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Let the “Elephant” Save the “Parrot”

February 26th, 2010 . by economistmom


YouTube video of a GE commercial (there’s both a dancing elephant and a parrot in it–as well as other supporting characters in this unusual “Singin’ in the Rain” cast).

The “elephant” is not a reference to the GOP, but the “parrot” is a reference to health care reform… (Stay with me here…)

The Washington Post’s Kevin Huffman writes about both animals today, in the context of yesterday’s health reform summit (my emphasis added):

Thursday’s health-care summit was the latest episode in an epic battle between the elephant and its rider.

The elephant, in a metaphor originally devised by psychologist Jonathan Haidt, stands for our emotional side. It enables our capacity for love and loyalty and is behind our drive to protect our families. The rider stands for our rational side. It’s what makes long-term plans, sets the alarm clock and tells us to walk away from that pint of Ben & Jerry’s.

For the better part of the past year, Democrats have appealed to logic with health-care proposal after complicated health-care proposal, while Republicans have appealed to tea party emotion. It’s been comprehensive reform vs. the audacity of nope, and, if you believe the polls, nope is winning.

How is this possible? Well, in the fascinating new book “Switch: How to Change Things When Change Is Hard,” authors Chip and Dan Heath draw from social science research to argue that we embrace change only by bringing these oft-conflicted systems into alignment. They argue, “When change efforts fail, it’s usually the elephant’s fault since the kind of change we want typically involves short-term sacrifices for long-term payoffs.” At the same time, the rider without the elephant is prone to paralysis by over-analysis. Ultimately, the authors write, “a reluctant elephant and a wheel-spinning rider can both ensure that nothing changes.”

To me, this elephant-and-rider story is not just reminiscent of the health care debate; it’s the storyline of anything the government tries to do for the sake of “fiscal responsibility.”  It’s a hard problem to solve and the “elephant” in all of us isn’t just unconvinced, but completely disengaged…disenchanted…uninspired… BORED.

At yesterday’s health care summit, the President was indeed in control and acting like “commander in chief”–but more than that he was acting like “professor in chief” (as the Post’s Dana Milbank emphasizes in his front-page story and as I “tweeted” saying “Professor Obama is on a roll…”).  But who was listening, and who changed their minds?  Out of everything the President explained, got right, and straightened out (like the wise and commanding professor), the line that probably made (or should have made) the most impact with not just the politicians but more importantly the American public (if they were watching at that point) was this one highlighted by E.J. Dionne:

[G]ood for Obama for asking Sen. John Barrasso (R-Wyo.) if he would really rather have catastrophic care than comprehensive health coverage…But Obama then made the central point of the whole day. Speaking of the uninsured, he said: “We can debate whether we can afford to help them. We can’t say they don’t need help.”

Back to Kevin Huffman’s column, he also thinks appealing to the compassion in the politicians and Americans more generally would have been better than lecturing to them:

My unsolicited advice: a little less rider, a little more elephant. When Kathleen Sebelius talks up “pooled purchasing options,” people’s eyes glaze over. The logical arguments are good, but my elephant could not care less. Instead, try tapping into a deeper sentiment: This is America. We are the kind of country that doesn’t let a man go bankrupt because his wife or kids get sick. We believe everyone deserves a doctor. That’s who we are.

So what’s the “parrot” got to do with anything?  Again from Kevin Huffman:

In “Switch,” the authors tell a story about the St. Lucia parrot — a magnificent, colorful creature that lives only on that Caribbean island. Biologists were writing the species’ eulogy when conservation activist Paul Butler found himself charged with figuring out how to save the parrot. Butler had ideas: create a bird sanctuary, license eco-tourism and muscle up the punishments for harming the parrot. But he also had a problem. Most people on St. Lucia didn’t know about the parrot, let alone care, and some people even ate the poor bird. What to do?

Instead of making an analytical case, Butler went for the emotional. He appealed to St. Lucians’ national character. The message: We are the kind of people who take care of our own. This bird is ours alone, and we must protect it. He built popular support for new laws, and today, there are seven times as many parrots happily squawking on the island.

If the appeal to “emotional side” in all of us had been emphasized at yesterday’s summit, not only would the politicians have been more likely to see the “common ground” between them in terms of the goal or the “prize,” but they also would have been more inclined to work together to find agreement about the really tough choices about how to afford to claim the prize–how to achieve what everyone actually wants to do about health care, and deficit reduction, and all the other difficult policy issues that get stuck because people care only enough to want the goodies but not enough to be willing to pay for them.

It’s like I said in reaction to the President’s fiscal commission:

[T]he first thing the President’s fiscal commission needs to do is to start getting out there and talking with real Americans, educating them about why we even need to worry about the budget deficit, and asking them about the (hard) choices they’re willing to make (or not).

…because I have a feeling that what Paul Tsongas said was right (that we are better than what our leaders ask us to be), and we as Americans may be more willing to save the “parrot” of health care reform (or fiscal sustainability more generally) than our politicians realize.  They just have to talk with us more about the parrot and all there is to love about it, rather than all there is to think about it.  They have to let our elephant in us save the parrot.

26 Responses to “Let the “Elephant” Save the “Parrot””

  1. comment number 1 by: Matt Franko

    Mom,

    “…educating them about why we even need to worry about the budget deficit, …”

    Why do we need to worry about if the Treasury transfers more balances to the non-govt sector than it withdraws? Are you concerned about the amount of Treasury Securities that are issued for some reason?

  2. comment number 2 by: BillSmith

    “if he would really rather have catastrophic care than comprehensive health coverage”

    Depends on the costs… which depend on what is mandated in ‘comprehensive health coverage’.

  3. comment number 3 by: Brooks

    The Republicans have provided an abundance of silliness, but Democrats shouldn’t unjustifiably flatter themselves by thinking that they presented a very logical case for healthcare “reform”. Much of their case was of the “rock soup” variety or worse, and they (Obama most of all) have constantly said we have to do what they wanted because the status quo is unsustainable, as if the case didn’t need to be made as to (1) why what they proposed would substantially help or even not hurt regarding our need to mitigate the long-term fiscal imbalance or (2) why we needed that entire hugely expensive package to get whatever cost control can be achieved by relatively small elements (medical IT, comparative effectiveness research, different provider payment structures, etc.). Their “logical” case as far as cost control is concerned was not much better than the “logic” of the South Park Underpants Gnomes’ business model http://www.kossan.se/roliga-filmer/south_park_underpants_gnomes_.htm

    And their incessant talk about “not adding a dime to the deficit” or even “reducing deficits” (Wow!) via “offsets” was terribly misleading in it’s implication that the legislation would make it easier or at least no harder to solve our long-term fiscal imbalance problem, when the opposite is the case (even IF, IF, IF the supposed “offsets” actually materialize) because the least painful and least politically difficult deficit-reduction measures would be used up for this incremental spending rather than used for deficit reduction.

  4. comment number 4 by: AMTbuff

    The non sequitur is that if you want to solve the health care crisis, putting more people into third party payment is the best method.

    By now it should be clear to all that third party payment (yes, even single payer) is the root of the problem. Any solution must therefore minimize, not maximize, third party payment.

    The way out is private payment for routine care, with demogrants as necessary to cover that expense for the poor while maintaining accurate marginal pricing. Plus private insurance for catastrophic costs, with a threshold so high that less than 10% of people get anything from it. The government could provide that policy free of charge to the needy and subsidized via assigned risk for the non-healthy. All this would cost much less and save a whole lot of money and eliminate a whole lot of low-value care.

    Put that plan on the table and we’ve got something that would live up to the name of Health Care Reform. The current bills are simply Health Insurance Expansion, not reform of anything related to costs.

    I still maintain that any expansion of government benefits that is enacted now will be overcome by events, specifically a government bond market crash, before it takes effect.

  5. comment number 5 by: Matt

    Why not just adopt the Health Care proposal of Warren Mosler, declared candidate for President in 2012:

    ?Everyone gets a ‘medical debit card’ with perhaps $5000 in it to be used for qualifying medical expenses (including dental) for the year.
    ?Expenses beyond that are covered by catastrophic insurance.
    ?At the end of the year, the debit card holder gets a check for the unused balance on the card, up to $4,000, with the $1,000 to be spent on preventative measures not refundable.
    ?The next year, the cards are renewed for an additional $5,000.

    Link here

  6. comment number 6 by: John Bailey

    AMTbuff right on! Get rid of the tax subsidy for employer coverage. Make health savings accounts universal.

    AMTbuff right on II!! The U.S. government has to borrow around $100 billion per week ($60 billion rollover existing debt, $40 billion borrow new money). I believe that the Fed will have to fund most of that borrowing.

  7. comment number 7 by: SteveinCH

    Democrats define reform as including the following items.

    1. A large/massive increase in the number of people insured, funded by the citizens.

    2. Substantially increased regulation, now including price controls on insurance companies.

    3. Constraining the costs of the entire health care system (although none of the bills under consideration actually does this even though the Ds pretend it does).

    I’m not sure I really understand how the elephant helps here. The implicit argument is that we can all agree that the government should provide people with health insurance if they can’t get it themselves. First, I suspect many of us would answer it depends on what it costs. Second, I don’t think there’s an argument from the elephant side that addresses point 2 of Democrat defined reform.

    Back on point 1, were that the only goal, a simple proposal to expand Federal funding of Medicaid (which would cause the states to up eligibility thresholds all other things being equal) and a high risk pool (public or private with guarantees) would solve problem 1.

    The issue of course is that much of the reform is funded by people through their increased health insurance premiums. A straight up expand coverage bill would cost more than the Dems want to spend.

    Brooks, you like to go on about tax expenditures. What about “legal expenditures”. HCR is an example of this. The government is going to impose costs on people to force cost shifting across different elements of the population. Farm price supports is another example as is discounted bus fares for seniors. IMO, these are more outrageous than tax expenditures because their cost is entirely hidden.

  8. comment number 8 by: SteveinCH

    On the substance of HCR, I agree almost entirely with AMT. The market should become entirely individual (coop) based with no tax subsidy. The only place I disagree is I believe an individual should be able to purchase dollar one coverage if he or she chooses to do so.

    There’s no logical reason in my mind to exclude this since they are spending their own money.

  9. comment number 9 by: Brooks

    Steve,

    Re: Brooks, you like to go on about tax expenditures. What about “legal expenditures”. HCR is an example of this. The government is going to impose costs on people to force cost shifting across different elements of the population. Farm price supports is another example as is discounted bus fares for seniors. IMO, these are more outrageous than tax expenditures because their cost is entirely hidden.

    What is your question? Please be more specific than “What about…?” What are you asking me?

    Re: discounted bus fares for seniors, if that’s a discount on a government-run bus, that’s arguably a subsidy* (paid for by other taxpayers). If so, it wouldn’t be substantively different (other than any difference in timing) if it were provided as a tax expenditure or as a voucher check rather than as a discount on the price. Now to proceed in Rumsfeldian, ask myself questions and answer mode…

    1. Is the cost to others less transparent than it would be if it were an explicit “spending” subsidy, such as voucher checks being sent out to seniors? Yes, and many conservatives would jump up and down decrying them as more “spending”.

    2. Is this discount less transparent than it would be if it were a tax expenditure subsidy? Much less difference in transparency than the difference between the discount and an explicit “spending” subsidy (e.g., vouchers), and as a tax expenditure it would be (irrationally) much less conducive to criticism from conservatives (and more likely to be applauded by them) than if it were an explicit “spending” subsidy. If the cost is shifted to other bus riders I would agree that the cost imposed on others is probably somewhat less transparent than if the cost is, in effect (but still stealthily) shifted to other taxpayers via tax expenditure form. But that difference in transparency is dwarfed by the difference in transparency between tax expenditure subsidies and explicit “spending” subsidies.

    3. Would I prefer it be reviewed via the same process and scrutiny as is discretionary (explicit) spending rather than continued via inertia as an entitlement (the latter being the case with a tax expenditure and perhaps also with a discount)? Yes, if it’s a subsidy — i.e., except insofar as point at asterisk below applies.

    * I say only “arguably” a subsidy because it could alternatively be viewed as price discrimination (and I mean “discrimination” neutrally, not pejoratively) to generate incremental bus ride consumption in a way that increases/maximizes net income of the “bus” program, thus not costing other taxpayers anything or even relieving other taxpayers somewhat.

  10. comment number 10 by: SteveinCH

    Brooks,

    Sorry for being nonspecific but you got the point. The bus fare thing will never come up during a budget discussion nor will the true cost of HCR (including cost shifting) ever be calculated by the government.

  11. comment number 11 by: Brooks

    Steve,

    I agree with the undesirability of the lack of transparency vis a vis hidden costs, whether they are hidden costs to other taxpayers via tax expenditure subsidies, hidden costs to other consumers via cost-shifting*, or both.

    * Same applies to costs imposed on consumers (and business customers) to (unjustifiably) benefit some particular industry — e.g., import quotas/tariffs that result in higher prices. And that’s one relatively hidden cost of the political influence of big money via campaign funding, which is one of many reasons I support a much greater degree of public funding of campaigns (and the Fair Elections Now Act would be a good start)

  12. comment number 12 by: SteveinCH

    My point on HCR is that part of the reason the current proposal looks to cost so little (beyond the CBO gamesmanship) is that a lot of the costs are borne by people in the form of new or higher health insurance costs rather than passing through the hands of the government.

    I agree with your asterisk although I sometimes wonder whether someone should do and ROI analysis on political contributions. I bet there are a lot of losing projects and a few very big winners as opposed to a lot of winners.

  13. comment number 13 by: Brooks

    That dancing elephant version of “Singing in the Rain” is very cute (I remember enjoying the commercial). I just wish A Clockwork Orange hadn’t created an uncomfortable association with that song.

  14. comment number 14 by: Brooks

    Steve,

    Re: the ROI on political contributions, Jim Glass links to a paper on it and I think Jim asserts that such money doesn’t really have much influence, something I find intuitively quite dubious, and I suspect that at best the analysis overlooks at least some forms of influence (I think I once took a quick glance at the paper and found that suspicion confirmed in my view).

    Re: that additional cost of HCR, you may be referring (partly/mostly/completely) to something I’ve mentioned previously, which is the incremental inflation of healthcare “prices” as aggregate demand is increased. I think it is a widely accepted assumption that people with insurance are heavier users of healthcare and that this effect substantially exceeds savings from having fewer uninsured people getting care less efficiently (via emergency rooms; after a condition that could have been prevented or treated earlier worsens instead; etc.).

    Also, if there were a public option that “negotiated” lower “prices” to providers and to healthcare product suppliers (drugs, equipment, etc.), I assume there would be some cost-shifting as well.

  15. comment number 15 by: johnkennedysmith

    The issue is providing health care to Americans. That does not necessarily mean health insurance. There is a tremendous transaction cost for each dollar of healh insurance spent - the administrative loss factor is real. Between the profits to the insurance company and the administrative costs for both the private physician and the insurance company, the amount of actual health care delivered to individuals for each taxpayer dollar has been diminished substantially. The country would be better off focusing on the delivery of health care in the form of a public health system. The health insurance proposals will reduce the reimbursement to physicians and will result in the economic untenability of private physician practice. The creation of public hospitals, hopefully staffed by physicians whose education would be subsidized by subsidies, would result in more health care for individuals without insurance for each government tax dollar spent. Any elephant could go with that!

  16. comment number 16 by: Jim Glass

    For the better part of the past year, Democrats have appealed to logic with health-care proposal after complicated health-care proposal, while Republicans have appealed to tea party emotion.

    You know, it is possible to disagree with this — and even to make the reverse case.

    “Without this thousands will die! will die!!” Ezra and Yglesias have actually called oppents “killers” you realize. That’s not emotion?

    Yet calm analysis of the data says, maybe not so at all.

    I could give many other examples. Many.

    Frankly, the whole notion smacks of ye olde-time, “We are intelligent thinkers, you are just emotional children who need us to take care of you”, patronization that the left has always flattered itself with, as self-justification to extend its agenda.

    Do you remember the great scene in Citizen Kane when Kane while running to be the “reform” governor of New York says, “The people need me Jedediah, they need me.” And Jedediah (who’s had a drink too many) answers, “OK, and what happens when the people realize they can take care of themselves and they don’t need you — what happens to you then? Oooh, boy”.

    That was 1941. It’s at least that old.

    To me, this elephant-and-rider story is not just reminiscent of the health care debate; it’s the storyline of anything the government tries to do for the sake of “fiscal responsibility.”

    If this means there is some sort of disconnect between the “emotions” and the “intellect” in our Washington politicians, causing us to have an $11 trillion debt plus $40 trillion more in unfunded entitlement opbigations and growing, please, I couldn’t disagree more.

    The politicians have run all that up and are running up more because they get votes by doing so, and lose votes doing the opposite. There is no disconnect at all, they know exactly what they are doing — benefitting themselves today, and dropping the pain on somebody else’s watch in the future. It is cold, clear calculation.

    In 1941 FDR vetoed Congress’s conversion of Social Security from funded to paygo — making it fiscally unsound and dropping a big bill on the future.

    FDR’s head of SS, Arthur Altmeyer, went to the heads of Congress and pleaded with them to uphold the veto — he told them that, by arithmetic, they were unfairly reducing the net benefits to future retirees and causing a future funding crisis to SS. (He was right on both counts.)

    They ignored him and overrode the veto. He said that they told him, “You’re right, we know, but it will be on somebody else’s watch. We’ll be gone”. (They were right.)

    They are the politicians who started this whole process — and there was no “disconnect” with them, they knew exactly what they were doing, it was cold political calculation.

    And the exact same thing continues today. Of course, back then they also said they were acting for “the people” — those people being the people whose votes they were gaining. And that continues today too.

    The day our politicians will change course is the day when they start losing votes by continuing this course. Which day will definitely come. But will probably be a very painful day for all of us, when “somebody else’s watch” actually arrives.

    But they are not going to change one day before vote-losing causes them to. There’s no disconnect about it. “Compassion” and “emotion” have exactly nought to do with it.

  17. comment number 17 by: Jim Glass

    AMTbuff right on! Get rid of the tax subsidy for employer coverage. Make health savings accounts universal.

    There was, of course, a truly bipartisan-sponsored bill, Wyden-Bennett, co-sponsored in the Senate by eight Republicans and nine Democrats, that:

    * Repealed the tax subsidy for health insurance.

    * Used the savings from repealing the subsidy to insure the uninsured.

    * Made insurance portable — people could keep it if they left their employer, thus resolving 90% of the “pre-existing condition” problem, since one you had insurance you’d have it forever if you wanted. (Also eliminating all the inefficiencies and unfairness of the employer-tie — why should the quality of your insurance depend on your job? … the fate of your employer? … your changing jobs?

    * Opened up inter-state sales of insurance, breaking the state-protected cartels that hugely increase the price of insurance in states like NYS — making insurance markets open to competition via the Commerce Clause like every other product in America. This would be *real* competition, not pretend competition as from a “public option”.

    * Provide a standard benefit, and as per the previous point, freed people if they wished to buy more comprehensive insurance as they desired in a competitive market. (Not *forcing* then to buy hugely over-comprehensive , and thus over-expensive, insurance as the cartel states like NY do now.

    And CBO scored it as budget neutral.

    Benefits right out front:

    * The uninsured get insured — the left likes it!

    * Serious market reforms — the right likes it!

    * The tax break repeal actually *does* “bend the cost curve” — economists and Orszag like it!

    * Portability arrives and “pre-existing condition” problem disappears — everybody likes it!

    Even an intelligent parrot could see this is *hugely* better on the merits (and truly far more bipartisan!) than the ever-mutating 2000-page monstrosity the Democratic committee heads have been trying to push out on the world.

    In fact, even Ezra Klein himself said this would be better than what the Democrats were actually producing.

    So, why wasn’t this the starting point for health care reform? The parrot might ask.

    Well, as David Brooks reported, even as one economist after another, from political left-to-right, testified to the merits of the idea before the Senate finance committee, its Democratic chairman Baucus got all emotional about how they were wasting his time, because there was no way the unions in particular were going to go along with losing this tax deduction (as we have since well seen!).

    So maybe that parrot should be pretty annoyed at that elephant of the Democratic interest group establishment. Get a little emotional himself! Maybe mad enough to peck the dang elephant’s eyes out, on behalf of all the rest of us.

  18. comment number 18 by: SteveinCH

    Largely speaking, I agree.

    It’s sad that so many people are buying into the story that Republicans are using fear to derail this wholly rational and reasonable approach to health care reform.

    It’s not that Republicans aren’t using fear, they are as do all politicians when they don’t like something. The silly part of the story is that the Dems are the parrot.

    Current versions of HCR do almost nothing to reduce costs. In fact, in practice, they are doing less than nothing because the only surviving cost saving measures are either in 2018 or dependent on Congress to pass cost savings measures that they have never passed before. My parrot tells me there’s not cost savings here.

    And it also tells me that rather than pass a straight up bill about expanding coverage that is fully funded, the Dems propose to fund this bill largely through cost shifting. Just think about the raw math…you can’t insure 30 million people for even $150 billion a year. The math just doesn’t work unless you fund a lot of it through cost shifting.

    Medicare and Medicaid cost per person are north of $10,000 so that would be about $300 billion per year (since about half of the newly insured are through Medicaid).

    So although the left may buy the elephant/parrot analogy, there are a whole lot of parrots who oppose HCR without an elephant in the room.

  19. comment number 19 by: Brooks

    Steve,

    Just an analytical note: When calculating cost-shifting, don’t forget the reduction in cost-shifting as fewer uninsured people are getting healthcare that they don’t pay for (and the fact that much of the care they get is particularly inefficient). I’m not saying anything about the size of that factor or the extent to which it affects your point, just pointing out something not to be overlooked in your calculations.

  20. comment number 20 by: SteveinCH

    Brooks,

    It’s a fair point and I don’t have enough data to do the analysis, particularly since that cost shifting is marginal, meaning one should only consider the marginal cost of care in that case because that is the true cost that is being shifted. By that standard, I’m actually not sure how inefficient the care is. A different way to look at, for example, gong to the ER for primary care is that the net effect is increasing the capacity utilization of the ER. When looked at that way, the only real cost shift is in the differential prices of, for example, medications. The ER care costs more argument is only at the level of the patient, not at the level of the system is, I guess, what I am trying to say.

    My point is simply the net effect implies some serious cost shifting (also to states from the Feds) because you can’t cover the number of people in question at the quoted cost without getting more money from somewhere.

  21. comment number 21 by: SteveinCH

    Said differently, price differentials between different ways of achieving care are not accurate measures of cost shifting at the system level because hospitals largely eat the cost of providing those services. Thus, it is their marginal cost rather than their price that is truly shifted.

  22. comment number 22 by: Brooks

    A Q&A with the supposed Democratic (logical) “parrot”:

    Q: You want government to establish a new entitlement that will increase government spending substantially via subsidies. Should we do that, given the enormous, unsustainable long-term fiscal imbalance we already face?

    “PARROT”: We need this healthcare reform because our current course is unsustainable. Healthcare costs will skyrocket and eventually consume our budget, depress wages, etc., etc., so the status quo is simply unacceptable.

    Q: But will your plan mitigate that problem?

    “PARROT”: The status quo is simply unacceptable.

    Q: You didn’t answer my question.

    “PARROT”: We need this healthcare reform package because it contains elements that will bend the cost curve down while also INCREASING quality of care. Stuff like comparative effectiveness research. And much more preventive care.

    Q: Will anyone’s quality of care decrease? Will anyone have to make such a sacrifice?

    “PARROT”: No. People will just end up taking a more effective, less expensive blue pill instead of a less effective, more expensive red pill. It’s win-win-win all around. We should all say to this healthcare reform package what Seinfeld’s mom always said to him: “How could anybody not like you??”

    Q: How will that preventive care yield substantial savings?

    “PARROT”: Isn’t that obvious? It’s much less expensive to catch an illness early than to treat it after it’s gotten much worse. Duh.

    Q: But aren’t you forgetting to factor in the cost of all that broadly-provided preventive care (screenings, etc.) to people who don’t have that illness at all? And don’t the studies show that a broad expansion of preventive care actually would NOT net out saving us money (even leaving aside the additional factor of some people dying younger and thus collecting less in retirement benefits)?

    “PARROT”: Sounds like you want people to get really sick or even die from illnesses that could have been treated earlier, and you prefer us to pay even more to treat them. How horrible.

    Q: No, that’s not…never mind. So back to this comparative effectiveness research and other elements that you say will bend the cost curve (e.g., medical IT). Why is it that we have to adopt this entire, expensive package of “reform” in order to implement and get much of the benefit from those initiatives?

    “PARROT”: It’s all tied together. The knee bone is connected to the thigh bone. Know what I mean?

    Q: Well, can you explain?

    “PARROT”: We can’t bend the cost curve unless everyone is covered – unless everyone is in the system.

    Q: Can you please explain?

    “PARROT”: The status quo is simply unacceptable.

    Q: But…ok, forget it. So when you say we’ll bend the cost curve, are you saying just that at some point in the foreseeable future you think the slope will be lower than it would be with no changes at all, or are you saying that at some point in the foreseeable future we’ll be spending LESS than we would be even net of all these new subsidies, and so much less that the present value of projected spending will be lower than otherwise?

    “PARROT”: We need to bend that curve. Current course unsustainable. Status quo unacceptable. ‘nuff said.

    Q: If this were such a big money-saver, such a great investment, why do we need all those things you’re calling “offsets”?

    “PARROT”: Ahh, glad you mentioned offsets. Did I mention that we can do all these great things without adding a dime to deficits even over the long term?

    Q: Is that something we can really safely assume?

    “PARROT”: Oh yeah. CBO scored it that way, so you can take it to the bank. After all, if we can’t even agree on the referee, we can’t get anything done, and CBO is clearly the trusted referee, right?

    Q: Yes, CBO is an appropriate referee, but don’t their scoring rules require them to score a plan assuming that ALL the policy changes in the plan are actually implemented, regardless of how unlikely some of those assumptions may be, and hasn’t CBO explicitly expressed doubts about the likelihood of implementation of some of those future cuts in projected spending that you call “offsets”?

    “PARROT”: Hey, CBO is the referee. Stop being unreasonable, man.

    Q: But…whatever. Listen, putting aside the question of whether or not the assumptions of those “offsets” are realistic, even if we assume that those “offsets” will really happen, won’t it make it more politically difficult and more painful to eventually solve our long-term fiscal imbalance problem if we use up (as “offsets” for a new entitlement) the politically easiest and least painful sacrifices?

    “PARROT”: What sacrifices? No sacrifices. All we’re doing is getting rid of wasteful and bad healthcare, taking away excess payments to greedy insurers for Medicare Advantage, and asking really, really rich people to accept expiration of obscene tax cuts they got from Bush.

    Q: Whatever. What about my question about using those supposed savings and incremental revenues to “offset” spending on a new entitlement rather than using them to help us solve the long-term fiscal imbalance problem?

    “PARROT”: That long-term fiscal imbalance problem is a healthcare problem. We’re gonna solve that by bending that curve. Yup, bending that curve…with the blue pill… which also means better quality for everybody. Or would you rather keep the status quo, have lousy healthcare, and continue on our unsustainable course?

  23. comment number 23 by: Brooks

    Oh, I forgot to add the ending exchange:

    Q: But…never mind. Let’s just stop here.

    “PARROT”: I’ve overpowered you with my logic, haven’t I? :)

  24. comment number 24 by: Brooks

    Steve,

    There are papers on cost shifting from the uninsured to the insured in general and in particular re: emergency room care. If you’re interested, I think you’d find some good stuff if you Googled a bit.

  25. comment number 25 by: Brooks

    I should say “cost shifting from the uninsured to the insured and to taxpayers

  26. comment number 26 by: Brooks

    Steve,
    FYI
    http://www.politifact.com/truth-o-meter/statements/2009/sep/20/barack-obama/uninsured-cost-shifting-debated-experts/ and
    http://www.kff.org/uninsured/upload/7809.pdf