The Gentleman From Indiana

In his Washington Post column this week Dan Balz wonders whether Evan Bayh was overstating the degree of partisanship in Congress and whether, notwithstanding that, he should have stuck around to deal with the problem.

I don’t think any of us have been alive long enough to know whether the first is true. Politics always seems at its worst when you are in the middle of it. It may be, though, that the existence of social media has made it more combative, for the old-style behind-the-scenes sausage making is no longer possible. Also, clever users of these media can create a “movement” in just a few hours, pushing positions to the extreme. Though politicians have become experts in using social media to run election campaigns, they have not yet figured out how to use these tools to help build bipartisan coalitions to govern.

And, on the second, we have no right to judge this gentleman on his personal decision. If he no longer wants to try to stay in Washington to work on the problem, there will be plenty of other candidates. No one is indispensable.

But I was struck by this quote, “”If I could create one job in the private sector by helping to grow a business, that would be one more than Congress has created in the last six months.” Senator Bayh’s statement is emblematic of an underlying philosophy of government that might be at the heart of the current partisanship. In this country, many people feel that it is really not the job of the government to be the job creator.

I think lots of people intuitively understand the Keynesian imperative to use federal fiscal policy during a recession in a counter-cyclical manner to boot-strap the economy. But there comes a point where the cost of doing so, and the burden it puts on future generations of taxpayers, becomes a political argument against further expansion along those lines.

In my view, that is the tectonic fault line currently in Congress.

I don’t dispute that nasty tactics are in use, by both parties. But I am suggesting that there is a legitimate public policy debate behind the discord.

Thus far, President Obama has not figured out how to bridge this gap. Bill Clinton did, after he lost the Congress to the Republicans. He moved their way politically and was able to build a bipartisan coalition on several issues. The first George Bush did likewise with the Democrats.

Obama does not model the behavior he asks Congress to employ. He calls for civility, but then he demonizes or rails against industries and people (banks, bankers, insurance companies, even Cambridge police officers.) Parts of his speeches are brilliant; but parts make him sound like a partisan legislator. He has never really run anything, and he is still getting his leadership legs. He has not figured out how to make his voice count for something in the Senate. There is thus no role model to provide coverage for moderate people in both parties who might be able to build the winning coalition.

A basic rule of negotiation is to give the other side something they can take home to their constituency. That is also an inherent characteristic of the republican form of government that comprises our Congress. Someone has to model that behavior. In these times, it has to be the President.

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15 replies »

  1. So many physician’s rail against payers and all those greedy a-holes on the ‘other side.’
    To me, there’s a lot of hypocrisy from these MD’s. I’m 50 years old, I’ve been increasinging ‘knowledgeable’ about healthcare for 20 years – I work in the industry. And I know very few physicians who do not make a crap ton of money and are always moaning about how they are getting squeezed.
    And it defies common sense when I hear an MD who touts increased government control and universal healthcare. Simply amazing how little business sense many doctors possess – evidently as a result of earning too much for too long.
    No sympathy from this guy.

  2. Well then, maybe we should HELP Wellpoint and take that losing business off their hands and off the hands of all other private insurers who are probably losing money on the individual markets well. That would be the “public option”. One big pool of losing business. Why would insurers be opposed to that?
    Regarding the MDs that “enjoy salaries at least twice as high as their foreign counterparts”, which they do, does anybody have a comparison of insurance companies (or sick funds) CEOs (and other executives) compensation here and in foreign countries?

  3. archon41 –
    Classic. The current system (for the over 250 Million insured) where the third party pays has allowed MDs to enjoy salaries at least twice as high as their foreign counterparts. PCPs may have a beef given their salaries versus their medical school debt, which is why Medical Schools turn out more specialists than PCPs.
    If money is going to be thrown at the problem, the government could help pay off PCPs loans. Repubs have also suggested Tort Reform, which should hold down Malpractice Insurance premiums.
    Margalit –
    I repeat, WLP LOST MONEY on the block of business getting the 25% (up to 39%) increase. Because of the competitive nature of Health Insurance (the know nothings who think a “public option” is needed not withstanding) they can not simply continue to undercharge these folks and subsidize this by overcharging others (say, large groups) because the others will soon go to another carrier.

  4. How very true. It is unseemly for the caring, committed, medical professional not to stand well above the welter of conflicting interests presented by HCR. But why do we see so many Jaguars parked in the “staff only” lots of the radiant temples of Asclepius? Still, I have no reason to doubt that the hearts of the priesthood will be gladdened by passage of a broad Public Option with reimbursement rates tied to “Medicare + 5%.”

  5. That’s ok MD as HELL. Bayh pretty much ensured that the next Gentleman from Indiana will be Republican.
    I am positive he will vote “No” on everything…..

  6. He should have voted “No” on healthcare prior to his departure. That would have been a powerful statement of his contempt for Congress

  7. What the politicos are hearing is not the tweeting of canaries, but cries of “Get the rope!”

  8. I come back to this blog to see this as a posting? This is why this site is bs as a health care site invested in health care issues. Yeah, there is politics in every issue we handle, if you want to dissect the dynamics of every challenge we face in this culture. But, isn’t it old that we let dissent and dialogue become “politics”?
    It is simple, people. Take profit out of health care matters, and let people dialogue about health care struggles on the principles of care, and watch the a-holes scurry around and find other arenas to feed on their narcissistic and greedy needs.
    You know, the longer I practice health care, the more I realize that people who care and are invested are the minority. Doesn’t that bother you as a reader who either wants to be treated or provide the level of care you were trained to offer?!

  9. Actuary, I understand that healthcare costs are rising, but they have not risen by 50% since last year. 10% increases would have gone unnoticed.
    archon, the seemingly adequately insured “constituencies” are ignoring the “canaries in the mine” at their own peril. It’s not about “feelgood”. It’s about survival.

  10. Excellent commentary. Evan Bayh was among the centrists who are increasingly villified by the vocal extremists on both ends of the political spectrum.
    The HHS “report” is a farce. Health care COSTS are rising, hence insurance rates are rising, not the other way around. WLP lost $$$ on their Individual Business in CA in 2009. Maybe they could have given lower increases to these guys, but some other insureds would have to pay for it (and by the way, the other (group) insureds do not want to pay for it).
    The Obama “reform” would increase costs at a faster pace than if we did nothing (look up Richard Foster, CMS Actuary).
    MD as HELL
    Perhaps you already know this, but in the “reform” packages, even the plan with the least benefits on the insurance exchanges would cover more (and therefore cost more) than about 1/3 of the current plans out there. HSAs (a type of insurance which is perfect for catastrophic events) would be axed.

  11. Might you be speaking of the “constituencies” who have adequate insurance, and are unwilling to pay more to fund “feelgood” expansions of “access”? The “constituencies” who, with respect to control of provider costs, are demanding to know “Where’s the beef?” The “constituencies” who see your attempts to liquidate insurers as a short path to your grim, single-payer regime? The “constituencies” who see that patronage politics has been made a quid pro quo for cost controls?

  12. Everyone should have major medical. It is cheap. No one needs this penny ante managed care for colds and sore throats. Insurance should not cover having a baby. You knew you were going to incur those costs. Everyone should have catestrophic coverage for an obstectrric catastrophy, but not for a Normal Spontaineous Vaginal Delivery.
    We are shipping our money and our power to the insurance companies. We need to stop doing that.
    Getting rid of managed care and keeping the money will go a long way towards creating jobs.

  13. Senator Bayh’s decision should of course be respected. It could be argued that the timing is a bit peculiar and calculated, to say the least.
    As to the ideological rift in Congress, maybe it isn’t the government’s job to actually create jobs, but it should be the government’s job to create an environment where jobs can be created and where workers can prosper through honest work.
    I would think that the current healthcare insurance situation is detrimental to both objectives. So just to take the “demonizing” notion one step further, here is today’s HHS report on premium increases:
    Ignoring the rhetoric and sticking to the numbers, there seems to be some reason for demonizing insurers, and supposedly non profit ones too. Now just because we identified one demon, it does not imply that there aren’t more out there….
    I really don’t know what the President can give Republicans to take home to their constituencies more than he already gave (universal care – killed, public option – killed, abortions – restricted, unions – penalized,….). Maybe he can add some tort reform in there, but I don’t even know if the Feds have the right to alter State legislation.
    Are you sure, Paul, that these folks are willing to take something, anything, from this President? Are you sure that it is concern for their constituencies that is prompting this behavior?

  14. I think bipartisanship is really hitting the skids of late. Politics seems to be turning the corner, once and for all, from a position in which the politician works to serve his constituents to a career not much different than maximizing profit in a private firm.