Dionne always gets down to bottom lines:
What today’s health-care summit can accomplish
The real value of today’s White House health-care summit came clear to me during a conversation with my friend Steve Luxenberg. Steve, who was editor of The Post’s Outlook section for many years, was speaking generally about what he saw as the difference between “honest disagreements” and “dishonest disagreements.”
If today’s summit does nothing else but to sort out the difference between these two kinds of disagreements in the health-care debate, it will be a huge success.
At the heart of the fight between Republicans and Democrats is an honest disagreement over the role of federal government. The Republicans don’t want our national government to play a major role in solving the core problems of our health-care system. They insist that more federal action will simply make things worse. (Although they then turn around and criticize any cuts President Obama proposes in Medicare, which, last I looked, is a federal government program). The GOP’s suggestions are small because they don’t want government to do much. The party’s main health-care proposal would spend $61 billion over 10 years -- in other words, an average of $6 billion a year -- and cover an additional 3 million people, according to the Congressional Budget Office. The amounts they propose are a smidgen compared to the value of the tax cuts the Republicans voted for during the Bush years.
And the truth is that if using the federal government to solve some of the problems in the health-care system had been a priority for Republicans, they could have passed something when they controlled the White House and both houses of Congress. They chose not to.
Obama and the Democrats, on the other hand, believe that the federal government must take large steps to repair a broken health-care system. The proposal the president put on the table this week would spend $950 billion over 10 years to insure 31 million people.
If both sides are honest about this core difference, they probably won’t reach agreement, but at least Americans will know why we are having this fight. In fact, it’s absurd to expect sudden compromise from two parties so far apart philosophically and so far away from each other in how much they want to do. Does anyone really think they can, say, split the difference between $950 billion and $61 billion?
That’s the honest disagreement. Then there are the dishonest ones, which I hope today’s lengthy discussions can clear away. I offer my top candidates for arguments that deserve to be thrown into the trash bin:
“We don’t need a 1,500 page (or 2,000 page -- or, well, pick your number) bill to solve this problem.”
If Democrats printed exactly the same bill in 6-point type single spaced and therefore instantly cut it down to, say, 200 pages, would Republicans suddenly support it? You know the answer. Once Congress decides to pass comprehensive health-care reform, which affects about one-sixth of the economy, it’s stuck writing a long bill. There are new regulations, new taxes and new tax credits to subsidize the uninsured, changes in Medicaid, changes in Medicare, and a slew of other matters to deal with. One provision can have an unintended consequence unless it is tempered by another provision. This is not only a dishonest disagreement; it’s dumb.
“Everyone wants to ban discrimination against people with preexisting conditions. Let’s just pass that.”
There are many variations on this theme, all of which claim that passing some insurance reforms could be counted as a big victory. But insurance reforms on their own couldn’t be effective. If health insurers were required to give coverage to people with preexisting conditions, for example, the premiums of healthy people will rise inexorably to cover their costs. The way to prevent this is to mandate that everyone buy health insurance. This creates a broad pool, spreads the costs and prevents spikes in premiums. No mandate, no effective insurance reforms.
“These health bills bust the budget. Oh, yes, why do they include all these tax increases?”
No, these bills don’t bust the budget precisely because they do include tax increases. The Medicare prescription drug benefit passed under President Bush was not paid for and has added to the deficit. And these bills include cuts in other government programs to balance off some of the increased costs. The Congressional Budget Office, which is very tough on these matters, says these health bills will cut the deficit in the long run. If someone wants to argue otherwise, they need to offer evidence. And while there is plenty of room to argue over which taxes should be raised to pay for health care, you can’t claim to be fiscally responsible and oppose all the tax increases included in these bills.
“We can do lots of good things without spending this much money.”
The most honest conservative approach has involved getting rid of the tax exclusion for health benefits and using the revenue for tax deductions and credits to help more people buy health insurance. If Republicans put an idea of this sort on the table today -- say, something along the lines of a bill introduced by Sens. Ron Wyden (D-Ore.) and Robert F. Bennett (R-Utah) -- that would be serious. (I say that as someone who respects the work Wyden and Bennett have done, but has some qualms about their proposal.) What’s not serious is to pretend that much can be done with little money. Obama’s proposal is expensive because health insurance is expensive and insuring an additional 31 million people will cost a lot of money. If you don’t want to spend public money, you’re not going to get a significant expansion in the number of Americans who have health insurance.
You can tell that I have very low expectations for sudden bipartisan concord out of today’s meeting. I’ll be perfectly happy if today clarifies for Americans what the choices are. And I think that if Obama does his job right, Democrats will find the courage (and the votes) to pass comprehensive reform. Then voters can render a judgment on their actions in November. Advocates of reform will have an easier time defending themselves if they pass a bill than if they throw away this opportunity. Today should represent the first steps in the final lap.
By E.J. Dionne | February 25, 2010; 12:18 AM ET |
