Commentary Magazine


Topic: health-insurance plans

Flotsam and Jetsam

A couple of good questions (which should have been asked before the bill was passed): “Now that Congress has imposed new requirements on health insurance plans, regulators are trying to resolve another big question: Which plans must comply with the requirements? In keeping with President Obama’s promise that you can hold on to your insurance if you like it, the new law exempts existing health plans from many of its provisions. But the law leaves it to regulators to decide how much a health plan can change without giving up its grandfathered status. In other words, when does a health plan cease to be the same health plan?”

A very belated apology: Ben Smith writes, “Richard Blumenthal’s defiance got him through his first day, but his most expansive apology yet — to the Courant — indicates both that the damage isn’t controlled, and that he himself thinks he has something to apologize for.” Sort of like Bill Clinton: apologize when you’ve exhausted all other possibilities.

A boffo suggestion: “Democratic Rep. Anthony Weiner (N.Y.) called on the White House on Monday to detail conversations it allegedly had with Rep. Joe Sestak (D-Pa.) to try to convince him to drop his Senate bid. Weiner said that allegations that White House officials had offered Sestak an administration job in exchange for his dropping of his primary bid against Sen. Arlen Specter (D-Pa.) had become a growing political liability. ‘I think what the White House should do is, to some degree, say, ‘Here are the facts,’ Weiner said Monday morning during an appearance on MSNBC. ‘If there’s not a lot [to] what’s going on here, then just say what happened.'” Like be transparent?

A new stonewall in a long series of stonewalls (e.g., Fort Hood, Black Panthers): Reid Wilson writes that the GOP “is pleased” Sestak won since it can pummel the job-offer scandal. “GOPers have used the issue to raise questions about the WH’s honesty, transparency and ethics. … The stonewalling has gone to incredible lengths. On Thursday, Gibbs parried with reporters 13 times, refusing to address Sestak’s claims, referring to previous comments he made in March. The refusal to talk about Sestak at all has given GOPers an opening.”

An excellent inquiry: Bill Kristol on Fox News Sunday: “President Obama spent much more time talking about this immigration law in Arizona and spent much more time talking with President Calderon of Mexico about it than with the governor of Arizona, whom he’s never had the courtesy to call and say, ‘Well, would you like to make a case for the law to me — make the case to me for the law before I go around trashing it?'” Well, he didn’t get the facts before trashing the Cambridge police in Gatesgate either. He tends to avoid getting information from those with whom he disagrees.

A savvy political calculation (subscription required): “The House Democratic freshmen who rose to power riding then-candidate Barack Obama’s coattails are now eager to strut their independence heading into the midterms. Some rookies opposed Obama’s cap-and-trade climate change bill; others rejected his health care plan. But even those Members who backed all of the president’s signature initiatives are ready to show that they can win their first re-election bids without leaning on Obama’s star power. ‘You have to be an independent, no matter what,’ Rep. Kathy Dahlkemper said.”

A keen insight: “Despite his newfound prominence, Todd, like his colleagues, has limited access to the man he is covering. ‘Obama himself is the one who doesn’t like dealing with the press,’ he says, exonerating the White House staff. ‘You can’t even do shouted questions.'” Now he has to actually report on that, not just offer it to Howard Kurtz in a puff piece on himself.

A near-certain pickup for the Republicans: “Governor John Hoeven now has the support of nearly three-out-of-four North Dakota voters in his bid to be the state’s next U.S. senator. The latest Rasmussen Reports telephone survey of Likely Voters in North Dakota finds Hoeven earning 72% support, while his Democratic opponent State Senator Tracy Potter picks up 23%.” Yeah, 72 percent. (Looks like the statewide House seat is a goner for the Democrats too.)

A vote of no-confidence: “Confidence in America’s efforts in the War on Terror has fallen again this month, and, following the unsuccessful terrorist bombing attempt in New York’s Times Square, more voters than ever now believe the nation is not safer today than it was before the September 11, 2001 terrorist attacks. The latest Rasmussen Reports national telephone survey shows that only 31% now believe the United States is safer today than it was before 9/11, down seven points from last month and the lowest level of confidence measured in over three years of regular tracking.”

A couple of good questions (which should have been asked before the bill was passed): “Now that Congress has imposed new requirements on health insurance plans, regulators are trying to resolve another big question: Which plans must comply with the requirements? In keeping with President Obama’s promise that you can hold on to your insurance if you like it, the new law exempts existing health plans from many of its provisions. But the law leaves it to regulators to decide how much a health plan can change without giving up its grandfathered status. In other words, when does a health plan cease to be the same health plan?”

A very belated apology: Ben Smith writes, “Richard Blumenthal’s defiance got him through his first day, but his most expansive apology yet — to the Courant — indicates both that the damage isn’t controlled, and that he himself thinks he has something to apologize for.” Sort of like Bill Clinton: apologize when you’ve exhausted all other possibilities.

A boffo suggestion: “Democratic Rep. Anthony Weiner (N.Y.) called on the White House on Monday to detail conversations it allegedly had with Rep. Joe Sestak (D-Pa.) to try to convince him to drop his Senate bid. Weiner said that allegations that White House officials had offered Sestak an administration job in exchange for his dropping of his primary bid against Sen. Arlen Specter (D-Pa.) had become a growing political liability. ‘I think what the White House should do is, to some degree, say, ‘Here are the facts,’ Weiner said Monday morning during an appearance on MSNBC. ‘If there’s not a lot [to] what’s going on here, then just say what happened.'” Like be transparent?

A new stonewall in a long series of stonewalls (e.g., Fort Hood, Black Panthers): Reid Wilson writes that the GOP “is pleased” Sestak won since it can pummel the job-offer scandal. “GOPers have used the issue to raise questions about the WH’s honesty, transparency and ethics. … The stonewalling has gone to incredible lengths. On Thursday, Gibbs parried with reporters 13 times, refusing to address Sestak’s claims, referring to previous comments he made in March. The refusal to talk about Sestak at all has given GOPers an opening.”

An excellent inquiry: Bill Kristol on Fox News Sunday: “President Obama spent much more time talking about this immigration law in Arizona and spent much more time talking with President Calderon of Mexico about it than with the governor of Arizona, whom he’s never had the courtesy to call and say, ‘Well, would you like to make a case for the law to me — make the case to me for the law before I go around trashing it?'” Well, he didn’t get the facts before trashing the Cambridge police in Gatesgate either. He tends to avoid getting information from those with whom he disagrees.

A savvy political calculation (subscription required): “The House Democratic freshmen who rose to power riding then-candidate Barack Obama’s coattails are now eager to strut their independence heading into the midterms. Some rookies opposed Obama’s cap-and-trade climate change bill; others rejected his health care plan. But even those Members who backed all of the president’s signature initiatives are ready to show that they can win their first re-election bids without leaning on Obama’s star power. ‘You have to be an independent, no matter what,’ Rep. Kathy Dahlkemper said.”

A keen insight: “Despite his newfound prominence, Todd, like his colleagues, has limited access to the man he is covering. ‘Obama himself is the one who doesn’t like dealing with the press,’ he says, exonerating the White House staff. ‘You can’t even do shouted questions.'” Now he has to actually report on that, not just offer it to Howard Kurtz in a puff piece on himself.

A near-certain pickup for the Republicans: “Governor John Hoeven now has the support of nearly three-out-of-four North Dakota voters in his bid to be the state’s next U.S. senator. The latest Rasmussen Reports telephone survey of Likely Voters in North Dakota finds Hoeven earning 72% support, while his Democratic opponent State Senator Tracy Potter picks up 23%.” Yeah, 72 percent. (Looks like the statewide House seat is a goner for the Democrats too.)

A vote of no-confidence: “Confidence in America’s efforts in the War on Terror has fallen again this month, and, following the unsuccessful terrorist bombing attempt in New York’s Times Square, more voters than ever now believe the nation is not safer today than it was before the September 11, 2001 terrorist attacks. The latest Rasmussen Reports national telephone survey shows that only 31% now believe the United States is safer today than it was before 9/11, down seven points from last month and the lowest level of confidence measured in over three years of regular tracking.”

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Obama’s Credibility Deficit

Obama faces not simply a shortage of votes for his health-care plan but also a diminishing reservoir of credibility. The longer he talks, the less believable his arguments have become. After a year, dozens of speeches, hundreds of interviews, and a health-care summit, who believes of ObamaCare that: 1) you will get to keep your health-care plan; 2) it won’t add to the deficit; 3) it will cut costs; 4) it won’t adversely affect Medicare patients; and 5) it won’t affect the status quo on abortion funding? The endless discussions and Obama’s obvious discomfort in hearing informed arguments from Republicans at his summit (e.g. John Boehner on abortion and Paul Ryan on the rest) have served to undermine the president’s credibility on these points with all but the most devoted spinners.

The abortion issue is particularly revealing. Whether or not one thinks the government should subsidize abortion, Obama’s claim that his favored bill (essentially the Senate bill) doesn’t subsidize abortions simply doesn’t stand up to scrutiny. Charmaine Yoest of Americans United for Life explains:

The president’s latest proposal mirrors legislation that has passed the Senate, which doesn’t include a Hyde Amendment [prohibiting taxpayer funding of abortions], and would inevitably establish abortion as a fundamental health-care service for the following reasons:

• It would change existing law by allowing federally subsidized health-care plans to pay for abortions and could require private health-insurance plans to cover abortion.

• It would impose a first-ever abortion tax—a separate premium payment that will be used to pay for elective abortions—on enrollees in insurance plans that covers abortions through newly created government health-care exchanges.

• And it would fail to protect the rights of health-care providers to refuse to participate in abortions.

The president’s plan goes further than the Senate bill on abortion by calling for spending $11 billion over five years on “community health centers,” which include Planned Parenthood clinics that provide abortions.

The president insists that his bill maintains the status quo on abortion funding, but those most concerned and whose votes are at stake, namely pro-life House Democrats, know better. So when Obama and Nancy Pelosi repeat their assertion that the bill contains no federal funding of abortion, they are being less than truthful.

The president’s repeated misstatements have rendered him less and less effective as a salesman for his plan, both with the public and key lawmakers. Just as his claim of the stimulus plan’s job-creating success now engenders eye-rolling and groans, his health-care talking points have also become the objects of derision. The impact may extend well beyond the health-care debate.

After all, in matters large and small, on both foreign and domestic policy, the president must be taken seriously and his word respected by the public and lawmakers if he is to sustain support for his initiatives. Obama, among his many errors, has frittered away not only a year on hugely unpopular legislation but his own credibility as well. The year is gone for good; his credibility may likewise be impossible to recover. Obama, if he were prone to self-reflection, may come to regret having been so cavalier with the truth.

Obama faces not simply a shortage of votes for his health-care plan but also a diminishing reservoir of credibility. The longer he talks, the less believable his arguments have become. After a year, dozens of speeches, hundreds of interviews, and a health-care summit, who believes of ObamaCare that: 1) you will get to keep your health-care plan; 2) it won’t add to the deficit; 3) it will cut costs; 4) it won’t adversely affect Medicare patients; and 5) it won’t affect the status quo on abortion funding? The endless discussions and Obama’s obvious discomfort in hearing informed arguments from Republicans at his summit (e.g. John Boehner on abortion and Paul Ryan on the rest) have served to undermine the president’s credibility on these points with all but the most devoted spinners.

The abortion issue is particularly revealing. Whether or not one thinks the government should subsidize abortion, Obama’s claim that his favored bill (essentially the Senate bill) doesn’t subsidize abortions simply doesn’t stand up to scrutiny. Charmaine Yoest of Americans United for Life explains:

The president’s latest proposal mirrors legislation that has passed the Senate, which doesn’t include a Hyde Amendment [prohibiting taxpayer funding of abortions], and would inevitably establish abortion as a fundamental health-care service for the following reasons:

• It would change existing law by allowing federally subsidized health-care plans to pay for abortions and could require private health-insurance plans to cover abortion.

• It would impose a first-ever abortion tax—a separate premium payment that will be used to pay for elective abortions—on enrollees in insurance plans that covers abortions through newly created government health-care exchanges.

• And it would fail to protect the rights of health-care providers to refuse to participate in abortions.

The president’s plan goes further than the Senate bill on abortion by calling for spending $11 billion over five years on “community health centers,” which include Planned Parenthood clinics that provide abortions.

The president insists that his bill maintains the status quo on abortion funding, but those most concerned and whose votes are at stake, namely pro-life House Democrats, know better. So when Obama and Nancy Pelosi repeat their assertion that the bill contains no federal funding of abortion, they are being less than truthful.

The president’s repeated misstatements have rendered him less and less effective as a salesman for his plan, both with the public and key lawmakers. Just as his claim of the stimulus plan’s job-creating success now engenders eye-rolling and groans, his health-care talking points have also become the objects of derision. The impact may extend well beyond the health-care debate.

After all, in matters large and small, on both foreign and domestic policy, the president must be taken seriously and his word respected by the public and lawmakers if he is to sustain support for his initiatives. Obama, among his many errors, has frittered away not only a year on hugely unpopular legislation but his own credibility as well. The year is gone for good; his credibility may likewise be impossible to recover. Obama, if he were prone to self-reflection, may come to regret having been so cavalier with the truth.

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So Many Bad Deals

Harry Reid and the rest of the Democratic leadership thought themselves so very clever. A deal for Sen. Ben Nelson. Another for Big Labor. Some Gator-Aid to help Bill Nelson. And presto: they’d have health-care “reform.” But in doing so they gave Scott Brown and every other Republican a juicy target, which fused together many of the themes conservatives have raised: corruption, lack of transparency, statism, and simple unfairness. To get a sense of just how unpopular these deals are, take a look at the latest Rasmussen poll:

A new Rasmussen Reports national telephone survey finds that just 33% of U.S. voters support enacting a significant excise tax on the most expensive health insurance plans provided by employers. … To keep union support for the overall health care plan, President Obama and Democratic leaders agreed last week to exempt union members from the tax for five years and modify it in other ways so they don’t pay as much. Voters really frown on that action. Only 27% support the excise tax if it exempts union members, while 70% are opposed. But even more significantly, if the union members are exempt 11% Strongly Support the tax while 51% Strongly Oppose it.

In short, in an effort to pass an unpalatable bill, the Democrats have made it — and themselves — more unpalatable to the voters. (Rasmussen reminds us: “Voters generally are unhappy with special deals for favored groups. In December, Nebraska Senator Ben Nelson gained concessions for his home state in exchange for his vote to keep the health care legislation alive. Just 17% of Nebraska voters approved of his action.”) Last night Scott Brown proclaimed:

This bill is not being debated openly and fairly. It will raise taxes, hurt Medicare, destroy jobs, and run our nation deeper into debt. It is not in the interest of our state or country – we can do better. When in Washington, I will work in the Senate with Democrats and Republicans to reform health care in an open and honest way. No more closed-door meetings or back room deals by an out of touch party leadership. No more hiding costs, concealing taxes, collaborating with special interests, and leaving more trillions in debt for our children to pay.

That’s a message many candidates will sound this year. Democrats will need to scramble to dump those deals before angry voters run them over — and out of office.

Harry Reid and the rest of the Democratic leadership thought themselves so very clever. A deal for Sen. Ben Nelson. Another for Big Labor. Some Gator-Aid to help Bill Nelson. And presto: they’d have health-care “reform.” But in doing so they gave Scott Brown and every other Republican a juicy target, which fused together many of the themes conservatives have raised: corruption, lack of transparency, statism, and simple unfairness. To get a sense of just how unpopular these deals are, take a look at the latest Rasmussen poll:

A new Rasmussen Reports national telephone survey finds that just 33% of U.S. voters support enacting a significant excise tax on the most expensive health insurance plans provided by employers. … To keep union support for the overall health care plan, President Obama and Democratic leaders agreed last week to exempt union members from the tax for five years and modify it in other ways so they don’t pay as much. Voters really frown on that action. Only 27% support the excise tax if it exempts union members, while 70% are opposed. But even more significantly, if the union members are exempt 11% Strongly Support the tax while 51% Strongly Oppose it.

In short, in an effort to pass an unpalatable bill, the Democrats have made it — and themselves — more unpalatable to the voters. (Rasmussen reminds us: “Voters generally are unhappy with special deals for favored groups. In December, Nebraska Senator Ben Nelson gained concessions for his home state in exchange for his vote to keep the health care legislation alive. Just 17% of Nebraska voters approved of his action.”) Last night Scott Brown proclaimed:

This bill is not being debated openly and fairly. It will raise taxes, hurt Medicare, destroy jobs, and run our nation deeper into debt. It is not in the interest of our state or country – we can do better. When in Washington, I will work in the Senate with Democrats and Republicans to reform health care in an open and honest way. No more closed-door meetings or back room deals by an out of touch party leadership. No more hiding costs, concealing taxes, collaborating with special interests, and leaving more trillions in debt for our children to pay.

That’s a message many candidates will sound this year. Democrats will need to scramble to dump those deals before angry voters run them over — and out of office.

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Another Backroom Deal

According to this report, Big Labor bosses and the Obama administration have cut a deal on the plan to tax the so-called Cadillac health insurance plans:

Under the Senate bill, health insurers would pay a 40% tax on premiums that exceed $8,500 annually for individuals, or $23,000 for family plans. Those thresholds will increase under the agreement reached Thursday, though it could not be immediately learned by how much.

Dental and vision benefits won’t count toward those plans, according to Congressional sources.

Democrats also agreed to add a provision making the tax less onerous on older workers and women, a union official said. Union sources cautioned that the agreement isn’t finalized because it is still being presented to the various unions.

So Obama will still renege on his pledge not to tax those making less than$250,000 — but not as badly as before. And union members will get taxed, but a little less. Aside from the thrill of being part of a historic sellout . . . er . . . grand compromise, what is in this for Big Labor? Their members have health-care benefits. Now they are going to be taxed or have their plans trimmed to subsidize other Americans. That would include many Americans who will be forced to buy insurance they heretofore didn’t want or couldn’t afford. But now they have no choice. They must sign up with Big Insurance for a plan approved by the government.

If ever there were an example of what drives average Americans nuts, this is it. A behind-closed-door deal in which Big Labor, Big Government, and Big Insurance cut an agreement to raise taxes and tell the rest of us what insurance we are going to buy. And the elite media and liberal politicians can’t figure out why there is a rising tide of populist anger out there. Really, it’s not that hard to figure out.

According to this report, Big Labor bosses and the Obama administration have cut a deal on the plan to tax the so-called Cadillac health insurance plans:

Under the Senate bill, health insurers would pay a 40% tax on premiums that exceed $8,500 annually for individuals, or $23,000 for family plans. Those thresholds will increase under the agreement reached Thursday, though it could not be immediately learned by how much.

Dental and vision benefits won’t count toward those plans, according to Congressional sources.

Democrats also agreed to add a provision making the tax less onerous on older workers and women, a union official said. Union sources cautioned that the agreement isn’t finalized because it is still being presented to the various unions.

So Obama will still renege on his pledge not to tax those making less than$250,000 — but not as badly as before. And union members will get taxed, but a little less. Aside from the thrill of being part of a historic sellout . . . er . . . grand compromise, what is in this for Big Labor? Their members have health-care benefits. Now they are going to be taxed or have their plans trimmed to subsidize other Americans. That would include many Americans who will be forced to buy insurance they heretofore didn’t want or couldn’t afford. But now they have no choice. They must sign up with Big Insurance for a plan approved by the government.

If ever there were an example of what drives average Americans nuts, this is it. A behind-closed-door deal in which Big Labor, Big Government, and Big Insurance cut an agreement to raise taxes and tell the rest of us what insurance we are going to buy. And the elite media and liberal politicians can’t figure out why there is a rising tide of populist anger out there. Really, it’s not that hard to figure out.

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The Opposition Coalition

Conservatives will most likely nod in agreement with this critique of the Senate’s health-care plan:

The last thing the American middle class needs right now is a big new tax on health insurance plans. … But the U.S. Senate wants to further impoverish the American middle class. As many as 30 million working people will pay a massive new tax in the first five years of the Senate health care reform plan. …

The tax would apply to one-fifth of all employers in 2013, the first year that health reform takes effect. More and more people would get hit each year after that. The threshold for taxable plans is indexed for inflation, which doesn’t rise as fast as health care costs.

Here’s an example of how it would work for federal workers covered by the Blue Cross/Blue Shield standard plan. Single people in the plan will immediately pay an average of about $1,600 more per year for 10 years. Families will get hit in the third year, paying an average of about $2,000 more per year for 10 years.

By 2022, the Blue Cross/Blue Shield standard family plan will cost $5,500 in taxes per worker. Single people could pay as much as $3,500 per worker.

Middle-class families in private and public sector jobs, union and non-union alike, will be hit hard by this tax on health care benefits.

Yuval Levin? Sen. Jim DeMint? No, it’s Teamster president James Hoffa. Nevertheless, the President Obama is bent on adopting the Senate tax scheme. The result, as Hoffa and conservative critics of the plan have observed, will be a repudiation of the president’s pledge not to tax those making less than $200,ooo. Democrats, who fancy themselves as the protectors of “working” Americans, are understandably nervous about the president’s desire to impose a heavy tax on their constituents:

“We did in our house bill something that protects middle class Americans from having to pay more for health insurance and health insurance reform,” Rep. Xavier Becerra, D-Calif., a member of the House leadership, said Wednesday. “So far we want to stay to that principle.” House members “have been very clear on that issue and working with the president to stick to what he said when he was campaigning for president, we’re trying to make sure this does not affect middle class Americans,” Becerra said.

So far they want to stay to that principle? Well that doesn’t sound like Hoffa’s members are going to be able to count on Becerra and his colleagues. And if the Democrats do follow the president’s lead, a political firestorm may well ensue.

What’s at risk here is an unraveling of the Democratic coalition that elected Obama and the Democratic majority. Union members, elite urbanites (who will get slammed with new taxes), high-tech entrepreneurs (who get a new employer mandate), young voters (who will have to buy insurance plans they don’t want), and older voters (whose Medicare benefits will be slashed) may find common cause with fiscal conservatives, libertarians, and, yes, those angry Tea Party protesters, who all find ObamaCare objectionable. Obama, Pelosi, and Reid seem determined to ignore all these groups. For the sake of passing a “historic” bill and out of fear of appearing inept, they seem bent on passing something their own core political supporters find highly objectionable. Do they really imagine they can do so with no adverse political consequences?

Conservatives will most likely nod in agreement with this critique of the Senate’s health-care plan:

The last thing the American middle class needs right now is a big new tax on health insurance plans. … But the U.S. Senate wants to further impoverish the American middle class. As many as 30 million working people will pay a massive new tax in the first five years of the Senate health care reform plan. …

The tax would apply to one-fifth of all employers in 2013, the first year that health reform takes effect. More and more people would get hit each year after that. The threshold for taxable plans is indexed for inflation, which doesn’t rise as fast as health care costs.

Here’s an example of how it would work for federal workers covered by the Blue Cross/Blue Shield standard plan. Single people in the plan will immediately pay an average of about $1,600 more per year for 10 years. Families will get hit in the third year, paying an average of about $2,000 more per year for 10 years.

By 2022, the Blue Cross/Blue Shield standard family plan will cost $5,500 in taxes per worker. Single people could pay as much as $3,500 per worker.

Middle-class families in private and public sector jobs, union and non-union alike, will be hit hard by this tax on health care benefits.

Yuval Levin? Sen. Jim DeMint? No, it’s Teamster president James Hoffa. Nevertheless, the President Obama is bent on adopting the Senate tax scheme. The result, as Hoffa and conservative critics of the plan have observed, will be a repudiation of the president’s pledge not to tax those making less than $200,ooo. Democrats, who fancy themselves as the protectors of “working” Americans, are understandably nervous about the president’s desire to impose a heavy tax on their constituents:

“We did in our house bill something that protects middle class Americans from having to pay more for health insurance and health insurance reform,” Rep. Xavier Becerra, D-Calif., a member of the House leadership, said Wednesday. “So far we want to stay to that principle.” House members “have been very clear on that issue and working with the president to stick to what he said when he was campaigning for president, we’re trying to make sure this does not affect middle class Americans,” Becerra said.

So far they want to stay to that principle? Well that doesn’t sound like Hoffa’s members are going to be able to count on Becerra and his colleagues. And if the Democrats do follow the president’s lead, a political firestorm may well ensue.

What’s at risk here is an unraveling of the Democratic coalition that elected Obama and the Democratic majority. Union members, elite urbanites (who will get slammed with new taxes), high-tech entrepreneurs (who get a new employer mandate), young voters (who will have to buy insurance plans they don’t want), and older voters (whose Medicare benefits will be slashed) may find common cause with fiscal conservatives, libertarians, and, yes, those angry Tea Party protesters, who all find ObamaCare objectionable. Obama, Pelosi, and Reid seem determined to ignore all these groups. For the sake of passing a “historic” bill and out of fear of appearing inept, they seem bent on passing something their own core political supporters find highly objectionable. Do they really imagine they can do so with no adverse political consequences?

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Just a Notch on a Belt

Buried deep inside an angst-filled column complaining that Obama is underappreciated and overly criticized, Richard Cohen concedes what many on both the Right and Left suspect: “He wanted a health-care bill. Why? To cover the uncovered. Maybe. To rein in the insurance companies. Maybe. To lower costs. Maybe. What mattered most was getting a bill, any bill. This is not a cause. It’s a notch on a belt.” We suspect that is true in part because Obama never really told us what he wanted in the bill. He never sent a proposal to Congress. He didn’t spell out specific requirements for his plan in that game-changing (not) speech in September. Each time Congress moved ahead with one version or another, Obama praised the effort without much comment on the content. Some thought it was tactical. But maybe he never really cared what was in it.

That conclusion is reinforced by the bill’s content and timing. As for the content, it doesn’t do what the president in broadest strokes said he wanted to accomplish. James Capretta points out that this isn’t “universal” care:

The House and Senate bills would add 15 million or more people to [Medicaid’s] rolls without any guarantee whatsoever that there will be doctors and hospitals that can see them. Ironically, the very Democrats who most frequently tout “universality” as the goal are also the ones who ensure it will never actually come about by insisting that America’s lower-income families enroll in government-run insurance — with no other options. Beyond the Medicaid expansion, Obamacare is really an obligation, not a right. Every citizen would be required to sign up with a government-approved health-insurance plan or pay a tax penalty for going without coverage.

And even its proponents concede there will still be 23 million or so uninsured. Nor does the bill meet the president’s goals of deficit neutrality or cost cutting:

[T]he claim that bill lowers the deficit means that, in addition to cutting Medicare by half a trillion dollars, the Senate would also raise half a trillion in new taxes — during a recession. Only a series of accounting gimmicks — such as implementing benefits beginning in 2014 but raising taxes starting in 2010, and double-counting Medicare savings — allowed Senate majority leader Harry Reid to get a CBO cost estimate that pretends to add “not one dime” to the deficit. Medicare actuary Foster found that the Senate bill would bend the cost curve up, not down, and that the new taxes on drugs, devices, and health-insurance plans would increase prices and health-insurance costs for consumers.

But the telltale sign that Obama doesn’t really much care about the merits of the bill or any of the bill’s promised benefits is the timeline. The Heritage Foundation lays this out in detail:

2010: Physician Medicare payments decrease 21% effective March 1, 2010

2011: “Annual Fee” tax on health insurance, allocated according to share of total premiums. Begins at $2 billion in 2011, then increases to $4 billion in 2012, $7 billion in 2013, $9 billion in the years 2014, 2015, and 2016, and eventually $10 billion for 2017 and every year thereafter. Two insurers in Nebraska and one in Michigan are exempt from this tax.

2012: Medicare payment penalties for hospitals with the highest readmission rates for selected conditions.

2013: Medicare tax increased from 2.9% to 3.8% for incomes over $250,000 (joint filers) or $200,000 (all others). (This is stated as an increase of 0.9 percentage points, to only the employee’s share of the FICA tax.)

2014: Individual mandate begins: Tax penalties for not having insurance begin at $95 or 0.5% of income, whichever is higher, rising to $495 or 1% of income in 2015 and $750 or 2% of income thereafter (indexed for inflation after 2016). These penalties are per adult, half that amount per child, to a maximum of three times the per-adult amount per family. The penalty is capped at the national average premium for the “bronze” plan.

2015: Establishment of Independent Medicare Advisory Board (IMAB) to recommend cuts in Medicare benefits; these cuts will go into effect automatically unless Congress passes, and the President signs, an override bill.

2016: Individual mandate penalty rises to $750 per adult ($375 per child), maximum $2,250 per family, or 2% of family income, whichever is higher (capped at the national average premium for the “bronze” plan). After 2016, the penalty will be increased each year to adjust for inflation.

2017: Itemized deduction for out-of-pocket medical expenses is limited to expenses over 10% of AGI for those over age 65.

Bottom line: nothing but taxes and Medicare cuts begin before 2014. This is not a serious plan to address a health-care “crisis,” is it? No. It is an effort to throw something up against the wall and clean up the mess later. It won’t be proven “not to work” before Obama’s last election because it isn’t designed to really do anything, other than raise taxes, for the next four years. It is the ultimate placeholder that Obama can check off on his to-do list without the responsibility for actually solving the crisis he told us we had to fix urgently — before Christmas 2009.

It is hard, then, to quibble with Cohen. This isn’t a serious effort to reform health care. It’s lazy governance from a president who couldn’t face failure or craft a coherent bill. He and Democrats in the House and Senate imagine that the voters are too dumb to figure this out. We’ll test that proposition in November.

Buried deep inside an angst-filled column complaining that Obama is underappreciated and overly criticized, Richard Cohen concedes what many on both the Right and Left suspect: “He wanted a health-care bill. Why? To cover the uncovered. Maybe. To rein in the insurance companies. Maybe. To lower costs. Maybe. What mattered most was getting a bill, any bill. This is not a cause. It’s a notch on a belt.” We suspect that is true in part because Obama never really told us what he wanted in the bill. He never sent a proposal to Congress. He didn’t spell out specific requirements for his plan in that game-changing (not) speech in September. Each time Congress moved ahead with one version or another, Obama praised the effort without much comment on the content. Some thought it was tactical. But maybe he never really cared what was in it.

That conclusion is reinforced by the bill’s content and timing. As for the content, it doesn’t do what the president in broadest strokes said he wanted to accomplish. James Capretta points out that this isn’t “universal” care:

The House and Senate bills would add 15 million or more people to [Medicaid’s] rolls without any guarantee whatsoever that there will be doctors and hospitals that can see them. Ironically, the very Democrats who most frequently tout “universality” as the goal are also the ones who ensure it will never actually come about by insisting that America’s lower-income families enroll in government-run insurance — with no other options. Beyond the Medicaid expansion, Obamacare is really an obligation, not a right. Every citizen would be required to sign up with a government-approved health-insurance plan or pay a tax penalty for going without coverage.

And even its proponents concede there will still be 23 million or so uninsured. Nor does the bill meet the president’s goals of deficit neutrality or cost cutting:

[T]he claim that bill lowers the deficit means that, in addition to cutting Medicare by half a trillion dollars, the Senate would also raise half a trillion in new taxes — during a recession. Only a series of accounting gimmicks — such as implementing benefits beginning in 2014 but raising taxes starting in 2010, and double-counting Medicare savings — allowed Senate majority leader Harry Reid to get a CBO cost estimate that pretends to add “not one dime” to the deficit. Medicare actuary Foster found that the Senate bill would bend the cost curve up, not down, and that the new taxes on drugs, devices, and health-insurance plans would increase prices and health-insurance costs for consumers.

But the telltale sign that Obama doesn’t really much care about the merits of the bill or any of the bill’s promised benefits is the timeline. The Heritage Foundation lays this out in detail:

2010: Physician Medicare payments decrease 21% effective March 1, 2010

2011: “Annual Fee” tax on health insurance, allocated according to share of total premiums. Begins at $2 billion in 2011, then increases to $4 billion in 2012, $7 billion in 2013, $9 billion in the years 2014, 2015, and 2016, and eventually $10 billion for 2017 and every year thereafter. Two insurers in Nebraska and one in Michigan are exempt from this tax.

2012: Medicare payment penalties for hospitals with the highest readmission rates for selected conditions.

2013: Medicare tax increased from 2.9% to 3.8% for incomes over $250,000 (joint filers) or $200,000 (all others). (This is stated as an increase of 0.9 percentage points, to only the employee’s share of the FICA tax.)

2014: Individual mandate begins: Tax penalties for not having insurance begin at $95 or 0.5% of income, whichever is higher, rising to $495 or 1% of income in 2015 and $750 or 2% of income thereafter (indexed for inflation after 2016). These penalties are per adult, half that amount per child, to a maximum of three times the per-adult amount per family. The penalty is capped at the national average premium for the “bronze” plan.

2015: Establishment of Independent Medicare Advisory Board (IMAB) to recommend cuts in Medicare benefits; these cuts will go into effect automatically unless Congress passes, and the President signs, an override bill.

2016: Individual mandate penalty rises to $750 per adult ($375 per child), maximum $2,250 per family, or 2% of family income, whichever is higher (capped at the national average premium for the “bronze” plan). After 2016, the penalty will be increased each year to adjust for inflation.

2017: Itemized deduction for out-of-pocket medical expenses is limited to expenses over 10% of AGI for those over age 65.

Bottom line: nothing but taxes and Medicare cuts begin before 2014. This is not a serious plan to address a health-care “crisis,” is it? No. It is an effort to throw something up against the wall and clean up the mess later. It won’t be proven “not to work” before Obama’s last election because it isn’t designed to really do anything, other than raise taxes, for the next four years. It is the ultimate placeholder that Obama can check off on his to-do list without the responsibility for actually solving the crisis he told us we had to fix urgently — before Christmas 2009.

It is hard, then, to quibble with Cohen. This isn’t a serious effort to reform health care. It’s lazy governance from a president who couldn’t face failure or craft a coherent bill. He and Democrats in the House and Senate imagine that the voters are too dumb to figure this out. We’ll test that proposition in November.

Read Less




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