Federal Judiciary

What Now? -- By: NRO Symposium

With the Democrats? health-care legislation having cleared the last legislative hurdle, it is all but inevitable that President Obama will be signing it into law. Is this the end of the road for the debate, or is there a way forward for real reform that puts decisions into the hands of health-care consumers rather than the government? National Review?s panel of health-care watchers weighs in.

REP. TOM PRICE
Last night in the House of Representatives, a majority of Democratic lawmakers, led by the liberal wing of their party, flagrantly ignored the wishes of the American people. It was an oppressive and arrogant move to cram through a massive expansion of government authority -- one that will severely damage the accessibility, affordability, and quality of health care in this nation.

This is not a victory for patient-centered health care. And so the fight to enact commonsense reforms to preserve and protect patient-centered health care must go on, and it will go on. The American people are eager to embrace a plan that will expand access, preserve quality, provide coverage for those with preexisting conditions, strip away the barriers to insurance competition, and finally address the runaway costs of lawsuit abuse. These are just a few of the items that would positively reform health care in this nation while not sacrificing the care already enjoyed by millions of American families.

The cause of patient-centered health reform will continue even in the face of the Democrats? big-government agenda. I, along with my conservative colleagues in Congress, will press on against this takeover and for solutions all Americans can embrace.

-- Rep. Tom Price is a physician and chairman of the Republican Study Committee.

SCOTT GOTTLEIB
The question arises: What next? How will the health-care landscape evolve on the heels of Obamacare?s passage? Economic forces provide some clues.

The insurance market will begin to shake up almost immediately, as health-care plans jockey for advantage in advance of the legislation?s full implementation. Insurers will begin pulling out of the individual market, and they will aggressively hike premiums in the small-group market. These consequences are the market?s response to the bill?s new regulations, which effectively prevent insurers from underwriting risk. Insurers are forced to take all comers and, in many cases, they will decide that certain business lines are no longer profitable.

The net result is that two years from now we will likely be looking at an insurance market that has become worse, not better, with premiums higher and more Americans joining the rolls of the uninsured.

Longer term, insurers will begin to consolidate into a handful of very large national carriers backed up by small, state-based plans that try to attract consumers using regional appeal. Health insurance will become a commodity product, one that offers little consumer choice and with benefits that are mostly defined by regulations issued in Washington. Doctors will begin to consolidate their practices into larger groups, or sell their offices to hospitals or large medical chains. That is how physicians will gain leverage on health-insurance plans and take advantage of new reimbursement rules created under the legislation?s Medicare reform.

In the end, there will be only two places for consumers to get health coverage -- through a large employer (most likely a union plan) or through the new state-based exchanges. Many large employers with a preponderance of middle-wage employees will move their workers into the exchanges, since the subsidies are richer than the tax exclusion they get through worker-provided coverage. Only employers with sticky union contracts, or those that employ a lot of high-wage workers (e.g., Goldman Sachs) will continue to offer workplace coverage.

Eventually, the federally regulated exchanges will be the only game in town. That was the idea behind Obamacare from the start.

-- Scott Gottlieb, a practicing physician, is a resident fellow at the American Enterprise Institute.

JOHN HOOD
I?m as angry and disappointed as any conservative about the vote of the House of Representatives to nationalize the regulation and funding of health care. But as I watched the debate Sunday afternoon, I found that competing with these sentiments was a different feeling -- the one you get when watching a slow-motion film of a car crash, or maybe an episode of Cops. You want to yell, ?Look out, you?re about to drive into a tree!? or ?Dude, don?t bother telling the cop the weed isn?t yours, he?s not buying it!? But you know that it won?t make any difference. So you watch, open-mouthed and, somewhat guiltily, entertained.
 

The Democrats think that by shoving this idiotic, unpopular bill down our throats, they?ve won. They keep thinking the massive tree in front of them is a mirage, or that the skeptical cop will buy their nonsensical version of events. They?re deluded. It?s sad but fascinating to watch.
 
It?s become trite to say that this vote is only the beginning of the health-care debate, not the end. But observations often are trite because they are so obviously true. Since major portions of Obamacare don?t come into effect for many years, there?s plenty of time for repeal legislation -- and any future Republican Congress and president should feel entirely justified ignoring filibusters and other procedural roadblocks to repeal, given the way Democrats have handled this legislation.
 
Until then, every time a health insurer raises premiums or denies a claim, the Democrats will be blamed. As with the stimulus issue, the Democrats will claim that things would have been worse without their bill, but few will believe them. Ceteris paribus claims are hard enough to argue when they?re true. Theirs won?t be.
 
Tired of hearing about health care? Sorry, but it will be a dominant political issue for years to come, much to the Democrats? regret.
 
-- John Hood is president of the John Locke Foundation, a North Carolina-based think tank.

JAMES C. CAPRETTA
The special-election Senate race in Massachusetts was a watershed moment in the year-long health-care debate. Scott Brown gave voice to the millions of citizens around the country and his state who were aghast at the willful disregard the president and congressional Democrats had shown throughout 2009 toward public opposition to a government-heavy reform effort. He won the election, handily, as a result.

Since Brown?s stunning victory, the White House and its allies in Congress have spent two months concocting ever-more-elaborate schemes to get around the verdict rendered by Massachusetts?s voters on their health-care ambitions. The question is: Now that the bill has passed, what will the public?s reaction be?

Democrats think the public will turn their way, grateful that the party?s enlightened leadership ignored their views and gave them what they needed, not what they wanted.

Perhaps. But there is another possibility. It might be that many concerned citizens actually understand the issues and the choices better than the national Democrats think they do. It could be that the public saw that the Democrats were constructing a massively expensive program and putting the federal government in the health-care driver?s seat. Yes, millions of low- and moderate-wage Americans will become eligible for a new entitlement in 2014. But it will come with costs as well as benefits, as many workers will still have to pay large sums for rigid, government-approved plans. Citizens may have looked at all of the pros and cons and concluded that the bill was not worth the cost to the budget, their tax bill, or the quality of their current health care.

If that is the case, then voters may not be quite as willing as Democrats expect (or hope) to quietly go along with the partisan power-play Democrats have executed in recent weeks and days.

All of this is to say that the final word on the health-care bill was not uttered on the House floor today. It will be, by voters, in November of this year and again in 2012.

-- James C. Capretta is a fellow at the Ethics and Public Policy Center. He was an associate director of the Office of Management and Budget from 2001 to 2004.

MICHAEL G. FRANC
Just as the Dred Scott decision inspired the creation of the abolition movement, and Roe the pro-life crusade that continues to this day (especially this day!), today?s passage of the single most significant expansion of the government?s role in our lives marks the first day of a new political order. That the 2010 elections will be a national referendum on one word -- ?repeal? -- is a certainty. Voters will want to know how politicians running at both the federal and state levels stand on one overriding question: Are you for or against repeal? No one will have to ask what it is they want repealed.

Want to take a guess what H.R. 1 will be should Republicans regain control of the House in November? It will consist of one succinct sentence: ?Public Law 111-___ is hereby repealed.?

Passage of H.R. 1 will be the first order of legislative business on the first day the next Congress convenes. The appropriations process will become a bloody legislative battleground where lawmakers who support the repeal movement seek to limit funds to agencies tasked with hiring the tens of thousands of new bureaucrats to write the regulations and otherwise implement health reform. In the Senate, the repeal movement will mount legislative assaults as well, but the supermajority requirements there will necessarily impede their efforts. Until the 2012 election cycle begins in earnest, that is.

Slowly, it will become clear that it is this new relationship between Americans and their government that lies at the crux of the seemingly endless political controversies swirling around us. If you thought ordinary citizens set new land-speed records for hurling heretofore arcane provisions of the Constitution or direct quotes from the Declaration of Independence at their elected representative, get ready for even more. The public?s healthy appetite for more knowledge of the principles of America?s founding, and what they mean relative to all this new government authority, will only grow in intensity. First-principles book clubs, anyone?

The good news for conservatives is that the natural instincts of the American citizenry lie firmly with the values that animated the Founding Fathers, and therefore with us -- a government of limited power; a nation of laws and not of men, where the spirit of entrepreneurship is honored and encouraged; and a government that recognizes that the most important institutions in our society are families, churches, communities, and then, and only then, government.   
 
The new law has already inspired a reaction among the states. State attorneys general are receiving instructions from their governors and state legislatures to challenge various provisions of the new law. Legislation to negate the effect of the new mandates has advanced in dozens of states. The vast expansion of the state-federal Medicaid program has prompted similarly dire concerns over the fiscal implications for state budgets. Two offshoots: First, candidates for even the most obscure state offices will quickly realize that their would-be constituents want to know their position on the new law. Second, a long-overdue rebirth of the concept of federalism may be in the offing.

So, if you get the feeling that something profoundly important just changed, you?re right. Put down the remote. Get off the couch. Suit up. Study the issues and the history of our great nation. Then, go get ?em!

-- Michael G. Franc is vice president of government relations at the Heritage Foundation.

SALLY C. PIPES
Nancy Pelosi effectively arranged a series of political bribes to House members in order to get the votes she needed, telling the New York Times, ?We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn?t work, we will parachute in. But we are going to get health-care reform passed.?

It goes to show the lengths to which Pelosi, President Obama, and Senate Majority Leader Harry Reid are prepared to go to take over 17.3 percent of the American economy.

The CBO estimates that the reconciliation bill will cost $938 billion over ten years while reducing the deficit by $124 billion over the same period. If enacted, the plan will likely cost in excess of $2 trillion and result in higher taxes, increased deficits, and rationed care for all Americans. This debate is not about achieving universal coverage at a lower cost; that will not be done under Obamacare. This debate is about an ideological insistence on having the government make decisions about our health care rather than letting individuals make them. Their goal is a single-payer, government-run system called ?Medicare for All.?

The Republicans do have ideas about how to make health care affordable, accessible, and of a higher quality. The party must find a strong leader with a clear vision of how to reform our health-care system based on patient-centered solutions. In the 2010 elections, they must make large gains in the House and the Senate. In 2012, a Republican president must be elected so that the repeal process can be consummated.

There is precedent: In 1989, Medicare Catastrophic was repealed, and this can be, too, though no one should pretend that it will be easy. In fact, the repeal of this titanic new initiative will be enormously difficult. We are driving headlong down the road to serfdom, and no advanced democracy that has come down this far has ever found an off ramp.

-- Sally C. Pipes is president and ceo of the Pacific Research Institute. She is author of The Top Ten Myths of American Health Care.

TEVI TROY
The Democrats may have passed their health-care bill, but this does not mean the end of the argument. Going forward, we will certainly have more taxes, more subsidies, more rules, and more people covered via Medicaid, all of which will make it harder to improve the system. But many of the good Republican ideas still apply and can help make things better.

We can still benefit from tort reform, which will both save the government about $54 billion over ten years and reduce the practice of defensive medicine, which leads to too many unnecessary tests and procedures. Even though the new bill will impose new regulations on insurance companies, we can still promote a fuller liberalization of purchasing of insurance across state lines to expand access to the market for insurance and drive down prices. We can still promote price and quality transparency to encourage consumers to make smart decisions regarding their own health care, which can also help drive down prices. And we should encourage experts to watch the implementation process for the new legislation, a process that will take years, to make sure that the executive branch is not taking the new law even beyond where Congress wanted it to go.

Furthermore, Republicans need to promote the development of more good ideas on health care and link them to a political operation that can effectively push those ideas with voters. In short, Republicans have a lot to do. We may have lost an important and expensive battle, but the need to fight the good war continues.

-- Tevi Troy, deputy secretary of health and human services from 2007 to 2009, is a visiting senior fellow at the Hudson Institute.

ROBERT P. GEORGE
Congratulations to the Republicans for standing firm and united against the giant step that is being taken towards refashioning the United States of America as a European-style social democracy.

As for the Democrats who joined the Republicans in voting against the Obama-Pelosi health bill, their ?no? votes should give them no immunity in November. This is not a time for sentimentality. We should target the Democratic ?no? voters for defeat no less vigorously than we will be targeting the ?yes? voters.

First, many of the Democrat ?no? voters were prepared to vote ?yes? had their votes been needed to pass the Obama-Pelosi bill. They were given permission by the Democratic leadership to vote ?no? in the hope that recording a ?no? vote would enable them to hold their seats against Republican challengers by falsely claiming that they opposed this travesty. Second, even the sincere Democrat ?no? voters are culpable: Their votes for Pelosi as speaker helped to put the House in the control of left-wing Democrats.

The question we face now is how to stop this train before it reaches Stockholm. The good news is that millions of our fellow citizens are outraged and energized. The November elections can?t come quickly enough for them. Republicans need to see to it that every swing district Democrat is sent home to face the voters with Nancy Pelosi hanging like an albatross around his neck.

-- Robert P. George is McCormick Professor of Jurisprudence and director of the James Madison Program in American Ideals and Institutions at Princeton University.

GRACE-MARIE TURNER
The 219 House Democrats who voted to pass Obamacare may think that their vote puts health care behind them, so they can move on to other issues.

Dream on. President Obama?s reassurances that the public?s opposition to this massive overhaul will turn to approval are pure fantasy. The American people have rejected the substance of the health overhaul legislation, they are repulsed by the special deals and pork used to get it passed, and they are outraged that Speaker Pelosi jammed the bill through with threats and promises to members despite the deafening disapproval of the American people.

Democrats issued a list of the Top Ten Immediate Benefits the bill will offer, but they are either too modest to affect many people or likely will cause unintended consequences. Everything bad that happens next in our health sector will be blamed on the inevitable failings of this top-down, centralized approach to reform.

The uninsured rolls will continue to swell, it will be harder to find a doctor as many quit the practice of medicine altogether, deficits will continue to soar, and the quality of care will get steadily worse as doctors and hospitals become more responsive to bureaucrats than to patients.

And then consider:

Cost: Health-insurance costs will continue to soar. Premiums will continue to rise and will likely rise faster because of new mandates on insurers.

Medicare: The added drug benefit will assist a few, but at least 10 million seniors are threatened with losing their Medicare Advantage benefits because of deep cuts to the program. When they lose their coverage, they will blame Obamacare. And it will come sooner rather than later.

Jobs: Employers will face new taxes, along with fines and penalties, if they don?t provide insurance or if one or more of their employees seeks coverage in the new government exchange. Hiring new workers, particularly entry-level employees, will be a risk fewer employers will be willing to take.

Coverage: Many people who value their job-based insurance will lose it. Employers will face huge risks if they continue to offer health insurance, and some already are considering dropping health benefits altogether. Many will find it is cheaper to pay the fine and send their employees to the exchanges or other government plans than to pay for increasingly expensive government-defined insurance for their workers.

Members who voted for this bill, boasting of its benefits, should expect to find themselves perpetually on defense in explaining the cascade of problems it creates. An electorate that has been so ignored in this process will look for every opportunity to remind them of the high cost of false promises.

-- Grace-Marie Turner is president of the Galen Institute.

Full post as published by Bench Memos - National Review Online on March 21, 2010 (boomark / email).