Why It is Inevitable That the Debate over Health Care Will Be Partisan

In a post earlier this week, Bob Laszewski reported that “the extension and expansion of the State Children’s Health Insurance Program (SCHIP) has now passed the full House and the Senate Finance Committee and is on its way to the full Senate where it will undoubtedly also pass and then be reconciled with the similar House bill.

“However,” he warns, “the way it is being done does not give me a good feeling.

“In the Senate Finance Committee the Democrats were only able to get the support of one Republican–Maine’s Olympia Snowe–on the way to a 12-7 approval.

“They did not have the support of the ranking Republican, Chuck Grassley of Iowa.”

Laszewski is worried: “Senate Finance Democrats lost the support of the Republicans when they insisted on departing from last year’s bipartisan agreement to leave existing policy on covering the children of legal immigrants as is. As it now stands, a legal immigrant agrees not to apply for Medicaid and SCHIP benefits for the first five years they are in the country. Under the new rules states would have the option of covering legal immigrants. The new bill also left out provisions from the earlier bipartisan comprise to limit benefits for higher income families.

“Without judging on the merits whether these two new provisions should have been in the bill, what the Democrats have done is moved away from earlier bipartisan agreements,” he points out, “ and in doing so lost moderate Republicans like Grassley who showed good faith in reaching an earlier bipartisan compromise.

He concludes: As I have repeatedly said on this blog, major health care reform is not possible unless it is bipartisan.”

Here I have to disagree with Laszewski.  Inevitably, health care reform will be partisan because it is all about social values—and our beliefs about what is fair.  Progressives tend to emphasize a collective vision of the common good. Conservatives are more likely to stress the rights of the individual.

From a progressive point of view, it seems only fair that poor legal immigrants should have access to health care, especially if they are children. They have done nothing wrong. And they need help. Some would say: “from each according to his ability, to each according to his need.”

Many conservatives would reject that sentiment as socialist dogma. “Why,” a right-learning business man might ask, “should I pay taxes to provide health care for every poor immigrant who comes to this country?  I have worked hard all my life. And if I have more ability than the next fellow, and so amassed a certain amount of wealth, why should I be penalized for that?  ‘From each according to his ability, to each according to his need,’ means that the strong are supposed to support the weak. I take care of my family, that’s my responsibility. But it’s unfair to ask me to support everyone else’s children. I didn’t bring them into this country.”

In many ways the debate about whether legal immigrants have a right to share in national health care is a perfect test case for the difference between the two parties. The debate is about values. Progressives and conservatives each are committed to certain beliefs about what is “right.”  When it comes to bedrock values, how do you split the difference? How do you compromise your values?

Ultimately, universal health care is not just about technical details. There, we can compromise. But it also is about what we, as a society, believe is ethically right. So the debate over health care reform should be a partisan debate.

In part two of this post, I’ll comment on Senator Daschle’s statement that, when it comes to health care reform, legislators should “be guided by evidence and effectiveness, not by ideology.”  Certainly, Daschle is right: medical evidence and science should guide our decisions about what to cover. But when it comes to who to cover—and whether we are going to continue to ration care according to ability to pay,  country of origin, or some other rule that divides “us”  into “me and people like me” versus “them,”—we are going to have to wrestle with “ideological questions”.

For many the word “ideology” has a negative connotation. During the Cold War we used “ideology” to refer to communism. Capitalism, by contrast, was not an ideology. But if you look at a dictionary you’ll find that the word is not as charged as the “Red Scare” made it seem.  An ideology, it turns out, is simply “A set of doctrines or beliefs that form the basis of a political, economic, or other system.”

Health care reform is about beliefs as well as science. We can try to sweep that under the rug, but I doubt we’ll get far.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

8 replies »

  1. I think there’s a role for ideology and partisan debate, but too many conversations are dominated by those factors these days. Many reform discussions, including some on THCB, never reach a conclusion because the two sides simply won’t concede on anything. Effective reform is going to require concessions from everyone.

  2. in regards to Neimon’s comment about compassion for others and Maggie’s idelogical hit piece which does the uninsured children more good a new art project or conservation park funded by liberals, or free care from Catholic Healthcare West? I have also seen numerous churches pick up the tab for rent or COBRA when members need it.
    Peter I would debate your conclusion, it’s based on the premis that the reform advocated by liberals would work. Contrary to Maggie’s claim most conservatives I know have no problem helping their fellow man, we do object to giving the government $1.50 in taxes to provide $0.70 cents of assistance. It’s dishonest to classify this like Maggie does or your assumption implies. It doesn’t make us bad people when we feed our neighbor directly and save $0.80 doing it. As my link and most studies show and Brad appears to agree conservatives are far more likely to actually assist our neighbor in their needs then Liberals who are offended we do it without them.
    On another blog it would be interesting to discuss your point further Brad. The reason to give to a religious organization I feel is far different then when you give to the arts or your college. Liberals give to charaties from which they get a greater personal sastisfaction where as conservatives take greater pleasure from giving when they know it is helping someone else. The polar opposite of Maggie’s claim.

  3. Nate, I don’t think conservatives can hold their heads that high or feel too smug because at the same time they’re “giving” they’re also working against reform that would make charity less needed. As Ralph Nader is quoted; “”A society that has more justice is a society that needs less charity.” Charity may also be considered by conservatives as just good strategy rather than good intensions as not giving would make the disadvantaged more visible and increase the pressure for reform. In the same book it also showed that people at the low end of the income scale give 30% more of their income than people who earn over $1 million. Charity is nice and may help you sleep better at night, but it is no substitute for policy. As a realistic liberal I also get frustrated with the needy wanting better policy but who don’t participate in politics or even vote, and worse, don’t adapt their attitudes and approach to help their kids do better than they are doing.

  4. Nate
    Kristof wrote an interesting op ed a few weeks back on charitable giving. Interesting. If you look at secular conservatives, they are lower than liberals in their giving percentage. Religious conservatives, however, exceed liberals, but their charity is directed to mostly religious organizations. Liberals tend to give greater amounts to the arts, environment, etc. Not looking to stir the pot, just adding a little background. Thought it was enlightening. Grist for both sides

  5. Moving on a little from the abuse…
    Imagine if we had a health care system to which every legal resident contributed, either through taxes or mandated premiums (and assuming that the lowest-income group would make minimal contribution). There would be little need to worry about how long anyone had been in the country, since everyone would be paying their share.
    Would some immigrants receive far more care than their contributions had paid for? Certainly. And many other immigrants would use far less care than their premiums or taxes could have purchased.
    Sounds like reform to me.

  6. “to the point of denying aide to all, lest someone be unaccountably helped, saved or caused not to die today.”
    Typical progressive, why bother with the truth when you can just parret your own reality?
    ” In 2000, households headed by a conservative gave, on average, 30 percent more money to charity than households headed by a liberal ($1,600 to $1,227). This discrepancy is not simply an artifact of income differences; on the contrary, liberal families earned an average of 6 percent more per year than conservative families, and conservative families gave more than liberal families within every income class, from poor to middle class to rich.”
    Those evil conservatives never help anyone do they Neimon. The honest difference is conservatives give their money to help others, progressives give other peoples money(tax payors) to feel good about themselves.

  7. “Conservatives prefer a system that actually spends the money where it is needed.”
    More accurately, conservatives prefer a system in which no money is spent in any way that could even accidentally go to someone who doesn’t “deserve it,” to the point of denying aide to all, lest someone be unaccountably helped, saved or caused not to die today.
    Are there no workhouses? Why no, Mr. Scrooge, there are not. We don’t even allow that anymore.

  8. If only it really was this naively simple. Children of legal immigrants is what Progressives will try to paint the argument as but is just the tip of the iceberg, that doesn’t even begin to cover the issue. What about illegal immigrants? Progressives have already stated they want them covered as well. States do a terrible job of verifying eligibility already, opening it up to legal immigrants just leaves more room for States cover non eligible children. They have no incentive to not game the system, it bring tens or hundreds of millions into the state with minimal risk of getting caught and on the off chance you do they just pay it back, no jail or fines.
    When the last bill was vetoed;
    “House Democratic leaders,” Congressional Quarterly reports, “may have only limited flexibility to negotiate” because liberals, black and Hispanic members “have already expressed frustration that the bill Bush vetoed was itself a compromise.” When rumors circulated that House leaders were contemplating language to require tough proof-of-citizenship requirements for SCHIP enrollees, representatives of the several race-based congressional caucuses as well as other “progressive” members jumped into action. They sent Speaker Nancy Pelosi a strongly-worded letter warning against further concessions, especially, CQ reported, “on immigration issues.”
    “We are deeply concerned,” they wrote, “by the continued compromises we may be asked to make on behalf of our communities.” “Such compromises,” they warned, “cause us to question our support for the overall package.”
    These members like the vetoed SCHIP bill because it would weaken the citizenship and identity verification requirements in current law to prevent illegal immigrants from enrolling in SCHIP. Current law places the burden on citizens and nationals to provide the documentation necessary to prove their citizenship and their eligibility for programs such as SCHIP.
    We already provide billions in free education to illegal immigrants now progressives want to spend billions on their healthcare. If that is not your intent then why not write very strict and enforceable verification requirements into the bill?
    This is what audits of the current inadequate system say;
    Because Medicaid and SCHIP are Federal/State matching programs, improper payments by States lead to corresponding improper Federal payments. Identifying payment errors and their causes in the Medicaid and SCHIP programs is particularly difficult because of the diversity of State programs and the variation in their administrative and control systems. Until recently, little was known about payment error rates in the Medicaid and SCHIP programs. This lack of information represented a substantial vulnerability in preventing fraud, waste, and abuse.
    For the 6-month period ending June 30, 2006, approximately $363 million (Federal share) in Medicaid payments and $67.2 million (Federal share) in SCHIP payments were made on behalf of beneficiaries who did not meet Federal and State eligibility requirements in these three States.
    OIG is statutorily required to determine every 3 years whether Medicaid-eligible children are inappropriately enrolled in separate SCHIP programs. States receive a higher matching rate for SCHIP than for Medicaid, thus creating incentives for States to inappropriately enroll Medicaid-eligible children in SCHIP. Most recently, OIG found that an estimated 4 percent of children enrolled in separate SCHIP programs were eligible for Medicaid in 2006
    Additionally, 4.5 percent of cases lacked sufficient documentation to enable OIG to make a determination regarding Medicaid eligibility.
    9) The SCHIP error rate is composed of three components fee-for-service, managed care, and eligibility. The component error rates are 11.0 percent, 0.1 percent, and 11.0 percent, respectively. The States were asked to report the eligibility data in three categories: eligible, ineligible and undetermined. The eligibility component noted above counts the ineligibles and the undetermined cases as errors. The undetermined portion of the eligibility component error rate was 8.3 percent. When the undetermined cases are not included, the eligibility component error was 2.7 percent. HHS also calculated a national case error rate. The active case error rate for SCHIP is 11.5 percent and the negative case error rate is 1.6 percent. In FY 2007 91.1 percent of sampled active cases were determined eligible; 5.7 percent of sampled active cases were determined ineligible; and, 3.2 percent of sampled active cases could not be determined. For the sampled negative cases, 97.9 percent of cases were correctly denied or terminated and 2.1 percent were improperly denied or terminated.
    The FY 2007 annual national SCHIP error rate is 14.7 percent. The FY 2007 annual component error rate for SCHIP fee-for-service is 11.0 percent.
    Read the rest of the report, it’s damning of all government ran healthcare systems for any honest person. There in lies the partisanship, when progressives so blatantly lie how are conservatives to agree with them on anything? Double digit error and fraud rates are not acceptable…unless you’re a progressive. That’s how they can champion Medicare for All with a 10% fraud rate and pretend it doesn’t exist. Medicare is more efficient…as long as you overlook the FACT it loses 10 cents on every dollar to fraud and waste. SCHIP presently is a mess and almost a disaster. Progressives want to further weaken the controls. Conservatives don’t mind helping out our neighbor, in fact every study shows we are more charitable, but that doesn’t mean we want to educate and insure the world while corrupt liberals skim 10% off the top.
    Contrary to Maggie’s claim this is not about values in relation to insuring kids of legal immigrants. It is about government programs with next to no accountability, high rates of fraud and waste, and unchecked abuse. Progressives advocate for a system where you can steal as much as you can while contributing as little as possible, Conservatives prefer a system that actually spends the money where it is needed.

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