America's healthcare system is a mess

Published 7:41 am Monday, June 22, 2009

By By Tray Smith
Everett Dirksen, who served as the Republican Senate Minority leader from 1959 through 1969, is often credited, possibly incorrectly, for the phrase, “A billion here, a billion there, and pretty soon you are talking about real money.” It would be interesting to hear Dirksen describe the money talked about in last week’s Congressional Budget Office (CBO) report predicting a draft health care reform proposal from the Senate Health, Education, Labor and Pensions Committee would cost $1.6 trillion over the next decade.
Dirksen, one of the main opponents to the liberal excesses of the Johnson administration, has several lessons to offer Republican senators today. Like them, he was vastly outnumbered.
At no time in Dirksen’s tenure were there more than 37 Republicans in the Senate. Yet, he was able to count on one significant source of support only just beginning to materialize in this Congress: moderate Democrats.
Moderate Democrats have only recently expressed skepticism over the health care proposals emanating from their leadership. Most still maintain that a bipartisan compromise is in reach. However, that possibility will appear less and less likely as the process continues, and the implications of what is being considered become more apparent.
Indeed, even if the key players shaping health care reform do what they say they are going to do, and reduce the price tag to less than $1 trillion, it will be difficult for Democrats alone to agree on a way to pay for it. They have already factored the money that will come from allowing the Bush tax cuts to expire next year into their budget. Therefore, they will have to devise new funding streams.
Considering Republicans still want to extend the tax cuts, they are not likely to agree to any measure that levies new, additional taxes.
And they shouldn’t. As the conversation about health care has morphed into a debate, it has become increasingly clear that this entire effort is an absolute mess. Too intimidated by organized labor to pass a meaningful tax on employee health benefits, Democrats are now looking to fund their program by taxing soft drinks and charitable contributions. The political implications of this are obvious. It is not hard to imagine advertisements criticizing politicians who support “Coke” taxes.
With deficits already soaring to pay for the stimulus and other budget busting programs, additional borrowing is not an attractive source of revenue either. Going down that path would not only open up political risks for the Democrats; it would create economic vulnerabilities for the country.
Meanwhile, the CBO estimated that the plan would only cover 16 million uninsured Americans, a little more than a third of the total uninsured population. That was before the Senate scaled back eligibility for the program, so the number is likely lower. A lot of money would be spent assisting people who already have private coverage.
Add to this wide ranging debate the very controversial public option that would give individuals the ability to buy into a Medicare-like government program, and the likelihood lawmakers will be able to come to an agreement becomes even less likely. That’s probably best. It’s better for health care reform to blow up in the Senate while under consideration than for it to blow up after it is enacted, sending us down the road to fiscal ruin.
That is the bottom line.
Tray Smith is a former page in the U.S. House of Representatives. He can be reached at His column appears weekly.

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