February 8, 2010

"What I'd like to do is have a meeting whereby I'm sitting with the Republicans, sitting with the Democrats, sitting with healthcare experts, and let's just go through these bills..."

"... in a methodical way so that the American people can see and compare what makes the most sense."

President Obama is now trying to do what the Democrats had said they were going to do and didn't do.
For months, the president has endured criticism that he reneged on a promise to televise healthcare negotiations on C-SPAN. By opening up the summit to the cameras, Obama can argue he is making good on that commitment at a crucial point in the process.
You want to resort to an approach that you promised but avoided when you thought you could get away with it? To say that's the same as keeping the promise is like saying you're not a thief after you try to shoplift and then offer to pay when you get caught.

But if it was a good idea to televise negotiations once, it might be a good idea now. It would test the Republicans' assertion that although the current bills are bad, reform is needed.
[T]he summit gives the president a chance to paint Republicans as obstructionists who refuse offers of compromise. If that's how the event is perceived, it could pay off for Democrats in the November midterm elections.
Or the event could be perceived as a political tactic, which is what it is. The Republicans could participate, but only in order to make their own strong offer. Let the GOP say exactly what the GOP position would be if it had the majority power. Think of it as a debate for the fall election. Defend that plan and critique the Democrats' plan. Put the choice before the people, so we can think about which party it wants to put in power in the fall. It should be: Decision 2010 time. Not: Come on, we're on TV, now compromise.
Republicans said Sunday that they are prepared to participate in the summit, but would like a White House commitment to start from scratch.
That's the way to get out of the TV show altogether. A good parry.
Senate Republican leader Mitch McConnell of Kentucky said: "We always appreciate the opportunity to share ideas with the president, particularly on an issue where Americans have spoken so clearly. If we are to reach a bipartisan consensus, the White House can start by shelving the current health spending bill."
Oh, let's share ideas. An amusing/infuriating way to put it.
But starting fresh is not part of the White House plan.
In an interview Sunday night, a White House official said, "The Republicans are going to interpret this as we're starting over. We're not starting over. We're coming in with our plan. They're welcome to come in with whatever plan they'd like. But we're moving forward."
Healthcare reform is a big, overloaded truck — currently stalled — the Democrats intend to drive in a direction they like to think of as "forward." The Democrats' idea is that the Republicans can take a couple little things off the truck and then give them a jump start. But if the Republicans' plan is to go in a different direction — preferably in a Smart Car — how does the truck start moving again?

69 comments:

cokaygne said...

Great move by Obama. The ball is now in the GOP's court. They are right to insist that the current bills be taken off the table because, apparently, the House and Senate bills are so different that the two chambers cannot move forward.

Of course Obama will insist on making the current bills the starting point for the discussion. The Republicans will have to give in and participate. Maybe their best approach would be to emphasize the points where House and Senate Democrats disagree and promote their own good ideas like malpractice reform and allowing consumers to purchase health insurance plans from other states.

Will either party talk about this issue in its wider context? Specifically, the bills under discussion are paid for in part with promised Medicare savings. Neither party has implemented past promises to save money in Medicare. Then there is the issue of deficit reduction. That has to include Medicare cost containment, but Medicare cost containment is already promised for health care expansion.

This is a hail mary pass that will end in a disputed pass interference call as the clock runs out. Both parties will grandstand and mouth sound bites, but health reform is dead for this year.

edutcher said...

Desperation move by Bambi. A year after, "I won", it's, "Please save my effete, scrawny little ass".

DaveW said...

For some reason I'm not buying the whole 'I want to negotiate with Republicans and produce a bi-partisan bill' thing after what has transpired over the last year. The Dems could have easily tossed a couple of bones to Pubs and pulled in a few votes.

I suppose the O wants us to believe he was powerless to do this but I don't think people are going to buy that. We'll see.

Michael said...

It is really hard for me to see what Obama expects sitting down and talking to achieve. It's only slightly more likely to produce an agreement than sitting down and talking with the North Koreans, Iranians or Russians. (I mean that less as a comment on the Republicans than on Obama's belief in magical diplomacy.)

Republicans have certain major ingredients in their idea of health-care reform: Tort reform, allowing inter-state insurance competition, getting rid of the employer tax subsidy, and so forth. These are things that the Democrats explicitly rejected when drafting the House and Senate bills. Republicans tried to insert some of these changes, but the Democrats voted those amendments down, and instead voted for tort subsidies (to states willing to find new ways to find doctors liable for their actions), more government-run insurance and individual mandates.

It's a tactically good move for Obama; Republicans will have to sit down and take part in these discussions. The longer term strategy seems less enlightened. The outcome be win-lose, not win-win, and the winner will be the one who makes the other side look worse. That might be the Republicans, by highlighting that the Democrats want the fig leaf of bipartisanship more than the substance of it--or by reminding the public of how tread-worn Obama's rhetorical tricks are. It might also be the Democrats, if they can continue to paint the Republicans as the party of no (or the party of no new ideas). The Republicans have relatively easy counters for those claims, as long as they are smart enough to use them.

Paul Zrimsek said...

It might be a good idea. But Republicans are surely right to want to start with a clean sheet of paper, not "these bills".

AllenS said...

A smart Republican would vote present and not show up.

WV: hooed

George Grady said...

Obama had better be careful. This is just the sort of circumstance where he can't resist channelling Don McLean.

AprilApple said...

shamelessly lifted from the corner:
cuz I agree:

"Obama is pegging the hopes for health-care reform on a big, televised victory over Republicans on the merits. It's a desperate but admittedly novel gambit. I just don't think it will materialize. For one thing, Obama has been explaining and explaining his bill for over a year now, over which time the polls have shown support fade in inverse proportion to the rhetoric. At the State of the Union, armed with the national stage, Obama waited 50 paragraphs to broach the subject of health care, and when he did he offered nothing new or game-changing.

For another, the Republicans would be foolish to let Democrats stake the fate of this zombie of a bill on a televised publicity stunt. For a year, Democrats have built this trillion-dollar entitlement — every sweetheart deals, every kickback, and every carve-out — in the cloakrooms of Washington. Now, at the moment when transparency is at its most valuable as politics and its least valuable as policy, the administration has found religion, complete with much public wailing and teeth-gnashing about how openness was sacrificed at the altar of efficacy.

Republicans shouldn't let Obama get away with this. The time for Republicans to demonstrate the superiority of a conservative approach for lowering health-care costs and expanding coverage is after Obamacare is defeated, once and for all."

Montagne Montaigne said...

"The time for Republicans to demonstrate the superiority of a conservative approach for lowering health-care costs and expanding coverage is after Obamacare is defeated, once and for all."

How convenient. I would suggest an alternative. If Republicans were in power again they would drop health care reform from the agenda. Health care would get no reforms. And the disaster of rising costs would continue.

Republicans have no solutions for health care. Interstate and tort reform, if enacted, would fix about 2% of the problem. And that's the entirety of the Republican plan.

traditionalguy said...

"If you are on board a train it is no use running along the corridor in the opposites direction." said Dietrich Bonhoeffer who also lead resistance to suicidal plans of a man out of touch with any reality except his own glory.

Hoosier Daddy said...

If Republicans were in power again...

Monty you should look at those words again very carefully.

Your party owns Congress. Your party owns the White House. Your party spent one year screwing around trying to get this passed, which based soley on the numbers, should have been a slam dunk for this administration.

Now one year later you guys are crawing to the party that was supposed to be in the wilderness, rejected by the electorate, etc. That's a pretty pathetic commentary on the leadership and chohesiveness of your party.

Stew on that for awhile.

Hoosier Daddy said...

Republicans have no solutions for health care.

And its pretty evident the Democrats don't have one either otherwise the bill would have been passed a long time ago.

AJ Lynch said...

Haha -it will be like my favorite Super Bowl ad where the bridge had crumbled but they had to get the Bud Lite truck into town. The townspeople were desperate for beer so they helped to replace the bridge.

So Obama wants us to build a bridge into town for his crappy Obamacare. Poor Obama - I doubt many folks will want to build that bridge.

AprilApple said...

Any cost-saving, competitive, pro- free market ideas the republicans offer will be laughed at by the know-it-all socialist-progressive-democrats. Free-market solutions are not acceptable to progressives.

Meanwhile, the American people understand clearly now- that they were about to be had by the democrat's back-room deals. Back room deals between money-grubbing money-wasting corrupt democrats and high powered lobbyists in the medical and insurance industry.
We all know the democrat health care bills would have raised costs, taxes and reduced access.
The American people saw through the lies about promised lowered costs.

Now the desperation is so thick – the democrats must run and hide behind the republicans. Funny –we were told that republicans have nothing to offer? The Republicans did offer solutions, but those offers and solutions were ignored.

Joan said...

I was so annoyed that CBS had an Obama interview on before the SuperBowl -- can't that guy ever leave us in peace? How lame was it that he had to air an interview on SuperBowl Sunday to assure some ratings?

I'm sick of hearing that the Republicans have no plans for health insurance reform. They have plenty of plans, they just can't bring a bill to the floor because they're in the minority. Tort reform alone has done wonders in TX and would certainly help. Why should the Republicans bother to attend this meeting? Obama dissed the proposals at his meeting with Senate Republicans -- as if a billion in savings here, a billion in savings there wouldn't help. He has already shown he isn't serious about listening.

wv: ceish. I usually spell it "sheesh" but, yeah.

AllenS said...

Perhaps the Republicans could try to get special deals for their respective states. Like Nebraska and Louisiana. Same with the deal the unions got for their Cadillac-type health plans. Do it right on tv. Let everyone watch the sausage being made.

Scott M said...

@Dave

For some reason I'm not buying the whole 'I want to negotiate with Republicans and produce a bi-partisan bill' thing after what has transpired over the last year.

It's called being minimally observant. I especially like Anne's analogy of the shoplifting thief because that's exactly how I feel they've been acting of late.

vet66 said...

It's a setup to portray the Republicans as retrograde in the face of the Obamessiah's Humanity. He believes in his religion and desires to seperate the true believers from the retrograde infidels, apostates and unbelievers.

His notion of "Positivism" is foundering on the shoals of reality but he remains undeterred. Obama has held out his hand in supplication and been snubbed. At Harvard and the rest of Ivy League he was a "GOD" whereas in reality his positivisim is replaced handily by realpolitic.

AprilApple said...

Why should the Republicans bother to attend this meeting?

Obama and the progressives are desperate.
So here comes the--
Blame shifting.
Desperation.
Publicity stunt.
Another opportunity to roll out the "we must do something now!" BS.

The democrats prescription for everything is more spending, higher taxes and more government intrusion and control. All other ideas will be given lip service only.

Ignorance is Bliss said...

The problem is, to any small government conservative ( or any of the big government Republican politicians who want votes from the small government conservatives ) the Democratic plan is a giant shit sandwich. The Democrats want Republican support, in exchange for which the Republicans will be allowed to choose whether to add ketchup or mustard to the shit sandwich.

If everyone agrees that we should subsidize insurance for the poor, then we can compromise on how poor, and how large a subsidy. If everyone agrees that we need to insure everyone we can compromise on exactly what procedures are covered. But for anyone who believes in the power of the free market, there can be no compromise on how much further we separate the people consuming healthcare from the people paying for it.

Scott M said...

@MM

How convenient. I would suggest an alternative. If Republicans were in power again they would drop health care reform from the agenda. Health care would get no reforms.

True enough. For ill or will, though, I would have to say that with a conservative (not necessarily Republican) president and conservative control of both houses, I doubt very seriously their focus would be on health care at all right now. Maybe next year or the year after, depending on how things shake out, but not right now. Political spin aside, the only reason the Dems tried to ram it home in 2009 was because they thought they could...not because it would do anything to our current debt and employment problems.

And the disaster of rising costs would continue.

You and I must have a very different view of what constitutes a disaster. I see crushing debt, constantly raising the debt ceiling, and going from the biggest creditor nation to the biggest debtor nation a disaster. How about you?

Republicans have no solutions for health care. Interstate and tort reform, if enacted, would fix about 2% of the problem.

That's roughly 2% more that will get fixed on the trajectory the Dems have us on which was, thankfully, altered into a harmless ocean splashdown due to the huge gravitational pull of one single guy that owns a truck in MA.

Seriously...a 2% fix followed by another 2% fix followed by another 2% fix...isn't this the way to go? Rather than a huge, corrupt, blue whale piece of legislation that the CBO determined wouldn't cover the millions of uninsured the Dems started this thing over in the first place? That Obama was forced to admit would have put the government between your doctor and yourself? That you would be able to keep your current plan if you wanted, etc, etc?

Small, incremental change is how our system was designed to function. Not sweeping, ponderous bullshit.

paul a'barge said...

Hey Obama ... "Talk to the Hand!".

DaveW said...

In order to get a tort reform number in the 2% range you have to exclude defensive medicine costs and use the $50b award figure. The AMA estimates defensive medicine cost at $200b per year so the 2% figure is deceptive at best.

I can't find any figures for interstate competition expressed as a percentage of annual cost. I do see a lot of reports that a health policy in NY costs about $8k per year verse Missouri at $1,500.

And if you had a single payer system that eliminated health insurance company profits entirely that is still only 2-3% of the 60% of the market not handled by government programs now. That's even assuming the government would deliver the services more efficiently than the private sector which is pure comedy gold.

Through such incremental changes a cost curve will be bent if it is going to be bent at all. If one is offended by the idea of insurance companies drawing off a few percent in profit I don't get the logic of thinking it is OK for tort lawyers to distort the system by several percent so they can buy yachts. What is the reason to oppose malpractice caps or some other form of tort reform *except* that tort lawyers are big Dem donors? What is the reason for opposing interstate competition?

There are no good reasons for producing a health care reform bill that doesn't address these issues. The only reason is raw Dem party politics.

RigelDog said...

Yup...the Democrat version of the health care bill is an omelet made with craisins, caviar, road-kill, pate, and unicorn poop. The Republican version is more like celery and cream cheese. The Dems will magnanimously offer to leave out the craisins.

TosaGuy said...

horse....barn....door....closed....

Regular Dem office holders have other things on their mind right now and don't want another summer of town yells where they are yelled at.

damikesc said...

Couldn't the GOP save their energy and just send some straw men? It is all Obama deals with anyway.

damikesc said...

They could start off by saying all federal government employees must accept the plan they are proposing. Its always easy to propose ideas if they will never impact you. Sure, it will piss off the unions, but that is just a bonus.

knox said...

I am amused by democrats' assertions that republicans have no solution.

What's the democrat solution? Really. I know a public option was supposed solve everything, but if Americans don't want it, then it's worthless.

And as far as the current bill, everyone but a few hangers on hates it. Great "solution," dems.

Derek Kite said...

I guess the Democrats don't want Obama around anymore, so he has to find someone to talk to.

Derek

former law student said...

The Republican ideas are pathetically weak.

their own good ideas like malpractice reform

Eliminating malpractice as a cause of action will save 3.5% of health care costs annually, per Amitabh Chandra of Harvard's Kennedy School.

Whoop-ti-do.

and allowing consumers to purchase health insurance plans from other states.

If you live in Manhattan, you have to pay what Manhattan hospitals and doctors charge.

If you want to buy insurance that covers Fargo hospitals and doctors charge, you pretty much have to move to North Dakota.

Are Republicans advocating such ineffective reforms because they're stupid? Or because they're evil?

There's really no alternative that I can see.

avwh said...

Are Dems advocating such ridiculous and ineffective reforms because they're stupid? Or because they're evil?

There - FIFY, fls.

Ignorance is Bliss said...

fls said...

There's really no alternative that I can see.

Maybe that's because the other alternatives are not currently lodged in your rectum, which seems to be limiting your field of view.

Scott M said...

@FLS

Eliminating malpractice as a cause of action will save 3.5% of health care costs annually, per Amitabh Chandra of Harvard's Kennedy School.

That's 3.5% (just using your own numbers as cited) that would be taken care of. That's progress is it not? I find it odd that you're being flippant about 3.5% of a problem that, when taken with a few percent here and there add up to significant sums of money saved. Further, it's 3.5% more than the Dem's plan is going to save because those two bills are deader than Tiger's marriage. Sure, it's still officially a going concern, but everyone knows the writing is on the wall.

Regarding your interstate insurance comments, I believe you are forgetting the primary reason it saves money and local costs ain't it. By the by, if ever we tussle over local costs, please explain to me why Obama/Biden have been trumpeting this magical $250k a year (for a married couple) as their baseline for tax increases WITH NO REGARD TO COST OF LIVING.

Interstate insurance purchasing will save money, as I understand it, because each state has a Christmas list of things that get tacked on that EVERYONE in that state must have. For instance...I don't think pre-natal care or care for a heroin addiction, but I'm forced to pay for that as part of my insurance. Allowing interstate plans opens options up to cherry-pick what you need. Increased options = decreased costs if my memory of market forces is intact.

former law student said...

The Republican Tort Reform Emperor has no clothes. Read for yourself. Download the full article:

"Tort reform has not led to health care cost savings for consumers. Given the strength of this finding, the authors assert legislators need to reexamine whether tort reform offers consumers any benefits."


http://www.rwjf.org/pr/product.jsp?id=36768


Medical Malpractice Reform and Employer-Sponsored Health Insurance
By: Morrisey MA, Kilgore ML and Nelson LJ


In: HSR: Health Services Research, 43(6), pp.2124-2142


Publisher: John Wiley & Sons, Inc.

Published: December 2008 .

Medical Malpractice Reform and Employer-Sponsored Health Insurance Request print version of this publication
Medical Malpractice Reform and Employer-Sponsored Health Insurance
By: Morrisey MA, Kilgore ML and Nelson LJ
Published In: HSR: Health Services Research, 43(6), pp. 2124-2142

Tort reform has been championed as a way to reduce health care costs for consumers. But this analysis of health insurance premiums several years after states have enacted tort reform reveals families and individuals have not realized any savings, thus raising the question of why consumers should trade off legal rights without economic gain.

Tort reform advocates have argued capping the amount of money medical malpractice victims can potentially collect for noneconomic damages will directly reduce malpractice insurance premiums, as well as change the way doctors practice medicine. Freed from the fear of large court judgments, providers will practice medicine less “defensively” and thus more efficiently. Health care cost reductions should then be passed on to consumers as lower insurance premiums, in effect, their “trade-off” for capping potential damages.

This analysis of health insurance premiums was based on data collected from private and government employers with more than 200 employees for the period from 1999 to 2004 and examined premiums three to five years after tort reform was enacted, allowing for the impact of reform to filter through the system.

Key Findings:

1.Caps of noneconomic damages did not translate into lower health insurance premiums for consumers. Various types of analyses did not alter this finding.
2.A survey of empirical research does suggest tort reform has constrained the growth of malpractice premiums for providers but, as these authors note, these premiums are a very small component of health care costs and do not have much impact on overall costs.
3.From research by others, it is less clear whether doctors change the way they practice medicine after tort reform, although there is evidence of some cost reductions in cardiac and obstetric care.
Tort reform has not led to health care cost savings for consumers. Given the strength of this finding, the authors assert legislators need to reexamine whether tort reform offers consumers any benefits.

former law student said...

That's 3.5% (just using your own numbers as cited) that would be taken care of. That's progress is it not?

Considering that health care costs have been rising at over 6% a year, a 3.5% reduction will have no lasting impact.

From the Kaiser Family Foundation

Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.2 trillion in 2007, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. Stemming this growth has become a major policy priority, as the government, employers, and consumers increasingly struggle to keep up with health care costs. [1]

In 2007, U.S. health care spending was about $7,421 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries. Total health care expenditures grew at an annual rate of 6.1 percent in 2007, a slower rate than recent years, yet still outpacing inflation and the growth in national income. Absent reform, there is general agreement that health costs are likely to continue to rise in the foreseeable future. Many analysts have cited controlling health care costs as a key tenet for broader economic stability and growth, and President Obama has made cost control a focus of health reform efforts under way.


http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358

former law student said...
This comment has been removed by the author.
Scott M said...

@FLS

All well and good, but reality seems to be a tad askance to your cited source. Purely anecdotally, I admit, my brother and sister in law are married docs (optical surgeon and pediatrician respectively). They moved to Texas after the "draconian" tort reform was enacted and are extremely happy with the results. According to them, so are their peers and the stats of docs flocking to Texas to set out their shingle seems to bolster that.

Contrast that to my mother-in-law, an ER doc, who is very involved in the various machinations of tort reform/liability insurance in Missouri. She's very close to simply retiring because of the climbing costs and she's not alone in that sentiment.

Aside from the fact that Texas has had significant success with tort reform, you're ignoring the fact that good, experienced doctors will simply stop practicing. What then? Our best and brightest stop going into medicine and start going into government service?

former law student said...

Maybe that's because the other alternatives are not currently lodged in your rectum, which seems to be limiting your field of view.


Hey, don't get upset just because you can't think of an alternative to "stupid or evil."

Fen said...

April: Now the desperation is so thick – the democrats must run and hide behind the republicans.

And April wins the thread.

I hope the Republicans will highlight the graft and corruption behind the Dem plan.

ObamaCare is dead. Obama is just dragging the corpse before the GOP so he can blame them for it.

Scott M said...

@FLS

Considering that health care costs have been rising at over 6% a year, a 3.5% reduction will have no lasting impact.

Well, admittedly, I disagree with your 3.5% to begin with, so this seems like a non-starter as far as arguments go. But that doesn't address the fact that I brought it up in addition to other fixes that can be done to cumulatively combat higher costs.

All of this aside, health care had no place in last year's center stage. It should have been the economy and unemployment. I believe the administration is finally coming to see that as well. What we're seeing globally (and from the recent G7) is that the advanced economies are going to have to address an upcoming budgetary/debt cliff. This WILL occur in our lifetimes and, frankly, is terrifying. Subsidy and entitlement spending is mentioned over and over again by everyone involved as the largest problem.

The current plan (just barely averted) would have exacerbated an already out-of-control problem. That should be this administration's first priority and were all of it's political capital is being spent. Instead, they've made themselves very weak, politically, and received nothing in return.

Fen said...

former law student: "Republicans are stupid or evil"

What? No more race cards in your hand?

former law student said...

you're ignoring the fact that good, experienced doctors will simply stop practicing.

The federal government has stepped in to make low-cost flood insurance available -- perhaps they could provide "single-payer" malpractice insurance to keep doctors from bailing out. Or doctors could band together in clinics to demand lower rates, or they could work for HMOs which, if big enough, could self-insure.

Scott M said...

@FLS

Considering that health care costs have been rising at over 6% a year, a 3.5% reduction will have no lasting impact.

Just to reiterate, tort reform doesn't exist in a vacuum, so your point is, I believe, a weak argument against it. Further, the AMA has estimated defensive medical spending at somewhere around $200B. Those are savings completely seperate from tort reform inasmuch as calculations are performed, but are the net result of doctors not feeling like someone needs a CAT scan for a sprained ankle.

Scott M said...

The federal government has stepped in to make low-cost flood insurance available -- perhaps they could provide "single-payer" malpractice insurance to keep doctors from bailing out. Or doctors could band together in clinics to demand lower rates, or they could work for HMOs which, if big enough, could self-insure.

Apples and oranges. Besides...you're actually supporting large HMO's? (lol)

Remember what I said upthread about subsidy and entitlement spending? I don't think you're seeing the forest fire for the trees.

former law student said...

All of this aside, health care had no place in last year's center stage. It should have been the economy and unemployment.

I agree 100%. Why didn't Obama solve in one yeat the problems it took W. eight years to create?

DaveW said...

3.5% (assuming that's accurate) of $2.5T is $87.5B per year. It cannot be seriously argued this is real reform if it ignores that much scratch laying around especially if it does so merely as a political payoff.

Synova said...

We could auto-magically reduce health care costs to, say, 1975 levels, or any other arbitrary year, simply by providing medical care at the level available in 1975.

Problem solved.

I *get* that the various Republican and other suggested reforms won't do a lot... but what about the Democrat mega-bills will do anything at all to reduce costs?

The biggest reason that health care costs so much is that it can *do* so much.

We just don't feel comfortable letting people die.

So, if we can start this bipartisan meeting, this discussion... shall we start with determining what our goal is. Do we want to save money, or do we want to improve access.

The two are not compatible.

And any 2000 page monstrosity that claims to do both is a lie.

Scott M said...

I agree 100%. Why didn't Obama solve in one yeat the problems it took W. eight years to create?

Incompetence is the first word that comes to mind. Add ideologue to that and we've got a very dangerous combination. And don't get me started on what the President's administration has done to the debt...which I keep telling you is the real danger here.

Seriously...it's like amateur hour at 1600 Penn Ave. Combine all that with President Obama's admission that his claims of the fed not coming between people and their docs, people keeping their plans if they want to, etc, were backdoored by Congress just adds to the black humor. Seriously, if he couldn't see that coming or have enough Rahm to spread around to make sure it didn't happen to begin with, what we're left with, again, is a very weakened political figure with nothing to show for it.

And a debt tsunami that the Boomer's are going to saddle us with that he's doing nothing substantial about...

Synova said...

"I agree 100%. Why didn't Obama solve in one yeat the problems it took W. eight years to create?"

He did.

He pushed through a ginormous stimulus bill and several other pay-off schemes that were going to solve those problems simply by throwing enough money into the economy.

It's not like that took a lot of time or attention. By design and intent it was just supposed to work no matter where that money went.

AJ Lynch said...

FLS:

I don't know why you sneer at saving only 3.5% of health care costs. Per Dave W.'s comment- If we agree with your 3.5% figure, that is almost $90 Billion per year.

As an example, on 2011, the Dept of Transportation budget is $106 Billion so $90 Billion is big money IMO.

Ignorance is Bliss said...

Synova said...

So, if we can start this bipartisan meeting, this discussion... shall we start with determining what our goal is. Do we want to save money, or do we want to improve access.

Or, as a third option, do we want to empower people to make those decisions for themselves, instead of having them made by the federal government, or even their employer.

DaveW said...

It isn't just that.

That $87.5B is roughly a trillion smackers over 10 years. So you're going to reform health care by cutting a half trillion in medicare over 10 years while leaving a trillion for personal injury lawyers?

Good luck selling that one.

former law student said...

Further, the AMA has estimated defensive medical spending at somewhere around $200B.

Where did they get that number from?

Further, the Republicans have yet to put a dollar amount on the savings that would come from buying insurance across state lines. And they have completely ignored the difference between what doctors and hospitals charge in Fargo and what they charge in Manhattan.

Bushman of the Kohlrabi said...

I agree 100%. Why didn't Obama solve in one yeat the problems it took W. eight years to create?

Yeah, because we know health care wasn't on the national radar before Bush. I guess Hilary was just joking back in 1993.

Scott M said...

Where did they get that number from?

I'll dig it up here shortly if I can retrace my net steps. What say you if it's true?

Further, the Republicans have yet to put a dollar amount on the savings that would come from buying insurance across state lines. And they have completely ignored the difference between what doctors and hospitals charge in Fargo and what they charge in Manhattan.

So...in effect...what you are saying is that it costs the exact same thing to have your car repaired after a collision in Fargo as it does in Manhattan? I find that hard to be true.

Synova said...

fls... insurance companies are very good at charging different people different rates on account of risk.

Buying across state lines increases competition. But there is no reason that a person living in Manhattan would have to be charged the same as a person living in Fargo.

(Fargo has very very good hospitals, BTW, quite out of proportion to the size of the city due to serving most of northern Minnesota and North Dakota as well as *gasp* significant numbers from Canada.)

former law student said...

Dave -- 3.5% is the reductio ad absurdam. That's when you complain about the surgeon removing your one good kidney, and they say "Too bad." That's when your doctor is tempted to run the MRI that might detect a cancer, but the cost-benefit isn't favorable.

Freeman Hunt said...

No need to start from scratch. I'm sure the bills have words in them like the, on, in, and a number of similar that we could use.

Synova said...

"That's when your doctor is tempted to run the MRI that might detect a cancer, but the cost-benefit isn't favorable."

With health care reform a government "best practices" board will make those decisions for your doctor, so that your doctor can't screw you over like that.

No?

Kirk Parker said...

Be careful, Althouse, you're verging on Tom Friedman abuse-of-metaphor territory here! :-)

The difference, of course, is that you have a brain, and a sense of humor (not to mention a feel for the language), so that so far at least it works.

But I'd sure hate to see you fall off that linguistic precipice you're standing on! (Oh, ok, I'll admit it: I'd laugh my head of first, then feel bad for you.)

ricpic said...

Obama's plan and Obama's birth certificate: will we ever see either?

DaveW said...

FLS I ran across the $200B figure earlier while googling on the subject and I can't find it quickly now. I'm guessing it was third party since it doesn't come up quickly, but I don't remember the exact search term I was using. We can use the 3.5% figure (which is a good bit lower).

This is all abstract anyway. You wouldn't save 100% of the cost of torts with tort reform obviously. You'd save some percentage by limiting awards. And you wouldn't save 100% on defensive medicine either, just some percentage depending on the dynamics of how it played out and affected the behavior of doctors.

Scott M said...

It was the WSJ, but I'm having trouble retracing my steps (remotely to computer I originally read the article on). I trust FLS and I have tussled enough that there's no assumption of outright bullshit on my part. T'aint mah styyahl.

Agreed on limiting awards. Texas has had success with this but are now getting some pushback on the amount. It seems an across-the-board limit was too one-size-fits-all and their looking to amend it.

Ignorance is Bliss said...

fls said...

That's when your doctor is tempted to run the MRI that might detect a cancer, but the cost-benefit isn't favorable.

Well, the only way to bring costs down significantly is to do the cost-benefit analysis, and then to not perform the procedures for which the analysis is not favorable. However, it should not be the doctor who makes the final decision. The only one who has any business making a decision based on the cost-benefit analysis is one paying the cost. The Democrats would like that to be the government. I'd like it to be me, at least for as many cases as possible.

Big Mike said...

Let's see, we have three plans, two of the them Democrat-produced 2000-pager bills which probably no one understands completely (and which are probably internally contradictory, to go with being contradictory with each other), plus an outline for a plan that Republicans published but have not yet fleshed out (no provisions of which were considered in the makings of the 2000-pagers).

And Obama thinks he can clear up this self-inflicted mess with a simple televised meeting with lots of people around a table? I can't imagine getting through either the House or the Senate version of healthcare in less than 5 days of round-the-clock meetings, and which broadcast networks will give up all that revenue to televise such round-the-clock meetings?

My own take? Democrats want desperately to kill their own two bills in an effort to staunch the bleeding, but for obvious political reasons they want to pin it on the Republicans.

Big problem that Obama is overlooking is that he is giving Republicans a stage on which they can project themselves as the thoughtful grownups who don't want to rush into things without thinking them through. To the extent that such a forum provides the likes of McConnell and company with an opportunity to paint Obama, Pelosi, and Reid as out of touch with the concerns of the people, and going off half-cocked like some silly teenagers, this will backfire on the Dems.

So why would Obama give his opponents such a slam dunk set up? Probably because like most Democrats wrongly thinks that he's much smarter than any Republican politician. I don't think he learned anything from his short stay in the US Senate.

Methadras said...

cokaygne said...

Great move by Obama. The ball is now in the GOP's court.


Bullshit. He copied it from the movie Dave, where Kevin Kline is the do-gooder twin of the President and in one part of the movie brings in all the members of the cabinet to hammer out a budget with essential budget cuts to save the American people money. President Barely thinks that he can take this tact and he will fail. His incompetence is staggering in it's breadth and scope.

c3 said...

fls;
Eliminating malpractice as a cause of action will save 3.5% of health care costs annually, per Amitabh Chandra of Harvard's Kennedy School.
There's plenty of disagreement about the fiscal impact of tort reform. But I can say as a doc, it is an absolutely HOT BUTTON ISSUE for all docs.

And so if it only "bends the cost curve ever so slightly" but gets docs revved up about the bill, why wouldn't you put it in?

It's just too easy to conclude that BO and the rest of the Dems are beholden to the lawyers. Foolish

That single addition in the bill (please stop with the studies or demonstration projects...) could get that most precious of items, a (meaning one) Republican vote.

So BO, if you want it, work for it. Do some heavy lifting beyond talking.

BJM said...

This is so phony it makes my hair hurt.

Revenant said...

Megan McArdle said it well -- the public doesn't mind when politicians are "obstructionist" towards bills the public hates. See, e.g., Bush's attempt at Social Security reform.