Thursday, March 11, 2010

Health-care reform's sickeningly sweet deals

By Kathleen Parker

Skipping through the Candy Land of the health-care bill, one is tempted to hum a few bars of "Let Me Call You Sweetheart."

What a deal. For dealmakers, that is. Not so much for American taxpayers, who have been misled into thinking that the sweetheart deals have been excised.

Not only are the deals still there, but they're bigger and worser, as the Bard gave us permission to say. And the health-care "reform" bill is, consequently, more expensive by billions.

Yes, gone (sort of) is the so-called Cornhusker kickback, extended to Nebraska Sen. Ben Nelson when his 60th vote needed a bit of coaxing. Meaning, Nelson is no longer special. Instead, everyone is. All states now will get their own Cornhusker kickbacks. And everything is beautiful in its own way.

Originally, Nelson had secured 100 percent federal funding for Nebraska's Medicaid expansion -- in perpetuity -- among other hidden prizes to benefit locally based insurance companies. When other states complained about the unfair treatment, President Obama and Congress "fixed" it by increasing the federal share of Medicaid to all states through 2017, after which all amounts are supposed to decrease.

Nelson's deal might have escaped largely unnoticed, if not for his pivotal role on the Senate vote last December. The value of what he originally negotiated for Nebraska -- about $100 million -- wasn't that much in the trillion-dollar scheme of things, but the cost of the "fix" runs in the tens of billions, according to a health lobbyist who crunched the numbers for me.

Other sweetheart provisions that remain in the bill include special perks for Florida ("Gatorade"), Louisiana ("The Louisiana Purchase"), Nevada, Montana, Wyoming, North Dakota and Utah ("The Frontier States"). There may well be others, and staffers on the Hill, who come to work each day equipped with espresso shooters, magnifying glasses and hair-splitters, are sifting through the stacks of verbiage.

Wearily, one might concede that this is, well, politics as usual. But weren't we supposed to be finished with backroom deals? Whither the transparency of the Promised Land?

During last month's health-care summit, Sen. John McCain had the audacity to raise -- "with respect" -- the specter of opaque and "unsavory" dealmaking, whereupon Obama reminded his former presidential foe that the campaign was over. Which isn't exactly true, of course, but point taken.

The effort to push any health-care bill through Congress is relentless, no matter how many Americans oppose it. All reasons are known and understood, at least politically. But taunting comprehension is how any member of Congress can view his reflection while carving out expensive deals instead of seeking every possible way to cut costs and reduce the likelihood of crippling taxes. It's not as though any of this is free.

To his credit, Obama conceded McCain's point in a post-summit letter to Congress, noting that some provisions had been added to the legislation that shouldn't have been. His own proposal does not include the Medicare Advantage provision mentioned by McCain that allowed extra benefits for Florida, as well as other states. The president also mentioned that his plan eliminates the Nebraska yum-yum (not his term), "replacing it with additional federal financing to all states for the expansion of Medicaid."

More fair? Sure, but at mind-boggling cost to taxpayers. To correct a $100 million mistake, we'll spend tens of billions instead.

Throughout the health-care process, the Democrats' modus operandi has been to offer a smarmy deal and then, when caught, to double down rather than correct course. The proposed tax on high-end "Cadillac" insurance policies to help defray costs is another case in point. Pushed by the president, and initially passed by the Senate, the tax was broadly viewed as an effective way to bend the cost curve down. But then labor unions came knocking and everyone caved. The tax will be postponed until 2018.

And the cost of the union compromise? According to the Congressional Budget Office, the original Cadillac tax would have saved the Treasury $149 billion from 2013 to 2019. Under the postponed tax, the savings will probably plunge to just $65 billion, or a net loss to the Treasury of $84 billion.

Regardless of what the CBO reports in the coming days, no one can claim the bill is as lean as it could be. A spoonful of sugar may indeed help the medicine go down, but even King Kandy and the Gingerbread People can choke on too many sweets.

Tuesday, March 2, 2010

Theater of the electorate

by Kathleen Parker

WASHINGTON — For all our bemoaning the tortures of health care reform, the debate has been healthy for the nation.

Everybody’s crazy aunts and uncles have been let out of their respective attics and basements, and it’s good to know who they are. It’s also been helpful for Americans to see how the sausage is made and figure out whether they really want any.

Last week’s summit was not wasted time, despite criticism that it was only political theater. What’s wrong with that? I like theater. I especially like the tiny details and what they tell us. In theater, as in life, details matter.

My major professor in graduate school, a scholar of 17th-century Spanish drama, used to say: “Always trust the artist.” If there’s a small, white house perched on a hill, assume there’s a reason for it. Consider why the artist put it there.

And so I watched the summit with this in mind. What did the actors in this particular play do and why? What did they want us to see? What were they trying to convey?

From the physical evidence alone, one could draw certain conclusions. If you looked closely, you saw that Republicans all carried the same briefing book with the same seal. Message: Unity and discipline. Loaded with numbers and power points, they presented themselves as the party of reason.

Democrats, who toted various binders and materials, presented a far less-unified, less-disciplined image and relied heavily on anecdote. Message: Caring.

What do people remember from the summit, to the extent they watched? They surely remember Wisconsin Rep. Paul Ryan hammering the Republican message about deficit spending in the health care legislation. And, they remember New York Rep. Louise Slaughter telling about a woman who, because she had no insurance, had to wear her deceased sister’s dentures.

There’s nothing to laugh at here, obviously. If true — and she dared us not to believe her — it’s a pathetic tale. Right-wing talk show hosts who have made sport of Slaughter’s story don’t get much credit for cleverness, but truly, sometimes an anecdote is too strange to be effective.
Maybe Republicans can trade Sarah Palin’s “death panels” for Louise Slaughter’s dentures and call it a draw.

As a political point, however, the contrast between personal anecdote versus mastery of health care economics is stark and telling. If you’re in the market for competence, which vendor gets your attention?

Theatergoers learned a couple of other things at the summit. The Democratic spin that the GOP has no ideas was contradicted by the summit. And, the bumper-sticker slogan that the GOP is the party of “no” isn’t quite true.

It’s the party of “hell no.”

There’s good reason for this. Republicans feel the wind at their backs, not only because of polls, but also thanks to these unsubtle clues: New Jersey and Virginia both elected Republican governors; Massachusetts sent Republican Scott Brown to the U.S. Senate.

And, two words: tea party.

Meanwhile, incumbent Democrats are in trouble. If they pass health care reform without Republican support, those from conservative districts likely won’t be returning to Washington next year. If they don’t pass health care reform, they may be tossed out anyway.

If you’re a Republican, why would you want to fix this?

And yet. Does anyone really think that no reform is an option?

On one thing, regardless of political affiliation, everyone seems to agree: The gridlock now clutching Washington is unacceptable.

Health care reform is now about the November election. It’s about gamesmanship. And though the parties differ in fundamental ways that really do matter, a growing majority of Americans no longer care who’s up or down, who wins or loses. A pox on everyone’s house, they say.

The tea party movement is partly a manifestation of this perspective. And, contra wing-nuttery in the margins of the movement, most constituents are everyday Americans who don’t think the federal government should control one-sixth of the economy.

This is not an irrational position, but rather suggests respect for human nature and chaos theory.

At the same time, more and more Americans are abandoning traditional political parties, with about 40 percent of the electorate identifying themselves as independents. A perfect storm this way comes.

Regardless of whether health care reform passes in the coming weeks or months, the debate has forced Americans to organize their thoughts. Come November, climate change is going to have a whole new meaning.

Talk about good theater.