Tuesday, November 24, 2009

Michael Barone

Obama Less Likely To Get Healthcare Reform

Which is good, because more of them will come

Posted February 11, 2009

Tuesday, February 3, was a terrible, horrible, no good, very bad day for Barack Obama. First, his appointee for White House chief performance officer resigned, apparently because she had failed to pay unemployment taxes on household help several years ago. Then, in the early afternoon, before the president was scheduled to have interviews with five television news anchors, former Senate Majority Leader Tom Daschle wrote Obama asking that his nomination to be secretary of health and human services (and to serve as a White House staffer on health) be withdrawn because of his tax problems. He had failed over the past three years to pay about $142,000 in taxes. Even more embarrassing, most of the unpaid taxes were for the value of a car and driver service he had enjoyed for three years. He had come a long way since his intensive personal campaigning elected him to the House from South Dakota in 1978 by 139 votes—out of 129,000 cast—at age 30.

Michael Barone
Michael Barone

Daschle was the second cabinet nominee with a tax problem. Timothy Geithner was confirmed as treasury secretary despite having failed to pay about $26,000 in self-employment taxes when he was employed by the International Monetary Fund. The argument was made on behalf of both Geithner and Daschle that they were uniquely qualified for their jobs—but uniquely qualified in different ways. Geithner is arguably uniquely qualified to make policy. As head of the New York branch of the Federal Reserve, he may have had more knowledge of the workings of financial markets than anyone else in the world, with the additional advantage that he had not been working for any of the financial firms that have encountered turbulence. And, with Federal Reserve Chairman Ben Bernanke and former Treasury Secretary Henry Paulson, he has been making decision after decision in the financial crisis.

Daschle was uniquely qualified for his job not on policy but on politics. He evidently knows a lot about healthcare policy, but many other people acceptable to the Obama administration do too. The unique value that Daschle has is that he knows the legislative process and the players (he served with 69 current members of the Senate, and 21 of the rest are Democrats). As majority or minority leader for 10 years, he knows how to put legislation together, overcome objections, negotiate deals, and reach compromises. Obama got it right when he told Fox News's Chris Wallace just hours after Daschle's withdrawal that he was the "best person to achieve healthcare reform and get people together." It's hard to think of anyone else who has that combination of knowledge and political skills. (One I'd suggest looking at is Tennessee's Democratic Gov. Phil Bredesen, who fashioned a state health insurance program that has turned out to cost less than projected.)

So it looks less likely now that the Obama administration is going to be able to put together a health insurance program and pass something resembling it through Congress anytime soon. Getting 218 votes in the House for any Democratic plan will be easy. Getting 60 votes in a Senate that currently has only 58 Democrats (and will have 59 if Minnesota's Al Franken is seated) will be much harder. And there's another problem when you tackle healthcare. America does not have one healthcare and healthcare finance system; it has many healthcare and healthcare finance systems. That means that different states and different regions have players with different interests—interests that will generally get a hearing from their members of Congress. Those who will be negatively affected by an Obama plan will lobby their representatives, including Demo-crats, and many of them may be heard and heeded.

You can imagine what the outcry will be. Special interests! Lobbyists! But remember that the unique qualification that Daschle brought to the table was not policymaking but lobbying. The First Amendment of the Constitution gives all of us, "special interests" included, the right "to petition the government for a redress of grievances." When government channels vast flows of money or when it decides moral issues on which people have strong views, Americans are going to lobby to affect its decisions. Candidate Obama denounced the influence of lobbyists and said they would have no place in his administration. President Obama found it necessary to ask for exceptions for his deputy secretary of defense and his HHS and agriculture secretaries.

On the terrible, horrible, no good, very bad day when Daschle bowed out, the Senate was considering the stimulus package Obama wants to sign by February 16. His efforts to get bipartisan support in the House failed after the Appropriations Committee added many of its pet projects and the Democratic leadership made only the most minor changes, at Obama's request, to attract Republican votes. The question now is whether Obama will muscle Senate Democrats and press for changes that will make the bill more palatable to Republicans. He made one such move in his interview with ABC News's Charles Gibson, who asked him whether he wanted the House's "buy American" provisions out of the bill. Obama indicated that he didn't want "provisions that are going to be a violation of World Trade Organization agreements or in other ways signal protectionism." That answer and his demeanor in all five anchor interviews showed a coolness and sense of command, even on a terrible, horrible, no good, very bad day. A positive sign, for there will be more such days ahead.

Reader Comments

HEALTHCARE WAS THE FIRST HIT

HEALTHCARE WAS THE FIRST HIT THEN GASOLINE AND NOW OUR SAVING!

OHIO RETIRED POLICE AND FIREFIGHTERS HAVE WATCHED THEIR HEALTH INSURANCE GO FROM $300 A YEAR TO $8,055. IN 2008. WHILE OUT OF POCKET COST HAS MORE THAN TRIPLED IN THOSE SEVEN YEARS. ALL THE WHILE THEY AND THEIR CITIES TOGETHER HAVE PAID IN THE MOST OF ANY OHIO RETIREMENT FUND FOR THEIR PENSIONS, EXCEPT FOR ONE AND RECEIVE THE WORST IN HEALTHCARE BENEFITS.

OVER THOSE SEVEN YEARS, THE OP&F PENSION FUND HAS INCREASED THE MONTHLY MEMBER CONTRIBUTION FROM $25.00 TO MORE THAN $710.00 MONTHLY. 19% OF MY 2008 GROSS PENSION WAS SPENT ON HEALTH CARE PREMIUMS. WHILE A TOTAL OF 28% OF MY GROSS PENSION WAS SPENT ON HEALTH CARE IN 2008! 2009'S INCREASE IS ANOTHER $40. PER MONTH FOR PREMIUMS. SOMEONE MUST STOP THIS MADNESS!

WHEN I RETIRED MY WIFE AND I HOPE TO TRAVEL A LITTLE AND ENJOY OUR RETIREMENT. BUT, ALL WE DO NOW IS WORRY WERE WILL WE GET HIT NEXT! WE WORKED HARD TO PAY OFF OUR HOUSE AND SAVE A LITTLE FOR WHAT? TO WATCH ALL WE HAVE HAD TAKEN AWAY OVER THE LAST 8 YEARS. WE CAN’T HELP THE ECONOMY BECAUSE INSURANCE AND THE ECONOMY ARE KILLING US!

Senator Wyden of Oregon

I believe that this Senator has a lot of the right ideas regarding healthcare reform. The main key being that health care and insurance are the responsibility of the individulas - not the government and our employers. The more responsibilty we put on ourselves to get healthy and stay their the higher likelihood that is to happen. Personal responsibilty for the lifestyle choices you make is not only fair but is practiced by almost all other "insurances" - life insurance, malpractice insurance, etc. The higher risk you are the higher premium you pay BUT there are also incentives (like having all your policies with one company, or a clean driving record, or being a part of a wellness program) that can reduce the premiums. I do not know what his lobbying or other experiences have been but combining some of his ideas with the idea of a National Insurance pool would be a great plan that puts personal responsibiity where it belongs

one correction...

I am speaking from experience as a consumer advocate in Tennessee working for a non profit--the only state-wide agency working to improve the health care in TN: Phil Bredesen is NOT a good choice for Sec. of HHS!!!

During Bredesen's campaign for Governor, he promised that he could manage the state's Medicaid program--TennCare and that cuts were not necessary. After he became Governor, he systematically cut eligibility for close to 300,000 adults between 2005 and 2008. For adults left on the program, year after year, he has cut benefits, and protections.

Over the last 3 years of cuts, he has shifted costs to families, forced many into bankruptcy (some have died), shifted care to county and local government, hospitals, or people who have insurance. He worked to reduce government regulations and protections and is a master at spin

Although Bredesen talks a good game and is a smart politician, he has shown time and again that the only thing he is truly concerned with is balancing the state budget. If in balancing the budget, the sickest, poorest, and most vulnerable Tennesseans lose their health care, he quickly blames enrollees rather than his management.

Uninsured numbers have increased under Bredesen’s watch. When he became governor, about 1 in 8 Tennesseans were uninsured. Into his second term, about 1 in 6 are uninsured. TN also ranks #1 in personal bankruptcies, half of which are related to medical debt.

Bredesen’s ideas for coverage aren’t working. He has devised a set of health care products, cleverly called Cover Tennessee. Trouble is the programs cover few Tennesseans.

Cover TN a programfor low-wage workers of small businesses is entering its third year and to date is “covering” less than 18,000 of Tennessee’s nearly one million uninsured. Bredesen likes to say of the program: "something is better than nothing". Apparently, sensible Tennesseans disagree, understanding this pretend, limited, insurance offers little in way of health and financial security compared to its costs.

In 2007, Advocates had to push the governor to add dental and vision benefits to CoverKids (SCHIP), like every other state has. But, to date, the state has not made good on its promise. And, more than 50,000 kids who are eligible for the program are still not enrolled.

AccessTN, the state’s new high-risk pool has enrolled less than 5,000 people because it remains too expensive for most Tennesseans.

Bredesen plays a shell game. The thousands of very sick people who were cut from TennCare did not go away . The medically fragile uninsured had to turn to already financially burdened local government, free clinics and hospitals to get some care. Bredesen simply balanced the state’s ledger page by shifting the costs to families, local governments, hospitals, and county jails. The data that explains this comes Tennessee’s own Comptroller’s office, http://www.thcc2.org/index_folder/financing_healthcare_07.pdf

you were wrong on Bredesen. he will hurt america.

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