Thursday, September 10, 2009

Yet Another Obama Health Policy Speech Roundup

I'm sure that everyone can stand to use just one more health policy roundup from President Obama's speech last night. There were a couple of points to take away from the speech that have been covered elsewhere. Here are the highlights, with my added analysis:

1) How come President Obama said that hundreds of millions of Americans already have insurance and he downgraded the number of people who don't have insurance from his widely touted 47 million to 30 million? Instead of 15% of the population without insurance, we're now less than 10%? What gives?
So why did Obama make the change? The first possibility is the difference between people who "don't have any health insurance" and people who "cannot get coverage." Millions of Americans who can afford health insurance choose not to have it, many of them because they are young, healthy and unlikely to need it. The second difference in Obama's phrasing is between "people without health insurance," in his old phrasing, and "American citizens" without coverage, as he said in last night's speech. Was Obama, faced with the (accurate) charge that the current Democratic health care proposals have no enforcement mechanism to prevent people in the United States illegally from receiving government-supported coverage, excluding non-citizens from his total?
Another more likely scenario is that he's about to embark upon an incremental approach, and if you make the problem seem more manageable, you're going to get people on board with an approach that appears to be more reasonable.

The main problem with this downgrade in the numbers is that the crisis suddenly becomes much less of a crisis.

Of course, the problem was never accessibility to health care. It's been about the cost of that health care.

2) And what about that cost? Who believes that any of the bills or proposals under consideration will be deficit and revenue neutral (requiring no additional tax hikes down the road)? Even the AP isn't buying into that as Don Surber notes:
OBAMA: “I will not sign a plan that adds one dime to our deficits either now or in the future. Period.”

THE FACTS: Though there’s no final plan yet, the White House and congressional Democrats already have shown they’re ready to skirt the no-new-deficits pledge.

House Democrats offered a bill that the Congressional Budget Office said would add $220 billion to the deficit over 10 years. But Democrats and Obama administration officials claimed the bill actually was deficit-neutral. They said they simply didn’t have to count $245 billion of it — the cost of adjusting Medicare reimbursement rates so physicians don’t face big annual pay cuts.

Their reasoning was that they already had decided to exempt this “doc fix” from congressional rules that require new programs to be paid for. In other words, it doesn’t have to be paid for because they decided it doesn’t have to be paid for.

The administration also said that since Obama already had included the doctor payment in his 10-year budget proposal, it didn’t have to be counted again.

That aside, the long-term prognosis for costs of the health care legislation has not been good.
Period? Looks to me like a promise that President Obama can not possibly deliver.

3) What about the promises that you'll be able to keep your existing coverage? After all, President Obama said that hundreds of millions of Americans already have coverage. Will it be affected? Well, not at the start, which means the year of inception of the plan. After that, the answer is that millions may start to see their benefits change substantially, as the AP notes:
The Congressional Budget Office analyzed the health care bill written by House Democrats and said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it.

In the past Obama repeatedly said, “If you like your health care plan, you’ll be able to keep your health care plan, period.”

Now he’s stopping short of that unconditional guarantee by saying nothing in the plan “requires” any change.
The President has at least recognized that he's making promises he can't keep, but this is one that will seriously affect public opinion on the proposal.

4) Cutting waste and fraud should be a big way to save money for the system, as numerous reports have shown massive fraud costs taxpayers tens of billions of dollars annually. If Obama's plans don't go forward, how come there's no emphasis on making sure that reform of Medicare and Medicaid address the existing fraud and waste. After all, if the expansion of health care is predicated on curbing waste and fraud, why not impose it on Medicare and Medicaid first and see whether the cost savings materialize - and use that to incrementally address expanding care? Arnold Kling has more on that.

5) The President proposes an individual mandate for coverage. What happens if you don't want to get coverage? Well, you're going to pay one way or another, which will be a tax hike regardless of whether you are forced to get coverage or choose not to get coverage. You're paying for the program one way or another, and the need to get more healthy bodies paying into the system will be needed to cover the other major promise made under the health care proposals - that no one with preexisting conditions will be denied insurance.

6) Those who oppose the bill use fear to try and defeat any kind of progress on health care reform, but President Obama gets a pass when he makes similar doom and gloom prognostications?
Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result.
The deficit grows because of unfunded mandates such as Medicare, Medicaid, and Social Security. Profligate government spending adds to the deficit, and doing nothing to address those issues further destabilizes the government and the national economy. Doing nothing on health care since the last attempt by the Clinton Administration during their first term hasn't brought the nation to ruin, even though many of the same arguments are in play today. Businesses close because of bad business practices and a bad business climate - taxing them doesn't make them more competitive and increases the cost to the end user who bears the brunt of costs that are passed on to them. But worst of all is the claim that people will die if nothing is done.

Dying is a fact of life. The lack of a new government health plan doesn't change that. The President once again attempts to conflate access to care with cost.

Meanwhile, what about Rep. Joe Wilson (R) and his interruption of the President when he shouted out that Obama was a liar? It was wrong, and he apologized after the fact. Then again, for all those partisan Democrats out there who are busy complaining about the lack of decorum, Instapundit rounds up a greatest hits list of incidents where Democrats booed and hissed at President Bush during various appearances, including the State of the Union and the inauguration of President Obama this past January. And that doesn't even begin to address the repeated calls for impeachment over a policy dispute (the war in Iraq as a policy). Bad form? Absolutely. It just goes to show that there are all too many people in and around politics who are without class and attack the person instead of addressing the issues. Decorum in politics has gone out the window.

Will this speech do what all President Obama's other attempts did not accomplish? Did he sell this to Americans that we're in a crisis with health care and that we must address these issues? I'm not alone in thinking he didn't get it done.

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