Its all about health reform
January 2, 2013 9 Comments
Amidst the sound and fury, there is a central fact in the drive to obtain a long run budget path that is sustainable:
- the Republican party has no coherent health reform plan. This means they have no means of addressing the biggest long run spending side problem in the federal budget.
In the past 9 months, Republicans have:
- embraced a $716 Billion over 10 year cut to Medicare in the April 2012 House budget (same as the ACA spending route over the same period)
- run a Presidential campaign whose central health policy claim was to pledge to do nothing in Medicare for 10 years when Gov. Romney said he would cut nothing from Medicare over the same period (restore the $716 Billion in cuts) and start a premium support plan with a public option in 10 years. Quite a turnaround in a few months.
- during the fiscal cliff “thing” they reversed course again and said that we needed fundamental entitlement reforms for more taxes. A reasonable position if they had a coherent health reform plan, or were clear about what they meant on entitlement cuts. Of course, they are not.
If we go further back, Obamacare is now nearly 3 years old. Republicans won a great victory in the 2010 midterms saying they would repeal and replace the law. They controlled the House of Representatives for the past 24 months and never got past the repeal part. That was a central part of the past election as well. However, they never did the hard work of saying what they were for. They passed nothing and as noted above, their standard bearer in the 2012 Presidential election pledged to do nothing to Medicare for a decade.
If the House Republicans had marked up a bill in the Commerce Committee, had it scored by the CBO and then passed it out of the full House in the 112th Congress, then you could imagine a negotiation on health reform that could result in some sort of compromise (I imagined such a deal here). During both the 2011 debt ceiling and the fiscal cliff negotiations, Democrats had to essentially negotiate with themselves by telling Republicans “you could be for this”, etc.
To go a bit further, Republicans are saying that this fiscal cliff deal is the last tax increase they will ever vote for, while also saying things like we don’t want to cut Defense spending. That is going to take one helluva health reform approach and they don’t have it.
There is a great policy opportunity for a Republican policy entrepeneur(s) to start painting their vision and logic of health reform. What they are for, given the reality that they will not repeal the ACA. They obviously still control the House, so Rep. Upton as Chair of the Commerce Committee has a big opportunity if he wants it.
However, I think the biggest story of this week is the rise of the Senate to play the “grown ups” in the Congressional room. Sens. Burr (R-NC) and Coburn (R-OK) who were co-sponors of the Patients’ Choice Act (for the under 65 age group; blogging here, here, here, here) in the 111th Congress also sponsored the Seniors’ Choice Act in the 112th (past blogging here, here, here) have talked about health reform, but I have always had a sense that it was just a foil to argue against something. Those two plus Sen. Corker who has been talking about health reform of late, I suspect could initiate some bipartisan discussion of what next on health reform in the Senate that is not based in fantasy. The country desperately needs for this to happen, because the route to a larger/long range budget deal runs through health reform.
update: I agree there are some reasonable reform ideas by Conservative intellectuals, but what is lacking (so far) are elected Republicans willing to push any reform agenda, which will require legislation.
another update: This from Reihan Salam is on point; he is a strong thinker.