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Politics : President Barack Obama -- Ignore unavailable to you. Want to Upgrade?

To: ChinuSFO who wrote (66981)	12/18/2009 2:05:23 AM
From: stockman_scott	Respond to of 149317

The Hardest Call _______________________________________________________________ By DAVID BROOKS Op-Ed Columnist The New York Times December 18, 2009 The first reason to support the Senate health care bill is that it would provide insurance to 30 million more Americans. The second reason to support the bill is that its authors took the deficit issue seriously. Compared with, say, the prescription drug benefit from a few years ago, this bill is a model of fiscal rectitude. It spends a lot of money to cover the uninsured, but to help pay for it, it also includes serious Medicare cuts and whopping tax increases — the tax on high-cost insurance plans alone will raise $1.3 trillion in the second decade. The bill is not really deficit-neutral. It’s politically inconceivable that Congress will really make all the spending cuts that are there on paper. But the bill won’t explode the deficit, and that’s an accomplishment. The third reason to support the bill is that the authors have thrown in a million little ideas in an effort to reduce health care inflation. The fact is, nobody knows how to reduce cost growth within the current system. The authors of this bill are willing to try anything. You might even call this a Burkean approach. They are not fundamentally disrupting the status quo, but they are experimenting with dozens of gradual programs that might bend the cost curve. If you’ve ever heard about it, it’s in there — improved insurance exchanges, payment innovations, an independent commission to cap Medicare payment rates, an innovation center, comparative effectiveness research. There’s at least a pilot program for every promising idea. The fourth reason to support the bill is that if this fails, it will take a long time to get back to health reform. Clinton failed. Obama will have failed. No one will touch this. Meanwhile, health costs will continue their inexorable march upward, strangling the nation. The first reason to oppose this bill is that it does not fundamentally reform health care. The current system is rotten to the bone with opaque pricing and insane incentives. Consumers are insulated from the costs of their decisions and providers are punished for efficiency. Burkean gradualism is fine if you’ve got a cold. But if you’ve got cancer, you want surgery, not nasal spray. If this bill passes, you’ll have 500 experts in Washington trying to hold down costs and 300 million Americans with the same old incentives to get more and more care. The Congressional Budget Office and most of the experts I talk to (including many who support the bill) do not believe it will seriously bend the cost curve. The second reason to oppose this bill is that, according to the chief actuary for Medicare, it will cause national health care spending to increase faster. Health care spending is already zooming past 17 percent of G.D.P. to 22 percent and beyond. If these pressures mount even faster, health care will squeeze out everything else, especially on the state level. We’ll shovel more money into insurance companies and you can kiss goodbye programs like expanded preschool that would have a bigger social impact. Third, if passed, the bill sets up a politically unsustainable situation. Over its first several years, the demand for health care will rise sharply. The supply will not. Providers will have the same perverse incentives. As a result, prices will skyrocket while efficiencies will not. There will be a bipartisan rush to gut reform. This country has reduced health inflation in short bursts, but it has not sustained cost control over the long term because the deep flaws in the system produce horrific political pressures that gut restraint. Fourth, you can’t centrally regulate 17 percent of the U.S. economy without a raft of unintended consequences. Fifth, it will slow innovation. Government regulators don’t do well with disruptive new technologies. Sixth, if this passes, we will never get back to cost control. The basic political deal was, we get to have dessert (expanding coverage) but we have to eat our spinach (cost control), too. If we eat dessert now, we’ll never come back to the spinach. So what’s my verdict? I have to confess, I flip-flop week to week and day to day. It’s a guess. Does this put us on a path toward the real reform, or does it head us down a valley in which real reform will be less likely? If I were a senator forced to vote today, I’d vote no. If you pass a health care bill without systemic incentives reform, you set up a political vortex in which the few good parts of the bill will get stripped out and the expensive and wasteful parts will be entrenched. Defenders say we can’t do real reform because the politics won’t allow it. The truth is the reverse. Unless you get the fundamental incentives right, the politics will be terrible forever and ever. Copyright 2009 The New York Times Company

To: ChinuSFO who wrote (66981)	12/18/2009 4:15:58 AM
From: stockman_scott	Read Replies (1) \| Respond to of 149317

Health Care Dies at Hands of One Angry Man: Commentary by Margaret Carlson Dec. 18 (Bloomberg) -- Health-care reform is dead. Time of death: 6 p.m., Dec. 15, 2009, Connecticut Standard Time. Signing the certificate: Senator Joseph Lieberman, the former Democrat turned Independent turned health-care slayer. In retrospect it’s easy to see that no bill with competition for the insurance industry would get Lieberman’s vote, although Democrats tried. Out went the opt-out public option, the opt-in public option, triggers and co-ops. Still Lieberman was unhappy. Finally with only days to spare Democrats proposed a Medicare buy-in for those aged 55 to 64. That was sure to please Lieberman since it was his idea. Yes, he was for a Medicare buy- in (in September) but that was before he was against it (in December) because by then it had Democratic cooties on it. On Sunday, Lieberman, hiding behind fiscal prudence, said he would wait for the Congressional Budget Office to score the Medicare expansion before deciding. But he just couldn’t wait. On Monday he announced his unequivocal opposition. That’s when White House ally and leading outside expert cheering for the bill, former Vermont Governor Howard Dean, folded his tent, calling the weakened bill “a bigger bailout for the insurance industry than AIG.” Senator Bernie Sanders has announced he won’t vote for the bill. What’s telling is that the White House got angry at Dean for coming out against a bill that had been gutted, but held its fire against Lieberman who’d done the gutting. The generous view of the coddling of Lieberman -- he got to keep his committee chairmanships after campaigning for John McCain last year -- is that Barack Obama must hold on to him to get to a 60-vote, filibuster-proof majority. Giving Cover The ungenerous view is that Lieberman gives cover to a watered-down bill that is consistent with agreements made with the drug and insurance industries by Obama, who is as determined to be known as the man who brought civility to the capital as the one who brought competition to Aetna. Look how reasonable a Democrat can be. In exchange for promising to deliver $80 billion in savings, Big Pharma wouldn’t be pressured to give high-volume discounts on drugs nor subject to imports of cheaper medications. When a bill came up this week that would allow re-importation of Canadian drugs, it went down with the blessing of the White House. As for insurers, they could get 30 million new customers. All they would have to do is forgo a Harry-and-Louise-type anti- reform ad campaign and drop the insidious practice of insuring as few people likely to get sick as possible while purging their rolls of those unlucky enough to get seriously ill. Bury the Option The only brake on that windfall was the possibility of competition. But back in June, White House Chief of Staff Rahm Emanuel told members of Congress that Obama was “open to alternatives” to the public option, which turned out to mean open to burying it. Then on Sunday, Emanuel begged Senate Majority Leader Harry Reid to agree to drop the Medicare buy-in if Lieberman objected. The gutted bill turns insurers into too-big-to-fail bankers. For insuring those with pre-existing conditions (but still charging an arm and a leg for it), insurers get millions of new customers -- many of them young and healthy and forced to buy coverage -- all with no competition from a public program. What’s in this for Lieberman has less to do with protecting insurance companies than his seething contempt for his former Democratic colleagues and concerns for his political future. His Democrat Derangement Syndrome began in 2004 when he didn’t get the party’s presidential nomination. In 2006 it deepened when he was challenged by an anti-war Democrat who beat him in the primary election forcing him to run as an Independent to keep his seat. Lieberman’s Luck Then Lieberman got lucky in a three-way general election running against two flawed candidates. Democrat Ned Lamont never broadened his appeal much beyond opposition to the Iraq war. Republican Alan Schlesinger, a small town mayor and serious (but losing) gambler who played at an Indian casino under an assumed name, was so weak the Republican governor suggested he step aside. Instead, he helped Lieberman win. Lieberman is unlikely to be so fortunate again. In 2012 his political future rests on getting the Republican nomination. If the cost of admission is going against the very reforms he’s supported his whole life, then so be it. In outrage at Lieberman’s latest move, liberal bloggers have gone from trying to stop him to trying to hurt his wife by calling on celebrities on the board of Susan G. Komen for the Cure, a breast-cancer advocacy and education group, to drop Hadassah Lieberman as its global ambassador. The sins of the husband simply can’t be visited upon the good works of a spouse. It would be like deporting Elin Nordegren for Tiger Wood’s behavior. This very bad bill may have to go but not at the expense of Obama’s civility. (Margaret Carlson, author of “Anyone Can Grow Up: How George Bush and I Made It to the White House” and former White House correspondent for Time magazine, is a Bloomberg News columnist. The opinions expressed are her own.) To contact the writer of this column: Margaret Carlson in Washington at mcarlson3@bloomberg.net Last Updated: December 17, 2009 21:00 EST