HCR Roundup: Slaughter Strategy Fallout

by Benjamin Domenech on 7:31 pm March 16, 2010

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The tea party activists took to DC today in a big way, in person and on the phone. And a lot of their frustration seems to be tied to the so-called “Slaughter strategy,” which Speaker Nancy Pelosi (D-CA) says is great “because people don’t have to vote on the Senate bill,” which the Washington Post calls “dodgy,” and which makes Robert Gibbs duck. The whole thing has served to put Democrats on the defensive for adopting the parliamentary strategy, which has been used on occasion in the past, but never for a sweeping social reform of this magnitude, which will effect so many Americans.

The interesting part is that in reaction to opposition to the approach from within his own party, Majority Leader Steny Hoyer (D-MD) acknowledges this is a tactic that is only taking place because they don’t have the votes for the Senate bill as an “up or down” matter. But that’s been a talking point for the bill’s supporters since day one, and the American people clearly understand it. Does Hoyer really believe they won’t respond?

Today I talked to Maureen Martin, senior fellow for legal affairs with the Heartland Institute, on the latest podcast from Health Care News. We talk about whether the proposed Slaughter strategy is constitutional, the individual mandate, the Health Care Freedom Acts, and other topics — including whether the Supreme Court will rule on these issues, and when. We make reference to this column in the Wall Street Journal, which hashes out the Article I issues involved. You can listen to it here.

Closed Door Negotiations to the End

Michael Cannon at Cato has some questions for thoughtful Obamacare supporters, including: “What does it say that pharmaceutical-industry lobbyists are meeting with House Democrats to write this legislation behind closed doors? Or that the pharmaceutical industry is preparing to spend millions of dollars on advertisements in support of the legislation?”

This should be of concern to more than just reasonable Obamacare supporters. In particular, as Politico notes, it should concern people that:

Drug makers were asked to sign off on multiple solutions, giving Democrats backup options should any of the fixes run into problems passing muster with the Senate parliamentarian, who, because of procedural rules, essentially has the final say over what’s included in the legislative package.

This is jarring stuff — industry getting to sign off on public policy behind closed doors, policies the American people haven’t even been able to see yet? Talk about a disturbing lack of transparency, but that’s par for the course.

Don’t Worry, It’s Not Like Massachusetts

More warnings from the former Massachusetts Treasurer, a Democrat now running as an Independent, about the consequences of this reform package at the national level.

The Massachusetts treasurer said Tuesday that Congress will “threaten to wipe out the American economy within four years” if it adopts a health care overhaul modeled after the Bay State’s.

Treasurer Timothy Cahill — a former Democrat running as an independent for governor — said the local plan enacted in 2006 has succeeded only because of huge subsidies and favorable regulatory changes from the federal government.

He asked, “Who, exactly, is going to bail out the federal government if this plan goes national?”

Cahill’s remarks serve as one more illustration why the people of Massachusetts delivered such a surprising electoral victory to Scott Brown in their primary: disgust with their state’s attempt at reform.

The Emergency Room Myth

A strongly worded piece from Robert Samuelson today, worth noting because of its rebuke of one of the oft-repeated justifications for nationalized reform which, like so many others, falls apart upon further study:

How often, for example, have you heard the emergency-room argument? The uninsured, it’s said, use emergency rooms for primary care. That’s expensive and ineffective. Once they’re insured, they’ll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it’s untrue.

A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency room use remained higher than the national average, reports an Urban Institute study. More than two-fifths of visits represented non-emergencies. Adult respondents to a survey said it was “more convenient” to go to the emergency room or they couldn’t “get (a doctor’s) appointment as soon as needed.” If universal coverage makes appointments harder to get, emergency room use may increase.

The Pro Life Case

Pro-life groups are pushing back against arguments that the Senate bill’s protections against abortion funding are acceptable (they aren’t). Groups are organizing events and running ads, and the Catholic Bishops released a statement detailing their opposition:

The American people and the Catholic bishops have been promised that, in any final bill, no federal funds would be used for abortion and that the legal status quo would be respected.

However, the bishops were left disappointed and puzzled to learn that the basis for any vote on health care will be the Senate bill passed on Christmas Eve. Notwithstanding the denials and explanations of its supporters, and unlike the bill approved by the House of Representatives in November, the Senate bill deliberately excludes the language of the Hyde amendment. It expands federal funding and the role of the federal government in the provision of abortion procedures. In so doing, it forces all of us to become involved in an act that profoundly violates the conscience of many, the deliberate destruction of unwanted members of the human family still waiting to be born.

The Job Ramifications

We’re not just talking about physicians jobs — though the fallout of health care reform for those are significant, according to the latest news from the New England Journal of Medicine:

46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

But the latest piece from Yuval Levin and James Capretta outlines why the reform package is essentially an anti-jobs measure:

Beyond taxes and spending, Obama-care would also wreak havoc on the labor market. Because employers would get penalized if any of their low- and moderate-wage workers ended up in the new subsidized insurance pool, they would avoid hiring such workers. Democrats claim they want to jam through health care reform so they can turn their attention to jobs, but the bill provides a strong disincentive for businesses to hire those who need jobs the most.

The plan would, moreover, trigger an inefficient and costly re-sorting of American labor. Under the bill, despite the enormous cost of subsidizing coverage in the new government-run “exchanges,” only 18 million people would be getting such subsidized coverage in 2016—even though there are 127 million Americans today with incomes in the targeted range of between one and four times the poverty rate. The vast majority of workers would still be in job-based plans and get no additional help. Gene Steuerle of the Urban Institute estimates that a worker making about $60,000 per year in 2016 would get $4,500 more in federal aid if he were able to get his insurance through an exchange rather than through his employer. That’s a powerful incentive for workers and firms to rearrange their operations to take advantage of the federal money. In time, the American economy would be divided into companies with low-wage workers getting government-subsidized health care and others with higher-wage workers who continue to get employer-based plans. This would make the labor market far less efficient (harming productivity), and it would mean that the subsidies themselves would cost far more than the CBO now estimates.

And for those workers who do end up getting federal subsidies for their insurance, the program is a trap. If they get a pay raise, they will lose some of their insurance subsidy. Indeed, the schedule of subsidy withdrawal is so severe that it will push many low-wage families into effective tax brackets of 60 percent to 80 percent, according to a CATO Institute analysis. Obama-care would thus provide a strong disincentive to work and so undermine the most successful policy initiative in generations: welfare reform.

This follows on the same path that my own piece at CBS did this week, on Obamacare’s Two Americas.

crossposted at Health Care News.

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