“What I want to do today is speak English with y’all,” Vice President Joe Biden told an audience of mostly older Americans at an event in Alexandria on Thursday afternoon’s meeting of his Middle Class Task Force.
Flanked by Health and Human Services Secretary Kathleen Sebelius, White House Health czar Nancy-Ann DeParle and Barry Rand, CEO of AARP, Biden said he wanted to make sure people understood the health care debate in plain language, without the kind of wonky jargon that dominates discussions of such subjects.
In the course of doing so, he made some bizarre analogies and never allowed the facts to get in the way.
“Can we possibly afford to do nothing when health care costs have gone up 57 — if I’m not mistaken — percent just since 2002?” Biden asked rhetorically. “Now folks, if your milk went up 57 percent and no end in sight, guess what? There would be a lot of dead cows. No one buying milk. You can’t afford it.”
Beyond the fact that it’s hard to understand why the price of milk or the mortality rate of livestock would have anything to do with health care reform, Biden’s example makes no sense from an economic standpoint. Basic economic theory would hold that, if anything, cattle ranchers would respond to rising milk prices by breeding more cattle.
In his opening remarks and throughout the question and answer period, Biden kept pounding on the administration’s theme that the only way to control costs is to overhaul the health care system the way Democrats want to. That in fact, having the government provide free or heavily subsidized insurance to tens of millions of more people was actually the fiscally responsible thing to do.
“The status quo is simply not acceptable — it’s totally unacceptable,” Biden said. “And it’s completely unsustainable. Even if you wanted to keep it the way you have it now, we can’t do it financially. We’re going to go bankrupt as a nation.”
He said he understood that it may seem counterintuitive to some people.
“When I say that, people look at me and they say, ‘You’re telling me we have to spend money when we’re going bankrupt?'” Biden exclaimed. “The answer is yeah, that’s what I’m telling you.”
Biden noted that Medicare and Medicaid, unless changes are made, “will eventually grow larger than what our government spends on everything else in the world combined.”
“Not only is it immoral not to provide everybody with decent health care, which is my view, the president’s view, and the administration’s view,” he said. “It is also fiscally irresponsible.”
His comments had an added irony coming on Thursday, because earlier in the day, the director of the Congressional Budget Office testified that the Democratic health care proposals only make the health care cost issue much worse.
Democrat Kent Conrad, chairman of the Budget Committee, asked CBO director Doug Elmendorf: “From what you have seen from the products of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?”
Elmendorf responded, “No, Mr. Chairman.” He explained, “In the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs.”
But in his remarks, Biden pushed back against the way the CBO assesses the cost of legislation, arguing that it failed to take into account savings from preventive care.
“We can show these studies done by really first rate think tanks like the Rand Corporation and these studies funded by medical schools and hospitals and universities that say hey, look, if we can prevent people from becoming obese, what would happen is we would save the health care system billions of dollars,” Biden said. “So we go, and we say to the people who are oppose us, look, we’re not wasting money, we’re going to save money, and they say, ‘Show it to me, prove it to me.'”
Then, in a clear reference to the CBO, Biden explained in layperson’s terms, “Then you have these good guys, these accountants kind of, the green eye shade guys, they sit there and say, ‘well how do we score this? How can we prove like we can prove in other savings we’re talking about where we can add up all the nickels and dimes and millions and billions and say we saved that much money?'”
He continued, “So even though we know we’re going to save a lot more money than we’re given credit for that we’re going to save with this health care plan, it isn’t susceptible to being able to prove with a sharp pencil, or now, with a mouse on a computer, exactly how much is going to be saved. So that’s what we mean when we say we’re doing things that we know are going to save you, your grandchildren, billions of dollars over the years and make you healthier. But, we’re not able to prove it yet, because there’s all those studies showing it, it’s not scorable.”
In reality, there’s far from a consensus on whether preventive care can save money. A New England Journal of Medicine article published last year warned against “sweeping statements about the cost-saving potential of prevention,” emphasizing that, “Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs.”
Increasing screening tests among a broader and mostly healthy population, for instance, can cost more than would be saved treating a smaller population of people who are actually sick.
As he was wrapping up his remarks, Biden claimed, “We’re not passing anything that isn’t paid for, it ain’t going to the deficit.” It’s rather odd, of course, because normally when you save money, it means you don’t have to pay for it.
In any event, Biden explained that the Democrats would use $600 billion in Medicare savings to pay for most the health care legislation, but the rest would either be made up of the tax “surcharge” proposed by House Democrats (which would drive the top rate above 50 percent) or through capping the charitable tax deduction on wealthier Americans. In reality, Democratic bills would also raise taxes on businesses that did not provide health insurance to their employees and on individuals who do not purchase insurance on their own — a direct violation of Obama’s campaign pledge not to raise taxes on those earning less than $250,000 a year.
Biden offered the crowd another whopper for the road: “If we did nothing, and did what the HELP committee just passed, we wouldn’t have to do a thing, just the Medicare savings alone would cover everything.”
To translate that into English, as Biden might say, what he is arguing is that the full cost of the Senate Health, Education, Labor and Pensions committee bill could be covered by the $600 billion in Medicare “savings” alone — without the need for any tax increases. It’s true that the CBO did put out an estimate assessing the cost of the legislation at $597 billion over ten years — but that estimate was only measuring a portion of the bill. Missing from the projection was the cost of expanding Medicaid to as many as 20 million additional beneficiaries, which the bill also calls for. And the CBO estimates that the Medicaid provision alone would cost $500 billion.
So it turns out Biden isn’t too good at speaking English. Maybe he should try Greek next time?
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