I am not naive enough to expect more than a half truth from a political leader anymore but I am still naive enough to do what little I can to expose the half of what they say that is false. The White House blog sets out to expose the Republican Leaders’ Plan to “Delay, Define, and Derail” health care legislation. Their closing statement is the classic half truth:
. . . while we remain committed to working with those in both parties who have good-faith proposals about how to strengthen the final reform bill, we will not stand idly by in the face of false accusations aimed to score political points or maintain the status quo at all costs.
They toss around the “false accusations” claim within eye-shot of publishing some false accusations of their own. For example, in that very statement they imply that Republicans have offered no good-faith proposals. That’s not the first time they make that claim in their post. Earlier they said:
Republican leaders will resort to the time-honored tactic of attempting to stall reform to death – raising arbitrary and disingenuous hurdles under the guise of wanting further debate, when in reality they have no intention of offering constructive proposals.
Every time they make the claim that Republican’s have offered no constructive proposals voters need to recognize that only two types of administrations could make that claim right now. Either the administration is lying through their teeth (the more likely of the two) or else they are genuinely unaware of the good faith proposals that Republicans have offered such as HR 3400, which Democrats in control of Congress are not even willing to debate. Either kind of administration (dishonest or ignorant) is extremely dangerous to our nation. If they are dishonest they must be stopped. If they are ignorant they must become informed. I’m willing to work on both routes until I can prove which kind of administration we have.
Another half truth offered by the White House in that post is to reassert the claim (by using the CBO) that their bill will lower the deficit.
Republican leaders intend to repeat their claims that reform “will raise insurance premiums on individuals and families, while failing to lower the overall amount of money that the U.S. spends on health care… even though the nonpartisan CBO predicted the [Senate Finance Committee] bill would reduce the deficit and lower the cost curve, even as it extends coverage to millions of uninsured Americans.”
It has already been shown by history that the CBO estimate is based on the shakiest footing imaginable because it depends on Congress doing what it has never done before – cutting medicare spending. Until democratic leaders can show how they will actually fulfill the mythical fiscal promises in the bill that make that CBO estimate possible there’s no reasons to believe them over the Republicans. No matter who is proposing a bill there is no reason to pass it so long as there are significant unanswered questions about how it will actually work.
The Democrats are proposing bills that will not take effect for years and which depend on premises that are not dependable and then they wonder why people are hopping off their “Hope and Change” train.
HR 3400 is not a good faith proposal, its loaded with political poison pills(and not just for democrats their is stuff in here many republicans couldn’t vote for), is mostly unfunded, well funded by repealing an unfunded spending bill the ARRA stimulus. HR 3400 is a good example of the republican party’s current crisis, This bill was written by their more “ultra conservative” side, and the “not conservative enough” side likely wouldn’t be able to tolerate provisions in it.
The Democrats have atleast 2 bills that would lower the deficit, HR 3200(well versions of it), and the senate finance bill, And they are rated by the CBO as lowering the deficit. Republicans praised the CBO upto the point where the CBO declared that the finance bill to lower the deficit, at that point all of a sudden their estimates where “shaky”. Given the proposed tax’s and Medicare cuts I can buy the claims about lowering the deficit.
Parts of the bill(hr 3200 atleast) do take effect on Jan 1. for one the medicaid mandates to the states increase to everyone below 133% of the poverty line(partly funded I like the idea but disagree with pushing it onto the states), The industry regulation related to rescission, and preexisting conditions goes into effect, regulations related to preventive care coverage go into effect as well.
I do buy that the atleast some of the Medicare cuts they are talking about can be pulled off, Most of the cuts come from Medicare Advantage, Which pays 115% the cost of a medicare recipient to a private company to insurance them instead, by cutting this down to the same as what standard medicare costs they can save alot. They do make some pie in the ski claims about lowering fraud and abuse, but most of the money will come from the cut fore mentioned.
I have not had time to go through all of HR 3400 so it’s possible that it does have poison pills in there (I’m not partisan enough to think only Democrats do that kind of stuff) but I find it disappointing to have people dismiss it as “not a good faith proposal” without addressing a single point from the bill – either to show how it is a poison pill, or to talk about the merits of specific points.
I have no faith that things will work out with the unfunded mandates that have been proposed. Remember, it’s the federal government that can print money, not the states, so in this recession where states are already struggling I have no doubt that an unfunded mandate will be followed up by a bailout from the federal government which is not included in the CBO estimates.
The regulations on rescission, preexisting conditions, and preventive care coverage are likely to result in higher insurance premiums which the administration will use as an excuse to take further, more drastic action.
I do agree that some of the medicare cuts can be pulled off, but I doubt’s that many of them will be pulled off. In other words, the CBO estimates are good enough to fool people into accepting the bill, but the realities are that whatever comes out of Washington will almost certainly end up adding to the deficit.
It all boils down to the fact that I have no faith that our big government Democrats and big government Republicans are capable of improving our health care situation. I agree that the system needs reforming, but I trust Congress with that reform as much as I would trust a porn distributor to protect children from internet pornography.
Look, the only proposals that the Democrats would consider “good-faith proposals” are ones that substantially agree with their predetermined agenda. Any proposal any Republican would put up can be disregarded as being in bad faith. Besides, Republicans are not so stupid as to see that they have almost zero power to influence any legislation at this point in time. Of course, they brought that on themselves. But that’s another matter.
Just a quick post sense i am in class atm.
David,
I will after class today post my analysis of HR 3400. I think I posted on HR 3400 before, But your request to put forth an argument is more then reasonable. I will link the prior post if I can find it as well.
I do agree about the unfunded mandate problem.
“The regulations on rescission, preexisting conditions, and preventive care coverage are likely to result in higher insurance premiums which the administration will use as an excuse to take further, more drastic action.”
I can buy that! And I will agree that isn’t the right way to do things.
The reason that I believe that the Medicare cuts or at least some of the Medicare cuts will work is because they are targeted at subsidies payed to the private industry. I don’t think the democrats will have any compunctions about cutting here.
Reach,
Most of the republican Proposals are unfunded tax cut bills. HR 3400 is the closest to a realistic proposal but even it is loaded with problems. I will give one of the criteria I use is that I have to believe that it can actually pass.
HR 3400,
In TITLE I..
First off the bill proposes tax cuts that would rival the size of the first Bush tax cut, And it does so Without any new revenue to offset these tax cuts.
In TITLE I sec 105, sec 106
The bill also contains some strong anti abortion clauses, their are at least 2 republicans that would be against this, the whole democrat party would appose this.
In TITLE I sec 106
Doctors could refuse to preform any treatment they are religiously apposed to. This is a HUGE poison pill. In fact their are republicans that would vote against this bill based on this alone.
In TITLE V sec 501 to sec 512
The bill goes for the whole run and mill of tort reforms, It doesn’t even try to be bipartisan. Their are a few tort reforms that could probably pass if they where proposed without the the poison pill of award caps, Specifically the medical courts, and some of the defense best practice guidelines.
In TITLE XII Sec 1201, sec 1211
The bill contains huge items unrelated to health care that really should be in their own bill or in the case of ARRA are already said and done, Discretionary spending limits, repeal of ARRA.
Their are a few good things in here as well, expansion of the tax benefit on HSA’s, expands federal student benefits for medial students. The bill also allows the poor(medicaid eligiable) to choose a private provider and provides them a tax credit to afford this.
The bill creates an interstate exchange for insurance for people to buy across state borders, this will be an issue that some states rights republicans may take issue with as it basically removes the states ability to regulate the health insurance industry in their state.
This bill would cost far more then any of the democrat bills proposed thus far.
I don’t really see how anyone can see this bill as being remotely constructive, It’s just a long list of pop shots at the democrats.
Ron,
Thank you for sharing that analysis on the bill. I edited your comment by ordering your paragraphs that reference specific sections of the bill into the same order as those sections appear in the bill. If that bothers you let me know and I will restore your comment to its original order.
Now to respond to your comments. You claim that the tax cuts proposed rival the size of the first Bush tax cuts – where do you get that information? I am not aware of any CBO analysis of this bill. (This same question applies to your statement that this bill would cost more than any of the Democrats’ proposals.) I would say that all the tax cuts that appear in the bill seem to be designed to make it easier to purchase health insurance which is the purpose of the bill so that seems appropriate. If there are tax cuts in the bill not related to health care feel free to point those out to me.
You say that these are made without offsetting revenue – it seems to me that their provisions relating to ARRA are meant as a measure to offset the cost of these cuts. I do agree that this might be more appropriate as a separate bill but I think that we must agree that they have addressed a budget issue to offset those cuts – although I would not pretend to know whether their offsets come anywhere close to paying for those cuts.
I can understand that there would be objections to the abortion restrictions in the bill although how can anyone imagine that a Republican bill would not at least attempt to limit federal funding of abortions (notice that they even have exceptions – it’s not absolute).
I am surprised that you would raise objections to the rights of conscience. I would consider it dangerous to force physicians to perform procedures to which they had conscientious objections. Non-discrimination seems appropriate there.
Considering that President Obama has expressed a willingness to explore tort reform I don’t see why the Republicans would not include that in their proposal.
The purpose of proposing a bill is not to have it as the end point, but to use it as a beginning to be debated and altered to find a workable position. It seems to me, after reading your objections, that the real problem is not that HR 3400 is not a good faith proposal, but that the congressional leadership has not acted in good faith by giving it an opportunity for discussion. They pretend that the bill does not exist rather than discussing their objections the the ideas raised in the bill. On their own bills they snuff out every Republican idea until the Republicans simply refuse to participate.
I’m not saying that the Republicans are right or that HR 3400 could not be changed but the claim that Republicans have not offered a good faith proposal is false. The truth is that the Democrats have not offered a good faith response, nor have they conducted negotiations in good faith – their negotiations have not been, “what do you have to offer on this issue?” so much as they have been “why won’t you agree with us so that we can all say that we did something about health care?”
The way I read the bill it would give nearly everyone a $2,000 to $4,000 tax credit to help buy insurance. Their are tax credits for business’s that adopt auto enrollment in their health plans but the formula for this is less understandable as to the cost.
ARRA is a one time cost, health care needs to be paid for over time continually forever more.
I hope your ER doctor is not a Jehovah’s Witness, No insult to them intended but they don’t believe in blood transfusions, do you want to die or be put at serious risk of death because your doctor thinks a procedure isn’t right in the eye’s of god? For completeness in this post I will note that Jehovah’s Witness’s are big funders of research of bloodless surgery and they very much put their money where their mouth is this I consider to be very commendable. Their are more then 2 republicans that would vote against this, and not a single democrat that would vote for this.
Obama has agreed to have new studies on tort reform, I should note that 38 States have already done tort reform and the cost savings it can provide is very much in question. And you are right their are tort reforms that could pass if they where proposed without award caps, I await the republican that will propose them that way.
The health care problem of this country can’t be solved with further tax cuts, really we can’t afford them. Tax’s are at a 78~ year low and we just don’t bring in enough to throw them around in the manner proposed.
On an unrelated note, I have heard through the grape vine that HR 676 is getting CBO scoring. The house leadership apparently is going to allow Anthony Wiener to propose his single payer amendment on the house floor. This has no chance of passing but it will be very interesting to see it scored for the curious to see.
The whole JW/blood transfusion argument rings hollow. How many JW doctors put themselves in a position where they would be asked to perform a transfusion? The same goes with virtually all practices that a doctor might conscientiously object to – those doctors will practice the kinds of medicine they are not opposed to practicing. The bill simply reaffirms that the government agencies cannot discriminate “on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.”
Republicans do not need to propose tort reform without award caps – Democrats are perfectly capable (if unwilling) of allowing debate on this bill (or any other Republican proposal) and offering amendments to remove the award caps or whatever they don’t like about the bill.
What we really can’t afford in this country is to try to do everything through government, that’s why even our highest tax rates in history would not come close to covering the deficits we have been facing in the last few years.
I have not looked at 3400 except for the analysis above. If it does propose tax cuts of the magnitude listed I am for it. We can obtain revenue offsets with the $500 billion proposed by Obama and Baucus related to the alleged frauds and abuses already in Medicare programs.
It seems to me that the Obama definition of bi-partisan means “agreement with Obama” otherwise it is nothing more than an effort to destroy his mission. That is not good-faith negotiation, and although some of the provisions that are stated to be in 3400 are idiotic even by my standards, there are some very good points for discussion.
Nonetheless, the longer and longer this healthcare debate can be drawn out, we will be in better shape because ultimately, non-government entities (insurance companies, business–big and small–drug companies, associations, etc.) will find real solutions to changing and reforming health care. It is already happening and we will begin to see the roll-out of these changes in new platforms being offered by insurance companies. But there will never be true reform until we fundamentally change the underlying principles of health care payment mechanism from an employee-benefit function to a individual/family purchasing function, remove government mandates, and let the people solve the problem rather than the politicians.
The beauty of a free market system is that people innovate and try new ideas. Even in a market as chained-down as the current health care system the market is not static about seeking for solutions.You can see some examples of the market trying to correct the flaws in this John Stossel segment.
Scott, David,
I take it that you believe the advantage of the national exchange proposed out weights the states rights issue? Its not a big Issue for myself but I would like to understand your position on the issue better.
Scott,
$500 billion would not be enough to cover these tax breaks, I agree with Obama that the bill needs to be paid for.
David,
If a doctor doesn’t want to perform all of the work necessary to be a doctor perhaps he/she should find another career. I will give that I would fine with such a clause in the case of elective surgery/treatment.
I believe that the vast majority of those who do not want to do all the work of a doctor do find another career. I also believe that abortion (which is the only practice that applies to the bill being discussed) is not generally necessary in the work of a doctor. I’d love to see statistics, but I am confident that number of emergency abortions performed in this country in any given year is virtually ZERO. I also believe that in virtually every case where there is a doctor available who has conscientious objections to performing such an abortion there is also a doctor available who does not. If it’s an emergency call the doctor in who does not have the objections. If it’s not an emergency take the time to find a willing doctor. The number of abortions performed annually is irrefutable proof that such doctors can be found.
The objections to the conscientious objections clause is a red herring.
As for the national exchange – once upon a time I believed it was a good idea, that was before I took a good look at the situation. Now I am not sure that the benefits would be as much as advertised and I am not at all confident that those benefits out weight the states-rights risks associated with it, which is why I have said nothing about that issue in this discussion.
Ron,
I am totally and completely opposed to a national exchange (that is if you are referring to the so-called “public option”). My opposition does not rest in a states’ rights issue, although I have no problem including that in my opposition.
I oppose the national exchange because I believe it will ultimately be run similar to Medicare, Social Security and any other program that is administered by the government. I do not believe government can run such a program effectively. As opposed to a privately run insurance company who has to manage to a profit, the government will only add taxes to pay for it’s waste of resources. I believe the profit is an extremely good motivator for better performance and will better control costs–as long as there is competitive companies to which an individual/family can go to buy insurance. Limitations on the ability to move to and from insurance companies will not create the best price opportunities, and hence, this leads me to the fundamental position of a change in how health insurance is paid for in the US–that is, change from the employee-based formula.
I will allow for some level of government participation in an exchange, but only to the extent that it is necessary for those who may be unemployed or who are currently receiving like benefits. States may be able to handle this better because of geograhic efficiencies as opposed to a federal system.
I am not opposed to provisions in any bill that allow for migration to plans when changing jobs (given an assumption that we will not ever get to my preferred position) and I do not think that when transferring to a new plan due to job changes should result in loss of coverage for pre-existing conditions. I think this could effectively be re-insured by the insurance companies anyway.
Scott,
I believe that when Ron is talking about a national exchange he means the ability to buy insurance across state lines (Correct me if I’m wrong Ron).
David,
your correct.
Scott,
I am not including the public option when referring to the National exchange proposal.
Thanks for the clarification. And I’ve never let being confused by the facts ever get in the way of my opinion.
Anyway, I am not certain on a exchange whether national or state exchanges. I understand your arguments against a national exchange on a states’ rights issue and that makes sense. But if states’ rights are going to be the trump card in any exchange, the separate laws of the separate states will make administration of any exchange extremely difficult. Now if the states could somehow negoatiate a compact between them stipulating the laws and regulations that an exchange would be subject to (irrespective if there are inconsistencies between the exchange rules and a particular state’s laws) then progress can be made on this. Again, and I am in agreement, this should be done by the states at the respective discretion of their legislatures.
Something to be wary of in such an exchange is the states that another state may partner with. Frankly, I would not want my state to have any sort of cross-state exchange with California, New York, New Jersey or Massachussetts because of their respective economic states and principles. I don’t want to be in Nevada or Washington (where I work) absorbing the costs of the horrendous mismanagement of the California Democratic Republic.
Now, the plan that my company currently has (I know this is not an exchange) is being replaced by a new plan that will be in three states rather than one. Therefore–I am deducing here–that the insurance company somehow negotiated a compact among the state regulators. If so, this is a very positive forward movement as well as an example of the private sector making good decisions without the interference of a government entity.
I have never seen the differing state regulations as being a serious block to insurance company’s offering services in more then one state, its not hard to follow a different rule set per state and their are plenty of insurance company’s that do just that.
On the states rights issue how do you feel about the Kucinich amendment that would allow states to establish a state single payer system if they choose? I was surprised at how little opposition to this amendment the republicans have put up so far, I am guessing due to states rights which is why I ask.
On another unrelated note, What do you think of the New York House district #23 2009 special election? It seems all hell as broke lose, The Conservatives have tossed the Republican party and are running a candidate from the Conservative Party, Doug Hoffman’s site.
The Kucinich amendment is bomb waiting to explode down the road. If it passed because it, in theory, passes a states’ rights issue, then those who support states’ rights and voted for it are really not all that bright.
It is nothing more than a game being played. When a majority of states do establish single payer plans–or rather the major populated states like California, New York, Massachussets, Florida–then it not very hard for the federal government to effectively nationalize all those plans. I could very easily see the 2016 Emergency Stimulus package doing such a thing, not at all unlike the 2008/2009 Stimulus plans that transferred money to bankrupt states.
Irrespective of what governmental entity puts in place a single payer plan, it is, in my opinion, a terrible waste of precious resources. The government will not manange it efficiently or effectively and the people who need such a plan the most, will be the ones who are hurt the worst. Again, look at Social Security and Medicare as prime examples.
As to the New York matter, I was not aware of it and will read up on it. I’ve got no problem with a “revolution” on either political party that would bring some sense back into governing this country away from it’s current trend. We left Europe in 1776, and I don’t want to go back now!
I could see that being used as the Trojan horse to a national single payer plan.
Medicare’s administrative overhead is around 3%(actually 5.4% after accounting for cost shifting), So no I don’t see that as an example of your statement.
I can understand your argument however.
The support for my statement on Medicare is the President’s own suggestion that there is $500 billion of waste and fraud within a government program.
I don’t have facts in hand to debate the administrative overhead figure, but as an accountant I warn all to be very, very careful as to how government accounts for things vis-a-vis how a business accounts for things. They have two completely different sets of accounting principles and can, and usually do, give two completely different answers to the same transaction. Thus, it can be even worse than trying to compare apples to oranges–you could be comparing apples to ring-tailed lemurs.
I see the Kucinich amendment as similar to the states forming interstate compacts – if the states want to do that (develop their own single-payer systems) right now they can – they don’t need any action from Congress.
On the NY23 race – I think it’s healthy for the GOP to have this struggle. I don’t have all the details, but having the people run their own candidate rather than support the party-picked candidate should be a stark reminder to the party that they’re supposed to be listening to the people, not telling them who to vote for.
Scott, how exactly do apples compare to ring-tailed lemurs?
They don’t, they can’t and they never will. That is, unless you are trying to cram a huge tax increase down some people’s throats and then somehow, politicians can make an apple look exactly like a ring-tailed lemur–well, at least on a Sunday talk show.
Most of the cuts are related to Medicare’s interactions with private industry, $254 billion for example will come from the over payment on medicare advantage plans. This over payment was placed in to Medicare advantage by the republicans to give it an advantage over standard medicare.
Many of the abuses are a result of the private industry, using them as an argument for private industry doesn’t pass muster.
I thought you would get a kick out of the NY23 race. I wonder if this is the start of greater fissures in the Republican party or just a freak happen stance, might be to early to tell but it certainly is an interesting question.
I don’t think NY23 is the start of a fissure (I think the fissure started during the 2008 campaign or earlier) but it is a very visible proof of that division.
Currently the states can not start their own single payer systems due to the Employee Retirement Income Security Act, The Kucinich Amendment made is into the house bill hr 3200 on a 27-19 vote with 14 Democrats and 13 Republicans supporting it. The Kucinich Amendment would empower the Secretary of Health and Human Services to waive the federal law that pre-empts state law on employee-related health care.
I knew there was a reason that Kucinich is among my favorite Democrats. I was not aware of the federal law that preempts state law on employee health care but I like the idea of leaving that in the hands of the states where it belongs.