Scott Spiegel

On Saturday President Obama magnanimously announced that he was willing to support cutting $33 billion from 2010 federal spending levels for 2011—which, for the mathematically challenged, is about 1% of infinity.

Congressional Democrats screamed that these cuts were way too large.  Republicans countered that the cuts didn’t go far enough and should be extended to $61 billion, which amounts to about 2% of infinity.

With current spending set to run out this week, the federal government faces a shutdown on Friday night unless Congress can agree on which of these piddly sums to cut from the budget.

Tea party supporters have been rightly insulted by these farcical negotiating positions, arguing that hundreds of billions could be saved just by, for example, eliminating redundant programs.

As Rasmussen reports, a majority of Americans haven’t been snookered into thinking these microscopic doses of fiscal austerity will do a thing to address our long-term budget crisis.

Meanwhile, the only Congressman clear-eyed enough to appreciate the extent of the crisis, knowledgeable enough to propose a plan to resolve it, and brave enough to stand up for his proposal in the face of Republican wishy-washiness—namely, House Budget Chairman Paul Ryan—and also not crazily isolationist on foreign policy (Ron and Rand Paul) has offered a blueprint called “A Path to Prosperity,” modeled after his 2008 “Roadmap for America’s Future.”

Ryan’s plan proposes phasing out Medicare by replacing it with vouchers and turning it over to the states, making major changes to Medicaid, and taking similar action with Social Security after these two behemoths have been wrestled to the ground.

The central irony of Ryan’s stance is that, as he claims, his is the only proposal that will help “save” these programs, whereas current entitlement obligations will, if continued at their present levels, lead to eventual insolvency.

While Medicare/Medicaid and Social Security are unsustainable, unconstitutional Ponzi schemes, and while our country somehow managed to survive 189 and 159 years respectively without them, I suppose we need to start somewhere.  I guess a Budget Chairman who wants to drastically reform these albatrosses in order to save them is as good a start as we’re going to get nowadays from a political standpoint.

Ryan’s plan proposes cutting $5 trillion from the national debt over the next decade, and eventually eliminating the national debt, all without raising taxes.

On Tuesday, Obama rejected a third stopgap offer from House Majority Leader John Boehner to keep the government open another week while budget negotiations continue.

Obama’s right—we shouldn’t settle for on-the-fly, seat-of-our-pants, week-by-week spending plans.  Republicans should hold their ground and not be afraid to shut the government down on Friday.

Some who claim to favor entitlement reform have counseled House Republicans to compromise with Democrats on this week’s negotiations, so that Democrats will work with them later on more substantial cuts like Ryan’s.  The Chicago Tribune counsels, “Better to declare victory at $33 billion, or whatever more Republicans can wrest from Democrats, and move on to the bigger picture.  Because sanity in federal spending isn’t going to be restored by dealing in billions.  It’s going to be restored by dealing in trillions…  A deal today on discretionary spending could lay the foundation for bipartisan agreement on the far more impactful issue of entitlements.”

So giving in to Democrats will create goodwill and set the stage for larger-scale cuts, whereas shutting down the government will cause Democrats to dig in further and resist compromise later on.

One question: Since when did Democrats respond to Republican compromise with magnanimous, reciprocal behavior?

Sensing that they’re about to win on the shutdown, dyed-in-the-wool leftists like E. J. Dionne are already crying, “The Ryan budget’s central purpose will not be deficit reduction but the gradual dismantling of key parts of government…  Americans are about to learn… how radical the new conservatives in Washington are, and the extent to which some politicians would transfer even more resources from the have-nots and have-a-littles to the have-a-lots.”  Ezra Klein whines that Ryan’s plan will mean “leaving the old and the poor without health care.”  These are the people who are going to be placated by giving in on minute cuts now into accepting huge cuts several months from now?

Republicans’ negotiation strategy, from Bush I to Bush II to Boehner, has always been: The other side asks for an inch; Republicans give a mile.  Democrats’ strategy is: The other side asks for an inch; Democrats take a mile.  See how fair and evenhanded things are!

To take just one recent example, Congressional Republicans begged Democrats to consider including medical malpractice tort reform, legalizing health insurance sales across state lines, and offering greater tax deductions for health care costs in their ObamaCare bill.  Democrats responded by ignoring all these ideas and muscling through their bill inappropriately using the budget reconciliation procedure after the enraged residents of Massachusetts denied them their 60th Senate vote.

Battling Democrats legislatively is like fighting terrorists militarily—you don’t show them how weak and spineless you are; you show them how ruthless and merciless you can be.  They don’t respond to anything else.



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What kind of benevolent dictator would declare his love for Britain’s stingy, depressing, complicated, cold and arbitrary National Health Service by describing it as “generous, hopeful, confident, joyous and just”?

That would be Harvard-based pediatrician Donald Berwick, who recently received a recess appointment as Administrator of the Centers for Medicare and Medicaid Services by the benevolent dictator who describes his pessimistic and stale vision for America as “hope and change.”

Recess appointments are an executive procedure used, for better or for worse, when the Senate gives a presidential appointee a difficult time during confirmation hearings—for example, when they filibuster a nominee.  Obama’s appointment of Berwick bears the distinction of having been given without a confirmation hearing having even been scheduled.

It’s as though Obama decided that the very requirement that his nominee appear before a Democratic-controlled Senate constituted an unreasonably difficult hurdle.  This isn’t a recess appointment—it’s a vacation to Bermuda appointment.

As the Wall Street Journal noted, “Circumventing Senate confirmation to appoint the new Medicare chief is part of the same political willfulness that inflicted ObamaCare on the country despite the objections of most voters.”  CBS News observed, “The debate over Berwick’s recess appointment makes clear what the White House knew all too well—Berwick may not have survived the Senate confirmation process, which would have turned into a proxy debate over health care reform.”

Berwick, who will be put in charge of the health care of 100 million Americans without so much as a public query about his plans in office, has been quoted saying, “I am romantic about the N.H.S.; I love it.”  He has called himself “an American fan” of the system, “distant and starry-eyed.”

In his London speech commemorating the N.H.S.’s 60^th birthday, Berwick delivered such pro-American pronouncements to his audience as “Do not trust market forces to give you the system you need…  I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care.  That is for leaders to do.”

When it comes to Berwick’s affection for health care systems centered around use of death panels, apparently absence makes the heart grow fonder.  After returning home and mooning over the UK’s National Institute for Health and Clinical Excellence, the operational arm of the N.H.S., Berwick realized that “All I need to do to rediscover the romance is to look at health care in my own country.”

That country would be the United States, which has the greatest health care system in the world, and would be a profound source of inspiration for anyone who truly loved medicine.  Berwick’s own place of employment is Harvard Medical School, where you would think there would have been a few medical advances in recent years to set his heart aflutter.

But no—Berwick’s passion is for euthanasia counseling and quality-adjusted life years.

Berwick of course has never had to live under the jurisdiction of the N.H.S.  You might call his affair with the British health care system a long-distance relationship.

Describing the supposed British backlash against American conservatives’ depiction of the N.H.S. during the health care reform debate last summer, the New York Times gushed, “A Twitter campaign, We Love The N.H.S., is still going strong, with supporters sending messages about their own good experiences.”

In fact, said campaign didn’t even last 30 days from its first Tweet to its last, and has attracted a piddly 520 followers internationally.  This is despite such helpful but unheeded administrative prompts as “What do you love about the nhs?” and “Please Retweet: 10,000 supporters visualised.”

Admittedly, the riotously popular N.H.S. does have a Facebook fan page with 3,500 members.  Then again, an ill-worded N.H.S. sign implying that contraception would be facilitated by anal rather than vaginal intercourse has a Facebook fan page with 124,475 members.  So perhaps fan counts are not such a flattering measure of the N.H.S.’s popularity.

Even the New York Times admitted that Brits “complain endlessly about the National Health Service…  They deplore the system’s waiting lists, its regional disparities in treatment, its infection-breeding hospitals and its top-heavy bureaucracy.”  I guess the grass is greener on the other side of the pond!

If Donald Berwick wants to swoon over endless waiting lists, fatally protracted wait times, diminished access to specialized care, craven efforts to shield patients from learning about or acquiring costly life-saving drugs, dismal heart attack and cancer survival rates, depersonalized patient treatment, and centralized bureaucratic decision-making about individual health care options, that’s his prerogative.  But forgive the rest of the U.S. if we aren’t quite as smitten as he is.



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Each of the two ratified versions of the health care bill currently waiting in Congress was barely passed, by virtually the slimmest margin possible, in a hectic last-minute stampede.  Dozens of harsh compromises had to be hammered out to cobble together the fragile framework now standing in each chamber.

The two bills are like delicate Jenga towers, swaying nerve-wrackingly in the breeze, that must now be reassembled by a team of 535 clumsy attention-seekers into a tower twice as tall.  But legislators across the two chambers—and even within them—are not even speaking the same language.

Here are a few of the myriad discrepancies legislators must reconcile to ensure that their monument to Obama’s greatness doesn’t fall:

In the House version of the bill, a government-run insurance exchange is created on a national level and includes a public option.  In the Senate version, exchanges are created on the state level and do not include a public option.  Virtually identical!

The House completely bans the practice 0f charging those with preexisting conditions higher premiums.  The Senate allows insurers to offer unlimited discounts for customers who engage in subjectively defined wellness activities: say, exercising, eating healthy, “not having contracted lung cancer”…

Insurance exchanges are implemented in 2013 in the House bill and 2014 in the Senate bill.

In the House version, employers are forced to provide insurance for their employees and pay a fine if they do not.  In the Senate version, employers are not required to provide insurance, but pay a fine for employees who opt for government-run insurance and receive federal subsidies.  The House has higher penalties than the Senate.

The House version funds the bill by imposing a surtax on families making over $1 million a year.  The Senate version establishes a tax on those with “Cadillac” plans, which includes not only many union members, but millions of families who will unexpectedly find themselves unlucky Cadillac owners over the next 10 years due to the non-inflation-adjusted nature of the provision.

The House version does not tax insurance offered by employers; the Senate version taxes employer insurance above a threshold.

The House version charges older people a maximum of twice the premiums as younger people; the Senate version sets a maximum ratio of three-to-one.  The House offers fewer insurance subsidies for the middle class than does the Senate.  The Senate offers weaker measures to limit out-of-pocket costs than does the House.

The House bill covers 5 million more people than the Senate bill by expanding Medicaid to those earning up to about $2,000 more than in the Senate bill.

The Senate version gives $100 million to Nebraska for indefinite coverage of all new Medicaid enrollees in the state (to buy Ben Nelson’s vote).  The Senate bill gives $300 million to Louisiana for Medicare increases (for Mary Landrieu’s vote); $10 billion to Vermont for new public health centers (for Bernie Sanders’ vote); billions to Nebraska and Michigan to waive nonprofit insurers’ excise taxes (for Ben Nelson and Carl Levin’s votes); millions to Massachusetts and Vermont for Medicaid; and millions to Florida, New York, and Pennsylvania for Medicare Advantage.  None of these provisions is in the House bill.

The Senate version includes, per the insistence of construction unions, an important exception to the employer mandate.  As an article in the New York Times titled “In Health Bill for Everyone, Provisions for a Few” reports, “Under the Senate bill, businesses with fewer than 50 employees would be exempt from the penalties in every industry but construction.”  In the construction industry, the mandate holds for employers with as few as 5 employees.  The House includes no such provision.

Restrictions on abortion funding are tight in the House, with no federal funding allowed; and loose in the Senate, with mere separation of federal and private money, and states allowed to make up whatever rules they want regarding abortion funding.

Coverage for illegal immigrants is not disallowed in the House; it is explicitly banned in the Senate.

It should be sobering for Democrats to realize that if just one Senator or two Representatives decide they can’t tolerate the alternative version of even one of these provisions, that will be enough to topple the whole health care reform edifice.

It’s no wonder, then, that Congressional Democrats now plan to merge the bills behind closed doors, shutting out all Republicans from discussion of the reconciliation process and preventing them from using parliamentary procedures to slow consideration of the bill and allow the public to digest the proposed changes.  Talking Points Memo cites one Democratic House aide who proudly admits, “This process cuts out the Republicans.”  The House will simply take the Senate’s bill, amend it, vote on it, and send it to the Senate; who will then amend the bill, vote on it, and send it to the House; and back and forth until some hideous, lopsided, structurally unsound blueprint garners enough votes in both chambers.

If Democrats had to merge these two bills in a public conference committee—never mind on C-SPAN, as previously promised and recently offered by the network’s CEO—it would take about five minutes for the cacophonous clatter surrounding their health care Tower of Babel to bring it crashing down.

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