"Repeat after me," TNR's health care wizard Jonathan Cohn exclaims, "This is only a partial estimate." Cohn's referring to the Congressional Budget Office's preliminary score of the Senate HELP committee's health care plan. Cohn's exactly right:
Let's extend Cohn's analogy. Imagine, if you will, that you're trying to sell another house on the block, and this ugly partially-finished monster sits on the lot next to yours. You certainly would do your best way to wait until the eyesore was finished -- and therefore was less of an eyesore -- before you brought potential buyers around.But wait. The Senate HELP bill is not yet finished. Like the house design without the plumbing, wiring, and roof, the HELP bill is missing several key elements that would dramatically change the final estimate.
The most important of these, by far, is the employer mandate--that is, the requirement that employers either pay for their workers' coverage or pay the cost of covering them through a new insurance exchange, set up and run by the government. The HELP bill has a big blank in the employer mandate, because it was an area over which the committees Democrats and Repbulicans were still negotiating when the committee submitted its language
Privately, most Democrats will tell you that the HELP plan is not the plan to watch in the Senate; that'd be the Finance Committee's draft legislation, due out very soon. So it might not matter what the CBO's HELP score is, even though elements of the legislation will be very similar.
But you can't blame the Republican Party for finding a way to exploit the partial release. Given the ease with which the CBO numbers are digested on Capitol Hill, the GOP now has a significant talking point, one that's reflected in news coverage already: the President says health care will be revenue-neutral, but the Kennedy plan in the Senate would add at least $1.3 trillion to the deficit...and wouldn't cover half of the uninsured! Sure, the bill's a work in progress, but it could get worse, right? You can see the ads now: a melifluous voice asking "Can we really afford to spend 1.3 trillion dollars?"
After reading the report, a senior Republican Senate aide e-mailed me: "So, the main things the President claimed today--it will be fully paid for, people can keep the coverage they like and currently have--don't seem to be operable under the current proposal."
The actual Senate Democratic proposal may differ considerably from the HELP plan, but this predecisional period is quite important so far as setting the contours of the debate. The president's defensiveness about the "public plan" option, his float of medical malpractice insurance reform and his insistence that Amercians who like their health care can stick with the status quo suggest that there is a greater political opening for Republicans than some polls might suggest.
White House officials wouldn't speak about the CBO score yesterday, but I can't imagine they're happy with the timing.
I don't think that's the best analogy for him, because houses rarely get cheaper when you add the plumbing, wiring, and roof.
If we assume that the current bill is somehow going to a) cover more people and b) not impact the budget so much, then it will have to either c) raise taxes (as the New York Times discusses) and/or d) cut coverage/spending.
Of course, Candidate Obama ran against both c) and d), and attacked McCain in ads for suggesting c) or suggestion that Obama would do c), and attacked McCain in speeches for having voted for d)-- even more modest restraint in Medicare spending in the past.
Aren't they taking a two bill approach? The HELP plan is the popular dessert of expanding coverage. The Finance Committee is the spinach and brussels sprouts of higher taxes and cutting Medicare and Medicaid benefits and reimbursements to pay for it. Each committee is writing its part. Then the two bills will be combined on the floor into a compromise.
So this bill tells us that the Finance Committee, right now, has to find $1 trillion in taxes or spending cuts over a decade.
The HELP plan will have another source of revenue, mind you. The individual mandate, i.e., taxing the young and healthy who otherwise wouldn't participate, and the employer mandate, i.e., taxing businesses to pay for it.
Keith Hennessey's discussion of the scoring is useful.
I like this article. There are probably 50 ways to do it better, and any plan that works even though it is not like all the others would be fine.
I sense an unhealthy faith within officialdom that money is a unitary solution, when the problem being addressed is a symptom of an empire going down, not one coming up.
Throwing money at this type of problem is just another symptom.
This is outrageous. Such a costly plan that covers so few Americans that also completely eliminates private sector health insurers shouldn't be on the Congressional docket. This plan will no doubt be the end of free-market healthcare if it is passed. Why can't we look to free market alternatives to fix the problem of the uninsured in America? Small businesses are the backbone of our economy, and are a major reason why Americans go uninsured. Especially in an economy like this, small businesses are unable to afford the outrageous cost of healthcare for their employees. Lets allow them to reach across state lines to band together to spread risk and increase bargaining power. They should also be able to purchase individually owned plans, like health savings accounts, for their employees using pretax dollars. These things would allow the free market to thrive while at the same time reduce the cost of healthcare to small business owners. www.familyissues.ncpa.org
Congress and the Obama Administration are pushing for health care reform that will move the US health care system closer to that of Canada or the UK. You can help stop a government takeover of health care from happening. Send a message to the White House and Congress by signing the “Free Our Health Care Now” petition. Go to www.freeourhealthcarenow.com and sign the petition today!
Interestingly, $1 trillion to insure 16 million works out to $6250/person. We already spend more than that per capita for health care in this country. It's safe to assume that the HELP bill will greatly raise the standard of care and lower the out-of-pocket cost for many Americans, also. I don't even see that $1 trillion is a terrible price to pay for that.
And, TerryNeese, fantastic astroturfing there. I'm glad the industry subsidized opposition is apparently coalescing around a strategy of making shit up. If you noticed during the 2008 campaign, Obama successfully ran on an economic plan that actually *increased* taxes for many Americans. No one's won that fight in the post-Reagan era. I think you'll see that people aren't particularly convinced by lies.
We don't look towards purely free market plans to achieve universal insurance because it'd cost a hell of a lot more than $1 trillion.
Alchemy Today:
I think you're off by a factor of 10. Perhaps you divided by 10 years and you meant to say "per year".
You also left off $300B I think. My math says it's about $8667 / person / year.
Yeah; per person per year. I saw $1 trillion as the 10 year cost this morning and didn't notice the bonus $300 billion in this article. Anyway, my point isn't that it's not expensive but that it's not wildly expensive. People are acting absolutely shocked at this number when it seems to be in the ballpark of what one would expect given increasing costs of healthcare (even with cost reduction measures; those aim to decrease the rate of cost growth) over the next decade. Presumably the 16 million that get insurance are relatively expensive to cover for one reason or another, also.
Alchemy, you say it's no big deal to pay $8667 per person per year, because we're already paying about that amount, right? Well who is currently paying that? Individuals, or the government? If the cost is currently being paid by individuals/companies, then it's a huge difference if taxpayers are now paying that amount for the uninsured.
Also, I'm with Thacker...the house construction analogy is definitely not a good one. I work for a large construction company, and I've never seen the cost of a project come DOWN when the "details" are filled in. That's when it goes up...especially when you are initially trying to sell the plan to someone/the public.