Tag Archives: healthcare

by | February 3, 2012 · 12:06 PM

Individual Mandate Supporters – Conservative Commentators?

By John Stang

A new phenomenon, out of the aligning of the stars I guess, is beginning to take hold, conservative commentators are supporting Romneycare.  Romneycare is Mitt Romney’s Massachusetts healthcare plan that he supported while he was governor.  That plan had the individual mandate, where people must purchase health insurance on the private market.  It was also the model for Obamacare.  Ann Coulter stated this about Romneycare:

In November 2004, for example, libertarian Ronald Bailey praised mandated private health insurance in Reason magazine, saying that it “could preserve and extend the advantages of a free market with a minimal amount of coercion.” A leading conservative think tank, The Heritage Foundation, helped design Romneycare, and its health care analyst, Bob Moffit, flew to Boston for the bill signing. Romneycare was also supported by Regina Herzlinger, Harvard Business School professor and health policy analyst for the conservative Manhattan Institute. Herzlinger praised Romneycare for making consumers, not business or government, the primary purchasers of health care. The bill passed by 154-2 in the Massachusetts House and unanimously, 37-0, in the Massachusetts Senate — including the vote of Sen. Scott Brown, who won Teddy Kennedy’s seat in the U.S. Senate in January 2010 by pledging to be the “41st vote against Obamacare.”

All those facts are right.  Many Republicans were for the mandate before they were against it.  Here is where Coulter makes a crucial distinction:

One difference between the health care bills is that Romneycare is constitutional and Obamacare is not. True, Obamacare’s unconstitutional provisions are the least of its horrors, but the Constitution still matters to some Americans. (Oh, to be there when someone at The Times discovers this document called “the Constitution”!)

She adds:

The only reason the “individual mandate” has become a malediction is because the legal argument against Obamacare is that Congress has no constitutional authority to force citizens to buy a particular product.

Yuval Levin and Ramesh Ponnuru at National Review make a similar claim:

Governor Romney has at times attempted to argue that the chief problem with the federal law is that it imposes a sweeping one-size-fits-all model for the health-care system on the entire nation and prevents the type of state-by-state experimentation that could yield solutions that are better, and better fitted to local circumstances. This critique of Obamacare, though it contains a lot of truth, is both substantively and politically inadequate. The political inadequacy comes into relief when one looks at Obamacare’s least popular feature, its requirement that all Americans buy insurance policies that meet the federal government’s approval. Romney can rightly say that this requirement, when imposed at the federal level, raises constitutional issues that a state requirement does not. But much of the opposition to the mandate rests on hostility to being ordered around unnecessarily by any level of government, and Romney, alas, cannot align himself with that sentiment.

David Frum then offers this answer:

“The devil is always in the details. Yes, you adopted the basic design I pioneered in Massachusetts. You’re welcome. But then you added features that ruined a good basic concept. You finance your plan with the worst kind of tax increases: tax increases on work, saving, and investment. You expand coverage mostly by expanding our broken Medicaid system: more than half the people who will gain coverage under your plan gain coverage from Medicaid, not private insurance. You’re extending federal benefits by adding new costs onto state governments. Yes, you give the states a bit of money to help for a short period of time. Over the longer haul, your plan will force up state taxes as well as federal taxes.

state governments aren’t well positioned to control costs. Only the federal government can do that. Yet your plan’s cost controls are inadequate and worse.

In summation, the two arguments being offered here are that Romney’s healthcare plan is constitutional because it happens on the state level, while Obama’s individual mandate is unconstitutional because the federal government cannot mandate that citizens do something.  The other answer, offered by Frum, is that states are better at controlling costs than the federal government is.

Why are conservatives cheer leading this plan now?  First, Romney is going to be the nominee and this is a major weakness of his, so they might as well start coming up with a defense for their followers now.  Second, is a way to change history, slightly.  The truth is Bob Dole proposed a similar plan in the 1990s on the federal level and Romney has said he wanted his plan to go national.  These columns and blog posts are a way to walk back conservative support for the individual mandate, without actually supporting the plan in its current form.  Basically, we were young and stupid then, now we got a religion called the Tenth Amendment.  Now, not all conservatives will buy this argument and the individual mandate will still be a big liability for Romney.  So, since the commentators know their stuck with him they might as well find ways  to defend his record.

 

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by | December 20, 2011 · 11:13 AM

Reaction to Lie of the Year

By John Stang

Every year the nonpartisan, Pulitzer Prize winning fact-checking website Politifact chooses a “Lie of the Year.”  Politifacts purpose is to check how accurate political statements are and rate its accuracy.  The 2009 Lie of the Year was “Death Panels” and the 2010 Lie of the Year was “Government Takeover of Healthcare.”  Both of those were mischaracterizations of President Obama’s healthcare plan by the right, especially Fox News.  This year, Politifact selected “Republicans Voted to End Medicare” as the 2011 Lie of the Year.  Bill Adair, the editor of Politifact explained his reasoning on the Early Show:

 ”This was a claim we heard over and over again after the House voted in April on a budget by (Rep. Paul Ryan (R, Wis.). It’s just not true,” Adair said. “The way they say it, they say the House voted to end Medicare. That’s not what they did. The House voted to protect Medicare on people who are 55 or older, but to privatize it and restructure it in a dramatic way for people who are younger. It’s wrong to say ‘end Medicare’ and it’s the classic scare tactic we’ve seen targeting the elderly for many years.”

Needless to say, the left is not too happy about this.  New York Times Nobel Prize winning economist and columnist Paul Krugman wrote:

How is this not an end to Medicare? And given all the actual, indisputable lies out there, how on earth could saying that it is be the “Lie of the year”? The answer is, of course, obvious: the people at Politifact are terrified of being considered partisan if they acknowledge the clear fact that there’s a lot more lying on one side of the political divide than on the other. So they’ve bent over backwards to appear “balanced” — and in the process made themselves useless and irrelevant.

On its merits, two voices of the left have come out to criticize the decision.  Steve Benen at the Washington Monthly says:

It seems foolish to have to parse the meaning of the word “end,” but if there’s a program, and it’s replaced with a different program, proponents brought an end to the original program. That’s what the verb means. I’ve been trying to think of the best analogy for this. How about this one: imagine someone owns a Ferrari. It’s expensive and drives beautifully, and the owner desperately wants to keep his car intact. Now imagine I took the car away, removed the metallic badge off the trunk that says “Ferrari,” I stuck it on a golf cart, and I handed the owner the keys.

Matt Yglesias at Slate notes:

The entire argument hinges on point two. House Republicans voted to replace Medicare’s existing single payer fee for service program with a different program, also called “Medicare,” under which (in the words of Politifact) retirees “would receive ‘premium support payments’ from the government to help pay for the private insurance.” Whether or not this change should be described with “harsh” terms is clearly a matter of ethical judgment. But it’s obviously a big change. Mitt Romney, for example, lauded the plan as reflecting “the need to fundamentally transform Medicare.” If friends of the plan describe it as fundamentally transforming the program, can it really be wildly illegitimate for its foes to describe it as ending Medicare? That doesn’t make sense to me. According to Mitt Romney, we’re fundamentally transforming Medicare. According to the DCCC we’re ending Medicare and replacing it with a fundamentally different program. This is a hair-splitting disagreement, not a gaping void of factual error and deliberate deception. The philosophy major in me will happily grant that Saul Kripke would agree with them, but I think their take on this (like Saul Kripke’s philosophy of language) flies in the face of common sense. Sensible people, following Wittgenstein, will hold that “Medicare” is a cluster concept and that whether or not a given transformation of the program is so fundamental as to constitute “ending” it is precisely what needs to be contested in the public arena.

In the end, it all comes down to semantics, whether or not the word transform means that Medicare will be ended.  Although, as Greg Sargent of the Washington Post Plum Line blog tweeted:

Obviously, all the lefty criticism of @PolitiFact‘s Lie of the Year only proves how unimpeachably nonpartisan it is

I want to know what you think.  Is Politifact correct in giving “Lie of the Year” to “Republicans voted to end Medicare?”

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by | November 6, 2011 · 12:02 AM

I’d Like a Catscan with Extra Radiation

By John Stang

At a Tea Party fundraiser debate, supposed to be based on the Lincoln-Douglas debates of the 1850s, Newt Gringrich and Herman Cain both showed off their skills at discussing policy, or lack thereof.  I was busy getting my groove on at dance, so I missed the debate, but I did hear this line espoused by Gingrich about healthcare policy:

“Think about going to McDonald’s,” Gingrich said. “We have no national hearings on fraud at McDonald’s. You show up and say, ‘I’d like a Quarter Pounder with Cheese.’ You give them money. They are happy. You are happy. If you open up your bag and there’s no Quarter Pounder with Cheese, you are unhappy.”

Except, it’s not.  If you don’t like your insurance policy, changing companies will not be the easiest thing to do.  There’s pre-existing conditions, piles of paperwork to fill out, and limited options in terms of policy choices.  Plus, submitting a claim for your insurance to cover can be scary for a big procedure if the company thinks the procedure was not necessary to start with.

Not everything works better as a business. In an area like healthcare, the goal is to serve the most people to make sure that people stay healthy.  It’s good economically and people are happier too when they have insurance.  The private sector might run something more cost efficiently, but does that really mean it’s always the best policy option?  Whether Gingrich likes it or not, government bureaucrats file reports, perform investigations, follow stricter rules, and set regulations for the public good.  It is not something bureaucrats do because they hate you (as many conservatives want you to think).  They do it, no matter how long it takes, because it insures safety, accountability, and fairness.  In contrast, the private sector will quickly audit a project and find ways around regulations to make more of a profit, not necessarily to serve customers better.  Which system makes more sense, McInsurance Company or a public option?

 

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by | October 28, 2011 · 11:38 AM

Good Luck Repealing “Obamacare”

By John Stang

A constant campaign platitude of most GOP presidential candidates is a pledge to repeal President Obama’s signature healthcare law, demonized as “Obamacare.”  Mitt Romney is out in front on this, indicating that he might be overcompensating for having the bill modeled after his own reform plan in Massachusetts.  The Wall Street Journal explains Romney’s plan:

Mr. Romney has proposed signing an executive order on “day one” offering waivers to any governor who wants his or her state to opt out of the law. His rivals note that by law, such waivers can’t take effect before 2017. The move would also leave untouched the focus of conservative opposition: the requirement that individuals carry insurance or pay a fee. Mr. Romney said he would follow this on “day two” with legislation to repeal the law, using a Senate tactic called budget reconciliation. That would require only 51 votes to succeed, a total the GOP might reach after next year’s election.

Got it: day one, executive order giving states an option not to be part of the individual mandate and day two is senate reconcilation.  Reconcilation is a parliamentary tactic used for budget bills, it only requires 50 votes instead of the normal 60 to avoid a filibuster.  Without going into the nitty-gritty of why this process is necessary, just understand that the healthcare bill was passed with the use of reconciliation after Scott Brown won in Massachusetts.   Oh, the irony!

All this is much easier said than done, as with any political promise.  The individual mandate is the part of the law that Republicans hate and want to see repealed, but there are also provisions, such as reforms to hospitals and eliminating the denial of coverage to those with pre-existing conditions, that remain very popular.  Rounding up the votes will  not be easy either.  Republicans will need a majority in the senate, or, God forbid, work with the other side to get votes.  If you want a glimpse at failed presidential promises, Obama signed an executive order his first day in office declaring the detention center at Guantanamo Bay to be closed within a year, and it has not happened yet.  Does “Read my lips, no new taxes, mean anything?  Congress does not move with the will of the president.  If Romney wins, he will learn that soon enough.

One final thought to consider is how the GOP will be perceived by repealing the law if the economy is in bad shape.  The Obama administration was criticized that more economic measures should be taken by the government, that was not part of the stimulus, and that more energy needed to be placed on jobs instead of healthcare.  While healthcare and economy are both intertwined, that was not explained very well.  If Romney, or the any GOP candidate, gets into office with unemployment still at 9% and they want to focus on repealing healthcare instead of creating jobs, then that will not sell well with the American people.  The lesson here, fighting for your idealistic cause when not everyone thinks that is top priority can make you seem like just a purist more than a leader.

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by | September 21, 2011 · 1:35 PM

Uniting Extremes?

By John Stang

An odd couple of sorts has formed over a recent bill that was introduced into the House regarding illegal immigration.   The new bill requires businesses to use an E-Verification system when hiring employees to make sure that person is not an illegal immigrant and entered information into the system.  The program is currently done on a voluntary basis.  Tea Party Republicans say it violates personal rights of Americans and puts an unfair burden on small businesses because of all the forms they need to fill out.  Funny how the Tea Party never really cared about fourth amendment rights during the debates about the Arizona or Alabama laws on illegal immigration, but I digress.  Liberals also see it as a violation of rights and support more constructive immigration reform.  The Wall Street Journal reports:

The letter said requiring the use of E-Verify, which is currently voluntary, would create a de facto national identification system, infringe on rights such as the freedom to seek work, cripple small businesses, turn employers into immigration agents and encourage identity theft. The letter calls the bill a “job killer” that will cost employers millions of dollars. Judson Phillips, founder of Tea Party Nation and one of the letter’s 27 signatories, said that his movement strongly opposed illegal immigration but that “it’s not private enterprise’s job to enforce immigration.”

WSJ continues:

The efforts of the conservative and libertarian groups put them on the same side of the bill as liberal organizations that favor an amnesty for millions of illegal immigrants. “We may disagree on many aspects of the immigration debate, but we can all agree we want to see this bill fail,” said Michael Ostrolenk, national director of the conservative Liberty Coalition and coordinator of the campaign against mandatory use of E-Verify.

Shouldn’t this happen more often?  I’ve never really understood the antagonism between liberals and so called liberrtarian (I realize this term is not used properly in this context) Tea Party.  We always try to formulate legislation to please the all knowing moderates in the House and Senate for votes.  However, the extremes do have some common ground.  Granted, they might oppose bills for different reasons, but that actually engages in a strong discourse about that particular piece of legislation.  For example, the Tea Party disagreed with the Healthcare bill’s individual mandate and liberals found the reform did not go far enough, the story is the same with the Dodd-Frank Financial reform bill.  Democrats only passed the bills with their deficiencies as to not lose a political battle, and because Democrats didn’t want to wait another century to do healthcare again.  Sometimes scrapping legislation that both extremes disagree with is not a bad thing.

At the same time, the Tea Party and liberals could have united for Washington reform.  Neither like the influence of lobbyists or the complicated bureaucratic structure.  Foreign policy was another area of agreement.  Both found Libya to be an example of executive overreach and wanted troops withdrawn out of Afghanistan and Iraq.  The only team that came together was Senator Barney Frank and Representative Ron Paul in finding defense cuts.  All these examples show that common ground does exist within the two parties extremes.  I guess, in the end, political expediency will always trump legitimate policymaking.

 

 

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