23 March 2010

Comprehensive health care reax

The health care legislation passed Sunday was classic sausage-making, with bribes for the honorable senators from Louisiana, Florida and Nebraska, and unsavory deals cut with Big Pharma and the Democrats' most beloved constituency, labor unions. The president delayed an overseas trip to put the full-court press on waffling House members -- both liberal (Dennis Kucinich) and moderate (Bart Stupak, et al.).

As an aside, I find it humorous that most conservatives recoil at President Bush's creation of Medicare Part D, but shrieked in opposition when a Democratic-controlled Congress proposed cutting $500 billion from Medicare. It really is all about this November, isn't it?

The quality of the debate devolved so severely that my first reaction to the bill's passage on Sunday was, for the first time, a degree of embarrassment for my country. Most conservatives -- regurgitating the talking points of Republican congressional leaders -- term this legislation a "government takeover of health care." This is absolutely idiotic. No single payer. No public option. No "death panels." Handouts to Pharma. "Government takeover" -- you're kidding, right?

Just because Mark Levin or Rush Limbaugh pounds his fist on the desk and use such catchphrases as "socialism" or "government takeover" to drive up listenership doesn't mean you get to parrot them. An informed citizenry is crucial, and conservatives do themselves, their party and their country a disservice by regurgitating talk radio talking points and being unable to otherwise argue against what is actually a bad policy.

And that is the critical conclusion of the last 6 months -- conservative opinion leaders have whipped their disciples into such a frenzy that conservatives' only opposition to the bill is in the form of buzzwords. Conservatism continues its steep descent into a movement devoid of anything but reflexive, hysterical opposition. This is a sad trend for the movement started by William F. Buckley.

Mitch McConnell led the Republicans in staunchly opposing the totality of the Democrats' bill. This is perfectly acceptable conduct, but if you do so, you must have an alternative in hand that you can present to the American people. This is precisely what Newt Gingrich warned the GOP of a year ago. While some Republicans -- namely, Wisconsin Rep. Paul Ryan -- put forth interesting, substantive proposals, those floundered outside the mainstream of Republican policy and were never embraced or proffered by Mitch McConnell or John Boehner (and in fact, barely acknowledged) as alternatives to the Democrats' plan. If Ryan & Co. couldn't get anywhere with the Republican leadership, why should Pelosi and Hoyer take them seriously in crafting the final product?

What McConnell should have said at the health care summit was the following: "Mr. President, after hearing the proposals from each of our parties, it is clear that we have agreed upon items A, B, C and D. On Monday, you, Sen. Reid and Speaker Pelosi will each have a bill on your desk setting forth these policies and only these policies." McConnell would have backed Obama into a corner and painted him as the partisan ideologue he is -- instead, the awkward, wooden Kentuckian displayed his sheer ineptitude by assuming that the Democrats' bill would fail on its own merits. McConnell made a gamble that treating this as Obama's Waterloo, and opposing the totality of the bill, would be a better political gambit than publicly embracing some of the more popular elements of the bill (removing lifetime maximums), but not others (the employer mandate). This was a crucial miscalculation. When Obama called the health care summit, he was on the ropes. McConnell and Boehner had a chance to go for the throat by forcing the president to publicly reject the most popular aspects of the bill -- and they didn't do it. This fact cannot be overstated.

The problem with the Republican leadership's approach to the entire process was that although the Democrats' bill in its totality -- all 2,700 pages worth -- was opposed by a majority of Americans, some specific elements of the bill were actually highly popular. Removing the antitrust exemption, eliminating lifetime maximums and addressing preexisting conditions each enjoyed support among a high percentage of Americans, and the GOP ignored this fact at its peril.

On the other side of the aisle, liberals have been blinded for years by the moral imperative argument -- their claim that access to health care is a right and that therefore, the government has a responsibility to provide it. The same Democrats who criticize pro-life Republicans for opposing abortion on moral and ethical grounds claim the same moral and ethical grounds as their sole reason for supporting expanded access to health care. This is pure hypocrisy.

Health care is no more a right than a doctor has an obligation to give it to you for free.

The most objectionable specific provisions of the bill are the expansion of Medicaid, the subsidization of health insurance for individuals earning nearly $90,000 annually for a family of four ($90,000!), and most especially, the mandate. The government can force you to do a lot of things -- serve in the military, pay taxes, etc. -- but this is the first time I can remember that the federal government has compelled citizens to engage in some sort of private activity. The bill is obviously susceptible to a challenge under the 10th Amendment, and it will be good for our country (and the federal courts) to have this discussion. The Constitution specifically sets forth that the federal government is to be one of enumerated powers only, and the 10th Amendment specifically reserves all powers not expressly enumerated to the federal government to the states. This is precisely why the State of Missouri can fine me if I don't buy auto insurance, but the federal government, to this point at least, wasn't able to. For a good discussion of the constitutionality of the mandate, click here.

Additionally, the employer mandate will do nothing more than hit businesses of all sizes in the pocketbook. If employers over a certain size don't provide their employees some sort of health insurance plan, they will be fined $2,000 per worker. This is absurd. As our country tries to climb out of a recession, what effect do Democrats think this provision will have on the economy?

But the most compelling reason to vote against the bill? It doesn't reduce health care costs in any measurable way -- and health care costs, rising at a double-digit inflation rate annually, are precisely why the system is broken. The Democrats' bill purports to provide insurance or subsidies to purchase insurance to 32 million Americans, but does nothing to stem the tide of costs in the health care sector generally. Any reduction in costs by introducing millions of new insureds into the market will almost certainly be stunted by insurance companies' inability to deny coverage based on preexisting conditions. Shouldn't any so-called "comprehensive reform" -- and this it clearly is not -- of 1/6 of the American economy include some way to stem the skyrocketing costs that have made coverage so expensive?

Less than a month ago, Joe Biden appeared on Larry King Live and unequivocally stated that cost containment must be one of the central features, if not the one of most paramount importance, of any legislation.

I repeat: The Democrats' bill does nothing to control costs. And this was the exact problem in the first place, and the reason the national debate has occurred. That was precisely why 48 million Americans were uninsured in the first place -- the cost of health care has simply risen too high.

Republicans screamed "socialism." Democrats screamed "moral imperative."

I've about had it with you idiots.

That said, the horrifically embarrassing national discussion hasn't been wholly devoid of fascinating commentary.

Glenn Greenwald scoffs at the notion that special interests took one on the chin. For all the president's rhetoric that a vote against him was a vote for the insurance companies, he sure gave his supposed adversaries quite the bag of goodies.

Jonathan Chait goes so far as to call the bill "moderate."

Mitt Romney's presidential ambitions hinge entirely on Republican voters forgetting the type of governor he was in Massachusetts. I wonder what Romney's biggest backers in the GOP -- e.g., Rush Limbaugh, Sean Hannity, Jim Talent -- think about this?

The invaluable FactCheck.org evaluated the makeup of the uninsured.

Ross Douthat and David Frum debate the extent to which the Republican leadership set the table for the GOP's Waterloo. Both make compelling arguments, and I'm not sure who I agree with.

In a separate post, Douthat opines that neither party will make difficult decisions on health care "until we're way too close to the fiscal wall for comfort."

Mark Halperin thinks that Republicans running against the bill is medicine for defeat in November. I agree with him -- instead of slamming the totality of the bill, the GOP needs to pick out specific provisions -- the mandate, the sleazy deals, etc., the simple fact that it won't cut costs a dime -- and run against those.

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