Disaster is in the Details

On my way to work this morning I listened to the re-run of President Obama’s interview with Fox News, which had been vilified by him and his staff at every turn and now apparently rates his attention when he feels the need to  plead for support from those who don’t understand the new math.  I, too, was unclear on the details of the massive program that is not being voted on this week.  He clearly stated that the details of the health care plan, which he doesn’t know, will be posted many days before the actual vote which is funny because Nancy Pelosi said last week that if you want to know what is in the health care bill they will have to pass it first.  Huh? 

I also missed the math class in school that allowed you to save money and still spend it- I’d like to be able to do that in my own expenses.  

This whole Health Care Debacle  Debate- feels kind of like a marathon in which everyone disagrees on the route and the goal, and we aren’t making good time.  And the people who are in charge of it are fish.  I don’t mean that Congress People are slimy sea creatures, though I’m not ruling this out, I just mean that fish don’t ambulate, so have a difficult time telling bipeds how to provide health care.  

Are we really talking about adding a trillion dollars to the deficit that we can’t pay now?  Doesn’t the word “deficit” mean that we can’t pay it now?  That’s what it means in my house.  It is like the thought that we can’t be out of money because we still have checks left.  We just came through a financial crisis that was partially caused by thinking like that.

I’m confused and want to know- is tort reform in or out?  Is the public option in or out?  Is the opening of health insurance sales across state lines in or out?  Are we still voting on the bill?  Because it doesn’t sound like congress is even going to vote on the bill, but on the second derivative of the bill, and this violates the principles of SchoolHouse Rock in which the rules were clearly laid out by Jack Sheldon (www.schoolhouserock.tv/Bill.html).  So you can understand my confusion.

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  1. #1 by shadowfax MD - March 18th, 2010 at 13:04

    Can’t blame you for being confused, but there are facts available. If you want to follow health care reform causally, I highly recommend Jon Cohn’s excellent blog at The New Republic, titled The Treatment.

    To answer your questions:
    1. The bill does not increase the deficit — in fact it REDUCES the deficit by hundreds of billions of dollars. It does this through savings in Medicare (elimination of Medicare Advantage overpayments to insurers) and new funding sources.
    2. Tort reform is not in and never has been. Obama offered this to the Senate GOP in June in return for bipartisan support and was rebuffed.
    3. Public option is finally dead once and for all.
    4. States will have the option to form compacts in which insurance can be sold across state lines, which is good. However, unrestricted sale of insurance across state lines will not be allowed, which is also good (see this for an explanation why).
    5. The House will vote implicitly on the bill with the “Deem and Pass” strategy, which is not in SchoolHouse Rock, but then neither is the filibuster. But it helps avoid a vote on the flawed senate bill (i.e. Cornhusker kickback) and allows only a vote on the “fixed” bill.

  2. #2 by Ben Kulow - March 18th, 2010 at 20:25

    I agree completely with shadowfaxMD. It really shouldn’t be that hard to believe that you can spend money while still reducing total expenditures. If you have a family budget and decide you want to subscribe to netflix all you have to do is either no longer go to starbucks every day (reduce outflows) or make more money (raise taxes). Now, if after you’re done making more money or no longer going to starbucks and you subscribed to netflix, you realize that you have more money than you started with then you have a net surplus!
    Genius I know.

    There are many other ways to better spend the money you currently have to be more productive that would in the end help the bottom line. I believe they call it research and development in the pharma industry. Or how about from your own MD life. You borrowed money to become a doctor but in the end you make more money than you borrowed. I believe that would be a net surplus.

    It’s very fair to be confused by the whole process. It’s complicated and not an easy issue. But it seems that you’re just spouting off Republican talking points so perhaps you know more than you’re letting on.

  3. #3 by rjc - March 18th, 2010 at 22:06

    Shadowfax is the one spewing talking points.

    This is an entitlement program reportedly to cover 30 million more people by adding over half of them to the medicaid program. The CBO can only score what is given to them. The dems have created a gimmick that was sent to the CBO knowing that if they tax for 4 years before they start to spend (on “benefits”) then the program looks like it may pay for itself or ‘reduce the deficit.” Long term, this entitlement will be like all the others, grossly overbudget and putting the USA in peril of bankruptcy.

    This whole thing is a public option. It’s government gone wild. Medicare and Social Security have 10s of trillions of dollars of unfunded liability. This will too. There is nothing good about Medicare and we would all be better off without that program. Yes, I mean it.

    Allowing purchasing of insurance across state lines is a good idea. Ezra is a huge lib and only presents half the story in his article. People are not stupid and can read about what’s included in their plan. Once the contract is made, they have recourse in the court of law and the court of public opinion if the insurance company misbehaves.

    The house will not vote on the senate bill because Pelosi cannot get her members to agree with the trash the senate put together. So instead of voting on it, (as she said, “nobody wants to vote for it”) they’re trying to fool thepublic by using the Slaughter rule. The problems are that in this instance, it appears unconstitutional and the people are not stupid. She will get what’s coming to her and those that participate in this tyranny.

  4. #4 by Aaron Lovinger - March 19th, 2010 at 01:50

    The bill is estimated to cost over $820-950 billion over the next ten years, which will be paid for with Medicare cuts and new funding sources. Umm, just say TAXES. The projected deficit reduction over the next ten years will be around $130 billion, and for the following decade around $1 trillion. So TAXES (and Medicare cuts, believe it when I see it, I can’t even go there right now) equaling $1 trillion for the first decade…what are they? One new tax is a 2.9% increase in the capital gains tax (unearned income tax). Increasing this tax prevents capital appreciation and limits upward mobility. Another is an increase in the Medicare payroll tax on upper income wage earners, the so-called rich $200k/$250k crowd. Then there is the excise tax of 40% on high cost insurance products. (This is an issue with the unions because a lot of their members have these plans; at one point in this whole debacle the democrats were going to cut a deal with the unions to exempt them from the excise tax to ensure their support.) Remember how often Obama said he wasn’t going to raise taxes on the middle class…well this is a huge one. This tax won’t start until 2018 but will balloon up after that. It is also from this excise tax they hope to deliver the trillion dollars in deficit reduction projected in the decade 2020-2029. The sustainability and feasibility of this tax is extremely debatable. So almost a trillion in new spending, over a trillion in taxes and hoped for savings from Medicare, and by 2020 they still expect around 20 million uninsured. I’m confused too, why would anybody support this legislation?

  5. #5 by Nick Genes - March 19th, 2010 at 14:14

    The Central Line has quickly built a reputation for high-quality writing on a variety of topics, from academic to personal to political, with a good range of perspectives in emergency medicine represented. I’ve learned a lot by following this site, and gained a deeper appreciation for the breadth of expertise and interests shared by my fellow EM physicians.

    I was disappointed to read this post, in which the author admits to confusion over some fundamental aspects of the healthcare reform process.

    Of course, some confusion is understandable, especially when one acknowledges the legislative process isn’t as simple as a child’s cartoon. But I think any physician with even a passing interest in current events would know whether tort reform or a public option was part of the healthcare reform bill.

    I’m not saying it’s bad to ignore much of the features and news surrounding with this bill. I’m just questioning ACEP’s judgement in placing this rather uninformed perspective as the top entry on the organization’s official blog for two days now.

  6. #6 by Angela Mattke - March 19th, 2010 at 20:22

    Clearly my attempts at injecting a little levity into what has become a grim, sometimes bare-knuckles debate have not met with the response I anticipated. Perhaps the “humor” tag should be a little larger. Disagreements on the best course of action should not remove our ability to have a little chuckle every now and then. I’ll try to be funnier.

(will not be published)

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