“The time for debate over Health Care Reform has come to an end” (President Obama -Health Care Summit, Thursday February 25, 2010)

“Let us get it done”
(President Obama address, March 3, 2010)

At the Health Care Summit which has taken place on Thursday, February 25th, 2010, the President sought to elicit support for the health care reform bill before Congress in the hope that the deadlock over its passage may be broken. Another motive more significant perhaps is to gain the support of one or more Republicans so that the passage of the reform bill may be touted as “bipartisan”. To those of us who have watched the progression of the bills (The House and Senate) from their inception more than a year ago until their final resting place in the hands of the democratic majority in the House and the super majority in the Senate, it is not only disheartening to witness the dysfunctional public sector but worse than that the egotism and self promoting public servants at the expense of those they are supposed to serve.
Having said that, it does not follow that elected public servants do not serve their constituents in voting for or against a legislation. But the spectacle of the debate on the health care reform, if nothing else it has confirmed what ordinary Americans (not the health care experts, journalists as well as health economists) have maintained for decades—that the federal government is ‘BROKEN’ that changing the man at the helm does nothing to fix it.
The 2008 campaign put forth the priority to fix the nation’s health care system. At the February 2010 Summit and in speeches given by both Republicans and Democrats there and elsewhere the public is told that the US health care system is riddled with inequities and inefficiencies and that something has to be done to correct it.
Having acknowledged these deficiencies, politicians and experts alike do not go about the business of addressing those issues in a manner consistent with the public interest but rather to promote their own ideas or better yet, their self importance.
Being a Republican or a Democratic member of Congress should not be the overriding reason to accept or reject the reform because it is put forth by a Democratic President. Our newly elected Senator from Massachusetts in his critical assessment of the reform bills before congress argued that the Obama Health Care Reform is not so good for Massachusetts. Massachusetts after all passed over the objections of some Republicans Health Care Reform that requires all Massachusetts’ residents to have proof of insurance coverage and penalizes those who do not. It is interesting that Senator Brown uses Massachusetts as an example that the reform did reduce the cost of insurance. Most significant perhaps is the fact that the Senator’s remark that what is good for the nation is not good for Massachusetts flies in the face of what the “Constitution” stipulates: The United States public sector is a federal system comprising three levels of governments: National, State and local. The legal division of responsibility among the three levels is found in the Constitution and in court interpretation of the Constitution. The Constitution divides the powers of government: Those of the national government are specified in articles I, section 8, while those of the states and their subdivisions are residual. The federal government, through Congress, was given the power to levy and collect taxes, duties, imposts and excise, to pay the debts and provide for the common defense and general welfare of United States. During the 1930’s, amidst the problems and pressures of the greatest depression in US history, there developed a Judicial interpretation of the Constitution which accepted a reading of the general welfare clause that placed no discernable Judicial limits on the amounts or purposes of federal spending (for details on federal, state and local responsibilities, see Ott, D. and A. Ott, Federal Budget Policies, Third edition, The Brooking Institutions, 1978; see also, A. Ott, Public Sector Budgets: A Comparative Study, 1993, Edward Elgar Publishing, ch. 6) Hence, the federal government and not each state has a constitutional duty to enhance the welfare of the citizens. Given that medical care enhances welfare, the federal government has a responsibility to promote the welfare of all citizens.
Disinformation along with a “heap” of unsubstantiated claims has soured the public about health reform—any reform regardless of who has originate it. In an AEI commentary “Here’s the RX for a Bipartisan Health Care Reform Bill” (American Enterprise Institute, February 24, 2010), Norman J. Ornstein addresses both of my comments. First he states that “ The plan that Obama has put up on the White House website, while basically built on the senate-passed bill as amended by the House and refined by the President, is no radical leftist plan, much less a government takeover of our health care” . Second, that “The public unhappiness with health care reform is built not on the substance here but on the distrust of Washington polls, the messy and the rancorous powers and the unease about a leap of faith to get change”.
The media and the Republicans summiteers keep repeating that public opinion is against the reform. It would be enlightening if the media were to focus a bit more on how a majority who put Obama and the Democrats in Congress are turning against one of the pillars of the Democratic agenda. But this is another story.
Let me now turn to the “Summit”. Politicians and commentators are fond of using mega phrases for an event to signal not the importance of said event but of who’s who attending the event. Merriam-Webster dictionary defines the word “summit” as “the highest point attained or attainable”. That, it “implies the top most level attainable”. In the political arena the “summit” label is meant to confer a status of the event not in terms of the issue, of “the raison d’être” of the Summit but rather in terms of who is attending the Summit.
An event, hence, is called a summit if attendees are heads of states (like the G-20 Summit) or that the attendees are highest-level officials. The Health Care Summit is clearly an event that brought together congressional leaders—officials at the highest level of government. (A detail coverage one hour after hour and who’s who at the Summit from 10:00am until 5:25pm, is given in the Washington Post, February 26, 2010)
The Washington Post, The Wall Street Journal, The New York Times as well as Research Institutions such as the American Enterprise Institute have adequately dealt with the Summit not only in terms of producing excellent summary of the issues debated but also provided their “experts’” analysis of the “contestable” provisions in the reform plan. By now, those who watched the health care reform saga unfold, and those who are satisfied with “snips” of the debate are aware of the major elements of the reform:
• Requiring health insurance coverage with penalty for lack of coverage. (The state of Massachusetts requires it)
• Regulating the insurance market by creating an oversight body.
• Cost saving through changes in Medicare reimbursements and hence the “deficit” effect.
• Expand Medicaid coverage by subsidizing state governments for services to the uninsured people who cannot afford to purchase insurance.
These are simple provisions which ought not to have taken a year’s time to formulate and certainly not to have raised the blood pressure of so many of those “high government officials” attending the Summit. But then as someone put it, “the devil is in the details”. This is not surprising given the size of the bill which is put at some 2700 pages.
Where do we go from here?
One option embraced by the Republicans and few health experts and economists is to start over. (see for example Glenn Hubbart et al “A Better Way to Reform Health Care”, WSJ, February 25, 2010). Maybe it is good business for quite a few to start over (many speeches, articles and media blitz) but for some of us and in my view the public at large this is not an option, it is a “penance”. In his third of March address, the president urged the congress to vote the “Reform Bill up or down”.
“Now it is time to make a decision. Let us get it done”.
To that there is but one word: “AMEN”.