Watching this reform process, at least for me, is now like watching a Ping Pong match or a Nascar race (sorry Nascar fans); back and forth and round and round. Even for someone who watches and interprets health policy for a living, this stuff is getting boring, monotonous and frankly, now somewhat nauseating, content wise. Maybe the intent is to literally “mind numb” all the people like me who analyze, consult and write about health policy with the goal of shutting us up or in my case, the goal of disconnecting my brain from my fingers so that I can no longer write about the insanity that is “health care reform” in Washington.
Getting to the meat: The Senate, namely Harry Reid, is working feverishly to buy votes, cajole fellow Democrats and to obfuscate the details in his (the Senate’s) 2,000 plus page, Nancy Pelosi light, reform bill. I say “Nancy Pelosi light” because the Senate remains, even though Democratically controlled, moderate enough not to blindly drink the policy Kool-Aid produced in the House. This past Saturday, via a host of back room deals and pay-offs to fence-sitting Democrats, Reid cajoled a cloture avoidance vote, sending the reform bill to the floor for debate. This mid-level stall tactic buys Reid additional time to arm twist colleagues and to literally, buy votes. Without this Chicago-style tactic, Reid knows the votes for passage are non-existent in the Senate. In reality, the votes for passage in its current form may still be non-existent regardless of the price offered due to the taxation issues within the legislation, the abortion issue and the government option issue.
Looking at the Bill in detail (I’ll admit that I haven’t read the whole thing as of yet and frankly, I may not as I have now mastered the trick of speed reading these monstrosities, getting to the heart and soul and avoiding the painful tedium that is the politically and socially engineered garbage which consumes hundreds of pages), one quickly sees that key similarities with the House version are imbedded albeit with a more moderate twist in order to appeal to the more moderate Senate membership (if that’s possible). For example, the government option is actually a state option, triggered only by the states that desire to introduce a government option (however that should work). The payment methodology incorporates greater taxation options and fees (such as a 5% tax on cosmetic surgery) including on benefit plans – absent in the House bill. The Senate bill still does not require all employers to offer health insurance while the House bill does although it does require all Americans to purchase insurance or face fines and penalties. Both the House and the Senate bills call for wholesale expansions of Medicaid as a means of providing coverage to lower-income individuals. The House bill prices in at $1.2 trillion (not including the costs of the recently passed Doc Fix legislation) while the Senate bill weighs in at just under $900 billion and is mute about the doc-fix issue.
Before the fog of cynicism creeps fully into my brain and dulls all of my senses, I’ll finish this post with a few succinct and brutally honest comments on the Reform process.
- I can’t say it any more plainly or write it any more plainly, what is happening now is not Reform. Neither the House bill or the Senate bill does anything to reform how health care is delivered in this country or to frankly, improve it. The incredibly antiquated, bureaucratic and inefficient programs of Medicare and Medicaid remain essentially untouched save for their funding mechanisms. Medicaid, a horribly structured program rife with individual state bureaucracies and excessively varied benefit plans is being expanded but not reformed – a recipe for wholesale disaster for the millions of new beneficiaries who will enter a system incapable of providing adequate and decent care for the current beneficiaries.
- The economics of all numbers attached to the reform discussions is literal, laughable dog “doo doo” (substitute if desired, B.S., crap, garbage, cow chips, etc.). No person who can do simple math and apply any basic economic principles should buy for a moment that either plan (House or Senate) is capable of reducing the deficit, being deficit neutral or not ultimately deleterious to the U.S. economy. The smoke and mirrors financing techniques applied in both bills (start with the revenue for a few years then gradually add the expenses) is alchemy of the poorest kind; a brew that no sane human should swallow. Both bills will add billions to the deficit, increase taxes across the board and become an entitlement and bureaucratic monster unlike any that has ever been seen before in the lifetime of mankind. If this sounds harsh, consider the following. The Constitution of the United States, the seminal document of U.S. governance is sixteen pages in actual content, inclusive of all amendments and the Bill of Rights. The House bill and the Senate bill are 2,000 plus pages in length, each costing the U.S. taxpayers over $1 trillion ($1,000,000,000,000), and neither substantively reforms Medicare or Medicaid or assures that any citizen will receive better health care despite the enormous price tag. If that isn’t bureaucracy “Washington” style, I don’t know what is.
- In spite of polls that show less than half of all citizens are in favor of the present course of reform (and a trend that continues to move lower), the elected officials in D.C. plow on their present course. Someone once told me that the definition of insanity is when, in spite of not getting something correct, you continue to do the same thing over and over again, hoping to get a different result.
- The U.S. debt load (deficit) now totals $12 trillion and change and the total GDP of the U.S. economy is $14 trillion. Adding more debt, which both bills will certainly do, is preposterous and economically incomprehensible. Granted, the economy will return to a growth pattern but no reasonable economist will assume that future GDP growth could possibly outstrip the present growth of Washington deficit spending or for that matter, be aided during recovery by additional deficit spending to the tune of $1 trillion or more.
- In spite of the rhetoric and the foolish fodder from Washington, Medicaid and Medicare will geometrically expand and their growth will be unconstrained by either bill. Medicare will be cut in the short run by $500 billion damaging providers and beneficiaries temporarily but Congress will come to the rescue, abandoning most of the painful cuts, restoring funding and adding more to the deficit, all in the shadows of their post-reform victory dance. Trust me on this one as I have been involved in healthcare and health policy now for almost three decades and it is a cycle that constantly repeats. For those that are even skeptical, look at the House’s bill for the physician payment fix. In Washington, the squeaky wheel gets the grease and when the election cycle heats up, seniors, hospitals, doctors and any other interest group with voting blocks will be pounding the corridors in search of “Benjamins for votes”.
- There are no winners in this process save a handful of special interests and the usual D.C. elitists and certain political classes. The losers are too many to count but at the top of the list are individual tax payers, individuals with current health insurance, the poor without insurance (they ain’t seen nothing yet until they take their new Medicaid insurance in a state like Mississippi and try to get decent healthcare), companies that presently provide benefits, anyone with a HSA, and of course, anyone who owns or thinks about starting, a small business. Again, if you think I’m full of you know what, read the gosh darn bills.
I try to avoid ranting in this Blog because I do find it somewhat counter-productive and often, overdone. Personally, I am not really a ranter anyway as I rely generally on intellectual discourse and analysis to pose my point and to beg the questions. In the end, I suppose I have found my breaking point for the moment courtesy of Harry Reid, Nancy Pelosi and President Obama, all I have never met and if I did, I would probably enjoy chatting with – maybe even over a cold beer. Just not today.