Healthcare, one more time

On the most important domestic issues of the day, our two political parties don’t merely lay out competing arguments; they inhabit alternative realities.

The chasm was apparent over the last few days as the House of Representatives churned relentlessly toward its vote to repeal President Obama’s healthcare law. The two-day debate, carried out in a marathon series of two-minute speeches, remained civil. But it was clear that civility alone won’t lead to consensus.

To listen to Republicans, the healthcare law will destroy as many as 1.6 million jobs; to hear Democrats, it will create jobs.

Republicans say the law will bust the national budget and deepen the federal deficit; Democrats say the law will reduce the deficit by $230 billion over the next 10 years and even more after that.

As usual, of course, the facts are more complicated than either side acknowledges.

Will the law kill jobs? In raising insurance costs for some businesses, it could deter some hiring. But by making health coverage portable, the law should also make the economy more efficient and so promote job creation in the long run.

Will the law deepen the deficit or reduce it? That depends on whether Congress is brave enough to enforce cost controls on Medicare and Medicaid in the future, action that could mean lower payments to physicians and healthcare providers and restrictions on available treatments.

Unfortunately, as is usual in floor debates, the discussion didn’t get into the nuances of these real-world dilemmas. Instead, members on each side spent their allotted time reinforcing their parties’ incompatible worldviews.

To Republicans, the law will “fundamentally change the doctor-patient relationship,” freshman Rep. Ben Quayle (R-Ariz.), son of former Vice President Dan Quayle, asserted in his maiden outing on the House floor — though given his two-minute limit, he didn’t spell out exactly how.

To Democrats, the law “is a moral imperative.... We are our brothers’ keepers,” said Rep. Christopher Murphy (D-Conn.).

What the House was doing this week, of course, wasn’t really legislation; it was politics. The new Republican leaders of the House know that the Senate, still in Democratic hands, isn’t going to give repeal a chance to get to the floor, much less pass. Instead, this was merely the opening round in a long re-litigation of the healthcare debate that dominated the last Congress.

That’s why the Republicans relied on what they see as their strongest argument: the fear that extending health insurance to more of the uninsured will be too costly for small businesses and taxpayers. And that’s why the Democrats relied on theirs: the voter-pleasing consumer protections that the law enacted. To listen to the Democrats, you’d think the cornerstone of the law was the clause that lets children stay on their parents’ insurance policies until they’re 26.

On both sides, the goal isn’t to design a new healthcare system but to create new political facts. The Democrats want a chance to resell a law they sold poorly the first time around, and to create new vested interests around provisions that block insurance companies from denying coverage to customers with preexisting conditions. The Republicans want to impede implementation of the new law (by blocking funding of its main provisions, among other means) long enough to win a majority in the Senate and perhaps even the White House in 2012 — their best hope for really repealing the law.

Public sentiment is still up for grabs. Several Republican members of Congress called the law “wildly unpopular” this week, but they’re wrong. Some news reports have said the public is “evenly split” on the issue, but they’re wrong too. An even 50% of the public told pollsters for ABC News last week that they favor repealing the bill, but that included 13% who want it repealed because they don’t think it goes far enough.

The poll showed that partisan voters, like their members of Congress, live in two parallel worlds: Most Republicans say they think the law will destroy jobs; most Democrats think the opposite.

But feelings about some parts of the law actually cross party lines. Most people like the provisions that protect patients from insurance companies, but they don’t like the individual mandate that requires people to buy insurance whether they want it or not. And most people worry about cost.

That’s why Republican leader Eric Cantor (R-Va.), one of the fiercest opponents of the healthcare law, spent time this week promising that his party wouldn’t merely repeal the Obama bill but would also produce new bills of its own to guarantee the new rights that patients already hold dear.

“Republicans care about healthcare,” Cantor told reporters Tuesday, sounding almost plaintive.

When his lieutenants get to work this spring on their own ideas for healthcare reform — proposals Cantor promised will protect patients, give more people access to insurance, lower costs and reduce the deficit — the debate will turn interesting again. Then, in the committees of the House, we’ll get a chance to hear reasoned arguments on what the true costs of the new law will be, and whether insurance can be expanded without imposing that unpopular individual mandate.

But we’ll have to wait. Reasoned arguments on those issues weren’t on the agenda in this week’s floor show in the House of Representatives.

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