Obama Challenges Republicans By Supporting Wyden-Brown
Last week, President Barack Obama tried to make some news on the healthcare issue. Unfortunately for him, the story was all but swallowed by bigger news (Libya, the budget fight, Charlie Sheen...). But this is a story which deserves some attention, because it might prove to be the answer to the endless bickering on Capitol Hill on what to do about the newly-passed healthcare law. Obama, by backing a bill put forth by Democratic Senator Ron Wyden and Republican Senator Scott Brown, has essentially tossed a gauntlet down in front of the Republican Party. The heart of Obama's challenge: "You think you can do healthcare reform better in your states? Fine. Go ahead and do it better."
From an article on the Washington Post website, back when Wyden and Brown announced their bill last year:
This morning, Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) introduced the "Empowering States to Innovate Act." The legislation would allow states to develop their own health-care reform proposals that would preempt the federal government's effort. If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would've given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill.
Wyden, with the help of Sen. Bernie Sanders (I-Vt.), was able to build a version of this exemption into the original health-care reform bill, but for various reasons, was forced to accept a starting date of 2017 -- three years after the Patient Protection and Affordable Care Act goes into effect. The Wyden/Brown legislation would allow states to propose their alternatives now and start implementing them in 2014, rather than wasting time and money setting up a federal structure that they don't plan to use.
In general, giving the states a freer hand is an approach associated with conservatives. On Wednesday, Sen. Orrin Hatch (R-Utah) sent a letter to the Republican Governors Association advocating exactly that. "The most effective path to sustainable health care reform runs through the states, not Washington," he wrote. If it's really the case that the states can do health reform better, Wyden and Brown are giving them a chance to prove it.
Two days ago, the Washington Post featured an article which explained the corner Republicans now find themselves in:
It's put-up-or-shut-up time for Republicans. They managed to make it through the health-care debate without offering serious solutions of their own, and -- perhaps more impressive -- through the election by promising to tell us their solutions after they'd won. But the jig is up. They need a health-care plan -- and quickly.
Republicans, throughout the entire extended debate on healthcare reform, hewed to a few core ideas: Republican reform ideas were better, and a state-by-state approach was much preferable to a one-size-fits-all federal approach. Now they have a chance to put their legislation where their mouths have been all along. Republicans made much political hay out of "repeal and replace" during the last election cycle, but so far have only been concentrating on the "repeal" part of their motto. No brilliant ideas (much less bills) have emerged from the Republican House as yet, and Republicans have all but stopped talking about what they're going to do to "replace Obamacare" (as they put it) after they repeal it.
They've certainly had long enough to come up with their own plan. This issue has been front-and-center in Congress for almost two solid years now. And yet, the Republicans have yet to rally behind any one overall plan or idea (although, to be fair, they have rallied behind individual components, such as "tort reform"). From their actions in attempting a sweeping repeal of the Democratic law without proposing any viable replacement, Republicans have shown that the previous status quo is preferable to them than where we find ourselves now. Sooner or later, the public is going to notice this.
Passing the Wyden-Brown bill would make this more apparent. It would also stop the lawsuit challenging the constitutionality of the law in its tracks. If your state didn't want to institute a universal mandate, then it could easily attain a waiver -- as long as it came up with something equally as good which was equally as cheap.
This is the crux of the challenge of Wyden-Brown. When the original Democratic law was written, Wyden stuck in the waiver idea, but was forced to accept instituting it in 2017 -- creating a three-year window for the states that made no sense. Wyden-Brown merely moves this date up. It is not a radical bill, or a radical idea. Truth be told, it's actually a conservative idea. Or, at least, it used to be (conservatives are notable for rejecting their own ideas when Obama supports them, especially when it comes to healthcare reform). All Wyden-Brown does is reset the calendar, to allow the states maximum flexibility to choose their own systems instead of Washington telling them how to do things. As I said, this was previously a Republican tenet.
The states are (theoretically) supposed to be little "laboratories of democracy" where ideas and policies are tested out. Wyden-Brown would allow them free reign to do so on healthcare reform. It is a bipartisan bill, as well. You'd think Republicans would be supporting this effort and declaring a certain amount of victory in their fight against a "Washington takeover" of healthcare reform in the states.
So far, Republicans have not noticeably leapt to do so. They know full well that passing Wyden-Brown would put the entire onus of testing out Republican ideas back on individual states, rather than on the federal government or on President Obama. The Republicans, to be quite blunt, do not have the courage of their own convictions. They know, deep down inside, that the ideas which they have proposed simply would not work as well as the dreaded "Obamacare." Because the bill would require the states to cover the same number of people at the same cost as "Obamacare," Republicans would be hard-pressed to come up with an alternative which achieved the same goals. Leaving them, currently, to attack the goals themselves. But, as the Washington Post article points out:
Conservatives once offered solutions competitive with what the Democrats were proposing, but over the past 30 years, they've abandoned each and every one of them to stymie Democratic presidents. Confronted with a challenge to provide broader access to better health care at a lower cost, they're reduced to complaining that those aren't the right goals for health-care reform. But we've yet to see how "less comprehensive insurance for fewer people" would play in Peoria. My hunch is it wouldn't play very well.
I agree. I don't think it would play very well either, but that is the hand Republicans have been dealt, if they choose to oppose Wyden-Brown. With Obama voicing high-level Democratic support for the bill, opposing it may become a political liability for Republicans. An average citizen-on-the-street would likely wonder why Republicans were suddenly opposing something they have been calling for since the debate began. The only possible explanation for doing so would quite obviously be: "We think our plans won't achieve the same goals." In other words, in the marketplace of ideas, Republicans would be admitting a big loss.
I have previously called on President Obama in the past to jettison the individual mandate, since it is such a white-hot focus of the opposition to the Democratic law. But in doing so, I have to admit that I had no better idea for how to solve the actuarial problems doing so would cause. By supporting Wyden-Brown, Obama has brilliantly turned the argument on its head: if your state wants to opt out, that's fine -- as long as it reaches the same goals.
This would even open the door for Democratic states to institute more progressive plans, it bears mentioning. Vermont is on the brink of passing a true single-payer plan -- the Progressives' "impossible dream" during the whole debate. California has also gotten close to doing so in recent years, and may soon pass single-payer as well (now that they have a Democratic governor who will sign such a bill). Republican reactions to states voluntarily instituting "the horrors of socialized medicine" should be to pass their ideas in reliably "red" states -- confident in the knowledge that their free-market ideas will beat any Socialist nonsense in "blue" states.
The fact that Republicans are running away from this sort of challenge is telling. If they truly believed, deep down, that their ideas for making our healthcare system better were superior to Democratic ideas, then they would jump at the chance to prove it. Wyden-Brown is that chance. Wyden-Brown gives the Republicans everything they asked for -- the freedom to do things their own way in Republican states, the freedom from the "individual mandate," the freedom from every single "Washington takeover" in the dreaded "Obamacare." The only thing they wouldn't be able to do is punt -- by not fixing the problems and not achieving the same goals.
With President Obama's high-profile support, Wyden-Brown has a better chance of being taken seriously. Bringing it up for debate and a vote in the Senate would go a long way towards getting the subject out in the open. It would go a long way towards changing the debate over "repeal" to what, exactly, the Republican ideas are for the "replace" part of their campaign slogan. Democrats should enthusiastically support this bill. Even if it doesn't pass, politically it would show what the Republicans are fighting against -- covering as many people as possible. It would expose their opposition for what it is -- not merely opposition to the Democratic law, but opposition to the actual goals of the Democratic law. That would be a debate worth having, don't you think?
Cross-posted at The Huffington Post
Cross-posted at Business Insider
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-- Chris Weigant
Wow. I hadn't seen this in all the blather about Charlie Sheen.
What a great idea ... Thanks for posting, Chris!
-David
[cross-posted]
wow. brilliant move, and perhaps the timing is a good thing. if people are focused on other issues, congressional republicans might have some cover to let the bill pass quietly.
So Obama finally admits that CrapCare is ..well... Crap...
Good for him...
I agree completely. As you have explained it, the GOP would be fools not to get behind this bill..
Michale.....
It's a load of smoke and mirrors. The Republicans want a free-market based approach, yet that's impossible under this so-called Bipartisan "olive-branch".
I'll start with the most obvious argument why that's true. In order to get a waiver from the individual mandate, states must show that, in a free market, as many people would buy health insurance as would under a law which forces them to. An administration that felt the need to implement a mandate is hardly likely to accept that a free market could do the same, otherwise why have a mandate at all?
In my opinion a free market proposal could create a situation where as many people have access to care as would do under ObamaCare. Yet it cannot, without the mandate, create a situation where, people being free to spend their money as they like, as many will buy health insurance as they would if forced to.
That's simply illogical, and has never been claimed by free-market proponents.
Beyond logic, there are constitutional issues at stake that would prevent this from working too. Republicans have long argued for reform of the tax exempt status of employer-based insurance. Yet this cannot be achieved on a state-by-state basis, because this would fall afoul of Article I of the constitution. Without changes to the tax code, Republican proposals would simply not work.
One of the major criticisms of ObamaCare is that it goes beyond merely ensuring all Americans are covered, it has generous benefits that go way beyond basic coverage, and it will fall under HHS's discretion as to whether individual states' proposed coverage is "as comprehensive" as that offered by ObamaCare.
As you know, I've long argued on this site that it's an awful state of affairs where the richest country in the world cannot provide basic coverage for all its people, and I've advocated for universal basic coverage. Yet such an approach, where basic coverage was universal, but where elective healthcare procedures (such as orthodontics) required the use of HSAs or non-subsidised insurance would fail to meet the criteria of "as comprehensive", because it wouldn't be open to all.
Then there's the provisions on out of pocket spending, which would put paid to any high deductible HSA-based proposals, as they are predicated upon the idea that if people had to pay more out of pocket for trivial stuff, they wouldn't burden the system where there's no need and that would bring costs down.
HHS retains the final say-so on any waiver applications. There's no way a member of Obama's administration will allow Republican states to prove just how badly he botched healthcare reform by letting them implement better proposals.
In my opinion a free market proposal could create a situation where as many people have access to care as would do under ObamaCare. Yet it cannot, without the mandate, create a situation where, people being free to spend their money as they like, as many will buy health insurance as they would if forced to.
That's simply illogical, and has never been claimed by free-market proponents.
That's a good point.. Any comparisons must be of a "what's available" variety, as opposed to what people actually purchase..
The Federal (or even the State) government cannot force people to buy a product that only serves themselves..
Go ahead..
Someone bring up the mandatory auto insurance requirement.. I double dog dare ya!! :D
Michale.....
moderate,
i agree with you regarding the best course of action, "basic" universal healthcare by a flat tax, and all "elective" stuff by private insurers. if states would step up and try, i bet that would meet the requirements.
michale,
we've already hashed out our differences over the distinction between mandatory auto insurance and health insurance. you can take the bus instead of driving, but unless suicide becomes legal there's no choice about owning your body. why, did you have anything new to add?
we've already hashed out our differences over the distinction between mandatory auto insurance and health insurance.
why, did you have anything new to add?
In a way...
Many people still buy into the fallacy that, because a government entity can force someone to purchase Auto Insurance, they can also force someone to purchase Health Insurance....
The difference is that the forced purchase is for LIABILITY... That's a whole different kettle o' fish than what CrapCare forces...
Michale.....
The difference is that the forced purchase is for LIABILITY... That's a whole different kettle o' fish
i thought your first argument was better. someone who doesn't have health insurance, goes to the hospital and cannot afford to pay, IS a liability on the hospital, the state, the country and all the other taxpayers who were more responsible. the only other option we have is to let the person die.
NYPoet,
So we are back to the idea that people MUST pay money based on the POSSIBILITY that they MIGHT get sick and they MIGHT need medical treatment..
That's not America....
Michale.....
Michale -
Um, here in America, paychecks are docked every single week for Medicare and Medicaid. How, exactly, is that different?
-CW
Um, here in America, paychecks are docked every single week for Medicare and Medicaid. How, exactly, is that different?
Touche' :D
But Medicare and Medicaid are government programs like SS... I don't like that my paychecks are garnished, but have little choice over that..
But why should people have to pay even more, ON TOP of Medicare, Medicaid and Social Security??
Why not just invoke a system where people give all their money to the State and then the State will take care of all their needs....
That's what it all boils down to.
The mandate is simply un-Constitutional.
I think we can agree on that...
Michale.....
i wasn't commenting on the constitutionality of a health insurance mandate, just the trouble with people having the right to put themselves in mortal danger and put the rest of us on the hook for saving them. as cw said, the horses have already left the barn on public health insurance. it's the mandate to buy private insurance that poses a problem.
just the trouble with people having the right to put themselves in mortal danger and put the rest of us on the hook for saving them.
Living in a hurricane prone area as we do, maybe we should adopt the SAR mentality. If people are stoopid enough to stand in the way of a Cat 5, they don't deserve to be rescued...
But you do raise a good point about people putting themselves in mortal danger. But I don't think we are talking about those kinds of people. Sure, if a race car driver or a skydiver doesn't carry health insurance and they are medically tended to on the public dole, I would agree with your assessment.
But what about the people who just don't think they will ever need medical help..
You know young people. They think they are going to live forever and never need to see a doctor...
They have the right to feel that way, to be sure.
And what about those who truly DO never see a doctor or need medical attention. Why should THEY have to pay for someone else's health care??
There is no easy solution... But violating the US Constitution is NOT the way to go...
This abomination should never have seen the light of day.. It's a gift to the GOP that just keeps on giving...
Time will tell if the GOP can come up with something better...
Michale......
i agree with you regarding the best course of action, "basic" universal healthcare by a flat tax, and all "elective" stuff by private insurers. if states would step up and try, i bet that would meet the requirements.
Looking at the list of requirements that's been put out, I doubt it, since that would probably fall foul of the requirement that coverage be as comprehensive (which I doubt "basic" coverage would satisfy), and would almost certainly fall foul of the requirement for it to reduce out of pocket expenditure (since the "elective" stuff could be subject to deductibles).
If, however, assurances that such a scheme would, in theory, satisfy, as long as it meets the metrics set out regarding quality of care, then Wyden-Brown is a bill that the Republicans should support.
thank you very much
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In general, giving the states a freer hand is an approach associated with conservatives.
Not really. It's rhetoric associated with conservatives. They want stuff decided at the state level when they think they'll win at the state level; they want stuff decided at the federal level when they think they'll have more advantage there in a particular case.
Republican reactions to states voluntarily instituting "the horrors of socialized medicine" should be to pass their ideas in reliably "red" states -- confident in the knowledge that their free-market ideas will beat any Socialist nonsense in "blue" states.
What, like literally with a stick? Of course Republican status-quo "ideas" outperform "the horrors" -- at advancing Republican goals. This country has a highly disproportionate number of the world's richest rich people, and one of the highest Gini coefficients outside southern Africa. What more could we ask?
But tolerating state-by-state creeping socialism makes no sense: how are you going to keep 'em down on the old plantation, after they've seen Vermont?