Where are health care reform's defenders?
The bill crafted in the Senate and signed into law by President Obama was a health care policy wonk's dream, containing nearly every public health, prevention, and cost-control idea floated across the pages of Health Affairs and the New England Journal of Medicine over the last ten years. In the months leading up to passage of the Patient Protection and Affordable Care Act, the Commonwealth Fund and the Kaiser Family Foundation filled my email inbox with studies justifying reform.
Yet last week, after the Republicans seized control of the House and pledged to repeal or prevent the law from going into effect, I heard nothing.
The legislation was also a Christmas morning stocking stuffed with goodies for the special interests. Yet where was PhRMA, now that it has had its donut hole filled? Or the Association of Health Insurance Plans, which backed the legislation until it opposed it, but still gets its ultimate reward -- 20 million new customers through a mandate that makes everyone buy its members' products or pay a penalty? One searches the news pages in vain for comments from these inside-the-Beltway lobbying powerhouses.
Progressive bloggers were not much better. They stumped for the individual mandate, the tax on high-cost plans, for rational discussions about end-of-life care and other controversial elements of reform, which only stoked the fires of the Tea Party rebellion. After Tuesday? Silence.
I take as my ur-text a column in Sunday's Washington Post by Ezra Klein, a blogger-turned-mainstream journalist (like myself) whose rapid ascent to card-carrying member of the punditocracy was a direct result of his willingness to master and communicate the arcana of policy issues like health care reform. I cheer his rise. He's young, smart and progressive.
Yet on the Sunday after the election, he ignored health care reform while doubling down on big tax policy ideas that stand no chance of passage. If you think the Republicans had a field day calling health care reform a government takeover of one-seventh of the U.S. economy (a complete lie), what do you think they would do with his recommendations that the Democrats (because there would be few if any Republican votes for any of these ideas) back total repeal of the health insurance deduction and the home mortgage deduction, and slap a new tax on carbon?
What was especially disheartening about his column was that it ignored solid rejoinders for the coming debate over Social Security and Medicare, which, as it happens, can also be framed as tax issues. Both programs' long-term fiscal stability would be substantially enhanced (and in Social Security's case, made secure) by extending the payroll taxes to all unearned income (right now, dividends, interest and capital gains are excluded from Medicare and Social Security taxation) and to every bracket (right now, people who earn over $106,800 a year do not have to pay additional payroll taxes for Social Security).
Okay, there's no Republican votes for that either. But as long as we're not living in the real world where election results matter, why not take on something immediately relevant, especially with President Obama's National Commission on Fiscal Responsibility and Reform a month away from issuing its report?
The coming months will be trying times for health care reform's defenders. There will be votes on total repeal, which will probably pass the House. Republicans will try to remove funding from key elements of the bill (see this article in Sunday's New York Times and my article, which appeared Monday morning in The Fiscal Times).
President Obama signaled his willingness to compromise on non-essential parts of reform when he said during his post-election press conference that Congress should repeal the hated provision requiring businesses to fill out a 1099 form for every expenditure over $600, a feeble attempt to raise money by cracking down on tax scofflaws. It only succeeds in adding paperwork to the vast majority of honest small businesses.
The president and his advisers should be thinking bigger than that. The first thing Democrats in the House should do when Congress reconvenes in January is jump on board legislation that would repeal the individual mandate. After the insurance industry stabbed them in the back during the election season, they owe those companies nothing. When the insurance industry cries out that it will have to raise rates to cover the uninsured who show up on their doorsteps after 2014 demanding low-cost coverage for pre-existing conditions, the Democrats can respond that they'll cross that bridge when they get to it.