Legal Commentary

Cost Control

By Big Tent Democrat

[I]f you think that the administration will simply give up on the excise tax -- which does them virtually no good in the first 10 years anyway -- why is it in there at all? It's unpopular with their allies and wins them no friends among their enemies. Indeed, it's easy to see why so few presidents attempt cost control: You get hammered by the people who usually like you and dismissed by the people who usually like cost controls but don't fundamentally trust you. That leaves you with, well, virtually no one.

(Emphasis supplied.) In addition to accepting the false right wing frame that Republicans "like cost controls" (they don't), Ezra's argument is belied by the fact that the Obama Administration abandoned the most effective cost control measure that was proposed for health care reform - the public option:

[P]ublic insurance is simply more efficient. Medicare holds costs down better than private health insurance. The substantially public systems employed by every other industrialized nation cost less and cover more than the American model. So the question became how to marry the policy need for public insurance with the political need to preserve the status quo.

Enter the public insurance option. It doesn't replace the insurance individuals already rely on. But it provides an alternative. It lets them make the decision. It's the health care equivalent of being pro-choice. And it thus serves two purposes. The first is to act as a public insurer. To use market share to bargain down the prices of services, much as Medicare does. To lower administrative costs. To operate outside the need for profit, and quarterly results. The Commonwealth Fund estimated that this would result in savings of 20%-30% over traditional private insurance[.]

The person I am quoting? One Ezra Klein. now correct me if I am wrong, but I am pretty sure the "President's friends" would not have been upset with a public option. Indeed, quite the opposite. Hell, the public option was the most popular part of the health proposals:

The survey of 2,999 households by Thomson Reuters Corp shows a public skeptical about the cost, quality and accessibility of medical care.

Just under 60 percent of those surveyed said they would like a public option as part of any final healthcare reform legislation, which Republicans and a few Democrats oppose.

[. . .] * 86 percent of Democrats support the public option versus 57 percent of Independents and 33 percent of Republicans.

you might want to ask yourself this, why didn't the President fight for a public option? why does the health bill contain nothing as effective as the public option for controlling costs? Why did they insist on doing this crappy health bill with 60 votes and no effective cost control or political support instead of passing a public option with financing and Medicaid expansion through reconciliation?

The explanation Ezra gives about why Presidents do not want to do cost control does not hold water. I do not think there is anything nefarious involved, other than the fear of the effects of industry opposition.

Mostly, in my view, it was due to timidity and political incompetence. Rahmbo and Axelrod are just not all that when it comes to governing politics.

I hope it is ok to say that.

Speaking for me only

Full post as published by TalkLeft on January 15, 2010 (boomark / email).