Debating the President’s Portsmouth Pitch (Final)

Finalizing the debate of Obama's town hall pitch in Portsmouth, NH earlier this week, Mr. Hennessey debates the issue of treatment in private versus government run health care, increasing deficits, increasing costs, AARP, and government control:


Debating the President’s Portsmouth Pitch

By Keith Hennessey, August 12, 2009

PART 3
Here’s the President again at the Portsmouth, NH town hall on health care reform:

(In response to a gentleman’s question about Medicaid forcing him to take a generic equivalent for Lipitor):

THE PRESIDENT: "Now, I want to be absolutely clear here: There are going to be instances where if there is really strong scientific evidence that the generic and the brand name work just as well, and the brand name costs twice as much, that the taxpayer should try to get the best deal possible, as long as if it turns out that the generic doesn’t work as well, you’re able to get the brand name."

The proxy for the taxpayer is the government bureaucrat running the program. At least for this Medicaid patient, the President is in effect saying that, “if there is really strong scientific evidence” of medical equivalence, then a government official, on behalf of the taxpayer, should make the decision for you “to get the best deal possible.”

It’s hard to square this with his earlier statement that “This is not about putting the government in charge of your health insurance.”

Continuing with this same case, the President said:

"So the basic principle that we want to set up here is that — if you’re in private insurance, first of all, your private insurance can do whatever you want. If you’re under a government program, then it makes sense for us to make sure that we’re getting the best deal possible and not just giving drug makers or insurers more money than they should be getting. But ultimately, you’ve got to be able to get the best care based on what the doctor says.

And it sounds like that is eventually what happened. It may be that it wasn’t as efficient — it wasn’t as smooth as it should have been, but that result is actually a good one."

The questioner said “And I had to go through two different trials of other kinds of drugs before it was deemed that I was able to go back on the Lipitor through the New Hampshire Medicaid system.” The President responded, “It may be that it wasn’t as efficient – it wasn’t as smooth as it should have been, but the result is a good one.”

This man had to wait in a line. Earlier the President said about reform, “You will not be waiting in any lines,” and yet in this case, “The result is a good one.”
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PART 4
Here is the President speaking about health care reform at a town hall in Portsmouth, New Hampshire:

THE PRESIDENT: "And finally – this is important – we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies …

(later) And I would like to see a mental health component as part of a package that people are covered under, under our plan."

In this case, “we” and “our plan” mean “the government.” I can’t see how he squares that with “This is not about putting the government in charge of your health insurance.” And yet the President is talking about the government mandating specific benefits.
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PART 5
Here again is the President speaking about health care in Portsmouth, New Hampshire:

THE PRESIDENT: "… because there’s no reason we shouldn’t be catching diseases like breast cancer and prostate cancer on the front end. That makes sense, it saves lives; it also saves money – and we need to save money in this health care system."

Here is the key sentence from CBO Director Dr. Douglas Elmendorf in a letter he sent to Rep. Nathan Deal (http://tinyurl.com/lnda6k) last Friday:

CBO: "Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall."

Dr. Elmendorf eloquently explains why:

CBO: "But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. Even when the unit cost of a particular preventive service is low, costs can accumulate quickly when a large number of patients are treated preventively. Judging the overall effect on medical spending requires analysts to calculate not just the savings from the relatively few individuals who would avoid more expensive treatment later, but also the costs for the many who would make greater use of preventive care. As a result, preventive care can have the largest benefits relative to costs when it is targeted at people who are most likely to suffer from a particular medical problem; however, such targeting can be difficult because preventive services are generally provided to patients who have the potential to contract a given disease but have not yet shown symptoms of having it."

Finally, Dr. Elmendorf makes a key point (also on his blog http://tinyurl.com/lqjwde):

CBO: "Of course, just because a preventive service adds to total spending does not mean that it is a bad investment."

The President could have correctly said, “Preventive care saves lives. It increases spending, but I think it’s worth it.” He was incorrect when he said “It also saves money – and we need to save money in this health care system.”
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PART 6
Continuing with the series, here is the President talking about health care reform in Portsmouth, New Hampshire:

THE PRESIDENT: "And we will do this without adding to our deficit over the next decade, largely by cutting out the waste and insurance company giveaways in Medicare that aren’t making any of our seniors healthier.

(later) First of all, I said I won’t sign a bill that adds to the deficit or the national debt. Okay? So this will have to be paid for."

And yet:

•CBO says the House bill would increase federal deficits by $239 B over the next ten years.

•CBO says the House bill would increase the deficit in 2019 by $65 B, meaning the bill fails the President’s “10th year test.”

•CBO says the House bill would result in increasing deficits beyond 2019, because the new spending would grow faster than 8% per year, while the offsets would grow only about 5% per year.

The House bill would not just slow Medicare growth, but would also raise taxes on high-income individuals and small business owners.
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PART 7
Here’s still more from the President in the Portsmouth, New Hampshire town hall on health care reform:

THE PRESIDENT: "We have the AARP on board because they know this is a good deal for our seniors.

(later) AARP would not be endorsing a bill if it was undermining Medicare, okay?"

After the town hall, AARP issued a statement including the following sentence:

AARP: "While the President was correct that AARP will not endorse a health care reform bill that would reduce Medicare benefits, indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate."

A political observation: With this statement AARP embarrassed the President. It is a huge deal for a left-leaning interest group like AARP to directly and immediately contradict the President on his top policy priority. I infer that AARP’s leadership is more afraid of their members attacking them for perceived support of these bills than they are of infuriating the President and his staff.
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PART 8
Here is the President talking about health care reform in Portsmouth, New Hampshire:

THE PRESIDENT: "[If we do nothing] our deficit will continue to grow because Medicare and Medicaid are on an unsustainable path. Medicare is slated to go into the red in about eight to 10 years."

This statement is true. But the President and his budget director have lowered their bar to say only that health care reform must not increase the deficit, not that it must reduce the deficit. If legislation “cuts” Medicare spending and turns right around and re-spends those funds to create a new rapidly growing health care entitlement, then the underlying deficit problem is unresolved. The legislation being developed in both the House and the Senate just barely meets this condition.

The President’s budget director argues that other reforms in legislation will “bend the cost curve down.” The nonpartisan Congressional Budget Office disagrees, and says the House bill will increase long-term budget deficits relative to current law.
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PART 9
Here is still more from the President’s health care town hall in Portsmouth, New Hampshire:

THE PRESIDENT: "And so I do think it’s important for particularly seniors who currently receive Medicare to understand that if we’re able to get something right like Medicare, then there should be a little more confidence that maybe the government can have a role — not the dominant role, but a role — in making sure the people are treated fairly when it comes to insurance."

But Medicare is fiscally unsustainable. The President already said that earlier in the discussion. So Medicare is not a successful model for a new system, because we can’t afford it.
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PART 10
Here’s more from the President’s health care reform town hall in Portsmouth, New Hampshire:

THE PRESIDENT: "We also want to make sure that everybody has some options. So there’s been talk about this public option. This is where a lot of the idea of government takeover of health care comes from."

The President is correct that “a lot of the idea of government takeover of health care comes from” the public option. Many of the critics are missing that, even if the public option drops out of legislation, other provisions in these bills will effectively put insurance under government control, even while it is offered by private firms.
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Part 11
Here are two Presidential answers to different questions. The contrast is instructive:

THE PRESIDENT: "And I do think that having a public option as part of that would keep the insurance companies honest, because if they’ve got a public plan out there that they’ve got to compete against, as long as it’s not being subsidized by taxpayers, then that will give you some sense of what — sort of a good bargain for what basic health care would be."

"… We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits. The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get a $177 billion of taxpayer money to provide services that Medicare already provides. And it’s no better — it doesn’t result in better health care for seniors."

On the one hand, the new public option would “keep the insurance companies honest” and be something “that they’ve got to compete against.” On the other hand, where that competition exists today in Medicare, he argues the government should cut payments to private plans that are competing with the Medicare “public option.” This is one reason I fear the public option. A future President could easily make the arguments that President Obama made Tuesday about Medicare Advantage plans, and seek to tilt the playing field toward the public option.
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PART 12
We continue debating the President’s health care pitch at the Portsmouth town hall:

THE PRESIDENT: "Another way of putting this is right now insurance companies are rationing care. They are basically telling you what’s covered and what’s not. They’re telling you: We’ll cover this drug, but we won’t cover that drug; you can have this procedure, or, you can’t have that procedure. So why is it that people would prefer having insurance companies make those decisions, rather than medical experts and doctors figuring out what are good deals for care and providing that information to you as a consumer and your doctor so you can make the decisions?"

The quote takes on a whole new meaning if you insert a legislative detail that the President omitted. I’ll put it in brackets:

"So why is it that people would prefer having insurance companies make those decisions, rather than medical experts and doctors [chosen by the government] figuring out what are good deals for care and providing that information to you as a consumer and your doctor so you can make the decisions?"

In a world of limited resources, we cannot just make decisions about medical care based on whether an additional treatment provides a medical benefit. Someone must instead decide whether that benefit is worth the cost. The third MRI on the sprained wrist may provide more up-to-date and useful information, but the benefit is probably small compared to the additional cost. Someone must have authority to decide whether additional care is “worth it.” That person must control the dollars. Ultimately, the health policy debate comes down to the question: Who should make the cost/benefit decision? The pending legislation would move some of those decisions from insurers to the government.

I think it’s a mistake to have government make more cost-benefit decisions on our behalf in part because people are different. The President is talking about government policymakers (who would also happen to be medical professionals) making determinations about “what are good deals for care.” But cost-benefit tradeoffs depend on the particular medical conditions, situation, and preferences of the individual. I would like more of these decisions to be pushed away from insurers to individuals and families, rather than to people chosen by the government to make those tradeoffs for us.
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Other post in this series: http://tinyurl.com/paswuw

Debating the President's Portsmouth Pitch

While the power hungry Obama was full of platitudes at his Portsmouth hand-picked townhall Tuesday, manipulating the American people and vilifying doctors, Keith Hennessey was carefully laying out the facts. This is the health care system I believe in. The rest is theft of private property:


Debating the President's Portsmouth Pitch
By Keith Hennessey, August 12, 2009

The President talked about health care reform at yesterday's town hall meeting in Portsmouth, New Hampshire. There is so much substance to debate that I have broken my response up into a bunch of small parts. I will spread my response out among a bunch of small posts over the next two days.

PART 1
This is the first in a series of posts. I had written this as one piece, but it was way too long. So I am going to try it in lots of little nibbles. I will post one nibble every two hours over the next two days.

At a town hall meeting in Portsmouth, New Hampshire yesterday, the President said:

THE PRESIDENT: "(L)et me just say there's been a long and vigorous debate about this, and that's how it should be. That's what America is about, is we have a vigorous debate. That's why we have a democracy. But I do hope that we will talk with each other and not over each other -- (applause) -- because one of the objectives of democracy and debate is, is that we start refining our own views because maybe other people have different perspectives, things we didn't think of.

Where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed."

In the spirit of informed and vigorous debate, let's look at what the President said about the pending legislation at yesterday's Portsmouth town hall.

THE PRESIDENT: "Now, let me just start by setting the record straight on a few things I've been hearing out here -- (laughter) -- about reform. Under the reform we're proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan."

And yet here is what CBO said about the House bill: http://tinyurl.com/l3j4tt

THE PRESIDENT: "In addition, CBO and the JCT staff estimate that nearly 6 million other people who would be covered by an employment-based plan under current law would not have such coverage under the proposal. That figure includes part-time employees, who could receive subsidies via an exchange even though they have an employer's offer of coverage, and about 3 million people who would not have an employer's offer of coverage under the proposal. Firms that would choose not to offer coverage as a result of the proposal would tend to be smaller employers and those that predominantly employ lower-wage workers--people who would be eligible for subsidies through the exchanges--although some workers who were not eligible for subsidies through the exchanges also would not have coverage available through their employers. Whether those changes in coverage would represent the dropping of existing coverage or a lack of offers of new coverage is difficult to determine. (p. 5)"

According to CBO, the President's statement is incorrect for a portion of these 6 million people who as a result of the House bill would lose employment-based coverage they would otherwise have under current law. Some of those 6 million people would lose the opportunity to get employment-based coverage, while others would "represent the dropping of existing coverage." CBO reached similar conclusions. Here is a more detailed explanation of this problem (http://tinyurl.com/qa7dy4) that I wrote for an earlier draft of the Kennedy-Dodd bill, under which 10 million people would not have lost the health plan they would otherwise have under current law. CBO dialed this number down to 3 million for a later draft of Kennedy-Dodd.

This is an inevitable consequence of moving away from a system that is so heavily biased toward higher subsidies for employment-based coverage. My preferred plan (http://tinyurl.com/qua9f3) would have a similar effect. Nonetheless, the President is overpromising, at least relative to CBO's view of the House bill.
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PART 2
This is the second in a series of posts on the President's comments about health care reform at yesterday's town hall in Portsmouth, New Hampshire. Here is the President again:

THE PRESIDENT: "You will not be waiting in any lines. This is not about putting the government in charge of your health insurance."

And yet section 3103 of the Senate HELP Committee bill (http://tinyurl.com/qd2pbg) would give the Secretary of Health and Human Services authority to appoint a Medical Advisory Council that would determine what items and services are "essential" for a "qualified health plan," and, by implication, which benefits are not essential. The House bill is parallel but less specific (http://tinyurl.com/obvym4), creating an "independent public/private advisory committee," in which the members are chosen by the government. In both cases, the recommendations would be packaged together and approved or disapproved en bloc by the Executive Branch and Congress.

These bills would give government officials, or people chosen by the government, authority to determine benefit packages, copayments and deductibles, relative premiums, as well as health plan expenses and profits. They would, in effect, turn health insurance into a utility, run by private companies, but with policies and rates set by the government. While privately-owned firms would be implementing the decisions, the key decisions would be made by government officials or people chosen by government officials.

THE PRESIDENT: "I don't think government bureaucrats should be meddling, but I also don't think insurance company bureaucrats should be meddling. That's the health care system I believe in."

Resources are constrained, and so someone has to make the cost-benefit decision, either by creating a rule or making decisions on a case-by-case basis. Many of those decisions are now made by insurers and employers. The House and Senate bills would move some of those decisions into the government. Changing the locus of the decision does not relax the resource constraint. It just changes who has power and control.

The health care system I believe in moves no more decisions into the hands of the government, and instead creates incentives for people to control more of these decisions and make these hard tradeoffs for themselves. Insurance would evolve from pre-paid medical care, as it is today for many, to a more traditional catastrophic protection model, as we now have for other kinds of insurance.

FISHY STATEMENTS ABOUT HEALTH CARE REFORM

There seems to be a lot of 'disinformation' about what is in the government-run healthcare bill, and what is not. In order to assist this administration understand their Health Care Reform Bill HR3200, Keith Hennessey sent an email to flag@whitehouse.gov.


Fishy Statements About Health Care Reform
By Keith Hennessey, August 11, 2009

I sent the following email to flag@whitehouse.gov this morning.

From: Keith Hennessey
Sent: Tuesday, August 11, 2009 7:47 AM
To: flag@whitehouse.gov
bcc: surveil@fbi.gov; bigbro@dhs.gov; patriot.act@nsa.gov; anon6427@dni.gov

Subject: Fishy statements about health care reform

The Honorable Linda Douglass
Communications Director
Health Reform Office
The White House

Dear Ms. Douglass:

I write in response to the request posted on the White house blog, "Facts are stubborn things."

If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov .

I call to your attention several fishy statements about health care reform legislation made by a gentleman named Dr. Douglas Elmendorf. He claims to be Director of the "Congressional Budget Office" and has posted frequently about health care reform on his website, cbo.gov. This information takes the form of personal posts on his Director's Blog, as well as in-depth reports that have the veneer of competent, thorough, impartial professional analysis. The IP address of his site is 206.106.246.254, and his organization has named their hideout the "Ford House Office Building" (http://tinyurl.com/qodpfm).

Elmendorf appears to have several hundred followers in his organization, which has extraordinary influence over many in Congress. I understand that some right-wing Members of Congress support and even vote for his annual funding source.

CBO and Elmendorf make extraordinary claims about bills moving through Congress that attempt to implement the President's plans for health care reform. I bring them to your attention so that you can refute them. I have included these allegations below. Specifically, Elmendorf and his rabble-rousers make the following claims:

- The House bill would increase the budget deficit by $239 B over the next ten years. This conflicts with the President's goal of not increasing short-term deficits.

- Ten years from now the House bill would add $65 B to the budget deficit. This conflicts with the President's insistence that legislation must not increase the deficit in that year.

- The House bill would increase long-term budget deficits by ever-increasing amounts, making our long-term debt problem worse than under current law. This of course conflicts with the President's statements that "health care reform is entitlement reform," and that health care reform is essential to addressing America's long-term budget problems.

- Rather than "bending the cost curve down" as the President has laudably insisted, Dr. Elmendorf said the Senate HELP Committee bill would "raise the cost curve."

- Under the House bill, in the year 2015 about 8 million uninsured Americans would remain uninsured and pay higher taxes. This would violate the President's pledge not to raise taxes on anyone earning less than $250,000 per year.

- Under the House bill, about 3 million people who now have employer-sponsored health insurance would lose that coverage because their employer drops it, violating the President's bold promise that no one will lose the health plan they have now.

- The President's Medicare Commission proposal would probably save only $2 billion over ten years, and there is a high probability it would save no taxpayer money. In the long run the saving would be "modest."

If this suspect "Congressional Budget Office" is publishing disinformation about either health care reform, I hope you can correct it. A lot of important people seem to listen to this Elmendorf guy. Left unrefuted, these claims suggest that the bills being developed in the House and Senate would harm the U.S. economy and millions of Americans in violation of the President's stated goals.

Sincerely,

Keith Hennessey
KeithHennessey.com
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Seemingly fishy statements about health care reform
made by Dr. Douglas Elmendorf and his "Congressional Budget Office"

Effect on short-term budget deficits

"According to CBO's and JCT's assessment, enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period. That estimate reflects a projected 10-year cost of the bill's insurance coverage provisions of $1,042 billion, partly offset by net spending changes that CBO estimates would save $219 billion over the same period, and by revenue provisions that JCT estimates would increase federal revenues by about $583 billion over those 10 years." Elmendorf blog post (http://tinyurl.com/ls27yu).

"By the end of the 10-year period, in 2019, the coverage provisions would add $202 billion to the federal deficit, CBO and JCT estimate. That increase would be partially offset by net cost savings of $50 billion and additional revenues of $86 billion, resulting in a net increase in the deficit of an estimated $65 billion." Elmendorf blog post (http://tinyurl.com/ls27yu).

Effects on long-term budget deficits

"In sum, relative to current law, the proposal would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window." Elmendorf letter to Reps. Camp, Barton, Kline, and Ryan (http://tinyurl.com/ltbo2e).

"The net cost of the coverage provisions would be growing at a rate of more than 8 percent per year in nominal terms between 2017 and 2019; we would anticipate a similar trend in the subsequent decade. ... Revenue from the surcharge on high-income individuals would be growing at about 5 percent per year in nominal terms between 2017 and 2019; that component would continue to grow at a slower rate than the cost of the coverage expansion in the following decade." Elmendorf letter to Reps. Camp, Barton, Kline, and Ryan (http://tinyurl.com/ltbo2e).

Eight million uninsured paying higher taxes

See table "Preliminary Analysis of the Insurance Coverage Specifications Provided by the House Tri-Committee Group," of this CBO cost estimate (http://tinyurl.com/m3wg2u). 16m people would be uninsured post-policy, of whom about half would be unauthorized immigrants.

Three million people losing the health plan they have now because of the bill

"In addition, CBO and the JCT staff estimate that nearly 6 million other people who would be covered by an employment-based plan under current law would not have such coverage under the proposal. That figure includes part-time employees, who could receive subsidies via an exchange even though they have an employer's offer of coverage, and about 3 million people who would not have an employer's offer of coverage under the proposal. Firms that would choose not to offer coverage as a result of the proposal would tend to be smaller employers and those that predominantly employ lower-wage workers--people who would be eligible for subsidies through the exchanges--although some workers who were not eligible for subsidies through the exchanges also would not have coverage available through their employers. Whether those changes in coverage would represent the dropping of existing coverage or a lack of offers of new coverage is difficult to determine." Elmendorf letter to Chairman Rangel, July 14, 2009 (http://tinyurl.com/l3j4tt).

The President's "IMAC" Medicare Commission proposal

"CBO estimates that enacting the proposal, as drafted, would yield savings of $2 billion over the 2010-2019 period (with all of the savings realized in fiscal years 2016 through 2019) if the proposal was added to H.R. 3200, the America's Affordable Health Choices Act of 2009, as introduced in the House of Representatives." Elmendorf letter to House Majority Leader Hoyer, July 25, 2009 (http://tinyurl.com/lftd5z).

"This estimate represents the expected value of the 10-year savings from the proposal: In CBO's judgment, the probability is high that no savings would be realized, for reasons discussed below, but there is also a chance that substantial savings might be realized." Elmendorf letter to House Majority Leader Hoyer, July 25, 2009 (http://tinyurl.com/lftd5z).

"Looking beyond the 10-year budget window, CBO expects that this proposal would generate larger but still modest savings on the same probabilistic basis." Elmendorf letter to House Majority Leader Hoyer, July 25, 2009 (http://tinyurl.com/lftd5z).

"The proposed legislation states that IMAC's recommendations cannot generate increased Medicare expenditures, but it does not explicitly direct the council to reduce such expenditures nor does it establish any target for such reductions." Elmendorf letter to House Majority Leader Hoyer, July 25, 2009 (http://tinyurl.com/lftd5z).

OBAMA'S GREAT HEALTH SCARE

While some Chicago-style thugocracy goes on behind closed doors in Congress this week, we have a President appearing in one of his daily, carefully hand-picked Townhall meetings deceiving the American public. Karl Rove, former senior advisor and deputy chief of staff to President George W. Bush, breaks down the myth of the uninsured and the double-speak coming from the White House.

Rove states some startling numbers from the CBO (the bi-partisan Congressional Budget Office) and an analysis by Keith Hennessey, former National Economic Council director for President Bush – both carefully researched and read, as opposed to Congress.


OBAMA'S GREAT HEALTH SCARE
By Karl Rove - July 30, 2009

On the campaign trail last year, Barack Obama promised to end the “politics of fear and cynicism.” Yet he is now trying to sell his health-care proposals on fear.

At his news conference last week, he said “Reform is about every American who has ever feared that they may lose their coverage, or lose their job. . . . If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction.”

A Fox News Poll from last week shows that 84% of Americans who have health insurance are happy with their coverage. And because 91% of all Americans have insurance, that means that 76% of all Americans will be concerned about anything that threatens their current coverage. By a 2-1 margin, according to the Fox Poll, Americans want coverage from a private provider rather than the government.

Facing numbers like these, Mr. Obama is dropping his high-minded rhetoric and instead trying to scare voters. During last week’s news conference, for example, he said that doctors routinely perform unnecessary tonsillectomies on children simply to fatten their wallets. All that was missing was the suggestion that the operations were conducted without anesthesia.

This is not a healthy way to wage a policy debate. It also risks making the president look desperate at a time when his proposals are looking increasingly too expensive for Americans to accept.

Last weekend, the Congressional Budget Office (CBO) demolished Mr. Obama’s claims that his plan cuts the growth of future health spending and won’t add to the deficit. Responding to a White House proposal to create an independent panel to recommend Medicare cuts, the CBO said on Saturday that “The probability is high that no savings would be realized” in the next decade, while entitlement spending would rise $1.042 trillion. The CBO did say there might be $2 billion in savings in the second decade of the program—a pittance.

White House Budget Director Peter Orszag shot back at the CBO with a blog posting on the White House’s Web site arguing, “the point of the proposal . . . was never to generate savings over the next decade.” Really? The White House rolled out the proposal hoping to give cover to Blue Dog Democrats in Congress barking about the cost of overhauling health care.

The House version of ObamaCare adds to the deficit even though the new taxes to pay for part of it begin two years before the program itself kicks in. That head start puts ObamaCare in the black through 2013. But net new spending after that overwhelms future revenue to add to the deficit each year.

Keith Hennessey, who was a National Economic Council director for George W. Bush, estimates the annual deficits in Mr. Obama’s plan will grow to $64 billion a year by 2019. And this assumes that Mr. Obama gets all the tax increases and Medicare cuts he wants.

On Sunday, the CBO released another torpedo at the burning hull of USS ObamaCare. Responding to an inquiry by Rep. David Camp (R., Mich.) about whether the House bill would run a deficit in its second decade, the CBO reported it would “probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window.” The CBO does not believe that Mr. Obama’s proposal “bends” health-care spending down, as the president has repeatedly claimed it would. The CBO says it escalates above today’s rate.

By 2029, Mr. Hennessey estimates that new taxes will bring in $143 billion a year, while net new health spending will have increased by $348 billion a year.

Damaging reports from the CBO had earlier provoked some Chicago-style intimidation, with the president summoning CBO Director Douglas Elmendorf to the Oval Office. It’s safe to assume that they didn’t talk about the Chicago White Sox. Imagine if Mr. Bush had done that after the CBO released numbers that undercut the centerpiece of his domestic agenda. “White House thuggery” and “intimidation” would have been the theme of nearly every editorial writer in the country.

Team Obama’s pressure, however, might have caused the CBO to release its latest missives on a weekend, when fewer people are paying attention to the news.

Mr. Obama’s problem is that nine out of 10 Americans would likely get worse health care if ObamaCare goes through. Of those who do not have insurance—and who therefore might be better off—approximately one-fifth are illegal aliens, nearly three-fifths make $50,000 or more a year and can afford insurance, and just under a third are probably eligible for Medicaid or other government programs already.

For the slice of the uninsured that is left—perhaps about 2% of all American citizens—Team Obama would dismantle the world’s greatest health-care system. That’s a losing proposition, which is why Mr. Obama is increasingly resorting to fear and misleading claims. It’s all the candidate of hope has left.