More "Project Runway" Than "The West Wing" in Congress

by Tim Foley

categories: Comparative Effectiveness Research, Enemies of Reform, Obama and Congress

Published June 18, 2009 @ 12:04AM PT

Four Senators – two Republican and two Democrats – stood up today and proposed a solution to our health care crisis.  Their package isn’t perfect, but it showed leadership, a balanced and serious approach, and creativity in finding the $1.2 trillion in new revenue and savings over 10 years that the package would require to be revenue neutral.  It also happens to match up 80% or so with the current legislative outlines in the House and in Congress, as well as what President Obama campaigned on.  With these bipartisan leaders coming together to propose a comprehensive solution, it should be easy to get their peers to sign on.

But there’s catch – all of these guys are retired.

Yep, it was all former Senators making the bipartisan proposal today, with Democrats George Mitchell and Tom Daschle joining Republicans Howard Baker and Bob Dole working with the Bipartisan Policy Center.  Not far away, in the active Congress, the tone was significantly less hopeful.  During the first official mark-up of a health care bill in the Senate, Sen. Judd Gregg was comparing a similar package to something that you’d get if you put “Rube Goldberg, Karl Marx, and Ira Magaziner in a room.”  Sen. Barbara Mikulski, whose had been the point person on determining ways to improve quality in a health care system where, according to the RAND Corporation, we get the preventative care we need only half of the time, hit back not on substance but with, “Our current system is a combination of Adam Smith, Darth Vader, and Invasion of the Bodysnatchers.”  So much for quality.

All we were missing were the reality TV show confessionals.

The debate in Congress is now focused on showmanship for the cameras.  Of course, there are concerns with the way this bill is structured and some of its provisions.  But we’re not talking about those concerns.  At all.  We’re talking about dramatics and scoring points.  How many times has John McCain sat in a bill markup when he didn’t have a full CBO projection in front of him? Heck, until this year we regularly saw budgets approved without any projection for the wars in Iraq and Afghanistan, let alone a full projection.  Yet he interrupted chair Chris Dodd’s opening statement to complain about not having a full projection and called the process a joke repeatedly.

Anyone looking for a high-minded debate doesn’t know the current composition of the United States Congress very well.  Other highlights from a week of inanity:

• Sen. John Kyl – the other guy from Arizona – joined with Mitch McConnell and Pat Roberts to push legislation that would ban the government from making any decisions on covering a treatment based on comparative effectiveness research.  That’s right – at a time when the same people complain that Medicare’s rate of spending is unsustainable and we have to make tough choices, they want us to avoid using evidence or data in making those choices.  I guess we can default to the old standby, then – who has contributed more to your campaigns (nearly $2 million to Mr. Kyl from pharma and medical technology firms.  Good times.)
• There have been nearly 400 amendments filed for consideration for the bill in the HELP committee.  About 28 of them are from Democrats.  Some of my personal favorites so far include “To prohibit the Secretary from requiring the use of best practices” from Mike Enzi and “To prohibit the Department of Health and Human Services from providing funding for fashion shows” from Tom Coburn (someone’s been watching a little too much Project Runway).  And from the party that brought you a resolution saying the Democrats should rename themselves the Democratic Socialist Party, we get this gem:  “To rename the community health program subtitle IV - would rename it the ‘Federal Takeover of Local Communities.’”  Yup, this is time well-spent.
• Remember Roy Blunt in the House and his House GOP Health Care Solutions Group – you know, the group that couldn’t be bothered to put together a decent Web site?  Turns out that couldn’t be bothered to put together a decent plan either, as their proposed solution takes up about two pages.  So if I were to proportionally devote as much attention to it based on the volume of work that went into it as compared to what I wrote about the GOP Patients Choice Act compared to the work that went into that… hm, guess I should stop writing now.

It’s easy to pick on the superficiality.  It may also strike you as a waste of time – after all, who cares, right?  The forces of the status quo are up to every parliamentary trick, falsehood, and controversy – even if they have to manufacture it themselves – to delay a push for comprehensive health care that they just don’t have an answer to.  Aren’t they just irrelevant and acting out of frustration?

The problem is, Democrats in the Senate seem to care about this.  Far more than the general public does, in fact.  A new poll today about whose opinions on health care inspire the most confidence had doctors at 73%, Obama at 58%, health insurance companies at 35%, and Congressional Republicans dead last at 34%.  And yet Sen. Dodd has repeatedly set himself up for disappointment by trying to get bipartisan consensus.  At the same time, a different poll showed that 76% of respondents thought having a “public health insurance option” was either extremely or quite important.  And yet Sen. Baucus is bending over backwards to jettison a public health insurance option to appeal to Congressional Republicans.  Despite a bipartisan collection of former Senate Majority Leaders endorsing a $1.2 trillion plan, Baucus is looking to trim $600 billion out of his plan – even if it means that its ability to cover more Americans will be substantially reduced.  You can’t cut out a third of your bill without taking the axe to primary care, prevention, subsidies for the middle class to afford premiums, and everything that we know our health care system actually needs, and needs desperately.  And what, aside from a couple fewer insults from John McCain, will you have gained?

Simply put:  Congress is focusing on the wrong thing.  Leaders who are able to get us over the finish line by creating a bill that can substantially improve health care access, cost-control and quality in this country aren’t focused on the best bill – they’re focused on a dog and pony show of interpersonal drama, and looking to placate a constituency with no credibility rather than solve the problem.  It's time to turn off Project Runway and start making the change we elected them to create.

(Photo credit:  I_am_indisposed on Flickr.)