Thursday, January 21, 2010

A missed opportunity on health care reform


Sen. Ben Nelson (D-Neb.) must be smarting now that Democrats aretalking about pulling the plug on the “deal” they crafted just for himand his State of Nebraska as the price of his support for Obamacare,now polling at W’s lows and threatening the loss of TedKennedy’s seat—a provision that would exempt Nebraska from paying forthe Medicaid expansion designed to cover currently uninsured low-incomefolks.
“Get as much gunk out of the Senate bill as possible.That Nebraska thing is really hurting us,” Bill Clinton told HouseDemocrats in a closed-door speech during their annual “retreat” thisyear at Capital Visitor Center, far from the spa resort in colonialWilliamsburg they usually decamp to. (Washington Post, 1/16/10)
Before they cut that deal, the White House brazenly threatened to hurt Nelson, a coalition of physicians allege in a lawsuit, by putting Offutt Air Force Base on the BaseRealignment and Closure Commission (BRAC) list, slating it for closure,unless Sen. Nelson voted the right way. Offutt AFB, Strategic AirCommand headquarters, employs approximately 10,000 military and federalemployees in Southeastern Nebraska. (So, Americans might not havejobs—either by an Act of God, an Act of Obama, or an Act of FinancialRecklessness, if you don’t believe Lloyd Blankfein’s version ofevents—but they’ll have health care to deal with the resulting ulcers.)

Nelson’s was just one of many tailor-made deals that—Clinton’sright—are patently unfair to everyone else not in on the fix. Sen.Nelson, recognizing the obvious injustice, now says he wants to scratchthe Nebraska provision but then replace it with a much more expensiveprovision that would exempt every state from the costs of expandedMedicaid coverage.

Problem is, Obama’s contention that health care reform would savemoney would then, finally and irrevocably, be exempted from reality,since Nelson’s “solution” to other states’ legitimate grumbling wouldexplode costs, making former Comptroller of the Treasury David Walker’squip at the budget commission’s opening hearing last month that “Harryand Louise” have morphed into “Thelma and Louise” a fitting summationof the year-long health care “debate.”

And, to think, the mess Democrats find themselves in was all so unnecessary.

If they had taken a cue from the Republicans, who contrary torepeated false assertions by Democrats that they were onlyobstructionists, did, in fact, offer an excellent alternative: It’scalled the Patients’ Choice Act (PCA)—co-sponsored by Sens. Tom Coburn(R-Okla.) and Richard Burr (R-N.C.) and Reps. Paul Ryan (R-Wisc.) andDevin Nunes (R-Calif.)—that in contrast to the Democrats’ PatientProtection and Affordable Care Act, would achieve universal coverageand create a true insurance market, thus removing anti-competitiveinequities currently plaguing the system.

And, most brilliantly, it transforms Medicaid from its currentthird-rate status to a first-class, stigma-free health care system forlow-income, making it the natural corollary to Republican-craftedwelfare reform Bill Clinton smartly co-opted in one of the crowningachievements of his presidency. Plus, it saves money and tackles health care’s structural deficiencies by realigning “how nearly $1 trillion, currently assumed under law, isspent by involving individual beneficiaries in a way that deceleratesthe healthcare spending growth rate, through a carefully calibratedtemplate and formula that emphasizes health outcomes…”

States would save $1 trillion and the federal government $300million, thus responding to voters’ most pressing concern—to containexploding health care costs.

Not only that, Democrats could have counted on Sen. Nelson’s votewithout resorting to such unseemly tactics. And, today’s effort,sailing in the perfect storm to save Ted Kennedy’s seat, wouldn’t seemlike Mission Impossible.