Washington Post — In Retooled Health-Care System, Who Will Say No?
With the president overseas, the ideologically flexible Rahm Emanuel opened the door rather widely to the notion of a health plan with a government-run component that would only go into effect if new proposals for private insurance fail to produce the desired result. A murmur ran through liberal interest groups, still smarting from recent reversals on global warming, transparency, gay rights and the war on terror from the administration. The concern was enough that the president had to issue a brief statement from Moscow reasserting his commitment to a national health service.
What Emanuel was trying to save Obama from was the battle that writer Alec MacGillis lays out in a useful piece – the coming fight over rationing.
Americans view health care not as a means of preserving or extending life, but as part of the quality of life – a few more months more for a cancer patient or a springy new hip for an 80-year-old aren’t considered wasteful, they’re considered humane.
But to achieve his twin goals of controlling costs and covering the uninsured, the president’s plan would necessarily ration care for the folks on the government plan. A Medicare/Medicaid model would be a crushing blow to an already exhausted Treasury, but does Barack Obama really want to be the head of a large, stingy HMO?
Savvy Democrats want a private entities to take the heat for chopping access, giving their party the chance to then express shock and outrage for the poor care later on. But unable to produce a bill that can pass without a public option, lawmakers remain willfully ignorant while meandering toward rationing.
“Although Obama and his advisers have held up providers’ spending patterns as the crux of the crisis, proposals in Washington go only so far in addressing the thorniest questions about who gets what care. Instead, cost-saving measures are focused on introducing a public insurance option to compete with private insurers, or on general cuts in Medicare and Medicaid payments to hospitals.
The bills being written would put new emphasis on evaluating treatments according to their “comparative effectiveness,” or weighing the risks and benefits of different types of treatment for the same illness, but the bills stop short of incorporating cost-benefit analyses into the findings or of requiring that providers abide by conclusions.”
New York Times — Health Deals Could Harbor Hidden Costs
Examiner colleague Julie Mason has a look at the somewhat bogus claims of the administration on the trillions in health care savings wrung from the industry. But aside from being gross overestimates of real savings, writers David Herszenhorn and Sheryl Gay Stolberg explain at greater length but no greater clarity how the deals benefit the companies and groups supposedly making the sacrifices. As Senate Finance Committee Chairman Max Baucus defies the president and now the Senate majority leader over his vision of a private system governed by concessionary cuts by interested parties, the agreements may carry more weight than just photo-ops for the White House:
“As part of their deal with the White House, pharmaceutical companies say they won an agreement from Mr. Baucus to oppose efforts by House Democrats to sharply reduce what the government pays for drugs for some Medicare recipients previously covered by Medicaid.
The deal with doctors could come at a steep price: a $250 billion fix to a 12-year-old provision in federal law intended to limit the growth of Medicare reimbursements. The American Medical Association and other doctors’ groups have sought to change or repeal the provision, and they are likely to try to extract that as their price for boarding the Obama train, people tracking the negotiations said.”
Washington Post — Power of Stimulus Slow to Take Hold
Part of the argument for February’s $787 billion Obama stimulus was the psychological effects it would have on consumers and markets. While economists acknowledged that the real effects wouldn’t be enough to break the back of the recession, supporters argued that the idea that a big dose of help was coming from Washington would help allay fears and help stop contraction. Ever-higher unemployment rates have wiped out the desired emotional side effects of the stimulus and the staggering debt from the largest-ever spending bill has actually increased concerns rather than allaying them.
So now panicky Democrats want more stimulus, figuring that the deficits are so bad that another three-quarters of a trillion dollars would hardly be noticed amid the welter of new spending programs.
Writer Lori Montgomery mostly passes on the White House argument to congressional Democrats — the stimulus is working, and that it was designed to kick in with greater vigor through the end of this year and the beginning of next year. Master economists built in fiscal afterburners will kick in just in time for the 2010 elections.
Maybe. But moving the goalposts can’t compensate for the administration’s admissions that it misread the economy and the forecasts of double-digit unemployment through much of 2010, neither of which have inspired confidence on Capitol Hill. White House loyalists fear that a second stimulus would prevent passage of a national health plan and global warming, but the political consequences of the ongoing slump may prevent those things too as Democrats are left with thin cover on the economy.
“‘I think the president was very clear that things were going to take a long time to turn around,”’said Rep. Chris Van Hollen (D-Md.), who leads the Democratic Congressional Campaign Committee in charge of electing Democrats to the House. Republicans ‘are making the argument to the American people that doing nothing would have been the best policy. And I don’t think people will buy that. . . .
‘The measures we have taken have certainly prevented things from getting much worse.’”
USA Today — Report: States aren’t using stimulus funds as intended
Writer Matt Kelley provides a very useful look at one reason why the stimulus has failed to produce its promised results is that cash-strapped states soaked up the first tranche of the spending package to prevent budget cuts to programs and personnel budgets still bloated from the recent good years. The first report from the Government Accountability Office also found waste, misdirection and a general diffusion of the proposal’s objectives.
“As required by the $787 billion stimulus law, the GAO is monitoring stimulus spending in 16 states and the District of Columbia that will receive two-thirds of the federal funds. It reports to Congress every two months.
The report says that as of mid-June, states had received about $29 billion of the estimated $49 billion in stimulus funding they are scheduled to get before the federal budget year ends Sept. 30. More than 90% of the money given to the states so far is for Medicaid and a fund meant to prop up states’ budgets for schools and other basic services such as public safety.”
New York Times — Despite Shift on Climate by U.S., Europe Is Wary
As he gets settled in Italy for a G-8 summit after his time in Russia, President Obama will be working hard to convince the Euros that the U.S. is really getting serious about punishing people for emitting carbon dioxide.
While carbon-crazed Europeans are warily impressed by the passage of the Waxman-Markey climate bill in the House, they are frustrated by the refusal of the U.S. to get behind legislating the actual temperature of the planet, rather than just the amount of carbon in it. The Brussels crowd wants extra limits to kick in if the global temperature rises above a certain point.
But the real fear in Western Europe, as always, is of irrelevance. With the U.S. still hanging with growing economies in places like China and India, the Euros wonder if we’re really committed to economic suicide in the name of neo-Fabianism.
“Michael Starbaek Christensen, a senior climate-change official in Denmark, said he was worried that the United States and China — the two largest emitters of greenhouse gases in the world — would cut a separate deal and push the rest of the world into a treaty that did too little to curb emissions.
‘I can only encourage Europe to stay in the lead and not let a bilateral U.S.-China relationship take over,’ Mr. Christensen said, ‘because one concern I would have with the U.S.-China relationship is that they would find a lower common denominator.’”
