Being a health care pundit has long been a quiet job. No more, thanks to the attention that the nation’s ailing health care system is getting from presidential candidates. The comments, ideas, suggestions and plans are coming from all sides. But not all ideas have equal merit.
George W. Bush decided that the way to save his presidency from irrelevancy was to threaten a veto of a bipartisan extension of the Childrens Health Insurance Program (SCHIP). SCHIP was a program developed in bipartisan fashion between a Republican Congress and a Democratic President back in the halcyon 1990s. It’s been a relatively ineffective program in that there are still 8 million American kids uninsured at any one time. But, as Spot-on Christopher Brauchli said, it’s clearly better for those kids than nothing. And nothing has been the alternative offered since 2000.
The threatened veto must be driving any Republican running for election in 2008 berserk. “Republicans hate children” is shaping up to be the 2008 equivalent of 1988 “Democrats love criminals.” You’d think that on health care, as with the rest of his disastrous policies, the Republican Presidential candidates would be running away from Bush as fast as they can.
Instead we’re seeing the Republican front-runner, Rudy Giuliani, announce that the Democrats want to join Michael Moore in offering Cuban health care to Americans.
Moore indeed pointed out that access to health care for Americans who had helped at Ground Zero in 2001 was better in Cuba than they could get in the US – provided they had a TV crew with them. But whatever Giuliani wants to say, none of the major Democratic contenders wants to create any type of socialized medicine delivery system.
Hillary Clinton hasn’t announced her financing scheme yet, but it’s likely to be less aggressive than those already outlined by her fellow Senator Barrack Obama or the other Democratic hopeful John Edwards. Both of those proposals keep employer-based health insurance in the mainstream, with a wrap around system of public programs to ensure (close to) universal coverage. Both are a relatively big difference to what we have now, but neither exactly takes us on a one way trip to Havana.
So Rudy Giuliani’s rush to judgment last week was relatively amusing. He started by lumping the Canadian, UK and French systems all together – a mistake Moore also made. Policy wonks like Jonathan Cohn (and myself) have been stressing how significantly different those systems are to each other, even if all do better in terms of both covering everyone and containing costs than the American one.
Then Giuliani went off into the weeds of cancer care, and how much more effective it is here than it is in Europe. Of course he has a vested interest given his bout of prostate cancer in 2000. However, he didn’t say that plenty of universal health care systems do better in several other types of care such as cardiac or diabetes care, and neither did he mention that the cancer care statistics have been shown to be much less favorable to the U.S. system than the way Giuliani’s quoting them. Ezra Klein and Jonathan Cohn have pretty comprehensively shown that because we catch cancer earlier, we call several cases “cancer” which don’t get defined as such in other countries. Hence our “cure” rate is higher.
But this is a conversation that comes up between health care geeks. Why is a major Presidential candidate, especially one who’s mantra is based on toughness and strong management rather than the intricacies of policy wonkery, going down this path?
Perhaps the answer lies in the people he’s surrounding himself with? And this starts to give us a clue. In choosing health care advisers, Giuliani has done the equivalent of Hillary Clinton getting Noam Chomsky to help her with foreign policy. His advisers include Sally Pipes and David Gratzer, two Canadians from far-right think tanks who spend their lives attacking universal health care, and anything to do with Canada where they once lived. I’ve spoken extensively with Gratzer, and the only sensible conclusion is that he and Pipes are so far off the reservation that they make the Bush Administration’s health care policy look normal.
And Giuliani’s main proposal appears to imitate something that George Bush brought up 18 months ago – a $15,000 tax deduction for health care. This was so ridiculous that even the then Republican Congress never considered it. Essentially the idea is to destroy employment-based insurance while doing nothing to reform the disastrous individual insurance market that this action would push most Americans into. So why would Giuliani select this pair of extremist advisers, and reintroduce this type of unlikely policy proposal? Ezra Klein’s take, and I more or less agree, is that Giuliani sees mileage with the right-wing primary base in attacking “socialized medicine,” even if it’s empty rhetoric. But the weird thing is that apparently in everything else Rudy is trying to to be the non-partisan moderate Republican candidate who just wants to kick terrorist butt. The true Bush-type Republicans like Brownback and points right are failing to differentiate themselves from the Bush Administration. Whereas Rudy, McCain and Romney are at least trying to appear not to be Bush-lite even if their adoption of the mantle of Ronald Reagan looks very strained.
The joke is that there are two moderate Republican health care proposals out there – one of which Romney was a big part of. Those of course are Massachusetts law, currently being implemented and Schwarzenegger’s California proposal. And the people behind those proposals are the mainstream corporate CEOs who want America to fix its health care system so that their costs are brought under control, and so that they can get on with the real business of America – as defined by another Republican from a different age.
So why wouldn’t Giuliani go down the path that mainstream corporate America would be happy with? My guess is that if he eventually gets elected, he might well do that and then he’ll send Pipes and Gratzer back to their wacky think-tanks. For the moment calling Hillary Clinton and Barrack Obama patsies of Michael Moore’s Cuban adventurism is all he needs to do to check the box on health care among Republican primary voters.
It won’t be enough come November 2008. But ignoring health care, if the Democrats leave any Republican with a chance in the Presidential race by then, well, there’ll be good reason for moving to Canada for reasons beyond the free-health care and lifetime supply of Prozac.