Tag Archives: health care reform

Republican Calls for Repeal Invite Deficit Scrutiny and Skepticism

By Marc Seltzer; originally published on March 29, 2010 at care2.com

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Reform is Bitter Medicine

One aspect of President Obama’s health care reform legislation that has not received enough serious discussion is deficit reduction.  Despite claims that the legislation expands government, the non-partisan Congressional Budget Office (CBO) says that it will reduce the deficit by a significant amount over the next twenty years.

This has not stopped Republicans, such as Lindsey Graham, from announcing a campaign to “repeal and replace” the legislation.  What the Republicans have not said, is whether they would increase the deficit by such repeal, or find a way to match or improve upon the projected $130+ billion dollars in deficit reduction over first ten years and more than a trillion dollars in projected saving by 2030 contained in the Obama plan.  (Atul Gawande in the New Yorker gives some context)

It’s not hard to create popular legislation if it gives benefits that it does not pay for.  Remember that President Bush’s Medicare Prescription Drug benefit was popular, but was also a giveaway, increasing the deficit.  The harder part is to create legislation that lowers the deficit, without losing support among constituents, who like the idea of deficit reduction, but don’t want to see their own benefits taken away.

No matter what happens in November, President Obama would surely veto any attempts to repeal health care reform.  He may be open to improving upon current legislation, but he has promoted the “PayGo” (from pay-as-you-go) rule, which requires that new legislation not raise the deficit.  “PayGo” requires cuts in spending or increases in taxes to offset any new program spending.  “PayGo” led to surpluses in the Clinton presidency, and will again, so long as it is followed.  However, Republicans have no credibility on fiscal discipline.  They may run for office on a repeal platform, but will they propose alternatives to health care reform that cut the deficit?

Remember, repealing the current law would, in itself, raise the deficit, since Obama’s new legislation substantially lowers the deficit.

Republicans’ most appealing political argument, superficially, at least, against Obama’s health care reform, is that it takes money from Medicare.  Republicans claim it will bankrupt Medicare and hurt senior care.  Democrats refute these claims, arguing that the elimination of waste, fraud and abuse and the establishment of an independent panel to review Medicare spending will lower costs without cutting the quality of senior’s care.

An ongoing disagreement over doctor reimbursement rates may be another difficult challenge or an opportunity for creative problem solving, when it resurfaces in coming months or years.

It is no surprise that Republicans have come down on the side of spending more, and reassuring constituents, rather than bold action and fiscal responsibility.  But if Republicans are going to have any relevant part in the health-care debate going forward, they must be willing to offer potentially unpopular proposals that the CBO agrees will cut the deficit.  So far, Republicans have shown no appetite for the politically difficult task of cutting spending, not in Medicare, not in Social Security, and not in Defense.

President Obama has taken criticism for his stimulus spending.  But this was one-time emergency spending to stave off economic crisis, and the benefit of a rebounding economy should include increased tax revenues and a lowering of the deficit over time.  The President has since made it clear that he came to Washington to make the tough decisions, including long-term deficit reduction.  His health care reform triumph follows through on that promise.

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For more on health care reform:  You’ve Got to Hand it To Them:  Obama, Pelosi and Reid.

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You’ve Got to Hand it to Them: Obama, Pelosi and Reid

By Marc Seltzer; originally published on March 22, 2010, at care2.com

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Watching the proceedings in the House of Representatives tonight, I came away with an appreciation of just how strong the Democratic leadership is.  We all knew that Barack Obama had discipline in the way his presidential campaign never faltered.  He kept his eye on the prize and didn’t sweat the small stuff.  But the first year in office raised questions about how much political capital he had lost because of the economic downturn and the unpopularity of the government’s response.  Republicans refused to break ranks.  Democrats were split.  Then came Scott Brown.  How much would the President be able to accomplish?

Click here for the rest of the story.

“My Take” — Marc Seltzer on understanding politics

“My Take” podcast, March 12, 2010 (Click to hear)

Today’s topic is health care reform.  I discuss a few good articles (below) and a few bad misconceptions about current reform efforts.

Krugman “Health Reform Myths” in the New York Times

LA Times Cost Control the Key

Is Obama Winning? by Robert Shrum in The Week.

Disgraceful for Dems to Sabotage Health Bill.  This is the Real Clear Politics title, but its better than the original, “A Disgrace for the Democrats.” By Michael Tomasky.

Earmark Reform.   New York Times

President Obama Speaks to His House, King Harry to his Men

By Marc Seltzer; originally published on March 21, 2010, at care2.com

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The President gave a great speech to the Democratic Representatives (excerpts below) on the day before the health care vote in that body.  It reminded me of the glorious speech in Shakespeare’s Henry V made by King Harry to his men the day before battle.  I know it sounds like I am gushing Obama here, but I have taught Henry V to high school students for many years and I know this speech too well not to think of it.  It is one of the great speeches of all time.

Shakespeare’s language can be difficult, but what comes through is the greater pride in fighting a tough battle than an easy one.  Facing battle with France, Harry of England’s men have expressed their doubts and fears about their prospects against the French, who vastly outnumber them.  Would they be better off back home?  Would they be better led away from battle than into the slaughter? Or at least, could they not have more men on their side?

The beloved King responds:

“What’s he that wishes so?
My cousin Westmoreland? No, my fair cousin:
If we are mark’d to die, we are now
To do our country loss; and if to live,
The fewer men, the greater share of honour.
God’s will! I pray thee, wish not one man more.”

“By Jove, I am not covetous for gold,
Nor care I who doth feed upon my cost;
It yearns me not if men my garments wear;
Such outward things dwell not in my desires:
But if it be a sin to covet honour,
I am the most offending soul alive.”

“No, faith, my coz, wish not a man from England:
God’s peace! I would not lose so great an honour
As one man more, methinks, would share from me
For the best hope I have. O, do not wish one more!
Rather proclaim it, Westmoreland, through my host,
That he which hath no stomach to this fight,
Let him depart; his passport shall be made
And crowns for convoy put into his purse:
We would not die in that man’s company
That fears his fellowship to die with us.”

“This day is called the feast of Crispian:
He that outlives this day, and comes safe home,
Will stand a tip-toe when the day is named,
And rouse him at the name of Crispian.
He that shall live this day, and see old age,
Will yearly on the vigil feast his neighbours,
And say ‘To-morrow is Saint Crispian:'”

“Then will he strip his sleeve and show his scars.
And say ‘These wounds I had on Crispin’s day.’
Old men forget: yet all shall be forgot,
But he’ll remember with advantages
What feats he did that day: then shall our names.
Familiar in his mouth as household words
Harry the king, Bedford and Exeter,
Warwick and Talbot, Salisbury and Gloucester,
Be in their flowing cups freshly remember’d.
This story shall the good man teach his son;
And Crispin Crispian shall ne’er go by,
From this day to the ending of the world,
But we in it shall be remember’d
;”

“We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother; be he ne’er so vile,
This day shall gentle his condition:
And gentlemen in England now a-bed
Shall think themselves accursed they were not here,
And hold their manhoods cheap whiles any speaks
That fought with us upon Saint Crispin’s day.” (Henry V, Act 4.3, spacing added)

President Obama has something entirely different to say.  He is recognizing that Democratic congresspersons are making a vote that appears politically challenging.   But he calls on them to understand the importance of this moment in their lives as leaders, in the historic context of votes on Social Security, Medicare and Civil Rights, as well as in the needs of the American people for help with health care reforms.

President Obama:

“. . . Now, I can’t guarantee that this is good politics.  Every one of you know your districts better than I do.  You talk to folks.  You’re under enormous pressure.  You’re getting robocalls.  You’re getting e-mails that are tying up the communications system.  I know the pressure you’re under.  I get a few comments made about me.  I don’t know if you’ve noticed.  (Laughter.)  I’ve been in your shoes.  I know what it’s like to take a tough vote.

But what did Lincoln say?  “I am not bound to win, but I am bound to be true.”  Two generations ago, folks who were sitting in your position, they made a decision — we are going to make sure that seniors and the poor have health care coverage that they can count on.  And they did the right thing.

And I’m sure at the time they were making that vote, they weren’t sure how the politics were either, any more than the people who made the decision to make sure that Social Security was in place knew how the politics would play out, or folks who passed the civil rights acts knew how the politics were going to play out.  They were not bound to win, but they were bound to be true.

And now we’ve got middle class Americans, don’t have Medicare, don’t have Medicaid, watching the employer-based system fray along the edges or being caught in terrible situations.  And the question is, are we going to be true to them?

Sometimes I think about how I got involved in politics.  I didn’t think of myself as a potential politician when I get out of college.  I went to work in neighborhoods, working with Catholic churches in poor neighborhoods in Chicago, trying to figure out how people could get a little bit of help.  And I was skeptical about politics and politicians, just like a lot of Americans are skeptical about politics and politicians are right now.  Because my working assumption was when push comes to shove, all too often folks in elected office, they’re looking for themselves and not looking out for the folks who put them there; that there are too many compromises; that the special interests have too much power; they just got too much clout; there’s too much big money washing around.

And I decided finally to get involved because I realized if I wasn’t willing to step up and be true to the things I believe in, then the system wouldn’t change.  Every single one of you had that same kind of moment at the beginning of your careers.  Maybe it was just listening to stories in your neighborhood about what was happening to people who’d been laid off of work.  Maybe it was your own family experience, somebody got sick and didn’t have health care and you said something should change.

Something inspired you to get involved, and something inspired you to be a Democrat instead of running as a Republican.  Because somewhere deep in your heart you said to yourself, I believe in an America in which we don’t just look out for ourselves, that we don’t just tell people you’re on your own, that we are proud of our individualism, we are proud of our liberty, but we also have a sense of neighborliness and a sense of community — (applause) — and we are willing to look out for one another and help people who are vulnerable and help people who are down on their luck and give them a pathway to success and give them a ladder into the middle class.  That’s why you decided to run.

And now a lot of us have been here a while and everybody here has taken their lumps and their bruises.  And it turns out people have had to make compromises, and you’ve been away from families for a long time and you’ve missed special events for your kids sometimes.  And maybe there have been times where you asked yourself, why did I ever get involved in politics in the first place?  And maybe things can’t change after all.  And when you do something courageous, it turns out sometimes you may be attacked.  And sometimes the very people you thought you were trying to help may be angry at you and shout at you.  And you say to yourself, maybe that thing that I started with has been lost.

But you know what?  Every once in a while, every once in a while a moment comes where you have a chance to vindicate all those best hopes that you had about yourself, about this country, where you have a chance to make good on those promises that you made in all those town meetings and all those constituency breakfasts and all that traveling through the district, all those people who you looked in the eye and you said, you know what, you’re right, the system is not working for you and I’m going to make it a little bit better.

And this is one of those moments.  This is one of those times where you can honestly say to yourself, doggone it, this is exactly why I came here.  This is why I got into politics.  This is why I got into public service.  This is why I’ve made those sacrifices.  Because I believe so deeply in this country and I believe so deeply in this democracy and I’m willing to stand up even when it’s hard, even when it’s tough.

Every single one of you have made that promise not just to your constituents but to yourself.  And this is the time to make true on that promise.  We are not bound to win, but we are bound to be true.  We are not bound to succeed, but we are bound to let whatever light we have shine.  We have been debating health care for decades.  It has now been debated for a year.  It is in your hands.  It is time to pass health care reform for America, and I am confident that you are going to do it tomorrow.”  (Source link below)

President Obama’s Speech to Democratic Representatives March 20, 2010 (video link).

Click here for the transcript of the speech.

Follow the vote live this afternoon on C-Span.  Coverage beginning at 1:00 p.m. Eastern Time and culminating with a vote at 6:00 p.m. (this could change).

Marc Seltzer’s writing and podcasts at https://marcivanseltzer.wordpress.com/

Universal Coverage or Maintaining the Status Quo?

Photo credit: cdc.gov

By Marc Seltzer; originally published on March 13, 2010 at care2.com.

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For all the smoke and mirrors, all the outrageous claims, and all the frustration about what is not in the Democrat’s health care reform legislation, the fundamental impact of the proposed reform is very simple.  The Senate bill, soon to be voted on by the House, uses public funds to insure Americans who do not have insurance.  (Making sense of the polling, from the Washington Post)

In providing for universal coverage, it satisfies President Obama’s preeminent campaign goal — one he has not walked away from despite profound economic turmoil and deep political resistance.

It is amazing that the debate over such a simple idea took so long and involved so many distractions.

Republicans do not want to spend public funds to insure the uninsured — plain and simple.  Though they do not say it so clearly, instead, hiding behind claims that the deficit, the recession, and public opinion polls are the reason that the bill is wrong for America.

Smoke and mirrors.  (Krugman dispels some myths)

President Obama seeks to add an entitlement, consistent with contemporary democratic principles of capitalism with a social safety net.  Republicans, consistent with principles of individual effort and individual reward, seek to resist it.

What is more puzzling is why the left is so fractured in its desire for reform.  There has not been a serious proposal for an open-enrollment public option or for single payer public insurance on the table since the beginning.  This is not to say that the United States wont move towards public insurance or public medicine in the long run.  But with only a subsidy and insurance regulation on the table, the left’s threats to undermine President Obama’s universal coverage program because it does not do away with the for profit medical system makes little sense.

What would make sense is to take a longer range view:  To believe that universal coverage is an important step in the direction of providing good care for all; to trust that reforms included in this legislation can be used to regulate for-profit insurance practices to eliminate exclusions and rescissions which kept people who wanted insurance from receiving it; and to recognize that a variety of reasonable cost-containment measures will be used to slow the growth of health care inflation.

I have written often about deficits and debt, reform of fee for service medicine and changing financial incentives in health care.  And I think this legislation is serious medicine for the problems we have in these respects.  And I have spoken with Canadians and Europeans who love their publicly funding health care systems.  And I still think that this legislation is a serious attempt to insure that all Americans can receive adequate health care.  If I were like most supporters of this health care reform, I would say that this legislation is poor, for one reason or another, and then suggest that it was the best we could get under the circumstances.  But this legislation is powerful, historic and designed to solve the problems we face.  So why, complain?

Pass the bill.

(Sign the petition)
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More thoughts on national issues: my podcast ramblings and conversations with Jessica Pieklo.

March 19, 2010 Update:  Paul Krugman sounding more positive, as well, in the New York Times.

Podcast March 10, 2010

“My show” podcast — March 10, 2010

David Leonhardt’s article on health care finance.

Why don’t we leave the lawyers alone?  Detainee lawyers criticized by Lynn Cheney, while other conservatives come to their aid.  (New York Observer commentary) (New York Times article)  The left criticizes Bush administration lawyers.  This is politics.  The lawyers are doing their job, fulfilling an important role in the system — in both cases.  What do you think?

The Chief Justice wonders, “why we’re there” referring to the State of the Union address and Obama’s criticism of the court.

Podcast March 9, 2010

March 9, 2010 “My Show

Health care reform vote counting.  Tension or media hype? (Wall Street Journal)

Democrats and Republicans differ on universal coverage.  Cost cutting in tax on high value insurance plans gets little credit.

Military tribunals and civilians courts.  Will legislating the answer help or hurt?