• Blahous on CLASS, reform

    I respect Charles Blahous a great deal as an analyst, and I like him and think that he is a nice guy. In fact, I brought you a series of interviews with him last May on the Medicare and Social Security Annual Trustee reports. However, I find his latest at e21 on the CLASS Act and health reform generally to be frustrating, because it focuses on deconstructing (CLASS and the ACA) without offering something better.

    I agree with him that CLASS as passed wouldn’t work, but it is just as clear that there are policy options that could make it work and address LTC. Imagine the impact a post by him (Medicare and Social Security Trustee) offering solutions might have–saying something like “CLASS was flawed but how we deal with LTC is also flawed, and the the current default is for Medicaid to be on the hook for massive nursing home expenditures. Here is how we could move to implement a voluntary LTC insurance program. This is good for the country.”

    However, I respect the idea that an adversarial political system creates better policy through the competition of ideas. Yet, in health reform, conservatives seem to be far clearer about what they are against as compared to what they are for (I mean this generally, and am not singling Blahous out here). When I hear Republicans say “lets repeal Obamacare and we will then pass common sense reforms” I can only think why didn’t you do anything from 2002-06 when you controlled both branches of Congress and the White House?*

    I can respect the adversarial argument, and have spilled about 50,000 words saying the key to a long range sustainable budget is a compromise on health reform. However, it takes two sides to compromise. The House of Representatives owes it to the country to move ahead and begin marking up bills like the Patients’ Choice Act, and Rep. Ryan’s Medicare reforms in the committees with jurisdiction such as Commerce and Ways and Means to show us what they would do. They need to commit to the details so that the CBO can weigh in and we can look at both the fiscal impact and effect on the uninsured of their ideas under the same bright lights to which the ACA has rightly been exposed. And then we can decide what to do.

    *Many of my conservative friends will say they did worse than nothing, they deficit financed the Medicare Part D drug benefit during this period.

    • I am with you here. When my conservative friends, mostly other doctors, ask why I supported the ACA, I often tell them there was no other choice. The bill has many flaws, but it was the only choice offered. The GOP has only offered reform to counter Dem proposals. I do not expect that to change. SCoring the PCA would be a first step to convince me otherwise.


    • I think Blahous’ piece is simply a (in my opinion needed and welcome) reaction to the spin we’ve seen over the last week and a half about CLASS. Sometimes people ought to just own up to a gimmick being a gimmick. The entire CLASS experience has been a complete debacle, and we’re not any closer to solving the LTC problem. In fact we’re probably worse off now, because efforts to try and solve the problem at the federal level will be met with a great deal of skepticism after CLASS.

      Yet despite all of this, all the commentary from progressive and/or ACA-supporting pundits was to downplay the issue, claim that CLASS was actually an example of gov’t working well, and to either ignore or deny the fact that CLASS was a budget gimmick that never represented real savings. Even Austin tweeted approvingly of a Jon Cohn column that did just that, and he even put scare quotes around the word gimmick. But it was a gimmick! I can’t see how any person can be intellectually honest and suggest otherwise. The leaked emails from a month or two ago showed that everyone knew it was a terribly designed program, but they wanted the “savings” CLASS provided (the reverance of Teddy Kennedy didn’t help either).

      I think if people had just owned up to this in the first place instead of trying to defend the indefensible, people like Charles Blahous wouldn’t need to write columns like this, and we could move on to actually figuring how to solve the LTC puzzle. But the spin was ridiculous, and while you are right that this is not solving the problem and we need alternative solutions, Blahous is also right to not let it go unchallenged.

    • @AB
      I wish we could get to where everyone could say “see I am right” and then we could cut the deal.