What’s worse — the bill or the process?

Answer: They both stink to high heaven.

The cram-down has begun in earnest. The shell-bill is in place, ready to be emptied and refilled with . . . something. One thing’s for certain, the final product will be bad, because every iteration thus far has exacerbated problems it’s supposed to fix. Robert Samuelson busts a couple of persistent healthcare reform myths:

How often, for example, have you heard the emergency-room argument? The uninsured, it’s said, use emergency rooms for primary care. That’s expensive and ineffective. Once they’re insured, they’ll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it’s untrue.  [. . .]

You probably think that insuring the uninsured will dramatically improve the nation’s health. The uninsured don’t get care or don’t get it soon enough. With insurance, they won’t be shortchanged; they’ll be healthier. Simple.

Think again.

Read the whole thing for his evidence.

Rep. Paul Ryan in today’s Washington Post:

Rather than tackle the drivers of health inflation, the legislation chases the ever-increasing premiums with huge new subsidies. Already, Washington has no idea how to pay for the unfunded promises in Medicare, Medicaid and Social Security — and creating this new entitlement would accelerate our path to fiscal ruin. When you strip away the double-counting, expose the hidden costs that must be funded and look at the price tag when the legislation is fully implemented, the claims of deficit reduction are as hollow as claims of cost containment.

This legislation includes a range of job-killing tax hikes and controls on all Americans — to fund this new entitlement and to penalize employers and individuals who don’t play by Washington’s new rules. The CBO said last July that “requiring employers to offer health insurance, or pay a fee if they do not, is likely to reduce employment.” The mix of mandates and higher costs will drive Americans into government exchanges, with an ever-enlarging number reliant upon taxpayer subsidies for their care. The architecture is designed to give the government greater control over what kind of insurance is available, how much health care is enough and which treatments are worth paying for.

Read the rest.

Jennifer Rubin on that:

In short, the cost-containment problem (otherwise we’ll bankrupt ourselves, the president once threatened) is made worse, dramatically so, by the bill. And when we add on “a range of job-killing tax hikes and controls on all Americans,” you have a truly destructive, ill-conceived piece of legislation. If members think hard about that, rather than the arm-twisting and bravado from the White House, what the leadership is up to will become apparent. They are not, it seems, in the business of passing anything remotely resembling “reform.” They are rather attempting to avoid humiliation and prevent a tidal wave of rage from their liberal base.

That’s small consolation to moderate Democrats, who, in their quieter moments of self-reflection, understand not only that their constituents intensely dislike the bill but also that such aversion is fully justified. It would be one thing to challenge public opinion for a noble and necessary bill; it’s quite another to walk the plank for what Ryan dubs “the Democrats’ health-care train wreck.” All the tricks — reconciliation, voting but not really voting on the Senate bill — are designed to encourage lawmakers to do something many know isn’t wise substantively or politically. If Republicans are smart, they’ll spend the week forcing Democrats to look at their handiwork and reminding them that voters will hold them fully accountable for their mischief.

And this just in: they have no shame. Obama is totally fine with backroom deals now, because this power grab cannot happen any other way. AP:

Clinching support for the bill might require Obama to back away from his insistence that senators purge the legislation of a number of lawmakers’ special deals.

Taking a new position, Axelrod said the White House only objects to state-specific arrangements, such as an increase in Medicaid funding for Nebraska, ridiculed as the “Cornhusker Kickback.” That’s being cut, but provisions that could affect more than one state are OK, Axelrod said.

That means deals sought by senators from Montana and Connecticut would be fine — even though Gibbs last week singled them out as items Obama wanted removed. There was resistance, however, from two committee chairman, Democratic Sens. Max Baucus of Montana and Chris Dodd of Connecticut, and the White House has apparently backed down.

Axelrod said the principles the White House wants to apply include “Are these applicable to all states? Even if they do not qualify now, would they qualify under certain sets of circumstances?”

Insert primal scream here.