John Moser's post put me in mind of Ross Douthat's comment that while individual Republicans might have credibility on the health care issue, the party as a whole (and especially the top congressional leadership) does not. I mostly agree with both John and Douthat, but I would like to add my own thoughts.
1. Parties are always getting better and worse. A Republican President imposed wage and price controls. Another Republican President appointed John Paul Stevens to the Supreme Court. Parties should never be trusted, and can never have clean histories, but they can be moved to better directions.
2. Republicans deserve alot of criticism for their neglect of the health care issue, but as Avik Roy pointed out in National Affairs many of the ideas for market-oriented health care only matured in the 1990s. The Republicans and most other center-right institutions were slow to pick up on and popularize these ideas, but not quite as slow as one might think. It wasn't like any of them had been taking those ideas in with their mother's milk. My first exposure to those ideas was in a Christopher DeMuth speech on CSPAN.
But the slowness in engaging with and popularizing those market-oriented health care ideas had consequences. One of them is that you get taunted for your party's past flirtation with a policy of mandating and subsidizing what amounts to comprehensive private prepaid health care as a way of avoiding a single payer system. Those taunts are actually the least of the Republican's problems. The biggest problem is that the failure to popularize those ideas in the past, imposes costs on the party leadership if they want to talk about them now.
Take Douthat's criticism of the Republicans for not offering a Ryan or Daniels approach to transforming the health care system as an alternative to Obamacare. In the real world, the past failures to popularize market-oriented healh care put all of the short term political incentives against such a strategy. There would have been no internal consensus within the party about which type of market-oriented policy to follow. There would not even have been a real consensus in favor of such a general approach. Does anyone think that the two Republican Senators from Maine would stick their necks out for any market-oriented health care policy without clear evidence that the public was strongly in favor of such an approach? Another problem is that the public starts off with zero understanding of those ideas and a great deal of anxiety about losing their access to our health care system. The Democrats would have been able to launch a devastating series of attacks (at least as effective as those launched against Obamacare) and the Republicans would have been on the defensive having to spend enormous amounts of time trying to explain what was wrong with the Democratic attacks. I wish they had. I think the long term investment would have been worth it, but I'm not trying to win a congressional election in November. As a tactical matter, it made sense to combine an attack of Obamacare's mandates, Medicare cuts, and tax increases with offering an alternative that consisted of a series of uncostly regulatory changes that would put downward pressure on premiums but leave the system untransformed. If the choice had been between Obamcare versus Ryancare (which included Medicare cuts), rather than Obamacare vs. a center-right tweaked status quo, public opinion might well have been more favorable to Obamacare in the short run. That might well have translated into an easier time passing Obamacare and fewer Republican gains in Novemeber.
Douthat is of course right that by not making the harder but more farseeing choice, the Republican congressional leadership missed one more chance to begin the process of educating the public about market-oriented health care. It is an irony that the political incentives that made that choice so hard were put in place by the failures of earlier Republican Presidents and congressional leaderships. It is a vicious circle. Or maybe not. Maybe the problem is one of expectations. Maybe it makes no sense to expect the congressional leadership to unite their party around a set of policies the public does not yet understand. Maybe the congressional leadership enters into the picture at some later time, when tens of millions more people have been exposed to the arguments for market-oriented health care and have heard the criticisms of market-oriented health care answered in detail. The first step of getting the public to gain a basic understanding of market-oriented health care is not going to be taken by John Boehner. It will have to be taken, if it is taken at all, by back bench or more junior leadership members of Congress, by governors and presidential candidates, and by all the institutions of the right of center that have an audience. There is no one else.
Although the government pretends otherwise, Social Security and Medicare are, in fact, welfare programs. There is no relation to today's payroll tax payments and tomorrow's benefits. In fact, we simply pay current benefits out of today's taxes.
That gives me an idea. Conservatives sometimes note that roughly 50% of Americans don't pay income tax. The Left replies by pointing to the payroll tax. If we classify it honestly, as a transfer payment, that is correct.
The only way to end the myth that social security and medicare are pensions is to kill the payroll tax. There's nothing left to cut in the income tax for close to a majority of Americans, if memory serves. Including the payroll tax in that calculation would change that. By eliminating the payroll tax, and rolling it all into the income tax we find a way working class Americans and, at the same time, create a more honest and transparent tax policy. That would also set up a major change in federal old age benefits that would help with the long-term deficit. It would make a convenient time to means-test benefits. Why should wealthy people get transfer payments. As a result, we could get a more "progressive" tax system and system of federal hand-outs, and, at the same time, we eliminate the myth that our old age hand-outs are, in any sense, pensions.
Republicans have lately been denouncing mandatory health insurance as an unconstitutional assault on personal freedom. However, in the 1990s many of them were actually touting mandatory private health insurance as a "free-market" alternative to government-run health care, as this article illustrates. Even the Heritage Foundation was pushing it, and this partly explains why Obama publicly opposed it during his presidential campaign. There are, of course, plenty of reasons to object to the recent legislation, but this demonstrates, once again, that the GOP is a weak reed on which to rely on matters of individual liberty.
Yesterday, the Washington Post argued that Congress may regulate health insturance throughout the Union because health care is a "commodity,"
The Supreme Court has given Congress wide but not unfettered latitude in regulating interstate commerce. It barred federal efforts to promulgate laws that ban guns near schools and those addressing violence against women, ruling that these activities have nothing to do with commerce. But health insurance is a commodity, and a consumer who sits on the sidelines has a significant impact on the market.
Strange argument. I thought that the Court ruled that the gun free school zone act was unconstitutional because it did not regulate commerce, not because it was regulating commerce, but, at the same time, that commerce was not interstate. The same is true of the other case. The court was saying that not all activity is commerce, even if it might, in some way, have some consequences for the market.
What's behind the Post's language, I suspect is Wickard v Filburn, a ruiling of the FDR Court which ruled that a farmer growing wheat on his own land for his own use was still engaging in interstate commerce, because his actions had an impact on the market as a whole. What was really going on is that many other farmers were doing the same thing, trying to get around the limits the federal government sought to impose on wheat production. If there was a private use exemption, the regulation would be greatly weakened, therefore, the court argued, the law must allow the U.S. government to limit a farmer's use of his own land for his own purposes.
The trouble with that ruiling is not that it is entirely illogcal. One can make a case that the decision was, indeed, necessary to regulate interstate commerce in the fashion the federal government wanted to. The trouble is that it makes a mockery of the Constitutional text. Regulating the amount of his own, private land that a farmer may use is not a constitutional means of economic regulation. If the Congress has the right to regulate "interstate commerce," and not simply "commerce" throughout the U.S., that necessarily implies that there is such a thing as non-interstate commerce. The Court ruiled that, in effect, there is no such thing. As Thomas Jefferson noted long ago, "It is an established rule of construction where a phrase will bear either of two meanings, to give it that which will allow some meaning to the other parts of the instrument, and not that which would render all the others useless." The Court violated this rule in Wickard, ruiling that, in effect, all commerce is interstate commerce, and thus interpreting an important provision of the Constitution out of existance.
P.S. As Randy Barnett reminds us, in the eyes of the Constitution, "commerce" does note mean "economic activity," even if that's how our ruiling class tends to understand it nowadays.
Update: I wrote the above in a bit of haste as I was rushing off to a meeting. I fear I didn't quite complete my thought. It may be true that one could argue that all farming is, somehow, connected to interstate commerce. That was no less true in 1789 than it is today. The logic of the constitution suggests that simply having an impact, however remote, on the general flow of commerce across statte lines, is not a sufficient condition for concluding that an activity may be regulated as "interstate commerce" in the eyes of the constitution. Beyond that. the language of the constitution is built upon a deepter understanding of the nature and purpose of government, and that deepter understanding is the criterion which we should use to interpret the text.
Supposing, in my old house, for example, I discover the dry-rot beginning in the timbers, or that my foundation is settling a little, or perhaps my neighbor is setting up a business that affects the purity of the air. . . . What am I to do then? Must I be conservative here too? The true conservative policy in such a case is not submission, but reform--something that will restore to me the advantages of my old way of life; something that will prevent me suffering by a most unpleasant change.--Speech of Charles Francis Adams to the Republican National Convention, 1860
1. Patrick Ruffini says alot of the stuff I've been trying to say only better. He is right to mention all the honorable conservative policy analysts who have been trying to develop free market-oriented health care policies. He is also right that the failure of the right to sell the public on those policies (or even make the average citizen aware that such policies exist) gave liberals the initiative, and made it much easier for liberals to pass a government takeover. My one reservation is that a free market-oriented approach that gets traction won't be a "Republican" approach. To the extent that a free market-oriented approach will tend to first appeal to conservative Americans, and to the extent that those Americans are concentrated in the Republican party, free market-oriented health care will tend to win most of its earliest and most fervent converts among Republican voters and leaders. But if supporters of free market-oriented health care start winning the argument (HUGE if), converts from the Democrats will be found for both reasons of principle and calculation. Some of that happened in the debates over tax cuts and welfare reform. Its not for nothing that one of the best recent articles in favor of moving in the direction of free market-oriented health care came from a Democrat writing in a liberal-leaning general interest magazine.
2. Ross Douthat is wasting his sympathy on Stupak, but he otherwise makes some good points. Stupak is a discredit to every category with which he is associated - to include Democrats, politicians and carbon based life forms. But Douthat is right that there is a pro-life constituency out there that is uncomfortable with the liberal position on abortion, but also uncomfortable with much conservative rhetoric they are hearing on economic issues. A well thought out, well articulated, pro-family economic agenda might go a long way to winning over many voters that are not impressed by what they hear at the Tea Parties.
3. John Cornyn demonstrates some of the problems inherent with trying to repeal Obamacare without having a better alternative in sight. There are parts of Obamacare that poll well and some that poll really badly. The problem will be in trying to cherry pick what gets repealed based on what will help Republicans make short term gains in November. The problem is that the popular stuff (like guaranteed issue) and unpopular stuff (like the mandates, tax hikes, and Medicare cuts) tend to go together. As Douthat points out, getting rid of the unpopular stuff that pays for the popular stuff makes Obamacare worse rather than better. The regulations like guaranteed issue would make premiums higher (indeed would make health insurance a joke), and getting rid of the tax increases and Medicare cuts would balloon the deficit by hundreds of billions more dollars. The only responsible way to beat the combination of popular and unpopular elements of our new Obamacare system will be to convince the public that there is a better alternative on offer.
Richard Adams explains why one of the unintended consequences of the recently-passed health care reform is likely to be a rise in medical tourism. Here is one more, courtesy of economist Steven Horwitz:
Requiring that insurance companies cover people with pre-existing conditions is like asking an auto insurer to cover a car with demonstrably bad brakes. That is, it's not so much insurance as it is an outright subsidy. Larger firms will probably be able to afford this, particularly with the individual mandates, but smaller ones will be pushed to the wall. The result will be an oligopoly. Of course, for most liberals the bill is only supposed to be a way station on the road to a single-payer plan, so they might not see this as a problem.
Men and Women
I think that the initial job of selling conservative approaches to health care will have to be a decentralized approach in which dozens and dozens of center-right elites make it a mission to explain health care to the public on many different platforms over of period of years.
The passion against this intrusion goes beyond the mind-numbing numbers. Health care affects each of us in an intimate and personal way. The American people's engagement is driven by our deep aversion to the federal government's unprecedented reach into our lives. The entire architecture of this overhaul is designed, unapologetically, to give the government greater control over what kind of insurance is available, how much health care is enough and which treatments are worth paying for . . .
. . . The proponents of this legislation reject an opportunity society and instead assume you are stuck in your station in life and the role of government is to help you cope with it. Rather than promote equal opportunities for individuals to make the most of their lives, the cradle-to-grave welfare state seeks to equalize the results of people's lives.
The indefatigable Michael Barone has an excellent piece this morning on federal bond prices over the last few days. In short, U.S. bonds are ascending to higher levels of risk in the eyes of investors. Buffett's Berkshire Hathaway and Proctor & Gamble are now safer investments. Of course, the increasing expense for the government to borrow, made exponentially worse by Obamacare, raises the next move for Obama. The markets are obviously making decisions that incorporate the future effects of this legislation on U.S. fiscal policy. Thus, the bond markets, not the CBO, accurately reflect the true consequences of the Healthcare reform bill.
We now come to Obama's next move and this is to push for tax increases and some new tax to stabilize this process of escalating borrowing costs for the Treasury. I fear that on a push for a national sales tax or other increases in taxation Obama will be able to paint himself as the responsible one trying to manage government growth and ensure broad equality. Conservatives will have to engage in persuasion, actually making real arguments and not just venting at Obama, across the electorate to stop this eventuality. The case will have to be made along the lines of Ryan's RoadMap, and the notion, classically expressed by Hayek that we must reintroduce the price system and its crucial role in allocating resources and services back into the healthcare market. To do this in a convincing fashion is now the real test.
Every bill has unintended consequences. That does not mean one can't predict what that are likely to be, if one pays attention. People don't like being told what to do, and will, if possible try to find ways to avoid laws.
In the case of the increasing concentration of health care regulation and payment by the federal government, the predictable consequences is the likely increase of medical tourism. The more the U.S. market is squeezed, the more incentive there will be for quality doctors to offer their services abroad, and let Americans who can pay come to them. One interesting, and related, question, is whether U.S.insurance would cover the costs. On one hand, it would probably be less expensive for each procedure. On the other hand, part of the reason why that would be the case is that doctors would be less well regulated.
On the other side, would a U.S. citizen be allowed to buy a basic, high-deductable, catastrophic-care policy from a foreign company? Would that qualify as meeting the insurance mandate, assuming the Courts don't have the guts to strike it down.
It is difficult to imagine the Ninth Circuit as any more radically liberal than it already is. Despite a few stellar judges, the Court is full of liberal activists who have earned it the reputation of having the highest Supreme Court reversal rate of any court in the nation. But, with his latest judicial nominee, President Obama just may do what seemed impossible.
There are many red flags in the judicial record of Ninth Circuit nominee Goodwin Liu, who is Associate Dean at the University of California Berkeley Law School.
Judicial Philosophy: Though Liu has stressed "constitutional fidelity" in several articles, he has also stated that he "envisions the judiciary...as a culturally situated interpreter of social meaning." While this statement makes it ever so clear that Liu is an academic, it also makes clear that he does not understand the judiciary's role. Judges are not interpreters of "social meaning." They are interpreters of the Constitution and laws. Regrettably, it is just this sort of loose theory that allows judges to ignore the plain and ordinary meaning of the Constitution and statutes, and to instead replace it with what they personally think is best based upon their subjective interpretation of "social meaning."
Constitutional Welfare Rights: Liu has a strong penchant for redistribution, and it is clear that he believes judges should play a role in it. In an article titled, "Rethinking Constitutional Welfare Rights," he lays out his vision for the creation of a constitutional right to welfare. He desires a "reinvigorated public dialogue" about "our commitments to mutual aid and distributive justice across a broad range of social goods." Once this dialogue takes place among policymakers, Liu wants the courts to recognize "a fundamental right to education or housing or medical care...as an interpretation and consolidation of the values we have gradually internalized as a society."
In another article, he stated that "negative rights against government oppression" and "positive rights to government assistance" have "equal constitutional status" because "both are essential to liberty."
Unfortunately for Liu, our Constitution's Framers disagree. They recognized that these two concepts are indeed mutually exclusive: if we allow the government to "assist us" by giving it a redistributive power over our personal property and the power to control health care, education, etc., individual liberty will necessarily erode. Indeed the Framers sought to prevent such redistribution by limiting government's power and providing what Liu considers as "negative" property rights. These protections have already been eroded by activist judges, and it is clear that Liu would like to erode those protections still further.
Radical on Death Penalty: Liu has been outspoken in his opposition to the death penalty. Kent Scheidegger of the Criminal Justice Legal Foundation has stated that, "To anyone familiar with the death penalty debate, it is painfully evident that Professor Liu takes the murderers' side on every debatable point. If confirmed, there is no doubt in my mind that he will be a vote to obstruct the enforcement of capital punishment in virtually every case."
Reasonable people can disagree on death penalty policy, but it is not up to judges to determine that policy or undermine it through judicial obstruction. The American people decide through the democratic process whether their respective states will utilize the death penalty. The judge's role in capital habeas corpus cases in the federal court of appeals system is predominantly to assure that grave errors were not made in the process--the questions of guilt or innocence and sentencing are reserved first and foremost for juries and are decided by multiple state and federal appeals before a federal appeals court judge takes a first look at the case. But too many activist federal court of appeals judges treat death penalty cases like they are hearing them de novo--like it is their job to put themselves in the place of the jury, so that they can impose their own preferences, rather than simply review for actual legal errors. Given Mr. Scheidegger's warning, there is little doubt that Liu would be just this sort of judge.
Racial Preferences and School Choice: Ed Whelan has pointed out that, in an article titled "School Choice to Achieve Desegregation," Liu never embraces or even states his agreement with the Supreme Court's 2002 ruling in Zelman v. Simmons-Harris that school-choice programs that include religious schools are constitutional. However, Liu is willing to embrace school choice if it is directed to the illegal end of ensuring racial quotas in schools. For example, Liu advocates "a funding set-aside in federal and state charter programs to create and reward charter schools that reflect the racial and socioeconomic diversity of the metropolitan area...where they are located." These set aside programs should "use the racial composition of the broader metropolitan area as the reference point for measuring and rewarding diversity."
Liu's other writings also make clear that he would impose racial preferences directly if he could.
Lacking Experience: Ed Whelan and The Washington Times have noted that Liu does not even meet the standard for federal judgeships outlined by the American Bar Association, which includes substantial courtroom and trial experience and at least 12 years practicing law. Thirty-nine year old Liu has no experience as a trial lawyer and has not even been out of law school for twelve years. (The fact that the ABA nonetheless rated him "well-qualified" suggests that their ratings are perhaps based on something other than qualification.)
Many pundits are speculating that the Ninth Circuit may be Liu's stepping stone to the Supreme Court. If this is the case, he could potentially be one of the most activist justices the High Court has seen yet. Even the Washington Post admits that Obama's other federal nominees have been "more moderate" than Liu.
Liu's confirmation hearing before the Senate is tomorrow.
Cross-posted on the Foundry.
For reasons ranging from the sublime to the ridiculous the conservative movement must focus on the politics of repeal. Failure to make this argument because of the difficulty and challenges involved in achieving repeal of Obamacare are I believe beside the point. Many conservative intellectuals will point to the difficulty of rolling back elements of the democratic welfare state. While the facts of this particular argument are hard to ignore, there are crucial moments will retrenchment, if not repeal, of welfare state programs are eminently possible. I believe we are in such a moment. Reuven Brenner of McGill Business School has written on these possiblities in the course of his broader reflections on democratic finance and its ability to level government spending and power. In short, voters will turn on profligate government spending when they clearly understand that the funding model for these policies is no longer juiced. This requires information and awareness that an entire political-fiscal-social model is no longer viable. To refuse to act is to accept death. We seem obviously to be at the end of a fiscal model that has powered government spending and its entitlement programs for decades. Moreover, the voters are aware of this fact. Assuming the accuracy of Brenner's reflections, and solid precedent is available, even in our own country, then repeal is not just a strategic political calculation to energize activists and focus the tea party movement, but is something doable that will stabilize our country. If not, then conservatism in America will again find itself playing on terms set by the Progressives. We can look forward to another generation of arguments where we eventually do nothing but urge adjustment and try to retard rapid fiscal growth.
David Frum is very wrong in his argument that Republicans should have tried to compromise with the Senate health care bill as the basis for some right of center tweaks. The problem was that a national version of state-mandated comprehensive health care prepayment really is a move in the wrong direction whether it is financed by taxes on income, investments, energy (seemingly Frum's preferred method) or high-end health insurance policies. And Obama wasn't going to go for a real left/right compromise (one that might have included direct subsidies for health insurance with opening up the market for HSAs and high deductible policies). Obama wanted a reform that would be transformative from the left. His first preference was for a straight single payer system. His second choice was for a public option that would get us to single payer on the installment plan. His third choice was the corporatist arrangement we just got. This was the leftmost bill he could get past his swollen congressional supermajorities. It was never about the Republicans (though it would have been nice if they would have signed up for some bipartisan cover). It was about what "moderate" [spitting sound] Democrats could be bribed and browbeaten into accepting.
I think that the strategic error made by conservatives and Republicans was more subtle and older. I think that if conservatives and Republicans had done a better job (and worked alot harder) at explaining right-leaning ideas about health care policies, the Democrats would not have been able to seize the initiative in quite this way even if with their supermajorities. There is a reason why Obama and Pelosi aren't trying to return to the pre-Reagan marginal tax rates or launch a principled frontal attack on 1996's welfare reform or try to ban a bunch of rifles. Conservative victories in the realm of public opinion placed limits on what a liberal President and liberal congressional leadership are willing to do. The conservative error was in things that were unsaid and undone since the failure of Clintoncare. So much time time wasted on arguments about my tax cut is better than your tax cut, compassionate conservatism, John Kerry looking French, and elitists picking on Sarah Palin because she grew up in a small town and didn't go to an Ivy League school. Now, when conservatives try to explain the Ryan Plan or the Goldhill strategy of the incremental Levin-Capretta strategy, they start at square zero with the average American,
One Democratic talking point about the health care bill is that it is not a national takeover because citizens will still be purchasing insurance from private corporations, rather than simply going to a government paid doctor. At some point in time, however, an industry grows so heavily regulated that the businesses are no longer truly private enterprises. Perhaps utilities fit this bill. Hence we should ask whether, after these new regulations become law, insurance companies are still truly private corporations.
I am reminded of a bit of wisdom, or something like it, from the editors of the Legal Papers of John Adams: "It was common 18th-century practice to divide the proceeds of such suits, a third each to Governor, informer, and Crown. In many situations, fees and forfeitures were used to encourage an element of private enterprise which helped to keep salaries low and place the cost of government on those who invoked its powers." To call the work by government officials, backed by the powers and instruments of law "private enterprise" because they could exercise individual initiative, is a perversion of language. The same might be true of health care in the U.S.
National Review has a symposium on what to do in the wake of Obamacare. I mostly agree with Tevi Troy's idea that Republicans should push for particular changes to the health care bill in the direction of tort reform and the liberalization of the health care market to allow the offering of low cost high deductible policies and connecting those policies to a relentless political operation that tries to sell the benefits of those policies to the public. The changes won't happen in 2011, and they might not happen in 2013 or 2015, but if the public can be won over to such policies, the chances of moving away from Obamacare increase a lot.
The first instinct among many conservatives is to argue for a simple repeal of Obamacare. That is what most conservatives want - even more than any particular reform. Repeal also has the seeming advantage of uniting conservatives with nonconservatives who were happy (or at least not too unhappy) with the pre-Obamacare status quo. The problem is that this alliance of conservatives and cautious nonconservatives will weaken with time if it is based on mere opposition to Obamacare. No matter what happens in November, Obamacare will not be repealed for as long as Obama is President. The veto pen will see to that. The cautious nonconservatives will, over the next few years, get used to the new status quo. Most Americans are happy with the quality of their medical care and that quality will not be change much or at all in the next few years. Fears of government rationing are well founded, but it will take years and years of overpricing and overuse to get there. Many of the cautious nonconservatives will become invested in the new system, and only a well argued positive alternative will get them to to take the risks of major change. And soon enough, changing back o the pre-Obamacare status quo will be just as big a change as moving forward to a more free market-oriented alternative.
My great worry is that conservative passion about the health care and the public's attention to what conservatives have to say will be wasted in an unproductive cause that lets conservatives vent their spleen in the short term but leaves them with no real political or policy gains. I look at the Sotomayor confirmation hearings. Conservatives could have used them to highlight widely shared concerns about judicial liberalism related to issues like the Second Amendment, partial birth abortion, and the death penalty. Sotomayor might have dodged, but the public would have heard conservatives on those issues and every time Sotomayor voted with the Supreme Court liberals on those kinds of issues, conservatives would have been in a stronger position to tie Obama and the Democrats in general to her positions. Conservative instead wasted too much time and energy on the "wise Latina" crack. It just felt too good to tweak liberals that one of their own had made such a slip, even though that attack didn't go anywhere (it was never going to sink her nomination and it is doubtful she will be some kind of racist Latino supremacist from the bench) and might have alienated some Latino voters.
I suggest that the best course for conservatives (and that includes the Republican leadership, prospective 2012 Republican nominees, and the right of center pundit and popularizer community) is to start making the long term investment of explaining to the public the benefits of various conservative health care reforms. Paul Ryan, the think tankers, and the people at National Affairs can't do it all by themselves.
Over the weekend, I was on the exercise bike reading the March Madness issue of Sports Illustrated when I was surprised by a full page ad placed by the U.S. Census Bureau. Written in an average Joe script, it said: "If we don't know how big our community is, how do we know how big our hospitals need to be?" Coming on the weekend ObamaCare passed, this ad almost perfectly expresses the "administrative despotism" that Tocqueville warned against. First of all, it is so reasonable and caring, who could be against it? I was enjoying the lowly pleasures of college basketball, but even I can agree with my neighbor, Mr. Census Bureau, that "we" should have hospitals big enough to serve "our" community.
On the other hand, the ad implies that a national census is the only or best way to determine how big any community is. It also suggests that the size of one's community is the sole or main consideration in determining the size of hospitals. Sure, the Census Bureau could add other considerations to the mix, but the point is that central planning inevitably simplifies and standardizes. And that - central planning - is the ad's most important premise: one arm of the Federal bureaucracy will supply the information that another arm of that bureaucracy needs to deliver services. The ad implies (at least to someone in small town Ohio) that decisions about the size of hospitals should be made by some distant experts, or at least with their information and under their guidance. And that mix of compassionate and gentle though irresistible suasion from outside is the problem. The more the decisions that affect our lives are made by others, Tocqueville argued, the less opportunity each citizen has to use and develop his or her own faculties and the less attached that citizen will be to his or her own community. The immediate danger is not tyranny, but that in turning over more and more decisions to the government shepherd, we become less and less like self-governing citizens and more and more sheep-like.
We're sure to hear a lot of oratory in the coming days about yesterday's great legislative accomplishment. The administration will be thanked for its relentless pressure on wavering Democrats, as will Nancy Pelosi and her lieutenants. And we'll certainly hear a great deal of praise for Bart Stupak for the outrageously low price he set for his alleged pro-life principles. But there are others who will no doubt be left out of the speeches, even though they deserve the thanks of the Democrats:
1) The Republican leadership in 2003, for meritorious service in forcing through a massively expensive prescription drug benefit for senior citizens, using every legislative trick in the book to overcome bipartisan opposition. This undoubtedly made GOP criticism of the current bill--on grounds of expense, as well the Democrats' tactics--seem partisan and hypocritical.
2) Anthem Blue Cross of California, for its invaluable assistance in making the Democrats' case for them by suddenly announcing in February that it was jacking up its premiums by a whopping 39 percent. From the White House's perspective, the timing of the rate hike couldn't have been more perfect, as the Senate bill looked to be in serious jeopardy.
3) Finally, special recognition must go to the unnamed yahoos in the crowd of protestors outside the Capitol Saturday who thought it was a good idea to hurl racial epithets at members of the Congressional Black Caucus. What better time to resuscitate the old chestnut that opposition to Democrat policies equals racism? How con-VEEEN-ient, one might say....
The Dems get rid of their "pro-lifers," who will be wiped out in 2010. Republicans get to run against "deem and pass" Dems for a good decade or so, at least, if they understand how to teach constitutional government and the rule of law. Impeach Obama for signing an executive order he knows is unconstitutional? What about Bush signing McCain-Feingold into law, while saying he believed it unconstitutional? Republicans need to convince themselves about the Constitution before they can preach it to others.
Of course now GOP can demagogue about how every medical tragedy and disparity in treatment results from Obamacare, just as the Dems did with insurance companies.
See Paul Ryan for a higher road.
So the House vote is going pretty much as I figured. The moderates are folding to their party leadership. But I didn't think that Stupak would sell himself so cheap. Just goes to show that when it comes to our current politics, you can't be too cynical about or contemptuous of those politicians who get the label of"moderate" (or even worse, pro-life Democrat).