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The 'Recession' Excuse

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Joe Lieberman's heterodoxies were, for a time, quite contained. He might have been a Kristol-ite neoconservative on foreign policy, but he remained a Connecticut liberal on domestic and social policy. That was before Ned Lamont's challenge, and before Lieberman was abandoned by many of his Democratic colleagues, and before he was ousted in the primary and began finding his best friends were conservative talk show hosts. The result has been a slow transition away from liberalism on all issues, not just foreign policy. The latest step in this process is Lieberman's Sunday call to wait on health-care reform:

Morally, every one of us would like to cover every American with health insurance, but that’s where you spend most of the trillion dollars plus, or a little less that is estimated, the estimate said this health-care plan will cost. And I’m afraid we’ve got to think about putting a lot of that off until the economy is out of recession. There’s no reason we have to do it all now.

Putting it off is likely to mean the same thing as not doing it, as anyone with a passing familiarity of past decisions to "put off" health-care reform will tell you. But I'm more interested in this idea that we shouldn't make large social investments until we're out of recession. First, we probably are out of recession.

Second, health-care reform is scheduled to begin in 2013, by which time we will almost certainly be out of recession, and if we're not, we have bigger problems. Lieberman might be uncommonly pessimistic about our prospects for growth, but that would imply support for health-care reform, as it will pump a trillion dollars into the economy and thus stimulate demand.

Third, the costs of reform largely manifest in the later years of the decade, namely 2015-2019, by which point we may or may not be in recession, but if we are, it will probably be a different recession than the one we're in now.

There is, in other words, no connection between whether GDP growth is slightly negative in the third quarter of 2009 and whether we should spend money between 2013 and 2019 building a universal health-care system. When people say we shouldn't do health-care reform because of the recession, they're saying something about their preferred approach to health-care reform, not to recessions.

Photo credit: AP Photo/Evan Vucci.

By Ezra Klein  |  August 24, 2009; 8:20 AM ET
 
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Comments

Ezra is 1000% correct when he states all of this.

The problem is though that these entitlement programs have NEVER been accounted for correctly.

Medicare Part A was to cost $9 BILLION in forcasted dollars in 1991 and in actuality it was $61 Billion.

I don't trust it will be $1 TRILLION or whatever final figure CBO scores it at because there's always added crap to it. Why don't they be honest with us and tell us they have NO IDEA what it will actually cost (into the trillionS) and we're looking to cover say another 10+ million or so that can't afford it or can't get it (because of pre-ex).

That to me is a whole lot of waste of taxpayer funds, my taxpayer funds but yet I keep hearing how efficent the government is???

Posted by: visionbrkr | August 24, 2009 8:28 AM | Report abuse

I want to remind you that Lieberman voted against health care reform in 94. True other Democrats like Kerry opposed health reform in 94 so this may not be exceptional. But I think its clear that the mistake with respect to Lamont is that he didn't finish the job.

Posted by: CraigMcGillivary1 | August 24, 2009 8:44 AM | Report abuse

"we probably are out of recession" - True, but try telling that to folks without jobs. At present, we have torrential trickle-down recession without a drop of trickle-down recovery.

"we have bigger problems" - True. It's hard to urge a formerly productive, now-unemployed family to stop worrying about food and shelter and instead to worry more about the health care needs of a layabout underclass.

"the costs of reform largely manifest in the later years of the decade" - True. Current reform proposals are very, very costly and a substantial portion of the hefty price tag is being pushed forward (or pushed back, if you're a journalist).

Given your facts, Lieberman, Conrad and the other Sunday guests seem 'even more correct' in being concerned about the heath care reform cost balloon. I'm sort of relieved to hear these folks recognize cost issues and am glad that such recognition does say "something about their preferred approach to health-care reform".

Posted by: rmgregory | August 24, 2009 9:11 AM | Report abuse

I love how people start mentioning costs as the main argument against health care reform. What about the balloning/untenable cost of maintaining the status quo? That will cost MUCH more in the long run. But do they even mention that? Nope. It's all about how much it will cost to do now.

People have absolutely no concept of the term "investing in our future". Lack of imagination? Lack of creativity?

Or in this case, lack of both, plus lack of a soul?

Until you get sick and your insurance drops you, that is. You will change your mind pretty quickly then. Either that, or live in pain/agony due to not treating your treatable disease until you eventually die. Or, conversely, treat it with all of the financial resources you have, leave your family ruin and poverty. And then you die.

I'm in a good mood today, aren't I?

Posted by: JERiv | August 24, 2009 9:42 AM | Report abuse

Oh, and by the way, I voted for Lamont when I lived in CT. Both in the Primary and in the General Election.

Lieberman is an egotistical self-serving excuse for a human being. Has been, always will be. I am always amazed by his capacity for political self-preservation. Cockroaches would be proud.

Posted by: JERiv | August 24, 2009 9:44 AM | Report abuse

I LOVE those that don't even bother to mention the cost and the "cost per" to determine these things. Do they balance their own checkbooks or just spend like there's no tomorrow?? And yes we should be out of Iraq and Afghanistan as soon as possible and never should have been there in the first place.

What Lieberman did say is FIX what doesn't cost issues. he said let's get rid of pre-ex.

So under lieberman's plan if you get sick YOUR INSURANCE CANNOT DROP YOU.

how do some progressives that want EVERYTHING RIGHT NOW not see that pre-ex goes away in that instance?? Do all reforms EXCEPT the public option that is the most controversial piece of the pie.

So the idea of some on the far left is don't do any reform if you don't get your precious public option. So you want to cut off your nose to spite your face. Good luck with that one.

Posted by: visionbrkr | August 24, 2009 9:58 AM | Report abuse

So if we're out of the recession, can we cancel the unspent portion of the stimulus?

Posted by: tomtildrum | August 24, 2009 10:28 AM | Report abuse

Lieberman specifically stated that he would focus this round of health care reform on delivery reform and insurance reform. This is basically the version of health care reform that the Obama administration has been selling. So why is Klein up in arms?

Posted by: Dellis2 | August 24, 2009 10:52 AM | Report abuse

If Lieberman is concerned about saving money, then I suppose it's logical to assume that he thinks that a public option should be enacted now in order to keep cost down.

Posted by: newjersey_lawyer | August 24, 2009 11:00 AM | Report abuse

newjersey_lawyer,

here are some interesting facts from OUR home state.

NJ doesn't need a public option and here's why.

one of the parts of H.R.3200 as well as all the other bills states that insurers must work off 85% loss ratios. (Ezra i smell a column).

Currently NJ is at an 80% requirement, the highest in the nation I believe. Do you know that this past year NJ's health insurers met an 85% loss ratio as per the NJ SEH board. Also the largest insurer Horizon BCBS met an 88.2% loss ratio.

They're not making egrigous profits. We don't need a public option in NJ to as the President says "KEEP INSURERS HONEST". Costs are rising because of utilization as well as unreimbursed charity care. They're also rising becuase not everyone is in the pool. Get everyone in and costs will come down in NJ.

What we need is insurers to stop giving in to hospitals when it comes to asking for exorbident increases in reimbursements due to their shortfalls in receiving charity care, medicare etc. Let a hospital leave a network, who cares.

The problem is that since many people still have "out of network" benefits if we take this a step further and hospitals drop out of networks for say BCBS they will recieve MORE in reimbursement than if they were in a contracted situation. One way to resolve this? Have everyone in HMO's. Then hosptials would be forced to negotiate with insurers. The downfall? We'd have more hospitals going bankrupt than we do now, but hey our premiums would be more in line. Another way to resolve this? Fix the loophole that has providers reimbursed ridiculously for out of network procedures.

Another solution? Tort reform to stop defensive medicine practices but i guess we know where you stand on that one.

Posted by: visionbrkr | August 24, 2009 11:10 AM | Report abuse

Ezra is 100% correct, delay = no health care reform. But let's acknowledge that Leiberman is a Moses-like figure to insurance and pharm lobbyists.

A holy man.

Posted by: lichtme | August 24, 2009 11:38 AM | Report abuse

Maybe Ezra missed the leaked OMB report that the deficit projections are much worse than they were just 8 short months ago. We are on a path to ruin as a nation if we do not line up our obligations with our financial resources to pay them. Lieberman is wisely saying that we can not take on billions of dollars of increased obligations when there is simply no money to pay them. That is how great nations die.

Posted by: lancediverson | August 24, 2009 11:42 AM | Report abuse

Joementum is concerned about a Libyan that was released from prison by Scots and is demanding a full investigation of something he or anybody in this country has any control over.
He's a grandstanding putz.

Posted by: Canonera | August 24, 2009 12:23 PM | Report abuse

visionbrkr's solutions are interesting, in that he regards the private insurers as the constant, and everyone else -- greedy doctors, greedy hospitals, dumb patients -- as the variables.

But once again, he forgets that when it comes to the crunch, private insurers can be completely written out of the healthcare equation. Doctors and patients, not so much.

Posted by: pseudonymousinnc | August 24, 2009 1:02 PM | Report abuse

Ezra,

Joe the Lieberman began his rejection of liberalism in a big way when he was shunned by Democratic voters and officeholders during run for the presidency in 2004.

Joe and family spent months living on the road during the Dem primaries, and his fragile bitter ego never got over it. Ever since then, he has taken particular delight and gone way out of his way to attack Dems and reject everything actually liberal, including much common sense policies.

Such as telling a raped woman to go to a different hospital for emergency after-rape contraception, if the hospital she had chosen was anti-choice.

The man is bitter, knows no shame, and has no clue of the puniness of his ego. It's always someone else's fault. You're damned right the Democratic Party left him, after it discovered his true colors, during the 2004 primaries.

Posted by: lapiltz | August 24, 2009 1:36 PM | Report abuse

pseudonymousinnc,

haha. everyone's replacable including me. I think i've said that on more than one occasion.

The problem is that NONE of you understand the healthcare system as it is, was or shall be. You cannot take the for profit equation out of it no matter how much you want to. Hospitals are for profit, doctors are for profit, labs, x-rays, every medical provider is for profit. Pharma is for profit.

You can cut off insurers at the knees and force every bit of profit out of there but it still won't solve the problem.


If you think the public option is going to be so good do you not realize that its going to be nothing more than another insurer? For example what if your doctor sends labwork to a lab that doesn't accept the public option. Its not going to be covered just like its not covered when its BCBS.

I think some people have this utopian view of the public option as a cure all and it just won't work that way. Not if its going to rein in costs at all and remain defecit neutral.

And as for dumb patients they are out in abundance. There's nothing that can be done to help in that regard. And some doctors and hospitals are laughing all the way to the bank. But hey don't take my word for it, just look at your premiums that increase so ridiculously high.

Again look to my example of NJ in the past year and their loss ratio. They've squeezed every bit of profit out of it to the levels that even Nancy Pelosi wants and costs are STILL going up.

Posted by: visionbrkr | August 24, 2009 1:52 PM | Report abuse

Please delete Canonera's anti-semitic comment.

Posted by: Dellis2 | August 24, 2009 2:19 PM | Report abuse

"The problem is that NONE of you understand the healthcare system as it is, was or shall be. "

The implication being that you do. Hm. Presumptuous, much?

The public option is important because a mandate without it is a state-run extortion scheme on behalf of parasites.

Posted by: pseudonymousinnc | August 24, 2009 2:24 PM | Report abuse

pseudonymousinnc,


Yes being in the business I do. I have NEVER in my lifetime had costs that were "not covered" by my insurance our outside the realm of what I expected.(I'm fairly healthy and my wife had 3 kids over the past 14 years).

And the sad part of it is that it took relatively little on my part to do this. What you call "work", I call being proactive to ensure my costs are low. It entails just asking your doctor to send lab-work to a participating lab. It entails making sure the doctor you're sent to is participating (5 minutes on a website). if that's too much to ask to help you avoid medical bankruptcy then well I guess you can't be bothered then.

Oh and the kicker is that most of the "steps" that I take in my daily healthcare life are logical steps that anyone would take outside of healthcare.

For example if you were buying a car would you just take someone's word for it and buy the car from a dealer, sight unseen, PRICE unseen??? No absolutely not. Just take that same tact with healthcare decisions whenever possible and you'll have won half the battle.

------------------------------

The public option isn't important. YOu could have a co-op that does everything that your blessed public option does and its the same thing. Who cares what the name is.

And when insurers profits have been destroyed (and i'm fine with that BTW) with an 85% medical loss ratio who will you blame then when costs are going up? The only person left . . .

YOU.

Posted by: visionbrkr | August 24, 2009 2:55 PM | Report abuse

@visionbrkr - I'm happy for you and your family's good health but it's UNEXPECTED medical costs that cause bankruptcy, not "costs that were "not covered" by my insurance our outside the realm of what I expected". People don't expect to have a genetic predisposition to condition X, expect to get an infection, expect to break bones playing pickup basketball, etc. Your anecdotal good health isn't a good stand in for the range of financial challenges facing people with a variety of conditions and a variety of insurance coverages.

Lots (though not all) of private health insurance plans are very good. That's why ALL the plans that have passed committees in Congress encourage you to keep your private insurance!

Posted by: jamusco | August 24, 2009 3:13 PM | Report abuse

Stop putting words in my mouth, visionbrkr.

You've admitted that it takes your insiders' knowledge to get the most out of the system for the least cost. So it's clearly not "just asking" or "just looking at a website".

Even if it wasn't a specious comparison -- as I've said before, and as Ezra has also said countless times -- the tools aren't there to treat healthcare as just another retail purchase. That's mainly because it isn't a retail purchase, just as a corporate database system or industrial plant is not priced for retail.

Where is the Edmunds.com for getting a good deal out of your doctor, or listing the appropriate price for a procedure? Where are the haggling tips? Where's "Healthcare Cheap for Dummies"?

Doesn't exist, because people generally don't show up at a car lot thinking that the salesmen have been trained to *make them better*. Oh, and they trust their doctors.

But please, keep blaming everyone else. It makes the case for proper reform so much more compelling.

Posted by: pseudonymousinnc | August 24, 2009 3:17 PM | Report abuse

pseudonymousinnc,

but the point is I'm no genius. I was an average student at best in school from early education through college. I don't have an IQ that's off the charts by any stretch. I only have insiders knowledge from experience and I think (IMO) i take a common sense approach to things and I pass that rationale onto my clients and they thank me every day for it while you curse me as evil.

My point which you didn't get is I'm a Type A personality, anal retentive to a fault. I'll ask my doctor's office staff at each visit that they send my labwork to a network provider, I'll spend 5 minutes on a website to make sure where I'm sent is participating. Sorry, to me, that's not too much to ask. Maybe it is for you.

I'm not saying you shouldn't trust your doctors because you should. As i've said before they have your medical wellbeing in their best interest but its YOU who should have your financial wellbeing at heart. And there are several simple steps to do that in today's world which I've detailed before.

You keep bashing me but you need to realize that I'm for proper reform too.

As far as haggling tips, I've posted a week or so back to another person that hospital charges when you have no insurance are negotiable. A hosptial wants to get something back and they'll many times take 40 cents on the dollar to ensure they get paid something. Exactly how is that "blaming everyone else?"

Oh and by the way, insurance agents are involved in YOUR proper reform that is H.R. 3200 and every other proposal so you won't be left behind when and if you're not familiar with the government's public option and its intricasies because as we know governemnt never does anything small and easy to understand.

Posted by: visionbrkr | August 24, 2009 3:54 PM | Report abuse

jamusco,

Thanks and I wish you and yours good health as well.

Yes it is the unexpected that causes PART of the medical bankruptcies in my opinion and that's why the reforms that need to happen include caps on costs. We have them here in my state of NJ but they should be nationwide.

In the insurance industry its called "MOOP" or Maximum out of Pocket" but what people dont' realize is that there is no cap on non network serivces, only in network services. I don't expect that a public option would have a cap on these things as well becuase you can't. If a doctor wants to charge $10,000 for an ER visit who is to stop him to do so??? No one asks when going to an ER what they charge nor should they. Do you think the public option will pay him $10,000? Absolutely not. There will be plenty of doctors that won't take the public option and plenty of people still left to medical bankruptcy. In fact there may be more because there seems to be this feeling out there that the glorious public option will cover everything for everyone and I'm sorry that's just not the case.

There are also many times when in emergency situations whether you're in a public option or insurance that it should be treated at 100% of usual and customary so that it keeps the possibility of medical bankruptcy low because in those situations its very difficult if not impossible for people to ensure they're taking steps to keep their costs low.

Posted by: visionbrkr | August 24, 2009 4:05 PM | Report abuse

jamusco,

and that's why I hope progressives if they don't get the reforms they want aren't dumb enough to make sure NO reforms happen as some of them have suggested. An end to pre-ex and an end to recision needs to happen no matter whatever else happens. Republicans need to make sure the right reforms happen too.

Posted by: visionbrkr | August 24, 2009 4:35 PM | Report abuse

The lesson is that party really really matters today in who you vote for, because the parties are so amazingly different.

You could say, I vote for the person and the issues, but if your issues you favor are things like valuing universities, universal healthcare, consumer protections, public investment in basic medical research and science (even a belief in science), not taking a monumental risk of global warming, etc., rather than tax cuts for the rich at all costs and as much as possible, then it's hard to explain how your candidate could chose to be/remain a Republican.

And if he's an independent like Lieberman you have to ask carefully why, and whether you care more about a grandfatherly smile, or health care for your grandchildren.

Posted by: RichardHSerlin | August 24, 2009 8:07 PM | Report abuse

"Oh and by the way, insurance agents are involved in YOUR proper reform that is H.R. 3200"

You're putting words in my mouth again. MY proper reform is H.R. 676 or a variant of it.

"Sorry, to me, that's not too much to ask. Maybe it is for you."

Spare me the pat on the head. Ever spent three hours on the phone to an insurer trying to get a yes/no answer on a particular test? I've seen that happen. James Fallows did recently -- read his blog.

" Exactly how is that "blaming everyone else?""

You've missed my point, again. You're implying that you should just have a good ol' insurance agent who'll tell you how to grease the wheels. I'm still waiting for you to point to the Edmunds.com of the medical world, which treats a broken leg like a 2004 Camry. I'm also envisaging a world in which doctors are regarded with the same respect and trust accorded to car salesmen.

You just don't see what you're doing, which is a whole lotta buck-passing. I have no problem wanting doctors and hospitals brought to heel, but you seem to think that doing that exonerates insurance companies for years of bad faith.

I don't have a problem with insurance agents. They're good at finding the right policy for homes, cars, sailing boats, etc. I want them out of the health business, other than perhaps to cover co-pays and cable TV in the room.

Posted by: pseudonymousinnc | August 24, 2009 10:14 PM | Report abuse

psuedonymousinnc,

well we all know single payer's going nowhere at least for the forseeable future so I won't bother answering that post and there are very valid reasons that it shouldn't go anywhere as well as valid reasons that it could make sense when done the right way.

No I normally spend about 10 minutes on a daily basis on each issue that arises for my clients. The issue gets resolved and then I move onto the next one. AGAIN, I'll give you a heads up on how it works even though I'm sure you'll continue to bash me for doing so. If you care enough to be worried about it get your doctor's tax ID number, the diagnosis and procedure code and then call your insurer with this. They will tell you if its covered. I do it all the time and it takes all of 5-10 minutes, not 3 hours. Oh and get the name of the person you spoke to as a reference point both at the doctors office and the insurer.

Again common sense. No Mensa card required.

I don't think insurers should be exonerated for what they've done negatively in the past just as individuals shouldn't expect to be covered for things while they weren't covered. How is it a healthcare system if you only come into the game when you have a disease like cancer for example? How will that control costs (if you care to at all) if you're only in the game when you most need it? Whether you see it or not people adversely select against insurers all the time and you know who pays for it? Those of us with insurance. No one's going to sympathize nor should they with insurers or even those with insurance espeically if they're speaking to an uninsured person but the fact of adverse selection absolutely happens all the time. I read a study somewhere (can't find it right now or i'd link it) that showed that insurers lose tens of billions of dollars a year from people changing their plan from say a $20 copay to $40 or a $500 deductible to $1000 but the plan takes weeks to put into place and insurers don't go back and revise claims based upon that. Could they, ya sure they could and they wouldn't be wrong to do it but it NEVER HAPPENS.

And as far as insurers covering copays you have no clue, sorry but you don't and its thoughts like that that are bankrupting Medicare. Insurance should be for catastrophic (with catastrophic being a relative term for what an individual can afford). It should NEVER pay for copays. That just breeds excess utilization. Insurance worked in the days of indemnity plans because people had a stake in the game. NOw they don't. Everyone thinks their cost is just $20 when its much more than that.

Posted by: visionbrkr | August 25, 2009 12:40 AM | Report abuse

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