Health Care Reform | Two Old Friends Chat Each Other Up

A note from an old friend begins...

Hey Jim, since you've gone political on us, a few questions. First, where is your proof for all these claims? Second, where is Obama's "plan" so I can read it? He's never put it in writing. It remains a moving target. Third, all these points are high claims, most of which are being disputed by reputable people and groups, even within Obama's camp (ie. the CBO). I'm sorry, but most of us don't want the government to mess with the world's best heath care. :)


And I respond...

hey; nice to hear from you. I haven't used any numbers that aren't documented in the links from the blog posts in this series on health reform. I'll be happy to dial that in for you if you have trouble finding something.

I ought to have linked this morning's post—sorry; i thought it was more widely available than perhaps it is. You can find the list of essentials here.

The Congressional Budget Office is not in President Obama's camp any more than the Institute of Medicine that produced the 2004 guiding principles was in President Bush's camp. The CBO is chartered specifically to provide economic data to Congress.

My understanding of the CBO health care numbers that seem, as far as I can tell, to be thrown around fairly haphazardly, is that they were requested and delivered in response to first drafts of the health care bill while it was still in committee—multiple committees if I have the story right.

So it's like the first blue sky draft of most any kind of budget: Everyone on the committee puts in everything he or she would like to have and, if it's a good brainstorm, nobody says "we can't afford that" because nobody knows what it costs yet and there are no bad ideas in a first draft.

It's the job of CBO to count costs, not make policy. They put a good faith estimate on what's placed before them and, in many cases—probably most—the sticker price for the gold-plated, handmade, spare not expense first draft of the plan is a splash of cold water in everybody's face. I imagine you've read some film scripts that reflect that process.

Harmonizing a bill that's actually deliverable is what the committees have to do before they put it on the floor of the House or Senate to be further amended and sent yet again to the CBO for cost analysis.

The CBO letter to Congressman Rangel on July 17, 2009 roughly projects the House bill (H.R. 3200) as proposed would produce a reduction of the deficit of about $44BN from 2010-2014 and an increase to the deficit of about $65BN from 2015-2019. These numbers are nothing like the ones thrown around in Knucklehead Nation which I think, generously, must have come from the CBO estimates on the first draft.

So, already, the bill the House is considering is more measured than most of us have been led to believe, and it will be even more realistic before they're done with it.

All this craziness about ObamaCare from the Knuckleheads has been sound and fury signifying nothing but their knuckleheadedness because, as you note, other than what he posted during the campaign (which I don't think many people actually read) he hasn't put a plan in play until now—he is not, after all a legislator and seems to respect the separation of powers to a degree that makes his predecessor look like the socialist dictator his detractors claim the president is.

Putting his plan up now, as chief executive and leader of his party seems about right to me, but I think he's mostly right about this stuff so take that for what it's worth.

...and with this I close: By the end of 2008, the percentage of Americans covered by government-sponsored health insurance plans rose to 29%. Increasingly, I think the "most of us don't want this" refrain depends on getting the right people in the room (or studio) and wording the questions very carefully. In the last decade—much of which was decidedly Republican depending on how you look at it—private health care subscribers grew by one tenth of a percent while public health care subscribers grew by nearly 30%. Assuming a lot of that growth is Boomers, we're not going to see a decline in that shift any time soon.

OK, I'll try to tackle these one at a time. My point in citing the CBO (part of the gov't.) is that it is contrary to Obama's preposterous claim that it won't cost us (the taxpayers) a nickel or add a dime to the deficit.

The Knuckleheads you talk about are, in many cases, disputing Obama's claims and can substantiate their arguments as good or better than Pres. O can. But we're just talking generalities here...

And yes, I'll stand with my comment that the President really has no "Plan". Its not written anywhere and never has been. His speeches have put it in play but its like nailing jello to the wall. Let's see the "Plan" and then lets debate the merits, the solutions and the costs. Wouldn't that be fair?

And the House Plan is so great that every member of Congress is making sure that they are exempt from it!

Well, you didn't cite the CBO, you mentioned it, vaguely and not in a particularly accurate manner. I'll be happy to have you take me to school on what the CBO has said that's more recent or factual or conclusive than the July 17, 2009 letter to Congressman Rangel I linked to above that relates to H.R.3200 as proposed, the only actual health care bill under consideration as far as I know until a) the House does its magic and b) the Senate puts a bill on the table.

No offense intended here, but if you have a case to put forward, please do so. "There are Knuckleheads who disagree" is not a case I can engage.

I couldn't agree more, with your contention that we need to see the president's plan and debate the merits, solutions and costs. That's entirely fair. At the end of the day, of course, the law that's enacted will be legislation harmonized between the House and Senate versions. I think the president is obliged to speak into that process but he's not a lawmaker anymore. American democracy is a beautiful thing...especially when everyone works together.

You're the second person who's mentioned that exemption thing today and I have to admit I'm not familiar with it. I haven't found it in H.R. 3200 (which, not to beat a dead horse, is the only bill under active consideration at present). Can you direct me to something definitive on the subject?

The exemption for Congress has been around since at least the early 90's, as far as I can tell. Here's a couple of links:

here and here.


Jim, thanks for batting this back and forth with me. But I don't want to get lost in the controversies. Can we agree on a few basic points? Would you agree:

1. that we have the best healthcare in the world?
2. that, unfortunately, healthcare insurance seems to cost way too much?
3. that it would really be nice if everyone could afford to have excellent health insurance?

I think that is the basic problem - affordability.

You wrote: "The exemption for Congress has been around since at least the early 90's, as far as I can tell..."

I suppose I hadn’t heard anything about it because it’s a red herring and hasn’t been part of the serious discussion of health care reform.

Here’s a research-based examination of the question from the St. Petersburg Times' Pulitzer Prize-winning Politifact.com.

and

"1. that we have the best healthcare in the world?"

You’d think, wouldn’t you? But the outcomes don’t support that assumption. The most recent evidence based study I know of—published by The Commonwealth Fund in May 2007—compared health care over time in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. US health care ranked sixth. You can download the report here.

and

"2. that, unfortunately, healthcare insurance seems to cost way too much?"

I wouldn’t say it’s unfortunate, I would say it’s contrary to American ideals.

and

"3. that it would really be nice if everyone could afford to have excellent health insurance?"

Yes. And I would add that I think it’s really not nice to stand in the way of that.

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