Mitt Wit

The GOP candidate's logic on Obamacare is taxing.

Roberts Rules

My Nixon brother Hugh Hewitt doesn't like the Supreme Court's health care ruling. But he knows the chief justice, John Roberts, with whom he shared an office in the Reagan White House, and believes that he ruled as his conscience dictated:

The Chief Justice's decision is the consequence of his personal integrity as it would have been much, much easier for him to rule the other way. Critics of him will have to consider what they would have done if they believed the mandate to have been justified by the taxing power.

Ted Kennedy's Legacy

The Economist sums up the arguments being presented before the Supreme Court this week for and against the individual mandate, the centerpiece of the Obama administration's health care reform:

The challengers have simplicity on their side. They argue that Congress cannot compel individuals to buy something. Its powers are only those enumerated in the constitution. Let Congress regulate inactivity, challengers say, and there will be no limit to its meddling.

Mr Obama’s lawyers must rely on a more complex chain of reasoning. America’s huge health sector, they point out, is dysfunctional. People with pre-existing health conditions pay extortionate rates for their insurance, if they can get it at all. In part because of this, some 50m people have no insurance cover; yet many of them receive emergency care they cannot pay for. This raises the cost to everyone else; by an average of about $1,000 each year per family, the government argues.

The health law attempts to remedy these failings by requiring insurers to cover the sick without raising their fees. The mandate, by insuring more healthy people, would help offset these costs and fix the problem of uncompensated care. The mandate is constitutional for two reasons, says the government. The penalty falls within Congress’s power to tax (though Mr Obama has denied the mandate is any such thing). And the constitution’s “commerce clause” authorizes Congress to regulate interstate activity. Not buying insurance is a decision to pay for your own care, the reasoning goes. This has a big effect on interstate commerce, though arguably by similar logic one might oblige people to buy gym memberships or broccoli....

The Supreme Court is expected to issue its decision by the end of June. By then the Republicans will probably have chosen a presidential nominee, Mitt Romney, who signed a mandate of his own in Massachusetts (he says it is fine for states to do this but not Washington). However the court rules, the political consequences will be huge. Even more important, for the long term, will be the court’s articulation of congressional power. Washington subsists on hyperbole. But this time it is all true.

If the mandate is overturned, and especially if the court junks the rest of the bill, too, health care reform could end up being radioactive for a generation. The tragedy would be that near-universal health insurance coverage, and the resulting more rational distribution of costs, could have been achieved without a federal individual mandate. Richard Nixon proposed requiring employers to share or pay employees' premiums for private insurance. Credits and subsidies would have enabled coverage for the self-employed and unemployed. The relative few who would have opted out and used the ER when they got sick wouldn't have caused anything like that $1,000-per-family distortion and the resulting spike in premiums and pricing anomalies such as $1,500 blood panels.

Ted Kennedy, who crusaded for health reform throughout his Senate career, blocked the Nixon plan because it relied on private insurance instead of a single-payer system. Nixon wanted the same outcome for people as Kennedy did but without creating vast new federal powers. If Barack Obama's bill dies because he overreached as well (in his case by failing to anticipate the intervention of the most conservative Supreme Court since the 1930s), he could end up sharing Kennedy's legacy of 50 million semi-permanent uninsured. In politics, having your heart in the right place doesn't excuse poor tactics.

Nixoncare

The AP's Calvin Woodward on the roots of Obama- and Romneycare in Richard Nixon's 1974 health care initiative, torpedoed in Congress by Ted Kennedy:

Nixon's initiative was bold for its time — and even bolder now — because it contained measures that have become anathema to the Republican mainstream, including a requirement that all employers offer coverage to their workers. To his everlasting regret, Democratic Sen. Ted Kennedy, his party's broker on health care, chose not to seal a deal with Nixon along those lines, reasoning that a Democratic president down the road could achieve a single-payer government system like Canada's.

"You never know how the thing would have played out," said [Stuart] Altman, an architect of Nixon's initiative and author of a new book on the century-long struggle for expanded medical care, "Power, Politics, and Universal Health Care." ''There was no question that the stars were aligned in 1974 for the passage of something important."

Nixon declared, "The time is at hand this year to bring comprehensive, high-quality health care within the reach of every American. I shall propose a sweeping new program that will assure comprehensive health insurance protection to millions of Americans who cannot now obtain it or afford it."

With the Watergate scandal soon to destroy Nixon's presidency, health care was surely a topic he preferred to talk about. It's just not one that Romney or Obama want to talk about now.

Political Theater Of The Absurd II

Mitt Romney was for the federal individual health care mandate before he was against it.

Obama: To The Right Of Nixon

Jesse Curtis speaks up for the moderate Republican in the presidential race -- Barack Obama:

I think the Affordable Care Act is a good starting point because the president's opponents seem to agree that it, more than anything else, shows his radicalism. If we can show that this, his signature piece of legislation, is not particularly radical at all, then it calls for a reappraisal of his entire presidency.

It's worth noting some background that many conservatives, to this day, remain unaware of. The idea of universal health insurance coverage in America has been kicked around for the better part of 100 years. Presidents Nixon, Carter, and Clinton all had serious proposals to enact universal coverage, but all failed to get them passed. So when President Obama set out to get it done in 2009, he took a more cautious and less transformative approach than all of those former attempts.

In fact, President Obama was so pragmatic about it that one of the core features of the law, the individual mandate, was borrowed from the Heritage Foundation, the rock-ribbed conservative think tank. Conservatives had promoted the mandate as a way to prevent free-riders in our health care system. Rather than offloading the cost onto the rest of us when they get sick and go to the ER, the uninsured would have to take responsibility for their health by purchasing insurance or paying a yearly fee. As soon as President Obama adopted this idea, however, conservatives no longer looked at it through the prism of personal responsibility. Now it is all about governmental coercion.

In other respects, the law is also careful to implement change incrementally. Rather than instituting a socialized system in which the government owns hospitals and doctors are government employees, President Obama left the private insurance market intact. Instead of creating a bunch of new programs, the law extends coverage to millions through the existing Medicaid program, and helps others comply with the mandate through subsidies. In short, the Affordable Care Act is bringing universal coverage to America in about the least disruptive way one could imagine, and with significant deference for existing systems and institutions. (Of course, the more outlandish claims about Obamacare being socialism are thus hard to defend. If it is socialism, conservatives ought to ask themselves why so many of them promoted it in the 1990s.)

One-Man Health Care Reform

A friend sent me this LA Times editorial this morning. Whom shall we blame for out-of-control health care costs -- insurance companies? health care providers? the uninsured (who drive up costs for everyone else)?:

Defending insurers is a bit like expressing sympathy for the devil, given how their premiums have skyrocketed. Not so long ago, this page blasted Blue Shield of California for proposing three rate hikes in quick succession that threatened to raise some customers' premiums by nearly 60%. Since then, however, the nonprofit has pledged to cap its net income at 2% of its revenue. The cap means that any future increases in premiums will be driven by higher charges from doctors and hospitals, not by increases in Blue Shield's operating margins.

Hospitals costs have risen particularly rapidly, with the average daily fee for a bed in an acute-care ward more than tripling since 2000. UCLA's reimbursements from Blue Shield have almost doubled in the last five years alone, the insurer says. That's partly because the university has been shifting onto Blue Shield some of the expense of treating patients with Medicare, Medi-Cal or no insurance. But it's a trend that even University of California officials acknowledge cannot continue.

One more culprit occurs to me: I and my fellow discretionary overweight insured. I can hold down health care costs and insurance premiums by losing 30 pounds and reducing the chances and expenses of adult-onset diabetes, cancer, heart disease, and stroke. I decided this morning I couldn't wait for Lent. Hold me accountable, reader!

Freedom To Believe Isn't Freedom To Act

Nicholas Kristof:

I wondered what other religiously affiliated organizations do in this situation. Christian Science traditionally opposed medical care. Does The Christian Science Monitor deny health insurance to employees?

“We offer a standard health insurance package,” John Yemma, the editor, told me.

That makes sense. After all, do we really want to make accommodations across the range of faith? What if organizations affiliated with Jehovah’s Witnesses insisted on health insurance that did not cover blood transfusions? What if ultraconservative Muslim or Jewish organizations objected to health care except at sex-segregated clinics?

The basic principle of American life is that we try to respect religious beliefs, and accommodate them where we can. But we ban polygamy, for example, even for the pious. Your freedom to believe does not always give you a freedom to act.

In this case, we should make a good-faith effort to avoid offending Catholic bishops who passionately oppose birth control. I’m glad that Obama sought a compromise. But let’s remember that there are also other interests at stake. If we have to choose between bishops’ sensibilities and women’s health, our national priority must be the female half of our population

The GOP's War On Reason

Steven Mazie argues that contraceptive services for employees of Roman Catholic universities, hospitals, and charities is 100% a public health and 0% a religious liberty issue:

It is time to put an end to the hyperbolic charges that Obama is waging a war on religion. John Boehner’s claim on the floor of the House of Representatives on Tuesday that the mandate represents “an unambiguous attack on religious freedom in our country” is unambiguously baseless. The Health and Human Services guidelines serve important public health goals and threaten no defensible concept of religious liberty.

Hat tip to Tom Tierney

The Great Debate

William McGurn says liberals have won the arguments about whether less advantaged people deserve help. The remaining debate with conservatives, and it's a big one, is how it's done. The GOP's proposed Medicare reforms are an example:

[Rep. Paul] Ryan proposes a simple but dramatic shift: helping people afford private coverage. Under this reformed system, seniors would have their private premiums subsidized, and the poorest would get the largest subsidies. The hope is that over time it would have the opposite effect of the present system. Instead of increasing the dependence of the middle class, it would help make all seniors consumers.

Same with Richard Nixon's health care proposals in the 1970s, which would have enabled virtually all workers to purchase private health insurance. They were torpedoed by Ted Kennedy, who held out all his life for for a single-payer system.
Hat tip to Buddy Lang

Semifinal Five

Filling out his brackets on behalf of thinking and probably overly optimistic center-right conservatives everywhere, my Nixon brother Hugh Hewitt picks five 2012 GOP frontrunners without including a placeholder for the likes of Michele Bachmann and Mike Huckabee, whose prospects seem to have improved now that they've coyly arched their eyebrows in the direction of the Obama birthers. Perhaps Hugh thinks that he's got the fringe covered by including Newt Gingrich, whose love gift is of the Muslims-as-Nazis variety.

And where's Sarah Palin in Hugh's morning line? Maybe if no one mentions her, she'll go away.

Con law professor Hewitt even has a talking point for the leader of the pack (Hugh's pick in 2008 as well):

[Mitt] Romney remains the front runner, with strength in staff and fundraising and the experience of having been around this track once before. The "MassCare is Obamacare" trope is old already, though it will be used by his GOP competitors and by the president again and again. The best response remains the true one: An attack on an experiment in Massachusetts is an attack on federalism -- dangerous in the era of the Tea Party -- and that which is allowed to the states -- individual mandates -- is not constitutional when attempted by the federal government.

Their Hearts Are In The Wrong Place

Rob Stein in The Washington Post:

The nation's organ-transplant network is considering giving younger, healthier people preference over older, sicker patients for the best kidneys.

Instead of giving priority primarily to patients who have been on the waiting list longest, the new rules would match recipients and organs to a greater extent based on factors such as age and health to try to maximize the number of years provided by each kidney - the most sought-after organ for transplants.

"We're trying to best utilize the gift of the donated organ," said Kenneth Andreoni, an associate professor of surgery at Ohio State University who chairs the committee that is reviewing the system for the United Network for Organ Sharing (UNOS), a Richmond-based private nonprofit group contracted by the federal government to coordinate organ allocation. "It's an effort to get the most out of a scarce resource."

Worst idea of the year. It's one thing to argue, as I do, that our society overspends on end-of-life care because patients and families haven't faced up to their mortality. It's quite another to say that a 20-year-old is more deserving of a new kidney than an otherwise healthy 60-year-old.

Dr. Andreoni appears to be in the thrall of kidney idolatry. The gift of the organ is nowhere near as valuable as the life it saves -- and when it comes to human lives, well-meaning medical ethicists shouldn't be exempt from our hard-won rules against discrimination on the basis of age. The same utilitarianism could be used to justify a preference for choosing an able-bodied transplant candidate over a disabled one, and from that point the slippery slopes run in a dozen other directions.

Justinifying

Huffington Post celebrates a 16-year-old singer's enlightened views on Canada's health care system and laboriously explains his views on abortion.

Did The Democrats Win?

William Saletan says the health care bill was more important than the election.

If Compromise Is So Bad, Why Do We All Want It?

Barack Obama didn't receive a mandate for radical change in 2008, and Republicans didn't get one Tuesday. Andrew Sullivan:

The pre-election NYT poll found that 78 percent want the Republicans to compromise with Obama rather than stick to their positions in the next two years; 76 percent want the Dems to do the same; and a slightly lower percentage, but still overwhelming, wants Obama to compromise too: 69 percent.

For archival purposes (well, maybe my reader will enjoy it, too), I'm reproducing a post I wrote on the Nixon foundation's blog a week before the 2008 election. I'll admit that, as an intestinal moderate, I'm mandate-averse. When any leader begins to envision himself or herself as a singular visionary, watch out. But Tuesday's result looked like nothing more than a rebuke of President Obama's overreaching (not because we didn't need health care reform, which we did, but because it kept him from focusing on jobs one in order to demonstrate a relentless desire to get his people back to work). Anyway, back to October 2008:

It’s not over yet. But while almost everyone will blame either Sen. McCain or Gov. Palin for the expected GOP debacle on Nov. 4, it’s important to fix the blame for the party’s dire prospects where it belongs — the plummeting economy, whose authors are Republicans and Democrats, Congresses and Presidents, Fed chairmen and Americans who borrowed more than they could afford in the hope that real estate prices would balloon indefinitely.

Amid the dread that millions of Americans are feeling, no different VP nominee would have helped McCain more, and no different GOP nominee — Romney, Huckabee, Reagan — could probably beat Sen. Obama. By the same token, Obama’s considerable gifts notwithstanding, Sen. Clinton would have done just as well. It’s just like 1980, when any Republican — Connally, Bush, Reagan — could’ve beaten Jimmy Carter thanks to the abysmal mess his administration had made of the economy and foreign policy.

President Reagan’s hagiographers have turned the 1980 election into a mandate for Reagan-Goldwater Republicanism rather than for the doctrine of anybody-but-Carter. They’re wrong. Not his election but his first-term tax cuts and tough Cold War line earned him his legacy, along with his unfailingly sunny demeanor.

If Obama wins, he won’t have an ideological mandate. Reagan could blame his predecessor for most of the nation’s problems in 1981 far more legitimately than Obama will be able to in 2009, especially now that Iraq war has taken such a positive turn. Even more than Reagan, who talked right but often governed as a moderate, Obama is more likely to succeed by walking right down the middle of the road. Just like Reagan, his greatest resource will be his temperament.

Which Obaman temperament I had completely misread, incidentally. A general outlook that appeared sunny and nonanxious during the campaign now appears to be prone to being gloomy, inflexible, and restive.

Obama Agonistes

Democrats and journalists are talking hopefully about the ultimately happy outcome in 1994, when that year's disastrous midterm election -- the GOP won both houses of Congress -- spurred Bill Clinton toward the center and a six-year second presidency now considered one of the most successful in recent memory. There's also 1936, when FDR was reelected in spite of the ravages of the Great Depression.

It's a long way to 2012, when we assume Barack Obama will seek reelection. Perhaps by then he'll have transformed himself into the new Roosevelt or Clinton. But I fear not -- and I mean fear, because I don't crave Republican rule. For months, he's evinced no joy about the job he won so effortlessly. Instead, he seems impatient and restive, as he has his whole adult life. He seems like a leading candidate to be the new old Bush.

Obama's proud of what he takes to be world-changing initiatives such as health care reform, perhaps even a little smug about having had the vision to force them through. He still blames his predecessor for the lagging economy. And yet I wonder how different the world would be if he'd decided to spend his first two years on nothing but jobs and GDP growth. Instead of turning the architecture of the 2009 stimulus bill over to congressional leaders who cobbled it together out of every ward-heeling pet project members had been saving up for years, what if he he'd spent the same near-trillion on a coherent jobs, investment, and infrastructure package designed by the best and the brightest among a range of economic experts? Instead of spending a year on health care, what if he'd used every public appearance to promise his worried people that he wouldn't rest until every American who wanted to work was doing so?

Assuming today's obstructionist Republicans would even work with him on those kinds of policies, does he have the talent and heart for a log-rolling, back-scratching, Ronnie-loves-Tip presidency? That would take passion he hasn't demonstrated yet. The patrician Roosevelt learned to love his suffering people. After his '94 drubbing, Clinton learned to master and love the presidency. Remember when George H.W. Bush looked at his watch during one of the 1992 debates, a few months before Clinton beat him? I'm wondering if Obama isn't looking at his and saying to himself: I've got two more years of this?

BBQ Averted By Good Advance Work

To reconnect with the American people, President Obama is having a series of casual backyard chats -- you know, get together with a nice couple from Falls Church, their neighbors, and whomever happens to have been flown in by the White House:

Half the guests were neighbors of the Brayshaws; the other half — who, along with the president, did all the talking — were handpicked by the administration and came from around the country to share exactly the kind of stories the White House wants to tell, personal tales of how the [health care] bill had improved their lives.

A cancer patient who had been uninsured told Mr. Obama she had joined a high-risk pool and now has coverage for her chemotherapy and radiation. A mother told the president that her son, who had a disorder that required repeated eye operations, could now get insurance because the law bars companies from excluding children with pre-existing conditions. An elderly woman told Mr. Obama that she paid for her heart medication with a $250 government rebate check.

“That’s a wonderful story,” the president said.

“And I thank you from the bottom of my heart,” the woman replied.

Bipartisan Embitterment

A former Ted Kennedy aide calls Jimmy Carter "embittered" for saying this in a "60 Minutes" interview that will be broadcast Sunday:

“The fact is that we would have had comprehensive health care now, had it not been for Ted Kennedy’s deliberately blocking the legislation that I proposed,” Mr. Carter told Leslie Stahl. “It was his fault. Ted Kennedy killed the bill.”

I'd be happy to take some of the heat off the former president by saying that it was also Kennedy's fault that we didn't have nearly universal health insurance coverage when Richard Nixon proposed it in 1971. Kennedy even admitted it.

Ai Yai Yai Of Newt

Pretty soon they'll be saying this about Nixon, too. Responding to Newt Gingrich's latest bizarre accusation, that the president of the U.S. is promoting a Kenyan anti-colonial world view, Andrew Sullivan asks:

If Obama wants access to private health-care insurance, while Richard Nixon backed a far more expansive program, does that make Nixon a Ugandan Marxist?

Except I'm pretty sure that Nixon's proposals were to increase dramatically people's ability to purchase private health insurance or have it purchased for them by employers. That's why Ted Kennedy, who was holding out for a government system, refused to support it.

The Revenue Side Of Health Care Reform

Charles Krauthammer says use the 2,000-page House and Senate bills to ignite the Yule log and start over:

Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method -- a $1 trillion new entitlement of stupefying arbitrariness and inefficiency.

The better choice is targeted measures that attack the inefficiencies of the current system one by one -- tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000 -- and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.