Tag Archives: Health Care Reform

The Morality of Health Care Reform

Do Republicans care about heath care reform?

That has been the questions a lot of bloggers have been asking in the weeks following the Supreme Court’s decision to uphold the Affordable Care Act, also known as Obamacare.  The answer from many of those bloggers, including some that lean libertarian, has been a resounding no.

Is it true?

Yes and no.

As Ross Douthat notes today, there have been several proposals over the last few years from lawmakers and even the Bush Administration to try to reform health care.  Many of those proposals went nowhere for various reasons, but there has been some effort from the Right to deal with the problem of health care coverage in America.

But as Douthat also notes, there isn’t really a constituency in the GOP coalition calmoring for health care reform.  So, while lawmakers and policy wonks come up with market-based solutions to the providing health care coverage, there is not that much interest among the organizations and voters who tend to lean Republican.  There has been a lot of ruckus against the health care law, which is why there has been so much noise to repeal Obamacare and not so much to replace it.

The GOP is playing politics, while coming up short on policy.  Douthat’s final paragraph spells out how repealing the ACA would be a moral scandal to the party:

If the Republicans win the White House and the Senate and then somehow manage to repeal Obamacare without putting any significant reforms in its place, it will represent not only policy malpractice, but a moral scandal as well.

I think Douthat is correct here.  The problem of the lack of health care coverage is a real problem in America, one that I have myself encountered one-too-many times.  I have a lot of philosophical and ideological problems with Obamacare, but I also think that a woefully imperfect plan is better than no plan at all. Part of my support for some kind of health care reform comes from my Christian faith and Rod Dreher pretty much sums up my reasoning:

…as a practicing Christian, I find it hard to justify a society as well-off as ours tolerating a situation in which so many people lack affordable, decent health care. Back when Congress was debating Obamacare, I was prepared to believe that Obama’s proposal was unacceptable, but it bothered me a lot that the Republicans had nothing to offer in its place. It seemed to me that they were implicitly denying that affordable health care was a problem.

That said, I don’t think that the GOP will heed Douthat’s warning.  The reason being, there has been no price to pay for coming out against the law.  Yes, there has been tons of ink spilled on how conservatives want people to die, but I doubt that most movement conservatives care.  They see polls that say that folks are against the law, and the base is fired up against the act.  Why would you care about morality when it seems like there is a wave of people supporting you?

I think one of two things have to happen before we see GOP leadership embrace health care reform: a dramatic loss at the polls that de-legitimizes the tactics of pure politics, or a growing voice for reform from constituencies from within the party.

Do Republicans Care About Health Care Reform?

Blogger E.D. Kain has a post up on health care.  More specificially, it focuses on the GOP efforts or lack there of on health care. He opines:

There have been no real efforts at reform emanating from the right. The closest thing was the Wyden/Bennett bill to which Bob Bennett hung his name and and for which he subsequently lost his long-held senate seat. That, in any case, was the brainchild of Ron Wyden, a real champion of the healthcare debates. I’m glad several Republicans were willing to sign on to it, even if they did so knowing it would never pass. Certainly no Republicans would now. Continue reading

The Republican Political Trolls

Mark Thompson has an interesting views of the GOP during and after the debate on health care reform.  He bypasses all the talk about how their historonics have created a climate of fear or even talking about civility and instead liken the tactics of Republicans to that of an internet troll.  He explains:

…what the GOP and conservative leadership did was to refuse to respond to any of the Democrats’ actual arguments or counterargument for their health care reform bill. When the reforms were proposed, they cried “socialism!” and “fascism!” and, eventually, “death panels!” So far, so good, though – by themselves these claims aren’t too much different from implying that Barry Goldwater was a card-carrying member of the KKK with a devious plot to initiate a nuclear holocaust. Where they went off the rails, though, was when they failed to address the Democrats’ calls of “Bullshit!” – calls that usually came with at least some evidence. As soon as the Dems called “Bullshit!” the cowards turned tail and ran from the argument rather than defend themselves. Rather than waving aloft provisions of the bills that at least provided a grain of truth to their hyperbole or refuted the Dems’ own defenses, they just shouted “death panels” as if that were an argument; instead of putting Ruth Ann Johnson, that poor widow from Wichita who’s going to see her Medicare benefits cut, on center stage, they just whined about how those mean liberals are being so uncivil to them; and so on.

In essence, from my perspective the course of the debate seemed to go thusly (and remember, I think the health care reform bill that the Democrats passed will cause far more problems than it solves):

Democrat: We have 55 million uninsured in this country who need our health; health care reform will go a long way to solving that problem.

Republican: Bullshit! It’s socialism! And fascism! And there’s going to be death panels!

Democrat: This bill ensures health insurance remains a private sector business. And what death panels? There’s none in this bill. And as things are, we already have death panels – they’re called insurance companies.

Republican: It’s socialism! And fascism! And there’s going to be death panels!

Democrat: Hey asshole, are you deaf? Did you not hear anything I just said?

Republican: How dare you call me a deaf asshole? This is just proof that you are not at all interested in anything that I or anyone of the decent, hardworking real Americans that I represent have to say, you liberal, latte-sipping East Coast elitist douchebag!

Democrat: Aw, screw it. I think we’ll just take our chances with our 60 votes in the Senate.

It’s a worthy argument to make and I think Thompson makes a lot of sense.  Now, I don’t think the Dems were as serious about bringing the GOP on in the health care debate, but then the Republicans were never that serious either.

I dealt with my share of internet trolls both on this blog and elsewhere.  You try to talk with them and bring some logic into the debate, but all that the people are interested in is fighting.  So after a while, you tired of trying to reason with them and you leave them alone.

The GOP was interested in trying being the troll and leave it to moderate and pro-life Democrats to scuttle the bill.  Of course, the moderates and pro-lifers decided to make deals and support the bill and left the Republicans looking like fools.

The fault of the GOP is not in their rhetoric as Mark states.  The problem is that this was all they had and in the end it was not enough.

Frum was Right: It’s our Waterloo

David Frum, a conservative columnist who needs no introduction to those of us who have been arguing for some time that embracing any and all aspects of extreme right wing politics whether it be extreme social conservative or libertarian conservative views, has been offering a stinging rebuke of the far-right in the last few days.

This healthcare fight, as he says, did bring us to a “Waterloo moment”.  One that he believes is politically disastrous for the Republican Party in the long-term even if not in the short term, although maybe even that is now threatened.  A few weeks ago it had seemed that the Tea Party movement had gained such an advantage over the entire debate that healthcare would not be passed and their prime goal of destroying the Presidents entire agenda for the remainder of his presidency would be achieved.  Such a political loss would then propel conservatives and especially hardcore, antigovernment conservatives back into a long term power to balance out the president and even potentially challenge him for the Presidency itself.  All that had come into question on Sunday and David Frum realizes this.  Some of us predicted early on that possibly the 2006 and 2008 elections would lead the party even further right, and that is exactly where it headed.  While it seemed for a time a viable option the only outcome has been a complete and dramatic failure, even if many provisions within the bill itself were of Republican origin such as the individual mandate and no public option.

The steadfast resolve and “stay the course” attitude that the party has taken has effectively led them over a cliff on this one, not even being able to own the ideas that the democrats had taken and made their own with many cases of, in fact, rejecting those very same ideas in order to court the Tea Party activists.  It was a zero-sum game that the Republican Party embraced, rejecting all forms of compromise and realization of their own place as a minority party for an angry, hate-filled, obstructionist fueled message.  It was a movement built upon fear, not one of ideas unless you consider saying “no” to any and all active government efforts to reform broken market systems as an idea.  In doing so the party has let the virulent element that IS the Tea Party to take control of the party apparatus by using fear itself to a point where even in defeat it still lacks the ability to do what is necessary and drop the fringe.  This was a loss that, even if the Republicans win back the house in the coming elections, will hurt the party’s ability to truly win in the future elections.  By being a solid block of “no” even when many of their own past republican ideas of healthcare were included is not a stand of principle, it is a stand for irresponsible governance and failure.  Zero-Sum.  Waterloo.  It sure as hell turned out that way, didn’t it.

Everybody, Take a Breath

The Fountain of Wisdom known as Facebook has been gurgling furiously the past few days.  My fundamentalist friends (yes, I still have some) being more righteous than most of us, seem to feel an uncommon freedom to share their opinions on sensitive subjects.

This coy, faux-subtle, post in the wake of the health care legislation seemed particularly disturbing:

Prov 28:15, Like a roaring lion or a charging bear is a wicked man ruling over a helpless people.

It was followed by the mandatory serious of escalating comments comparing the damage done by traitorous Democrats and RiNOs to that inflicted by terrorists, along with innuendo about the President’s secret birthplace and Muslim sympathies.

Nice.  Good times.

First of all, whenever affluent, white, Southern, religious folk gripe about their oppression my irony meter goes whizzing. But for people who lack a sense of irony – or history – this kind of talk is well beyond funny.  For some time now our political discourse has been drifting into dangerous territory.  Short of bombs going off, there is no bright line or siren that defines for us when things have gotten out of hand.  We must have the good sense and character to do that for ourselves.

Perhaps this political defeat can provide an opportunity for us all to check ourselves, take a look at where we are, and re-calibrate our language.  More of us need to speak out forcefully against those who have lost their sense of measure and reason.  We can dial down the rhetoric.  We can restore basic civility to our politics.  We can understand why we fight while also remembering what we all cherish in common.

The republic still stands.  Let’s keep it strong and united.

Jules, from Pulp Fiction has some fine wisdom we can use in a situation like this (Earmuffs!).

We’re all gonna be like Fonzi, here.  We’re gonna be cool.

Be cool, Hunnybunny.

Liberty, Community and the "Blue Beast"

A very liberal colleague of mine opined recently on Facebook if God was more concerned about budget issues which in his view only affected the rich, or in making sure that health care was expanded.

I tend to think that most of my pastor friends, who tend to be liberal are thinking the same thing.  They tend to believe that making sure that people have health care is not only the moral thing to do, but it is something God requires of all people and damn the cost.  For them, this is an issue of justice, not economics.

While I share some of their concerns about the lack of access to health care, I do think that budgetary concerns are an important issue.  They can’t be the only issue, but they are important.  If we enter a Greece-style situation, then we will have to slash all these domestic programs we have enacted, but never truly funded.  It’s far better to make sure these programs are sustainable in the long run instead of whistling past the graveyard.

What this comes down to is what economist Greg Mankiw notes as a trade off between equality and efficiency or between liberty and community.  Neither side is necessarily bad, they are just two ways of look at American society and government.  Liberals have always concerned themselves more with equality and community.  This explains why they were so adamant on health care.  Having millions of Americans with no access to health care and millions more in danger of losing it, is something that Democrats can’t tolerate.  In their view, this leads to a breakdown in community.  Conservatives tend to focus more on efficiency and liberty.  Conservatives wonder about the cost of something, especially a government program.  They worry about debt and dysfunction (or at least they pretend to worry).  They see government as something that can intrude up liberty. Continue reading

Did Gays Get Shafted in the Health Care Deal?

Two conservative gay groups, GOProud and Log Cabin Republicans are reporting that several provisions that would have helped gays and lesbians have been scrapped. They were in the House version of the bill, but dropped in the Senate version, the same one that passed the House last night. As far as I can tell, it won’t none of the changes will be included in the so-called “fixes” the Senate will take up after the President signs the bill into law on Tuesday.

Stephen Miller of the Independent Gay Forum shares one of the missing GLBT friendly provisions:

The original House-passed health care bill contained a provision extending to domestic partners the same tax exclusion on the value of employer-provided health benefits that spouses of employees receive. That was a major step forward—the taxes paid by domestic partners but not spouses for “family coverage” are huge.

The Senate dropped the tax-equalizing provision entirely in its version of the health care bill, although at the same time it loosened the language restricting government funding of abortion. Score: One for the pro-choice/abortion lobby, zero for gays.

A news service article shares that the efforts of Tammy Baldwin, the only open lesbian serving in Congress, to include gay-friendly provisions came up short:

Baldwin had sought and secured four pro-gay provisions in the original House version of health care reform, including a prohibition on discrimination based on sexual orientation and gender identity in health care.

But neither the Senate bill nor President Obama’s proposal late last month included those provisions. Baldwin had held out hope, as late as Thursday morning, that at least two of the provisions might be added back under whatever legislative package the House and Senate would eventually vote on.

But by Thursday afternoon, when the text of that final package was posted on the Internet, that hope was quashed.

The version of health care reform legislation being considered now by Congress – with the final critical votes scheduled to begin this weekend – does include some relief for people with HIV on Medicare who must purchase expensive AIDS-related medications.

But it does not include the anti-discrimination provision or three others. Those others included the “Early Treatment for HIV Act,” which sought to allow states to provide Medicaid coverage to low-income HIV positive individuals; the Tax Equity for Health Plan Beneficiaries Act, which sought to end the tax for gay employees whose partners/spouses are covered under their work health insurance coverage; and a provision to collect data toward ending disparities in health care for LGBT people.

However, the DC Agenda notes there are some bright spots for persons living with HIV/AIDS:

Although the LGBT and HIV/AIDS provisions unique to the House legislation weren’t included in the reconciliation package, the final bill has one provision aimed to help to HIV/AIDS community that was included in both the House and Senate versions of the legislation.

The language would enable AIDS Drug Assistance Program expeditures to count toward out-of-pocket expenses under Medicare Part D. In other words, people with HIV/AIDS on Medicare who receive help purchasing HIV drugs would have a lesser burden for other prescription drug costs.

Other provisions in the final bill less explicitly directed at people with HIV/AIDS would assist people living with the condition.

The final health bill eliminates discrimination based on health status or pre-existing conditions, such as HIV/AIDS. Additionally, the bill expands Medicaid eligibility for people with incomes below 133% of the federal poverty level, allowing more low-income people with HIV to access Medicaid and its prescription drug coverage.

I’m not under any illusions that Republicans would have done better on these issues, but it does seem like yet again, the Democrats are taking advantage of the gay community and we are letting them do it.

Monday Morning Quarterbacking

Bill Golden, one of RU’s contributors, wrote a very smart reply to one of my posts. I thought I would share it with the wider public.

Tactics may win battles but poor strategy loses or wins wars. The Republican strategy had no tactics except delay and obstruction, and their strategy was to hope that the TEA Party rallied enough support to scare the bejesus out of lawmakers. A war lost due to squandered opportunities to capture the conversation and to work for the American people.

Here is the Election 2010 scenario as I see it: there will be a constitutional challenge to the passage of the Health Care Reform. However, there is a degree to which that really doesn’t matter. Timing will reward the Democrats.

The Supreme Court will not hurriedly accept appeals to overturn the new Health Care Reform Act. Sometime in 2011 may be the earliest that they accept a challenge, late 2010 at the earliest. This is bad news for Republicans.

Between now and late spring 2010 there are no major political issues for Republicans to champion. They have put all of their hopes into a single issue and failed miserably. Their closest allies, the TEA Party in particular, already consider the GOP largely impotent and this just proves it. Republicans can expect to face challenges across the nation in their primaries and in the general election from third party and independent conservatives.

Between now and late summer 2010 the economy will make improvements. These improvements will be sufficient enough to make President Obama and the Democrats look like they are doing good things — although I do predict an economic downturn in late 2010: see 2010 Dog Catcher Predictions – Economics, from January 3, 2010.

The Democrats, despite their historic ability to grab defeat from the jaws of victory, will do well enough in November 2010 to maintain control of one or both houses of Congress. The Republicans — between now and November 2010 — will descend into self-pity, playing pin the tail on the donkey, anger and will remain without a strategy.

There are issues that Republicans can win on in November but they will need to listen to cooler heads — and I think that there are some smart folks in the TEA party that actually have the basis for a winning plan, although TEA must work to overcome their negative imagery: one part deserved and one part the natural way politics works when there is strong disagreement and your opponent wants to paint you as being on the edge … about to fall off.

That's All, Folks.

The Washington Post is reporting that the health care bill has passed in the House by a vote of 219 in favor and 212 against. So, now that all the votes have been taken,  and conservatives and Republicans have egg on their faces, I have a few thoughts:

  • I’m come away with mixed feelings.  Like many, I have long thought that the health care system needed an overhaul.  I’ve gone without insurance, not knowing how I could afford the medicines I take for depression and racking up bills while off of insurance.  During one of those times I was without insurance,  I came down with a severe infection that landed me in the hospital.  If it wasn’t for a government-sponsored plan (in this case, Medicaid) I would have faced a huge bill that I would still be paying for today, some fourteen years later. So, I know that there needs to be reform and I acknowledge that the government has to have a role. I am glad the current bill would ban insurers from using pre-existing conditions as a way to not insure people.That said, I don’t like this current bill and what it will create in America. I’m not worried about a “government takeover,” but I am concerned that about how this program will pay or not pay for itself. I tend to believe that this will impose a new entitlement on Americans that we can’t afford. If you thought the addition of prescription drug benefits to Medicare was costly, just wait. Peter Suderman and Douglas Holz-Akin do a good job of trying to explain that the supposed savings of this plan are just that, supposed.
  • Does anyone really believe when Republicans say that they are going work to repeal this bill?  I mean, who the hell are they kidding?  Are you really going to tell older Americans that they will reinstate the so-called “donut hole” in currently in Medicare?  That’s not gonna happen, and those bloggers and politicians that are pushing for repeal are either lying or smoking something.
  • I’ve already said this before, but I think the GOP really blew it in their handling of health care.  They expected a repeat of 1994.  That didn’t happen.  Then they hoped that socially conservative Democrats would block the bill because of fears that it would fund abortions.  They didn’t expect the President to make deals with those Democrats.  David Frum had a good piece about a year ago about the so-called “Goldwater myth” that allowed the Dems to spend like crazy and invest in programs that were wasteful.  1994 might not be repeating itself, but 1964 surely is.
  • I also don’t see Congress going back to “fix” things later.  We’ve spent a year debating this bill, does anyone think we want to go back to debate again? Megan McArdle is correct:

    Those like my colleague Andrew, who want Republicans to turn to the task of improving this monstrous bill–how is that going to happen? The “fixes” are all the unpopular stuff: the taxes, the spending cuts. You think that now that Democrats got to hand out the goodies, Republicans are going to be the nasty folks who volunteer to hand around the bill for a law they didn’t even want to pass?

    Every time I hear comments on this sort of thing, I want to say, “And what other things have you been wondering during your visit to our planet?”

For better or for worse, and I think there is a little bit of both, we are stuck with this bill. I’m glad we might be able to give health care to millions of Americans that are without it, but I do have to wonder at what cost, and if we can afford that cost.

A Republican Waterloo

David Frum lets conservatives and Republicans have it for their intransigence during the health care debate:

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

I totally agree. GOP leadership can huff and puff all they like, but they aren’t going muster any votes to take away something that has been given to them. It’s a nice issue to stir up the passions of the base for the next few years, but let’s face it: this legislation is here to stay.

Sure, conservatives and Republicans might have their revenge in November and pick up a few seats-something that will make the hardliners feel good- but in the end, this is victory for the Democrats. We will end up with a bill that will be in effect long after the leading GOP leaders have left Washington.

Ross Douthat has made fun of moderate Republicans in the past for basically becoming the accountants of the welfare state– allowing Democrats to have their big government programs, but making sure these plans were fiscally sound. What would have happened had the party allowed Olympia Snowe to help work out a deal that would have made health care reform more fiscally sustainable? What if an Orrin Hatch (who is not a moderate) or Bob Bennett had been able to force a tax on so-called “Cadillac Plans” that would help fund the deal and also lead to some meaningful reform on costs?

We will never know because the leadership made damn sure no Republican cooperated. I think in the long run, this will be the GOP’s Waterloo, a big spectacular loss. We can’t see it now, but give it five or ten years.

We lost this one, big time.