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The President’s Health Care Plan

It is hard to see how the health care plan the President released this week changes anything.

There is nothing new in it save a health insurance rate regulatory board that is an awkward political proposal at best. What powers would it really have and how would it operate in conjunction with the states already
charged with insurance company oversight are just two of the first questions it does not answer.

Fundamentally, what good would insurance rate regulation do if the President’s plan has only tepid cost containment built into it in the first place?

There are not the votes in the House right now to pass this new proposal—or the Senate bill. There are not likely even the votes in the Senate under a 51-vote rule for the President’s new plan.

That could change if the President scores a game changer on Thursday at Blair House that finally moves the polls from the 40% approval rating Democrats have had on health care to something over 50%.

But there is nothing in the White House health care proposal that was released this morning that will do that. If the President thinks he can do it alone on the back of his “communication skills” then all the adulation on the part of his supporters, like his Nobel Peace Prize, has gone to his head.

If Obama wants to score a real game changer on Thursday, when the Republicans call for starting over on health care, I will suggest, the President ought to say, “Deal.” Then call on the Republicans to join he and the Democratic leadership in 60 days of intensive negotiations to get a bipartisan deal. That would really put the Republicans on the spot—and Democrats as well.

If what both sides want is bipartisan health care reform then what they should be agreeing to do is achieve that in a time certain with no preconditions on the table.

Then let’s see who comes to the table in good faith.

The outcome of that exercise, successful or not, would give us a real issue to take to the polls in November.

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33 replies »

  1. Appreciating the dedication you put into your blog and detailed information you offer.
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  2. I dont see how this bill can even be passed, it is clearly unconsitutional. No where in the consitution does it even hint that a national healthcare is right. Even if this bill
    is passed, someone will be smart enough to bring it before the supreme court to
    challenge it, to where that person shall win the case and national healthcare will be
    gone. This bill will no good for the people it will push the waiting lines by months,
    the quality of medical attention is going to sharply decrease. We as a nation already
    have some sort of national healthcare because EVERY public hospitol has to help to some
    one who is injured because if they dont its illegal.he is not looking at the nations
    number carefully i believe, last time i checked it was about 37 million uninsuranced
    people….ok now lets think, How many of these people are illegal immigrants? How many
    of these people are young adults that do not even want health care who wish to spend
    money on different things because their health is fine? how many of these people
    actually qualify for medicad/medicare but dont even look into it? because are thinking
    this is going to help the economy…ok this wont make jobs, how do you think government
    is going to get this money? tax the shit out of people… the only solution to the
    economy is for less government involvement and let the people have more freedom to spend
    their money, not by forcing every american to pay for this shitty form of insurance
    (which some people may never see a doctor). all iam trying to say is that this
    unconsitutional bill is not the answer we are looking for.

  3. I think that the current discussions about healthcare are shortsighted. They do not look to the future.
    Healthcare initiatives to date have focussed on providing healthcare to the needy. This is good. But what about addressing the prevention of ill health. Poor personal health practices is responsible for creating the need to address healthcare at this time.
    It is said that it is better to teach a starving man how to fish than it is to give him fish to eat.
    Much has been written about the obesity epidemic. Obesity, of course, leads to ill health and exacerbates the need to address healthcare.
    Why is noone talking about educating children in the subjects of fitness and nutrition in schools? Doing so would contribute to improved health in future generations and therefore diminishing pressure on the healthcare system in the future.
    In the meantime, a way needs to be found to educate the current generation in these matters . Information similar to what is contained in the article about
    Fat Burning Exercise needs to be taught to the general population.

  4. This is what the President needs to make clear to get the ball rolling on healthcare: A nation of healthy people is a nation of happy people is a nation of successful people is a nation of powerful people is a powerful nation. And full healthcare, not this 31 million out of nearly 300 million.

  5. Can we call a sped,a sped,i mean ,it is not hidden but revealling,ha ha,you know what i mean.we are better than that,nobody knows tommorow,the worst sickness might come in your backyard,maybe,big maybe and God forbid,you just lost your job,do you no what that means?,you will be like those people you fear that will benefit from the health care bill.

  6. TO MUCH HEALTH COST EVERY YEAR INCREASE WITHOUT ANY VISIT WITH DOCTOR. PAYROLL SAME BUT COST GOING UP AND UP. NO TAKING CARE ABOUT THIS REALITY HAPPEN. ALL POLITICIAN WORRY ABOUT HIS/HER POSSESSION.

  7. The reason why most peaple expecially white foxs are not supporting this Obama health care is just one reason,racism,they fear that black people are the fox that will benefit from the whole deal,being poor and not much in work force,even Hispanics.it is time to bypass and overgrow that aspect and do the right thing by supporting the bill.

  8. Mr Obama’s Health Plan eventually squeezes out the Private Insurance Industry, leaving the US GOVT in control.
    And this event and strategy is against our 10th Amendment. The US Govt can not make us buy their goods & services and make us pay a fine or penalty for non-compliance.
    Rep. Paul Ryan, WI (R) has an approved by the C.B.O. Reform Pkg that’s, lst of all, legal. This is a State Issue.
    http://www.house.gov/ryan/roadmap
    It’s 87 pages long. It covers all inter-locking topics, including tax reform. He’s worked on it for 6 years. The Progressives don’t want it, as it doesn’t expand Federal Powers and Union Powers.
    Finally, the present proposal is not Mr. Obama’s. Instead it is Pelosi’s and Reid’s Plan.
    All confusion is of the Devil, which is Reid’s & Pelosi’s plan. Has anyone really read the Bill?

  9. Everybody wants health care reform, me included. Everybody who is sane and responsible wants peace on earth, goodwill to all men, hunger be abolished, and children be able to grow up and do the best they can.
    Ok, let’s look at some realities here:
    Universal health care? What will the government do about tobacco? Who gets access to expensive procedures and medications, and who doesn’t? And, who pays for it?
    To readers who know me, what about profit? What is done with any monies that exceed expenses? Does someone/some organization get it? Does it get allocated to improve the system? What if the system operates in the red? Who gets figuratively and literally bleed to balance it?
    Finally, do all health care providers agree to accept a base rate for the work they do? And who defines this base rate? Is it a peer? Is it a bureaucrat? Is it a business person? And who pays for the education to learn this professional skill that not all could learn?
    There are probably hundreds of other questions to ask to set up health care reform. I don’t have the time or interest to think them up. And yet a lot of you think these idiots is DC have done this?
    What is a delusion? Believing things that are not in the reality of the community around the individual with the beliefs. Hmmm, maybe our politicians aren’t delusional, because their constituents have the same expectations. Or, maybe America is delusional as a culture and society.
    Man, I can’t treat 300 million people!

  10. And is it Obama’s failure to advocate “single payer” that has inclined you to place him, uhm, “right of center,” didn’t you say? I can see where he might shy away from antagonizing the doctors and their SEIUized support staff. “Single payer,” for all that, has been a rallying cry for the… how shall I put it…those to the left of Obama? You know, the Kosites?

  11. “But, using what they have already said and done, my bet is on more talking point politics from the GOP.”
    Republicans in Congress know that they have nothing to offer. The Administration and the Democrats in the Senate should agree to whatever the Republicans define as “tort reform” in exchange for support of a public insurance plan that has no restrictions on it whatsoever.
    I doubt that Republicans Congress members can even define “tort reform” at this stage in any case. It could be defined in a way that is in fact beneficial to the public, although certainly inimical to contingency lawyers, so both Democratic and Republican politicians might benefit from it.
    “Single payer would at least have given you control of the practices and charges of providers. You have lost that, and now try to substitute, in defiance of the objective statistical record, the notion that the cost of health care can be slashed by liquidating the insurers.”
    A single payer/insurer scheme has never been considered by most Democrats in the Senate nor by any key Administration official nor by the Obama presidential campaign. It was explicitly excluded by the campaign and by those in the Senate involved in determining legislation.
    Republicans, as I always note, are in fact the ones who should propose that scheme. Business interests – large and small – which Republican politicians uniformly represent would support it wholeheartedly. The scheme and its benefits to business as a whole have never been presented to groups that represent the various segments of the business community.
    Businesses have zero interest in providing healthcare benefits to employees, so would be delighted to pass the responsibility on to a governmental entity, particularly if they can be reasonably assured that the net funding cost (by substituting taxes for benefits costs) is likely to decline over time.
    Private insurers would in effect be liquidated if forced to absorb higher costs without increasing revenue. Simple arithmetic. There is no chance of that however despite current political rhetorical posturing.

  12. Abortion is not pregnancy reform and this monstrosity is not healthcare reform. Ramming this through reconciliation will be just like the shot at Fort Sumpter.
    Too much debt. Too much big government. Ignoring the Constitution is a violation of every officer holder’s oath of office.
    Only five days until the Medicare fee cuts take effect. My office will not see Medicare patients under the schedule now in place March first.

  13. Obama could just offer up tort reform (health courts) to easily get 61 votes and declare victory – the fact that dems are so concerned he might just do this shows it’s the trial lawyers, not republicans , that are holding up health reform/senate plan —
    anyway, neither party is serious about this — nothing new-all posturing, spin and protecting their seats in a primary-
    there will never be meaningful healthcare reform until
    1. majority of citizens who vote and pay taxes lose health insurance )currently we have a long way to go here — only 15% of voters who are employed lack insurance
    2. we have major election reform that a) ends gerrymandered congressional districts, b) installs term limits, or c) regulates campaign financing more effectively
    3. we develop a third party to give independent and centrist voters a real choice to express their concerns/outrage

  14. “In order to fix health care, we should first remove all current government distortions. Let’s abolish Medicare and return paid premiums with a cash-based annuity. ”
    And when a senior citizen’s annuity runs out, hhow does that person get health care?

  15. Dennis have you ever heard of the interent? You can go to the GOP site and see their full proposal, it basically is a one stop shop that disproves everything you said. How about a little less propoganda and mix in even one or two facts for a change?
    Just becuase you don’t understand any solution that doesn’t get delivered by big government doesn’t mean they don’t exist and aren’t in fact more likely to work. As a sustainable solution to solving the uninsured problem making insurance affordable works far better then subsidies we already can’t afford.
    From one uninformed clown to the next…
    “As long as they can collude, price fix and collectively determine what gets covered, or not covered,”
    Linda you never heard of a state or federal mandate? Your commnet is complete ignorance and 100% factually wrong. Government already decides what gets covered and what doesn’t. The emexption you talk about predates HMOs by 40-50 years and doesn’t do anything you think it does.

  16. I agree, this proposal is nothing new. There are more than a few people uneasy with the whole concept. From the stripping Medicare to help cover for it to the concept of how are the general public going to have to pay for it. Many people in countries with government run health care come to the USA and pay for services due to the fact that we have the best available. This will not be the case if we price fix Medicine.
    Edward Camp San Francisco Chiropractor

  17. I agree with archon41. The Democratic health care bill will very likely not pass because the “Citizen Right-of-Center” does not care much about the uninsured. The majority (correctly or incorrectly) perceives the bill as being a giveaway to other groups: the poor, illegal immigrants, abortionists, people who don’t exercise, insurance company lobbyists, farmers in Nebraska, etc.
    After all, why would a senior receiving government-guaranteed health care coverage want to spread that benefit to others? Why would a Massachusetts resident, or a union worker, or a government employee want to pay for others to get benefits they already have? Why would an employee with a stable job want to give up his tax exclusion and his community rating?
    In order to fix health care, we should first remove all current government distortions. Let’s abolish Medicare and return paid premiums with a cash-based annuity. Let’s also abolish Medicaid and CHIP. We should get rid of the employer-based health insurance tax exclusion and ERISA/HIPAA regulations. We need to privatize VA hospitals and any other government interest in health care. We should replace all government employee (federal, state, local) health care benefits with cash payments. And of course, we should nullify all state-based mandates. Then let everybody buy individual insurance with their own money in a completely unregulated market.
    After 5 years, if the majority of people are happy with this, then great. We have solved the health care crisis and we have proved to the world that we can get things done with no government.
    If after 5 years, the majority realizes we need some sort of government involvement, then let’s create a legal framework that gives everyone EQUAL rights and protections. No special treatment for seniors, veterans, federal employees, or citizens of Nebraska.
    By doing nothing, all we are proving is that some special interests are much better than others at milking the government.

  18. Linda – you know that those behaviors are not actually what the “anti-trust” exemption permits, right? The practices that you reference are already not permitted.

  19. President Obama is not god and he had better listen to Christian leaders who are trying to get him to bow before the living God, whose son’s name is Jesus Christ.

  20. Please, can’t someone do something to stop this absurdity? There is no government health care program that delivers adequate healthcare. America is known for private enterprise, why change now?

  21. You’re right about one thing: The Proposal is DOA in right-of-center territory. What is new in it is not good, and what is good is not new.
    Citizen Right-of-Center is not agonizing over the “uninsured.” He does not see this as a “crisis,” moral or otherwise. He does not see the pronouncements of the World Health Organization about “equality of access” as representing the voice of the moral universe. What he sees is moral posturing and patronage politics.
    Cries of “The sky is falling!” fall incessantly on Right-of-Center’s ears. “The system is underfunded! The rise in costs is becoming ruinous! The center cannot hold!” And what is he offered? “Comparative effectiveness research,” and such flapdoodle. That, and multitudinous schemes to fund, and conceal the true costs of,the entitlement to “equality of access.”
    Right-of-Center may not be an “intellectual,” but he sees clearly enough that the private insurance system is the only thing standing between him and the procrustean bed of “standardized” health care you would force him into. Do you really think he can be persuaded to delegate regulation of that system to those who desire its destruction?
    There was at least a grain of rationality in your original objectives. “Single payer” would at least have given you control of the practices and charges of providers. You have lost that, and now try to substitute, in defiance of the objective statistical record, the notion that the cost of health care can be slashed by liquidating the insurers. Right-of-Center isn’t buying it. Besides, he has a few equities in his 401k, which he is not minded to dedicate to the greater good. He also realizes the futility of trying to bargain with partisan animosity and ulterior motivation. He will keep his powder dry until after the November elections.

  22. There will never be true health care reform unless the HMO’s anti-trust exemption is repealed. As long as they can collude, price fix and collectively determine what gets covered, or not covered, there will never be true reform or any safe way to pull back the state mandates they hate so much. Wanna lower premiums? Then make the HMO’s actually compete against each other without their anti-trust exemption. It is the only real starting point.

  23. When you write that the President’s proposal changes nothing, it’s difficult to tell if you are talking about policy or politics. The reason we face a crisis of health care in the United States is because politics has shouted over the discussions of policy. The President’s proposal is an attempt to force the Republicans to talk about policy instead of just parroting their political poll-driven talking points, which has been a successful strategy.
    I know many will take exception to that statement, but consider what the Republicans do not talk about. They do not talk about covering the 30-plus million uninsured — America’s moral scandal — but which is the heart of the President’s plan. It’s a year into discussions of health care reform and I doubt anyone here can articulate what the GOP leadership really stands for in concrete terms beyond calls for tort reform (a partial solution) and “market-driven” reforms (whatever that means in an already unregulated free market). It’s revealing that the one time the GOP publicly put something on the table, namely their substitute amendment during the House floor debate back in November, they offered a plan that the CBO scored at leading to an INCREASE in the number of uninsured Americans ten years from now. I’d like to something defending that as “reform.”
    So, when the President meets with the GOP on Thursday, my hope is that they will finally talk about important policy prescriptions and provide a concrete proposal to cover the uninsured (among other matters). But, using what they have already said and done, my bet is on more talking point politics from the GOP. So, in the end, the President and Congressional leaders will finally decide to move on a bill through reconciliation. After all, they are already on record as voting for this. They might as well make it official and pass a comprehensive reform bill.

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  25. Looks like I fell into error on this rate regulation business. Apparently, there is no complete “presidential bill,” just the Proposal and the Summary. Kim quoted from the former, I from the latter.
    The proposal seems to contemplate shared authority between the state and federal governments with respect to rate oversight. Several insurance commissioners have already expressed uncertainty concerning who has final authority (State Regulators Criticize Obama Plan. . . Kaiser Health News, 2-22-2010.)

  26. Well, Kim, I can’t reconcile what I quoted with what you quoted. I guess someone, eventually, with more initiative than either of us will dig into the PDF text of the Bill.

  27. “If Obama wants to score a real game changer on Thursday, when the Republicans call for starting over on health care, I will suggest, the President ought to say, “Deal.” Then call on the Republicans to join he and the Democratic leadership in 60 days of intensive negotiations to get a bipartisan deal. That would really put the Republicans on the spot—and Democrats as well.”
    Deal? Deal for what? Republicans and Republican Like Democrats, and Independent Republican Joe Lieberman, have already denuded the bill of anything that would give Democratic supporters something to admire in Democrats. The insurance lobby and the medical provider lobby are left to their usual money making selves, while the government extends yet another subsidy to prop up medical/insurance community income/profits, because they just can’t help themselves. Only adding tort limitations, government control of jury awards, (funny how Republicans like that type of government control) is left to “deal” and may cause a couple of Republicans, who haven’t quite developed all the Cheney/Rove-flared-nostril political blood spilling qualities of a good Republican yet, to side with Democrats who are on their way to election oblivian anyway. And who in Fox News is going to credit anything that looks like Democratic “dealing” anyway. We all know that come election time any “bipartisan” kernel of “cooperation” from Republicans will be turned against Democrats and not into the hand holding, “We did it for the nation” kumbaya that Amerians say (but don’t really mean) they want.

  28. I don’t think the rate review is advisory:
    “The President’s Proposal strengthens this policy by ensuring that, if a rate increase is unreasonable and unjustified, health insurers must lower premiums, provide rebates, or take other actions to make premiums affordable.”
    It does sound like the rate increases may be reviewed by States OR the Secretary, although I’m not clear in which cases the Secretary gets the authority.

  29. Looks like the Feds, with respect to rate increases, may be limiting themselves to an advisory role. The Overview of the White House Summary contains this language: “a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices. . . .”

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