Obamacare is far from “socialism”

Opponents of the Affordable Care Act claim it is a disaster for the country, mainly because it gets government into the health insurance business.

They say it amounts to “socialism” in the United States, just as supposedly exists in Europe and other places that use government as the lone insurer.

The system used in Canada, Europe and almost all other developed countries is not for us, they say, because government as the “single payer” displaces investor-owned insurance companies.

We should not let “big government” provide health insurance. We should leave that to the private sector, just as we always have. And Americans should protect individual freedom not to have health insurance, they say.

The facts are somewhat different from the opposition claims.

It’s true that Americans have traditionally had the right not to buy health insurance. When they fall ill and use health facilities, the rest of us get to pay their costs in higher health insurance premiums.

Health care grows more costly, because tens of millions remain outside the insurance system, most of them forced to do so.

The Affordable Care Act is not a single payer system and leaves private insurers in business. In fact, it produces more insurance buyers and relies on competition among insurers to keep costs down.

And it will not directly affect most people. The majority will continue to receive coverage through employer-sponsored plans, Medicare, Medicaid, the Veterans Administration and other existing plans.

Neighboring Canada has a national health plan, and nobody there thinks it is socialism. The current Conservative government has not tried to repeal or defund it.

It is worth comparing it with the Affordable Care Act, an exercise that was recently carried out by Antonia Maioni, a faculty member at McGill University in Montreal.

To start with, in Canada, government is the single payer, while in the U.S. there are many insurers.

In Canada, every legal resident is covered, Maioni notes. In the U.S., about 20 million people are expected to end up without coverage.

The Canadian system is truly national with coverage required to be the same across the country. In the United States, because some states have refused to expand Medicaid, despite a massive federal subsidy, the health insurance system varies. Major differences also result from different insurers operating in each state.

To keep premiums low, especially for young people, the American system provides a variety of coverages. The more you spend, the better the coverage.

In Canada, everybody is treated the same and nobody pays, because the system is financed by tax dollars. That provides “equal access,” not a feature of the U. S. approach.

The American law does little cost containment, especially when it comes to what Maiono calls “the administrative burden of multiple payers, providers and plans.”

In short, despite the charges made by its critics, the Affordable Care Act is far from the single payer system of much of the rest of the world.

And, with competing insurers, it isn’t “socialism.”

The complex system created by Congress to avoid a single-payer system has contributed heavily to the current disastrous start-up and its inevitable costs.

There is quite a bit wrong with the new health care law, so Congress, if both sides were willing, could make it work better.

When asked, not a single Republican senator thought the law could be repealed. So, there’s a basis for serious talk about improvement.

One problem is uneven Medicaid coverage. Some states, including Maine, have opted out of expanding coverage, even with federal support, because of GOP opposition and worries about future state costs.

Recently, some conservatives have suggested that Medicaid should become a completely federal program. That would relieve states of a huge burden, though it risks being called “socialism.”

But wouldn’t that make the program even more costly? Of course, you cannot extend health insurance coverage to millions more people without it costing more. It has been an illusion to claim otherwise.

Though it’s difficult to predict the trade-off accurately, a comprehensive, tax-financed system would reduce insurance premiums at least in large states. In states like Maine, with few competitors, premiums remain relatively high.

Increasing Medicare and Medicaid spending is becoming a huge and burdensome part of federal outlays.

Competition would have to work, if costs are to be pushed down. That may be beginning to happen in large states, but not for prescription costs.

If government cannot control costs by being the single payer, like Canada, Europe and our own Veterans Administration, it may need something like the regulatory authority it now has over utilities.

U.S. pays for shutdown, default crisis

Suppose you are the loan officer in a bank.  Today, you have three customers coming in.

Customer A arrives. This customer has a good and stable income, pays bills on time, has made debt payments reliably and is a community leader.

Then comes Customer B.  This customer has just had a pay cut, lives from paycheck to paycheck, has barely kept current with loan payments, but reassures you about future intentions to make loan payments a high priority.

Finally, here’s Customer C.  This customer has no job, has repeatedly threatened to halt loan payments and is inclined to think the bank could get along all right without the loan being paid off. 

Sound familiar?  It should, because there are people in Washington who fit each of these descriptions. 

The bank?  That’s the lender of all the previous debt on which payments are now due – the American people, financial institutions and foreign countries.  In short, the bank is the world.

Customer A represents the United States playing its usual role as the most powerful nation in the world, a country whose dollar is the standard by which all other currencies are measured.

The dollar is the world standard, because everybody believes that the United States will use all of the resources necessary to maintain its reliability.  In other words, America has always stood behind its debt.

The Washington leaders who have traditionally supported this view were both Republicans and Democrats, people whose politics differed but not to the point of weakening the country.

Customer B represents the members of Congress who said they were willing to shut down the government and to threaten defaulting on the government debt.  Some of them suggested using gimmicks to make loan payments for a few more days, giving them a little more time to try to change Obamacare.

This year, the group included every Republican member of the U.S. House and Senate.

Customer C represents the members of Congress who voted, even at the last minute, against reopening the government and letting it make debt payments.  They attacked others in their party who refused to go along with them.

This group included 144 Republican House members – three-fifths of all GOP representatives – and 18 Republican Senators.

For a while, Republicans in Congress gave a higher priority to “defunding” Obamacare and mandating the Keystone XL pipeline than to safeguarding the dollar and keeping the government in operation.

None of this means that the GOP was wrong on the issues it raised. While they do not control either the Senate or the presidency, they virtually had the obligation to offer their alternate policy views and fight for them.

But there are limits how far people should go in seeking to change national policy.  Finally, a majority of Senate Republicans and a minority of the House GOP came to that view.

Centuries ago, Robert Burns, the Scottish national poet, wished that some power would give us the gift “to see ourselves as others see us.”

Probably, every member of Congress wants the United States to be seen as the world’s greatest power, having the economic and military strength to influence events everywhere on earth to America’s benefit. 

Yet those who shut down the government and brought the country to the brink of default on its debt appear not to recognize that their strategy undermines the world’s confidence in the United States and weakens the American economy.

Countries with which the United States does business are openly worried about the value of the “full faith and credit” of this country.  Countries with which the United States competes could quietly sit back and let this country discredit itself.

Respected economists, including some of the most conservative, warned that the government closure and risk of default would harm the economy, especially the recovery from the crippling recession.  Polls reported that people do not dislike Obamacare to the point of being willing to pay this heavy a price.

Consumer confidence in the economic outlook plunged. That translates into less consumer spending and fewer retail sales, the backbone of the economy.

The pundits are already saying that we will face much the same government crisis in a few months.  The two sides will not agree on a budget, they say, and default will again loom.

If they are right, the cost could be a greater economic impact and more harm to America’s standing in the world.

 
The revival of the traditional GOP, determined to overrule the Tea Party, is the key to preventing this outcome.  Customer B will have to start behaving like Customer A.

Distrust, minority tactics plague Washington

The level of distrust in Washington has sunk below the level between the United States and the Soviet Union during the deepest crisis of the Cold War.

In 1962, the United States detected missiles from Communist Russia being shipped to Cuba.  Work had begun on readying missiles to reach many American targets.

President John F. Kennedy prepared an American response if the Soviets did not turn their ships around and take the missiles back to Russia.  The world was at the edge of war.

The Soviets were willing to back away in the face the threatened American action.  But, in return, they wanted the United States to remove its missiles from Turkey, right on the border of the Soviet Union.  Kennedy seemed to refuse.

History has shown the Soviet Union was quietly promised that American missiles would be withdrawn in a few months, so that the United States would not be seen to have taken the action in connection with the Cuban missile crisis.

The Soviets took the Kennedy diplomats at their word and withdrew their missile operations from Cuba.  Their trust was rewarded when, several months later, the U.S. missiles were pulled out of Turkey.

Now, look at the dispute in Washington that led to the government shutdown and the threat of default on U.S. debt payments.

House Republicans blocked votes on funding government and raising the debt ceiling unless they got concessions on defunding Obamacare and making other spending cuts.

President Obama said that he would not accept demands backed by holding the government hostage.  As the crisis continued, he said that he was willing to negotiate on the matters raised by the Republicans only after they stopped blocking government funding and raising the debt limit.

The House GOP would have to trust that Obama would keep his word, promised publicly, and back off their action to end the government crisis, as the American public overwhelmingly wanted.

But they refused to extend to the president the same degree of trust that the Soviets had been willing to give the United States.

It would not be too far a stretch to say that the danger to the constitutional order in the United States of this year’s conflict was as serious as the danger to the world of the Cuban missile crisis.

Obama’s stance was meant to defend a widely held view of the Constitution as much as to protect his health plan or spending priorities.  The issue is about the rights of a minority in the American system.

Some conservatives say that, because the United States is a republic, the rule of the majority is not required, and the minority must have virtually as much influence.  Only in a direct democracy, like a Maine town meeting, does a majority rule.

The United States is a republic and that means that government is run by people elected directly to serve the public good.  It does not mean that majority rule can be ignored.

The Constitution is clear that decisions are made by a simple majority, except in a handful of specific matters. It did not require that all decisions had to be made jointly by the majority and minority.

While ideally the two sides should negotiate and arrive at a common agreement on major issues, the minority should not be able to block any action with which it disagrees.  Obama said he was willing to negotiate, but would not make up-front concessions on key Obamacare provisions.

That’s why the president rejected the offer by Maine Sen. Susan Collins, who wanted concessions on Obamacare from the White House to allow government to re-open.

If the president let the minority dictate to the majority, it would promote stalemate and possibly damage the ability of future governments to make decisions as foreseen by the Constitution.  What would be the point of elections for president and Congress?

Obama deserves credit for defending the Constitution, because he refused to use it for his own purposes in the debt limit conflict.

The Fourteenth Amendment says: “The validity of the public debt of the United States, authorized by law, ... shall not be questioned.”  Some scholars say that provision was meant to prevent to Congress from reneging on already authorized borrowing.

Obama declined this advice and accepted that Congress can vote a debt limit that would apply to future borrowing, though it should not cause a default on existing debt.

 
In the end, what matters most is not Obamacare or the level of government spending.  What matters most is protecting the Constitution and that means majority rule.

Moderate voters have nowhere to go

More American voters consider themselves politically moderate than either conservative or liberal.

So, why is our political system so deeply polarized between conservatives and liberals?   

Why don’t politicians cater to the middle of the spectrum?

One answer may be that our entire political debate has slid to the right.  With the exception of the hot-button, social issues, today’s liberals are a shadow of what it once meant to be a liberal.

Traditional liberals would be fighting for more programs to aid the disadvantaged, less military spending, tougher controls on financial institutions, and stronger protection of civil liberties.

Now, the Democrats, often considered the more liberal party for its historic support of positions like these, is reduced to fighting a rear-guard action to defend programs going back 50 or 70 years, like food stamps or Social Security.

That shift applies as much to so-called liberals on the Supreme Court as it does to Congress.

In short, most of today’s liberals look like yesterday’s moderates.

Meanwhile, the Republicans have moved to the right.  The tea party movement has the support of about a fifth of the electorate, enough for its activists to take control of the party and push aside traditional, moderate GOP leaders.

These newly active Republicans control the party apparatus so well that they condemn moderates who were party leaders long before them as RINOs – Republicans in name only.

Neo-Republicans have polarized political choice to the point that many would-be moderate voters may not find leaders to support.  Without a moderate alternative, they have no choice but to line up with one side or the other.

A recent independent national survey found that, when considering GOP efforts to block Obamacare, moderates oppose Republican hard-core tactics by more than 2-1.

In the battle for the moderate vote, the Democrats count on this split, while the Republican right seeks to convince the GOP that, because about half of all voters don’t like Obamacare, any tactic to oppose it will pick up some moderate voters.

In the struggle over Obamacare and the national budget, the small band of House Republicans who oppose the health program but also reject a government shutdown could be the core of a moderate political force. 

They offer a sign of principle over pure politics. Whether it is a political turning point remains to be seen.

Perhaps the notion of conservative-moderate-liberal is only relative, despite the right side of the GOP promoting ideological purity.

Maine may provide a good illustration of how ideology mixes with pure politics.

In 2010 governor’s race, Republican Paul LePage was the obvious conservative, Democrat Libby Mitchell ran as a liberal traditionalist, and independent Eliot Cutler offered a pragmatic alternative to both, especially LePage.  Thanks to the split in his opposition, LePage won.

In 2014, LePage will seek re-election. The Democrats will offer Mike Michaud, the second district congressman and member of the party’s moderate “Blue Dog” group.

Cutler, running again, is unlikely to profit from a weak major party candidate in the field, as he did in 2010.  As a result, he might end up as a liberal, attempting show that Michaud, the moderate, is too conservative for Democrats.

Cutler would move from moderate to liberal.  His problem may be that Michaud has a mostly progressive record, yet conservative enough to please all but hard-core LePage voters.

In the Senate race, GOP incumbent Susan Collins can legitimately claim to be a rare congressional moderate.  Her voting record produces a moderate rating and could make her hard to beat. 
 

Democrats might believe that Collins is vulnerable because she is not liberal enough for today’s voters. Shenna Bellows, the former executive director of the Maine ACLU and newly announced
candidate for the Democratic Senate nomination, may be betting on it. That presumption could be a mistake in a state where unenrolled voters outnumber Democrats or Republicans and may
see Collins as their choice.

Conservative Republicans may dislike or even challenge Collins, but her problem could be more that she is a good Republican than because she is a moderate.  She shows remarkable loyalty to the GOP, even after its Senate leader killed her transportation bill, partly because it had bipartisan backing.

Trying to appear moderate by proposing a back-down by the Democrats on a couple of 

Obamacare provisions before her party agreed to end the government shutdown, she merely repackaged the position of House GOP hard-core conservatives.

Being a moderate may be ineffective in Washington, as shown by Collins’ need to support the GOP conservative position in the shutdown showdown.

There now seems to be little chance of a moderates gaining power in Washington.  That would take Collins and other Republicans being willing to buck their more conservative party mates.