Conservative Principles Now

Senator Daniel Inouye (D-HI), chairman of the Appropriations Committee, took to the floor yesterday to protest an effort led by Senators Jeff Sessions (R-AL) and Claire McCaskill (D-MO) to place a relatively modest cap on discretionary spending. Before raising a budget point of order (which requires 60 votes to overcome), Chairman Inouye made two interesting arguments against the measure.

First, he argued that the cap on discretionary spending would allow entitlement programs to continue their unabated growth. The chairman is, of course, correct. However, he is most certainly aware that over the past three years, discretionary, non-emergency spending has increased nearly 25%. If Sessions-McCaskill had been in place three years ago, the taxpayers could have saved $165 billion. And, as Senator McCaskill kindly pointed out, the caps mirror President Obama’s budget request.

Second, the chairman suggested a Congressional spending cap would preempt the President’s debt commission. Earlier this year, my Heritage colleague Stuart Butler suggested that an executive commission “would merely remove pressure on Congress or the President to take action.”

Inouye’s desire to punt on tough issues and place responsibility in the hands others is one reason why Americans are so frustrated with Washington. Last month, Rasmussen found that 83% of Americans believe Congress’s “unwillingness to reduce government spending” is to blame for our exploding debt. At this point, Congress is clearly incapable of handling these complex issues and the presence of a faux-commission only serves as a scapegoat for inaction.

Fortunately, there is a silver lining. On January 28, only 56 Senators voted for an earlier version of the Sessions-McCaskill spending caps. This time around, 59 Senators vote for a slightly revised proposal. Senators Thad Cochran (R-MS) and Maria Cantwell (D-WA) switched from Nay to Yea votes and new Senator Scott Brown (R-MA) supported the measure.

Incredibly, Senator Patrick Leahy (D-VT), who is also an appropriator, actually changed his position during the roll call vote. He initially voted Yea, which would have given the measure the necessary 60 votes in support. However, at some point before the vote was finalized, he changed his vote to Nay resulting in failure for the spending caps.

Congress has a terminal spending addiction, and spending caps are a good first step to curing that addiction. Time will tell if they are willing to take that step, and more. The American people will certainly be watching.

The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute just released a new report that exposes the diversity of health care across the country on a county-by-county basis. What’s striking about the interactive report is the high level of variance found in health care for counties within a single state.

For example, Montgomery and Howard counties ranked in the top slots in Maryland while Baltimore City and Allegany County trailed at the bottom. “In health care, one size does not fit all,” said Dr. Donald Shell, the health officer for the Prince George’s County Health Department, during a discussion of the report findings.

No truer words could be spoken. However, Congress has been trying to enact a one-size-fits-all measure for the past year with Obamacare, which would indiscriminately impose nationalized health requirements on counties. As Heritage health policy expert Stuart Butler has noted, Congress should be examining modest adjustments to the health care system and allowing states to take the lead in experimenting with new reform models:

History shows that changing even seemingly minor features of legislation or administrative decision making with regard to health care can have major — and sometimes unintended — consequences for the systems evolution.

Taking even small steps to improve coverage, it turns out, involves decisions that could have profound effects on the future of the U.S. health care system. Thus, it would be unwise to try to rush through a scaled-back bill on the assumption that minor changes do not require careful scrutiny. It is important to take the time to think through the implications of any new legislation.

Butler along with analysts within Heritage’s Center for Health Policy Studies has long advocated the need for genuine reform of America’s health care system. But that approach must be state-based to determine what works best in the intricate and complex workings of the U.S. health care sector. Nevada state officials will have a better idea of what residents in Lander County (ranked 14th in the state) need over those in neighboring Pershing County (ranked second).

States must have the tools and flexibility from Congress to test their ideas and find out what reforms work best or need to be changed. That won’t happen with the Obama Administration’s current health care agenda, especially in light of the upcoming Health Care Summit. The new report should serve as a wake-up call to Congress and the Obama Administration — trying to create a one-size-fits-all health care system is harder than it looks.