Tuesday, December 15, 2009

Built By Committee - Designed to Fail

Senator Harry Reid is fighting a deadline. The President may have wanted a bill before Labor Day, but they want ice water in Hell, too. Reid, the pragmatist, knows the real target, December 31st. The last thing he wants is to be holding a hot potato of a health care bill in January, or worse, February.

Senator Reid has a problem.

Regular readers of this blog know that I have been asking one question from the start, What is our Goal? It is unfortunate that even though our political leaders may not have had well defined, easily explained goals, they all had solutions. Creating questions to given answers is the basis of the television show Jeopardy! Creating legislation to preconceived answers puts all in jeopardy.

It is hard to describe the pending legislation as health care reform. In fact, it is not even insurance reform. The current bills appear to reposition the government’s role in the payment of health services. Based on the numbers coming from the Congressional Budget Office, some critics think that this is just Washington once again proving that it can turn wine into water.

Let’s take a quick look at a few of the issues:

PUBLIC OPTION – Previous blogs have dealt with this particular issue. If nothing else, the Senate does not have 60 votes to pass a bill containing a Public Option.

MEDICARE OPENED TO PEOPLE AGE 55 TO 64 – This idea had a two minute life span. Nancy-Ann DeParle, the director of the White House Office of Health Reform, is quoted in the December 12th Plain Dealer. “Let me be clear, it’s not adding 55 year olds to Medicare.” If this is only Medicare-like coverage, it is really the Public Option. Please see the above.

ABORTION - Once you get the government involved, really involved, in the delivery or payment of health care, abortion is almost always the first serious question. Conservatives, Democrats and Republicans, won’t allow federal money to pay for this procedure. Liberals want to pretend that they won’t back down. Again. Couples suffering from infertility issues want to insert coverage for in-vitro into this discussion.

NEW TAXES AND FEES #1 – The pharmaceutical industry thought that it had a deal with President Obama at a very fudgeable $80 billion. The House of Representatives passed a bill that would hit the drug makers for $140 billion. The Senate’s version has yet to be released.

NEW TAXES AND FEES #2 – The Senate has proposed a new, non-deductible, tax of $6.7 billion a year on the health insurers. The easiest way to make health insurance more affordable is to add huge new costs to the health insurance companies. Makes perfect sense. To Congress. You and I might also wonder if, as the President suggested, the purpose of a Public Option was to give the insurers real competition. The best way to compete? Give the insurers huge new taxes.

NEW TAXES AND FEES #3 – The Senate has proposed a new tax on cosmetic surgical procedures. The bill currently includes a 5% tax on tummy tucks, facelifts, etc… This is a tax on medical procedures that are not usually covered by insurance. The doctors are howling. Their first line of defense is to note that the majority of these procedures are performed on middle class women with an average income of $30,000 to $50,000 per year. The second line of defense will be to add that other elective procedure, abortion, which should end the conversation.

NEW REDUCTIONS IN MEDICARE PAYMENTS - The Senate bill anticipates significant cost cutting at hospitals and nursing homes. They are so sure of this happening that they are lowering Medicare payments now. We already have Medicare’s underpayments shifted to those of us with private insurance. Reductions in Medicare reimbursements simply mean more costs shifted to us which just means higher insurance premiums. The Government’s Centers for Medicare and Medicaid Services (CMS), according to that same Plain Dealer article, states that the other option from these cuts will be the forced closing of about 20% of these institutions.

Today is December 15th, nine days till Christmas Eve. Can Reid deliver a bill for Christmas? If the President and the Democrats, and at this point it is a one party bill, enact legislation, the Republicans will have a winning campaign next fall. If legislation is blocked by the Republicans, the President and his party can paint the opposition as obstructionists who were too busy saying “NO” to help solve the problems of average Americans.

Considering how awful this legislation is, will Senator Reid win now and lose next November or has he already realized that the reverse, losing now and winning later, is much better? Is this program designed to fail?



  1. Hi Dave:

    It's great having somebody like you around to study and make sense of this very complex issue. It would seem to me you should send your letter to the president and suggest he extend the deadline into 1st quarter of next year so that one-by-one each of the flaws you outline above can be reversed. I can't see anything that sounds GOOD in the proposal. Where's the good part. Surely there must be SOMETHING. Too bad reform can't start piece by piece....Too bad all the pieces seem to rely on a holistic solution.

  2. Our system is the direct result of a piecemeal approach to solving problems. Action / Reaction repeated again and again. There are members of Congress who will never be happy with a system that relies upon private enterprise (insurance). There are others who refuse to believe that the Government should be writing checks to doctors and hospitals. I am hopelessly stuck in the middle. I really do see a need for both. My friends on the extremes view the other side as the enemy and those of us in the middle as weak and indicisive.