ObamaCare: The General Situation
[Posted by Karl]
As the Democrats’ attempted government takeover of the US healthcare system moves into the back rooms for a bit, it seems like a moment to take a step back from the trees and look at the forest.
Bob Laszewski (who reminded me of how important the CBO would be in this debate back in May) recently summed up this debate as “the coming convergence on Capitol Hill of three extraordinarily powerful, and contradictory, forces”: (1) the Democrats’ near-religious fervor on this issue; (2) the public’s anxiety — leaning toward disapproval — of the effort; and (3) the fact that the Dems still do not have a bill that can become law. Currently, I would say that (1) trumps (2) — though that could change once bills start emerging from those back rooms. Accordingly, it is (3) that is crucial.
Moreover, I tend to agree with Laszewski that “[t]he big issue is going to be money — just whose taxes are going to get raised to the tune of $500 billion to pay for it.” If the Baucus vapor bill’s tax on “Cadillac” insurance plans is unacceptable to Big Labor, and the House’s surtax on “millionaires” is unacceptable to moderates in both chambers (Democrats are the “party of the rich,” y’know), it is far from clear that those babies can be split — but then what?
This yawning chasm is why the Senate is going to try to pay off the AMA by fixing the Medicare Sustainable Growth Rate (SGR) fee cut problem off-budget and (ostensibly) separate from ObamaCare. But even if the Dems can clear the procedural hurdles to that shell game, they will have closed only about half of the gap.
The Dems also have to face the the Pushmi-pullyu of “affordability”, otherwise known as mandates and subsidies. The Baucus vapor bill gutted the fines for enforcing the individual mandate, but still requires insurance companies have to get rid of medical underwriting and pre-existing conditions provisions. That creates a “death spiral” for insurers, which is why they have belatedly leapt into opposing ObamaCare. Liberal wonks may want to dismiss the insurers, but the insurers’ studies and campaigns can fuel the pre-existing public opinion that ObamaCare will increase costs and decrease quality. Amping up that public anxiety would make it more difficult for the Dems to maintain the unity necessary to pass a bill.
Keith Hennessey also raises the potential for a fight over regional disparities in the subsidies, if they follow the approach in the Baucus vapor bill. For example, similar families would get a $6,365 subsidy in Las Vegas, Nevada, but only $3,220 in Portland, Maine. In contrasting high-cost vs. low-cost areas of the nation, I am sure it was coincidence that Hennessey picked the home states of Sen. Majority Ldr. Harry Reid and swing RINO Sen. Olympia J. Snowe.
If I have any disagreement with Laszewski, it is here:
The public option, employer mandates, a turbo-charged MedPAC? These are not the biggest issues. The White House will take any deal they can get and will quickly pressure liberals to back off wherever necessary.
These may not be the biggest issues, but the “public option” has become something of an article of faith on the Left, which is why we see House Speaker Nancy Pelosi trying to get centrists to sign on to a strong “public option,” just days after suggesting that liberals consider a watered-down “public option” — and why we see Sen. Maj. Ldr. Harry Reid and Sen. Chuck Schumer exchanging barbs over Reid’s not-so-veiled reluctance to include one in the merged bill in the Senate. If the “public option” is seen as dead or neutered too soon in the process, the Dems’ near-religious fervor likely cools a bit, making it harder to pass a bill.
Moreover, there are issues missing from Laszewski’s list that certainly will register with Congress. Subsidizing abortions and coverage of illegal immigrants may seem like sideshows to health policy analysts, but they are hot-button, high-intensity issues with voters, so attention should be paid. And there are the cuts to Medicare and Medicare Advantage that will antagonize seniors, who make up a disproportionate slice of the electorate, especially in midterm elections.
Given this set of issues, it is not surprising that despite Pres. Obama’s frequent declarations that the time for debate is over, House Maj. Ldr. Steny H. Hoyer says that Congress will probably be in session until mid-December and possibly even later. As time runs on, the Democrats may be tempted to exploit the budget reconciliation option they have been quietly keeping on the table. However, as Rick Weissenstein, a health care analyst for Washington Research Group, told CBS:
“I think it would be perceived, certainly by Republicans and moderates, as a last ditch effort to pass something that didn’t have popular support,” he said. “If you’ve gotten to that point, in some ways you’ve kind of lost the war.”
Indeed, with only 24% of voters nationwide saying Democrats should pass ObamaCare on a partisan basis, it is entirely possible that trying to pass the bill alone would sink it entirely.
–Karl
That the insurance companies thought they could cut a deal with these dirty socialist fanatics makes me feel very smart cause of even I knew better than that and makes them look very very stupid and like they really have no business being in business but I bet they still drive more better cars than me. I think this needs to be addressed.
happyfeet (f62c43) — 10/18/2009 @ 5:01 pmIt was hilarious to watch the Senior Senator from Montana on the Finance Committee debate Arlen Specter this morning on Fox regarding this bill – Specter won’t sign anything without a public option, while his counterpart won’t sign anything that includes it.
Dmac (5ddc52) — 10/18/2009 @ 5:20 pmKarl – I thought it was hilarious that Rahm had arm twisted the unions into staying silent on their opposition to the Baucus Vapor Bill while it was in committee. The day after it cleared committee, BOOM, full page advertising in the national press by what was it, 17 or 27 unions, announcing their opposition. Somebody needs to remind those UAW workers how to be properly grateful, the Chicago Way.
daleyrocks (718861) — 10/18/2009 @ 5:25 pmI watched Kent Conrad and felt that, if I trusted the DEmocrats, I might be interested in his ideas about non-profit coops in healthcare. That is close to the French system, which I believe to be the model for reform for the US. The trouble is that, even if Conrad is sincere, nobody in his right mind would trust the Democrats. The second impression is that Specter really is a despicable human being. I can see him as the defense attorney to Ira Einhorn. This disgusting story is right up there with child abuse as the most nauseating political story of the past 50 years. Specter is finally at home in the Democrat Party.
Mike K (2cf494) — 10/18/2009 @ 5:47 pmThe following isn’t totally OT because it does relate to the image of so many of the people currently in charge of decisionmaking and policies, including those pertaining to healthcare, being like a bunch of Bozos in a clown car. And almost none of them being reliable or trustworthy. One of the head drivers of that car — along with Bozo Obama, Bozo Pelosi and Bozo Reid — is Bozo Madame Secretary of State.
Mark (411533) — 10/18/2009 @ 5:49 pmHillary Clinton lying at Stormont? How apropos.
Brother Bradley J. Fikes, C.O.R. (0ea407) — 10/18/2009 @ 6:05 pm#4, Mike K, Arlen Specter’s treachery goes back over 45 years. He invented the absurd single bullet theory to protect the conspiracy that murdered JFK.
ropelight (ca73a6) — 10/18/2009 @ 6:38 pmQuiz:
Q. The statement “Pres. Obama’s frequent declarations that the time for debate is over” refers to what issue?
A) Global Warming
Teflon Dad (287a17) — 10/18/2009 @ 8:53 pmB) Obama’s Health Care Insurance Reform
C) Obama’s worthiness for the Nobel Pea Ce Prize
D) Hillary’s veracity
E) America is the Great Satan
F) All of the above
Obamacare is a secret plot to kidnap all Republicans give them pre-frontal lobotomies.
Prove I’m wrong.
David Ehrenstein (2550d9) — 10/18/2009 @ 9:08 pmMikeK, Specter has always been a Democrat despite having been elected as a Republican. He wanted to run for Philadelphia DA in the late ’50s. Philly had a Democratic DA at the time and Specter, then a Democrat, judged he could not win a primary against an incumbent supported by the local Democratic machine. So he ran as a Republican and won. The term RINO fit Specter to a T during his 40+ years as a Republican elected official.
He judged that he would lose the Republican primary for the 2010 Senate seat so he returned to the party where he is ideologically at home.
Stu707 (0981d5) — 10/18/2009 @ 11:02 pmObamacare is a secret plot to kidnap all Republicans give them pre-frontal lobotomies.
Prove I’m wrong.
Comment by David Ehrenstein
David had his years ago and can tell you that they are not so bad. Imagine what he would be like without it.
The public option is what this is all about. The left will not accept anything that does not have, at least, a provision that will pave its way. In the Baucus bill, the most likely is the mandate with inadequate penalty for failure to purchase, plus the guaranteed issue provision. This combination will kill conventional health insurance just as it has in Massachusetts and New York. They are not dead yet but both states are seeing the huge rise in premiums that is required to pay for the free riders. The next step is price control followed by collapse.
One reason why the health insurers bought into the Obama program was the fact that they don’t really want to be in the business; they want to be ASOs, as they are for self-insuring employers. They are ready to be the admin for single payer. We have talked about it where I work in the workers comp field.
Mike K (2cf494) — 10/19/2009 @ 9:40 am[…] the primary to sole imperative of Democrats was to “keep the process moving.” The general situation was always the Democrats’ ideological fervor trumping not only the public opposition to the […]
The Greenroom » Forum Archive » ObamaCare: What Went Wrong? (e2f069) — 2/5/2010 @ 9:49 pm[…] the process, the primary to sole imperative of Democrats was to “keep the process moving.” The general situation was always the Democrats’ ideological fervor trumping not only the public opposition to the […]
ObamaCare: What Went Wrong? »• for •, >> and » » Conservative Viewpoint Blog (1cad67) — 2/6/2010 @ 5:05 pm