Obamacare: The Lying Strategy

This has been making the rounds, but in case you haven't seen it, Ezra Klein in 2008 laying out the strategy for Obamacare:

I'd say "shocking", but of course it isn't. This is what we expected. And the last bit about creating a system that would gently lead us to single-payer: yep, just as we suspected. Thanks, Ezra, for finally telling the truth. Now to abolish this abomination.

Post-Election Wrap-Up

Well, Tuesday was unpleasant. We were standing athwart history, and history rolled over us like a freight train. We really can't deny that.

At the moment, at least, this is not a center-right country: it's center-left. Some would have us believe that this is due to demographics, and thus has an unstoppable momentum behind it. But I don't think that has to be the case.

In the near future, some predictions:

1. There won't be any conciliation between the parties, unless the GOP chooses to roll over. Obama won narrowly, but he's going to view this as a mandate and push his agenda as aggressively as ever.
2. We will see even more abuses of executive power over the next two, and possibly four, years. (My biggest fear is that this won't end with Obama's second term, but may become a permanent fixture of American politics. If I'm right about that, then we'd better hope we never elect an ambitious power-monger President.)
3. Taxes are going up for most people. The most obvious top-line effects will be on "the rich", but if business taxes are raised, that affects everyone. If gas is taxed more heavily, that affects everyone. And so on.
4. Health care coverage will get worse as more companies opt not to provide it to their employees. We're going to start the long march towards universal care. I predicted this two years ago and so far have seen no reason to doubt it.
5. Iran will get a nuclear weapon.

The Bully Pulpit

In America's system of separated powers, the executive power is more limited that in most systems. The President cannot, for example, propose a budget. (In the parliamentary model, the government generally proposes budgets which are then debated and usually passed by the legislature. It's usually a smooth process because the government is usually the party of the majority. Not so in America, where we often find the executive and legislative branches controlled by different parties.)

However, one great advantage of the Presidency is the so-called "bully pulpit", a term coined by Teddy Roosevelt, who meant "bully" in the sense of "great" or "terrific". My generation might called it an "awesome platform", a great place from which to advocate for an agenda or position.

President Obama seems to have taken "bully" to mean something else: to harass or coerce. His preemptive attack on the Supreme Court over Florida v. HHS cannot possibly have any populist effect: the legislative work, after all, is done. The only effect it can possibly have is to try to cow the Supreme Court justices to decide in favor of the government. That is the other form of bullying.

Whether he'll get away with it is another matter. I would hope not. Everyone expects the case to be decided 5-4, with Justice Kennedy, as usual, the swing vote.

Catholics and Contraceptives

At first blush, the Obama administration's heels-dug-in posture of not allowing a religious exemption to the requirement for insurance to cover contraceptives and abortifacients seems like a political mistake. But I wonder if there's a grand plan here?

First, a quick overview of the arguments on both sides. Catholics and conservatives say that this is an attack on religious freedom. Liberals say that Catholics are hypocritical to object since some large percent of them use contraceptives anyway (I've heard 50% and I've heard 98%, but I will argue that the actual number makes no difference). The liberal argument is incorrect on two grounds. First, it isn't hypocritical. Many Catholics drink alcohol. That doesn't mean the State should force the Catholic Church to buy it for them. Second, even if it were hypocritical, that wouldn't argue in favor of the requirement. Liberals often use "hypocrisy" as a brickbat to attack principled arguments. But merely because a person has a gambling problem doesn't mean he's wrong to oppose gambling.

Conservatives are, I think, in the right here. It gets worse when you consider that the Obama administration has already granted over a thousand waivers to other PPACA requirements. They are meant to show that the law is "flexible". Not, apparently, in this case.

There may be method to the madness, though. If the administration continues to be uncompromising, the result will probably be that the Catholic Church will cease to provide health insurance to its employees, and will pay a fine instead. Fast forward a few years. The next step the liberals will take is to continue the push to a single-payer system, and then they will tout the current crisis as a point in their favor! Look, they'll say, this whole thing could have been avoided if we had a single-payer system. The Church wouldn't have any objection, no one would have lost insurance coverage, and everyone would have been happy.

Of course, there still would be a loss of religious liberty. Catholics would still be paying for contraceptives and abortions, via their tax dollars instead of their tithes.

The White House's Incoherence on Health Care

From the White House blog today:

Those who claim that the “individual responsibility” provision exceeds Congress’ power to regulate interstate commerce because it penalizes “inactivity” are simply wrong. Individuals who choose to go without health insurance are actively making an economic decision that affects all of us.

I hope it's clear to them what a dangerous precedent this would create. If doing nothing can be construed as an economic act that affects all of us, then what can't be? For example, once I've been forced to buy my health care, then literally doing nothing can be hazardous to my health. This potentially raises my future health care costs, and when those costs are shared by all, it affects everyone. Therefore, according to the White House's logic, it would be perfectly Constitutional to fine me for not exercising.

Of course, many liberals may well believe this. Nancy Pelosi expressed shocked disbelief at the notion that the PPACA's health insurance mandate might be unconstitutional. When Elena Kagan was asked during confirmation hearings whether a law requiring people to eat vegetables would be unconstitutional, she evaded the question.

Simply put, the left does not believe the Constitution is a "living document". They believe it is an irrelevant one. Only when the Constitution happens to coincide with one of their sacred cows do they recognize it; whenever it poses the slightest barrier, it is met with utter disdain.

Obamacare Wipes Out Health Care For Children

Matthew Shaffer lays out the case for why Obamacare was responsible for wiping out the market in child-only health insurance policies.

Insurers say the blame for their withdrawal lies not with them, nor even with the Obama administration’s general desire to extend health coverage, but rather with a single, hastily written provision of Obamacare. As the bill was being negotiated, insurers accepted that it would prevent them from denying coverage to those with pre-existing conditions, but they assumed that other means of managing risk — such as pricing, co-payments, and restrictions on coverage — would still be available. So insurers were surprised to discover that the law essentially required full “guaranteed issue” and banned price discrimination across the child-only market, regardless of clients’ risk profiles.

[...]

[Health Care for America Now (HCAN) communications director Avram] Goldstein thinks that argument is misleading. “When the industry expressed reservations about the rules, the Obama administration accommodated them,” he explains. “HHS Secretary Sebelius and her staff added in the ability for insurers to create open enrollment periods, so that a child who suddenly developed a health problem could not just rush over and buy a policy that would be guaranteed issue. Instead you have to say during the year, when you don’t know if you’re sick, whether you’ll enroll. They tried to accommodate insurers.”

This is true, but insurers still have good reason to be skittish. [America’s Health Insurance Plans] explains insurers’ uncertainty with a thought experiment: Suppose twelve different insurers each had an enrollment period in a different month of the year; then parents could still wait until kids got sick to purchase insurance, because they could simply pick the insurer that was enrolling that particular month.

Shaffer doesn't quite connect the final dots, though. The basic problem is that the goal behind setting up an open enrollment period is at odds with that of providing health care for all. Suppose a parent wants to sign up a kid for a child-only policy. If there are many open-enrollment periods scattered throughout the year (from different insurers), then adverse selection allows the parent to wait until the kid is sick before signing up. If there are few open-enrollment periods, though, then the kid may have to wait an arbitrarily long time before getting covered.

It's a teeter-totter: when one side goes up the other goes down. You can attempt to balance the tension between the two, but you cannot resolve it.

UPDATE: I forgot to link to the article in the original posted. That oversight has been corrected.

The Democrats' Long Game on Health Care

If you read the conservative press, you'll see a litany of stories about how the health care bill is already showing signs of trouble. It'll increase costs, they say. It'll force people to change insurers, they say, or even to change doctors. It'll increase budget deficits, they say. It'll create moral hazard for people to game the system (as they have in Massachusetts under a similar plan), they say. All of this runs counter to the Obama administration's statements during the debate about the bill.

I can't, however, shake the feeling that this is all part of the plan. Of course a massive reform of our health care system is going to cause unexpected consequences, many of them painful. Of course you can't increase coverage massively while also cutting costs. Surely the Democrats know this. So what, exactly, is the plan?

It's simply this: the worse, the better. The existing bill is a horrendous mishmash of conflicting measures, poorly-understood provisions, and possibly unenforceable and/or unconstitutional mandates. This will all become apparent in a few years. And when it does, what will the Democrats say? Think they'll say, Oh, sorry, we were wrong, now we're ready to consider the Republican ideas? No. They'll say: See what happens when we're forced to compromise?

President Obama is already getting ahead of this. He laments the exigencies of democracy. If only, he said, he could have crafted a perfect bill with an academic imprimatur and no messy legislative fingerprints. That "perfect" bill will, of course, be single payer. Next time this comes around, that's what they're going to demand. Enough compromise, they'll say. It's time for purity.

The conservative pundits highlighting the problems are not wrong to do so, though. Their hope is that all or part of the bill might actually be repealed before it's implemented. This won't happen before 2013 at the earliest, because of Presidential veto power, and it's unlikely even then. But pointing out all the flaws as they become apparent is the best way to swing enough public opinion to make repeal a possibility. So more power to them... but watch out for the other side's long-term strategy.

No Need for "No, Sir"

Senator Waxman has canceled the hearings I previously blogged about. Good for him.

Mandate, Pick One: Unconstitutional or Unenforceable

Jed Lewison, from DailyKos, writes:

First, the health care bill does not give IRS employees any power to enforce the mandate -- there will be no audits, no IRS agents, not even any penalties.

Daily Kos, of course, wants to view this in only the best way possible: The mandate is so constitutional you can't scare up a law professor to take the other side, they say. And it won't lead to more IRS hiring, no sir, because it won't be enforced.

If the mandate can't be enforced, then it won't be followed. And that means that healthy people can drop out of insurance at no risk to themselves. If they get sick, they can buy insurance then, and be guaranteed coverage because pre-existing conditions must be covered under the health reform bill.

If what Lewison says is true, then it really doesn't matter if the mandate is declared unconstitutional. The bill is already a failure.

Obesity = Hunger?

Today on NPR, guest Bill Ayers (wait, where have I heard that name before?) argues that hunger is a major problem for the poor in the USA. Obviously, a major problem with this position is evidentiary: the biggest health problems among the poor are related to obesity, not starvation. So, applying pseudoscience that would make L. Ron Hubbard blush, Ayers asserts that the two are really the same thing.

A true Alinskyite, Ayers knows that lies that contain a kernel of truth are the best ones, and this one is exemplary. It's certainly possible to be malnourished and also obese. And obesity caused by excessive consumption of junk food has bad side effects. But these effects are secondary.

An obese person simply isn't going to die of starvation, or lack of nutrition. Take two people. One of them is given a steady diet of McDonald's chicken nuggets and Egg McMuffins. The other is given 800 daily calories of rice. Is there any doubt which is the more healthful diet? The chicken nuggets contain all sorts of bad stuff, but they contain enough nutrients to sustain life indefinitely. The first person might die of a heart attack at age 50, but the second person is unlikely to survive to adulthood.

By ignoring this primary fact, Ayers tries to create the myths necessary to underpin more government control of our economy. First, it's health care. Then, it's food production, because, as he asserted (with no evidence at all) on the show, eating a (more expensive) apple today instead of an apple pie leads to equivalent health care savings in the future. He does not connect the dots (yet), but it's easy to see where this leads (just look at the U.K.): restriction of "unhealthy" foods, subsidy of "healthy" foods, rationing of government-run health care for people who lead "unhealthy" lifestyles, etc.

Health care is one of the key commanding heights of the entire economy. If the left is allowed to control it, all sorts of other, smaller battles will be lost. It's just a matter of time.

And by the way, why is Bill Ayers still allowed in polite society? Doesn't NPR know he's an unrepentent terrorist?

The Potential Constitutional Nightmare

I don't know enough Constitutional law to judge the merits of this, but some people who do clearly think that the insurance mandate in the health care bill may be unconstitutional. Let's just imagine for a moment that it fails a constitutional challenge. What happens next?

Well, what happens next is a disaster of epic proportions, because the rest of the bill would still stand. So with the provisions preventing insurance companies from denying coverage of pre-existing conditions, there would be no reason to have coverage until you needed it. So healthy people would stop buying coverage, and the pool would be only sick people. Premiums would skyrocket; sick people would go bankrupt; insurance companies would go out of business. It would basically mean the regulatory destruction of an industry.

Now, most likely this sequence of events wouldn't actually occur because, if the mandate is overturned, there would be some time to legislatively repair the damage before the pre-existing condition provision comes into effect. But the mandate is the linchpin of the whole bill. I'm really not sure how any of the rest of it stands without it. It would be extremely interesting to see how the debate on how to fix things afterwards would play out.

Poor Saps

Last night on NPR, a young New York bike messenger was interviewed about his take on the health care bill. I'm paraphrasing from memory, but essentially what he said was: "Public options? Single payer? I have no idea what's in the bill. But I've been uninsured for five years so I hope it helps me."

This poor guy. Sure, he's going to be "helped." The insurance mandate will require him to buy insurance or pay a fine. Will either one make him better off? Probably not. Either way, he'll basically be subsidizing health insurance for older, sicker people. This is entirely by design. And this guy has no idea what's coming.

David Frum: Monday-Morning Quarterback

David Frum writes a hard-hitting after-action report of the health-care battle. I'm pretty sure this is the same David Frum who used to be a conservative and wrote for National Review. But it's possible he's being impersonated by some sort of doppelganger. We've known for some time that Frum has divorced from the Buckley wing of the conservative movement, but this column makes me wonder just where he's coming from at all.

...[W]e do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney's Massachusetts plan.

If this is true, then Republicans shouldn't mind the bill all that much, should they? But then why does Frum say: "Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s"? Apparently, this bill is basically conservative, with a few liberal problems tossed in like "redistributive taxes on productive enterprise", "weighing so heavily on small business", and "expanding Medicaid". News to me. I thought conservatives ideas for health care reform revolved around tackling the third-party payer problem, tort reform, and, you know, all those other things that Republicans were offering as counter-proposals to the Democrat bill.

Frum wants to believe that Republicans were the party of "no." I can understand why, if he's listened to the Democrats and the MSNBC media. But if he had watched the health care summit he'd know that Republicans have actually offered lots of ideas. It's just that Obama and the Democrats rejected them out of hand. Democrats have huge majorities in the House and Senate, and the Presidency. That pretty starkly limits the power of the opposition. That the bill came as close to failure as it did attests to the leftward maximalization strategy the Democrats followed when crafting the bill and propelling it through the legislature.

Finally, Frum levels a major accusation of duplicity at the popular mouthpieces of the right:

So today's defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it's mission accomplished.

It's understandable that Frum is bitter, but this is terribly disingenuous. Does Frum seriously believe that Limbaugh, Hannity, Fox News, the NY Post, and the handful of other opinion makers on the popular right were hoping for the success of Obamacare and the rest of the lefty legislative agenda on the way, and are trashing it in a clever, deep game to maximize their markets? If that were true, why does the left want to quash them? Frum is engaging in paranoid fantasy here.

Furthermore, he himself is a member of the conservative entertainment industry. Or at least he purports to be. I'm not sure he's all that conservative or, for that matter, all that entertaining.

The Burden of Liberty

Another timely Google quote of the day:

Liberty means responsibility. That is why most men dread it. (George Bernard Shaw)

Indeed. Much easier, for example, to hand over to the government the responsibility for our health care, than to take on that responsibility ourselves. As we have seen.

Ugh

The health care debacle, obviously, is deeply, deeply disappointing. America is changed forever. The culture of dependence becomes more entrenched. The likelihood of rolling back these entitlements - or any entitlement - lessens. The one-time American culture of bumptiously independent, self-reliant individuals, if it wasn't dead already, is now in a coffin, nailed shut, six feet under.

It would be nice if we could just stop talking about it now, but we'll have to endure months of Republicans (rightly, but still exhaustingly) campaigning for its repeal, then Republicans winning big in November, then Republicans failing to repeal it, then Supreme Court challenges to certain measures, and on and on forever. Health care will now be part of every public debate. I should just include it as a permanent label on every blog post.

Kucinich in the Coal Mine

It's no surprise at all that Dennis Kucinich (D-OH) has switched his previous "no" vote on the health care bill to "yes." His reasoning for the earlier vote was that the bill wasn't progressive enough; specifically, because it lacked a public option. His statement on his change to supporting it:

If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform.

Of course. As we have been saying all along, the Democrat bill is the first domino in a series that ends with what Kucinich deems "comprehensive health care reform," and what a normal person would call "government-run health care." It's foolish for leftists to want to kill this bill because it isn't lefty enough - all they need is to proceed in steps until their ultimate vision is realized.

Deeming the Bill Passed

The Democrats are up to something new in the health care saga. Instead of actually passing the Senate bill by a, you know, vote thingy, they are talking about "deeming" it passed if some other legislation is passed. This trickery is supposed to give Democrat congressmen cover when they face voters this fall - they can say, hey, we didn't actually "vote" for the Bill. It just passed by some magic process, outside of our control!

The politics of this seem highly dubious, but we can worry about that later. The interesting part is the "deeming" trick. Republicans have used it before, and it's been challenged and upheld in the Supreme Court. So there's little doubt that, even though any normal person would instantly recognize this as a shady, undemocratic, shyster trick, it's probably technically legal.

Former prosecutor Andy McCarthy tries to make the case that it's OK that the trick has been used by Republicans before, because those were for "uncontroversial" measures, like raising the debt ceiling. It still shouldn't be used, he says, for passing such a major piece of legislation as the health care bill.

Sure, we don't make lawmakers dot every "i" and cross every "t" every time. But that doesn't mean we've abandoned the right to make them play it by the book when it comes to a controversial matter. When there's a real dispute, they have to pass the bill the regular, constitutionally mandated way: Both houses on the exact same text, with every legislator accountable for his vote.

An alternate solution is simple and, I think, preferable: make lawmakers dot every "i" and cross every "t" every time. McCarthy's analogy to a criminal trial is false: such trials happen every day, incur significant expenses, and have a well-established appeals process if something goes wrong. Legislation in Congress, on the other hand, only passes a few hundred times a year at most (with only a few dozen bills a year that are controversial), has widespread consequences, and cannot be repealed without another act of Congress (or Constitutional invalidation).

Furthermore, as McCarthy says, "stipulation" happens in nearly every trial. The Slaughter procedure is invoked only rarely. And when it has been in the past (by Republicans), it was challenged by Democrats on Constitutional grounds, which leads me to believe that the legislation involved was not uncontroversial. (It's undeniably true that raising the debt ceiling is less consequential that the health care bill. But that was not McCarthy's argument: he said "controversial.")

The unfortunate but inescapable conclusion is that Republicans helped create this legislative environment by their own trickery, and now they are reaping the consequences. We all may end up paying dearly as a result.

Brown on the Jobs Bill

Newest Senator Scott Brown broke ranks with most other Republicans to vote for cloture on the new "jobs" bill (quotes added out of skepticism at what this bill will actually accomplish). I wrote this the day after Brown was elected:

[Brown] isn't going to become another Rick Santorum. In my opinion, that's a good thing. It's possible that Brown is close to my ideal candidate: fiscally conservative, socially moderate. He was elected primarily on the former, and we will have to see how he does. But even farther-right conservatives than I should be happy if he legislates around the middle of the party.

I'm not surprised to see Brown exercise his independence. It's slightly disturbing to see it come on a fiscal measure. And if he continues to vote for fiscal "stimulus" then that'll be a shame and I'll have to re-evaluate him.

But he'd have to commit an awful lot of sins before I'd regret supporting him, as long as the health care bill in its current form dies a final death.

Brown!

Well, the unthinkable has happened: a Republican has been elected Senator from Massachusetts. This is certainly a repudiation of the current state of the health care bill. For one thing, Brown ran (in part) on a platform of voting against it. For another, he will replace Ted Kennedy (not counting placeholder Paul Kirk), the Senator most responsible for driving health care deform to where it is today. For a third, lots of voters polled said that their experience with MassCare had soured them on a federal version.

It would be madness for the Democrats to double down and try to ram through a bill via trickery. Using the reconciliation process seems to be off the table. Having the House simply pass the Senate bill remains an option, but given the narrow 220-215 passage of even the House bill, it's not at all clear where Pelosi finds the votes for this. That's especially true given the political environment that all House members must be eyeing warily. The public's ire is aroused and a wrong vote at this juncture could be fatal in November - which is rapidly approaching. The window for Obamacare may have just closed.

One more thought: we should celebrate Brown's victory tonight. But expectations should not go too high. He isn't going to become another Rick Santorum. In my opinion, that's a good thing. It's possible that Brown is close to my ideal candidate: fiscally conservative, socially moderate. He was elected primarily on the former, and we will have to see how he does. But even farther-right conservatives than I should be happy if he legislates around the middle of the party.

Jobless Recoveries

There's been much talk lately about the "jobless recovery" we're experiencing. The recession is technically over, in the sense that GDP has returned to growth. But unemployment continues to rise and most indicators of job creation are still negative (with a few contrarian bright spots: temp employment is up and hours worked are up).

The problem with all the talk is that this is the normal course of things. In their early stages, most recoveries are "jobless". Companies are loathe to hire when they are unsure about the future. The way economies normally recover is that consumer spending picks up, inventories fall, then manufacturing picks up, and finally employment rises. In the normal "virtuous circle", the rise in employment then leads to more consumer spending (since employed people have more money to spend than unemployed people), and so on. We've seen some signs in the first three stages of this cycle, but they're weak. So it's no big surprise that the last stage remains to be seen.

Government intervention can prolong the process. The "stickier" employment is, the less risk companies want to take in hiring someone new. It already takes months for most new employees to learn a new job; it's often that long before the new hire is earning money for the employer. When additional costs are piled on - guaranteed health care, unemployment insurance, Social Security and Medicare - that just increases the risk. And when it's hard to lay someone off, that increases it further.

That doesn't mean that these measures are necessarily wrong, but we should recognize the costs of having them. One of those costs is that employment recovery following a recession will be slower than it might otherwise be.