Sunday, July 26, 2009

Roses Are Red, Violets Are Blue, Blue Dogs Do, What They Have to Do

When history is writ, liberal Democrats and Obama followers will look back and thank conservative Blue Dog Democrats. For what? For saving the left from its worst instincts – reflexing lurching left in full Bush whacking mode. Health care is Obama's issue, not Bush's.

The Blue Dogs are doing what they have to do – swinging towards the center so save their re-election chances in November 2010. The full House will be up for election, and many Blue Dogs come from swing districts where they unseated Republicans. Traditionally the party out of power regains seats, and Republicans may do so with a vengeance if the stimulus fails, deficits climb, unemployment continues, and health care falters. Democrats stand to lose big in conservative districts concerned about the huge Federal budget deficits, and in liberal wealthy districts perturbed by the onerous surtax on millionaires.

The Blue Dogs know the U.S is a center-right country. Most Americans prefer incremental to radical change; demand prompt access to the latest medical technologies; like to make their own health care decisions rather than depend on government. hate the thought of waiting in line for care and being denied treatment want to pick their own doctors; like their own private plans and fear giving them to some public plan.

These citizens are skeptical of such things as comparative effective research, which they suspect is denial of care for the elderly in disguise; bundling of care to do away with fee-for-service, which may be more about bureaucratic bungling than bundling.

Moreover, Blue Dogs know Americans loathe uncertainty, and uncertainties are in the air, as liberal activists try to rein in Blue Dogs. But Blue Dogs are barking back. The Dogs want four questions answered: one, what are the details of Obamacare; two, how are you going to pay for it; three, where is the solid evidence you’re going to save any money; and four, what sacrifices are my constituents going to have to give up to make Obamacare a reality? Will they, for example, have to give up cataract, joint, and heart surgery - the three leading Medicare cost items - because they are too old to qualify?

So far the Director of Office of Management and Budget, Douglas W. Elmendorf, is not impressed the Obama teams promises to save money through prevention, universal EMRs, or primary-care based care coordination. These savings, he says, are more likely bend the cost curve upward by $253 billion, not downward. Nor is Elmendorf impressed by the argument that Obama could appoint an “independent” Medicare Advisory Council recommendations “as approved by the President.” This is interpreted by some as grab for executive power.

I keep hearing the argument that the Obama team and the Blue Dogs have agreed on 80% of the principles and that only 20% of the details need to be worked out – grimy little details like how much is this 10 year reform effort cost, how many uninsured will it cover, and what freedoms are my constituents going to have to sacrifice.

Rhetoric has carried Obama as far as it can. Now is the time for realities.

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