Medicare Math: The Latest With Which to Discombobulate Your Mind, Wallet, Future


If you're left puzzling over how to carry the $940 billion in spending and subtract the $138 billion in deficit reduction as health care reform is being debated, check out Tobin Harshaw's excellent round-up of dueling scratchpads over at the New York Times' Opinionator blog. The conclusion, after running through a pretty thorough summary of arguments claiming the bill does cut the deficit over its first decade and that it does not (Reason's own Peter Suderman has a star turn in that section!): "Only time will tell."

Those last four words are the saddest in an opinion editor's vocabulary — always true and never helpful in the slightest. The additional problem here, of course, is that members of Congress have only the rest of the weekend to guess what time will reveal.

More here.

It seems to me that if that's the best you can come up with after running through the numbers, that's enough on its face to say no to this bill, given all the other stuff it does, from mandating insurance coverage, to expanding all sorts of control over how coverage is delivered. Given the history of other interventions into the medical industry, it's implausible that this won't end up costing massive amounts more than whatever figures are being bandied about.

But apart from that, this doesn't even represent a fundamental reform, one that would radically open up the health care industry to the sorts of personalized service and market competition that have actually driven costs down and services up in every other aspect of the economy that is not subject to huge amounts of cheap government money and subsidies (read: house prices and education, which along with health care tell you everything you need to know about what happens when the government gets overly involved in a given sector).

It's also worth noting that a hunk a hunk a burning change is not included in this bill but is surely coming down the road. That's the so-called "doc fix," which routinely staves off cuts in Medicare reimbursements to physicians in the name of propping up one of the great boondoggles of the past 45 years. As Reason alum Ed Carson writes in Investors Business Daily:

The Sustainable Growth Rate imposes automatic cuts in Medicare payment rates to doctors.

For several years, fearing a revolt by doctors — and seniors — Congress has suspended those cuts. The original draft of the House health care bill included a permanent "doc fix." But that ballooned deficits, so Democrats dropped it, even though everyone knows Congress isn't going to slash doctors' rates. The CBO has estimated a "doc fix" would cost $247 billion over 10 years.

Supposed cuts in Medicare spending help to squeak this bill under the fake door titled "cuts deficit by a teeny amount over its first 10 years," as does the inclusion of a student loan provision (yes) in the reconciliation version that cuts subsidies to private lenders for student loans. Don't hold your breath on any of this actually happening. The feds, you see, are looking to cut out the middleman when it comes to brokering student loans; they promise $19.4 billion in savings from this, which as Carson writes, "for virtually all of the $19.8 billion in deficit reduction from the [House's] health care reconciliation bill." 

Regarding the "doc fix," look for it to come into play soon enough if/when the health care reform passes. Here's Speaker Pelosi talking on the record on Friday, on why the fix wasn't in the bill that's getting voted on today. Especially since a permanent fix was part of earlier versions of the House bill:

Well, we have been including it in legislation for a long time, because it's not about a doctor fix, it's about our seniors or anyone who relies upon Medicare to have access to physicians, that they be in their region and in their program.

So this is again, you call it the doctor fix, but it is really about access to health care for Americans. It's not in this bill, but we will have it soon. And we have made a commitment to do this. This is very important.

That's from the liberal site TPM, which notes "Leadership aides would never say that a doc fix definitely won't happen." Which is, of course, another way of saying they will. And when they do, say goodbye to even the fiction of deficit cuts via a $940 billion (and counting) health care reform bill. But as any number of really bad gamblers could tell you (but probably wouldn't): You gotta spend money to lose money.

NEXT: Health Care: Endgame

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. Of course it’s not a fundamental reform. How would entrenching the existing interests onto the government payroll constitute a fundamental reform. It’s the ultimate bulwark against reform, an unbreachable wall against reform ever threatening the powers that be again.

    It’s Chicago.

  2. Even if they believe that they are doing good, they shouldn’t try to cram this bill down the throat of the hundreds of millions of people who are against it. Socialism can only work when large percentages of the population agree on the specifics, which is why a government encompassing 300 million people has a much harder time passing such “reforms” than smaller, more homogenous countries. How can you possibly please all interests, without picking favorites, and please all 300 million individuals concerned in a way that people can even come to a majority consensus? You can’t!

    Why couldn’t we have experimented with a basket of reform options on the state level first? Could we have given deregulation a shot? What the hell!

  3. On an unrelated note, i was watching paul ryan talk about medicare, and couldn’t help getting pissed off at all of the old people worried about their medicare. As a 23 year old, I don’t take too kindly to being asked to pay into a system that I’ll never be able to conceivably benefit from. Not only will I never benefit from the system, it will bankrupt me, and take me down with it as it collapses.

    I’m sorry, but aren’t senior citizens the richest segment of society? Didn’t they have their entire lives to plan for their retirement? If we kept every government program alive on the grounds that “people have been paying into for so long expecting their cut” wouldn’t we never see any spending cuts anywhere, ever? I’m sorry that you paid into a shitty system all of your life instead of saving for your own retirement, but you could have reformed the system years ago and chose not to. We’ve all had to bite the bullet of ending programs that everybody expected to benefit from, that’s how you keep spending from increasing to infinity.

    Considering that my generation is also being asked to pay off all of this debt, you old folks are lucky if you get one red cent from me. Fucking generational thieves! Not only would I end all social security and medicare payments tomorrow, I’d also knock the dentures out of your mouth while I was at it. At this point, you old fuckers are lucky that my generation is so apathetic that we don’t just throw you overboard into the Boston Harbor. That would be our own little tea party.

    Worried about not receiving your benefits that you knew would bankrupt the system? You should be more worried about us pissing on your face while stuffing you into a garbage bag! Sorry, just had to get that out of my system.

    1. That is amazingly close to how I feel. Bravo! Somehow I think the demographic’s going to turn around in a few years when everyone gets a job.

    2. Shut up and make your student loan payments on time ya ungrateful little whippersnappers.

      1. i have to start paying my student loan back in may, even though i never received a degree, because all private lending stopped with this recession. I should have had the foresight, though, so I just look at this as my alimony/child support (another payment required for bad decisions), and in that regard my payments aren’t that bad.

        1. I drank the college cool aid and got really ill. Let my experience be a lesson to you folks.

    3. “At this point, you old fuckers are lucky that my generation is so apathetic that we don’t just throw you overboard into the Boston Harbor. That would be our own little tea party.”
      Just don’t fuck up the Trinity River 😉

    4. Hell, this is exactly how I feel and I’m 40. It’s not just the 20 somethings.

      1. Ditto here

      2. Word! Baby Boomers were given the ferrari and turned it into a fucking detached Amtrak car. 30 somethings are just as fucked, young fella.

        But, hey, have you seen the new hip-hop 2010 Census commercial – young hipsters dancing around with ipods, excited about the Census? Now there’s something you youngsters can get excited about.

        1. I hate it when they pander to us. It’s so insulting, lol. Glad to see that my generation isn’t alone in hating ss and medicare.

          1. I personally don’t know any libertarian younger than I. I just hope that I’m not the last libertarian, ever. Pls tell me it won’t end with me as an endangered species.

    5. Taking bets on the fact that you WILL collect substantial money and benefits from Social Security and Medicare (or their replacements) when you hit old age?

      I am in the mood to make some money off fools that don’t seem to understand how these systems work, or that while maybe not “enough” money will be there, substantial amounts will. Most likely, the retirement age will be bumped back a few years, taxes raised a bit, and benefits cut back for the wealthy. But you will still be getting a check and by the time you retire, there will be some variant of univeral coverage. Retirees will be first in line, not last, so you have nothing to worry about it.

      1. Wow.

        Someone actually believes that a Ponzi scheme will pay off.

        1. I can’t believe how stupid we are, EVL! We can just raise taxes! Why didn’t we think of this before!!!!!??!?!? It’s all so simple now!

      2. I should be happy, because I’ll get mine too? Of course the amount I get, if anything, even if they managed to resurrect these programs in their current form, will still be paltry compared to what I would have if I got to save that 15% of my paycheck (total SS and Medicare expenditure for 2009 amounted to 1.35 trillion dollars)in a proper investment account. These programs already suck, and now they are going bankrupt. Everybody knows it, but nobody has even really tried to make any changes. No eventual phase into a more poverty focused program or voucher/privatization system has even seriously been brought to the table. The fact is that the time to make small reforms to this program was years ago, and the older generation blew that chance. Now a clean break is the only way to achieve any significant change. The most effective way to reform these programs to create a real retirement plan for americans is to outright end them now. Don’t bullshit me chad. Nobody is even talking about reforming the system at this point.

        If they bump the retirement age to 72, I won’t receive any money until 2058. Till then, I have to pay taxes into a program, that I know needs serious alteration just to be of any use to me ever in the distant future for the benefit of old people now, who had their entire lives to save and prepare for old age. If i could just save that money myself, I could pay for my own retirement at a young age and then some.

        1. Of course, I’m just an idiot who doesn’t understand how these programs “work.” Either way, the young who are starting out their lives shouldn’t have money taken away from them to fund people who had their whole lives to work and save. The program doesn’t even benefit the people it is supposed to be helping who, in retrospect, would have been better off just investing that 15% of their paycheck themselves.

          Does it work something like this Chad:

          1. Collect underpants.


          3. Profit!

          something like that I assume? Please explain how these programs work, Chad.

          1. I would have been all for reforming the system, but nobody wants to do that. Now I’m convinced that we should just end SS and medicare, and cut the payroll taxes by half, then transfer that tax burden to a consumption tax rather than an employment tax. Then that 675 billion a year that we still raise could go towards health savings accounts and deficit reduction. Or that money could be used for ANYTHING else, I don’t care at this point. The only reform to SS and Medicare that I’ll be happy with will just about completely transform the programs into something different.

    6. If I wasn’t in the library right now I’d do a little cheer. I’m so angry right now.

    7. and, of course, tkwelge is correct.We elect a Congress to make intelligent decisions for us and there isn’t an educated economist among them. I am on the other end of the spectrum being retired and living on Social Security.

      If Social Security had been planned correctly in the first place he wouldn’t be in the position he is.

      No provision was ever made for investing a part of the Social Security taxes and it finally became a part of federal income in the ’60’s paying the lowest rate of interest possible.

      Unless American voters wake up and start electing men capable of making educated economic decisions or listening to their economic advisors instead of voting everything according to party dictum the U.S. is in dire trouble.

  4. Prepare, folks. The revolution cometh.

    Putting money into hard assets? Check.

    Accumulating a stockpile of canned goods and ammunition? Check.

    Studing a martial art? Check.

    Voting against the incumbent in every election? Oh yeah. Check.

    1. I have been thinking about about taking a martial art. Right now I am too busy working and learning Spanish in my spare time. What martial art are you learning?

      1. There are lots of choices–pick one that combines striking techniques with grappling/throwing techniques to cover all the bases.

        1. There is a place just down the road from where I live that offers classes in something called Capoeira. Do you know anything about that?

          1. Capoeira is to martial arts what hacky sack is to sports.

            1. I’ve never heard of it, but that’s not a good endorsement.

          2. It’s fun and good exercise but the main focus is not on street-realistic techniques. Capoeria was developed in Latin America by slaves who disguised their kicks and other techniques as dance moves.

            1. I think I saw some of that on fight science. Doesn’t seem very efficient.

          3. Brazilian break dancing. Unless you can do full front and side splits, I wouldn’t waste my time.

            1. Thank you. That is all I needed to know. I will not waste my time.

              1. Study anyone of the Okinawan Karate (shorin-ryu) or Southern Chinese martial arts styles (tiger claw). They are heavy on close hand to hand with limited high kicking.

      2. You’ll want to learn Krav Maga.

        1. Krav Maga is not nice. Probably the most effective style to learn if you want to defend against someone with a weapon.

      3. I’m just taking judo. I have a decent reach, so in a self defense situation I would just keep someone on the outside until they try to close the gap, or until I have the chance to do so. If you’re not used to being slammed flat on your back, it will put you out of commission for at least a few minutes, long enough to get away.

      4. Check out hapkido, krav maga, cuong nhu, or a good MMA gym that teaches muay thai along with some type of grappling. These all combine a variety of techniques from other, older martial arts.

    2. Thanks to everyone for all of the martial art info!

    3. It’ll really change the stereotype of libertarians from gun toting hillbillies to martial artists. lol. Kinda like the boxer rebellion, except for the OPENING of markets.

      1. I say all libertarians need to learn a martial art. It’s the last thing they can take away from us!

      2. Where is our Empress to grant us invulnerability to bullets? Ayn Rand’s ghost?

        1. They can’t shoot us all, sir. Even if they think they can, they wouldn’t. We’ll use the power of the powerless. How do you think people felt living under communism for generations? They kept moving forward, we can too. We hardly have that much adversity in front of us. Its just that our cushy lives are over, and now we must breed a hardier citizen/libertarian.

    4. No one suggests suiken (drunken boxing)? With all the alcohol we’ll need to drink to drown our sorrows about the country we live in, I would think this is the most obvious.

      1. IS there a weed equivalent? Maybe I’ll invent it…

    5. The only hard asset worth considering is a piece of land. Ever try to digest a chunk of gold?

      When your stockpile of canned goods runs out you can use your ammunition to obtain more? Better advice: Learn to grow your own food.

      Martial arts? You’ve got to be kidding. If you come my way with harmful intent the ammunition will end that quickly.

      Kick them all out now I can agree with. How about voting intelligently instead of electing men and women who toe the party line? The idea of kicking them out repeatedly ends continuity. It makes more sense to find men of thought and intellect and keeping them rather than wholesale change every four years.

  5. “Given the history of other interventions into the medical industry, it’s implausible that this won’t end up costing massive amounts more than whatever figures are being bandied about.”

    Sometimes a little bias isn’t a bad thing. We all use biases. They’re inevitable in a world of uncertainty. We don’t know what the future is going to be, exactly, but we have to make decisions now. Sometime we call our biases things like “educated guesses”. I guess that makes us feel better about the decisions we make.

    Sometimes we substitute our faith in other people instead of a bias when it’s something we really don’t understand. We believe what the people we trust tell us when we don’t or can’t know the facts–con men and religions have lived on that for centuries. I think I’d rather trust my own biases.

    Recent revelations about climate change are a good example of that, but losing faith in someone doesn’t necessarily mean we shouldn’t trust the data. Seeing that someone’s faked the data doesn’t necessarily mean the conclusions are wrong.

    …that’s the the logic of the OJ Jury, isn’t it? If one of the cops was a racist and a liar, that must mean OJ didn’t kill his ex? No, of course not!

    Anyway, I’ve got my own biases to believe in–I don’t need to substitute any politician’s biases for my own.

    I never believed the Iraq War was going to pay for itself, and I think it’s even less likely that Obamacare will bring about deficit reduction. Even if it did brings about deficit reduction, I suspect it would end up costing heatlhcare consumers more, either in higher premiums or in terms of less care being made available.

    I have another bias too. I’d rather have more choices available to me, even if that means some of them will costs a whole lot more. And since when has restricting market forces made more choices available? Aren’t market forces simply people making choices?

    Maybe that is just a bias though. But so what?

  6. As another wise commenter opined, if you are enough of a fool to believe a massive entitlement program will bring deficit reductions, you get what you deserve.

    1. A massive entitlement program coupled with a massive tax increase can bring deficit reductions, if the tax increase is large enough.

      1. No. Massive tax increases (particularly in capital gains) are economy killers – combined with entitlement growth they will ballon the deficit.

      2. Seriously folks, I have a question.
        In what other country does one have the freedom to enrich himself through his own effort.
        Do note that I said through his own effort and I am speaking of those whose income tops $500,000 per year.
        The Economic Recovery Tax Act of 1981 dropped the top tax rate for the super rich from 70% to 50%.
        Tax Reform Act of 1986 dropped the top tax rate for the super rich from 50% to 28%.
        The effects of these tax cuts can be seen at: Tax cuts info. The figures show that there has been a deficit every year except for the effects of the last three years of the Clinton administration
        Even though riches are obtained through personal effort other nations tax these individuals at levels far above those of the U.S.
        My personal take is that they pay very little for the opportunity and priveledge of enriching themselves in the U.S.
        In particular there are many corporate officers who make millions of dollars while the companies they run underperform.
        Does anyone support a sliding scale increase in taxes on such individuals?
        There is no necessity of changing the tax rates on investment income.

  7. If this were simply a money trick. . .

    True, what’s on the table will do nothing to reform health care, but it will serve as a lever to transform the American outlook – into a nation of proto-fascists; unthinking minions to serve as fully corrupted minions of an ever expansive nanny-state. The evidence for this is seem even among the most vehement opponents of the legislation, in the form of “put down that twinkie, fattie, you’re on MY dime now’.

    It financially incentivizes everyone to ‘police’ each other against non-politically correct activities. Which is a most dangerous mindset to instill in a general populace.

    A much longer exploration of this is found at Pajamas Media, from Zombie.

    That’s the truly insidious nature of this steaming pile of collectivist crap being shovelled upon us, far away and apart from the money tricks.

    1. I like this comment. It shows spatial awareness and looks behind a mask that is front of us.

  8. I’m really not sure why they’re even keeping up the fa?ade of fiscal responsibility. Everyone knows it’s going to ultimately cost more than the country’s earners could possibly afford. And the slimy deals they’ve made to secure votes shows that appearances are otherwise out the window. So why is anyone still bothering to pretend?

    1. To get the support of the mathematically challenged citizens (i.e. ~40% of the US population …thank you Dept. of Education, run by liberals)

  9. It seems to me that if that’s the best you can come up with after running through the numbers, that’s enough on its face to say no to this bill

    If the people running the game won’t (can’t) tell you what the odds are, don’t bet.

  10. From today’s NYT op-ed page, former CBO director Douglas Holtz-Eakin writes

    Removing the unrealistic annual Medicare savings ($463 billion) and the stolen annual revenues from Social Security and long-term care insurance ($123 billion), and adding in the annual spending that so far is not accounted for ($114 billion) quickly generates additional deficits of $562 billion in the first 10 years. And the nation would be on the hook for two more entitlement programs rapidly expanding as far as the eye can see.

    I will take no joy in reminding the Democratic supporters of this fiscal travesty in the making “I told you so”.

    But I will be reminding the historically ignorant fools nonetheless.

    1. They won’t listen to you. It will be all someone else’s fault. And they will claim it would have been worse if they hadn’t acted.

      1. Oh, and there’ll be a lot of, “But Bush…” You can bet on it.

        1. George Bush is just like Farmer Jones in the book “Animal Farm.” No matter how bad things get, Obama/Napoleon can always just mutter about how bad things were under the rule of Bush/Jones.

  11. Will there be live-bloging of the (possible) death of our country today?

  12. I’m sorry, but aren’t senior citizens the richest segment of society? Didn’t they have their entire lives to plan for their retirement?

    What the fuck is wrong with you? That money is for ecotourism, and sending the grandkids on Semester at Sea, not for doctors’ bills.

    Why are you such a greedy ingrate? If it wasn’t for those people, you’d be speaking German and eating sushi.

    1. “Why are you such a greedy ingrate? If it wasn’t for those people, you’d be speaking German and eating sushi.”

      I like sushi!

      1. Superbe article, vraiment simple et utile. Bravo pour sa mise en ligne. C’est ce genre d’information que le public (et moi en particulier) recherche biletul zilei

    2. I don’t know whether I should laugh or cry at all of the 20 somethings with their Sheperd Fairey posters and their “I was a part of history” T-shirts who are now going to be forced to buy insurance they don’t need thanks to all that hope and change they wanted so badly.

      1. “I was a part of history”

        That part is true. And not in a good way.

        1. I want a shirt or poster that says, i got rubed into being part of history! Or, “I had history forced upon me.”

  13. If it wasn’t for those people, you’d be speaking German and eating sushi.

    I love sushi.

    1. We almost posted this at the same time. Great minds think alike.

    2. I hate sushi. But I speak some German.

      Damn you, old people!

      1. I agree you should just go do away with your parents, uncles and aunts to start with dumbass. You probably skipped history class so you repeat mistakes over and over again.

    3. I think that the generation to really screw things up came after the wartime generation. Really, the babyboomers have done nothing for us.

  14. http://www.nytimes.com/2010/03…..tml?src=me

    Then there is this little fact. We really are close to losing our AAA debt rating. That story hasn’t gotten the media attention it deserves because to give it attention might derail the healthcare train. But it is too big of a deal to ignore for long.

    Expect the state run media to take up the mantle of austerity and the need for soul killing tax increases come this summer.

    1. Can’t see Moody’s downgrading Treasury debt, because then I can see DOJ stopping by and asking them about their decision-making from 2005-2008 concerning MBS ratings, and saying things like RICO and obstruction of justice, etc…

      Basically, the same sort of tactics that were used to get telecom cooperation after Qwest’s CEO initially said no to warrantless wiretapping.

  15. I can’t believe this thing is going to pass. We’re so screwed as country. I love immigrants (illegals too) and seniors, but the U.S. has too many of them to make a socialist health care system work.

    Bad times for America are on the way, and this time it’s for real.

  16. I’ve been watching the Drudge report, and nothing new has been coming up. I hesitate to put on CSPAM. Who’s keeping up with the latest?

  17. There were a few good twitter feeds going yesterday, I think Suderman posted them.

  18. OK, let’s put some odds on this. Takin’ all bets: who thinks this will actually pass?

    1. I hope it loses by exactly ONE vote. Rep or Dem, it really doesn’t matter – just the look on the Dems’ faces if they lost by one vote, would be worth a years’ pay. Hell, I’d damn near consent to a voluntary limb amputation.

      1. I’ll wager 400 quatloos on the newcomer!

    2. Drudge Report has this (unlinked) text at the top of his page as I type this “OVERHEARD: Walking into Capitol this morning on phone, Speaker Pelosi tells Hoyer: ‘Steny, we have to get to 217. None of these members wants to be the deciding vote’… Developing…” If this is true I think they Democrats are in trouble. I know they only need 216 but if no Democrat wants to be 216 that may mean that in effect they only have 215.

      1. I’m setting the spread at 217. If you beat the spread (meaning the Dems get 216 and you called it), you are one crazy motherfucker.

    3. 100% It is as good as passed right now.

      1. 231 – 200 Fail! Feel free to call me a fool, but I have money to burn, especially when the rest of you start subsidizing my lifestyle here in about five years or so.

    4. Pass… I’m hoping that its @ 216 votes, but probably 218

      Although considering how my NCAA bracket looks it might not be a good idea for my guesses on these things (UNI and Washington, what the fuck)

      1. Always bet on black, Bingo.

  19. To big to fail! Doesn’t this fall into that category? This encompasses everybodys money. This is bigger than any bank or insurance company ever. You will not have freedom of choice of how to spend your money, someone else will have that freedom. Every person I know from former soviet countries are against this reform as it says they left their old homes to get away from exactly what is happenning here. I am for social security for older people but not for the lazy bastards that have never worked. Welfare should be eliminated. How much would that save? This whole bill, since it affects everyone, should be put to the public vote as the politicians are all too corrupt to speak for us truthfully.

  20. they have stupak, it’s done

    1. I hope this is not true … if it is how? Did they threaten his kids? I would not put it past those assholes.

      1. Reports of Stupak’s folding are premature.

        I would not count out pro-federally-funded-abortions representatives balking at this compromise.

        1. How could anyone trust an executive order? An executive order can be repealed just as easily as it can be issued.

          1. Like I said, live by the executive order, die by the executive order.

      1. From that source “Stupak told CNN that there is no deal yet but that he and the White House are “close” to an agreement. “It’s a work in progress,” he said.”

        In other words he may still have some principles left.

  21. I do like the revealing comments on the lefty blogs. They’re calling for SWAT teams to “take out the teabaggers” while the more moderate voices are wondering if they can all just be rounded up for indefinite detention m.

    1. These are the people who call for peace and tollerance and diversity.

      1. You can find links on Weigel’s twitter.

        1. What did the tea parties do that was so bad again?

          1. Protesting fiscally irresponsibility and being certified gun owners = domestic terrorism!

            1. Lol, i remember seeing footage of protests that took place a generation ago involving fruit and rock throwing. The tea partiers are poodles in comparison. Maybe they’ve been too soft.

  22. I have a question: the fact that the Dems are going to the mat on this, yet it will fucking kill them, just doesn’t make sense. There has to be another reason. It’s not ideology; these people are scum interested in one thing–their own power. So why are they doing something that’s going to destroy them?

    It makes no sense. Is it that they’ve been bribed by the insurance companies? I just don’t get it. Please contribute any theories that you have as to why they’re doing this.

    1. The glory, of course. Read any news article that is a little more in-depth on the history of health care “reform” and you will see a common thread: this is historical because it has never been achieved.

      Also, like it or not, most commentators have it right: the defeat of this thing, after all the time, money and energy poured into it, would effectively bring the Presidency to a total standstill. He would be a lame-duck with three more years to go.

      1. I don’t know if I buy this. They are going to get DESTROYED in November. You really think “glory” is enough?

        Sure, Obama doesn’t want to seem like a lame duck, but fuck him; is a Democrat rep going to essentially ensure their own failure so that Obama looks good?

        I just don’t get it.

        1. They are going to champion it, and people will forget their vehement opposition and go on with their lives. As it is, the Democrats are not going to do well in November anyway, and the damage is done, so why not go for broke?

          Think about it: if the bill failed today, would that help them any? I think not.

          1. If the bill failed and a Dem could say “it failed because I refused to vote for it”, that could massively help their re-election chances.

            Again–there’s something else going on. The arm-twisting is so severe specifically because of that.

            1. One possibility: they are going down in November either way so why not?

    2. to destroy health insurance creating a clamor for single payer and to skim all they can off that one sixth of the economy. they think it will be impossible to roll back creating a permanent left of center govt.

      1. I don’t really buy into that. It’s too organized. The Dems are, amazingly, seemingly stupider than the Republicans (that is one hell of a feat), and I just don’t think they could possibly organize enough to make a plan like that.

        There has to be another reason. Of course, I am ill-equipped to understand the motivations of parasitic scum, so maybe I’m just not seeing it.

    3. Maybe they actually believe it is the right thing to do?

      Discounting sincere motivations is one of the biggest mistake people make about their political opponents. Most people don’t go to the stake because they have been paid to do so but because they believe. You may disagree with their beliefs and you may be cynical but that doesn’t mean that your opponent is.

      1. Not a chance, dude. These fuckers are parasites. They don’t do shit for ideological reasons, they do it to stay elected. If you think that I believe for one second that Nancy Pelosi is doing this because she “believes it’s right”, you are nuts.

        “No, Leo–you do things for a reason.”

        1. Do you really believe that or is it just rhetoric?

          “‘We alone,’ they say, each behind his rampart, ‘we alone are the guardians of courage and loyalty, of ability and good taste!'”

          1. Do you actually believe politicians have principles? Really?

            Even if they tell themselves that they have principles, their actions show that they don’t. They are scum of the highest order.

            1. You’re making a serious mistake by believing that. If politicians as a class have no principles then which class of people, however defined, can have principles?

              They may or may not be scum, but many of them do have principles even though those principles are not yours.

        2. There are two main species of left wing legislator, each of which feeds off the existence and actions of the other for its own continued existence.

          First, you have what I might term the ‘Wellstone’ type; these act for what they honestly believe are pure reasons. In reality, their ideology consists entirely of emotional platitudes and trite talking points, which they simplistically synthesize into what they consider to be a world view. They are successful because their simple-mindedness allows them to operate from a position of fundamental sincerity. The majority of legislators fall under this category.

          Second, you have what I might term the ‘Dodd’ type; these are the ultimate source of the pseudo-ideological line internalized by the ‘Wellstone’ group. They are calculating and conniving, and operate for the purpose of enlarging the power of the organism of government, and thereby to augment their own substantial power.

          A similar ecology exists on the right wing.

    4. They think the damage will be worse if it doesn’t pass. And that ultimately the public will like being forced to buy health insurance.

      Projection, in other words.

  23. The budget assumptions underlying this bill are a mountain of lies, namely (i) moving medical expenses (such as doctor fix) out of the bill, (ii) double counting reductions in other programs necessary for the solvency of those programs (medicare cuts), (iii) raiding other funds (social security and others), (iv) placing unrelated revenue savings with their own ludicrous assumptions into the bill (student loans), (v) raising $500B in new taxes on capital gains, and (vi) fairy tale estimates of growth (too low) in medical spending and economy (too high).

    Look at each one of these:

    (i) & (ii) – doctor’s fix: Current law requires that medicare reimbursements be reduced But the notion is so toxic that it can never be done, hence the doctor’s fix (which is conveniently left out of the bill). So this medicare reduction can never be accomplished, but we are supposed to believe that the Congress will be able to reduce medicare expenditures by $500B how?

    (iv) The government is already soaking up all available capital to fund the deficit. Banks aren’t making loans because it is far easier to essentially engage in an internal US carry trade at a 3% spread with no risk. Raising the cost of capital by raising the effective capital gains tax will only cause more layoffs and raise government expenditures on the program.

    Finally, even if everything mentioned above were taken into account, the estimate of the cost of this monstrosity is a joke. We have a real life example in Medicare between what original estimates versus realized costs have been:

    This from a Senate Joint Economic Committee released report late last year studying exactly that issue. From the report:

    “Medicare (hospital insurance). In 1965, as Congress considered legislation to establish a national Medicare program, the House Ways and Means Committee estimated that the hospital insurance portion of the program, Part A, would cost about $9 billion annually by 1990.v Actual Part A spending in 1990 was $67 billion. The actuary who provided the original cost estimates acknowledged in 1994 that, even after conservatively discounting for the unexpectedly high inflation rates of the early ’70s and other factors, “the actual [Part A] experience was 165% higher than the estimate.”

    Medicare (entire program). In 1967, the House Ways and Means Committee predicted that the new Medicare program, launched the previous year, would cost about $12 billion in 1990. Actual Medicare spending in 1990 was $110 billion?off by nearly a factor of 10.

    Medicaid DSH program. In 1987, Congress estimated that Medicaid’s disproportionate share hospital (DSH) payments?which states use to provide relief to hospitals that serve especially large numbers of Medicaid and uninsured patients?would cost less than $1 billion in 1992. The actual cost that year was a staggering $17 billion. Among other things, federal lawmakers had failed to detect loopholes in the legislation that enabled states to draw significantly more money from the federal treasury than they would otherwise have been entitled to claim under the program’s traditional 50-50 funding scheme.

    Medicare home care benefit. When Congress debated changes to Medicare’s home care benefit in 1988, the projected 1993 cost of the benefit was $4 billion. The actual 1993 cost was more than twice that amount, $10 billion.

    Medicare catastrophic coverage benefit. In 1988, Congress added a catastrophic coverage benefit to Medicare, to take effect in 1990. In July 1989, the Congressional Budget Office (CBO) doubled its cost estimate for the program, for the four-year period 1990-1993, from $5.7 billion to $11.8 billion. CBO explained that it had received newer data showing it had significantly under-estimated prescription drug cost growth, and it warned Congress that even this revised estimate might be too low. This was a principal reason Congress repealed the program before it could take effect.

    SCHIP. In 1997, Congress established the State Children’s Health Insurance Program as a capped grant program to states, and appropriated $40 billion to be doled out to states over 10 years at a rate of roughly $5 billion per year, once implemented. In each year, some states exceeded their allotments, requiring shifts of funds from other states that had not done so. By 2006, unspent reserves from prior years were nearly exhausted. To avert mass disenrollments, Congress decided to appropriate an additional $283 million in FY 2006 and an additional $650 million in FY 2007.”

    1. BTW, on the student loan bullshit, the entire student loan industry will now be nationalized and subsidized; putting our control over the student loan market in a similar position to where we were in with respect to home loans and the securitization market being largely underwritten by Fannie and Freddie prior to 2008.

      What could go wrong?

      1. Hmm, we might actually save a bunch of money and the bankers won’t be getting their cut anymore?

        Don’t you just HATE it when the government does something BETTER than the private market? I know it crushes your entire world-view, so you must really be hurting inside….

        1. I don’t know how robbing one group of society to pay another counts as “working better than the free market.” I hate it anytime I lose freedom, even if it is for a good cause. Yes, the government is at an advantage being able to act as thugs and all….

          1. Yes, the freedom to pay higher prices for student loans is one that every American should be loathe to lose.



            1. Are you a fucking moron? I know that is a dumb question, but don’t you realize how the government has to get that money? They don’t ask for it! You fucking dumbshit…

            2. I had all private student loans through my bank (possibly subsidized, but still given to through a private company). After I graduated, a roughly $5,000 loan was bought up by the Dept. of Ed. In addition to that one, I had 3 loans totaling about $6,300. Now please tell me why it was necessary for the Department of Education to buy up one of my loans and charge me almost the same per month as the other set of loans, when I could be paying significantly less by making payments to ONE party.

          2. Not that I personally disagree with the plan to switch to a direct funding to cut out the middle man. It just pisses me off that chad and his cohort use any little thing they can bite on to try to “prove” how superior the public sector is to the private sector.

  24. you’d be a chump to keep paying for health insurance if this passes. just buy it if and when you need it. the fines are small. if you have a cadillac plan, the fine for no insurance is probably smaller than the tax on insurance anyway. health insurance is for sick people.

  25. As entertaining as ever.

    If Bush/Gore is elected, life as we know it will end …

    If Bush/Kerry is elected, life as we know it will end …

    If Obama/McCain is elected, life as we know it will end …

    If this bill is passed/defeated, life as we know it will end …

    Call me when the Pinkerton’s are shooting down strikers or the Army is bulldozing squatter camps or the police are turning the dogs and firehoses on demonstrators. Then we’ll know we’re in a real crisis.

    1. One would think that a Jew would have a little more appreciation for the slippery slope.

      1. It is only a few books and windows. Where not like those dirty men with the beards and hats, we’re cultured. These kind of things happen. It will blow over.

        1. I would find your comment offensive if it weren’t so stupid.

          1. I would find you stupid if you weren’t so offensive

            1. Nyah, nyah, nyah.

              1. kinda like an x-black man;-)

                1. +1

                  Point of my original remark.

              2. are walking down the street, and they pass a ten year old boy sitting by the side of the road. Catholic priest says to the rabbi, “Damn, that’s a good looking kid. I sure wish I could fuck him.”

                The rabbi looks at him, puzzled, and says, “Out of what?”

      2. I am confused. Is that the slippery slope from “single payer” to “Kill the Jews!” or the one from marijuana to PCP?

        1. How about “no denying pre-existing conditions” to “exterminating the sick because we cannot afford to cover them”?

          Is that so far-fetched?

          1. Yes and it displays a profound misunderstanding of the motivations of your opponents (of which I am not one, but we’ll leave that be.)

            1. It is not about motivations; it is about the inevitable consequences.

              1. Nothing in human affairs is inevitable. To assert such is a rhetorical parlor trick.

                If you’d prefer I will write the following.


                1. Nothing in human affairs is inevitable.

                  Are you saying it is not certain that this legislation is going to inevitably reduce the deficit and increase the quality of healthcare in the United States? Darn.

                  1. That too. Although I’d prefer to say that it’s possible but very unlikely that the spending and revenue projections are accurate.

                    When employed as a political argument, the five or ten year projection dodge is often intellectually dishonest. One principle that many people cling to is that the ends justify the means. Therefore, a little white lie is justified whether it’s for heath care reform or for war.

                    Personally, I am more inclined to fiat justitia but that has it’s own problems as well.

            2. Personally, I’m not worried about death panels. I’m much more worried about all the things that the government will now regulate arguing that it is necessary to contain health care costs. Your health is no longer your business. What you eat, what you inject into your body, your choice of treatment, what you enjoy doing in your free time, and maybe even reproductive rights will now all be subject to government scrutiny. We have no idea what future governments will do with this either.

        2. I think it’s more along the lines of enshrining a corporatist system into law than it is a step toward socialism. I’m not so sure that it is any different than the last 60 years of American government, except that now its being applied toward health care. After this is passed, any chance of market-based innovations for health insurance products will be essentially zero.

          It firmly cements the status quo for big players.

          1. “It firmly cements the status quo for big players.”

            Exactly the unintended consequence that the true believers don’t want but are going to get. We’ll have a bigger medical-government complex to go along with our military-industrial complex and both created with the best of intentions.

  26. They are going to get DESTROYED in November

    I think Pelosi & Co are betting the “progressive” middle class just won’t have anywhere else to go, in November. How many Bernie Sanders are there?

    It’s like the Republicans; the fiscal conservatives are expected to hold their noses and vote for whatever Bible-thumping imbecile the party puts on the ballot.

    1. The Dems just saw–and profited–from people punishing the Republicans a year and a half ago. Are they so abjectly stupid that they can’t see the exact same train barreling down on them?

    2. If they don’t pass this, progressives won’t show up in November.

      They’re doomed either way, so they’re gonna take the rest of the country down with them.

  27. I used to think we should vote out incumbents, fight for smaller limited government, etc. But really you will never win. Now I think we should support all the horrible back breaking spending and government largesse in order to hasten the demise.

    1. That is the only reason I’m not freaking out right now.

      The shitstorm is inevitable,so why not get it over with.

      Bit like a 600 pound gorgo eating pizza and doughnuts at every meal. Sure it’s stupid,but the massive coronary is going to happen anyway…

  28. I’m watching C-Span right now, and man Patrick Kennedy (d-ri) is a nervous wreck up there. He’s shaking like an unbalanced washer and screaming into the microphone.

    1. Abusing drugs and alcohol will do that to you.

    2. That’s that Kennedy courage.

    3. “I’m watching C-Span right now, and man Patrick Kennedy (d-ri) is a nervous wreck up there. He’s shaking like an unbalanced washer and screaming into the microphone.”

      I call this a hopefull sign. If he knew it was in the bag he would be more confident and less nervous. Our country may well survive.

      1. It looked more like stage fright than anxiety about the bill. I was just surprised that a Kennedy, born and raised for political office, would exhibit such a trait.

    4. Isn’t he always doing that? Whenever I’ve seen him on TV he’s either screaming or crying. Never saw why his constituents kept sending him to DC.

      1. I don’t know, this was the first time I’ve ever seen him speak. It wasn’t just a nervous tic or a cracking voice, it was really severe shaking and shouting.

        1. I saw him on C span a few years ago going on and on about banning assault weapons. He was crying and screaming at the same time. And he’s always blubbering during his numerous apologies for drunk driving, etc

    5. That is just the palsy caused by prior generations of Kennedy inbreeding. When those genes fused with those of WASP during the previous generation a special form of retardation never seen in the human condition before occurred where smugness, a sense of entitlement, and myopia fused together into a creature that can only be called Lovecraftian in the degree of his wretched abomination.

      Third Generation Kennedys: The Shadow Over Hanover!

      1. Speaking of Abominations:


        or what I refer to as The Thing That Should Not Be.

        1. I take it you mean Snuggies? But there is a better product out there:

          Blanket! The Snuggie without holes

          1. Yep, that’s the one.

            I want to see a remake the ending of Apocalypse Now, The End fades away, you hear Kurtz’ voice as he speaks of a pile of limbs from Cambodian children, the camera close in, he is wrapped in a bright pink Snuggie whispering,

            ‘The horror! The horror!’

        2. The first time I saw an ad for the snuggie, I thought to myself, “wow, it must take huge balls to pass off an already existing product (for thousands of years) as a new invention.” I mean isn’t it basically just a robe turned around?

          1. Dude.

            Pet rock.

  29. I WANT this thing to fall apart, but it’s hard to bet against the innate stupidity and egotism of politicians.

  30. Oooooo! Now the Republicans have moved from calling the deem-and-pass the “Slaughter rule” to calling it the “Slaughter House Rules”.

  31. Just in case no one who writes for Reason’s H&R liveblogs I found a liveblog here:


  32. Acording to the RCP liveblog Stupak is telling Fox that he’s still a “no.”

  33. The reason that this will be a budget-killer is very simple – much of what is supposed to control costs is backloaded into the bill, because this Congress doesn’t have the courage to pass it now.

    If this Congress, with a massive majority and a fully committed President, can’t implement this stuff, why does anyone think a future Congress will?

    And don’t say, well, its baked in now, future Congresses won’t have to do anything. Congress after Congress hasn’t had the courage to implement the “automatic” controls on doctor spending passed several years ago.

  34. Congress after Congress hasn’t had the courage to implement the “automatic” controls on doctor spending passed several years ago.

    This is why all doctors must be employed enslaved by the government. No more fee-for-service.

  35. Here’s a silly question: Obama, Pelosi and their various assembled minions are holding the holdouts” feet to the fire; is there anybody pulling those holdouts back from the brink?

    (I think we can assume the constituents (aka “rubes”) have no discernible influence.)

  36. All right, Jeff Flake gets to raise a point of order about earmarks!

  37. Stupak has been under so much pressure that he will be looking for any flimsy excuse to change his vote and be done with it. The promise of an executive order from one of the most dishonest men to hold the nation’s highest office will be enough.

    1. “The promise of an executive order from one of the most dishonest men to hold the nation’s highest office will be enough.”

      Who was more dishonest? Has this country EVER had a more dishonest president?

      1. By what measure? Bush and Clinton were both compulsive liars as well.

        1. Bush’s lies seemed to be limited to one sphere – foriegn policy and war (except in the last few months of his presidency.) Granted, that was a huge sphere with life and death consequences. But in other spheres I do not think he KNOWINGLY lied to the same degree.

          Clinton was slick but the difference there is that, when he lied it was almost with a wink and most people knew they were being lied to but it did not matter so much because it was Clinton. I give as an example the statement he made that “I didn’t inhale.” Everyone knew that was a lie.

          1. I would think a statement like “most dishonest president ever” should take into account his lies on foreign policy, war, and in the last months of his presidency. It also includes bad lies.

  38. Kathy Castor (D-Tampa) is going on about how we need to pass this bill because “we’re going to pay more to doctors who take Medicare”. Wrong bill, honey.

    1. She is in desperate need of a stranger’s (back)hand.

      1. Is your Castor hand strong enough Alan?

        1. I learned my mad casting skills from Dr. Strange comic books. Harry Potter’s silly spidery gestures make me laugh.

          1. A cape of levitation beats the shit out of a cloak of invisibility any day ? H. Potter is a pussy

  39. Suderman, on the twitter, ofers the theory the Dems are going to get the last needed votes because of the “angry” protesters and their “racist snake flag”.

    1. ” “racist snake flag”.”

      So I take it Suderman has never taken a course on American History that covered the American Revolution?

    2. Wonder if #HCR protesters are actually pushing Dems toward support of the bill: http://bit.ly/bEXaRa

    3. Oh, fuck. I’m done with you people!

  40. Really stupid move by the Republicans: reserve 15 seconds to ask Slaughter a question that takes 25 seconds to ask. Then as the speaker bangs his gavel, ask for 10 seconds more. Then she asks him to repeat the question, and time runs out again.

  41. Riding on a roaming wilderbeast in Spain,
    All the Republicans are evil, and all of the Democrats are insane.

    1. Our government like the forest tree grows so very tall, but mark my words like the tree it too shall one day fall.

  42. Stupak is having a press conference in 10 minutes. I guess we will have to see what he says, but it probably is not good.


  43. Those morons are going to trust an executive order.

    I wonder, though…will the pro-“choice” people flip now?

    1. Nope, because they know its a sham.

  44. So now we’ve got a deem-pass on the Senate bill in the house, a budget reconciliation in the Senate, and an executive order daisy chained together.

    Separation of powers, RIP.

  45. Slaughter is now complaining of a brick that was put through her district office window in Rochester. Maybe there’s hope for my old town after all.

  46. So, my libertarian friends: Are you moving to Singapore, or just jumping in front of a bus?

    Oh wait, Singapore’s system is far to the left of Obamacare. I guess it’s the bus then, eh?

    1. Left in the sense that Singapore is one of has one of the most statist/corporatist systems of governments in the world.

      I’m sure Obama would love it.

      1. Odd, I have seen plenty of libertarians taughting the merits of Singapore (and HK). Yet those wild and wooley socialists have universal coverage.

        Actually, you should check out Singapore’s system. It is actually very market-oriented, basically consisting of high, sliding co-pays (rich people have 50%+ copays, a poor person might have a 10% copay, for example). Most “good” jobs provide supplemental insurance to further reduce the copays.

        1. I know a lot about both systems (as I have actually had to use both). HK has a dual health care system: universal (and incredibly crappy) subsidized health care and (fairly good but not nearly as good as US) private health care.

          I think, regarding Singapore, in general that is a fairly good atmosphere to practice business in if you are in a favored industry. But there should be a map of Singapore in the dictionary under the definition of Crony Capitalism (look at Telecom, Airline Industry, etc)

          1. Over to you Chad…

    2. Gloat now chad. Have your little fun. Relish it sir.

  47. So frustrating – It’s like we are trying to get a short term loan to solve our mortagage problems in trying to solve medicare problems like this. It just is not smart.

    We need better resolutions to this problem than short term help.

  48. why does anyone think a future Congress will?

  49. Who thinks this will actually pass?

  50. I think, regarding Singapore, in general that is a fairly good atmosphere to practice business in if you are in a favored industry. But there should be a map of Singapore in the dictionary under the definition of Crony Capitalism (look at Telecom, Airline Industry, etc)Pehari

  51. I think, regarding Singapore, in general that is a fairly good atmosphere to practice business in if you are in a favored Pehari industry. But there should be a map of Singapore in the dictionary under the definition of Crony Capitalism (look at Telecom, Airline Industry, etc)

  52. I would think a statement like “most dishonest president ever” should take into account his lies on foreign policy, war, and in the last months of his presidency. It also includes bad lies in invitatii nunta

  53. midical and sports both import to us

  54. They must have plenty ofparticipant in this site, i think they will contact all the people to see their opinion bout the new topic. Once, i take a part and become their participant too Pariuri Sportive

  55. Many thanks sharing fantastic informations. Ones websiteis consequently cool. We are impressed from the main factors that you’ve with this blog. The item reveals precisely how nicely people perceive this specific subject. Thank your share with me!

  56. We have full office staff ready to assists you in any way possible to buy Coach outlet handbags. We can guarantee the best quality to you if you buy Cheap Coach bags

  57. We have full office staff ready to assists you in any way possible to buy Coach outlet handbags. We can guarantee the best quality to you if you buy Cheap Coach bags and Cheap Coach Purses from cheapcoachbagspurses.com.

  58. We have full office staff ready to assists you in any way possible to buy Coach outlet handbags. We can guarantee the best quality to you if you buy Cheap Coach bags and Cheap Coach Purses from cheapcoachbagspurses.com.

  59. We have full office staff ready to assists you in any way possible to buy

  60. We have full office staff ready to assists you in any way possible to buy

  61. We have full office staff ready to assists you in any way possible to buy

  62. We have full office staff ready to assists you in any way possible to buy

  63. Good article makes constant progress, thank you share, the accumulation of knowledge is to keep learning, attention is the beginning of wealth!

  64. Hi, the article is so wonderful.

  65. Hi, the article is so wonderful, I am interested in it.

  66. Cheap air jordan 5 are hot selling all over the world.

  67. It seems to me that if that’s the best you can come up with after running through the numbers, that’s enough on its face to say no to this bill, given all the other stuff it does, from mandating insurance coverage, to expanding all sorts of control over how coverage is delivered.

  68. As I site possessor I believe the content material here is rattling wonderful , appreciate it for your hard work.

  69. i like these articles, it can help me so much~~67sd8gh

  70. so great, have some useful~~67sd8gh

  71. this article give me so much things, i like this~~SCFCHU64

  72. i can’n do like that DT45DIFD

  73. Good opinions, now the midicare technology is popular in the world. It’s more important to prevent than care

Please to post comments

Comments are closed.