Selective History

This morning Nicholas Kristof puts those who oppose the sham of a healthcare bill makes its way through the Congress “on the wrong side of history”:

It’s now broadly apparent that those who opposed Social Security in 1935 and Medicare in 1965 were wrong in their fears and tried to obstruct a historical tide. This year, the fate of health care will come down to a handful of members of Congress, including Senators Joe Lieberman, Blanche Lincoln, Ben Nelson and Mary Landrieu. If they flinch and health reform fails, they’ll be letting down their country at a crucial juncture. They’ll be on the wrong side of history.

I think that Mr. Kristof’s reading of history is highly selective. He neglects to mention that the House version of the Social Security Act of 1935 passed 372-33 with overwhelming majorities of both political major political parties voting “Aye”, the Senate version similarly passed 77-6, and the version that emerged from conference was approved by acclamation. If the healthcare bill is passed at all—far from assured at this point—it is likely to pass both houses with narrow majorities composed exclusively or nearly exclusively of Democrats. It would, indeed, be historic to pass such a major piece of social legislation in such a fashion but not in a good way, a wholly political act.

The experience with the Social Security Act of 1965 that enacted Medicare and Medicaid was similar.

Further, at present there is a dilemma about the present legislation that wasn’t present in either the Social Security Act of 1935 or that of 1965. If the Congress funds the bill as they currently plan, by reducing compensation paid to Medicare providers, they will de facto repeal universal healthcare for the elderly that Mr. Kristof celebrates. If they repeat what they have done in the past when they have pledged to reduce the compensation paid to Medicare providers and restore the cuts via other legislation, the plan will be in the red from Day One.

I think it’s also worth remembering that the tide of history does not flow in a single direction. A longterm care rider was added to Medicare under Ronald Reagan. The premium payments proved so unpopular that the legislation was quickly repealed in a panic.

6 comments… add one
  • For Kristof:

    “Being on the wrong side of history” = “being Republican in eras of Democratic dominance”

    “Eras of Republican dominance” = “history being on the wrong side of history”

    It’s a handy little worldview with its only drawback being its incoherence.

  • And of course there are the serious fiscal issues that Social Security and Medicare impose. Expanding and entrenching health care plus Social Security, Medicare as it is current structured, and the other spending the Democrats are undertaking paint a very grim fiscal picture with rising taxes, which in turn will likely lower growth rates.

  • steve Link

    Ok, this is a bit much. You often say we need to decrease Medicare costs. Now you say that if compensation is cut that the elderly wont be able to get care. You are saying that we cannot cut Medicare expenses? What about your idea of increasing the number of providers? Wouldnt that reduce compensation to individual providers (if it worked)?

    I know my fellow docs. They like their money. If they have a viable alternative to Medicare rates, they will take it. Many/most do not. You are partially correct in that a blunt tool will probably be used, i.e., broad percentage cuts for all. What needs to be done is to cut the subsidies to the over-utilizers. This will make people prefer private insurance, but you are forgetting that private insurers already pay more than Medicare. Those who can, already preferentially take private vs Medicare.


  • Drew Link

    Social Security and Medicare are viewed (by the left) as being “successful” only because every time they face bankruptcy taxes are raised to save them. No private enterprise would apply the same standard.


    An anecdote: I was in Canada this past week speaking with potential investors. At one of the dinners the talk turned to politics etc. I couldn’t resist, and inquired “so the biggest topical issue is Canadian health care; we hear so much about it in our own debate, but what is your first hand view?”

    The basic answer was what might be expected: the rationing and waiting claims are true. Quality of care did not seem to be a frustration……….just getting to the point of getting that care. In addition, the rationing issue did not seem to be so acute for surgical procedures, but for more routine issues.

    I’m not surprised.

  • Ok, this is a bit much. You often say we need to decrease Medicare costs. Now you say that if compensation is cut that the elderly wont be able to get care.

    Well, technically no. What Dave said was that if the legislation is followed as it is currently structured then the changes to medicare will, de facto, repeal univeral health care.

    Thats a bit different than saying, cutting costs of Medicare (in any way what-so-ever) will repeal universal health care for the elderly. Maybe Dave thinks that, but a careful reading of his post doesn’t really answer that question. I’m going to guess here that Dave thinks we can reduce Medicare costs without adversely impacting the care the elderly recieve. It might close off some treatment options in some cases, but possibly those were not really reasonable to begin with. For example, if under the current system and elderly patient has access to treatmen A and B and both have similar success rates and outcomes, but A is much cheaper than B, close off access to B in this case. Yes, choices are limited, but the over outcome from a health stand point and fiscal standpoint is either no worse, or an improvement.

    What needs to be done is to cut the subsidies to the over-utilizers.

    I’m going to hazard a guess here that if you are talking about the 65 and under crowd you wont get much savings at all.

  • Ghostzapper Link

    Nicholas Kristof should explain where in the US Constitution it is allowed to impose a mandatory federal government requirement for an individual citizen to have to purchase health care insurance. Plan and simple, the current sham of a bill is unconstitutional. If he can get over that hurdle, then there can be a discussion. It is fundamental and most people are missing the main point.

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