The Congressional Republicans may be on their way to getting trounced on November 2nd. The entire party establishment is clueless and confused by the Obama-Pelosi legislative victory on health care and they are bound to face the same music on financial regulation, energy and education with the President asking the Republicans at the stump in November where the other party was with their proposals when they were needed most. With a President who likes to wield the scalpel, sledgehammer politics will not succeed.
The Democrats have once again done the same thing to the Republicans as they have before the last November election: the team player president dictated the principles and delegated the politics to his colleagues in the Congress. He gave them his full support when they needed it and passed a historic reform.
This President’s choice of political priorities has always been clearly aimed at his legacy. Not energy, not financial regulation, not education but the legislation of universal health care in the United States is what would guarantee him his third indelible sentence in the history books, next to being the first Africa-American president and a Nobel Peace Prize winner.
He is pragmatic enough to balance his desire for legacy with what he can politically accomplish to ensure it and that is universal health care. All else in his bill can change in the future, but not the legislative requirement of its universality. The country, given the dire economic situation, agreed nearly unanimously that health care reform was needed. It also agreed that any reform must assure universality. The crux of the debate was about how to achieve it at an optimal cost. And that debate will continue to be alive and well until the cost issue is addressed. In the meantime, the 40 million or so uninsured Americans out of choice or its lack of affordability will get health care and there should be no disagreement on this.
The projected cost of health care that could take up the entire Federal budget and raise the government budget to about 40 per cent of the national output by 2030 is not because of the government. It is not high for the Pentagon. It is not high for Veterans Administration. But it is exorbitant for the Department of Health and Human Services (HHS) and the states that share Medicaid expenditures with HHS. It is so precisely because of what is wrong with the President’s health care bill: the reliance on private markets which are the sole contributors to the rising health care costs. And private markets are a Republican issue.
There are two options, which are not either/or but sequential, if health care costs are to be reduced solely as a matter of Republican politics. The first is government reform and the second is health care entrepreneurship. Both of these options can be pursued without revisiting the current health care reform legislation. Thus, any attempts to repeal the current legislation by the Republicans will constitute a fool’s errand politically, only to lose at the polls in November for looking mean spirited beginning the day after a historic vote.
A small and efficient government has always been a corner stone of Republican politics. The Obama bill increases government size. Therefore, as a first step, delinking insurance providers from HHS for Medicaid and Medicare by extending Pentagon and Veterans all-public care to the two can greatly relieve the fiscal stresses on both the federal government and the states, besides expanding accessibility of care across all the 50 states and territories.
The United States needs an all-public health safety net, not expensive private health care in Medicare and Medicaid that fleeces the tax payers. And as a matter of politics, such a consolidation of the all-public health safety net under HHS will end the legacy of LBJ while not stepping on the President’s feet. There can be no better reason to consolidate and streamline all of the health care costs of the government under one agency than the gargantuan national debt and the projected budget deficits as far as the eye can see.
A robust and a vibrant free market for health care is not feasible unless market behaviors change through small scale health entrepreneurship that can provide lower cost health care across the country without relying on the big insurance and health care corporations. It is a market trend that is already underway for preventive and primary care from the Walmarts, CVSs and Safeways to other health care business chains, and the Republicans can help it along to fruition sooner by promoting health information technology and standardization of health records through the expansion of national broadband. It will complement the web insurance exchanges which have been legislated in the current bill.