We On The Right Should Remember 2003 When We Lament 2010
I was distressed to read this post by Megan McArdle about "The Future after Health Care," particularly this part:
There seem to be three complaints here. The first is that the American people don't want health care reform, or at least this version of health care reform. I don't think anyone will hold up the bill that will pass as exemplary, but it does reflect elements of health care reform that Democrats campaigned on and won on in 2008. So I have a hard time seeing this as doing violence to the will of the people as it is typically expressed in our electoral system. Elections matter. This is how they matter.
The third complaint is the most legitimate of the three, that we have created a new entitlement with dubious financing and greater government involvement in the provision of health care. This is more true than I would like it to be, but given what Republicans passed with Medicare Part D, they have surrendered the fiscally responsible high ground. And, more importantly, they surrendered the political high ground when they failed to propose a coherent alternative that addressed the critical problems of pre-existing conditions in health insurance markets. It was a mystery to me that no Republican stepped up with a sensible alternative that addressed the structural problems without committing to such a large federal government role in the conduct and financing of health care markets. That was the fight they should have had. To say that they lost would not be right. They simply didn't show up.
Shorter McArdle: The Dems are
Shorter McArdle: The Dems are committing political suicide by passing this massively unpopular bill, but the Republicans won't repeal it when they win because that would be political suicide.
Both things can't be true, even if you accept McArdle's hallucinatory characterization of the Democrats as ideological extremists hell-bent to legislate heedless of the polls, and the Republicans as cautious pragmatists ever sensitive to shifts in the political winds. Simply put, if, as she contends, the Republicans have persuaded the overwhelming majority of Americans that this bill is a bad idea, then the Republicans will easily win in the fall, and just as easily pass legislation repealing HCR in toto. Failure for either to come to pass would quite obviously refute McArdle unequivocally.
The Republicans lost after 2003
The Republicans lost a lot of support from fiscal conservatives after 2003. If the Democrats had nominated a more creditable candidate in 2004, they could have won the Presidency then; they did have gains in the House and Senate over the next 3 elections.
If I remember the last Presidential campaign correctly, Clinton (who I supported) campaigned on ending the exclusion for pre-existing conditions and the individual mandate, was attacked by Obama over the mandate, and lost. Then, McCain campaigned on taxing Cadillac health plans, was attacked by Obama for it, and lost. So whatever mandate Obama had for health care reform, it wasn't this.
The fact is, the Democrats deserve to lose heavily after this travesty; the problem is, the current Republicans don't deserve to win. Quite a dilemma. I need a drink.
I think you are missing her main argument...
put succinctly, she is concerned about the precedent of governing to one's base in a partisan way to enact broadly unpopular legislation. American government is formed on the consent of the governed; that will not last long if our political leaders throw red-meat to the base and ignore the rest of us. That's true in 2003, 2010, or 2013.
But his base wanted...
the public option or single payer. They got neither....so who exactly was he pandering to? It seemed like Obama governed from the center. Exactly what he said he would do.
That is because her main argument (as you describe it) is silly
Given that we have a two-party system constituted through winner-take all legislative and executive elections, the idea that there is some kind of 'precedent' in 'governing to one's base in a partisan way' is pretty silly. Even if this is what the health care finance bill had been -- and the fact that many politically-engaged Democrats are extremely lukewarm about its provisions suggests otherwise -- the fact is that each party consists of a complex coalition whose shape varies considerably depending on the issues involved.
Or rather, the Democratic party still consists of a complex coalition whose shape changes. What's most unusual about the entire legislative history of this bill (and of the entirety of Obama's first term, on the whole) is that the Republican party in Congress is behaving like a Parliamentary party. The party's ability to maintain discipline and prevent even minor defections is quite extraordinary, in historical terms, and does not bode well. I'll leave it to the Congressional historians to find the last such block voting pattern -- Republicans in the 1930s? Democrats in the 1850s? -- but I doubt it was a sign of good times coming.
American government is indeed based on the long-term consent of the voters (if not the governed), but the voters are all over on the specific issues involved. Many of the provisions of the just-passed bill are overwhelming popular (for emotional if not rational reasons, e.g. banning recission). Others trigger reactionary responses from downwardly-mobile portions of the economy, who have benefited from very few of the developments over the past half-century, and whose ire can be steered, although it's fairly unpredictable. Others are technical enough that they are unlikely to sway votes, compared to much more visible macro variables such as jobless rates, inflation, and so forth.
Short version: if the economy continues to improve steadily, most of the health care finance bill will not have much effect on the next election, though it may have some further down the line. But if problems continue, and -- crucially -- if Democratic voters are disheartened, for whatever reason, in November 2010, then we are likely to see a larger swing. Time will tell.
Yes
"they failed to propose a coherent alternative that addressed the critical problems of pre-existing conditions in health insurance markets"
Indeed.
They had their blank sheet of paper for eight years.
Bit Victor, Good government
Bit Victor,
Good government can only be formed on the informed consent of the governed. What we have here is massive misinformation blanketing the governed by an irresponsible media. There is a reason why democracies function best when the population is educated.
Comparing 2003
I am not a fan of these crazy parliamentary tricks, but just rewind the clock, as Bruce Bartlett does so well, to the 2003 legislative process on Medicare Part D. The Republicans had both houses of Congress and the White House but had trouble getting the bill passed. Again, I am going to need to be convinced that what happened in March 2010 is a more hideous affront to standards of legislative conduct than what happened in November 2003.
This is not excusing the current process -- it is calling BS on claims that the Democrats have somehow stooped to a new low.
BS? Hmmm....
In 2003 the Republicans had only 51 Senators. The Part D bill passed the Senate 76-21 with a majority of Democrats voting for it. The Senate cloture vote on the conference bill passed 70-29.
There was a conference bill, of course. Perfectly normal procedures. They didn't have to try anything like reconciliation to avoid a filibuster with all those Dems on board supporting the bill, nor try as best they could to pull a Slaughter maneauver to avoid an accountable vote on the Senate bill. There were no "parliamentary tricks", no "affronts to standards of legislative conduct" whatsoever due to problems in the Senate which did not exist.
There's no comparison at all between 2003 and today as far as all that is concerned.
The Repubs in 2003 had their problems in the House where they had 229 seats versus the Dems' 204. They engaged in a lot of unseemly arm-twisting and threats and bribery and pushed procedures to swing enough votes to "for" at the very last minute to pass the bill 220-215.
Today the Dems had their problems in the House where they have a 257-178 majority, much larger than the Repubs had in 2003. They engaged in a lot of unseemly arm-twisting and threats and bribery and pushed procedures to swing enough votes to "for" at the last minute to pass the bill 219-212.
That's comparable enough.
(Although of course the Dems this time resorted to all that unseemly bribery and all in the Senate too -- even when having 60 votes there -- to keep their own people on board, which the Repubs didn't have to do in 2003 with so many Dem votes in hand.)
The third complaint is the most legitimate of the three, that we have created a new entitlement with dubious financing and greater government involvement in the provision of health care. This is more true than I would like it to be, but given what Republicans passed with Medicare Part D, they have surrendered the fiscally responsible high ground.
They surrendered the high ground but never went so low as this.
Medicare Part D wasn't financed with $53 billion of Social Security taxes, leaving that much in SS benefits unfunded outside the scoring window ... nor by promising (very much on the quite) to hack $29 billion in Medicaid payments, which is about as likely to occur as all those promises made to date to cut Medicare payments ... nor by planning to cut $400 billion of Medicare provider payments, such cuts to be figured out only later ... nor by imposing a new "Medicare tax" to be spent on things other than Medicare, on the claim that running the taxes through the Medicare Trust Fund first it will "strengthen" Medicare by issuing all those bonds that add to the national debt ... nor with the promise that a major tax already soundly rejected by Congress will make a miraculous comeback in the few years, counting that revenue today ... nor by accelerating corporate income tax payment due dates to within the scoring window, *as if* that increases revenue ... shall I go on?
Do you really think all this is comparable to 2003?
In 2003 the big argument was about the cost scoring for Part D. The Bushies projected $400 billion over 10 years. One month after enactment the estimate went to $530 billion. Scandal! The Bushies lied!
Well, maybe so, I don't doubt it. Except half way through the 10 years, now the estimate is $410 billion again. In 2008 the cost to the federal govt was $37.26 billion. Probably they thought they were lying.
But that dollar amount aside, the Repubs never gamed how Part D was to be paid for -- just like the rest of Medicare, mostly with general revenue, plus some premiums and state contributions.
They never did anything like take $50 billion of Social Security taxes to pay for Part D, leaving SS benefits of that amount outside the scoring window unfunded ... or move corporate tax payment due dates to within the scoring window, as a "revenue increase" ... or pretend to promise $29 billion of Medicaid cuts to be found later ... or count the future revenue from a tax that had already been rejected ... or any of the rest.
Do you really see all this as just the same as 2003?
Hey, the $463 billion of cuts "to be named later" from Medicare alone exceed the 10-year cost of Part D.
ISTM this bill really goes well beyond what happened in 2003. Both as to procedure (no procedural tricks needed with 76 Senate votes, including a majority of Democrats, 70 for cloture on the conference bill) and budget gaming.
We've set a new fiscal precedent. From now on we can commit to spend as much as we want and feel good about how we are "fully paying for it" with spending cuts nobody can agree to now but which we can assume everyone will agree to later, plus already rejected taxes that we can assume will be enacted later and so count today, plus whatever more Social Security taxes we can find, plus new Medicare taxes that we won't spend on Medicare.
Happy fiscal days are here again! 2003 was never so good.
We on the right should
We on the right should remember that republican and fiscal conservative may not be mutually exclusive, but its darn close.
"This is more true than I
"This is more true than I would like it to be, but given what Republicans passed with Medicare Part D, they have surrendered the fiscally responsible high ground."
The GOP surrendered the 'fiscally responsible high ground' in the early 1980's; they've been living on lies and people's long-obsolete beliefs for a quarter-century now.
In discussing Megan McArdle's writings, the simple fact that she took the pen name 'Jane Galt' pretty much sums up her attitudes and writings. Her finance is part of Dick Armey's astroturf brigade, but you wouldn't know it from her writings. Odd, that - it's almost like, perhaps, she herself is an astroturfer. If one were to test the hypothesis by means of her writing, one couldn't reject it.
As for the GOP playing nasty in return, we've got the Gingrich Era and the Bush II administration as evidence that the GOP will *always* play nasty - while accusing their opponents of exactly what they themselves are doing.
Excellent post Dr. Samwick
I knew there was a reason I followed you over from the old Vox site.
Boudreaux's Bet
Now that it's all over save the shouting, who will take Boudreaux's Bet, here described by Bryan Caplan?
http://econlog.econlib.org/archives/2010/03/boudreauxs_bet.html
Anyone? I'd guess not.
Counterpoint to counterpoints
#1:
If universal health care reform was the central Democratic issue of the 2008 campaign (as in "We're gonna spend 14 months on it, almost exclusively") - it somehow missed millions of independents' attention.
This is, ya know, the "internet" - how about posting links to three or four major Obama *campaign* speeches that support your hypothesis that this *isn't* an epic electoral bait-and-switch.
#2:
Part D(efense): The Republicans engage in shitty vote buying behaviour where they trumpet utopian objectives and vacate any responsibility for actual, objective consequences.
So the Democrats get to, too - pfffttt!
Again, as an independent who is compelled to actually, you know, live with the recklessness and depradations of the political class, I'm not big on Samwick's advice to sit back and endure it (because "everyone" does it).
#3:
Part D(efense), Part II - Yeah, sure Dr./Rep. Pelosi Rictus has created a financial monster, but since Republicans didn't solve the intrinsic problem of adverse selection in insurance risk pools, lets just socialize the sonofabitch and by the time the whole crapola rattletrap contraption collapses of its own internal contradictions (I'm guessing far far off - say 2020...), Rep. Rictus will happily be off blowing our new Chinese overlords...
And to think, Calculated Risk torpedoed Mish for *this*...
And the solution is ???
You write: "...since Republicans didn't solve the intrinsic problem of adverse selection in insurance risk pools, lets just socialize the sonofabitch..."
Since that's the choice made by every other developed country in the world, pretty much, it doesn't seem quite as crazy as you imply. From Taiwan to England to France to Switzerland, socialized management of the distribution of health care cost risks is the norm, and most of the countries involved are doing reasonably well -- better, in many cases, than the United States, in the absolute and relative cost of health care, the outcomes, and the condition of their national economies.
Rationality echoes what experience demonstrates. After all, the problem of adverse selection in insurance risk pools is, to use your own word, intrinsic. That is, in the context of for-profit businesses, it is not solvable by 'market mechanisms' that any economist has been able to develop. Health insurance companies who (rationally and prudently) use information available to them to eliminate risks, as well as the tendency of buyers who need to product to buy proportionately more of it, lead to the collapse of all private for-profit insurance schemes. This obvious intrinsic logic, by the way, explains why insurance products from their founding through the rise of the cult of St. Reagan were sold primarily by mutual assocations, or provided by governments. Only in the 1994, we should remind you, did Blue Cross and Blue Shield stop being non-profit. Other big insurers -- Prudential, etc. -- stopped being organized as mutual companies (to the great profit of their managements, in the process) in the same frenzy of neo-liberalism. The results have not been happy.
Thus: If historical experience and rational calculation both tell us that commoditized for-profit health insurance suffers intrinsic market failure; and if (a premise that the Tea Baggers reject, but most of the rest of us find persuasive) the provision of universal risk mitigation and cost distribution for medical costs* provides a net benefit to economies and societies,** then "socialize the sonofabitch" is a rational and prudent policy.
* PS: I recognize that the benefit depends on prudent system construction and management -- here, the experience of the rest of the world shows that details DO matter!
** PPS: It is easy enough to provide plausible ways such a benefit works in direct economic terms that are acceptable to pure economics, not to mention the moral, social and political dimensions. For example, universal coverage increases the fluidity of labor (not tied to bad jobs by their inability to get insurance if they quit), which a libertarian should favor, and levels the playing field between smaller and larger corporations (whereas our current mess punishes small corporations for being small risk pools).
PS and PPS Counterpoint
PS Counterpoint:
Prudent System Construction...does the current legislation cum abortion (ahem) look particularly well constructed to you? Designed for long-term stability?
To take but a few points, by *denying* private insurers risk management tools to avoid adverse selection and to put any risk caps in place...the current legislation dooms any long-term private provision of health insurance - **unless** everyone elses' rates inflate significantly (to re-dilute the *now* risked poisoned pool).
**Then** President Poseur will attack the Potemkin Villains (health insurers) again - "See, those rat-bastards hiked rates after I warned 'em" (but don't you dare look behind the curtain of *why* they had to raise rates - Poseur's Presidential Prescriptions...Guaranteed To Poison Risk Pools").
But of course your answer is that if logic and economics dooms any long-term attempt to use private companies as a front for the socialization of personal risk, then we'll just of course do the mature, sclerotic European thing and replace premium-fronted socialism with tax-backed socialism.
Funny how that foreordained conclusion never passed the fixed grimace (and Really Big Gavel) of Speaker Rictus.
PPS Counterpoint:
Okay, it is now 2020 and "dem evil" insurance bastards are all out of business and we have single payer (which has never been wanted here but is "Big in Europe" - like Hasselhoff's music).
Our Heroic Federal Government, having defrauded us into doing the "wise sclerotic European thing" and rope-a-doped us all into one-happy-Woodstockian-hippie-dippie-risk-pool (mud, BO, cholera, and subsidized stupidity included) will...fully consistent with "Officially Sanctioned, MSM-Retailed Heroic Federal Government History" "prudently manage" the sonofabitch.
Yep, we can eagerly look forward to a single-payer health care system with all...
1) **The economic accuracy of Social Security projections** (and SS is fully funded right? Not cash-flow negative as of...er, last year?)
married to...
2) **The iron cost control discipline so repeatedly and so very recently demonstrated in the annual Medicare SGR buggerings of the public fisc**
Yep...democracies have a stellar record with "prudently managed" socialized entitlements.
Go ask Greece.
If you can get anybody on the phone...the Germans may have repossessed them by then.
The phones...not the Greeks.
(But just give Greek irresponsibility and German resentment time...another poisoned pool marriage made in heaven...)
PPPS Counterpoint (I'm anticipating you here).
"Okay, so maybe...
1) President Poseur pulled an electoral bait-and-switch (health care reform way, way before any economic focus),
2) Has constructed a class of Potemkin Villains (the insurance companies - after all it ain't like 85% of health care dollars go to, you know, health care "providers"),
3) Has bravely manipulated us into inevitably having to eat our European spinach (single payer), and
4) can be "trusted" (of course, just look at 1-3 above) to manage the Socialized Sonofabitch safely - lessons of the annual SGR buggerings (and infinite others) notwithstanding.
*But It Is All Worth It* just to see the young, economically unwilling, actuarially unneedy, currently-uninsured thrown into the loving arms/gaping maw of the Federal Single Payer Machine.
After all, how else to cover up the fact that the "well-managed," "beloved" **Medicare** is broke (like SS) *today*.
(Yes, I know, Medicare and SS can't technically go "broke" so long as there is a single percentage point of the private sector GDP to be bled off...wonderful).
Funny, isn't it, how just as the bills come due on Entitlement Fiasco #1 (Medicare is cash-flow broke) our attention is kindly drawn/compelled to the Sunlit Uplands of Health Care for the...Uninsured (but actuarially sexy).
So Medicare, having pissed *its* pool, will inevitably be blended with the (temporarily) purer "new" risk pool made up of the compulsory contributions from "Health Care Reform".
The whole HCR scam isn't really about healing the actuarially unneedy young - it is about propping up the previously defrauded but politically potent old.
Just watch for the two-steps:
A) Insurance "reform" designed to result in "single payer"
B) "Concern for the young" acting as cover for cross-subsidization of the old.
Sir, You may have very valid
Sir,
You may have very valid points. A coherent English translation of your comments may be cogent and will help me understand them.
The only thing worse than
The only thing worse than tyranny of the majority is tyranny of the minority.
And, more importantly, they
And, more importantly, they surrendered the political high ground when they failed to propose a coherent alternative that addressed the critical problems of pre-existing conditions in health insurance markets. It was a mystery to me that no Republican stepped up with a sensible alternative that addressed the structural problems...
And what would that alternative be? Probably something that looks like the bill that just passed. If you don't require everyone to have insurance, people will go without it until they get sick. That's like letting people buy auto insurance after they have a car accident. The result will be only sick people will be in the insurance pool. This will drive up premiums and more employers will drop coverage for their workers, concentrating even more sick people in the insurance pool. That will lead to a single payer system, which would be a good thing.
"it does reflect elements of
"it does reflect elements of health care reform that Democrats campaigned on and won on in 2008. So I have a hard time seeing this as doing violence to the will of the people as it is typically expressed in our electoral system. Elections matter. This is how they matter."
I guess people remember what they want to remember. I barely remember health care even being mentioned in the 2008 elections. The big issue with virtually everyone was the two simultaneous overseas wars our military was fighting, with no end in sight.
By election day, we had two candidates. One promised to end neither war, and said our military could be there another century. One promised to end one war, and escalate the other. (Other candidates who promised to end both wars had dropped out early enough that I couldn't even caucus for them. Whether that's the fault of the electoral system or the candidates is another debate unto itself.) I never believed anyone would think that the election was an endorsement of any of Obama's policies, but rather simply a condemnation of Bush's, which McCain promised to continue.
To date, Obama has put more troops in Afghanistan, but has not withdrawn from Iraq. I would not call that "the will of the people as it is typically expressed in our electoral system". We put him in office to end a war. I can think of no other presidential election in recent history that was so direct in purpose.
What he has done so far is promised to end "combat operations" in Iraq in 18 months (over 12 months ago), while leaving 50,000 troops on the ground (as far as I can tell) indefinitely. In comparison, Gorbachov withdrew every Russian soldier from Afghanistan in 10 months, and even then he was criticized for how slow the withdraw was.
Most Americans today oppose the Iraq war, and have for years. How, exactly, are citizens supposed to convince the President to stop fighting a war, if not by electing someone on that very issue? I do want health care reform, eventually, but right now it looks like a great political distraction from ending the wars. America has always been at war with Iraq!
Campaign 2008
Actually, the Iraq war featured heavily during the primary season, but during the general election campaign, Bush had already agreed to a withdrawal deadline, making this a moot point. By that time, the foreign policy question was about style, engagement, and experience. The domestic issue--based on Obama's, Clinton's, and McCain's websites was indeed healthcare. All described their plans in greater or lesser detail.
Granted, this changed dramatically after Lehman folded and the entire economy seemed to go into panic mode.
Obama has actually supported a bill which is far more centrist than his campaign promised. In the meantime, Republicans seem to have stuck to the points McCain championed during his campaign--give everybody a tax cut to pay for insurance and let the free market solve everything else.
What I found very telling was a Republican comment during the Senate debate I watched during the passage of the enhanced CHIP bill in early 2009. Surprisingly to me, the Republican, Lindsey Graham, iirc, stated as a core assumption that of course, "our" basic objective was to get all citizens into private insurance policies. That "our" may be the Republican assumption, but most progressives see no compelling reason for that approach. We may think it is the only politically feasible path, or that it is the easiest path given our history, but very few of us would state that as an overriding objective.
McArdle's claim is incoherent
"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! "
I am sorry, but this is incoherent and on the facts-wrong. First, how do you make this claim and in the next breath suggest that entitlements (for very good reasons of basic human psychology) are hard to repeal? Second, and following on from this observation, didn't then President Bush wish to "spend his political capital" in 2005/6 and try to modify Social Security to make a more market friendly institution? How did that go with Republican majorities? Not well, I vaguely remember. Your claims appear to fly in the face of history and also incentives facing electors and the elected. It is easier to pass an entitlement that benefits me (in a very real way, and possibly harms me through an indirect and circuitous route) than it is to rescind it (which won't benefit me except in some abstract and indirect sense, and hurt me directly).
Surrendered the High Ground?
I have no brief for the Republicans, or the Democrats for that matter ("Indispensable Enemies" as the late Walter Karp so aptly described the two parties), but I can't see why Part D invalidates the point that this Rube Goldberg contraption was put over with some real whoppers regarding cost and payment (evicerating any claims that Obama is something new). Whatever went before, they are the opposition; it's their job to raise the alarm.
I barely remember health care
I barely remember health care even being mentioned in the 2008 elections.
Sigh. Selective amnesia is such a drag.
What I remember from the 2008 elections is Hillary and Barack spending most of the Democratic primary season debating the need for individual mandates (Obama, of course, was against them before he was for them) and Obama telling the AFL-CIO in April that "we're ready to play offense for universal health care," and him telling the Democratic National Convention in August that "now is the time to finally keep the promise of affordable, accessible health care for every single American." I also remember John McCain rolling out a competing plan, which would have taxed employee health care benefits (which might be a good idea, but didn't exactly wow the voters). I also remember newly inaugurated President Obama promising "to raise health care's quality and lower its cost." (OK, so that one was probably a whopper.)
Not to mention the fact that I distinctly remember Democratic candidates and presidents voicing their support (strictly rhetorical at times, but still) for universal health care since, oh, about 1932.
Point is: You have to be sunk pretty deep in an Orwellian vision of a mutable past to flush all that history down the memory hole.
Seems to me your real complaint here is that a Democratic president finally delivered on one of the party's key campaign planks. A rarity, to be sure, but in no way a violation of the truth in political advertising rules (such as they are.)
great discussion
I just wanted to say that the level of discussion on this blog is very impressive and it's been really great to read all that people have taken the time to post here. Now, I can't talk much about what happened during the medicare part D time period. I was out of the country and not paying attention to the US political scene. But as I understood what was happening in the senate these past months, the use of the filibuster was unprecedented. I might be slightly off on this. I do think that history will look back on these changes to that are being made to our health system with less focus on how it came to be, and more on the tangible results that will hopefully come to fruition. I have believed for a long time that it was incredible that a country with the strength and power of the US didn't have Medical Insurance for all it's citizens. Now we just have to figure out how to pay for all this worthwhile social legislation.