Tuesday, August 25, 2009

Where Are Washington's Mavericks?

During the election, we heard the word "maverick" thrown around a lot by presidential and vice-presidential candidates John McCain and Sarah Palin, but now that the election is over, where is the reaching across the aisle?  Palin toots her own horn about how she acted as a bipartisan governor, but now she tweets and facebooks about how her baby named Trig, with Downs Syndrome would be put in front of "death panels" under the Obama health care proposal.  McCain's suggestion was that the Democrats drop a government option... but what else have the Republicans done that is real mavericky recently? 

What exactly are some of the Republican legislative health care proposals?

John McCain's proposal during the election focused on a shift to consumer based insurance, increasing individual choice and responsibility.  One issue that McCain had mentioned was allowing the purchase of health care policies from insurance companies nationwide, instead of being restricted to in-state companies.  This would surely help increase competition in the marketplace and breakup regional monopolies.  He had also referenced during his campaign the reduction of certain regulations, both federal and state, to help streamline the process and reduce costs.

These ideas were mentioned a year ago, but where have the Republicans been since then?  I have seen an occasional Republican legislator talk about tort reform, but then they shift back to the scare tactics of "death panels" and ballooning national debt.  They have gotten the average American upset, with claims that health care would be rationed and you would lose your current  insurance plan under the administration's new policies, and now the republican National Committee has shifted gears, trying to court the most powerful lobbying group, the AARP (whom by the way the AARP are frustrated with, but I will address that later), which boasts 38 million members, and voter demographic, senior citizens, with their new Republican Healthcare Bill of Rights for Seniors.  The RNC website states the following:
America’s senior citizens deserve access to quality health care and coverage that will not bankrupt them. Republicans believe that reforms to America’s health care system are necessary, but that reform should first do no harm, especially to our seniors.
  This sounds oddly like what Democrats have been saying, since health care is a leading cause of bankruptcies.  The Republicans are sure to point out that although reform is necessary, their reform should not harm those (especially seniors), which implies that the current reform is harming those it is intended to help, especially seniors. It seems a bit hypocritical that Republicans, who claim health care reform is socialist in nature and will lead this nation into communism, argue for defending socialized care for the elderly, in the form of Medicare and Social Security.  If you look at the sentence above, which is simply a introductory statement to their health care plan, then you would see how they subtly differentiate socialized medicine for the elderly and for the rest of us.  They recognize the status quo is not working by the statement that reform is "necessary", however they do not want to cause any harm to seniors, who already collect socialized benefits.  Is it safe to say Republicans prefer Medicare for the elderly, but reform for the rest of us?  Considering figures state that 47 million people are uninsured while the seniors in America, according to the census, is roughly 37 million, so it would be reasonable to question why one group of citizens (of lesser size) are getting preferential treatment, especially from the Republicans (considering they used the word "especially" when discussing senior benefits?

The intended results of the Republican's Bill of Rights is to "protect medicare", "prohibit government from getting in between seniors and their doctors", "prohibit efforts to ration health care based on age" (which I believe is effectively done with Medicare), "prevent government from interfering with end-of-life care discussions", "ensure seniors can keep their current coverage", and "protect veterans by preserving Tricare and other benefits programs for military families".  Not only is it a complete contradiction with conservative beliefs, the Republicans are pandering to not only seniors, but veterans, using exaggerations of interpretations, while offering little or no alternative to the plan they attack.  It makes sense to try to indulge lobbyists and their membership, considering how much money is spent on lobbying each year.  According to the Center for Responsive Politics, spending on lobbying has more than doubled in the last ten years, which makes the prospect of winning over an important group that much more lucrative, both politically and economically (especially considering elections are approaching and campaign donations are a legal form of bribery).  So you also have a better idea of who else your elected officials represent, here is a graphic (too large for me to include on this site) of the various lobbyists linked to the Republicans in the Senate Finance Committee, and in all fairness, another interactive graphic for the Democrats can be found in this article from The Huffington Post.  The Republicans offer the Bill of Rights, but what are they doing to ensure the Bill of Rights?  Nothing, and that is the complaint that the AARP has with it.

Although the AARP welcomed the Republican statement, they dismissed it as nothing more than misleading and alarmist.  According to John Rother, the AARP's executive vice-president, "The debate as I see it doesn't even focus on health care, it is all about the role of government and the importance of the federal deficit" and he is correct.  The focus has been on the budget, with the dissenting Democratic voices being those of the fiscally conservative Blue Dogs.  The AARP is frustrated that the Republicans have not put forth any proposals of their own, and considering their opinion of the legislation supported by Obama, where the Rother had stated that that they the AARP has analyzed the legislation and that "the proposed Medicare savings do not limit benefits, they do not impose rationing and they do not put the government between patients and their doctors", so this raises the question, why are the Republicans dead set against this reform?

The divisions within the Democratic party are evident, otherwise Obama would have had this bill on his desk before his vacation, but the Democrats are divided as usual, but so are the Republicans.  Some are willing to make proposals, but the majority of the party has decided on a strategy of inaction, opposing the Democrats, and attempt to build momentum, presumably to help dethrone the Democrats during next years elections, and why not?  It appears to be a worthwhile strategy.  If they can maintain public dissatisfaction through their manipulation of the media, they may be able to influence a couple elections, where Democratic legislators seek reelection in conservative districts.  The only problem with that is in the meantime, nothing gets accomplished, and the only positive talking point the Republicans maintain is that they were against it from the start, eliminating any kind of flip flopping.  For those who have taken that stance, they are locked in, and any deviation will give them the appearance of being weak, although the base would spin it as they usually do.  For those who are "mavericks", they face the possibility of being roped in with the naysayers, and as for the Democrats, either liberal, regular, or blue Dog, they have to answer to their constituency regardless, solely because they are the party of the sitting president.

What confuses me more than the Republican's opposition to reform, without any conservative proposal of their own, is how they are attempting to become the party that represents the interests of Medicare recipients.  The spiritual lead of the Republican party, Ronald Reagan, had proposed cuts in Medicare totaling $1 billion dollars back in 1981, out of a total budget of $40 billion ($2,339,344,300 in 2008 dollars).  Even as recent as the nineties, Republicans have tried to slash funding for Medicare, while simultaneously pushing their "Contract With America", and in some regards, the Bill Of Rights proposed by the RNC is remarkably similar to the Contract, except the Bill Of Rights lacks any corresponding legislation to back it up, so essentially the RNC is relying on tough rhetoric.  One other major difference is back in the nineties, the Republicans were able to gain a majority in congress (one that they would keep until 2006).  The Republicans now face the same dilemma, except this time they are offering Americans nothing more than lip service, and it seems to be having an effect, at least for now.  With claims that the Republicans are resorting to scare tactics to get their way, the RNC essentially agrees, stating that Obama had done so in the campaign against John McCain, and what comes around goes around.

Considering the bill opposed by Republicans, H.R. 3200, better known as America’s Affordable Health Choices Act of 2009,  it is curious as to see what the Republicans have been doing with their spare time, other than mangling the true meaning of this 1017 page bill, and even using the length of the bill as a negative talking point, with conservatives claiming the horrible things enclosed, regardless of whether or not they had actually read the bill themselves.  Legislation has been proposed by Republican congressman, such as The Patient's Choice Act by Senator Burr (R-NC), Senator Coburn (R-OK), Representative Ryan (R-WI), and Representative Nunes (R-CA), which is similar to the Republican Study Committee's Empowering Patients First Act, which provides refundable tax credits to patients who wish to buy a private plan, with Medicaid continuing to cover the disabled.  Another proposal by Democratic Senator Wyden (D-OR) and Senator Bennett (R-UT) is The Healthy Americans Act, which guarantees health care for all, with the freedom of choice over individual health insurance plans, make medical care portable inbetween jobs, provide incentives for prevention and wellness and healthy lifestyles, establish cost containment, and allow the average American to have the same level of coverage as their members of congress.   

Although the bipartisan Healthy American bill sounds too good to be true, one interesting figure mentioned in The Patient's Choice Act is that $60 billion is wasted annually due to Medicare fraud.  It seems obvious to me that the potential for savings from fraud prevention, coupled with the increased taxes (on those making upwards of $350,000 per year) and the spending cuts, as well as Obama's deal with the pharmaceutical industry to cut costs for the elderly, the projected annual costs for the reformed health plan would be like music to any fiscally conservative's ears.  It would also make sense to me that the Republicans would want to support cost cuts to medicare, if the costs are the result of increased efficiency and adjusting payment schedules.  Essentially Medicare is the same as private insurance, with the costs of medical care being offset by customers who purchase insurance premiums, or in Medicare's case, a pay-roll tax levied on all workers.  Simplistically, a healthier, and in Medicare's case, a younger generation pays into a system for future coverage, while the elderly benefit immediately.  Because the Republicans are against the reform bill, but for Medicare, you could pretty much argue that they are for taxing the majority of Americans, particularly the middle class, in the form of a payroll tax (this is the same argument they had used recently raise in cigarette tax), and I would equate any reduction in the cost of Medicare as a reduction in taxes, although I doubt the government would be willing to put that money back into our pockets, but if spent wisely, and a greater system can be established to benefit the whole society, I would think the investment would be worth it.

One other argument I dare to make, although I worry I shouldn't because it indulges the conservative fancy, is the hypothetical question of "What if seniors lose their Medicare?"  In theory, they would be picked up by the universal coverage, so really, what is the gamble for the elderly?  In reality, there is none (unless you believe in "Death Panels"), but if the truth were to be told, it may discredit the RNC's Bill of Rights that much more.  The end result has seniors insured, so why are the Republicans trying to court them, and in essence, the largest lobbying group for a single interest, other than to try and spread the appearance that they are the party to trust in, because the Democrats obviously don't care about the elderly, especially if you consider the much misquoted comment made by Obama, suggesting Grandma merely takes a pain pill and prepares to die, rather then endure a pointless surgery.
I would also like to consider the belief that Republicans, being free market thinkers and champions of the entrepreneurial spirit, represent the interests of not only people, but small businesses (owned by people).  A concern addressed is that by creating a so-called public option, businesses will opt to shift from the current employer-employee relationship, essentially dropping insurance policies, causing more people to enter into the government system, but is that necesarily bad?  In order to make any government system work, you would need more people paying into the system then those accessing the system (which could be viewed as a simplified reason why medicare is not working).  Maybe this is why most small businesses support a government option (refer to graphic I found online).  Also considering the reality that small businesses, which make up roughly 50% of the gross domestic product, freeing up costs associated with not only with insuring employees, but maintaining healthy employees in a future system, such reform may be a tremendous gain.  Also considering the percentage of small businesses that make up health, finance, and insurance industries, entrepreneurs may find the new system to better promote competition.  To illustrate that point a little better, I offer another pie chart, but this time in color:

With Health Services around provided by small businesses accounting for 9% of that industry's GDP, and Finance and Insurance at 8% (granted that this figure includes services not associated with the health care industry), even a slight increase would infuse more money into smaller, regional businesses, and as famously associated with Reaganomics, the flow of money would trickle down back to the people.  Currently, America's health care system is controlled not by the government, but by a select few corporations, that essentially dictate who is "eligible" for coverage, and who is not, either by definitions of a network or by other clauses such as a pre-existing condition, and for those found to have a pre-existing condition, finding coverage is near impossible and if a situation arose regarding that condition, the person denied coverage would shoulder the exorbitant costs.  Is this fair?  No, but it is the corporation's prerogative to turn a profit for it's shareholders, so any person with a conditioned deemed a liability would simply be denied, and forget about making a claim, or you may fear being dropped, and as we are all familiar with the story of Humpty Dumpty, even his insurance couldn't put him back together again.

Considering the vitriolic debate that has been occurring throughout the nation regarding health care reform, with conservative pundits stoking the fire while Republican candidates just sit back and watch, it makes you wonder where that "maverick" attitude went.  John McCain had overused that term during his campaign, and I had begun to believe that it was true, that he would work along side political opponents to get the job done, and not to say that he has not, but it increasingly appears as if the attack ads played last year, that described McCain's voting record to be more in tune with the views of President Bush, held more truth.  One thing to consider is that McCain is also up for reelection in 2010, and he just may be one of those Republicans caught in the middle, but considering his recent mention in the news, McCain seems to be playing the politician, smartly distancing himself from the ridiculous claims, such as "death panels", but at the same time lending credence to the concerns of the misinformed.  Look at his interview with George Stephanopoulos, when asked if he believed in Palin's "death panels", McCain responded:
Well, I think that what we are talking about here is do -- are we going to have groups that actually advise people as these decisions are made later in life and ...
And when told that it is not in the bill, McCain defended his position, claiming that the bill does not explicitly mention "death panels", but the vocabulary is "a little bit ambiguous".  Ambiguous?  McCain referenced a provision that called for a board to study the most effective measures to provide health care to people, but he feels that allowing for such studies to be done is a slippery slope into rationed health care because the bill did not specifically state that the board's jurisdiction was limited, and would have no impact on individual interaction between a patient and their doctor, and would only serve merely to provide statistical data.  McCain also supports Palin's claims, halfheartedly, by stating that Republicans proposed an amendment that would clarify what role these "death panels" would have, and the Democrats rejected inclusion of the amendments, supporting arguments against the bill.

Although John McCain lost, he still raked in over 58 million votes, which would equal a good amount of political capital, but unfortunately he was pushed out of the way when the Republicans scrambled to find leadership.  President Bush had intelligently decided to stay out of the public eye for a while and refuse to criticize President Obama.  Dick Cheney, who was widely unpopular also remained out of the light for the while, leaving policy to be interpreted by conservative pundits, who tend to lean farther right then the actual right, and with Republican base ralliers like Sarah Palin scratching at the national headlines, it is only natural that a progressive Republican would be pushed aside.

Even Republican leadership has it backwards.  House Republican Leader John Boehner states on his website that veterans, seniors, doctors, and small businesses do not like the proposed bill.  The veterans are worried that they would lose their government benefits (in exchange for universal coverage?). The seniors are worried access to health care would diminish, even though the AARP has dispelled those rumors as nothing but scare tactics.  The doctors are worried about regulation of the market and government mandates, and small businesses are concerned that they wil be shouldered with a large portion of the bill, that will cause them to reduce the size of their businesses, costing jobs.  He stresses that the proposal aims to cut over $300 billion from Medicare, which will result in lower health care quality for America's seniors.  I thought Republicans were for less government interference with the free market, but to maintain high opperating costs for Medicare would only increase the government's involvement in the industry.  I understand the veteran's fears because they had gotten the short end of the stick before, with wounds from Vietnam still open, and I also understand the concerns of small businesses, who are trying to make their mark in the free market.  According to the World Health Organization, there are 1.5 million physicians in America, and Representative John Boehner mentions that several medical societies and associations representing 43,000 doctors wrote to House Energy & Commerce Committee Chairman Waxman that they opposed the bill.  This number represents less than 3% of all physicians, with the amount of American physicians in support of the legislation actually increasing.  As for small businesses, they have much to gain through tax credits, and with studies point to the smallest of businesses that offer insurance saving $3,500 per worker, and according to the Joint Tax Committee, 96% of taxpayers with any business income would not see an increase in their taxes.

When will a Republican take the reigns of their party, and fight back?  When will we have one of these self proclaimed mavericks hammer out a deal with Democrats to help make meaningful legislation that would benefit America?  When will they fight corporate interests and reduce waste and fraud within the existing bureaucracy?  When will our elected officials accept responsibility?

All these questions are important, but when will anyone listen?  Inaction is not the best policy, because in the long run, the public is getting screwed.  Politicians need to do what is right and allow the results to speak for themselves at the election booths, and if the Democrats really cared about the electorate, more so than their own political career, then they would push through this legislation, and not let irrational fear (both their's and the public's) take over.

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