| Ok, I've tried to keep an open mind on this. I prefer single payor, but a properly done public option could, indeed, drive down costs and help some people get care. But I'm no longer sure I can maintain benefit of the doubt. First it was the AMA endorsement, which was bought by a promise not to reduce medicare rates as much as initially planned. Now I read from Robert Reich that the price of pharma not killing it is: - Not allowing drug reimportation from Canada
- Not allowing the government to negotiate drug prices
The 80 billion pharma promised last month is a small price to pay for that, and I'll tell you right now that that 80 billion won't appear anyway. As soon as the pharma companies can betray, they will. The mandate, as Reich points out, can easily lead to insurance companies earning more money than they'll lose, which since the insurance companies are the problem, means that costs won't go down much, if at all. All in all, I don't think any bill that's going to come out of this Congress is going to be strong enough to drive down costs or even significantly reduce the growth rate. The mandates, combined with insufficient subsidies mean that many people are going to be hurt by being forced to buy insurance. The Massachussets plan, which this is based on, has not worked well. This isn't going to either. This bill is turning into a pork-fest. Buy-in is being achieved by making it clear that stakeholders will make more money once it's done, not less. My biggest weakness this year in doing analysis has been hope. I have let hope that the Obama administration and a Democratic Congress will do the right thing, and that they aren't corrupt and incompetent, get in the way of clear thinking. Enough. Hope isn't a plan, and hope isn't policy. Hope without good policy is a con-job. There hasn't been a good, major, bill come out of this Congress this year. They have all been fatally compromised, from the stimulus bill (larded up with useless tax cuts and without necessary State relief) to the global warming bill, which is so far from doing enough that it's a joke. At this point I see no reason to believe this bill won't be the same. Yes, a few people may get health care who wouldn't otherwise and that matters, but it won't contain costs to any significant degree and it will put a huge burden on Americans who can't afford it. The likelihood that a surtax on the rich to pay for it won't happen just makes this even more clear. This is not the Bush administration, but the primary assumption of the Bush years that nothing would get through Congress that wasn't bought and paid for; that wasn't fatally compromised at very best still holds in only a mildly mitigated form. Yes, Obama and the Democrats sometimes try to do the right thing while Bush almost never bothered, but the bills that come out at the end are still awful. This year is effectively over. Obama's ratings are dropping and will continue to drop as the economy doesn't improve for ordinary people. In future years he will reap what he has sown: bad policy will lead to bad real results, and Obama and the Democratic Congress will be blamed for that. They will deserve it. Hope I'm wrong about this. But I wouldn't bet on it. Even hope wears thin over time. |
