[FoRK] The Hope of Audacity

Stephen Williams 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!
> From:
>     http://www.thenewatlantis.com/blog/diagnosis/on-the-fly-audacity
> 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 
> operations.

"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.

> jb

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