Ronald Reagan Socialized Medicine Quotes — The Hill Blog — NYT Economix (Socialized Medicine) — WSJ (Critical Condition) — Ronald Reagan/Milton Friedman You Tube Videos
- Freedom is never more than one generation away from extinction. We didn’t pass it on to our children in the bloodstream. It must be fought for, protected, and handed on for them to do the same, or one day we will spend our sunset years telling our children what it was once like in the United States when men were free.
- Address to the annual meeting of the Phoenix Chamber of Commerce, (1961-03-30).
- Later variant : Freedom is a fragile thing and is never more than one generation away from extinction. It is not ours by inheritance; it must be fought for and defended constantly by each generation, for it comes only once to a people. Those who have known freedom and then lost it have never known it again.
- California Gubernatorial Inauguration Speech (1967-01-05).
- Back in 1927, an American socialist, Norman Thomas, six times candidate for President on the Socialist Party ticket, said that the American people would never vote for socialism but he said under the name of liberalism the American people would adopt every fragment of the socialist program.
- Ronald Reagan Speaks Out Against Socialized Medicine (recording) (1961)
- But at the moment I’d like to talk about another way because this threat is with us and at the moment is more imminent. One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. . . . Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We have an example of this. Under the Truman administration it was proposed that we have a compulsory health insurance program for all people in the United States, and, of course, the American people unhesitatingly rejected this.
- Ronald Reagan Speaks Out Against Socialized Medicine (recording (1961)
- The doctor begins to lose freedom. . . . First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then doctors aren’t equally divided geographically. So a doctor decides he wants to practice in one town and the government has to say to him, you can’t live in that town. They already have enough doctors. You have to go someplace else. And from here it’s only a short step to dictating where he will go. . . . All of us can see what happens once you establish the precedent that the government can determine a man’s working place and his working methods, determine his employment. From here it’s a short step to all the rest of socialism, to determining his pay. And pretty soon your son won’t decide, when he’s in school, where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do.
- Ronald Reagan Speaks Out Against Socialized Medicine (recording (1961)
- Government is like a baby. An alimentary canal with a big appetite at one end and no responsibility at the other.
- Joke during his 1965 campaign for Governor of California, as quoted in The New York Times Magazine (14 November 1965), p. 174
- Government is like a baby. An alimentary canal with a big appetite at one end and no sense of responsibility at the other.
- As quoted in The Reagan Wit (1981) by Bill Adler, p. 30
- Welfare’s purpose should be to eliminate, as far as possible, the need for its own existence.
- Interview, Los Angeles Times (1970-01-07)
If it’s to be a bloodbath, let it be now.
Appeasement is not the answer…
July 29th, 2009
1. New Government Run Plan to “Compete” with Private Companies
* Doctor Payments Based on the Medicare Model. Plan would reimburse providers at Medicare payment rates for at least the first three years, with a 5% bonus payment. After that, reimbursement could be no more than Medicare rates. The Secretary of Health and Human Services could coerce doctors to participate in the program by tying participation to other government run health programs.
* Lawsuits. Bill exposes employers operating group health plans to state law remedies and private causes of action, but the government run plan can only be sued in federal court.
* Rationing. A new Health Care Commissioner would have unprecedented authority to determine what is “acceptable” health care coverage and set all the rules for what an health care coverage must include in addition to what treatments patients could receive and at what cost.
* The “Invisible” Government Run Plan. Requires private insurers to comply with new coverage and underwriting rules in order to offer insurance products both inside and outside of the new national and state insurance exchanges.
2. Costs Go Up for the Government and Everyone Else
* CBO Director Elmendorff said on July 16th that, “…the legislation significantly expands the federal responsibility for health care costs… The way I would put it is that the [cost] curve is being raised…”
* Bigger Deficits. CBO estimates that the bill will increase the deficit by $239 billion in the first ten years. Even this is misleading though, since the tax increases in the bill start immediately, but the new spending is delayed. Once the spending fully starts, the bill adds over $60 billion a year to the deficit.
* New Tax on Individuals of 2.5% if they don’t purchase “acceptable coverage.”
* Many Currently Insured Individuals Will Face More Expensive Insurance Premiums based on new rules for “acceptable” insurance coverage.
* Expands Medicaid eligibility to all individuals up to 133% of poverty and “low income” subsidies” can go to a family of four making more than $88,000.
3. Pay or “Play” Employer Mandate
* An 8 percent Payroll Tax on: Employers who can’t afford to offer health insurance to their employers; employers who do the right thing and offer health coverage to their employees but it’s deemed “insufficient” by the government; and employers who aren’t paying at least 72.5% of an employee’s premium (65% for family coverage).
* Fines of up to $500,000 on employers who make an honest mistake, thinking they had provided what the government deemed “sufficient” coverage.
4. If You Like What You Have, You Can’t Keep It
* 2 out of 3 Workers will Lose Coverage. Independent analysis by the Lewin Group shows that 2 out of every 3 people would lose their current coverage, including over 114 million people who receive health benefits through their employer or other current coverage.
* 11 million Seniors will Lose Medicare Advantage Plans
* More than 8 million Health Savings Accounts not deemed “acceptable coverage.”
* It will be Illegal to Renew your Current Health Insurance and you will be left only with plans approved by a new federal regulator—plans that can’t compete with a new government run plan.
5. Raises Taxes on Small Businesses through Surtax Increase
* Filers making $280,000 ($350,000 joint) will be hit with a 1% surtax, filers making $400,000 ($500,000) will be hit with a 1.5% surtax and filers making $800,000 ($1,000,000) will be hit with a 5.4% surtax. The Democrats imbedded an automatic tax increase in their bill by doubling the 1% and 1.5% small business tax in 2013 continuing their revenue grab from small businesses.
* Of taxpayers who file in the top brackets more than half of them are small business. The Democrat plan, according to a study by the Tax Foundation, would raise the top tax rate in 39 states to more than 50%.
* According the National Association of Manufactures, an industry hit hard by the economy, 68% of manufactures file as S-corporations with an average income of $570,000, well above the $350,000 base the Democrats have set for the surtax.
Uwe E. Reinhardt
Uwe E. Reinhardt is an economics professor at Princeton.
With another “national conversation” about health reform upon us — as it is every decade or so — we will hear a lot of derisive talk about the evils of “socialized medicine.”
The term is regularly confused with “social health insurance,” which is not at all the same concept. The chart below may be helpful in appreciating the distinction.
Socialized medicine refers to health system in which the government owns and operates both the financing of health care and its delivery. Cell A in the chart represents socialized medicine.
Social health insurance, on the other hand, refers to systems in which individuals transfer their financial risk of medical bills to a risk pool to which, as individuals, they contribute taxes or premiums based primarily on ability to pay, rather than on how healthy or sick they are.
Socialized medicine is one form of social insurance. More typically, however, social insurance is coupled on the health-care delivery side with a mixture of government-owned facilities (e.g., municipal hospitals), private nonprofit hospitals (roughly 90 percent of all American hospital beds) or private for-profit facilities (investor-owned hospitals, private medical practices, pharmacies and so on). It follows that one cannot simply treat social insurance as socialized medicine. In principle, one could have social insurance with 100 percent private for-profit delivery facilities.
Under private commercial insurance, individuals also transfer the financial risk of bills for health care to a risk pool, but the premium the individual contributes to the risk pool reflects that individual’s health status. These premiums are, as actuaries put it, “medically underwritten” and “actuarially fair.” The risk pools under private insurance can be operated by not-for-profit or for-profit insurers. And like social insurance, private insurance typically is coupled with a mixed private and public delivery system.
In the chart, cells A, B, C jointly represent single-payer social insurance — e.g., traditional Medicare. Cells D, E, F jointly represent multiple-payer social insurance — e.g., Medicaid Managed Care. Cells G to L jointly represent individually purchased private insurance with actuarially fair premiums. Finally, cells M, N and O represent the uninsured or the cost-sharing portion of insured persons.
In between these distinct systems falls employment-based health insurance.
Large employers typically self-insure and use private insurers only to procure health care on behalf of employees (e.g., negotiate fees with the providers of health care) and administer claims. Other employers do not self-insure and instead purchase so-called group health insurance policies for all their employees jointly, as if they were one large family. The premium for a group policy is “experience rated” over the covered group of employees, which means that they reflect the average actuarial cost of all of one company’s employees.
The individual employee’s own contribution toward his or her employment-based insurance, however, is divorced from the individual’s (or the attached family’s) health status. In this sense, then, employment-based insurance could be described as “private social insurance,” as distinct from “government-run social insurance.”
Former Mayor Rudolph Giuliani of New York has exemplified the perennial confusion in this country over socialized medicine. In his ill-fated presidential bid, and subsequently as a supporter of Senator John McCain’s bid for the presidency, Mr. Giuliani routinely decried as socialized medicine (or “socialist”) any proposal presented by Democratic candidates, because typically the latter advocated tax-financed subsidies toward the purchase of health private insurance or expansions of public insurance programs. But technically none of them advocated socialized medicine.
Perhaps Mr. Giuliani was unaware that Americans all along the ideological spectrum reserve the purest form of socialized medicine — the V.A. health system — for the nation’s veterans. I find this cognitive dissonance amusing. Indeed, if socialized medicine is so evil, why didn’t Republicans privatize the V.A. health system when they controlled both the White House and the Congress during 2001-06?
Mr. Giuliani also seems to forget that, in 1996, he found social health insurance a perfect solution to the financial problems faced by former Mayor John V. Lindsay, who fell on financially hard times during the 1990s as a result of chronic illness.
In a fit of compassion, then Mayor Giuliani rushed to his friend’s assistance with — you guessed it — taxpayers’ money, rather than with a private sector solution. He did so by appointing Mr. Lindsay to two no-show city jobs that came with tax-financed municipal health insurance and a tax-financed pension.
It seems fair, then, to ask Mr. Giuliani why it was perfectly fine to bail out a financially distressed man who had been wealthy enough in his younger years to provide adequately for his old age, when proposals to extend the same kind of assistance to hard-working, uninsured members of lower-income families are decried by him as “socialism.”
One can only hope that our members of Congress and the typical American voter can make the right distinctions.
A transcript of the weekend’s program on FOX News Channel.
Paul Gigot: Up next:
President Obama: We will pass reform that lowers cost, promotes choice, and provides coverage that every American can count on, and we will do it this year.
Gigot: President Obama’s health-care scramble amid falling poll numbers and Democrats in disarray. Will he get the bill he wants when he wants it? Plus, your stake in the overhaul. Can you really keep your current insurance plan, and will the middle class get stuck paying the bill? We’re breaking down the policy and the politics of health care on this special edition of “The Journal Editorial Report.”
Gigot: Welcome to “The Journal Editorial report.” I’m Paul Gigot.
Well, from a prime-time press conference to a town-hall meeting in Ohio, it was a full-court press by President Barack Obama this week to sell his health-care reform plan to an increasingly skeptical public. A new FOX News/Opinion Dynamics poll shows that nearly half of all Americans, 45%, think the quality of their family’s health care would be worse under the proposed reforms. Just 29% think it would be better. Are they right to be worried?
Former New York lieutenant governor Betsy McCaughey is a patient advocate and chairman of the Committee to Reduce Infection Deaths. She joins me now.
Good to have you back again.
McCaughey: Thank you.
Gigot: Now, you wrote this week that seniors could be the biggest losers under this health-care reform plan that’s emerging in Congress. How so?
McCaughey: Certainly seniors bear the brunt under this bill, the House bill, and under the companion Senate bill, produced largely by Sen. Kennedy’s staff, for several reasons. One is–first, they will pay for with it cuts to Medicare. The $1 trillion to $1.6 trillion price tag on these bills will be paid for by tax hikes. Everybody’s heard about those.
McCaughey: But by at least $500 billion to $550 billion in cuts to Medicare.
Gigot: Estimated over 10 years.
McCaughey: That’s right, and that’s about a 10% cut in the Medicare budget at the same time that Medicare enrollment will be increasing by about 30% as the baby boomers reach Medicare age.
Gigot: Well, this is fascinating to me, because how can they cut Medicare spending–because doctors are already complaining they get reimbursed by Medicare, only 20% or 30% less than the real costs of their procedures. Hospitals as well.
McCaughey: It’s going to mean reductions in hip replacements, knee replacements, bypass surgery, angioplasty–the major procedures that have enabled this generation of the elderly to–
Gigot: Lead better lives.
McCaughey: –avoid disability, avoid deteriorating in nursing homes, and instead lead active lives.
Gigot: Well, wait a minute. How is that going to happen? I mean, doctors are not going to stop prescribing these things. How is that–what is that mechanism?
McCaughey: Well, they will have to. They will have to. Tucked into the stimulus package that was signed into law on Feb. 17 was a provision for computers to be in doctors’ offices and hospitals at bedside–computers that would deliver protocols to doctors electronically on what the government deems cost-effective and appropriate care. And there will be penalties built-in for doctors who are not meaningful users of this system. In March, the president appointed Dr. David Blumenthal national coordinator of health information technology, and he’s going to oversee ensuring that doctors obey these protocols. In fact, on April 9 in The New England Journal of Medicine, he wrote an article describing how he’s going do it. And he said he does anticipate some push-back, some rebellion from doctors who don’t like losing their autonomy over what’s good for their patients.
Gigot: I would think push-back too from Congress. Do you really think that this is something that the American public is going to stand for? Won’t Congress push back?
McCaughey: Well, that’s why Peter Orszag, head of the Office of Management and Budget–again, part of the White House–went to Congress earlier this week and asked for permission to really remove those decisions from Congress. He asked Congress to delegate the authority to make these decisions about what Medicare covers and how doctors are paid instead to a body outside of Congress, either MedPAC–a body that already exists, an advisory board–or a council created within the White House.
Gigot: This MedPAC idea–the president really, really hit this hard at his press conference this week. And this would be a group, a council of wise men and women, medical experts presumably, who would propose protocols for spending–for saving costs, in particular, trying to be more effective, they say, with their medical procedures–then present those as a package to Congress, which could vote up or down. And what’s wrong with that? Why shouldn’t we turn this away from these political types in Congress and give it to a panel of experts?
McCaughey: Well, Congress is accountable, and seniors would certainly raise a lot of fury if suddenly they could not avoid the crippling affects of arthritis by getting a knee replacement. And the fact is that the president likened this proposal to a base-closing commission so it would be immune from those popular impacts.
But the fact is, I don’t believe we can count on the doctors that would be appointed to this to make the right decisions because, for example, the doctors that the president has already chosen to be his chief health advisers are ardent advocates of limiting care for the elderly. Dr. Ezekiel Emanuel, for example–brother of president’s chief of staff, Rahm Emanuel–highly educated man who has written extensively on his views that the elderly should get less care, that Americans are too enamored with high-tech care, and that people who have incurable illnesses–and he uses specifically the example of dementia–should not be guaranteed health care because they no longer contribute to society. These are views that most of us don’t share.
Gigot: All right. Well, we certainly need a debate about this. But let’s get another clip of the president on this point.
Obama: Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts.
Gigot: Why wouldn’t the American Association of Retired Persons oppose this if what you say is in fact going to happen?
McCaughey: Paul, I am shocked at the AARP’s behavior, and frankly, to me they’ve betrayed seniors. I’m amazed that seniors continue to pay their dues to the AARP. The AARP says that they support universal coverage. Well, seniors already have that. And they have so much to lose under this.
One of the other things that’s very dangerous to seniors in this legislation is the dramatic shift in funding for–away from specialty medicine to primary care, on the misconception that Americans overuse specialists and drive up health costs in the process. But study after study showed that people with heart disease who rely on primary-care medicine are frequently misdiagnosed and incorrectly treated.
Gigot: Cardiologists are better at heart care.
McCaughey: That’s right. They are readmitted to the hospital far more often, and they die sooner.
Gigot: All right, Betsy. Thanks so much.
We’re going to have much more. When we come back, the House and Senate health care plans up close. What exactly is in the proposed legislation, and how do they plan to pay for it? Our panel breaks it down and answers the big questions, next.
Obama: If you have health insurance, the reform we’re proposing will provide you with more security and more stability. It will keep government out of health-care decisions, giving you the option to keep your insurance if you’re happy with it.
Gigot: Perhaps the biggest concern for many Americans, being able to keep their current health-care plan. President Obama says you can. But for how long?
We’re back with Betsy McCaughey. Also joining the panel, Wall Street Journal assistant editorial page editor James Freeman, senior editorial page writer Joseph Rago and Washington columnist Kim Strassel.
All right, Joe, let’s take them one by one. Let’s start with that claim you will be able to keep your health plan if you want to. Can you? Is that true?
Rago: Well, no. I don’t think so at all. First, you’re going to have a government insurance option, like Medicare but open to the middle class, that will pay doctors and hospitals submarket rates, undercut private insurers. Private insurers will be regulated to within an inch of their life basically. And then you’ve got the government mucking around with some of these rules that allow large employers to offer coverage to their employees.
Gigot: And avoid state mandates and state rules because they have national plans.
Rago: And a lot of federal rules, too. So now this will be sort of be subject to a Health Choices Administration that will gradually make employer-sponsored coverage work just as poorly as the rest of the insurance markets.
McCaughey: It’s not a matter of speculation, however, or even prediction. The letter of the bills say that you will be able to keep your existing plan. You will be forced to move into a managed-care plan that restricts your access to specialists and diagnostic tests.
If you look on the Senate bill, page 15 through 17, or in the House bill–excuse me, the House bill, 15 to 17, the Senate bill, 56 to 58–you will see that you are required to enroll in a qualified plan. That means a plan that the government deems appropriate. And it has to be managed care. That’s spelled out in the bill. If you get your insurance through your employer–if you get your insurance through your employer, as most Americans do, your employer will have a grace period in which to move you into managed care. If you buy your insurance individually, through a broker, for example, you won’t have a grace period. As long as anything changes in your current contract, your co-pay changes–
Gigot: So once the contract changes, then you go into this government–new government regulation, OK.
McCaughey: So it’ll be in a few months, right, because usually those things change every year.
Gigot: All right, but what about the fact that you have these union plans that are done, that are the product of collective bargaining done in good faith, that are often very, very good health care. Are they really going to abrogate these contracts?
McCaughey: Some of the union plans are exempted under these bills. But most employers will only have the grace period to move their employees, all of them, into these lower-grade HMOs, because the point of these bills is not to just cover the uninsured. It’s to limit everyone’s health care consumption–and using managed care will do that–and to ensure that everyone has the same health-care experience regardless of ability to pay. They don’t want executives or people who go out and buy more-expensive plans to have a different health-care experience.
Gigot: All right, James, let me ask you about this–the public option. Because the president says, Look, all this is, is going to compete with the private plans, keep them honest. The insurers are making a lot of money right now. We need to keep them honest.
Freeman: Right, and I think the beauty of this is we don’t need to guess or estimate or just posit what might happen, because the people of Massachusetts since 2006 have been running the experiment for all of us, and we can go to school on it.
Gigot: Thanks to Mitt Romney, former Republican governor.
Freeman: That’s right.
Gigot: Or no thanks to Mitt Romney.
Freeman: And it’s very clear what happens. Private insurance goes away, more people go on the public plan, costs explode, more costs go onto small business, and people lose their jobs or they get salary freezes.
McCaughey: That’s a very important point that more and more people are losing their jobs in Massachusetts. I was reading about an employer just today, who had to close up part of her business, close one office, sell a couple of trucks, and lay off an employee in order to meet the government requirement to pay for health insurance.
Gigot: OK, Kim Strassel, let me ask you about the cost question, because that’s an important one. CBO said–the president of the Congressional Budget Office said the president’s proposal–the House proposal will not save money. But can you save money overall, somehow, if you cover more people, if you cover 44 million more people? How do you save money?
Strassel: Well, the argument that the White House has always made is that if you did that and you had more competition and you somehow managed to get more efficiency across the board, that you could lower costs in the long term. The CBO has blown that up. They have done an initial analysis of the House bill. It says that there’s going to be about $820 billion in new taxes, most of them on families and small businesses. And even with that, there’s still going to be another $250 billion of more deficit spending over the next 10 years. And even then, that doesn’t count in the fact that both of these bills, bear in mind, are designed to hide a lot of the costs that are going to come up front, and only have them start to kick in toward the end of the bill. So what we’re actually looking at is trillions in new spending over the upcoming years.
Joe, I want to give the House Democrats credit for one thing. By raising, by proposing–putting this tax increase on the table, a 5.4-percentage-point surtax, they’ve at least showed people this is not going to be a free lunch, that somebody is going to have to pay for it. Now they claim that it’s only going to be the wealthy will have to pay that, to the tune of $550 billion. But this thing is going be enormously expensive.
Rago: Yeah, I mean, all government health programs start small and grow over time.
Gigot: That was the experience with Medicare.
Rago: Experience with Medicare. And this is sort from the same playbook. On the taxes, you know when you’ve got some states–California, New York–with top rates pushing 50%–.
Gigot: Sixty percent.
Rago: Sixty pecent.
Gigot: Higher than Sweden! Federal-state combination: Oregon, California, New York, New Jersey would have top marginal tax rates higher than almost all of Europe.
Rago: Yeah, and the truth is you can’t finance health care for 98% of the population with tax increases on 2%.
Gigot: On 2% of the population.
Rago: So eventually this is just going to have to reach down into the middle class. There’s just no way to make the money work.
Gigot: All right, thank you all.
Still ahead, the politics of health-care overhaul. Amid the president’s falling numbers and Democratic disarray, all eyes are on Republican senator Chuck Grassley. We’ll tell you why when we come back.
Gigot: We’ll get to the Republicans in a minute. But as the president touts his health-care overhaul and his plan to tax the rich to pay for it, he’s finding he can’t even count on some members of his own party. There’s the so-called Blue Dog Coalition that met with President Obama this week at the White House, and some freshmen Democrats from the nation’s wealthiest congressional districts are balking at the plan as well.
All right, Kim, so, what’s the problem the president has with these Democrats? Or maybe, what problem do the Democrats have with his plan?
Strassel: The problem that he has is that he stepped back and let some of the most liberal members of Congress write the bills that have come out of both the House and the Senate, so Ted Kennedy in the Senate and Nancy Pelosi and Henry Waxman in the House. And what has happened is these bills that have come out with these soaring taxes, these business mandates, individual mandates, the lack of choice for consumers, have scared a lot of Blue Dog and freshmen Democrats. Remember, Mrs. Pelosi’s margin was based on winning a lot of seats in very conservative districts over 2006 and 2008. These guys do not want to go home and say they voted for a bill that looks like this. So he cannot get his caucus together.
Gigot: So what the president’s saying now to get the Blue Dog Democrats on board, who care a lot about costs, is, he’s talking about MedPAC, which Betsy and I talked about before, which is this idea that a council of wise men and women would somehow propose things that would keep costs down. Is that kind of cover going to work for them, Joe?
Rago: Well, it might. I mean, the Blue Dogs are always looking for a reason to roll over–
Gigot: Roll over and vote for it, yeah.
Rago: –and vote for what they said they weren’t going to.
And I think the larger issue is that Congress tries all sorts of schemes like this all the time, and it never happens, so spending continues to rise. The only thing that would prevent that from happening is when the liabilities are just so large that they’re swamping the entire federal budget.
McCaughey: I predict that there will be real rebellion to the decisions of this MedPAC commissioner or other commissions, because baby boomers are not going to want to live their later years in pain.
Gigot: But will that happen before this passes, Betsy? That’s the question. The Blue Dogs are looking for political cover, and the president is trying to give it to them by saying we have this commission that will solve everything.
McCaughey: You know, I’m curious about why the Republicans have not much more aggressively proposed a fix-what’s-broken-leave-the-best-alone alternative that reaches out to provide coverage for the 24.7 million or so people who are involuntarily uninsured–they can’t afford a health care plan; they earn too much to be eligible for Medicaid or Schip–and we could take this issue of the uninsured simply off the table in a compassionate way and say we’ve fixed the problem.
Gigot: But the Republicans have proposed some ideas like that, through a refundable tax credit, for example. Now, they haven’t gotten a lot of publicity because everybody is focused–rightly so, I think–on what the Democrats, who run Congress and the White House, are proposing. So there are some other ideas out there that could–you’re saying, solve this problem in a more humane and less costly way.
McCaughey: Oh yes, it would cost $28 billion to $49 billion a year, depending on the level of coverage provided to uninsured individuals in this income group–lower-middle-income families who are struggling to pay for health insurance. And it could be implemented quickly, because in all 50 states, debit-card technology has enabled state governments to deliver purchasing power to families, even people who need it temporarily. And 22% of the uninsured are just in a temporary dilemma.
Gigot: All right, I think that those are excellent points. But that’s not going to happen in Congress unless–right now, because the president is focused on these current efforts that we’ve been describing. That’s where the Republicans come in.
Freeman: Yeah, he’ll have to abandon them, and these alternatives are going to start to get a lot more attention, because right now his sales pitch is higher taxes, less care for the elderly, and Washington’s going to decide whether your kid gets a tonsillectomy. This is not a winner as a political sales pitch. So these alternatives–using the tax code, fixes to encourage more people to get insurance–are going to start to get more attention.
Gigot: But in the immediate term, as he’s dealing–trying to get through this Congress–Kim Strassel, what you’re seeing is the president really trying to work with some Republicans in the Senate, particularly Iowa Republican Chuck Grassley, senior Republican on the Senate Finance Committee, to get him to sign on with Senate Democrats and maybe some other Senate Republicans to some kind of compromise they can then get through the Senate, get the 60 votes they need. And so they’re looking for that Republican cover. What role do you think Grassley’s playing?
Strassel: Well, up to now, I mean–and you’re right, this is all about cover. They need Grassley to bring along both a handful of Republicans and reassure their conservative Democrats. But the role he is playing here is–I mean, Chuck Grassley is increasingly the guy who is either going to blow up some of these bad ideas–and he has the power to do that by stepping back and saying no–or the guy who may become the Republican known for delivering the nation socialized health care. So he’s really in the middle. He’s been working very hard with Max Baucus to try and get a compromise. We don’t know what’s happening in those negotiations. They now have an extension of time because the president has basically said he’ll step back and wait to see what happens after the August recess.
Gigot: So the president hauled in the CBO director, Doug Elmendorf, who had given that bad score that–brought him in with a phalanx of White House aides. Was that subtle pressure?
Rago: I don’t think it was subtle at all. It sort of put LBJ to shame. But you know, I think what the Republicans really have to do now is kill this thing as it is, so that opens up the space for other alternatives. Otherwise, they’re just going to be providing a bipartisan gloss on what is really a terrible plan.
Gigot: But Republicans can’t kill it. Democrats have to kill it. If every Republican voted against this, it could still pass.
McCaughey: When Democrats go home, they will hear loud and clear from their constituents that people don’t want to give up the health plans they have now for the rigors of managed care. They rejected it in the 1990s, and they want to stick with the health plans they have.
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