by Mortimer B. Zuckerman
Obama's ongoing focus on healthcare instead of jobs and the economy suggests a lack of empathy and imagination
By initiating yet another public debate on healthcare instead of focusing on jobs and the economy, the Obama administration has once again gone off message. Almost every poll shows that the economy is, far and away, the major personal worry for most Americans. Unemployment is the singular issue that they feel demands bold, unrelenting, and detailed attention. And they're right.
In Obama's State the Union speech, the one sentence that resonated was this:
"Jobs must be our No. 1 focus in 2010."
It suggests a lack of real empathy and imagination to make the declaration and then divert the focus.
Almost as misguided as the administration's desperate desire to get the health plan enacted is the way the
Democrats are resorting to the special legislative procedure called "reconciliation."
The administration claims that this special procedure to avoid a Senate filibuster is similar to how
welfare reform, the COBRA insurance act, and George W. Bush's '01 and '03 tax cuts were passed.
But as the accomplished political analyst Mark Penn points out, in 1996, 68 percent of the public
favored President Clinton's welfare reform. It attracted fierce liberal opposition but a good deal
of bipartisan support and proved highly successful. In 2000, just before President Bush's
$1.3 trillion tax cut was introduced, 63 percent of Americans believed their income taxes were
too high. Even after many months of legislative squabbling over his tax program, 56 percent still favored Bush's
cuts. Indeed, 52 percent supported the second round of tax cuts in 2003.
By contrast, a recent CNN poll puts voters' backing of the Obama administration's health bill at just 25 percent. A similar percentage suggests forgetting about healthcare reform altogether, and 48 percent would like Congress to start over with an entirely new bill. Of even greater political concern for the Democrats is--or ought to be--that only 18 percent of independent voters support their plan. Some 52 percent of independents call for a wholly new bill. These are the voters who will determine the election outcomes in November.
Other contentious national debates ended when support had solidified as a precondition for final passage. President Lyndon Johnson's Medicare plan had 63 percent public support when it was passed in 1965 with a significant number of Republican votes. His civil rights push won 60 percent public approval.
Today, 52 percent rate jobs or the economy as their top issue, according to a recent New York Times/CBS News poll; just 13 percent cite healthcare. Indeed, many view the proposed version of healthcare as medicine that is worse than the disease, given their conviction that it is questionable to undertake costly healthcare reforms when the economy is so battered, especially since most Americans think that theirs is the best healthcare system in the world.
By many measures, the United States provides better healthcare than the universal systems in countries like England and Canada. This includes such benchmarks as the success rate of cancer survivors five years after diagnosis; the time people must wait for treatment and surgeries; the number of MRI scanners per million people--and the beat goes on.
To justify his argument that healthcare is a top domestic priority, President Obama is now forced to explain his rationale not only to the public but to his own skeptical party. Democrats know that to adopt the Senate program under the reconciliation process will remind the public about all the sweetheart deals made by Majority Leader Harry Reid in order to win the 60 votes he needed to get the bill passed by the Senate. Remember the "Louisiana purchase" and the "Nebraska payoff" that enabled those states to pay less for Medicaid than other states, requiring the rest of us to pay for them? Or protecting seniors in Florida but not protecting seniors in California, Illinois, and Wyoming? Or giving the unions a free pass for five years on their "Cadillac" health programs? Where is the equity in these shenanigans? They simply add to the public sense of despair that Washington is out of control--the Washington Obama promised to fix.
On healthcare, the American public is focused primarily on the costs. No wonder.
According to the Centers for Medicare and Medicaid Services, health plan costs increased 73.5 percent from 2000 to 2009; prescription drug costs rose 104.2 percent; physician and clinical services went up 82.8 percent; hospital care costs grew 82.5 percent; and national healthcare expenditures jumped 82.7 percent. Medicare now has a $38 trillion unfunded liability; Medicaid is growing at 21 percent a year, suffocating state budgets. Yet the Obama administration is proposing the biggest expansion of federal healthcare guarantees in 40 years, adding trillions of dollars in obligations that we have no means to pay--indeed, when we have no idea of how to pay for the entitlements we already have.
Of even more concern are the premises that were provided to the Congressional Budget Office to secure its stamp of approval on costs. Many of these suppositions are reasonably open to question. The CBO projections are based on 10 years of tax increases--almost half a trillion dollars--and 10 years of reducing Medicare costs, also about half a trillion dollars. But the estimates count only six years of spending increases. Then the bill takes monies that were designed for other purposes and counts them as offsets to the healthcare cost increases: $52 billion from Social Security revenues, $72 billion from a long-term insurance program, and half a trillion dollars out of Medicare. It assumes that payments to Medicare physicians will be reduced by Congress, when everybody knows this cut will never take place, just as all such promises in the past have been unfulfilled.
In effect, this is double counting. When you strip out these credits and other dubious premises, the full cost of the bill comes to a $460 billion deficit in the first decade and a $1.4 trillion deficit in the second decade. Is it any wonder, then, that people don't trust the official projections? In a Rasmussen poll, 81 percent of voters say it is likely the plan will end up costing more than projected, while only 10 percent feel the official numbers are likely to be on target, and 78 percent say that the proposal is likely to mean higher taxes for the middle class. Fifty-seven percent believe it would hurt the economy versus only 25 percent who believe it would help.
So the Republicans have been able to gain traction by alleging that the CBO numbers are based on accounting and budget gimmicks. They question the notions not only that the bill will bring down the cost of healthcare but that it is fully paid for and will reduce our deficits. "I have pledged that I will not sign health insurance reform that adds even one dime to our deficit over the next decade," President Obama said. "And I mean it. We have estimated that two thirds of the cost of reform to bring healthcare security to every American can be paid for by reallocating money that is simply being wasted in federal healthcare programs." Frankly, it's a statement that risks his credibility.
There is a different approach that seems to make political sense: the step-by-step approach. Basically, this would mean determining what costs we can save and, therefore, what we can spend and then dealing with provisions that are supported by the American people. Included in these would be banning discrimination by insurance companies based on pre-existing conditions, moving to standardized electronic medical records, caps and controls on malpractice rewards--all with the idea of reducing costs and improving the system. Only when we know what we can save should we try to expand coverage.
But the Obama administration seems to be heading in the direction of the man who jumps off a 40-story building and, as he is hurtling past a 12th-story window, yells out, "Don't worry, nothing has happened yet!"
Available at Amazon.com:
Inventing the Job of President
The Political Fix: Changing the Game of American Democracy, from the Grassroots to the White House