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.


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)


 More on James C. Capretta

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

Wednesday, September 9, 2009

The President Has No Plan to Fix Health Care 

President Barack Obama says he wants to be the last president who has to deal with health care. But it is abundantly clear from his speech tonight that he has no plan to fix the problems in health care as they exist today, much less to settle the issue for good.

The primary problem in health care is rapid cost escalation. The president has promised for months now that he would have a plan to “bend the cost-curve.” Indeed, even tonight, he spoke of the plans being worked on in Congress as if they would address the problem of rising costs and improve our long-term budget outlook.

It’s as if the president and his team haven’t read anything that the Congressional Budget Office (CBO) has said about the health care bills under consideration. The truth is that these bills would add an additional runaway health care entitlement to the ones already on the federal books. CBO has said that the House bill would set in motion new spending that would grow at about 8 percent rate per year, while the revenue to pay for it would increase only about 5 percent per year. You don’t have to be a financial genius to sse a problem here.

Today, the Lewin Group confirmed again how fiscally irresponsible the House bill is. According to Lewin’s estimates, the bill passed out of the House Energy and Commerce Committee would increase the federal budget deficit by $1 trillion between now and 2029, and permanently increase the nation’s total health care bill. Moreover, they estimate that the uninsured would face an average of $1,400 in increased costs from the House bill per year. Others with insurance would see a small decrease in costs, but that assumes no increase in taxes to pay for the government’s mounting bills.

The country does need to enact sensible health care reforms. But the plan the president is pushing would exacerbate the fundamental problem, not address it. And that’s why the public has turned against it.

posted by James C. Capretta | 10:10 pm
File As: Health Care

Wednesday, September 9, 2009

Apparently, August Never Happened 

During August, in scores of meetings which were held in all parts of the country and attended by thousands, concerned citizens sent unmistakable signals to their elected political leaders that if Congress is going to produce anything on health care this year — and many openly stated they hope nothing at all will pass — they want it to be a more targeted, less expensive, and less controversial product, and one based on bipartisan consensus and not ideological ambition. Polls show most Americans are strongly opposed to a full governmental takeover of U.S. health care, and they rightly sense that is exactly what would happen if the bills currently under consideration were to pass.

And so how are Democrats responding to this spontaneous display of widespread public disapproval of their planned agenda? Not with a sensible course correction, it seems. No, by all appearances, it’s still full steam ahead.

Monday, President Obama delivered a campaign-style speech to his union supporters which made news mainly because the president went off of his prepared remarks to deliver a false attack on his political opponents. The president said those who are against his government-heavy plan have offered no alternatives, which is flatly not true. Months ago, Senators Coburn and Burr and Congressmen Ryan and Nunes offered the Patients’ Choice Act, which would build a true consumer-driven marketplace for insurance and medical services.

Today, Senate Finance Committee Chairman Max Baucus distributed a summary of his long-awaited plan to selected members of his committee, and it looks to be the same plan that was under discussion in June and July, with only the most modest of tweaks. It is built on the same flawed foundation as the House bills, starting with a so-called “individual mandate” that would penalize any American who didn’t sign up for government-approved insurance. Employers would also pay a tax if any of their lower-wage workers ended up on government-subsidized plans, which would create a strong disincentive for hiring such workers in the first place. The federal government would vastly expand health care entitlement spending by enrolling millions of people in Medicaid and standing up a new entitlement for persons with incomes between 133 and 300 percent of the poverty line. The new spending in the Baucus plan is said to be near $900 billion over a decade, but no official estimates are available.

To “pay for” the additional federal costs, Senator Baucus wants to impose a vast array of new taxes, on health insurers, drug companies, device manufacturers, and clinical labs, all of which will be passed on to patients, of course. In addition, Senator Baucus wants to impose payment rate reductions in Medicare and Medicaid, which will save between $400 and $500 billion over ten years. Among the cuts would be a deep reduction in Medicare Advantage payment rates, which would force millions of seniors out of their current coverage and back into the traditional Medicare program and expensive Medigap plans.

The Baucus plan is flawed from the get-go because it starts from the same misguided premise as its counterparts in the House. It seeks to achieve “universal coverage” but without building a functioning marketplace to slow the pace of rising costs. And so, if it were to pass, costs would escalate just as rapidly in the future as they have in the past, and it would only be a matter of time before the current administration or its successor proposed new and draconian “cost control” measures to hold down governmental health care spending. At that point, federal central planners would resort to the same kinds of price setting devices that have been tried for years in others settings, including Medicare. And the predictable result would be a large reduction in the willing suppliers of medical services, which would mean queues and lower quality care all around.

posted by James C. Capretta | 11:16 am
File As: Health Care

Friday, September 4, 2009

A “Narrowing” Experience 

Is the administration really willing to compromise?

We learned this week that President Barack Obama’s aides are negotiating directly with Republican Senator Olympia Snowe of Maine to strike a deal on a “narrower” health-care bill.

It’s easy to see why the White House would be eager to secure Senator Snowe’s support for something. She signed onto the so-called “stimulus bill” earlier this year, and throughout her career has voted quite frequently with Senate Democrats on social and economic issues. If the White House is able to get her vote — again — they will be able to claim “Republican support” for the health-care effort, even if it is just one Republican with a voting record that is anything but conservative.

But would an Obama-Snowe deal mean something like the bills now moving through Congress will definitely pass?

Far from it.

The political problems with these bills are deep and structural. Democrats very self-consciously set out at the beginning of this year to pass something akin to the next New Deal or Great Society. Their goal is a dramatic and historic signing ceremony at which they take political credit for finally passing so-called “universal coverage.” They weren’t thinking “narrow” in January.

But passing “universal coverage” means a lot of additional political baggage that Democrats are now finding is not so easy to carry. Covering everybody means forcing Americans to buy government-approved insurance, whether they want it or not. And that means an expensive new subsidy program for lower income households, as well as a new tax on employers who don’t provide qualified coverage. The additional federal costs for the new subsidy program and an expansion of Medicaid will be at least $1 trillion over ten years, which means the bills also raise taxes by as much as $500 billion over a decade and impose cuts in Medicare and Medicaid of a similar magnitude. All of this is highly unpopular, as town hall meetings around the country over the last month have demonstrated. Moreover, many Americans rightly sense that the bills being written by the majority in Congress would amount to a federal takeover of U.S. health care, which they fear and adamantly oppose.

It should be clear based on what has taken place around the country this summer that the Obama administration and Democrats in Congress massively overreached on health care and now find themselves in a position where they can’t pass the bills they have been working on since the beginning of the year.

Leaks of pursuing a “narrower” bill are an indication that the administration finally understands this. So far, the only detail about what “narrow” might mean is the possible inclusion of the so-called Snowe “trigger.” Senator Snowe has suggested that the bill should not, at the outset, include a new government-run insurance option. However, if cost escalation does not slow and insurance coverage does not increase as expected, then in perhaps five years a new “government option” might be stood up. That kind of “deal” would find no support among Republicans other than Snowe, but it might placate some House liberals who are now threatening to jump ship if the bill were to drop the possibility of a “public option” altogether.

But even if the administration solves their “public option” problem, the bills as currently constructed still can’t pass unless they really do become much, much narrower. Is the president ready to drop the individual mandate and the Democratic goal of “universal coverage”? If he were to do so, many possibilities would open up. If not, the bill will still include massive new entitlement spending and taxes, deep cuts in Medicare, onerous requirements on employers, and far too much federal control. Which also means it will be near impossible to pass.

posted by James C. Capretta | 10:27 am
Tags: trigger, Snowe, mandate
File As: Health Care

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

Wednesday, August 26, 2009

The Obama Agenda and Fiscal Reality 

Yesterday, both the Obama administration and the Congressional Budget Office (CBO) released new, ten-year projections of the federal receipts, spending, deficits, and debt. The administration’s Mid-Session Review (available here) provides an updated forecast of what executive branch scorekeepers think will happen if the Obama budget plan is adopted in full. CBO’s forecast looks at federal revenue and spending over the coming decade assuming no changes from current law. Both documents, despite their different premises, point toward a fast-approaching fiscal crisis.

According to CBO, the federal budget deficit will approach $1.6 trillion in 2009 and $1.4 trillion in 2010. That’s $3 trillion in new borrowing in just two years. The country accumulated $5.8 trillion of government debt from 1789 to 2008.

According to the Administration’s own numbers, the Obama budget plan would push the debt burden to more than $17 trillion by the end of 2019. Total spending in the Obama budget would reach $5.3 trillion in 2019, or $2.4 trillion more than was spent in 2008 — almost doubling the size of government in a decade. And that doesn’t even include the health-care plan, which the administration assumes will be “budget neutral.” Piling up debt at this kind of rate is not sustainable, to put it mildly. Sooner or later, and probably sooner, something will give. More than likely, a time will come when the U.S. government will no longer be able to borrow money at preferential rates. Interest rates will go up, growth will slow, and unemployment will rise. At that point, there will be no choice but to embark on a painful period of austerity and pronounced fiscal contraction.

The Obama team made a strategic decision at the beginning of this year to focus first on passing a governmental takeover of health care and climate change legislation. Any effort to close the widening budget deficit was put off until 2010, at the earliest. The thinking was that the health care and climate change bills would be so controversial that they could only pass in the president’s first months in office, and they are what the Democratic left most wants to see enacted during the Obama era. Moreover, the health care plan, in the administration’s view, would lay the predicate for future deficit reduction because it would hand over to the federal government new levers to pull to keep costs down in the future. Or so they thought.

Things certainly look very different today than they did in January. The Obama administration has no credible plan to slow the pace of rising health care costs, and never really did. The health care plans emerging in Congress would add a new runaway entitlement program on top of the ones already on the books and substantially worsen both the near-term and long-term budget outlook. Beyond health care, the administration has not offered anything resembling a credible government reform or deficit-cutting plan. Recent suggestions by Treasury Secretary Timothy Geithner and National Economic Council Director Larry Summers that a large tax increase may be needed were quickly shot down by the White House.

So what’s the game plan? The federal government is rushing headlong toward a fiscal crisis that could seriously harm the U.S economy. The president has spent much of his political capital this year promising that health care reform would be tantamount to entitlement and budget reform because it would “bend the cost-curve.” Now that that contention has been thoroughly discredited, it appears the administration has no coherent plan B to get our fiscal house in order. Moreover, even if they did have such a plan, it’s not at all clear that the current Congress could or would pass the highly controversial tax increases and defense cuts that this very conventional Democratic president would almost certainly be pushing.

The first priority of a new president should be to make sure his administration has the capacity to govern. That means cultivating a reliable political coalition that can keep the trains from running off of the rails. President Obama has put at risk his ability to get the hard but necessary things done by pursuing an ultra-liberal agenda that will exacerbate the budgetary problems he should have been most concerned about during his first year. As a result, his entire agenda is now seriously at risk as fiscal reality pushes the federal government toward a massive course correction.

posted by James C. Capretta | 11:05 am
File As: Health Care

Thursday, August 20, 2009

What Will Bring About More Mayo Clinics? 

David Ignatius has an interesting piece in today’s Washington Post on what Dr. Denis Cortese, the head of the Mayo Clinic, is saying about the health care debate as it has been playing out this summer.

Dr. Cortese certainly comes to the reform table with unsurpassed credentials. Mayo is universally acknowledged to be an industry leader in high quality, low cost health care — the kind of health care people would like to see available in every town in America. So when Dr. Cortese speaks, people listen, and rightfully so.

And what is Dr. Cortese saying? According to Ignatius, it’s no ringing endorsement of Obamacare. He is concerned that the legislation moving in Congress is too focused on new insurance coverage and not enough on getting better health care value for what is already being spent. He advocates focusing first on reform of the programs the government already runs — Medicare, Medicaid, the VA, military and federal employees' health care — to make them much more efficient than they are today. If the government paid for value instead of services, Dr. Cortese suggests, new more efficient and patient-focused integrated systems of care — other Mayos — would replace the fragmented and disorganized arrangements which are dominant in most communities today.

So far, so good. But how exactly will the government move from paying for “services” to buying value? Here, it appears both Ignatius and Dr. Cortese fall into the same trap as the Obama administration. They all seem to hold the view that if central planners were just given the chance, they could devise new and clever ways to pay for health care that will drive physicians and hospitals to act differently than they do today.

But why would we expect future efforts to be any more successful than the scores of governmental initiatives that have been launched in the past? The federal government has been running Medicare for nearly half a century, and for at least twenty-five years, there have been repeated initiatives to move the program in exactly the direction Dr. Cortese recommends. They have come up woefully short. Why? First, there’s politics. Buidling a network of high value providers of care means excluding some hospitals, physician groups, labs, and home health agencies from favored status. That is nearly impossible for Congress to sustain, especially when those left out complain that the data used to measure their performance is inaccurate or of poor quality. A few years ago, HHS tried to designate certain hospitals as “Centers of Excellence.” The effort died when the centers deemed not so excellent went to Congress and complained of an unfair designation process.

But even if political considerations could be overcome, the idea that the federal government has the capacity to construct a new payment system which will provide ongoing rewards for innovation and quality is foolhardy. The U.S. health system is too complex, diverse, and dynamic to fit neatly into the kinds of one-size-fits-all payment systems bureaucracies inevitably devise.

If we want our health- are system to be patient-focused and provide the highest quality care possible, we have to give patients the financial power to hold doctors and hospitals accountable. That can only happen in a market-based system where consumers have the ability to take their money elsewhere if they are dissatisfied with how they are being treated. Building such marketplace will require changing the tax treatment of employer-sponsored insurance to give workers more control over the federal tax subsidy for such insurance, and reform of Medicare and Medicaid to give the beneficiaries more control over their entitlement. The government can provide appropriate oversight of the marketplace, but, fundamentally, it needs to be driven by consumers selecting the kinds of insurance and medical care arrangements they find most satisfactory for the prices that are charged. In that context, is there any doubt that organizations which can deliver high value at a reasonable cost — more Mayos — will flourish?

posted by James C. Capretta | 7:34 pm
File As: Health Care

Thursday, August 20, 2009

Where Things Stand 

President Obama has changed his health care sales pitch. Gone is "health-care reform" and "bending the cost-curve." Now he emphasizes "health insurance reform" and "basic consumer protections." But the legislation moving through Congress hasn't changed to match the new rhetoric. The bills under consideration would still lay the groundwork for a complete federal takeover of U.S. health care. This disconnect is the subject of a column I wrote for Kaiser Health News, available here.

posted by James C. Capretta | 2:40 pm
File As: Health Care

Thursday, August 20, 2009

Never Inevitable, Now Implausible 

Wednesday, White House spokesman Robert Gibbs denied the premise of a New York Times article, which is that Democrats have all but abandoned hope for Republican votes in the health care fight and are planning a go-it-alone approach come September.

We’ve seen this two-step before. In today’s version, “top Democrats,” presumably including Chief of Staff Rahm Emanuel, who is quoted in the story, suggest Team Obama is ready to pass a bill with just Democratic votes. Earlier this month, it was Sen. Charles Schumer who said Senate Democrats were preparing to pass a health care bill using the so-called “reconciliation” process, which would allow them to do so with a simple majority instead of sixty votes. In both instances, denials quickly followed that the Democrats were abandoning bipartisanship in health care.

What’s really going on here? Is this yet another sign of Democratic disarray on health care? Or is it simply a premeditated bad cop/good cop routine aimed at scaring moderate Republicans into agreeing to something soon, or else? That’s the hypothesis of John Podhoretz in this post, and he’s probably right.

The bottom-line question is this: can Congressional Democrats pass a sweeping and controversial takeover of American health-care on their own? Here’s a clue to the likely answer: if they could, that would have been plan A. Why bother talking with political opponents if you could pass the next New Deal without them?

Nothing is certain of course, but it should be obvious to all concerned that Obamacare is not inevitable, and never was. Most Americans do not want to hand over total control of U.S. health care to the federal government, and that is the central premise of the bills now being written in Congress. Beyond that, the bills are highly controversial for many other important reasons, any one of which is enough to sink the entire effort. The massive, $1 trillion-plus price tag, even as the government is already piling up debt at a record pace. New taxes and mandates on employers which stifle hiring and job growth, which is the number one concern of most voters. The regressive requirements on low wage workers to buy government-approved insurance. The one-size-fits-all regulatory scheme. The prospect of government-driven rationing of care. None of this is popular.

Then there are the “pay fors.” In addition to massive tax hikes, House and Senate leaders are looking at $400 to $500 billion in cuts in Medicare to pay for their ambitious plans. Whatever else might be said about this month’s town halls, it should be obvious by the reactions of large numbers of senior citizens that deep cuts in Medicare to pay for “universal coverage” will generate significant political heat, to put it mildly. Are rank and file Democrats really prepared to carry that political baggage into 2010?

The public is sending unmistakable signals that they want their elected leaders to drop the controversial provisions and pursue consensus and targeted reforms instead. So far, it appears the Obama White House and Congressional Democrats are ignoring what’s being said and are hoping to scare Republicans into helping them pass a government takeover as originally planned. If Republicans simply hold firm in unified opposition, it is much more likely the public will, in the end, get a bill that’s tolerable, or that nothing at all will pass.

posted by James C. Capretta | 2:35 pm
File As: Health Care

Monday, August 17, 2009

The Flawed Bills Under Discussion 

I was recently interviewed by Paul Howard, Director of the Center for Medical Progress at the Manhattan Institute (and coauthor of this recent New Atlantis article), on the flaws in the health-care bills now pending in Congress. During the discussion, I note that some of the most unpopular aspects of the bills as currently drafted have yet to get the public attention they deserve. For instance, the bills are highly regressive, requiring millions of low wage workers to take up insurance offered by their employers with no additional financial assistance from the government. That "mandate" will be viewed as a tax when properly understood by voters.

Click Play below to hear the interview.


posted by James C. Capretta | 5:28 pm
Tags: interview, Paul Howard, mandate
File As: Health Care

Thursday, August 6, 2009

The Baucus Employer Mandate and the Democrats’ Strategy 

The Washington Post has another piece in today’s paper — there seems to be about one per week — on the ever-so-close “bipartisan plan” being negotiated by Senate Finance Committee Chairman Max Baucus and five of his committee colleagues.

Among other things, the Post provides a side-by-side analysis comparing the Finance Committee “plan” — though no one has really seen it yet — to the bills approved by the House Energy and Commerce Committee as well as the one approved by the Senate Health, Education, Labor, and Pensions Committee. According to the Post, the emerging Baucus proposal will not include an employer mandate. Rather, it will impose a “free-rider” penalty on employers whose workers end up getting subsidized coverage through the so-called “exchanges.”

As I have written previously, this is a distinction without a difference. The Baucus plan would require employers to provide some level of coverage acceptable to the federal government or pay a tax to partially cover the costs of premiums for workers with incomes below 300 percent of the poverty line. Any way you look at it, that’s a “pay or play” employer mandate.

The reason for the semantic game is politics, of course. Senator Baucus is desperate to get the sign-off of the three Republican negotiators in the gang of six — Senators Grassley, Enzi, and Snowe — and they don’t want to be accused of supporting a job-killing “employer mandate” with unemployment heading toward 10 percent nationally. And so the “free-rider” penalty is peddled as a non-mandate “responsibility” provision.

The only real difference between what Senator Baucus is trying to do and the emerging House bill is that the Baucus mandate wouldn’t apply to workers with incomes exceeding 300 percent of the poverty line. They wouldn’t be eligible for the subsidy program, and so employers wouldn’t face a penalty for not offering them qualified coverage.

Normally, liberals do not worry too much about the job-killing impact of employer mandates and taxes, but the Baucus plan’s differential treatment of workers by income is so transparently regressive that the Center on Budget and Policy Priorities (CBPP), a liberal-leaning think tank, and the Leadership Conference on Civil Rights have begun sounding the alarm that it would discourage the hiring of low-wage workers and minorities. As reported in National Journal’s CongressDailyAM (subscription required), Wade Henderson, the Leadership Conference president, said the Baucus plan “creates a powerful incentive for employers to fire or not to hire the very people healthcare reform is supposed to help.”

So will these groups oppose the Baucus plan and force the committee to go back to the drawing board? Apparently not. CBPP President Bob Greenstein said in the same CongressDaily story that he expects the Finance Committee to approve the Baucus mandate but hopes it will be changed down the road. In other words, he doesn’t want to slow down the Baucus process but is confident that House Democrats will never go along with the Baucus approach if they aren’t forced into it.

Which raises another question: What exactly are Senators Grassley, Enzi, and Snowe negotiating, anyway?

It is beyond obvious that what the Obama administration and most Democrats desperately want from the “gang of six” is “to keep the process moving.” They don’t view the product of the Baucus negotiations as the final word by a long shot. They just want to get it over with. In fact, Greenstein’s comment that the Baucus mandate can be fixed later is indicative of the prevailing sentiment among Democrats. If they can just get past the Finance Committee, they surmise, political momentum will build, and a final bill will become all but inevitable. At that point, the only question will be about “what” not “if,” and Democrats would control all of the details in a conference between the House and Senate.

In recent days, Senate Democrats have suggested that if the Baucus negotiations don’t make progress soon, they just might try to pass health-care on an entirely partisan basis in the Senate, using the so-called “reconciliation” procedure. That would allow them to pass a bill with a simple majority instead of sixty votes. They might be able to do so. After all, there are sixty Democrats in the Senate. But, then again, such a bill would carry a lot of political baggage. More than $1 trillion in new spending over the coming decade and growing obligations in the years following, new costly requirements on low-wage workers to buy insurance without any additional financial support, new taxes on the middle class, deep cuts in Medicare benefits, job-killing mandates in a recession, and, of course, a government-run option that would displace private coverage for tens of millions of happily insured Americans.

Indeed, the threat by Democrats to move a bill under reconciliation seems really to be just that — a threat intended to force Senators Grassley, Enzi, and Snowe to agree to something, anything, to keep the process moving. Which is why Senate Republicans should ignore it entirely. If Democrats really thought they could pass a government-takeover of American health care over the unified objections of Republicans, they probably would have tried to do so already. The public is already uneasy about what is being considered in Washington. The last thing they want to see is a partisan bill passed with limited debate in a highly charged environment.

No, it remains the case that it will be exceedingly difficult for the Democrats to try to pass a bill without any Republican support, especially in the Senate. Which means, for Republicans, the trick is to stick together. If they do, they will wield much power over whatever happens.

posted by James C. Capretta | 5:22 pm
Tags: Max Baucus, mandate, reconciliation
File As: Health Care

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