The nature of the legislative process makes it easy to miss the forest for the trees, and that has certainly happened in the health-care debate. As members of congress have focused on a series of discrete concerns about the various bills, these concerns have become a kind of checklist that substitutes for an assessment of the bills themselves. This member needs abortion language, that one needs a tax provision, that one wants no public option. Once each box is checked and enough members are on board, you’ve got your vote count and you pass a bill. But what has actually become of the bill in the course of making all these changes? What whole do the parts make after the various bargains are struck? What is the positive case for the bill once the negative cases against certain elements are cleared away?
The answer, when it comes to the health-care bill the Senate is working on, is really quite appalling now, and should be so not only to conservatives. In essence, what’s left of the bill compels universal participation in a system that everyone agrees is a failure without reforming that system, and even exacerbates its foremost problem — the problem of exploding costs.
Conservatives in this debate have argued that the tradeoff proposed by the original Democratic concept — massive spending, massive taxes, huge cuts in Medicare that don’t address the problem with the program and instead fund a new entitlement, and a proliferation of additional bureaucracy all in return for a significant socialization of the insurance system — is not a wise bargain for the country. Democrats have argued that the bargain would allow the government to control costs and would make the system more fair. In the course of working to get the votes of various senators, however, the Democrats have given up not the downsides of the bargain but the reasons for voting for it from their own point of view.
What remains, as my Ethics and Public Policy Center colleague Jim Capretta has argued, is a bill that requires all Americans to pay large and growing premiums to our existing private insurance companies. It then prohibits those companies from charging people differently based on their health, age, and the like, which means they will just charge everyone more. The bill has some subsidies to help people who can’t pay their premiums, but that just means that most Americans will be paying the insurance companies more and more for premiums both as individual health insurance customers and as taxpayers. The bill is basically a massive subsidy to the insurers — it is not a reform of the system.
Liberals and conservatives in recent years have tended to agree that the health-insurance system we have doesn’t make sense. Several federal government policies, and most notably the structure of Medicare and the employer tax exclusion, lead to massive cost inflation. They have disagreed over how to move away from that system — with the Left arguing we should move toward a more socialized system of insurance, and the Right arguing we should move toward a genuine individual insurance market while reforming Medicare. But what is left of this bill doesn’t pick either of those options. It just subsidizes the existing system — which both sides agree is a failure. And it does so at very great expense, while also adding on some layers of bureaucracy and complexity.
For conservatives, this version of the bill is not as bad as what the Democrats originally proposed (because it involves less abject socialization of health insurance), but it is still significantly worse than the status quo (because of the spending, taxes, bureaucracy, and new entitlement involved). For liberals, it is not as good as the bill the Democrats originally proposed, and it is also worse than the status quo — because it funnels huge amounts of money to the insurance companies they hate so much and doesn’t really change the system.
Democratic members of congress should look past the narrower debates about the public option, abortion funding, and the like, and ask themselves just what exactly is the case for voting for this bill now? What are its merits? What ends does it serve? They won’t come up with much.