GOP vs. Health Care for Kids

As often happens when a government does something particularly loathesome, the Bush administration waited until Friday evening, in the middle of a congressional recess, to announce its drastic new restrictions on SCHIP:

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families....

In interviews, they said the changes were intended to return the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

After learning of the new policy, some state officials said yesterday that it could cripple their efforts to cover more children and would impose standards that could not be met.

“We are horrified at the new federal policy,” said Ann Clemency Kohler, deputy commissioner of human services in New Jersey. “It will cause havoc with our program and could jeopardize coverage for thousands of children.”

The new policy, coming as Bush promises to veto any bill expanding SCHIP, makes it nearly impossible for states to to cover children in families whose income is over 200% of the poverty level. Keep in mind that the poverty level for a family of four is an absurdly low $20,650. Trying to feed four kids on an income of $41,300? Good luck with the health insurance -- you're on you're own. The Bush administration is trying to prevent states from offering health care to kids whose families need the help. Dennis Smith, Bush's director of the Center for Medicaid and State Operations, said that the point of the new rules was to prevent states from "sustituting for private coverage." This is purely ideologically driven -- we're talking about denying kids health care for the sheer bloody-minded sake of satisfying the conservative think tanks. It's arrogant, cruel -- and perfectly in line with the opinions of every single Republican candidate for president.

As Paul Waldman has pointed out, the only GOP candidate to support expanding SCHIP was Tommy Thompson, now out of the race. Rudy Giuliani said it would make kids "wards of the state." Duncan Hunter called it -- what else -- "socialized medicine." As Waldman points out, the Republicans' real problem with SCHIP is that it is a widely popular government program that works well. They hate it because they are ideologically against the notion of government-supported health care. They want to take health coverage away from kids because they hate anything that shows that government can work, when it's not in the hands of incompetent Republicans.

They hate SCHIP because it shows America just how wrong and heartless the conservatives really are.


UPDATE: Gene Sperling (h/t DemFromCT) systematically dismantles the Bush administration's stated reasons for opposing the SCHIP expansion, and sums up:

Before, "compassionate conservatism" may have seemed like a political bumper sticker. Now it seems like the punch line of a sad joke, at the expense of millions of impoverished children.

Labels: health care, Republicans, SCHIP

  ¶ Posted by Paul Curtis 8:09 AM 0 comments

  Universal Health Care: Now or Never

I'll return to this in much more detail soon, but here's a short version: The Bush administration's "compassionate conservatism," as much as it was mocked by liberals and derided by the right, drew from an important insight about the future of American conservatism - one that the Milton Friedmanites haven't understood. The idea, in part, is that conservatives can no longer ignore issues like health care and public education. Instead, the compassiocons realized, they needed to transform those issues so as to move them onto conservative turf. And while compassionate conservatism, the brand, has been discredited, the concept lives on - and is likely to become even more important.

Thus the op-ed by Kimberly Strassel in today's Wall Street Journal. Strassel reports a sudden optimism among conservatives - on the health care debate, of all things. The effort to remake health care as a conservative issue got a big boost this week,

when Oklahoma Sen. Tom Coburn released a big-ideas blueprint for restructuring the entire health-care system--the tax code, Medicare, tort liability, insurance laws--along free-market lines. Dr. Coburn's plan builds on the White House's own bold proposal in January to revamp tax laws so as to put consumers back in control of their health-care decisions. Both plans are about fundamental, bottom-up health-care reforms, cast in the language of markets, consumers and individual control.

Describing the chintzy little tax breaks President Bush proposed in the last SOTU as "bold" may call Strassel's judgment into question, but there's no doubt that conservatives feel they're onto something here. Strassel frames it as a distinct alternative to Romney- and Arnold-style insurance mandates, as well as to the frightening specter of "government-run" health care as proposed by The Libs. Strassel even has the chuztpah to try and smear single-payer proposals with a reference to the Walter Reed scandal - once again demonstrating how conservatives mistakenly believe that everyone else is as incompetent as they themselves are when it comes to governing.

Whether the conservative plan for "health savings accounts" is serious or not is a matter for debate. What are conservatives trying to accomplish? Pardon my cynicism, but the least likely possibility seems to be that they are genuinely trying to find an affordable way for all Americans to have adequate health care. Oh, I'm sure a few of them are really after that goal, but not enough to matter.

Another possibility is that conservatives are hoping to use the health savings account concept to undermine any social insurance-based approach to health care. They see another social security about to be born, and they're looking to strangle it in its crib. Yet another possibility is that they simply want to look like they're doing something about health care, for short-term electoral reasons.

This is all pretty surface-level analysis - we'll get into in greater depth soon. The point for now is that the right is now talking about health care, for real. And with increasing enthusiasm:

Conservative health-care guru John Goodman remembers going to Washington in the early 1990s to get Republicans interested in individual health savings accounts, and "only about five guys would even meet with me," he recalls. Now, HSAs "are a religion" among the right, he notes, and Republicans used their last years in the majority to significantly expand access to these accounts. In the past 15 years, the GOP has also planted the roots of Medicare reform, looked at interstate trade in health insurance, and got behind competitive Medicare reforms in their states. [...]

The important thing is that debate equals education, which equals understanding, which equals precisely what the GOP needs right now. The Heritage Foundation's Mike Franc says Republicans are still too preoccupied with health-care small-ball--which procedures should be covered by Medicare, how much should generics cost--to get their heads around the broader subject. "This is still outside their intellectual comfort zone, and Republicans never do well in that situation," he says. "But to win this debate--the defining issue of the next 40 or 50 years--they're going to have to address it forcefully, head-on, and with every bit of their intellectual firepower."

Of course, "for real" is a relative term when discussing conservative policymaking. But at the same time, compared to liberals, the right has better understood the power of words. And they're putting their linguistic talents to work in a debate which we should have won years ago:

Those on the free-market side are starting to understand the need for a new language, especially if they are to coax more nervous elements of their party into embracing radical change. When President Bush unveiled his health-care tax overhaul in the State of the Union, he stressed that health-care decisions needed to be made by "patients and doctors," not government or insurance companies. Mr. Coburn's bill summary is littered with the words "choice," "empowerment," "competition," "flexibility," "control"--which is not only an honest assessment of what his proposal would provide, but one with which Americans can identify.

There are all kinds of reasons why conservative health care "reform" is a ridiculous idea. But even if it never goes beyond rhetoric, the right's health care plan could fatally cripple any attempt to achieve truly universal coverage. All the more reason for liberals to be bold and simple when talking about health care, rather than dinking around with what seem like safe little proposals. Mike Franc is right: it's time to stop playing small ball.

The health care debate is suddenly far, far more urgent than many Democrats realize. Because if we don't get the public's attention, the other side will.

Labels: conservatives, health care, Kimberly Strassel

  ¶ Posted by Paul Curtis 10:55 AM 3 comments

  Sick

It's a good thing: I've been complaining about the left's inability to personalize the health care crisis. Well, this looks like a good start.

I'll even forgive the typo on the front page of the website...

Labels: health care, Jonathan Cohn

  ¶ Posted by Paul Curtis 10:18 AM 0 comments

  Seriously, This is a Big Deal

Vernon Lee further considers the fact that progressives have been out-storytold by the right:

How Democrats haven't figured this out is quite a mystery. From the right, we have ludicrous inventions such as the imaginary family farm that went under because of the "death tax" that nonetheless manages to eclipse the combined trillions of net worth the estate tax actually protects. We have the gruesome Terry Schiavo spectacle and not one personification of the results of 45 million Americans who have no health insurance.

Spot on. How in God's name have we failed to beat the right into total submission simply by telling the stories of people suffering for lack of universal health insurance? How monumentally incompetent have we been that the most effective personification of the health care debate was made by the insurance industry in an anti-universal care ad?

It goes beyond boggling the mind. It boils the mind.

Labels: health care, political communication, Vernon Lee

  ¶ Posted by Paul Curtis 5:04 PM 21 comments

  Right-Wing Think Tank Review: 2/13/07

American Enterprise Institute (Sourcwatch profile here)

"Good Medicine for the Tax Code"

'Short Publication' by Joseph Antos, "Wilson H. Taylor Scholar in Health Care and Retirement Policy" at AEI.

This article, published in AEI's online magazine American.com on Jan. 25, praises President Bush's "bold" health care proposal, which

would help lower-income people buy health insurance while putting the brakes on runaway health spending. Unlike his last big initiative—the Medicare drug benefit—the new proposal will have the support of conservatives and deserves the support of liberals.

Antos says that the plan would address a "defect" of tax policy: the employer-based health insurance deduction. Many liberals have also argued that the deduction, and the employer-based health care system it supports, is problematic (see for instance this article by Ezra Klein). But Antos goes on to make a surprising claim: that this system is the primary cause of inequality in America:

As a result, the more income workers receive as health care, the more income they get to keep free of taxes.... That differential has led to a shift in employee compensation away from taxable wages, toward non-taxable health benefits. Consequently, workers are not seeing their wages increase despite a booming economy. Most of the increase in labor productivity over the past few years has been eaten up by health benefits.

Your humble reviewer is not an economist, but in an era of skyrocketing corporate profits and massive increases in executive compensation, this seems like a rather brazenly absurd claim. However, if it provides a narrative by which conservatives can simultaneously co-opt the inequality debate and the health care debate, it's worth watching.

Antos goes on to repeat a number of other conservative claims about the Bush plan and about health care in general. In this analysis, the primary issue is cost control, and the best way to control costs is to allow individuals to decide how to spend their health care dollars. Moreover, argues Antos, the plan would be "mildly redistributional, favoring those with lower incomes" (by contrast, the Center for American Progress points out that "most uninsured Americans pay low or no taxes and would get a smaller benefit from this plan than higher-income Americans").

"The President’s proposal," says Antos, "gives workers and firms a new reason to ask whether their insurance is right for them, but it would not impose change from above." This seems to be the conservative position on health care in a nutshell. However, if it appears to lack urgency, liberals should nonetheless be careful to note that it does indicate a developing conservative attempt to seize the agenda in the health care debate.


Manhattan Institute (Sourcewatch profile here)

"Consumerism: A Prescription for Change"

Op-Ed by David Gratzer; originally published in the San Francisco Examiner.

Gratzer celebrates prescription drug programs by Wal-Mart and other pharmacy chains, arguing that they offer a low-cost, free-choice alternative to the "paternalism" of those who agree with Howard Dean that "there is no such thing as an informed consumer of health care." This "revolution," made possible by the internet (which is "empowering people with information and options"), is "potentially transformative."

Echoing Antos, Gratzer says that "one of the biggest problems with American health care is its cost." The reason for high medical costs? "Third-party payership." Gratzer cites Health Savings Accounts as "a step in the right direction" toward fixing this problem.

HSAs, of course, are the centerpiece of the conservatives' emerging effort to address the health care crisis (or, alternately, to prevent the Democrats from addressing the health care crisis). As Fred Barnes wrote a few weeks ago, they've already been authorized and need only to be promoted. See this fact sheet from Families USA for an analysis of how HSAs may in fact represent a step backwards in American health care. If it all sounds suspiciously like "private Social Security accounts" to you - you're not wrong.


Heritage Foundation (Sourcewatch profile here)

"Don't Rush to Judgment on UN IPCC Global Warming Summary" (WebMemo No. 1351)

Article by Ben Lieberman, Senior Policy Analyst in the Roe Institute for Economic Policy Studies at Heritage

Lieberman continues the conservative effort to put the brakes on the global warming consensus, this time in response to the summary of the UN Intergovernmental Panel on Climate Change Fourth Assessment Report ("IPCC Report"). "It's just a summary," Lieberman cautions, and "the full scientific debate over the report has not yet begun." Moreover, "IPCC summaries are written at the direction of political appointees representing member nations" - thus, presumably, opening the door to an attack on the summary's credibility. This seems to fall squarely within the conservative strategy of asserting controversy in order to muddy the waters and delay action.

While acknowledging that the summary indicates an increasingly solid consensus that human action has been causing climate change, Lieberman argues that

This upward revision in the certainty that mankind has impacted the climate should not be confused with an upward revision in the predictions of consequent harm.

The more important questions have always been the extent of warming, the seriousness of the consequences, and what responsive policies make sense.

Moreover, he suggests that the report has "backtracked" on a number of key claims - for instance, de-emphasizing the "hockey stick" model of recent dramatic climate change, and dramatically revising estimates of future sea-level rise (this post from RealClimate debunks similar claims made by Christopher Monckton).

Lieberman once again returns to the conservative "neo-denial" argument that emissions limits as called for by the Kyoto protocols would be too expensive and would have little effect.


Cato Institute (Sourcewatch profile here)

"Live with Climate Change"

Article by Patrick Michaels, Senior Fellow; appeared as an op-ed in USA Today on Feb. 2, 2007.

Michaels joins in the defeatist conservative neo-denial framing of climate change: yes, it's happening, but "actually 'doing something' about warming is a daunting endeavor." And, par for the course, he pairs this statement with an argument for a solution combining technology development and just getting used to it:

The stark reality is that if we really want to alter the warming trajectory of the planet significantly, we have to cut emissions by an extremely large amount, and — a truth that everyone must know — we simply do not have the technology to do so. We would fritter away billions in precious investment capital in a futile attempt to curtail warming.

Consequently, the best policy is to live with some modest climate change now and encourage economic development, which will generate the capital necessary for investment in the more efficient technologies of the future.

This is a significantly more defeatist position even than that of Samuel Thernstrom and Lee Lane, who at least argue for some government action on R&D and a carbon tax. Michaels, in the best tradition of glib laissez-faire complacency, prefers to let the market take care of the problem.

Labels: Ben Lieberman, David Gratzer, global warming, health care, Joseph Antos, Patrick Michaels, Right Wing Think Tank Review

  ¶ Posted by Paul Curtis 11:54 AM 2 comments