The Future of Health Care Reform

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There is an increasingly wide divide in the health care debate that at its source comes down to a fundamental disconnect between the opposing sides. While the Democrats are trying to explain what is in the bill and what is not, the opposition continues to harp on government takeover and death panels. The reality is that both sides are correct, and the concerns of the opposition are well founded in government history. There is a long history of Congress passing bills with good intentions, only to see it morph, over time, into something not entirely intended.

The National Indian Gaming Regulatory Act passed in 1988 was intended to give Indian Tribes the ability to build one casino on reservation land as a means to improve employment on the reservation. Now, 20 years later it has become the means for tribes to build unregulated casinos pretty much anywhere they want and as many as they want. When the federal courts have ruled a casino illegal (as was recently done in Buffalo) the Department of Interior hands the casino a license anyway and does nothing to enforce the law. Unemployment and welfare for tribes has not really changed despite tens of billions being pumped into casinos on an annual basis.

The ink was barely dry on TARP before the White House diverted funds meant to shore up the banking system to the auto industry without a vote by Congress. This was well outside the scope of the law and the decision was unilaterally made by bureaucrats in the White House.

Farm price supports were passed to help family farms through some difficult times, but over the last few decades they have become an untouchable program that primarily benefits corporate agriculture at the expense of small farms. Most major programs that have been implemented by Congress have suffered from scope-creep over time, health care reform will be no different.

In large measure, a discussion of what is in the bill today is a pointless conversation. It does not matter what is in the health care bill today, what is driving opposition concerns is a forecast of where it could lead over the next 10-20 years when, once again, it takes on a life of its own and morphs into something quite different from todays political intentions. President Obama continues to criticize opponents for using scare tactics and claiming their concerns are not in the bill. But our government has a long history of changing what is in a bill over time, so are their fears really groundless? As long as the President and congressional leaders continue to talk about what is in the current bill, without addressing the long term concerns of many people, they will not be successful in winning large scale public support. It is not irrational or ignorant to choose to deal with the devil you know rather than take a risk with the devil you don’t know.

About Craig Mayberry

Closed Account • Member since Jan 17, 2008

While writing his articles from 2008 to 2011, Craig lived near Lynden and taught at both Whatcom Community College and Western Washington University. He was active in politics and ran for public [...]

Comments by Readers

David Marshak

Aug 19, 2009

Craig wrote:  “The reality is that both sides are correct, and the concerns of the opposition are well founded in government history. There is a long history of Congress passing bills with good intentions, only to see it morph, over time, into something not entirely intended.”

I AGREE that there is some truth in Craig’s claim, above. However, we have a context in which 45% of Republicans don’t believe that Barack Obama was born in the United States and thus reject his legitimacy as President.  50% of Republicans believe that Sarah Palin’s “death panel” assertion is true, even though Lisa Murkowski says it’s “nonsense” and Johny Isakson says it’s “nuts.”

In this context it seems unlikely that the central concern that this 45-50% of Republicans has is mission-creep. As both Rush Limbaugh and Jim DeMint have made clear, the mission is to destroy the Obama presidency.

I suggest that you devote one day from 9 AM to 10 PM listening to KGMI, and it will become clear to anyone what the opposition to health care reform is about.

Craig also wrote: “In large measure, a discussion of what is in the bill today is a pointless conversation. It does not matter what is in the health care bill today, what is driving opposition concerns is a forecast of where it could lead over the next 10-20 years when, once again, it takes on a life of its own and morphs into something quite different from todays political intentions.”

IF WE TOOK this insight as our guidance, then we would never want any government to do anything. One fundamental quality of democratic governance is that citizens can effect change.

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Craig Mayberry

Aug 19, 2009

I appreciate your points.  The whole birth certificate issue is an interesting one, but frankly not worth talking about (ironically it is probably about the same percentage that feel the Bush stole the election from Gore in 2000) so can probably be chalked up to finding a good excuse to be mad at the outcome of the election.

The death panels is an example of scope creep and you are correct that a lot of people are concerned, but not because it is in the bill today, but because of a potential scenario that may play out if private insurance falters and government funding struggles to find enough to cover everyone, what happens then?  I agree that one is a little far fetched, but some amount of rationing will occur and the question becomes what the criteria will be and who controls it. 

The issue of scope creep is a difficult one because you cannot have government do nothing, but in many cases it turns out different then we expect over the long term.  I am not sure I have the answers to that issue, but it is a great point.

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David Marshak

Aug 20, 2009

I think the question of rationing is central to much of this issue. And I believe that all of our political leaders, D’s and R’s equally, are not being truthful about this.

There is rationing of health care right now, much of it determined by access to health insurance and ability to pay. But if we keep inventing new, expensive high tech disease remedies and life extension techniques, the divide between what we can afford and what these treatments cost will only increase.

Presumably there’s an infinite demand for treatments that will keep us alive longer?but limited means to pay for them.

Given this situation, I liked the effort that Oregon made in the 1990s to make healthcare rationing public and explicit rather than hidden and, more and more, a matter of privilege. Unfortunately that model fell apart, but as far as I know (and my knowledge on this is limited), it was not that Oregonians rejected explicit rationing of healthcare but because the state’s entire healthcare system lacked adequate funds.

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Craig Mayberry

Aug 20, 2009

David,

I absolutely agree with you.  Rationing does occur now with the decisions made by insurance companies and the government (the State of Washington restricts access to their taxpayer subsidized plan), which is not always fair.  I believe the biggest mistake being made by Pres. Obama and Congressional leaders is not addressing the rationing question.  They continue to try to convey the message that there will be no rationing, but the average citizen knows that is not the case, and in reality it is not the case.  The fundamental question still becomes who will be making the decisions and how.  We know who makes the current decisions and who they are handled, but under the new plan there is no clarity, therefore many people have concluded they would rather stick with the devil they know then the devil they don’t know.

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