cutting, entitlement reform. Writing at Firedoglake, he concludes:

Obama has said that "entitlement reform" is a top priority, and with this plan he makes absolutely concrete that entitlement reform is his number one budget priority, and after getting past the current crisis, his number one economic priority. His plan is to increase taxes on upper incomes, push down costs, but retain the current system in almost every detail, and then use some of that savings to fund access. Single payor? No. Patient driven? No. In fact, oversight driven. Universal? Perhaps. It's most important virtue however, is that the price tag is fixed, and interests in Congress will have to fight within a very tight range, limiting the chances for cost over runs. It's most important defect is that it neither is, nor leads to, significant savings. To underline the essential point. The plan offers savings of roughly 33 billion a year, when, by best estimates, the amount of over charging in the US health care system is 700 billion. The plan then addresses roughly 5% of the current problem. That is enough to contain costs, and enough to keep the system going longer, but not enough to put the system on a sustainable footing. The cost reductions envisioned by Obama's plan shave, at best, 1.2% of GDP off the future peak of 12% of GDP of Medicare expenses. When combined with a potential Health IT program, the ground work being put in the budget by Obama, this could produce further savings of another 1% of GDP in the rest of health care, but in his incarnation at CBO, OMB Director Orszag cautioned against rosy estimates from computer systems.

The take away is that this plan reflects a belief that the problem with the health care system is about 5% of the costs of the total system, that it lies in process problems which can be addressed by going into the weeds and [w]resting inefficiencies out, and that oversight and containment will be enough, because that is the amount budgeted for "comprehensive" reform, and that is the method given to achieve the results desired. (My emphasis)

This is healthcare reform as tackling costs of one government program.=:

It is also clear that Obama's target is Medicare costs, not a general health care reform. Indeed, by focusing on give backs on Medicare, he invites companies to attempt to make up the lost revenue on other parts of the health care system. It's a variation on "starve the beast" tactics, because part of the problem of Medicare is that it takes much of the most unprofitable health services off the books of insurance companies, while still providing for profits for the services to health care providers. By pushing costs back on to the insurerers and providers, they will either have to eat some of the profits, or they will have to charge more to their private customers, or both. This could work, or it could back fire badly, by creating a large wave of uninsured, the way mandates have in Massachusetts. Trying to get people to pay who have falling real wages is trying to get blood from a stone. (My emphasis)

He also sees the WH as taking the same approach as they did with the Obama Stinulus Bill, charging the House with a general outline, letting the House develop a bill, then working in the Senate to make it more conservative. A big shout out to the The Gang of Screw the People!

Now, since there are so few details, this is still like reading tea leaves or entrails, so much may change. But it does seem to clarify Obama's take on things. Yikes.

sees tremendous pitfalls. Both Stirling and he reference the Mass experiment in noting that even with mandates, people will pay for food, rent, transporation before health insurance if they don't have much income.

...individual mandates. It's not that they can't be done well, various European countries have individual mandates, and they work fine, but that's because they place very strict cost controls on insurers for ALL patients. Exactly what must be covered by the basic plan and what the rate of profit is on the basic plan is strictly regulated. Patients must be accepted even if they have pre-existing conditions and they can't be charged more.

If a government doesn't do this, two things can happen:

1) If the government has its own healthcare plan open to everyone (remember, everyone can't enroll in Medicare or Medicaid) then the most expensive patients will wind up on the government's dime. Private insurers will cherry pick the healthy people, then when they get sick do their best to dump them onto the public plan. Costs will soar, the government will get soaked and you won't get the savings one should get from true universal health care (which are about 1/3 of current US costs.)

2) If the government doesn't have its own healthcare plan open to everyone, the insurers will simply soak everyone who can't be on the Medicare and Medicaid. So the government may pay less for healthcare, but all it's really doing is moving costs around—from poor people and old people and on to everyone else.

In other words, for Obama's plan to work it must have individual mandates and a public insurance option open to everyone and insurance companies must be forced to compete on even ground with the public plan - same cost schedule and the same underwriting (basically none). (My emphasis)

And..it's a Ten Year Plan! Talk about gradualism, incrementalism, huh? Cautious. Wouldn't be prudent to take the bull by the horns, now would it?

Are we having fun yet?

After all, it's going to take some time to turn them into regulated public utilities. I'm quite reasonable about this.

Give Obama credit, he's consistently frame it as cost. As usual, anybody who thought he was a progressive was fooling themselves.

Politico writes:

...President Obama says in the budget released Thursday that he wants Congress to follow a "set of eight principles" for "Transforming and Modernizing America's Health Care System" as the White House and Capitol Hill work together to write legislation for health-care reform "over the coming year":

1. Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.

2. Make Health Coverage Affordable. The plan must reduce high administrative costs, unnecessary tests and services, waste, and other inefficiencies that consume money with no added health benefits.

3. Aim for Universality. The plan must put the United States on a clear path to cover all Americans.

4. Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.

5.Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. They should have the option of keeping their employer-based health plan.

6. Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking — as well as guarantee access to proven preventive treatments.

7. Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.

8. Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue. (my emphasis)

Love #'s 3 and 7!!!!

Of course, the approach which would most equitably meet these "principles" is single payer. Which is off the table for Obama.

And didn't he talk about opening the Fed employees' plan to the public??

Oh, and didn't Obama tell us healthcare is a right? (Albeit under pressure and a bit grudgingly....)