Last week, 42 freshman House Members sent a letter to President Barack Obama urging him to stop Democrats from employing “Mediscare” tactics on them and their colleagues for their votes in support of Rep. Paul Ryan’s (R-Wis.) Medicare proposal and other health care policy changes.
Lots of columnists, pundits and pols hooted at this, given that most of the freshmen had run for their jobs by treating the Patient Protection and Affordable Care Act, aka Obamacare, as a piñata, railing against death panels and its burn-and-slash approach to Medicare, which in turn had rallied senior support to the GOP cause.
I could hoot at the hypocrisy, too, even as I wish we could tone down the rhetoric and find a way to actually have — I shudder to use the hackneyed phrase, but will — an “adult conversation” about the urgent need to find some common ground on health care reform. Somebody has to start. So I have a suggestion for the freshmen that goes beyond a letter to the president asking for a one-way truce. Make it a two-way truce. You start by declaring that, regardless of whether you like it, the Affordable Care Act is the law of the land, and even if you dislike some of its provisions, you will help to facilitate the implementation of those consensus elements that will help people get services, help the health care provider system work better and help to bend the cost curve without unnecessary pain to patients or providers.
On Monday, the Washington Post reported that a commission designed to help match the supply of health care workers with the demand that will increase as the ACA gets implemented (and it should be noted, that is increasing even without the law) is in trouble because Republicans in Congress refuse to fund it — not a big budget item but a mere $3 million to hire staff and get under way; the 15-member commission was appointed not by the president but by the Government Accountability Office, and it is forbidden to seek outside foundation support in lieu of federal funds.
Everybody who has taken even a cursory look at the American health care system knows we have a serious mismatch between the health workforce we have and the needs for health care in all corners of the country. We have serious shortages of primary care physicians and nurses in many places and will have a serious shortage of nurse practitioners down the road when we are able to move many of the frontline duties of health care to MinuteClinics and the like, to facilitate care and reduce costs. Nobody should oppose a panel of experts from across the spectrum dedicated to those goals.
The Post article noted many other provisions of the law that are fundamentally noncontroversial and wholly constructive, from an expansion of the National Health Service Corps to an enhanced role for community health centers. Many of the cost-control measures in the ACA came out of long-standing bipartisan consensus, with a large share originating in conservative policy circles. But all are being obdurately opposed by House Republicans — including the 42 freshmen who signed the plaintive letter — because they have declared a holy war on Obamacare, with designs on killing every element of it, whether good or bad. I could add the independent commission set to oversee Medicare to reduce the Congressional interference endemic up to now and to find good ways to reduce the fee-for-service-driven costs in the program.
Much of this battle, as in other policy areas, is not based on genuine policy differences but on who is proposing or supporting the policy. Thus, the Ryan budget includes every bit of the $500 billion in cutbacks in Medicare that are in the Affordable Care Act — and that were excoriated by House and Senate Republicans, and candidates in 2010, as devastating to seniors, forcing the closure of 20 percent of hospitals, and that precipitated the Medicare bill of rights pledge drafted by the Republican National Committee that promised to protect seniors against the ravages the cuts would cause. And the Ryan health plan for Medicare is built around regulated insurance exchanges, which even Speaker John Boehner (R-Ohio) has said are identical to those in the Obamacare plan — but that last year he and others said were a giant step toward socialism. And that is not even to mention the individual mandate; I’ll leave that one to Newt and Mitt. On the other side of the coin, the basic structure of Ryan’s Medicare proposal involves premium support, an idea originated by liberal Democrats.
None of this is to say that Republicans should have embraced every part of the ACA or that liberals should be ashamed for ripping into Ryan’s plan; one can be for premium support but passionately against a pathetically low level of premium support. Acceptance of basic ideas or structures doesn’t mean support for specific proposals. What it does mean is that there is actually a huge acreage of common ground that can and should be the basis for debate and ultimately for compromise. But the fact that the health care plan supported by the votes of nearly all House Republicans includes key elements of the plan they excoriated in the harshest of terms a year earlier — and that they are trying every day to strangle in its crib — just underscores the fact that it is not the idea but the messenger that drives our policy debates in this era of the permanent campaign.
Two-way truce, anyone?
Norman Ornstein is a resident scholar at the American Enterprise Institute.