Commentary Magazine


Topic: interstate insurance sales

RE: ObamaCare and Political Theater

Pete, it’s hard to see exactly what Obama is doing here. Certainly, even in the hubris-filled halls of the West Wing, the Obami must know that the votes aren’t there in the House, and as a result, it will be mighty hard even to get 50 Senate Democrats to walk the plank for a bill that is so grossly unpopular. There are a few theories circulating.

First, Obama is simply tending to his base, trying to demonstrate how he did everything possible (other than find a reasonable bill the country could support). He is, he will tell his netroot base, simply a victim of the Republican attack machine and all that misinformation. He’s putting on a show summit, giving his faithful a reminder of better days when dog-and-pony shows and big speeches seemed to be the road to legislative victory.

Another theory is that this is simply a prelude to a bare-bones bill that will save him from humiliation. Regulation of the insurance industry — i.e., price controls and federal micro-management — might be popular and passable. That was Obama’s “added element” in the ObamaCare II rollout. And if he can throw in some tort reform studies, a Medicare reform commission, some tinkering on interstate insurance sales and the like, he can declare “victory” and climb out of the hole he dug for himself as he pursued an unpopular signature agenda item at the expense of achieving anything else of note.

And finally, Obama might have no game plan at all. It wouldn’t be the first time. He’ll have a summit. Maybe the poll numbers will improve. Maybe he’ll force the Democrats to take a vote. Maybe not. Just figure it out as he goes along. After all, if he had planned on garnering bipartisan support and actually passing something, Obama wouldn’t have rolled out an ObamaCare II so similar to  ObamaCare I, nor would he have threatened the Republicans with reconciliation in advance of the summit.

In the end, there are two simple realities. The public doesn’t like the bill at all. And it’s an election year, following a losing run for Democrats that has spooked incumbents. That’s why it’s hard to see how ObamaCare II will ever become law.

Pete, it’s hard to see exactly what Obama is doing here. Certainly, even in the hubris-filled halls of the West Wing, the Obami must know that the votes aren’t there in the House, and as a result, it will be mighty hard even to get 50 Senate Democrats to walk the plank for a bill that is so grossly unpopular. There are a few theories circulating.

First, Obama is simply tending to his base, trying to demonstrate how he did everything possible (other than find a reasonable bill the country could support). He is, he will tell his netroot base, simply a victim of the Republican attack machine and all that misinformation. He’s putting on a show summit, giving his faithful a reminder of better days when dog-and-pony shows and big speeches seemed to be the road to legislative victory.

Another theory is that this is simply a prelude to a bare-bones bill that will save him from humiliation. Regulation of the insurance industry — i.e., price controls and federal micro-management — might be popular and passable. That was Obama’s “added element” in the ObamaCare II rollout. And if he can throw in some tort reform studies, a Medicare reform commission, some tinkering on interstate insurance sales and the like, he can declare “victory” and climb out of the hole he dug for himself as he pursued an unpopular signature agenda item at the expense of achieving anything else of note.

And finally, Obama might have no game plan at all. It wouldn’t be the first time. He’ll have a summit. Maybe the poll numbers will improve. Maybe he’ll force the Democrats to take a vote. Maybe not. Just figure it out as he goes along. After all, if he had planned on garnering bipartisan support and actually passing something, Obama wouldn’t have rolled out an ObamaCare II so similar to  ObamaCare I, nor would he have threatened the Republicans with reconciliation in advance of the summit.

In the end, there are two simple realities. The public doesn’t like the bill at all. And it’s an election year, following a losing run for Democrats that has spooked incumbents. That’s why it’s hard to see how ObamaCare II will ever become law.

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Lincoln Sinking

Another day, another poll, and another Democratic incumbent on the rocks. Public Policy Polling tells us:

John Boozman will enter the Arkansas Senate race this weekend as the frontrunner. He leads incumbent Blanche Lincoln by an amazing 56-33 margin in our first poll of the race.

Lincoln’s approval rating has sunk to just 27%, with 62% of voters in the state disapproving of her. She’s at a middling 51% even within her own party and just 17% of independents and 9% of Republicans are happy with how she’s doing.

A look inside the health care issue gives a good indication of how Lincoln has managed now to get it from all sides. 61% of voters in the state oppose the President’s plan, and among those folks Lincoln’s approval rating is just 8% with 79% of them expressing the belief that she’s too liberal.

That’s what Nancy Pelosi’s pole-vaulting is getting the Democrats: more and more endangered incumbents. There are just so many Democrats who can “retire” and be reshuffled by those not tainted with votes in favor of the Obama agenda. There are just so many candidates and just so much money to be raised to fill the slots of those being sacrificed by the Democratic leadership. And in Lincoln’s case, there is no sign she’d go quietly.

There may be no “solution” for the Democrats. The damage from a year of votes on extremist legislation is there for all to see. The Obama budget — with rampant spending, huge tax increases, and a record deficit — will be hard for most Democrats to defend. The best that some can do is to put distance between themselves and the agenda of their far-Left leadership. Here’s a suggestion for those who still have a fighting chance: cut funding for domestic trials and incarceration of Guantanamo detainees, keep the Bush tax cuts in place (at least until unemployment comes down to low single digits), come up with a short, bipartisan list of targeted health-care reforms (e.g., tort reform, removal of the ban on interstate insurance sales), and put an end to the Obama spend-athon, starting with the new budget (which includes $25 billion more in Medicaid spending, $100 billion for Son of the Stimulus, and hikes in outlays for many domestic programs). It might not be enough to save all the Democrats, but it could spare a few.

Another day, another poll, and another Democratic incumbent on the rocks. Public Policy Polling tells us:

John Boozman will enter the Arkansas Senate race this weekend as the frontrunner. He leads incumbent Blanche Lincoln by an amazing 56-33 margin in our first poll of the race.

Lincoln’s approval rating has sunk to just 27%, with 62% of voters in the state disapproving of her. She’s at a middling 51% even within her own party and just 17% of independents and 9% of Republicans are happy with how she’s doing.

A look inside the health care issue gives a good indication of how Lincoln has managed now to get it from all sides. 61% of voters in the state oppose the President’s plan, and among those folks Lincoln’s approval rating is just 8% with 79% of them expressing the belief that she’s too liberal.

That’s what Nancy Pelosi’s pole-vaulting is getting the Democrats: more and more endangered incumbents. There are just so many Democrats who can “retire” and be reshuffled by those not tainted with votes in favor of the Obama agenda. There are just so many candidates and just so much money to be raised to fill the slots of those being sacrificed by the Democratic leadership. And in Lincoln’s case, there is no sign she’d go quietly.

There may be no “solution” for the Democrats. The damage from a year of votes on extremist legislation is there for all to see. The Obama budget — with rampant spending, huge tax increases, and a record deficit — will be hard for most Democrats to defend. The best that some can do is to put distance between themselves and the agenda of their far-Left leadership. Here’s a suggestion for those who still have a fighting chance: cut funding for domestic trials and incarceration of Guantanamo detainees, keep the Bush tax cuts in place (at least until unemployment comes down to low single digits), come up with a short, bipartisan list of targeted health-care reforms (e.g., tort reform, removal of the ban on interstate insurance sales), and put an end to the Obama spend-athon, starting with the new budget (which includes $25 billion more in Medicaid spending, $100 billion for Son of the Stimulus, and hikes in outlays for many domestic programs). It might not be enough to save all the Democrats, but it could spare a few.

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Reform or Revolution?

Ross Douthat makes the case that ObamaCare was doomed from the start:

You can make big changes to small programs, and small changes to big ones. But comprehensive solutions tend to produce comprehensive resistance. And the more sweeping the stakes, the greater the chance of political disaster — whether your name is Clinton or Gingrich, Bush or Obama — when your bill goes down to defeat.

Such a bill would have had many fewer beneficiaries — but far fewer enemies as well. It wouldn’t have transformed the system, controlled costs for the long term, or guaranteed universal care.

Douthat argues, as did many Republican lawmakers, that Democrats overshot the mark, attempting something too grand, too complex, and too scary. He contends: “The lesson for Democrats should be obvious. They wanted, admirably, to help the low-income uninsured, and Americans with pre-existing conditions. And that’s exactly what they should have done — with tax credits or vouchers or a Medicaid expansion for the poor, and better-funded risk pools for the sick.”

But is that what they really wanted to do? Or did they want to plant the sapling of a European-style welfare state that couldn’t be rooted out, setting up a new relationship between citizens and their government? At times, many liberals were candid that this is precisely what they had in mind. The public option, they confessed, was the proverbial camel’s nose under the tent, the entry to a single-payer universal-health-care system. It was not simply, one could argue, that in their zeal to tinker with the existing system Democrats went overboard. It often seemed (because they said so) that they intended a “new foundation” for the country. That would entail a whole new model of government dependency for each and every citizen.

In the wake of the Scott Brown epic upset, Democrats are reduced to seeking small, focused fixes to the existing health-care system to save political face. Liberal pundits are beside themselves that they’re likely to get “no more” than something to address pre-existing conditions, some equalization of tax treatment for individual-purchased insurance plans, tort reform, and a lifting of the ban on interstate insurance sales. Well that’s “all” that’s left, given that ObamaCare has crashed and burned. Greg Sargent notes with chagrin:

Is it really advisable, in political and policy terms, for Dems to agree to pass something approximating the GOP plan and no more? Because in the real world, that’s the only way Dems will win any bipartisan cooperation.

It’s quite a comedown to simply reform the existing system. With visions of a revolutionary transformation of American society dancing in their heads, the Left imagined they could get far more. The voters, however, didn’t want to throw out the entire health-care system. They simply wanted cheaper health care and some portability. But if it meant a scary new regime of government control and “comparative effectiveness research,” well then the Democrats could forget the whole thing as far as ordinary Americans were concerned.

So Douthat, I think, is partially correct. Mega-reform wasn’t going to happen. Mostly it wasn’t going to happen because the proponents of the ObamaCare weren’t candid with the public, which they rightly suspected all along wasn’t going to go for a reorientation of a sixth of the economy and their own personal health care. Reform is hard enough; it’s near impossible when it’s a camouflaged revolution.

Ross Douthat makes the case that ObamaCare was doomed from the start:

You can make big changes to small programs, and small changes to big ones. But comprehensive solutions tend to produce comprehensive resistance. And the more sweeping the stakes, the greater the chance of political disaster — whether your name is Clinton or Gingrich, Bush or Obama — when your bill goes down to defeat.

Such a bill would have had many fewer beneficiaries — but far fewer enemies as well. It wouldn’t have transformed the system, controlled costs for the long term, or guaranteed universal care.

Douthat argues, as did many Republican lawmakers, that Democrats overshot the mark, attempting something too grand, too complex, and too scary. He contends: “The lesson for Democrats should be obvious. They wanted, admirably, to help the low-income uninsured, and Americans with pre-existing conditions. And that’s exactly what they should have done — with tax credits or vouchers or a Medicaid expansion for the poor, and better-funded risk pools for the sick.”

But is that what they really wanted to do? Or did they want to plant the sapling of a European-style welfare state that couldn’t be rooted out, setting up a new relationship between citizens and their government? At times, many liberals were candid that this is precisely what they had in mind. The public option, they confessed, was the proverbial camel’s nose under the tent, the entry to a single-payer universal-health-care system. It was not simply, one could argue, that in their zeal to tinker with the existing system Democrats went overboard. It often seemed (because they said so) that they intended a “new foundation” for the country. That would entail a whole new model of government dependency for each and every citizen.

In the wake of the Scott Brown epic upset, Democrats are reduced to seeking small, focused fixes to the existing health-care system to save political face. Liberal pundits are beside themselves that they’re likely to get “no more” than something to address pre-existing conditions, some equalization of tax treatment for individual-purchased insurance plans, tort reform, and a lifting of the ban on interstate insurance sales. Well that’s “all” that’s left, given that ObamaCare has crashed and burned. Greg Sargent notes with chagrin:

Is it really advisable, in political and policy terms, for Dems to agree to pass something approximating the GOP plan and no more? Because in the real world, that’s the only way Dems will win any bipartisan cooperation.

It’s quite a comedown to simply reform the existing system. With visions of a revolutionary transformation of American society dancing in their heads, the Left imagined they could get far more. The voters, however, didn’t want to throw out the entire health-care system. They simply wanted cheaper health care and some portability. But if it meant a scary new regime of government control and “comparative effectiveness research,” well then the Democrats could forget the whole thing as far as ordinary Americans were concerned.

So Douthat, I think, is partially correct. Mega-reform wasn’t going to happen. Mostly it wasn’t going to happen because the proponents of the ObamaCare weren’t candid with the public, which they rightly suspected all along wasn’t going to go for a reorientation of a sixth of the economy and their own personal health care. Reform is hard enough; it’s near impossible when it’s a camouflaged revolution.

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Why the Universal Health-Care Insurance Fetish?

Republicans have been tossing out alternatives to government-centric ObamaCare for some time. They have suggested, among other ideas, that we change the tax treatment of individually purchased insurance plans, reform the tort system, and allow interstate insurance sales. But now Jim Prevor raises an interesting and compelling question: if people want to go without insurance and instead self-insure, why is it the government’s job to stop them? Or put differently:

The fact that the national debate has focused on insurance for health care–as opposed to the accessibility of care–is a byproduct of the particular worldview that all “basic needs” should be provided by communal institutions, preferably the government but, alternatively, highly regulated companies that do the government’s bidding.

Prevor suggests that we “give families money or vouchers that they could use to buy health insurance or any other thing they deemed helpful to their family’s future” and urges lawmakers to work on the supply side of care, not insurance, by among other things “wreak[ing] havoc on the American Medical Association’s efforts to restrain the supply of doctors.” Along the lines of Prevor’s argument, one of the more successful ventures in the Bush administration was emphasis on community health centers that expand care for needy Americans, quite apart from the insurance part of the equation. And expansion of medical accounts, which allows individuals to either buy insurance or pay for medical cost directly, would, following Prevor’s argument, maintain personal responsibility, individual choice, and make health-care purchases more accessible by allowing individuals to use pre-tax dollars to pay for their own care.

But what of the “cost shifting” problem caused by uninsured people? Well, now that the Democrats propose to dump millions of people into Medicare, which doesn’t fully compensate doctors and hospitals, it appears as though that argument is going by the wayside. Furthermore, as Mike Tanner of CATO has explained, cost shifting in the current system has been exaggerated and may account for a small portion of health-care costs. He notes that “it is a manageable problem. According to Jack Hadley and John Holahan of the left-leaning Urban Institute, uncompensated care for the uninsured amounts to less than 3% of total healthcare spending — a real cost, no doubt, but hardly a crisis.”

Tanner has also addressed the implied assumption of health-care reformers that universal health-care insurance will improve the nation’s collective health. He says that “in reviewing all the academic literature on the subject, Helen Levy of the University of Michigan’s Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a ‘causal relationship’ between health insurance and better health. Believe it or not, there is ‘no evidence,’ Levy and Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health.” A New England Journal of Medicine article in 2006 likewise found that “health insurance status was largely unrelated to the quality of care.” It seems as though even if we force people to self-insure, they may not wind up much healthier.

In sum, Prevor raises a key point: the fixation on universal health-care insurance has distorted the health-care debate. It might, as he suggests, be a good time to take a step back and see whether the quest for universal insurance is really where we should be focusing our attention. Maybe it is time, as he puts it, to remember that “the moral imperative is not making everyone buy insurance. The moral imperative is freedom.”

Republicans have been tossing out alternatives to government-centric ObamaCare for some time. They have suggested, among other ideas, that we change the tax treatment of individually purchased insurance plans, reform the tort system, and allow interstate insurance sales. But now Jim Prevor raises an interesting and compelling question: if people want to go without insurance and instead self-insure, why is it the government’s job to stop them? Or put differently:

The fact that the national debate has focused on insurance for health care–as opposed to the accessibility of care–is a byproduct of the particular worldview that all “basic needs” should be provided by communal institutions, preferably the government but, alternatively, highly regulated companies that do the government’s bidding.

Prevor suggests that we “give families money or vouchers that they could use to buy health insurance or any other thing they deemed helpful to their family’s future” and urges lawmakers to work on the supply side of care, not insurance, by among other things “wreak[ing] havoc on the American Medical Association’s efforts to restrain the supply of doctors.” Along the lines of Prevor’s argument, one of the more successful ventures in the Bush administration was emphasis on community health centers that expand care for needy Americans, quite apart from the insurance part of the equation. And expansion of medical accounts, which allows individuals to either buy insurance or pay for medical cost directly, would, following Prevor’s argument, maintain personal responsibility, individual choice, and make health-care purchases more accessible by allowing individuals to use pre-tax dollars to pay for their own care.

But what of the “cost shifting” problem caused by uninsured people? Well, now that the Democrats propose to dump millions of people into Medicare, which doesn’t fully compensate doctors and hospitals, it appears as though that argument is going by the wayside. Furthermore, as Mike Tanner of CATO has explained, cost shifting in the current system has been exaggerated and may account for a small portion of health-care costs. He notes that “it is a manageable problem. According to Jack Hadley and John Holahan of the left-leaning Urban Institute, uncompensated care for the uninsured amounts to less than 3% of total healthcare spending — a real cost, no doubt, but hardly a crisis.”

Tanner has also addressed the implied assumption of health-care reformers that universal health-care insurance will improve the nation’s collective health. He says that “in reviewing all the academic literature on the subject, Helen Levy of the University of Michigan’s Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a ‘causal relationship’ between health insurance and better health. Believe it or not, there is ‘no evidence,’ Levy and Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health.” A New England Journal of Medicine article in 2006 likewise found that “health insurance status was largely unrelated to the quality of care.” It seems as though even if we force people to self-insure, they may not wind up much healthier.

In sum, Prevor raises a key point: the fixation on universal health-care insurance has distorted the health-care debate. It might, as he suggests, be a good time to take a step back and see whether the quest for universal insurance is really where we should be focusing our attention. Maybe it is time, as he puts it, to remember that “the moral imperative is not making everyone buy insurance. The moral imperative is freedom.”

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