Green Room

ObamaCare: The public option and liberal fascism

posted at 12:07 am on October 29, 2009 by

House Democrats are planning to unveil their version of ObamaCare this morning, without a “robust” government-run insurance plan, which would slash reimbursement rates to some variation on Medicare rates. This has bloggers like OpenLeft’s Chris Bowers wondering whether the House can pass any ObamaCare bill:

This is going to anger quite a few members of the Congressional Progressive Caucus. Some of them might not vote for passage now, because they consider the public option too weak.

This matters because there are around 18-25 Democrats who will vote against the bill from the right, pretty much no matter what at this point. With every Republican likely to vote against the bill, this means that opposition from 15-22 Progressives would sink the entire bill.

And maybe pigs would fly out of my butt. The House proggs will cave in the end, having to settle for a bill that requires insurers to accept all customers and charge all the same price, regulates all aspects of their marketing to make sure they aren’t discriminating, and then redistributes the profits to make sure that no company gets penalized unfairly.

On the flip side, Megan McArdle explains why the “robust” public option would be an economic and political disaster:

[T]he thing about patients whose insurance doesn’t cover the average cost of treating them is that they cannot be 100% of your patient pool. Someone has to cover the cost of that MRI machine. If the public option does manage to crowd out other insurance–as it might well do, with the ability to dictate price controls–then suddenly, the public option won’t be cheap any more. Hello, fiscal crisis.

That’s the financial problem. Here’s the political problem: if you insert a strong public option, the providers will revolt.

You’ve already lost the insurers. Try to reimburse hospitals and doctors at Medicare + 5% for any large segment of the market, and you’ll lose them too. Health care reform is likely to survive the defection of the much-hated health insurance industry. I doubt there is any way at all that it survives negative ads from coalitions of doctors, hospitals, and other assorted healthcare workers. I don’t see Obama having much success getting on the radio one Saturday morning to complain that doctors are all a bunch of lying obstructionists.

McArdle wonders why the fixation with a “robust” public option has persisted. Her commenters correctly note that it makes a nice bargaining chip and distraction from the mandate-driven government takeover of the US healthcare system. And the cheap shot answer is that the nutroots generally lack a nuanced understanding of economics or practical interest group politics.

However, all of that is only a partial answer. The Obama administration has long seen this issue as another in the long tradition of corporatism, a staple feature of what Jonah Goldberg calls liberal fascism since the days when Big Meat co-opted the Teddy Roosevelt adminstration. One of the adminsitration’s main strategies on ObamaCare has been to pay off the “stakeholders”, i.e., the special interests most affected by the bill. Big health insurers, Big Pharma, AARP, doctors, etc. — have all been promised goodies under this approach. The point of friction with the “stakeholders” has been the public option, which is opposed by the insurers and the Business Roundtable (a major player which is otherwise with the SEIU and AARP on ObamaCare). This is implicit in McArdle’s analysis (though it is not entirely clear that the Dems have lost insurers, provided the Dems can fool AHIP into believing the mandates and penalties will be stiffened and enforced).

The history of the 20th century shows that progressives have generally been content to pursue corporatism clothed as “reform.” So why are liberals not content to let health insurance companies become the premium collectors for the welfare state?

Two possible answers leap immediately to mind. The first possibility is that healthcare is different. Socialized medicine has been the Holy Grail for the Left for the better part of the century because they see it as the cornerstone of a proper, Euro-style welfare state. Control over the healthcare system gives the government influence and control over many life-and-death decisions (except abortion, though that issue may be a monkey wrench in the House yet). In this context, corporatism leaves open the possibility that non-state actors would remain dominant, which is simply unacceptable to the true believers of the Left. This is why the Left freely admits they view the public option as a Trojan Horse for socialized medicine when talking among themselves.

The second possibility is that the 21st century Left is different. It may be that last year’s meltdown on Wall Street has actually convinced them that capitalism is a failure. They look at the bailouts, TARP, etc. and see most of the same flaws the Right sees — but concludes that the financial sector should have been nationalized instead. In this view, a version of ObamaCare that is merely corporatist simply does not take enough steps down the road to serfdom.

Of course, those possibilities are not mutually exclusive. I’ll be interested to hear if there are other possibilities I missed. In the meantime, a couple more ObamaCare tidbits. Yuval Levin notes that it looks like Pelosi may again be forcing her vulnerable Dem colleagues to vote before the Senate, which may be bad strategy in the short- and long-term. Sen. Evan Bayh may not be able to support a motion to proceed with the health care debate on the Senate floor, and he is practically daring his Dem colleagues to try getting the public option through budget reconciliation. (A reminder: Bayh’s wife is a director at Indianapolis-based health insurer WellPoint Inc).

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The Left believed that Obama was going to let government bureaucrats control people’s healthcare if they got him 60 votes in the Senate.

The worked for him, ‘found’ enough ballots in MN, and expect him to deliver.

Who knew all those feminists in the long ago before Obama were really saying, Keep your laws off my body – but oh your federal regulations and mandates…yes…yes….YES! Give it to me Big Brother…oh yes!

18-1 on October 29, 2009 at 12:19 AM

Pelosi is also holding the insurance company’s “feet under the fire”:

Pelosi told reporters a provision eliminating the health insurance industry’s exemption from federal antitrust law would be incorporated into the House measure.
Officials said a similar move was under discussion in the Senate, part of a strong response to recent industry criticism of the legislation.

Liberals calling themselves progressives? Put some more lipstick on, Mz. Pelosi.

Rovin on October 29, 2009 at 7:00 AM

Officials said a similar move was under discussion in the Senate, part of a strong response to recent industry criticism of the legislation.

Can you even imagine if the Republicans had tried something like this?

That’s a nice business you’ve got there…shame if anything were to happen to it…capiche?

18-1 on October 29, 2009 at 9:59 AM

I believe that yes, the public option fiasco is simply a distraction from what is the government takeover of healthcare detailed in both bills. But, I also believe the battle is between who controls healthcare premiums. The end game is the creation of another GSE such as Fannie and Freddie where huge sums of money is funneled through government appointees and provides a nice coffer for political operatives.

The insurers want to control this intake because they make profits with this investment principle. The Dems want that for themselves and a public “option” makes this possible. Health insurers would then eventually be relegated to healthcare administrators just as Blue Cross is now with Medicare and in fact, how health insurers operate within ERISA (self insured employers) where profits can be higherthan in their primary insurance line. That’s why health insurers have figured out they can win no matter which way health reform goes.

polmom on October 29, 2009 at 10:00 AM

No one should have much doubt as to what the real agenda is here–and in the other Comrade Obama (PBUH) plans. Just look at his mentors, pastor, video statements, voting record, and appointments.
NAME THIS CHILD! The new United Socialist States of America is my guess.
John Bibb

rocketman on October 29, 2009 at 10:25 AM

“Who knew all those feminists in the long ago before Obama were really saying, Keep your laws off my body – but oh your federal regulations and mandates…yes…yes….YES! Give it to me Big Brother…oh yes!”

Feminism in the Age of Obama – every “No” is really a “Yes!”

WWS on October 29, 2009 at 11:20 AM

Bayh was our pick for HRC VEEP. He had a really good chance at it,. He is very mod.

ginaswo on October 29, 2009 at 1:13 PM

No morality, no sense. America (And AllahP), you got your freedom from God, now enjoy the fruit of your labors. How long before this battle is a forgotten skirmish, and we face Democrats trying to push churches out of the culture, and usher in Islam’s demands? All in the name of tolerance and diversity. Then we’ll see how far gay rights get when Shariah has something to say about it.

leftnomore on October 29, 2009 at 1:14 PM

I think their motives are a combo of both those you list

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”

C. S. Lewis

ginaswo on October 29, 2009 at 1:14 PM

“Experience hath shewn, that even under the best forms of government those entrusted with power have, in time, and by slow operations, perverted it into tyranny.”
Thomas Jefferson

rabidamerican on October 29, 2009 at 1:32 PM

public fascist option

agmartin on October 29, 2009 at 1:32 PM

By now we have all heard the cliches and seen the posters from the “Tea Parties” espousing freedom, less government, and perhaps most of all, how the federal government had better back off trying to shove their national healthcare down our otherwise healthy throats. The truth of the matter is all the slogans of “Don’t Tread On Me” or “Give Me Liberty Or Give Me Death” or “We’re Mad As Hell And We’re Not Taking It Anymore,” don’t mean a thing when compared to reality; the real and actual answer to all the protests, marches, and outrage. The answer is in our own backyards! The States can stop every bit of it! That’s right, the individual States can stop “Obamacare” and all other forms of out-of-control federal government mandates and “big brother” tactics. If Arizona, Hawaii, New Hamshire, Texas, etc. want nothing to do with National Healthcare as proposed by Barack Obama or Congress, then all they have to do is say “No!”

If we are to take back America and keep this process peaceful, then state and local officials will have to step up to the plate.

For you skeptics who think the States could no more do this than fly to the moon, let’s look at the law. First, the U.S. Constitution is the ultimate and supreme law of the land. More specifically, the Bill of Rights was established, because some of our Founding Fathers, feared that the Constitution did not go far enough in restricting or limiting the central government. Hamilton was one of a select few who wanted a bigger and powerful federal government. However, several key states and powerful delegates such as Patrick Henry, said they would not support the formation of a new government if the Constitution did not contain a Bill of Rights, a supreme law to establish basic and fundamental human rights that could never, for all future American generations, be violated, altered or encroached upon by government. So the Framers of our Constitution came up with ten; ten God-given freedoms that would forever be held inviolable by our own governments.

The last of these basic foundational principles was the one to protect the power, sovereignty, and the autonomy of the States; the Tenth Amendment. This amendment and law underscores the entire purpose of the Constitution to limit government and forbids the federal government from becoming more powerful than the “creator.” Let’s be very clear here; the States in this case were the creator. They formed the federal government, not the other way around. Does anyone believe rationally that the States intended to form a new central government to control and command the States at will? Nothing could be further from the truth. Article 1, Section 8 of the Constitution details what duties the federal government will be responsible for under our new system of “balanced power.” Anything not mentioned in Article 1, Sec. 8, is “reserved to the States respectively, or to the people.” (Tenth Amendment) Hence, the federal government was not allowed creativity or carte blanche to expand or assume power wherever and whenever they felt like it. The feds had only discrete and enumerated and very limited powers. Omnipotency was the last thing the Founding Fathers intended to award the newly formed federal government. They had just fought the Revolutionary War to stop such from Britain and their main concern was to prevent a recurrence here in America.

In perhaps the most recent and powerful Tenth Amendment decision in modern history, the U.S. Supreme Court ruled in Mack/Printz v U.S. that “States are not subject to federal direction.” But today’s federal Tories argue that the “supremecy clause” of the U.S. Constitution says that the federal government is supreme and thus, trumps the States in all matters. Wrong! The supremacy clause is dealt with in Mack/Printz, in which the Supreme Court stated once and for all that the only thing “supreme” is the constitution itself. Our constitutional system of checks and balances certainly did not make the federal government king over the states, counties, and cities. Justice Scalia opined for the majority in Mack/Printz, that “Our citizens would have two political capacities, one state and one federal, each protected from incursion by the other.” So yes, it is the duty of the State to stop the Obamacare “incursion.” To emphasize this principle Scalia quotes James Madison, “The local or municipal authorities form distinct and independent portions of the Supremacy, no more subject within their respective spheres, to the general authority than the general authority is subject to them, within its own sphere.” The point to remember here is; where do we define the “sphere” of the federal government? That’s right; in Article 1, Section 8 of the Constitution and anything not found within this section belongs to the States or to the People. So where does health care belong? The last place it belongs is with the President or Congress. It is NOT their responsiblity and the States need to make sure that Obama does not overstep his authority.

Just in case there is any doubt as to what the Supreme Court meant, let’s take one more look at Mack/Printz. “This separation of the two spheres is one of the Constitution’s structural protections of liberty. Hence, a double security arises to the rights of the people. The different governments will control each other…” What? The Constitution, the supreme law of the land, has as a “structural protection of liberty” that States will keep the federal government in check? No wonder it was called a system of “checks and balances.” The States (and Counties) are to maintain the balance of power by keeping the feds within their proper sphere.

So do the States have to take the bullying of the federal government? Not hardly! The States do not have to take or support or pay for Obamacare or anything else from Washington DC. The States are not subject to federal direction. They are sovereign and “The Constitution protects us from our own best intentions.” (Mack/Printz) Which means the States can tell national healthcare proposals or laws to take a flying leap off the Washington monument. We are not subject to federal direction!


patriotparty1 on October 29, 2009 at 1:36 PM

“..Socialized medicine has been the Holy Grail for the Left for the better part of the century because they see it as the cornerstone of a proper, Euro-style welfare state.

Close, but no cigar. I might be parsing words here, but the distinction is worth noting.

Socialized medecine is the keystone for the left. From he who might have some faliarity with the subject, Vladimir Lenin-“medicine is the keystone in the arch of Socialism.”

The importance to the progressives of passing, and by whatever maens necessary will pass, I recently covered here.

Archimedes on October 29, 2009 at 2:01 PM

NAME THIS CHILD! The new United Socialist States of America is my guess.

rocketman on October 29, 2009 at 10:25 AM

People’s Republic of China

People’s Republic of North Korea

People’s Republic of America

Dominion on October 29, 2009 at 2:30 PM

Progressives are all about intentions over results and style over substance. If Barry flashes his patented come hither smile and tells them it’s a good deal thrills will run up their legs and something else will run down them.

miles on October 29, 2009 at 2:58 PM

if i were a leftist, i’d want the insurance companies to be gone because then they couldn’t come back.

if you have a residual “corporatist” model then they could be “spun off” and resume their private role.

r keller on October 29, 2009 at 3:40 PM

It doesn’t matter what any of the written rules are. Once the program becomes law, it’s going to be excepted ad infinitum until all semblance of non-government control is absent.
Here’s a perfect example of the psychology to be used derived from a current HOA case in Florida: a little six-year-old girl is about to be evicted from a 55 & over only community because she is living there with her grandparents. The little girl’s drug-addicted mother cannot care for the little girl by state decree (DFS order, you know). The grandparents are willing to move but can’t find a buyer for their home in the depressed real estate market of the area. Remember, the HOA covenant is 55 years and over for residents and people have invested in the community on that basis.
The media view of the HOA attempt to enforce the covenant: heartless. That’s the kind of sob-story anecdote that will chip away at any semblance of enforcement of a “bi-partisan” public option deal. You know it’s coming so get ready for it: heartless, mean and cruel.

ExpressoBold on October 29, 2009 at 6:30 PM