At First Anniversary, ObamaCare on the Run
One year ago today, President Barack Obama signed ObamaCare into law. I recap ObamaCare’s first year in my latest Kaiser Health News column. Here’s some additional news surrounding the law’s anniversary.
Politico reports that supporters won’t have the vast war chest to defend the law that they once said they would:
Democrats are under siege as they mark the first anniversary of health care reform Wednesday — and they won’t get much help from the star-studded, $125 million support group they were once promised…[N]ine months later, the Health Information Campaign has all but disappeared. Its website hasn’t been updated since the end of last year. Its executive director and communications director are gone. There’s no sign that it has any money. And neither [former senator Tom] Daschle nor [former White House Communications Director Anita] Dunn will return calls asking about it.
Politico also reports on what everyone knows, but few reporters seem willing to say. ObamaCare is unpopular, and growing more so:
Although Democrats insisted that the [law] would become more popular once the congressional debate ended and the benefits started to kick in, the reverse has actually happened. According to a Kaiser Health Tracking poll released Friday, 46 percent of the public opposes the law, up from 40 percent a year ago. Only 42 percent support the law, down from 46 percent a year ago.
Finally, Politico (again) reports that yet another governor — Louisiana’s Bobby Jindal (R) — has refused to implement ObamaCare:
The Louisiana governor’s office gave PULSE the first definitive answer on whether it would run its own health exchange, and it took them only two letters: no. “Obamacare is a terrible policy that needs to be repealed and replaced,” Gov. Bobby Jindal’s press secretary Kyle Plotkin tells PULSE. “It creates enormous new costs and future unfunded liabilities for states financing their Medicaid programs.” That puts him in a similar camp with Florida Gov. Rick Scott, who recently told us that Florida is “not doing anything with regards to the exchange, I don’t believe in the exchange. It doesn’t do anything to improve access to care. It does nothing to drive down health care costs.”
It’s worth emphasizing that Scott and Jindal probably know more about health care than the other 48 governors.
Filed under: Cato Publications; General; Government and Politics; Health Care
’1099′ Repeal Speaks Volumes About ObamaCare
From my latest Kaiser Health News op-ed:
When 34 Senate Democrats joined all 47 Republicans last week to repeal ObamaCare’s 1099 reporting requirement, their votes confirmed what their talking points still deny: ObamaCare will increase the deficit, no matter what the official cost projections say…
This public-choice dynamic [of concentrated benefits and diffuse costs] is why the Congressional Budget Office, the chief Medicare actuary, and even the International Monetary Fund have discredited the idea that ObamaCare will reduce the deficit. It is one of the principal reasons why, as Thomas Jefferson wrote, “The natural progress of things is for liberty to yield, and government to gain ground.” In other words, the game is rigged in favor of bigger government.
It also explains why the Obama administration is sprinting to implement ObamaCare in spite of a federal court having struck down the law as unconstitutional. The White House needs to get some concentrated interest groups hooked on ObamaCare’s subsidies – fast.
Read the whole thing here.
Non-Taxpayers for a Tax Hike
Advocates of limited government often worry about how to maintain republican government and freedom if a substantial portion of the population don’t pay taxes and are net beneficiaries of government largesse.
Lately, it seems like a lot of the advocates of bigger government and higher taxes don’t pay their own taxes — like Tom Daschle, Timothy Geithner, Eleanor Holmes Norton, Charles Rangel, Al Franken, Governor David Paterson’s top aide, Democratic National Convention staffers, Al Sharpton, and so on.
Now the Washington Post has found another one:
Since joining the D.C. Council two years ago, Michael A. Brown has become the chief advocate for raising taxes on the city’s wealthiest residents, arguing that those who earn at least $250,000 a year are not paying their share.
Yet Brown and his wife have failed to pay the property taxes on a Chevy Chase home assessed at $1.4 million, according to public records. Brown, who earns more than $300,000 a year, owes the District $14,263 for property taxes, the records show.
I guess it’s easy to support higher taxes if you don’t intend to pay them. But I suggest that Brown bite the bullet, recruit Daschle, Franken, Norton, and their colleagues, and form a new organization:
Non-Taxpayers for a Tax Hike
Bending the Cost Curve: Ryan’s Roadmap Would Succeed Where ObamaCare Fails
From my oped in today’s Investors Business Daily:
Rep. Paul Ryan’s (R-Wis.) “Roadmap for America’s Future” proposes even tighter limits on Medicare’s growth, leading columnist Bruce Bartlett to opine, “the Medicare actuaries have shown the absurdity of the Ryan plan by denying that Medicare cuts already enacted into law are even worthy of projecting into the future.”
On the contrary, experience and public choice theory suggest that the Ryan plan has a better shot at reducing future Medicare outlays than past efforts, because the Roadmap would change the lobbying game that fuels Medicare’s growth.
For more on Ryan’s Roadmap, click here. For more on Medicare, read David Hyman’s Medicare Meets Mephistopheles. For more on public choice economics, click here.
Did ObamaCare Get Medicare’s Price Controls Right?
Congress uses price controls to pay Medicare-participating providers. Those providers invariably complain that Congress sets prices too low, but many are no doubt too high.
Congress chose to pay for ObamaCare‘s new entitlement spending in part by ratcheting down many of those prices. That suggests supporters either believe that Medicare’s controlled prices generally exceed the marginal value of the relevant services, or that those prices will begin to exceed marginal value as providers become more productive (i.e., as they learn to provide those services at a lower cost).
Neither assumption is necessarily wrong. Producers operating under price controls nevertheless have an incentive to improve productivity. When costs fall relative to prices, producers get to keep the difference. Ambulatory surgical centers saw a windfall because Medicare took two decades to update those price controls for productivity gains.
Medicare’s chief actuary and many others doubt that providers will realize the productivity gains assumed by Congress. If the assumed productivity gains do not occur, those price reductions would reduce Medicare enrollees’ access to care. Medicare providers and enrollees would likely persuade Congress to block the price reductions. Medicare spending and the federal debt would rise.
Yet even if those productivity gains do occur, ObamaCare’s price reductions would still reduce access compared to a world without them, therefore enrollees and providers may still persuade Congress to eliminate them. Regardless of what happens with productivity, as Tom Daschle notes, the patient-provider pincer movement usually carries the day.
This is an inherent defect of Medicare not found in markets. Competitive markets automatically translate productivity gains into lower prices for consumers. Medicare protects providers at the expense of enrollees and taxpayers.
(Cross-posted at National Journal‘s Health Care Expert Blog.)
By Pulling His Punches, Bernanke Shatters ObamaCare’s Credibility
Federal Reserve Chairman Ben Bernanke gave a speech in Dallas yesterday where he inadvertently discredited claims that ObamaCare would reduce health care costs and the federal deficit. According to The Washington Post:
Federal Reserve Chairman Ben S. Bernanke warned Wednesday that Americans may have to accept higher taxes or changes in cherished entitlements such as Medicare and Social Security if the nation is to avoid staggering budget deficits that threaten to choke off economic growth…
While the immediate audience for the speech was the Dallas Regional Chamber, his message was intended for Congress and the Obama administration…
Bernanke has urged Congress to address long-term fiscal imbalances in congressional testimony before, but usually only when he is asked about them by lawmakers. His speech Wednesday aimed to reach a broader audience, steering away from technical economic speak and using plain, sometimes wry, language — a rare thing for a Fed chairman.
The non-partisan Congressional Budget Office projects the annual federal deficit will be at least $700 billion in each of the next 10 years. Deficit spending is a form of taxation without representation, because it increases the tax burden of generations who cannot yet vote (often because they are as yet unborn). Bernanke wants us to end deficit spending. Kudos to him.
But consider the timing of his speech. Why wait until April 7, 2010, to deliver that message directly to the public? Why not give that speech in January? Or February? Or any time before March 21?
The reason is obvious: Bernanke held back to appease his political masters.
Howard Baker and Universal Coverage
Add former Senate Majority Leader Howard Baker (R-TN) to the Church of Universal Coverage faithful:
Health care reform and universal coverage is [sic] indeed something [sic] whose time has [sic] come.
Baker joined fellow former Senate Majority Leaders Tom Daschle (D-SD) and Bob Dole (R-KS) to introduce a health care reform package. Daschle is already a high priest in The Church. For backing this proposal, Dole probably is too, but I don’t have any juicy quotes handy.
The Beginning of the End of All that Comparative-Effectiveness Research
In “A Better Way to Generate and Use Comparative-Effectiveness Research,” I predicted that taxpayer-funded research on which medical treatments work best would ultimately be defunded at the behest of those who make a living providing the less-effective treatments. Because, well, that’s what always happens.
Well, it turns out those folks have gone and formed themselves a coalition and launched a media campaign to ensure that comparative-effectiveness research doesn’t put a dent in their incomes. According to the Associated Press:
People’s lives and plenty of money are at stake when it comes to determining which medical treatments work best.
So some prominent health industry and patient advocacy groups are trying to reframe the debate over how such decisions are made in order to ensure their interests are protected…
It’s a big concern for drug and biotech companies too since they could lose out if a treatment they’ve developed is found to be less effective than a competitor’s. But a drug company’s bottom line isn’t likely to draw as much public sympathy as a disabled person’s needs.
That makes [former Rep. Tony] Coelho a good face for the Partnership to Improve Patient Care, which formed as the issue began to surface last fall and is funded by groups including the Easter Seals, Friends of Cancer Research, the Alliance for Aging Research, the Advanced Medical Technology Association and the powerful pharmaceutical and biotech industry lobbies.
It also makes the Partnership to Improve Patient Care the very type of “patient-provider pincer movement” of which Tom Daschle wrote in his book.
The Audacity of Spin
Regarding Tom Daschle’s withdrawal from consideration to be the next secretary of Health & Human Services, a front-page story in this morning’s Washington Post pulls off one of the most ingenious feats of political spin I’ve ever seen:
But some observing the debacle wondered if the capital’s ways were changing. The story of how [Daschle] fell in with the monied elite and out with the popular mood involves a longtime Democratic financier, Leo Hindery Jr., and his keen interest in currying influence with powerful politicians. The outcome caught many in Washington off guard.
“I think it’s possible this is some sort of bridge between an old Washington and the new Washington,” David Arkush of Congress Watch said of the initial backing of Daschle and the sudden reversal.
So you see, Daschle’s withdrawal is actually a victory for President Obama! He’s changing Washington already! Brilliant!
Actually, the brilliance is Arkush’s for getting the Post to adopt his spin both in the article and the subtitle (“Some See Failed Nomination as Harbinger of Change“).
For the record, I hope Arkush is right. I hope Obama does something about the revolving door that lets people like Daschle write complicated laws and then make millions of dollars helping people navigate and alter them. Of course, as they say, the only way to reduce the amount of money in politics is to reduce the size of government.
Sometimes, the Tax Code’s Complexity Helps Preserve Freedom
Click here for other ironies of Tom Daschle’s ill-fated nomination to head the Department of Health & Human Services.
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