A few thoughts on today's "bi-partisan" health care summit. "Bi-partisan" is in quotes because it will only be bi-partisan from the standpoint that both Democrats and Republicans will be in the same room at the same time.
They can't do that- can they?
No matter what happens tomorrow, I have been convinced since December, and remain convinced, that the Senate is planning on using "reconciliation" to pass a final draft of the health care reform bill with 51 votes, rather than the normally-required 60. Reconciliation is a procedural rule which has been invoked by both Senate Republicans and Democrats over the years.
Reconciliation was intended to be used only in case of an impass on budgetary items- where failure to authorize the necessary spending would cause the federal government to literally shut down, fail to pay its employees, etc. It has been abused by both parties over the years; however, the White House and Democratic leadership in the Senate, rather than adhering to the Constitution, will ram health care reform through, and justify it based on the half-baked excuse that Republicans have invoked reconciliation before, too.
That's certainly true, but does it justify cramming a bill of this magnitude down the throats of the American people, the majority of whom oppose Democratic proposals for healthcare reform- particularly when getting sixty "yea" votes required the now infamous "Louisiana Purchase" and "Cornhusker Kickback" be inserted into the original Senate bill?
In any case, political-fallout-be-damned, Reid's going to push this through the Senate with a simple majority if necessary no matter what happens today. There's a lot of talk about whether Pelosi has the votes in the House or whether the House will vote first, etc. Those issues notwithstanding, if a health care reform bill comes to the Senate floor for a vote, reconciliation will be invoked; fifty-one (or fifty with Biden casting the tie-breaking vote) will be enough. Time to call your senators.
"I can't believe I ate the whole thing."
Hardcore fans of The Simpsons will immediately recognize Homer Simpson's senior yearbook quote- in this case it's a reference to the over-reaching of Congressional Democrats on this issue in their desire to do everything-at-once on healthcare reform. There's an inherent, and reasonable skepticism on the part of the American people when it takes Congress more than 2,000 pages to do anything.
Also, many Americans are fearful of the frenetic pace at which the Democratic Congress has been working to cram its agenda through, and with virtually no Republican support to boot. Against the backdrop of Obama's campaign promises of bi-partisanship and Nancy Pelosi's promise of "no earmarks" this legislature stands out in stark contrast. As the deficit grows more Americans are pushing back against the urgent need of the Democratic majority in Congress and the White House to 'do it all, do it now, and do it by any means necessary.' That's not the change people are looking for.
Baby Steps
President Obama seems to have resigned himself to the notion that, when it comes to health care reform, failure is not an option. His legacy is on the line, or so he seems to believe. It was surprising even to me, then, that rather than "pivot" and move to the center on healthcare reform in his State of the Union Address, as most political pundits predicted he would, Obama remained on the far-Left of this issue and further dug his heels in. This is further evidenced by the White House's release of its health care plan Monday morning (http://news.yahoo.com/s/nm/20100222/pl_nm/us_usa_healthcare), which was largely a re-tread of the same ideas his party has been pushing all along.
If the White House and Congressional Democrats are serious about a bi-partisan solution on health care that the majority of Americans would support, they'll have to do two simple things differently than they have to this point.
First, they would make sure NOTHING in the bill gives any unfair exemptions to any particular groups- no special deals for certain states, no earmarks, no exemptions for union employees if the bill contains a tax on so-called "Cadillac plans" and, most importantly, members of Congress and all federal employees are all required to participate in the same plan or be subject to the same requirements and restrictions as everyone else.
Second, take an incremental approach. No 2,500-page monstrosity- no single bill, but a series of bills which can stand on their own merits and addresses a few agenda items at a time. Reform should begin with the issues about which there is most bi-partisan agreement and work backwards rather than the-other-way-around. Here are five key area where Democrats and Republicans could pass true bi-partisan reform:
1) Medicare Reform
Medicare is rife with waste and fraud. It's so rampant, so profitable, and, apparently, so easy that even the Mafia has jumped in to the business of defrauding the program (http://www.breitbart.com/article.php?id=D9B5OKO01&show_article=1).
Estimates on the amount of fraud perpetrated against the Medicare system each year range from 60-120 BILLION dollars a year! Let's suppose that there are thirty-million uninsured Americans (despite the fact that excluding illegal aliens and households making over $75,000 per year, the number of uninured is probably half of that); eliminating the fraud from Medicare alone would fund 166-333 dollars per month per uninsured American that they use toward the purchase of health care.
Given that every health care reform bill proposed by Congressional Democrats proports to pay for itself, in part, by scrubbing this fraud out of Medicare, three questions come immediately to mind:
First- what exactly makes lawmakers think they can eliminate fraud from Medicare?
Second, assuming that the federal government is competent and capable enough to eliminate Medicare fraud, why haven't they done so before now?
Third, wouldn't proving that they can clean up Medicare be a good jumping-off point for reform? Seriously, is there anything that's been proposed in the entire health care debate that makes more sense? Regulating commerce is an enumerated, Constitutional power of the federal government. If dishonest physicians and organized crime are bilking the American taxpayer out of billions of dollars, shouldn't stopping this be at the top of Congress' to-do list?
If Democratic lawmakers want to claim that this savings, as well as eliminating other "waste" from Medicare, is going to provide much of the funding for their health care reform legislation, how about they prove it can be done and go from there?
Maybe next they can go after the three-billion dollars in unpaid taxes owed by federal government employees (http://voices.washingtonpost.com/federal-eye/2009/12/federal_employees_owe_3_billio.html).
2) Insurance Reform:
This is largely the "let the people purchase insurance across state lines" mantra, which has been a key piece of every Republican proposal for health care reform. Most Democrats have opposed it, mantaining that only a public option will create "choice and competition" and that the 'evil insurance companies' will collude on pricing no matter how many new carriers are introduced into the marketplace for consumers to choose from. I disagree.
Democrats can make this claim all they want- they still haven't offered a shred of proof for that argument, and if allowing competition across state lines doesn't drive down premiums, you still haven't cost the taxpayer a dime in additional governemnt spending. Let's try it and see what happens.
One caveat: this type of reform will be a bit sticky because most insurance plans are regulated at the state level and every state has its own department of insurance and its own state "mandates" as to what provisions policies sold in each state must include. Larger companies which have locations in multiple states do not have to comply with state mandates; instead they are requireds to comply with ERISA- the federal law regulating benefit and retirement plans.
Unlike most members of Congress, I am very wary of intruding on states' rights; however, we've got some very "creative" lawmakers on Capitol Hill these days. I'm sure they can work with the states to craft something which will make mandates more uniform on a state-by-state basis, thereby increasing competition and reducing administrative costs to insurers and consumers.
3) Tort Reform:
This is also a states' rights issue. States like Mississippi and Texas, whose legislatures have passed tort reform, have seen increased access and lower costs as a result(http://www.sfexaminer.com/opinion/columns/oped_contributors/Tort-reform-must-be-part-of-health-care-reform-53083662.html). Trial lawyers are vehemently opposed to it- go figure.
The empirical evidence regarding tort reform needs to be presented at the next Governor's conference, presented to the state legislatures, etc.- put everyone involved including the trial lawyers together and let them make their case, and let each state make its own determination.
The line of demarcation between states that have enacted tort reform and those who have not is already clear- in states that have not enacted it providers are fleeing and malpractice attorneys are flocking. What more evidence do we need?
4) Individual Empowerment:
This one is simple- encourage increased deductibility (higher contribution limits) on contributions made to medical savings accounts; increase portability of health insurance, including (rather than COBRA) allowing individuals who would lose their coverage when they lose (or quit) their job to convert to an individual policy or enter Medicaid for such time as they can demonstrate that they cannot afford individual coverage; finally, allow individuals who purchase their own health insurance the ability to deduct their premiums just as businesses are currently allowed to do.
5) Expand Medicaid:
When Barack Obama was running for President, he vowed to make "affordable" (without defining affordable) to the uninsured and those who can't afford insurance, 'the same coverage members of Congress have.'
As President, he's walked in lock-step with Congressional plans to radically transform the entire healthcare system and specifically exempt members of Congress and other federal employees from participating in the public option that's been proposed. That's not exactly the same thing.
Assuming the fraud and waste can be scrubbed from Medicaid and Medicare, those savings could be used to provide Medicaid coverage to the uninsurable and subsidize premiums for those who cannot afford
to purchase health insurance on their own, whether they use their subsidy to purchase private insurance or pay for access to Medicaid or Medicare coverage.
Drink!
I don't know if anyone is actually planning on watching the health care summit, but the American people will finally have the opportunity to see their elected leaders debate health care reform on C-SPAN just like the President promised...a year-and-a-half ago. Let's face it, little will be accomplished today. Democrats will use this forum to paint Congressional Republicans as "the party of 'no'" and allies of the greedy, evil, insurance companies, validate their parking, and move full-steam ahead on passing their proposal for health care reform with no bi-partisan support. This is merely political theater for the American people- period.
That being said, if you do tune in for this six-hour dog-and-pony show, you might as well enjoy yourself and have some fun with it. You're going to need a drink, so might I suggest you invite your friends over and make a game of it. Depending on how you set up the rules you might need Speaker Pelosi's alcohol budget to get through it (http://www.businessinsider.com/nancy-pelosis-in-flight-food-and-drink-costs-101000-2010-1). You can divide up these catch-phrases amongst the various players or break into teams- I wouldn't recommend everyone drink every time one of these happens, but you can make your own rules. Here are a few suggestions:
1) Each time a member of the summit mentions Insurance giant Wellpoint by name- someone has to drink. (Remember that when I say drink, I mean a sip- not an entire drink; you want to make it through the whole six hours- don't you?)
2) If someone specifically describes Wellpoint using the phrase "insurance giant"- that's two drinks.
3) If someone accuses the Republicans of being obstructionists (can use another form of the word), that's a drink.
4) If they specifically use the phrase "party of no"- that's two drinks.
5) If someone references greedy insurance executives, drink.
6) Someone mentions tort reform, drink.
7) Someone mentions or implies the use of reconciliation, drink.
8) If anyone mentions the United States Constitution, the Founding Fathers, Framers' intent, the enumerated powers of the federal government, or state's rights, everyone playing at home has to finish their drink (don't worry- this won't happen very often).
You get the idea. Feel free to make other rules and send me your suggestions as well. And if anything other than partisan bickering and political posturing takes place, if something substantial happens that both sides can build on...
...I owe you a drink.
