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Opinion

Commentary: Obama missing some facts on health care

E. Thomas McClanahan - The Kansas City Star

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September 16, 2009 04:12 AM

The first hints of real trouble can be found in President Obama's initial address to a congressional joint session on Feb. 24. That's when the jarring incoherence of his lavish plans came into full view.

He said the "state of the economy is a concern that rises above all others." He said it was imperative that the nation bring its budget under control so that we don't bequeath to our children a debt "they cannot pay."

But by then he had signed a $787 billion stimulus bill that would dramatically worsen the deficit. In that same speech — in which he called the economy the top priority — he pressed Congress to approve major legislative initiatives that had nothing whatever to do with the immediate problem of economic growth: a job-killing cap-and-trade plan and a deficit-bloating health care reform plan.

But that was early in his term. He was still learning. For political cover, he could point to the large deficit inherited from the Bush administration, as well as the severe financial crisis that even then was grinding down college and retirement funds held by millions of Americans.

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With the health care debate, the game is different. He's fully the president now. The honeymoon is over. He's no longer learning on the job. President Bush can't be blamed. It was Obama's decision to move health care to the top of the national agenda.

Now, with the public paying full attention, Obama's poll numbers have gone wobbly. Quickie surveys after last week's speech showed a bounce, but such blips are short-lived. As the debate has progressed, the contradictions embedded in Obama's ideas for health care have become only more glaring.

Last week's speech highlighted the two most obvious problems: his claim that the plan would reduce costs, and his assertion that the goal of the government option is simply to provide honest competition, rather than create a path to a single-payer system.

Obama pledged that he would not sign a reform plan that added a dime to the deficit. He claimed most of the costs could be covered by eliminating waste and inefficiency in Medicare and Medicaid.

That's patently ridiculous. Obama's biggest nemesis in this debate hasn't been the GOP. It's the Congressional Budget Office, which over the last few months has slapped down one dopey Democratic assertion after another. Of the cost issue, the budget office dryly concluded that the Democratic bill in the House fails to offer the "fundamental changes" needed to reduce the ruinous trendline of federal health spending.

Then Obama offered another howler: He would have us believe that if the savings proved insufficient in practice, then Congress would simply cut spending in other areas. He said this with a straight face, but he knows better. Congress isn't an institution known for doing subtraction. The members know that they get re-elected only if they do addition.

As for the public option, Obama said it would not be subsidized, meaning it would have to support itself from what it charged for premiums.

But as former Bush economist Greg Mankiw has pointed out, if such a plan were feasible, why isn't someone doing it now? And even if it isn't initially subsidized, a public option would probably evolve into something like a health care Fannie Mae.

Fannie, the government-sponsored mortgage company, was a private company but it was treated in the market as if it had implicit government backing. Sure enough, as the housing boom went bust, the implicit guarantee became explicit.

"Such explicit or implicit subsidies would prevent a public plan from providing honest competition for private suppliers of health insurance," Mankiw wrote in The New York Times.

"Instead, the public plan would likely undercut private firms and get an undue share of the market."

With the public plan offering a better deal, employers would have an incentive to drop their own plans — even if they have to pay a penalty — and let their workers sign up for the less costly government deal. Indeed, the Congressional Budget Office estimates that 3 million workers will lose their insurance in this way by 2016. Other estimates have been much higher. The appropriate Obamaism here is: "I have no interest in putting insurance companies out of business."

The Democrats have solid majorities. Obama will probably get some bill that will allow him to claim victory. But the last few months have revealed a great deal about this president, and the next three and a half years are likely to be a very rough ride.

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