Parsing the Senate Debate on Health Care

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I spent eight hours this weekend watching the Senate debate on whether to proceed with debating on whether to pass a health care bill.  This was largely a sort of kabuki ritual, since Senate Majority Leader Harry Reid already knew that he had the sixty votes needed to stop a Republican filibuster.  But it tells you what the talking points are on each side, which is going to matter as the debate actually plays out.

The Republican position is fairly incoherent.  The major talking points are these:

  1. This bill uses accounting gimmicks to front load the taxes and back load the spending, which is the only reason it's deficit neutral over the ten year window.
  2. The Democrats are refusing to let cuts to doctor payments stand, and also, doctors don't get paid enough.
  3. Millions of people are going to be added to Medicaid, which is a terrible program because providers don't get paid enough.  Also, it would be too expensive to add people to Medicaid.
  4. Medicare costs too much, and also, shouldn't be cut.
  5. The Republicans favor "real reform" which mostly seems to consist of liability caps.

Somewhat to my surprise, John McCain was on fire, in full on "flaming sword of righteousness" mode.  He was practically shaking with anger as he called out the government for negotiating with the pharma companies, and yelled at the pharmas for raising their prices this year.  Pharma seems to have followed a standard "Memorial Day Sale" strategy--they've raised prices by about 10% this year, in preparation for the deep discounts they'll have to offer in the future.  John McCain thought that this was terrible, and said so, to awkward silence from his colleagues.  They brightened up considerably when he said "Shame on the AARP" for endorsing this plan that does its members no good, accused them of getting paid off, and told people to tear up their AARP cards.  He and Bob Corker were pretty much the high points.  The rest was mostly boilerplate.

Luckily for the Republicans, they weren't exactly playing against the varsity.  The Democrats had their own set of uncompelling talking points:

  1. Insurance companies are evil institutions which deny everyone any care that costs more than a pack of Freedent gum.  Also, they cannot control health care costs without substantial government intervention, because they spend far too much on expensive procedures.
  2. Ted Kennedy sure was a swell guy, wasn't he?  He'd be proud of every dang one of us today.  (It is impossible to exaggerate how great a role this point played.  There was a five minute stretch which consisted largely of people telling Ted Kennedy's replacement that Teddy would be awfully proud of him, and him saying, "No, really, Ted would be proud of you.")
  3. Small- and medium-sized businesses are groaning under the weight of their health care costs.  Also, starting next year, we're going to force them to give you much more generous coverage from your employer, such as coverage for non-dependent "children" up to the age of 26.
  4. This problem is incredibly urgent, which is why we have to pass this bill, which now takes effect in 2014, RIGHT NOW.

The best talking points on both sides were, sadly, anecdotes.  Democrats had the predictable parade of people who were denied coverage for various treatments.  Republicans had doctors who cannot afford to take Medicaid, hospitals which can't survive on Medicare and Medicaid reimbursement levels, and Senator John Barasso, whose wife was diagnosed with breast cancer by a mammogram in her early forties.

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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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