About the Author

James C. Capretta

James C. Capretta

New Atlantis Contributing Editor James C. Capretta is an expert on health care and entitlement policy, with years of experience in both the executive and legislative branches of government. E-mail: jcapretta@aei.org.


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James C. Capretta’s Latest New Atlantis Articles

 Health Care with a Conscience” (Fall 2008) 

 Health Care 2008: A Political Primer” (Spring 2008) 

 The Clipboard of the Future” (Winter 2008)

 

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Text Patterns - by Alan JacobsFuturisms - Critiquing the project to reengineer humanity

Tuesday, September 1, 2009

Lack of Tort Reform Is Not the Main Problem with Obamacare 

With Obamacare’s prospects sinking by the day, there’s no shortage of opinions about what the Obama administration should do to resuscitate it.

Former Senator Bob Dole has a piece in the Washington Post suggesting that the administration is running into trouble on health care because the president ceded too much control over the drafting of the legislation to Congress. But, truth be told, the specific ideas the president has offered up to date — the massive tax hikes and arbitrary across-the-board Medicare cuts in his 2010 budget, and a power grab for unilateral control over Medicare — do not build confidence that a plan drafted by administration officials would be at all attractive to Republicans.

Former New Jersey Senator and Democratic presidential candidate Bill Bradley has a different take on how to get Republicans on board in his piece yesterday in the New York Times.

Bradley was one of the main architects of the 1986 tax reform law, which President Reagan signed into law. That legislation dropped the top individual income tax rate to 28 percent by broadening the base of income subject to taxation. It was more or less revenue-neutral — not a tax increase or a tax cut. And it attracted large numbers of votes from both sides of the political aisle.

Bradley believes that the 1986 experience provides valuable lessons for this year’s health care debate. He says the reason tax reform enjoyed strong support from both Republicans and Democrats is that both parties got something they long desired in return for giving up a sacred cow. Republicans got lower rates but had to give up protecting energy and other business sectors. Democrats got more equity with the rich paying a higher percentage of the total tax take, but they had to give up explicitly higher tax rates to get there.

Why not strike a similar grand, bipartisan compromise on health care, Bradley says? Of course, there’s a certain appeal to his argument. No complex and sweeping legislation ever gets broad support from both parties unless there is something important in it for both sides. But what Bradley suggests as the makings for such a deal in health care is completely implausible. Democrats, he argues, should get “universal coverage” in return for giving Republicans tort reform, including serious reform of the nation’s medical malpractice laws.

Don’t get me wrong. Strong reform of medical malpractice laws is long overdue and could eliminate the serious distortions which now occur as hospitals and physicians reduce the risk of getting caught in the lottery-like system of jury awards.

But should Republicans sign onto something even remotely resembling the bills now being considered in Congress if tort reform were thrown into the mix? No way. The bills written by the Democratic majority are so fundamentally flawed from beginning to end that they can’t be fixed. They would cause tremendous economic harm with massive new unfunded liabilities, taxes, and job-killing mandates on employers. Moreover, they would cede vast power to the federal government over virtually every aspect of our health care system. The result would be a long and likely irreversible deterioration in the quality of U.S. health care, with less innovation and more government-driven rationing of care. No amount of tort reform would be worth agreeing to that.

The Obama administration isn’t running into trouble on health care primarily because of poor legislative tactics. In fact, for the most part, they played it brilliantly — from their perspective — for the first six months of the year, hiding the ball as long as possible and resorting to vague pronouncements of broader coverage and cost-control. Their hope was that momentum would build and allow them to shorten the time between bill introduction and final passage. Unfortunately for them, many Americans actually wanted to know what these bills would do to their health care, and as they learned more in the last two months, they turned against the administration’s plan in large numbers. That won’t change even if President Obama offers medical malpractice reform as a small concession to conservatives.

posted by James C. Capretta | 11:40 am
File As: Health Care