Thoughts on the President's Health Insurance Reform Speech

The President can give one hell of a speech. No denying it, he's incredibly talented. The soaring oratory can sometimes crowd out the analysis, and a couple days on, distance can provide clarity.

1. The President did a good job sounding bipartisan. Now, given the current make up of the Senate and House, it's very unlikely that many, if any Republicans will sign on to whatever legislation makes it out of committee, so when I say he did a good job, I don't mean that it will actually make the bill BIPARTISAN. Like Ezra Klein has said, there is a new era of bipartisanship, one in which bipartisanship is mostly about posturing, and that's because the audience isn't in the Congress, it's the public. To maintain a winning coalition you must satisfy the need of the 'independents' for bipartisanship. That's hard considering the Republican caucus has decided that obstruction is their best political opportunity at present (and that's likely because all the 'accomidationists' lost to Democrats in the 2006 and 2008 election cycles). Sounding bipartisan is being bipartisan, and the President did a good job sounding bipartisan.

2. Still wondering why the public option isn't just, hey, anyone can buy into Medicare. People who have Medicare like it, a lot. So much so that they have convinced themselves that 'government' has nothing to do with it. Sure, you'd be called a 'socialist' but that's what you're called anyway. I've been trying to figure out if it would have made this process harder or easier, and I have no idea.

3. Why $900 Billion? Senator Baucus seemed to arbitrarily choose this to make his 'Gang of Six' work. That seems to have worked itself out as well as it could (it makes the President at least sound bipartisan, which, for the moment is all bipartisan can mean), so why stick to it. It was arbitrary in the first place. I mean that's what 'moderates' seem to be all about, arbitrarily cutting the price by 10%. Why does it matter if a DEFICIT NEUTRAL program is $1 trillion or $900 billion? Isn't what matters the effectiveness of the program?

4. The President offered up a concession to Republicans in the form a pilot program on tort reform limits. Limiting damages in law suits does not reduce health-care costs. Texas, not surprisingly, instituted the harshest limits in the US some years ago (2003 or 2004) and they are still leading the nation in health-care costs. There is no evidence that tort reform reduces health care costs.

5. I am curious about what kind of savings there would be through simply introducing a universal mandate and a highly regulated exchange system. Even instituting price controls, like defined benefit packages at a defined cost, maybe even a non-profit base level health insurance system supplemented by a for-profit additional benefit system (I think this is, more or less, how the Swiss do it). Could this bend the curve at all? Would it depend on how many people sign up for a basic plan (I imagine many would)? Of course, this would only affect 30 million folks who will enter the exchanges, the rest of us have our employer's purchasing power to use as leverage to lower insurance premiums.

More later...