“Health Care – End of the Beginning”

Weeks of drama in the health care debate ended when the suspense of a Christmas Eve vote has been replaced by the certainty that the legislation will pass the Senate.

As we take a step back from the day to day debates, the polity can take a deep breath and look more carefully at what Congress had wrought in recent weeks. The most obvious question is “why.”

There was certainly no public clamor.  For those with insurance, up to 80% express satisfaction. As far as priorities, the economy and jobs remain the most important issues for Americans.  And as their distant third priority, Americans are skeptical at best about what Congress is doing regarding health care reform

55% disapprove of the legislation including a subset of 60% of seniors.  57% believe passing nothing is preferable. And despite all protestations to the contrary from the Democratic majority, 53% believe they will see lower quality in health care if the bill passes, 58% believe the bill will drive up costs. Those have got to be frightening numbers for any Member of Congress on legislation that will impact every American and affect a sector of the economy that will spend $33 trillion in health careover the next decade

And it certainly isn’t a matter of principle. The world’s Greatest Deliberative Body, under Harry Reid’s leadership, turned one of the most consequential debates in recent American history into a bazaar of backroom deals to buy the requisite votes for passage. A grizzled used car salesman would look on with disgust.

Writing in the Washington Post on Tuesday, Dana Milbank hilariously outlined how the game was being played inside Reid’s office.  “Cash for Cloture” it was called, as Democrats lined up to bid their vote to support the Cloture vote procedure that closes off debate and allows a vote.

There was the “Louisiana Purchase,” awarded to Senator Mary Landrieu of Louisiana.  $100 million in extra Medicaid money for her state.  Apparently unaware of how unseemly this was, Landrieu took to the floor of the Senate to say that she had no apologies and that the correct amount was $300 million.

The longest holdout, Senator Ben Nelson from Nebraska, was apparently more principled about how much Medicaid money his state would receive than his purported interest in how the new health care bill will affect current abortion policy.

Nelson got the “Cornhusker Kickback;” a landmark, exemption – in perpetuity – for his state’s share of Medicaid expansion under Obamacare. Beyond the simple egregiousness of the deal, the agreement demonstrates how flawed, unseemly and tactical the process has been.

Has no one thought to consider the overall implications for Medicaid itself and the logical repercussions for other states with the Nelson deal consummated?  If Nebraskans don’t have to fork over more cash for Obamacare, why should New Yorkers or Californians, or Floridians?

And all of this skullduggery was going on behind the scenes as the Senate spent 17 days publicly debating a 2,100 page bill, which – when all the fixes were in to get 60 votes –  was promptly replaced with Reid’s “Manager’s Amendment” that magically became the new health care bill. Members had 38 hours — if they cared – to read the bill before the first Cloture vote toward passage.

As the Wall Street Journal said on December 21st, “An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it.”

From a partisan point of view, in an event that creates new meaning for the word amazing, Harry Reid is prepared to move a bill on a party line vote — without so much as a single Republican in support.

Considering that the GOP minority represents at least one Senate seat in 26 states and controls both seats in 14 of those 26 states, Reid is effectively disenfranchising between 75 and 108 million Americans, whom these Republicans represent in pursuit of Obamacare.

This is beyond reckless, and on a major policy issue, is virtually without precedent.

No “divisive” decision during the Bush administration was ever made on a party line vote like this, including tax cuts, No Child Left Behind education reform, the Patriot Act, and even the Iraq War resolution, among others

On a policy level, to the extent there was policy in the Senate’s efforts, they quickly undid the handiwork of the House, throwing out the holy grail of liberal orthodoxy on medicine, the “public option.” The Senate bill also brings fresh attention to thorny issues through the bill’s financing and abortion coverage.

It does not help that the Senate bill is deeply disingenuous, both in the claim that the bill will reduce health care costs overall, and do so  without impacting the quality of care or the cost to individuals.

Democrats crow that the Senate bill will cost only $871 billion and will actually reduce the deficit by $132 billion. But this is a gimmick, unworthy of the Senate and its feckless Democratic majority.

The government will start collecting fees for Obamacare immediately, while not providing service until 2014 — yet another good argument on the necessity of “now.” The accumulated fees offset the real cost of the program as it expands over the decade.

On the other side, there’s the $500 billion in promised cuts to Medicare, which are equally bunk.  The Senate bill includes an accounting formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that.

While we can dwell momentarily on the catastrophe this would be for seniors, the political reality allows us to move on quickly. Everyone knows that this cut is simply not politically viable. Proof? Even as the health care bill was being debated in the Senate, the Democratic leadership was attempting to pass a standalone bill that would restore Medicare reimbursement cuts from this year.  $500 billion in savings?  There is simply no way.

So as a cost savings device, this was only a face saving device. Generational theft in the form of additional borrowing and accumulation of astronomical national debt will be the real result.

And as far as care for individuals, the Congressional Budget Office (CBO) stated recently that the Senate bill would substantially reduce flexibility in terms of types, prices and number of private sellers of insurance. Harvard’s Medical School Dean, Jeffrey Flier wrote that, “Ultimately our capacity to innovate and develop new therapies would suffer most of all.”

More specifically, according to the insurer Wellpoint, which mined its actuarial data to model the Senate bill, a healthy 25 year old in Wisconsin buying coverage on the individual market will see costs rise by 178%.  A small business based in Richmond with less than ten employees will see an average 23% increase. A 40 year old with a family living in Indiana would pay 106% more.

In sum, according to James Capretta and Yuval Levin, the Senate bill, “would spend hundreds of billions on a new entitlement even as our debt is mounting, inflict massive tax increases on a troubled economy, impose costly mandates on employers at a time of high unemployment, squeeze money out of Medicare without fixing the program, insert the government in countless new ways between doctors and patients…and pay even higher premiums.”

So “why?”

We all remember the moniker attached to large financial institutions during last year’s economic crisis; “too big to fail.”  If Citi, AIG, JP Morgan and others went under, the economy itself could come undone as lending came to a halt, with a cascade effect on production and employment.

The whole concept of “too big to fail” has taken a beating in recent months as banks have repaid taxpayer funds and awarded monumental bonuses to staff, while unemployment is stuck at 10% and populist anger festers.

But ironically “too big to fail” is the only logical explanation for passing an unpopular bill through a process that has been craven bordering on obscene. A bill that is financed through gimmicks that no one believes, that will undermine the very health care it was ostensibly designed to support and expand.

But crucially, a bill that will create an entirely new and massive federal government program infrastructure.

You see, if there can be an emerging consensus among liberals who have watched the Senate flush most of their sacred priorities, it is a growing understanding that passage of something called health care reform, with all of its contradictions, disappointments and limitations, will in fact, be a beginning.

It won’t be the robust and comprehensive reform that liberals envisioned, but it will the framework from which health care policy and politics will be managed for years to come.

Will Democrats take a hit for this in 2010?  The odds are yes, and they are growing.

But even if 2010 was a repeat of 1994, a new Republican Congress will still have to deal with President Obama. If Congress gets him a health care bill before January 2011, Obama himself can stop the Republicans from making any major changes through the use of the veto.

And while no one can know the political climate two years out, could a rational argument be made that GOP efforts to undo Obama-care in a 2011-12 period would be the very conflict that could propel Obama to a second term, not unlike the government shutdown all but assured Clinton’s re-election by positioning him on the side of the common man?

Following the logic, after eight years, Obamacare will be embedded national policy. It will effectively be “too big to fail”with so many dependents, new infrastructure and processes, not to mention an entirely new set of stakeholders and interest groups, formed in the wake of the bill’s passage, many who will have an interest in keeping the new public health system.

The discussion will shift to the margins; rates, coverages, costs, but not the underlying legislation that will effectively put 1/6th of the American economy in the hands of unelected and mostly unaccountable bureaucrats.

As the Wall Street Journal noted, “The goal is to ram it into law while the political window is still open and clean up the mess after.” Obama and the Democrats are in a rush to finish the bill while they have the legislative means to conclude something on their terms that will advance the most ambitious takeover of the private sector in American history.

Democrats may continue to decry “too big to fail” in the private sector, but they have used the principle to create, effectively, the same thing at the federal level, to our collective peril.

Never have so few, done so much, to abuse so many.

That is the epitaph of the Democratic majority from this emerging health care debacle.