Awhile back Harold Meyerson wrote a column called “Master of the Poison Pill” in which he outlined the Karl Rove method of taking an issue away from the opposition. For example, in 2002 the Dems were getting traction on their proposal for a cabinet-level Department of Homeland Security, which the White House opposed. When the Bushies decided to flip-flop and create the DHS, they inserted a union-busting poison pill into the bill. Dems balked, and the Bushies promptly claimed the DHS as their own invention, accusing Dems of being opposed to national security.
Sometimes it’s more than just a pill being used to poison a debate. Wingnuts still equate opposition to the war in Iraq with being “soft” on national security, even though Iraq ain’t doin’ a bleeping thing on behalf of national security except draining resources that could be put to better use elsewhere while causing more people to hate us. The Bushies tried to pull something like this with Bush’s Social Security “reform”; Dems were accused of being unwilling to “fix” Social Security because they didn’t back Bush’s plan. Fortunately the American people realized the “plan” was ridiculous.
I’m already seeing signs that the Right is going to use Bush’s utterly absurd health care proposals to claim that Democrats aren’t serious about health care reform. There are two columns in the Washington Post today that say Dems are poopyheads for not even listening to Bush’s “ideas.” One is by the already mentioned and cognitively challenged Ruth Marcus, whom Brad DeLong and Ezra Klein skewer a lot better than I did. The other is business columnist Steven Pearlstein:
… the most surprising and encouraging development is that a president who for six years has only nibbled around the edges of health-care issues has weighed in with some bold ideas to expand coverage, rein in costs and bring some fairness to the tax code. And get this: It actually involves raising taxes on the rich and lavishly insured and giving the money to the working poor and the uninsured.
Given that, you’d think Democrats would have welcomed a politically courageous proposal to put a cap on one of the biggest and most regressive features of the individual income-tax code. But instead, they’ve shifted reflexively into partisan attack mode, mischaracterizing the impacts of the proposal and shamelessly parroting the propaganda from the labor dinosaurs at the AFL-CIO.
“Dead on arrival,” declared Rep. Pete Stark (D-Calif.), chairman of a key health subcommittee in the House, hinting at a dark conspiracy to kill off employer-sponsored health insurance.
In fact, Pete Stark’s web site proudly states:
I’ve introduced a Constitutional Amendment to establish a right to health care for of equal high quality for every American. If ratified, this would force Congress to make health care coverage available to all Americans. My preferred approach to universal coverage is to build on the success of the Medicare program, which provides universal health care for our nation’s seniors and people with disabilities.
Sounds to me as if Rep. Stark has already moved beyond the employer-based health insurance model, and that Steven Pearlstein is parroting propaganda from the policy dinosaurs at the Heritage Foundation.
Pearlstein goes on to sing the praises of Bush’s proposal while accusing Dems of “class warfare.” He also says,
Almost every health economist agrees that the tax subsidy for employer-paid health insurance is not only unfair but that it also encourages people to buy too much insurance, consume too much health care and pay too much for both. Bush deserves praise for having the political courage to confront the issue.
Mr. Pearlstein, meet Paul Krugman.
Some nameless dweeb at Opinion Journal credits Bush for initiating a discussion on health care:
The U.S. has long needed a debate over health care and tax subsidies, and President Bush got ready to rumble last night with his proposal to make insurance more affordable for most Americans.
That was bad enough, but in the very next sentence the dweeb actually wrote “Americans have the most advanced health care in the world,” meaning the dweeb plans to rumble with his head firmly planted up his ass. That should be a sight. Although notice he wrote “most advanced” instead of “best,” and it’s possible he could make an argument for “most advanced.” Years of “market forces” have given us a system that is grand at delivering state-of-the-art, boutique health services to the wealthy, even as poor women lack basic prenatal care and emergency rooms close.
The dweeb puts forth more howlers, such as:
These new [private health insurance] products are also likely to be policies that put individuals directly in charge of more routine spending. That’s because removing the tax advantage would mean it will make less financial sense to “insure” for predictable expenses like several annual office visits.
In other words, he thinks insurers should not be covering preventative medicine, meaning people are less likely to indulge in those gold-plated, frivolous office visits to get their cholesterol monitored or their hearts checked or some such. Unfortunately, skimping on preventative care is a sure way to drive up costs overall.
That in turn could put pressure on health care providers to post–and actually compete on–prices. Such new price awareness might even generate pressure for states that overregulate their insurance markets (New York, Massachusetts) to ease their costly mandates
The “costly mandates” prevent insurers from refusing insurance to people who have pre-existing health problems. In states without these “costly mandates,” insurers can refuse to insure people with health problems. That reduces the insurers’ costs but doesn’t exactly solve the health care problem.
It’s true that additional subsidies might be needed for some people with chronic illnesses who might have a harder time finding private insurance in this kind of world. And we’d also like to see a more national insurance market, with companies able to sell policies over the Internet free of the worst state mandates.
You see the problem. While the dweeb casually acknowledges that a lot of people will need “additional subsidies,” he goes ahead and endorses the very policies that create the pool of people who need “additional subsidies.”
Insurance works by pooling risk. The premiums paid by people who don’t file claims help pay for the claims that are filed. It’s true that many kinds of insurers charge more for people who have higher risks, such as a teenage driver. But essentially what the private health insurance industry wants is to insure pools of healthy people and force those with chronic health problems onto the mercy of taxpayers. If taxpayers are going to be stuck paying for the high-risk pool anyway, one wonders why we need private insurers at all. One big national system that puts everyone into the same pool would be more cost-effective for taxpayers, obviously.
The dweeb concludes,
This status quo won’t hold, and the political race is going to be between those who want to move to a more genuine market and consumer-based health care, and those who want to move toward Canada, Europe and more government control. The Bush plan ought to jump start that debate.
Many nations have devised national health care plans in which people are free to choose their own doctors, make their own decisions, and keep their medical records private from the government. See Ezra Klein’s Health of Nations series for details on what works and what doesn’t. But what we have here is even worse than government control, because citizens still (although barely) have some say in what government does. Instead we have control by the private insurance industry, meaning people with no medical licenses right now are shuffling papers and deciding who gets treatment and who doesn’t.
I believe it is overwhelmingly likely that this is, in fact, a bluff. And it is not clear to me why anybody should be in the business of welcoming things that are not “real solutions.”
We should certainly welcome real solutions. But otherwise it seems to me that we are still in the standard Bush administration game of Dingbut Kabuki. The administration has made no effort to convince us that this will do more good in terms of redistributing income and increasing access to health insurance than it will do harm in magnifying adverse selection problems.