As published for Critical Condition on nationalreview.com on March 11th, 2010:
I have a new piece online from the April Commentary, which argues that contrary to the conventional wisdom, health care has been a poor political issue for the Democrats, and that a measured approach has tended to work better. Given this two-decade history, Democrats should be very wary of the politics of voting yes on their trillion-dollar overhaul.
In addition to the historical politics of the issue, the short-term politics are problematic for the Democrats as well. Today’s CBOscore should not be very reassuring to the Democrats on a number of fronts:
1. More Costs — CBO states that we should expect as much as $70 billion in additional discretionary costs that they did not score. This includes $5 to $10 billion for the IRS, “at least” an additional $5 to $10 billion for HHS, and “at least $50 billion in specified and estimated authorizations of future discretionary spending for a number of grant programs and other provisions of the legislation.” That $5 to $10 billion to the IRS, in particular, should worry lawmakers and citizens alike.
2. Continued Access Problems — At great cost, the bill will cover 31 million people by 2019, but that will still leave 24 million people uncovered. In addition, over half — 16 million — of the newly covered people will be covered throughMedicaid, and not through private coverage. This is both a fiscal challenge, as Medicaid’s long-term finances are extremely shaky, but also a political challenge, as many doctors refuse to take Medicaid patients. Putting more people on Medicaid will not solve the access problem if doctors refuse to see them.
As published for the April issues of Commentary Magazine:
In 1991 the political world was rocked by the unlikeliest of victories. Harris Wofford, a former aide for John F. Kennedy, upset two-term Republican Governor Richard Thornburgh in a special election to fill the seat of the late Pennsylvania Senator John Heinz. Wofford was guided to his victory by a little-known campaign manager named James Carville, who told him to make a bold and unequivocal case for “universal health care.” Wofford’s underdog victory left the GOP shell-shocked.
Fast-forward 19 years: it is the Democrats who are now faced with divining the results of another underdog’s victory. In January, a little-known state senator named Scott Brown defeated Massachusetts Attorney General Martha Coakley in a special election for the United States Senate. Universal health care was once again on center stage. This time around, though, the Republican seized on widespread antipathy to what has come to be seen as an incoherent Democratic scheme for an unworkable federal takeover of health care.
The unlikely victory not only defied the odds of a Republican winning in Democrat-owned Massachusetts; Brown’s ascent also put him in the storied seat of the liberal lion Ted Kennedy. Before Brown, no Massachusetts Republican had won a Senate election since Edward Brooke in 1972; no Republican presidential candidate had secured Massachusetts’s electoral votes since Ronald Reagan in 1984; even more striking, the Bay State had not sent any Republicans to the House of Representatives since 1996. However, beyond the mere realization of an improbable data point, this special election called into question much of the received political wisdom of the past 20 years. Brown’s victory directly contradicted the liberal claims that Democrats own the health-care issue and that comprehensive reform is popular. As a candidate, Brown ran on a platform promising to serve as the health-care roadblock he instantly embodied on being elected.
In fact, the Brown election can be seen as the closing of the door on a two-decade era in which Democrats, Republicans, and most of the political class came to believe that the Democrats possessed an inherent electoral advantage on the health-care issue. The history of the past 20 years reveals two Democratic presidencies, first Bill Clinton’s and now Barack Obama’s, upended by health care, whereas a single administration—that of a Republican, George W. Bush—benefited from it. In 2004, Bush was able to secure a narrow re-election victory in part because of his success in securing a form of targeted health-care reform through the creation of a Medicare prescription-drug benefit.
The combination of Democratic wishful thinking and an American electorate suspicious of the intentions of those pushing relentlessly for an ever greater government involvement in health care has proved a ballot-box disaster for Democrats. How did this happen? And why?
As published for Critical Condition on nationalreview.com on March 11th, 2010:
The New England Journal of Medicine’s Career Center has a report by the Medicus Firm talking about how the Democrats’ health bills would drive doctors out of the profession. According to the report, “nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.” At the same time, they report that the Bureau of Labor Statistics predicts that the U.S. will need 22 percent more doctors by 2018. Worse, 46 percent of primary-care docs said that they would leave or try to leave medicine as a result of the proposed overhaul’s changes to the system.
Reasons that doctors would want to leave include a fear that “reform could result in a significant decline in the overall quality of medical care nationwide” and that “reform will cause income to decrease, while workload will increase.”
As published for The Arena on Politico.com on March 5th, 2010:
The truth is that the public option has had up or down votes and fallen short. Two versions of the public option came before the Senate Finance Committee, which crafted the outlines of what became the Senate health care bill. Both public option alternatives failed in that committee, thanks to bipartisan opposition. Sen. Reid later tried to insert the public option into his version of what became the Senate bill but found that he could not keep his bloc of 60 non-Republicans together with the public option included. Adding the public option back in now would make an already unpopular package even less popular.
As published for Critical Condition on healthcare.nationalreview.com on March 3rd, 2010:
By my count, President Obama’s health-care speech today was at least his 40th speech focusing on health care; as part of his effort to push his health-care plan, he has had seven major “stop the presses” events on the subject: his White House health-care forum last March; his ABC infomercial with Charlie Gibson and Diane Sawyer in June; the joint session of Congress speech in September; his State of the Union address in January; last Monday’s release of his new eleven-page proposal; the health-care summit last Thursday; and now his 1:45 pm speech today.
Unsurprisingly, given how many times we have heard him on this subject, the speech today did not provide any new revelations. He asserted that all agree on the problem, but then tried to triangulate the fix by saying that he did not support a government-run system, nor did he support giving “the insurance industry even freer rein to raise premiums and deny care.” (Note: In case you were wondering who supported giving the insurance companies “freer rein,” he probably meant you, dear reader, since only about 40 percent of Americans back the president’s approach.)
He used an old Henry Kissinger trick to show the reasonableness of his approach. Kissinger is reputed to have framed decisions to his bosses in the following way: “The choices before us are thermonuclear war or utter capitulation. And then there is the staff-preferred option.” Given those choices, of course, any president would prefer the staff-preferred option.
As published for Critical Condition on healthcare.nationalreview.com on March 2nd, 2010:
After two and a half months of relatively light Congressional activity on the health-care front, Democrats are apparently gearing up for a hyperactive March. According to Inside Health Policy (subscription required), the period between now and Easter will be filled with a series of complicated steps that will all need to work perfectly in order for the Democrats to pass their health plan before Congress leaves for its spring break. First, the president will be issuing his revised new proposal, which will be converted into legislative language and then scored by CBO. By March 19, the House would then pass the health bill that the Senate passed back in December — and that the House has repeatedly said they did not like and would not pass — with the assurance that the Senate would go forward and fix it in accordance with some type of bicameral compromise. The House would then have to act again, by March 21, and pass a reconciliation bill amending the Senate bill that the House would have just passed.
At this point, and only after the House had acted twice, the Senate would take up the reconciliation bill changing the original Senate bill to reflect the president’s new proposal. This bill would be considered under the reconciliation process, with 30 hours of debate and passage via a simple majority rather than the 60 votes the Senate typically requires. Effectively, this process will use the passage of the Senate bill to enable the reconciliation vehicle to proceed and become the new health-care law.
As published for The Corner on nationalreview.com on March 1st, 2010:
It has been a good day for the nascent Mitch Daniels in 2012 campaign, with op-ed pieces by him the Journal, and about him in the New York Times — both highlighted in the NRO Web Briefing. The Journal piece highlights how effective Indiana’s Health Savings Accounts have been in driving consumer-based health purchasing in the state. A consumer-driven approach is one of the best ways of bringing down costs economy wide, and we would benefit from using that approach in the health sphere. The Timespiece, a column by Ross Douthat, calls Daniels “America’s best governor.” Given the long-term fiscal difficulties we are facing, a former OMB director with executive experience could be a good call. And he is smart, funny, and conservative to boot.
As published for The Arena on politico.com on March 1st, 2010:
Given that the Democrats only had 220 votes in the House for their health care bill back in November and have lost four votes since then – Wexler, Abrecrombie, Murtha, and Cao – I would imagine that it would be difficult for them to round up the votes for ramming health care through via the reconciliation process.
The health care bill was not popular then, and it has not gotten any more popular since. Furthermore, the Scott Brown upset win in Massachusetts – in which he even won Barney Frank’s liberal district – has made Democratic members realize that they all could be vulnerable.
By the time the wheeling and dealing is done on this one, the “Cornhusker Kickback” and “Louisiana Purchase” will seem tame.
has been a poor political issue for the Democrats, and that a measured approach has tended to work better. Given this two-decade history, Democrats should be very wary of the politics of voting yes on their trillion-dollar overhaul.
