nova.com/2010/01/06/the-good-the-bad-and-universal-health-care/ for an example.
The Democrats are the ones who are willing to nuke the bill over abortion funding (pro and con). My original point was two fold:
1. The Democrats fealty to abortion is what jepordizes this bill. The Republicans only now with Brown have any chance to stop the bill. Even the Democrats had just simply not funded abortion, the House bill would probably be law right now.
2. MM and others have insisted that we look past abortion funding in order to pass healthcare reform. Until the posters here realize that by advocating this bill despite abortion funding they only undermine their own cause (as amply shown by Democrats, see point 1).
You have yet to reply to the substance of my post and assume a variety of opinions about me. It may comfort you but it doesn’t conform to reality.
Even the Democrats…
Should read “If teh Democrats”
Oy! Cannot type today. “If the Democrats…”
Colin,
Senator Elect Brown has made it quite clear if the House bill was brought before the Senate today, he would vote no as would every other Republican member of the Senate.
We already know for a fact that every Republican House member (save one) voted no on the pro-life, universal coverage bill they had before them.
So please save us the objectively untrue assertion that all the Democrats have to do is put forward a bill without abortion funding. We already did and it got us ONE Republican vote.
It would be unfair to say the pro-life movement has sold out its principles like a ten cent lady of the evening. That is because it is not acting conrary to its principles but among and high of its principles is stopping health insurance for 30 million Americans regardless if abortion is a part or not a part of the bill.
Kurt,
Wow. Let us count the ways you misrepresent my point. I never claimed that the Republicans are acting on pro-life grounds. This is a claim YOU have made, and then attempt to point out the contradiction. I NEVER claimed such.
My point, again, is that it is the pro-life DEMOCRATS and the Blue Dogs that have slowed the bill down. For all the talk from the Republicans they had no power to stop the bill. Now with Brown they are now a player in the power struggle.
If the Democrats had put together a bill without abortion funding they could have passed a bill. (albiet if the pro-abortion dems would fall in line, which is a debateable point, but doesn’t disprove my main point). The point being is the Democrats fealty to abortion is what doomed this bill.
You have yet to address my original points. Your confusion as to who is responsible for slowing down the bill is quite sad.
BTW, your binary view of “those who oppose this bill want uninsured people to die” is slander. You may tell yourself this but you really only harm yourself in the long run.
Colin,
You keep repeating the same misstatement. It is not a debatable point as to if the pro-choice House Democrats would fall into line and support a bill without abortion funding. There is a public recorded vote of the House in which one Republican (Cao) joined with the vast majority of pro-choice and anti-abortion to pass a bill without abortion funding.
This is simple and objective fact. That you and so many others continue to deny this reality just adds to the overwhelming evidence that the Pro-Life Movement is about stopping 30 million people from getting health care rather than a movement solely dedicated to a Life agenda.
Kurt,
I think we are talking past each other.
I never denied that the House passed a bill that banned abortion. What I said was two fold:
The Republicans had NO POWER whatsoever to stop this bill (until now). They couldn’t. They didn’t have the numbers. The DEMOCRATS had the numbers that if voting on a straight party line could have passed anything.
It is the DEMOCRATS infighting over abortion. It is the DEMOCRATS, Pelosi, Reid, et at that forced a reconcilliation of the bills with the contentious abortion funding. Had the Senate adopted a bill with language similar to the Stupak admendment the reconciled health care bill would have hit Obama’s desk by now.
My main point this whole time is that while it must be fun for those on this site to bash Republicans it is the Democrats collapsing that allowed this bill to stall. And that collapse came because the DEMOCRAT leadership insisted on abortion funding.
The Republicans could only make noise. They didn’t have the numbers to stop this bill (again until now). If Pelosi, Reid, etc had accepted the House bill we would have the healthcare reform now. It is the Democrats, in their insistence that abortion be funded, that have killed this bill.
I’m not sure how to communicate my point further. So I’m pretty much ending this, since we don’t seem to be making headway.
Colin,
You repeatedly made statements in the future tense (“if only the Democrats would…”). Now you admit they did, except you think they took too much time getting there.
All but at most two pro-choice House Democrats* set aside their opinons on abortion and voted yes on final passage. Only a single Republican had the courage or principles to vote for the House pro-life health care bill. Every other Republican voted NO.
*Kucunich and Baird voted no on final passage dissenting from the Left, though neither said it was specifically the Stupak amendment that was their problem.
Kurt,
I’m sorry we can’t seem to communicate. I make point A, you counter argue point B. I never made point B. Never implied point B.
My point for the final record is that if the Democrats had voted on a straight party line, the healthcare bill would have passed in both houses. Instead, they chose to fight over abortion. The House bill didn’t have funding, the Senate bill did. The Democrat leadership made it very clear they were going to support abortion funding come heck or high water. It was this that caused the bill to now die. This is the only point I was trying to make.
I’m sorry we are talking past each other. Not sure where the communication breakdown is.
Yes, we need a way to let everyone be able to ride the train. But it does little good to wreck the train standing on the tracks and say ‘Good, now we can all get on, at least we did something’. Cheers
Colin,
You wrote on Jan.22 (long after the pro-life health bill passed) that “It is time to dump this bill and start over with real reform.”
Asked what real reform would be you said no abortion funding would be a starting point.
When it was pointed out that no abortion funding is exactly where the House bill is, you still blamed the Democrats.
Sure if the Congress had moved quicker in resolving the points of contention before the unfortunate Mass. elections, we would have a health care bill. And if even one Republican senator would stand up and say he would vote for the pro-life House bill, we would have it.
In the end, all but maybe 2 pro-choice House Democrats were willing to put aside their views on abortion to support universal coverage. Only one House Republican was willing to put aside Republican orthodoxy and vote for the pro-life House bill.
Rather than the Democratic leadership saying they would support abortion funding come heck or high water, every single member of the House Democratic leadership compromised their views on abortion and voted FOR the pro-life bill.