Blue Mass Group

Reality-based commentary on politics.

Lehigh boots it again, this time on health care

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How do you solve a problem like Scot Lehigh? How do you hold a moonbeam in your hand?

Yes, the CBO costed out a not-finished, in-progress, incomplete version of a Senate health care bill, and found it wanting. That's to be patched up, but it's a real, substantive issue. But to Lehigh,

 A bigger issue, however, is whether liberal overreach will get in the way of possible bipartisan accomplishment. The critical issue there centers on proposals for some kind of public plan for health coverage.

Oh really? Liberal overreach? Overreach supported by at least 65% of the public. Some overreach. Sounds more like a mandate to me — something for which you'd get punished if you didn't do it.

No, don't you see, the real goal is bipartisanship. You see, we have to compromise with people who, explicitly or implicitly, don't want health care reform to pass, in order to pass health care reform.

And is this sequence not a perfect example of circular logic?

Different proposals float around for restricting public plans in ways designed to ensure fair competition. But though the design is tricky, the political test is simple: a bill that can clear the Senate without resorting to reconciliation rules.

Why? Because something as complex as healthcare reform needs the broadest support realistically possible. Democrats shouldn’t attempt to push it through with the slenderest of majorities, under a process Republicans will portray as an abuse of the rules.

You need broad support, well, because you need broad support. For legitimacy, you see. Which you get from having broad support.

Howard Dean had a great line the other day about Kent Conrad's supposed “co-op” compromise: It solves the Senate's problem, but it doesn't solve America's problem. And unfortunately, Lehigh is writing primarily about the Senate's problem, and without much logic, either.

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  1. was seemingly able to do whatever he wanted, ramming things like the Iraq War and the Patriot Act down everyone’s throat, opposition be damned. But Obama needs the support of each and every right-wing lunatic or his proposals are presumably DOA.

  2. oppose favor a national health-care plan.

    Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine.

    But don’t listen to them – the AMA and its core of elite retired doctors know better!

  3. In the far-left liberal mind, you seem to read whatever you want into what’s a “mandate.”  I quote from your source of that mandate in the box below.

    <

    p>Operative phrase: opinion is “highly moveable”  

    <

    p>As details of the Kennedy national healthcare takeover emerge, and cost estimates are floated, the price tag keeps increasing.  Perhaps people will tell pollsters they want “reform,” but when the bill is presented, they change their mind.

    <

    p>Politicians know this.  Scot Lehigh knows this.  The Congressional Democrat leadership knows this.  And Obama knows this.  Hence the rush to shove legislation through before the check arrives at the dinner table.

    <

    p>

    Six in 10 Americans agree that getting health care reform is “more important than ever” but only four in 10 are willing to pay more for health reform, according to a new poll conducted for the Kaiser Family Foundation.

    The national survey found that public opinion is “highly moveable” on what President Obama has defined as the country’s most important domestic issue.

    A key question in the survey asked what opinion came closest to that of the voter. The options:

       * “It is more important than ever to take on health care reform now.”
       * “We cannot afford to take on health care reform right now.”

    The results: 61 percent agreed that it is important to act immediately, while 35 percent said the country can’t afford it.

    <

    p>The point is the 35% in the last line will grow as more is learned about the real cost of this plan.

  4. . . . there are some real problems with the President’s approach.

    <

    p>In particular, there is a failure to recognize that greater access — which HAS to be job one — raises costs, at least in the short run, if not for longer.  You don’t solve that problem by reducing federal appropriations to Medicare.  You solve it by raising taxes to pay for something we all know is important.

    <

    p>See more here, please, http://runningahospital.blogsp…  This field is more complicated than anything I have seen before.  By trying to obtain global change in one piece of legislation, you create lots of unintended consequences.  Better to take it a step at a time, as we did in MA, rather than to confidently act as if you know all the answers today.  Nobody does.

    • by saying that I love your blog and the fact you come and post on these issues.  You know a lot more than I do about these things and we really value your input.

      <

      p>It seems to me that everyone wants the other participants in the healthcare system to “reform” but no one will gore their own sacred cows.  So I’d like to know, where do you think your own interest group (http://www.aha.org/aha/advocacy/health-reform.html) is wrong or is over-protective of their self-interest?  Readmissions?  New reimbursement codes and bundling?  Comparative efficacy research (and downstream reimbursement changes)?  You’ve never shied away from controversial statements previously so I’d be surprised if you didn’t have opinions here.

    • Better to take it a step at a time, as we did in MA, rather than to confidently act as if you know all the answers today.  Nobody does.

      <

      p>If the debate between the Republican and Democrats was what’s the best way to get everyone access to proper health care (or the US was a one party state like MA), I’d say your point is dead on.  That’s not the debate, however – the Republican party (and far too many moderate Democrats) want to let the market decide who has health care.  If the Dems don’t maintain control of the House in 2010, any incremental reform will be dead in the water.  If Obama doesn’t win in 2012, it’ll be dead then – and no matter how bad the GOP looks today, we don’t know what’s going to happen in those elections.    

      <

      p>The party that wants to expand health care is in power, it’s time for them to implement a big, bold program filled with mistakes we don’t yet know about.  Then, we can fight over the best way to fix the problems, not whether poor people should have health care.  

  5. has got to end.  Bipartisanship for its own sake is totally meaningless.  The point is to get through something that works.  If something works, no one cares who voted for it.  

    <

    p>The National Journal weekly bloggers poll in which I take part asked this last week: “Politically, how important is it to President Obama that health care reform be bipartisan?”  There was quite a diversity of opinion on that question from both lefty and righty bloggers.  I answered “Not at all important,” and explained as follows:

    <

    p>

    What’s important is that he get it passed, and that it works. If it works, no one will care if no Republicans voted for it. And if it fails, no one will care if it was the most bipartisan bill ever.

    <

    p>Only the punditocracy cares about whether something is “bipartisan.”  Normal people just want policies that work.

    • Of course, your position here is logical and it is certainly true that new laws that have little appeal to anyone or simply don’t work aren’t made any better because they represent a bipartisan compromise (DOMA anyone?).

      <

      p>However, your “not at all important” approach is unnecessarily short-sighted both politically and as an approach to policy-making.

      <

      p>Any new law or, especially, a major reform is more likely to be used as political cannon fodder (and/or ultimately fail as policy) if it can be easily characterized as only the policy prescription of a single party.  Do you think “eliminate the Bush tax cuts” would have been such an effective political position for the Democrats in 2006 and 2008 if Cheney hadn’t had to be called in to cast the deciding vote?

      <

      p>On the other side, imagine that the Patriot Act was passed on a narrow partisan vote rather than getting only one no vote in the Senate (Senator Feingold).  It’s hard to believe that what I and many, many others still feel was a fundamentally flawed serious of “reforms” would really have sustained itself if it is true that “no one will care if it was the most bipartisan bill ever.”    

      <

      p>I hope Obama stands ready to abandon “bi-partisanship” should it become necessary to pass workable health reform that truly provides universal access and cost containment.  But disagree that this carries few if any practical, policy or political consequences in the long run.

      <

      p>

      “It serves always to distract the public councils and enfeeble the public administration. It agitates the community with ill-founded jealousies and false alarms; kindles the animosity of one part against another; foments occasionally riot and insurrection… A fire not to be quenched, it demands a uniform vigilance to prevent its bursting into a flame, lest, instead of warming, it should consume.” – President George Washington on partisanship

      • … that the ‘rightness’ or ‘effectiveness’ of legislation is a characteristic that is independent of its ‘bipartisan-ness’. If the goal is to be bipartisan, then it simply must be stated that this is different than a goal to enact good governance and effective policies.  

        <

        p>It has been interpreted that the real manner of the GOP’s current polling woes is their failure to govern.

        <

        p>John Dean:

        If I could turn on a blincking red light to catch a reader’s attention, to give him a heads=up to alert him to pay attention, I would place it next to the following observations of political scientist Alan Wolfe:* “Political parties expend the time and grueling energy to control government for different reasons,” he explained, viewing politics with his wide-angle lense.

        Liberals, while enjoying the perquisites of office, also want to be in a position to use government to solve problems.  But conservatives have different motives for wanting power.  One is to prevent liberals from doing so; if government cannot be made to disappear, at least it can be prevented from doing any good.  The other is to build a political machine in which business and the Republican Party can exchange mutual favors; business will lavish cash on politicians (called campaign contributions) while politicians will throw the money back at business (called public policy).  Conservatism will always attract its share of young idealists.  And young idealists will always be disillusioned by the sheer amount of corruption that people like Gingrich and DeLay generate.  If yesterday’s conservative was a liberal mugged by reality, today’s is a free-marketer fattened by pork

        …

        I have taken little joy in writing this book.  Frankly, I once believed Republicans would be good at governing.  But I was wrong: They have demonstrated that they can only rule for limited periods.  As used in the pages that follow, “governing” is a craft, a skill, even an art; it is an effort to find common rules under which all can pursue happiness; “ruling,” by contrast, is merely reigning and exercising power.

        *Alan Wolfe, a Ph.D. from the University of Pennsylvania, is a professor of political science and director of the Boisi Center for Religion and American Public Life at Boston College, and a Prolific Author.

        <

        p>Simply put, it may be a better outcome for the will of the people if we just stop worrying about bipartisanship when in those areas where the outcome of good governance is outrageously important, such as it is in this case.

        • No amount of (ultimately repeal-able) health reform is worth it if it means Republicans ride the wave of “no socialized medicine” back to legislative majorities in 2010.  Or, god forbid,  Mitt Romney wins the Presidency on the “End government-run health care.  As I did in Massachusetts, I’ll responsibly reform health care without taxing your employer-sponsored insurance, taking away your doctor or having government bureaucrats ration your care” platform.

          <

          p>I have little confidence that whatever the Democrats alone could approve (even if it includes a robust public plan) will be so inherently “good” and above attack that it won’t be usable as a political hammer.

  6. Instead of a debate about single payer and a compromise on a system of greater competition — everyone gets medicare as an option — the debate is turning into a “can we afford it” discussion. The insurance companies and their big paycheck bosses should be very pleased.

    <

    p>Oh well.

    <

    p>That said, I didn’t think Lehigh’s article was so bad. He’s right at least with respect to his diagnosis if not, in my opinion, his prescription.

    <

    p>As to Obama, he has been very explicit for a long time that he prefers solutions 85% of the Senate can endorse if relatively small modifications can produce such a result. In The Audacity of Hope he describes how alienating and destructive he felt the Bush administrations 50 + 1 approach to government was for the country. But, that’s a big if.

    <

    p>The fact of the matter is that this debate pits a small but rich health care cabal with perhaps  25% of the country behind them for one reason or another against a solid majority of perhaps two-thirds that recognizes our current health care system hurts our economy, provides very poor quality health care, or none at all, to a large and rising fraction of the population (including most people with insurance … I’m still getting incorrect bills for a procedure two years ago and I believe that is the norm for pretty much everyone who goes to the hospital), and is completely unsustainable even at that pathetic level of performance.

    <

    p>The power and desperation of the oligopoly will always ensure that this issue remains a political football. The debate needs to be framed as “America versus the malefactors of health wealth.” If Scott Lehigh wants to bang the drums for Richard Scrushy and his friends, God bless him.

  8. While conservatives have self-destructed cyclically by overreaching each time (51% becomes “Ah got me some political capital and Ah’m gonna spend it”), I feel like I’m still waiting for the first instance of “liberal overreach”; our tendency as a group is to shrink back from the prospect of success at the precise moment it’s within our grasp (“Don’t Ask, Don’t Tell”, anyone?).  But that’s a topic for another post.
  9. Underreach is the real danger here; single-payer is not just the romantic solution, it’s the only payer-side option that incorporates a mechanism by which costs will be reduced.  Any compromise solution exposes us to spending billions of taxpayer dollars without either reducing costs or improving care (see next bullet).
  10. This now-infamous New Yorker article should be mandatory reading.  Unless we can replace a financially-driven system on the provider side with one that is patient-centric and incorporates a team approach, it won’t matter who pays; outcomes and costs won’t improve.

  11. works in a system that does not practice what he preaches.  Does that suggest anything to you about the acceptability of his policy prescriptions?

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