09/20/2009 05:12 am ET Updated May 25, 2011

The Dog Days of August

It is hot and humid in New York City. After an unseasonably cool summer, the natural order has reasserted itself.

So, too, it appears in the nation as a whole.

The Republicans have now pretty much embraced their alternative to Obama's politics of change. To "Yes, We Can" they shout "No, We Won't". The issues are more or less irrelevant. When the Administration proposed the stimulus package earlier in the year, the GOP rediscovered its hatred for deficits and opposed it. Never mind that the country was rapidly traveling down the slippery slope to Depression. Or that they themselves had inherited Clinton's trillion dollar plus surplus only to squander it on tax cuts for the top 1% and an off-budget war without rationale (at least one based on fact) in Iraq. The party of one and a half regions (the old Confederacy and some Plains states) would rather oppose than propose.

A few years ago, I wrote an email to to E.J. Dionne of The Washington Post. I told him that Republicans and conservatives run on the platform that government can do no good, and once elected, try to prove it.

Now they are doing that even when they are out of power.

The issue du jour is health care. Progressives already have given up on their preferred reform -- Medicare for all, which is a form of single payer. Instead, as the Clintons did in the '90s, they have accepted the notion that health policy must be fashioned on the dysfunctional foundation created by insurance companies. I suppose there is some market based mechanism that might provide reasonable care for all at costs that do not bankrupt the country. Hillary certainly tried to craft one in 1993, only to be told that her combination of employer mandates, community based rating, and regulatory oversight was government run amok. Her proposal never even made it out of committee. It just became a battering ram for Gingrich's revolution.

Now, in this potential summer of his discontent, Obama is running into the same buzz saw that killed health care reform in the last Democratic Administration. The President, of course, did not march blindly down the path trod by his predecessor. Where the Clintons created first a task force and then an enormous legislative package, sent to the Hill on a wave of "You will pass and I will sign" inspiration from the Presidential bully pulpit, Obama has allowed the Congressional committees to do their work, proposing only broad principles that had to be respected for him to get on board. For him, in truth, there are only two sine qua nons -- all must have access to quality health care and costs must be contained.

So much, however, for differences that don't matter.

This GOP is no different from Gingrich's.

Which was no different from Goldwater's.

Which was no different from Herbert Hoover's.

They do not believe in health care reform. They believe in the profit motive and pretty much nothing else, at least when it comes to domestic economic policy. Applied to the current health care crisis, that results in what for them are a number of ostensibly fundamental principles.

First, for them, there is no crisis. They note that three quarters of the country claims it is satisfied with their current health coverage. What counts as "satisfied" in this context is, of course, more than somewhat loaded. People who have health insurance are "satisfied" only because they have it. If they lose their jobs (and hence their insurance), actually get a serious illness (which then becomes a pre-existing condition, precluding insurability in the future absent later employment based coverage), have a chronic condition like diabetes (in which case, they are forever hostage to being lucky enough to have continuous employment with firms that provide insurance lest they too become uninsurable), or run a small business where they actually have to pay the premiums for everyone else (in which case, they know that premium costs have skyrocketed by more than 80% over the past eight years), they aren't all that "satisfied."

Lucky to be insured, yes.


Not on your life.

Second, conservatives believe that profit motivated competition actually works in the health sector. Though this is more an article of faith than an empirical reality, it is nevertheless a fundamental element of their economic religion. It ignores, however, a number of salient facts. One is that, for those 65 and older, Medicare already has lopped off the highest risk category of insured, i.e. , those most likely to get sick. Given that the largest proportion of our health care dollars are spent in the last days of life, this is no small point. Put bluntly, we already have socialized well more than half the health delivery system. There really should be nothing wrong in principle with socializing the other half.

The right wing's politics of loud, however, will have none of this. They have now transformed Medicare -- a program the Goldwater Republicans of the 1960s opposed and voted against -- into a government program that no one who has wants in any way to lose ("Keep Your Hands Off My Medicare" said the sign at one of those euphemistically named "Town Hall" meetings where the screamers wouldn't even let the legislators speak), but no one who doesn't have can in any way propose getting (which is what the screamers are saying when they yell about "socialism" or "communism" or anything remotely "European").

The rest of us are left to trust that the benighted insurance companies will take care of us as they run up their profits. This, unfortunately, is a non sequitur for two reasons -- (1) the surest way to higher profit for the insurance companies is less coverage for all of us, whether by exclusions or higher co-pays or the managed "denial" practiced by insurance company bureaucrats under the rubric of "managed care," and (2) in an unregulated environment, the insurance companies can and always will pass the (high) cost of gold-plated care, emergency room treatments for the uninsured, and their bloated administrative budgets (26% of every insurance dollar goes to administrative cost; the comparable amount under Medicare is about 3%) onto us consumers, which is why premium costs have skyrocketed in the last decade.

So much for competition working.

Obama and the Democrats have proposed a sensible solution to these basic problems. To rein in health care costs, they contend that a publicly funded insurance option should be available for those who want it. This is a form of Medicare-lite. If you can't get health care because it is either too expensive, your employer doesn't provide it, or the private sector will no longer give you it, you get to enroll in the public taxpayer financed plan.

Everyone will be legally obligated to have insurance (just as anyone who has a car is obliged to carry auto insurance), so the pool of available premium payers will increase by the 45 million who are now uninsured (minus those who can't afford to pay). Employers who don't insure will pay a small tax, so no one gets to be a financial free loader on the public option plan. (Like the Hoover Republicans who opposed Social Security in the '30s, the right wing today claims that this feature will cost us jobs in the small business sector. It won't, largely because employers who do not now insure are doing so not because they once couldn't, but rather because they no longer can given the quadrupling of insurance premium costs in the last decade.)

And the public plan will keep the insurance companies honest. They won't exclude, or deny, or bloat their administrative budgets because, if they do, they will lose policy holders to the public alternative and eventually go out of business. For the same reason, they won't increase their charges at rates five times that of inflation, which is what they are doing now. The GOP claims that the the public option will rapidly deteriorate into a form of rationing, though the basis for this charge is impossible to ascertain. The screamers who love their Medicare apparently aren't worried about rationing now, and the public option won't be any different. If consumers enrolled in the public option want to buy supplemental plans, they can, just as is the case with current Medicare recipients. In addition, the present system already rations. It gives gold plated care to those who can afford it, and something less to everyone else.

The right wing calls that market based competition.

The diabetic who can't pay for her insulin knows she is being rationed.

Back in the '90s, policy wonks proposed all sorts of competitive solutions to the problem of government waste in general and the assumed (but never proven) lack of productivity of union workers in particular. Osborne and Gaebler wrote a book about it called Reinventing Government. In it, they gave example after example of how competition could make government more efficient. They even pointed out how, in one example that refutes a whole host of conservative shibboleths, unionized sanitation workers in Phoenix agreed to compete with non-unionized waste haulers in that city. The winners were the citizens. Sanitation costs went down.

And, oh, by the way, the union delivered the less expensive product.

Lots of folks on the right embraced this formula when it gave them a perceived cudgel to use on organized labor. Now, however, that the tables have been turned, and public agency competition has been proposed to make health care affordable and accessible to all, the free marketeers are screaming about uneven playing fields and socialism.

They are even showing up at their health care rallies and Town Halls with guns strapped to their legs.

I hope one doesn't accidentally go off during one of their screaming fits.

The resulting injury . . .

Probably won't be covered by their insurance company.