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 that 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 in the Washington Post, 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 that 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 that 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 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?
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The Republicans have passed a repeal of ObamaCare in the House (one of the things they ran on) and a court has declared it unconstitutional. It will eventually go to the SC.
And just in case you forgot there were Multiple Health care reform bills put forth by Republicans but they were shut out of the debate and never voted on by the Democrat legislature.
Now once we get rid of this obamacare law we can look at voting on some of the Republican proposals.
Here's your $2 medicare voucher, try not to spend it all, in one place.
http://www.roadmap.republicans.budget.house.gov/Issues/Issue/?IssueID=8516
republican nominees for president is very telling. Who would want to run as the reasonable
candidate when the way to get elected is to try and out crazy the field. Republicans will never out
line their plans for health care reform, not as long as killing "Obamacare" seems to be what will
get them elected.
I see this statement as being a reason it will not pass.
This move is a tactic I've been hoping to see for a long time. It reminds me of the difference between meeting a physical attack with a frontal defense like a boxer, or like a jiu-jitsu or kung fu fighter who turns the opponent's, who has committed himself in a fateful direction. weight and momentum against him, essentially causing him to defeat himself. Cool.
Also the Wyden-Brown Act does not require the states to increase medicaid funding. They can do what ever they like as long as people get some kind of coverage. It does not have to involve medicaid at all.
It's all in the timing, Chris. They haven't made an official presentation simply because they don't want the Left and its sidekick mainstream press corps trashing it into the ground before CrapCare is even killed. The Republicans want to control the narrative, and that that happens when CrapCare is killed and everybody's looking at each other, in shock, and saying "Well, NOW what do we do?" There's no reason for the Republicans to introduce a proposal now, with CrapCare still in effect. What would THAT achieve?
Uhh... the man of change did that himself: http://www.youtube.com/watch?v=5PwqSCJmbxk
That's a little tough, when you've got Pelosi refusing to allow it to come to the floor and a press corps that might as well be receiving their salaries from the DNC. The Republicans have always had a plan to bring prices down, which John McCain spoke about all throughout the campaign, but which has always, HISTORICALLY, been ignored by the press because one very big component to bringing prices down is tort reform. Only guess which industry gives money to the Dems as religiously as Big Unions do? Big Legal. The lawyers. That's what makes it "not serious" in the minds of mainstream op-ed writers, like the Washington Post.
It's also been simply dismissed by the Left and the press likely because it's only a couple of pages long, vs. the thousands and thousands of pages that the Left's classic power-grabbing legislation generally consists of. It's that Leftie mindset: liberals just simply have it in their heads that BIG REFORM means thousands of pieces of paper and a BIG new federal agency and LOTS of new regulations, etc. The fact, however, is that prices can be brought down — i.e., the OPPOSITE of what's been achieved by CrapCare, if I might remind — by making insurance competitive across state lines and initiating tort reform. Those two very simple, fundamental things alone would reduce the cost. But that just does not compute in the Leftie head, is all. Look no further than financial reform, which is also monstrously BIG, with lots of pages and a mega-expensive new government agency, etc. yet ALSO fails to achieve the goal.
Allowing insurance companies to sell across state lines will mean one thing - all insurance companies will simply set up shop in the state that has laws that favor the insurance company the most. That's exactly why so many companies incorporate as Delaware corporations now, because the Delaware laws are more favorable to them.
Tort reform is in place in several states already and it has done nothing - absolutely nothing, to lower the cost of health care or health insurance.
Well, that's where laws/regulations would come in, right, duh?
>>>Tort reform is in place in several states already and it has done nothing - absolutely nothing, to lower the cost of health care or health insurance.>>>
Well, just as long as you say so. Don't bother backing up any of your declarations with, like, statistics or anything. Let's just go with your word for it.
If we created the inter-state highway system of Health care IT. Cost control can done through IT automation. By creating a public-private open-source Health care Information Technology process between HHS and the Health care Industry and using the best evidence based-medicine from around the world come up with “Best Medical Practices (BMP)” diagnostic and treatment interactive-electronic-medical-workbooks using: XML, XML schema, XForms, Dita and web-services which are IETM Class V compliant documents that when each step is filled out is checked for accuracy and completeness in real-time and saved to one of the telecoms (third-party). Savings former OMB Director Orszag's 700b a year using BMP, since your insurance is based on BMP it could be fully automated, savings Senator Sanders 400b a year in administrative costs, since the workbook format is public the HHS like the IRS could offer rewards to independent programmers savings 60b a year in fraud. Like Newt Gingrich has said if you're using BMP, a malpractice case should never go to court savings 100b a year. Your personal EHR is also at the telecoms secure with bio-metrically audited access and no name or address attached, from anywhere in the world. The DOD, IBM, and many others are already using these technologies. Now there is no Health care or Medicare deficit.”
Now the government has predicted the future, because of that, investors can invest and innovators can innovate. Now the home medical office is a reality.
References
EHR http://en.wikipedia.org/wiki/Electronic_health_record
XML http://en.wikipedia.org/wiki/XML
XML schema http://en.wikipedia.org/wiki/XML_schema
XForms http://en.wikipedia.org/wiki/Xforms
web-services http://en.wikipedia.org/wiki/Web_service
IETM Class V http://en.wikipedia.org/wiki/IETM
DITA http://en.wikipedia.org/wiki/Darwin_Information_Typing_Architecture
A presentation by IBM using DITA
IBM http://dita.xml.org/sites/dita.xml.org/files/IDCMSBlue.pdf
Cloud Computing http://en.wikipedia.org/wiki/Cloud_computing
SaaS http://en.wikipedia.org/wiki/Software_as_a_service
An excellent article from a Brookings Institute Study from a medical standpoint http://www.brookings.edu/reports/2009/0901_btc.aspx
GO VERMONT
Many who view this negatively do so because it didn't go far enough.
Why would the insurance lobbyist want to LOWER costs? http://www.youtube.com/watch?v=5PwqSCJmbxk The only reason we even HAVE a laughably unconstitutonal King George-style "mandate" is because the lobbyist had insisted that the man of change kill the public option and institute her little money-making machine if he wanted her cooperation in getting his "historic" legislation through (and into the history books, which is what Obama got from the quid-pro-quo).
>>>The Wyden/Brown bill is great because the goal is the same, as many insured as possible>>>
Nobody ever needed federal CrapCare to achieve that. All that is is simple legislation. What's so comical about Wyden/Brown is that it's basically what should have been done all along: leave it to the states to initiate their own health care plans and laws. That's the way the Constitution always meant for such things to operate. All Obama is essentially saying now is "Since CrapCare is gonna get killed by the Supremes and you'll be free to do whatever you want, I'd like to propose that you do whatever you want." The guy's just spinning, is all: trying to get out in front of the inevitable demise of CrapCare and make it seem as the next natural step was all his big idea. And every last liberal is falling for it, as usual.
Why would they jump? Doing that would mean they agree that the federal government, and not the individual States has the right under the Constitution to dictate to the States what must be the minimum terms, conditions and the costs of any health insurance plan issued by that State; otherwise, they have to abide by the Federal Mandate, which is patently unconstitutional.
The States do not need any waiver from the Federal Government to do their own health care plan (e.g. see Massachusetts) and more importantly, their health care plan does not have to meet any minimum terms and costs requirements set by some Federal Insurance regulator (e.g. see Massachusetts). Does the writer think that 'Romneycare' (passed before Obamacare) had to meet some minimal Federal standard in terms of cost of provisions? Or that MA (or any State for that matter) did not have the right to act with or without any Federal input?