The President's speech raises a few more questions in my mind. In no particular order, here's what I'm wondering:
1) There are references in the speech to reducing costs in Medicare and Medicaid to help pay for the bill. Why will there still be a need for Medicaid for the non-elderly population if this plan goes forward? I thought that everyone was going to be eligible for the public option and subsidies would be given to make it affordable for those with low income. So why would anyone be on Medicaid if they weren't in a nursing home?
2) The President said that he was serious about not signing a bill "that adds one dime to our deficits -- either now or in the future." He said:
And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize. Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for – from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.
So this is the usual procedure of including a trigger in the bill to cut costs if they appear to be getting out of line. These triggers simply don't work -- Congress finds away around them if they involve any pain to anyone. So I don't beleive this is effective at all. I would be persuaded if the implementation of the costly parts of the proposal were delayed until after the savings had been realized.
3) On the subject of whether reform would cover illegal immigrants, the President said:
There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I'm proposing would not apply to those who are here illegally.
I don't believe this one either. The most obvious reason is that there was vocal disagreement in the chamber after he said this -- if this provision is ever expressed in a bill that passes the House or Senate, it is sure to be stripped out in the conference committee. Another reason is that to enforce this, we would know who is an illegal immigrant when he or she shows up requesting care and is not in an otherwise universal system. So how's that going to work? Some states will presumably look to formally include them in their systems, like they do with drivers' licenses, and in the rest of the places they'll get the same treatment they currently do.
You may also recall that the immigration debacle in 2005 was also a case where the government was unable to do the hard stuff, like securing the border, in advance of the easier stuff, like normalizing the treatment of illegal immigrants.
4) I still haven't heard or read anything about the details of the insurance reforms; specifically, how will we implement the key combination of community rating, guaranteed issue, and ex post risk adjustment. The private system cannot work without them.
health care insurance
Everything about forcing people to buy health care rests on the details. You can force people to buy auto insurance, because most people with cars can budget the $500 to $1,200 it takes.
Health care coverage starts at around $8,000. Even at that level, the kind of policy you get is subject to all sorts of chicanery to make it suspect. Ok, let's assume Obamacare makes the $8,000 policy viable. At 300 percent of the poverty level (which is the top income level single people will get government help to pay for insurance) $8,000 is roughly a third of a single person's income after taxes. Even at $60,000, that amounts to roughly 13 percent of before-tax income. It gets worse when you do the math for a family of four.
The planet I come from, most people cannot shift one third to one eighth of their income away from paying bills they are already paying to add a completely new, government required, insurance bill. Offering people tax credits. Tax credits? RYFKM? Then, if you don't avail yourself of this generous program, you will be fined (taxed) $1,000 and up.
This would be a cruel joke, if it wasn't so serious.
Forcing people to buy insurance is simply a way to increase that industry's customer base. It does little to nothing to improve health care in this country. Plus, we already have a shortage of primary care doctors to serve the current insured population. Obamacare does nothing to improve this problem.
The American people are in quicksand up to their necks and Obama is asking us to pay for a worn, thin rope.
One more thing: the Obama plan will not take place until his reelection campaign and the reelection campaigns of two Congresses are over. If this is change to believe in, why not face the voters immediately? Guess.
Really?
"The most obvious reason is that there was vocal disagreement in the chamber after he said this "
That's why you believe this? Seriously? Joe Wilson is from S. Carolina's second Congressional District. I've been there, and that's all I'm gonna say about that . . . .
Before Wilson's Outburst
There were jeers. I thought they were coming from the more liberal members of the chamber. Even if I am mistaken about that, it is clear from what happened in 2005 that there are many legislators who want to give more services to illegal immigrants.
down the rat hole
Way to throw in common cause with the xenophobes, bigots, and haters in your rapidly disintegrating party. I thought you were on eof the levelled headed ones.
He didn't say no undocumented person could ever evade the plain language in these bills, he said they are excluded from subsidized coverage. What congressman Wilson would prefer is that every health care provider check your birth certificate at the door. You should also note that these same folks object to Medicaid paying for labor and delivery of illegals. That is, no government payments for the birth of a US citizen. Nice friends you got there.
So, presumably since subsidies will be administered through the tax system anyone with an invalid Tax ID or SSN would not be getting a credit. the same way it works with social Security. Lot's of undocumented people pay payroll tax, but there are not getting tax refunds.
Medicare/Medicaid Waste and Inefficiency
Is it really enough to pay for most of this program?
Arnold Kling asks the sensible follow-up---if the President's proposal fails, will he not still attack the waste and inefficiency?
http://business.theatlantic.com/2009/09/comments_on_the_presidents_healt...
Why not do it now?
Why did the president mention
Why did the president mention Intermountain health care and Geisinger Clinic last night?
Why did he mention the independent board of experts?
Andrew's colleagues at Dartmouth (see the Dartmouth Atlas Project) have for 20+ years been detailing the extent to which geographic variation in Medicare spending is due to unwarranted patterns of practice and overutilization of care. Places like Intermountain and Geisinger ( and a host of other including mayo Clinic and Cleveland Clinic to name the more well-known) deliver higher quality care for lower costs precisely becuase they have very intentionally organized themselves to root out waste. This is not pie in the sky. It is proven, it works. In fact it's mostly a rigorous application of the principles of Deming--improving quality lowers cost-- that worked so well for Toyota, to one of the most inefficient industries we have.
Unfortunately, Medicare payment policies encourage waste. Lack of comparative efectiveness data make it hard to insist on evidence based care.
Lot's of people know this. MedPAC (the model for the independent board of experts) knows this. Problem is Congress must act. It's t in the President's plan. Guys like Peter Orzag are all over this stuff. CBO won;t really score it until the see the independent Board's rec's but to deny that vast cost savings are possible is simply to not have a clue what is actually going on in the trenches.
??
"what happened in 2005"
What happened in 2005? And what does that have to do with the truth of Obama's statement last night?
Re: There are also those who
Re: There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I'm proposing would not apply to those who are here illegally.
Based on the analysis at Politifact (which I've found to be generally fairly-to-good but occasionally missing major points that should have affected their overall ratings of statement validity) http://politifact.com/truth-o-meter/statements/2009/sep/09/joe-wilson/jo... , Obama's statement is technically false, but closer to true in spirit than is the opposing argument. Basically, illegal immigrants would probably end up able to purchase insurance under the public option (which may not happen, for now, but which Obama was advocating) -- so Obama's claim is false (and that should have kept Politifact from labeling Wilson's claim as purely "False") -- BUT they would receive no subsidy for it; they'd have to purchase it at full premium price. IF one assumes that the public option premium itself is not subsidized, then Obama's statement, while technically false (because they would indeed end up insured under the public option) would be close to true in spirit (taxpayers wouldn't be funding it). Of course, if one assumes (or at least assumes a significant possibility) that public option premiums would be subsidized, then Obama's statement is not only technically false, but also false in spirit.
As a kid I went to a little
As a kid I went to a little country school in the 1950s in the hills of north Georgia-- think Deliverance.
I had a teacher that taught that zero times a number was the number. There probably is still a community in those hills where most people over the age of 60 believe that zero times a number is the number.
Reading the convoluted reasoning some Republicans go through to make obviously incorrect comments on government policy and the economy reminds me of that teacher.
It's over and done
the stock market LOVED Obama's speech. Stocks hit 2009 high today.
The plan is great for all businesses (excepting the health insurance industry, because it provides more competition). It means cost trend will be better controlled, and that saves big business big money. The market's reaction was a big YES vote for Obama's proposed reforms.
http://www.marketwatch.com/story//us-stocks-end-at-2009-highs-streak-int...
Nice job, Mr. Obama. Thanks for doing something for the American middle class, and nice stimulus for American business to help create jobs.
Over and Done?
Based on a one-day stock market move?
Wow.
Yep
This is what they all knew was coming. Polling numbers after the speech were off the charts.
Crossing the wires:
US Senators nearing "closure" on health bill, Baucus says - DJ
Didn't take long, did it?
Over and Done?
Did the stock market like the speech today?
Yes, it's over and done
Today wasn't about Obama's speech. The biggest driver of down draft in the markets this morning was a false report about a coast guard ship shooting at a boat on the Potomac. Any time the market even gets a whiff of anything terrorist-related, especially on American soil, it takes a dive. Traders were spooked, and the market continued down for some time while confusion reigned. The markets began to rebound, and came back in the afternoon, but didn't quite make it out of the red. Take a look at the spike down at 10 AM on the DJIA chart, and subsequent downdraft until media corrected the story.
So today's market action ended essentially flat to slightly down, which is pretty much par for the course for a Friday after a 5 day run up (a rest, and short term, day and swing traders don't stay in over the weekend, so Fridays often look like this -- some down draft, but usually more than this). Dow down .23%, Naz down .15%, and S&P index down .14%.
Actually today should have been much worse, because of the news event factor crossing the wires in the morning (Coast guard training exercise in the Potomac came across the wires as them firing on a boat inside a security zone) that rattled the markets and sent the market down around 10 am. If not for that the markets likely would have ended in positive territory.
The Republicans have made themselves largely irrelevant in this debate. They aren't making any counterproposals, just supporting the status quo (which is unsustainable).
Obama's speech was primarily directed at the Blue Dog Dems.
Anyhoo, today's market action wasn't about Obama's speech -- that's ancient history now ;-)
Most Americans now want the public option. The polls are clearly showing that sentiment. They want healthcare security, and they don't care who delivers it (but right now it looks like the Dems, as the Repubs haven't come up with a plan to ensure healthcare security). And, if the Democrats can deliver they'll be in power the next 16 years . . . and that's what scares the Republicans . . . and why they are so shrill and nonsensical in their opposition. They have abandoned civil discourse completely, and if that didn't come through in the town hall shouting matches, Wilson's breach shouted it out . . . he did the Dems a big favor.
I wish the Republicans could come up with something, I really do because I think the system works better when we have two strong parties. Right now they are divided, lack leadership, and are largely irrelevant -- just the noisemakers in this debate. The Dems are providing the signal, and the Republicans are the noise.
I don't know if my response was posted
I wrote a lengthy analysis of today's market action, but suffice it to say it's 9/11, and that was the market driver of the day (market no longer focused on Obama's speech). At 10 am there was a false report of the coast guard shooting at a boat in DC (look at the DJIA daily chart to see the spike down). After the confusion was cleared up, the market began a march back up (afternoon). It ended essentially flat (down .23%), but if not for the false alarm in the morning it would likely have ended green.
"There were jeers. I thought
"There were jeers. I thought they were coming from the more liberal members of the chamber. Even if I am mistaken about that, it is clear from what happened in 2005 that there are many legislators who want to give more services to illegal immigrants."
They were jeering at the GOP Rep. who yelled "You lie," not the president.