Right Wing Nut House

This gorgon of a bill isn’t dead - not by a long shot. But it has been stalled by the inability of Democrats to come together and pass it.

Blue dogs are beginning to talk with Republicans about overhauling the entire bill. Liberals think it isn’t going far enough and will vote against any bill that doesn’t have a public option. Fiscally responsible members are terrified of adding to the deficit. And even the president has acknowledged that his deadline of getting it done before the August recess may be impossible.

I might add that there is precious little from the White House except speechmaking. This president apparently doesn’t know how to govern. He has handed responsibility for getting this bill passed to Pelosi and Reid while he stands on the sidelines kibitzing.

Bottom line: No one is in charge. Committee chairmen have their own ideas about what should be in the bill while Blue Dogs and liberals are rejecting their formulations and want to substitute massively.

Here’s Jennifer Rubin this morning in PJ Media:

“Back to the drawing board,” announced Democratic House Majority Leader Steny Hoyer on health care reform.  Indeed, it seems that in one short week, the single most important item on the president’s agenda is in need of some critical care.

[...]

The president rushed to the microphone on Friday afternoon to assure the country the patient was fine, just undergoing some expected surgery and far from terminal. Absent was any mention of his August deadline, however. He appeared miffed at “Washington” and the “24-hour news cycle.” He took no questions, likely because he had few answers to the hard queries. (Why is his own party in revolt? Why would he raise taxes on small businesses? Why don’t people like the idea of a “public option” as much as they did a few months ago?) Despite Obama’s lecture and show of bravado (”this is going to happen”), all signs pointed to the demise of the House Democrats’ trillion dollar, soak-the-rich public option scheme. And it is far from clear what replacement plan might be offered.

Revolts are breaking out all over the place and both Reid and Pelosi are incapable of putting out the fires. Again, it should be stressed that Democrats may be  waking up to the fact that they have a pretty damned ineffective president - one who doesn’t lead and is beginning to sound like something of a whiner.

Matt Welch and Nick Gillespie writing in the Washington Post , actually use the “C” word to describe Obama:

From a lousy cap-and-trade bill awaiting death in the Senate to a health-care reform agenda already weak in the knees to the failure of the stimulus to deliver promised jobs and economic activity, what once looked like a hope-tastic juggernaut is showing all the horsepower of a Chevy Cobalt. “Give it to me!” the president egged on a Michigan audience last week, pledging to “solve problems” and not “gripe” about the economic hand he was dealt.

Despite such bravura, Obama must be furtively reviewing the history of recent Democratic administrations for some kind of road map out of his post-100-days ditch.

So far, he seems to be skipping the chapter on Bill Clinton and his generally free-market economic policies and instead flipping back to the themes and comportment of Jimmy Carter. Like the 39th president, Obama has inherited an awful economy, dizzying budget deficits and a geopolitical situation as promising as Kim Jong Il’s health. Like Carter, Obama is smart, moralistic and enamored of alternative energy schemes that were nonstarters back when America’s best-known peanut farmer was installing solar panels at 1600 Pennsylvania Ave. Like Carter, Obama faces as much effective opposition from his own party’s left wing as he does from an ardent but diminished GOP.

Carter never had a clue about how to govern in Washington and neither does Obama - something many of us warned about before the election. Anyone with an ounce of sense knew his grandiose promises about changing the way Washington does business were as empty as Harry Reid’s head. It wasn’t just his inexperience. It was his rhetoric being incapable of matching reality that was most telling.

And now, Obama has apparently dropped the idea of passing a health care bill before the August recess. What will emerge after Labor Day may be nothing like what is being talked about today - scaled back, no public option, a bigger small business exemption, and no real reform of Medicare. Instead, look for expanding Medicaid and S-Chip at the state level to cover the uninsured and perhaps some fiddling with Medicare payments.

In that form, it has a chance of passing with GOP help. But unless Obama can pull off a miracle, his big plans for health care reform are going to become as extinct as the dinosaurs.

When campaigning for president, Barack Obama went out of his way to reassure the American people that his health care plan wouldn’t require Americans who are happy with their insurance now, to give it up in favor of a government run insurance plan.

He was emphatic on this point, as his campaign website highlighted the promise: (PDF)

Q. I like my current insurance coverage. Will I have to change plans?

A. No, you will not have to change plans. For those who have insurance now, nothing will change under the Obama plan – except that you will pay less. Obama’s plan will save a typical family up to $2,500 on premiums by bringing the health care system into the 21st century: cutting waste, improving technology, expanding coverage to all Americans, and paying for some high-cost cases.

As recently as yesterday, he reiterated the promise:

At a rally in Holmdel, New Jersey, today, President Obama continued making a promise about health care reform that he has acknowledged isn’t literally true.

“Let me be exactly clear about what health care reform means to you,” the president told residents of the Garden State. “First of all, if you’ve got health insurance, you like your doctors, you like your plan, you can keep your doctor, you can keep your plan. Nobody is talking about taking that away from you.”

But last month, as the president acknowledged during a press conference, he doesn’t literally mean that you are guaranteed to be able to keep your health care plan, and your doctor, if and when health care reform passes.

“When I say ‘If you have your plan and you like it,… or you have a doctor and you like your doctor, that you don’t have to change plans,’” the president said after we asked him about this, “what I’m saying is the government is not going to make you change plans under health reform.”

Importantly, the government might create circumstances – say, a public health care option that is less expensive since profit is not a concern and overhead is lower – where you might find your business forcing you into that public plan.

This is not only misleading, it is an outright falsehood:

PRESIDENT Obama promises that “if you like your health plan, you can keep it,” even after he reforms our health-care system. That’s untrue. The bills now before Congress would force you to switch to a managed-care plan with limits on your access to specialists and tests.

Two main bills are being rushed through Congress with the goal of combining them into a finished product by August. Under either, a new government bureaucracy will select health plans that it considers in your best interest, and you will have to enroll in one of these “qualified plans.” If you now get your plan through work, your employer has a five-year “grace period” to switch you into a qualified plan. If you buy your own insurance, you’ll have less time.

And as soon as anything changes in your contract — such as a change in copays or deductibles, which many insurers change every year — you’ll have to move into a qualified plan instead (House bill, p. 16-17).

When you file your taxes, if you can’t prove to the IRS that you are in a qualified plan, you’ll be fined thousands of dollars — as much as the average cost of a health plan for your family size — and then automatically enrolled in a randomly selected plan (House bill, p. 167-168).

It’s one thing to require that people getting government assistance tolerate managed care, but the legislation limits you to a managed-care plan even if you and your employer are footing the bill (Senate bill, p. 57-58). The goal is to reduce everyone’s consumption of health care and to ensure that people have the same health-care experience, regardless of ability to pay.

One begins to wonder if the president and the Democrats are capable of telling the truth about anything. Their lies about cap and trade not costing jobs and not adding substantially to American’s energy bills is disproven by how the program works in Europe where thousands of dollars have been added to the household energy tab and millions of jobs have been lost with precious few “green jobs” created in their place.

And here we are being told that we shouldn’t even read this health care bill being crafted in secrecy (with precious little input from the White House), that we should just trust the Democrats and the president on this.

To Obama supporters, I have a question: If your man had run on the kind of health care bill emerging from Congress, do you think he would have been elected? If you think so, you are out of touch with ordinary Americans. Being forced into a government run insurance plan is not what the American people had in mind when they elected Barack Obama. They expected cheaper insurance with the same benefits - just as he promised. What they are going to get - much to their shock - is the prospect of losing benefits and paying more for their medical insurance once they are forced to choose among the several plans that will be offered by the government.

They also didn’t expect a massive addition to the federal budget. That CBO report will be ignored by Democrats despite the fact that it gives the lie to their claims that going the public route will save money.

The bills that are emerging from both the House and the Senate are too complex, too expensive, rely too much on pie in the sky forecasts of both participation and cost, and point the way to a system where the vast majority of Americans will have the bare minimum of coverage for as much or more money than they are spending now.

And despite what Obama and the Democrats say, this is not the only way to reform the health care industry. It is the most expensive, least efficient, and most liberal way to do it. But it is a lie to say there are no alternatives to these bills that are cheaper, more efficient in that they utilize resources more effectively (bigger bang for the buck), and would accomplish the same goals that Democrats claim they want to achieve.

After all, the Obama bill will not cover everyone. After 10 years there will still be 17 million people without health insurance. And certainly, there are better ways to pay for this than raising taxes on the middle class - which will be the only alternative once Democrats admit they were lying about the other revenue generators in the bill. Medicare savings of the size and scope being postulated have no realistic chance of being realized.

Soak the rich if you want. But that will only get you so far. To go the rest of the way and fund the entire measure, tax increases (they will be called “fees” and “surcharges”) will be necessary. Even that won’t be enough. The CBO estimate of a little over a trillion dollars may be wishful thinking. Others have figured the cost going over $1.5 trillion and beyond.

Name one entitlement program that has ever met budget expectations. There isn’t one - they have all been more expensive than anyone realized when they were created. Why should something as gargantuan as national health insurance be any different?

This is a disastrous measure that will suck the life out of our health care system while adding hundreds of billions to our deficit. And the helluva it is, the bill will pass based on lies and deceit of what it’s true costs are and what it will actually do for the average American.

This should be worrisome to Democrats and Obama partisans because it is the essence of governing; getting things done in Congress.

The fact is, since the stimulus bill passed, only one or two of Obama’s major agenda items or policy prescriptions has made it to the floor of the House or Senate - yet. Climate change - a much watered down version of what the president wanted (itself evidence that he is not fighting for his agenda with the usual vigor that presidents are wont to employ on centerpiece agenda items) is due to hit the floor of the House this week but other than that, the list of legislative initiatives in limbo is a long one:

1. EFCA. Despite pouring half a billion into his election campaign and those of other Democrats, unions are still having a devil of a time coming up with a legislative majority in either body.

2. TARP II. Dead in the water with no visible movement from the White House in getting it restarted.

3. Cap and Trade. This was the centerpiece of Obama’s climate change bill and was supposed to fund the health care initiative to the tune of some $700 billion. Alas, farm state lawmakers whose utility companies would be forced to charge out of sight prices for electricity have so watered down the program (and the senate is set to make even more drastic changes - perhaps even scrapping cap and trade altogether) that it not only won’t be bringing in much revenue but it won’t do what it’s advertised to do.

4. Immigration reform. Nowhere on the radar except for a vague promise to bring it up later this year.

5.. Health care. Several versions still moving through Congress.

The common thread in all of these initiatives is a lack of effort from the president to shape the debate in his own party. He has been very comfortable in allowing Congress their heads in forming legislation with very little obvious input from the president.

Bush was engaged on his major initiatives, with Karl Rove acting almost like a committee chairman at times in helping to shape legislation. Obama’s team is very adept at politics but I have yet to see the kind of engagement from the White House on legislation that a president needs in order to get most of what he wants.

Yes, the president tries to “sell” his programs. But his efforts are better suited to the campaign trail than the Big Chair in the Oval Office. The nitty gritty of “herding cats” in Congress is a matter that takes a lot of effort. And I allow for the idea that I may be mistaken, but I don’t see that effort forthcoming from the president or his top aides.

He appears to be most effective (from his point of view) where only the executive branch is involved. The auto takeovers and subsequent bankruptcies of Chrysler and GM have gone smoothly. Part of the reason there was some effective pressure put on the principles that smacked of goon tactics at times. Presidents bust heads in their own administration but the real test is in how they can cajole, plead, threaten, and reason with Congressmen in order to get what they want.

You would think a lot more would have been done in 6 months given the economic crisis and the administration’s admitted excuse to use it as a club to pass what they see is necessary legislation. Obama has imparted no sense of urgency to legislation (except for the stim bill), nor has he sought to leave many fingerprints on bills moving through committee.

Michael Tomasky argues pretty much the same thing in the Guardian and Steven Benen puts it into plainer language:

Tomasky’s argument, then, suggests it’s time to expand the elements these Dems are afraid of, and include the popular president. It’s time, Tomasky says, for Obama to show he can “scare people.”

Obviously, different approaches would be needed with different senators. There’s probably not too much the White House can do to scare Ben Nelson. But if the vote-counters are lining up support on, say, a genuine public option, I can imagine someone in the West Wing letting Joe Lieberman know, “The president is interested in hosting a town-hall event in Bridgeport, and he’s about to tell everyone in the state to call your office.” Or maybe calling Arlen Specter to mention, “Obama is going to talk about reform in Pittsburgh, and Joe Sestak might be there.”

Or maybe just telling the whole caucus, “If health care drags me down, I’m dragging all of you with me.”

There’s still time to see how all of this plays out, but when push comes to shove, it’s not too much of a stretch to think Obama might turn to his chief of staff for a few ideas on how best to scare members. When it’s time to “start banging some heads,” I suspect Rahm Emanuel might have a few ideas.

It is that kind of engagement that I am arguing is missing from the Obama White House. It raises questions about whether the president is still getting his feet wet or whether he really doesn’t have much of a clue how to govern.

Benen’s “town hall” idea is a case in point. Curiously, Obama’s forays into activating his grass roots network to help with Congress have so far met with limited success. Holding a “town hall” event to get citizens to deluge a member’s office with mail and phone calls wouldn’t be much of a threat given that fact.

Why not call the senator on the phone and use some of those community organizing skills to bring the member around? During the Reagan administration, it was Mike Deaver who would put out information on how many calls the president made to members of Congress or who he had in for a little personal lobbying. This was routine stuff and, I may be oblivious but has Obama made that kind of personal lobbying effort? I haven’t seen it so if he has, it has been under the political radar.

The aimlessness of Democrats on the health care issue as they are looking at several competing bills also suggests a lack of input by the president. It isn’t a question of expending political capital. He is head of the party and should be able to wrangle what he wants from Congress. It may be occurring at a level of which I am unaware but direction in this intra-party health care debate seems lacking. He is giving Congress their head and at this stage, it appears that the whole idea of a “public option” for health insurance - even in his own party - may be in danger.

We are far enough along in the Obama presidency to make judgments like this and my take is that either he doesn’t feel the need to get involved or he doesn’t know how to do it effectively. I’m not talking about press conferences, or town hall meetings, or his upcoming infomercial on June 24th with the Obamabots at ABC news. That’s all well and good and we know he can sweet talk with the best of them.

What we haven’t seen is the president getting in the trenches to fight for what he wants from Congress on specific bills. And unless he is prepared to do that, I don’t see how he will be a successful president.

Yeah, I know. Riehl and I are usually at each other’s throats but in this case, his thinking mirrors my own thoughts when I first read about this story:

This is the stuff of apparatchiks and Politburos, not a healthy, ethical free press. ABC will become the Obama network to sell his health care plan for an entire day.

I was going to start by saying, unbelievable. But given the media’s coverage of Obama from the primary to November, it may not be as unbelievable as it should. This is the single most dangerous thing for this Republic I’ve seen from their dysfunctional relationship since Obama announced and they fell in love. Health care reform is a major issue that will ultimately impact every American living and to be born. If anything, we need a balanced debate by a media that hasn’t picked a side.

I’m not even sure it’ll help Obama as much as he may think, but the principle here is even more important. I don’t know if ABC will cave, but if they offer Republicans a half hour at the end, or an hour some other night, it is not the same thing. This can’t be happening here.

What Mr. Riehl is rightly incensed about is the news that broke this morning that ABC will, in effect, join the executive branch of government and act as an appendage to the Obama PR machine to sell his - and his alone - health insurance plan.

From Drudge:

On the night of June 24, the media and government become one, when ABC turns its programming over to President Obama and White House officials to push government run health care — a move that has ignited an ethical firestorm!

Highlights on the agenda:

ABCNEWS anchor Charlie Gibson will deliver WORLD NEWS from the Blue Room of the White House.

The network plans a primetime special — ‘Prescription for America’ — originating from the East Room, exclude opposing voices on the debate.

The RNC sent a letter to ABC News President David Westin that sounds almost plaintive in its complaints:

As the national debate on health care reform intensifies, I am deeply concerned and disappointed with ABC’s astonishing decision to exclude opposing voices on this critical issue on June 24, 2009. Next Wednesday, ABC News will air a primetime health care reform “town hall” at the White House with President Barack Obama. In addition, according to an ABC News report, GOOD MORNING AMERICA, WORLD NEWS, NIGHTLINE and ABC’s web news “will all feature special programming on the president’s health care agenda.” This does not include the promotion, over the next 9 days, the president’s health care agenda will receive on ABC News programming.

Today, the Republican National Committee requested an opportunity to add our Party’s views to those of the President’s to ensure that all sides of the health care reform debate are presented. Our request was rejected. I believe that the President should have the ability to speak directly to the America people. However, I find it outrageous that ABC would prohibit our Party’s opposing thoughts and ideas from this national debate, which affects millions of ABC viewers.

In the absence of opposition, I am concerned this event will become a glorified infomercial to promote the Democrat agenda. If that is the case, this primetime infomercial should be paid for out of the DNC coffers. President Obama does not hold a monopoly on health care reform ideas or on free airtime. The President has stated time and time again that he wants a bipartisan debate. Therefore, the Republican Party should be included in this primetime event, or the DNC should pay for your airtime.

Not even granting the GOP the courtesy of giving them a half hour to respond? What’s with that?

Obviously, ABC saw the reasonably good ratings for NBC’s genuflecting coverage of the show featuring Obama in the White House, hosted by the obsequious Brian Williams and wanted a piece of that action. But at what price to their integrity? Williams may have bowed and scraped like a serf from the Middle Ages acknowledging his lord but that was just silly press worship of Obama.

If this story is true (and Drudge has been known to exaggerate things in the past), it’s a game changer. This isn’t anything like the networks offering time to the party holding the White House. It’s different than presenting biased coverage in favor of the president. There is nothing stealthy about it at all. This is putting a huge media conglomerate at the disposal of the executive branch in order to achieve the president’s policy goals.

A one trillion dollar program that will fundamentally alter not only our health care system but re-order American society itself and we are only to be presented with one side of the debate? Riehl has it right; why not just rename ABC, OBC and get on with it.

It’s not like the Republicans don’t have a viable alternative. About a month ago, they released “The Patient’s Choice Act” that totally eschews the so-called “public option” in favor of a federalized, tax friendly approach that even Democratic critics called “comprehensive.”

Now, I have serious problems with the GOP plan. It is hardly perfect. And I suspect ABC will, at some point, offer the GOP some kind of rebuttal, although as the RNC letter points out, fat lot of good it will do when ABC will be promoting the hell out of this program and the details of the Democratic plan.

But health care is really not the issue here. The issue is the crass, obvious, dangerous, and radical manipulation of the media to serve the ends of government and not serve the people. ABC News should immediately alter the program to include opposition voices to what the Democrats are proposing or cancel it altogether.

And if they don’t, I wonder if any journalists at ABC will take the honorable route and resign?

UPDATE: ABC NEWS RESPONDS

No, the Dems are not paying for the airtime. And ABC assures us that they will pick the audience members and that they will give a fair hearing of all sides of the debate.

Fine. One question: WHY DO IT FROM THE FRICKING WHITE HOUSE?

To that end, ABC News announced plans to broadcast a primetime hour from the White House devoted to exploring and probing the President’s position and giving voice to questions and criticisms of that position. We hope that any American concerned about health care will find our efforts to be informative, fair and civil.

Second, ABC News prides itself on covering all sides of important issues and asking direct questions of all newsmakers — of all political persuasions — even when others have taken a more partisan approach and even in the face of criticism from extremes on both ends of the political spectrum. ABC News is looking for the most thoughtful and diverse voices on this issue. ABC News alone will select those who will be in the audience asking questions of the president. Like any programs we broadcast, ABC News will have complete editorial control. To suggest otherwise is quite unfair to both our journalists and our audience.

Third, there already has been extensive coverage of the upcoming health care debates, on ABC and elsewhere, and there will be much, much more. Indeed, we’ve already had many critics of the President’s health care proposals on the air – and that’s before a real plan has even been put before the country.

In the end, no one watching, listening to, or reading ABC News will lack for an understanding of all sides of these important questions.

No mention of the fact that they will get all day access to the White House with GMA and WNT getting to host from there.

And a program devoted “to exploring and probing the President’s position and giving voice to questions and criticisms of that position” starts from the premise that the Democrat’s program will be discussed, not alternatives - just “questions and criticisms.”

No doubt there will be some pointed questions about the cost of the program. But my question above remains; why put this on at the White House? Why not someplace like Constitution Hall or some other place that would have real meaning.

It still smacks of partisan shilling in my book. And as my friend Lionheart points out in the comments, if Bush had tried this, many on the left would have hit the roof.

Reading through the excellent summary by Peter Ferrara at The American Spectator, I don’t see much new or revolutionary in the GOP alternative. Much of it was offered by John McCin during the campaign. And it appears that the authors of the bill - Senators Tom Coburn (R-OK) and Richard Burr (R-NC), and House members Reps. Paul Ryan (R-WI) and Devin Nunes (R-CA) - borrowed heavily from Heritage Foundation and American Enterprise Institute ideas put forward over the years. I suppose what’s different is that the plan is pretty comprehensive and, from my viewpoint, has a chance to work if the goal is to cover those who are uninsured, allow people to keep the coverage they have, provide more choices of affordable health insurance, and reduce health costs.

I won’t attempt to summarize the entire plan here but, according to Ferrara, “The bill would assure essential health coverage and health care to every U.S. citizen, without increased federal spending and taxes, and without the federal government taking over your health care.”

Much of the heavy lifting will be left to the states as they would set up insurance “exchanges” that will be like insurance bazarrs where consumers can shop for the best plan at the best price. States would also have to set up uninsurable risk pools to spread out the costs of covering people with pre-existing conditions.

But they don’t call it the “Patients Choice Act” for nothing. Health care consumers would be in the driver’s seat:

The key to the bill is that it shifts the tax benefits for employer provided health insurance from corporations to all workers. As a result, every citizen not retired on Medicare will get a refundable tax credit of $2,300 per year for individual health insurance or $5,700 per year for family coverage. For workers who don’t have insurance now or who pay for their own insurance, that is thousands of dollars a year they don’t have today to help pay for health insurance. Workers with employer-provided coverage can keep that or use these credits to purchase their own preferred insurance instead.

This immediately shifts health care power to workers and patients, who would be the ones making health insurance choices rather than employers. All consumers would be free to choose from the full range of coverage alternatives available in the marketplace, from Health Savings Accounts (HSAs) to Health Maintenance Organizations (HMOs) to standard fee-for-service coverage with different health provider network arrangements. The consumer could choose coverage options with maximum choice of doctors and hospitals and alternative treatments and care, like HSAs, or could choose coverage where the insurer takes responsibility for managing health care in return for lower premiums, like HMOs. Workers can take the health insurance they choose with them when they change jobs, as this new system makes such insurance fully portable.

The Wall Street Journal has a bare bones summary:

Four Republicans in Congress — Sens. Tom Coburn (Oklahoma) and Richard Burr (North Carolina) and Reps. Paul Ryan (Wisconsin) and Devin Nunes (California) — will today introduce a bill that moves away from federal centralization. Aptly called the Patients’ Choice Act, it provides a path to universal coverage by redirecting current subsidies for health insurance to individuals. It also provides a new safety net that guarantees access to insurance for those with pre-existing conditions.

The nexus of their plan is redirecting the $300 billion annual tax subsidy for employment-based health insurance to individuals in the form of refundable, advanceable tax credits. Families would get $5,700 a year and individuals $2,300 to buy insurance and invest in Health Savings Accounts.

Low-income Americans would get a supplemental debit card of up to $5,000 to help them purchase insurance and pay out-of-pocket costs. They would have an incentive to spend wisely since up to one-fourth of any unspent money in the accounts could be rolled over to the next year. The combination of the refundable tax credit and debit card gives lower-income Americans a way out of the Medicaid ghetto so they can have the dignity of private insurance.

The great majority of Americans with job-based health insurance would see little more than a bookkeeping change with the Patients’ Choice plan. But implicit in the policy is the acknowledgment that our system of tying health insurance to the workplace is not working for upwards of 45 million uninsured Americans.

That’s a pivotal point in the fight over reform: Will the next health-reform bill lock in a system of job-based health insurance or allow more individual choice and portability to fit a 21st century work force?

Arnold Kling:

The basic idea is a health care voucher (like food stamps) as opposed to a health insurance mandate. This is a logical approach, one which every health care policy wonk can appreciate and support. However, it does not give government the kind of hands-on, top-down control over the health care system that the Democrats want, and hence it is a political non-starter.

He’s right, of course. The Democrats will treat this with the same contempt they gave the GOP budget alternative. This is really a shame because the last we heard, it appears that there will indeed be some kind of mandate in the Democrat’s final version that will force every American to buy into their scheme.

We are told that this is no big deal, that Americans already are forced to buy auto insurance so what’s a few hundred extra dollars out of the consumer’s pockets in order to to get everyone covered - an absolute must, experts say, if health care costs are to come down and make national health insurance work?

The problem from a conservative standpoint is twofold. First, just because one bad idea - mandated auto insurance - is accepted by the voter doesn’t mean that a second mistake should be made by mandating health insurance. Secondly the auto-insurance analogy should frighten anyone who thinks that mandating insurance for anything is a good idea:

In some respects, requiring auto insurance coverage is a poor analogy. In others, it points out challenges that a mandatory individual health insurance plan would find it hard to overcome.

There is still no guarantee that the uninsured will join the insurance pool. Despite auto liability insurance being mandatory in almost all states, large numbers of uninsured drivers take to the roads anyway. In New Jersey, the highest-cost state for auto insurance, about 12 percent of drivers are uninsured, contributing to higher rates for others.

Penalties for non-compliance for lacking health insurance would be harder to assess. The uninsured driver can be fined or have his license revoked. Most Americans would find it draconian, on the other hand, to refuse medical care altogether to the uninsured. Assessing financial penalties on the uninsured who have sought health care would be similarly counterproductive.

“Counterproductive” is an understatement. From yesterday’s Politico:

Under the Senate proposals, taxpayers would be required to obtain insurance by 2013 and report their coverage on federal tax returns. Those who do not purchase coverage would pay an excise tax, which could be as high as 75 percent of the premium for the lowest-cost health plan in the individual’s area. “This ‘individual mandate’ has been embraced by an array of stakeholders, but we do not know whether or not it enjoys broad appeal across partisan and sociodemographic groups,” three health policy and political experts wrote last month in Health Affairs, a leading health care journal.

Empowering the IRS to police the health insurance mandate will have predictable results with our bureaucratic overlords being able to assess thousands of dollars in penalties. Of course, they will never make a mistake. And the Congressional Budget Office has figured that millions will still refuse to get health insurance even if it is made affordable. This sets up a nightmare enforcement operation for the IRS where the more important job of going after income tax cheats will probably suffer - unless the agency is expanded considerably in order to handle the additional responsibilities.

The conservative alternative offered by Republicans would use the tax system as an incentive not the threat of having the IRS on your tail. Which plan has a better chance of succeeding in insuring most Americans? I think the GOP plan would work to bring more of the most resistant groups to health insurance into the game such as the poor and those who are single, young adults. There would be additional subsidies to low income folk and the basic coverage a healthy, young single adult would want to carry would almost be completely covered by the tax credit (Here in Illinois, a good major medical plan costs a single healthy adult around $300 a month). It is not too much of a stretch to imagine a better outcome with the Patients Choice Act.

Predictably, the left is looking at the plan as warmed over McCaincare, although Mathew Yglesias makes some good points on the differences:

— This plan seems to try to grapple with the problems involved in the individual insurance market, and in that sense is a big step forward from McCainCare, but it’s not clear that it successfully grapples with them.

— One clear step forward from McCainCare is that it broadens the scope of consideration and does various things in the prevention and wellness space.

— On the other hand, near the end they appear to be trying to gut Medicare and replace it with a more-expensive but less-generous system of subsidies to private insurance firms.

— Relatedly, very brief discussions of the VA health system and the health care system for Native Americans point toward privatization and subsidies of private firms.

Actually, the plan doesn’t “gut” Medicare but rather mostly expands existing programs:

Medicare includes an option for retirees to choose private coverage, called Medicare Advantage. Almost 11 million retirees have chosen such private coverage, close to 25% of all Medicare enrollees. The Republican plan would expand this option by allowing private insurers to competitively bid down the Medicare payments they would receive for providing the specified benefits. The insurers would also be able to modify benefits to provide more of what seniors are telling them they want, and then compete in the marketplace to sell those benefits to seniors. This same competitive bidding system has been in use for Medicare prescription drug benefits and is estimated to have reduced costs by 26%, with premiums charged to seniors 37% lower than originally expected. This private option would enable seniors to avoid the increasing threat of rationing under Medicare.

The bill also provides new performance for pay incentives for Medicare services. Physicians, hospitals, pharmacists, nurses, and others could form Accountable Care Organizations (ACOs) and receive bonuses for documented improvements in quality and patient satisfaction while lowering health care costs.

Overall, I’d give the plan a B+. I think the family subsidy is probably too low and it is probably overly optimistic that insurance companies will suddenly develop a soul and compete fairly on these exchanges to be set up by the states. They are going to have to be watched like a hawk to prevent price fixing and other ways they will try and game the system. And there is the probability that these uninsurable pools will not perform as advertised which may require additional funding. Critics of these ideas over the years have pointed out that the biggest failing of market based solutions to health insurance is that it won’t solve the problem of rising medical costs.

Yglesias points to this curious measure in the bill that appears to be targeted toward preventative care but does so in a strange way:

Government health programs should adhere to the Hippocratic Oath to “First, do no harm.” This means federal programs should not promote or support unhealthy behaviors and taxpayers should not be expected to support programs that do not show positive results. This act would require reviews of existing programs and the consolidation of overlapping programs and the elimination of ineffective programs. Additionally, “junk food” that does not meet nutrition standards would be prohibited for purchase under the federal Food Stamp Program.

Taking poor people’s potato chips away won’t change the fact that people who receive food stamps are still largely ignorant of what constitutes a proper diet despite efforts for 40 years to pass on nutrition information by the government. A better, more comprehensive effort there might be better than simply denying people a snack.

But overall, a good stab at addressing a very complex and thorny problem. And who knows” A few years of Obamacare and America might beg for a change to a system that will give them adequate care at an affordable price without having to deal with rationing or tax increases.

That $1 trillion is a number the Congressional Budget Office is looking at right now. Estimates by others have used $1 trillion as a starting point and go up to $1.5 trillion.

Please recall that our president “budgeted” only $637 billion for health insurance. But that number presupposes that almost everyone who is not now insured will buy the subsidized package. The only way to realize the $2 trillion in savings Obama needs to make the plan work is for nearly everyone to be on board.

But the CBO says that’s a crock as The New Republic’ s Jonathan Cohn points out in his exclusive look at the early CBO estimates:

So what does CBO think this time around? Late last month, after weeks of working overtime to keep up with the huge domestic agenda, CBO began delivering some prelimiary estimates on health reform. According to several sources familiar with the estimates, it’s something of a good news/bad news story:

The good news for reformers is the CBO’s determination that expanding health-insurance coverage would cost a lot less than many outside experts had predicted. Instead of a politically daunting $1.5 trillion, the CBO figures the price tag will be closer to $1 trillion, at least under certain parameters. But the reason for the lower estimate is a bit unsettling. Even with a requirement that everybody obtain insurance–a so-called individual mandate–the CBO assumes a that between a quarter and a third of the uninsured still wouldn’t have coverage. That would leave the country short of universal coverage, the goal Obama and his allies have repeatedly cited.

What Cohn doesn’t mention is that the reason Obama needs almost everyone on board his health insurance boondoggle is that the uninsured are one of the major reasons for skyrocketing health care costs. No one knows the true number of uninsured in the country. The Democrats like to throw around the number 48 million but that is too high by almost a factor of 4. Many of those 48 million are between jobs and will get health insurance when they are employed again or there are other factors as this AP article, summarized by The National Review Institute makes clear:

• The Census Bureau itself says that “Health insurance coverage is likely to be underreported…” (See Appendix C of THIS report) For example, “16.9 percent of people with an MSIS record indicating Medicaid coverage reported…that they were uninsured.”
• According to Sally Pipes of the Pacific Research Institute, “as many as 12 million uninsured Americans are eligible for Medicaid and the State Children’s Health Insurance Program-but they haven’t signed up.”
• More than half of the uninsured are between 18 and 34 years of age, a group which has relatively few expensive health issues and for whom self-insuring (paying their own medical bills) makes sense. Only 14% of people over the age of 55% are uninsured.
• Over 9 million of the “uninsured” have household incomes over $75,000.
• Roughly 30% of the uninsured are without insurance for less than 6 months (though this statistic will likely worsen during the current recession).
• And finally, estimates are that between 7.5 million to over 10 million of the uninsured (15% of them or more) are illegal immigrants.

A more cautious estimate of the uninsured is perhaps 12 million - most of them young and single. And that’s not the only myth about health care that the left has been promoting:

The top three myths are: 46 million Americans have no health insurance and therefore no health care; an individual mandate will lead to universal coverage; and socialized systems such as those in Canada and Europe are cheaper and more efficient than ours. If I were to write the book today, I would add another myth: that America’s health-care system puts our employers at a competitive disadvantage and hurts our economy. No less an authority than the Congressional Budget Office has debunked this myth, noting that it is employees who pay the tab, not the company, as it’s merely a substitute for wages. Yet this is a major selling point in the Democratic push to government health care.

The more uninsured, the higher the cost of health care. The higher health care costs will mean a larger subsidy for health insurance. This is exactly what they are finding in Massachusetts where the state subsidy has skyrocketed.

The estimate of $9.3 trillion in deficits the budget will run over the next decade has to be increased - perhaps by as much as $800 billion. Here’s Robert Samuelson writing in Investor’s Business Daily:

It’s true that since 1961 the federal budget has run deficits in all but five years. But the resulting government debt has consistently remained below 50% of GDP; that’s the equivalent of a household with $100,000 of income having a $50,000 debt. Adverse economic effects, if any, were modest.

(Note: Deficits are the annual gap between government’s spending and its tax revenues. The debt is the total borrowing caused by past deficits.)

But Obama’s massive, future deficits would break this pattern and become more threatening. At best, the rising cost of the debt would intensify pressures to increase taxes, cut spending - or create bigger, unsustainable deficits.

By CBO’s estimates, interest on the debt as a share of federal spending will double between 2008 and 2019, from 8% of the total to 16%. Huge budget deficits could also weaken economic growth by “crowding out” private investment.

At worst, the burgeoning debt could trigger a future financial crisis. The danger is that “we won’t be able to sell it (Treasury debt) at reasonable interest rates,” says economist Rudy Penner, head of the CBO from 1983 to 1987. In today’s anxious climate, this hasn’t happened.

At risk in this fiscal crisis is spending on national defense. At a time when our military must reassess its priorities due to the changing nature of enemy threats, it is likely we will be hamstrung by the massive deficits. Since most experts believe we have to increase the size of the army, Marines, and Special Forces, it is difficult to see where the money will come from - especially since cutting entitlements is off the table with Democrats in charge.

More likely, Obama will take a meat cleaver to our defense budget, cutting modernization and perhaps even cutting benefits to defense personnel. There are several vital programs that will likely see the ax, including the F-22 fighter and a drastic cutback in the number of next generation destroyers for the navy.

Samuelson guesses that the reason that few are speaking out about these catastrophic deficits and piling up of a massive amount of debt is the severity of the recession. But given the stratospheric budget deficits being run by Obama, any recovery will be stillborn as interest rates will have to be raised significantly to entice people to purchase Treasuries in order to fund the debt while inflation is likely to take hold as the trillions in bail out monies dumped into the economy by the Fed means too many dollars will be chasing too few goods and services.

Even a Keynesian can understand those basic economic principles.

We are in for a very rough ride for the next several years. It will take someone with courage and leadership ability to call for making tough choices. Obama has said time and time again that such choices are “false,” that we can have it all by only raising taxes on the rich.

When that chicken comes home to roost, it will probably be too late to stop the disaster from occurring.