It's Geek Time!

Wow, what a wonderful time to be a healthcare geek! The Obama Health Reform train is fully gassed and charging out of the station…coming this weekend to a living room near you!

In case you missed it, Organizing for America has reached out to David Plouffe’s massive database to enlist grass-roots support for the President’s health reform plan. This Saturday (June 6) people will be hosting house parties across America to discuss reform. Whoda thunkit? Tupperware parties across the U.S. to talk about re-engineering the US health system. Funny thing is, I don’t expect these to be “open-sourcing the solution” events, but rather, “call your representative and tell your friends to do the same” kind of things. I gotta find one to attend! Rumor has it these events are motivated, in part, as a response to Rick Scott’s one-man crusade for personal vindication—but dare I digress.

With that as a backdrop, I loved a HealthLeaders piece from last week titled, “Targeted Tax Hikes Would Raise Billions for Health Reforms.” It had lots of potential blog fodder in it, but my favorite lines came from Michael Cannon, director of health policy at the Cato Institute (just to the right of Ayn Rand). Quote, “It’s a flawed premise—that the problem with healthcare in America is we aren’t spending enough.” If you haven’t seen, there’s a bunch of new taxes being floated out there as a way to pay for the increased costs of universal coverage, including a smack on high-fructose corn syrup-containing sodas. A possible “beer tax” has made news recently as part of a higher levy on alcohol. Then there's everything I blogged about last week about "missed revenue" from taxing employer provided benefits and similar targets (hope you're not in love with your MSA/HSA!).

Today, HLM reported from the blogosphere with posts from top government officials, OMB Director Orszag and CBO Director Elmendorf (everybody blogs these days!). Orszag: “Healthcare reform will likely increase total national spending as healthcare coverage expands under current proposals. However, reform actions eventually will slow the growth of healthcare spending. "What we see is that it takes only 10 to 16 years after reform for federal healthcare spending to be lower than it would have been in the absence of reform.”

“Within the 10 year budget window, the impact of healthcare reform on the budget will be "negligible" because the plan is fully paid for [read: taxes]. The short term increase in spending will be offset with greater revenues. Over the longer term, the budget situation "improves considerably" because healthcare spending declines and because taxable compensation increases.”

Looking back over past blog posts, I know some people might suspect I am a conservative Republican in the classic style. I’m not. Seriously. I’m socially liberal and fiscally conservative…that makes me…well…confused mostly. But I am skeptical of Orszag’s assertion that “the situation” will improve because of projected spending declines and increased tax revenue. I think you can plan for the latter but there’s little-to-no proof you should expect the former.

In the HealthLeaders article, President Obama told the footsoldiers, “If we don't get it done this year, we're not going to get it done…We're going to need to mobilize all of you." I wish I knew where the fire was. Yes it’s a huge and growing portion of the national budget, but, jeezus, taxing the snot out of the populace is not a prescription for political survival. At a time when people are seemingly comfortable to forgo medical treatment, telling them you’re going to pile on their burden so they can be better off…it just doesn’t seem like folks are saying they want it.

I suspect universal coverage has to happen. It’s the only thing the President can do by executive fiat (other than car mergers) and claim victory come campaign time. He can’t stand up at a re-election rally and cry, “on my watch we’ve launched 16 demonstration projects of which 7 show real promise and scalability for long-term health system reform some day!” He can, however, say, “they said it couldn’t be done. But we showed the nay-sayers that by ____ (insert date here), every man, woman and child will have the security of health insurance and no American will ever have to wonder about changing jobs, losing their job or making the right choice for their family because of health insurance.”

So, it’s inevitable. It’s going to be a mess. Senator Kennedy’s Health, Education, Labor and Pensions Committee seems ready to buy-off physicians with the promise of a Medicare +10% fee schedule in return for support of some public plan.

I want it all to work, I really do. And, you don’t make meaningful long-term progress without bold, often controversial short-term actions. I must say that, more than anything else, I am surprised at the size of the risk the President and Congress are willing to take.

Oh, and if anyone gets to one of these health care house parties, please post!!