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Monday, December 14, 2009

2009 Roundup: Health Care, Afghanistan & The Economy

UPDATE 12/24/2009: The United States Senate has passed its version of the Democrats' health care bill on a 60-39, strict party-line vote which took place Christmas Eve morning. Democratic leaders in the House and Senate will now work to merge the Senate bill with the much more liberal House bill. Senators Lieberman (I-CT) and Nelson (D-NE) have vowed to veto the final bill if it moves left of the version they supported this morning. With their more moderate interest on one side and disenchanted House liberals on the other, the Conferencing of the two bills promises more drama, deal-making and a still uncertain fate for President Obama's top legislative priority.

ORIGINAL POST: As the pre-teens draw to a close, let's look at the big issues dominating our collective consciousness and political discourse, issues that set the stage for the 2nd decade of the 21st Century and will determine the course of politics and the balance of power for years to come. 2009 began with a monumental event in history as America saw the first black citizen assume the office of the presidency. Most Americans met this milestone with enormous hope, hope that far out-sized any one man's ability, even the most powerful man in the world. Hope has turned to frustration as President Obama has struggled to unite political factions, quickly repair the economy or pass his landmark legislation, health care reform, to this point. The President has three years to recover; Democrats on the Hill have 10 months. Both have seen their fortunes turn rather dramatically since sweeping wins in November of 2008.

Democrats' health care reform legislation remains bogged down in flying sausage, though an end is potentially within site as Democrats desperately fight to give Obama a landmark 1st-year achievement and pass a bill before Christmas. I've written 8 posts on health care with a good bit of background and plenty of my views on the issue. In sum, health care reform is of critical importance to the longterm sustainability and decency of the country we all love, BUT, unlike Americans, all health care reform is not created equal and is not by definition a positive step forward for the nation. Health care reform which fails to address the fundamental issues underlying our health care crisis of costs, quality & coverage and only adds more people, programs and taxpayer dollars to a quickly failing system will only exacerbate the problem and send us faster into the abyss. This type of legislation is indeed far worse than doing nothing. This is not to say that all Democrat ideas embodied in their bills fit this profile, but those which do are a grave concern. Indeed there is room for hope that with some of the pilot projects in the Senate bill aimed at controlling costs, current legislation will be a first step in a long process of getting the system under control. Forgive me for being skeptical and believing Democrats have put the cart before the horse, expanding coverage with very little real effort to first control exploding costs. With all of that said, let's see where we are with 17 days remaining in 2009.

For months now, public opinion has been trending against Democrats' health care reform, with no momentum following passage in the House. The latest CNN poll shows 61% in opposition to the bill. Also, a majority disapprove of the President's handling of the issue. Americans' believe health care coverage is not the government's responsibility and that their costs will increase. They think it is the wrong time for health care reform in light of the economy, unemployment and the growing deficit, which most believe these bills will increase. Perhaps surprisingly, much opposition is from the left.

This has made health care reform an excruciatingly tenuous issue for Democrats facing voters in only 10 months. The fact that they are sitting on a very different political timeline than that of President Obama is causing much concern. These lawmakers are trying to figure out how a vote for health reform against the will of voters will be anything less than a death sentence for their political careers. Despite being the Senate Majority Leader, Harry Reid is in
more political trouble over health care than most members of his caucus as his state stands firmly against his bill. One idea is to push benefits up to 2010 in order to show tangible, positive results before voters head to the polls. Stu Rothenberg wonders Democrats are trying to walk off a cliff as those most likely to vote in 2010 are against the Democrats' reform.

The bills passed by the House and the one currently at play in the Senate are being decried by smart observers and activists on the right and left. The left complains that the bills do not contain a "robust" public option, aka quick trojan horse to single payer care, that they still leave millions uninsured and that the House bill restricts government subsidies of abortions. The right is incensed by the expansion of government control over patients' decisions and treatments, the fact that the bills bend the cost curve up instead of down as confirmed by the director of the Congressional Budget Office and the CMMS, the increase in individual insurance premiums, that they fail to block illegal immigrants from receiving coverage, that millions will lose their coverage, that they include potentially unconstitutional individual mandates, and that the Senate bill slashes Medicare, an arguably hypocritical stance. Some Democrats and liberals are also raising alarms over the costs of the bills and demanding the ban on taxpayer funds for abortion. These bills indeed send several of the President's promises down the river.

The dean of Harvard Medical School penned a must-read piece in the WSJ saying he gives the current bills a failing grade. In Dean Flier's words,

Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care...

The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost—and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform...

In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system...

In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.

As Harry Reid frantically tries to round of the 60 votes needed to pass his health care bill, even inserting $100 million dollars for Louisiana to get Landrieu's support, Joe Lieberman has become the biggest thorn in his side. Lieberman was one of the Democratic Senators (yes, I know he's technically an Independent following his 2006 loss in the Connecticut Democratic primary, but he caucuses with Democrats) to demand scrapping the public option from Reid's bill. They succeeded. Yesterday, Lieberman announced that he would vote against the current bill, due to its expansion of Medicare (a "compromise" many, including the Washington Post, believe is a faster route to single-payer than the public option). Democrat Ben Nelson is also against the compromise. With only 60 votes in his caucus, including Lieberman, and no Republicans likely to support the bill, Reid has zero room for error. Politico is reporting that Obama has told Reid to give Lieberman what he wants (a report the White House denies), but Reid is holding on as the Senate is in hurry up and wait mode for the CBO score of the latest compromise deal due in the next day or two. Meanwhile, in the House, Speaker Pelosi proclaims she is ready to do "almost anything" to pass reform this year, setting up a potential showdown with her liberal wing who won't like the watered down Senate version. Needless to say, these disputes among Democrats pose a grave threat to the self-imposed imperative of passing reform in 2009. Obama has summoned the entire Senate Democratic caucus to the White House tomorrow for a meeting at this "make-or-break" moment for his health care overhaul.

In the end, as David Brooks says, health care reform rests on a values question, our values individually and as a nation. Their is no clear right answer. It is a "brutal choice." No one in this debate is evil or selfish. With all of our similarities as fellow citizens we have different values. That is as it should be, and those values inform our stance on health care reform. As Brooks explains the dichotomy,

Reform would make us a more decent society, but also a less vibrant one. It would ease the anxiety of millions at the cost of future growth. It would heal a wound in the social fabric while piling another expensive and untouchable promise on top of the many such promises we’ve already made. America would be a less youthful, ragged and unforgiving nation, and a more middle-aged, civilized and sedate one...

We all have to decide what we want at this moment in history, vitality or security. We can debate this or that provision, but where we come down will depend on that moral preference. Don’t get stupefied by technical details. This debate is about values.

The other major story as we conclude 2009 is President Obama's bold decision to send 30,000 more American troops into combat in Afghanistan. Obama rightly sees Afghanistan as imperative for our security. As he put it in March, “This will not be quick, nor easy. But we must never forget: This is not a war of choice. This is a war of necessity. ... This is fundamental to the defense of our people.” Everything is easier said than done. At West Point, the President turned those strong words into strong action, much to the relief and pleasure of conservatives, who feared weakness, and to the dismay of many liberals. Indeed, on Afghanistan, the President is dealing with reverse coalitions. The political peril in the President's decision makes it all the more admirable.

The President has tried his much discussed soft, outstretched hand approach and against challenges, reality and limited success, has been forced to move on to plan B. His decision process on Afghanistan was long, laborious and, to some, amounted to dithering. It was clouded with leaks and angry conflict between the White House and its own commanders. However, he did come to a firm decision and is moving forward. This President operates in "analytic mode," dispassionate but serious and thoughtful.

In the next sentence after announcing the troop buildup, the President stated that troops would begin withdrawing in July of 2011, an obvious concession to his base. His advisors differ on how firm that date is, but we know now this President is serious about and taking ownership of this war. I, therefore, have little concern that he will cut and run in July of 2011. He said nothing about how steep said draw-down would be.

In Oslo last week, President Obama accepted the Nobel Peace Prize. He used the opportunity to give a poignant defense of war. This was no doubt jarring to his immediate audience but encouraging to conservatives at home who have worried this man is too naive and idealistic to lead in our world in which, as he stated, "evil does exist." We learn a lot about Obama the man through his speeches and some see the most recent as a move to the center, a place of strength for an American president, and a foreign policy shift as Obama bows to reality.

The stark reality is that terrorists dreaming of and plotting for the destruction of America are still not tired. We must fight on, steadfast in our commitment to freedom and security. To prevail we must have strong allies, a major question mark in Afghanistan. I hope and pray Obama's decision was right. I hope he found the perfect balance between our national security, his most solemn duty, and the risk to our brave men and women, our most precious treasures. Obama can win in Afghanistan, and if he remains firm in his resolve, conservatives and Americans at large will stand behind him through thick and thin, all the way to victory.

The economy, the one issue in politics that voters think about every single day, every time they pull out their wallets and every time they think about the future. The economy is the top issue for voters now as it has been for most of 2009. With unemployment rising to 10.2 percent in October and the '09 deficit topping $1.4 trillion, Americans are understandably worried and skiddish. The U-6 statistic tells us that a more accurate look at total economic dislocation is 17%, which includes underemployment. For Democrats, that means it's time to put jobs first or risk enraging the struggling electorate. With every passing day, the "rubble" of the economy is increasingly at Obama's feet, and Americans expect him to fix it. Interestingly, Democrats are more likely to be unemployed than Republicans. Blacks are worst hit, with 35 percent of the young unemployed.

While there are green shoots in the economy, recovery is scarcely touching jobs. The White House is doing its best to convince voters that the stimulus package has "created or saved" thousands of jobs, but watchdogs have concluded those advertised numbers are inflated, inaccurate, temporary or just made up. Now, finally, the White House seems to be turning its attention to the deficit, hopefully in earnest. The wave of debt payments facing the government have the potential of crippling the economy, again. Voters rightly see deficit reduction as the top budget priority for Washington, well above health care. At the same time, voters worry the government will do too much for the economy, making the situation worse and hampering recovery. Only 23% of Americans trust the federal government to do what is right. 76% prefer a free market economy, and Republicans are now trusted more than Democrats to fix the economy. Mitt Romney, an almost certain presidential candidate in 2012, has outlined his plan.

Americans need economic recovery. We need a renewal of "moral materialism" and the manic energy which has taken America from the banks of Plymoth to the pinnacle of prosperity, power and influence. We've survived the shocks of a year ago, but people are truly struggling and having a hard time seeing the light at the end of the tunnel. We must unleash market power and individual innovation to ensure a bottom up recovery for America, quick, strong and enduring.


As you enjoy the many college football bowl games this holiday season, think about whether or not the government should intervene to push for a playoff to replace the BCS system. Principled conservatives believe this idea, by a Texas Republican, should "draw a 15-yard penalty for unnecessary roughness to the idea of limited government."

On Tiger, how utterly disappointing. Read Bill Simmons' piece on the "zoo."

As far as views on Christmas across the country, 76% believe religious symbols should be allowed on public land, 72% prefer "Merry Christmas" to 'Happy Holidays" and 77% say they've been nice this year. I'm with the majorities!

As we move into decade 2 of the 21st century, we're witnessing the end of the email era as Twitter is changing the way we live.

Consider giving cash or gift cards this year. It's better for the economy.

Finally, I'm very proud of Raleigh-Durham, NC for being ranked the smartest city in America! Let's Go Duke! And Carolina is pretty smart too.

Have a Merry Christmas & Happy New Year!!
Seeya in 2010! Midterm elections anyone?!

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