According to Ezra Klein, the Obama administration intends to finagle universal health care coverage out of its budget proposal, including an individual mandate:
I’ve now been able to confirm with multiple senior administration sources that the health care proposal in Obama’s budget will have a mandate. Sort of.
Here’s how it will work, according to the officials I’ve spoken to. The budget’s health care section is not a detailed plan. Rather, it offers financing — though not all — and principles meant to guide the plan that Congress will author. The details will be decided by Congress in consultation with the administration.
One of those details is “universal” health care coverage.
Some of you may recall that Obama, while in campaign mode, consistently denied that he wanted to introduce mandates as part of his health care package. Paul Krugman cited that opposition as the major difference between Obama and Hillary Clinton:
Let’s talk about how the plans compare.
Both plans require that private insurers offer policies to everyone, regardless of medical history. Both also allow people to buy into government-offered insurance instead.
And both plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.
But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn’t.
Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.
Now that he’s been elected it’s presto hope’n change-o, and voila! Mandates!
Ezra Klein notes that the difference between the pre- and post-election plans is based on one word in the budget — “universal”:
That word is important: The Obama campaign’s health care plan was not a universal health care plan. It was close to it. It subsidized coverage for millions of Americans and strengthened the employer-based system. The goal, as Obama described it, was to make coverage “affordable” and “available” to all Americans.
But it did not make coverage universal. Affordability can be achieved through subsidies. But without a mandate for individuals to purchase coverage or for the government to give it to them, there was no mechanism for universal coverage. It could get close, but estimates were that around 15 million Americans would remain uninsured. As Jon Cohn wrote at the time, “without a mandate, a substantial portion of Americans [will] remain uninsured.”
In essence, unless everyone is forced to buy insurance, there is no “universality,” and the benefits of large participation in the insurance pool cannot be realized. An even shorter version is, if healthier people opt out, then sicker people can’t sponge off them.
The budget — and I was cautioned that the wording “is changing hourly” — will direct Congress to “aim for universality.” That is a bolder goal than simple affordability, which can be achieved, at least in theory, through subsidies. Universality means everyone has coverage, not just the ability to access it. And that requires a mechanism to ensure that they seek it.
Administration officials have been very clear on what the inclusion of “universality” is meant to communicate to Congress. As one senior member of the health team said to me, “[The plan] will cover everybody. And I don’t see how you cover everybody without an individual mandate.” That language almost precisely echoes what Senate Finance Chairman Max Baucus said in an interview last summer. “I don’t see how you can get meaningful universal coverage without a mandate,” he told me. Last fall, he included an individual mandate in the first draft of his health care plan.
The administration’s strategy brings them into alignment with senators like Max Baucus. Though they’re not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody.
So it looks like you better start scarfing down those cheeseburgers, eating transfats, smoking cigarettes, or whatever it is you do that’s not considered healthy, because once the federal government pays for health care (which is what individual mandates essentially works out to), then it also has the power to determine what “healthy” means. After all, since everyone will be pulling from the same health care pot, and since each claim on that pot diminishes what someone else can get, then each claim must be a legitimate one as weighed against all the competing interests. Because the viability of the system depends on healthy people making much fewer claims than sick people against the collective health care resources, the government now has a vested interest in making people healthier, whether they like it or not.
Another way to put it is that we will have entered a Pareto optimal world where no one can change their position for the better (i.e. receive more of the pooled benefits) without hurting someone else. Whereas in a competitive market system, each person can get at least as much health care as he or she wants to buy and can afford, in a Pareto optimal world, we are competing for the same scarce resources (health care dollars), and our claims are granted based on a a third party’s (the government’) determination of worthiness. No longer can we get what we can afford, we get a predetermined portion of what the government decides to pay for. That, of course, is why there are 6+ month waiting lists for routine health care in places like Canada and the UK.
Possibly the most depressing result of yoking America with universal health care, is that we can pretty much kiss medical and pharmaceutical innovation good bye.
Government run health centralizes the risks of exploring new technologies, medicines, techniques, etc. Centralized risk translates into (i) observing a very cautious approach to advances, and (ii) the politicization of research … From a purely capitalist point of view, opportunites that might have been pursued otherwise, are foregone since those who accept the risks of pursuing them do not get to maximize their reward, so instead those advances must come from the government. With government as the sole innovator, there are now two types of risk (1) the risk of failure (i.e. spending gobs of money on something that does not deliver as promised, or that costs significantly more than the benefit), and (2) the political risks (i.e. what politicians face for advocating spending on projects that either fail or that don’t disproportionately benefit favored voters). The result is that risk is increased overall, and fewer innovations are realized.
America is pretty much the last industrialized nation to still have a (semi) private health care system, which should be understood to include the pharmaceutical industry (as a supplier of that health care system). What would happen to the growth and advances we’ve realized over the past few decades if (when?) we adopt universal health care? Where will the innovation come from? Who will take the risks? Without the proper incentives, and indeed with some of the worst possible incentives as the only driving force to creation, I fear that the scientific and medical Atlas will shrug.
I don’t mean to say that there will be no breakthroughs ever again, but the pace will be slowed dramatically. That’s because, one the government is in charge of paying for health care, it will also be in charge of paying for medicines. As we’ve already seen around the world, drug companies will be forced to sell their wares for much less than the (legal) monopoly prices they charge now. The result, therefore, will be much less risky and expensive research into new drugs that may never come to market, and much more emphasis on improving old drugs so as to continue to pay for further research.
Surely the federal government will pony up money for research into some diseases. But then the government will be in charge of picking winners and losers when it comes to whose diseases will get cures and whose won’t. To imagine what this would look like, just think back to how AIDS and breast cancer research dollars were successfully lobbied for, despite neither affecting anywhere near as many people as other deadly diseases.
In the end we will be left with less individual freedom, worse health care, and fewer prospects for any improvement in either. That is not the change I was hoping for.
UPDATE: Tom Maguire helpfully reminds us of how the health care debate progressed during the Democratic primary season:
For folks whose memories have blessedly erased any recollection of the endless Democratic candidates debates, let me toss in a brief reminder. Obama claimed that he would offer health insurance subsidies so generous that most folks would volunteer to sign up. Hillary mocked that, insisting that the young and healthy would decline to subsidize the rest of us, especially since they could not subsequently be denied coverage on the basis of pre-existing conditions; her plan included a mandate obliging everyone to buy health insurance, like it or not (as in Massachusetts). Hillary then diligently ducked the “or else” question of what penalties she would inflict on the young, helathy and recalcitrant who would prefer to hold off on buying insurance until they were sick. As a nostalgia piece here is a link to a lefty wondering why his party was so committed to forcing young, healthy members of the working class to subsidize the rest of us on health care; that seems like a good question but I am long resigned to not being smart enough to be a lefty.
Aww, Tom. You’re plenty smart enough. Just not angry, bitter or jealous enough.
As for the “or else” question, Obama and the Congress won’t be able to duck that one. I can only imagine what sort of sword they intend to dangle of recalcitrant ,
comrades citizens who refuse to sign up for the program.
Where to start with this joker:
California Republican Gov. Arnold Schwarzenegger suggested that his party is out of touch with average Americans on the issue of health care.
“You’ve got to listen to the people. If the nation is screaming out loud, ‘We need health care reform. We want to have universal health care. We want to have everyone insured. We want to bring the costs down. We want everyone to have access.’ I mean, that’s what they want; that’s what you do,” Schwarzenegger said on ABC’s “This Week.”
Arguing that California Republicans were out of touch with the majority of Californians who wanted to raise taxes to fix the state’s budget crisis, Schwarzenegger said it is “the same nationwide.”
He said Republicans need to embrace what the people want, even if it means accepting tax increases that go against their party principles:
“Even though it maybe is against your principles or philosophy, you still have to go, because that’s what the people want you to do,” he said.
A) Healthcare: the nation isn’t screaming any of that out loud. A definite minority want it. But just as large a minority don’t want any part of it. A third minority isn’t sure one way or the other.
B) If the purpose of government is to simply give the people everything they want, then there’s no reason for a budget, a legislature or a governor. Just put everything to a direct vote via referendum, write a program that can figure the cost of each “yes” referendum, figure the tax necessary to fund the approved program and assess the tax. If you must have a legislature or governor, they would only write the law and rubber stamp it based on the referendum (per the Schwarzenegger “philosophy” only unanimous approvals allowed) and the “governor” is there to do nothing more than to sign it into law – period. Once taxes reach 100% nothing else can be signed into law and the legislature is in permanent recess and the governor is no longer needed (hey I can be just as absurd as Schwarzenegger).
Oh, wait, I forgot – you have to have a governor and a legislature to pile up trillions of dollars of debt “giving the people what they want” and drive the state into bankruptcy – my bad.
C) Why have principles if you’re not supposed to live by them/act on them. Why run on them, tell voters they’ll be your guide and get elected because of them? Schwarzenegger has gone from a somewhat entertaining RINO to an outright idiot.
“Even though it may be against your principles or philosophy” do it anyway because that’s what the people want? This guy would obviously rather be liked than principled (if he ever was really principled). Principles are a hindrance to his pursuit of approval (see what steroids will do to your brain?). And my guess is, he’d label this nonsense as “leadership”.
Lord help California. Schwarzenegger makes Gray Davis look great.
Most economists agree that America has enjoyed unprecedented prosperity, based primarily on excessive debt. Thus, any healthy correction would necessarily involve serious deleveraging and a severe recession. After a lot of pain, the economy would rebuild with healthier fundamentals. Infrastructure improvement would aid, but not cause, the eventual recovery.
Recession is the natural cure for the politically inspired profligacy that America has enjoyed for almost 40 years. Unfortunately, the side effects of this medicine, namely the rapid reallocation of labor resources and deflationary damage to debtors, are still unpalatable to pandering politicians.
The Washington regime, particularly members of the Democrat persuasion, leans towards a socialist solution of avoiding recession at any cost. After all, the bills are paid by others, such as taxpayers and holders of US dollars. This results in an increasing amount of other people’s money being spent on “public” works that would in other times carry the label “pork barrel”.
Washington is choosing to pursue the policy of continued and ever-increasing false prosperity, financed eventually by hyper-taxation, hyper-debt and hyper-inflation accompanied by a gradually eroded standard of living. The jobs created by the bill are by and large non-productive and will divert resources from the private sector and rob consumers of their power to make free choices in the marketplace.
Pain avoidance drove the call for stimulus. Politicians are naturally for that because it ensures their future. But in reality it isn’t pain avoidance at all, but simply a form of pain management. And since that management will be spread over many years, those who will lose under it will be less likely to notice that loss over the years than they would if that loss happened all at once. But there’s a price for that, and it will become apparent eventually. That gradual loss won’t allow the recovery to the previous standard of living because government will have supplanted much of the private sector and many of those options (and resources) for regaining that level are no longer available.
Of course, the good news for the present crop of politicians is that realization of loss won’t happen on their watch. And as far as the political class is concerned, that’s all that matters.
Let the good times roll!
Nice biased environmentalist metaphor, isn’t it?
You know we see these sorts of stories all the time, and because they’re just people using causes to attempt to change our behavior, we don’t pay them the attention they deserve. But, if any of the things associated with what you’re about to read were to become law, suddenly choices and amounts of beef could easily be rationed to “save the planet”. Add a little health care legislation and it’s a lock.
When it comes to global warming, hamburgers are the Hummers of food, scientists say.
Simply switching from steak to salad could cut as much carbon as leaving the car at home a couple days a week.
That’s because beef is such an incredibly inefficient food to produce and cows release so much harmful methane into the atmosphere, said Nathan Pelletier of Dalhousie University in Canada.
Pelletier is one of a growing number of scientists studying the environmental costs of food from field to plate.
By looking at everything from how much grain a cow eats before it is ready for slaughter to the emissions released by manure, they are getting a clearer idea of the true costs of food.
The livestock sector is estimated to account for 18 percent of global greenhouse gas emissions and beef is the biggest culprit.
Even though beef only accounts for 30 percent of meat consumption in the developed world it’s responsible for 78 percent of the emissions, Pelletier said Sunday at a meeting of the American Association for the Advancement of Science.
That’s because a single kilogram of beef produces 16 kilograms carbon dioxide equivalent emissions: four times higher than pork and more than ten times as much as a kilogram of poultry, Pelletier said.
If people were to simply switch from beef to chicken, emissions would be cut by 70 percent, Pelletier said.
Another part of the problem is people are eating far more meat than they need to.
“Meat once was a luxury in our diet,” Pelletier said. “We used to eat it once a week. Now we eat it every day.”
If meat consumption in the developed world was cut from the current level of about 90 kilograms a year to the recommended level of 53 kilograms a year, livestock related emissions would fall by 44 percent.
The way things are going it wouldn’t surprise me one day to see PSAs like the Chik-fil-A commercials saying, “Eat More Chikin” and cut emissions by 70% – it’s the law!
Not content with busting the bank with the Pork bill and TARP II, now, finally, the 50+ trillion in unfunded mandates are apparently next:
The following week, the president will host what the White House is billing as a “fiscal responsibility” summit on February 23. The goal of the summit is to begin weighing the impact of massive federal programs like Social Security and Medicare just days before the president plans to unveil his first annual budget to Congressional leaders.
Budget? There’s nothing left to spend. Frankly I think Michael Ramirez has the best take on it.
My guess is this can will get kicked down the road, left for 45 or 46 to deal with.
I‘m sure this will come as a complete surprise to some on the left but the people didn’t go for Gov. Paterson’s idea at all:
New York Gov. David Paterson admitted Thursday one of his most talked-about tax proposals, an obesity tax on sugary drinks, is fizzling.
But he said it popped the right question.
In meeting with college students over his budget, Paterson told the young New Yorkers not worry about his soda tax because the Legislature won’t go for it. But he said it has served its purpose of raising awareness of childhood obesity.
It served another more important purpose – it showed the extent to which politicians are willing go to control your life and that they are only limited by their imagination. Without a public outcry, this might have found its way through the legislative process. Eternal vigilance is the price of freedom.
And another point to ponder – if government was the sole purveyor of health care, how outlandish of an idea do you really think this would be? A legislature looking for ways to raise revenue while cutting costs in health care? A fat-tax would be a no-brainer and its justification would be found in government’s assumed responsibility for your health.
[HT: Matthew H.]
Some real anger is welling up down under against some “green” laws which prevented residents from taking prudent fire control measures which may have prevented both property destruction and deaths:
ANGRY residents last night accused local authorities of contributing to the bushfire toll by failing to let residents chop down trees and clear up bushland that posed a fire risk.
During question time at a packed community meeting in Arthurs Creek on Melbourne’s northern fringe, Warwick Spooner — whose mother Marilyn and brother Damien perished along with their home in the Strathewen blaze — criticised the Nillumbik council for the limitations it placed on residents wanting the council’s help or permission to clean up around their properties in preparation for the bushfire season. “We’ve lost two people in my family because you dickheads won’t cut trees down,” he said.
Sound familiar California? And there are other places as well where environmental activists have successfully blocked forest management procedures which help inhibit the type of holocaust loosed in the bush of Australia and in the California fires of a year or so ago.
It seems, when given the opportunity, environmentalists tend toward the extreme. The result in Australia, of course, just as in California, was the total destruction of all the trees they were supposedly saving. Not doing what anyone with common sense would call prudent has also lead to the deaths of not only masses of wildlife, but fellow human beings as well.
There was widespread applause when Nillumbik Mayor Bo Bendtsen said changes were likely to be made about the council’s policy surrounding native vegetation.
But his response was not good enough for Mr Spooner: “It’s too late now mate. We’ve lost families, we’ve lost people.”
The rent-seekers find another ally:
BILL PRESS: …And, thanks for your leadership, thanks for your good work, it’s great to have you there Senator. And, great to have you on the show. Appreciate it.
SENATOR TOM HARKIN (D-IA): Well, anytime – just let me know Bill. I love being with you, and thanks again for all you do to get the truth and the facts out there. By the way, I read your Op-Ed in the Washington Post the other day. I ripped it out, I took it into my office and said ‘there you go, we gotta get the Fairness Doctrine back in law again.’
BILL PRESS: Alright, well good for you. You know, we gotta work on that, because they are just shutting down progressive talk from one city after another. All we want is, you know, some balance on the airwaves, that’s all. You know, we’re not going to take any of the conservative voices off the airwaves, but just make sure that there are a few progressives and liberals out there, right?
SENATOR TOM HARKIN (D-IA): Exactly, and that’s why we need the fair—that’s why we need the Fairness Doctrine back.
BILL PRESS: We’ll work on that together. Hey, thanks, Senator! Always good to talk to you.
SENATOR TOM HARKIN (D-IA): Thanks Bill, see you, bye.
BILL PRESS: There it is – you heard it here on the Bill Press Show. Senator Tom Harkin: bring back the Fairness Doctrine!
If you can’t make it on your own merit, get the government to step in and grant you what you haven’t earned.
Good work there, Billy.
If you harbored any doubt about the real purpose of the recent S-CHIP bill which expanded government health care, these excerpts should remove it:
Obama at a White House signing ceremony said, “I refuse to accept that millions of our children fail to reach their full potential because we fail to meet their basic needs” (Pulizzi/Johnson, Wall Street Journal, 2/4). He added, “In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation, and health care for our children is one of those obligations” (Mussenden, Media General News/Richmond Times-Dispatch, 2/5). He said, “The way I see it, providing coverage to 11 million children [through SCHIP] is a down payment on my commitment to cover every single American” (Levey, Los Angeles Times, 2/5). He continued, “It is just one component of a much broader effort to finally bring our health care system into the 21st century,” adding, “I am confident that, if we work together, if we come together, we can finally achieve what generations of Americans have fought for and fulfill the promise of health care in our time” (Washington Times, 2/5).
House Speaker Nancy Pelosi (D-Calif.) said, “This is the beginning of the change that the American people voted for in the last election and that we will achieve with President Obama” (Los Angeles Times, 2/5). Rep. Charles Rangel (D-N.Y.) said, “I cannot think of a better investment than the health of our children” (Graham, “Triage,” Chicago Tribune, 2/4). Sen. John Kerry (D-Mass.) said, “We’ve waited far too long for this day. America’s kids should be guaranteed comprehensive care whether they need dental care, mental health, medical or surgical treatment” (Rhee, “Political Intelligence,” Boston Globe, 2/4). House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) said, “While this bill is short of our ultimate goal of health reform, it is a down payment, and is an essential start” (New York Times, 2/5).
Keep your eye on the ball because this is moving very, very quickly.
I‘m not much of a fan of Saturday Night Live anymore. The overly partisan commentary was bad enough, but when Will Ferrell left, there wasn’t much reason to stick around anymore. Despite all that, however, I think Seth Meyers pretty much nailed it on the Michael Phelps pot smoking non-story: