...when legislators actually need to figure out how to pay for things...

And why would they start figuring that out now?

So $300 billion in new taxes from changes in deduction policy, a couple hundred billion more from taxing health care benefits, plus something else will still be needed.

Overall, they'll need to raise over $1 trillion in new taxes to provide health coverage for the uninsured. I just don't see how they'll be able to spin that away.

My guess is we'll see a plan focused on Medicaid expansion, potentially Medicare expansion, individual mandate to push the young ones onto the rolls, with an overall estimate that we'll get down to 15 million uninsured.

As usual, Ezra seems convinced that what he's seeing in looking-glass world must be good, because Obama people tell him so; why is it good to discuss financing a mythical plan with no hard details? Because they said so.

That doesn't make it true - for a variety of reasons, we need more of a public discussion about the actual healthcare reform proposal now, ahead of how we pay for it, if only to help adjust the thinking of ordinary folks, many of whom (still) only barely get the issues involved or why they matter. If people are won over to an actual plan, then the question of how to pay for it isn't just urgent... it's necessary. Instead, he Obama team has created two painful conversations where one full discussion might be better and more useful. We'll argue over tax policy and cap and trade for months... and then, just when we've guaged the depth of people's resistance to taxes, we'll start a new debate about government run health insurance. And don't look at me - I'm actually for government run health insurance. But will a lot of other people be? I'm not confident about that, and even less confident in a mood swing where people, tired of arguments, just want the whole thing to go away.

The reality is we face an enormous dilemma on health reform because truly comprehensive reforms will be expensive and complicated to implement, and what we do matters as much or more than how we pay for it. In ruth, the Obama team isn't really having either discussion - what it is or how to pay for it - but instead is dawdling, I suspect, in hopes that much of the hard work of making a plan can be done back of house and then rammed through by any means necessary. The danger, really, is that we tried that, in 1993. The lesson I thought we learned was that we needed to do this up front and openly and accept the possibility that a good plan makes incremental progress. Apparently, not.

RE: "They've kept, for instance, the idea to limit the itemized deductions of the richest Americans..."

That's dead wrong, if it means what I think. Everyone gets compensation in various forms for various reasons, and I'd bet there is less correlation between 'rich' workers getting good health care than there is 'union' workers getting good health care.

Unions have spent 20 years giving up raises to keep good health care, now they are set to lose 25% of the value of that exchange -- though they are rarely rich. Other workers have taken health cuts instead, as no one bargained for them and the company thought it was a cut that was easier to swallow.

Sure, a few CEO's will take a hit, but in actual numbers this will be a tax burden on workers who have made trade-offs based on current rules in place at that time.

Everyone talks about 'gold-plated' health insurance. My family insurance is probably worth >$20k per year, but it doesn't cover boob-jobs and face-lifts. It just has low copays and deductibles. That's the going rate for basic employer-provided health coverage (everyone else is picking up the difference themselves.)

That's dead wrong, if it means what I think.

It doesn't mean what you think, it means what it says. They are proposing a tax change on itemized deductions, this isn't about health insurance.

No matter how you slice it, your taxes are about to go sky high.

Much to the chagrin of the liberal left, there just aren't enough "rich" to pay for all they want to spend. You could take ALL their income and still not have enough.

Since there isn't enough at the top to pay and the bottom 50% currently pay only about 2% of the income tax burden, guess who's gonna pay?

Buckle up. There is a reason why Democrats are known as "Tax and Spend"

weboy,

your comment made me think of something that bummed me out. There's really no way to escape one of the biggest problems of 1993, i.e, health reform is really effing complicated...

The health reform website, the announcements like today's (which I agree was more about posturing than substance), all that still won't bring the average American up to speed enough to understand, let alone have an opinion on things like DRG reform, Medicaid FFP reform, casemix, blending risk pools, the public plan, comparative effectiveness, etc. There's too much of a learning curve, and too many moving pieces to make for good billboards and commercials. The public discussion is somewhat doomed before it starts.

I hope the white house has very, very good PR people thinking about this. I mean, we're a self-selected group of people who mostly understand this and we don't agree on many things. How are the American people supposed to understand and support this reform?

I think it needs to be framed apolitically like a giant civil engineering project, something like the Panama Canal or the highway system, or maybe even the Manhattan project. Something where the best and brightest are working together on something and, though the average person might not be able to follow, it's understood it's for the common good. That's vaguely the direction things seem to be going but now I'm worried we're going to see a million ads pro/con on everything from post-acute bundling to further standardization of electronic transactions and the american people are going to tune out.

I suspect, in hopes that much of the hard work of making a plan can be done back of house and then rammed through by any means necessary. The danger, really, is that we tried that, in 1993. The lesson I thought we learned was that we needed to do this up front and openly

hope the white house has very, very good PR people thinking about this.. thanks for sharing with us..

___________________
Jessica
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