The President has already telegraphed that he intends to call them obstructionists with no ideas, and then argue that we’re way too far down the track with the current bills to even consider starting over. If they’re going to counter him, Republicans will have to be a lot more agile than they have been. They’ll have to know their message and stay on it, which will mean figuring out who is quick enough on their feet to be the talking head. It might be better if they used some bench strength and left the CEO-lookalikes in the cloakroom.
First issue: that they have no ideas. They have to slap that one down, hard, fast, and relentlessly. If the President says it, the President must be mocked—politely, but mocked. They were successful in their last meeting with this technique. “The President says we have no ideas, and then reads from our plan to explain why it's wrong? Didn’t his staff tell him he was reading from our plan?
Second: that the train left last year. The American people pulled the emergency cord on that train. They don’t like it; they like it less every day, and Republicans aren’t about to help the Democrats pass something the American people don’t want. Democrats didn’t fail to pass their bill because of Republicans—they had all the votes they needed. Democrats failed to pass their bill because even their own members didn’t like it. Why would anyone with sense sign on to that? That’s like the captain of the Titanic complaining Republicans won’t help him rearrange the deck chairs!
Third: Republican ideas. Pithy, clear, and specific, but it’s also time to be a policy wonk. The ideas have to be completely spelled out, in advance, in legislative language, or it’s a return to issue #1. They can’t be a hodgepodge of “ideas.” They have to be a complete package, one that addresses or refutes every aspect of the Democrats' argument. No weaseling; no deliberate ambiguity; no assuming the American people are idiots. Pound ‘em with substance. To wit:
Cost versus price. Democrats argue they want to keep costs down. A: No, Democrats are trying to control price. That’s not the same thing. Price controls lead to rationing. Everybody knows that. (Don’t forget the “everybody knows that” part.) The solution is really to control costs. Cut costs, and competition will drive down prices. So, the goal needs to be to drive down costs.
Cutting costs. A) Malpractice reform. (Stop calling it tort reform. I took civil law and still think it sounds like we’re talking pastry.) Get some doctors to work through the “But what about…” arguments, or just accept that tough cases make bad law. For that matter, go after the lawyers—argue we should cap their fees. Why does John Edwards deserve $28 million for winning a case? Any case? B) Let insurance companies compete across state lines. How can Democrats oppose that? Their bill requires everyone to buy insurance from those companies, so why wouldn’t they want everyone to get the best deal possible? No weaseling here—defend the insurance companies? Yes. “Folks, the President want you to think the insurance companies are evil. He’s been demonizing them and their profits. We recognize they may drive you nuts, but the reality is their profit margin is about 2%. 2%. If you make them completely non-profit, that isn’t going to save you any money. They aren't the problem, but they can be part of the solution.” C) Time for “the vision thing.” Here goes—
Vision. Health care ‘costs’ are climbing, with no end in sight. Democrats’ solution is to cap prices, and guarantee rationing. Even the President has acknowledged that we might have to cut back on end-of-life care. (“Maybe your grandmother should just take the pain pill.”) No, no, no. Republicans absolutely do not, will not, must not ever agree that the solution is for government to ration care, or for government to suggest that doctors ration care. Wrong approach. Dangerously slippery slope. Immoral. But…what about cost?
Here’s where it comes full circle, and Republicans haven’t yet answered the mail. Yes, end of life care is the most expensive, so pretending there isn’t a cost issue suggests this is all just cynical political positioning (or naiveté). And the answer is…Capitalism. With a capital C.
The solution to making end-of-life care more affordable is to make all care more affordable. To encourage research and development into new, cheaper drugs; new, cheaper treatments. To allow patients to pick insurance plans that only cover what they need. To figure out whether there are real things government can do to help out—say, by encouraging new medical research reactors to bring down the cost of radiopharmaceuticals. (You think radioisotopes grow on trees? Why do you think Iran claims it wants one?) Or, by allowing hospitals to depreciate new equipment faster. Or (gasp!) by making all hospitals tax-exempt. There's more, but this is getting long enough already.
On that last idea—cutting business taxes on hospitals—here’s the real trick. When Democrats argue, “But how will we pay for that?” do not accept the premise of the argument. This discussion is not about keeping tax dollars rolling into the Treasury. It’s about getting medical costs down. “How will we pay for that?” is a deliberate distraction.
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