Obama, Race, and Health Care

Understanding America's real and imagined grievances

After an exceedingly disappointing 10 months in office pursuing a hyper-partisan agenda, President Barack Obama reminded me last week of why, for a brief moment during his campaign eons ago last year, he actually won my heart. He seemed then to be a genuinely different kind of candidate, heterodox and capacious, capable of transcending the great divides of our time to forge perhaps a new—and improved—political consensus.

Remember that great line from his speech? "There is not a liberal America and a conservative America; there is the United States of America. There is not a black America and a white America and Latino America and Asian America; there is the United States of America."

He reignited that spirit over the weekend when he took to the airwaves and rebuked—calmly but firmly—the ideological yahoos in his party—the Nancy Pelosies, Maureen Dowds, and Paul Krugmans—for calling opponents of ObamaCare racist. "[Race] is not the overriding issue here," he admonished. It's an argument about "what's the proper role of government."

Exactly. But if Obama wants to regain the momentum on health care reform, he will have to do more than just refrain from impugning the motives of his opponents. He will actually have to listen to them and do what he said he would during his campaign: put affordable coverage within the grasp of more Americans without forcing them to purchase it, without raising their taxes, and without breaking the federal bank.

Obama has been trying to shore up support for health care reform by noting that he will veto any health care bill that isn't deficit-neutral. "I will not sign a plan that adds one dime to our deficits either now or in the future. Period."

But it isn't racist to wonder if that statement depends on what Obama's definition of "deficit neutral" is. The Congressional Budget Office, for instance, had noted that the House Democrats' health care bill would add $220 billion to the deficit over 10 years. But the White House proclaimed the bill to be "deficit neutral" anyway. Why? Because it simply refused to count $245 billion in Medicare payments to providers in the bill that it viewed as excessive.

Since then, the CBO has certified that the Senate's Baucus bill (which many House Democrats have already declared dead-on-arrival because it does not contain their beloved public option) would reduce the deficit by about $50 billion over 10 years. But that's only because it will offset its costs by sticking it to the American people—many of them making under $250,000—in the form of higher taxes, penalties, and fees.

Despite that, its "deficit neutrality" depends on two caveats: one, leaving 17 million Americans uninsured. And two, Congress holding Medicare reimbursement rates to providers to the declining levels prescribed in the bill for the next two decades. But this is something that Congress has never been able to do, so the CBO projection is totally meaningless. The CBO itself says as much, noting that its analysis assumes that the Baucus bill will be followed in toto forever, which is "often not the case for major legislation."

But the real issue is that deficit neutrality—even if it were achievable under ObamaCare—is a sham goal. The country's deficit has tripled since last year and is expected to balloon to $9 trillion over the next decade. Declaring "neutrality" in the face of this is not a policy position. It is a cop out. It is code for permanently cementing deficits into the federal budget, and virtually guaranteeing either hyper-inflation, hyper-taxation, or both down the road.

Obama insists that two-thirds of his health care tab—or over $500 billion over 10 years—will be paid for by squeezing out waste and inefficiency from Medicare. But if there are such savings waiting to be tapped in Medicare, shouldn't they go toward slashing the deficit—not adding more entitlements? Is it a symptom of racism or the mental health of the American public that it is taking to the streets to protest such warped priorities?

Indeed, if Obama were genuinely interested in helping uninsured Americans purchase health care, he wouldn't be talking about imposing an individual mandate and confiscating up to $3,800 in penalties every year (as per the Baucus plan) from families that don't comply. He would do what he said he would during the campaign: make irresistibly cheap options available to them.

Obama's whole argument for the mandate is based on the idea that uninsured folks impose an unacceptable financial burden on the rest of us when they land in emergency rooms and get care they can't pay for. But uncompensated care costs only about $40 billion annually—or about 2 percent of the country's $2.2 trillion health care spending. That's less than what department stores lose to shoplifting every year.

But even if one accepts that argument, shielding the insured from the costs of this uncompensated care requires only that the uninsured get some form of bare-bones, catastrophic coverage. And a healthy, young guy could do so for as little as $80 a month if he could purchase insurance from states like Kentucky, that haven't jacked up coverage costs by forcing insurance companies to include everything from in-vitro fertilization to hair prostheses in their basic package, as states like New Jersey have done. Indeed, if individuals could purchase coverage across state lines, the ranks of the uninsured might be cut by up to 17 million—almost half of uninsured Americans—without costing Uncle Sam a dime.

The main reason Americans can't do so is a 1945 federal law called the McCarran-Ferguson Act. This law handed states the primary role in regulating health insurance in violation of the Constitution's Interstate Commerce Clause, which expressly gives Uncle Sam authority to check state barriers that inhibit the free flow of goods and services. Yet Obama has said not a word about reforming this law in the scores of speeches he has given. Nor have his fellow Democrats made any mention of it in the thousands of pages of legislation they have produced.

Americans elected Obama because he presented himself as a fiscally responsible adult who—in contrast to his predecessor—was interested in looking for workable, pragmatic solutions, not promoting an ideological agenda. But Obama pulled a massive bait-and-switch upon assuming office, using every issue—the financial meltdown, the recession, the deficit, global warming, and, of course, rising health care costs—to expand the scope and size of government. That's what Americans are protesting now, not his skin color.

He was, after all, black before he got elected, as he himself pointed out to David Letterman.

Shikha Dalmia is a senior analyst at Reason Foundation and a biweekly Forbes columnist. This article originally appeared at Forbes.

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  • ||

    What a racist article.

    No, but seriously though I do like that he is slightly reprimanding his fellow Democrats. He might not have been the best pick for prez (Bob Barr, anyone?), but I think he is a better choice than that old robot McCain and his idiot poodle Palin. I'd rather work for the benefit of the poor than live under the rule God. And you do know what I mean. Whereas Obama simply wants to tax us, McCain would have given religion a voice in government.

  • Tony||

    I don't see where Obama has strayed unacceptably far from his campaign promises. I don't get why you seem to think he campaigned as a libertarian, though.

  • ||

    I don't see where Obama has strayed unacceptably far from his campaign promises.

    C'mon, you guys, stop spoofing Tony.

  • ||

    And a healthy, young guy could do so for as little as $80 a month if he could purchase insurance from states like Kentucky,...

    I seem to recall that one of our Kentuckians said that that was no longer possible.

    Don't remember which one, so, of course, I might have got the whole message garbled. :)

  • jesse||

    Wait! he was black BEFORE he was president? WTF? when was someone going to tell me?

  • ll blow j||

    "I seem to recall that one of our Kentuckians said that that was no longer possible."

    Yup. I don't recall who it was, but they mentioned it more than once.

  • Brian Combs||

    "After an exceedingly disappointing 10 months in office pursuing a hyper-partisan agenda"

    Do I have today's date wrong? I believe it's been just over eight months since Obama took office.

    The rest of the article I pretty much agree with...

  • ||

    Brian, you're forgetting the rather bizarre enhanced transition/virtual co-presidency between the election and the inauguration.

  • smartass sob||

    Excellent article, Ms. Dalmia!

  • ||

    "He might not have been the best pick for prez (Bob Barr, anyone?), but I think he is a better choice than that old robot McCain and his idiot poodle Palin. "

    I'd say it was a wash between McCain and Obama. If it wasn't for McCain's stance on foreign policy, I'd have voted for him. Your description of Palin hits the nail on the head. However, I think Ron Paul would have been the best choice for president. Due to voting regulations, he wasn't on the ballot in Ohio.

    When I tell people I voted for Bob Barr, they all say "Who??""

  • ||

    true, I do like Ron Paul better, however he ran in the Republican primaries and lost, leaving Bob Barr as the best choice. He wasn't in Oklahoma either.

  • monkeys||

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    Could use a little Zaporizhzhya pizzaz, if you know what I mean.

  • Cleaves M. Bennett MD||

    Every pundit, every news analysis, and every politician is ignoring that huge, smelly, dead elephant lying in Obama's office. The reason that healthcare is unaffordable to millions of individuals and companies, local and state governments and the always before (but no longer) deep pockets feds is that way, way too many people need to use it much too often. The why is so simple! Here are a few bullet points: 90% of Americans get high blood pressure before they die. 20% of 4 year olds are obese. Lipitor is the best selling drug in history (despite 5 competitors that are equally effective). There is a critical shortage of Primary Care docs, but we prefer specialists anyway. They order all those neat expensive tests and procedures we hear about on the news every day.
    America is one of only two countries that allow direct to consumer ads for prescription drugs. We have a diabesity pandemic that is spreading worldwide, following our penchant for fast foods. McDonald's newest offering is a hamburger with 4 patties, one for each chamber of your heart! Baskin Robbins Large Chocolate Oreo Shake has 2600 calories, 135 g of fat and 263 gm of sugar. That's one shake for one person at one sitting. Google "worst foods in America" for more. Every holiday is celebrated by eating too much and lying groaning on the floor afterward. "All you can eat" is a common marketing ploy at American restaurants.
    Everyone wants pre-existing conditions to be covered by "insurance'. Could you call up State Farm and get a new homeowners policy if your kitchen was already in flames and the fire engines on the way? Could you buy a new life insurance policy if you were already dead? David Walker, the former head of the GAO, has predicted that as the 75 million Baby Boomers become eligible for Medicare, the country goes bankrupt in 2017. Bill Clinton is the poster adult for this. Before he turned 60 he had a heart attack and needed open heart surgery. Hey, the echo boomers are no healthier. Figuring out how, who or what is going to pay for all of this is an exciting and controversial but ultimately a meaningless exercise.
    Our only hope is that large numbers of Americans (and their kids) need to start taking much better care of themselves, lose weight, eat only slow food, buy running shoes and bicycles and avoid elevators. I have been a doctor for 50 years. I have taken care of 1000s of patients who were hospitalized despite taking up to 10 different prescription medications for years. Pills are like seat belts. Seat belts prevent injuries and save lives, but you really do have to drive carefully. At 75 I do walk the talk. Visit nomoremedicines.com for more.

  • ||

    You're right, the real goal in all of this seems to be to get someone else to be responsible for an indivuals healthcare, whether financially or in terms of behavior. People eat themselves into high cholestrol and expect a pill to replace diet and exercise, paid for by someone else.

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  • abercrombie milano||

    My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp.

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