Patterico's Pontifications

6/17/2009

Obamacare as Obamacomedy

Filed under: General — Karl @ 9:56 am

[Posted by Karl]

Conservatives for Patients Rights is calling Obamacare an “old joke,” but it is rapidly resembling a comedy of errors filled with bad new ones.

The wheels of the Congressional clown car started coming off when Senate Budget Committee Chairman Kent Conrad admitted not only that the Left’s beloved “public plan” option doesn’t have the votes, but also that trying to railroad Obamacare through as part of the budget reconciliation process was not a viable option. The AMA opposition to any “strong” public plan was also a big red flag.

In the first ring of our circus, you could see the panic among the punditocracy. David Broder started banging the drum for the more bipartisan Wyden-Bennett bill. Al Hunt started praying that a government takeover could be saved by former Senators Tom Daschle, Bob Dole and Howard Baker. And David Brooks dreamt that Obama will force Congress to give up contol of government spending on healthcare to the Medicare Payment Advisory Commission — all through a process that suggests Brooks outsourced his column to underpants gnomes.

Indeed, in the second ring, the gnomes also may have been responsible for the half-baked Kennedy-Dodd markup of healthcare “reform,” which the Congressional Budget Office said would cost a trillion dollars and force about 15 million people off of their employer-based coverage, while extending coverage to only 16-17 million of the uninsured. The Obama administration ran away from the story like the plague, while The New Republic’s Jonathan Cohn literally tried to calm his readers with a clip from National Lampoon’s Animal House. Spoiler for Mr. Cohn; Kevin Bacon ends up trampled flat. Similarly, with private estimates of a Kennedy-Dodd bill providing universal coverage ranging as high as $4 trillion, and the inclusion of a public option pushing as many as 119 million out of the coverage they generally like, taxpayers will keep running when Kennedy-Dodd is scored in full.

Over in the third ring, the ostensibly more realistic Senate Finance Committee has yet to get all of the plates spinning:

Several officials said the Congressional Budget Office had issued a cost estimate of $1.6 trillion, with only about $560 billion paid for. They spoke on condition of anonymity, saying the matter was confidential.

Sen. Max Baucus, D-Mont., chairman of the panel, dismissed the estimates as outdated, and officials predicted the final bill would come in under $1 trillion.

Sen. Kent Conrad, D-N.D., said that with cost estimates coming in so high, “It is clear there have got to be changes made to make the whole package affordable.”

Those missing hundreds of billions of dollars ensure still more comedy gold as Dodd and Baucus openly feud over the unpopular proposal to tax health insurance benefits, which Obama opposed as a massive middle-class tax hike during the campaign.

Baucus and Obama would also like to slash hundreds of billions from Medicare and Medicaid over the next decade. This proposal is a laff riot on several levels. First, there is the rank hypocrisy of a Democratic proposal that Democrats would mercilessly demogogue had it been made by the GOP. Second, the broad-based cuts put the lie to the fantasy of expert bureaucrats surgically rationing healthcare. Third, widening the gap between public and private payment rates would shift more of the costs to private premium payers, ultimately forcing even more people into whatever public plan the Left would propose.

Ringmaster Obama hit the road to sell massive new government spending as the way to control massive government spending, but on this issue, there isn’t one born every minute.

Maybe ABCNews is rushing to air its Obamacare infomercial next week because it’s the last week they can air it without a laugh track.

UpdateThe Hill has even more Democratic flailing and infighting.  Deadlines are being pushed back.  Democratic constituencies are getting unhappier with the Congressional sausage.  Tyler Cowen seems surprised at how quickly health care reform is being crushed between Lefty demands and the CBO.

–Karl

45 Responses to “Obamacare as Obamacomedy”

  1. I haven’t looked at the details but just what is Obama proposing that will cost $1.6 trillion?

    He’s planning on giving health care to those without insurance (he’ll structure it as giving them health insurance but the end result is he’s giving them health care for free)… does anybody how much would this cost, how much of the total is this?

    And what is he planning on doing that would cost whatever was left over? I doubt he’s offering anyone better insurance coverage (less cost, more coverage) than what they have with their private plans, so where is this pot going? To pay for the tens of thousands of new government employees to administer this mess?

    steve sturm (369bc6)

  2. What nobody seems to understand is that it would be cheaper to give the uninsured the money for a bare bones health insurance policy than to uproot 100 years of evolution of American healthcare. The problem with that proposal is that it would not lead to another 500,000 government jobs to manage the new program. Therefore, it is a non-starter.

    Continued cuts in Medicare will drive all the good physicians out of it and into market systems. In a way, that might solve some of the problem but it will guarantee that the poor will get screwed once again.

    The only thing Obama has going for him is the slavish support of the media that is not reporting on all the scandals that are blossoming.

    Mike K (90939b)

  3. steve sturm,

    Of course, Obama really doesn’t have a plan — and Baucus is stalling on the $1.6 billion version.

    However, the Kennedy-Dodd bill is spending it mostly on new subsidies for individuals to buy insurance. It’s a phase-in, so the true cost would be much larger in the out years.

    Karl (f07e38)

  4. Mike K,

    The Left rejects your proposal because they are ideologically opposed to a two-tier system. So they are making plans that will result in a two-tier system. But they aren’t happy about it — they want a closed-loop, no private care system of the sort Canada and others have been forced to abandon. Not a surprise — Leftists live on the conceit that this time, progressive bureauucrats will get it right.

    Karl (f07e38)

  5. Isn’t that referred to as the Eternal Leftist Conceit, Karl?

    JD (50d704)

  6. Why would sane people allow the take-over of the health-care system by the same people that are denying adequate health-care to Native-Americans, Veterans, and the Aged, whom they have promised to serve?
    This is like taking your car to the DMV for a tune-up.

    AD - RtR/OS! (65f6c2)

  7. Do you think the new plan will cover aspirin? I just want an aspirin.

    Maybe two.

    Em (b2bb53)

  8. If the GOP had any brains left at this juncture, they’d hammer away at the runaway Medicare and SS programs, and ask the Dems to “reconcile” those budgetary disasters before this one is even encountered. The majority of the heretofore “ignorant masses” that the Dems are relying on to allow this thing to pass are finally waking up to our impending financial disaster.

    Dmac (f7884d)

  9. This is masterful and it really should be published in print. (This is one of the few times I wished I owned a major newspaper.) I read it twice: Once for content and a second time to make sure I didn’t miss any of the great circus metaphors.

    DRJ (180b67)

  10. Several officials said the Congressional Budget Office had issued a cost estimate of $1.6 trillion, with only about $560 billion paid for. They spoke on condition of anonymity, saying the matter was confidential.

    Why? National security?

    KB (5a6552)

  11. Circuses have clowns. Clowns are evil. I am scared of clowns. ‘Nuff said.

    JD (50d704)

  12. JD,

    The Obama Administration does remind me of Krusty the Klown‘s quest for money, fame, and power. Not to mention its willingness to bet against the Harlem Globetrotters free market.

    DRJ (180b67)

  13. I will not click on that link, thank you very much.

    JD (50d704)

  14. The problem with that proposal is that it would not lead to another 500,000 government jobs to manage the new program. Therefore, it is a non-starter.

    As well as the fact that it doesn’t put money where it’s supposed to go.

    Let us be clear on this matter. Obamacare is not about extending health insurance. It is about coming up with a legal way for the government to get the trillions of dollars Americans spend on healthcare annually into its pockets, using peoples’ health as an excuse.

    What the Obama Party wants is the same setup as Social Security, where you pay cash now in exchange for an IOU whose terms are completely subject to the whim of the person who is giving you the IOU. They are depending on the fact that the vast majority of their base has no risk in this process, since they pay nothing up-front.

    This is rapidly reaching the point where the only solution is similar to Diomedes’s mares — we need to cut off the Federal government and let those who it’s been feeding human flesh for decades come and devour it.

    North Dallas Thirty (416e07)

  15. However, the Kennedy-Dodd bill is spending it mostly on new subsidies for individuals to buy insurance. It’s a phase-in, so the true cost would be much larger in the out years.

    What’s your proposal, Karl?

    Is there any medley of plans that might contain costs and enhance competition, or are those abject goals?

    steve (628a2c)

  16. I was not aware that Karl is in Congress. Maybe Teh One should lay out his detailed proposal first. Nah. Silly idea.

    JD (df39e3)

  17. Here is my plan – keep government out from between me and my doctor. The government has no business in this business.

    JD (df39e3)

  18. JD, that’s what I find so bizarre. Obama is doing all this hoopla and propaganda … but without any plan of his own to back it up.

    Zip, zilch, nada.

    A circus barker selling tickets but without an actual, like, circus sideshow.

    SPQR (72771e)

  19. C’mon, steve. Shouldn’t Teh One actually present a detailed plan first? Or, should we just take his word for it like with the “stimulus”?

    JD (df39e3)

  20. steve,

    Megan McArdle says it nicely:

    I’d say we have substantial empirical evidence that we are not going to control the health care cost inflation which is busting Medicare’s budget, much less the new costs the administration is planning to add. We have been trying to control health care costs since the 1970s made it clear that Medicare was going to get really, really expensive. And any idea that you care to name, from comparative effectiveness research to healthcare IT to preventive medicine . . . these have all been on the table for more than thirty years, under one name or another. They haven’t happened.

    The answer that those promising magical cost reductions need to ask is “Why haven’t they happened?” and “What has changed to make them feasible now?” But when I ask this question, I get angry demands that I put forward my plan for cost control, rather than merely critiquing everyone else’s. This seems rather like demanding that I put forward my design for a perpetual motion machine before I am allowed to point out problems in the US energy market.

    Karl (f07e38)

  21. If your position is that the federal government has no business or Constitutional authority for doing this in the first place, there is no need to put forward a competing plan. What is it with the Left and their “plans” anyway? Kerry and Silky Pony had a plan for everything, though some were super-duper double top secret.

    JD (df39e3)

  22. I have been recommending the French system as a model for real reform. Details here, with the next several posts explaining how it might be done. The basic principle is that the French set a national fee schedule that the health plans (and note there are several) pay but patients can pay more and good doctors can charge more. It removes some of the moral hazard but keeps freedom of choice and fee-for-service which makes the doctor work for the patient and not the plan. The fee schedule is lower than ours but medical education is free.

    What if our government set a national fee schedule for all doctors and hospitals (they do now but it is distorted) and made a deal that young doctors could abide by the fee schedule and in return their student loans would be gradually forgiven ?

    The way to do this is gradually and with input from all sides. The Bush Medicare Part D, which I thought would be a disaster, is actually well under projections.

    Mike K (90939b)

  23. The basic principle is that the French set a national fee schedule that the health plans (and note there are several) pay but patients can pay more and good doctors can charge more.

    That is exactly what Medicare doesn’t do now, isn’t it? With Medicare, doctors are not allowed to take more money from patients than Medicare allows. Doctors who don’t accept Medicare are also not allowed to see Medicare patients, even if the patient is willing to pay for the service.

    MayBee (cca412)

  24. Hello, hottie ;-) !!!

    JD (dab43d)

  25. [...] Patterico’s Pontifications for the more on that score: The wheels of the Congressional clown car started coming off when [...]

    How To Counter ABC’s Health Care Propaganda On June 24 « Nice Deb (05b5a7)

  26. This seems rather like demanding that I put forward my design for a perpetual motion machine before I am allowed to point out problems in the US energy market.

    Yeah, it’s JUST like that.

    Megan McArdle (former nom de blog, Jane Galt) never cites a source other than “a former prof said” and “I have some friends who know something about this, and they say…”

    An inability to tell the difference between anecdote and evidence is not going to advance the health care debate.

    steve (e34ca8)

  27. That’s pathetic, steve. That’s all you have got?

    SPQR (26be8b)

  28. No.

    Is throwing rocks from the curb all you got?

    steve (e34ca8)

  29. steve – Since Obama is the freakin’ President, and he is the one that is proposing nationalizing the healthcare system, don’t you think he should actually put a detailed plan out there for people to discuss and review? Or, for a matter this big, should we just take his word on it? Why demand of your political opponents, who are not in power, what your own people will not produce?

    steve – How do you plan on paying for this, and what will be done differently this time around to control costs?

    JD (dab43d)

  30. Judgement!, Brilliance!, Transparancy!, Bi-Partisanship!

    O!

    Bob (99fc1b)

  31. JD!

    steve – Since Obama is the freakin’ President, and he is the one that is proposing nationalizing the healthcare system, don’t you think he should actually put a detailed plan out there for people to discuss and review? Or, for a matter this big, should we just take his word on it? Why demand of your political opponents, who are not in power, what your own people will not produce?

    Exactly. Man’s gonna have a big ABC special about health care, and he isn’t even writing the bill. How about ABC invites the Congressional Dem and Rep onto the show?

    My favorite thing is how he talks about “his plan”. All the promises he makes are based on his plan, which doesn’t exist.

    MayBee (cca412)

  32. #14
    “…we need to cut off the Federal government and let those who it’s been feeding human flesh for decades come and devour it.”

    Totally agree. The only way to fix this boat is to sink it and build a new one.

    Corwin (ea9428)

  33. The costs are so staggering that, for the first time in my financial management career, I had to resort to scientific notation to figure the annual per capita cost.

    $1,600,000,000,000 (or $1.6 x 10^12) covers 18,000,000 (1.8 x 10 ^7) people for 10 years (1.0 x 10^1). That works out to $8,889 per person per year.

    If this program is so great (and for that level of cost it should be), why isn’t Congress covered under it?

    arch (3a7360)

  34. steve’s response to the McArdle quote was one part ad hominem, one part snark, no parts substance.

    The when steve was asked, “is that all you got?”, his answer as, “No,” but then added nothing of substance. Which suggests his answer should have been “Yes.”

    Karl (ade276)

  35. Is steve done mooning everyone ?

    JD (dab43d)

  36. MayBee – We know, politically, why they are not releasing the details of the plan – by all measures, whenever people start talking about the details of their “plan”, it becomes less and less popular. They are not going to get bogged down by little things like rationing, punitive fines, etc … on their route to national healthcare nirvana.

    JD (dab43d)

  37. steve’s response to the McArdle quote was one part ad hominem, one part snark, no parts substance.

    I see NO substance in glibly stating that “we are not going to control the health care cost inflation.”

    “All of us must be assured of access to reasonably priced health insurance,” as Sen. Tom Coburn plaintively argues.

    Megan McArdle might as well say we no longer possess the entrepreneurial vision and skills to develop the products that people want at a price they can afford.

    Coburn and Paul Ryan propose a “Medi-Choice” tax rebate that will give individuals $2,200 and families $5,700 to spend on health insurance. Who’s buying?

    steve (35f1d9)

  38. Where is Barcky’s plan, steve?

    JD (d3f3ab)

  39. Exactly. Why is it that Obama has no plan at all?

    SPQR (72771e)

  40. steve writes:

    I see NO substance in glibly stating that “we are not going to control the health care cost inflation.”

    She didn’t glibly state it. She stated it as a conclusion based on the historical evidence, as part of an argument that those claiming it will happen now ought to explain why conditions have changed now.

    And it appears that neither you nor Obama have said explanation.

    steve also writes:

    Megan McArdle might as well say we no longer possess the entrepreneurial vision and skills to develop the products that people want at a price they can afford.

    The mistake in this analogy is that steve (shocka) seems to have no grasp of the distinction between the private sector and the public sector. The former has a track record of being entrepreneurial and innovative; the latter, not so much. What we are seeing now is Congress attempting to make a “product” (service) that people will want at a price they can afford. And they are failing, as they have in the past.

    Karl (f07e38)

  41. So, you’re on board with the Coburn-Ryan scheme?

    steve (35f1d9)

  42. steve – Do you any intention of actually engaing in a discussion?

    JD (d3f3ab)

  43. ” … might as well say …”

    Translation: I might as well invent another strawman to attack.

    **yawn**

    SPQR (72771e)

  44. That is exactly what Medicare doesn’t do now, isn’t it? With Medicare, doctors are not allowed to take more money from patients than Medicare allows. Doctors who don’t accept Medicare are also not allowed to see Medicare patients, even if the patient is willing to pay for the service.

    Comment by MayBee

    With Medicare, they have an allowance and a payment. It was once possible to be non-participating and collect a deposit (some elderly patients will get a check that is for six providers and they can’t remember who gets what) and charge the regular fee but they would pay the same regardless of whether you were “participating” or not. They will also not let you do more than Medicare allows, as some geriatric specialists have found out the hard way.

    Medicare now pays about 25% of billed charges for surgeons. They have cut the payments by close to 50% in the past 25 years. What is now happening is some surgeons dropping out of Medicare completely, giving up provider numbers. Then they are practicing for cash for Medicare patients. Many internists have limited their Medicare patients to 10 to 20% of their practice. The optimum, according to practice consultants, is 11%.

    The only fellowship trained geriatric specialist in central Iowa dropped out of Medicare completely because she was being harassed and she is totally private now and totally for cash. She is making a living although not getting rich.

    There will be more and more of this unless some sensible reform happens. In a way, it is the libertarian option. Going John Galt.

    It isn’t just Medicare. I was at a vascular meeting a few years ago. At the time, the best place to be if you had an aortic arch aneurysm was the Ochsner Clinic at Tulane. They had the best results so everybody used to refer their cases unless they were too critical to move. At the meeting, the chief of vascular surgery got up and announced that the financial loss on these cases was so great they could no longer accept transfers. They hated to say it but they lost $250,000 on each case.

    There is a war on technology going on. Cardiac and vascular surgery have taken the biggest hits and fewer people are going into those fields. The actual dollar payment for lower leg bypasses has dropped by two thirds in the past 20 years. Some of those cases take seven hours.

    Mike K (90939b)

  45. The twin demons of bad government and bad lawyers, Dr. K.?

    Eric Blair (0b61b2)


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