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Health-Care Reform Between the Walls


One of the iron laws of the legislative process is that every battle on the Hill occurs within clear ideological parameters. By definition, for a bill to reach the president’s desk it must fall somewhere between these Right and Left Walls. The Right Wall defines the most plausible conservative outcome; the Left Wall the most plausible liberal outcome.

This is a useful but humbling prism through which to view the health-care debate. Humbling because of the five proposals now under consideration (three committee bills in the House and two in the Senate) the Senate Finance Committee’s proposal, flawed though it is, represents the Right Wall of this debate. In other words, for us conservatives this is as good as it’s gonna get.

The Senate Finance bill’s negatives, of course, are numerous: It costs $829 billion in only six and one half years; it levies half a trillion in new taxes, penalties, and fees, all of which will be passed along to consumers; it contains the largest expansion ever of the fiscally troubled Medicaid program; it suffocates the popular Medicare Advantage program; and its so called “consumer protections” would so roil the nation’s health-insurance market that the cost of our health coverage (according to the Price Waterhouse analysis) would increase by thousands of dollars per year.

Nevertheless, this legislative monstrosity is the Right Wall.

Projecting ahead, one sees the potential for the Senate Finance bill to sprout new and even more hideous heads. It is entirely conceivable, for example, that the Senate will grant Senator Schumer his fondest wish and add a lethal public-plan option to the bill. A public option could become in short order our largest health-entitlement program, enrolling even more Americans than do those other out-of-control health entitlements, Medicare and Medicaid. Pressure to shelter more low-income Americans from the costs of the individual mandate could result in an even larger Medicaidexpansion. And union-inspired objections could convince lawmakers to jettison the Senate Finance tax on high-cost Cadillac health plans (no bargain) and replace the lost billions with the House’s preferred option, a 5.4% surtax on the incomes of the wealthiest Americans (an even worse one).

The silver lining in this dark cloud is that all five bills, including the Senate Finance plan, may tilt too far to the Left. Even with Sen. Olympia Snowe’s announcement that she will vote for the Finance Committee bill, Majority Leader Harry Reid still must thread the old legislative needle to attract the requisite 60 votes. Any further leftward migration on the Senate floor or in a House-Senate conference and this tenuous balance may give way and force Hill leaders to devise an entirely new path to final passage.


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