Stolen Content - Voices from the past

I remember having Bruce Bartlett on the radio show a number of times when I was working with Jerry Bowyer.  So it was with great interest that I hapened to find this while surfing this evening, sort of a catching up if you will. 

Notations
The Democrats' Gratitude List
Bruce Bartlett, 03.26.10, 12:01 AM ET

House Speaker Nancy Pelosi (D-Calif.) owes Newt Gingrich a debt of gratitude. One of the big reasons why both Jimmy Carter and Bill Clinton failed in their big legislative initiatives is that until 1994 the committee system in Congress, especially in the House of Representatives, was very powerful. Many initiatives with strong presidential support died simply because of the tugs of war that went on interminably as various committees competed to have jurisdiction.

This all changed in 1995 when Republicans took control of the House and Newt Gingrich (R-Ga.) became Speaker. One of their first actions was to thoroughly gut the committee system, which they saw as the liberals' base of power and an impediment to fast action on the Contract With America. Thousands of Democratic committee staffers were fired and control of the legislative process was centralized in the Speaker's office. Such longtime staples of legislative activity as hearings and markups were essentially dispensed with.

In practice, the only committee that mattered anymore was the House Rules Committee, which is completely controlled by the Speaker. Historically, its only job was to set the terms of debate in the House--the length of debate on bills, what amendments would be in order, etc. But under Gingrich the Rules Committee became the committee of primary jurisdiction in many cases, often writing bills from scratch in the dead of night.

Personally, I lament the decline of congressional committees. They came into being for a reason--to provide specialized expertise, allow experts and interested parties to review and comment on pending legislation, allow time for thorough analysis and fix potential problems before a bill reached the House floor.

Nevertheless, Gingrich's innovations proved indispensable to Ms. Pelosi, who was able to ram a massively large and complicated bill through the House in a way that would have been impossible under the pre-1995 committee structure. Under that system, Republicans would have had many more opportunities to amend or kill the health bill. Their failure to do so, therefore, rests partially with Gingrich, who unwittingly provided Democrats with the parliamentary tools they needed to enact it.

Democrats also owe a debt of gratitude to Sen. Scott Brown (R-Mass.). When he was elected in a special election on Jan. 19, it appeared that HCR was dead. Because of Republican filibusters and delaying tactics, Democrats needed all 60 of their votes to get it passed. Brown's election reduced their numbers to 59, which appeared fatal to HCR in the view of many close political observers.

What happened instead is that the Democrats' supermajority loss in the Senate forced the House to either accept the more moderate Senate bill or nothing. It also forced House Democrats to get moving and pass a bill. In the absence of the Brown victory, the House would likely have insisted on its more liberal approach to HCR and would still be endlessly debating the public option and other liberal hobbyhorses that would never pass the more conservative Senate.

Incidentally, liberal opposition to HCR is a very underreported story. Something like a third of those who opposed it in public opinion polls did so because it didn't go far enough even though Republicans continually asserted that all opponents agreed with their argument that it went much too far.

In the end, House Democrats realized that they couldn't go back to the Senate for another vote and had no choice but to accept its version of HCR. Had Democrat Martha Coakley prevailed in Massachusetts the forces that led to passage of HCR might never have come together.

---

I think with time Republicans will recognize that HCR changes our health care system far less than they said it would and in ways that they will eventually acknowledge as improvements. Indeed, within hours of passage some Republicans were changing their tune from complete repeal as the first order of business should they regain control of Congress--which was stupid anyway since Obama would veto any such effort and Democrats in the Senate would filibuster it--to reform; fixing the legislation rather than repealing it in toto.

One reason for the Republican change of heart is that HCR is in many ways a Republican bill virtually identical to the health legislation enacted in Massachusetts under Republican Gov. Mitt Romney in 2006. And if one goes back and reads conservative think tank proposals for health care reform since the 1990s, it's clear that Obama's plan owes more to them than to liberal ideas, which mostly involve moving toward a Canadian-style single-payer system.

Here's the basic logic. If you want to cover preexisting conditions, which just about every Republican does, you have to have a mandate for people to buy health insurance, otherwise no one will buy it until they get sick, which would bankrupt every health insurance company overnight.

Once you accept the principle of a mandate, which conservative health reformers have long done, then you have to confront the fact that some people won't be able to afford it, so you have to have subsidies. And subsidies have to be paid for by raising revenue in some way. This leads us basically to where HCR ended up.

The biggest problem with HCR, which Republicans could have improved if they had chosen to cooperate rather than fight it to the death, is that the financing is less than ideal. The cost of the program should be largely paid by its beneficiaries, and soaking the rich is unwise for both political and economic reasons. It would have been much better to eliminate the tax exclusion for health insurance, as Republican presidential nominee John McCain proposed in 2008. This is an issue that will have to be revisited, but I think Republicans will eventually come to support the benefit side of HCR just as they now support Medicare.

Despite Obama's victory on HCR, I think it may have been a political mistake for him to pursue it. The reason is that presidential popularity is largely a function of how well the economy is doing. Presidents get the benefit when things are good and the blame when things are bad, regardless of whether they or their policies had anything to do with it.

Obama came into office in the midst of the second-greatest economic crisis in our nation's history, and I think he should have focused on it pretty much to the exclusion of all else. There may or may not have been anything more he could do substantively after passage of the $787 billion stimulus bill in February 2009, but I think he would have benefitted politically by doing more to show that he cares about the unemployed and those suffering from the economic crisis.

Washington insiders place great weight on presidential successes in getting big legislative victories in Congress. But I don't think average Americans care much about such things unless it benefits them immediately and directly. And their memories are short. Few presidents in history were more successful than Lyndon Johnson in getting big legislative victories in Congress, yet he was so unpopular that he chose not to run for reelection in 1968.

Perhaps Obama concluded that the economy was either going to recover on its own by 2012, in which case it cost him nothing to get HCR enacted, or it wouldn't, in which case it wouldn't matter one way or another. But Democrats in Congress may differ in their assessment because many of them are almost certain to lose in November in part due to controversy over HCR, perhaps giving Republicans control of the House, which would be like déjà vu all over again given that Bill Clinton's ill-fated health reform effort is widely credited for giving them control of Congress in 1994.

---

I think it would have been a good idea for the country to have had a debate about single-payer even though I don't think it would have been a good idea to implement it. The reason is that it would have highlighted the biggest problem with our health care system, which is that it costs far too much for what we get, and forced us to think about some ways in which other countries have developed health care systems superior to ours.

Here is the central fact about the American health care system: We spend 16% of the nation's entire output on health. The country with the second-largest health spending as a share of the gross domestic product is France, which only spends 11%. The average of all major countries is 8.9% of GDP.

A key reason why conservatives oppose further government intervention into our health care system is that they think it will become even more expensive as a consequence. Yet almost every other major country has some sort of national health insurance, and they not only spend a lot less than we do but have better health by many measures.

Moreover, I don't think most Americans realize just how much government already pays for health through programs like Medicare and Medicaid, not to mention a vast tax subsidy for private health insurance. According to the Organization for Economic Cooperation and Development, we are paying 7.3% of GDP through government for health care now--and I don't believe this counts tax expenditures that add another percentage point or two. This is considerably more than most other nations pay for universal coverage. Here is the cost to taxpayers of single-payer systems in some other countries (percentages of GDP): Canada, 7.1%; U.K., 6.9%; Japan, 6.6.%; and Switzerland, 6.4%.

What this means is that for no more than we are paying in taxes right now we could have universal health coverage for every American, a health care system no worse than that in countries where health is as good or better than here, and give the entire country an effective tax cut equal to 8% or 9% of GDP--more than $1 trillion--by completely eliminating the cost of private health insurance and all out-of-pocket health costs.

Of course, there are legitimate reasons why we might not want to adopt the same health care system that they have in other countries. But a serious discussion of single-payer might have highlighted some ways in which our system could be improved and things we might learn from them.

Bruce Bartlett is a former Treasury Department economist and the author of Reaganomics: Supply-Side Economics in Action and Impostor: How George W. Bush Bankrupted America and Betrayed the Reagan Legacy. Bruce Bartlett's new book is: The New American Economy: The Failure of Reaganomics and a New Way Forward. He writes a weekly column for Forbes.