Wednesday, March 15, 2017

The Elephant, the CBO, Health Insurance and Paul Ryan

John Godfrey Saxe was not the inventor of the saxophone.  That was actually a different man, Adolphe Sax.  This bit of history is completely irrelevant, except that heretofore we can comfortably assume that the two men had never been put intentionally in the same paragraph.

Mr. Saxe, the former, was a poet of some renown.  One of his most familiar works is the poem "The Blind Men and the Elephant" which, even if we didn't memorize it, at least we have read it enough to know the point.  It derived, to be fair, from ancient parables across the west Asian continental peoples.

Six blind men in India ("Indostan", in the original work) are led to an elephant, which they approach from different angles -- one touches the trunk, another the side, a third the tusk, etc.  Being blind, they touch the first elephant part they come upon, and being simple, they make the assumption that "this wonder of an elephant" is very like some analogous reference and stop there.

The blind man touching the tusk, for example, immediately decides that the elephant is "very like a spear", while the one touching the side decides that the elephant is like "a wall."  A rope, a fan, a tree -- you get the idea.  And if somehow you don't get the idea, Saxe closes with this verse:

And so these men of Indostan disputed loud and long,
Each in his own opinion, exceeding stiff and strong,
Though each was partly in the right, and all were in the wrong!

Such it is with the health insurance bill being shepherded through Congress by the Speaker, Paul Ryan.  To be accurate, it is not about that bill itself; it is about the overall program which consists of three parts.  Only the first, the "reconciliation" bill, is available for discussion at this point.

I would like to hope that by now everyone understands what the repeal-and-replace program is.  The first part consists of the repeal of significant parts of Obamacare.  The parts of the program that are in that bill are what can be legally done through "budget reconciliation", i.e., using the same legislative trick that was used by Democrats to pass Obamacare in the first place.

That has to be done because any such bill has to be passed by both the House and Senate.  The House just needs a simple majority, but the Senate needs 60 votes to avoid a filibuster that would kill the bill -- unless it goes through under reconciliation, which needs a simple majority in the Senate.  And that is what the currently-considered bill does, and why it is not the complete repeal and replace we all wish we could get.  Not all of the replacement is budget-centered, so the rest has to be passed in the normal process.

The second part is the gift from the original Obamacare legislation, which vests lots of power in the hands of the HHS Secretary.  The current Secretary, Dr. Tom Price, operates "phase two" by neutralizing everything done by the previous secretary.  That takes no votes at all, since it is an executive action by the Secretary.  I hope we infer that so much power vested in an unelected government official is yet another reason to get rid of Obamacare in the first place.  But by not being a legislative step, it can start already, and according to Secretary Price, it has.

Finally, whatever is left goes into the third phase, the final bill with the parts that couldn't, procedurally, go into the reconciliation bill in phase one.  Those are unfortunately subject to the 60-votes-in-the-Senate rule, which is why they're last.  But they also have the good parts, such as the ability to sell and buy health insurance across state lines, parts that will drive down costs and facilitate R&D and quicker-to-market drugs, address tort reform (badly needed) and the like.

All three phases are needed, and Speaker Ryan sees the three, properly, as all necessary to achieve the needed reform.  So they need to be seen in total, and that (you were waiting) is where the elephant comes in.  It is the rules of the legislative branch that force a multi-phase solution, and so any review of the program needs to be done in total.

The Congressional Budget Office just this week "scored" the bill, making a recommendation as to what its impact would be.  But that review was just of phase one, the reconciliation part.  They came out with some dollar figures and, for some reason, an estimate that 20 million or so would no longer have insurance as a result of that first phase.

Now that is deceptive on its own -- no one will "lose" insurance at all; the decline is because since no one will be forced to buy health insurance under penalty of law, some people will decide to "go naked" and not buy any.  But that won't stop the Democrats from racing to the nearest camera to put their two cents in.

Most importantly, it is an incomplete review, because phase one is a part of a total program.  Obamacare's legislation did not make its dismantling easy.  And we can't say that all three phases will be approved, or at least the first and third where Congress reigns.  But we have to look at all of it.

Otherwise, the commentary on the overall program will sound like it is being done by six Indostani blind men, who may look at only the reconciliation portion and say that "the wonder of the Speaker's plan is very like a mess."  And they would be horribly wrong.

Note: A hat tip here to Fox commentator Greg Gutfeld, who is one of the group on the late-afternoon comment show "The Five."  He consistently attempts to point out that there are three parts to this, and all need to be done to overhaul and completely dump Obamacare.  Anytime one of the panel critiques phase one for something it doesn't do, Gutfeld quietly points out that "No, that is done by the HHS Secretary" or "That is in the third part, because it is not allowed to be put in the reconciliation bill."

And a hat tip to John Godfrey Saxe, who so clearly pointed out that you need to get all the facts on the table, all the parts seen as a whole, so "this wonder of repeal/replace is very like a plan."

And so this wonder of a tag can well and truly scan.

Iambic heptameter.  Try it sometime. 
Sutton out.

Copyright 2017 by Robert Sutton
Like what you read here?  There's a new post from Bob at at 10am Eastern time, every weekday, giving new meaning to "prolific essayist."  Appearance, advertising, sponsorship and interview inquiries cheerfully welcomed at or on Twitter at @rmosutton.

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