Health Care Reform and the State of the Republic
While not at all pleased by the outcome of the year-long sausage making extravaganza that gave us a health care reform bill that virtually no one likes, I’m much closer in agreement Steven Taylor than with Megan McArdle over what it all means for the system.
Do we, as Megan suggested at the apex of her depression, “now in a world where there is absolutely no recourse to the tyranny of the majority?” Not hardly.
In November 2008, the voters elected a Democratic president and sent overwhelming Democratic majorities to the House and Senate. Thanks to Arlen Specter’s fecklessness, a defection gave the Dems a “filibuster proof” 60 votes in the Senate. And, yet, we wound up with a bill that — while exceedingly distressing to libertarian and fiscal conservative types like Megan and myself — was much, much milder than anything that conservatives could reasonably have expected. Certainly, much, much milder than Obama had campaigned on and so full of compromise that a goodly portion of the Progressive Coalition had to be arm twisted into voting for a bill they hate almost as much as I do.
How did that happen? Because the Republicans are just as skilled at using the various tools of legislative trickery available to them as the Democrats, managing to drag this thing out so long as to have it seem dead when Scott Brown was elected to fill Teddy Kennedy’s seat.
The Dems came back with a resort to a tactic that many of their own leaders deemed too foul to use the day after Brown’s victory: misuse of the budget reconciliation process in a way that would preserve the pre-Brown Senate package with some dubious “fixes.” Not exactly according to Hoyle, to be sure, but they did in fact manage to get 60 legitimate Senate votes for it last December.
As to the prospects of the Republicans, however, I tend to side with Megan’s future hubby, Peter Suderman rather than David Frum. While Frum’s right that the short-term blow this defeat sends to the Republicans is “crushing” and that many conservatives are living in a fantasy world about the extent of the voter revolt that’s coming in November, Peter’s quite right that Frum’s Rodney King vision of how American politics works is Pollyannish.
RomneyCare may have been developed with Republican establishment support, but if your focus is good policy rather than good politics, it’s not worth defending. Neither would any potential compromise along similar lines have been.
Frum doesn’t spell out exactly what deal he thinks Republicans should’ve cut, but the ground that he’s implicitly suggesting should’ve been given up was basically the whole enchilada: the insurance mandate, the subsidies, the government run and regulated marketplaces, the expansion of Medicaid. These are rotten policies that, in just a few years, have already had rotten outcomes. What would have been gained by ObamaCare opponents caving and supporting something along these lines?
The bottom line is that the Republicans had a very weak hand, at least largely of their own making, after the elections of 2006 and 2008. As noted earlier, it seemed inevitable after Obama won that we’d see something much, much worse than this (from a conservative perspective). It’s truly amazing how much of a firewall they managed to erect given how little leverage they had.
Moving beyond electoral politics into leadership — two very different things that are frequently conflated — I tend to agree with my colleague Dave Schuler’s longstanding insistence that the Republicans should have, at the very least, offered an actual bill of their own to show how they would have proposed to solve the actual problems which exist with our health care system.
Despite its many good even great qualities our system is looney. There’s no conceivable way that everybody can get all the healthcare they want and healthcare providers can get whatever they want for providing it. Furthermore any system in which the government with its deep pockets and regulatory capability bids against private individuals for healthcare services is neither good nor sustainable. It’s a flywheel ready to spin off.
But, given the vagaries of electoral politics, one understands why they didn’t. Then again, as Dave explicates at length in two recent posts, the Democrats haven’t solved them either.
James,
And, yet, we wound up with a bill that — while exceedingly distressing to libertarian and fiscal conservative types like Megan and myself — was much, much milder than anything that conservatives could reasonably have expected.
You’re writing as though the fat lady has finished singing.
Bah. I feel highly confident that McArdle, along with the rest of the whiniest chicken-little conservatives, never gave a rat’s ass about the “tyranny of the majority” until they stopped being in the majority. Then it became a crisis.
Mr. Joyner,
Good observations.
I think the nightmare (and I fervently hope I am right) for Republicans could very well be that the compromises and modifications they were able to wrest from the Dems, will actually help this reform to be more successful than the full “Marxist” takeover they feared.
Can you imagine Repubs attempts to take any credit (even if their moderating contributions are responsible)in the future if, GASP, this reform actually is successful?
It will be a reverse Kerry, “I voted against it, but now I am for it.”
And, btw, that is EVERY Republican in the House who voted against it….very much like the Omnibus Act of 1993, which all Repubs voted against, citing “the end of prosperity as we know it..destruction of America blah blah” if it passed…then watched 3 years of budget surpluses and record low unemployment…and Clinton’s re election.
P.S. Tangoman, is that the “white” fat lady or the “rainbow coalition” fat lady that is not finished singing?
Nothing to control costs and an inter generational transfer of wealth is what we got. Lovely. It’s worse than doing nothing at all.
The voter revolt that’s coming has more behind it than this health care scam. State and local governments have betrayed the citizens by overspending as much as the federal government has. Although they couldn’t rack up debt they did something just as bad by racking up unfunded pension obligations that are bad as debt. As these stories come to light more citizens will start voting as fiscal conservatives.
Let’s hope this fight continues into the fall and remains a topic of discussion rather than fades away. The combination of all the past and present sins of the liberals will come to bear fruit soon enough.
@Steve Plunk
Steve, did you miss this in JJ’s post, “Dave Weigel to WaPo” that preceded this one:
If that’s true, then how are we to account for the current state of affairs? If conservatives have been in the ideological saddle for decades, then I guess we’d have to say that that ideology counts for zip in terms of any meaningful change. And if that’s so, if decades of conservative hegemony have not altered the landscape in any meaninful way, what makes you think the future will be different from the past?
Mr. Plunk,
I think you are half right.
People are mad and spending by gov’t at all levels has been irresponsible.
But, the liberals are far from responsible. In fact, it is the failed conservative fiscal policy which is responsible for the tax burden shifting from high income to middle income taxpayers.
This is the little known fact that can be used for
populist revolt against the greedy elite siphoning off public funds for private losses.
Once the little man understands this mentally as well as viscerally, your side is cooked.
To wit:
In 2007 the top 400 taxpayers had an average income of $344.8 million, up 31 percent from their average $263.3 million income in 2006, according to figures in a report that the IRS posted to its Web site (the latest year available)….
Their effective income tax rate fell to 16.62 percent, down more than half a percentage point from 17.17 percent in 2006, the new data show. That rate is lower than the typical effective income tax rate paid by Americans with incomes in the low six figures....Payroll taxes did not add a significant burden to the top 400, not changing the rounding of rates by even one decimal. With payroll taxes taken into account, the effective tax rate of the top 400 would be 17.2 percent in 2006 and 16.6 percent in 2007. As a point of comparison, about two-thirds of Americans pay more in Social Security, Medicare, and unemployment taxes than in federal income taxes.
Please conservatives admit your mistakes.
After all, isn’t that what conservatism is all about? Taking personal responsibility?
Oh, wait, its always the liberals fault.
Classic victopub to paraphrase Larry Elder.
Payroll taxes are not the same as income taxes. Payroll taxes were sold as a forced savings plan for retirement – you’re supposed to be prefunding your own retirement years. That being the case they’re not a tax in the way an income tax is a tax, where proceeds are used for running the government.
To combine the two and develop a new metric “effective tax rate” is to engage in chicanery.
It is so “radical” that it basically is the Republican plan from 94 combined with Romney care.
I think the problem for the democrats is that the bill isn’t going to do what they say it will-it isn’t going to make healthcare more affordable, and it also isn’t necessarily going to result in better access to healthcare (just because a person has insurance, they are not guaranteed the ability to see a doctor and there are some regions that are underserved by medical professionals).
Eventually the taxpayer is going to realize their healthcare is getting more expensive, and it is going to be difficult to blame the republicans.
My real problem with the whole thing though is the cost, and the democrats has managed to creatively hide the real cost of the bill, and it may in the end hurt them as well, because so much of the bill’s provisions are going to be delayed not just a couple of years, but as many as 4 or 6 years. We won’t really see the true costs of this bill for almost a decade.
Sam, Spend some time at a school board meeting or a city council study session and you will see liberalism where it really creates problems. Those unfunded pensions start right there where nobody wants to seem cheap or make enemies by holding the line on costs. I just chaired a county roads meeting where we discussed spending $375,000 on a quarter mile of bike lane on a rural road with no bike connectivity but the money is grant money so it’s “free” and many felt we should spend it regardless of little beneficial outcome.
Q, The politics of envy will not solve our problems. Taking only two years of stats doesn’t prove anything either. Of those richest 400 I wonder how many of them have contributed much more to society than their tax bill might indicate? I wonder how many jobs they have created? Owning a business I also know profits are up some years yet down others. Lastly I wonder what moral justification there is for taking any of their money and who decides what is appropriate? I doubt those 400 change their voting philosophies while many who have voted for Democrats will undoubtedly change theirs. This “little man” has understood for years how it works and begrudging the rich guy for being rich only makes us all poorer.
Yes, the individual mandate was conceived by a conservative economist, Mark Pauly from Wharton.
If Republicans had chosen to participate, I think we could have had several improvements.
1)We could have had a better shot at malpractice reform. The Republicans have never tried to accomplish this, but in trade for some votes, we might have had a shot at it.
2) The current bill has catastrophic insurance in it, but is limited by age. If Repubs had participated, this could have been more widely available and probably more HSA support.
3) If you read through the tiers of care listed in the Kaiser summation below, essential health benefits are not, by my reading, well defined. Republicans could have influenced this area with a few votes.
http://www.kff.org/healthreform/upload/housesenatebill_final.pdf
Steve
Hey, John, I see you teed up Rick Moran over at your place, so I headed over to the Nuthouse to see what was up. I was vastly amused by his closing:
After the GOP’s heroic attempts to “save Medicare,” anybody doubt that prediction?
If conservatives have been in the ideological saddle for decades, then I guess we’d have to say that that ideology counts for zip in terms of any meaningful change. And if that’s so, if decades of conservative hegemony have not altered the landscape in any meaninful way, what makes you think the future will be different from the past?
That’s what I call a dagger to the heart. A very good observation and follow-on question. Here’s my stab at the answer:
Some wise wag, I can’t remember who, observed that any institution that isn’t purposely conservative, will over time become inhabited by liberals who bend the institution to serve their goals. We most frequently see this with foundations, where rich, conservative capitalists donate their money, and after they pass on, the managers subvert the mission of the foundations towards leftist causes. This is a variant on the famous Principal-Agent theorem. This applies to government in spades.
Where conservatives have failed is in the oversight of the implementation of their policies. Conservatives develop policy and count on it being sufficient to survive administrative interpretation, interpretation which is quite often left in the hands of government employed liberal-inclined bureaucrats.
As for your question regarding the viability of future conservative efforts, my position is that if the modus operandi of future policy formulation and implementation is the same as the past, the outcomes will also lead to little meaningful change. If however, they insure that policies are implemented according to design and are not subverted by agents, which means that the policy design stage needs to purposefully restrict the ability of agents to interpret counter to policy goals, then they’ll be on a different path which likely will produce results that are different from those seen in past attempts.
Are conservative leaders intelligent enough to identify and correct past methods of doing business? Shrug, I doubt it.
Heh, by Tango’s logic Dick Cheney was the “deficits don’t matter” liberal mole.
Mr. Plunk,
Lets see if I can make it easy for you in a macro sense to fully comprehend my position, since this blog is full of endless debate, debasing, debunking of the “other” side’s foolish, moronic points of view.
Are there undoubtedly idiotic liberal positions which are indefensible?
Of course. I live in California and the public unions are almost as big a threat as the conservative Jarvis types in my opinion.
There should be little debate that the rich are getting richer and the poor are getting poorer and the middle are being strangled in today’s economy.
Leaving aside the why and the how, can we basically agree that, like the sun rising in the east and 2+2=4 and a triangle has 3 sides, that the wealth inequality is approaching/surpassing historic levels in the U.S?
If you answer no, then there is little to argue and there is no other choice left than to pick up a machete and axe all those who disagree, because basically this is what history teaches us will happen if inequality is left unchecked.
It happened in France, the U.S., Russia,Cuba, in short it has happened in every region, under every economic system, to every culture, every race.
When income inequality gets to certain levels, social calamity/unrest usually follows.
Are you with me so far? Have I said anything too controversial or false?
I think, it is beyond controversy, that under the admittedly “liberal” policies which America followed (i.e high marginal tax rates, high corporate taxes, robust anti trust enforcement, regular annual increases in the minimum wage, establishment of S.S. etc)from 1932 to 1979, that the real income for the average worker doubled (1948 – 1973).
Are you truly gonna argue any of this as false?
I can already hear Mr. Tangoman’s Cum hoc ergo propter hoc response already.
But, like I said, I am not ascribing the cause of the doubling of income to New Deal policies, merely that usually Dem administrations (even Ike) were more “friendly” to the little guy…or are you conservatives gonna argue this as well?
Finally, my point is this, I believe (much as Mr.Tangoman believes with all his heart that diversity doctrine is the great leviathan causing all social ills)that policies which either directly or indirectly lead to massive increases in wealth inequality are just bad politics and lead to divisiveness, anger, bigotry and ultimately revolution.
Mr. Plunk you “wonder what moral justification there is for taking any of their money and who decides what is appropriate.”
Uh, dude, are you an infant? I am sorry but this is the ludicrously insane argument that ultimately your side always parrots.
Here’s why, if we don’t tax their money and recycle/redistribute it rationally, with reason, with debate and in a democratic manner, the hordes of the dispossessed with come roaring from the urban jungle and kill you for it…or wasn’t anybody watching Koreatown during the 92 riots in LA, when the shopkeepers literally cradled machine guns while guarding their stores because the LAPD couldn’t protect them.
You are kidding yourself if you think this will not/could not happen again.
My point, Mr. Plunk, is your conservative policies of deregulation etc. caused massive financial dislocation which Joe Dipshit had to pay for (i.e. the great depression, S&L debacle, this last recession).
His patience is wearing thin and his gun collection is growing and it would be real easy for a demagogue on the left to easily convince them that the real danger is not the Negroes on main street and their welfare fraud of a few hundred million, but rather the white “nig$gers” of Wall street who lost trillions because of Republican (and democratic)neglect of regulatory constraints.
Usually revolutions are fomented not by mendicants, but rather by the disgruntled intelligentsia (see Jefferson, Thomas, Adams, John, Lenin, Vladimir, Castro, Fidel).
Its ironic that the ones holding back the lynch mob from hanging conservative bastards from the highest yard arm, are gonna be people like me who promulgate “stupid” policies which, paradoxically, are designed to, oh lets see “establish justice”, “promote the GENERAL welfare” and “insure domestic tranquility.”
If that means taxing you greedy sons of bitches at 90%, so be it.
We did it in the past in this country and the bottom did not fall out, contrary to EVERYTHING you and your conservative cohort believe in.
Both sides do this all time. Deficits didn’t matter to the republicans under Bush, but the democrats talked about Bush’s deficits continuously. Now that there is a democratic president, suddenly deficits don’t matter for them, but the republicans have now seen the light and decided that deficits are important after all.
The importance of public opinion is another amusing one. When the majority of the public were against the Iraq war, the democrats were convinced that public opinion was vital, whereas Cheney and Bush made the point that you can’t govern based on public opinion. Now the democrats are in power, and pushed through a medical reform that the majority of the public is against. Suddenly its the democrats who say that public opinion isn’t the key element, while the republicans are converted to believing that public opinion is king.
Is there any wonder that a majority of the public thinks both parties are absolutely untrustworthy hypocrites who wouldn’t know a principle if it came up and smacked them in the face.
Deficits under Bush were bush league compared to Hussein’s spending patterns. Bush had actually reduced the deficit, while BHO has raised the debty to new levels. Bush was fighting two wars. He accomplished something for the money. What has Obama accomplished with his stimulus rip off? Where are the jobs? Hussein promised much and has delivered very little. 8% unemployment my ass. Dude is a crack smokin control freak.
Guess you were snoozing while health care costs skyrocketed under Bush…
If my fellow conservatives are distressed by this turn of events, they only have to look so far as the Republican Establishment to find the true cause.
That would be the same Republican Establishment which really holds the view of Conservatives as “useful idiots”, and nothing more.
I believe Mr”Georgie” Bush and “Darth Vader” Cheney are prime examples of these highly “principled” Republican Establishment types. Who in reality set the stage for this Democratic triumph.
The aircraft is coming back to earth. The only question is the time and place of contact with the “Big Ball”. “Strap in tightly” the arrival will be most unpleasant, one way or the other. What ever your political view point is.
A people’s mandate for progressive change in the last election?
Hell, Mr. Joyner, I’m a Conservative Republican, and in my view, people would have voted for Hitler if it meant getting rid of Bush and his cabal of war criminals and outright crooks. All Obama needed to do to get elected was to characterize McCain as Bush III. He did, and he got elected. Mandate for progressivism, my sweet patute! By all rights the next election will be an incumbent slaughter. Mostly for the Democrats, thanks to Pelosy, but also even for Republicans. The watch phrase for the November election will be, “Throw the bums out”!
I think Tango is actually correct in a way. The conservative movement is much different than what it was under Reagan. It used to have a pragmatic side, a part that looked at what has worked in the past and what was currently working. Reagan passed a huge tax cut and increased spending, largely on the military, but deficits continued to rise. So, he raised taxes. IMHO, it still was not enough, looking at our debt, but it was a start. Reagan embraced traditional values, opposing torture, even signing a treaty against it. He did not panic when our Marines were killed and start torturing Muslims, abandoning a principle we have tried to honor since Washington. Reagan used non-military methods preferentially to achieve our foreign policy goals.
The modern conservative only knows how to cut taxes. They embrace torture and those who engaged in it. They invade countries to engage in nation building. They seem to embrace the Ledeen principle. They remember that government is the problem, but not the rest of the quote.
Steve
The modern conservative only knows how to cut taxes.
We can thank the Grover Norquist faction for this. This is governance by slogan and stupidity and it can’t be the hammer for every policy nail.
They embrace torture and those who engaged in it.
I take your point but I wouldn’t phrase it quite so definitively, though there is a kernal of truth there.
They invade countries to engage in nation building.
This makes my head spin. Bush is adopting the principle that Gore advocated in their 2000 debate. I guess that 9/11 changed things or if you’re cynical, it brought to the fore what was the buried intent.
They seem to embrace the Ledeen principle.
Good point. I can’t imagine that earlier iterations of conservatives would have lined up with Ledeen.
They remember that government is the problem, but not the rest of the quote.
I’m curious to see if an internal revolution within conservative circles will avert, for the Republicans, the cross-party slide towards irresponsible governance.
So This is How Liberty Dies…With Thunderous Applause: http://mittromneycentral.com/2010/03/21/this-is-how-liberty-dies-to-thunderous-applause/
The post I just linked to is the best post I have read in months. I know it’s easy to get down after last night, but this post really picked me up and I hope it picks you up as well.
DOW up about 44 today and closing in on 11K. You would think that in the face of the economic armageddon the right is predicting the market would be fleeing in terror 🙂
DOW up about 44 today and closing in on 11K. You would think that in the face of the economic armageddon the right is predicting the market would be fleeing in terror 🙂
Speculators always move in when money is left on the table. Millions of new insured joining the ranks because insurers can’t turn them away + rate hikes spread across a larger base = good short term news. There is going to be a window of lag time before healthy people, now faced with having to subsidize the new members who’ve joined with pre-existing conditions, decide to self-insure and pay fines, and then follow the same tactic as the pre-existing condition folks, which means that insurance companies’ risk pools will tilt everymore to sickos and away from healthy people and before that happens the speculators will bail out of the stocks.
I actually agree that there was a Republican change, the Nordquist faction, etc., but it’s pretty foolish to think spending in response to the Great Recession is just “Hussein’s” or typically Democrat.
The financial collapse was baked in by 2007. We know that now as MBS, CDO, and CDS are unwound.
Minor maintenance stuff…
The Peter Suderman link above should go to this rather than David Frum’s article.
Major comment stuff…
Suderman also writes:
He seems to think that the Democrat’s legislative victory is somewhat Pyrrhic in nature. They won the battle, but will lose the war, so to speak.
But if entitlements create their own constituencies, and they rarely are ever repealed, I don’t see how complete and total opposition will work in the GOP’s favor. Rather, by sitting on their hands, they helped to create a constituency that knows the Dems are responsible for their access to health insurance, who doesn’t really care if liberals were given political cover (that’s an insider’s ballgame), and who will oppose any reform/repeal efforts launched by Republicans.
Hinted at but not really explored in Frum’s piece is that Republican pols are getting too used to making big gambles that (in many cases) don’t really pan out.
And their constituents are getting too used to shrugging off these failures as noble or accepting them outright as expressions of solidarity.
Republicans could have improved the bill, but they didn’t. They couldn’t even stop it. Will a missed opportunity to ameliorate a flawed bill and an embarrassing legislative failure cost them any capital among their constituents?
Hardly. It will only have those constituents begging for more.
Under Ronald Reagan it was headed by a very intelligent man (see his diaries and letters). I’m afraid what we have now with the conservative movement is nothing so much as the party equivalent of Harry Lyme’s characterization of Switzerland…with the cuckoos loosed from the clocks.
The Q, What started as a civil discussion you have now brought down to name calling and insults. I would be much more likely to listen to the opposition if you would just stay out of the gutter.
You cherry picking data, building straw men, and generally using the internet playbook of illogical arguments. Good luck with convincing anyone with such tactics.
The numbers we are dealing with are in a different league than the spending numbers of 1948. The debt levels are higher and the consequences likely more severe. Many of us are angry and will be more political than in the past. The result will be an interesting November.
Mr. Plunk,
I apologize for the name calling. Your are correct.
Please enlighten me though. What facts are cherry picked?
Which are the straw men? What illogical arguments?
Lets see 10 years ago we had budget surpluses for 3 years running…is that 1949?
Your side made Colossal policy mistakes, viz. tax cuts for the rich, iraq war, zero interest in regulating Wall Street (Gramm, Leach,Bliley Act of 1999)….and you can’t own up to them.
Tell me where I have erred.
This is my frustration with you conservatives, you can never admit fuc%k^ups.
My contention (and I can back it up) is that the middle class generally had it better under Dem. policies than conservative ones.
Is that too hard to understand?
Your side takes the cowardly way out by deception, obfuscation and demagoguery.