Friday, August 21, 2009

Does the Republican Party have a proposal for health insurance reform?

So just exactly what does the Republican Party stand for these days? Health care costs are skyrocketing. Rising premiums for health insurance reduce what employers could otherwise give workers as a pay raise. Corporate profits remain high as health insurers actively deny legitimate claims. Administrative costs for corporate health care are about 20%, compared to 3% for government run Medicare. Even ignoring the millions of people with no health insurance, is there not still a need for reform of the health insurance industry?

Joe Klein argues the Republican Party is focused on acquiring and maintaining power - not doing what is best for the citizens it allegedly represents. So in the health care debate, they are obstructionists. Even when conservatives have helpful contributions, they are silenced by pressure from those who do not want the current administration to accomplish anything of benefit to the American people.

In his August 20, 2009 TIME magazine column "The GOP Has Become a Party of Nihilists," Klein argues:
In one of those awful collisions between public policy and real life, I was in the midst of an awkward conversation about end-of-life issues with my father when Sarah Palin raised the remarkable idea that the Obama Administration's attempt to include such issues in its health-care-reform proposal would lead to "death panels." Let me tell you something about my family situation, a common one these days, in order to illuminate the obscenity of Palin's formulation and the cowardice of those, like Senator Charles Grassley of Iowa, the lead Republican negotiator on the Senate Finance Committee, who have refused to contest her claim.

Both my parents are 89 years old. They have been inseparable, with the exception of my father's service in World War II, since kindergarten. My mother has lost her sight and is quite frail. My father takes care of her and my aunt Rose, lovingly, with some — but not enough — private help at their home in central Pennsylvania. One night in early August, I had a terrible scare. I called home and Aunt Rose was freaking out; she didn't know where my father was. All the worst possibilities crossed my mind — it turned out he was just getting the mail — as well as a very difficult reality: if he'd had a stroke, I would have had no idea about what he'd want me to do. I had lunch with him the next day to discuss this.

It wasn't easy. My dad is very proud and independent. He didn't really want to talk about what came next. He was pretty sure, but not certain, that he'd signed a living will. He was very reluctant to sign an enduring power of attorney to empower me, or my brother, to make decisions about his care and my mom's if he were incapacitated. I tried to convince him that it was important to make some plans, but I didn't have the strategic experience that a professional would have — and, in his eyes, I didn't have the standing. I may be a grandfather myself, but I'm still just a kid in my dad's mind. Clearly, an independent, professional authority figure was needed. And this is what the "death panels" are all about: making end-of-life counseling free and available through Medicare. (I'd make it mandatory, based on recent experience, but hey, I'm not entirely clearheaded on the subject right now.)

Given the heinous dust that's been raised, it seems likely that end-of-life counseling will be dropped from the health-reform legislation. But that's a small point, compared with the larger issue that has clouded this summer: How can you sustain a democracy if one of the two major political parties has been overrun by nihilists? And another question: How can you maintain the illusion of journalistic impartiality when one of the political parties has jumped the shark? [Watch Fonzie jump the shark.]

I'm not going to try. I've written countless "Democrats in Disarray" stories over the years and been critical of the left on numerous issues in the past. This year, the liberal insistence on a marginally relevant public option has been a tactical mistake that has enabled the right's "government takeover" disinformation jihad. There have been times when Democrats have run demagogic scare campaigns on issues like Social Security and Medicare. There are more than a few Democrats who believe, in practice, that government should be run for the benefit of government employees' unions. There are Democrats who are so solicitous of civil liberties that they would undermine legitimate covert intelligence collection. There are others who mistrust the use of military power under almost any circumstances. But these are policy differences, matters of substance. The most liberal members of the Democratic caucus — Senator Russ Feingold in the Senate, Representative Dennis Kucinich in the House, to name two — are honorable public servants who make their arguments based on facts. They don't retail outright lies. Hyperbole and distortion certainly exist on the left, but they are a minor chord in the Democratic Party.

It is a very different story among Republicans. To be sure, there are honorable conservatives, trying to do the right thing. There is a legitimate, if wildly improbable, fear that Obama's plan will start a process that will end with a health-care system entirely controlled by the government. There are conservatives — Senator Lamar Alexander, Representative Mike Pence, among many others — who make their arguments based on facts. But they have been overwhelmed by nihilists and hypocrites more interested in destroying the opposition and gaining power than in the public weal. The philosophically supple party that existed as recently as George H.W. Bush's presidency has been obliterated. The party's putative intellectuals — people like the Weekly Standard's William Kristol — are prosaic tacticians who make precious few substantive arguments but oppose health-care reform mostly because passage would help Barack Obama's political prospects. In 1993, when the Clintons tried health-care reform, the Republican John Chafee offered a creative (in fact, superior) alternative — which Kristol quashed with his famous "Don't Help Clinton" fax to the troops. There is no Republican health-care alternative in 2009. The same people who rail against a government takeover of health care tried to enforce a government takeover of Terri Schiavo's end-of-life decisions. And when Palin floated the "death panel" canard, the number of prominent Republicans who rose up to call her out could be counted on one hand.

A striking example of the prevailing cravenness was Senator Johnny Isakson of Georgia, who has authored end-of-life counseling provisions and told the Washington Post that comparing such counseling to euthanasia was nuts — but then quickly retreated when he realized that he had sided with the reality-based community against his Rush Limbaugh-led party. Mitt Romney, the Republican front-runner for President according to most polls, actually created a universal-health-care plan in Massachusetts that looks very much like the proposed Obamacare, but he spends much of his time trying to fudge the similarities and was AWOL on the "death panels." Why are these men so reluctant to be rational in public?

An argument can be made that this is nothing new. Dwight Eisenhower tiptoed around Joe McCarthy. Obama reminded an audience in Colorado that opponents of Social Security in the 1930s "said that everybody was going to have to wear dog tags and that this was a plot for the government to keep track of everybody ... These struggles have always boiled down to a contest between hope and fear." True enough. There was McCarthyism in the 1950s, the John Birch Society in the 1960s. But there was a difference in those times: the crazies were a faction — often a powerful faction — of the Republican Party, but they didn't run it. The neofascist Father Coughlin had a huge radio audience in the 1930s, but he didn't have the power to control and silence the elected leaders of the party that Limbaugh — who, if not the party's leader, is certainly the most powerful Republican extant — does now. Until recently, the Republican Party contained a strong moderate wing. It was a Republican, the lawyer Joseph Welch, who delivered the coup de grâce to Senator McCarthy when he said, "Have you no sense of decency, sir, at long last?" Where is the Republican who would dare say that to Rush Limbaugh, who has compared the President of the United States to Adolf Hitler?

This is a difficult situation for the President. Cynicism about government is always easy, even if it now seems apparent that it was government action — by both Obama and, yes, George W. Bush — that prevented a reprise of the Great Depression. I watched Obama as he traveled the Rocky Mountain West, holding health-care forums, trying to lance the boil by eliciting questions from the irrational minority that had pulverized the public forums held by lesser pols. He would search the crowds for a first-class nutter who might challenge him on "death panels," but he was constantly disappointed. In Colorado, he locked in on an angry-looking fellow in a teal T shirt — but the guy's fury was directed at the right-wing disinformation campaign. Obama seemed to sag. He had to bring up the "death panels" himself.

This may tell us something about the actual state of play on health care: the nutters are a tiny minority; the Republicans are curling themselves into a tight, white, extremist bubble — but there may be enough of them raising dust to render creative public policy impossible. Some righteous anger seems called for, but that's not Obama's style. He will have to come up with something, though — and he will have to do it without the tiniest scintilla of help from the Republican Party.

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