Oct 22 2009

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“Trick or Treat”

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“To that end, keep an eye out for shortcuts and chicanery in the legislative process that could be part of getting a [health care] bill done before the elections.”
– Duffysoapbox – 10-12-09

  • Well that didn’t take long.
  • For most of the year we have been told that one of the central elements of health care reform was “bending the cost curve;” to somehow get control of government payments to Medicare and Medicaid and slow spending to a more sustainable pace.
  • Cost of reform has been one of the most important elements in the health care debate. Speaking before a joint session of Congress on September 9th, President Obama was emphatic that he would not sign a bill that adds “one dime” to our deficits now, or in the future; a definitive statement and a very steep climb.
  • Since September, committees in Congress have labored mightily to write health care bills that contain costs. The Finance Committee was only the latest to rely on budget tricks to keep the final number under $1 trillion; the apparent threshold for thrifty reform.
  • Senator Baucus’s bill comes out as “fiscally responsible” because the cost increases and cuts kick in immediately, but the actual health care extensions don’t kick in for four years. His Committee’s ten-year projection looks rosy because he’s effectively banked four years of surpluses before the program begins, distorting the actual cost if the expansions, costs and cuts all happened simultaneously.
  • But even that fast and loose calculation is of marginal relevance since the Baucus bill is not going to be the final bill.  Five people are in a room in the Senate deciding the fate of 1/6th of the US economy, by blending the Baucus bill, and the far more liberal Kennedy-Dodd bill into one for consideration by the Senate.
  • They do so in secret, with no input advice or counsel from pesky citizens.  So much for transparency and C-Span debate as promised, well, a year ago. In any case, the final Senate bill, in all likelihood will be to the left of the Baucus bill.
  • Over on the House side, Nancy Pelosi is doing the same reconciliation exercise with the three bills that have passed her Chamber, and her much more liberal base is sure to create a blended bill much more to the left of the Senate bill, and will – in all likelihood – include the private sector crushing “public option.”
  • If both bills pass their respective chambers – still a pretty big if – the House and Senate must blend their bills together into one final bill that will be re-voted in the House and Senate and sent to the President.
  • If you follow the linear progression, the Baucus bill, which attracted one GOP vote, is ironically the most conservative of all the bills that will be considered.  What comes back from Conference will be significantly more liberal, with corresponding increases in government control, bureaucracy, mandates and cost.
  • Which brings us to trick or treat.
  • Remember now, all that talk about “bending the curve, and deficit neutrality and containing costs. Well, it can’t be done; at least not using the government expanding and government control philosophy of the Democrats with regard to health care.  The numbers just don’t add up.
  • Thus comes Senator Debbie Stabenow of Michigan.  With a straight face, Senator Stabenow wanted to bring a $250 billion “Medicare Reimbursement” bill to a vote in the Senate.  The bill would ensure that doctors who accept Medicare would have no cut in payments for ten years.  As you might expect, this was cheered by the American Medical Association (AMA) and AARP.
  • The question of course, is why an issue that is central to cost control in the health care debate is being brought up as an ostensibly separate bill, with no impact on health care?
  • Trick or Treat!
  • If you guarantee government payments to doctors you’ve just blown the cap off of the cost of health care, even with Finance Committee chicanery.  Add it in and health care costs simply blow past $1 trillion.
  • But it gets better.
  • Consider that various versions of the bills being reconciled call for expanding Medicare/Medicaid with new patients. If you guarantee doctor payments based on today’s current patient load and suddenly you have, say, millions more patients, based on separate health care reform, the costs skyrocket.
  • Senator Lamar Alexander (R-TN) said it best yesterday when he stated, “Finally we’re coming to the first vote on health-care reform, and what do the Democrats propose to do? They propose to raise the national debt by…a quarter trillion dollars, plus $50 billion in interest.”1
  • Spoken plainly, this is nothing more than a cynical gimmick to hide the true cost of the reform Democrats are proposing.  The bone-crushing, budget-busting, eye-popping cost of Democratic reform.
  • But there are still moderate Democrats who actually care whether or not the US has the financial standing of a banana republic.  The “Doc Fix,” vote was postponed both Monday and Tuesday when it became clear that moderate Democrats (and all the Republicans) would oppose the bill, including Budget Committee Chairman Kent Conrad (D-ND).
  • Now there is talk of a scaled back bill, maybe one that would cover only a year or two; anything to avoid having to add the cost of this bill to the total for health care reform now undergoing a secret blending exercise in the House and Senate.
  • We are better than this. As citizens we deserve better than this; parlor tricks, secret negotiations with special interests, bills voted out without text or comment.  Duplicitous legislative gambits designed to hide costs.
  • At this current trajectory, we will not only have the public finances of a banana republic, but the laughing-stock government institutions to go with it.

    1. Washington Post, A2, 10-21-09


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