Democrats are the New Republicans

Imagine, if you are under the age of 40, that once, not really so long ago, one of the two major American political parties espoused the following ideals, and the other party did not believe in these ideals strongly at all.

• Free Enterprise -- That companies should operate in a market under the law without subsidies from government....  Without, for instance, subsidies for oil exploration.  ("According to...the Congressional Budget Office, capital investments like oil field leases and drilling equipment are taxed at an effective rate of 9 percent, significantly lower than the overall rate of 25 percent for businesses in general and lower than virtually any other industry." -- NYT)
• Market Solution for Health Care -- Health Care should be extended via a market solution: a regulated marketplace of private insurers and providers, a mandate, and subsidies for the poorest families (Nixon).
• Naive Free Trade -- Extend free trade everywhere possible, regardless of factors like currency manipulation.

So, which party was that?

The Republican Party.

Today, one party pays lip service to these ideals at times, but the other party truly believes in these ideals.

More of the true believers are Democrats.

I'd go further.

Today, it is the Democratic Party that believes in the Horatio Alger story, the upward mobility, the land of opportunity.

These are strong ideals, and the Democrats, having the real belief, should embrace the first two of these ideals, and Horatio Alger, more forcefully, publicly, rhetorically.

Free Trade, on the other hand has a complexity that is crucial:  Free Trade isn't actual unless the currencies freely float (click link to understand why).

...

I was surprised as I began to finish this post and looked up when Elizabeth Warren was a Republican because her party affinity history, wiki nutshell version, is just like my own:

"Warren voted as a Republican for many years saying, "I was a Republican because I thought that those were the people who best supported markets." She states that in 1995 she began to vote Democratic because she no longer believed that to be true, but she says that she has voted for both parties because she believed that neither party should dominate."

People, Elizabeth Warren has evolved some, but not that much.  It's the Republican party that has changed so drastically.

Republican Rationing Rhetoric

One Republican Representative during the grand House debate on the reform bill today just spoke of going fishing not long ago with his 82-yr old father, who recently had triple-bypass surgery.

Having asserted that reform is trying to make American health care like Canadian and British health care, he concluded that under the coming reform he might not have been able to go fishing with his father if his father had faced a system like this, like British health care.

He finished with a crescendo against "rationing," etc.

There's a problem with this line of argument.

1. There is no rationing anywhere in reform, nor any mechanism that would allow it.

While there is no rationing scheme anywhere in proposed legislation, the most plausible assertion about rationing is that the IMAC panel, which suggests reforms for Medicare, could potentially suggest some sort of rationing scheme someday. But, the legislation explicitly forbids IMAC from even considering rationing. Rationing is disallowed. It's not in sight. It's not on the horizon.

I wrote a scathing post against rationing here months ago.

Rationing: A failure of Knowledge...

A few weeks later I had a lengthy discussion with a very skeptical ideologue about whether and how there could be any rationing. Finally, rationing via IMAC proposals was his most plausible scenario.

But then Congress explicitly prohibited IMAC from considering rationing in its legislation.

So not only is there no rationing proposed, it is even prohibited for future consideration.


2. The British system actually is nationalized health care, where the government owns most hospitals and employs most doctors.

Nothing remotely like that is anywhere in this reform.

Hospitals and doctors remain private, as now.

Neither is single payer in this reform. Nor is there a slippery slope towards single payer. Analytic experts believe this form of "level-playing-field" public option has little chance of crowding out private insurers if such insurers choose to be efficient.


Essentially the problem with Republican rhetoric is they are arguing against stuff that isn't there, just like before with the "death panels."

It hasn't changed. They are still arguing against imaginary stuff that isn't there.

Republicans would be doing great if the things they are arguing against were actually in the legislation!!

If we faced actual socialism, they would be doing a fine job defending us against it.

Instead, many Republicans currently are like Don Quixote, full of passion, seeing dangers everywhere and tilting their lances at windmills.

Will this matter?

Can't Republicans just argue against straw men, imaginary reform, that isn't in the legislation?

I think that's actually an open question. This is the age of the Internet.

Bloggers, both individual and those associated with major news sites, can just paste the videotaped comments of representatives in a blog post and then lay open the distortions, lies or incompetence...and more and more people are looking to see such reporting...

I think Republicans can get away with this practice less and less.

Non-ideological bloggers like yours truly will pin them to the wall.

Why?

Because I believe in America.

See, I know that a national drift towards defamatory ideological rhetoric is far more dangerous to America than more government regulation of health insurance.

The danger in such speech is its corrosion of the national character.

AHIP Says Premiums Will Rise

Costs will rise? Tell us what else is new. We already learned premiums for small business will rise about 15% in 2010.

America's Health Insurance Plans (AHIP) tells us that premiums will rise under reform.

But we already know that premiums must rise under reform because insurance will have to begin to cover health care without tricky loopholes, won't be able to exclude sick people, and can't drop policy holders that become sick.

When Americans will have more of the significant health care costs (the bigger bills) covered by insurance under reform, they will therefore have to pay for this newly-improved coverage through additional premiums, instead of paying those same costs out-of-pocket.

For lower income people, federal subsidies will help pay those premiums. Instead of some dying from lack of basic care, and some going bankrupt or losing their homes, they be able to get good, basic coverage. Some will get coverage for the first time.

For upper-middle-income households (north of $80,000/yr), the increased health insurance premiums will be like taking money from one pocket and putting it in the other. More spent on premiums, less spent out-of-pocket. As this true insuring for health costs occurs, the long term costs of health care become more visible.

This is similar to how the current administration reversed the Bush policy of counting the costs of the wars in Iraq and Afghanistan off-budget (as if the wars didn't count as part of federal spending), and began instead to count the war spending as part of the federal spending and deficit.

Reacting to the House health reform bill, AHIP put out a statement hoping to undercut the public option in the bill by trying to associate the reality of already skyrocketing costs (before reform) with the future under reform as proposed with a public option.

Let me offer the AHIP statement (in red) with my illuminations:

AHIP says:
“The promise of health care reform has been that if you like your current coverage, you can keep it. We are concerned that this proposal will break this promise by increasing health care costs for families and employers across the country and significantly disrupting the quality coverage on which millions of Americans rely today.

My interpretation: We know people change their current coverage often, even every year, and employers are now rapidly dropping coverage or changing coverage, so let's take advantage of the political rhetoric about "keeping your current plan." Our payments to doctors/hospitals/labs are skyrocketing, and the new 2010 premium increases are huge. We don't want a public option competitor, so we'd like everyone to associate the current reality into the future, and imagine it is happening because of coming health reform. We want you to feel that the coming health care reform is responsible retroactively for what is happening to you right now and will soon happen as the new 2010 premiums are unveiled.

“The lack of system-wide cost containment is a missed opportunity. Without a greater focus on health care costs, families and employers will not be able to afford coverage and health care costs will rise at a rate much faster than the overall economy is able to sustain.

We'd love health cost inflation to somehow be controlled by federal regulation, so we wouldn't have to work hard to create new efficiencies and care-coordination innovations on our own. {See my footnote about cost containment at the end of this post}

“We share the concerns that doctors, hospitals, employers, and patients have all raised about the significant disruption a new government-run plan would have on the current health care system. A new government-run plan would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid, and ultimately increase the federal deficit.

We know that the current finances of health care are already a train wreck, worse than the public realizes. We know this news will be coming in 2010, so let's try to associate this coming reality to the public option, if we can. Many hospitals are already in serious financial trouble -- let's pin that on having a public option in the health care reform somehow. Let's use the disproven canard of "cost-shifting" again. Let's try to use financial fear to fight the public option.

“Estimates show that a government-run plan would cause millions of people to lose their current coverage. Moreover, massive Medicare Advantage cuts would cause millions of seniors to lose their Medicare Advantage coverage altogether, while millions more would face benefit cuts and higher out-of-pocket costs.

We already know for sure that "millions of people to lose their current coverage" is going to happen, no matter what. It's underway. We'd like for Medicare recipents to be afraid of reform. We DO NOT want to lose our Medicare Advantage subsidy, because we pocket 86% of that extra federal subsidy as pure profit for ourselves, and only pay out 14% of that extra money for actual benefits. We'd like people over 65 to falsely think reform will lessen their health care.

“Health plans strongly support comprehensive, bipartisan health care reform and have proposed sweeping insurance market reforms and new consumer protections to ensure that every American has guaranteed access to affordable health care coverage. Experience in the states has shown that insurance market reforms must be paired with an effective personal coverage requirement for these reforms to work. While this legislation recognizes the key linkage of market reforms and a personal coverage requirement, more needs to be done to ensure coverage is affordable and our health care system is sustainable.

Listen, "insurance market reforms must be paired with an effective personal coverage requirement [a mandate] for these reforms to work" -- people, we are actually telling you the truth on this one! If people can just wait until they are sick to buy real insurance, the whole health insurance system is in great danger. But...we'd love it if the main solution for this is to increase the subsidy levels, since that provides the most headroom for us to keep profits stronger.

“As the process progresses, health plans will continue to work to advance bipartisan legislation this year that will cover all Americans, make coverage more affordable, and improve quality.”

We like the "bipartisan" approach, because it has no public option. Please, let's just do some kind of reform, any kind! without a public option. And, let's be sure to increase the premium subsidies for health insurance!

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"Cost Containment"

The "missed opportunity" for cost containment is about what is possible politically, and just exactly how deeper health care delivery reforms could be designed.

Legislators should not feel confident enough to try to specify everything. Indeed, it's better to set up systems that encourage the needed innovation.

Congress has proposed some helpful pieces of cost-reduction, some pilot programs for delivery reform (to change away from fee-for-service) and a panel of experts to recommend changes in Medicare -- IMAC. But even these cautious but good moves toward controlling costs could become a "missed opportunity" if lobbyists can weaken and betray these proposed cost-containment measures in the details of the legislation.

If the currently proposed cost-containment measures are weakened it will be due to influence buying --in plain language, corruption.

Buying influence with money.

Americans call this "bribery" most of the time.

The trillion dollar question now is whether Congress will be bribed this time, now, today, under the spotlight of public attention.

Health care inflation is a bigger issue than the Public Option or even Single Payer. Some of the most crucial kinds of change that will counter the health care inflation are in the way health care is paid for, and proposed legislation attempts to make avenues for significant reform over time by such mechanisms as giving IMAC (modeled on the existing MEDPAC) leeway to innovate. IMAC isn't unchecked -- its proposals would not be enacted unless accepted by Congress and the President. Since future IMAC proposals might limit some forms of easy profit (based on non-market-like structures), the challenge for Congress is to avoid corruption.

The danger is that vested interest groups making contributions here and now -- direct payments (contributions) to Congress from entities that profit from current non-market-like structures likely to eventually be reformed -- will be bribes meant to pay representatives to cripple or reject the proposed legislation.

I'm not sure one way or the other how this will turn out -- whether Congress will resist the bribery this time.