Conservative Principles Now

You might have seen this week a stunning demonstration of political condescension on the health care front. In remarks at the 2010 Legislative Conference for the National Association of Counties, House Speaker Nancy Pelosi said, “But we have to pass the bill so that you can find out what is in it, away from the fog of controversy.”

This revealing comment reinforces a patriarchal (or in Pelosi’s case matriarchal) attitude Congress has taken with the American public: What lurks within the House and Senate health care bills will be revealed in the fullness of time, and it’s really good for us if we only knew better.

Ordinary Americans have had a common-sense resistance to Washington’s feverish attempt to overhaul one-sixth of the U.S. economy. But Congressional leadership has ignored the public’s concerns and instead clung to the idea that if they simply ram the bill through the legislative process — using unprecedented tactical maneuvers that may not even pass the parliamentarian’s smell test—Americans will finally understand and embrace ObamaCare.

When it’s law, then Americans can finally grasp the “goodness” of what’s in the 2,700-plus-page Senate bill, which is the most likely legislative vehicle that Congress will push to President Barack Obama’s desk. The problem for Pelosi and congressional Democrats is that Americans have been reading these bills, and they don’t like what they’re reading.

The more the public learns about the taxes, individual mandates, taxpayer-funded abortion coverage, and the potential breakdown of the private health insurance market, the less jazzed they are about ObamaCare. But politicians have blithely waved away little details like reading the actual bill and instead said “trust us”—at a time when public trust for Congress is at an all-time low during Obama’s presidency.

This whole dynamic helps explain why Obama and congressional leadership are insistent on another artificial deadline of March 18 for final passage of ObamaCare. They know that members of Congress, particularly those in the House, could see another wave of townhall protests when they go on a two-week recess starting March 26. That’s because the American people do know what’s in these bills. Popular discussion and debate—that “fog of controversy”—has helped to enlighten them.

In the run-up to his proposed health care summit, President Barack Obama this morning unveiled an 11-page outline of his health care proposal. Within the outline, there are 33 specific policy changes. Of course, there is no legislative text yet, so the full impact of what the President is proposing will not be known for some time.

The President’s revisions are based on the Senate bill, as amended by Senate majority Leader Harry Reid (D-NV), and passed last Christmas Eve. According to the February 22, 2010, edition of Congress Daily, on paper, at least, the President’s outline would increase the cost of the Senate bill from $871 billion to $950 billion over ten years. Of course, the real costs depend upon the years of implementation, counting both the revenues and the benefits together.

Bridging the Gap between House and Senate Liberals. The President describes his proposal as a set of policy changes that would “ bridge the gap” between the unpopular House and Senate health care bills. The President stresses that his proposal “… adds new provisions to crack down on waste, fraud and abuse.” He also says that his proposal “puts American families and small business owners in control, of their own health care.” This latter claim is, in point of fact, disingenuous. Americans would have less control over health care decisions today, what kind of plans and benefits they get, and Washington would exercise even more control over health care financing and delivery than it does today.

Same Policy Direction. Given that the President’s proposal builds off of the Senate bill, that means that a number of features of the Senate bill that many , if not most, of Americans find objectionable are going to be retained. For example, the President insists on an individual mandate for Americans to buy health insurance coverage that is approved by federal authorities. The President’s proposal adopts the Senate approach to imposing an individual mandate but lowers the tax assessments. He also insists on the imposition of an employer mandate, though he would soften it to some extent by providing $40 billion worth of tax credits to small businesses. Consistent with the Senate bill, he would exempt small firms with less than 50 employees from the employer mandate.

Even more important is what the outline does not spell out. Assuming that the proposals are to be meshed with the Senate bill as the preferred vehicle for enactment, that means that the key mechanisms for federal control are retained: federal control over the content of health benefits packages, including new benefit mandates that federal authorities may improve over time ; the federal mandates on the states to establish a federally-designed health insurance exchange for health insurance; the creation of new powers for the U.S. Office of Personnel management (OPM) to sponsor two health plans nationwide to compete against private health plans (the Senate version of the “public plan”); and the Senate language ( the Reid-Nelson compromise) that provides for taxpayer funding of abortion.

Some Tweaks. The President’s proposal would cancel the “Cornhusker Kickback”-  the federal taxpayer funding for Nebraska’s Medicaid expansion – but increase more federal taxpayer funding for all of the states. He would close the congressionally-created Medicare drug “donut hole” that is a gap in insurance coverage for seniors enrolled in the Medicare drug entitlement; and increase the Cadillac-tax threshold for high cost health plans from plans valued at $23,000 per years to $27,500 per year, starting in 2018.

New Federal Powers. In his outline, the President would add to the federal powers embodied in the Senate bill. The most important one is a new Federal Health Insurance rate Authority, which would provide federal “assistance and oversight” to the states conducting reviews of “ unreasonable rate increases” and “unfair practices” of health insurance plans. This, of course, establishes for the first time a legislative basis for the imposition of price controls on health insurance. If government can control both health benefits and health care pricing, that’s the proverbial ball game. Private health care is private in name only.

Co-authored by Nina Owcharenko