Health Care Reform Follies

by Pejman Yousefzadeh on July 9, 2009

Jonathan Cohn appears to be upset that the political establishment has skipped the crucial step of figuring out how to pay for health care reform, before actually working to enact reforms in the first place. I completely sympathize. It’s like putting on one’s shoes before putting on one’s socks. How very annoying!

But now that we have acknowledged the annoyance that goes with realizing that one has forgotten to put on socks before putting on shoes, can we also acknowledge that such instances of annoyance ought to be rare, at the most? Indeed, can we go further and acknowledge that such instances of annoyance ought to be nonexistent? We make jokes about putting on one’s shoes before putting on one’s socks, but no one we know really does it.

Unfortunately, Washington has decided to pull a humdinger equivalent to a shoes-before-socks fiasco by settling on the outlines of health care reform, without figuring out first how reform ought to be paid for. This officially enters the category of “Worrisome,” and that’s understating matters. The natural reaction would be to ask ourselves whether we can really enact a health care reform package that we don’t know how to pay for, conclude fairly quickly that the answer is “no,” and then go back to the drawing board to create a new approach–considering costs first, rather than waiting until the middle or the endgame of the political process before we work to figure out how our grand ambitions are to be financed.

Cohn’s approach to solving the cost problem is, er, different:

Obama, to his credit, has done his share to solve the financing problem. He’s put on the table almost a full trillion dollars in new revenue and spending cuts, including a proposal for reducing itemized income tax deductions that remains, by the way, a perfectly good idea.

But when you’re the president and you’re trying to pass a historic, complicated piece of legislation like health care reform, doing your share isn’t enough. You have to lobby for your ideas, and lobby hard. You have to sit people down, get them to specify what they can abide and what they can’t, whether it’s members of the opposition or members of your own party. You have to call in favors, make trades, and threaten retribution to would-be allies who aren’t falling in line.

Yeah, horsetrading will make the numbers add up. Someone has seen too many West Wing episodes. But TV-watching isn’t going to get you anywhere when the Senate Democratic Leader says “nyet” to taxing health benefits. Taxes on sugary sodas and drinks are ridiculous as well; it doesn’t speak well of a health care reform policy that requires taxes on bad dietary choices to finance it–it is one thing to try to tax a negative externality out of existence, but another altogether to depend on that negative externality to fund health care reform. Increasing income taxes during a recession? Sure, it’s possible that the Democrats will try it . . . at which point, devastating and devastatingly accurate 30-second ads can quickly be ginned up by Republicans already looking forward to the 2010 elections more than they were in the recent past.

How bad are things for the Democrats? This bad:

As the Senate Finance Committee tested its own alternative funding options, Reid (D-Nev.) met privately with four Republicans active in the negotiations to assure them that he still wanted a bipartisan bill. This was a shift in tone from a day earlier, when the Democratic leadership expressed frustration with Baucus over the extensive courting of Republican senators.

Harry Reid wants to make nice with Republicans. Either the Apocalypse is upon us, or his political situation is significantly weakened by the fact that Democrats did not think to search for funding before crafting a health care plan. To be fair, it is entirely possible that Reid’s fellow Democrats will save him by presenting a united political front on this issue of health care reform.

Maybe Reid should tell his fellow Democrats to hang together. Thus far, they appear content to hang separately:

The Obama administration, hoping to boost its health-care reform effort with financial concessions from the hospital and pharmaceutical industries, is instead confronting deep dissension on several fronts within Democratic ranks and possible defections among key constituencies.

Rep. Henry A. Waxman (D-Calif.), lead House architect of the landmark health legislation, warned yesterday that he is not obligated to abide by deals struck recently by the White House, Senate Finance Committee, industry executives and interest groups such as AARP.

“The White House is not bound. They tell us they’re not bound by that agreement,” Waxman, the chairman of the House Energy and Commerce Committee, said at a National Journal breakfast. “We’re certainly not bound by that agreement. The White House was involved, and we were not.”

Waxman’s comments came amid several other warning signs for the administration, including a slipping timetable in the Senate, internal division in the hospital industry and mounting tensions between AARP and the pharmaceutical industry that threaten a temporary detente between the two negotiated last month by the White House.

And a day earlier, President Obama took the unusual step of issuing a statement from Moscow correcting comments by White House Chief of Staff Rahm Emanuel that creation of a government-sponsored insurance program is “negotiable.”

No single development appeared likely to kill Obama’s signature domestic agenda item, but the relentless barrage of challenges that seemed to hit hourly served to demonstrate why no president since Lyndon B. Johnson has been able to enact large-scale health legislation.

Oh, snap. Incidentally, with someone tell Steve Benen that he should stop slamming Senate Finance Committee Chairman Max Baucus for negotiating with Republicans, now that, you know, Reid has to do it, and now that Democrats have formed themselves into a circular firing squad?

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