Based on the media coverage of health-care reform, one might think that Obamacare is inevitable. National Review Online wanted a second opinion, so we consulted some of our health-care experts to ask: Can Obamacare be beaten, and how can we beat it?
JEFFREY H. ANDERSON
Obamacare can, and should, be beaten. Only one thing has changed since August: President Obama’s speech to Congress turned a deaf ear to the American people and showed he thinks he can pass his agenda through sheer force of will. So far, the Democrats believe him. But that’s not how American politics works.
Here’s how things would change: Most Americans’ insurance premiums would rise — substantially — as Obamacare would let people wait until they need insurance to sign up for it, leaving others to pay the bill. Obamacare would be paid for by increasing Americans’ taxes, decreasing Americans’ Medicare benefits, and/or leaving America’s children a far greater inheritance of debt. And employers would quickly realize it’s much cheaper to choose the “public option” for their employees, funneling them into the government-run plan, than to continue offering private insurance.
– Jeffrey H. Anderson is a senior fellow in health-care studies at the Pacific Research Institute and was the senior speechwriter for Secretary Mike Leavitt at the U.S. Department of Health and Human Services during Pres. George W. Bush’s second term.
Many believe Obamacare is invincible given Washington’s current partisan makeup. From a political perspective, it’s “too big to fail.”
Politics trumps all, according to this view. It’s the president’s signature first-year initiative. He and the Democratic leadership also signaled it’s a test of their political virility. “Losing” is the only option off the table, so the White House possesses broad negotiating range.
Even Harry Reid’s public-option gambit fits with this “just pass something” three-dimensional chess game. Force a vote on the issue (the full Senate will strip it out) and use that as further leverage to bring liberals on board to a bill without the government-run plan.
Can you stop a partisan steamroller intent on winning at any cost and armed with large majorities in the House and Senate? Yes you can!
Some Democratic lawmakers’ instincts for personal political survival may doom Obamacare. The White House failed to grasp the reality that initial support for the goals of health care would wilt when the public focused on specifics, like costs and affordability. Ironically, the fatal blow was a self-inflicted wound caused by the president’s approach to Congress.
The White House made a huge strategic blunder at the beginning of the year. The president should have insisted on bringing Republicans on board at any cost. Some say that was impossible. I disagree.
True, gaining GOP support required scaling back White House ambitions. But focusing on fixing problems, not overhauling the system, could have attracted Republican votes. He should have used his political capital to fight the Left, not the GOP. Yet hubris, inexperience, and his true partisan instincts prevailed.
Now three or four Democratic senators are forced to choose between fatally damaging their own reelection hopes and compensating for the president’s errors in judgment. In the end, the only thing really “too big to fail” may be these lawmakers’ personal electoral ambitions.
– Gary Andres is vice chairman of research and policy at the Dutko Group Companies and a frequent NRO contributor.
MICHAEL G. FRANC
Can Obamacare be stopped? The answer depends on several factors:
1. How seriously do Democrats, especially those who characterize themselves as moderates, take the voter discontent now raging in their states and congressional districts?
2. In the event a lawmaker concludes that a vote for Obamacare is tantamount to political suicide, does the age-old political instinct for self-preservation kick in, or is there something else at work here? This question is most relevant with respect to unapologetically liberal Democrats who won in center-right states and districts. There are more than a few of them.
3. How many single-issue voters will there be on Capitol Hill when a vote on final passage looms? Will a pro-life liberal hold true to pro-life values and vote against a bill that subsidizes abortion even if he approves of every other provision in the bill? Will regional concerns relating to hospital or physician reimbursement or how a bill might impact large, local health employers (see the concerns of Minnesota’s two liberal senators relating to a proposed tax on the health-technology sector) determine a lawmaker’s vote?
4. Our liberal friends have been working tirelessly for a government takeover of the health system since at least 1944. That’s when FDR used his Annual Message to Congress to proclaim that every American had the right to “adequate medical care and the opportunity to achieve and enjoy good health.” Will the hard Left be unyielding when it comes to realizing this age-old dream and threaten to sit on the political sidelines if they do not get their way?
5. Will the president conclude that winning passage of a scaled-back reform plan is worth alienating his most loyal political supporters?
My guess is that political suicide is not an option and that an overtly ambitious reform plan will fail. It will be replaced by a compromise that its advocates will insist is “moderate” but that in reality is every bit as lethal. The fine print of the compromise will raise the same concerns. It will still pose an existential threat to our freedom; it will still diminish the quality of and access to the care we receive; and it will still increase overall health costs in both the short and the long term.
But don’t lose heart. Conservatives will be in a position to prevail because, ultimately, America remains a right-of-center nation. And ultimately this debate will not just be one about our health system.
Rather, it will be a complex and layered debate about many other issues, issues where conservative values carry the day. Lawmakers will be hearing from their constituents on issues as varied and important as the individual’s relationship to government, the size and scope of that government, debt and deficits, our responsibilities to future generations, life (both at its beginning and its end), the level of taxation on individuals and work, job security, and privacy.
We’ll win because there is no other option.
– Michael G. Franc is vice president for government relations of the Heritage Foundation.
There is but one force that can stop politicians from going over the cliff on health reform, and that’s the American people. Poll after poll has shown that the more the American people learn about the emerging plans in Washington, the more they dislike them. And rightfully so. Every bill under discussion spends too much, creates ever more bureaucracy, raises taxes, and limits individual choice.
Yes, there are foundational problems with our health-care system. That’s the reason I founded the Center for Health Transformation in 2003. We need a system that delivers more choices of greater quality at lower costs to every American. But more government is not the answer. The Center has developed solutions that empower individuals, introduce real competition and choice, and improve the way medical care is delivered.
The American people have long demanded reforms, but they demand the right reforms. Ones that save money, not spend more of it; changes that create more choices, not fewer; improvements that lower costs, not raise them. Democrats would be wise to listen to the American people. That may take time. It did with the debate in the late 1980s over Medicare catastrophic coverage and its ultimate repeal. Perhaps a similar kind of outcome may occur if the Democratic plans are as egregious as they look now. Whatever the outcome, Democratic leaders will fail to listen to the American people at their own peril.
Obamacare can certainly be beaten. It is bad policy and bad politics, and that’s a bad combination. The key to beating it is to make very clear to American voters what it will do and what it will mean for them.
Obamacare would spend nearly a trillion dollars over a decade even as our debt is mounting, would impose a massive tax increase in the midst of the worst recession in a generation, impose costly mandates on employers that will discourage hiring as unemployment nears 10 percent, force all Americans to buy one-size-fits-all government-defined insurance, squeeze money out of Medicare not to save the program’s faltering finances but to create a whole new enormous federal entitlement alongside it, and insert the government in countless new ways between doctors and patients. For millions of middle-class families it would mean losing the employer-based insurance they have today, paying even higher premiums, and finding themselves herded toward a government insurance provider. All to increase the portion of Americans who have health insurance from 83 percent to 95 percent — which could be done much more efficiently by modest, discrete steps to create a genuine individual market for coverage.
Only in a hermetically sealed media bubble could this be thought a winning approach. To defeat it, conservatives must burst the bubble: they must help the families who would bear the burden understand what it involves, and make sure they are heard in Washington.
– Yuval Levin is the editor of National Affairs and a fellow at the Ethics and Public Policy Center. He is the author of Imagining the Future: Science and American Democracy.
SALLY C. PIPES
Looking into my crystal ball, I put the odds at 50–50. Since Labor Day, the momentum in Congress for some form of a “public option” has been gaining strength. The health-care-reform bill from Senate Majority Leader Harry Reid (D., Nev.) needs 60 votes to move forward. It is not clear to me that he has the votes. Democratic congressmen are now calling for the president to step up to the plate and start lobbying for the package.
If the plan does not get the votes, I think it will be impossible for the Democrats to get a bill passed by Thanksgiving and on the president’s desk by December 31. The president has repeatedly said that health-care reform needs to be wrapped up by year end before the 2010 election cycle begins.
Such a scenario gives the Republicans an opportunity to unite early in 2010 with a coherent plan based on patient-centered health-care solutions. The American public does not support the plan proposed by Democrats in Congress and President Obama. The latest Rasmussen poll shows that only 45 percent are in favor and 51 percent are opposed. Fifty-seven percent of voters believe health-care costs will rise and 53 percent say the quality of care will decline.
If reform does pass, the United States will be on the path to a “Medicare for All” system where Americans will face higher taxes, rationed care, and long waiting lists for procedures. While I put the odds of passage at 50–50, we need to fight hard to derail this train before it leaves the station. Politicians need to remember the Hippocratic Oath, “First do no harm.”
– Sally C. Pipes is president and CEO of the Pacific Research Institute. Her latest book is The Top Ten Myths of American Health Care.
While the media have been focused on the ups and downs (or ins and outs) of the so-called public option, the real vulnerability of Obamacare continues to lie with the Democrats’ inability to pay for it.
Despite using every budgetary gimmick in her arsenal, Nancy Pelosi has reportedly still not brought the House bill below $1 trillion. The ability of the Senate to keep its bill below $900 billion has collapsed with the failure of the Medicare “doc fix,” embarrassingly defeated with the help of 13 Democratic defections last week.
There is a huge disagreement between the House and Senate over which taxes to increase. The House wants an income tax surtax on people earning more than $250,000. The Senate wants an excise tax on so-called Cadillac insurance plans. Deciding between those two unpalatable options won’t be easy for moderate Democrats.
The American people may ultimately be fooled by claims that the public option just means more choice and competition. But the public is clearly fed up with government debt, spending, and higher taxes. Opponents of government-run health care should focus more on this weakness.
– Michael Tanner is a senior fellow at the Cato Institute.
Given the large Democratic majorities in both the House and the Senate, it’s actually surprising that the Democrats have not passed something yet. This failure is due to three factors: Democratic overreach, principled and focused Republican opposition, and some very damaging initial scores by the CBO. Still, the fight is far from over, and Republicans will need to step up their efforts in the crucial weeks ahead. Two suggestions for Republicans going forward include:
Stick Together – Harry Reid’s decision to ignore Olympia Snowe’s wishes and push forward with the public option despite Snowe’s support at the Committee level should tell other wavering Republicans that they have little to gain from switching sides. The Obama plans are expensive, fail to insure everyone, do not bend the cost curve down, and will raise taxes. There is no benefit to Republicans in jumping aboard, and a lot of potential gain in having the ability to say “I told you so” when this turns out badly.
Push for Good Ideas — One of the oldest rules in politics is you can’t beat something with nothing, and the only reason Republicans have done as well as they have thus far is that the Democratic somethings have been so bad. That said, the Republicans need to show that they are not, as the Democrats have accused, the party of no. There are many good Republican ideas out there, whether stand-alone concepts like allowing individuals to purchase insurance across state lines, or packages like Jeff Anderson’s simple plan and the Coburn-Burr/Ryan-Nunes Patients Choice Act of 2009. Republicans need to show that they have great ideas that would insure as many or more people with less money, but that Democrats will not let GOP ideas come up for a vote.
– Tevi Troy, deputy secretary of health and human services from 2007 to 2009, is a visiting senior fellow at the Hudson Institute.
Whether or not Congress passes health-reform legislation depends largely upon whether policymakers in Washington start listening to the American people. If they do, they could pass reasonable, targeted reforms. But that is not the track this Congress and the White House are on now. A poll released last week by the Galen Institute shows the public is overwhelmingly opposed to critical aspects of Obamacare. We asked people their opinion of key aspects of the health-reform legislation making its way through Congress and found that: More than seven in ten Americans oppose a federal mandate that everyone must have health insurance approved by the government or pay a penalty of $750 or more per year.
More than two-thirds oppose cutting benefits for seniors to pay for coverage for some of the uninsured.
And 58 percent oppose raising taxes on the working and middle class to provide health insurance for more Americans. People are frightened about spending at least $1 trillion to create a new government entitlement when our nation already is awash in debt. If Congress doesn’t change course, those who support this legislation will surely pay a price the next time they face the voters. Rather than the sweeping changes Congress is contemplating, the public favors targeted reform to address the most pressing problems first. A better approach that is much more in line with the wishes of the American people would be helping the uninsured get affordable private coverage, encouraging genuine competition to get health costs under control, making health insurance portable, making sure those with pre-existing conditions can get coverage, and reforming medical malpractice. This could be part of the new Health Care Contract with America that would have much broader support from the American people.
– Grace-Marie Turner is president of the Galen Institute, which promotes market-based ideas for health reform.