13 January 2010
Washington's massive new health care legislation has one set of rules for three counties in Florida, and another for the remaining 3,137 counties in the United States.
Federalizing health care policy means 2,140 pages of special rules and special deals. It doesn't mean making sure no one is different. It means an ugly process of carving out fun little deals for powerful people.
At the beginning, the health care debate was about competing approaches to reducing costs or creating economic incentives to increase coverage or slow down price growth. But like every process in Washington, it got hijacked, not on purpose but because of the nature and culture of D.C. decision-making. Health bills gradually increased in size from a few hundred pages to the Senate's 2,140-page Christmas present. Weeks later, we are still unraveling all the secret deals and special treatment that no one knew about before the vote.
The Medicare Advantage program will be cut in every county in the United States except three counties in South Florida -- even the rest of Florida is annoyed by that.
Everyone in the town of Libby, Mont., is automatically enrolled in Medicare. It has to do with asbestos issues, but it applies to only that one small town in Montana.
Health insurance companies get new fees and taxes to pay unless they happen to be in Michigan or Nebraska. The same is true for some hospitals in Connecticut and Michigan.
You'll notice that Michigan comes up enough in the special treatments that the tourism department could change its slogan from "Say Yes to Michigan" to "Michigan -- it's the new Nebraska."
Nebraska's Medicaid treatment is changed forever, but there's also a special deal for Vermont (Bernie Sanders was wavering). In addition, hospitals get special treatment if they are in one of four "frontier states." I didn't know we even still had a frontier. I thought Alaska was once "the last frontier," but it didn't make the list.
Treatment for states under the "disproportionate share" program is changed, except for the state of Hawaii.
The bill taxes tanning salons (I'm not sure why) and eliminates a tax credit for the paper industry. But the provision that takes the cake is the mystery hospital. In fairly convoluted language, the bill provides $100 million in construction and renovation costs for a health care facility "affiliated with an academic health center at a public research university in the United States that contains a state's sole public academic medical and dental school."
At first, people thought the money was for a medical school in Scranton, Pa. In the weeks that have passed, reporters have decided the money is for Connecticut. Probably. It shouldn't take three weeks to figure out where your senator just voted to send $100 million.
This goofy process is sure to get worse. Congressional leaders are working on reconciling differences between the House and Senate versions. Unfortunately, those drafts are not public and will not be shown to the public before our representatives have to vote on them.
Nebraska Sen. Ben Nelson now has been enshrined in American history as a sort of anti-Mr. Smith because of the special deals he pushed into the bill while pretending to be worried about principle. But he's merely the most public and obscene example of goodies hidden away.
The vast majority of senators and representatives voted for or against this bill because they believed it was good or bad policy. But a few bad apples snuck in a carve-out or an add-on because they could.
Nebraska's other senator is not Monte Hall, but Mike Johanns. He had a better approach than his wheeler-dealer colleague. Sen. Johanns asked for an amendment to remove all the special deals before a final vote -- no South Florida exception, no Lousiana Purchase, etc. He tells us and his much-reviled seatmate that "Nebraskans don't want special deals; they want good policy."
Unfortunately, that amendment failed.
These sorts of shenanigans are why President Obama has talked about posting bills (and amendments, I presume) for public comment for five days. He also demanded that all congressional negotiations be conducted in public so favors could not be slipped into bills at the last minute. Though that didn't happen with the health care bills, it was good advice then and remains good advice now.
Charles M. Arlinghaus is president of the Josiah Bartlett Center for Public Policy, a free-market think tank in Concord.