The OMB Strikes Back
Tim Fernholz has a good summary of the latest developments in the Orszag v. Elmendorf battle of the budgeteers:
The White House scored a point today in its ongoing battle to convince establishment Washington that health-care reform will succeed at cutting costs even as it expands coverage. The White House and budget director Peter Orszag, as well as the House Blue Dogs, are very bullish about allowing an independent board to pursue cost-cutting measures in Medicare. But when CBO scored the measure to determine if it would be succesful, they produced a very lukewarm estimate. Today, though, a group of health-care experts sent a letter [PDF] to Obama arguing that IMAC, the independent cost-cutting board, would be very effective if done right — and nine of the signatories are members of the CBO’s Panel of Health Advisers, nearly half the membership. It’s a good sign for the White House, and will help push the message that, while CBO’s scores are important, the assumptions made in that office are not carved in concrete.
Not surprisingly, according to Peter Orszag this is a huge victory for truth, justice, and Peter Orszag.
When thinking about both the politics and policy here, it’s important to distinguish between two different administration promises. One promise was that their proposal will be “paid for,” i.e. deficit neutral, over the course of the ten-year budget window. On that issue, the CBO’s word is God. The other promise was that their proposal will “bend the curve,” i.e. reduce the pace of health care cost increase relative to baseline. On that issue, the CBO’s word may matter, but it’s an inherently speculative enterprise and both the White House and Congress are free to see things however they think is best. IMAC is primarily about this latter issue.
10 Responses to “The OMB Strikes Back”
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August 4th, 2009 at 9:25 pm
Being Libertarian in philosophy, there are several points I do not understand.
1. Why is health insurance not like car insurance? (i.e. – car insurance doesn’t cover oil changes or tune-ups, why should health insurance cover doctor visits or meds?)
2. Having been in the workforce since 1978, why should I be coerced (through taxation) into providing health insurance for anyone not in the workforce or retired?
3. Can anyone enumerate the reasons why I should believe that the Federal Government can run health care, or health insurance, in an efficient manner?
4. If the Sovereign God only requires 10% of my income (the “first fruits”) why on Earth do the Local, State and Federal governments require over 60% of my income?
August 4th, 2009 at 11:13 pm
1) Because your car is a luxury, your health is a necessity.
2) Because no man is an island.
3) Because?
4) Because God doesn’t have bills of his own.
August 5th, 2009 at 3:19 am
What the hell is a libertarian? I thought they believed in unchaining themselves from ALL forms of authoritas, including Sovereign Gods. I mean, a Sovereign God requires his libertarian subjects to pony up ten percent directly payable?
It sounds like some kind of metaphysical oxymoron. On a more worldly level, it would be like an anarchist who dreams of playing football for Bill Belinchik, because he knows he thrives only in a highly structured environment.
And why are there only three comments in a Peter Orszag post? What is going on, here? Peter Orszag! Come on! Don’t underestimate him. Listen to me. He is a ruthless motherfucker. Peter Orszag is going to be wheeling and dealing at the pinnacles of power long after many of us are gone.
Unless, of course, Handsome Pete is gunned down first by a clandestine CBO operative, or a spurned lover.
August 5th, 2009 at 4:20 am
What a ridiculous letter. In essence its authors fantasize about some Board of Dictators free from any real control by the electorate or the voters’ representatives. (Read the letter: “short term gains” and “narrow interests” must be ignored, and the Council’s recommendations “must be implemented fully.) Sure, let’s put “wise men” (and women) in charge — what could go wrong?
I’d call the authors intelligent idiots. It’s fine for the Executive and Legislative branches to seek advice from experts (real or so-called) in a variety of fields. But the notion that something as massive and contentious as health care policy can be “solved” by punting it to some board of “experts” is nothing but a pipe dream.
August 5th, 2009 at 8:05 am
“1. Why is health insurance not like car insurance? (i.e. – car insurance doesn’t cover oil changes or tune-ups, why should health insurance cover doctor visits or meds?)”
Because preventative medicine cuts costs and keeps epidemics at bey… ”
“2. Having been in the workforce since 1978, why should I be coerced (through taxation) into providing health insurance for anyone not in the workforce or retired?”
You don’t have to be – but don’t look to the government to protect you when the masses rise up and take what you have. You can only keep people poor, overworked and sick for so long….we’ve seen what happens in nations where the poor have been ignored – and nations where they’re smart enough to know that a few small bones thrown to the unwashed keeps the wealthy in power…
“3. Can anyone enumerate the reasons why I should believe that the Federal Government can run health care, or health insurance, in an efficient manner?”
The Federal government not only won WWII, but it put a man on the moon, built the federal highway and parks system, and through common sense regulation has elminated much injustice, the worse of our poverty, rampant illness such as small pox and measles and even a good deal of pollution. Think Washington and realize that our brilliant history of medical, scientific and agricultural research and development came straight from the coffers and imputus of our government…
“4. If the Sovereign God only requires 10% of my income (the “first fruits”) why on Earth do the Local, State and Federal governments require over 60% of my income?”
because God won’t pick up your trash, fix your roads, protect your borders or educate your children. And that’s just the start. You want to see a nation where God comes first and the people second – go live in the Middle East…
August 5th, 2009 at 9:07 am
Obama and the congress have squandered their credibility. The consensus is that the Stimulus bill was badly flawed and did not do what was intended, nobody likes the Cap & Trade bill. And everyone is enraged that the pols didn’t read either of these bills…just too darned urgent to worry about niggling details I guess.
And now they’re doing the same thing with Health Care. A Rube Goldberg pile of paper that nobody has read that they’re trying to ram through RIGHT NOW. The fact is, the Dems couldn’t care less about what this does to the economy…whether it’s paid for or not. Future generations can deal with that mess. The Dems’ only priority is to get something passed; anything!
August 5th, 2009 at 9:19 am
A simpler way to ask JohnWGalambos’s question would be, What part of the constitution lists health care as a right, requiring the federal government to take money from one citizen and give it to another?
What evidence can you point to that would give us confidence the government won’t completely screw this up and bankrupt us in the process?
This is not a left-right issue. Anyone still falling for the Demican vs. republicrat bread and circuses kabuki needs to wake up. Government is a two-headed monster eating corporate political contributions and crapping BS on the heads of the supplicant citizens.
BTW, I rarely agree with you Matthew, but I always find you to be interesting and well-reasoned.
August 5th, 2009 at 9:40 am
The so called Universal Health Care bill is just the first versions of Spread the Wealth around. Too much is given to the President, Congress and Senate in way of contributions from the medical industry so now we will spread it around to the average man who does not understand all the fuss. After all this is what Obama promised in his campaign.
August 5th, 2009 at 1:32 pm
Why do Americans believe we are the only people capable of inventing a wheel? Just about every other (if not all) industrialized nations of the world have universal health care and spend far less than we do with better results. Investigate the World Health Organization to see data reflecting health care quality. The US is significantly behind in almost all categories. Not 2nd or 3rd place but 20th or 30th. How can our industries compete in the foreign market with the disadvantage of more costly overhead due to health care costs. Are we so arrogant that we can’t recognize a better “wheel” and learn from others? Even if it is France?
August 5th, 2009 at 1:34 pm
The important thing for everyone to keep in mind for this issue is where your information is coming from. The “consensus” that people continue to refer to as though it were a given that nationalized healthcare can’t work is derived from information given to us from the very insurance and pharmaceutical companies who wish to see nationalized healthcare fail. Do your research people and then research where the information you researched came from. I am confident you will find a great deal more bias coming from the rightwing backed by business lobbies than the left. After all, the rightwing has always defended business before social interests in this country.
As for paying for other’s healthcare, I don’t have children and my wife and I don’t plan on having any. However, I am more than willing to have my tax dollars to go to schools that educate our nation’s children. Is having a sense of community with your fellow citizens such a bad thing? I am not talking about a free lunch, I am talking about leveling the playing field that big business has created through their greedy pursuits.
Regarding the efficiency of our government in regulating a nationalized healthcare plan, look into Medicare. My parents have it and works great for them. Why couldn’t our government regulate healthcare? And who the hell says that big business is doing such a great job of regulating healthcare these days? If we are going to compare things we at least need to be holding big business to the same standards as people wish to hold the government in this issue.