Well, the speech did not change my mind. The same “plan” that the CBO scored earlier at $0.9 trillion over 10 years was trotted out. The “health care/Medicare advisory panel” idea to recommend cost savings mentioned in the speech is the same as before–that the CBO judged would be ineffective. No new arguments were presented to convince people (me) about why it would prove effective.
The speech threw a couple of (weak) bones in the Republicans’ direction on pilot projects to reduce malpractice-insurance costs, and on ineligibility of illegal immigrants (that was vocally disputed during the speech).
Essentially, the president’s approach involves major additional costs from expanding coverage to 30 million currently uninsured coupled with a “promise” that cost savings and elimination of waste and abuse would fully pay for it without increasing the deficit. This has never worked in the past and won’t work now.
I would advise against supporting a deal where we remain at risk for bearing higher tax burdens or higher insurance premiums from the multiple additional constraints on insurance companies, in exchange for a promise of a future return by way of reduced health-care cost growth. I need to see concrete provisions that would enforce the hard choices that must be made, especially in Medicare and Medicaid.
The one element in the speech that I agreed with is that those two programs will before long grow larger than all the rest of federal programs if costs are not controlled. Where are the concrete proposals to control them?
– Jagadeesh Gokhale is a senior fellow at the Cato Institute.