James Pethokoukis

Politics and policy from inside Washington

GOP uses Dem playbook to kill healthcare reform

August 19, 2009

What’s good for the donkey is good for the elephant — or at least as politically effective.

For years, Democrats hampered Republican efforts to overhaul Social Security by making three main arguments. First, reform was a just a euphemism for kill, thus Republicans were violating the social-insurance contract with older Americans Second, building a new Social Security system around personal investment accounts would subject peoples old-age to the vagaries of the financial markets. Third, there was no Social Security crisis, only a successful, decades-old program that merely would need a couple of tweaks down the road (presumably when Democrats again controlled the White House and Congress).

Did these argument hold water? Not really. Various Republican ideas would have changed the program only for younger people. And if you don’t think the stock market is a good long-term investment, then you’re also betting that the American economy will underperform, thus calling into question the country’s ability to meet its long-term Social Security obligations. Finally, it is indisputable that Social Security is underfunded and benefits will need to be cut or taxes raised sharply.

Whatever the accuracy of their arguments, Democrats were able to stymie Republican efforts to fix Social Security, most notably President George W. Bush’s 2005 attempt. Now Republicans are using the same playbook to stop President Barack Obama’s plan to reform America’s healthcare system.

Today’s arguments are similar to those from 2005. Healthcare reform would eviscerate Medicare for the elderly by making cuts to pay for expanded coverage for younger Americans, and that’s unfair since seniors have paid for their benefits. Treatment decisions would be left to the vagaries of Washington bureaucrats. And hey, there really is no crisis since a) polls show most people are satisfied with their current healthcare plan, and b) even if healthcare spending takes up a greater share of GDP in the future, it’s not a big problem since the entire American economy will be much bigger.

But Republican arguments are just as flimsy as the Democrat version four years ago. Rising costs mean less take-home pay for American workers, and Medicare, to a great degree, is what’s driving those costs since it makes using pricey, premium medicine seem cost free to seniors. (And despite Republican claims, the average senior will get $100,000 from Medicare than what he puts in.) What’s more, the U.S. could be spending far less on healthcare, including Medicare, and getting equally good results. Still, those economic realities are just a distraction when your goal is more about political victory than solving a national problem.

The politics may be dicey, but anyone truly serious about overhauling the American healthcare system needs to acknowledge that total spending must be reduced and that any aspect of the system — including Medicare and employer-based health insurance — that distances patients from the true costs of their healthcare is part of the problem. Republicans could even, theoretically, support a bare-bones public option if it had low premiums but high deductibles and co-payments to increase consumer awareness. (Just as Democrats should be able to support a system based on more private health insurance if there were substantial subsidies for the poor.)

Of course, that would be sound economic policy and the current debate has precious little to do with that.

Comments

Lots of people are fighting this reform Democrats and Republicans. The Democrats don’t need a single GOP vote to pass this. So they blame the GOP. That is baloney! The people of America do not trust either party with health care.
I do not support the Democrats-Obama’s plan for the following 20 reasons.
1. I am not aware of any program the Government runs that is more efficient then private plans.
2. No cost savings from malpractice -defensive medicine the lawyers, give too much money.
3. No fraud control-Today Medicare has 3 to 5% fraud how is that being addressed?
When will they start auditing medical care? Assign FBI fraud teams? Pay the States for fraud control.
4. What reward is there for a healthy lifestyle? The Safeway plan is a model we should consider.
5. When did health care become a tax payer supported right?
6. Where are the doctors and structure to handle 40+ million new people covered by health care
7. Tennessee and Massachusetts programs costs soared
8. Why the rush to get this passed, doing it is worth doing it well.
9. Illegal immigrants get coverage without paying taxes, what is to stop thousands of Canadian and Mexicans coming to America for treatment of whatever ails them.
10. What are the details, co pays, what is covered, who decides and how.
11. The Canadian, French and British systems are nothing to be proud of.
12. Do you think the Veterans and medic aid programs are that great how about Indian reservation care?
13. How do we pay for another TRILLION dollar program.
Is Washington being honest about how they want to pay for this.
14. How willing are you to pay taxes on your benefits so those that don’t work are covered.
When it becomes free people abuse the system. (600 ambulance rides in a recent story).
15. The devil is in the details, they have not been very forthcoming with the details.
16. What will the standard of care be?
17. The current House bill is a job killer, how is a small business going to be able to do this.
How many small businesses will be put out if this passes? (two of my children are employed by small business)
18. The Government already controls 46% of health care decisions. They set the payments for Doctors and services. They mandate the minimum’s a doctor can charge. They set up the payment tables. My bet is they don’t adjust them very often. There is no free market competition.
19. The 8% solution: The house bill says employers who do not offer health care pay a 8% tax.
Average cost of benefits exceeds 8% it is usually 10 to 14% of payroll cost. Many businesses will elect to drop coverage and pay the tax. How does that help the employees?
20. Mandated health costs will increase the price of everything a $10 pizza will be a $13 pizza.

Posted by Ron 8200 | Report as abusive
 

Bottom line if you vote for national healthcare you are a commie. What insure illegals. Why not insure the world you grandiose sickophants. Max Baucus if he is a freedom loving american will not support government takeover. If he does Max will be out of a job shortyl.

you turds can’t even run cash for junkers. what are you going to pay for that with. Money from china. balance your checkbook like the rest of us you tax and spend liberal theifs.

barac says false witness. barac’s healthcare will kill two birds with one stone senior and unborn babies. why not have the death panels give barac’s blue pills to the garbage people like welfare recipients, union workers, social workers, gang bangers, and all other garbage. Oh I forgot these are the trash that elected barac.

dont forget he got elected by sticking the economic debacle that frank and walters caused on the republicans. don’t forget that it was fannie and freedie and the democrats that caused you retirement years to be short in duration.

even once the takeover is stopped throw all democrats out in 2010 because remember they strongly embraced changing america into a communist country and we don’t like commies.

Posted by angie | Report as abusive
 

Hi Reponses under your questions,
1. I am not aware of any program the Government runs that is more efficient then private plans.
Since there is no public plan yet, that’s not quite fair, but both Medicare and the VA have muhc lower overhead than private plans.

2. No cost savings from malpractice -defensive medicine the lawyers, give too much money.
Malpractice contributes about 1% of medical costs. States like Texas that have malpractice reform don’t have cheaper care overall than states that don’t. In fact medicare costs per patient in Texas are higher than in other states

3. No fraud control-Today Medicare has 3 to 5% fraud how is that being addressed?
When will they start auditing medical care? Assign FBI fraud teams? Pay the States for fraud control.

Both the House and Senate have parts of the bill devoted to combatting fraud in both Medicare and private plans (which also have fraud)

4. What reward is there for a healthy lifestyle? The Safeway plan is a model we should consider.

Senate Bill allows differences in premiums for tobacco use. However making it harder for people who need health care from getting it is something that is wrong with teh current system. There’s nothing in either bill that would prevent employers from rewarding healthy lifestyles.

5. When did health care become a tax payer supported right?
Do you want to end Medicare ? you can debate whether it’s a ‘right’ or not. I think it’s a good idea for public health and economic reason. Many other countries think so too.

6. Where are the doctors and structure to handle 40+ million new people covered by health care

http://voices.washingtonpost.com/ezra-kl ein/2009/08/do_we_have_enough_doctors_fo r.html

They are already using the system, but they are using expensive ERs. There are provisions for training more doctors in both Senate and House bills.

7. Tennessee and Massachusetts programs costs soared

Neither program is able to control costs in the same way a Federal plan could. They don’t have a public plan which would
provide competition. This link says the Mass costs have been overblown
http://www.masstaxpayers.org/publication s/health_care/20090501/massachusetts_hea lth_reform_the_myth_uncontrollable_costs

8. Why the rush to get this passed, doing it is worth doing it well.
Most major plans get passed fairly quickly or not at all. The Patiot Act got passed much faster. Bush’s attempts at Social Security reform did not. There has been a tremdous amount of review. It’s been through a bunch of commtees and a untold number of town hall meetings. How many bills are the subject of that much scrutiny?

9. Illegal immigrants get coverage without paying taxes, what is to stop thousands of Canadian and Mexicans coming to America for treatment of whatever ails them.

That’s a myth, both bills exclude illegals from getting any coverage, and certainly not free care.

10. What are the details, co pays, what is covered, who decides and how.

I’m not writing the details of 1000 page bills here. Read the bills or the summaries. There is a required basic coverage for preventative care, hospital stays, drugs, mental health and substance abuse.
Read Ezra Klein’s summary of the House Bill
http://voices.washingtonpost.com/ezra-kl ein/2009/07/the_house_releases_its_healt h-.html

11. The Canadian, French and British systems are nothing to be proud of.
This is not a question. But all those systems cover their citizens and for less. Both left and right wing in England support their health system, http://www.conservatives.com/News/News_s tories/2009/08/We_are_proud_of_the_NHS.a spx

12. Do you think the Veterans and medic aid programs are that great how about Indian reservation care?

Veterans seem to like them. http://ajm.sagepub.com/cgi/content/abstr act/17/4/155

13. How do we pay for another TRILLION dollar program.
Is Washington being honest about how they want to pay for this.
The trillion dollars is over 10 years. The Bush Tax cuts that started in 2001 have cost well over 1 trillion dollars, do you feel richer because of them? About half will be due to savings in Medicare delivery, new competitive bidding in Medicare and reduced fraud. The House bill covers the rest by a progressive tax on any income earned above $350,000, the maximum would be an additional 1.5% on any income over $1 million.

14. How willing are you to pay taxes on your benefits so those that don’t work are covered.
When it becomes free people abuse the system. (600 ambulance rides in a recent story).

Since some good friend can’t get coverage due to pre existing conditions, I’m fine with it, but as stated above, most people won’t. And it’s not free, you’ll still be paying premiums and some co-pays, even on the public plan

15. The devil is in the details, they have not been very forthcoming with the details.

It’s in the bills and summaries if you spend time to look at them. It’s a big topic so there’s not a one sentence explantion

16. What will the standard of care be?
Meaning what? I already covered the basic required coverage above.

17. The current House bill is a job killer, how is a small business going to be able to do this.
How many small businesses will be put out if this passes? (two of my children are employed by small business)

Actually the bill benefits small businesses. In the house bill, businesses under payroll of $250,000 wouldn’t be required to provide insurance, and companies up to a large amount would get a tax credit to help them pay for insurance.

18. The Government already controls 46% of health care decisions. They set the payments for Doctors and services. They mandate the minimum’s a doctor can charge. They set up the payment tables. My bet is they don’t adjust them very often. There is no free market competition.

Insurance companies do much the same thing. Just as no doctor is required to accept Medicare, no doctor will be required to accept public plan patients. If it’s too low, people will go to private insurance, that’s free market competition. People could do, that since under both bills they can’t be turned away for health status.

19. The 8% solution: The house bill says employers who do not offer health care pay a 8% tax.
Average cost of benefits exceeds 8% it is usually 10 to 14% of payroll cost. Many businesses will elect to drop coverage and pay the tax. How does that help the employees?

The house bill has a gradual penalty that starts at 2% and goes up to 8%. If an employer decides not to offer insurance, then the employees can get individual insurance, either private insurance or the public plan, either way the bills say they can’t be turned down due to health reasons and wither way there are tax credit for individuals who make under 400% of Federal Poverty Level ($43,800 for singles $88,000 for families).

20. Mandated health costs will increase the price of everything a $10 pizza will be a $13 pizza.
This is also not a question, Like I said, the tax will affect people with incomes above $350,000. A big part of the reform is to bring prices down. If more people can get a check-up and catch something ahead of time, instead of going to an ER when it becomes life threatening, the costs to them , insurance companies or the govt (who ever ends up paying) will be much less. If we can encourage hospitals to use electronic records,so a new doctor can see recent tests rather than do them over again, that saves money, If everyone has drug coverage and can benefit from the bulk buys that insurance or the govt can do then that saves money. Currently insurance premiums are rising at a rate much higher than inflation. That cuts into everyone’s pizza budget.

 

This is funny because the GOP has nothing to do with health care. The Dems have the majority and could pass it without the Republicans but even the Dems see how destructive this health care plan is LOL

Posted by gary | Report as abusive
 

James makes some good observations and many good point.
Let’s look at them
1. Many people love to criticize the government for not being able to run anything right. While it is true that the government makes a lot of mistakes, it is also true that the private sector makes just as many. Government and private sectors are run by PEOPLE. The economic crisis we find ourselves in were largely a result of private sector making some bad decision. General Motors , Lehman Brothers, toxic assets, bailout. On the flip side, last month we celebrated the 40th anniversary of one of America’s crowning achievements courtesy of NASA…sending a man to the moon and back. A government feat that no private enterprise has been able to replicate to this day.

2 Malpractice lawsuits certainly drives up medical costs.
And many Americans would like the government to put a cap on lawsuits. Of course, this would require injecting the government into the free market…something conservatives have railed against. If the government can control lawsuits then why not control insurance company premiums….or doctor’s fees. I’m all for starting with the lawyers…but I wouldn’t stop there,

3. Right on. Let’s really get serious about medicare fraud…in fact all fraud!!!

4. Healthy lifestyle. Excellent. People should be rewarded for being healthier. But that’s an uphill battle unless We also penalize soda, candy and fast food companies that advertise products that contribute to unhealthy living. Are we ready to do that?

5. Health care is a right. I believe that if a baby has a right to life there also must be a right to medical care that supports that life. People are dying of AIDs not because we don’t have the medicines to save them but because they can’t afford the medications and patent laws to protect drug company profits don’t allow them access to more affordable generic AIDs medications

6. Yes, there is a serious shortage of primary care physicians…in part because primary care doctors are at the bottom of the physicians pay scale. Just providing insurance for everyone may not solve the problem if there is a shortage of doctors. However, increased demand should take care of that over time

7. Read and judge for yourself if Massachusetts model is worth trying
http://www.google.com/url?sa=t&source=we b&ct=res&cd=2&url=http%3A%2F%2Fwww.hsph. harvard.edu%2Fnews%2Fpress-releases%2Ffi les%2FMassHealthReform2008_Topline.pdf&e i=zBmNStOiOoH4sQOn2ezyCQ&usg=AFQjCNE64BV VIieMDHi019O0ZSmgBACOoQ&sig2=FIjXRx6yg6f mNJmhUctqag

8. I agree. As long as we keep discussing this like adults, we should keep the discussing going. When it degenerates into shouting matches, slogans and slurs, it’s time to end the public discussion and let legislators go to work. That’s what we pay them to do.

9. There is NO provision that would allow illegal aliens to get health care coverage under the democratic plan.
If you have other knowledge please site which plan and a quote from the plan to support your statement

10 Agreed. The democratic plan…and the republican plan..are too vague at this point even to begin debating. There are 5 democratic plans out there with a lot of details but no single plan has actually been decided upon. The republican plan is only 4 pages long and not worth discussing without more details.
What lawmakers need to do is get back to Washington and hammer out a plan that can be debated. Right now all we have is a bunch of ideas.

11. The World Health Organization ranks health outcomes in France as #1, Britain #17, Canada #30 and the US #37
If you have issues with the world health organization you can examine poll data from each country mentioned to determine what their citizens think of their health insurance and health care system

13. Obama claims that he will not increase the deficit to pay for health care. Instead he proposes cuts, administrative savings and raising taxes on those earning over $250,000 a year. It remains to be seen if he can achieve these targets. He has said he will not sign a health care reform bill that increases the deficit.
That remains to be seen. The Trillion dollar price tag is spread over 10 years…100 billion a year (about what we spend in Iraq and Afghanistan)

14. Health care premiums are not taxed even though they are part of an employees pay package. This is an inequity in the tax system favoring those are employed by others. Self employed people do NOT get this tax free benefits. It is unfair and should be eliminated. Most people would be opposed to paying taxes on their health care benefits. But it still is unfair to the millions of self employed Americans who have to pay 100% of their own heath insurance premiums and do it with AFTER tax dollars.

As far as abusing the system, people are abusing the system we have right now…and the cost is being shouldered by the rest of us.

15. Yes. The devil is in the Details. Congress needs to get to work and come up with a detailed proposal that everyone can start debating. There’s too much smoke and no flames, as they say.

16. Who knows at this point what the care standards will be??

17. Know one knows yet how this will affect small businesses. The plan has not been hammered out yet so no one knows how small a business has to be in order to be exempt from providing health benefits to employees

18. Other than medicare, the Federal government doesn’t set rates for doctors. As far as Medicare goes, if the government sets medicare rates too low, doctors will opt out. In many cases they have begun doing just that. Once too many doctors opt out, Medicare will have to raise it’s rates in order to re attract doctors. That’s supply and demand.

19. the concept of employer mandated health care needs to be rethought. In most developed countries, the government pays for health care. Not businesses. This is one reason why American businesses are at a disadvantage. Foreign companies do not have to pay health care costs. Health care is paid for by their government. So These countries can produce more cheaply than US companies.
The concept of businesses providing health care is an unintended outgrowth of post World War II when the US had price and wage controls. One way to attract workers back then was to offer them heath care.

20. Right. Health care cost will increase prices since businesses pay for worker’s health care. Problem is the vast majority of Americans like it that way. There hasn’t been any serious movement to delink businesses from their responsibility to provide health care for their workers. Americans have come to expect it as a part of their employment package.

Posted by Norris Hall | Report as abusive
 

Yeah, remember all that talk about the whether the Republicans should just “go it alone” on Social Security reform because they have the votes and don’t need Democrats? Oh, wait, never mind. . .

If medical costs aren’t being addressed through any other method than rationing, the bill is a loser – and deservedly so. Why is tort reform not even on the table in this debate.

Increased personal control would incentivize people to scrutinize their medical costs more closely. Get rid of employer-provided health care and make people responsible for themselves. Give poor people “insurance stamps” to help them buy what they need. Allow nationwide competition – as all the “public option” freaks admit, competition lowers prices. The big problem is cost, and if the gov’t takes over, the only answer will be rationing. Use market principles to lower costs through the “profit motive” – i.e, incentives to lower costs through greater efficiencey. Profit motive doesn’t incentivize raising prices, since raising prices above market price lowers revenue; instead “profit motive” exerts downward pressure on costs. This is what we need, not gov’t rationing.

Posted by Dave H | Report as abusive
 

WHAT IS THE PUBLIC OPTION DEFINED? IT MEANS THAT SOMEONE ELSE PAYS FOR IT AND NOT YOU. IT’S A FREEBIE. IT’S AS IF A MONEY TREE IS IN YOUR BACKYARD. IT’S A BELIEF THAT YOU ARE ENTITLED TO HEALTHCARE AS A RIGHT FOR FREE AND SOMEHOW A DOCTOR WILL JUST HAVE TO RECOGNIZE THAT THEY ARE NOT GOING TO GET PAID FOR YOUR DOCTOR SERVICE BECAUSE YOUR ENTITLED. IT’S WELFARE AND WELFARE MENTALITY. I’M A DEMOCRAT BLACK AND MY GRANDFATHER 200 YEARS AGO WAS A SLAVE AND NOW YOU OWE ME EVEN THOUGH I’VE NEVER BEEN A SLAVE AND I CAN FREELY MOVE TO AFRICA. I’M GAY AND I HAVE AIDS AND YOU PLANTED AIDS SO YOU OWE ME FREE HEALTH CARE. I’M A UNION WORKER AND I CAN WRECK GM AND CHRYLSER BY GOING ON STRIKE AND I JUST PLAIN GET MY WAY THROUGH STRIKING AND YOU BETTER GIVE ME FREE HEALTHCARE BECAUSE IF NOT I’LL GET MAD AND PICKET YOU. I’M A WHITE WOMAN WITH INTER-RACIAL KIDS AND MY BLACK MAN THOUGH NOT AROUND HAS TOLD ME THAT WHITIE CAUSED ME TO BE ON WELFARE WITH MY MIXED CHILDREN AND BECAUSE OF THAT YOU THE WORKER OWES ME. I’M A BLACK WHO WITHOUT AFFIRMATIVE ACTION CAN’T GET A JOB, I DON’T STUDY AT ALL AND I PLAY BASKETBALL ALL OF THE TIME BUT ACORN TOLD ME TO VOTE DEMOCRAT AND YOU WILL GET EVERYTHING GIVEN TO YOU WITHOUT WORKING FOR IT.

IN CONCLUSION, HEALTHCARE DOESN’T GROW ON TREES AND NEITHER DOES MONEY. MOST PEOPLE WHO ADD VALUE TO AMERICA WORK UNLESS THEY ARE TRULY DISABLED (UNLIKE WELFARE RECIPIENTS). YOU ENTITLED DEMOCRATS USE THEIVERY AND MYTHS TO PROJECT THAT YOU ARE A VICTIM AND ENTITLED TO A FREE RIDE. YOUR NOT

Posted by Nancy | Report as abusive
 

Norris (and Chrisfs) make some good points here; especially on the topic of public vs. private. We Americans love to call the government out on all the mistakes they make – and we certainly have every right to do so. After all, it’s supposed to work for us, right? But where is all this trust for the private sector coming from?

Let’s not forget the miscues by the financial industry which plunged us into this recession or the scandals at Enron and WorldCom that happened before that.. or the IT bubble burst that happened before that. Even Republicans were talking about a stronger government hand earlier in the year when it became apparent that the lending industry was out of control. But now that the topic has changed to health care, they’re singing a different tune.

I don’t know how anyone can claim the private health care industry is efficient when they obviously can’t control the costs. So do we wait until we have a collapse like we saw in the lending industry before we try to fix it?

The conservative argument is suspicious and reeks of cherry picking. As Norris points out, they don’t want the government active in the industry but they want tort reform – which is the government being active in the industry. I guess having the government involved isn’t so distasteful as long as they are protecting the right people.

Posted by Justin Perry | Report as abusive
 

I think this is one of the best articles about the issue I’ve read.

 

I’m against the public option and I may not agree with everything here but it’s refreshing to see some non-confrontational replies (except from “Nancy”) from both sides. I wish it was always like that.

Posted by Rick D. | Report as abusive
 

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