The GOP’s Health Policy Cynics
The health care community is discovering to its shock and dismay that it’s not simply traditional Republican conservatives who have taken control of the House of Representatives, it’s a new group of cynics.
Conservatives, like liberals, have a more-or-less coherent set of ideas. They use political power to push preferred policies, whether related to health care, housing or a hundred other possible issues. William F. Buckley Jr., one of the fathers of modern American conservatism, “had a way of … making conservatism a holistic view of life not narrowed to the playing fields of ideology alone,” as one admirer put it.
Although cynics may claim conservative credentials, their view of government is really nothing more than a quarrel about its cost. It brings to mind Oscar Wilde’s immortal phrase, “The cynic knows the price of everything and the value of nothing.”
The contrast between the two viewpoints was on stark display at two recent marquée meetings, AcademyHealth’s yearly policy conference and the sprawling Health Information and Management Systems Society — HIMSS – Health IT Conference and Exhibition.
AcademyHealth’s “Running of the Wonks” (my term, not theirs) is a magnet for researchers and policy mavens who are inured by long experience to most political rhetoric. Yet at the general session featuring a bipartisan dialogue among congressional staffers, the harsh rhetoric from the GOP participants stunned the crowd. The new federal health law, it seemed, was evil incarnate, and the rhetoric of “repeal and replace” was wielded with a fundamentalist zeal.
“The bureaucracies that administer ObamaCare” must be cut, declared one aide to a powerful congressional leader, setting the tone. And in case anyone didn’t get the point, the word “ObamaCare” was deliberately repeated every few syllables in a tone of disdain combined with wonder at how such a monstrosity had ever come to be. (AcademyHealth meeting rules said the staffers could not be quoted by name.)
The audience of wonks quailed, then quietly queued up for the question-and-answer period. They knew, after all, that the health law’s fine print incorporates a generous helping of initiatives championed by both conservatives, and those on the left. Besides, these were staffers speaking, not politicians playing to the press. Surely, gentle reason would triumph. Alas, it was not to be.
The Prevention and Public Health Fund? “You mean, the prevention health slush fund, as we like to refer to it?” replied a GOP staffer.
The Innovation Center at the Centers for Medicare & Medicaid Services? “An innovation center at CMS is an oxymoron,” responded a Republican aide, before adding a personal barb aimed at the attendees: “Though it’s great for PhDs who come to Washington on the government tab.”
There was also no reason the government should pay for “so-called comparative effectiveness research,” another said.
“Everything’s on the chopping block,” said yet another.
Everything? At HIMSS, where GOP staffers also spoke, attendees were chagrined to learn that “everything” applied to them, too. The subsidies for health information technology that were part of the American Recovery and Reinvestment Act were targeted in legislation introduced in late January by Rep. Jim Jordan, R-Ohio, chairman of the Republican Study Group. His bill would repeal this funding and eliminate all remaining stimulus spending, including about $45 billion in unspent health IT funds.
Those focused on the substance of health policy might be forgiven for feeling blindsided. After all, the McCain-Palin health policy platform in the 2008 presidential election called for coordinated care, greater use of health information technology and a focus on Medicare payment for value, not volume. Once-and-future Republican presidential candidates such as former governors Mike Huckabee (Ark.), Mitt Romney (Mass.) and Tim Pawlenty (Minn.), as well as ex-Speaker of the House Newt Gingrich, have long promoted disease prevention, a more innovative federal government and increased use of information technology. Indeed, federal health IT “meaningful use” requirements can even be seen as a direct consequence of Gingrich’s popularization of the phrase, “Paper kills.”
Ah, but that was back before the Republican cynics swept into power. It was back before traditional GOP conservatives — worried that any suggestions outside a single-minded focus on slashing spending would be seen as disloyal — eschewed ideas in favor of ideological declarations.
This column was filed just days after a two-week compromise was signed into law to avoid a federal government shutdown. It allowed funding for health reform to continue, but instituted other budget cuts. Obviously, the cynics yielded a bit, at least for the moment, to the conservatives, and the liberals and centrists have given ground to both.
Still, one wonders what the urbane Buckley would think of a movement that seems intent on ignoring the real-world context of its actions. Buckley launched his lifetime crusade against liberalism with God and Man at Yale, a book that took aim at the academics who’d taught him as an Ivy League undergraduate. Alas, the GOP cynics are cocooned instead in an underground bunker of their own design, as impervious to realities they’d prefer to ignore as the ivory tower academics they’ve come to scorn.
By: Michael Millenson, The Health Care Blog, March 9, 2011. Post Originally appeared in Kaiser Health News.
When Did Anti-Abortion Radicalization Become Acceptable?
On Thursday, the House Homeland Security Committee held a hearing on the threats Muslim “radicalization” poses to America.
Meanwhile, a woman seeking healthcare at a Planned Parenthood clinic in Denver, or anywhere in the country, was screamed at as she walked through the door. How about some Homeland Security for her?
Every day in this country, reproductive healthcare providers at Planned Parenthood clinics, and abortion doctors at other facilities, and the patients who need them, are routinely harassed and threatened. When did this become OK?
Dr. George Tiller, an abortion provider in Kansas, used to wear a bulletproof vest to work. He made the mistake of not wearing one to his church, which is where he was shot and killed. How many other civilian professionals have to wear a bulletproof vest to do their job?
We have so normalized the anti-choice extremism in this country that a certain level of mundane, daily ugliness has become unremarkable. It’s a yawner to policymakers, unfit for congressional hearings or regular news coverage.
And if the harassment inside the building isn’t enough, now policymakers are forcing harassment inside the building. Texas Republicans in the state legislature voted this week to force any woman seeking an abortion—even if she’s a victim of rape or incest—to undergo a sonogram and a lecture about the fetus. Similar laws have passed and are likely to pass in other states. Because, apparently, women are too dumb to think through the implications on their own.
This harassment even extends to ballot measures. Last fall I worked on the No on 62 Campaign, part of a broad-based coalition opposing an anti-choice amendment to the Colorado Constitution. Part of our training for the No on 62 Campaign included a briefing by Planned Parenthood security officers, many of whom have worked in law enforcement for years.
The Planned Parenthood clinic in Denver where we often met—and this is a pro-choice city in a pro-choice state—is ringed with a 10-foot-high fence, cameras, and manned by a guard at the gate. Every day, a group of about a dozen people parks outside with grisly pictures and bullhorns and screams at anyone—patient, provider, visitor—who enters the clinic. Even our campaign headquarters were the object of nasty phone calls—our pregnant admin person, who answered the phones, got called some ugly names at least a couple times a week. It became a humorous game of epithet bingo—“Have you been called a fornicating whore today?”
Our press conference in Colorado Springs was hijacked by the opposition, who shoved people out of the way to grab the microphone and start yelling. Our Facebook page was hijacked by the opposition posting gruesome pictures and accusing us of being “No on 62 Nazis,” and put up their own Facebook page stating the same. And when I accompanied one of our spokespeople, Jeremy Shaver from the Interfaith Alliance, to a debate, there were armed guards in the room keeping an eye on the other side.
It’s not the posturing about “outside agitators” that worries me. It’s the acceptance of a level of hatred directed at women, especially poor women, seeking reproductive healthcare and abortions. And it’s the acceptance of threats and violence directed at the doctors, staff, and healthcare workers trying to provide it to them.
By: Laura Chapin, U.S. News and World Report, March 11, 2011
Meanwhile…Washington’s Budget Folly
The Senate on Wednesday voted down the House budget bill, with its string of $61 billion in mostly political cuts through Sept. 30. That formally puts an end to the House’s grandstand play. But the Senate also rejected its Democratic leaders’ own plan to cut $6.5 billion. The government’s financing is due to run out in eight days. To prevent a shutdown, the two chambers will probably have to agree to yet another short-term financing bill.
That would be politically and fiscally irresponsible. But the House Republicans will be happy to agree, as long as Democrats agree to a vigorish of $2 billion a week in cuts to vital government programs.
Unless the White House and Democratic lawmakers start pushing back a lot harder — and do a better job of explaining the disastrous effects on the economy and everyday life — the Republicans will win the argument. If it keeps going on this way, they will get the $61 billion they demanded.
The White House again threatened on Wednesday to veto the House bill, and said it supported the Democratic bill that did not even draw a simple majority. It has been hosting what appear to be unproductive talks among legislative leaders; Vice President Joseph Biden Jr., who is nominally in charge of the talks, is now visiting Eastern Europe and tried to mediate by telephone.
President Obama has yet to take a firm public stand and make clear his bargaining limits and priorities. Understandably, he does not want the government to shut down and is hoping that quiet negotiations will produce better results than loud declarations of principle. But there is no sign that the House freshmen have an interest in compromise, or that Representative John Boehner, the House speaker, has any control of his caucus.
A brief shutdown, painful as it would be, would be far less damaging than a sudden withdrawal of tens of billions in government spending from the economy, which would lead to widespread layoffs.
Mr. Obama could well follow the example of Senator Charles Schumer of New York, the third-ranking Democrat in the Senate, who on Wednesday called for a “re-set” of the negotiating process. The only way to have a meaningful discussion of the budget, he said in a speech, is to consider all of its parts at once over the long term, not for a few weeks or months at a time. That includes all the issues the Republicans wouldn’t deal with in their bill: cuts to the entitlement programs and to the Pentagon budget and ways to raise revenues at the same time.
The Republicans, as Mr. Schumer noted, aren’t really interested in lowering the deficit. If they were, they would never have insisted on $800 billion in tax cuts for the wealthy without paying for them, or on repealing the health care law, which saves $230 billion over a decade.
They are only interested in slashing government, no matter the cost to the country. It is time for the president — and responsible Congressional leaders of both parties — to reject their tactics and their goal.
By: Editorial, The New York Times, March 9, 2011
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