Plain speaking

by on March 23, 2010 at 3:28 am in Medicine, Political Science | Permalink

The oddest thing about the health care debate, at least in my view, is that Republicans basically did not engage on the actual substance of the bill.  Lots of stuff about death panels, and lots of stuff about procedure, lots of stuff about backroom deals (most of which will be gone after reconciliation) but shockingly little about the individual mandate — or, as Tim Noah points out, about the actual taxes that really are being raised for this.  The only real substantive complaint they highlighted was Medicare, where they argued against their own position. 

That's from Jonathan Bernstein.  David Frum is also right on the mark.

Barkley Rosser March 23, 2010 at 3:38 am

Indeed. And while there is all this loud talk now of repealing it, I can hardly wait to see if they actually
do retake re-impose the right of insurance companies to deny coverage to people with pre-existing conditions
or dumping people who make claims? Sure, cutting the increased tax on those making over $250,000 might play
to some of their better off base. But unless they are cutting back on large parts of it, just what are they
going to replace that with, given that it is quite likely we will still be running very large deficits?

cdavid March 23, 2010 at 4:04 am

Really?

That’s the best you have?

Shit, you haven’t been listening. I didn’t realize that you have no access to alternative media.

Gotta love our friends who are just trying to help.

Brian Gaerity March 23, 2010 at 4:15 am

Frum has it just right. Someone needs to lash responsible Republican leaders to the mast and plug their ears. Because the vast majority of the crew has been mesmerized by the siren calls of the “conservative entertainment industry.” Sadly, it doesn’t look like they will be coming home anytime soon….

Doc Merlin March 23, 2010 at 4:20 am

Bah, that should read “a couple republican congressmen”

Nathan Tankus March 23, 2010 at 6:59 am

it’s difficult for republicans to argue against the individual mandate in health care when they created, developed and proposed that idea for the last three decades. i guess difficult is the wrong word. republicans do that all the time. I meant completely and utterly hypocritical.

I also think that the republicans here miss the point. it doesn’t matter that on some random blog somewhere a republican made a good argument against hcr. what matters is public perception of the republican position. In that sense i completely agree with tyler.

E. Barandiaran March 23, 2010 at 7:56 am

Tyler, as we use to say in Argentina, “estás meando fuera del tarro”. I was expecting you to comment on the substance of Obamacare but you preferred to subcontract your opinion to people that at best pretend to know about political strategies. I hope that at least you take time to comment on what Bryan Caplan has written:

http://econlog.econlib.org/archives/2010/03/obamacare_what.html

josh March 23, 2010 at 8:36 am

Which republicans were saying a lot of things about death panels? The press turned that phrase into something so low-status that nobody but Sarah Palin would dare use it. I have really only ever heard the term used by left-wingers.

Chris March 23, 2010 at 8:59 am

I think you’re confusing “the media only reporting non-substantive objections” with “republicans not engaging the substance on the bill”.

The GOP kept making complaints about the mandate, fiscal impact, consequences of removing consumer control, and perverse incentives for insurance companies. It’s a little unfair to blame them for the fact that the papers decided to only cover the lowest end of the GOP IQ bell curve.

John March 23, 2010 at 9:10 am

If someone had proposed an abortion bill, you won’t get pro-lifers engaging with the substance of the bill to tweak it. They’ll just say: no abortion. When issues are viewed in a frame of fundamental values, it’s hard to become complicit with a compromise. Expanding an entitlement to a large swathe of the country is a fundamental issue for people who favor small government.

Plus, Democrats had no incentive to deal with Republicans because they had a super-majority.

There were plenty of articles from the start that listed the GOP’s favored changes: tort reform, buying across state lines, and leveling the tax treatment between employer and self-bought insurance. Plus the simple insight that when we have two entitlement time bombs on our country’s balance sheet, we shouldn’t be creating a third.

These are all substantive points, admitting that health care is the passion of the left, as Brooks has been pointing out.

Anon March 23, 2010 at 9:18 am

I think the fact that not ONE Republican in either House was able to vote for the Bill speaks volumes ; such monolithic opinion is almost fascist by definition.

hris March 23, 2010 at 9:49 am

From a tactical respective, the Republicans have always simply positioned themselves as being relatively less statist than the Democrats. This is very different from saying that they oppose health care reform. In fact, they could easily support much of the Democrats’ plans, as long as their positions were still relatively less statist.

This is a position that allows them to collect considerable rents that come with controlling government while at the same time pacify those small-government segments of society that genuinely oppose bills like this. So it is not completely surprising that they decided to take a position that, in the end, enabled the passage of this bill. In the short run, it may seem like a political misjudgment. In the long run, it will help them increase their share of wealth and power in our redistributive state.

Tom March 23, 2010 at 9:58 am

George Lakoff – professor at Berkley – doesn’t think the Democrats get their message out well enough.

Sounds like another ‘professor’ who is convinced if everyone just knew more about his plan, they’d understand how brilliant it is.

Rock n Roll Nigger March 23, 2010 at 10:07 am

I knew that Barkley Rosser was a dishonest liberal (what other kind is there), but I figured he at least understood the purpose of insurance. I guess not.

DanC March 23, 2010 at 10:11 am

People remember

Obama ran against the war in the middle east and sent more troops.

Obama ran against Gitmo and it remains open.

Obama ran against taxing health care benefits and now supports it.

Obama ran against the Patriot Act but uses it.

Obama promised opened meetings on health care and closed them.

Obama promised to end earmarks and threw around millions in new earmarks to get health care.

Obama cooked the books to get a CBO scoring he liked.

But this time Obama and the Democrats are telling the truth and the Republicans couldn’t overcome the big lies spread with the help of a largely biased media.

Scotch Hamilton March 23, 2010 at 10:21 am

Sorry, Republicans, you cannot run two fools like John “Bomb Bomb Iran” McCain and Sarah “Death Panel” Palin as your Presidential ticket and then complain that the media “caricatures” your point of view. You desperately wanted the Stupid Vote and now you’re known as the Stupid Party.

The GOP made that bed, and they can lie in it.

Andrew March 23, 2010 at 10:31 am

Anon,

I’m not sure what definition of fascism you are working off of, but I’m thinking you will learn how fascist the voters are going to be come election time.

Barkley,

Don’t take this wrong by including a response to you with the likes of the above, however, you equated the forcing of buying car insurance to buying medical services insurance in the previous post. Come on. People are not required to buy comprehensive car insurance.

Now you equate the “right” of insurance companies to deny pre-existing conditions to ‘rescission.” These are in fact opposites. Though I think you are honest, the commenter is right, you don’t get insurance. There could be a different product to pay for pre-existing conditions. But the right of contract would allow exempting pre-existing conditions while prohibiting rescission, if the government were worth a damn.

But, to deny me the right to buy the type of insurance that I want is what we are really talking about. And the kind of insurance I like is actually the only known and demonstrated solution to the problems that Obama thinks is the gravest danger to our economy.

nate p March 23, 2010 at 10:48 am

All politicians have the same goal. To get elected and stay elected.
Republicans and Democrats are no different. When it comes to hcr
I agree with Noah. We subsidize heath care in this country period.
Republicans know the money has to come from someplace. Investment income
Vs some other income it is inevitable one way or another.
The Republicans have to argue in ways that distract from the things they know
They can’t or I should say will not change.
People without insurance get treatment when they go to the hospital.
That costs us all†¦Republicans and Democrats.

Mason March 23, 2010 at 11:33 am

Considering nearly every Republican supported Medicare Part D, which hugely expanded government expenditures on health care without ANY way of paying for it all (in fact, taxes were cut at just about the same time they passed part D,) they came into this debate with zero credibility.

Democrats are at least honest enough to raise some taxes and cut some spending to partially offset their new HC spending (although anyone who believes ObamaCare will reduce deficits is hopelessly naive.) The fact that Republicans railed against Medicare cuts, and basically ignored the tax increases proposed, speaks volumes.

E. Barandiaran March 23, 2010 at 11:53 am

To the many readers that have not been able to control their irrational partisanship, please read

http://econlog.econlib.org/archives/2010/03/irrational_part.html

Dan H. March 23, 2010 at 12:12 pm

I spent some time reading through sections of the bill yesterday, and the thing that struck me most is that almost every page is a minefield of potential unintended consequences. I don’t think anyone can predict the net effect of this legislation on the country until it’s in place and people start responding to the incentive changes it creates.

Some examples:

The way the subsidy is calculated has the effect of massively raising the marginal rate of taxation for people trying to climb up the economic mobility ladder. According to this legislation, a change in income from 133% of the FPL (federal poverty level) to 150% of the FPL raises your mandatory contribution for health care from 2% to 4% of your *total income – a doubling of health care costs for a 13% increase in income.

The requirement that insurance companies must cover an unmarried child under 26 on the parent’s insurance plan is touted as a ‘pro-family’ measure, but in fact will have exactly the opposite effect for three reasons: Pregnant girls cannot marry the fathers without losing their health coverage at a time when they need it most, insurance rates will go up for family coverage, and people will be incentivized to marry later.

Small businesses are going to have a hell of a time competing. If even one employee is on subsidized health insurance, small businesses are going to be fined $2,000 per employee. Or, they can choose to offer health care, and get a subsidy for up to half the cost. But a family plan insurance policy for workers can easily cost $7,000-$10,000 per year, so it will be more cost-effective to just pay the penalty in some cases. That still means a $2,000 new tax per employee, a job-killing measure if I ever saw one.

The majority of the uninsured are the ‘working poor’, but it seems to me that this bill makes their life harder. It doesn’t take that much in income before you lose all subsidy ($43,000 for an individual, or a family income of $88,000). And the subsidies fall off pretty fast with income – if you’re an individual making $20,000, you’ll be expected to pay up to 6.3% of your salary for your health care before the government subsidizes the rest. That’s $1260. For a young person just starting out (exactly the kind of person who wouldn’t have health care today), their health insurance wouldn’t be much more than that anyway. So even a person at $20,000 is being given a mandate to buy health insurance, and no subsidy to pay for it. I wonder how many young people realize this?

Almost every page has stuff like this on it. Typical of federal omnibus regulation, it’s a giant grab-bag of giveaways, special interest inclusions and exemptions, and poorly thought out ideas. Some of them conflict with others (subsidizing health insurance, then taxing $60 billion from health insurers? Really?)

One of the flaws of the current system is that employer-provided health care locks you into a job. It seems to me that this bill makes that problem worse, because now if you leave a job that provides your health care, you don’t have the option of remaining uninsured until you find another. You will have to pay penalties or pay for your own health care in the interim, making job transfer harder.

The real-world application of this plan is going to be interesting to watch.

Popeye March 23, 2010 at 12:52 pm

Expanding an entitlement to a large swathe of the country is a fundamental issue for people who favor small government.

Yes. Hence: get your government hands off of my Medicare.

It’s all about principle, you see.

MIke March 23, 2010 at 1:29 pm

David Frum right on the mark? Are you kidding me? That is the stupidest column I’ve seen in months. What should the R’s have done — negotiated for socialism-lite? How, exactly, would that have helped them — or the country?? Frum calls this a crushing defeat, but remember, who even thought this would be a close vote a year ago, when Obama was still all shiny and new, with his Senate supermajority? It looked like an easy slam dunk for the D’s, and the R’s made it extremely close, in the process revealing Obama, Pelosi et al. as the duplicitous sleazoids that they are, thereby setting the stage for major R gains in the mid-terms. 60% of the electorate opposes this bill; a substantial proportion of that 60% utterly hates it. So the principled (or self-interested) strategy of the R’s should have been to take partial ownership of this?? You’ll have to explain this to me.

Barkley Rosser March 23, 2010 at 2:02 pm

Rock and Roll N-word and Andrew,

What you are speaking about is for-profit insurance. However, we are the only high income country
in the world with for-profit health insurers (except for Switzerland, where they are very
heavily regulated, and Switzerland has a universal mandate, gotta buy it). We used to have
non-profit health insurers; Blue Cross-Blue Shield was an example, and it worked just fine.
However, it got bought out by for-profit insurers. One of the failed opportunities here was
to turn all of them into non-profits like the rest of the world has (and if the GOP had been
on board, we could have had tort reform and some other much better elements in this). It is
the for-profit insurers who view recission and pre-existing conditions arrangements to be
normal. However, in most of the world, and indeed in the US as most polls show, such things
are considered to be inhumand and immoral.

E. Barandian,

So Bryan bets that private health insurance will disappear? Maybe all this will need tweaking,
but most high income countries have private non-profit insurers coexisting with either a public
option or in a setup somewhat like ours where those not covered otherwise are required to buy
insurance from the non-profits. Again, really, much of the reaction to all this is just
hysterical nonsense.

Lord March 23, 2010 at 3:16 pm

Republicans didn’t engage with this because it meant covering a lot of people they did not want to. They want them to rely on charity and they certainly didn’t want to lose their illegal workforce. Most of their criticisms were nonconstructive. Their offerings were lame like buying across state lines; if you believe the problem is state governments have too much power over what happens within there borders, or insurers based in other states had magical cost lowering pixie dust, this may make sense. As it was, it was just dishonest, subverting a real argument over what care should be required and provided into one about fictitious competition.

arik March 23, 2010 at 4:58 pm

The answer is that the ‘Pubs constituents are easily malleable. If they keep repeating “this is a travesty, and the Democrats will suffer severely in the polls this year because of it”, than people will really start to believe that the Democrats did something horrible.

In the converse, the Democrats assume that people have brains and when they experience the benefits of the bill, they will start taking the Republican hysteria less seriously.

Who actually understands the American people better I’m not so sure.

Eric March 23, 2010 at 8:41 pm

Tyler, Frum’s post was simply a thirdhand retelling of the standard media narrative, which was horribly flawed. Other commenters have already noted some of the substantive policy proposals suggested by Republicans, as well as Rep. Ryan’s response to Pres Obama. As an aside, the media also underreported the extent to which progressives opposed the bill: according to the latest polling on the subject, 1 of 5 people against healthcare, or ~12% (60%/5) of US citizens, were opposed to the bill on progressive grounds.

@ arik: It’s interesting to see the turnabout inherent in political argumentation; Republicans made essentially the same argument in favor of the Iraq War when polling went south.

Swimmy March 23, 2010 at 10:55 pm

There is one other major major issue of substance to challenge in the bill: the adverse selection it practically mandates into law. I suspect Republicans did not talk about this, however, because it is the most popular part of the bill.

Thehova March 24, 2010 at 12:15 am

I’m not sure if anyone else mentioned this but Ezra Klein has a smart reply to this:

http://voices.washingtonpost.com/ezra-klein/2010/03/the_costs_and_benefits_of_the.html

techreseller March 24, 2010 at 12:53 pm

A number of you are calling Congresspersons sleazes, duplicitous, only looking to get votes and the like. Why are you using all these extra words? In the words of Mark Twain, “my congressman is an idiot, but I repeat myself”.

Given the way Americans vote, how would you expect anything else?

Andrew March 24, 2010 at 5:08 pm

Nathan Tankus,

Please.

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