Monday, February 22, 2010

"The President's Proposal" on health care

The White House has unveiled President Obama's health care plan.

Is it about messaging or content?  I suspect the former:
The proposal will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy:

  • It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.
It's far from clear how a tax cut makes health care more affordable in terms of costs.  If my taxes are cut entirely then I am better able to afford a $50,000 Mercedes-Benz, but the cost of the vehicle doesn't change.  The reduction of premiums sounds like let another promise of getting something for nothing--either that or the traditional liberal approach of having "the rich" subsidize those who are "priced out of coverage today."
  • It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have. 
I smell a big, unspoken caveat in that one:  You get the same choices as Congress but not necessarily the ability to pay for all those glorious choices.
  • It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
Market competition keeps premiums down.  I imagine that insurance company abuses and denial of care help keep premiums down, so it will be interesting to see how the White House reconciles those contrary aims in this single bullet point.
  • It will end discrimination against Americans with pre-existing conditions.
The ending discrimination thing must play well with focus groups.  But adjusting risk according to pre-existing conditions is an ultra-basic feature of risk management in the health care insurance business.  Risk management of that sort is what helps keep premiums low for the majority.  A few weeks ago, I heard a caller to a radio show propose a similar arrangement for life insurance as a method of stimulating the economy.  Insurance companies would no longer be able to deny life insurance policies to people just because they happen to be dead.  It is an important analogy despite its inherent silliness.
  • It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.
This point sounds like the measures the CBO received with great skepticism.  The government has a poor record on cutting government spending and reining in waste, fraud and abuse.

The bullet point summary is singularly unimpressive.  I look forward to seeing more detailed analysis and perhaps a CBO analysis of the president's proposal.  It seems that either tax increases play a large part in the plan, or else the final bullet point represents the type of government control of health care services that Sarah Palin characterized as a "death panel."

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