Leadership and Crisis (31 page)

The commission had serious leadership that kept our proceedings from degenerating into a political sideshow. Bill Thomas quickly rejected suggestions from several commission members that we raise the commission’s media profile by inviting celebrities to testify. Thomas even resisted the idea of holding Medicare field hearings around the country. In the end we held only one, in Minneapolis, Minnesota. We were greeted by protestors there, but it needs to be said that Minnesota protestors are extremely polite. Kevin McCarthy, now a congressman and then a member of Thomas’s staff, invited them in for some food and lemonade. By the time the meeting started the protest had ended—they were all eating and drinking.

Commission members were struck by the contrast between the inefficient Medicare system and the well-functioning Federal Employees Health Benefits Program (FEHBP). FEHBP is not perfect, but it is less bureaucratic and more responsive to its enrollees than Medicare. (This helps explain why members of Congress who write the Medicare
rules and the bureaucrats who run the program are enrolled in FEHBP, not Medicare.) Instead of paying for services, FEHBP allows recipients to choose from hundreds of health insurance plans, and then it pays for a large portion of the premiums. Far from being a top-down system, FEHBP encourages competition among insurers for federal employees.

In light of FEHBP’s success, commission members proposed applying the FEHBP model of “premium support” to Medicare in order to spur competition, increase quality, and reduce costs. (Those who preferred the traditional Medicare system, however, would be allowed to stay in it.) Premium support would link the federal government’s contribution for each health option to the weighted average premium. If you selected lower-cost plans, a larger share of the premium would be subsidized by Medicare. If you wanted a Cadillac plan, Medicare would pay a smaller share and you would have to pay more. The reform would help solve a core problem of the Medicare system: there is no relationship between pay and performance, and no incentive to compete on price. With the premium support model, health plans would be given flexibility to compete by either reducing premiums or enhancing benefits.

We expected this reform would reduce the growth in Medicare spending by a modest amount up front, and by a significant amount in the long term through “the magic of compound interest,” as Senator Gramm was fond of saying. The commission estimated that premium support would shave between one-half and 1 percent a year off the program’s long-term cost. That might not seem like much, but it would amount to billions of dollars over the long term. In short, we found a way to expand choice within Medicare while significantly cutting costs. Dan L. Crippen, the Director of the CBO, argued the proposed
reforms “should enhance efficiency—the productive use of medical resources.” Our agenda for reform was endorsed by a broad coalition of organizations, including the American Medical Association, Democratic Leadership Council, Healthcare Leadership Council, the Mayo Clinic, the United Seniors Association, and the
Wall Street Journal
.

President Clinton complained after he left the White House that he never had the opportunity to be a great president. (Let’s ignore the narcissism for a minute.) But when it came to saving Medicare, he had his chance. He could have supported these bipartisan reforms and helped us to avert a looming fiscal nightmare while improving the lives of millions of American seniors. But instead, he chose to play a different role.
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The chairmen delayed the end of the commission just as it appeared tantalizingly close to agreeing on specific reform proposals. The main sticking point was the amount of prescription drug subsidies to be added to the Medicare program. Holdouts among President Clinton’s appointees seemed willing to endorse reforms, especially the centerpiece premium support reform, if the subsidies were high enough. Though the Republican members wanted to keep the subsidies low, both sides seemed to be negotiating their way to an agreement.

And then, suddenly, the holdouts became intransigent and the discussions ground to a halt. The abrupt change in atmosphere is hard to explain without knowing the wider political context; namely, the commission was operating during the Monica Lewinsky scandal. Some Democrats on the commission, like John Breaux and Bob Kerrey, bravely voted for reform. But President Clinton, who at a private White House meeting in 1998 had told the commission he wanted real reform and had praised premium support, now backed away. We can only guess why, but the reason probably relates to Clinton surviving
impeachment with the support of House liberals who opposed our Medicare reforms, favoring instead a hike in payroll taxes. Some have speculated these liberals pressured Clinton to reject Medicare reform as repayment for supporting him during impeachment.
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His appointees to the commission, including economists Laura Tyson and Stuart Altman, who had initially supported reform, now voted against it. (Altman would later express regret for not supporting the commission’s proposed reforms.) The final vote was 10-7 for the reforms—one vote less than we needed.

Ironically, Republicans under President Bush years later would spend far more on the prescription drug subsidy than the holdouts had demanded back in 1997—and without getting any comprehensive reforms in return.

The ideas that formed the basis of that Medicare Commission are still sound. Medicare may have lower administrative costs than FEHBP, but a single-payer system like Medicare is good at hiding its true costs and shifting them to you and me. At any rate, regardless of its finer qualities, the current Medicare system is simply not sustainable. In Washington we need to get control of entitlement spending and give our grandparents more choices regarding their healthcare. A premium support system would encourage competition and choice and drive down costs. We conservatives need to tackle the problem of entitlements head on. Let’s start by ensuring Medicare is viable and responsive to the needs of our children and grandchildren.

CHAPTER 15

FREEDOM ISN’T FREE

As governor of Louisiana, I’ve met with soldiers as they headed off to war and greeted them when they returned. I’ve met with widows and children who lost loved ones serving their country. Although I’m known as a real talker, the heroism of our soldiers often leaves me speechless.

One of my great privileges as governor has been awarding the Louisiana Veterans Honor Medal, which has given me the opportunity to meet some of the most extraordinary American patriots. I met a man who lied about his age so he could fight in World War II. I met a brave mother whose oldest son was killed in combat and whose younger son was seriously wounded—I met her when she was welcoming her grandson back from his service overseas. I gave a Vietnam vet his medal as he wept and told me how, when he returned from Vietnam, he hid his uniform in his closet because of all the animosity directed at vets back then.

I’m amazed at how many vets come from families with a tradition of serving—grandfathers, fathers, uncles, brothers, and sisters all serving in the military of this great country. And it’s striking how vets from any
war respond nearly identically when they receive the medal. When I thank them for their service and their commitment to our country, more often than not they humbly reply, “I just did what I was supposed to.” If only we had more of that sense of duty and humility in Washington.

War is an ugly thing—ask any vet who has seen combat. But tyranny and oppression are even uglier. Americans have been fighting for this country for more than 200 years because we know freedom isn’t free. And as strange as it might sound, peace is something for which you must fight.

You hear a lot of fashionable theories these days about how we can achieve peace. The Obama administration wants to focus on disarmament. Like those who argue that guns cause crime, President Obama’s team seems to believe that simply reducing the number of military weapons—including the weapons we ourselves possess—will reduce conflict. But weapons, whether hunting rifles or tanks, are inanimate objects. I’m not worried about the objects themselves, but about who controls them and where they’re being pointed. If Canada announces it is building a new missile, I wouldn’t be too concerned. But when Iran or North Korea do it, I’m a lot less sanguine. We can abolish as many of our missiles as we want, but that’s just not going to convince international miscreants to do the same. That’s why President Obama’s decision to drastically scale back our missile defense program was ill-advised.

The real cause of war and international conflict is not the existence of weapons, but authoritarian leaders trying to expand their power. If someone is willing to murder and oppress his own people, do you really think he would hesitate to break a treaty he might sign with us? We’ve had this debate before. After the carnage of World War I, a powerful disarmament movement arose both in the U.S. and abroad. Walter
Lippmann summed up the results in 1943, during World War II: “The disarmament movement has been tragically successful in disarming the nations that believed in disarmament.”

Treaties can be useful, but we need to “trust but verify,” as Reagan said. And treaties by themselves will not make aggressors more peaceable. Only the prospect of countervailing force will do that.

I’m convinced many people focus on inanimate objects as the source of violence because they can’t bring themselves to blame people for their actions. They’re uncomfortable using “judgmental” words like good and evil or right and wrong. Their moral confusion prevents them from identifying evil and confronting it. We saw one stunning example after 9/11, when former Vice President Al Gore was asked whether the hijackers who flew the planes into the twin towers were evil. The best he could muster was moral mush. “What is ‘evil’ anyway? I do not pretend to have the answer to such a question but my faith tradition teaches me that all of us have the potential inside of us for both good and evil.”
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I’ll tell you what my faith tradition and good old common sense tell me: terrorists who fly planes into buildings are evil.

In these politically correct times, it’s even too much to ask that our own government refer to Islamic terrorists as “Islamic terrorists.” Instead we hear the deliberately vague expression “extremists.” This is nonsense. People who root for Alabama Crimson Tide to beat LSU in football are extremists. People who want to kill Americans are terrorists. We should not be afraid to call it like it is. Apparently even the word “terrorism” is too judgmental, since Janet Napolitano announced shortly after being named secretary of homeland security that she preferred the ridiculous term “man-caused disasters.”
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I’m alarmed at how often we hear arguments of moral relativism, which hold that we aren’t any more moral than the terrorists we’re
fighting. President Obama doesn’t go that far, but he certainly doesn’t help establish moral clarity by infusing his foreign policy speeches with abject apologies for America’s supposed past sins.

Those who assert moral equivalence point to abuses like those that occurred at Abu Ghraib. But the fact that a handful of U.S. soldiers have committed infractions does not erase the huge distinction between us and the terrorists. Put simply, terrorists are fighting for death, we are fighting for life. It’s that simple. We have profoundly different views on the value of human life—we believe all life is intrinsically valuable and therefore all people deserve to live in freedom.

Here’s an example: NBC reported not long ago that a U.S. helicopter shot and wounded two terrorists who were placing an IED explosive device on an Iraqi road in hopes of killing U.S. soldiers. A U.S. Army medical team arrived shortly afterward and worked hard to save their lives. One of the terrorists was severely wounded and needed thirty pints of blood for surgery. At Camp Speicher near Tikrit, dozens of U.S. GI’s showed up to donate blood—to save the life of a man who was trying to kill them. As one soldier, Brian Suam, put it, “A human life is a human life.”
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When the terrorists stop blowing up innocent people and shooting at our soldiers and instead start organizing blood drives for Americans and Israelis, I’ll be glad to revisit the issue. In the meantime, don’t tell me that some moral equivalence exists between America and her enemies.

A common refrain we heard after 9/11, especially from the media, was “Why do they hate us?” The question itself implies we are somehow responsible for provoking the terrorists’ hatred. I don’t waste a lot of time with this view, because history is full of murderers and aggressors who claim they are victims and had no choice but to attack and kill innocent people. Adolf Hitler stormed into Czechoslovakia and
Poland after accusing those countries of persecuting their German minorities. The Soviet Union claimed it was defending its allies from foreign-backed counterrevolutionaries when it invaded Hungary in 1956 and Czechoslovakia in 1968. The point is that all aggressors claim legitimate grievances are behind their violent actions. Sociopaths and psychopaths are always full of explanations and justifications. It’s pretty rare to hear some tyrant proclaim, “I attacked that country because it’s weak and I thought I could get away with it.”

Al Qaeda claims they are fighting us because we are imperialists and we hate Muslims. They don’t seem impressed that the United States supported the Islamic Afghan resistance against the Soviet invasion, or that we’ve sacrificed many lives and billions of dollars to defend Muslims in Kuwait, Afghanistan, Iraq, Bosnia, Kosovo, and Somalia. Far from being anti-Muslim, the United States has done more for peace-loving Muslims that any other country on the planet.

Yes, there are peace-loving Muslims: we all know that. But let’s not be confused. There are also war-loving, murderous Muslims who believe it is their religious duty to destroy America. Although political correctness demands we ignore this inconvenient truth, we can’t forget that history is littered with the corpses of those who fail to recognize a real threat when they see it.