With the ruling by the Senate Parliamentarian that having a law means, you know, actually having a law in force, the self-Slaughter Strategy seems dead, further complicating matters for Democrats who are trying to find the procedural loopholes necessary to pass health care.  In effect, the Slaughter Strategy – a frankly bizarre attempt to redefine “passed” – was a way for the House to get the Senate to go first, even though right now, it’s the House’s turn.  The House clearly doesn’t trust that Senate will make changes, especially since, as far as the White House is concerned, it doesn’t really matter.  Remember, the Republicans are the opposition, but the Senate is the enemy.

Now, the House will actually be on the record on substantive, not procedural votes, and it will have to find a way to pass either the Senate bill or something acceptable to the Senate before reconciliation can move forward.

The Democrats will try to paint this as “raising the bar,” but of course, reconciliation simply cannot act on something that isn’t in force.  Voting that something is conditionally in force, never presenting a finished law to the President for his signature, doesn’t actually pass a bill out of Congress, so this ruling should be taken as common sense and perfectly reasonable.  That common sense and reason have departed from the Democratic camp by now should be evident to all.

One thing we should have learned by now is not to declare this thing dead until the new Congress is sworn in next January.  But if the House is resorting to parliamentary contortions like the Slaughter Strategy, it’s clear they don’t think they have the votes at this point.

And the Senate majority leader is “sending a letter to Minority Leader Mitch McConnell (R-Ky.) in which he dared the GOP to vote against reform,” which reminds me of nothing so much as this:

finding that flu vaccine.  Good thing you won’t have to wait for that hip surgery.

Back when the Town Hells started, I predicted that the President would give a health care speech in an effort to salvage an overhaul this year.  I thought that he would try to sell the same unpopular bill of goods, repackaged as a result of his having, “listened” to the anger and discontent that’s obviously out there.

I didn’t give him enough credit.  Instead, the President tried to repackage the same discredited speech.

Remarkably, the President managed to be defensive, dismissive, and deceptive all at the same time.  Which leads me to think that this speech was aimed not at the American public, but at Congressional Democrats.

The Denver Post this morning reports on Sen. Bennet’s town hall in Pueblo, and on a Denver Chamber of Commerce poll (PDF) on Coloradoans and health care, excuse me, health insurance.   Sen. Bennet seems to have remained an inscrutable non-entity when it comes to actual policy issues, but the DCC report provides at least a little insight, both into how Coloradoans feel about their coverage and reform efforts, and how the Denver Chamber thinks

While ignoring the 77% of respondents who believe they have “good or excellent” care, Lynn Bartels focuses on the 26% who have “skipped a recommended medical test, prescription, treatment in the past 12 months for you or a family member due to cost.”  But neither the Post‘s crack reporters nor the Chamber’s summary addresses either double-counting (a “yes” counts for either the husband or the wife), or the seriousness of the treatment foregone.  Consider four families of four, 16 people in all, and one person questioned in each.  If only one person out of the 16 has foregone care, the result of this question will show a 25% positive, even though only 6% of the people covered by the question actually did without.

Sen. Bennet did, apparently, show some Doomsday slides about the wreck our economy and personal finances become if costs continue to rise at current rates.  Naturally, the idea that individuals, deciding not to pay for certain procedures, or to negotiate down the prices, might actually help bring about cost control, has never entered his mind.  To that extent, the decision of some people to do without rather than pay the insurance- and government-subsidized prices, which are largely fictional in any case, is a feature of what reform should look like, not a bug.

The other striking point is that while the Chamber opposes mandates for its members, it’s ok requiring an individual mandate.  The larger business members that compose the Chamber have always been good at externalizing costs.

One question: when will the Post get around to linking to original source material when it’s available online?  They almost never do this, for some reason.

When Susie was living in Oceanside, the local hospital was located at – I’m not making this up – One Healthy Way.   Evidently the Democrats had already implemented their health care plans.

Of course, there are many healthy ways, but the only way to get all of them going at once is to put decision-making power in the hands of actual consumers.  In the latest Atlantic, David Goldhill takes a close look at the perverse economic incentives currently embedded in our health care system, incentives that create all sorts of inefficiencies.  In this case, “inefficiencies” can mean longer waits for worse care at higher prices.  Virtually all of these distortions originate from a house of cards of government policies, each policy intended to fix the problems that the previous ones created, all the while making things steadily less stable.

It’s a brilliant piece, really, applying basic supply-and-demand economics and marketplace dynamics to the pieces of this system, and showing how they explain what’s wrong, and why our health care and insurance are costing us so much.

As with housing, directing so much of society’s resources to health care is stimulating the provision of vastly more care. Along the way, it’s also distorting demand, raising prices, and making us all poorer by crowding out other, possibly more beneficial, uses for the resources now air-dropped onto the island of health care.

Starting with insurance,virtually everything we do in health policy prevents prices from finding their own levels, providers and consumers from adjusting to dynamic market forces, confuses prices with costs, discourages cost competition, and then punishes people for responding to the incentives that policy creates.  Fundamentally, the problem is an unwillingness to confront actual costs and to pay for what we use.  We expect insurance to cover routine expenses, which ought not be insurable events.  Medicare gets away paying less than cost for services that are only available because someone else picks up the difference.  We’re recklessly borrowing from our future.   The patient is rarely the customer, and when he tries to be cost-conscious, hospitals won’t let him.

Every distortion we complain about has some weird incentive behind it.  Insurance costs so much because we expect it to pay for too much.  We have to restrain hospitals from buying new equipment because we subsidize it.  We prevent specialty facilities from competing with hospitals because we overpay for some services and underpay for others.  And the hospitals’ objections to competition mirror those of the railroads 100 years ago.  Britain right now is suffering through the Conrail of public health.  He doesn’t specifically address the growing wait-times for specialists, but there’s probably a perfectly good awful policy behind that, too.

Goldhill also comes up with reasonable estimates of how much the current bogeymen actually cost us.  You could take the entire insurance industry profit for 2009 and pay for America’s medical care for 4 days.  Think about that.  The “excess profit” that insurance-company-haters rail about amounts to 1% of our health spending.  IT efficiencies would probably improve service, but would also return about 3% of actual costs.

Goldhill proposes shifting the decision-making and purchasing back to the actual patient.  You pay for routine expenses out of income.  You pay for big expenses out of savings and credit.  And a single, government-run policy would backstop against catastrophe.

It shouldn’t be a surprise that, in an article full of what should be commonplace economic observations, the one false note is political.  A government-run catastrophic health plan would be under constant political pressure to carve out exceptions to favored groups and to lower the ceiling for everyone.   Competing catastrophic plans would be able to experiment with coverage amounts and price points.

Still, this is the kind of rigorous application of basic economics that’s been missing from the debate, and especially missing from any Democrat proposals on the table right now.

I’m getting ready to hit the road here in Hazleton, Penn.  This morning’s news is full of angry reactions over the health care bill at Senators’ and Representatives’ townhall meetings.

Come late August, maybe a week before Congress reconvenes, expect a speech from Obama explaining how, “we heard from you.  Boy, did we hear from you.  And we listened.”  Obama will then go on to explain how the bill’s revisions that he is proposing will meet these complaints.  It’s unlikely that the bill will actually contain much retreat from the President’s goals of socializing the system.  In fact, he may use the break as an opportunity to re-insert some of the bolder proposals in the initial bill, and sell them as meeting people’s demands.

Why so late?  Well, it will give resentment a chance to build.  Scared Democrats may be looking for a political victory (i.e., as bill passed) and at the same time be looking to make use of Obama’s personal (although not policy) popularity.  And of course, the less time people have to actually look at the thing, the more likely Congress will be to pass it.