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What would the 2010 election look like without health-care reform?

Josh Kraushaar makes the case that health-care reform is a primary, not secondary, cause of Democratic distress in this election cycle. He marshals some persuasive evidence (though today's Politico disagrees that Democrats who opposed health-care reform are in good shape), though it's of course difficult to know how it stands up to a counterfactual in which health-care reform failed, or was never tried and was replaced by a push on cap-and-trade. As matters stand, President Obama and the Democrats are not popular and health-care reform is their most visible achievement. It makes sense that some campaigns would use it as a symbol of their failures.

I should say that I anticipated health-care reform would become more popular after passage. That was true for a couple of months, when the plan gained a couple of points, but now health-care reform's popularity is exactly where it was at passage. As the bill hasn't changed during that period, my sense is that has more to do with the deterioration in the economy (and thus in the Democrats' popularity, and the popularity of everything they've touched), but that's only a guess. The reality is that my political prediction on this didn't work out.

But since I'm interested in the counterfactual, let me offer it: How many seats do the Democrats lose in a world where everything is the same -- that is to say, health-care reform passed, and it was an ugly process -- but unemployment is 5.5 percent? How about in a world where unemployment is the same, but health-care reform was never attempted, and the Obama administration instead sought a price on carbon?

My best guess is that Democrats lose 25 fewer seats in the first world and five more seats in the second world (as cap-and-trade would provoke the same outrage on the right, and also harm some traditionally Democratic districts where they mine coal). But that's just my best guess. What's yours?

By Ezra Klein  | October 28, 2010; 9:04 AM ET
Categories:  2010 Midterms, Health Reform  
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Comments

Well, you're not quite grappling with the lazy insider argument. The proposal as I've heard it from Charlie Cook and others is that Obama should have focused like a laser on the economy and dropped everything else. So the primary counterfactual doesn't include a price on carbon either.

But as a number of folks have pointed out (and probably you too), it's not really clear what additional measures Obama would have taken in this counterfactual and how they would have broken through the Republican filibuster. If all we're talking about is optics - Obama talking about the economy every day for two years - then it's an utterly empty idea. And it is, because people like Cook and the National Journal experts know everything about politics and nothing about governing.

Posted by: tomh6 | October 28, 2010 9:22 AM | Report abuse

Ezra, thanks for the insight. I'm hoping to read your "Confirmation: Sun warms the Earth" column tomorrow.

Posted by: 54465446 | October 28, 2010 9:32 AM | Report abuse

"That was true for a couple of months, when the plan gained a couple of points, but now health-care reform's popularity is exactly where it was at passage. As the bill hasn't changed during that period, my sense is that has more to do with the deterioration in the economy (and thus in the Democrats' popularity, and the popularity of everything they've touched), but that's only a guess."

What actually happened is that the costs of the bill started to become more widely known, and in particular the public has received their increased premiums of between 10-15% that wasn't supposed to happen.

Posted by: 54465446 | October 28, 2010 9:39 AM | Report abuse

It was probably always too optimistic about the short term (this election) to think the ACA would be more popular, after all, much of it hasnt gone into effect so all we have to go on is the dueling rhetoric.

My sense is BFD. 20 years from now, that the Democrat party lost the 2010 election because the economy was lousy will be an interesting political bit of trivia. Passing the bill that moved this country toward universal health care is the thing that matters, and if the price is John Boehner becoming Speaker, so be it.

Posted by: zeppelin003 | October 28, 2010 9:43 AM | Report abuse

I would argue that it has much more to do with the current economic conditions than health care reform. This sounds like the case of having a theory and finding information to support it. Does Mr. Kraushaar take into account that Democrats are more popular and the fact that many people oppose health care because it didn't go far enough? What about the enthusiasm gap?

One of the biggest problems for health care reform is that Democrats have lost the message. Republicans have repeatedly lied about the bill and people believe it. Most Democrats that are running aren't talking about all the good things in the reform bill. This lack of support makes it seem like they don't think it is a good bill either and therefore the outspoken Republican opposition has become the conventional wisdom.

Posted by: furrinersblogspot | October 28, 2010 9:44 AM | Report abuse

If the GOP does as well on Tuesday as the polls suggest, then you can expect more demonization of healthcare reform. They'll vote to repeal in the House and then pressure Nelson and Pryor and maybe Manchin to go along in the Senate, and then the President will veto, fortifying their case that he should be a one-termer. Frankly, though, they're right about one thing: no one deserves more blame for these sucky numbers than Obama himself, who allowed the political process to unfold in such a foolish, destructive manner, all because of his own messianic complex.

Never, ever underestimate the Republican party's keen sense of how and why a plurality of Americans consistently votes against its own economic self-interests so as not to be associated with the poor, the minorities, etc. Status, tribal identity, all of it trumps policy, each and every time.

Posted by: scarlota | October 28, 2010 9:48 AM | Report abuse

furrinersblogspot wrote:

"Republicans have repeatedly lied about the bill and people believe it. Most Democrats that are running aren't talking about all the good things in the reform bill."

Yes R's lied about such things as death panels, but overall the D's told many more lies related to cost. All those good things have a price tag, and it was NEVER neutral as Reid, Pelosi, etc, said. You would never believe a builder who told you he could add a room to your house at materials cost only, would you? How could anyone be so foolish to believe that we could add adult children and no pre-existing condition and there would be no cost increase?

The American people are for the most part financial dolts, but even they can see the numbers change when they look at their own premiums!

Posted by: 54465446 | October 28, 2010 10:04 AM | Report abuse

It's the economy, period.

I think a cap and trade bill would have been much worse for the Democrats' election chances because Republicans would have been able to tie the crappy economy and the bill together. They can't do that very well with HCR.

I don't think a cap and trade bill will ever pass in a bad economy. Progressives need to start laying the foundation and making the argument so when the economy recovers we can pass a bill that the public understands.

Posted by: mschol17 | October 28, 2010 10:09 AM | Report abuse

Honestly, Obama could have been sworn into office, declared us the United States of Ronald Reagan, disbanded the Department of Education and Department of Energy, cut capital gains taxes to zero percent, hired John Boehner as his chief of staff, made the NRA the official spokespeople of our National Parks, and built a fence on the Mexican Border that put the Great Wall of China to shame and the GOP would have come out with exactly the same message about Obama and the Democrats: Too liberal, socialists, destroying our economy, too friendly with all the brown folks, shredding the Constitution etc. This was never about what was and wasn't accomplished by the Administration. It was about a poor economy and the Republican anger dial being stuck on eleven as soon as Obama was sworn in.

The Democrats were wise to pass HCR, FinReg, changing Student Loans, and the Credit Card regulations. Similar accomplishments will not be achieved at least until 2013 and probably not for another generation. None of these bills will be repealed outright and all of them set the stage for the real reform which is to follow. I'd say the big question facing Obama (and soon Congressional Republicans too) is what is next for America? We took Reaganomics to its logical conclusion. I think it was horribly unfair, but overall it probably served us well. But now there has to be a new model to replace it. What will it be?

Posted by: klautsack | October 28, 2010 10:19 AM | Report abuse

"What actually happened is that the costs of the bill started to become more widely known, and in particular the public has received their increased premiums of between 10-15% that wasn't supposed to happen. "


Bingo. They passed health care reform in the absence of logic and economics and then cried about the predictable results.

We got:

1. Higher premium increases (team obama admitted this would happen)
2. Companies dropping child only policies (team obama knew this would happen and whined about it anyway)

Of course, Obama tried to pay off his 18-25 base by letting them leech off the hard work of others. But I don't think that counts enough, since most of my 18-25 year old friends are still struggling to find jobs as they graduate from school.

Sucks to be an elitist liberal.

Posted by: krazen1211 | October 28, 2010 10:19 AM | Report abuse

"The Democrats were wise to pass HCR, FinReg, changing Student Loans, and the Credit Card regulations. Similar accomplishments will not be achieved at least until 2013 and probably not for another generation. None of these bills will be repealed outright and all of them set the stage for the real reform which is to follow. I'd say the big question facing Obama (and soon Congressional Republicans too) is what is next for America? We took Reaganomics to its logical conclusion. I think it was horribly unfair, but overall it probably served us well. But now there has to be a new model to replace it. What will it be?"


What it should be is to ensure that America has the necessary tools to compete in the global economy.

In New Jersey, for instance, we have politicians that march in lockstep with the teachers and public sector unions.

We spend over $1.5 billion a year on retiree 'benefits' rather than using that money to build a tunnel to New York City.

Posted by: krazen1211 | October 28, 2010 10:26 AM | Report abuse

A WSJ report ("Health Law Unpopular in Key House Districts", http://online.wsj.com/article/SB10001424052702303443904575578702952382546.htm) mentions that the PPACA is wildly unpopular in close House races; however, the report also reaches the more important conclusion that "On the state level, victories by Republican governors could lead more states to turn away funding to enact the law, as Minnesota's Republican Gov. Tim Pawlenty has done."

One interesting counterfactual is that when the unpopular PPACA disappears (as it indeed will do, most likely gradually) its disappearance will also benefit its opponents and not its advocates. At this point, it's the effect in the 2012 election that really matters.

Posted by: rmgregory | October 28, 2010 10:37 AM | Report abuse

krazen1211-

"What it should be is to ensure that America has the necessary tools to compete in the global economy."

That's conservo-speak for freezing wages. That's what's been done for the past thirty years. We were able to maintain consumption even in the face of flat wages by making credit cheap and later by forcing families to become two-income entities. Now we've basically tapped out that source of additional consumption. The result is that people are now realizing that they can't keep spending and domestic consumption is flat. And so the conservative answer is: Lower wages and fewer benefits. I don't get how that gets us back to a solid economy unless we dramatically de-value the dollar. Do you really want to turn us into China that badly? You always struck me as an anti-Maoist.

Posted by: klautsack | October 28, 2010 10:46 AM | Report abuse

When you add more people to your health insurance the price always goes up to cover possible future needs! Doctor and Hospital Costs have risen as well.

If you feel your Insurance Bill is overzealous with premium increases; File a Complaint with your State Insurance Board! That's what they are there for! If you live in a Republican State like Texas expect your complaint to disappear the first few times; be persistent.

Posted by: ddoiron1 | October 28, 2010 10:50 AM | Report abuse

What klautsack said. (Better than I could have.)

Plus, counterfactuals have to remain within the realm of plausibility. I don't think your first counterfactual--the one in which unemployment is reduced to 5.5% within eighteen months is plausible within any scenario in this recession. Also, an unexamined statement: "President Obama and the Democrats are not popular." Obama, as has been noted many times before, remains significantly more popular at this point in his presidency than Ronald Reagan or BIll Clinton, and more popular than Congressional Republicans for sure. And the generic D-R congressional polls have been relatively even (though they seesaw a bit) all year.

So in the end, I have to decline playing this game. The premises are just too weak. We're having a fairly normal midterm, in which the party out of power gains seats. And normal is fairly remarkable, given the level of orchestrated and spontaneous crazee out there.

Posted by: JJenkins2 | October 28, 2010 10:58 AM | Report abuse

Here in Maine, I have been receiving 5x11 mailers from 60 Plus, claiming "Obamacare" and the stimulus are the end of the world, with pictures of Depression style bread lines to prove it. These come at least every 2 weeks, and have been for probably at least the last 9 months. That's a lot of pressure.

Posted by: GBMcM | October 28, 2010 11:17 AM | Report abuse

Here in Maine, I have been receiving 5x11 mailers from 60 Plus, claiming "Obamacare" and the stimulus are the end of the world, with pictures of Depression style bread lines to prove it. These come at least every 2 weeks, and have been for probably at least the last 9 months. That's a lot of pressure.

Posted by: GBMcM | October 28, 2010 11:18 AM | Report abuse

54465446 the Premium increases have almost nothing to do with the health care reform bill. This is another lie. Even the Insurance industry says the majority of the increases are due to the rising cost of care.

As far as the costs, the CBO reported out cost savings. Is the CBO no longer a reliable source? If so, where are you getting your numbers from?

Posted by: furrinersblogspot | October 28, 2010 11:25 AM | Report abuse

How about the counterfactual where Obama didn't try health care or cap-and-trade, but focused everything on short-term stimulus combined with long term deficit reduction? What if Obama invested all his political capital into a $1.6 trillion stimulus spread out over 4 years (or maybe even $2 trillion spread out over 8-10 years), and keeping out the portions of the stimulus that were ineffective tax cuts meant to get GOP vote and ineffective Dem pet projects? And then an immediate pivot to deficit reduction to be phased in a few years from now?

Some will say that would've been impossible to do, but I find it no less impossible than getting health care passed. In fact, I find it amazing that the same people who were absolutely sure it was right to do ObamaCare rationalize it by saying further stimulus was impossible.

My guess is that unemployment now would still be around 8%, and stimulus still would've been declared a failure, and there'd be losses, but far fewer losses. I think the bigger key is that the economy would be stronger in 2012, plus would be able to start running on its own steam instead of stagnating once the stimulus phased out (as it has done now). So the Dems would be better off in 2012 and after, even if not significantly better off now.

Of course, then we wouldn't have universal health care...

Posted by: JamesCody | October 28, 2010 11:26 AM | Report abuse

furrinersblogspot-

That's all true, but it's not even the weakest part of citizen # 54465446's argument. All the stuff he mentions are the parts everyone (including Republicans) were supposedly in favor of. What people were split on was the individual mandate. And the mandate was the principal cost-control mechanism. In theory there is also cost control in the mandate that 85% of insurance companies' revenue go toward providing care, but that aspect seems much greyer (Bruce Webb has written about this).

Of course, the Republicans said they were in favor of all of the cost-escalating parts of the bill while they were opposed to the cost-control parts of the bill, but I suspect that if the cost-control parts of the bill were stripped out, they would have still voted against it because their problem wasn't HCR but Obama.

Posted by: klautsack | October 28, 2010 11:53 AM | Report abuse

ddorion1,

you're scary lack of knowledge regarding health insurance and what drives costs is, well SCARY.

and what furrinersblogspot doesn't tell you is that while the rising cost of care is the main driver of cost (not the only but the main as dependent coverage to age 26 isn't free) the main driver of cost's rising is doctors fees rising. Since there is no true marketplace for doctors fees and since we're all hidden from what doctors charge they can and do raise their fees to astronomical levels.

And through all that the insurance industry gets blamed.

Its like your taxes going up and blaming your accountant instead of the government that's raising taxes.

STUPID.

Posted by: visionbrkr | October 28, 2010 12:12 PM | Report abuse

Trying to link the economy to Health care was convuluted and the population could see right through it, because it's been a liberal wish since Truman. I think the opposite of mschol17. The economy and energy has a much more natural link and maintains the jobs focus. He could have sold a Manhattan project approach to energy creation and the nation would have bought it hook, line and sinker. Whether building wind and solar farms, high speed rail or nuclear, those are tangible jobs that people could see and would maintain the laserbeam focus on jobs that was lost on the healthcare debate. It may have actully reduced unemployment as well by building a new economy. The current healthcare bill took an ungodly amount of time and did nothing for unemployment, that is a big reason why they will lose and lose big.

Posted by: Jenga918 | October 28, 2010 12:26 PM | Report abuse

Trying to link the economy to Health care was convoluted and the population could see right through it, because it's been a liberal wish since Truman. I think the opposite of mschol17. The economy and energy has a much more natural link and maintains the jobs focus that was lost during the healthcare debate. He could have sold a Manhattan project approach to energy creation and the nation would have bought it hook, line and sinker. Whether building wind and solar farms, high speed rail or nuclear, those are tangible jobs that people could see. It may have actually reduced unemployment as well by building a new economy. The current healthcare bill took an ungodly amount of time and did nothing for unemployment, that is a big reason why they will lose and lose big.

Posted by: Jenga918 | October 28, 2010 12:28 PM | Report abuse

How mentally defective do you have to be to believe cap-and-trade would be more popular than health care reform?

Health care reform gave millions of people SOMETHING, to solve a problem that many of them cared about and had cared about for many years. Checks for the donut hole, coverage for kids under 26, all this happened in September.

Cap and trade gives people NOTHING, and it solves a problem that many of them don't believe even exists, while the people who do believe it exists don't really care all that much about it. Oh, and it has the added bonus of solving this problem so slowly that most people won't even notice that the situation is improving!!!

Next week, I look forward to seeing this guy argue that punching the voters in the nose would have been smarter for the Democrats than sending them a check in the mail.

Seriously, how freaking STUPID can political analysis get?

Posted by: theorajones1 | October 28, 2010 12:57 PM | Report abuse

How mentally defective do you have to be to believe cap-and-trade would be more popular than health care reform?

Health care reform gave millions of people SOMETHING, to solve a problem that many of them cared about and had cared about for many years. Checks for the donut hole, coverage for kids under 26, all this happened in September.

Cap and trade gives people NOTHING, and it solves a problem that many of them don't believe even exists, while the people who do believe it exists don't really care all that much about it. Oh, and it has the added bonus of solving this problem so slowly that most people won't even notice that the situation is improving!!!

Next week, I look forward to seeing this guy argue that punching the voters in the nose would have been smarter for the Democrats than sending them a check in the mail.

Seriously, how freaking STUPID can political analysis get?

Posted by: theorajones1 | October 28, 2010 12:57 PM | Report abuse

furrinersblogspot wrote:

"54465446 the Premium increases have almost nothing to do with the health care reform bill. This is another lie. Even the Insurance industry says the majority of the increases are due to the rising cost of care.

As far as the costs, the CBO reported out cost savings. Is the CBO no longer a reliable source? If so, where are you getting your numbers from?"


You are completely incorrect. The head of the FEHB ,and United Health have both stated that covering increased numbers of people is behind the larger increased premiums.

This was eminently foreseeable. How on earth did you think that you could add hundreds of thousands, perhaps millions of people to the rolls, as was done in October, and NOT increase premiums? You DO know that adult children have already been added do you not?

Furthermore the CBO can only go by what they are given. For instance, the CBO estimated cost savings from reductions to Medicare providers payments in their estimates. These cuts have been waived by every Congress, R or D, since they were first authorized. They will NEVER occur. Yet, the CBO HAD to include them in their cost estimates.


Posted by: 54465446 | October 28, 2010 1:39 PM | Report abuse

There's also the little surprises like the 1099 Reporting Requirement that Democrats claim they didn't know about in the bill.

http://voices.washingtonpost.com/ezra-klein/2010/09/the_senate_fails_small_busines.html

@furrinersblogspot "As far as the costs, the CBO reported out cost savings. Is the CBO no longer a reliable source? If so, where are you getting your numbers from?"

Provisions like the 1099 one which are unrelated to core health care were used to game the CBO score, so no, on this particular matter the CBO is not a credible source. This isn't because the CBO is dishonest but it's scoring process can be manipulated to produce the desired result. I predict this trend will continue and get worse in future Congresses.

As far as numbers go, I'd recommend this:

http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-1.html

Lastly, three promises were made by Obama regarding health care reform:

1. We can cover (almost) everyone
2. Costs will go down
3. If you like what you currently have, you can keep it.

You can't have all three at once. One of the three has to give. If supporters are correct, it will most likely be #3 through the effects of the payment advisory board on insurance practices over the long term. If the opponents are correct, it will most likely be #2 as the aforementioned advisory board is either overruled by Congress or lobbied into ineffectiveness.

Posted by: jnc4p | October 28, 2010 2:08 PM | Report abuse

Also, regarding popularity don't forget the effect of this:

"Democrats: 'If We're Gonna Lose, Let's Go Down Running Away From Every Legislative Accomplishment We've Made'"

http://www.theonion.com/articles/democrats-if-were-gonna-lose-lets-go-down-running,18333/?utm_source=recentnews

Posted by: jnc4p | October 28, 2010 2:13 PM | Report abuse

54465446 - You're buying the rhetoric of the insurance industry. Jay Angoff, who heads the Office of Consumer Information and Insurance Oversight for the U.S. Department of Health and Human Services. "It would be inaccurate and silly to blame [the increases] on the new law,". Angoff goes on to say that the increase due to the bill, including being covered up to 26 years of age, is between 1% and 2% not the 20% the insurance company is peddling.

Additionally Robert Zirkelbach of the insurance industry trade group America's Health Insurance Plans, says "In fact, the evidence is very clear that the rise in medical costs is a key factor in driving up health insurance premiums,".

I don't find where Congress has waived the cost controls that the CBO used. Yes, there are Republicans who are trying to repeal the savings that pay for the bill but in the context of Ezra's question people are not voting against Democrats because Republicans plan on ruining it later.

Posted by: furrinersblogspot | October 28, 2010 2:28 PM | Report abuse

On the Daily Show last night Obama said (paraphrasing) - "We have a framework in place that allows future reforms to happen....Remember that Social Security initially only covered widows and orphans". I think he basically acknowledged what everyone already knows to be true. That is, the current bill is a placeholder that will be modified by future Congresses, but there is really no going back at this point. Overall, it's not a terrible bill, but probably the single most important thing it does is to acknowledge that the Federal government has some role in making sure health care is adequate for the entire population. Once you get comfortable with that premise, things like the Public Option, expanded Medicare, or Single Payer (on the outside margins) don't seem so foreign. I think that Conservatives understand this maybe better than Progressives do and it explains why they were raving made over this even though they couldn't really point to anything in the bill that was a deal breaker. The individual mandate is the closest they came, but even if that part of it gets struck down by the Supreme Court, the bill doesn't necessarily fall apart. It simply provides the starting point for the coming fight over the Public Option.

Posted by: klautsack | October 28, 2010 2:35 PM | Report abuse

jnc4p - The Article by Ezra that you link does not show why health care reform is the Democrat's Waterloo. I would be shocked if the people who are voting for Republicans this year, point to provision 1099 as the rationale behind their vote.

Also the New Yorker article is hardly an adequate substitute for the CBO report. It contains almost no cost analysis what so ever other than costs of insurance for various groups. That is not an analysis of the overall costs of the bill. Even if the CBO numbers are off they would have to be significantly off to eliminate the $1.3 trillion in savings this bill provides in the second decade.

Posted by: furrinersblogspot | October 28, 2010 2:53 PM | Report abuse

Where did I say Cap and Trade? Reading comprehension is not your strong suit oraljones. If healthcare gave millions something and sending checks in an attempt to buy votes is all it takes, then you should have nothing to worry about next Tuesday. A energy policy on steroids and specifically one that enhanced infrastructure and did not penalize the current forms we have, wouldn't have given them nothing. It may have given them a frigging job, which is more than healthcare did. The minute they shifted to healthcare, they lost the jobs message and never got it back. Most people know we have an energy problem. Four dollar a gallon gas was not that long ago. Selling it as a global warming policy wouldn't have worked. Selling it as a sustainability problem would have.

Posted by: Jenga918 | October 28, 2010 3:13 PM | Report abuse

jnc4p,

actually the IRS has stated that the reporting requirement is being pushed back for now.

http://www.irs.gov/pub/irs-drop/n-2010-69.pdf

furrinerblogspot,

everyone who pays attention knows that the whole "we're saving a trillion dollars+" is a load of crap to put it nicely. First off it doesn't take into account the doc fix, secondly it doesn't take into account the CLASS act which is using class act premiums to pay for this but not factoring in monies that will go out due to the CLASS act. Its like letting Bernie Madoff concoct a ponzi scheme to pay off those he already swindled.

Add to that the fact that your comparing something that is UnGodly expensive to something that is a little less expensive than UnGodly. Sure you're saving but its still WAY MORE than we should be spending. Talk true cost controls and you'll get my attention, otherwise you're nibbling at the edges and paying off groups that pushed your reform. My God they gave Pharma tens of hundreds of BILLIONS of dollars of future expenditures (increased the length to generics) so that they'd spend $170 million to push pro reform ads? I'd rather them have taken it out of the Treasury.

Posted by: visionbrkr | October 28, 2010 3:31 PM | Report abuse

furrinerblogspot:

Look you're an intelligent person. You can see that the 1 to 2% number is beyond minimization. We are talking about mandatory insuring those MOST likely to require large payouts, namely those with pre-existing conditions. Keep in mind the FEHB already was forbidden to discriminate against them so that the FEHB increase will be less than those in private industry who have to change their coverage.

However, I am not saying that is the ONLY reason costs go up, just that the program was sold that there would be NO increase because of the legislation.

You wrote:


"I don't find where Congress has waived the cost controls that the CBO used. Yes, there are Republicans who are trying to repeal the savings that pay for the bill but in the context of Ezra's question people are not voting against Democrats because Republicans plan on ruining it later."

Why can't you find what is so easily available?

"The current physician payment baseline, based on 1996 expenditure levels, is no longer useful – it paints a false picture of actual Medicare spending. Medical technology, Medicare coverage and benefits, and the cost of running a medical practice have all changed drastically since 1996 yet the SGR has failed to adequately recognize those changes.

 Congress has ignored the baseline by interceding six times since 2003 to temporarily stop Medicare physician payment cuts. This has created a very large SGR debt burden that is impossible to eliminate if kept on the current path of kicking the can on reform to another year."


The CBO analysis included a reduction of 21% in Medicare payments as mandated by the 1996 legislation. As I stated before this will NEVER happen, and in fact Medicare provider payments will INCREASE, not decrease.

Again the goals and many of the provisions of the legislation are laudable but the budgetary numbers are beyond fantasy!

Posted by: 54465446 | October 28, 2010 3:37 PM | Report abuse

my wife is a human resource director of a mid-size company, she informed me that starting this January, her employees will be elgible to receive Mental health care benefits every day of the week, if the employee so chooses. Is this True ?

Posted by: tomkat2 | October 28, 2010 3:52 PM | Report abuse

my wife is a human resource director of a mid-size company, she informed me that starting this January, her employees will be elgible to receive Mental health care benefits every day of the week, if the employee so chooses. Is this True ?

Posted by: tomkat2 | October 28, 2010 3:53 PM | Report abuse

(CNSNews.com) – Congressional Budget Office Director Douglas Elmendorf said the most significant economic effect of President Barack Obama’s health care reform package will be to drive people out of the job market.

“For the economy outside the health sector, the most significant impact of the legislation will be through the labor market,”Elmendorf said on Oct. 22. “We estimated that the legislation, on net, will reduce the amount of labor used in the economy by roughly half a percent, primarily by reducing the amount that people choose to work.”

Elmendorf made the remarks at a conference sponsored by the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California.

He explained that people would choose not to work because they could subsist on the generous federal insurance subsidies and Medicaid payments contained in the health care overhaul.

“Some provisions of the legislation will discourage people from working more hours or entering the workforce, and other provisions will encourage them to work more,” he said, adding that “[t]he net reduction in the supply of labor is largely attributable to the substantial expansion of Medicaid and the provision of subsidies through the new insurance exchanges.”

Elmendorf’s analysis of the health care law’s economic impact seems to support House Speaker Nancy Pelosi’s (D-Calif.) seemingly off-the-cuff remark in May when she said that because of the subsidies in the health care bill, people could quit their regular jobs and pursue their artistic dreams because the government would now provide for their health care.

Posted by: tomkat2 | October 28, 2010 3:59 PM | Report abuse

@visionbrkr "jnc4p,

actually the IRS has stated that the reporting requirement is being pushed back for now.

http://www.irs.gov/pub/irs-drop/n-2010-69.pdf"

The document you linked to is a reporting requirement for group insurance costs on a W2 for an employee, not the 1099 requirement for all vendors of a company. I don't believe the 1099 requirements takes effect until 2012 and the Republicans should have it repealed by then.

Posted by: jnc4p | October 28, 2010 4:05 PM | Report abuse

@furrinersblogspot "jnc4p - The Article by Ezra that you link does not show why health care reform is the Democrat's Waterloo. I would be shocked if the people who are voting for Republicans this year, point to provision 1099 as the rationale behind their vote.

Also the New Yorker article is hardly an adequate substitute for the CBO report. It contains almost no cost analysis what so ever other than costs of insurance for various groups. That is not an analysis of the overall costs of the bill. Even if the CBO numbers are off they would have to be significantly off to eliminate the $1.3 trillion in savings this bill provides in the second decade."

The 1099 provision is an example of how the idea of "we have to pass the bill so that you can find out what is in it" hasn't worked out quite so well for Democrats, which was the original premise of Ezra's projection that the health care law would increase in popularity after the smoke cleared from the original legislative battle, much like Social Security did.

(http://www.speaker.gov/newsroom/pressreleases?id=1576)

Regarding John Cassidy's articles, I agree with his main points about the subsidies:

"The problem is fundamental. Setting aside the expansion of Medicaid and some long-overdue restrictions on the egregious behavior of health insurers, this isn’t really health-care “reform”: it is a significant expansion of the current system of private insurance, with the taxpayer footing the bill."

http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-1.html

"The C.B.O.’s analysis can’t be dismissed out of hand, but it is surely a best-case scenario. Again, I come back to where I started: the scale of the subsidies on offer for low and moderately priced workers. If economics has anything to say as a subject, it is that you can’t offer people or firms large financial rewards for doing something—in this case, dropping their group coverage—and not expect them to do it in large numbers. On this issue, I find myself in agreement with Tyler Cowen and other conservative economists. Over time, the “firewall” between the existing system of employer-provided group insurance and taxpayer-subsidized individual insurance is likely to break down, with more and more workers being shunted over to the public teat."

http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-2.html

The general history in this country is of underestimating the cost of new entitlement programs (with the notable exception of Medicare Part D). This would be less of an issue if the Democrats had primarily sold health care reform as a matter of it being worth the additional cost of insuring the uninsured. But they didn't. They sold it as having your cake and eating it too.

Posted by: jnc4p | October 28, 2010 4:22 PM | Report abuse

jnc4p,


sorry my bad. But i'd also say word is that they're looking to either scrap that portion or not enforce it.

tomkat2,


I don't believe that's the case (re: mental health benefits) but every policy is different. The mental health parity laws state they have to be treated as any other illness but does not stop plans from capping the number of outpatient visits at a reasonable and in turn affordable number. Same goes for physical therapy, speech therapy etc.

Posted by: visionbrkr | October 28, 2010 4:34 PM | Report abuse

We are really on the same page here with different conclusions. I believe the health care reform is good and saves money and the sources I have confirm this. Based on that I don't think health care reform is the reason for Democrats to lose seats.

You believe that it does cost money and your sources back that up sand based on that you believe the health care reform will cost Democrats in the election.

I haven't changed your mind and you haven't changed mine. If only Congress could debate these facts and root out the reality of it, we might have a really good health care reform bill.

Posted by: furrinersblogspot | October 28, 2010 5:10 PM | Report abuse

Think again why it might be growing in

UNPOPULARITY!

Read this Huffington Post article and see 1 reason why people are running from this healthcare debacle of a "reform" scam.

http://www.huffingtonpost.com/david-mixner/millions-of-lives-will-be_b_775494.html

Posted by: hcp1000 | October 28, 2010 5:57 PM | Report abuse

Independents (high turnout) are leaning 52% to 37% in favor of Republicans. Adding on undecided voters in rough proportion, and we're at 58% to 42%.

http://www.gallup.com/poll/127439/Election-2010-Key-Indicators.aspx

54% voted for Obama in 2008.

http://theweek.com/article/index/204772/why-are-independents-abandoning-obama

This isn't exactly apples to apples, but that suggests roughly a 12% pickup for the Republicans and a corresponding 12% loss for Democrats.

I'll arbitrarily attribute about half of that to the health care law - while the economy matters, I think focusing on health care over the economy probably turned off some single issue "economy" voters in addition to the independents against PPACA by itself. Also, you have to consider the effect of PPACA on turnout for both Republicans and Democrats which I'd take to be higher and lower, respectively.

Assuming self described independents are about 1/3 of the electorate, and half of the 24% swing in support is due to PPACA, meaning that (barring additional data) I'll interpret any Democratic loss by less than 4% as PPACA-related.

Given that tea party reaction has somewhat reduced electability for Republicans, I'll consider any close races by tea party candidates as effective PPACA casualties (i.e. a regular Republican would have won).

I'm not sure how that translates into seats, other than more than 5.

By the way, if unemployment was somehow down to 5.5% from 10% a year ago, I'd expect the Democrats to be picking up many seats (and if 5.5% from a hypothetical 5.5% a year ago, I'd agree with Ezra on minus a modest amount of seats).

Posted by: justin84 | October 28, 2010 6:13 PM | Report abuse

If the deal had been to drop the Medicaid expansion and the individual mandate, leaving in the public option, we'd be on a different planet right now.

Democrats would be touting reform in re-election ads portraying HCR as part of a "market based" solution to the economy as well as the health care crisis, liberals and progressives would be leading the charge, moderates wouldn't be complaining and Republicans would be shouting "Socialism!" no louder than they already are.

Basically, this is a terrible strategic mistake, or really, maybe, collateral damage from the incapacity and death of Sen. Ted Kennedy.

Posted by: pmcgann | October 28, 2010 7:24 PM | Report abuse

CONTINUE LAUGHTER


Anyone with a brain and common sense can see the UTTER STUPIDITY of RAMMING THROUGH a FISCAL MESS in a DEPRESSION.

Kid, if you cannot -- you are beyond help. Quit, and get a job at McDonald's.

Posted by: russpoter | October 28, 2010 11:09 PM | Report abuse

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