Who’d have thought CSPAN was going to be the most dramatic thing on TV this weekend?

Some assorted commentary on the impending health care bill vote in the House, which is slated for Sunday and which will in part resolve the long-running issue one way or the other.

Managed Care Matters: Unsustainable, irrational, unaffordable health reform

The Republican Congress passed and then-President Bush signed into law Medicare Part D which added about $8 trillion to our national debt. Now the Democrats want to one-up the GOP by passing what would be a massive entitlement expansion, with no meaningful cost containment. They want us to believe we can expand coverage now and fix the cost issue later.

No, we can’t, and no, we won’t. It is far more difficult to get people to give things up they already have than to convince them they can’t afford those things in the first place.

The health care reform debate has provided all the evidence we need to see how hard it is to get physicians, or insurance companies, or unions, or voters, or employers, or state regulators, or pharma, or device companies to agree to give back business/rights/revenue/coverage they have today.

Bob Laszewski said it well in his post today – “adding 30 million more people to an unsustainable system expecting it will create an even bigger crisis and thereby force real reform is tantamount to reboarding the Titanic in the hopes it will sink faster. It is also hard to see how doing such a thing is the politically courageous thing to do.

Just where is the moral imperative in ramming a trillion dollar entitlement expansion through knowing full well it will make our long-term deficit nightmare even worse–for those now uninsured and for everyone else?

The Democratic health care bill makes little if any systemic changes to the health care system–certainly not at the level we need.”

Neither party is acting in the best interest of the nation, or of their own constituents for that matter. And anyone who believes we can pass it now and fix it later is living in a fantasy world.

Insureblog: Obamacare in a Nutshell

Let me get this straight……we’re trying to pass a health care plan written by a committee whose chairman says he doesn’t understand it, passed by a Congress that hasn’t read it but exempts themselves from it, to be signed by a president that also hasn’t read it and who smokes, with funding administered by a treasury chief who didn’t pay his taxes, all to be overseen by a surgeon general who is obese, and financed by a country that’s broke.

What could possibly go wrong?

Insureblog: The Future is Now

As my better half is fond of telling me, “there are no coincidences.” Her point is that everything, no matter how seemingly insignificant, happens for a reason, a purpose.

I just experienced a “no coincidence” moment.

As is my wont, I had clicked over to read the latest at PowerLine, perhaps the most thoughtfully written political blog extant. A contributor had this to say:

“[T]he care-seeking population is about to become the Baby Boomers — i.e., the most indulged, demanding and complaining generation in a hundred years, or maybe ever. The Dems are (apparently) fixing to take over medicine at exactly the time The Giant Complaining Horde shows up at the door … people with money will still come out ahead … knowing I had a potential problem, I paid $4,000 out of my own pocket for an exotic annual physical exam beyond what insurance would reimburse.”

This is a critical point because, as my better half has also observed, “this [ObamaCare] isn’t about health care at all, it’s about control.” That is, even if it passes, it won’t address the underlying problems of health care and, indeed, will most likely exacerbate them by formalizing a two- (or even three-) tiered health care system. Currently, insurers can merely deny payment for a particular med or procedure; under a gummint-run system, the bureaucracy can actually withhold treatment. And then what?

Well, then one goes outside the system to one of the practices that has chosen not to participate…

Health Care Policy and Marketplace Review:Passing the Democratic Health Care Bill is Not the “Right Thing To Do”

Any big health care bill will be full of compromises—political or otherwise. But this bill doesn’t even come close to deserving to be called “health care reform.” As the Democrats make their final push to pass their health care bill many of them, and most notably the President, are arguing that it should be passed because it is the “right thing to do whatever the polls say.”

Their argument is powerful: We will never get the perfect bill. If this fails who knows how long it will be before we have another big proposal up for a vote. There are millions of uninsured unable to get coverage because of preexisting conditions or the inability to pay the big premiums and this bill would help them.

But as an unavoidable moral imperative, enacting this bill would fall way short:

• It is unsustainable. Promises are being made that cannot be kept. As the President has said many times, we need fundamental health care system reform or the promises we have already made—the Medicare and Medicaid entitlements, for example—will bankrupt us. What few cost containment elements the Democrats seriously considered are now either gone from their final bill or hopelessly watered down—most notably the “Cadillac” tax on high cost benefits and the Medicare cost containment commission.

• It is paying off the people already profiting the most from the status quo. Many of the big special interests, that will have to change their ways if we are really going to improve the system, are simply being paid off for their support. The drug deal, the hospital deal, promises not to cut or change the way physicians are paid, all add up to more guaranteeing the status quo rather than doing anything that will bring about the systemic change everyone knows is needed.

• Nothing in these bills will fundamentally change our current fiscal course. As the CBO, and every other expert has said, if this bill becomes law we will continue on the same cost trajectory we are already on. Yes, the CBO says the Democratic plan will reduce costs during the next ten years by about $100 billion—but that only means they would be $100 billion less than the $35 trillion they would have been anyway! That is merely a rounding error on the track we are already on.

• There is nothing here that will stop unaffordable health insurance rate increases. Lately supporters have said this bill is the solution to the recent big individual health insurance rate increases we have been reading about in the press. But there is little in this bill that will mitigate or control any such increases because so little would be done to impact underlying health care costs.
We often hear the argument, “Let’s get this entitlement expansion bill passed and it will force us to deal with costs later.” If we don’t now have the political courage to face daunting health care costs in the face of exploding deficits how will we have that courage later?

I will suggest that adding 30 million more people to an unsustainable system expecting it will create an even bigger crisis and thereby force real reform is tantamount to reboarding the Titanic in the hopes it will sink faster. It is also hard to see how doing such a thing is the politically courageous thing to do.

Just where is the moral imperative in ramming a trillion dollar entitlement expansion through knowing full well it will make our long-term deficit nightmare even worse—for those now uninsured and for everyone else?…

Proponents of the Democratic health care bill make the claim that it will make health insurance affordable, improve our deficit outlook, and make our health insurance system sustainable. None of those claims are even close to being true and everyone who knows anything about this debate knows that.

Robert Reich: Health Care 2010 and 1994, and the Political Lessons of History

Health care reform is necessary, and House Democrats should vote for it because it’s best for the nation.

They should also remember the political lessons of history…As the White House and the House Democratic leadership try to line up 216 votes to pass health care reform — and as Republicans, aided by the National Association of Manufacturers and abetted by fierce partisans like Newt Gingrich, try to kill it – I can’t help thinking back to 1994 when the lineup was much the same.

I was serving in the Clinton administration at the time. In the first months of 1993 it looked as if Clinton’s health care proposal would sail through Congress. But the process dragged on and by 1994 it bogged down. We knew health care was imperiled but none of us knew that failure to pass health care would doom much of the rest of Clinton’s agenda and wrest control of Congress out of the hands of the Democrats. In retrospect, it’s clear Republicans did know.

On February 5, 1994, the National Association of Manufacturers passed a resolution declaring its opposition to the Clinton plan. Not long after that, Michigan Democrat John Dingell, who was managing the health care bill for the House, approached the senior House Republican on the bill to seek a compromise. According to Dingell, the response was: “There’s no way you’re going to get a single vote on this [Republican] side of the aisle. You will not only not get a vote here, but we’ve been instructed that if we participate in that undertaking at all, those of us who do will lose our seniority and will not be ranking minority members within the Republican Party.”

In early March, 1994, Senate Republicans invited Newt Gingrich, then House minority leader, to caucus with them about health care. Gingrich warned against compromise, a view echoed by Senator Phil Gramm. A few months later, at a Republican meeting in Boston, Bob Dole, then Senate minority leader, promised to “filibuster and kill” any health care bill with an employer mandate.

By then Gingrich had united House Republicans against passage of health reform and told the New York Times he wanted “to use the issue as a springboard to win Republican control of the House.” Gingrich predicted Republicans would pick up thirty-four House seats in the November elections and half a dozen disaffected Democrats would switch parties to give Republicans control.

By August, it was over. It didn’t matter that Democrats outnumbered Republicans in the Senate by 56 to 44 and in the House by 257 to 176. Health care was a lost cause. Republican Senator Bob Packwood boasted to his colleagues “We’ve killed health care reform.”

In early September, William Kristol of the Project for the Republican Future spelled out the next stage of the Republican battle plan: “I think we can continue to wrap the Clinton plan around the necks of Democratic candidates.” And that’s exactly what they did. On November 8 voters repudiated President Clinton. They brought Republicans to power at every level of government. Democrats went from a controlling majority of 257 seats in the House of Representatives to a minority of 204, and lost the Senate.

I remember how shocked we were the morning after the votes were counted. I asked one of Clinton’s political advisors what had happened. “It was health care,” he said, simply. (That advisor, by the way, is now in the Obama White House.)

Today’s Republican battle plan is exactly the same as it was sixteen years ago. In fact, it’s been the same since President Obama assumed office. They never were serious about compromise. They were serious only about regaining power. From the start, Republicans have remembered the lesson of 1994. Now, as they prepare to vote, House Dems should remember the lesson as well.

Keith Hennessey: The inside game

In the past I have at least been able to fool myself into thinking there was a rational basis for my projections. Now I’m just guessing. I will stick with two in three (chances of the bill passing) for the moment, but I am now just picking numbers out of thin air based on some slightly informed guessing…

That’s because this is now entirely an inside game into which I have extremely limited visibility. If the Speaker can get 216 votes for two bills, then it’s over. But only a handful of people really know how far she is from that goal.

Since I cannot offer you genuine insight, I hope some broad observations will suffice, informed largely by my experience working for the best vote-counter in Senate history, Trent Lott. Senator Lott once said to me, “Keith, I know you were a math major. I’m going to teach you how to count.”

I hope you will accept these dozen observations in lieu of a real prediction.

1. The President and Democratic Congressional leaders have created an external appearance of momentum. That is necessary but not sufficient for legislative success.

2. Public expressions of confidence mean little. Democratic Leaders have to predict success whether they believe it or not, because those predictions affect momentum.

3. For some Members the substance matters. (I know, that sounds terrible.) We have not yet seen the text of Bill #2 or CBO scoring of it. Additional risk will be introduced as soon as those become public, probably within the next 36 hours. How many times so far have we seen CBO scoring trip up the majority?

4. There is a huge difference between needing 1-4 votes and needing 8-10 vote. I don’t know which she is really facing.

5. Effective vote counters pick up the easy votes first, so by this time each additional vote is nearly intractable.

6. Sometimes you bring a bill to the floor a few votes shy, thinking you can close those last few votes only when the vote is occurring. That’s a huge gamble. You do it only when you have no better option.

7. Senate Democrats are an underappreciated wildcard, as is the Byrd rule. Will Senate Democrats blindly accept the substance of Bill #2, or will they try to amend it before passing it? Can Senate Republicans use the Byrd rule to force a change and therefore another House vote? Because of these wildcard factors, House Democrats should be asking their leaders if they might have to vote again on Bill #2 after the Senate considers and possibly changes it, and maybe after the Easter Recess.

8. I wish I knew how well the House and Senate Democrats are coordinating. I imagine the trust and execution gaps on Bill #2 are among the largest hurdles the Speaker faces. If they are poorly coordinated, then I would expect some bumps once the legislative text is revealed.

9. The Saturday vote target is irrelevant. They will slip it as needed.

10. If the House passes Bill #2, assume 3 days minimum for Senate consideration. The motion to proceed is non-debatable, so that takes only 20 minutes for a vote. Twenty hours of debate typically takes two full days, plus one more for the vote-a-rama. House passage this Saturday would allow plenty of time for Senate consideration of Bill #2 and for completion of both bills if the Senate does not amend Bill #2. If the Senate does amend Bill #2, then the time for a second House vote on Bill #2 could bump up against the recess deadline. Of course, in this scenario Bill #1 is already on the President’s desk.

11. At least as of 2008, the phones still worked on Air Force One. I believe they have working phones in Indonesia and Australia as well. The President’s trip delay is much more about the optics of him being here (or more accurately, the downside optics if he were not here) than about his practical ability to influence votes.

12. So much for transparency. Bill #2 is being drafted in the Speaker’s office. So much for regular order in the legislative process, or open debate, or amendments… As recently as two weeks ago the President was admitting that they “could have done better” on transparency. We will never know the extent of side deals being cut to lock down votes, since many of them will be delivered outside this legislation.
Your guess is as good as mine.

EconomistMom.com: It’s a Good Plan. In 10 Years, Maybe</strong

The good ideas are all still there in some size or shape, but it’s fascinating how some of the most promising features in the health reform bill have been diluted and/or postponed so much that they barely show up in the official ten-year window of the official CBO cost estimate.

Take the excise tax on high-end employer-provided health insurance plans… In order to get the labor unions on board, the tax now doesn’t take effect until 2018. Partly to make up for that newly lost time with the excise tax, and partly to cover the additional cost of now-higher subsidies offered through the new insurance exchanges, the excise tax was modified with less generous indexing starting in 2020–indexing the threshold to general inflation rather than inflation plus one percentage point…

The revenue estimate shows that the excise tax now only raises $32.0 billion in the ten-year budget window, because it barely gets started within the ten-year window. In contrast, $210 billion–more than half of the total $409 billion in revenue raised–comes from the increased Medicare tax on high-income households, which would start in 2013.

However fair one thinks it is to increase taxes on the rich, this Medicare tax is not a tax on health spending (it’s another income-based tax), and so it’s not a tax that can keep up with rising health costs as a reliable offset for expanded health coverage.

Ironically, the (fiscally-wise) excise tax now scores as providing less than half the amount of deficit reduction within the ten-year budget window as the (somewhat-budget-gimmicky) Community Living Assistance Services Support (CLASS) program, which is shown as raising $70.2 billion, even though we know that over the longer-run CLASS is a new entitlement which is expected to be a net drain on the federal budget…

So in the overall assessment the health reform/reconciliation bill isn’t full of gimmickry (it’s only tinged with it), does still contain some good health policy in it, was scored fairly and as accurately as possible by CBO. And it does officially show a net $138 billion in deficit reduction in the ten-year budget window. If all goes as planned (as written in this bill), in ten years there will be a decently-large excise tax on employer-provided health insurance in place, and the IPAB (commission) will be recommending wise ways to reduce Medicare and overall health costs. In ten years we will have learned something from the demonstration projects about how to save money, and we’ll implement those ideas more broadly throughout our entire health care system. And thus we will start “bending the health cost curve.”

That is, unless we don’t. Unless we get to 2018 when the excise tax is supposed to kick in and say “wait, we don’t want to pay that tax.” And unless we get to 2020 and say, “no, hospitals aren’t going to accept those recommended payment reductions.”…

So it might be a good plan if you look at where the bill says we should be in 2020, if we actually follow through when we get there.

And by the way, even if we follow through, we still won’t have solved the problem of unsustainable health costs and federal entitlement benefits and not enough ways to pay for them….