No Kool-Aid here. Obama proposed the funding in his budget before the
health care battle started; it could have been included in the Budget
Resolution’s reconciliation instructions; the administration pressed House
and Senate to do that; they lost. But I don’t think it’s fair to say the
“set-aside” savings were something he just “left to the Congressional
leaders.”
CBO is right on the estimates. It is dead wrong in saying that, if the
legislation has some perfectly reasonable provisions such as an individual
mandate or risk-adjustment, that means the insurance will be “government
spending.” It was wrong to even answer a question about “scoring” rules
changes such as PayGo and IMAC. So it hasn’t quite been “right each time.”
But it’s right on the overall question of how much the various bills would
save. Not much.
The lever has always been business; they’ve stayed out of it; so there’s
nothing to pressure the Blue Dogs. Sigh.
But bizarre things do happen. The Red Sox won the World Series. Now if
only Obama and Pelosi were taking Andro…
(sorry, U.S. reference….)
Joe
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On
Behalf Of David Wilsford
Sent: Friday, July 31, 2009 1:34 PM
To: [log in to unmask]
Subject: Re: WP Charles Krauthammer - Obama Will Settle for Less on Health
Care - washingtonpost.com
Well, Adam, I think risk-sharing across generations is just fine (that’s
what any national-”ized” system does) and agree with Michael, too, that it’s
nothing new.
Moreover, as I grow old (I hope) in the French system, I hope I continue
to get fantastic care at superbly reasonable pricing through my French
assurance maladie. (Although, the French authorities and I agree that the
whole system is harder to control that it would be with much stronger
gatekeepers for ambulatory care, for example, but the French system has its
own difficulties with sticky institutions and path dependency!)
However, sitting inside the Beltway half the year, instead of down on
the Mediterranean, I disagree with Joe’s assessment: Obama handed over the
details explicitly to Congressional leaders, so no surprise that the result
is a mash. Moreover, his “pay as we go” proposals, of various kinds, to
raise revenues, have been mainly sleight of hand. Did you drink that
Kool-Aid, Joe? The CBO has been right each time.
Where I think that Krauthammer is on-spot in ways that many commentators
have not been is his laying out of how a modest version of health INSURANCE
reform — not health system reform — WILL happen and then Obama will declare
victory.
Systemically, costs will not be reigned in, because no structural
changes will occur in incentive frameworks for users, providers or payers
and because no structural changes will occur in the structure of paying
itself, i.e., a single payer system (which, interestingly, Gail Collins and
David Brooks re-visit together yesterday in the NYT).
But the great bargain that Krauthammer suspects will be struck between
the administration and health insurers (even though he is against it) is
indeed the best that can be hoped for now — and for many more years to come.
Yep, Krauthammer and Joe White are right, systemic change is a dead
letter now.
And always was, I argued publicly in early February 2009: There is
only so much oxygen in the room, and the financial bail-out(s) have sucked
it all up, not to mention ratcheting up in Afghanistan while ratcheting down
in Iraq. (Afghanistan will dominate Years 3 and 4 of this Obama term; it’s
a losing deal the way it is being approached now, and He made it His war.)
Besides all this, it would help if someone in the administration besides
Larry Summers had actually read Madison’s Federalist No. 10. The system
that we observe at work on health care reform attempts is precisely the way
it was engineered to work by the so-called Founding Fathers of the country.
You want to change Washington? You must change the institutions — which
is not going to happen. It does not suffice to sing a happy song around a
table together. Or have four different kinds of beer at a table in the Rose
Garden off the Oval Office.
Silly, when it comes to changing fundamentals, although making people
feel aglow inside is sometimes a nice extra. Just don’t mistake it for real
change, in health care or in race relations or in anything else.
Là voilà.
Cheers, friends.
David
--
David Wilsford Ph D
Professor of Political Science, George Mason University (Fairfax Virginia
USA) and
Visiting Fellow, London School of Economics (UK)
[log in to unmask]
French cell +33.6.11.16.50.93
U.S. cell +1.224.522.0111
On 7/31/09 3:25 PM, "Joe White" <[log in to unmask]> wrote:
Well, the values and angles he’s espousing come close to being evil. And
the piece is seriously misleading about what Obama has done. The numbers
refer to the House bill, not Obama’s proposals. Obama did not have to “flip
through” the tax code: he proposed a perfectly reasonable way to find a lot
of the money, namely changing the size of tax deductions for high-income
people, and those “fiscal conservatives” who are looking for a “bipartisan”
deal in the Senate rejected it.
That said, yeah, it’s dying on the vine.
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On
Behalf Of David Wilsford
Sent: Friday, July 31, 2009 8:18 AM
To: [log in to unmask]
Subject: WP Charles Krauthammer - Obama Will Settle for Less on Health Care
- washingtonpost.com
Good Lord, I don't often agree with Charles Krauthammer, but I think his
analysis in this morning's WP has the next six months of this process right
on target.
Yours
DW
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073002
819_2.html?wpisrc=newsletter
<http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR200907300
2819_2.html?wpisrc=newsletter&wpisrc=newsletter&sid=ST2009073002826>
&wpisrc=newsletter&sid=ST2009073002826
--
David Wilsford Ph D
Professor of Political Science, George Mason University (Fairfax Virginia
USA) and
Visiting Fellow, London School of Economics (UK)
[log in to unmask]
French cell +33.6.11.16.50.93
U.S. cell +1.224.522.0111
