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Tag: Jeff Goldsmith

The Unbridgeable Gap between Left and Right on Health Reform

Though thoroughly smothered under 2900 pages of well meaning but poorly focused, expert-driven “good works”, the core of the Affordable Care Act was providing 30 million people subsidized health insurance coverage. As the country continues to decide how it feels about this monumental legislation, a major ideological divide persists over whether the aggressive coverage expansion in health reform was really needed or not.

Far from “selling itself,” as a overconfident White House aide suggested it would back on March 23, 2010,  health reform remains strikingly unpopular. Only 37% of the public thinks the country will be better off as a result of health reform, and only 28% think their families will be better off, according to the May Kaiser Family Foundation tracking poll.  There is a stark partisan divide over health reform.  While 72% of Democrats have a favorable opinion of health reform, a substantial minority believes the bill could have done more (covered more people, provided a public option or path to single payer).  Alternatively, 74% of Republicans have an unfavorable opinion of health reform; the same percentage favors repeal.  Independents tend to break toward the Republican view of the bill (49% unfavorable vs. 35% favorable).  Those opposed feel more intensely about health reform than those in favor.

The Ryan House Budget for 2012 zeroes out all new spending for health reform (while keeping ACA’s Medicare cuts, devoting them to deficit reduction!).  The conservative narrative is that the problem of the uninsured was liberal mythology, not meriting major new spending.  In the blogosphere, an analysis surfaced suggesting that the real uninsured problem is only about 4 million people. This apparently originated in a Heritage Foundation blog posting from late August, 2009.  Other conservative analysts charitably suggest there may be as many as ten to twelve million uninsured worthy of federal help.   To take care of this smaller number, you do not need a major coverage expansion, but merely to apply the familiar market oriented remedies: selling insurance across state lines, high deductible health plans, malpractice reform, high risk pools, etc.

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Last Helicopter Out of Saigon!

Jeff goldsmith In popular psychiatry, a classic passive aggressive gambit is “malicious compliance”- intentionally inflicting harm on someone by strictly following a directive, even though the person knows that they are damaging someone by doing so. In Washington, the most skilled practitioner of this dark art is Speaker Nancy Pelosi If health reform craters, Pelosi will disingenuously claim that she did precisely what the President asked of her, and blame the Senate and the President for its failure.

In reality, Pelosi’s “leadership” almost fatally wounded health reform last summer. If the process does collapse, the blame should fall squarely on her shoulders. Her poor political judgment led directly not only to squandering a nearly 80 vote majority, but also exposed embarrassing and ill-timed disunity among Democrats on a signature domestic policy issue. It won’t be the Republicans that killed health reform, but incompetent Democratic Congressional leadership.

Last July 14, Speaker Pelosi unveiled the opening bid in the health reform process- HR 3200, America’s Affordable Health Choices Act of 2009. This bill was drafted largely without input from their Republican colleagues or from important Democratic moderates. It also put into legislative language virtually exactly what the President promised in his campaign, without considering seriously the political implications for the actual passage of the legislation- a political form of malicious compliance. Democratic moderates felt their input had been ignored and they were immediately trapped on the wrong side of this issue.

HR3200 had an immediate polarizing effect on the health reform debate, and the damage control process was on. In a sense, health reform has never recovered. Pelosi’s bill summoned the right wing talk radio demons (and the inimitable Betsy McCaughey) out of their caves, reviving long dormant rhetoric about a “government takeover of the health system”. This label has clung stubbornly to all subsequent versions of the legislation.

Unfortunately, the critics weren’t too far wrong. HR 3200 effectively federalized the employer health benefit. It mandated that employers offer a “one size fits everyone” health benefit to their workers, the benefit precisely defined by federal statute. It imposed an 8% payroll tax on employers who did not provide the benefit, pushing their federal payroll tax to 23% if you include Social Security and Medicare. It also moved the top tax rate for federal income taxes for businesses filing as “subchapter S” to 46%, a level not seen since Jimmy Carter was in the White House.

Given unemployment was climbing toward 10% at the time, HR3200 would have simultaneously diminished corporate cash flow and increased the cost of hiring new workers for firms that did not presently offer health coverage- a recipe for no recovery.

HR 3200 created new health insurance premium subsidy for workers covering and estimated 20 million new people, but without any meaningful brake on future federal subsidies. To enroll these new folk, however, health insurers would have to comply with provisions of a new federal health insurance exchange, whose rules would have effectively ended medical underwriting.

The health coverage gated through the exchange was no longer be “insurance”, but a federally defined health care entitlement financed largely by employers. The bill also created a public health insurance option, which had the effect simultaneously of competing with and financially undermining private health insurers. All of this was to be overseen by a politically appointed Health Choices Commissioner, in effect, a commissar for the health insurance system. This nominally private-sector approach had a distinctly Soviet flavor.

Almost immediately upon HR3200’s release and for the following seven months, the Democrats have been playing defense on health reform and losing. Democrats elected from Red or Purple states ran from the bill as fast as their legs would carry them. They rebelled against the “public option”, the employer mandates, as well as the tax increases required to fund the premium subsidies.

Moderate Democrats also objected to subsidizing private coverage of abortions and to any enrollment of people in the US illegally (roughly 7-8 million of the uninsured). It might have been possible to address these concerns “privately”, e.g. in the initial drafting process, but by the time HR 3200 was released, many After almost four months of contentious negotiations, a revised version of the House bill passed by only five votes, one of which came from a stray Republican.

By the time Democratic moderate concerns had been clumsily and publicly accommodated (in the late fall), the resulting House bill had gravely offended three core constituencies of the Democratic party- women, Hispanics and the single-payer advocates, without materially addressing the critics of a huge expansion of federal power (and spending). The Democratic base lost enthusiasm for the bill while Democratic moderates continued to struggle with the “government takeover” label. By late fall, the legislation had acquired the odor and toxic sheen of a rotten side of tuna.

In the court of public opinion, the ensuing seven months (with a brief blip after Labor Day after a well- crafted Obama defense of health reform), were all down hill for health reform. Opposition to the process, as much as the substance, of health reform hardened, aided materially by a flurry of dealing making around the Senate bill (Medicare or Medicaid carve outs for Florida, Louisiana and Nebraska most visibly).

The late January loss of Ted Kennedy’s seat to an insurgent “Tea Party” Republican, Scott Brown, was an unmistakable warning sign that even formerly unassailable Blue State Democrats were now at risk. Political pundit Charlie Cook, who follows the Congressional races at a microscopic level, wrote recently that the Democrats have been in free fall since August. They lost gubernatorial races in New Jersey and Virginia, county executive races in solidly Democratic Fairfax County (VA) and Westchester and Nassau Counties (NY). A surge of inconvenient scandals- David Paterson, Charles Rangel and Eric Massa- all in New York- have further tarnished Democratic credibility. Cook placed the odds on the Democrats losing the House this November at 50-50 and sliding.

On the eve of the Presidential health reform “summit”, a Newsweek poll revealed that independent voters, crucial to re-election of Democratic moderates, opposed passage of health reform by a stunning 62-29% margin. Despite the White House’s feeling that the President could paint the Republicans into a corner and blame them for halting health reform, a Politico.com reader poll after the summit suggested the Republicans decisively outpointed the President (52%-19%) by stressing the fiscal and economic risks of the bill. There aren’t a lot of undecided voters left on the health reform issue- and strongly “anti-” sentiment outruns strongly “pro-” sentiment by almost two to one.

Now the White House and Democratic leaders are in the final scramble to find votes to send the President something he can sign and declare this endless and divisive process over. Speaker Pelosi suggested last week that, regardless of the damage they may suffer at the polls in November, House Democrats owe her and the President a reaffirmation of their support. Pelosi basically ordered her troops to swallow their reservations about this bill and fall on their swords.

Gloria Borger of CNN reported late last week that a “senior White House aide” characterized the coming vote on health reform as “the last helicopter out of Saigon”, the most unfortunate political metaphor of the Obama era thusfar. (For younger people, that helicopter was ferrying South Vietnamese collaborators with the United States off the roof of the CIA compound before the North Vietnamese Army flooded into Saigon). What did the “senior White House aide” mean? That the Communists are coming and congressional Democrats need to save themselves and run for the hills? It sure doesn’t sound like a clarion call to do the right legislative thing.

It isn’t the Communists that are coming. It’s a lynch mob. And the angry horde is going to discriminate between “progressives” and moderates. They are simply going to find and hang as many public officials as they can get their hands on – incumbent Congresspeople, Senators, Governors, state legislators, county executives. Unfortunately for the Democrats, the majority of those incumbents are Democrats. I’ve not seen such a toxic electoral atmosphere in my lifetime.

If she cannot find the votes to pass health reform, Speaker Pelosi will be deflecting blame and knifing her White House colleagues in the back all the way to the guillotine. If it passes, it will be in spite of, rather than because of, her advocacy. By maliciously complying with the President’s mandate, Speaker Pelosi and her arrogant, tone-deaf management of the legislative process badly damaged the prospect for lasting health reform. She should scramble for a seat on that last helicopter herself.

Panicky People Make Bad Decisions : Salvaging Health Reform after Scott Brown

Jeff goldsmith

The shocking surrender of Ted Kennedy’s Senate seat to an insurgent Republican state legislator, Scott Brown, has imperiled President Obama’s health reform initiative. The Massachusetts “massacre” has unleashed a tidal wave of second guessing from Democratic pundits. Obama, the left argues angrily, got what he deserved for trying to find a bipartisan solution to health reform, for abandoning the beloved “public option” and snuggling up to the corporations they wanted to punish. If only he’d remained pure to their ideals, Martha Coakley would be a Senator and he’d have a bill on his desk by the end of the week. General Custer could not have gotten worse advice.

It’s possible that the loss of Ted Kennedy’s Senate seat might end up saving both health reform and the Obama Presidency. The President seems to understand what happened in Massachusetts better than his more ideological brethren. Disarmingly, he argued the day after Brown’s victory that it was produced by the same popular anger as his own election, though it’s worth noting an important qualitative difference. The 2008 election coincided with a full blown market panic, which the President’s calm and policies helped quell; What he is now facing is much closer to voter despair, as the domestic economy digests a huge overhang of debt, and unemployment lingers above the toxic 10% level.

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There Be Dragons: The Fiscal Risk Of Premium Subsidies In Health Reform

Last week, the Congressional Budget Office weighed in on the biggest economic imponderable in the health care debate: how private health insurance premiums will behave under health reform. Building on its December 2008 CBO health insurance market analysis, CBO forecast largely benign effects from health reform’s private market reforms and subsidies on the vast majority of the presently insured (e.g. voting public).

According to CBO, only 17% of Americans in the so-called non-group market–largely individuals–would see premium increases in 2016 (the CBO reference year), because they would be required to purchase fatter benefits with less economic risk. CBO believes that the other 83% of the presently insured will see little or no change.

Analysis of how the health insurance market will behave under health reform has become ferociously politicized. After the infamous PriceWaterhouseCoopers study sponsored by health insurers suggested possible large premium increases, the CBO report might provide cover for members of Congress who are contemplating irreversibly tying the federal budget to a volatile “private” insurance market. I think the fiscal risks of a partially federalized private health benefit are significantly greater than CBO has suggested.

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The Leaning Tower of Jello: Why No-one Believes Health Reform will be Deficit Neutral

President Obama has promised not to sign any health reform legislation that increases the federal deficit. This promise recognized rising public concern about an Argentinean fiscal trend that, unchecked, could leave us with $19 trillion in federal debt in a decade.

Without that pledge, given the current economic climate, health reform would be one dead mackerel.

Some clarifications are essential here. I’m a Democrat and fervent Obama supporter. I voted for him twice (and that was just in the Virginia primary). I’m proud of our President. He has first class economic and healthcare teams. He deserves credit for not postponing health reform. He’s right: it’s simply not tolerable, morally or economically, for a wealthy nation to continue having close to 50 million uninsured people.

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Why McAllen Should Have Mattered in the Health Reform Debate

Jeff GoldsmithBack in June, Atul Gawande, a Harvard trained surgeon, published a riveting article in the New Yorker   about the physician community in McAllen Texas. If ever an article was strategically timed to influence the nation’s health policy debate, this was the one. His story was accompanied by a graphic showing a patient as an ATM machine.  President Obama read it and put it on his staff’s reading list.  Yet, it’s depressing how little impact Atul’s article has had on health reform.

Atul’s purpose was to explain a major policy conundrum: why some communities manage to spend as much as triple on Medicare services as other communities. McAllen’s physicians practice some of the most expensive medicine in the United States, second only to Miami, and spend seven thousand dollars per Medicare beneficiary more than the national average. Peter Orszag has said that eliminating this type of variation could cut Medicare expenses nationally by as much as 30% and actually improve the quality of care.

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Hiding In Plain Sight: Using Medicare To Solve The ‘Public Option’ Conundrum

Barack Obama_addresses_joint_session_of_congress_2-24-09As Senate and House Committee versions of health reform move toward unified legislation and floor votes, the most complex political challenge is how to resolve the “public option” controversy. While one would have thought weightier issues such as the shape of Medicare reform, the taxation required to support coverage subsidies, or the presence or absence of mandates would have been pivotal in this debate, the seemingly peripheral issue of a Medicare-like “public option” might be the hill on which health reform dies.

The reasons are almost completely political. The Democratic base wants to end private health insurance. Single payer advocates view the public option as a down payment on an entirely public health financing system. Public option advocates believe that the plan’s bargaining power will drive private insurers out of business. (I’ve argued in a previous blog posting that, without fully understanding what they are doing, these single payer advocates are probably right.)Continue reading…

Capitol Shortage: Can the Two Democratic Parties Get It Together on Health Reform?

Hcan-june25crowd+dome3 As an exceptionally grumpy American summer grinds to a conclusion, it is apparent that only a bipartisan solution will enable Congress and the Obama Administration to complete health reform.  No, we’re not talking about co-operating with the Republicans. Other than a handful of contrarian Republican moderates on the Senate Finance Committee, at least one of whose votes might be needed for eventual passage, the Republicans are irrelevant to the final outcome.

No, the bipartisan solution we’re talking about is co-operation between the two Democratic parties represented in Congress:  the “Safe-Seat” Democrats- the Pacific Heights/Beverly Hills/Berkeley Hills/Upper West Side/Harlem Democrats and the “Running Scared” Democrats from the western, southern and border states, who actually require independent and some moderate Republican support to get elected.  These parties have very little in common other than the Capital D after their names.  

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Capitol Shortage: Can the Two Democratic Parties Get It Together on Health Reform?

Hcan-june25crowd+dome3 As an exceptionally grumpy American summer grinds to a conclusion, it is apparent that only a bipartisan solution will enable Congress and the Obama Administration to complete health reform.  No, we’re not talking about co-operating with the Republicans. Other than a handful of contrarian Republican moderates on the Senate Finance Committee, at least one of whose votes might be needed for eventual passage, the Republicans are irrelevant to the final outcome.

No, the bipartisan solution we’re talking about is co-operation between the two Democratic parties represented in Congress:  the “Safe-Seat” Democrats- the Pacific Heights/Beverly Hills/Berkeley Hills/Upper West Side/Harlem Democrats and the “Running Scared” Democrats from the western, southern and border states, who actually require independent and some moderate Republican support to get elected.  These parties have very little in common other than the Capital D after their names.

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A Wild Pitch: HR3200 Brushes Back Health Reform

Barack_Obama_addresses_joint_session_of_Congress_2-24-09 On May 12, the flame throwing Chicago White Sox pitcher Bobby Jenks was fined for throwing behind an opposing player, Texas Rangers second baseman, Ian Kinsler. When Jenks, who can throw a 102 MPH fastball, was asked about the pitch, he said, “Yeah, I wanted to go in and send a message and I think the message was sent.”  When asked later if he would do it again, he said, “We’ll have to see.”

Rarely do you see that kind of candor in baseball, let alone politics for that matter.  When Speaker Pelosi and House Leadership released their version of a health reform bill, HR 3200, America’s Affordable Health Choices Act of 2009 (AAHCA), she pulled a Bobby Jenks.  Rather than put the ball over the plate, and help frame a broad consensus for health reform, Speaker Pelosi “sent a message” to the President, which was:  “We’re in charge and we will do exactly what we wish.”

HR3200 is an arrogant, tone deaf and yet oddly cowardly bill that creates, among other things, a Health Choices Commissioner to help us with our health choices.  Its message to the voters seems to be, as David Brooks put it, “98% of Americans can party on, with the latest and costliest health care imaginable, no matter how ineffectual, and the top 2% will pay for it all.”

Just as she did with her “stimulus” pork fest back in February, Pelosi has created a huge problem not only for Obama, but moderate Democrats in her own chamber. Not only does the bill, under the best of circumstances, still leave nearly 17 million people without coverage.  It will greatly handicap any chance for recovery in our country’s ailing economy.  HR3200 is a recipe for a one-term Obama Presidency, and presents a nearly insuperable barrier to moderate House or Senate members seeking to run for re-election in a scant fifteen months.

The House bill lays a huge burden for financing health reform on the nation’s businesses, through a thinly disguised payroll tax (oops, I meant “Shared Responsibility payment”) and employer mandate, as well as a surcharge on the top tax rate that will have the effect of hitting many small businesses twice (in the worst business climate in 28 years).   If the CBO honestly scored the employer mandate as a tax, the tax increase part of the House bill’s financing scheme would far exceed the seemingly modest $544 billion advertised.

For businesses with payrolls over $400 thousand who presently do not offer health coverage, AACHA would raise their payroll tax (including Social Security and Medicare) to 23% or require them to purchase insurance for their workers, at a price which will not be a dime lower than it is today because of this bill.  Only businesses with a payroll less than $250 thousand would be exempt, and only those with low wageworkers will be eligible for any meaningful subsidy to defray the cost of complying with the mandate.

The economic context is worth reviewing briefly for those who have been living in a cave or were otherwise off the grid.   The US has lost 2.1 million jobs since President Obama took office. Financial services, manufacturing, retailing, light industry, even pharmaceuticals and biotech firms, are all shedding jobs at a pace not seen since the end of World War II.  Though the pace of job loss has slackened somewhat in the past two months (losing “only” 492 thousand jobs in June, for example), there is little likelihood of actual employment growth this year.

If you want job growth to resume next year, the last thing you do is make it more expensive to hire back workers, which is, unfortunately, precisely what the House bill does.  If you want wages to grow, so people can resume buying things (70% of our GDP!), the last thing you do is divert employer money from wages into a federally defined and managed health benefit.

One way or another, it isn’t wealthy Americans, the intended target of the House bill, who will pay the price for the House bill.  Who will actually pay: those American workers presently unemployed, or working involuntarily part time, or struggling to dig themselves out from under a mountain of debt, whose wages will not grow enough to offset their increasing cost of living. And though the bill explicitly forbids employers from lowering wages to pay for the mandate, it does not constrain employers from simply ceasing to increase their workers’ wages, or declining to hire back all the people they’ve laid off in the past ugly twelve months of collapsing sales and declining cash flow.

In addition to the payroll tax increase, for sole proprietorships and Sub S corporations, who pay taxes on their profits as ordinary income, after the expiration of the Bush tax cuts, the House bill moves the top tax rate to 46%, a rate we haven’t seen in the US since Jimmy Carter’s time.  Tax avoidance will experience a sudden and unwelcome renaissance, particularly in places like New York and California that could REALLY use a recovery, where, when you add in state and local taxes, the marginal tax rate is suddenly a Sweden-like 57%.   Party on, California!

What do we get for this steep price?  Well, we get an insurance industry that is regulated within an inch of its life.  It will be told the benefit package, its underwriting policy, the permissible amount of cost sharing each insured can bear, the medical loss ratio they are permitted to run, the ratio of premiums between highest and lowest cost enrollees (a 2:1 ratio is actually written into the bill, dramatically increasing the cost for ten million young people who are uninsured), and a whole bunch of other things, all managed by the Health Choices Commissioner (actually, Commissar).

To call it “health insurance” anymore is technically inaccurate because there is no longer any risk to patients. This risk is completely, comprehensively shifted to employers. Private health benefits will be, under AAHCA, a politically managed entitlement. Cost sharing will be reduced from today’s levels, in some cases dramatically.  “Consumer responsibility” is not part of the program. There is nothing in this bill that will make the bill for employers a dime cheaper than it is today, and a potential for their cost being a lot higher.

While the initial benefit package is comparatively modest, there is no insulation between a thousand hungry provider and patient advocacy groups and the employer’s health insurance premium except a Health Benefits Advisory Committee and a single political appointee, the Secretary of Health and Human Services.  Tom Daschle’s wisdom about the potential rapid expansion of the benefit package given the political realities in Washington has been lost on his elders in the House.  Congressional health barons are obviously disinclined to surrender any of their present power.

The eight hundred pages of the bill not devoted to the new entitlement make remarkably few substantive changes in our inflationary Medicare and Medicaid programs.  Despite Atul Gawande’s repellent portrait of rampant greed and self-dealing in McAllen, the bill declines to tighten meaningfully our existing Medicare fraud and abuse laws.  It extends a prohibition on new physician owned specialty hospitals, but only after carefully grandfathering in the money machines already on the ground and billing.

This is particularly disappointing given that the godfather of fraud and abuse enforcement, Pete Stark, is a cosponsor of this bill. This is prime time, Pete, a once-in-a-generation chance to do the right thing. There is clear and compelling evidence of abuse in imaging, surgery, radiation therapy, etc., so ripe you can smell it. If you don’t have the guts to clean up the program you’ve helped run for over thirty years, it’s time to go home to Piedmont and clip coupons.

Primary care physicians get a Medicaid pay increase; the rates are brought up to the inadequate Medicare levels that are driving out a whole generation of family practitioners, and then, only over a period of years.  Though primary care residencies are expanded and a medical home demonstration program is authorized, there is nothing in this bill that will meaningfully alter the economic choices of young doctors presently choosing to become dermatologists or cardiologists.  Those are your waiting lists now, Speaker Pelosi.  Radiologists do get clipped twice, and the updated Part B fee caps (under so-called SGR) are going to be split, between evaluation and management services, which may be increased someday, and procedure payments, which may be cut someday.

Hospitals will see modest reductions in their subsidies for caring for the uninsured, some reductions for those with excessive readmissions, a small nip in their DRG updates, and that’s about it. That and a demonstration project on post acute bundling, and otherwise, there are no meaningful changes in hospitals risks or responsibilities under Medicare, at least in this go-round anyway.   At least in the House, anyway, a huge bullet has been dodged by the industry.  And the do more/make more incentives to hospitalize Medicare patients, and for doctors to treat the heck out of them, survives for another, probably, five years.

Serious money is flung at community health centers (guess where those undocumented people will queue up), and at a black box labeled “Prevention and Wellness”, details to follow.  But there is nothing in this bill to deliver on the President’s bold promise to lower everyone’s health costs by $2500 a year, or to make the future year liabilities for Medicare any more affordable.  If someone can assert with a straight face that this bill is going to save money anywhere in the health system, they deserve to have their mouths washed out with soap.  It certainly didn’t fool Douglas Elmendorf, the head of CBO, who inconveniently said as much in Congressional testimony on July 16. .

The health reform financing problem with which we began is, sadly, of the President’s making.  He promised during the campaign what is turning out to be a $1.6 trillion extension of health coverage that 97% of Americans would pay nothing for.  With the crystalline clarity of hindsight, this was a costly political mistake.  He also explicitly promised not to tax health benefits, even for the wealthy that disproportionately benefit from the current exemptions, because it was a centerpiece of John McCain’s inadequate health platform. (Campaign’s over, everyone)

And on returning from his triumphal European tour to an increasingly skeptical United States, the President crisply reaffirmed both campaign promises, as well as his support for the troubled “public option”.  In a sense, all the House bill did was put into legislative form what Obama incautiously promised during his campaign. In other words, Pelosi narrowed his political options and dragged the whole process about sixty feet to the left at the very time financing options needed to be broadened and centered.

Unfortunately, it did so in a markedly more adverse economic climate, and in a country with rapidly narrowing economic options and a markedly diminished fiscal capacity.

If I were Tom Daschle and Peter Orszag, I’d barge my way into those political meetings, and help their President salvage this thing.   Way more savings need to come from the health system itself (50% isn’t enough), particularly from the rich matrix of subsidies and inappropriate incentives which sustain the industry’s inflationary cost curve, and the tax burden needs to be spread across consumption, particularly unhealthy consumption, and removed from the wage base.  Health insurance also needs to be much more affordable for ten million uninsured young people, or they’ll simply blow off the individual mandate and remain uninsured.

Otherwise, we’ll hate ourselves in the morning. The House bill is a sad reminder of why Americans detest Washington politics as usual.  AAHCA is right! (Say it again).  This bill is a bone in the throat for the Obama administration, and will divert vital political energy needed to bring the health reform process to a responsible conclusion.

If there is no job growth next year, the Democratic ascendancy in Congress will be bitter and short lived, and Obama, for all his bright promise, will have a very steep hill to climb to remain in office in 2012. If this recession is not over in less than a year’s time, it will be the President’s and Speaker Pelosi’s recession, and Lord Help Them politically.  They won’t be able to blame the Republicans either.  The Democrats will have squandered a veto proof majority in the Senate, and a seventy-vote margin of safety in the House.  And for what?  Mostly for more of the same, more broadly shared, at a huge cost to American workers.   Shame on the House!

Jeff Goldsmith is president of Health Futures Inc. He is also the author of a book released this year titled “The Long Baby Boom: An Optimistic Vision for a Graying Generation.” Health Futures specializes in corporate strategic planning and forecasting future health care trends.

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