Wednesday, December 30, 2009

The Tyranny of the Majority Party

If Democrats insist on passing unpopular laws, they won't control Congress for long.

Alexis de Tocqueville never met Harry Reid. Had he encountered the Senate Democratic leader—or President Barack Obama or House Speaker Nancy Pelosi—de Tocqueville might have learned about a new twist on his concept of the "tyranny of the majority."
The Frenchman toured America in the 1830s and published his conclusions in the classic "Democracy in America." He noted the powerful impact of public opinion. "That is what forms the majority," he wrote. Congress merely "represents the majority and obeys it blindly" and so does the president. They are free to brush aside minority opinion, creating a threat de Tocqueville described as the "tyranny of the majority."
Democrats in Washington do have large majorities in Congress. But instead of reflecting popular opinion, they are pursuing wide-ranging initiatives in defiance of the views of the majority of Americans. This stands de Tocqueville's concept on its head.
The most striking example is health-care reform. It is intensely unpopular but was approved by the House in November and the Senate on Christmas Eve. Asked in a Rasmussen poll in mid-December if they'd prefer no bill to ObamaCare, 57% said they would. Only 34% said they'd rather ObamaCare be enacted.
Associated Press 
Yet Democrats are forging ahead as if the public actually approves of their health-care reform. Why, when Republicans are preparing to hammer them on the issue in next year's elections, would they do that?
Democrats offer different explanations—besides their obsessive attachment to national health care—which suggests that they aren't quite sure of the political fallout.
After Senate Democrats locked up the 60th vote to assure Senate passage of ObamaCare, Mr. Obama sounded worry-free. Risk? What risk? The bill "is a major step forward for the American people," he said. The president didn't mention the public's disapproval as expressed in countless polls. Vice President Joe Biden, in an op-ed in the New York Times, didn't either.
David Axelrod, a senior adviser to the president, is more realistic. While acknowledging bad poll numbers, he suggested recently on ABC's "This Week" that enactment of sweeping health-care legislation will melt public misgivings. "The reality, I think, will trump poll numbers in the dead of winter as this debate is going on," Mr. Axelrod said.
Ms. Pelosi, too, is brimming with wishful thinking. "Now we will have the attention placed on the truly great things that are in the bill that we have in common," she declared recently. And Sen. Chuck Schumer (D., N.Y.) told Politico, "When people see what is in this bill and when people see what it does, they will come around."
Then there are the martyrs. Doing a reverse de Tocqueville, willingly endangering one's political career by voting for ObamaCare, hasn't fazed Democrat Michael Bennet, the appointed senator from Colorado. He was asked by CNN's John King whether he'd vote for ObamaCare "if every piece of evidence tells you, if you support that bill, you'll lose your job." Mr. Bennet said "yes."
Mr. Bennet isn't the only potential martyr. A Democratic strategist told Byron York of the Washington Examiner that Mrs. Pelosi "believes losing 20 or even 40 Democratic seats in the House would be an acceptable price for achieving a goal the party has pursued since Franklin Roosevelt." Now that Alabama Rep. Parker Griffith has bolted the Democratic Party, Republicans need 40 seats to capture control of the House.
With large congressional majorities, Democrats decided to forget about Mr. Obama's campaign theme of bipartisanship. They brook no compromise with Republicans and forge ahead on issue after issue—health care, cap and trade, Guantanamo, spending, the deficit—despite the public's mounting disapproval.
That arrogance shaped the economic stimulus passed in February. Republicans wanted tax cuts to spur investment and create jobs. Democrats rejected that idea and enacted a huge increase in spending. As unemployment continued to rise, public opinion turned against the stimulus. Nonetheless, House Democrats passed a new, smaller stimulus bill last week with the same emphasis on spending.
Large majorities create what de Tocqueville called a sense of "omnipotence." This leads to overreaching and spawns dubious ideas. Since Democrats believe they will benefit from passing any sort of health-care bill regardless of public opinion, they're committed to passing anything they can call a "historic" achievement. That makes little sense.
With history in mind, cutting procedural corners becomes acceptable. Thus Democrats have set arbitrary deadlines, scheduled post-midnight votes and put limits on debate, all in the name of achieving a breakthrough.
Not that such behavior is anomalous. To pass a Medicare prescription drug benefit in 2003, Republicans kept the House vote open for three hours to round up votes. Unlike ObamaCare, however, the drug benefit had popular support.
This is not the first time in recent memory when a sizeable congressional majority, feeling self-sufficient, ignored popular opinion at its peril. In 1995, Republicans, led by newly installed House Speaker Newt Gingrich, shut down the federal government in their fight over spending with President Bill Clinton. The public sided with Mr. Clinton, and the clash spurred his re-election in 1996.
William Daley, who was Mr. Clinton's Commerce secretary and is the brother of Chicago Mayor Richard Daley, worries that Democrats are doing now what Republicans did then: provoking a public backlash. Democrats must "acknowledge that the agenda of the party's most liberal supporters has not won the support of a majority of Americans," he wrote last week in the Washington Post. "Either we plot a more moderate, centrist course or risk electoral disaster not just in the upcoming midterms but in many elections to come."
"I regard as impious and detestable the maxim that in matters of government the majority of a people has the right to do everything," de Tocqueville wrote roughly 175 years ago. But what about a congressional majority—which lacks a mandate from a majority of Americans—seeking to do everything? The Frenchman might have dubbed that the "tyranny of the minority."
Mr. Barnes is executive editor of the Weekly Standard and a commentator on Fox News Channel.


Monday, December 28, 2009

Cross the River, Burn the Bridge

Obamacare is the fast-track to a permanent left-of-center political culture.

By Mark Steyn


Last week, during a bit of banter on Fox News, my colleague Jonah Goldberg reminded me of something I’d all but forgotten. Last September, during his address to Congress on health care, Barack Obama declared: “I am not the first President to take up this cause, but I am determined to be the last.”

Dream on. The monstrous mountain of toxic pustules sprouting from greasy boils metastasizing from malign carbuncles that passed the Senate on Christmas Eve is not the last word in “health” “care,” but the first. It ensures that this is all we’ll be talking about, now and forever.

Government can’t just annex “one-sixth of the U.S. economy” (i.e., the equivalent of annexing the entire British or French economy, or annexing the entire Indian economy twice over) and then just say: “Okay, what’s next? On to cap-and-trade . . . ” Nations that governmentalize health care soon find themselves talking about little else.

In Canada, once the wait times for MRIs and hip surgery start creeping up over two years, the government distracts the citizenry with a Royal Commission appointed to study possible “reforms” which reports back a couple of years later usually with recommendations to “strengthen” the government’s “commitment” to every Canadian’s “right” to health care by renaming the Department of Health the Department of Health Services and abolishing the Agency of Health Administration and replacing it with a new Agency of Administrative Health Operations which would report to a reformed Council of Health Policy Administrative Coordination to be supervised by a streamlined Public Health Operations & Administration Assessment Bureau. This package of “reforms” would cost a mere 12.3 gazillion dollars and usually keeps the lid on the pot until the wait times for MRIs start creeping up over three years.

The other alternative is what the British did earlier this year: They created an exciting new “Patient’s Bill of Rights,” promising every Briton the “right” to hospital treatment within 18 weeks. Believe it or not, that distant deadline shimmering woozily in the languid desert haze can be oddly reassuring if you’ve ever visited a Scottish emergency room on a holiday weekend. And, if the four-and-a-half months go by and you still haven’t been treated, you get your (tax) money back? Ah, no. But there is a free helpline you can call which will give you continuously updated estimates on which month your operation has been rescheduled for. I mention these not as a preview of the horrors to come, but because I’ve come to the bleak conclusion that U.S.-style “health” “reform” is going to be far worse.

We were told we had to do it because of the however many millions of uninsured, yet this bill will leave some 25 million Americans uninsured. On the other hand, millions of young fit healthy Americans in their first jobs who currently take the entirely reasonable view that they do not require health insurance at this stage in their lives will be forced to pay for coverage they neither want nor need. On the other other hand, those Americans who’ve done the boring responsible grown-up thing and have health plans Harry Reid determines to be excessively “generous” will be subject to punitive taxes up to 40 percent. On the other other other hand, if you’re the member of a union which enjoys privileged relations with Commissar Reid you’ll be exempt from that 40 percent shakedown. On the other other other other hand, if you’re already enjoying government health care, well, you’re 83 years old and, let’s face it, it’s hardly worth us giving you that surgery for the minimal contribution you make to society, so in the cause of extending government health care to millions of people who don’t currently get it we’re going to ration it for those currently entitled to it.

Looking at the millions of Americans it leaves uninsured, and the millions it leaves with worse treatment and reduced access, and the millions it makes pay significantly more for their current health care, one can only marvel at Harry Reid’s genius: government health care turns out to be all government and no health care. Adding up the zillions of new taxes and bureaucracies and regulations it imposes on the citizenry, one might almost think that was the only point of the exercise.

That’s why I believe America’s belated embrace of government health care is going to be far more expensive and disastrous than the Euro-Canadian models. Whatever one’s philosophical objection to the Canadian health system, it is, broadly, fair: Unless you’re a cabinet minister or a bigtime hockey player, you’ll enjoy the same equality of crappiness and universal lack of access that everybody else does. But, even before it’s up-and-running, Pelosi-Reid-Obamacare is an impenetrable thicket of contradictory boondoggles, shameless payoffs, and arbitrary shakedowns.

That’s why Nebraska’s grotesque zombie senator Ben Nelson is the perfect poster boy for the new arrangements, and not just another so-called Blue Dog Democrat spayed into compliance by a massive cash injection. There is no reason on earth why Nebraska should be the only state in this Union to have every dime of its increased Medicare tab picked up by the 49 others. So either that privilege will be extended to all, or to favored others, or its asymmetry will be balanced by other precisely targeted lollipops hither and yon. Whatever happens, it’s a dagger at the heart of American federalism, just as the bill’s magisterial proclamation that the Independent Medicare Advisory Board can only be abolished by a two-thirds vote of the Senate strikes at one of the most basic principles of a free society — that no parliament can bind its successors.

These details are obnoxious not merely in and of themselves but because they tell us the truth about where we’re headed: Think of the way almost every Big Government project bursts its bodice and winds up bigger and more bloated than its creators allegedly foresaw. In this instance, the stays come pre-loosened, and studded with loopholes. Because the Democrat operators — the Nancy Pelosis and Barney Franks — know that what matters is to get something, anything across the river, and then burn the bridge behind you.

My Republican friends often seem to miss the point in this debate: The so-called “public option” is not Page 3,079, Section (f), Clause VII. The entire bill is a public option — because that’s where it leads, remorselessly. The so-called “death panel” is not Page 2,721, Paragraph 19, Sub-section (d), but again the entire bill — because it inserts the power of the state between you and your doctor, and in effect assumes jurisdiction over your body. As the savvier Dems have always known, once you’ve crossed the Rubicon, you can endlessly re-reform your health reform until the end of time, and all the stuff you didn’t get this go-round will fall into place, and very quickly.

As I’ve been saying for over a year now, “health care” is the fast-track to a permanent left-of-center political culture. The unlovely Democrats on public display in the week before Christmas may seem like just a bunch of jelly-spined opportunists, grubby wardheelers and rapacious kleptocrats, but the smarter ones are showing great strategic clarity. Alas for the rest of us, Euro-style government on a Harry Reid/Chris Dodd/Ben Nelson scale will lead to ruin.

Mark Steyn, a National Review columnist, is author of America Alone

Wednesday, December 23, 2009

Businesses Brace for Health Bill's Costs

Resigned to Passage, Corporate Lobbyists Begin Jockeying for Modifications That Will Buffer the Impact


Companies are alarmed at potentially costly provisions in the Senate health-care bill, many of which they hope will be scrapped during a final round of negotiations early next year.
A scramble to massage the hefty measure, instead of pushing to kill it, reflects the view of many in the business community that a sweeping remake of the U.S. health-care system now appears inevitable.
The U.S. Chamber of Commerce is among a few big business groups calling for Congress to scrap the overhaul effort.
Business is worried that President Barack Obama's push to extend coverage to millions more Americans will raise the burden on employers. Business groups have widely criticized the 2,074-page Senate bill, which looks set for passage on Christmas Eve. They also have offered a variety of fixes.
From left, Democratic Sens. Christopher Dodd, Harry Reid and Max Baucus participate in a rally Tuesday after a series of votes on the health-care bill.
The legislation's scale and complexity, plus uncertainty over how the Senate bill will be meshed with the version that passed the House in November, make it difficult for most companies to gauge the effect it will have on the bottom line.
"We're still committed to the notion that health reform can be done right, but I know of no company that is warmly embracing what is in either the House or Senate bills," said Paul Dennett, top health-care adviser to the American Benefits Council, an advocacy group for large employers.
With all eyes now turning to House-Senate negotiations over a final bill expected next month, corporate lobbyists are jockeying for modifications that will buffer the impact.
Retailers want a longer delay before new employees qualify for company-subsidized benefits. Big employers such as Caterpillar Inc., Boeing Co. and Xerox Corp. want to modify Medicare tax provisions in the Senate bill that would cut their earnings. Small construction companies want an exemption from employee coverage that the Senate bill already applies to other businesses with fewer than 50 employees.
Across the spectrum, businesses worry that a series of new taxes and fees to pay for expanding health-care coverage will push up premiums, particularly for smaller employers.
The Senate bill calls for a nearly $70 billion tax over 10 years on insurance companies, plus a $2 billion-a-year tax on medical devices. Billions of dollars are also meant to be raised from added taxes and fees on wealthier seniors, higher-end insurance plans and tanning salons.
Companies of all sizes have been increasingly burdened by health-care costs, which topped $400 billion in 2007, according to data from the Employee Benefit Research Institute. Unrestrained, that figure is expected to double by 2017. About 70% of workers receive health insurance through their employers.
Groups representing smaller businesses say the threat of increased taxes and premiums could outweigh provisions intended to limit the impact on small employers. The Senate bill "will not only fail to reduce and control the constantly climbing health-care costs small-business owners face, but it will result in new and greater costs on their business," said Dan Danner, head of the National Federation of Independent Business.
Not all companies agree. David Ickert, vice president of finance for Air Tractor Inc., which produces airplanes used in agriculture and firefighting, said that from his analysis, the bill would have "no negative impact" on his operations. The company, based in Olney, Texas, employs about 200 people.
Under the Senate bill, most businesses with fewer than 50 workers will be exempt from penalties if they don't offer employee coverage. Larger companies would face fines as high as $750 per worker if even one employee seeks federal help to buy a policy.
Democrats say a package of tax credits within the Senate bill will reduce costs for small businesses. Small businesses that qualify would get a 25% tax credit to help pay for employee coverage. The legislation would also allow small businesses to band together to seek coverage at costs similar to those of much larger companies.
Large companies that fund their own insurance have been relatively positive about the Senate bill, which is much less prescriptive than the House bill and doesn't contain a government-run insurance plan. Still, large companies cite a list of concerns.
A top gripe is that the Senate bill would alter the tax rules that affect big companies providing prescription-drug benefits to their retired workers. Under the law earlier this decade creating a drug benefit in Medicare, companies that continued to provide such benefits qualified for a 28% tax-free subsidy. The Senate bill would tax that subsidy.
A spokesman for Caterpillar said, "The financial impact would be significant for Caterpillar, particularly in the first year."
Martin Reiser, a Washington representative for Xerox and chairman of the National Coalition on Benefits, said another big concern was "whether a lot of the provisions meant to contain [health-care] costs will actually do so. If they don't work -- and we won't know for years -- then the bill is a failure."
—Gary Fields and Ann Zimmerman contributed to this article. Write to Neil King Jr. at

Tuesday, December 22, 2009

O Come O Come, Emanuel

Will Democrats regret Rahm's wager on health care?

'Twill be the night before Christmas when the Senate delivers the top item on White House Chief of Staff Rahm Emanuel's wish list: a health-care bill. But like the beautifully wrapped gift that looks so wonderful under the tree, this health-care legislation might start to look more like the ghastly sweater from your Aunt Tilly once it comes out of the box.
Give Majority Leader Harry Reid his due. Notwithstanding the grumblings about the way he did it, getting the 60 senators he needed to avoid a Republican filibuster was an achievement. Assuming the House and Senate work out their differences, Mr. Reid's Christmas gift tees up the president for a triumphant State of the Union come January.
Yesterday President Barack Obama gave us a preview when he took a little victory lap amid a jab at critics who are "continually carping" about big spending. The health-care vote, he said, is "a big victory for the American people."
Chad Crowe 
Whether it's a "big victory" for the Democratic Party depends on whether you buy Mr. Emanuel's wager about 1994. The Emanuel Wager goes like this: It was the Democrats' failure in 1994 to pass a health-care bill that ushered in the Gingrich takeover of Congress. In his own meetings with Democrats, former President Bill Clinton has pressed the same line.
This was the message Mr. Emanuel delivered personally to Mr. Reid, when he urged him to cut a deal with holdout Joe Lieberman. This was the message the president echoed two days later in the West Wing, when he told Democrats that no piece of legislation would be perfect. And this appears to be the message embraced by Mr. Reid and House Speaker Nancy Pelosi, given their willingness to accept any amendment to get some health-care bill passed.
So here's the rub: Emanuel's Wager holds only if the merits of the legislation matter not at all.

OpinionJournal Related Stories:

Review & Outlook: Change Nobody Believes In
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Kim Strassel: Democrats on the Health-Care Precipice
That's a cynical view of politics. Of course, if you are Mr. Emanuel and you are looking across the table at senators such as Ben Nelson or Mary Landrieu, you can be forgiven for having your cynicism confirmed. Whether this same cynicism applies to the American people, however, is another question.
Here the signs should be less reassuring to Democrats. As polls have consistently shown, the more Americans learn about Democratic plans for health care, the more the opposition grows. Mr. Reid appreciates this dynamic, which is why he wrote his bill behind closed doors, when only Santa could have any real idea of who's earning a place on the naughty list.
If Mr. Emanuel is right, once health-care legislation is passed and Mr. Obama spins it as a huge victory, the American people will forget their objections and the Democrats will get credit for passing historic reform. If so, that will be some achievement. Because it means building on a health-care package supported by fewer than 38% of Americans (the RealClearPolitics poll average).
If the merits do matter, by contrast, passing this bill could prove more costly than failure. Mr. Obama has been unequivocal in his public statements. In his telling, this legislation will lower costs, reduce the deficit, help small businesses, maintain the status quo on abortion, offer Americans more choices, and so forth.
All these promises may look different when the details emerge, and we learn what change really means. If the president's promises do not hold up, all these Obama statements will be chopped into campaign ads that cut right to his credibility. As for his allies in the Senate, the 60 to 40 party-line vote to close debate means that every Democrat there can be held up as the deciding vote.
It's also unclear whether the traditional standbys for avoiding public accountability—e.g., hiding behind procedural votes—will fly this time. In the last few months, the American people have been watching. And they have learned a great deal about filibusters, manager's amendments, reconciliation, special Medicaid sweeteners for special states, etc.
So they are not likely to be fooled by a senator who tries to have it both ways: by voting to keep this bill alive when his or her vote could have stopped it (Monday morning's cloture vote), and then voting against it (the coming Christmas Eve vote) when passage was assured. Remember how well it worked for John Kerry in the 2004 campaign when his words explaining his votes on a supplemental to fund our troops were thrown back at him. Explained the then-presidential candidate: "I actually did vote for the $87 billion before I voted against it."
Mr. Emanuel was right to tell his fellow Democrats that the price of failure would be to make them all look weak. The question is whether there will be a larger price for looking arrogant.
Write to


Friday, December 18, 2009

Sen. Nelson Holds Up Health Bill

Dispute Over Abortion Threatens Democrats' Christmas Deadline for Passage

WASHINGTON -- Senate Democrats' drive to pass health-care legislation by Christmas showed signs of faltering Thursday, amid divisions over abortion and criticism by some Democratic supporters that the bill is unaffordable for lower-to-middle-income families.
In a seesaw day, Sen. Ben Nelson, an antiabortion Nebraskan who is the last Democrat withholding support for the legislation, rejected an overture by party leaders to address his concerns about the bill's handling of abortion. Among other things, Democratic leaders proposed to create a new tax credit that would promote adoptions.
Sen. Nelson said his concerns had "not been fully answered." In an interview with a Nebraska radio station, he suggested it would be difficult to vote on the broader bill by Christmas, as the White House wants.

On the Table

Compare the plans, point-by-point

Health-Care Overhaul Attempts

As costs have risen, attempts at change
"I accept the idea of deadlines and the pressure that that creates," he said. "But a deadline and a timeline that's out there, that is not achievable, isn't helpful." He added, "I do intend to be home for the holidays."
Labor leaders amplified their complaints about the bill. AFL-CIO chief Richard Trumka objected to the bill's proposed tax on high-value insurance plans, and the decision by Senate Democrats to drop a government-run insurance plan. Mr. Trumka said the Senate bill was "too kind to the insurance industry."
Senate Democratic Leader Harry Reid of Nevada continued to work to get 60 votes, the number needed to ensure passage of the legislation, said Reid spokesman Jim Manley. With Mr. Nelson's vote in doubt, President Barack Obama met with Maine Sen. Olympia Snowe, the lone Republican to show interest in supporting the package, to see if she would back the bill. Sen. Snowe is an abortion-rights supporter.
"He'd prefer to get this moving," Sen. Snowe said. She added that she urged the president to postpone action and use "part of January" to deal with her concerns, which include a proposal to establish a new long-term care program. "The time frame is totally unrealistic," she said of the push for a vote by Christmas.
The bill is designed to extend health-insurance coverage to tens of millions of Americans. It includes a mandate on individuals to carry health coverage or pay a fine -- a provision that is raising fresh concerns among some lawmakers who say that even with new tax credits, some people will find coverage unaffordable.
The Senate bill sets some limits on abortion coverage under insurance policies bought in the new national exchange -- or marketplace -- that would be created under the bill. It would still allow women who receive some government subsidies to buy insurance that covers the procedure, though they would have to use their own money to pay for an abortion.
Sen. Nelson is seeking to further tighten the bill's restrictions. He dismissed the latest attempt to find common ground. "As it is right now, without further modifications, it isn't sufficient," he said.
Associated Press
Nebraska Sen. Ben Nelson, center, flanked by Connecticut Sen. Joe Lieberman, left, and West Virginia Sen. Jay Rockefeller, right, as they prepare to leave after appearing on CBS's 'Face the Nation' Sunday in Washington.
With the holidays looming, some Democrats were beginning to suggest it might be difficult to make the Christmas deadline set by Mr. Reid.
"Obviously, we are going to take the holidays off, and if we haven't done health care, we need to keep going and come back and do it as soon as possible," said Sen. Jack Reed (D., R.I.). Sen. Debbie Stabenow (D., Mich.) added she didn't know when passage of the bill would come, saying it could be "Christmas Eve, or Christmas, or the week after, or the week after that."
Mr. Reid is juggling a number of year-end priorities. He was trying to push the Senate toward a final vote Saturday on a fiscal 2010 defense bill, which also includes provisions extending jobless benefits. Also pending is legislation needed to lift the nation's $12.1 trillion debt ceiling.
"This entire process is essentially a charade," said Senate Minority Leader Mitch McConnell (R., Ky.). Republicans threatened to resist Mr. Reid's efforts to proceed to a vote on the defense bill, in what would be a symbolic protest over the push on health. Mr. McConnell said Democrats were preparing to vote on a health bill "that no one outside of the majority leader's conference room has seen."
The White House brushed off suggestions that momentum may be turning against the health overhaul. "Despite all the cable TV chatter, nothing has happened in recent days that suggests that this bill is any less likely to pass," said White House communications director Dan Pfeiffer.
Democrats fear a delay could cause them to lose traction on the bill. Pushing the Senate vote past Christmas would add to the time it would take to piece together a compromise between the House and Senate, and would tie debate on that final bill more tightly to the 2010 election season. Polls show widening voter discontent with the health initiative.
Write to Greg Hitt at and Janet Adamy at


Democrats on the Health-Care Precipice

Enacting health-care legislation in the face of overwhelming public disapproval may cost the party its chance of forging a sustainable majority.

Barack Obama emerged from his meeting with Senate Democrats this week to claim Congress was on the "precipice" of something historic. Believe him. The president is demanding his party unilaterally enact one of the most unpopular and complex pieces of social legislation in history. In the process, he may be sacrificing Democrats' chances at creating a sustainable majority.
Slowly, slowly, the Democratic health agenda is turning into a political suicide pact. Congressional members have been dragged along by momentum, by threat, by bribe, but mostly by the White House's siren song that it would be worse to not pass a bill than it would be to pass one. If that ever were true, it is not today.
Public opinion on ObamaCare is at a low ebb. This week's NBC-WSJ poll: A mere 32% of Americans think it a "good" idea. The Washington Post: Only 35% of independents support it—down 10 points in a month. Resurgent Republic recently queried Americans over the age of 55, aka Those Most Likely to Vote In a Midterm Election. Sixty-one percent believe ObamaCare will increase their health costs; 68% believe it will increase the deficit; 76% believe it will raise their taxes.
Democrats also have managed to alienate the liberal base to which they were catering. The death of the public option and Medicare buy-in this week sent Howard Dean to thundering "kill the bill." A week from now, the current polls might look good.
Yet it is in individual states where the disconnect between the White House's soothing words and the ugly political reality is most stark. While Democrats are under fire for the economy and spending, it is health care that has voters thinking it's time for political change.
Associated Press
North Dakota's Sen. Byron Dorgan

Consider North Dakota. A recent Zogby poll showed 28% (you read that right) of state voters support "reform." A full 40% said they'd be less likely to vote for Democratic Sen. Byron Dorgan next year if he supports a bill. In a theoretical matchup with Republican Gov. John Hoeven (who has yet to announce), Mr. Hoeven wins 55% to 36%. Mr. Dorgan has been in the Senate 17 years; he won his last election with 68% of the vote. This should not be happening.
In Arkansas, 32% support this health-care legislation. Sen. Blanche Lincoln, also running next year, trails challengers by more than 50 points among the 56% of voters who strongly disapprove of the health plan. Senate Majority Leader Harry Reid, the public face of health reform, can barely break 38% approval in Nevada. In Colorado, where 55% of voters oppose a health bill, appointed Democratic Sen. Michael Bennet told CNN he'd vote for a bill even if it "cost him his job." Give the freshman credit for honesty.
Nor is this a red state/swing state phenomenon. In deep-blue Delaware, 46% oppose the health plan. Democrats pounded Delaware GOP Rep. Mike Castle, running for Senate, for voting against the House bill. That vote has in fact kept Mr. Castle leading his expected opponent, Beau Biden, the vice president's son. Chris Dodd helped author the Senate health bill and is up for re-election next year. He is arguably the Senate's most politically vulnerable Democrat.
Don't trust the polls? In the past weeks, four well known House Democrats announced they will not run for re-election. All are longtime incumbents; one, Tennessee's respected John Tanner, co-founded the Blue Dog coalition. These folks have seen the political handwriting on the wall.
Democrats have also been pulled by another White House promise: That once Americans witness reform, they will turn around. Yet even supporters know this ugly bill will not "fix" health care. The problems will remain—with more in addition—and Democrats will own them. Meanwhile, the backlash against the pending health-care legislation is seeping out to hamper Democrats' broader agenda. Pew this week published a poll in which it marveled (fretted?) over the "extent to which the public has moved in a conservative direction on a range of issues" since President Obama took office.
So why the stubborn insistence on passing health reform? Think big. The liberal wing of the party—the Barney Franks, the David Obeys—are focused beyond November 2010, to the long-term political prize. They want a health-care program that inevitably leads to a value-added tax and a permanent welfare state. Big government then becomes fact, and another Ronald Reagan becomes impossible. See Continental Europe.
The entitlement crazes of the 1930s and 1960s also caused a backlash, but liberal Democrats know the programs of those periods survived. They are more than happy to sacrifice a few Blue Dogs, a Blanche Lincoln, a Michael Bennet, if they can expand government so that in the long run it benefits the party of government.
What's extraordinary is that more Democrats have not wised up to the fact that they are being used as pawns in this larger liberal game. Maybe Mr. Obama will see a bump in the polls if health care passes; maybe not. What is certain is that this vote is becoming one that many in his party will not survive.
Write to:


Thursday, December 17, 2009

ObamaCare and the Liberal Obsession

Every Democratic president since FDR has failed to pass national health insurance. The current legislation in Congress is likely the last chance to enact it.

If President Obama's health-care initiative fails, there is no longer a rationale for being a liberal in the United States. Everything else on liberalism's to-do list is footnotes.
Passing national health insurance has obsessed every Democratic president since Franklin Roosevelt. Even Harry Truman, for some conservatives a model of "moderate" Democratic politics, wanted it. Looking back, Truman wept and warned: "I've had some bitter disappointments as President, but the one that has troubled me most, in a personal way, has been the failure to defeat the organized opposition to a national compulsory health insurance program. But this opposition has only delayed and cannot stop the adoption of an indispensable federal health insurance plan."
Daniel Henninger discusses how passing health-care reform is a liberal obsession.
No other issue has consumed more political energy in the U.S. than "health-care reform." Congress's half-year preoccupation with health care is only the latest blip in the Democrats' long march to a public option.
As we head to the final act, one element of this history stands out: The liberals' repeated failure to get it done.
The Democratic Mecca—a real national health insurance system available to all—has always encountered stiff resistance in Congress, notably as now from moderate Democrats. In the 1960s, Senate Finance Chairman Russell Long (of Mary Landrieu's Louisiana) railed publicly against Medicare's costs but as now, questions about cost were obliterated.
Frustrated at the failure to pass their "National Health Insurance" bill during the presidency of Dwight Eisenhower, the Democrats ratcheted back from the Euro-style idea of FDR and Truman to a plan that would cover only Social Security beneficiaries, the elderly. This was Medicare.
Medicare failed all its initial votes in 1960. A compromise known as Kerr-Mills, which limited federal coverage to the "indigent" elderly, passed the Senate by a vote of 91-2. Many said then that Kerr-Mills addressed the U.S.'s main problem, which was medicine for the poor. Ronald Reagan supported Kerr-Mills, arguing that people "worth millions of dollars" shouldn't be getting health care paid for by government.
For Democratic liberals, a lot is never enough. With John Kennedy's election, they resubmitted Medicare for the elderly regardless of income.
The Democrats still couldn't pass a health-care entitlement on the scale of Social Security. The politics they threw into the effort was massive. They put 20,000 elderly in Madison Square Garden to hear JFK's oratory. Rallies were held in 45 cities. Organized labor ran campaigns against members of the Ways and Means Committee in their home districts. For all this, in July 1962 the Senate voted 52-48 against Medicare. JFK denounced the vote on TV.
JFK pleads for universal health care in Madison Square Garden in 1962.

It is a familiar story that Lyndon Johnson got Medicare passed as part of the Kennedy legacy. But for LBJ in 1965, the political planets were in perfect alignment. He had an overwhelming victory in the 1964 presidential campaign and huge congressional majorities. He had a robust economy, a gift of the Kennedy tax cut passed in early 1964. Also, no House hearings were held that year on the 296-page bill, which Democratic Sen. Philip Hart of Michigan complained was "one of the most complex set of social security amendments ever brought before this body."
Oh, and let us not overlook the party's concurrent quest for money transfers. In a moment of glee over the 1965 bill, Rep. Phil Burton of California, a member of the liberal pantheon, intoned: "All in all, our fair state and its people in the first year will be favored to the tune of some $550 million, a not modest sum." (Norms of spending "modesty" have changed since.)
The Democrats' persistent problems with this issue, including the Clintons' Health Security Act in 1994, suggests a victory for ObamaCare is no sure thing.
Nearly every defeat of broad public health coverage has come amid some turbulence that scared the public or politicians.
For Truman it was the Korean War. For JFK it was a recession, Vietnam and the Cuban missile crisis. Walter Lippmann wrote of JFK that a too-confident president was exceeding the public's reach. The Social Security Administration's own history of the Kennedy effort notes, "Some experts still had doubts about the reliability of the cost estimates for the bill."
Now Democrats say this vote is about "history." No, it's about their history. As with past failures to federalize health care, the air in 2009 is full of static—high unemployment, Afghanistan, a terrorist prison in Illinois and a petulant White House. The Democrats' familiar problems with the politics of universal health care have turned the bill into one of the most degraded legislative exercises in congressional history. Left-wing Dems like Howard Dean are screaming "kill" the Senate bill, suggesting a progressive Jonestown over it. Public support is below 40%.
This is probably the final death struggle for universal health care. They may let Harry Reid's Senate seat itself go down in the bloodbath over the 70-year obsession. Anyone remotely opposed to this idea had better step forward. History says ObamaCare isn't a done deal til the fat lady votes.
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SEIU Pulls Back on Supporting Bill Amid Concerns Bill Isn't Progressive Enough

By Jeffrey Young - 12/16/09 12:37 PM ET

The Service Employees International Union (SEIU) backed out of an event with other organizations promoting the Senate healthcare reform bill Wednesday over concerns about changes made to the legislation to accommodate centrist Democrats.

The SEIU had planned to participate in a Capitol Hill press conference along with the AARP, the liberal advocacy group Families USA, Consumers Union and the American Cancer Society Action Network. As recently as Tuesday morning, the organizations distributed an advisory to the news media that included the SEIU.

But the move by Senate Majority Leader Harry Reid (D-Nev.) to excise provisions of the healthcare reform bill to create a government-run public option health insurance program and to allow people between 55 and 64 years old to buy into Medicare gave the labor union pause, spokeswoman Lori Lodes said.

"That decision has to be made by our leaders and our members," Lodes said. The event with the AARP and the other groups was scheduled before Reid made changes to the bill.

The SEIU executive board will hold what Lodes described as an "emergency" meeting Wednesday night to decide how to move forward. "Right now, they don't have the information they need to make this decision," said Lodes, who added that the SEIU informed the other organizations on Tuesday they would not be joining the press conference.

The board meeting likely will not produce a final determination by the union about whether to support advancing the Senate healthcare bill, which not only lacks a public option and the Medicare buy-in but also would levy an excise tax on so-called Cadillac health insurance plans that some union members have, Lodes said.

"We will not have an absolute decision coming," largely because Reid has not released the final language of the healthcare bill, she said.

The Big Scare: President Obama: Federal Government 'Will Go Bankrupt' if Health Care Costs Are Not Reined In

ABC's Karen Travers reports from Washington:
President Obama told ABC News’ Charles Gibson in an interview that if Congress does not pass health care legislation that will bring down costs, the federal government “will go bankrupt.”
The president laid out a dire scenario of what will happen if his health care reform effort fails.
Gibson Obama “If we don't pass it, here's the guarantee….your premiums will go up, your employers are going to load up more costs on you,” he said. “Potentially they're going to drop your coverage, because they just can't afford an increase of 25 percent, 30 percent in terms of the costs of providing health care to employees each and every year. “
The president said that the costs of Medicare and Medicaid are on an “unsustainable” trajectory and if there is no action taken to bring them down, “the federal government will go bankrupt.”
“This actually provides us the best chance of starting to bend the cost curve on the government expenditures in Medicare and Medicaid,” Obama said.
Watch Charlie Gibson’s interview with President Obama tonight on World News and check back on for the full interview.
Obama told Gibson that anybody who says they are concerned about the rising deficit or worried about tax increases in the future has to support this health care bill.
“Because if we don't do this, nobody argues with the fact that health care costs are going to consume the entire federal budget,” the president said.
Obama is facing an increasingly skeptical American public when it comes to his push for health care reform.
The latest ABC News/Washington Post poll found that support for the health care reform package, while never robust, is now at a low ebb and opposition has been steadily growing stronger in intensity.
For the first time, a majority of those surveyed disapproved of the president’s work on health care (53 percent) and oppose the health care reform package making its way through Congress (51 percent, compared to 44 percent approval).
That seven-point margin for opposition is its most to date -- indeed statistically significant for the first time -- and the differential in intensity of sentiment has grown since September.
More on the ABC News/Washington Post poll HERE.

Nancy Pelosi: No Health Care Deal This Year

Speaker Nancy Pelosi predicted Wednesday that job creation and deficit reduction will be the central Democratic themes for the coming year – and that public support for health care reform will rebound once a bill has been sent to President Barack Obama.

On the divisive issue of Afghanistan, the California Democrat ducked the question of how she would vote on increased war funding: “Let’s see what they request,” she said. But she has urged her party, including old allies on the anti-war left, to listen and give some “room” to Obama, recognizing that the president had been “dealt a very bad hand because there was no plan in Afghanistan for years.”

Pelosi made her comments at a year-end roundtable with reporters where she described herself as back in full “campaign mode” and confident House Democrats will retain “a strong majority” after the 2010 elections.

“He didn’t give me 72 hours notice,” she joked of Rep. Brian Baird’s surprise decision to not seek re-election in his swing district in Washington state. But Pelosi said her rule of politics was “don’t assume anything” and she wasn’t panicked by the recent spate of retirements in her ranks.

In the case of health care reform, Pelosi credited House Democrats with having saved Obama’s initiative after the onslaught of attacks during the August recess. And if the Senate can complete its bill this month, she will work to try to send a House-Senate compromise to the White House before the State of the Union.

“They will pass a bill and we will have a bill,” the speaker said, and once that happens, she predicted the focus will shift away from the differences among Democrats and more on what is in the package itself.

“We are in a define-or-be-defined occupation,” she said, and her adversaries have had the advantage of picking out single issues, such as abortion or the public option, to characterize the whole.

Matching the House bill against the still-evolving Senate package, she said she saw differences of affordability for families and the revenue-raisers that would have to be negotiated. But she downplayed differences over the public option for coverage, saying the emphasis had always been on giving consumers an insurance option, not that it be public or government run.
“We know that, between the two bills, we have the makings of a big difference for the American people,” Pelosi said. “When we have a bill . . . the discussion is no longer about the bishops or about the public options, and it’s about what’s in the bill for people.”

She plans to travel to Michigan for the Detroit auto show in January and is already pressing the Senate to respond quickly next month to a new job-creation package on the floor Wednesday. When a Michigan reporter asked her response to White House proposals about job-creating investments in environmental technologies, she bridled a bit: “We need no introduction to these subjects, and we’re thrilled that the White House is joining them.”

But in contrast with this past year, dominated by the Democrats aspirations for health care or climate change legislation, she said the grim federal debt now loomed over the agenda.
“There is a very, almost fierce determination to reduce the deficit,” she said, and repeatedly returned to her early years in Congress and budget battles under President Bill Clinton that contributed to the Democrats losing control of Congress in 1994.

“We’ve been here before,” she said. “We had to make very difficult decisions, and as you know, we paid a political price for it but we had to do it.”

Pelosi predicted in January ‘we’ll come to terms on a commission” such as those proposed to make recommendations to Congress on difficult deficit-reduction measures. But without mentioning Senate Budget Committee Chairman Kent Conrad (D-N.D.) by name, she seemed cool still toward his legislation, which would usurp the speaker’s power over legislation and dictate an up-or down-House vote -- without amendments -- on whatever the commission recommends.

“I said pass it in the Senate,” the speaker said. “Send it to me, I’ll have to face it.” But when Senate leaders told her that it was unclear still if the Conrad plan had the 60 votes needed for passage, her answer was: “Then let’s talk about what we can both pass rather than talk about what some people think should happen but doesn’t really have the votes.”

“This is not a completely whole new ball game because we had to do it when President Clinton made the determination that we would go forward,” the speaker said. “We know how to do it -- we’ll do it again.”

Nancy Pelosi walks before a press conference.
Nancy Pelosi seems determined to get her legislation passed. Photo: AP

Wednesday, December 16, 2009

The People Lose in Health Care Trainwreck

WASHINGTON -- This is what happens when the soaring promises of Hope and Change give way to old-style political prostitution on the Potomac.
President Obama won last year vowing to change the way Washington works.
Democrats clung to his coattails and won commanding control of Congress.
In less than 12 months, though, all the Democrats' promises of honesty, openness and common sense have sunken into the same old sordid sewer that has forever defined Washington as the loathsome, dishonest and wasteful place that it is.
The result is the health-care train wreck.

We must lower the skyrocketing costs, Dems said.
Now they are willing to spend any amount of your money it takes to get some kind of health-care legislation passed.
And they don't care how much their own accountants tell them the bill will actually raise the costs of health care.
We will usher in a new era of openness, they vowed.
Not anymore.
Openness and honesty were killing their health-care plans, so Democrats took it entirely behind closed doors.
The only way to provide health care for all Americans, they promised us, was if the government went into the insurance business.
Now they say states can opt out or opt in. Or you can join Medicare. Or, some people can join Medicare.
"Anything!" they are saying. "We just need a victory!"
This is what happens when politicians go from idealism to survivalism.
They no longer care what they promised voters. They don't care what the public wants. And they don't care about what is right.
All they care about is a victory so that they can claim to have accomplished something.

Tuesday, December 15, 2009

Sources: Medicare buy-in likely to be dropped from health care bill

Click to play
Lieberman talks health care
  • Plan to expand Medicare to those 55 and over will be dropped, sources say
  • Move aims to win back support of Sen. Joe Lieberman, they say
  • Senate Dems need 60 votes to close debate and bring health care bill to a vote
  • Lieberman support is key to the 60 votes
Washington (CNN) -- Senate Democrats are preparing to drop a compromise health-care plan that would allow 55- to 64-year-olds to buy into Medicare because of opposition from Connecticut Sen. Joe Lieberman, two senior Democratic sources said Monday.
"It's what the White House wants, and there aren't many other options that allow us to finish by Christmas," said one source.
Lieberman, an independent who caucuses with the Democrats, has emerged as the majority party's main obstacle to its efforts to get a health care bill through the Senate before Christmas. He ratcheted up his public opposition to the bill Sunday by threatening to join a Republican filibuster if the legislation contains either a government-run public health insurance option or a proposed alternative that would expand Medicare to people as young as 55.
"I think the danger always is you try to add too much onto a bill," he told reporters Monday evening. He said he supports the "core" of the bill, including tighter regulations on private insurers, but he wants Democrats to "take off some of this stuff that runs the risk of creating federal debt, and moves toward a government takeover of insurance, which I think would be bad."

Unanimous Republican opposition so far means Senate Democrats need all 60 votes in their caucus to close debate on the sweeping health care bill. Final passage of the bill would then require only a simple majority of 51.
Lieberman supported letting older workers buy into Medicare in 2000, when he was the Democratic vice presidential candidate, and as recently as September in comments to a Connecticut newspaper. But he said Monday that the idea was "no longer necessary," since the Senate bill includes subsidies to help people 55 and older buy insurance coverage before they become eligible for Medicare.
"I was suggesting various ideas for health care reform that did not involve the public option, and that was the focus at that time," he said. "But the important thing is I'm for health care reform, and if we get together, we're going to deliver a health care reform bill that will provide the ability to get health insurance to 30 million people that don't have it now."
Lieberman spokesman Marshall Wittmann said that now, "We have a huge national deficit and a program that analysts indicate is in dire fiscal straits in 2009."
Senate Democrats held an emergency meeting Monday night to discuss the issue, which threatens to derail the Obama administration's push for a sweeping reform of U.S. health insurance. Although a final decision was not made at Monday night's meeting, a second Democratic source said a final decision could be made at a White House meeting Tuesday between the Senate's Democratic majority and President Obama.
"I think there is a fundamental understanding of the direction we're going in," said Sen. John Kerry, D-Massachusetts.
Before the meeting, liberal Democrats Tom Harkin of Iowa and Jay Rockefeller of West Virginia indicated that the Medicare buy-in would likely be dropped. While they didn't like the idea, they suggested they would support a health care bill anyway.
Democrats "may have to do what Mr. Lieberman wants," Harkin said.
The Medicare expansion was part of a package of provisions announced by Reid last week as an alternative to a government-run public health insurance program, which lacked enough support among Democrats to break a filibuster. Negotiated by a team of 10 Democratic senators -- five liberal and five moderate -- the compromise package was hailed by Reid, Obama and others as an important step forward in the health care debate.
The package also would allow private insurers to offer nonprofit health coverage overseen by the government. But many senators have reserved judgment on the compromise proposal until the non-partisan Congressional Budget Office provides its analysis of how much it costs.
Senate Majority Leader Harry Reid would discuss no specifics of a bill after Monday night's caucus, telling reporters he would wait until the CBO finished its estimate of a revised bill's cost. But he said the measure "saves lives, saves money and saves Medicare."
"I am confident that by next week we'll be on our way to forward this bill to the president," he said.
Most Democrats support the public option as a nonprofit competitor to private insurers that would expand coverage and bring down prices. Republicans and some moderate Democrats, along with the health insurance industry -- one of the major employers in Lieberman's home state -- oppose a public option, calling it a first step toward a government takeover of the U.S. health care system.
Lieberman first expressed possible opposition to the health care bill in late October, saying he would join a GOP filibuster if the measure contained the public option. Asked about Lieberman's position then, Reid said: "Joe Lieberman is the least of Harry Reid's problems."
Another potential obstacle for Reid is moderate Democrat Ben Nelson of Nebraska, who said Sunday he cannot support the Senate bill without tighter restrictions on federal funding for abortion. The Senate last week defeated an amendment proposed by Nelson and two other senators that would adopt tougher language on abortion funding contained in the House health care bill.
A compromise on the abortion language is possible, said Nelson, one of 10 Senate Democrats who negotiated in private last week on the public option compromise.
If the Senate eventually passes a health care bill, its version will have to be merged with the version the House of Representatives passed in November, which includes a public health insurance plan. The final bill would then need approval from both chambers before going to Obama to be signed into law.
Obama and Democratic leaders have said they want the bill completed this year. The Senate would need to finish its work this week to leave a realistic chance of meeting that schedule.

Dems against Dems in health care vote struggle

WASHINGTON – The end game in sight, Senate Democrats coped with stubborn internal differences as well as implacable Republican opposition on Monday in a struggle to pass health care legislation by Christmas.
A liberal-backed call to expand Medicare as part of the legislation drew strong opposition from Sen. Joe Lieberman, I-Conn. and quieter concerns from a dozen Democrats, raising significant doubts about its ability to survive.
Congressional officials said the administration was recommending the provision be jettisoned to clear the way for the most sweeping health care legislation in a half-century. In response, a top presidential aide, Dan Pfeiffer, said, "The White House is not pushing (Senate Majority Leader Harry) Reid in any direction, we are working hand in hand with the Senate leadership to work through the various issues and pass health reform as soon as possible."
Disputes over abortion and the importation of prescription drugs from Canada and other countries also flared.
In an attempt to generate support for the bill, Reid promised late in the day that any final compromise with the House would completely close a gap in Medicare prescription drug coverage generally known as a "doughnut hole." The Senate bill goes only part way toward that goal.
Democrats are "looking for 60 votes," said Dick Durbin of Illinois, the party's second-ranking Senate leader — a statement that has characterized their effort to overcome Republican opposition for months.
President Barack Obama, the fate of his top domestic priority in doubt, invited all Senate Democrats to a meeting at the White House complex on Tuesday — possibly the final day for an agreement if the legislation is to clear the Senate before Christmas.
In the interim, the president's Monday schedule included a meeting with Sen. Bob Casey, D-Pa., who has been trying to negotiate a compromise on the abortion issue with Sen. Ben Nelson of Nebraska. Both senators oppose abortions, but Nelson has been outspoken in demanding changes in the bill before he can vote for it.
The overall measure, costing nearly $1 trillion over a decade, is designed to expand coverage and ban the insurance industry practice of denying coverage on the basis of pre-existing medical conditions. Obama has also urged Congress to slow the rate of growth in health care spending nationally, and several days after Reid submitted a package of revisions, lawmakers awaited final word from the Congressional Budget Office on that point.
Additionally, a top administration economic adviser acknowledged Monday that the Democratic-backed health care measure would raise spending in the short run, but she said it would eventually generate more than enough savings to offset the expense of expanded coverage.
"Our bottom line is that the bills as they are coming through will genuinely slow the growth of health care spending, both public and private, by about 1 percentage point a year for an extended period," said Christina Romer, chair of the Council of Economic Advisers.
Sen. Byron Dorgan, D-N.D., led the effort to lift a long-standing ban on the importation of prescription drugs from Canada and elsewhere. Obama favored the plan as a senator, but the pharmaceutical industry is opposed, and the White House appeared anxious not to jeopardize a months-long alliance with drug makers who have been helpful in trying to pass the overhaul.
But the obstacle that loomed largest was a proposal to permit uninsured men and women to purchase Medicare coverage as early as age 55.
It emerged last week as part of a framework agreement between moderates and liberals struggling to define the role of government in the newly revised health care system. Additionally, the proposal calls for creation of nationwide plans run by private insurance companies under the supervision of the Office of Personnel Management, the agency that oversees the system through which federal employees and lawmakers obtain their own coverage.
The two provisions were seen as a replacement for Reid's initial call for a government-run insurance plan to compete with private industry.
Liberals have long wanted a government-run option, but moderates oppose it as an unwanted intrusion into the health care system. In announcing the agreement last week, Reid told reporters he could finally see the finish line for his effort to pass a health care bill.
Despite that optimism, opposition to the Medicare changes blossomed from doctors and hospitals, who are paid less to treat patients under Medicare than those covered by private insurance companies.
Lieberman announced his opposition over the weekend, but he was not the only critic.
"We appreciate the rationale underlying the proposed Medicare expansion but fear that provider shortages in states with low reimbursement rates such as ours will make such a program ineffective, or even worsen the problems states are experiencing," a dozen Democrats from across the political spectrum wrote Reid.
Democratic officials said late last week that efforts were under way to try and ease the concerns of doctors and hospitals, as well as defray the cost of buy-in coverage for consumers. Under some estimates, the price tag could reach $7,600 annually or more.
Lieberman said on Sunday he was opposed to the Medicare provision, threatening to deny Democrats his vote if it remained in the bill.
That set off an unusual round of finger-pointing, in which Senate aides anonymously accused him of having flip-flopped on the issue after privately indicating to Reid he was in favor of it.
In a pointed rebuttal, Lieberman's spokesman said, the Connecticut lawmaker had told Reid privately on Friday "that he had problems with the Medicare provision." Marshall Wittman, the spokesman, added, "This position was also told to negotiators earlier in the week. Consequently, Senator Lieberman's position came as no surprise to the Democratic leadership. Any contrary charge by aides who cowardly seek to hide under the cloak of anonymity is false and self-serving."
But Lieberman's consistency on the issue came under question within hours, when House Democrats circulated a videotape from September in which he spoke favorably of allowing men and women as young as 55 to purchase coverage under Medicare.
Wittman said those comments were made before the Senate health care bill, which includes health insurance subsidies, was finalized. He said Lieberman believes the government assistance makes a Medicare buy-in program redundant.
One other proposal to emerge from last week's negotiations appeared headed for oblivion.
The Congressional Budget Office said a requirement for insurance companies to spend 90 cents of every premium dollar on medical care would transform the industry into "an essentially governmental program" that would more properly belong in the federal budget.
Reid's bill now includes some limits on insurance company overhead, but Sen. Jay Rockefeller, D-W.Va., and other liberals advocate the 90 percent proposal.

Obama: One Last Scare

WASHINGTON – President Barack Obama will meet with Senate Democrats at the White House Tuesday to press for action at a make-or-break moment for his health care overhaul.
All 60 members of the Democratic caucus have been invited, according to three Democratic officials. The officials spoke on condition of anonymity because the announcement was not yet public.
The meeting comes as Senate Majority Leader Harry Reid works to round up votes to get a sweeping health bill passed before Christmas. The outcome is uncertain with moderates in danger of defecting on issues including abortion and a proposed expansion of Medicare.

Monday, December 14, 2009

The 'Cost Control' Bill of Goods

How Peter Orszag and the White House sold a health-care illusion.

ObamaCare's core promise—better quality care for everyone at lower costs—is being exposed as an illusion as it degenerates into the raw exercise of political power. Naturally, the White House and its media booster club are working furiously to prop up this fiasco, especially on cost control.
As Obama budget director Peter Orszag put it at a revealing media breakfast earlier this month, the Senate bill does everything the experts recommend to "get at the underlying drivers of health-care costs." While he admitted that "we don't know enough" to produce results right away, the key is to encourage "continuous improvement" through pilot programs and demonstration projects. Cost containment will actually take "years to decades," Mr. Orszag conceded.
The torch was then passed to Ron Brownstein of the Atlantic Monthly, David Leonhardt of the New York Times and editorial writers for the New England Journal of Medicine, among others. Last week the New Yorker ran a 5,000-word apologia from Atul Gawande, who likewise owned up to the fact that there is "no master plan for dealing with the problem of soaring medical costs," only "a battery of small scale experiments." Keep in mind, this is an argument in favor of ObamaCare.
They might have piped up earlier: What they're finally admitting is that all the grandiose talk about "bending the curve" used for months to sell ObamaCare really comes down to their hope that bureaucratic improvisation will make a difference over the long term. Yet the liabilities of the greatest social spending program in American history will be added to the budget almost immediately, and what happens if Mr. Orszag's technocratic revolution doesn't work as promised? Or rather, when it doesn't?
Forgotten in ObamaCare's march-to-the-sea campaign is that during the transition and early on, the White House was divided on whether to pursue health reform at all. Opponents included Larry Summers, worried about the economy and deficits, and David Axelrod, worried about the politics. Another faction led by Tom Daschle preached from the conventional social-equity church of liberalism.
Mr. Orszag proposed another option, citing academic research observing that as much as 30% of health spending is "waste" that doesn't affect outcomes. He argued the country could save $700 billion a year without harming quality—more than enough to pay for universal coverage.
Associated Press
Peter Orszag.

Thus cost control migrated from Orszag theory to free political lunch. Mr. Gawande wrote an influential New Yorker essay on the topic in June, and the theme shaped both the case for a new entitlement and especially the appeal to potential opponents in business.
But then Congressional Budget Office director Douglas Elmendorf testified in July that "the curve is being raised," given that ObamaCare lacks "the sort of fundamental changes" necessary to tamp down costs. Meanwhile, it became clear that Mr. Orszag's favored research was always more nuanced and qualified than his pose of papal infallibility. One of his main gurus, Jonathan Skinner, mused recently that "the key lesson" from a new study challenging some of his findings "is how little we know about the science of health-care delivery."
Well, sure. A field as dynamic and innovative as U.S. medicine, in which costs are largely driven by new technologies and better ways of caring for patients, is rife with complexities and uncertainties. But no one bothered to strike that note of caution when Washington was hopped up on a cost-control gambit that was too painless to be true.
The new cost-control apologists concede that there isn't any actual plan for controlling costs: Throw enough speculative policies against the wall, they say, and some breakthrough will stick. Yet Mr. Orszag's no-less-confident predecessors spent decades trying to pull down Medicare spending with little to no success. Technocracy rarely if ever works as intended. Mr. Gawande points to the case study of U.S. farm policy, and if politically sacrosanct agriculture subsidies and rural price-supports are the best to hope for, then what's the worst?
More relevant examples include Medicare's "relative value" payment scale, which was designed in 1985 by the Harvard economist William Hsiao to encourage more primary care. That's this year's rallying cry too. "Diagnosis-related groups" were introduced into Medicare in 1983 to alleviate hospital cost growth, and what a monumental success that turned out to be. With only brief periods of relatively slower growth, nominal Medicare spending has risen on average at an annual rate of 9.6% since 1980. Over the same period total Medicare spending has grown 13-fold, climbing from 1.2% of the economy to 3.2% today.
Congress lacks the stomach for serious cost control in any case. One policy Mr. Orszag favors—Medicare penalties for hospitals that re-admit certain patients—is limited to only three conditions in the Senate bill, and the penalties are trivial.
Another—a putatively independent commission that is supposed to enforce cost cutting—is barred from going after costs incurred by doctors and hospitals, which leaves out more than half of Medicare spending. Earlier this year Mr. Orszag got into a heated debate with Henry Waxman over such a commission at a dinner party hosted by Connecticut Rep. Rosa DeLauro, precisely because the House baron enjoys the political power that flows from controlling health spending.
Even if Mr. Orszag's Princeton and Yale Ph.D.s really do cook up some hope-and-a-prayer savings plan, it will invariably offend one constituency or another and Congress will block it. Thereupon the political class will do what it always does when costs run over: Tighten price controls across the board, before moving on to denying patient access to costly treatments that will be defined as "wasteful." That is, ration care.
"Basically everything that has been put forward in health policy discussions for a decade is in this bill," Mr. Orszag said on a conference call shortly before Thanksgiving. He then asked critics pointedly: "What specifically else would you do?"
Hmmm. One liberal sage noted in a 2007 paper that "four decades of empirical research" have shown that insulating people through third-party insurance coverage "from the full cost of health care has been responsible for anywhere from 10% to 50% of the large increase in health expenditures." Ultimately, he concluded, increasing cost-sharing would give individuals a direct stake in more prudent purchasing, as opposed to today's invisible health dollars that vanish as more expensive premiums, foregone wages and higher taxes.
Those are the words of Jason Furman, now the White House deputy economic director who seems to have been put into witness protection. Every serious health economist in the country recommends reforming the tax exclusion for employer-sponsored insurance, perhaps by converting it to a deduction or credit. Cost control will never stick unless it is extricated from politics and transferred to individuals to make their own trade-offs.
Such reforms were ruled out by union opposition, so the Senate gestures at them with a 40% excise tax on high-cost insurance plans, on the theory that two wrongs will make a right. But this untargeted tax will simply raise the cost of coverage for all workers in a given pool—it's too clever by 40%—while doing nothing to stem the distortions from first-dollar, third-party insurance.
No doubt there are efficiencies to be had in health care, and maybe Mr. Orszag has even identified some of them. But all of his bright ideas could be taken for a whirl without adding trillions of new liabilities to the federal balance sheet. And the bad faith of the White House and its acolytes is breathtaking.
The White House hawked a permanent entitlement expansion on flimsy and speculative theories that its own partisans now admit—albeit when it is nearly too late—aren't more substantive than the triumph of hope over experience, while simultaneously writing off the one policy that has been effective in the real world. The cost control mantra of ObamaCare was always a political bill of goods, and its result will be the opposite of its claims: poorer quality care at higher costs.


Harry Can't Find 60

By Eric Zimmermann - 12/13/09 11:15 AM ET

Two key senators criticized the most recent healthcare compromise Sunday, saying the policies replacing the public option are still unacceptable.

Sens. Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.) both said a Medicare "buy-in" option for those aged 55-64 was a deal breaker.

"I'm concerned that it's the forerunner of single payer, the ultimate single-payer plan, maybe even more directly than the public option," Nelson said on CBS's "Face the Nation."

Lieberman said Democrats should stop looking for a public option "compromise" and simply scrap the idea altogether.

"You've got to take out the Medicare buy-in. You've got to forget about the public option," he said.

If Democrats stick to relying primarily on the bill's subsidies, the legislation would pass easily and with bipartisan support, Lieberman argued.

Nelson's comments are somewhat surprising, considering he was one of the 10 Democrats tasked with putting together the compromise.

He said this morning that he participated simply "to be a friend of the process."

"What we've put together is something to get scored," he said.

Most Democrats still don't know what exactly the compromise entails. Majority Leader Harry Reid (D-Nev.) has sent the bill to the Congressional Budget Office but will not release the details until a score is final.

Lieberman said this morning that Reid fears the new compromise proposals would "get mauled" if they're released without a score to back them up.

Indeed, another senate centrist said this morning that her vote would be decided by the results of the CBO score.

Speaking on "Fox News Sunday," Sen. Claire McCaskill (D-Mo.) said she would not vote for any bill that doesn't reduce the deficit and bring down healthcare costs.

If those two criteria aren't met, "we'll have to go back to the drawing board," she said.

Meanwhile, Sen. Jay Rockefeller (D-W.Va.) remained optimistic, arguing that as a final vote nears senators will come around.

"The closer you get, the more you have to look at the whole bill, and you say, 'I have to do this for the nation,'" he said.