Commentary Magazine


Topic: transportation appropriations

Re: The Culture of Corruption

Pete, your focus on the fundamental corruption at the heart of the Senate bill is, I think, exactly right and that corruption rather extraordinary. In the days after the Senate cloture vote on the health-care bill, you would think the mainstream media would be touting the bill’s benefits and focusing on the huge “win” for the president. But instead the buzz in both the mainstream and conservative media has not been about the merits of the “historic” legislation but about the backroom deals necessary to achieve its passage, which its sponsors assure us will usher in a wonderful era of improved health-care access and care.

We’re going to remember for years to come the names of the deals, just as surely as did the infamous Bridge to Nowhere become part of the political vocabulary: Louisiana Purchase, Cornhusker Kickback, U Con, Bayh Off, Handout Montana, and Gator Aid. Vermont and Massachusetts got billions more in Medicare funding. Sen. Roland Burris managed to slip in some funding for none other than ACORN, under the guise of improving minority community health. The scope and number of the deals are breathtaking, but it goes beyond the unseemliness of the average pork-barrel bill.

After all, this is not merely a transportation appropriations bill where the whole point is to dole out federal monies and the “game” is for each lawmaker to grab as much of the pie as possible for his own constituents. That might be distasteful to legislative purists and raise doubts as to whether all the money is being wisely spent. But it’s just about spreading the largess. In a case of transportation pork, one district gets a bike path and another doesn’t get the highway off-ramp, but neither district probably needed the project anyway.

In the case of health care, however, the bill rests on the premise that we are improving access to care and working toward a healthier society, reducing the problem of haves and have-nots. For decades that is how health-care “reform” has been sold by liberals.

But instead, what we “get” for health-care sweetheart deals is a new regime of rationed care, which will primarily impact the elderly. The nauseating plethora of backroom deals and special carve-outs for this or that state in health-care “reform,” therefore, is more egregious, and thus more politically toxic.

A central feature of this bill is the $500B cuts in Medicare funding, including slashing the popular Medicare Advantage plan and the imposition of a newly beefed-up Medicare Advisory Board, which will be empowered to devise new ways of cutting payments to doctors, hospitals, nursing homes, and other health-care providers. In the absence of any real reform measures, the only feasible way to control costs is limiting care—i.e., rationing. Medicare already denies medical claims at double the rate of many large private insurers. And with $500B or so less to work with, many more Medicare claims will be denied.

This is what the Cornhusker Kickback and the rest of the bribe-a-thon are enabling. The Senate bill spared voters in a few states the harshest impact of the new care-depriving regime so that the same regime could be foisted on the entire country. Connecticut voters get $600 million in additional Medicaid benefits, Vermont voters get $10B in health-care centers, and hospitals in North Dakota and Iowa get richer Medicare reimbursement rates. Those deals made possible reduced rates of reimbursement and Medicare funding for the rest of the country, rates so paltry and unacceptable to a few key senators that they had to use all their pull to spare their own states. If it is unacceptable for them, why must the rest of the country live with it?

The colorfully named backroom deals may well induce a fiery public backlash, complicating the bill’s passage and negating any political benefit derived by its proponents. Voters will discover not only the ugly side of secret deals; they may also figure out that the moral justification for health care has been jettisoned by those who used their clout to squeeze care for millions of voters while sparing themselves the worst of that backlash.

Pete, your focus on the fundamental corruption at the heart of the Senate bill is, I think, exactly right and that corruption rather extraordinary. In the days after the Senate cloture vote on the health-care bill, you would think the mainstream media would be touting the bill’s benefits and focusing on the huge “win” for the president. But instead the buzz in both the mainstream and conservative media has not been about the merits of the “historic” legislation but about the backroom deals necessary to achieve its passage, which its sponsors assure us will usher in a wonderful era of improved health-care access and care.

We’re going to remember for years to come the names of the deals, just as surely as did the infamous Bridge to Nowhere become part of the political vocabulary: Louisiana Purchase, Cornhusker Kickback, U Con, Bayh Off, Handout Montana, and Gator Aid. Vermont and Massachusetts got billions more in Medicare funding. Sen. Roland Burris managed to slip in some funding for none other than ACORN, under the guise of improving minority community health. The scope and number of the deals are breathtaking, but it goes beyond the unseemliness of the average pork-barrel bill.

After all, this is not merely a transportation appropriations bill where the whole point is to dole out federal monies and the “game” is for each lawmaker to grab as much of the pie as possible for his own constituents. That might be distasteful to legislative purists and raise doubts as to whether all the money is being wisely spent. But it’s just about spreading the largess. In a case of transportation pork, one district gets a bike path and another doesn’t get the highway off-ramp, but neither district probably needed the project anyway.

In the case of health care, however, the bill rests on the premise that we are improving access to care and working toward a healthier society, reducing the problem of haves and have-nots. For decades that is how health-care “reform” has been sold by liberals.

But instead, what we “get” for health-care sweetheart deals is a new regime of rationed care, which will primarily impact the elderly. The nauseating plethora of backroom deals and special carve-outs for this or that state in health-care “reform,” therefore, is more egregious, and thus more politically toxic.

A central feature of this bill is the $500B cuts in Medicare funding, including slashing the popular Medicare Advantage plan and the imposition of a newly beefed-up Medicare Advisory Board, which will be empowered to devise new ways of cutting payments to doctors, hospitals, nursing homes, and other health-care providers. In the absence of any real reform measures, the only feasible way to control costs is limiting care—i.e., rationing. Medicare already denies medical claims at double the rate of many large private insurers. And with $500B or so less to work with, many more Medicare claims will be denied.

This is what the Cornhusker Kickback and the rest of the bribe-a-thon are enabling. The Senate bill spared voters in a few states the harshest impact of the new care-depriving regime so that the same regime could be foisted on the entire country. Connecticut voters get $600 million in additional Medicaid benefits, Vermont voters get $10B in health-care centers, and hospitals in North Dakota and Iowa get richer Medicare reimbursement rates. Those deals made possible reduced rates of reimbursement and Medicare funding for the rest of the country, rates so paltry and unacceptable to a few key senators that they had to use all their pull to spare their own states. If it is unacceptable for them, why must the rest of the country live with it?

The colorfully named backroom deals may well induce a fiery public backlash, complicating the bill’s passage and negating any political benefit derived by its proponents. Voters will discover not only the ugly side of secret deals; they may also figure out that the moral justification for health care has been jettisoned by those who used their clout to squeeze care for millions of voters while sparing themselves the worst of that backlash.

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