The health care testimony of the director of the Congressional Budget Office sounded almost desperate.
There was poor Douglas Elmendorf — Larry Summers’ protegé, Brookings Institution liberal, Pelosi-picked, Harvard mega-wonk — practically begging his bosses in Congress to just slow down a little.
Elmendorf wants actual health care reform — the kind that President Barack Obama used to talk about. The kind that covers the uninsured, gets people into doctors’ offices instead of emergency rooms, and is paid for in a responsible fashion.
But now the White House and the Democratic leadership in Congress will take whatever they can get as long as it happens fast. It took the legislative titans who cut their teeth on the New Deal six years to make Medicare. The president wants the colossal lightweights of the current Congress to deliver Obamacare in 12 weeks.
Conscientious folks on Capitol Hill are very worried as the train keeps picking up speed and no one will touch the brake. But the president knows that the current health care legislation, like cap and trade and his stimulus, will never pass if anyone stops to read it.
Witness the horror on Elmendorf’s face after having read as much of the plans as the House and Senate could throw together.
Elmendorf made the mistake of also reading all the policy papers that were drummed up by the Obama campaign. That made it so much harder when the lazy, spendthrift Congress dropped 2,000 pages of shoddy health care legislation on his desk. And right there before the Senate Budget Committee, you could hear Elmendorf’s wonky heart breaking.
His predecessor, Peter Orszag, is now Obama’s director of the Office of Management and Budget. When he was advising Congress on budgetary matters, Orszag would have said the same thing as Elmendorf: The health care bills being considered are financial impossibilities. But in his new job, Orszag has been part of the quick trip from idealism to desperation at the Obama White House.
So now, he sallies forth for the president to explain that while it seems like a bad idea for a country in an economic slough and already borrowing its way to oblivion to add on a cripplingly expensive new health care entitlement with huge new costs for employers, it’s actually a brilliant plan.
What Elmendorf didn’t factor in, Orszag explained to Chris Wallace, was the independent commission. Why, an independent commission will make everything work out fine. It’s better than a blue-ribbon panel and stronger than a board of advisers.
In the Obama version of the future, Congress will pick a commission that will then propose draconian cuts to the programs that provide health care for senior citizens. Congress will then vote to enact those cuts even as its most politically active constituents rise up in outrage. That’s not naïve. That’s just a cover story.
Orszag, who once sent thrills up the legs of the think tank crowd, is now tasked with recycling talking points about long-term savings that will somehow occur without rationing care. In Massachusetts, the laboratory for American universal health insurance, the state health plan is an economic basket case. So lawmakers are getting ready to pay doctors for patient care by the year, instead of the treatment.
Good luck getting that second, “just-to-make-sure” test if your doctor is getting a flat rate and has been shielded from medical malpractice suits.
If he were being honest, Orszag would agree with Elmendorf that the only way to remake the system is to quit exempting employee health benefits from taxes. If Americans had catastrophic insurance and paid for regular treatments out of their own pockets, people would ration their own care instead of having commissioners do it for them.
And even that might be too risky a play with a sputtering economy.
Obamacare was supposed to be a Brookings Institution kind of proposal: a conscientiously liberal plan crafted and executed with care. Instead it is being done as a rush order by a president pretending to be a tough guy. I’m half-expecting to hear Obama say “smoke ’em out” and “bring ’em on” at his news conference Wednesday.
But Obama’s not talking about a war or even a financial crisis, so the urgency seems out of place.
What the Doug Elmendorfs of the world don’t understand is that this isn’t about health care anymore. This is about winning at any cost.
