Why the health-care bill isn’t reform.
Robert J. Samuelson
There is an air of absurdity to what is mistakenly called “health-care reform.” Everyone knows that the United States faces massive governmental budget deficits as far as calculators can project, driven heavily by an aging population and uncontrolled health costs. Recovering slowly from a devastating recession, it’s widely agreed that, though deficits should not be cut abruptly (lest the economy resume its slump), a prudent society would embark on long-term policies to control health costs, reduce government spending, and curb massive future deficits. The president and his top economic advisers all say this. (Click here to follow Robert J. Samuelson ).
So, what do they do? Just the opposite. Their sweeping overhaul of the health-care system—which Congress is halfway toward enacting—would almost certainly make matters worse. It would create new, open-ended medical entitlements that would probably expand deficits and do little to suppress surging health costs. The disconnect between what Obama says and what he’s doing is so glaring that most people could not abide it. The president and his allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both.
The campaign to pass Obama’s health-care plan has assumed a false, though understandable, cloak of moral superiority. It’s understandable because almost everyone thinks that people in need of essential medical care should get it; ideally, everyone would have health insurance. The pursuit of these worthy goals can easily be projected as a high-minded exercise in the public good.
It is false for two reasons. First, the country has other goals—including preventing future financial crises and minimizing the crushing effects of high deficits or taxes on the economy and younger Americans—that “health-care reform” would jeopardize. And second, the benefits of “reform” are exaggerated. Sure, many Americans would feel less fearful about losing insurance; but there are cheaper ways to limit insecurity. Meanwhile, improvements in health for today’s uninsured would be modest. They already receive substantial medical care; insurance would help some individuals enormously, but studies find that, on average, gains are moderate.
The pretense of moral superiority dissolves before all the expedient deceptions used to sell the health-care agenda. Obama says he won’t sign legislation that adds to the deficit. One way to do this is to put costs outside the legislation. So: doctors have long complained that their Medicare reimbursements are too low; the fix for replacing the present formula would cost $210 billion over a decade, says the Congressional Budget Office. That cost was originally in the legislation. Now it’s been moved to another bill, but because there are no means to pay for it, deficits would increase.
Another way to disguise the costs is to count savings that, though they exist on paper, would probably never be realized in practice. The House bill claims reductions in Medicare reimbursements of $228 billion over a decade for hospitals and other providers. But Congress has often prescribed reimbursement cuts that, under pressure from providers, it’s later rescinded. Claims of “fiscal responsibility” for the health-care proposals reflect “assumptions that are totally unrealistic based on past history,” says David Walker, former U.S. comptroller general and now head of the Peter G. Peterson Foundation.
Equally misleading, Obama’s advisers assert that the present proposals would slow the growth of overall national health spending. Outside studies disagree. Three studies (two by the consulting firm the Lewin Group and one by the Centers for Medicare & Medicaid Services, a federal agency) conclude that various congressional plans would increase national health spending compared with no legislation. The studies estimate the extra spending, over the next decade, at $750 billion, $525 billion, and $114 billion, respectively. The reasoning: greater use of the health-care system by the newly insured would overwhelm cost-saving measures (“bundled payments,” “comparative effectiveness research,” tort reform), which are weak or experimental.
Though these estimates could prove wrong, they are more plausible than the administration’s self-serving claims. Its health-care plan is not “comprehensive” because it slights cost control; and if its spending commitments worsened some future budget crisis, it wouldn’t qualify as “reform.” It would be a self-inflicted wound.
© 2009
The absurd right wing scare tactics never end. With the right wingers its always about the money it seems. Its almost as if the moral imperative to take care of the less fortunate is a wasted argument on the far right. The right claims the moral , in touch with God high ground and yet turn their backs on the people with no money.
I for one do not see this as a money issue. Affordable health care is a moral imperative to me. We must do more for our citizens who cannot afford the coverage that big insurance provides. I am willing to pay more so others can have some decent care.
It is not about the money!
Dave, you’re absolutely right. It is a moral issue. But because Mr. Samuelson is so worried about money, I refer back to an earlier piece I posted. The CBO reports that President Bush left Barack Obama with over a trillion dollar deficit. I don’t remember Robert J. Samuelson, or anyone else for that matter, signaling an alarm about the deficit when Bush/Cheney were scoundering billions in Iraq.
In fact, of all people, Fox News’ Neil Cavuto shut down Dick Morris the other day when Morris started leveling blame for the deficit on President Obama, reminding Morris that Obama inherited a huge deficit from George Bush. Cavuto went on and gave the current president credit for being honest and posting the cost of the two wars in the budget. Bush always kept the wars’ expense off budget.
However, back to your point: we have a moral obligation to provide affordable, quality health care for all Americans.
I just read a statement by a gentleman named Bruce McQuain on qando.net that adresses the moral obligation to provide healthcare much more eloquently than I could myself. He says, “In a free country if you feel you have a moral obligation to provide health care to others, no one will stop you from acting to provide it. However, in a free country, no one will force you to act on what they arbitrarily choose to define as a “moral obligation” and with which you don’t agree.”
And yet, the Right Wing feels they have the moral authority to stop a woman’s right to choose,.. or to intervene in a husbands wishes, (terri Shivo)
And.….. I do provide health care for my 30 employees, even though we get “rationed” health care from our insurance providers. Just yesterday I was rationed by my insurance company on my doctors choice of BP med for myself. I have a letter that says I must use a differentdrug and call for permission monthly AND get a letter from my doctor monthly to keep my RX,… oh yeah at the maximum co-pay. My current health choices are limited by some bean counter at an insurance company,… not my doctor now. I can afford to pay the difference, most cannot.
The “exempt from anti trust” insurance industry makes it so difficult to get health care now through their rationing system! Find one person who wants off medicare in favor of a for profit system and I will be surprised.
If we follow Mr. McQuain’s reasoning, then no one should be forced to pay taxes for police, fire, public libraries, Social Security, national defense, Medicare, Veterans Administration, and on and on we could go. After all, some one else “arbitarily” chose to define many of these things as a moral obligation; for example, someone long before I came along labeled paying to protect my neighbor from fire, crime, old age poverty, illiteracy, and foreign invasion as moral obligaitons that rest upon my shoulders as a citizen of society—-and as a human being. I accept those obligations. I also accept that it is my moral obligation to assist my government in promoting the general welfare, which includes making affordable, quality health care available to everyone in the land.
Dave, I understand that your insurance carrier can appear to be obstructionist in it’s stance toward covering certain drugs. However, your insurance contract had defined co– pays with a defined formulary that dictated coverage before you purchased the coverage. The insurance company’s stance on coverage of drugs is hardly rationing or arbitrary. I assure you, I respect the fact that you provide your employees insurance coverage. You are putting your money where your mouth is in regard to your feeling that health care is a moral obligation. But, you are also putting yourself at a competitive advantage with employers who do not offer health insurance. You are able to recruit and retain employees because you offer generous benefits and other employers do not. Your concern about anti trust exemption for health insurers is something I’d like to know more about if you are willing to sit down and discuss it.
But Jim, paying for police, fire department, national defense etc., are not something I am willing to pay for because it’s a moral obligation. I, and most other fair minded people, pay for these services because we are protected by police, fire, and the armed forces. Your rights end when your rights interfere with mine.
Once again Dan,.. NO this was not a part of my original agreement with my carrier. In fact I got the notification of changeof terms yesterday. My contract is not up until Feb 2010. Once again, Insurance companies ration healthcare every day by bullying doctors and insured alike.
They change the rules in the middle of the game frequently. They may not outright deny coverage but they make it so tricky that they effectively ration.
Regarding ant-trust,.. all you have to do is google mccarren fergusen and read about the back door deals done by politicians to protect the insurance industry from free market rules.
And yes being a good employer has given me a strong market advantage,.. why don’t right wingers get that? Being generous and good to your fellow man is not only the right thing to do,… the universe pays you back in abundance.
Dave, I guess we will have to disagree that a change in terms , which is likely allowable in the contract, is bullying. I ‘m not sure how you define right wingers, but conservatives are some of the most personally generous people I know. They just don’t think it is the role of government to impose a certain level of generosity.
Dan , you are correct, many conservatives and Liberals are generous.
Left wingers can be just as extreme.
It seems to me that conservatives see life as a transaction and liberals see life as a relationship. Just my opinion;)
Dan, I never said that you considered it a moral obligation to provide fire or police protection to your neighbor; I said “someone else” considered those services a moral obligation.
There was once a time when communities had competing fire companies. Houses literally burned to the ground because two fire companies would show up to a fire, then spend valuable time arguing over which company the fire fighting responsibilities rested with; sometimes no fire company would fight the fire because the owner hadn’t paid for fire protection. These tragedies led reformers to call for communities to have one publicly financed fire department—make everyone pay for the benefit of everyone else as well as themselves. A principal motivations behind this reform was the biblical admonition “To love your neighbor as yourself” or the more general Golden Rule—“Do unto others as you would have them do unto you.” In other words, people of good will simply could not live in good conscience knowing that someone’s house was turned to ashes because that person could not pay for a fire company’s protection.
Dan, having debated and discussed with you on this blog for several weeks, I have a hard time believing that you don’t think that it’s a moral obligation to pay for fire protection for your neighbor as well as yourself. If I am right about that, then simply transfer that philosophy to health care.