Sixty-eight years ago, after a long-sought victory in Egypt that marked a turning point in World War II, Winston Churchill said, “This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
In what will be a long and arduous struggle to bring fiscal stability and true reform to our tottering health-care system, partial Republican control of Congress was a necessary first step. But, now, the hard work begins.
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The Republican health-care platform, such as it is, is pretty simple: Repeal Obamacare and replace it with incremental, common-sense, politically popular reforms. The GOP’s “Pledge to America” may therefore have been an appropriate platform for a midterm election. However, the document barely begins to address the profound and difficult issues that any serious government must. Indeed, if the early signals are any indication, the troubling reality is that the Republican health-care agenda for 2011 and 2012 may actually make it harder to repeal Obamacare in 2013, and thereby harder to achieve conservatives’ long-term goal of a humane, efficient, and fiscally sustainable health-care system.
The best way to grasp the enormous difficulties ahead is to work backwards.
Runaway growth in government spending is America’s biggest fiscal problem today. Growth in Medicare and Medicaid spending, in turn, accounts for nearly all the projected future growth in government outlays relative to GDP. If the principal domestic-policy goal of conservatives is to restore the country to a truly limited government that can live within its means, we can achieve that goal only through serious and thoughtful reform of health-care entitlements.
That is to say: For the foreseeable future, health care must become the single dominant focus of conservative domestic policy.
Hence, our first and most important problem is intellectual. Conservatives speak often of repealing and replacing Obamacare. But how many can articulate a conservative vision of what our health-care system should look like? Leading Republican politicians have plenty of detailed opinions on a broad range of subjects. But does anyone know what John Boehner’s vision is for the future of American health care? How about the main contenders for the 2012 Republican presidential nomination? To ask the question is to answer it.
FREEDOM, SECURITY, AND INNOVATION It should be said that, within the diminutive circle of conservative health-policy wonks, there is a fair amount of agreement as to where we should go. But translating that wonkery into plain English isn’t easy.
Among less specialized conservatives, a common refrain is, “I’m not clear on the details, but that Paul Ryan sounds like he knows what he’s talking about.” And Rep. Paul Ryan’s plan is indeed a solid start. But unless other Republican leaders fully immerse themselves in health-care policy, they will be able neither to articulate the core principles of free-market health care, nor to address new issues as they arise, nor to persuade American voters that they should be trusted to enact far-reaching reforms.
The core health-care principles that Republicans should embrace can be summarized in three words: freedom, security, and innovation.
First, the conservative vision must, out of both principle and pragmatism, hold that the best health-care system is one that trusts individuals to make the choices that are best for them and their families. The liberal view of health care is the opposite: that individuals are neither knowledgeable enough nor wise enough to make health-care decisions for themselves; instead, these decisions are best left to unelected government experts.
Porky Pig Government has destroyed ALL free markets - name one market that Porky hasn't its snout in and screwing up.
Free markets are just as important as free speech - it's a right. A free market costs nothing to anyone - Porky controlled markets cost us dearly.
Liberals hate free markets - competition is hard. Conservatives must find ways to get Porky out of free markets or this is just a waste of time.
Even the internet, the last free market, is now regulated - Obama can shut it down if he wants and your eMails can be confiscated if Dear Leader Obama wants them........
Thanks for the article, Avik! We conservatives need to think seriously about the Replace part of the equation.
The libertarian approach to the problem of healthcare financing (the REAL problem) that simply wishes to ignore the issue and say, "it ain't gubermint's problem to solve" is fiscally naive, destructive to the nation and cruel to the most vulnerable of our citizenry. This problem deserve both a serious discussion and the proposal of efficient and sustainable solutions if the independent electorate is going to take any GOP majority seriously.
Well reasoned article on the policy front - from a practical perspective, the more the unsavory details come out on how this Bill was cobbled together, and who the benefited players were, the more unpopular this law will become. The intellectual dishonesty being displayed by the Administration in defending the individual mandate in court is truly amazing (it's a tax, no it's a penalty, no it's economic inactivity that is activity, well it's necessary & proper to make it work).
The average voter may not be a Constitutional scholar - but they know when somebody is lying to them. The hearts & minds can be won if the truth is known; every exemption issued should be widely publicized.
"First, the conservative vision must, out of both principle and pragmatism, hold that the best health-care system is one that trusts individuals to make the choices that are best for them and their families."
I challenge you to find anything on The Cato Institute's website that says anything remotely close to this assessment.
Fact is, libertarians were able to articulate and educate far better than conservatives about the hazards of healthcare run by government. All you need to do is check out the history.
They also have a plan for getting rid of it. Unfortunately, like conservatives, that hope rests with people in the GOP being expected to actually do something for once.
It was conservative sites like NRO, that continually proclaimed, "Obamacare is dead.", whenever there was a snafu that came up that delayed the eventual passage of Obamacare. You can research these articles as well from NRO.
The author talks about a "principled and pragmatic" approach. Yet, on the homepage of this website, Jonah Goldberg's teaser line referring to Schwarzenegger's and Bloomberg's inability to run for president was destroyed by their 'pragmatism'.
See, TPP, this is why conservatism doesn't work. It has no founding principle, and it has no plan for moving forward, even if those that adhere to its beliefs get everything they want. Conservatives cannot define themselves; therefore, they cannot possibly be expected to govern based on their principle, which aren't theirs to begin with.
"The libertarian approach to the problem of healthcare financing (the REAL problem) that simply wishes to ignore the issue and say, "it ain't gubermint's problem to solve" is fiscally naive, destructive to the nation and cruel to the most vulnerable of our citizenry."
TPP, this is the quote I copied in my response to you, not the quote that this blasted, and fauly, comment section decided to present.
The whole idea of total repeal of PPACA seems to be a non-starter. Why not start with ideas from several of the other proposed plans that were out there, made sense, and have already garnered bipartisan support. Before Bob Bennett was ousted in the primary, his co-sponsored bill with Ron Wyden seemed to be a paragon of reasonable, market-based, humane healthcare.
The other part that we have to recognize is that until we address the issue comprehensively, we are just playing games with tax policy. We need reform of malpractice which includes helping doctors get reasonable insurance rates and punishing those doctors who truly are negligent and contribute to everyone else's high insurance rates. We need more medical practitioners, especially in primary care. It would be a great investment to forgive medical school debt of individuals who become primary doctors and other types of primary caretakers to encourage more of our best and brightest who want to practice medicine to stick with it. We also need to open up the prescription drug formularies and recognize that drugs like Avastin, as seen by the outcry towards the FDA ban, work for some people and provide real value and benefit. The problem arises when doctors are too busy to do their own homework and simply prescribe the popular drug and then don't monitor the patients closely enough to see if they are having adverse reactions.
There's more, but I only have so much time to spend on these rants.
The AMA presently represents only 29% of doctors. The percentage has been falling for years. More than half of these doctors oppose Obamacare. Using support of the AMA for Obamacare as a sign of doctor support for the program is totally facetious.
After having an auspicious start as an organization dedicated to ethics and professionalism, the AMA has degenerated into a self promoting and self serving organization more interested in selling insurance and coding books to doctors, rather than in truly representing their members.
I agree with you that Republicans must highlight how the poor will still be served under their plan. They should consider subsidized HSA's for those on Medicaid. Poor people are not idiots, and should be respected enough to make their own healthcare decisions. Given the right incentives (allowing them to personally save money left over at the end of the year), they will make decisions that will reap enormous financial savings, without lowering their personal level of health.
I love it when conservatives pretend to be interested in the well being of everyday Americans. Disingenuous to the point of laughter. Please do go on and tell my why health insurance companies being required to spend at least $.80 of every dollar on actual health care?
"conservatives must stand firmly behind the principle of a safety net for those who are genuinely down on their luck, and also for the principle that those who pay for insurance and play by the rules will get the care that they’ve earned, without losing out on technicalities" - who is the author kidding? Conservatives are not interested in protecting anyone least of all the lower class. All they care is that the wealthy get to keep their money and that insurance companies make lots of profits. There main principle is - every man for himself and if you don't get the healthcare you need, it is your own fault.
**Here, too, we cannot afford any more Delaware Debacles: We need candidates who, whatever their flaws, are electable and who pledge to vote for repeal. A realistic best-case scenario is that Republicans get to between 51 and 55 seats in the upper chamber: a majority, but not a filibuster-proof majority. In the 2010 wave election, they gained six seats, raising their total to 47. Despite the favorable turf in 2012, they are unlikely to win the 13 additional seats needed to reach 60.**
Above is so important.
I'm not a Republican though I lean right, and I lean right often.
Initially unimpressed with Boehner, I've since acquired a bit of hope. He seems to understand the nature and gravity of his duties.
I have no confidence in Senator DeMint or Rep. Bachmann; they're insensible.
The essential thing for any 2012 presidential candidate to remember is that the branch extended to republicans by independents is thin and brittle. Indees are aware that PO is leading the Country down an inferior path, but I think they would prefer the inferiority of that leftward curve to the fracturing and dismembering the Right could inflict. Nihilism is a problem for the Right. It can't seem to grasp the fact that social cohesion isn't a luxury, that it's as essential for national stability as is mild, sustainable debt.
I don't see what's "conservative", except perhaps in the Disraeli sense, about Avik's second principle ("conservatives must stand firmly behind the principle of a safety net for those who are genuinely down on their luck, and also for the principle that those who pay for insurance and play by the rules will get the care that they’ve earned, without losing out on technicalities"). A safety net may be a concession to political reality, but let's not forget that it's a concession--it's not our (the Right's) principle. As for what's "earned", and what is a "technicality", that's a matter that should be left to state contract law.
And the idea of leaving the individual mandate alone so that the eventual CBO scoring of repeal looks better strikes me as too clever by half. If we have an opportunity to get rid of such a noxious and integral part of Obamacare, we need to take it, and worry about the rest later. In any case, it's likely that the entire edifice will become unsustainable without the mandate, making repeal a question of "when", rather than "if".
Someone has chest pain and has no insurance and is less than 65....
If he goes to a private hospital ER and is stable, he will be transfered to a tertiary care hospital. This is usually a training hospital/medical school with medical students, residents and fellows.
He will be treated. He will be evaluated for chest pain. If he needs a cardiac catherization, he gets one.
Next part is tricky...
If he is dirt poor, the social workers will enroll him in Medicaid.
The state/federal government pays his bills.
If he makes $75,000 a year and owns a house, life is going to suck for him. He will have to spend down his assets to become eligible for Medicaid insurance. This usually means that houses are sold, etc. etc.
That is the way the system is working right now. I am not sure if and when Obamacare solves this problem.
This morning, I had a cancer patient that is in her "spend down" to become eligible for Medicaid.
Shorembo...I would recommend that your hypothetical man with chest pain go to any ER. I know that liberal dogma says that he will be stuck with a big medical bill and therefore shouldn't go and therefore we should have provided him with free medical insurance before his chest pain started. I would hold that he had the freedom to purchase insurance ahead of time, and since he didn't, he now has to face the consequences of that irresponsible gamble: get stuck with a big ER medical bill.
And, nice try DavidG, Republicans care for individual freedom and responsibility.
Although I'm not sure I agree that repeal ultimately should be passed through reconciliation (unless it can be done without manipulating the budgetary effects or the legislative process), it seems to me that attacking the individual mandate, 1099 requirement, etc. makes the reconciliation process easier not harder. I'm likely mistaken here, but would not elimination of some of the funding mechanisms (e.g. 1099, mandate fines) and the decreased risk pool that would result from eliminating the mandate make the budgetary baseline for the health care legislation higher and more damaging to the deficit? If that is the case, then repeal of the bill would reduce the deficit - and make reconciliation permissible - by eliminating the cost-producing portions of the legislation that are no longer offset by some of the funding mechanisms and the larger risk pools.
I agree that politics and policy must be married in any attempt to repeal Obamacare, lest policy purity threaten the ultimate goal. And I follow the argument regarding the scoring trap. But is this not conceding far too much legitimacy to the CBO scoring, which is known to have been directed by Speaker Pelosi and the Democratic majority to assume politically untenable cost-cutting measures (such as the cuts to Medicare, the Doc Fix and others) and embrace outright accounting trickery (such as the 10-year revenue, 6-year service fraud)?
This was all done to arrive at an artificially set, politically expedient Obamacare cost under $900B. But the true costs are known to be at least $1.6 to $3 trillion over the first full ten years of revenue and costs, depending on what components are added back in.
This being the case, I would think a politically smart thing for the new GOP majority in the House to do is to re-score Obamacare with the GOP's numbers, for Medicare and the Doc Fix, and with 10 years for both revenue and costs. This would ideally have been done before the Repeal Vote next week...but I understand the symbolism of a quick vote to signal intentions.
However, the nasty numbers must eventually be put out to call attention to all the chicanery built into Obamacare, not just from the conservative think tanks and the pages of NR, the Weekly Standard, the American Spectator, Commentary and the WSJ, but from the floor of the House.
Being from the incredible socialist, or communist state of the Netherlands, i'm glad the we have a government that defines the minimal set of basic health care for everybody, that all insurance companies have to offer, and that i can insure additional health care for risks i want covered better, like dentist and mental/physical therapy. And that for a mere 125 euro per month!
Check out External Link and see what happened with health care spending in the republican Bush era (yes, it went up, way up).
And does anybody know what the $11,000 Medicare per year per beneficiary means? Is that a limit per year? Or does everybody in Medicare get this amount to spend on health care? Seams like an awful lot of money! But with full market control on medicines, and well paid specialists, it's no wonder!
Good luck with your health care, but don't forget, you're paying, either way...
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