Health-Care Reform Could Kill the GOP
Can policy be both wise and aggressively partisan? Ask any Republican worth his salt and the answer will be an unequivocal yes. Ask a Democrat of the respectable Beltway variety and he will twist himself into a pretzel denying it.
For decades Republicans have made policy with a higher purpose in mind: to solidify the GOP base or to damage the institutions and movements aligned with the other side. One of their fondest slogans is "Defund the Left," and under that banner they have attacked labor unions and trial lawyers and tried to sever the links between the lobbying industry and the Democratic Party. Consider as well their long-cherished dreams of privatizing Social Security, which would make Wall Street, instead of Washington, the protector of our beloved seniors. Or their larger effort to demonstrate, by means of egregious misrule, that government is incapable of delivering the most basic services.
That these were all disastrous policies made no difference: The goal was to use state power to achieve lasting victory for the ideas of the right.
On the other side of the political fence, strategic moves of this kind are fairly rare. Instead, for most of my lifetime, prominent Democratic leaders have been chucking liberalism itself for the sake of immediate tactical gain.
Former President Bill Clinton, who is widely regarded as a political mastermind, may have sounded like a traditional liberal at the beginning of his term in office. But what ultimately defined his presidency was his amazing pliability on matters of principle. His most memorable innovation was "triangulating" between his own party and the right, his most famous speech declared and end to "the era of big government," his most consequential policy move was to cement the consensus on deregulation and free trade, and many of his boldest stands were taken against his own party.
The results were not pretty, either for the Democrats or for the nation.
Still, conservatives have always dreaded the day that Democrats discover (or rediscover) that there is a happy political synergy between delivering liberal economic reforms and building the liberal movement. The classic statement of this fear is a famous memo that Bill Kristol wrote in 1993, when he had just started out as a political strategist and the Clinton administration was preparing to propose some version of national health care.
"The plan should not be amended; it should be erased," Mr. Kristol advised the GOP. And not merely because Mr. Clinton's scheme was (in Mr. Kristol's view) bad policy, but because "it will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests."
Historian Rick Perlstein suggests that this memo is "the skeleton key to understanding modern American politics" because it opens up a fundamental conservative anxiety: "If the Democrats succeed in redistributing economic power, we're screwed."
In the Clinton years, of course, it was the Republicans who succeeded. And the Democrats' failure -- the failure to deliver national health care that is, not the act of proposing national health care -- was a crucial element, in Mr. Perlstein's view, in the Republican Revolution of 1994. Assessing the accomplishments of the "party of the people" after those first months of Clintonism, middle-class Americans were left with what? A big helping of Nafta. Mmm-mmm.
Fourteen years later, we find ourselves at the same point in the political debate, with a Democratic president-elect promising to deliver some variety of health-care reform. And, like a cuckoo emerging from a clock, Mr. Kristol's old refrain is promptly taken up by a new chorus. "Blocking Obama's Health Plan Is Key to the GOP's Survival," proclaims the headline of a November blog post by Michael F. Cannon, the libertarian Cato Institute's director of Health Policy Studies. His argument, stitched together from other blog posts, is pretty much the same as Mr. Kristol's in 1993. Any kind of national medical program would be so powerfully attractive to working-class voters that it would shift the tectonic plates of the nation's politics. Therefore, such a program must be stopped.
Liberal that I am, I support health-care reform on its merits alone. My liberal blood boils, for example, when I read that half of the personal bankruptcies in this country are brought on, in part, by medical expenses. And my liberal soul is soothed to find that an enormous majority of my fellow citizens agree, in general terms, with my views on this subject.
But it pleases me even more to think that the conservatives' nightmare of permanent defeat might come true simply if Democrats do the right thing. No, health-care reform isn't as strategically diabolical as, say, the K Street Project. It involves only the most straightforward politics: good government stepping in to heal an ancient, festering wound. But if by doing this Barack Obama also happens to nullify decades of conservative propaganda, so much the better for all of us.
Thomas Frank's column, The Tilting Yard, appears every Wednesday at OpinionJournal.com
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Healthcare should be not for profit, period. Otherwise keeping us ill is good business.
RIP GOP. I got nuthin for you.
Mostly, getting us out the door is good for business. "Your leg hurts? Sounds like you've got mono. Nothing we can do for that. Next!"
I am still waiting for someone to explain to me who is going to treat the influx of millions of new patients if the government mandates healthcare for every American. I am fortunate enough to have health care insurance. That being said, when we go to an appointment we sometimes have to wait a week or two to get in to see the doctor. And when we get there there are 10 other people with the exact same appointment time as mine. So now we are stuck waiting an hour past my appointment time to get in. Now, when I go to the hospital for an emergency the same thing happens but even worse. I may have to wait 4 or 5 hours to see someone depending on priority of the visit. When you ask someone why the long wait, the answer is always the same. Not enough doctors, nurses or technicians. Now try going to see a specialist. My wife had to wait 4 months to see a specialist for her condition. And we have insurance. So tell me, when everyone wakes up one morning to find out they have health care, who exactly is going to treat all of these people?
Sounds like you have a bad insurance policy. Is it K a i s e r or something like them? Our doctor (a great one) takes us on time. My OBGYN was 20 minutes late last time due to an emergency.
I would shoot myself before using Kaiser. Some of our specialty doctors take us on time. But the family physician is a long wait. No matter how good your insurance is it doesn't increase the supply to meet demand. And if there is a supply problem now then how much greater will that problem be if we open up the flood gates? I'm not saying everyone doesn't deserve some time of insurance. What I am saying is that current medical profession operates on the supply and demand needs of today. The system is in no way ready for this kind of a change.
We currently spend twice as much per person as the other 23 industrialized nations. The money is there, but it currently goes to waste--fouled up paperwork and unnecessary treatment. In 2006, the paperwork errors alone cost our system $472 Billion--yes, billion.
You know about the paperwork problems if you are dealing with significant health care issues. These guys never get that right. (And I hope your wife is doing well.)
What we spend has nothing to do with staffing. We need more doctors. We need more nurses. Do you know that we import many of our nurses from foreign countries now? Now if you are talking about using some of that money to provide education grants for the medical field and for increasing the number of schools that can provide this training then I would not be opposed to that. There are many paperwork problems. But the simple fact of the matter in our case was that the doctor we needed to see was booked. And so were all the other doctors available to this in that specialty. Thanks for the well wishes. My wife is just fine.
I am always left wondering when the argument is given concerning the massive influx of people seeking care should a universal health care policy be implemented, what are all those people in need of health care doing now? Is it better they should continue to sit in some dark room suffering in silence so that we can schedule our appointments around Dancing With The Stars? Come on, I have never had to wait longer then 30 minutes to see my doctor after showing up to a scheduled appointment. I lived in Tokyo for five years and in Japan they have a universal health care policy. Again, in one of the most crowded cities on our planet, I never waited over 30-45 minutes (tops) to see a doctor and that was for walk-ins when I never made a prior appointment. I just don't buy the over-crowding argument.
I wouldnt want the suffering of other people to inconvenience you.
Castro is graduating Drs by the thousands, so we should stop our idiocy over the embargo and start trading for some Cuban Drs.
Govt could fund medical schools for Drs and Nurses.
Govt clinics can spread to counties and cities, efficiency will be improved with electronic records and forms. We'll get there.
"For decades Republicans have made policy with a higher purpose in mind: to solidify the GOP base or to damage the institutions and movements aligned with the other side. One of their fondest slogans is "Defund the Left," and under that banner they have attacked labor unions and trial lawyers and tried to sever the links between the lobbying industry and the Democratic Party."
Trial Lawyers are quick to tell you all they do for us "common people" but they take a big bite out of the health care budget. It would do more good to look at insurance companies and trial lawyers as siphons from the health care budget than debating how much to pay or not pay providers. Anyone who complains about waiting times and inattention in doctors' offices better get ready for worse if the emphasis of health care reforms maintains the current waste (big bucks to insurance company executives and persuasive trial lawyers. Frankly either party would do well to be severed from their own special interests, but as politicians are usually in their line of work for selfish reasons that isn't likely to happen.
Concise as always Tom. You're great at taking large issues and reducing them to the point that non politicos can understand them, without eliminating detail. I love using your talking points. Keep up the good work, and write more, dammit!
Insurance companies are needed in health care like
The Crips and Bloods are needed in Nursery School.
As a Canadian, let me assure you that we generally are quite happy to have our socialized Health Care systems in place, much like we are happy with socialized Police and Fire services, road construction, etc. Governments are supposed to provide basic human needs, using taxpayer money to the benefit of all. Health care is a basic human need. I owe my life to my government's acceptance of this concept. The notion that one shouldn't have to pay for another's medical bills is ludicrous. I don't use the roads in northern Ontario, nor do I have need of the police or firemen there, yet my tax dollars pay for those.
The fact that the Republicans use health care as a wedge issue to remain in power is positively criminal. Their greed and short-sightedness cost people their lives. People come first. Always.
Why haven't either the dems or reps died out yet?
You create two political parties that are both at extreme polar opposites in ideology. Nobody fits in either category, but tend to lean one way or the other from the middle. It really leaves little open ground for a 3rd party to take any real standing.
If they could create a true "moderate" party, it would probably succeed, but what issues could they really stand on? We support abortion, but we don't support it either. Also, we believe in universal healthcare, but only in certain cases. Just really wouldn't work. The extreme points are what make the "stand", then real people have to make it fit in with the "real" world.
Take the money we pay the insurance companies now, put them all out of business unless they fit one of the administrative roles in the new US Health System.
Now USHS establishes a paygrade/rank system similar to the US Military. Doctors come in as a D-1 with a rank1 pay. Over time, they can climb the pay scale and rise to rank 9 pay. There's no reason that a rank1 doctor still can't make good money, but it would take years of quality care/good evaluations to climb to a rank9 where they make the gravy train. Face it, they've commited a LOT of time to school, they do deserve to make a good living, but notso good that a McDonald's employee can't get health care.
I have to confess - At one time I believed private business could do everything better than government. I was wrong or at least partly wrong.
The majority of Americans want a SINGLE PAYER health plan administered by the government. A health plan like the Canadians have would cost our economy less, would cover everyone, and would deliver good to excellent care.
I don't fear william Kristol's opposition to SINGLE PAYER health care.
I fear Obama, the Democrats and most of all special interests - their money and comercials.
If you want SINGLE PAYER health care for yourself, your children, and your grandchildren start demanding it now.
Special interests are not waiting until January 20th to make their demands.
14 years later the whole landscape of health care reform has changed.
Here are the two main issues as I see them-
1) Some level of health care must be provided to every Americal citizen. Not as a constitutional "right "but as an obligation of any nation that lays claim to fundamental morality.
2) Fair,ethical and compassionate cost control is an imperative. THE SUSTAINABILITY CONCEPT must be applied to US Health Care which in its current form is not economically sustainable and could be our ruin as a nation.
Here is where PREVENTION also becomes imperative. Both individual (health behaviors)and more importantly ,institutional (public ealth) prevention are important
We must apply the same boldness and creativity to US health care reform as we are applying to the environmental crisis. Nothing less will carry the day.
Dr. Rick Lippin
Southampton, Pa
Medical doctors have zero supervision and oversight (do not think patients)
Too many doctors schedule appointments every 15 minutes, and if everyone shows up, every one waits.
Doctors cannot solve problems in 15 or 20 minutes! It's always Money, Money, Money.
There are too many specialists and not enough general practitioners - again, no planning or oversight.
The AMA is only a titular body, in essence
Doctors will resist national health insurance. The minority may care.
Doctors take advantage and,yes, cheat Medicare ad infinitum
Please don't tell me of the fiction of; "they need much schooling" PhDs make considerably less
Too much guesswork in diagnosing conditions, too often wrong
etc
An extremely clear view on the real purpose of politics. The game is not to service the public but to remain in power. The power achieved is then utilized to assure more power. The final goal is to obliterate opposition. Nowhere do we see in the right a goal to service the masses.
A very pure case of the Machiavellin philosophy of 'the end justifies the means." The end being only to remain in power and for no other purpose.
A 15-second synopsis of "The Wrecking Crew."
There are a few basic flaws in nationalizing healthcare.
1) Where is the money going to come from?
2) It is failing in the countries that have it now.
3) How are you going to FORCE doctors to take less pay for their services? If they go to school and spend big bucks to get an M.D. why does the government have the right to tell them how much money they can make. That is what you would HAVE to do in order to control the cost. Why go to school for 12 years to make $120,000 a year. You can do that in a big city as a plumber or a mechanic.
Wow.
So, basically, in your worldview, everyone is selfish and moneygrubbing. Meh.
As the son of two doctors, I can tell you that neither is in it for the money. Moreover, I went to a school that costs more than medical school to work in a field where I'll make what a plumber makes.
Working backward then, please tell me how you think it is "failing" in countries that have it? Please tell me how NOT having universal healthcare is not a MORAL failing.
Lastly, do you have any concept of how much money gets tangled up in the private insurance industry? But I suppose you prefer to pay for a lobbyist's swimming pool.
1) Where is the money going to come from?
We already pay more per capita for health care than just about any other nation. The money will come from what we're already forking over to insurance companies, but they'll be cut out. Too bad for them.
2) It is failing in the countries that have it now.
Which ones? Most countries have had nationalized health care for decades, did they all just start failing?
3) Insurance companies already dictate how much they'll pay for procedures, this isn't going to be a major change for doctors. Except they won't have to hire several office personnel to handle insurance claims.
As someone who works in the healthcare administration area, I have to say that you make very good points.
You talk as if the Insurance companies are actually paying doctors. By taing the costs of insurance companies out, there is a huge surplus for paying fot actual medical care.
Pink...you say national heathcare is failing abroad..wi
On another note...how much do you think doc's make..depe
Point #1 doesn't take much thought. Right now, all senior citizens have quite a nice socialized health care plan (why does everyone forget Medicare?) Where does the money come from? Duh, it comes from us, and so will a new nation wide health care plan. However, you won't have to pay your normal insurance costs, so it would probably be a wash.
Point #2 is completely incorrect, give your evidence if you're willing to - and I will throw back studies that show that the US ranks at the bottom of industrialized countries for health care provided to it's citizens. Trust me, Spain isn't planning on getting rid of socialized health care anytime soon.
Point #3 is interesting. Have you ever worked in a doctor's office? I have, and I have seen the hoops that the billing department has to jump through to keep the insurance companies paying. The doctors already take a healthy pay cut thanks to the insurance companies, and if health care is socialized, the government will not be able to cut their salaries to the point that doctor's are unwilling to be in that profession.
You call these arguments against nationalizing health care? Get your facts straight.
Yes, medicare does exist; however, it already has many unfunded obligations and could bankrupt the country if it is not reformed.
I don't think you understand the ENORMOUS burden this would put on WORKING Americans. You are correct, we would not have to pay our insurance payments. We would have to pay our share PLUS someone else's share as well so it would cost MORE. People don't have healthcare now because they cannot afford it, what is going to happen when everyone is ENTITLED to it and we have to pay for it?
See my post above for the answer to your second point.
"The doctors already take a healthy pay cut thanks to the insurance companies, and if health care is socialized, the government will not be able to cut their salaries to the point that doctor's are unwilling to be in that profession
The last part of your sentence is the WHOLE POINT of Socialized medicine. The government tells the doctors how much they can make. That is the only way the government could afford Socialized medicine. If you don't think so ask Canada. My friend dated a doctor there and the government told her how much she could make.
I think my facts speak for themselves.
"good government stepping in to heal an ancient, festering wound"?
http://www
This is where healthcare is headed in the United States. The NICE board sounds a lot like Tom Daschle's Federal Reserve Health Board.
"...the decisions that get the most attention are those involving new drugs. Any drug that provides an extra six months of good-quality life for £10,000 - about $15,150 - or less is automatically approved, while those that give six months for $22,750 or less might get approved. MORE EXPENSIVE MEDICINES HAVE BEEN APPROVED ONLY RARELY. [emphasis mine] The spending limits represent the health institute's best guess for how much the nation can afford....
I wonder if those that are approved rarely maybe know somebody in government. No, I'm just being pessimistic, politics should decide health issues.
Honestly, the more I read blogs, the more I am convinced that an entire generation of Americans have never taken one class in US history or politics. There are many events that could have "killed" a political party -- and a few have gone by the wayside (but those were only creatures of the moment anyway). The crushing defeat of the Democrats during the Civil War did not kill the party, although Republicans dominated for quite a long period of time. And the New Deal coalition did not kill the GOP.
And for so much, the Civil War did kill - or at least mark the death of - the Whig Party.
The political battlefield used to be a more volatile place - it's sort of astounding that both parties are still strong today. I would argue that regional politics is to blame. Interestingly, some have argued that this election marked the end of the Southern strategy, so we'll see.
As for your crushing admonishment of Frank's knowledge of US history: I think it is, in fact, you who is grossly misinformed.
Sure the civil war and civil rights did not kill the Democratic party, but today';s Democratic party would be a polar opposite of its former self. After all, mot Democrats do not celebrate Jefferson Davis or George Wallace as great members of their party. Just like today's Republican party would appall the likes of Bob Taft. Entrenched parties survive, but they change in such a way that they no longer represent their traditional values.
A classic example of this was Eisenhower as president; his policies represented a last ditch Republican effort to come back by conforming to the political norms of the time (i.e. not questioning the New Deal and embracing a Wilsonian (and imperialist) internationalism). In essence, they stopped being Republicans (by the standards of the old right) in order to regain power.
Students take many classes on US history (Whether they learn much or not is a matter of debate.) and they take classes on government, but contemporary politics are largely avoided for the sake of political correctness. Public schools generally avoid teaching politics.
Correction: Robert Taft (Bob was his son; not quite the same thing).
Insightful article.
While we're at it, let's kill the middle-men, too. We want health CARE, not health insurance.
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