While most Americans sought seclusion from partisan squabbles, Senate Democrats used the distraction of the holidays to ratchet up their relentless pursuit of a health care bill. It’s a bill that would, they hope, justify their use of considerable political capital on the issue, raise their fortunes in the polls, and enable them to claim a victory on a policy issue that has festered since the ’60s.
The bill that has since emerged from the Senate combines the worst forms of political corruption and anti-democratic legislation that we have witnessed in quite some time.
While our system (and our citizenry) has long tolerated the use of backroom deal-making to secure political victories, the wheeling and dealing that paved the way for the passage of the Reid bill strikes us as a pernicious assault on freedom itself.
Some of the bill’s most notorious accretions have been so widely publicized that they have even been given names of their own ““ such as the “Louisiana Purchase,” used to refer to a $100 million grant to Sen. Mary Landrieu’s state of Louisiana after the senator initially refused to back the bill. There is also the “Cornhusker Kickback,” the name given to the Medicaid windfall accepted by Sen. Ben Nelson (D-Neb.).
For many Democrats who have staked their political fortunes on the success of their health care campaign, the ignominy brought on by the publication of these behind-the-scenes deals may seem like a necessary sacrifice.
As their approval ratings receded, the attainment of anything that could be called a “victory” on health care reform might have seemed like an attractive way to stop the bleeding. The same goes for President Barack Obama, who is probably eager to refocus the national discussion on something else.
Of course, any Democrat wanting to keep his seat would refute the argument that personal interest was behind his vote for the health care bill. However, they will have to wrestle with this bit of evidence: In the week before the vote, a Gallup poll showed that only 46 percent of Americans supported the bill, while a majority ““ 48 percent ““ opposed it.
Obama has long spoken of a “consensus” that the health care system is broken, and he concludes that it has to be remade. In the process of trying to put his own stamp on an issue of paramount importance to Democrats, however, he seems to have forgotten that the way change is effected matters just as much as the change itself.
People naturally prefer slow, gradual change; in this sense, Obama’s catastrophism has not been helpful. Each time he speaks of the failure to pass health reform as a death sentence to the uninsured (while also reviling Republican “scare tactics,” ironically), he loses the public’s ear. For all the talk about his powers of persuasion, Obama has netted a greater than 35-point loss for his handling of health care since April, even with the untold millions his supporters have spent on lobbying.
In all fairness, however, many of those now opposing the bill are doing so on impulse. Months of debating health care have left the public understandably tired and frustrated ““ more eager to see it dissolve as an issue than to continue to be subjected to the cacophonous war of words impeding the post-partisan era. This is similar to what happened to former President George W. Bush with Iraq.
At the same time, the way in which the bill was hastily brought to a vote ““ at 1 a.m. ““ left little opportunity for people to become familiar with its fine points, even if they so desired. The senators themselves could not be sure what they were voting for; 38 hours before the Senate was scheduled to convene, the majority leader ““ Harry Reid (D-Nev.) ““ replaced the initial language of the bill with a so-called “manager’s amendment,” an insertion hastily thrown together.
Now that the bill is out for public view, however, we are beginning to see why Democratic leaders were compelled to pass it before anyone had a chance to read it. While many Republicans have applauded the elimination of the public option from the bill, the burdens placed on private health insurance companies removes any possibility that people might realistically have to “keep your doctor” in any meaningful sense.
There are a few reasons for this. Firstly, the vast underwriting powers that currently enable health care insurers to pick and choose their customers according to risk and turn down high-risk individuals ““ powers that are common to almost all other industries ““ are effectively destroyed by the increased regulatory powers that will inhere to the states if this bill becomes law.
Secondly, creating government-sponsored insurance “exchanges” (the public option in disguise) is a deathblow to private insurance. Particularly, the competitive advantages bestowed on these exchanges in the form of tax credits, immunity from judicial review, price-setting and other perquisites mean that private insurers will face prohibitive costs for not integrating themselves into the government scheme. Whether they join an exchange or not, insurers will have to grapple with noisome requirements not found in the old system.
In addition to having to take on all applicants regardless of pre-existing conditions, any plans allowed to enter the market will have to conform closely to the terms and conditions of the other government options, including using only the devices and procedures deemed acceptable by the powerful Independent Medicare Advisory Board (a permanent, unelected body). As a consequence, ingenuity would also be greatly discouraged.
Because the individual mandate will require all citizens to purchase insurance on pain of a heavy fine, everyone would necessarily face fewer choices due to these strictures. Forget about paying your doctor extra for additional care; that would be illegal.
Under the new system, the percentage of their medical bills that patients can pay directly to doctors will be capped at strict limits, the rest of the money going to higher premiums to help pay for the millions of people the government wants to bring into the fold. With more money going to insurers, patients would forfeit a major source of their independence.
If Congress passes some form of the Reid bill or, heaven forbid, adopts the public option supported by the House, the insurance market will likely die a painful death. If it does the latter, it will be a slow death: Private insurers will be asphyxiated by regulators until they are finally forced to surrender their sovereignty to the “exchange” or fold altogether.
Patients, meanwhile, will be left to flounder in the nauseating uncertainty of a government system with no incentive to deliver the quality of care that could be achieved by cracking the whip on the insurance industry and instituting market-oriented reforms.
Forget about a return to the days of the Clintonian “third way.” If public opinion remains laggard, this administration will not hesitate to produce uniformity by ruthless means.
E-mail Pherson at apherson@media.ucla.edu. Send general comments to viewpoint@media.ucla.edu.