In earlier posts, I've warned against a devious Democratic plot by bypass the normal policy reconciliation process, which would be defeated by Scott Brown's 41st vote against the Democratic Party Health Care Bill. Given the fragile nature of the Senate compromise, which explicitly ruled out the public option in the House bill, the Democrats have boxed themselves in. You still don't see a recognition of the fact that if the Democrats themselves have differences on how to proceed on health care, after months of negotiating bare majorities for passage in either the House or Senate under heavy leadership pressure, maybe it's not a good idea, given the fact that most polls I've seen recently reject the health care bill on the table and want the Democrats to scrap the current partisan vehicle and start over with a bipartisan consensus.
That was explicitly the message sent by blue state Massachusetts voters, whom voted a Republican into the US Senate for the first time in almost 40 years. The lesson of Scott Brown momentarily stopped the Democrats, whom regrouped, trying to figure out how to move forward, given the fact that their filibuster-proof margin in the Senate was undone. What has been the result of the regroup? Maybe pare down the size, scope and cost of the reform? Remove or moderate the new federal bureaucratic mandates? Of course not. Only a PR stunt of a summit, not resulting from weeks of bipartisan negotiations. (Do you think that's how we conduct foreign policy summits?) Obama cherry-picked which GOP ideas he might recycle in some form to argue his arbitrary concessions made the bill "bipartisan"--not of a substantial nature. (Let's now hear Obama, in his best George W. Bush accent, say, "I'm the decider"...) One of these involves Medicare fraud. Now since the Great Society of the 1960's, why is it that Big Government Democrats, who assure us Big Government is the answer, have suddenly discovered after 4 decades that one of their crown jewel programs has a fraud problem? Tom Coburn (OK-R) may yet rue the day he suggested improved fraud detection, which no doubt will be transformed by progressives to rationalize expansion of a federal justice system bureaucracy aimed at physician entrapment.
We have heard Obama ad nauseam declaring the battle over health care over, we are not going to continue to debate the issue--we've already spent a year discussing this, etc. A few relevant notes here, because I'm sufficiently annoyed at Obama's hidden assumptions and partisan political spin. Obama has implied that "all options have been on the table". This is demonstrably false. I've mentioned in my stream of posts a number of alternatives, including a federal (versus national) approach. For example, I suggested we could look at a cost-sharing relationship with the states to strengthen or establish state/regional high risk pools, just as we currently have a shared cost arrangement on Medicaid. Second, the entire process has been controlled by Democrats with essentially no Republican inputs (other than some recent lip service by Obama to Republican ideas like medical malpractice tort reform). If Obama is attempting to argue that there has been due process given to Republican less costly, market-based reforms, he's a liar. Third, Obama contributed to the process by taking the risk-averse approach of letting the House and Senate Democrats to flesh out their own approach, only with some generalized policies guiding the framework. This was to Obama's advantage, because he didn't want to outline a more specific plan and see the House or Senate crap all over it and hand him a high-profile policy defeat, probably making him an instant lame duck. The problem then became refereeing a food fight between the House and Senate Democrats. Fourth, the financing of the measure came under scrutiny. In yesterday's post, I pointed out that federal inflows peaked around the mid-2000's at roughly $2.5T. The current federal debt is $12.5T. This means it would take 5 years of robust federal inflows, assuming no federal outflows, just to work off the debt. (The public debt is roughly two-thirds of that, but still would require over 3 years to pay off.) This snake oil that the Democrats are trying to sell, that adding millions to health care insurance rolls will actually save the federal government money, would embarrass even the sleaziest used car salesman. The fact is that the Democrats are imposing unrealistic Medicare cuts on doctors (already providing such services below cost), which, if anything, should be used to shore up a $38T unfunded mandate; raiding the Medicare lockbox is not a viable mechanism for funding a new federal program.
There are several ways we could improve the status quo without resorting to the extreme of a Big Government approach of a federal bureaucracy micromanaging health care decisions. One would be for the federal government spread the costs of catastrophic health care expenses across the economy (something, for instance, which might be less feasible for smaller-population states like Alaska), say, for instance, a national sales tax on insurance premiums or a la carte medical services and/or a small national consumption tax. There are ways this could be implemented in practice, e.g., the federal government could reimburse insurance companies for policyholders whom have exhausted their policy benefit limits or migrate the policyholders to some state/regional/national high risk plan.
A second way would be to provide ways to make health care transactions more transparent. For example, the federal government could share regional comparative cost information of various procedure/bundles, prescriptions, etc., and provide government-subsidized patients incentives for choosing lower-cost facilities and physicians, using clinics instead of emergency rooms, at-home (versus hospital-based) convalescence, etc. Yes, I realize that many medical personnel express moral outrage at the very thought of this discussion--you could have a race to the bottom in terms of operators looking to streamline costs, how can you put a cost on good health, not all facilities provide the same quality, etc. The point is to empower the health care consumer with improved information for decision-making, not dictate it. Moreover, it's important for the patient to SHARE in the costs of their health care; if they are not vested because any and all out-of-pocket expenses are covered, they will not make cost-efficient decisions on their own. Let's take a well-known example of grocery shopping for context. One might think that lower-income Americans might make more use of product coupons, generic products, etc., but it turns out many lower-income people prefer name-brand items, even if they cost more (e.g., I may not be able to afford a big-screen TV, but at least I can eat well).
To give a relevant example from my own experience, I, who had been nearsighted nearly all my life, decided to have LASIK eye surgery done several years ago; my younger sister Diane (living in another state) did the same. I ended up having mine done at nearly half the cost as my sister; she wanted a surgeon whom had done the procedure several thousand times. I went to a clinic which offered an incentive for those choosing a junior partner, but it turned out he had already performed over 800 procedures. I could have elected the senior partner, but it would have added roughly another third to the cost. My procedure was successful, and I've never second-guessed my selection of a surgeon. The senior partner knew that people would pay a premium for his additional experience and charged accordingly.
A third way would be to provide or facilitate (in conjunction with health insurers) the development of more usable, portable, secure standard medical documentation of patient history and treatment. To some extent, the Democrats pay lip service to this concern, but again, after decades of managing Medicaid and Medicare, doctors are complaining over the heavy paperwork necessary to process modest charges. I've mentioned this before in the context of my own writings on usability. Without going in undue detail here, basically the idea is to provide doctors with a more natural interface (e.g., speech-to-text technology), seamless intelligent (doctor-centered) integration of technology and minimal obtrusiveness of tasks extraneous to patient treatment (e.g., completing paperwork). Imagine, for instance, if a doctor pulls up a diabetic patient's history and gets automatically alerted to the latest medical journal article summaries, relevant new FDA drug approvals or perhaps reviews trend charts on patient blood sugar readings (say, automatically uploaded with the doctor's patient database).
Obama is not a problem solver. A real problem solver (like me) first asks, "What can we do with the hand we've been dealt? A fragile economic recovery, lower federal tax revenues, looming entitlement fund solvency issues, an exploding federal debt that is flirting with hyperinflation?" We don't push on a string; how amazing is it that these progressives can talk about action needed now to deal with some abstract future health care crisis, whereas by any reasonable assessment of national priorities we are dealing with a fragile recovery and roughly 17% unemployed/underemployed workers and real, not imaginary, entitlement fund reserve crises? The answer is not some meglomaniac paternalistic health care sector takeover. We need to set priorities--deal with the treatment of catastrophic expenses, shore up existing state/regional vehicles for subsidizing high risk households, enable independently-managed, self-insured, tax-advantaged, cross-state cooperatives for small businesses, allow Americans more consumer choice of health care insurance plans without expensive individual state-mandated supplemental benefits, etc. If you are really worried about Anthem Blue Cross individual coverage customers with up to 39% premium increases in California, let them shop across the state line. The solution is NOT to micromanage rates that are necessary to cover the costs of a smaller, higher-risk pool of policyholders.
Policy Reconciliation = Budget Reconciliation?
In my view, if that complementary bill is subject to the filibuster, the Senate GOP should declare any complementary bill will be filibustered--otherwise, this essentially would allow the Democrats to work around Scott Brown's decisive vote as if the January election didn't mean anything.
According to the Washington Post, this fix-it will be precisely the reconciliation bill. What the Democrats are essentially doing is a workaround to major legislation that abuses process, i.e., strip Senate minority rights in dealing with reconciled bills. Standalone, the Christmas week Senate bill would never pass the House. If the present Obama-moderated bill, currently the basis of House/Senate legislation, would be presented to the Senate, it would be successfully filibustered, because all Obama does are fine-tuned cosmetic changes--essentially scrub some of the most egregious deal-making that Republicans have criticized, e.g., the Cornhusker kickback, and include some weak variations of certain Republican ideas, such as tort reform. So what the Democrats will do is get the House to pass the Senate bill into law (with Obama's signature--not a problem), while simultaneously abusing the budget reconciliation process to do policy reconciliation. The Democrats are already engaging disingenuous political spin by putting the cart before the horse, i.e., equating policy changes with budget reconciliation, claiming policies have budgetary considerations. This is an unethical leap-of-logic loophole which would set a precedent by allowing majority-controlled Congresses to bide their time to pass divisive policy legislation of their choice.
Republicans: Don't Underestimate the Senate Health Bill Carrying in the House
The GOP seems to think it's a no-brainer: the House just barely passed health reform, the Senate passed a bill without the abortion language and the public option in the House version crucial to the former's passage. So if you have some liberal Democrats voting against the Senate bill out of principle for lack of a public option, as they have repeatedly vowed, and the pro-life Democrats voting without the necessary abortion language, etc., that's more than enough to defeat the bill.
A couple of problems here. First, a number of conservative Blue Dogs voted against the House bill in large part due to things like the public option and the job-killing "soak the rich" financing. You would think that they would still oppose the Senate bill based on the grounds of fiscal conservatism, and they are well-aware of public opinion polls against the bill (never mind the likely fact that their districts are probably more conservative and hence less accepting).
Second, I find it hard to believe that Obama would be pushing for the bill without believing that he had the votes to carry the measure in the House. The "win one for the Gipper" pitch may be irresistible. Democrats already feel that they have been damaged by the year wasted on health care reform and they will get whacked at either end--if they don't pass something, they'll look ineffective; if they pass it, they will face an angry explosion in the heartland. I have no doubt that the Senate will hold on the reconciliation front, because all 59 Democrats are already on the record; in fact, Sen. Ben Nelson, after being saddled with the unpopular Cornhusker Kickback, is eager to establish that he voted on principle, not for a discredited political deal.
But all of this is purely speculative. Obama may also be trying to make a statement he made a good faith effort to pass reform, setting up a scenario of blaming the Republicans as obstructionists, of trying to blame them for not dealing with the problem of high health costs and of affordable, accessible health insurance. I don't think he'll succeed, in part because I think the American voters see Obama as obstinately continuing to push the same failed reform package they have repeatedly rejected in polls, they are worried about the long-term effects of this reform on their own health insurance, and they are concerned about the federal debt Obama has run up and inherently don't trust Obama's voodoo entitlement economics.
Political Cartoon
Dick Locher points out even after three high-profile election losses in blue and purple states, Obama continues to focus on health care reform (even though roughly 85% of Americans are already under some form of insurance and like their existing private-sector insurance plan), while his success criterion for passing a hugely expensive stimulus bill, i.e., unemployment capped at 8%, was surpassed months ago, and the economy has continued to shed jobs in every month of his Presidency except one (last November).
Quote of the Day
I tremble for my country when I reflect that God is just.
Thomas Jefferson
Musical Interlude: Days of the Week Songs
Mamas and Papas, "Monday, Monday"
Moody Blues, "Tuesday Afternoon"
Sandpipers, "Come Saturday Morning" (memories of high school choir)
Bay City Rollers, "Saturday Night"
