Wednesday, 29 December 2010

Democrats Prepare for Battle Over ObamaCare in Next Congress

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hospital emergencyBack in September, when Republicans first floated the idea of starving the ObamaCare beast, Health and Human Services Secretary Kathleen Sebelius argued that "what the Republicans will be faced with" when they try to defund ObamaCare "is really taking those benefits away," something the Obama administration was counting on to be a losing proposition for the GOP. The "benefits" to which Sebelius was referring include such things as the prohibition of denying health insurance to persons with pre-existing conditions, the extension of dependent coverage for children up to age 26, and the ban on lifetime coverage caps.

Now Congressional Quarterly reports that "House Democrats are trying to seize control of the message on the health care overhaul as they relinquish control to a Republican majority pledged to repeal or dismantle the law in the 112th Congress." The strategy, the report continues, is "to hit hard on the perils of repeal, emphasizing the loss of consumer-friendly provisions such as the ban on discrimination against people with pre-existing medical conditions."

The most significant effort in this direction is a report issued by Rep. Fortney "Pete" Stark of California. Stark writes in the introduction to his report that "the [ObamaCare] law improves the entire health care system." He then goes on to "detail different facets of the American health care system that would be harmed by the Republican agenda." Among the dangers of repeal are, he says, the reinstatement of "discrimination against people with pre-existing conditions," an increase in the number of uninsured Americans, a rise in the deficit, the repeal of "free" preventive care, the elimination of "guaranteed benefits" in insurance plans, the continuation of "unjustified" insurance rate hikes, and an increase in Medicare fraud.

Needless to say, all of the provisions Stark defends sound good. Who could be in favor of more uninsured people, higher insurance premiums, or more Medicare fraud? The problem is that nearly all of these provisions will ultimately lead to higher costs, increased demand, and concomitant denial of care. Others, such as the alleged deficit reduction, are debatable at best. Few are within the bounds of the federal government’s constitutional authority. However, given that Stark told a constituent that "there are very few constitutional limits" on federal power and that, in fact, "the federal government … can do most anything in this country," he is obviously not too concerned about such niceties.

Similarly, another Golden State congressman, Henry Waxman, "highlighted a Government Accountability Office report that said the overhaul … averted significant payment cuts to pharmacists for generic drugs under Medicaid," according to CQ. The congressman claimed that repeal of ObamaCare "would hurt pharmacists and other health care providers, leave millions of Americans uninsured, and increase the deficit."

CQ notes that while "public opinion about the overhaul is still sharply divided," with recent polls showing that only about 42 percent of Americans support ObamaCare, "other polls have found that many of the law’s consumer protections, such as allowing children to stay on their parents’ health insurance until age 26, are popular. In addition, a Kaiser analysis of polls found that some poll respondents say they support repeal when they mean they want to eliminate certain provisions, but keep others." Therefore, says CQ, Democrats benefit from the fact that the law "rolls out some of the important consumer protections years before making larger changes to the health care system," which is undoubtedly the way they designed it: "to give most of the goodies early on, and have the hard stuff happen after 2013," as American Enterprise Institute resident scholar Norm Ornstein put it.

Thus, while Republicans took control of the House of Representatives in part because of their opposition to ObamaCare, they do not necessarily have the public support to follow through with their promises to repeal the monstrosity.

Orange County Register columnist Mark Landsbaum predicted this turn of events in August:

Nevertheless, the reality is that people like to get something for less than it costs them. They like even more getting something for nothing. And although there is no free lunch, when revenue-raising is diffused and confusing, but the benefits are identifiable and specific, people act as if it doesn’t really cost them anything. The perception is that lunch actually is free.

Obamacare taps into this lust for unjust gain in a big way. And Democrats and the president have done so shrewdly…

The alleged "benefits" of Obamacare will begin soon — expanded Medicaid and mandated coverage, among them. The full bill for these benefits won’t come due until later, in some cases many years later. Almost never will the entire country simultaneously feel the entire pain of paying for what the government is doing. Obamacare segments the costs, which fragments the opposition...

As to getting rid of ObamaCare, Landsbaum asked:

Repeal it? What politician will risk his career by taking away "benefits" that voters imagine they gained from Obamacare? Reform it? When in history has the political class fixed something they’ve created without adding more to it instead of subtracting from it? For those who imagine Republicans on white horses will save them from Obamacare, remember it was the most-recent GOP president who presided over, not the contraction, but the greatest expansion of federalized health care in four decades by granting more Medicare drug coverage.

Indeed, House Republicans have already made it clear that they don’t intend to repeal ObamaCare in full but to "replace" it with a plan of their own. Their "Pledge to America" laid out a healthcare plan that includes many of the popular but perilous provisions that Stark and Waxman are claiming the GOP wishes to eliminate. This may be good politics for Republicans, helping them to parry Democrats’ attacks, but it is bad constitutional government.

Republicans, if they are really serious about repealing ObamaCare, need to offer a better alternative than ObamaCare Lite. Their plan should instead concentrate on reducing both government interference in the healthcare system and Americans’ dependence on third-party payments for their healthcare. Unlike ObamaCare, which strengthens the government’s grip on healthcare, such a plan could truthfully be portrayed as one that gives people more control over their own healthcare. Then let the Democrats howl about all the insurance mandates the GOP is taking away. If people no longer have to depend on insurance to pay for their healthcare, they will be far less likely to demand extensive benefits and far more likely to demand lower healthcare prices, which are best brought about by reducing taxes and regulations.

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