Archive for the ‘Health’ Category

Reflections on the Health Care Bill

March 22, 2010

I hope I’m wrong in thinking that the health care bill that just passed Congress is an imprudent mistake. As I’ve said many times before, this is the way to improve on the current system. President Obama’s reform efforts are going to insure lots of new people, an achievement to celebrate, but I’d have preferred bringing about that outcome via different means — I am particularly terrified of the fiscal implications of this bill, which exacerbates the American government’s addiction to living beyond its means.

Obviously Democrats bear a lot of blame for weaknesses in the bill, and some of them will rightly pay the price for serving their constituents insufficiently well in 2010. At the same time, David Frum is exactly correct about the approach taken by conservatives and Republicans:

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government.

So what happens next? While I agree with many Megan McArdle critiques of the bill on substance, I think she is uncharacteristically wrong when she writes this:

One cannot help but admire Nancy Pelosi’s skill as a legislator. But it’s also pretty worrying. Are we now in a world where there is absolutely no recourse to the tyranny of the majority? Republicans and other opponents of the bill did their job on this; they persuaded the country that they didn’t want this bill. And that mattered basically not at all. If you don’t find that terrifying, let me suggest that you are a Democrat who has not yet contemplated what Republicans might do under similar circumstances. Farewell, Social Security! Au revoir, Medicare! The reason entitlements are hard to repeal is that the Republicans care about getting re-elected. If they didn’t–if they were willing to undertake this sort of suicide mission–then the legislative lock-in you’re counting on wouldn’t exist.

Oh, wait–suddenly it doesn’t seem quite fair that Republicans could just ignore the will of their constituents that way, does it? Yet I guarantee you that there are a lot of GOP members out there tonight who think that they should get at least one free “Screw You” vote to balance out what the Democrats just did.

If the GOP takes the legislative innovations of the Democrats and decides to use them, please don’t complain that it’s not fair. Someone could get seriously hurt, laughing that hard.

The Democrats campaigned on health care in 2008, and at the time a majority of Americans supported reforms. Later the Republicans managed to change the polling numbers through some mix of valid critiques and outright lies. Most polls on the subject revealed that Americans were confused about the issue. Many people didn’t understand the questions being asked of them, or else held mutually exclusive positions at the same time. Much as I hate the outcome in this case, I’d much rather that elections influence policy than that politicians win mandates at the ballot box, and are thought to lose them because poll numbers shift. How easy is it to move poll numbers? How reliable are polls on complicated questions? We’re a republic rather than a democracy for a reason.

Moreover, I think that Megan’s comparison to Republicans dismantling Social Security and Medicare is unpersuasive. I highly doubt that the GOP is ever going to run on a “repeal Social Security and Medicare” platform, but if they do so as the centerpiece of a successful campaign, winning the White House and majorities in both houses of Congress, their critics will be exactly wrong to vilify them should they go ahead and more or less make good on their promises.

When Should Dissent Happen?

November 17, 2009

That is one of the many questions that Julian Sanchez and I discuss on Bloggingheads.

Paranoia Strikes Deep

October 18, 2009

Anyone who wonders whether demagogues on the left and right do real damage to the audiences they mislead need look no farther than how the partisan media is “reporting” on the vaccine for the swine flu. I am sensitive to this topic because I have cable news watching grandparents who I’d like to see survive the winter. The chances that they’ll do so are marginally improved if they get the flu vaccine, or so the best scientific information available suggests, there being no guarantees in these matters.

Chris Beam rounds up coverage in the partisan media that is bound to reduce the number of folks who get the flu vaccine.

On the anti-government right, swine flu vaccinations are seen as an example of government overreach. Last week, Rush Limbaugh made headlines by announcing that he would not be getting a shot. “Screw you, Ms. Sebelius,” he said on his radio show, referring to Secretary of Health and Human Services Kathleen Sebelius. “I’m not going to take it precisely because you’re now telling me I must.” Glenn Beck has declined to say whether he’s getting vaccinated. But he’s made his position pretty clear, suggesting that the vaccine may turn out to be “deadly,” raising the specter of mandatory vaccines (they’re voluntary), and saying he wants the “U.S. out of my bloodstream.”

On the left, there are prominent doctors, lawyers, and Hollywood celebrities skeptical of vaccines in general—and the swine flu vaccine especially. In a September article written for the Huffington Post, Dr. Frank Lipman recommended against getting vaccinated, arguing that the virus seems benign and the vaccine is unproven. Earlier this year, Jim Carrey—yes, that Jim Carrey—penned a HuffPost column reiterating the oft-made (and widely discredited) point that vaccines may cause autism. Robert F. Kennedy made a similar argument in a famous (and also largely discredited) 2005 article that appeared in Rolling Stone and Salon. The anti-vaccination movement is hardly exclusive to the left wing, but declines in vaccination rates have occurred in large part because of affluent parents in states like California.

Now, thanks to the government’s plan to ship 250 million doses of H1N1 flu vaccine to all 50 states this month, the two sides have finally found common cause. They may hold different political opinions, but they share a worldview: distrust—of doctors and modern medicine or of government. There’s even some overlap. Beck, for example, said that “you don’t know if this is gonna cause neurological damage like it did in the 1970s”—a fear commonly cited by vaccine skeptics. (Claims that the 1976 flu vaccine caused Guillain-Barré syndrome have not been proven.) Meanwhile, those who fear the needle aren’t all that confident in their government, either: Dr. Lipman warns that HHS has given the drug companies manufacturing the vaccines immunity from lawsuits.

So there you have it. Demagogues on the right and left whose irresponsible rhetoric is very likely to cost lives this flu season by scaring folks who’d otherwise get the flu vaccine into going without.