Robert Samuelson: BHO, Leader of the Status Quo

Michael C. Moynihan | August 10, 2009

If you hoped the debate Obamacare would be a break from business as usual, or that this administration was sitting on some clever plan to expand coverage while reigning in costs (ha!), Washington Post columnist Robert Samuelson advises you to think again. On health care, this guy is more status quo than Rick Parfitt:

One of the bewildering ironies of the health-care debate is that President Obama claims to be attacking the status quo when he's actually embracing it. Ever since Congress created Medicare and Medicaid in 1965, health politics has followed a simple logic: Expand benefits and talk about controlling costs. That's the status quo, and Obama faithfully adheres to it. While denouncing skyrocketing health spending, he would increase it by extending government health insurance to millions more Americans.

Between 1965 and 2008, Samuelson writes, health payments for individuals ballooned, "from less than 1 percent of federal spending...to 23 percent..."  Obama blathers on endlesslessly about the need to control costs, but hasn't even head faked in that direction:

Just imagine what the health-care debate would be like if it truly focused on controlling spending.

For starters, we wouldn't be arguing about how to "pay for" the $1 trillion or so of costs over a decade of Obama's "reform." Congress wouldn't create new benefits until it had disciplined the old. We'd be debating how to trim the $10 trillion, as estimated by the CBO, that Medicare and Medicaid will spend over the next decade, without impairing Americans' health. We'd use Medicare as a vehicle of change. Accounting for more than one-fifth of all health spending, its costs per beneficiary, now about $12,000, rose at an average annual rate of 8.5 percent a year from 1970 to 2007. (True, that's lower than the private insurers' rate of 9.7 percent. But the gap may partly reflect cost-shifting to private payers. When Medicare restrains reimbursement rates, hospitals and doctors raise charges to private insurers.)

Way back in January, Samuelson offered up a series of "lessons from the great inflation." Click here to see Samuelson discuss his lastest book, The Great Inflation and Its Aftermath, with Reason.tv's Nick Gillespie.

Comments

|8.10.09 @ 6:09PM|#

The first half of the article is right on.

The last part, about "capitation" payments is way off.

Picture this shit. Instead of fee-for-service, doctors would get paid a fixed value depending on how many people they served.

Instead of being paid for each service, doctors would be paid "by the hour" depending on how many patients they have.

I know most doctors are hard working, caring people, but don't you think the quality of care would go down? And I mean down from the quality of care most people experience now.

This capitation plan is total numbskullery.

|8.10.09 @ 6:16PM|#

That Rick Parfitt reference was downright Dennis Millerian in its obscurity, MCM.

Medicare Rocks!|8.10.09 @ 7:27PM|#

My bro' is in hospital administration.

He tells me Medicare says "This is how much we'll pay for that procedure." The hospital raises rates on everyone else to cover the shortfall.

Can't wait till an expanded Medicare shorts hospitals on EVERY procedure in the nation!!!

The Libertarian Guy|8.10.09 @ 7:39PM|#

"The last part, about "capitation" payments is way off."

If Obama keeps working his way towards being King, like Bush did, he can talk about DEcapitation payments.

And no one will be allowed to live after disagreeing with Him.

chi pink flat iron|8.11.09 @ 3:42AM|#

　Fear not that the life shall come to an end, but rather fear that it shall never have a beginning.

timbo|8.11.09 @ 8:35AM|#

Oddly enough Jonathan Cohn at The Treatment starts his response to Samuelson with the exact same quote. My reaction was a combination of Oatwhore's and Cohn's:

Samuelson sounds like he's endorsing Clintoncare '94. How odd.

Now it seems like Michael Moynihan is also endorsing Clintoncare '94, albeit in a one-step-removed-I'm-just-linking kind of way. What an odd morning.

Brian Combs|8.11.09 @ 9:32AM|#

I didn't read it as an endorsement of Clintoncare '94. To me, the message was "fix what's broken before you expand what's broken". That seems like a very pragmatic approach.

|8.11.09 @ 3:18PM|#

Capitation was tried during the '90s. Everyone hated it. It didn't really save money in the long run.

So, we have a tried-and-failed idea for health care reform. Let's try it again!

Health care will continue to be an insoluble "problem" until people can give up the idea that the third-party payer should pay first-dollar for anything, or that there shouldn't be substantial co-pays and/or deductibles for everything. Until the consumer has skin in the game, the system is fucked. Period.