Muzzled (17 page)

There has been a long history of calls for a national healthcare system, of course. And all such attempts have been defeated. Presidents Theodore Roosevelt, Truman, Nixon, and Clinton all tried and failed.

But by the 2008 presidential campaign the issue of health care had come back to life. The high price of health care was a drag on the economy. General Motors complained that the high cost of health insurance for its workers was adding $1,500 to the sticker price of every car it sold. The rising prices also pushed the cost of Medicare and Medicaid higher, burdening the federal budget. Both presidential candidates, John McCain and Barack Obama, produced plans. The key goal was to reduce the cost of health care. By the end of 2009 health-care spending had hit a record high of 17.3 percent of the gross domestic product. The Centers for Medicare & Medicaid Services reported the biggest one-year increase in federal spending on health care since 1960. They also predicted even larger, budget-busting increases to come. Obama proposed requiring every American to have health insurance to bring more young, healthy subscribers into the system. McCain criticized Obama’s proposal as another example of big-government overreach because of the mandate for every citizen to have health insurance. McCain countered with a proposal to give people tax credits to encourage them to buy insurance.

After President Obama’s victory he made health-care legislation his top priority. In an address to a joint session of Congress in 2009, he offered a vision of increased competition among health insurers, lower prices for prescription
drugs, and every American having insurance. He declared now was the time to get it done. Republicans strongly disagreed. When the president refuted criticism that his plan would give health-care coverage to illegal immigrants, one congressman, Representative Joe Wilson, yelled out, “You lie!” The unprecedented insult to the president of the United States was a deep tear in political decorum. It made headlines and hardened feelings. It set the tone for bitter, partisan battles as the House and Senate debated various ideas about a health-care plan. Republican leaders in Congress refused to even join in the discussions. They criticized the Democrats’ proposals as a “government takeover of health care.” Sharp rhetoric from Republicans about “socialized medicine” and potential tax increases tied to the cost of the reform succeeded in depressing public opinion of the proposals being considered by the Democrats. Representative Michele Bachmann, a Minnesota Republican and a leading voice of the Tea Party, declared that health-care reform was “the crown jewel of socialism.” Congresswoman Virginia Foxx, a North Carolina Republican, went to the floor of the House to proclaim, “We have more to fear from the potential of that bill passing than we do from any terrorist right now in any country.” The dispute allowed for no independent points of view that might have helped to resolve differences. When the nonpartisan Congressional Budget Office assessed the cost of the final reform bill, it announced that the bill would not add to the deficit. But the bill’s opponents said the calculation was wrong because it assumed that Congress would pass future cuts in Medicare spending to pay for part of the new plan.

A Tea Party movement, composed primarily of seniors and Republicans, emerged to condemn the health-care proposal. They labeled it a threat to Medicare and a likely cause for insurance companies to raise the premiums on insurance for all Americans. Sarah Palin, McCain’s former running mate, popularized the fallacious idea that the bill allowed federal experts to deny coverage to dying people if the care was expensive, calling them “death panels.” Democrats in return attacked the GOP critics. Congressman Alan Grayson, a Florida Democrat, accused the Republicans of not having any new ideas for the government’s role in providing affordable care to the sick. “The Republican health care plan is: don’t get sick.… In case you do get sick … the Republican health care plan is: die quickly.” The fury on both sides made it impossible to honestly debate the central issue of health care—its costs, its impact on the economy, taxes, and entitlement programs. When Congress went home for summer recess in August 2009, local town-hall meetings with constituents turned into angry confrontations as Tea Party activists, with support from the Chamber of Commerce and lobbyists who opposed the bill, poured vitriol on anyone who supported health-care reform. The president appealed for all sides to come out of their entrenched positions. “What we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government.… Too many have used this as an opportunity to score short-term political points even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and countercharges, confusion has reigned. Well the time for bickering is over.”

It did not halt the acrimony. President Obama had been slow to take control of the debate over health care as the proposal was debated in Congress. He wanted to give Democrats and Republicans the opportunity to put their stamp on the bill before he entered to strike a compromise. But Republicans responded by uniting in total opposition to negotiating. And President Obama’s slow entry into selling the need for reform to voters had a negative effect on public opinion. Polls consistently found most Americans opposed to the bill, including people who wanted health-care reform but felt the Democrats’ plan was too modest.

On the Republican side a familiar pattern emerged in the attack on President Obama’s health-care proposals. Kate Zernike, a
New York Times
reporter, in her book
Boiling Mad: Inside Tea Party America
, wrote, “Conservatives fell into the same positions they had during the Democrats’ last major effort, in 1993, invoking fears of health care rationing, long lines for treatment, and, in Sarah Palin’s warning, ‘Death Panels,’ that would coldly calculate whether Grandma got to live or die.” In fact, the same charges had been raised against healthcare reform going back to the era of Truman, whose healthcare plan was seen as a step into socialism.

What was different in the twenty-first-century version of the debate was the indisputable damage the high cost of health care was inflicting on the federal budget because of the rising number of ill and elderly people. Being sick in America is very costly. In 2010 there were forty-seven million Medicare beneficiaries. Even with federal money to help pay their bills, 90 percent of Medicare recipients needed private insurance to pay their medical bills. As Medicare’s cost continued
to rise, the unfunded liability of the Medicare system reached ninety trillion dollars. The annual report of Medicare’s trustees modified this figure to thirty trillion dollars, based on the Affordable Care Act’s promises to limit price increases and cut spending. But many observers felt those promises were unlikely to be met.

Health-care costs today account for 17 percent, or one sixth, of the nation’s economic activity. Doctor visits, prescription drugs, medical testing using the latest high-tech equipment, and hospital administration add up fast. They make the cost of getting health care in America by far the highest in the world. Yet for all the money we spend, the United States does not rank high on health-care outcomes as compared to other nations. The
CIA World Factbook
for 2010 ranks the United States only fiftieth in life expectancy and 176th in infant mortality. In a comparison of first-world nations—Australia, Britain, Canada, the Netherlands, New Zealand, and the United States—the United States ranked dead last. The nonprofit Commonwealth Fund reported that in 2007 the average health-care spending per person in the United States was $7,290, more than twice any other country surveyed.

While Americans are more likely to be obese than people in other developed countries, other nations had higher rates of smoking and some had older populations. Considering all those factors, the study found Americans are the most likely population in any developed country to go without health care because of the high cost. And Americans had more difficulty gaining access to primary care and after-hours care, according to the study. Every other system covered all citizens; in
the United States forty-six million Americans, 15 percent of the population, had no health insurance. These findings are consistent with a 2000 World Health Organization report: “The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance.”

The voting power of seniors, the biggest beneficiaries of Social Security and Medicare, combined with ballooning healthcare costs, for years have frozen all rational political debate about how to make cuts to save the programs. The media is equally culpable, as they celebrate the latest sound bite from Michele Bachmann on the Right or Alan Grayson and the like on the Left, even though they are minor players in Congress with little influence on the legislative process. The same sclerotic flow of debate has long limited the ability to deal with the out-of-control costs of existing entitlement programs, such as Medicare and Social Security. Eliminating the programs has been so politically out of bounds it has never been discussed. Similarly, budget discussions, until Republican Paul Ryan’s plan was announced in April 2011, were limited to mere slices of the federal budget, discretionary spending on small programs, while massive spending on entitlement programs and the defense budget went forward with no scrutiny. Right-wing Republican senator Jim DeMint, a South Carolina Republican Tea Party favorite, has openly declared that all efforts to cut government spending will be done “without cutting any benefits to seniors or veterans,” claiming Social Security is off-limits to the budget knife. John Boehner, the Republican Speaker of the House, proposed raising the age at which Americans qualify for Social Security as one way to protect its
solvency. But he was quickly chastised and repented. “I made a mistake when I said that,” he later explained.

This is the tyranny of political correctness. Comprehensive, genuinely bipartisan reform to better serve the American people—the most important work of the federal government—has been all but stymied. The stilted debate about health-care reform perfectly encapsulates the current dysfunctional political dynamic over tax policy, deficit spending, and entitlement reform.

One earlier politician to look over the cliff of eliminating some of the costly entitlement health spending on seniors was former Colorado governor Richard Lamm, a Democrat. In 1984 he said the terminally ill of all ages should not be burdening society with costly high-tech medical treatments that help them slow the approach of death even if they have no quality of life. “We’ve got a duty to die and get out of the way with all of our machines and artificial hearts and everything else like that and let the other society, our kids, build a reasonable life,” he said. Lamm is still castigated as unfeeling and mean.

Oddly enough, for all the controversy over the Democrats’ health-care reform plan and the political fallout that the Democrats suffered in the midterm elections, the bill has slowly begun to gain support from the public. Even as Republicans took advantage of their new majority in the House, won largely as a result of Tea Party–inspired backlash against Democrats, and voted to repeal the law, favorability ratings for the plan increased in the polls. Rather than offering proposals to fix the flaws in the health-care reform that have become evident as the bill begins to take effect, House Republicans instead voted to repeal, calling the reform “Obamacare” and
the “Job-Killing Health Care Law Act.” In fact, they banned any amendments to the bill. (As a result, they got little support from potential allies among conservative Democrats.)

The Republican repeal effort was pure posturing, since the Democrats’ Senate majority would never pass the repeal and President Obama would never sign it if they did.

But as a result, both sides have shut down pragmatic debate when it comes to health care. With Representative Ryan’s new proposal, on one side Republicans are going to continue bashing Obamacare as more bloated government, and on the other Democrats are going to criticize Republicans for cutting the health-care services for those who need them most. Both sides are maneuvering for the next election, in 2012. The political posturing is a vivid reminder of how hard it is to have real, honest, and productive discussions about this issue that is of vital importance to so many Americans. In the meantime we are left with the pleasure of mocking the hypocrisy of our politicians.

During the 2010 campaign one Republican candidate, Andy Harris of Maryland, defeated the incumbent Democrat by promising to repeal health-care reform. But reality proved embarrassing and shocking to Harris. When he attended orientation for new members of Congress and was told that his government-subsidized health-care plan would not go into effect until a month after he took office, Harris reacted with outrage. How could he and his family make do without health coverage for a month? Harris asked why he could not buy insurance from the federal government to cover the gap in his insurance, the same public option for health insurance that he had denounced as socialism during the campaign.

The Andy Harrises of the world can’t even think honestly about health-care reform. When smart people are so unaware of what they are saying that they make fools of themselves, the power of political correctness to stifle debate becomes obvious.

As
Time’
s Fareed Zakaria noted in an article published just after the Ryan budget was released, despite its many flaws the Ryan budget would be a test for President Obama when it came to the big issues at stake, showing whether or not he could break the stranglehold on the American dialogue. As Zakaria wrote: