The president has inexplicably doubled down on his stalled comprehensive heath care plans, in the face of a weakening recovery and more pressing and immediate concerns about dismal employment figures. At this late stage it is no longer appropriate to talk about how President Obama is squandering his political capital, because – remarkably – he’s already accomplished that.

Given the 10% approval ratings of the congress, that august institution’s political capital sailed port long ago. Only one thing was left to squander: The raw political power of numbers to deliver the president’s agenda no matter what the later electoral consequences might be.

This is what Mr. Obama said today (as taken from an embargoed ‘prepared remarks’ piece released shortly after the President’s presentation this afternoon.

(Under my plan) “No longer would (insurance companies) be able to deny your coverage because of a pre-existing condition. No longer would they be able to drop your coverage because you got sick. No longer would they be able to force you to pay unlimited amounts of money out of your own pocket. No longer would they be able to arbitrarily and massively raise premiums like Anthem Blue Cross recently tried to do in California. Those practices would end.”

Comment: Wouldn’t it be wonderful if it were actually possible to accomplish the delivery of more professional services without negative cost or quality consequences? The current stimulus bill has subsidized part of the COBRA payments for unemployed persons who carried insurance policies after being let go. That laudable, but narrow objective (narrow in the context of the president’s sweeping goal in the preceding paragraph), is being funded by deficit spending. Now, I’m just a lawyer with a laptop, but the following question occurs to me: If something like COBRA extensions and subsidies generate a federal deficit, and we offload that task to private entities, then — Who funds their deficits?

“Second, my proposal would give uninsured individuals and small business owners the same kind of choice of private health insurance that Members of Congress get for themselves.”

Comment: The phrase, ‘the same kind of choice” is a lawyerly evasion, because – trust me on this – nothing like the same kind of Cadillac (dare I say Mercedes?) fully-paid-for health care coverage enjoyed by your congressperson is contemplated for the rest of us. You can be assured that this is the case for one painfully simple reason. The country can’t afford it.

“Now, it’s true that all of this will cost money – about $100 billion per year. But most of this comes from the nearly $2 trillion a year that America already spends on health care. It’s just that right now, a lot of that money is being wasted or spent badly. With this plan, we’re going to make sure the dollars we spend go toward making insurance more affordable and more secure. We’re also going to eliminate wasteful taxpayer subsidies that currently go to insurance and pharmaceutical companies, set a new fee on insurance companies that stand to gain as millions of Americans are able to buy insurance, and make sure the wealthiest Americans pay their fair share of Medicare.

“The bottom line is, our proposal is paid for. And all new money generated in this plan would go back to small businesses and middle-class families who can’t afford health insurance. It would lower prescription drug prices for seniors. And it would help train new doctors and nurses to provide care for American families.”

Comment: If someone offered you a deal like this on the street, any competent lawyer would urge you to read the fine print. Many of this president’s supporters followed the same “trust me” logic when they bought into the investment plans of Bernie Madoff whose client accounts were “off “ by about 65 billion dollars and whose prison term of 150 years can do nothing to repair the damage left behind. Those experts who have read the fine print in the House bill and the Senate bill do not agree with the president’s rosy assessment.

“Both during and after last week’s summit, Republicans in Congress insisted that the only acceptable course on health care reform is to start over. But given these honest and substantial differences between the parties about the need to regulate the insurance industry and the need to help millions of middle-class families get insurance, I do not see how another year of negotiations would help.

Comment: Neither this administration, nor the current congressional leadership, have ever taken seriously any of the many proposals and proposed amendments offered in the last year to address the complicated finance and delivery of heath care issues at stake. The impasse was always between targeted, separate reforms vs. a comprehensive global package. See: and and

“So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on health care reform. We have debated this issue thoroughly, not just for a year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of sixty votes. And now it deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program, COBRA health coverage for the unemployed, and both Bush tax cuts – all of which had to pass Congress with nothing more than a simple majority.”

What all this really means:

Contrary to Mr. Obama’s previous stated positions, he now favors the ‘nuclear option’ by using the budget reconciliation process to achieve a massive restructuring of an entire industry.  In a similar context, Senator Obama has said, “...what I worry about would be you essentially have still two chambers -- the House and the Senate -- but you have simply majoritarian absolute power on either side, and that's just not what the founders intended.” 
The Senate Bill was the 2500 page ‘prop’ bought to the ‘summit discussions’ to which GOP representatives were invited and attended bearing the bill that could not be re-passed by a 60 vote margin because of Massachusetts voters. As CNN announced in 12-24-09, before the Mass. Special election changed the political calculus, “The (Senate) bill now must be merged with a $1 trillion plan approved by the House of Representatives in November. Democrats hope to have a bill ready for Obama's signature before the president's State of the Union address early next year.”  That bill (see ), will now be the basic template for the final law, after a parliamentary shuffle between chambers, and a series of amendments from which conservatives will be effectively excluded.
Assuming passage: The private health insurance companies that are required to meet the requirements sketched out by the president today – and the many more that are contained in pending legislation - will eventually be forced out of business because their current premium structure cannot possibly meet the new demands.
The subsidized inclusion of additional otherwise uninsured persons into “same kind of choice of private health insurance that Members of Congress get for themselves” will far, far exceed all current cost estimates, forcing a reduction in care.
The notions that “our proposal is paid for” and that the estimated additional cost of $100 billion each year can be made up “from the nearly $2 trillion a year that America already spends on health care” and “money [that] is being wasted or spent badly” are simply not supported by sound accounting analysis.
When the president said, “I do not see how another year of negotiations would help,” he actually was announcing that an ideological devotion to top-down comprehensive, bundled reform can only be achieved before the pending congressional elections.  On that point, he was most certainly correct.  All the polls indicate that a majority of American voters no longer trust the present congress and oppose passing the House or the Senate bills in anything like their current form.

The larger question is whether most Americans now trust their president.


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