COLUMNIST: Health care bill needs some compromise

Tuesday, March 30, 2010 | 12:01 a.m. CDT; updated 9:30 a.m. CDT, Wednesday, May 12, 2010

With satisfaction, fanfare and a bit of gloating, the president signed into law a landmark health care bill March 23, surrounded by the party leadership who managed to revive once more the oft-pronounced dead legislation. While lip service was paid to the transparency and cooperation promised, they did, in fact, accomplish bipartisanship — 34 Democrats stood against bribes and intimidation, joining Republicans in voting no.

While no elected member of either party or anyone capable of reason ever denied health care is in need of serious reform, only time will tell if the end justified the means in a government takeover of one-sixth of the economy. Inarguably, there are excellent and sorely needed reforms in the bill; however, it was orchestrated without any input from Republicans.

Having served on Capitol Hill in an advisory status for five years, I find this lack of common purpose among the political parties the most troubling aspect of this legislation. From day one, House Republicans were shut out of the discussion and other than a token offer from Senate Finance Committee Chairman Baucus of Montana, that door was closed as well. The election is history and "to the victor belongs the spoils," as interpreted by House Speaker Nancy Pelosi.

The Democrats and much of the mainstream media would have you believe that Republicans have been obstructionists, "the party of no," from Social Security through Medicare, civil rights and health care. Illustrative of this revisionist history have been the works of St. Louis Post-Dispatch cartoonist R. J. Matson's "Wrong Side of History" and MSNBC cartoonist Daryl Cagle's "Leaving Legacies" (Columbia Tribune), both accusing the GOP of opposing reform.

Had either availed themselves of readily accessible information, they would have discovered the reverse to be true. In the vote for the Social Security Act of 1935, 84 percent of House Republicans voted yes while 76 percent of Senate Republicans did likewise. For Medicare in 1965, 52 percent of House Republicans voted in the affirmative, as did 43 percent of Republican Senators.

While the revisionist history of the Social Security and Medicare vote is appalling, the distortion of the 1964 Civil Rights Act vote is worse. Eighty percent of House Republicans voted yes along with 82 percent of Republican Senators.The Democrats mustered 62 percent in the House and 69 percent in the Senate. Further research would have revealed the Civil Rights Act was written by Everett Dirksen, a Republican senator from Illinois, and that Republicans thwarted the attempt to kill the bill by filibuster.

Accordingly, both parties should review those landmark pieces of legislation for a lesson in the art of compromise. Somehow, House Speakers Joseph Byrnes and Carl Albert and Minority Leader Bertrand Snell (in 1935 and 1965) were able to gain bipartisan support, while in the Senate, Majority Leaders Joseph Robinson and Mike Mansfield and Minority Leaders Charles McNary and Everett Dirksen mirrored the efforts of the other body. I might add that the Democratic Party held the majority in each instance.

This health care bill was muscled through by one-party initiatives, some of which were considered unsavory even by Democratic Party members. Along with Republicans, the health care bill is opposed by a majority of Americans; consequently, to paraphrase a Colin Powell-ism: "You enact it, you own it." It may well prove to be an albatross for Democrats.

Two red flags in the bill are the constitutionality of forcing people to purchase health insurance and the accuracy of the Congressional Budget Office projections of the deficit reduction versus the actual cost. The oft-voiced comparison of requiring automobile insurance to that of health is false — there is no government mandate of car ownership. The question that must be adjudicated: "Does Congress's power to regulate interstate commerce empower Congress to compel citizens to engage in commerce?" (Article I, Section 8)

As for CBO cost estimates, the history of entitlements demands a comparison with Medicare. Its initial cost in 1966 was $3 billion, projected to cost $12 billion in 1990. Medicare's actual cost in 1990 was $107 billion, nine times the projected outlay. Beware of CBO estimates, as they have no control over the future.

It might be wise for the Democrats to accept two Republican ideas — tort reform and enabling people to purchase health insurance across state lines — as both reduce individual costs. Adding Republican ideas may provide Democrats with company when, and if, the boat sinks.

J. Karl Miller retired as a colonel in the Marine Corps. He is a Columbia resident and can be reached via e-mail at

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Gregg Bush March 30, 2010 | 9:20 a.m.

You have no credibility in this selective historical record. This bill, that I don't happen to like very much, looks like the Gingrich bill from back in the 1990s. The things that Sen. Grassley doesn't like now (mandates) are things he insisted on having in the bill. Mitt Romney hates this bill that is similar to the one he was championing from Massachusetts from the last election.
Your opinion could be based on a broader understanding of the recent past and not from AEI, Heritage or Boehner talking points. It robs you of any legitimacy.

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Christopher Foote March 30, 2010 | 3:44 p.m.

Though I generally try to avoid quoting others to make a point, John Holbo has penned a rather nice critique on the metrics used to assess whether a bill (and by extension the party sponsoring it) is or is not partisan:

"Suppose you have a two-party system.

One of these parties enjoys/enforces total party discipline, the other, not: members of the latter party side with their own, or cross the aisle, on individual issues/votes, as conscience or self-interest dictate. Let’s call the completely disciplined party the Partisan Party. The completely undisciplined, the Bipartisan Party (to reflect its principled commitment to always keeping the door open to the higher value of bipartisanship!)

Over time, both parties will push positive proposals/ legislation. Quite obviously, the Bipartisan Party will be at a tactical disadvantage, due to its lax discipline. Less obviously, it will have an ongoing optics problem. All the proposals of the Partisan Party will be bipartisan. That is, a few members of the other party will, predictably, peel off and cross the aisle to stands with the Partisans. None of the proposals of the Bipartisan Party, on the other hand, will ever be bipartisan. No Partisan will ever support a Bipartisan measure. In fact, all proposals of the Bipartisan party will face bipartisan opposition – as a few Bipartisans trudge across the aisle (there are always a few!) to stand with the Partisans. Result: the Partisan party, thanks to its unremitting opposition to bipartisanship, will be able to present itself as the party of bipartisanship, and be able to critique the Bipartisan Party, with considerable force and conviction, as the hypocritically hyperpartisan party of pure partisanship.

Conclusion: two measures of partisanship/bipartisanship that you might think make good heuristic sense – 1) being able to get bipartisan support for your proposals; 2) being opposed to those who can’t get any bipartisan support for their proposals – in fact aren’t good heuristics."

Excerpted from here:

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Don Milsop April 1, 2010 | 6:24 p.m.

Re Gregg Bush's March 30, 2010 posting, I would like you to clarify in detail regarding "the Gingrich bill from back in the 1990s." I know of no such bill. Under Speaker Gingrich's leadership a number of health care improvements were made. But there was no single bill or "Gingrich plan". In your response, please provide the bill #, who authored the bill, and when it was passed and signed.

Regarding Mr. Foote's post. We do have a two party system. One party quadrupled the deficit in one year more than any previous administration. One party wants a health care system that relies on numbers projecting 10 years into the future, mindless that no previous government health care system came anywhere near the projected costs and were all vastly understated. One party seeks to tell the majority of the American people that they need not worry about the previous inability of the federal government to meet projected costs and revenues.
One party did the vast bulk of their deliberations on these issues behind closed doors and excluded members of tthe other party.

That one party would be the Democrat Party. The party opposing them would be the Republican Party. Suppose the issue will really be decided in November, and that the American people hand the reins of control of congress over to the Republicans? Would that then convince you that the
majority of Americans clearly opposed this insanity, and that the Democrat Party is completely out of touch with the needs and wishes of the majority of Americans?

I'll leave you with this. The federal government's lead actuary in 1965 projected that the hospital program (Medicare Part A) would grow to only $9 billion by 1990. The program ended up costing more than $66 billion that year. Even after adjusting for inflation and other factors, the cost of Medicare Part A (in constant dollars) was 165 percent higher than the official government estimate, according to the actuary who produced them.1 (In unadjusted dollars actual costs were 639 percent above estimates.) In fact, in 2009, Medicare total costs were a whopping $468 BILLION dollars.

How can anybody in their right mind believe anything the Democrats say on projected costs. If I have a customer who I don't think is worthy of the amount of credit a salesman is asking me to give them, I ask the salesman to personally guarantee the order. Would you Mr. Foote, or you Mr. Bush, be willing to personally guarantee with your own assets that what the Democrats are proposing would be accurate? Would you guarantee with your own assets that you would cover any additional increases in costs? Do you think the Democrat members of Congress would do the same? Because that in fact is what you are asking all Americans to do. So put your money where your mouth is, and forward Colonel Miller your personal, notarized, signed guarantee today.

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Christopher Foote April 2, 2010 | 6:57 p.m.

@Mr. Milsop,
Well I wouldn't trust anyone who states:
" One party quadrupled the deficit in one year more than any previous administration."
Pres. Obama has been in office for 14 months. Thus, you must be referring to fiscal year 2009.
On Jan. 8 2009 (prior to Pres. Obama's inauguration) the CBO predicted that the federal deficit would be $1.34 trillion for fiscal year 2009. This analysis assumes there is no additional spending for fiscal year 2009, and is based on the policies enacted under Mr. Bush (and his predecessors). Reference here:
From the same report, the deficit for fiscal year 2008 was $638 billion. The actual deficit for fiscal year 2009 was $1.41 trillion ( That is not four times greater than $638 billion. Moreover the vast majority of the $1.4 trillion is due to Bush era policies as well as the great recession which occurred under Republican stewardship of the economy. President Obama's spending for 2009 is limited to ARRA . As of 3/26/10 the government has spent $99.1 billion on tax cuts and $120 billion on entitlements under the ARRA plan ( So Pres. Obama's contribution to the $1.4 trillion is approximately $200 billion.
If you wish to dispute this number, what do you think the number is? I guarantee you it is not $2.5 trillion (4 x $638 billion) . Feel free to reference the legislation passed during 2009, and thus signed by Pres. Obama, that contributed to the deficit number you have come up with.
I wonder where you get your economic information. Yesterday was April 1st, so perhaps one of the conservative sites was having a bit of fun with their readers.

(Report Comment)
Don Milsop April 5, 2010 | 8:10 a.m.

For some reason Mr. Foote wants to refer to CBO projections instead of read Treasury Department results.

The total deficit for fiscal year 2009 was $1.42 trillion, a $960 billion increase from the 2008 deficit. So let's review the differences between the GOP and Dems.

The 2009 deficit includes the cost of the Troubled Asset Relief Program ($154 billion in 2009), the American Recovery and Reinvestment Act of 2009 ($202 billion in 2009, $353 billion in 2010, and $232 billion in 2011 forward), and the 2009 Omnibus spending bill ($410 billion)—and changes due to President Obama's policy proposals. All of these bills originating in a Democrat controlled congress. Last time I looked, this isn't a monarchy. All spending bills originate in Congress. You may recall too that the conservatives largely railed against Bush's bailout of Wall Street. However, we also know that most of the $700 billion TARP money paid to Wall Street firms has already been paid back.

GOP Congress Budget 1/20/01 5,727,776,738,304.64
GOP Congress Budget 1/19/02 5,922,321,839,074.39 3.4%
GOP Congress Budget 1/19/03 6,388,587,973,011.41 7.9%
GOP Congress Budget 1/19/04 7,002,877,924,418.81 9.6%
GOP Congress Budget 1/19/05 7,613,772,338,689.34 8.7%
GOP Congress Budget 1/19/06 8,176,948,650,558.59 7.4%
GOP Congress Budget 1/19/07 8,675,085,083,537.48 6.1%
Dem Congress Budget 1/19/08 9,188,640,287,930.39 5.9%
Dem Congress Budget 1/19/09 10,626,877,048,913.00 15.7%
Dem Congress Budget 1/19/10 12,322,107,592,352.90 16.0%
Dem Congress Budget 4/1/10 12,764,878,911,618.10 3.6%

1/20/10 12,773,123,096,139.40
1/19/09 10,626,877,048,913.00

A 20.1964% in the national debt since Obama took office.

The 2009 budget deficit would represent 12.3% of gross domestic product, the largest share since World War II. I do note though, that you didn't dispute any of my other points about health care costs.

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