Diary of a health care debate veteran
What went wrong and what could go right
April 21, 2010
By U.S. Senator Mike Enzi
June 2007-April 2010
Contents:
1
President Obama signed a piece of health care legislation March 23 and an addendum to it March 30 that will go down in history. What history will say about this bold new health care edict that is now the law of the land, none of us truly know. A divided country makes different predictions.
One side sees this as granting Americans the “right” of basic health care. The other sees this legislation as the largest entitlement in history that will force younger, healthier people to give up more of what they earn to pay for older or sicker people, force those who work to pay for those who don’t work, force those who earn more to pay for those who earn less and force those not born yet to shoulder debts they had no part in making. They see the individual mandate as something that requires every American to buy something the federal government tells them to buy. They see another federal program that like Social Security and Medicare will require more money than we have and that will drive this country into such debt that the USA will lose its place in the world.
Regardless of what you think of the new health care laws though, most of us do agree that our current health care system has to be improved. Costs keep going up for families, for businesses and for governments. Unfortunately, I believe that as this new decree takes effect most of us will still be saying our system needs changes because this new law won’t bring costs down. It costs too much and expands the government’s role in our lives too much. Sure, there will be some groups, large groups who will be happy with the new benefits they will get, but as consumers of government services, we all need to evaluate what we expect the government to provide and take a look at the bigger picture. No single rain drop thinks it is responsible for the flood. Every dollar we add to the deficit strengthens our foreign competitors and creditors while it weakens us. If we bankrupt our country now, all of us will pay the price.
I’ve dedicated a large portion of my life to improving our health care system. I’ve intensified my efforts over the last three years as the chairman and now ranking member of the Senate Health Committee. I’ve sponsored bills and amendments, mounted health care idea campaigns, written thousands of letters, questioned witnesses in hearings, spoke to groups in Wyoming and Washington, done interviews with both national and Wyoming media, spent countless hours in meetings with my colleagues, made my case to the President directly in the White House and in a widely-viewed public forum. It’s been a long road and we’ve still got a long way to travel.
Below are some of my thoughts and personal perspective so far on health care reform. I would like to take advantage of my web page to show you ideas and changes that could and should be made to our health care system. I would also like to share with you what I see as perils of the new laws and the flawed process that produced them. This is an informal sketch of some of my ideas, opinions and notes taken during the debate. I appreciate the opportunity to share my insights with you. If you would like to share your opinion with me don’t hesitate to click on the “email Mike Enzi” tab on my home page.
2
Health care policy changes that could move America forward
**Our main goal should be to bring health care costs down. We’ll also need to protect and extend Medicare, ensure people with pre-existing conditions are able to afford care, prohibit caps on coverage and allow people who like the insurance they have now to keep it and cover more people- to name a few. Most of these goals remain unfulfilled even with the passage of these new health care laws. For those that are fulfilled, I believe there are even better ways to meet the goals than the new health care laws are likely to accomplish.**
How do we do all that? Here are a few ideas. They aren’t all my ideas and many have bi-partisan backing or easily could with a few changes.
- Increase competition: Competition is the way to bring down costs. Any law has to include as many ways to increase competition as possible.
- Exchanges that list ALL insurance: We need the insurance exchanges, but we should allow any company to list its policies and the price of those policies. The exchange would have information about the stability of each of the companies and the exchange could clearly mark any policy that did not meet “federal minimum standards”. Exchanges would reduce the cost of salesmen and allow people to study the policies without sales interference. Medicare Part D had a matrix so seniors could find the policy that best met their needs and budget. The program was available on the internet, at the local pharmacy at senior citizen centers and seniors could call toll free numbers and talk to real people. Prior to Part D, Wyoming only had a couple of companies selling prescription drug coverage in Wyoming. After Part D there were 49 companies vying for the business and the cost of prescriptions came down by 37% by the time the program went into effect.
Patients would benefit from the convenience of an exchange, but so would companies. Companies using the exchange should have to participate in a risk adjustment fund. Companies listed on the exchange should also have to take anyone who purchased their insurance. No company should be able to cherry pick by just allowing the least sick to purchase their insurance. To make it fair for all the companies on the exchange, each year each company whose customers had the most expenses for health care would get a payment from the risk adjustment fund in proportion to the rest of the health care payments.
- Sales across state lines: We need to allow the purchase of insurance across state lines to bring down the cost. If a person likes the benefits and costs of a policy in another state they should be allowed to buy it. State insurance commissioners would have some objection to this partly because fees on sales of insurance provide the money for their office often without the legislature’s budget request. These commissioners are also charged with seeing that the purchaser gets the benefits promised. To solve that objection, each policy sold across state lines should pay the usual fee to both commissioners. The commissioner in the state where the policy is bought would become a consultant to the commissioner where the policy is used. One is being paid for potential consulting time and the other for watching out for the customer. That would make the policy slightly more expensive, but it wouldn’t be purchased unless it gave more benefits or cost less. Some would buy in another state to get some additional benefits even though it would cost more than a policy available in their own state.
- Small Business Health Plans: Small Business Health Plans vary from Association Health Plans in that small businesses would band together through their association - across state borders or even nationwide - to have a big enough group to effectively negotiate with insurance companies. A key is they would still get their insurance through insurance companies - any company in the United States. That could more likely assure continued solvency. I did not make up this form of insurance. Ohio already has this insurance, but limited to within Ohio state borders. Ohio is fortunate to have the population necessary to build a state-wide pool large enough to cover the risk. These Ohio plans work. They save 23% just in administrative costs and another 8% in insurance costs. I’ve heard they could do even better if they could operate across state borders and/or nationwide.
We were very close to having small business health care plans well before the majority passed its new partisan health care decrees. Senator Kennedy and I had an agreement on Small Business Health Plans when my party was in the majority. Unfortunately my party’s leadership “filled the tree” - a parliamentary move to prevent any amendments. It’s very difficult for a bill to move past cloture of a filibuster if no amendments are allowed. (Unless you have a filibuster-proof majority like this majority had.) My small business health plan bill was no exception. Insurance companies were also working against the bill and buying lots of ads. Even so, the bill was only a couple of votes short of allowing it to proceed. An amendment by Senator Snowe could then have been offered and that probably would have eliminated most of the opposition to the bill. The Service Employees International Union liked the idea of Small Business Health Plans too and wanted to be sure the language was written to allow them to use that tool too. These and many other experiences have taught me how hard it is to pass good health care reform.
- Association Health Plans: We should have association health plans that would have the same Employment Retirement Income Security Act (ERISA) requirements as the big companies are allowed. Association health plans would work for small businesses grouping together across the nation the same way the ERISA plans work for big companies. The minimum federal standards wouldn’t apply to the associations either. If an employee didn’t like the program, they would be able to go to the exchange or look elsewhere for a better deal.
As with co-ops, there have to be minimum requirements about the plan’s assets to assure safety and soundness so the first big expensive illness wouldn’t put them out of business and leave many with no insurance and pre-existing conditions. Of course, we will be eliminating pre-existing conditions so that is not as severe a consideration as it has been. It is important that the association would have to take all members who request insurance.
- Co-ops: We should allow co-ops - but not put up $6 billion in start up money that would give them a subsidized advantage. Co-ops would be very similar to association health plans or small business health plans.
- The SHOP Act: This is a plan that sort of combines small business health plans with the insurance exchange. It would help small business and increase competition. The SHOP Act would allow those small businesses that do not have an association to go on the exchange and pick a policy for their employees. The company would be subsidized for providing insurance if the company meets certain characteristics. The employees might also be subsidized based on each person’s income.
- Health Savings Accounts (HSAs): Expanded use of Health Saving Accounts (HSAs) could also bring down the cost. Under these plans a high deductible can be saved for with tax free dollars (a little tax fairness like big companies already enjoy). With more promotion more healthy young people would purchase these accounts. HSAs are an option for federal employees. Many of my employees and those of other members use them. These employees studied their options. They found that the difference between traditional insurance and an HSA could be banked tax free and grow tax free and in as much as three years cover all the high deductible. People with HSAs make their own decisions on spending the money in their account. That leads to better decisions than might be made by those who have everything covered and might have a tendency to overuse their health care. We need more ways to have the patient involved in the decision. The patient is the only one who should be allowed to ration their own health care. HSAs also have the plus of being totally portable from one job to the next. HSA is the plan Starbuck’s uses for employee health care. They contribute to the deductible. They have a high satisfaction rate.
- Medicare for Medicare: Any savings from stopping Medicare fraud should be put back in the insolvent Medicare program. Seniors rely heavily on this program and strengthening it would give them more confidence in their health care plan. Everyone knows and agrees that Medicare is going broke. We also know that doctors are paid so poorly for seeing seniors that many are no longer taking new patients. (If you can’t see a doctor, you don’t have any insurance no matter how much “coverage” you are supposed to have). Assuming that we really could end fraud, (Senator Coburn suggested there should be undercover patients to uncover fraud in the Medicare and Medicaid systems) rein in Medicare Advantage excesses and fix other problems with the program, why wouldn’t we use those dollars to pay doctors so they will take seniors? Why wouldn’t we use that money to avoid the additional cuts envisioned by the powerful commission that will be set up under the new law?
- End Junk Lawsuits: To cut costs of health care we need to end junk lawsuits. There is a high cost of defensive tests and procedures. When the doctor is on the witness stand he has to answer why he did not do a particular test or procedure. Since those loaded questions are almost impossible to answer, doctors order a battery of tests. Tests cost money. There are enough demonstrations being done by states that show us paths to take that will assure that those who are harmed are compensated fairly and much quicker than happens now. These cases drag on for a long time. The injured patient has to hope he or she hired the right lawyer and draws the right jury or he or she might get nothing at all. The attorney’s hope is for a huge windfall from punitive damages, but then that means higher medical costs for the rest of us. In my opinion, the responsibility for punitive damages should be shared by all whose similar injuries contributed to the jury reaching the decision that it was egregious and repeated. I am not for caps on non-economic damages. Instead, our present situation is ripe for federal courts that would specialize in medical malpractice. The judges would have some expertise in medicine and would compare notes with the other medical judges so verdicts from different courts would have more consistent judgments. The verdict of a medical court would be appealable to a court with a jury. The decision and reasoning of the medical judge would be made available to the jury if the patient wishes to proceed. There is little chance of any tort reform happening without an uprising of the people as there are too many lawyers in the Senate and House.
We have tried a number of approaches to end junk lawsuits. We even got so specific as to have a bill that would provide some protection ONLY for OBGYN doctors. Baby doctors have to have insurance that covers them until the child is 21. Until that time the “child” can sue the doctor on their own even if the parents do not. Cost of insurance for OBGYN has gone up dramatically even if they have never had a claim. Some doctors, particularly in rural areas are even limited by their insurance coverage as to how many babies they can deliver. That means that the insurance dollars have to be allocated to that number of babies and raises the cost of delivery a lot. One Wyoming doctor used half-time of a high school basketball game to announce his retirement since he couldn’t afford the liability insurance any more. An interesting aside from that doctor’s announcement- almost every player on both teams was delivered by him. Even the OBGYN tort reform bill was defeated on the floor of the U.S. Senate.
- Emergency Care: We do need emergency care for everyone. We do need a safety net for everyone. That can be provided with community health centers that we fund. They should have a sliding scale to determine what a patient is charged based on the patient’s income. I think everyone agrees that community health centers provide a vital service.
- Skin in the Game: Most people on both sides of the issue say that patients should have more control over their own health care. The higher the percentage a patient pays of their own health care costs, the more they will care what it costs and insist they are getting value for their dollar. This is the direction we should be moving. Everyone should have to pay something, a co-pay for their own health care. This will lead to better decisions.
3
Problems with the new health care policies now in place
“Hey, it’s a free country.” At least that’s what people used to say. Our Constitution guarantees us certain freedoms, certain things that our government is not supposed to be able to do to its citizens. How free is a country with a federal government that can force its citizens to buy a private product or service and specify how deluxe it has to be? Even if the lawyers find a way to finagle a court into calling the new health care law Constitutional, which I can’t believe they would, it still goes against the spirit of the document and the ideals which our country was founded. The new health care law is rife with company and individual mandates. Previously, an individual has been prohibited from buying items by federal laws, but has never been required to purchase any items by a federal (car insurance is a state requirement) law. Forced purchase is and should be unconstitutional.
What’s this thing going to cost? The Senate Majority Leader chastised us, saying we had to use facts-not opinion - - and then he went on to give his own opinions using much of the worn out incorrect statements the President has been making such as, the Congressional Budget Office says the law will reduce the deficit by $132 billion the first ten years and $1.3 trillion the second ten years. Does anyone believe we can spend a trillion dollars for new programs without costing anyone a dime? They insist on ignoring the rest of what the CBO said and are also forgetting the fact that CBO cannot consider what is not in this piece of legislation even if missing elements will result in huge additional costs. A separate letter from CBO points out that their statements are only true if the money is spent twice. Another letter from CBO says the law will result in increased cost of insurance $1,300 a year more than if we did NOTHING!!!
We need to be concerned for healthy young people. Under the new law, insurance for most young people will dramatically increase. Sure a provision was made that they could be under their parent’s insurance until they are 26. Many will be married and have a family before that. At that point they will step off a big cliff. With the requirement that will help sicker older people adjust their premium, the younger healthier will see huge increases. A thirty year old man in Wyoming used to be able to get insurance for under $100 a month. Under the new law it will be difficult if not impossible and is likely to cost them $300 a month or more. I think they will notice and will wonder just who this insurance legislation was for.
At the other end of the scale are seniors. The reconciliation law or “fix” law, provides rebates of $250 to Part D enrollees who enter the coverage gap in 2010. Additionally, under the reconciliation law the discount would begin January 1, 2011, and higher income enrollees would be eligible to receive the discount. The reconciliation law would also phase out the Part D coverage gap. Specifically, the law would gradually reduce the amount of enrollee cost sharing for both generic and brand name drugs through the coverage gap; in 2020 and beyond, patient cost sharing would equal or be equivalent to 25% (similar to cost sharing during the initial coverage phase). Regardless of whether the senior chooses a brand name drug or a generic drug, the beneficiary will pay 25% of the cost. If the beneficiary chooses a brand name drug, the manufacturer will pay 50% of the cost, the federal government will pay 25% of the cost, and the beneficiary will pay 25% of the cost. If the beneficiary chooses a generic drug, the federal government will pay 75% of the cost and the beneficiary will pay 25% of the cost. That makes the majority party statements VERY misleading when they say the federal government is going to take care of the donut hole. It might come as a big surprise to seniors when they realize they will still have a 25% co-pay. Once seniors hit the catastrophic cap on Medicare drug benefits, they only have to pay a de-minimis co-payment (5% up to $6 for brands/$2 generics). Everyone should have some skin in the game and pay for as much of their own health care as they are able to, but my colleagues on the other side of the aisle are not being up front with seniors.
The new health care law also makes significant changes to the drug coverage employers provide to their retirees. As a result of the new law changing how these benefits are taxed, several large companies have already had to each reduce their estimates of future earnings by hundreds of millions of dollars. While these write downs have gotten lots of attention in the press, I believe the real story will be the retirees who will see their current employer drug coverage reduced or eliminated due to these changes. Because the bill makes it less attractive for employers to offer this type of coverage, many employers are going to drop their coverage as soon as they can. Ultimately, this will increase the cost to taxpayers, as more seniors sign up for Medicare Part D, rather than drug plans subsidized by their former employers.
Another claim being made is that the insurance exchange will provide choice and competition. It has potential, but what is left out is that to be listed on the exchange(s) the policy will have to meet minimum federal standards. Those standards are more insurance than what 50% of the people have already. Federal minimum standards require lower deductibles and lower co-pays than most insured people already have. That means they will have to pay more in premiums to make up the cost.
Medicare is going broke. The majority realizes that, so after claiming half a trillion dollars from Medicare for the new health care plan, they “solve” the problem by forming a special commission to make further cuts. Nursing homes, hospice, and seniors themselves will have to pay for a lot of the cuts and none of those three make up much of the pie.
Another way the law is paid, is for us to institute new taxes right away and not have the benefits kick in until much later. Unfortunately, most people who wanted the law expect that they will be taken care of the right way.
The law provides that 85% of premiums must go to care. Sales, management and operations and payment to stockholders would be limited to a total of no more than 15%. We all want insurance money to go to care, but there is still a lot of expense left that will have to be poured into finalizing this law. An army of unelected government bureaucrats will be filling in the blanks, details and definitions contained in this law, adding thousands of more pages of rules and regulations. You have to wonder about the unintended consequences of rules by people who have never been in business, let alone the health care business.
This heavy-handed law has the feel of past mistakes. Diana and I went into the shoe business just as President Nixon was advocating price fixing. When Congress just mentioned it, the shoe companies raised their prices. When the price fixing kicked in, each company raised the price as much as they were allowed each time they were allowed. In a very short time, the price of the shoes had doubled. Right now our discussion of fixing premiums is causing a quick rise in health care premiums. You should also know that many states already have the right to regulate premiums, but don’t and for good reason. They cannot know enough about the actuarial insurance costs to know they are not putting the company out of business or driving them out of their state. The proponents of this law don’t worry about things like that though. Now that it’s become law we’ll “find out what’s in it,” to paraphrase the speaker of the House.
4
A flawed process will produce a flawed law
Many of my constituents tell me that just saying “no” isn’t good enough, that I should work with the other party, put partisanship aside and get things done. I couldn’t agree with them more, but that didn’t happen with this health care debate. Let me tell you why. One of the main reasons is that with control of the White House, the House and a filibuster-proof majority in the Senate, the majority felt they were in the driver’s seat and didn’t have to listen to anyone else. They didn’t for the most part. Instead their leaders played winner take all pressure politics, where the bill is presented and then the leadership asks what is the minimum change they can make to get your vote, or is there something else you want for your vote.
Sometimes the majority would put on a show about bipartisanship, but if there had been substance to their claims of inclusion then their health care law would have gotten bipartisan votes. I believe most people in both parties here in Washington want to help make the country better, but the majority leadership wouldn’t let us make changes together on this issue.
Summits
Unfortunately, the White House’s summits have only added to people’s political cynicism. The White House health care summit meeting was held because of popular backlash against the health care bill. The American people have figured out that there are real problems with the health care bill. It is going to cost them freedoms and money add to our country’s debt. They have shown their anger and passion in town meetings and votes in Virginia, New Jersey and Massachusetts. The President saw a need to counter some of the criticism. Unfortunately he did not make the summit a true listening session. Instead he chose to rebut every differing idea and concern right after it was expressed. He didn’t take the time to digest what he had heard. He wrote his closing speeches the night before or he would have included some of our ideas. He had already determined that nothing was going to come out of the summit and no real changes would be made, but wanted the TV exposure anyway to make his point.
A true listening session is opened with a few comments and then the summit host actually listens while each person gets to speak. Then the host concludes by telling what was learned as a result of the session. Unfortunately, this was not a close the gap meeting. The die was already cast. The purpose of the meeting was to show us as being without ideas. It didn’t work. America was listening.
The President concluded by saying that people didn’t have seven or eight hours to do another summit or have another meeting, but if I thought it would achieve anything I would spend another day, more than that. I spent 100s of hours trying to get health care reform. But both sides have to be willing to leave out things that they want if the other side can’t stomach them.
I also participated in other White House summits on small business and education held in the first days of the new Administration, but they were similar to the health care summit. Following each summit I was sent a summary of the comments to comment on. Each time, what I said was left out or misstated. After I sent corrections I never saw a final copy.
HELP Committee Markup
The President used the same approach as the HELP Committee majority. They presented their bill as take it or leave it. I was brought a completed bill and asked if I wanted to make some changes. That’s the way the whole process went. In the Finance Committee we were given phony deadlines. What we needed to use was our tried and true process where we review everything in detail and bring in experts when we don’t understand something. We started down that road in the Finance Committee. We were in the process of talking to the governors about effects the law would have on the states’ Medicaid expenditures, but then Senator Baucus was told that the Gang of Six was done. No real changes were expected when we had the floor debate. In order to get enough votes, senators were asked what they needed to be able to vote for the bill. At great jeopardy to the senators, their few votes were bought. That’s not the way to legislate.
Special Deals
The law included deals for Louisiana and Florida and New York and Nebraska to name a few. Wyoming, Montana and North Dakota will get better hospital reimbursement, but that is not something where the Wyoming delegation asked special consideration as part of this law. We would much rather have smaller, understandable laws that actually bring down costs and is fair to all the states. Votes purchased by special deals should never happen - for the sake of good legislation and for the good of America.
Other deals were made earlier in the process. After looking at what happened to President Clinton when he tried to pass his version of health care, strategists concluded that it would be necessary to get certain interests to keep quiet and not oppose the bill.
The Administration made a deal with the pharmaceutical companies that if they would contribute $80 billion to closing the “donut hole” on Medicare Part D (the part above minimum care and before catastrophic kicks in that a person has to pay on their own) then payments would be made directly to the individual only if they STAYED WITH THE BRAND NAME DRUG. That way, the drug company’s more expensive brand name drug would still be the patient’s drug when they got through the “donut hole” when the taxpayers pay for the prescription. Currently with the patient paying, they have often been switching to the generic drug when they hit the donut hole - so big Pharma figured out how to make more money.
The majority made a deal with the hospital association for another $80 billion if the hospitals would not be asked to make any future cuts.
The American Medical Association made a deal on behalf of the doctors that their legislated cuts would be restored, they would not get any other cuts and there would be strong medical malpractice tort reform. (The AMA only represents about 7% of the doctors now.) This deal didn’t pan out for the AMA, however. It didn’t get the “Doc Fix” (the legislative cuts restored). Evidently some in the majority prefer to have that club to hold over doctors so the doctors organization will support the majority’s ideas a year at a time - actually right now, even a month at a time. They also did not get any semblance of tort reform.
The AARP bargained for lower rates for those 50-65 regardless of how much it drives up the cost for the young and healthy. Medical device manufacturers got a break on new taxes in exchange for backing the bill.
Proper Process
The committee process works when it is allowed to, but that didn’t happen with the health care law. Not only were we given completed bills to take or leave, if we were allowed to do amendments and one happened to get passed, we were threatened that they would throw it out if we didn’t vote for the package. That is just another form of trading votes and is seen as punishment. I’ve seen this happen with other issues too.
Throughout the health care process worthwhile ideas were discarded. There was a lot of talking past each other - using parts that sound good. Ideas were not considered on their merit, but on whether the member would vote for the entire bill. It didn’t have to be this way.
There is a proven way to get legislation done in a bipartisan way. Senator Kennedy and I had a way of doing bills when we ran the Senate HELP committee together. Senator Kennedy and I would begin on an issue by setting out some principles. We worked both sides of the aisle collecting ideas to meet those principles. (That is where the Ten Steps health care plan came from.) It worked well enough that 38 bills were signed by the President in just a three year period. Of course those bills didn’t get much publicity because there was no “blood on the floor” - no way to point out partisanship. Senator Kennedy was one of the most liberal senators. I am one of the most conservative, but the bills we passed together didn’t push us further into our own chosen philosophical camps as the division today does. It is hard to label a vote on an issue as a Democrat vote or a Republican vote if almost everyone voted for it. That’s why a lot of these special interest vote scorecards don’t really tell the whole story.
When I was chairman of the HELP Committee we introduced roundtables as a way to get more information on an issue. Instead of having a hearing where the chairman selects a panel that shares his or her point of view with one exception appointed by the ranking member, we selected 15 people with real experience in the issue area. The questions would be agreed on jointly by the chairman and the ranking member. The purpose was to find out what experts had done, why they had done it and how it had worked out. In a health care roundtable the question was asked, “Would universal single payer health care work in America?” All except one on the panel said no it wouldn’t work. Americans wouldn’t stand for the wait times for access. Following that roundtable Senator Kennedy came up to me and said he thought we better take another look at Small Business Health Plans.
Senator Kennedy and I had an agreement that every proposed amendment to a bill had to be looked at carefully. Every amendment was treated as though it had at least the germ of a good idea in it. We tried to find the idea and looked for common ground. That resulted in better results for finding unintended consequences using the varied background of all on the committee and in Congress. This is an effort that should have been done a year ago and in more detail instead of just inviting us to participate for show. That’s why bipartisan ideas didn’t wind up in the health care reform law. It didn’t start out the right way. Senator Baucus had already written a white paper on how he thought it should look. When the Gang of Six talks were forced to end, Senator Baucus reverted to his white paper.
The majority rejected our idea to take health care one step at a time. Each step would help, could have been bipartisan and people would have been able to understand it. This was an outcome a majority of people would have preferred, but the rejection of this method made the liberal partisans happy. The size of the laws has rightfully scared most people. People want to know what Congress is doing to them. They know much can be hidden in a large bill and it’s easier for large bills to accumulate enemies. Congress doesn’t do comprehensive well. Bills should be evolutionary, not revolutionary. Bills are usually successful when they cover one concept. That allows a thorough examination by all members and allows the public to understand what Congress is doing.
80 Percent Rule
Congress has moved away from using the 80 percent rule. The 80 percent rule says that on any given issue, there is 80 percent of it that we can all agree on. That’s the part we need to focus on if we are going to make any progress. If we focus on the 20 percent we disagree about, we’re likely to get bogged down in details and stuck in partisan gridlock with little to show for our efforts. People who work on an issue using the 80 percent rule don’t compromise, but rather leave out to work on later what the other side finds most objectionable. Trying to force one side to accept the 20 percent over which they disagree won’t produce a bipartisan bill. Compromising is a lot like meeting in the middle of two bad ideas. It’s not a good idea. Continuing to look for a new way to solve the problems is better. The interests of the people have to come before each party’s political interests.
5
It would have been so much better and easier to do health care reform the right way from the beginning. Unfortunately, that isn’t possible now and a repeal of the whole health care law, no matter how desirable that may be, it is unlikely to happen. A repeal would be vetoed and it takes 67 votes for an override. Once an entitlement takes hold it’s nearly impossible to end. It is like trying to put the toothpaste back in the tube. So our task now is to replace the law with workable solutions that actually bring down the cost of health care. That’s what I will continue to do. There is even more room for improvement now than there was before the majority passed its reform.
Not all parts of the new law were bad. There was much agreement on principles, but many of the principles weren’t in the new law. It’s like a huge sandwich. The bread/outside covering looks good and it is good, but customers are discovering what is inside between the slices. They are discovering things that should never have been put in the sandwich. They are finding meat substitutes too. Waiting to make changes likely will taint the bread. That could result in the government taking over the shop.
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