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National Review Online


The Two Obamas Problem

January 27, 2010

By David Gratzer

Which Barack Obama will take the stage for tonight’s State of the Union Address? Will it be candidate Obama — with a return to his 2008 focus on affordable, bipartisan, sensible health-care reforms? Many Democratic activists are lobbying for the alternative: They hope President Obama will adopt a more combative approach that’s even more liberal than his 2009 persona.

In practical terms, “more combative” would mean attempting to push through the unpopular Senate bill using some sort of high-speed procedural gimmick (like reconciliation) — a step likely to add contempt for the process to the existing public discontent.

But it’s not simply public angst that should make the president hesitate. It’s hard to understand what the rush is for. Health-care reform was supposed to reduce premiums for working Americans; but the Congressional Budget Office believes premiums would increase with passage of the Senate bill. President Obama wanted to “bend the curve” of rising health-care costs — but estimates indicate that costs would rise with these proposed reforms. The president wanted insurers to compete through a national health exchange, but the Senate’s compromise would allow only state-level health exchanges — leaving insurers competing in the same artificially small markets in place already, with the added burden of new federal regulations. If the probable results remain unclear, the total cost isn’t: The new taxes in the legislation mean that we would have to pay now for benefits that most Americans won’t see for years, if ever.

Perhaps the president thinks that fast passage of any bill will end a painful debate that is hurting his broader agenda. The problem is that the legislation that comes to his desk will be a patchwork of compromises that would only set up years more of debate. The president might be able to strong-arm wavering members into passing legislation only to gain a Pyrrhic victory that would create more problems than it solves:

Medicare fees for doctors. The federal government spends billions annually to compensate doctors for Medicare services. This government program is financially unsustainable, and it rewards volume, not quality. Medicare payment needs to be fixed — but Obamacare would simply cut reimbursement while making no larger reform. (Congress, for its part, has already agreed to delay debate on this issue.)

The Independent Medicare Panel. In the president’s plan, Medicare cuts will be made at the recommendation of an “independent” panel, charged with improving quality of care. The panel, however, will be endlessly scrutinized and questioned. The very premise — that a government body can steer America’s physicians toward better treatment decisions while saving money — is dubious and would be the source of much debate in the halls of Congress, and beyond.

Opt-outs and other provisions. In the final Senate bill, health-insurance exchanges are devolved to the states. That approach would create a series of state-by-state battles — since regulation of the new exchanges, opt-out clauses, Medicaid eligibility, and insurance co-ops, among other things, would be partly decided in Boston, Albany, and the other state capitals.

Appointments. Obamacare creates countless new organizations, committees, and offices, many with sweeping regulatory power. These bodies will be powerful — literally determining the type and scope of health insurance for tens of millions of Americans. These bureaucratic decisions will undoubtedly be politicized — and then criticized.

Contrast this deep political quicksand with the alternative:

If President Obama returns to his 2008 persona and seeks the bipartisan middle ground, there would be many winners, and few losers. You’d see a simple, cost-effective national market for health insurance, modeled on the benefits enjoyed by members of Congress. You’d see stronger protection for consumers to prevent unfair insurance cancellations and improve portability. No new taxes, no new committees, and no new regulatory agencies.

Remember, there is common ground in Washington: Both parties agree on the need to help the millions of Americans with pre-existing medical conditions, even if they differ on how. Both parties agree on the need for some new incentives to promote wellness in order to reduce health-care demand in the next decade, even if they differ on how.

Crafting a strategy to embrace that middle ground would be a certain win — for Democrats, for Republicans, and for millions of working Americans. Let’s hope the president likes a sure thing.

He can start tonight by putting aside the heated rhetoric of the past year. He can instead speak about bipartisanship and sensible reforms. He can sound, in other words, much the way he did before he took office.

Original Source:



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