Government Healthcare or Bust

November 19th, 2009 at 8:28 am David Frum | 26 Comments |

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In Sen. Reid’s bill as in the House bill, Priority 1 is the creation of some kind of government-run plan. The Dems are willing to accept that the plan won’t be offered in all states. They are willing to allow private insurance to coexist alongside the government-plan for many years to come. They are willing for the government-plan to retain many features of private insurance – premiums will be based on the allowed risk factors, not on “ability to pay.” They know that all those concessions will gradually erode. The key thing: establish the government-run plan now. Drive private insurers out of the market gradually. Shift only slowly from insurance-like finance to tax finance.

On that line, the debate is joined. Democrats now must worry: how many of their own senators will they lose in the final march to a state plan? How rough will their tactics have to be? How real is the risk of backlash?

If the bill does fail, future historians will wonder this:

What if President Obama had chosen a different path? What if he had told Congress in his 9/9 healthcare speech:

“I continue to support the public option personally and will work for it to be established later. For now, my priorities are (1) insurance reform, to outlaw the practices that most offend Americans, and (2) to create exchanges like those created by Gov. Romney in Massachusetts so that individuals and small businesses can buy insurance at the same favorable prices paid by large employers. We’re going to have an individual mandate to buy insurance – and subsidies to help those who can’t. We’re going to shift regulation of health insurance from the states to the federal government, so that we can write a single, predictable set of rules, rather than 50 different rules that allow lobbyists in places like New Jersey to push insurance prices up and up and up.”

Republicans could never have said no to that. He would have pushed his program through in a week. He would not have the cost problem, but then the current problem does not solve the cost problem either. What he would have done is open the door to market-driven change in the existing American system … to a gradual shift from employer-provided healthcare to individual purchase from a menu of regulated choices … without creating a new government entity. If further regulations were needed, they could be added later.

Such an approach would not have satisfied the desire of Democrats for a great 1964 or 1935 style messianic moment: “We’ve created healthcare!” But it would have expressed a broad national consensus, solved problems that people actually cared about, and put the country ahead of ideology.

And it would have been law by now.

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26 Comments so far ↓

  • ottovbvs

    …….Who are you kidding David?……the Republicans would not have cooperated in the passage of any sort of serious healthcare with or without public option because this is not about healthcare for them it’s about politics…….perhaps you’d like to give us a few examples of where we’ve seen evidence of this cooperation on any matters……as Grassley famously said even if the finance committee passes a bill that includes everything I demand that doesn’t necessarily mean I’m going to vote for it.

  • Raider1

    Otto you couldn’t be more wrong. Believe it or not there are those on this side of the aisle who care about the county. With deficits out of control, aware that no government health plan (medicare, medicaid, MIMA) has EVER come in even remotely on budget, aware that fraud will run rampant as government will have no incentive to remove waste and inefficiency, with the prospect of ever higher taxes with little to show, knowing that the private market will be driven out of the business leaving poorer delapidated government run helathcare as the only option, and in general believing that the federal government is too large as it is and that a bloated and centralized government has been shown to destroy rather than build up the nations it ends up subjugating in the end, destroy personal liberty and economies, we cannot fathom why this is such a holy grail for the left. For us, this is very much a debate not about “making Obama look bad” but we feel that the future of the United States and the principals it was founded upon are in very real jeopardy here. They truly believe, as I do, that blinded by their dispoven ideologies, believing in the misplaced role of government not as referee and supplier of national security, but rather a wealth redistribution vehicle whereby it is the state that is obligated to take care of people from cradle to grave–personal responsibility be damned–the Democratic Party’s vision will do great harm to this nation if enacted into law.

    Blinded by ideology yourself, (whichever Otto you are today that is) unable to even comprehend that there is another vision of what this country should be, you are incapable of seeing any motive but cynicism in the opposition. You probably do not even see yourself as left of center but rather, well, “reasonable” and therefore the opposition must all be neo-nazi nut jobs. It is the typical self-delusion of the self-righteous liberal. Liberals always think they are the only ones who “care”. As the past 50 years of Great Society destruction has shown, with friends like you, the poor, the downtrodden, the minorities need no enemies. We see this. We are opposed to reinventing this country and creating an image of European statist malaise whose welfare states are destroying the continent, and whose effects are only now being seen, cracks only now appearing in the dam.

  • sinz54

    Frum: Republicans could never have said no to that.
    Well, SOME Republicans, at least, could not have said no to that.

    Among Repub Senators, Obama would likely have peeled off Snowe and Collins to vote on health care reform. And he would have had a chance with a few other moderates: Lugar, Voinevich and maybe even McCain, who had tried to get modest health reforms passed in the 1990s.

    Instead, the partisan Dems–we want a public option now with no triggers and no restrictions–alienated even Olympia Snowe, who had tried to work with the Dems for months only to find her proposals trashed in the end anyway.

    The public option was the deal-breaker. If Dems truly wanted any Repubs to vote with them on health care reform, the public option had to be restricted. The Dems said no to that, and that was that.

  • MI-GOPer

    Raider, you’re wasting your breath on trying to get automaticBS, the Frum Forum’s Village Idiot, to listen to reason or anything that even remotely compliments a GOP effort.

    The House GOP, the Senate GOP, the RNC Chair, the Association of State GOP Chairs, the Midwest RNC Caucus, the Bush Administration and all GOP Administrations going back to Reagan in 1980 have advanced real alternatives for health care reform –but they’ve been unwilling to do what the Democrats seem intent on now doing: 1) declare War on Medicine, 2) cut senior benefits in MediCare but give them a $500 bribe to shut up, 3) push out the private sector from the health care insurance marketplace, 4) keep the trial lawyers happy and prospering, 5) make the big drug companies fatter, 6) put federal bureaucrats in charge of grandma’s medical treatments and 6) encourage the sick and infirmed to “move on” with their life decisions so that scarce resources in the system can be used for real medicial issues like paperless records and 30 hr work weeks for interns.

    Oh, I forgot, 7) create a national union for nurses. That’s important if unions are going to survive, the Obama must carve out new niches for union goons to prosper, too. Health Care Reform demands it!

  • MI-GOPer

    David writes: “Republicans could never have said no to that. He would have pushed his program through in a week.”

    I agree David. The Obama and Democrats have literally hoisted the opportunity for health care reform –and a meaningful attempt to restrain health care costs– on the petard of pure partisanship.

    It’s a shame that a masterly crafty political animal like Obama missed his best opportunity to secure victory. Now, he’ll be lucky to get all his fingers back as defeat snaps its jaws shut on health care reform.

    And he’s awaken the Sleeping Giant of Angry American Taxpayer & that informs or impacts public opinion. This may be the moment that we all look back and say, this was when Carter’s 2nd Term began to unravel.

    Obama will never be able to slow the inevitable slide in the polls. A one term wonder isn’t beyond a real possibility now… and to think the air still held the Democrats’ words of announcing the fateful end of the GOP just a few short months ago? LOL.

  • balconesfault

    David

    All of those sound like good, Republican proposals for healthcare reform. It is a shame that Bush and the Republican-led Congress didn’t push them through 6 years ago, and we could now be judging their effectiveness.

    Obama ran for President on the pledge that he would make a Federally-run healthcare plan available for people to buy into. This wasn’t some pocket pledge, but something he made a centerpiece of his campaign – what kind of healthcare reform would be proposed was a major subject of the Democratic Party Debates all through 2008.

    Again, “insurance reform” that would include required coverage for pre-existing conditions – one of the major problems Americans want addressed – structurally requires the individual mandate in some form, to keep people from staying off insurance until they absolutely need it and then demanding coverage. At the same point, requiring coverage for pre-existing conditions will give insurers a justification for further raising premiums, and forcing people to buy insurance will only push a larger amount of American’s hard earned money right into the pockets of the insurance companies.

    In essence – you’re saying that the Dems would do best if they pushed through a plan that really went against the interests of the Democratic Party. As I said, the Repubs had years to do that. Now it’s time to acknowledge that the voters spoke.

  • ottovbvs

    Raider1 // Nov 19, 2009 at 9:17 am

    “As the past 50 years of Great Society destruction has shown, with friends like you, the poor, the downtrodden, the minorities need no enemies. ”

    …….Yes there’s a huge groundswell of demand to repeal SS from the new deal, and Medicare/Medicaid from the great society…..I suppose no members of your family have participated in Medicare or SS…….one of these days you’re going to have to grow up and recognize that most Americans love these programs just as they are going to love universal healthcare……you’re going to have to recognize this is 2009 not 1809……that federal and state govt spend over 4.5 trillion a year……that the last time your party had control of the purse they doubled the national debt, that was and improvement on Reagan who tripled it…….basically you’re like kids you can’t be trusted with matches

  • ottovbvs

    MI-GOPer // Nov 19, 2009 at 9:30 am

    ……more wisdom from our MI lawyer (or laid off clerk)

  • MI-GOPer

    automaticBS notes: “… basically you’re like kids you can’t be trusted with matches”.

    Bad choice in metphors, there, BS-boi. Need we remind you of the words of Obama’s mentor, fellow activist and oft’ times babysitter…

    “I regret that we didn’t do more. We should have bombed more. We should have burned more. We should have turned America’s main street into a bloodbath with the pigs.” — Professor Wm Ayers

    Want to pick a different metaphor now? Or just call it a day ’cause you got p’wned, sweetie.

  • Raider1

    “one of these days you’re going to have to grow up and recognize that most Americans love these programs just as they are going to love universal healthcare……you’re going to have to recognize this is 2009 not 1809.”

    So what? A crack addict wants more and more crack but is that healthy in the long run?? What was the out of wedlock birth rate among minorities before and after Great Society? And how long do you think a ponzi scheme can last? Yes, Madoff’s so-called investors did quite well for a while too Otto4 (or is this Otto1?) Apparently you don’t pay taxes but RECEIVE them. I am sure you and Alex De Tpcqueville and you would have a lot to talk about.

  • ottovbvs

    MI-GOPer // Nov 19, 2009 at 10:28 am

    ……..in you’re dreams

  • ottovbvs

    10 Raider1 // Nov 19, 2009 at 10:35 am

    “So what? A crack addict wants more and more crack but is that healthy in the long run??”

    ………Another classic piece of reductio ad absurdum………Medicare is crack cocaine and not a hugely socially valuable program that provides healthcare for America’s elderly without forcing them into penury……are your parents on Medicare? ……..and actually I pay rather a lot to taxes even though retired…..de Toqueville visited America in the 1830′s……as I said time to grow up and move to the 21st Century.

  • MI-GOPer

    Ummm, BS-boi?

    It’s “in your dreams”… not as you wrote “in you’re dreams”. But you’re still p’wned… daydreaming of me or not.

  • MI-GOPer

    automaticBS provides some insight why he voted for Barry Obama with this tidbit: “… and actually I pay rather a lot to taxes even though retired….”

    Another Obama supporter put it this way: “Why work for a living when I can just vote for one? Obama helped me get my credit card debt written off. He helped me get my upside down mortgage rewritten and the rate reduced from 10.5% ot 5.25%. He helped me get a new car. He’s ready to give me free medical care. All I want now is a paid 3 week vacation and free food. Why work for a living when I can just vote for one?”

  • ottovbvs

    MI-GOPer // Nov 19, 2009 at 11:05 am

    “automaticBS provides some insight why he voted for Barry Obama with this tidbit: “… and actually I pay rather a lot to taxes even though retired….”

    ………..do you know what a non sequitur is?…….probably not

  • ottovbvs

    MI-GOPer // Nov 19, 2009 at 11:00 am

    ” It’s “in your dreams”… not as you wrote “in you’re dreams”. But you’re still p’wned… daydreaming of me or not.”

    ……and this is a guy who spouts paras on the subject of pedantry……it’s hard to make you up mi-goper…….lack of self awareness is fairly common amongst the right wing experts here but your (sic) in a class by you’re (sic) self

  • MI-GOPer

    AutomaticBs needs the dots connected for him?

    OK, BS-boi.

    Your reply at 15? your “retired” status is linked to not having to work for a living. Who’d have thought you were a loafer on society’s dole? Jeepers, not me.

    Can you stick to coloring between the lines, now? Or maybe you’d like to move on in the coloring book to “Obama for Dummies”?

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  • MI-GOPer

    David, there are so many Democrat promises out there that it’s going to be so difficult for the Democrats to act and not be shown up as the liars they’ve become.

    Obama’s promise not to raise the deficit with “reform”.

    Obama’s promise not to cut benefits of seniors on MediCare.

    The Senate Leader’s promise to be transparent.

    The Speaker’s promise not to pass a bill that didn’t contain the Public Option of Govt Control.

    Stupak’s promise not to allow abortion funding with govt subsidies.

    It’s an incredible example of a lack of political discipline on the part of so many ill-intentioned liars. When the music stops, the liars will still be standing and a few liars will be seated. But the only thing that they share as a value will be crass partisanship and lying.

  • sinz54

    balconesfault: It is a shame that Bush and the Republican-led Congress didn’t push them through 6 years ago, and we could now be judging their effectiveness.
    6 years ago, we were already at war,
    and any economist will tell you what happened to the U.S. economy when LBJ pursued both the Great Society and Vietnam at the same time. Bush took enough of a risk with Medicare Part D.

    Even FDR, as you remember from history, gave up on any further New Deal initiatives once the U.S. entered World War II. (Which caused the left-wing of his party, led by Henry Wallace, to walk out eventually.)

    The real question is, why didn’t Gingrich push health care reform when he was House Speaker, and the nation was still at peace. Once HillaryCare got shot down, he had a golden opportunity to introduce GingrichCare. If he had, he might have secured his place in history.

  • balconesfault

    Bush took enough of a risk with Medicare Part D.

    Out of curiosity – which was the more pressing issue at the time. Overall reform of healthcare to try to target affordability, or a prescription drug benefit?

    And please don’t compare this to WWII. During WWII we had 16 million people – well over 10% of the US population – serving in the military. The country was necessarily preoccupied with the war effort in a way that kept the other 85+% focussed on making sure those 16 million could do their job.

    Right now we have 1.8 million in uniform, if you count reservists (and clearly you might as well, given how they’ve been used in the last 8 years). That’s a little over 1/2 of 1% of the US population.

    I would think that the other 99.5% of us could multitask without harming the war effort. And if the war effort is that critical that we can’t multitask, perhaps we need more than 0.5% of the US population involved in it.

  • mlindroo

    Raider1 asks:

    > What was the out of wedlock birth rate among minorities before and after Great Society?

    The 1964 health care reform is hardly the only reason for rising out-of-wedlock birth rates…
    Society has changed and it’s not just “minorities” either. Even Sarah Palin’s daughter is an unmarried teenage mother. Are you going to blame Johnson’s Great Society for that too?

    ottovbvs is right. It’s great fun to read the hysterical things Barry Goldwater, Ronald Reagan & co. were saying about America turning into a communist country if the Medicaid and Medicare reforms were approved. Here we are almost fifty years later and today’s Republicans (even Mark Levin!) do not dare to criticize either program. But they still issue the same old “socialized medicine” warnings about ObamaCare, how it will destroy American civilization as we know it etc..

    MARCU$

  • LFC

    Republicans could never have said no to that. He would have pushed his program through in a week.

    Then why didn’t they offer a bill with all of these points? The only non-fictional thing that they supported in their talking points (it wasn’t even close to being a bill) was tort reform. They couldn’t even back the requirement that people with pre-existing conditions be offered affordable health insurance.

    sinz54 said… Bush took enough of a risk with Medicare Part D.

    And what risk would that be? It was a pander to the older voters, and they never tried to pay for it, not even a little. Risk would have been “I’m doing this, and I’ll a) cut that to pay for it and/or b) raise these taxes to pay for it.” Bush and the GOP did neither. It was a classic piece of politcal pansymanship. That day, the GOP proved they have no spine for deficit reduction.

    Real Clear Politics just had a post called The Party of Fiscal Babies that sums the GOP up nicely on this issue. They need to turn to somebody like Bruce Bartlett if they want to understand what being a fiscal conservative means.

  • sinz54

    balconesfault: Out of curiosity – which was the more pressing issue at the time. Overall reform of healthcare to try to target affordability, or a prescription drug benefit?
    From the Bush for President campaign brochure, 2000:
    George W. Bush’s goal is for every American to have access to quality health care. His proposal for tax credits will help working families buy affordable insurance. Bush will increase the number of community health centers to increase access to health services. Governor Bush will expand Medical Savings Accounts and strengthen and reform Medicare so everyone — especially low income seniors — has access to prescription drug coverage. He believes doctors should make medical decisions, not insurance companies. He’ll sign a Patient’s Bill of Rights that holds HMOs accountable and reduces junk lawsuits, as he did in Texas. Governor Bush will help people afford long term care policies with new incentives. Seniors should not worry about being burdens to their children. And families should get help with the cost of caring for elderly family members at home. He’ll expand research into curing cancer, Alzheimer’s and other diseases, in part by dramatically increasing the budget of the National Institutes of Health.
    http://www.4president.org/brochures/2000/georgewbush2000brochure.htm

    As you can see,
    Medicare Part D was just as integral a promise of the Bush for President campaign, as you claim the public option was of the Obama for President campaign.

  • sinz54

    LFC: They need to turn to somebody like Bruce Bartlett if they want to understand what being a fiscal conservative means.
    They understand what Bartlett thinks it means.
    It means losing elections.

    Belt-tightening and austerity have never won a national election, not ever.
    It was for that reason that conservatives, starting in 1978, stopped talking about belt-tightening and austerity and started talking about economic freedom and economic growth.

    Exuberance is built into the American DNA–living large.

    The only way Americans accept paying off debts is by growing out of those debts: A startup company that gets a loan to start its business and eventually pays off the loans out of profits, etc.

    And that had been the original Republican message since 1978: We’ll promote policies that lead to strong economic growth, which will increase tax receipts, out of which the national debt can be paid off.

    What changed was that the GOP forgot about the growth-promoting part, and started pushing any and all tax cuts as a dogma, rather than as the means to ensuring strong growth. (Not all types of tax cuts will promote investment and growth.)

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