Monday, July 13, 2009
Disarray. That's one word to describe the status of the Obama administration's legislative program as Congress heads into its final four weeks of work before the August recess. A watered-down cap-and-trade bill passed the House narrowly last month, but Sen. Barbara Boxer has decided not to bring up her version in the upper chamber until September.
Senate Finance Chairman Max Baucus, who promised a health-care bill last month, still isn't delivering, and neither is the Health Committee's Christopher Dodd. They're both trying to nibble down cost estimates from the Congressional Budget Office, which has put the price tag at a trillion or more. But their latest ploys -- broad-based tax increases, transferring more of the Medicaid burden to the states -- sound like sputtering.
Meanwhile, Majority Leader Harry Reid says he's taken off the table one approach that has potential bipartisan support -- ending the tax preference for employer-provided insurance.
In the House, there is more chaos. Commerce Committee Chairman Henry Waxman has delayed the health-care markup he had planned for this week, giving the Administration and House leaders a chance to win over balky Blue Dog Democrats. Ways and Means Chairman Charles Rangel is also stymied, and says all he knows about agreements that the White House has struck with various health groups (pharmaceutical companies, hospitals, HMOs) is what he reads in the papers.
All this sounds like muddling by incompetents, but in fact these Democratic legislators are (mostly) highly competent, and they are trying to do very hard things: restructure government regulation of -- or establish government control over -- one-sixth (health care) and one-tenth (energy) of the economy. And they're dealing with a president who has shown a striking lack of interest in details and whose signal legislative achievement so far -- the $787 billion stimulus package passed in February -- has visibly failed in its asserted goal of holding unemployment down to 8 percent.
It turns out that details matter, a lot, when you're slinging around great gobs of dollars. Barack Obama let congressional appropriators write the stimulus package. The result, according to the Government Accountability Office, is that only $29 billion had been spent as of June 19, 90 percent of it for Medicaid and "the State Fiscal Stabilization Fund administered by the Department of Education."
Translation: The money has gone to state governments in fiscal trouble because of declining revenues and (in some cases) profligate spending. This insulates public employee union members from the painful effects of recession that are being felt by almost everyone else, with the added political benefit of channeling money to unions, which in turn channel some of it to Democratic politicians.
Obama was also content to let Waxman and Edward Markey write the House cap-and-trade bill. To get needed votes, they gave away carbon credits to politically connected businesses rather than sell them by auctions whose revenues Obama planned to use to finance health care. And they included potentially embarrassing provisions, like one regulating the efficiency of candelabra base lamps. Better be prepared to face the federal candelabra inspectors.
Such are the people whom we are asked to trust to reshape the provision of health care. They are struggling to amass the votes to establish a government health insurance plan whose transparent purpose is to drive private insurers out of business and impose one-size-fits-all health care on the bulk of Americans. They already inserted into the stimulus package a provision funding "comparative effectiveness research," which purports to show what treatments are medically effective and cost-effective.
But comparative effectiveness research is, if not junk science, not a fully developed intellectual enterprise. Medicine is an art as well as a science, and comparative effectiveness research may too often compare apples and oranges. Meanwhile, as Europeans know, the most effective way to squeeze out costs, as Obama promises, is denial of care. Hip replacement at 60? Hey, that's expensive, and you're too old.
Polls show that most voters -- and increasing numbers of independents -- are queasy about vastly increased government spending and more concerned about bolstering the economy than about reshaping health care or addressing projected global warming. They've noticed that the stimulus package hasn't delivered the promised results. Do they want to turn over the health care and energy sectors to a president inattentive to details and congressional leaders in disarray?
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