Where to go from here on health care?
A National Review Online Symposium
Monday, November 23, 2009
Harry Reid scored a victory Saturday night. And part of the line of argument from those urging that senators vote against the motion to proceed Saturday night was: The bill is not likely to get better from here on in. So is it over? Abortion, high costs — is it all now a given? National Review Online asked a group of experts: What is a constructive, realistic conservative attitude toward Demcare in the Senate this Thanksgiving?
JEFFREY H. ANDERSON
The moment of truth is now here for Democratic efforts to overhaul our health-care system and inject the federal government into the historically private relationship between patient and doctor.
Poll after poll has shown the American people don’t want this legislation. President Obama’s popularity has plummeted as he’s pushed it. Americans think premiums, taxes, and deficits would rise, Medicare would be weakened, and the quality of care would decline. And they’d be right. Americans think the government-run “public option” could eventually funnel them into government-run care, and it likely would. Whatever happens, the government would largely now be running the show, with taxpayers, Medicare beneficiaries, and future generations footing the bill.
The worst thing Republicans can do is help mask the costs of this venture by parroting the Democrats’ deliberately misleading numbers. The Congressional Budget Office shows that only 1 percent of the costs from the Democrats’ “first 10 years” would hit before the fifth year. In the bill’s real first 10 years — from 2014 to 2023 — the CBO projects it would cost $1.8 trillion, raise taxes by $892 billion, siphon $802 billion out of Medicare to spend elsewhere, and either cut doctors’ pay by $431 billion or else raise deficits by $286 billion. And the CBO projects that costs, taxes, Medicare cuts, and doctors’ pay/national deficits would get much worse from there.
James Madison wrote in the Federalist Papers that “the cool and deliberate sense of the community ought, in all governments, and actually will, in all free governments, ultimately prevail over the views of its rulers.” Madison meant either before or after an intervening election or two. The Democrats are determined to show that Madison’s statement is as wrong as they regard his belief in limited government to be.
I suspect Madison will be proven right on both counts.
—Jeffrey H. Anderson is a senior fellow in health-care studies at the Pacific Research Institute.
JAMES CAPRETTA
The vote on Saturday in the U.S. Senate to end debate and proceed to consideration of Sen. Harry Reid’s health-care bill hasn’t changed the basic political dynamic that has been in place for some months now. The Obama White House and its allies in Congress are determined to pass a full governmental takeover of American health care, and they won’t be deterred unless and until it’s clear they don’t have the votes. So there is little choice for conservatives but to continue an all-out effort to defeat the legislation when the debate in the Senate begins in earnest after Thanksgiving.
Under normal circumstances, that would be easy. The Reid bill, as others have noted, is about as unpopular as can be imagined. It was written by liberals to appeal to liberals. It imposes a massive tax hike on the American middle class to finance the largest expansion of government in a generation — at a time when many Americans are already alarmed by the debt burden that the Obama administration is piling up for the next generation of taxpayers. It cuts deeply into Medicare and will force millions of seniors out of their Medicare Advantage plans. And, most importantly, it would lead to clumsy governmental cost-control efforts that would erode the quality of American medicine and lead to queues and other access restrictions.
The U.S. Senate is not known for readily going along with such highly ideological legislation. And there are plenty of indications that a handful of moderate Senate Democrats know full well that this legislation is a massive overreach that will lead to a backlash. The only reason the bill has gotten this far is that President Obama and his political advisers are claiming his presidency rests on passing it.
What’s needed at this point is a two-part strategy. Of course, Republicans must continue making clear to the public the devastating consequences of the Democratic plan, especially for the middle class. Contrary to what the president has promised, moderate-income families with insurance would see their costs go up, not down, and their health care would get worse, not better. But Republicans must also make clear that the choice here is not between Obamacare and nothing. There are much more rational approaches to reform that would extend coverage to more people, slow the pace of rising costs, and begin getting our fiscal house in order. House Republicans have offered such a plan, as have others. Senate Republicans need to make clear that they too support sensible reforms and are willing to work with Democrats to pass a reasonable bill, even early next year. But it does require setting aside the full governmental takeover now under consideration. Indeed, moderate Senate Democrats need to see that if they take hold of a lifeline offered by Republicans, it could very well result in a new law that is far more acceptable to the public that what Senator Reid has offered. That would be good for all concerned, perhaps even an administration that currently doesn’t see it that way.
— James Capretta is a fellow at the Ethics and Public Policy Center.
MICHAEL G. FRANC
To ordinary Americans, the health-reform debate in the Senate must be a curious spectacle indeed.
Non-experts who take but a few moments to study what passes for a debate may well ask why the only way to lower health expenditures (the very expenditures, we are told, that are crippling our economy) is to increase future expenditures?
What, they may wonder, are our lawmakers thinking when they propose to raise taxes and the regulatory burden on employment precisely at the moment when the unemployment rate exceeds 10 percent?
Anyone who has listened to the unending parade of budget experts bemoan the coming fiscal crisis brought on by the imminent retirement of the Baby Boomers must be shaking his head upon learning that the elder statesmen in the U.S. Senate believe now is the time to grow the entitlement state. Is this really the time to create a brand-new federal entitlement program — a national long-term-care insurance program that one budget-conscious senator has decried as a fiscal “Ponzi scheme” — that will be actuarially unsound the moment it goes into effect? And why, when voters are telling the pollsters that the number-one priority for Congress and the president should be to cut federal spending and reduce the government’s exploding debt, should we push the largest expansion ever of the troubled Medicaid program, one that will consign a quarter or more of some state populations to the tender mercies of a system that already rations care and wastes tens of billions annually?
The list of grievances, of course, goes on and on and on. Which raises the ultimate question: Why would so many political animals engage in behavior seemingly designed to eradicate their species? What is going on here?
We voters certainly haven’t moved from where we’ve been for many months now. We still do not trust politicians when they assure us that health reform will lower our health costs or improve the quality of the care we receive. Seniors believe that the quality of Medicare will diminish if Congress shifts a trillion or so in projected Medicare spending to other priorities. Independents, men, those living in middle-income households, and even a surprising percentage of young voters are either overtly hostile to all this or increasingly skeptical.
A surprisingly large number of Democrats in both the House and Senate, moreover, represent “red” constituencies that are chock-full of these voters — states or congressional districts that have voted Republican for president, governor, or other statewide office in recent years, or areas where self-identified conservatives outnumber liberals by large margins. In fact, one can make the case that but for these “Red State Democrats” the current Democratic majorities wouldn’t even exist.
Is there any precedent, then, for the leaders of one of our national parties to rush forward with such an ambitious yet unpopular legislative endeavor?
The short answer is no. Every group of political leaders fancies that, like FDR, it can create and maintain a permanent lock on political power. Another New Deal coalition that will sustain itself decade after decade, from one election to the next, is always within its grasp. So when a threat emerges in the form of a controversial and hugely unpopular legislative initiative, the political operatives study the polls, conduct a few focus groups, read the letters-to-the-editor pages, and calmly advise their party leaders to pull the plug or dramatically revise the legislation in question.
That traditional analysis, however, assumes that party leaders will always act to retain their power and will never knowingly don the robes of a political suicide bomber and pursue a strategy that guarantees its loss.
But what happens if the old instinct of political self-preservation gives way to a new paradigm, a new conception of power? Suppose the new premise is that in the modern age political power is a depreciable asset, something that ebbs and flows, and that, by definition, political majority coalitions are fleeting? What happens if a generation of party leaders concludes that while there are no longer any permanent political victories, permanent policy victories are still to be had? Use it, the bumper sticker might read, because you’re surely going to lose it.
In that case, it makes perfect sense to sacrifice political gains — including, when necessary, knowingly throwing some members of the governing coalition under the bus — if that’s what’s required to achieve an important policy victory. Given liberal hubris, don’t count out the possibility that the practitioners of this new art actually believe they can calibrate these sacrifices so precisely that only an acceptable number of their brethren end up under the bus, and not one more.
This strategy makes even more sense when the policy breakthrough in question, such as the Senate health-reform bill, also promises to create a new class of political rent seekers who, over time, will bestow political rewards on the politicians who bestowed the benefits in the first place.
Far-fetched? Maybe. But this is the only way I can explain why President Obama, Majority Leader Reid, and Speaker Pelosi are so fixated on achieving legislative victories such as health reform that will require perhaps half a dozen Senate Democrats and upwards of 50 of their House Democratic colleagues to walk the political plank.
Otherwise, none of this makes any sense.
—Michael G. Franc is vice president for government relations of the Heritage Foundation.
JOHN R. GRAHAM
Sen. Mitch McConnell is right: There is nothing in this bill to debate. On the other hand, I suppose it would have been too much to seriously expect any of the Democratic senators to accept that argument as a reason not to start discussing the bill on the floor.
Nevertheless, I remain hopeful that this “reform” will sputter out. Back in 1965, President Johnson signed the Social Security amendments that created Medicare and Medicaid on July 30. Supermajorities in both chambers had passed the bill (including a majority of House Republicans and almost half the Republican senators). By contrast, it’s pretty clear that the momentum in 2009 has all but disappeared. The 220–215 vote in the House was not adequate for such transformative legislation. And the difficulties that Senator Reid had even cobbling together his caucus to bring the bill to the floor indicates that there will be heavy lifting ahead.
We already know that Sen. Mary Landrieu’s vote was bought with a $100 million (or maybe even $300 million) extra Medicaid bailout for Louisiana. Protestations by her and other ditherers that their votes to bring the bill to the floor do not predict their votes for the bill itself are barely disguised demands for yet more earmarks. These should not be hard for the Republicans and the opposition media to uncover in the weeks to come.
The Republicans are doing a fine job pointing out the true costs of this legislation: higher premiums, worse access to care, bureaucratic micromanagement of the practice of medicine, and public deficits and debt driven to previously unimaginable size — with no end in sight.
Yet I am very concerned with the Republican offense. Tort reform, allowing businesses to band together to buy health insurance, and buying health insurance across state lines are all good reforms (although somewhat malformed in the current Republican version). But they have abandoned the simplicity of the basic, fundamental conservative reform: amending the tax code to make health insurance the property of the individual, rather than his employer or the government. I know from speaking to Republicans on the Hill that they are nervous about moving the American people out of their comfort zone — employer-based benefits. However, I don’t see a compelling, alternative, vision of reform in its absence.
— John R. Graham is director of health-care studies at the Pacific Research Institute.
RICK SANTORUM
Do not despair. Voting against your leader to simply bring up a bill on the floor, especially the most important bill to your leader, your president, and your party, was never, and I mean never, going to happen. This vote was not simply a procedural vote or a party-loyalty vote, it was a vote for who you want to control the Senate. I would not expect any Democrat to vote for Republicans to control the Senate agenda. Frankly, that’s why I was encouraged by the last few days. A handful or more of Democrats were publicly wrestling with a decision that would be seen as fratricide had they voted no. If Democrats are feeling the heat just on bringing the bill up, imagine the pressure to vote on cloture to bring it to conference. They can legitimately, in my mind, get away with saying this vote was not an indication of their support for Reid’s bill. That excuse’s ticket has been punched and will no longer be available for future cloture votes.
Republicans must use every tool in the shed — offer amendments that strike all the harmful provisions in this bill, propose conservative alternatives to “bend the cost curve,” improve access, choice, and quality — and finally, they must prolong this debate as much as possible. The longer this bill is examined, the better. It will take time for information about this bill to seep into the consciousness of America. When it does, poll numbers and Democratic support in the Senate will both drop. The pressure has been commendable to date, but over the next few weeks, including Thanksgiving break, the protests have to be bigger, louder, and focused particularly on Lincoln, Landrieu, both Nelsons, Dorgan, Bayh, Lieberman, Webb, Bennett of Colorado, and don’t forget Snowe.
What should you do? Call, e-mail, write, organize not just rallies at the senator’s state office but 24-hour vigils, attend his/her public meetings, and come to D.C. with as many friends as you can bring. Finally — contact your state’s senator and no one else. No senator cares about what people in other states feel or say. In this hectic environment, your call to an out-of-state senator is probably blocking a call from someone in her state. Focus on your senator even if it is just to say thanks to a Republican who voted the right way and to encourage him or her to continue to do so.
Fight on!
— Rick Santorum is a former Republican senator from Pennsylvania.
TEVI TROY
Saturday night’s 60–39 vote was certainly a bad sign for Republicans hoping to defeat the Democratic effort for a trillion-dollar health overhaul. Sen. Tom Coburn asked the Congressional Research Service how often winning the motion-to-proceed vote has led to final passage of a bill. From 1999 to 2008, CRS found that the answer has been a depressing 97.6 percent. This calls into question the statements by Blue Dog Democrats that they are only voting to begin debate and do not necessarily support the final product.
Yet while Democrats have reason to be optimistic, this is not yet over. Republicans need to do two things going forward. The first, in the short term, is to continue to point out the many holes in the House and Senate bills — both are important targets, as the final product that comes through some type of House-Senate conference will likely include elements of both bills. The votes were quite close in both the House and the Senate, and there are a variety of sticking points, most notably on cost, abortion, and the public option, that cause internecine strife among the Democrats. Highlighting the Democratic differences on these issues could still manage to defeat the trillion-dollar package speeding towards the finish line, but it will also lay important groundwork for the next two elections.
The second is to come up with an alternative that Republicans can sell to the American people in 2010 and 2012. Jeff Anderson and I took a crack at this on National Review Online last week by proposing an approach that would lower premiums, cut the number of uninsured by 15 million, and cost a fraction of what the Democratic efforts would spend. It’s easy for Republicans to say no when faced with such bad bills, but the way back to a majority is by proposing real solutions to knotty problems.
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