She's in the Wall Street Journal, talking about the need for "market-driven" solutions instead of more government. For liberals, the temptation with Sarah Palin is to mock her and roll one's eyes because she's been pretty clearly out of her depth when it comes to federal policy matters -- it really does feel similar to watching a child put on grownup clothes and march around proudly.
But let me try to take her seriously for a moment. She does, after all, have a rather devoted constituency. Mocking seeming lightweights has never, ever served Democrats well. Who knows? She could be the next president of the United States. And op-eds like this one will lay the foundation for the kinds of policies she would implement.
An attempt to meaningfully engage Sarah Palin, after the jump. Please click the "read more" button below.
Let's be honest here. She starts off promisingly:
Some 45 years ago Ronald Reagan said that "no one in this country should be denied medical care because of a lack of funds." Each of us knows that we have an obligation to care for the old, the young and the sick. We stand strongest when we stand with the weakest among us.
We also know that our current health-care system too often burdens individuals and businesses—particularly small businesses—with crippling expenses. And we know that allowing government health-care spending to continue at current rates will only add to our ever-expanding deficit.
You know what? Great. It's nice to see a leading Republican acknowledge a couple of things: A) That there's an "obligation" to take care of the old, the young and the sick. To my ears, it sounds like she's saying something that normally curdles GOP stomachs: That there's a "right" to health care. Super! B) That the current system is, in fact, a mess. Lots of leading GOpers -- including Palin's old running mate -- like to suggest we shouldn't tinker with American health care because it's the best system in the world. It's not. It's not actually close.
Admitting the problem is the first step to solving it. So Palin has at least moved that far.
How can we ensure that those who need medical care receive it while also reducing health-care costs? The answers offered by Democrats in Washington all rest on one principle: that increased government involvement can solve the problem. I fundamentally disagree.
Common sense tells us that the government's attempts to solve large problems more often create new ones. Common sense also tells us that a top-down, one-size-fits-all plan will not improve the workings of a nationwide health-care system that accounts for one-sixth of our economy. And common sense tells us to be skeptical when President Obama promises that the Democrats' proposals "will provide more stability and security to every American."
This is just sloganeering. Fine. But a "one-size-fits-all plan" isn't really what has been proposed -- unless you count "every American must be insured" as one size. In which case ... I'm cool with that. We'll see what parameters President Obama puts forth in his speech tonight, but the general proposals have been to let most Americans continue to receive coverage from their employers, subsidize others who can't afford it, and implement new regulations to keep insurance companies from earning their profits by turning poor sick people out into the cold to die.
Say what you want about it, but that's not "one size fits all." Different people are covered differently, depending on their context. For a big gubmint program, I think that's pretty nuanced.
With all due respect, Americans are used to this kind of sweeping promise from Washington. And we know from long experience that it's a promise Washington can't keep.
You know, except in the case of Medicare, Medicaid and Social Security. Sure, they have some financial problems that need fixing -- which Palin gets to in a moment. And that's going to be complicated. But those programs have offered more stability and security to the millions of Americans over several generations. Sounds like a promise that's been kept to a much greater degree than Republicans would have you believe.
Let's talk about specifics. In his Times op-ed, the president argues that the Democrats' proposals "will finally bring skyrocketing health-care costs under control" by "cutting . . . waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies . . . ."
First, ask yourself whether the government that brought us such "waste and inefficiency" and "unwarranted subsidies" in the first place can be believed when it says that this time it will get things right. The nonpartistan Congressional Budget Office (CBO) doesn't think so: Its director, Douglas Elmendorf, told the Senate Budget Committee in July that "in the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."
Sloganeering, again. Let us admit that the federal government, being a giant bureaucracy, is given to some waste and inefficiency -- and let us furthermore suggest that good citizens should be ever-vigilant against that waste and inefficiency.
That said, maybe Palin has a point. The current proposals don't actually seem to do much to bring down the costs of health care. Even liberals admit that. One thing that might help? A robust "public option" insurance plan offered by the government to compete with private insurers. But insurers and the Republicans don't really want that.
Now look at one way Mr. Obama wants to eliminate inefficiency and waste: He's asked Congress to create an Independent Medicare Advisory Council—an unelected, largely unaccountable group of experts charged with containing Medicare costs. In an interview with the New York Times in April, the president suggested that such a group, working outside of "normal political channels," should guide decisions regarding that "huge driver of cost . . . the chronically ill and those toward the end of their lives . . . ."
Given such statements, is it any wonder that many of the sick and elderly are concerned that the Democrats' proposals will ultimately lead to rationing of their health care by—dare I say it—death panels? Establishment voices dismissed that phrase, but it rang true for many Americans.
(Sigh.) "Ringing true" is not the same thing as "actually being true." I suspect Palin knows this. But whatever. The sad thing about the Palin-induced booting of the end-of-life counseling provisions is that it makes it less likely elderly Americans will have the control they'd want over their end-of-life care. Many Americans, I expect, would want everything possible done to keep them alive until the last possible breath. Many others, though, might decide that the end is coming anyway -- so why not go into hospice care and live out life's final moments comfortably? Yeah, that might end up saving a few bucks. But the choice would stay with the patient and their family.
Here's a good place to mention that any plan offered up by the president won't preclude private individuals paying for the services they want. This is not Britain's NHS, as much as Republicans want you to believe it is. The doctors and nurses and health care providers would remain private under the current proposals; they'd be obligated to follow Medicare rules for Medicare patients, but if Sarah Palin -- who surely has the dough -- wants to spend a few dollars extra on the shiniest respirator at the end of her life, nothing is going to stop her. Rationing Medicare dollars won't be the same as rationing health care. Health reforms, as proposed, don't put a ceiling on care: They just expand it and offer minimum expectations.
Speaking of government overreaching, how will the Democrats' proposals affect the deficit? The CBO estimates that the current House proposal not only won't reduce the deficit but will actually increase it by $239 billion over 10 years. Only in Washington could a plan that adds hundreds of billions to the deficit be hailed as a cost-cutting measure.
I outsource my reply to Matt Yglesias:
Ezra Klein offers a flashback: “To put that in perspective, many of the legislators who are balking at the cost of health-care reform voted for the Kyl-Lincoln bill to reform the estate tax at a cost of $75 billion a year, or $750 billion over 10 years.”
Specifically, all the Republicans plus Senators Baucus (D-MT), Bayh (D-IN), Cantwell (D-WA), Landrieu (D-LA), Lincoln (D-AR), Murray (D-WA), Nelson (D-FL), Nelson (D-NE), Pryor (D-AR), and Tester (D-MT) thought nothing of adding hundreds of billions of dollars to the deficit when the beneficiaries were a tiny number of already wealthy households. But quite a few of these people seem very concerned about the idea of spending similar amounts of money on making health insurance affordable to middle class Americans.
Right. It's a matter of priorities. We know where Sarah Palin's are.
Back to Palin:
Finally, President Obama argues in his op-ed that Democrats' proposals "will provide every American with some basic consumer protections that will finally hold insurance companies accountable." Of course consumer protection sounds like a good idea. And it's true that insurance companies can be unaccountable and unresponsive institutions—much like the federal government. That similarity makes this shift in focus seem like nothing more than an attempt to deflect attention away from the details of the Democrats' proposals—proposals that will increase our deficit, decrease our paychecks, and increase the power of unaccountable government technocrats.
Wait. What? A major emphasis of health reform is the new regulations. They're hardly a diversionary tactic -- they're one of the big reasons for doing reform at all. In fact, Palin even thinks they sound like a "good idea." So if she can't find anything legitimately bad to say about it, she'll just dismiss it as political gamesmanship. Which ... sounds like political gamesmanship.
Instead of poll-driven "solutions," let's talk about real health-care reform: market-oriented, patient-centered, and result-driven.
That's a fantastic idea. Why don't Republicans ever bring this up on their own, though? We just sat through eight years of a Republican presidency, and except for the naked electoral pandering of the 2004 Medicare drug bill -- which, incidentally, represented a massive GOP expansion of deficit spending -- the only attempt to address the costs and problems of American health care came, really, when George W. Bush suggested that poor people could just go to the emergency room if they need help.
If Republicans really want "market-oriented" health reform, they've had all the time in the world to get it done. It's not been one of their priorities. Perhaps if they'd made it so, their results would've won the day and Democrats wouldn't be making the push they are now. And you can't really blame Democrats for trying to do reform in the way that Democrats would do reform, would you? They are more inclined to see government as a possible solution to these problems. Contra the Republicans, though, that's not always been a bad thing.
(And Republicans know it: If a good health program gets passed, they're worried that voters will love the Democrats for a generation or more. That's one reason for their fierce opposition to the proposed reforms.)
In the end, Sarah Palin gives you what you expect of her: Sloganeering that obscures the nuances of the debate, a touch of rank dishonesty, and a little GOP boilerplate -- market driven! government inefficiency! common sense! -- to throw to the rabble.
Still, she's admitted there's a problem. Let's watch and see if she really does work for her preferred solutions. That'll let us know just how seriously to take her on the issue of health care.