The Obama campaign redux

We all know that President Obama is a very smart guy and a shrewd politician, so I am inclined to think that anything he does is very carefully calculated. From a political standpoint, this is a peculiar campaign. He spends most of his time vilifying the opposition rather than discussing the actual features of health care reform. In fact, the entire process has been designed to conceal rather than illuminate the debate on the actual features of a reform plan. So far most of the debate is very simplistic (socialism v. government).

But the President has created his own problems. He says that the cost of health care must go down. He says this will be achieved through savings from "efficiencies" but the few that he has mentioned such as unnecessary tests and procedures (tonsils) don't really add up. The American public is worried that a reduction in cost will translate into (1) a reduction of services ("rationing"); or (2) a reduction in provider payments which will translate into a reduction in services. This concern is compounded by the fact that the House Bill simply sets up a commission to decide future payments and services for medicare, which seems like a political move to take the hard decisions outside of public scrutiny. Maybe the President is right, but why not put this into an open discussion? Why the "rush to judgment" in trying to ram a bill through congress in two weeks?

The President says that the government option will keep insurance companies "honest" and not necessarily drive them out of business. But many Americans worry that a government option will become a magnet for small business and individuals and that its prices will become the "market". This is what has happened with Medicare. Its reimbursement schedule (with all of its quirks) has become the market setting mechanism with private insurance companies pricing off the Medicare rates. Again, maybe the President is right, but calling this "stupid" is not really fair. As a small business man, I can tell you that the government option would be very attractive to me. Frankly, with health care costs increasing uncontrollably, a flat tax would be very attractive, and the government "endorsement" would make this a very acceptable alternative for my employees.