[FoRK] The Hope of Audacity
sdw at lig.net
Thu Jul 23 18:17:08 PDT 2009
Jeff Bone wrote:
> Hey, y'all remember those quaint old days when I was all up in arms
> about Bush's absolutely egregious concentration, expansion and abuse
> of executive authority? And some if not most of you agreed? The
> arrogance, the hubris, the autocracy? Quaint indeed. Unchecked and
> unbalanced, let's rock!
> Here's the money bits:
> Today, the Obama administration delivered one of the more remarkable
> presidential power grabs seen in recent memory (the transmittal letter
> is here, and a section-by-section description of the proposal is
> available here).
Power grabs we can all get behind??
> That would be a remarkable shift of power on its own, but the
> president’s proposal doesn’t stop there. Not only would the council
> make recommendations on payment updates, it would also have the
> authority to propose other “Medicare reforms” which would go into
> effect unless Congress could muster veto override majorities in
> opposition. What are “Medicare reforms”? From the write-up, it seems
> they could be just about anything. Changes in beneficiary
> cost-sharing. New rules for establishing qualified hospitals and
> doctors. Penalties for physicians who don’t follow government
> guidelines. Pretty much anything except for the payroll tax and
> premium structure. The only parameters are that the “reforms” must
> improve the quality of medical care and the efficiency of Medicare
"must improve the quality of medical care and the efficiency" - That
would be some interesting constraint on action. Abusable, but at least
> The administration is touting this as a belated cost-control idea.
> It’s not. By itself, it doesn’t change anything, as there are no hard
> targets that must be hit. So it doesn’t answer the Elmendorf critique
> that the bills now moving in Congress, even if such a provision were
> added to them, don’t bend the cost-curve of governmental health spending.
That seems like a non sequitur. Clearly, amassing that authority is not
for nothing. Bending the cost-curve, in at least attempted intelligent
ways, is the point.
> Still, the fact that the administration is pushing this bill at all
> speaks volumes. Here’s a Democratic president telling a Democratic
> Congress that it can’t be trusted to run Medicare anymore. That’s
> stunning, especially so because Democrats, including the president,
> are working feverishly to exert additional governmental control over
> health insurance for working age Americans. If Congress can’t run
> Medicare well, what possible rationale is there for standing up
> another government-run insurance plan?
Refactoring? Changing the rules? New blood? Changed optimization
targets? "what possible rationale..." - What kind of a stupid question
is that? Oh, the kind that insists that government can never run
anything efficiently. (We all agree that government tends toward
inefficiency, but it is not a universal quantifier.)
> Nonetheless, the audacity is something to behold. Certainly unilateral
> executive branch authority to re-write entitlement programs from
> scratch would have come in awful handy during the Reagan and Bush
> years. But that may dawn on others as well. Like Medicare
> beneficiaries, physicians, hospitals, labs, nursing homes, and, of
> course, House and Senate members too. Good luck, Mr. President.
Good luck indeed. Perhaps it is just a big stick. The nuclear option.
That would be a great strategy.
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