Disguised Health Care Costs: The $1.5 Trillion Fraud
If House Democrats hold a vote on their health-care overhaul this weekend, they might as well vote to abolish the Congressional Budget Office too.
It would be no more audacious (and much more honest) than the way they have gamed the CBO’s rules to hide $1.5 trillion of the cost of their legislation — which has to be the biggest fiscal obfuscation in the history of American politics.
C/P Politico
Tuesday Links
- Dear members of Congress: If you’re not going to read the bills you pass, at least read the Constitution. Don’t fret; it’s short and written in plain English.
- Richard Rahn: Pay members of Congress more. (Or less, depending on their performance.)
- NYC: “The city that never smokes.” A proposal to ban lighting up in New York’s parks has exposed the puritanical agenda behind the crusade against smoking.
- Tyler Cowen: With health care costs high and rising, government mandates to buy insurance would make many people worse off.
- Podcast: “Pay Czar Cuts Checks“
Wednesday Links – Health Care Costs
The Congressional Budget Office released a report this week that revealed that the proposed health care bill would not increase the deficit. But is it that simple? Cato health care policy experts have examined the bill and added up the costs. Here are a few things they have found:
- Congress has been cooking the books: “When it comes to the health care reform debate…honest budgeting is nowhere to be seen.”
- Costs will only decrease if we give market forces room to breathe.
- How some in Congress are hiding the true costs of the health care overhaul.
- Healthy Competition: What’s Holding Back Health Care and How to Free It
What They Aren’t Telling You About the CBO Score
The CBO report that said the health care bill won’t raise deficits makes it clear that the Baucus bill’s reduction in future budget deficits comes not from controlling government spending or reducing health care costs, but because of a rapid escalation in tax revenues.
The bill imposes a 40 percent excise tax on health-insurance plans that offer benefits in excess of $8,000 for an individual plan and $21,000 for a family plan. Insurers would almost certainly pass this tax on to consumers via higher premiums. As inflation pushes insurance premiums higher in coming years, more and more middle-class families would find themselves caught up in the tax.
In fact, overall, the tax increases in the bill are more than double the amount of deficit reduction. This isn’t a health care efficiency bill or a cost containment bill. It is a tax and spend bill, pure and simple.
Wednesday Links
- Should more troops be sent to Afghanistan? Cato’s Malou Innocent weighs in alongside the policymakers.
- What does the end of the missile defense system in Central Europe means for U.S.-Russian relations?
- Signals indicate that the market just might be on the rebound. That’s great, but it’s important not to get ahead of ourselves, says Johan Norberg. “We must never forget that the light at the end of the tunnel can be an approaching train.”
- A few thoughts on the new rise of the Taliban in Afghanistan, and what it means for Pakistan and India.
- Michael Cannon continues his debate in the LA Times: The dirty little secret is that “Obama-care” isn’t about reducing health care costs or making coverage more secure. It’s about robbing Peter to pay Paul.
- Podcast: If you’d like to see what Obama wants to do to the U.S. health care system, don’t listen to his rhetoric…look at what he’s doing to Medicare.
The DNC’s Pure Uninformed Demagoguery
The other day, Sarah Palin cited my work in an oped for the Wall Street Journal. So when the Democratic National Committee savaged her for it, ABCNews.com asked me for comment. Here’s an excerpt from George Stephanopoulos’ blog:
“Instead of poll-driven ’solutions,’ let’s talk about real health-care reform: market-oriented, patient-centered, and result-driven,” wrote Palin. “As the Cato Institute’s Michael Cannon and others have argued, such policies include giving all individuals the same tax benefits received by those who get coverage through their employers; providing Medicare recipients with vouchers that allow them to purchase their own coverage; reforming tort laws to potentially save billions each years in wasteful spending; and changing costly state regulations to allow people to buy insurance across state lines.”
Cannon, the Cato expert referenced by Palin, has not had any direct contact with the former Alaska governor or any of her advisers.
He did, however, come to her defense on the Medicare issue.
‘Vouchers would not make seniors less secure, it would make them more secure,’ Cannon told ABC News. ‘Everyone agrees that Medicare cannot go on spending as much money as it does now. The voucher idea allows individual consumers to make their own decisions about what they need and what they don’t need.’
‘Giving Medicare seniors a voucher is the most rational, the most humane way to contain Medicare spending,’ he added.
Asked about the DNC’s charge that Palin’s proposal would leave seniors with pre-existing conditions vulnerable, Cannon, the director of health policy studies at Cato, called it ‘pure uninformed demagoguery.’
Cannon says that under proposals he has developed, bigger vouchers would be given to people with pre-existing conditions as well as to people with low incomes.
Actually, I think what I said was that DNC communications director Brad Woodhouse was engaging in pure ignorant demagoguery. But whatever.
The DNC is even running an ad claiming that Republicans are trying to “cut” and “kill” Medicare, presumably with vouchers. Never mind that President Obama proposes to “cut” (i.e., slow the growth of) Medicare spending too.
If Republicans were smart — hey, where are you going? — they would be running ads that say:
President Obama wants government bureaucrats to decide whether seniors get health care. Republicans are fighting to control health care costs and preserve seniors’ ability to make their own health care decisions and choose the benefits that they value most. Support Medicare vouchers!
For more on reforming Medicare the right way, click here.
Cato Institute to Launch Ad Campaign Against Government-Run Health Care
The Cato Institute will launch an ad campaign Thursday highlighting under-reported poll data showing Americans’ concerns that current health care reform plans will raise costs, limit choice and reduce the quality of their health care.
The campaign will feature full-page ads in major national newspapers, in addition to radio spots focusing on why government-run health care cannot address the problems of growing costs and lack of coverage for many individuals and families. The campaign will expand in the weeks ahead.
“Our goal is to help the American public navigate terms like ‘a public plan’ and ‘individual or employer mandates’ to understand what is really happening here,” said Ed Crane, founder and president of the Cato Institute. “The bottom line is, most of the plans coming from the White House and congressional leadership will result in a government-run health care system that is really not the best option for most Americans.”
A poll by the Washington Post and ABC News conducted June 18-21 showed that 84 percent of respondents were “very” or “somewhat” concerned that “current efforts to reform the health care system” would increase their health care costs. The survey also showed that 79 percent of respondents were concerned that current efforts would limit their choices of doctors or medical treatments.
As part of the campaign, Cato is running radio ads in major cities across the country. You can listen to them below, and embed them on your own blog using the code on the official campaign site.
Who Pays?
Who Decides?
Cato has also created a new website, Healthcare.cato.org, to promote more free market-oriented health care reform proposals.
Samuelson: Obama Would Increase, Not Reduce, Health Care Costs
Columnist Robert J. Samuelson, writing in this morning’s Washington Post:
It’s hard to know whether President Obama’s health-care “reform” is naive, hypocritical or simply dishonest. Probably all three. The president keeps saying it’s imperative to control runaway health spending. He’s right. The trouble is that what’s being promoted as health-care “reform” almost certainly won’t suppress spending and, quite probably, will do the opposite…
The president summoned the heads of major health-care groups representing doctors, hospitals, drug companies and medical device firms to the White House. All pledged to bend the curve. This is mostly public relations. Does anyone believe the American Medical Association can control the nation’s 800,000 doctors or that the American Hospital Association can command the 5,700 hospitals?…
The main aim of health-care “reform” being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans…But the extra coverage might actually worsen the spending problem.
How much healthier today’s uninsured would be with that coverage is unclear…
The one certain consequence of expanding insurance coverage is that it would raise spending…
It’s easier to pretend to be curbing health spending while expanding coverage and spending. Presidents have done that for decades, and it’s why most health industries see “reform” as a good deal.
The Cost of Health Care
From a patient’s point of view, the ideal health insurance policy would offer unlimited access to medical services at no charge. Unfortunately, it is not feasible to offer this to everyone.
The key to sustainable health care reform is restraining the use of services that have high costs and low benefits, says Cato adjunct scholar Arnold Kling. In the video below, Kling examines the challenges facing health reformers and the feasibility of alternative proposals.
The Economic Case for Health Care Reform
There’s an old Yiddish saying that, “If my bubba had wheels she’d be a trolley.” So goes the logic of the Obama administration in their paper released yesterday, “The Economic Case for Health Care Reform.” Their claim is that reducing health care costs would help the economy. Yes, if health care costs were reduced it would likely help the economy, though we should remember that the health care industry is part of the economy.
There is nothing in Obamacare, however, that will reduce costs. In fact, expanding coverage may cause costs to rise. One study by MIT’s Amy Finkelstein suggests that the prevalence of insurance itself has roughly doubled the cost of health care. So, if Obama succeeds in expanding insurance coverage, it’s very likely to increase the cost of care.
Take Massachusetts for example. Three years ago, Massachusetts governor Mitt Romney signed into law one of the most far-reaching experiments in health care reform since President Bill Clinton’s ill-fated attempt at national health care. Proponents promised the reforms would reduce health care costs, suggesting the price of individual insurance policies would be reduced by 25-40 percent. In reality, however, insurance premiums rose by 7.4 percent in 2007, 8-12 percent in 2008, and are expected to rise 9 percent this year. This is compared to a nationwide average increase of 5.7 percent over the same three years. Nationally, on average, health insurance for a family of four costs $12,700; in Massachusetts, coverage for the same family costs an average of $16,897.
In fact, since the bill was signed, health care spending in the state has increased by 23 percent. Thus, despite individual and employer mandates, the creation of an insurance connector and other measures that increase insurance regulations, Massachusetts has failed to bring costs down.
President Obama and Congressional leaders have endorsed expanding coverage in similar ways to Massachusetts. The proposals would undoubtedly make it easier for some people to get coverage, but would also raise insurance costs for the young and healthy, making it more likely they would go without coverage. This leaves two choices: revert to the individual mandate (President Obama opposed the mandate as a candidate) or increase subsidies to try to cut costs to young and healthy individuals, thereby adding to the already substantial cost of the proposed plans.
Ultimately, controlling costs requires someone to say “no,” whether the government (as in single-payer systems with global budgets), insurers (managed care) or health care consumers themselves (by desire or ability to pay). In reality, any health care reform will have to confront the fact that the biggest single reason costs keep rising is that the American people keep buying more and more health care.
GOP Health Care Alternative: Drinking the Massachusetts Kool-Aid
Earlier this morning, my colleague, Michael Cannon, blogged a devastating critique of the Coburn-Burr-Ryan-Nunez alternative to the Obama health plan. As he shows, while the bill has some good features (changing the tax treatment of health insurance, expanding HSAs), the good is swamped by a bizarre collection of regulation, mandates, and hidden taxes.
In fact, the bill appears to be based, in large part, on what its sponsors call “the well-known, bi-partisan achievement of universal health care through a private system in Massachusetts.” But the Massachusetts model has failed to either achieve universal coverage or control health care costs. Rather, as I noted in this recent blog, it has led to more regulation, less consumer choice, and increased insurance premiums, while running huge budget deficits that have already led to one tax increase and are now causing the state to consider premium caps and global budgets. One wonders why congressional Republicans would want to head down that road.
Notably, Coburn-Burr-Ryan-Nunez abandons Rep. John Shadegg’s proposal to allow Americans to buy insurance across state lines in favor of a requirement that states establish Massachusetts-style connectors. But the Massachusetts Connector has been one of the worst aspects of that state’s reform, acting as a super-regulatory body, adding new mandated benefits, restricting consumer’s choice of plans, and adding both regulatory and administrative costs to insurance. (In fact, the Connector adds its own administrative costs, estimated at 4 percent of premium costs, for plans that are sold through it.) What the Connector has not done is live up to its promise of breaking the link between employment and insurance, giving workers personal, portable insurance that they could take with them from job to job, and which they would not lose when they lost their jobs. Unfortunately, the Connector has not lived up to its promise in the latter regard. In fact, as of May 2008, only 18,122 people had purchased insurance through the Connector. That’s very little gain for so much pain.
Since there is virtually no chance that the Coburn-Burr-Ryan-Nunez will actually be enacted, perhaps one shouldn’t get too excised about its failings. No doubt it is far superior to Obamacare. And, it is understandable that congressional Republicans want to appear as more than the “party of no.” Still, this looks like a sadly missed opportunity.
A Not So Happy Anniversary for the “Massachusetts Model”
Three years ago yesterday, then-Governor Mitt Romney signed into law the most far reaching state health care reform plan to date. At the time, we warned that the plan, with its individual and employer mandates, new regulatory bureaucracy (the Connector), and middle-class subsidies would result in “a slow but steady spiral downward toward a government-run health care system.” Sadly, three years later, those predictions appear to be coming true.
- While the state has reduced the number of residents without health insurance, some 200,000 people remain uninsured. Moreover, the increase in the number of insured is primarily due to the state’s generous subsidies, not the celebrated individual mandate.
- Health care costs continue to rise much faster than the nationally. Since the program became law, total state health care spending has increased by 23 percent. Insurance premiums have been increasing by 10-12 percent per year, nearly double the national average.
- New regulation and bureaucracy is limiting consumer choice and adding to costs.
- Program costs have skyrocketed. Despite tax increases, the program faces huge deficits in the future. As a result, the state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a “global budget” on health care spending.
- A shortage of providers, combined with increased demand, is increasing waiting times to see a physician, especially primary care providers.
With the “Massachusetts model” being frequently cited as a blueprint for state or national health care reform, it is important to recognize that giving the government greater control over our health care system will have grave consequences for taxpayers, providers, and health care consumers. That is the lesson of the Massachusetts model.
Week in Review: No End to Spending and Regulation in Sight
Geithner to Propose Unprecedented Restrictions on Financial System
The Washington Post reports, “Treasury Secretary Timothy F. Geithner plans to propose today a sweeping expansion of federal authority over the financial system… The administration also will seek to impose uniform standards on all large financial firms, including banks, an unprecedented step that would place significant limits on the scope and risk of their activities.”
Calling Geithner’s plan another “jihad against the market,” Cato senior fellow Jerry Taylor blasts the administration’s proposal:
What President Obama is selling is the idea that government must be the final arbiter regarding how much risk-taking is appropriate in this allegedly free market economy. It is unclear, however, whether anybody short of God is in the position to intelligently make that call for every single actor in the market.
Cato senior fellow Gerald P. O’Driscoll reveals the real reason behind the proposal:
Federal agencies have long had extensive regulatory powers over commercial banks, but allowed the banking crisis to develop despite those powers. It was a failure of will, not an absence of authority. If the authority is extended over more institutions, there is no reason to believe we will have a different outcome. This power grab is designed to divert attention away from the manifest failure of, first, the Bush Administration, and now the Obama Administration to devise a credible plan to deal with the crisis.
A new paper from Cato scholar Jagadeesh Gokhale explains the roots of the current global financial crisis and critically examines the reasoning behind the U.S. Treasury and Federal Reserve’s actions to prop up the financial sector. Gokhale argues that recovery is likely to be slow with or without the government’s bailout actions.
In the new issue of the Cato Policy Report, Cato chairman emeritus William A. Niskanen explains how President Obama is taking classic steps toward turning this recession into a depression:
Four federal economic policies transformed the Hoover recession into the Great Depression: higher tariffs, stronger unions, higher marginal tax rates, and a lower money supply. President Obama, unfortunately, has endorsed some variant of the first three of these policies, and he will face a critical choice on monetary policy in a year or so.
Obama Defends His Massive Spending Plan
President Obama visited Capitol Hill on Wednesday to lobby Democratic lawmakers on his $3.6 trillion budget proposal. Both the House and Senate are expected to vote on the plan next week.
In a new bulletin, Cato scholar Chris Edwards argues, “Sadly, Obama’s first budget sets a course for more government bloat, more economic distortions, and ultimately lower standards of living for everyone who is not living off of federal hand-outs.”
On Cato’s blog, Edwards discusses Obama’s misguided theory on government spending:
Obama’s budget would drive government health care costs up, not down. But aside from that technicality, the economics of Obama’s theory don’t make any sense.
Obama’s budget calls for a massive influx of government jobs. Writing in National Review, Cato senior fellow Jim Powell explains why government jobs don’t cure depression:
If government jobs were the secret of success, then the Soviet Union wouldn’t have collapsed, because it had nothing but government jobs. Communist China, glutted with government jobs, would have generated more income per capita than Hong Kong where, at least before the Communist takeover, there were hardly any government jobs, but Hong Kong’s per capita income was about 20 times higher than that on the mainland.
Multiplying the number of government jobs did nothing then and does nothing now to revive the private sector that pays all the bills, in large part because of the depressing effect of taxes required to pay for government jobs.
Cato on YouTube
Cato Institute is reaching out to new audiences with our message of individual liberty, free markets and peace. Last year, we launched our first YouTube channel, which has garnered thousands of views and subscriptions. Here are a few highlights:
- Cato scholars offer ways to downsize the federal government
- The Supreme Court takes a massive step backward on private property rights
- Jim Powell explains the adverse effects of the New Deal on C-SPAN
- Juan Carlos Hidalgo discusses drug war violence in Mexico on BBC
Filed under: Cato Publications; Finance, Banking & Monetary Policy; General
Obama’s Spending Theory
President Obama focused on budget and economic issues in his press conference last night. One concern raised by reporters was that federal deficits were exploding and that Obama’s big spending plans would seem to make the problem worse.
Obama’s response was essentially that higher spending reduces the debt problem, which would strike most people as paradoxical to say the least:
Here’s what I do know: If we don’t tackle energy, if we don’t improve our education system, if we don’t drive down the costs of health care, if we’re not making serious investments in science and technology and our infrastructure, then we won’t grow [the economy by] 2.6 percent, we won’t grow 2.2 percent. We won’t grow. And so what we’ve said is, let’s make the investments that ensure that we meet our growth targets that put us on a pathway to growth as opposed to a situation in which we’re not making those investments and we still have trillion-dollar deficits.
First note that Obama’s budget would drive government health care costs up, not down. But aside from that technicality, the economics of Obama’s theory don’t make any sense.
Government spending on infrastructure, education, science and energy are already at high levels. For example, infrastructure spending today is as high as it was during the 1950s, and higher than it has been in recent decades. If government worked efficiently—as liberals believe it does—then all the highest-valued uses of taxpayer money would already be funded. At the margin, the only place for Obama’s new spending would be on low-value items of less economic importance.
Thus, Obama’s new college subsidies might induce some added young people to attend college, but most of those people are probably pretty marginal students because the high-quality students are already going to college. The marginal students might pick up some added skills, but at the cost of higher tax burdens and less economic output in the years when those folks are out of the workforce. Liberals assume that more spending on any activity they are interested in, whether public or private, is always better, but the real goal of economic policy is to find the optimum because all spending has a cost. (And the optimum level of government spending on most things is pretty darn low, or zero, in my view).
Obama is essentially claiming that even with federal, state and local spending at about one-third of GDP, there are government spending projects left over that are so powerful that “we won’t grow” if they don’t happen.
Serious economists know that that is nonsense. Most government activities have negative effects on growth, not positive effects. Take the largest federal program, Social Security, which will consume about $660 billion in taxpayer money this year. The program is a negative on economic growth because it suppresses personal savings and the taxes to fund it create large distortions. Lots of liberal economists support such transfer programs for non-economic or “social” reasons, but few economists would argue that they expand GDP on net.
The Easy Solution to Rising Health Care Costs
It turns out that solving the health care crisis is easy. There’s never been any reason for the lengthy, divisive, and impassioned debate. Explains the New York Times:
“Really controlling costs requires just stopping spending,” said Stuart H. Altman, a professor of health policy at Brandeis University.
Gees, it’s no problem then. Why didn’t I think of that?
More on that Massachusetts ‘Model’
Amid reports that the Obama administration, congress, and some conservative groups still consider Massachusetts to be a model for health care reform, the New York Times reveals that despite assessing insurers and hospitals, raising the penalty on noncompliant businesses, increasing premiums and co-payments for consumers, and raising the state tobacco tax, the program’s financing remains unsustainable.
Massachusetts has significantly reduced the number of people in the state who lack health insurance. However, it has not achieved, nor does it expect to reach, universal coverage. (The best estimates suggest that more than 200,000 state residents remain uninsured). And, significantly, roughly 60 percent of newly insured state residents are receiving subsidized coverage, suggesting that the increase in insurance coverage has more to do with increased subsidies (the state now provides subsidies for those earning up to 300 percent of the poverty level or $66,150 for a family of four) than with the mandate.
The cost of those subsidies in the face of predictably rising health care costs has led to program costs far higher than originally predicted. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009.
Now the state is turning to a variety of gimmicks to try to hold down costs, including possibly cutting payments to physicians and hospitals by 3-5 percent. However, the Times quotes health reform experts who have studied the Massachusetts system as warning “the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care.”
The more one looks at the Massachusetts “model,” the stronger the argument for keeping the government out of health care.
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