Shear Partisanship In The Washington Post

Michael Shear is identified as a “Washington Post Staff Writer,” but as we last saw here, his news articles are often indistinguishable from Washington Post editorials. A few days ago Shear wrote that

The White House is moving aggressively to remove the U.S. Chamber of Commerce from its traditional Washington role as the chief representative for big business, the latest sign of a public feud ignited by disagreement over the administration’s effort to overhaul the health-care system.

That article, however, had none of the bite displayed even by the often White House-compliant Los Angeles Times, which reported yesterday that

… President Obama, his Energy secretary and one of his other most senior advisors have begun criticizing the chamber publicly, casting it as a profligate lobbying organization at odds with its members in opposing the administration on such issues as consumer protection and climate change.

Just as Fox News, in short, is not a legitimate news organization, so the Chamber of Commerce should be ignored because it doesn’t represent its members.

Shear returned to this controversy today, but his article could have been written from a White House memo. Although he quotes the Chamber’s chief lobbyist complaining of White House “invectives” and “name-calling,” Shear gives no examples of any White House criticism. Instead, he reports only that “White House officials contend they are not waging a campaign against the Chamber and they say top officials remain open to discussions with the group’s leadership.”

What then, according to Shear, is this conflict all about? Easy: it’s the people against the special interests. Do I exaggerate? You be the judge. “[T]he clash between the Chamber and the White House,” he writes, “is a clear indication that Obama intends to challenge the power of lobbyists.”

During his presidential campaign, Obama vowed to “tell Washington, and their lobbyists, that their days of setting the agenda are over.” And just a month into office, he said in a radio address that “the system we have now might work for the powerful and well-connected interests that have run Washington for far too long, but I don’t. I work for the American people.”

That sentiment has run into a massive lobbying presence in Washington which is fighting back against the president’s push for health-care reform, his climate change legislation and his plans to regulate the financial sector.

But Obama is fighting back….

I would say that Shear has missed his true calling, writing fiction, but Mr. Smith Goes To Washington has already been written.

Shear’s article, of course, is not the only editorializing in the news pages of today’s WaPo. In a front-page article, Alec MacGillis asks, If you build a coverage mandate, will they come? His answer, you will not be surprised to hear, is yes, because “many economists say” that “the lesson of behavioral economics” is

that people do not necessarily make decisions out of well-reasoned self-interest. It is an approach that has gained a powerful foothold in the Obama White House.

For all I know this conclusion may well be true, but my quarrel is not with this prediction of enrollment success. It is with the limited way the article uses the Massachusetts experience to support that conclusion.

The best case study is Massachusetts, which instituted a health insurance mandate three years ago that has succeeded in bringing coverage levels from 91 percent of state residents to more than 97 percent. The state made it easy to sign up — people who qualified for subsidized coverage got help filling out forms at safety-net hospitals and clinics, while others could use a Web site to determine whether they qualified for subsidies or call a new agency, the Health Connector, for assistance.

The mandate had bipartisan backing, and residents were deluged with publicity. The Boston Red Sox promoted the mandate, pharmacy loudspeakers intoned it, grocery store receipts carried reminders and churches coaxed congregants. The Health Connector held 200 meetings with employers and two dozen outreach sessions, community groups received funding to help people sign up, and residents got red-lettered postcards in the mail.

And it worked: A Health Connector board member told Glied that a typical comment from young adults coming to sign up for coverage was: “My mom said I had to sign up for health insurance or I would get into trouble.”

My quarrel is not even with this successful enrollment experience in Massachusetts, and I don’t doubt that this White House, with help from the IRS and its enforcers in SEIU and ACORN, could plausibly threaten more “trouble” for the recalcitrant than the Commonwealth of Massachusetts. My problem is describing a central feature of the Massachusetts health plan by saying “it worked” without at least a nod toward the financial train wreck awaiting that plan in the absence of dramatically increased taxes or dramatically reduced costs, i.e., rationed care.

As the New York Times reported last March, Massachusetts “government and industry officials agree that the plan will not be sustainable over the next 5 to 10 years if they do not take significant steps to arrest the growth of health spending.”

Massachusetts is a model, for better or worse, that we may be about to emulate nationally, starting with the disingenuousness needed to pass it.

Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent — doctors, hospitals, insurers and consumer groups — would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said.

Now those costs, like the proverbial chickens, are coming home to roost.

Alan Sager, a professor of health policy at Boston University, has calculated that health spending per person in Massachusetts increased faster than the national average in seven of the last eight years. Furthermore, he said, the gap has grown exponentially, with Massachusetts now spending about a third more per person, up from 23 percent in 1980….

The state expects to spend $595 million more on its health insurance programs this year than in 2006, a 42 percent increase. But about 432,000 people have gained coverage, leaving only 2.6 percent of the population without insurance, according to a recent state survey. At only one-sixth the national average, that is by far the lowest rate in any state.

A commission has been set up to study various ways of controlling costs, primarily by doing away with the fee-for-service system, but that may well not be enough to avoid the looming train wreck.

Some health policy experts argue that changes in payment practices will not be enough to slow the growth in spending, even when combined with other cost-cutting strategies. To truly change course, they say, the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care.

“Really controlling costs requires just stopping spending,” said Stuart H. Altman, a professor of health policy at Brandeis University.

I realize that MacGillis’s Post subject was whether individual mandates work, not about health reform in general or its costs, but since the individual mandate must work, and at a low enough cost, for Obamacare not to drive up costs and the deficit, it is irresponsible to conclude that “it worked” in Massachusetts without at least referring to one or two of the problems that it did not solve there.