With everyone focused so heavily on Occupations of one sort ot another (We're invading Africa! Again!), perhaps now is not the time to remind everyone about the other thing that the Obama Administration still struggles with - health reform.
Kathleen Sibelius made it official today, but this was in the wind for some time: the Administration has abandoned CLASS, the part of health care reform that was meant to provide some form of long term care insurance for seniors. Some of the ACA's most ardent defenders have had to do some backpedaling over this, because the long term care piece was both a signature achievement (it was one of Ted Kennedy's must-haves), and a fallback position when people complained that the ACA was mostly some moderate insurance reforms. "But we've also dealt with long term care!" was a big defense.
In reality CLASS was doomed because it made little or no sense. Indeed, as some especially disgusted partisans note, the real use of CLASS in the bill was to mask the fact that claims the bill was "revenue neutral" were never all that true. CLASS wasn't scheduled to kick in until 2016, but collections of fees and premiums were set to begin next year. By raising CLASS revenues well in advance of the program actually going live, the overall cost of ACA could book the revenue, without discussing the costs. And, the longer term reality was that, after CLASS kicked in, costs for the program were likely to soar.
That's because long term care - like rehabilitation for physical injuries, mental healthcare and other less time defined conditions - is actually very expensive to provide. One reason Medicaid is in such a disastrous state (among many) is because much of the program's funds are used to pay for nursing home care for the indigent elderly, complicated by the fact that nursing home costs will make most elderly people indigent long before they die. CLASS was always unrealistic - filled with rosy scenarios about how much the long term care would cost (even the $50 a day per person estimate on payouts was pretty ludicrous), and even under the rosiest scenarios, the program would cost far more than it could ever take in. Like... well, Medicaid.
Conservatives, of course, always opposed CLASS, much like the rest of the bill, because the math was so obvious and because it looked, more or less, like another entitlement that couldn't be appropriately funded from the get-go. This, of course, is indicative of the problem with health reform on the right: not that they don't make reasonable points about the cost of reform... but they've got essentially no solution but "suffer" when it comes to the actual problem. Opposing CLASS because of the expense missed the obvious - a program as badly conceived as CLASS was never going to happen.
All of which is to say that the Administration today was forced, yet again to admit the obvious: that, in fact, one of the key elements of their health care reform plan, cynically derided as expensive and unworkable was... you guessed it, expensive and unworkable. But then, as we all know, a bunch of the ACA's key assumptions - from the expansion of Medicaid without paying for it, to the cutting of Medicare without wanting to cut anything - are ludicrous, expensive, unrealistic, and unlikely to happen.
And I suppose one could, yet again, express exasperation with this Administration; point to the lousy process of creating a deeply flawed, unworkable health reform plan; complain bitterly about how Washington works; maybe handwrite a sign and take it to a local protest.... but for me, all I can do is shake my head. Two years of pointing out that this stuff won't work... and guess what, it doesn't work. Nothing but class... all the way.
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