“On The Government Dole”: The Supreme Court And The GOP’s Healthcare Hypocrisy
There’s always hypocrisy in Washington but past and present Republican presidential candidates have used the debate on healthcare to take it to heights unimaginable even in the nation’s capital. This week the Supreme Court heard arguments on the Affordable Care Act and the GOP tried again to cripple Medicare, the federal health insurance program for seniors.
What do Rep. Michele Bachmann, former House Speaker Newt Gingrich, former Sen. Rick Santorum, and Rep. Ron Paul have in common? They were or are candidates for the 2012 GOP presidential nomination. They all oppose the Affordable Care Act, and they’re all hypocrites. Michele Bachmann feels so strongly about the law that she has been present in the Supreme Court during the oral arguments this week. Rick Santorum is so hostile to the Affordable Care Act that he took time away from the campaign trail to appear on the steps of the Supreme Court building on the first day of arguments. But Bachmann still enjoys the benefits of the gold plated federal healthcare insurance for members of Congress. Rick Santorum enjoyed the same government health benefits when he was a senator.
All of them say they oppose the Affordable Care Act because they claim it is “government run healthcare.” But don’t panic, because they’re wrong. Since President Obama decided not to fight for a single payer plan or even for the public option, healthcare is still in the deadly clutches of the insurance companies.
Even if the Republicans candidates were right, they have some nerve even making the argument. While they all criticize government run healthcare and Medicare, as members of Congress they took full advantage of the gold plated healthcare insurance provided by the United States government. What the Republicans are really saying is that government run healthcare is fine for them but too good for working families. Since Michele Bachmann and Ron Paul are still members of Congress, they could easily refuse their government run healthcare insurance and go into the private market like everybody else. But don’t hold your breath waiting for them to opt out. Bachmann and Paul are still on the government dole, and so are all the others members of Congress who opposed the Affordable Care Act. Hypocrites all.
Then there’s former governor and former liberal Mitt Romney who also has been very critical of the mandate in the new federal health insurance law. But the healthcare reform bill that he signed into law in Massachusetts has the same government mandate for everyone to have health insurance that is in the Affordable Care Act. After the reform bill became law in the Bay State, Romney said it was a model for the rest of the nation. Well he was right. Romneycare became Obamacare.
It’s not really surprising that Romney supported the insurance mandate in Massachusetts. The mandate was originally a Republican idea. Even Newt Gingrich supported the mandate in the 1990s. Republicans felt that people who didn’t buy health insurance were freeloaders. When people who don’t have health insurance are hurt or get sick, they go to emergency rooms and hospitals bill the taxpayers for the cost of treatment. The idea is that uninsured people should take financial responsibility for their own actions. That sounds pretty conservative to me, but it’s still a good idea.
So why do politicians like Romney and Gingrich oppose the mandate after they supported it. They thought it was a great idea when conservative think tanks developed it, but once a Democratic president used their idea in his bill, it became radioactive.
Rick Santorum is right about one thing. Mitt Romney will have a lot of trouble trying to explain why his mandate was such a good idea and why the president’s mandate is such a bad idea.
By: Brad Bannon, U. S. News and World Report, March 29, 2012
“Don’t Pick Out Hymns For Its Burial”: Still Plenty To Watch For In Health Care Debate
I have a few quick thoughts on this week’s Supreme Court hearings and what it will mean for our coverage of health reform.
Most people in the courtroom (or people who, like me, listened to audio, read transcripts, wrote and edited a ton of copy and couldn’t avoid Jeff Toobin) ended up with the gut feeling that health reform is in deep trouble – that the court is likely to toss the individual mandate, some of the insurance provisions, and maybe a whole lot more. Maybe all of it.
But of course, we don’t really know what the court will do. Tough questions in public certainly let us know that all nine justices are not exactly the law’s biggest boosters. But what they will do, as they mull and debate behind closed doors, is not a sure thing. We can guess, but we don’t know. And we won’t know for about three months. (There’s a chance that it will be sooner – but traditionally big rulings come out at the end of the term. And this is a big, big ruling).
Remember the “Conventional Wisdom” was wrong before – wrong from the beginning. The CW didn’t think Obama was going to push for comprehensive health reform. The CW didn’t think he’d be able to enact health reform – particularly not after Scott Brown’s election. The conventional wisdom didn’t think there would be a fight about the mandate. Or that the mandate would end up in the Supreme Court. Or that it would be in deep, deep, deep trouble once it got there.
So what do we do for the next three months?
First of all, we are going to get spun – and the negativity about the oral arguments is going to help the anti-health law camp of spinners. (The “hey it’s hunky-dory, it’s all fine” advocacy world rings a little hollow at the moment – although they may turn out in June to be right.) Keep an eye out for that “the law is dead so let’s get real” drumbeat because if things are said often enough, in a media or political context, they can start becoming the new conventional wisdom and affecting how we report and write.
We might get pushed by editors to be more forceful about predicting the demise of the law (or the mandate) than we are comfortable with. Push back – you can certainly say there are real questions about the law’s survival. You can’t pick out hymns for its burial.
Watch your state. Are officials slowing down implementation? Not submitting grant applications for exchange planning when they were before, or not putting out bids for exchange IT teams, etc.? Are the implementers slowing down – and are the non-implementers freezing? How much catching up will they have to do if the statute is upheld – and they have to meet some exchange certification deadlines by Jan. 1, 2013.
Is the court situation affecting state politics – local, congressional, presidential. How?
Is anyone talking about state initiatives to fill in if the parts of the federal plan are punctured? For instance, if the federal mandate fails, there’s nothing to stop a state from passing its own mandate; the federal constitutional questions don’t apply. I suspect few states will do this – but I can think of a handful that might. (If this does start to bubble up in your state, please email me your coverage.)
What are the hospitals’ and insurers’ and physician groups’ contingency plans? Are delivery system reforms and innovations on hold – or is the assumption that they can either proceed without the federal law, or that the relevant sections of the law will survive
And does the public know what it wished for? It wanted health reform when it didn’t have it. Then it decided it didn’t like health reform when it got it. Do Americans really want to go back to March 22, 2010 (the day before President Obama signed it)? And do they realize they can’t; that the health system has changed? Do they understand that people who are getting benefits under the first phases of the law’s implementation could lose them? And that costs will rise, the numbers of uninsured (now somewhere around 50 million) will rise, and Congress – so polarized that it has trouble doing much more than renaming post offices these days – is not going to come swooping in with a pain-free bipartisan fix-the-problems-with-no-cost-or-dislocation make-everyone-happy solution.
By: Joanne Kenen, Association of Health Care Journalists, March 29, 2012
“An Alternative Legislature”: Judicial Activists In The Supreme Court
Three days of Supreme Court arguments over the health-care law demonstrated for all to see that conservative justices are prepared to act as an alternative legislature, diving deeply into policy details as if they were members of the Senate Health, Education, Labor and Pensions Committee.
Senator, excuse me, Justice Samuel Alito quoted Congressional Budget Office figures on Tuesday to talk about the insurance costs of the young. On Wednesday, Chief Justice John Roberts sounded like the House whip in discussing whether parts of the law could stand if other parts fell. He noted that without various provisions, Congress “wouldn’t have been able to put together, cobble together, the votes to get it through.” Tell me again, was this a courtroom or a lobbyist’s office?
It fell to the court’s liberals — the so-called “judicial activists,” remember? — to remind their conservative brethren that legislative power is supposed to rest in our government’s elected branches.
Justice Stephen Breyer noted that some of the issues raised by opponents of the law were about “the merits of the bill,” a proper concern of Congress, not the courts. And in arguing for restraint, Justice Sonia Sotomayor asked what was wrong with leaving as much discretion as possible “in the hands of the people who should be fixing this, not us.” It was nice to be reminded that we’re a democracy, not a judicial dictatorship.
The conservative justices were obsessed with weird hypotheticals. If the federal government could make you buy health insurance, might it require you to buy broccoli, health club memberships, cellphones, burial services and cars? All of which have nothing to do with an uninsured person getting expensive treatment that others — often taxpayers — have to pay for.
Liberals should learn from this display that there is no point in catering to today’s hard-line conservatives. The individual mandate was a conservative idea that President Obama adopted to preserve the private market in health insurance rather than move toward a government-financed, single-payer system. What he got back from conservatives was not gratitude but charges of socialism — for adopting their own proposal.
The irony is that if the court’s conservatives overthrow the mandate, they will hasten the arrival of a more government-heavy system. Justice Anthony Kennedy even hinted that it might be more “honest” if government simply used “the tax power to raise revenue and to just have a national health service, single-payer.” Remember those words.
One of the most astonishing arguments came from Roberts, who spoke with alarm that people would be required to purchase coverage for issues they might never confront. He specifically cited “pediatric services” and “maternity services.”
Well, yes, men pay to cover maternity services while women pay for treating prostate problems. It’s called health insurance. Would it be better to segregate the insurance market along gender lines?
The court’s right-wing justices seemed to forget that the best argument for the individual mandate was made in 1989 by a respected conservative, the Heritage Foundation’s Stuart Butler.
“If a man is struck down by a heart attack in the street,” Butler said, “Americans will care for him whether or not he has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services — even if that means more prudent citizens end up paying the tab. A mandate on individuals recognizes this implicit contract.”
Justice Antonin Scalia seemed to reject the sense of solidarity that Butler embraced. When Solicitor General Donald Verrilli explained that “we’ve obligated ourselves so that people get health care,” Scalia replied coolly: “Well, don’t obligate yourself to that.” Does this mean letting Butler’s uninsured guy die?
Slate’s Dahlia Lithwick called attention to this exchange and was eloquent in describing its meaning. “This case isn’t so much about freedom from government-mandated broccoli or gyms,” Lithwick wrote. “It’s about freedom from our obligations to one another . . . the freedom to ignore the injured” and to “walk away from those in peril.”
This is what conservative justices will do if they strike down or cripple the health-care law. And a court that gave us Bush v. Gore and Citizens United will prove conclusively that it sees no limits on its power, no need to defer to those elected to make our laws. A Supreme Court that is supposed to give us justice will instead deliver ideology.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, March 28, 2012
“Mitt’s Q-Tip”: Appeal Helps Obama No Matter What The Supreme Court Decides
Irony alert — President Obama gets a boost no matter what the Supreme Court decides on his politically toxic healthcare reform law.
The high court either upholds Obama’s signature domestic accomplishment, imprinting it for history, or it overturns the law, thereby breaking a big stick with which the GOP planned to beat Obama this fall. Should front-runner Mitt Romney become the GOP nominee, what’s left of the stick would more likely resemble a Q-Tip.
Although a final ruling is nearly four months away, oral arguments at the Supreme Court on Tuesday called into question the constitutionality of a mandate to purchase insurance. But recall that four years ago, then-Sen. Barack Obama opposed a mandate for the purchase of healthcare insurance when he was running against Hillary Clinton in the Democratic primary. Four years ago, Romney, on the other hand, admitted his support for mandates.
Obama ultimately changed his mind, and followed the example then-Gov. Romney had set when he signed healthcare reform into law in Massachusetts in 2006. Both men concluded that conservative think tank Heritage Foundation was correct decades ago in deciding there was no way, without a mandate to buy coverage, to control prices or to protect the taxpayer from uninsured free riders who leech off the government every time they go to the emergency room.
While Romney could control the choice to build elevators for his cars at the beach house he is building in California, he could not control the fact that Obama changed his mind on the mandate, that his law evoked a visceral reaction from the GOP base or that Newt Gingrich and every other conservative who had supported the mandate earlier would flip from the concept and run. Romney, who started running for president in 2006 or earlier as the conservative alternative to John McCain, chose to run after them. Romney tried pivoting by claiming he never intended it to become a national model, yet a Google search proves that effectively false.
Fortunately for Romney, it hasn’t been that tough to keep his stride. Republicans seeking to defeat him in the primary campaign failed miserably to use the best weapon against him — he was given a pass on RomneyCare. But no more. Romney can be sure the Obama campaign will possess the discipline Rick Santorum did not and won’t be distracted from healthcare by messages that send female voters running for the hills. Obama the candidate surely won’t display any weakness or kindness to his rival, or whatever it was that caused former Minnesota GOP Gov. Tim Pawlenty to retreat from his planned attack on “ObamneyCare” and basically kill off his own candidacy for good.
Democratic strategist James Carville said on CNN that the prospect of the healthcare law being overturned might be the best political outcome for Democrats and Obama.
“I honestly believe — this is not spin — I think that this will be the best thing to ever happen to the Democratic Party, because healthcare costs will escalate unbelievably … the Republican Party will own the healthcare system for the foreseeable future.”
Unbelievably cynical. But Senate Majority Leader Harry Reid (D-Nev.) made the same point almost immediately.
Should ObamaCare be stricken, congressional Republicans will be free to paint the president and his party as socialists who passed a partisan, unpopular, unprecedented intrusion of government into the private sector and ultimately had to be stopped by the Supreme Court from destroying liberty in the United States for all time.
Romney might not want to, as it will only invite attacks on his ambiguous record of supporting insurance mandates. He will probably want to stick to the economy instead, and to hunt for some other sticks.
By: A. B. Stoddard, Associate Editor, The Hill, March 28, 2012
“Hello Public Option”: The Public’s Inch-Deep Hate Affair With The Individual Mandate
Maybe the individual mandate is doomed, as an agitated-slash-celebratory Twitterverse seemed convinced after conservative Supreme Court justices posed challenging questions about it (shocking!) on the second day of arguments on the Affordable Care Act. If the justices vote later this year to kill it, with the possibility that the whole law will collapse as a result, Republicans would be vindicated in their fight against “big government.” But in practical terms, would the country really know what it has lost?
From a political standpoint, the mandate invented by the GOP of yore (“yore” being a dozen years ago) has been manna for today’s GOP. Polling shows the requirement to buy insurance or pay a fine — meant to discourage freeloaders — has become highly unpopular. Strangely, the dreaded mandate is not particularly unpopular in Massachusetts, the only state that charges penalties for not buying coverage.
Disapproval of the individual mandate nationally, meanwhile, seems to be a mile wide but not all that deep. There’s evidence that many people don’t understand what it is, why it is, and how it would affect them, and that their answers change depending on word choice and word sequence.
They like it better – about even with disapprovers in a Pew poll — if the last thing they hear is about subsidies to help lower-income people buy insurance. They like it somewhat when it’s explained that without it, people would just buy insurance when they got sick (driving up costs for everyone) or alternatively, insurance companies could not be required to cover people with existing medical problems (because without a mandate, there wouldn’t be enough healthy people in the pool). They like it best – 61 percent approval in a Kaiser Family Foundation poll — when they’re told it won’t apply to most people because they have insurance through work.
That spike to 61 percent, nearly twice as high as the 33 percent who support the mandate when asked a simple up-or-down question, is telling. It suggests many Americans aren’t comrades-in-arms with conservatives waging an ideological battle – they’re just people nervous about change and relieved to hear it won’t affect them.
Attitudes toward the overall health law are just as complicated as those toward the mandate. A new CNN/ORC International poll, like most polls, finds that the law is unpopular – favored by 43 percent, opposed by 50 percent. Breaking down the numbers further, CNN found 43 percent favor it, 37 percent oppose the law because it’s too liberal, and 10 percent oppose it because it’s not liberal enough. Hello public option!
You have to wonder if that 10 percent – which has gone as high as 14 percent in earlier CNN polls – keeps doggedly voicing opposition to the law in hopes the Supreme Court will strike it down and force Congress to regroup. At some point, as 50 million uninsured rises to 60 million and 70 million and higher, as more states approach the astonishing Texas rate of 26 percent uninsured, Congress may decide it has to do something. And, barred from effectively regulating the private market, there will be no options except the public option – Medicare for all.
That should be a safe course. After all, the policy already exists. But in the current climate it’s not hard to envision a conservative challenge to Medicare, and who knows what the Supreme Court might do?
By: Jill Lawrence, The National Journal, March 27, 2012
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