How we know "The President’s Proposal" on health care really is Obama's baby
Sure, after a year's worth of health care back-and-forth, "The President's Proposal" is a twelve-page nothingburger of bullet points with no policy detail (except as... read on). Sure, the proposal is so über-pathetic that even the pathetic [a|the] [strong|robust|triggered]? public [health insurance]? [option|plan] isn't included, not even as a meaningless sop to help "progressives" get the next round of funding. Sure, women are treated as chattel. Sure, the CBO can't score it. (Remember how important that was?) And sure, this "initial offer" has a pre-compromised and capitulationist baseline that's so low it might as well have been set by Joe Lieberman doing the limbo.
But all that's standard operating procedure for Obama and the FKDP. How do we know that Obama gave this kabuki script his personal attention? Here's the tell:
Look to the wonk. We already know that Obama fancies himself a geek; what excites him about health
care insurance reform isn't saving lives, or even money: It's electronic medical records.* Let me start by quoting this sentence from "The President's Proposal":
Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year.
Millions! Just fancy! This from an administration, and a President, that's leaving at least $350 billion a year on the table by refusing to consider the only solution on offer that can actually be shown to work with evidence: Single payer.
And to save those millions -- that would be millions with an M, not billions with a B, or trillions with a T -- the "Proposal" spends many precious paragraphs of its twelve pages on a geek-type wonkfest of technical detail on -- yes, the standard Republican talking point -- "waste, fraud, and abuse":
Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General. ...
Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program ...
Expanded Access to the Healthcare Integrity and Protection Data Bank. Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. ...
Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. ...
Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. ....
Study of Universal Product Numbers Claims Forms for Selected Items and Services under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress .....
Establish a CMS-IRS Data Match to Identify Fraudulent Providers. The President’s Proposal authorizes the Centers for Medicare & Medicaid Services (CMS) to work collaboratively with the Internal Revenue Service (IRS) ...
OK! Dense, geeky detail! This is sure one President who does his homework!**
Now, I know what you're waiting for. You're waiting for what "The President's [cough] Proposal" has to say about the health insurance companies. Will there be a comprehensive sanctions database for them? Background checks? A health care integrity data bank? Real-time data review? A Universal Product Number claims form? A CMS-IRS data match? I mean, my gawd! If Obama's going into all that detail to save millions -- with an M -- from Medicare, what will he do about the billions -- with a B -- from the insurance companies, who take thirty cents of every health care dollar, when Medicare takes only three cents?
Yes, I know what you're looking for; but I'm having a hard time finding it. I just searched the PDF for "regulation" -- nothing. OK, give me a moment here, I'm wading through all the stuff about what's goingto happen to get to the mechanisms that will make sure it does happen... "Enforcement" gets two hits, one for Medicare (above), the other for prescription drugs. Well, heck, I guess I'm just going to have to read the thing. From the top:
One essential policy is “rate review” meaning that health insurers must submit their proposed premium increases to the State authority or Secretary for review. The President’s Proposal strengthens this policy by ensuring that, if a rate increase is unreasonable and unjustified [as determined how?***], health insurers must lower premiums, provide rebates, or take other actions [like what? Reading a sternly worded letter?] to make premiums affordable [which means what?]. A new Health Insurance Rate Authority will be created [responsible to whom? Staffed how? Created when?] to provide needed oversight at the Federal level and help States determine [What on earth does "help States" mean?] how rate review will be enforced and monitor insurance market behavior****.
We don't know how "rate review will be enforced," so we're going to punt to a magic board? That's a proposal to have a proposal, not a proposal! Next:
Within months of legislation being enacted, it requires ... State insurance authorities to conduct annual rate review, backed up by the oversight of the HHS Secretary.
Oooh! Reviews! Backed up by unspecified oversight. I bet the insurance companies are terrified. And then there are the vaunted exchanges:
When the exchanges begin in 2014, the President’s Proposal adds new protections that prohibit all annual and lifetime limits, ban pre-existing condition exclusions, and prohibit discrimination in favor of highly compensated individuals.
"New protections." Alright then.
OK, still reading... Page 4... Page 5... Page 6... Page 7.... Page 8.... Page 9.... Page 10... Page 11... Page 12. Yep, the "Health Insurance Rate Authority" seems to be it.
So, to sum up: Lots and lots of detail on cutting millions in Medicare "waste, fraud, and abuse." Virtually no detail on regulating billions in health insurance company revenue. And Republican talking points wherever you look. Say, that means it's Obama's baby too!
Like Yogi Berra says: "You can observe a lot by watching..." This is "the full PDF of the President's key improvements." I'll look at the "Titles" soon, but at first glance -- and I know this will surprise you -- they read like brochureware. There's lots of vaporous marketing prose on what will be, and virtually detail on enforcement or regulation. In other words, Obama's saying "Trust me."
And you know what "Trust me" is Democrat for...
NOTE * Granted, EMR probably also means a big payday for Google, and so a nice fat kickback to the rent seekers in the Democratic Party apparat. And, of course, another payday and kickback from Tufts Health Care CEO James Roosevelt, who was also -- wait for it -- the chair of the Rules and Bylaws Committee in 2008.
NOTE ** Or has sycophantic staffers who know how to appeal to his tastes.
NOTE *** Note the rhetorical precision of "waste, fraud, and abuse," in contrast to the mushiness of "unreasonable and unjustified." Since insurance companies bring no value to any transaction they engage, what on earth is "reasonable" and "justified"? Who determines that? The same WellPoint official who wrote the Senate Bill on which "The President's [cough] Proposal" is based?
NOTE *** Can this possibly mean they won't regulate the terms of actual policies?
NOTE Ya know, if I had a suspicious mind, I might think that all these new Medicare databases would be used to cut care, instead of "waste, fraud, and abuse." But that would never happen. After all, we're dealing with Democrats here. Oh, and send them some money, wouldja? I keep getting email about that, and I don't have any more space in my hutch for commemorative plates.
NOTE And this part is truly weird. You know the 31 million number that keeps getting tossed around? I always that was due mostly to Medicaid expansion --- moving the opportunity to get medical care after losing all your assets, like your house, up the income ladder -- but no. Right in the first paragraph
"The President's [cough] Option" -- sorry, "Proposal" -- makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.
It's a tax cut!? Are Republican talking points truly the only ponies left in the stable?