Archive for the ‘health care’ Category

The FDA has decided that your diet is far too savory.  It’s disappointed that you haven’t realized this on your own.  It’s understandable, of course, since salt has been a staple of the human diet since, oh, long before it was a form of currency.  But since you can’t be trusted to fix things yourself, the FDA will do you a favor and fix your food for you.

The government intends to work with the food industry and health experts to reduce sodium gradually over a period of years to adjust the American palate to a less salty diet, according to FDA sources, who spoke on condition of anonymity because the initiative had not been formally announced.

Officials have not determined the salt limits. In a complicated undertaking, the FDA would analyze the salt in spaghetti sauces, breads and thousands of other products that make up the $600 billion food and beverage market, sources said. Working with food manufacturers, the government would set limits for salt in these categories, designed to gradually ratchet down sodium consumption. The changes would be calibrated so that consumers barely notice the modification.

There is presently no statute that justifies the regulation of salt content in food.  No rule has ever set a “safe” amount of salt in any given food product.  To date, FDA has only required full sodium disclosure, allowing the consumer to make an informed decision about how she will regulate her salt content.  But we’re living in a world where EPA has decided that an biologically-benign, indeed botanically-necessary, atmospheric gas is a pollutant requiring massive regulation.  It’s not a very far step to prevent Americans from obtaining unlimited amounts of a naturally-occurring mineral that we all need to perform “basic biological functions.”

Although such a justification was not expressly made for this action, the FDA’s agenda here is an early example of how once the government pays for your health care, it makes everything you do the government’s business.  If you read the Washington Post article linked above, you may be saying, “Hey, Obamacare isn’t even mentioned in this article!”  And you would be right.  But the embedded logic of this move by the FDA will be used time and again to authorize the government to make decisions about your diet, your exercise routine, even your sexual habits.  That’s because, once the government is paying, it has virtually unlimited authority to condition its payments in ways that would be unconstitutionally coercive in other contexts.

Longstanding Supreme Court precedents, beginning in the New Deal era, have imposed only the flimsiest of boundaries on coercive requirements predicated on the receipt of federal funds.  A classic example is the Supreme Court’s decision in South Dakota v. Dole, upholding Congress’ refusal to give states federal transportation funds until they raised their drinking age to 21.  Justice Rehnquist, no less, held that the federal government’s interest in “safe interstate travel” was a sufficiently “reasonable relation” between drinking laws and roadbuilding funds to justify such a condition.

If it makes constitutional sense to parcel out road funds to states on the basis of when their legal adults can drink, how easy will it be for the Feds to justify the regulation of your salt content?  With its new mix of subsidies, tax breaks, mandates, and health care “marketplaces,” the federal government now has a monetary interest in how healthy you are.  If you are sick — or even if you’re not as healthy as you could be — that’s a matter of public concern.  We need to reduce the deficit — how better to do that than by reducing your salt content, making it less likely that the Treasury has to finance your heart transplant?  Far more inherently-risky activities — unprotected sex, smoking, drinking, even rock-climbing — could easily be outlawed on the basis of their threat to the government’s balance sheet.

That’s the dirty secret behind government health care — while it’s been sold as a response to the outrage of insurers’ heartless use of America’s preexisting conditions as a basis for higher rates, everyone knows that the only way to reduce health care costs is to change Americans’ behaviors.  Insurers try to do that with a mixture of carrot (rate reductions for gym memberships) and stick (higher premiums for type 2 diabetes patients), but in the end, it’s our choice.  Not so with government, which can perform the same task by using its regulatory power to prevent you from making those unhealthy decisions altogether – or else.

Of course, the government might decide that it’s cheaper to let you eat all the salt you want — and then refuse you that transplant.  Who is cheaper to care for, after all — a healthy person or a dead one?

The Enemy


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With apologies to Wallace Stevens.


Among fifty failing states,

The only moving thing

Was the cost of the health care bill.


The CBO was of three minds,

Like a hopper

In which there are three health care bills.


A health care bill swirled in the cloakrooms.

It was but a small part of the Big Lie.


A Reid and a Pelosi

Are one.

A Reid and a Pelosi and a health care bill

Are one.


I do not know which to prefer,

The folly of the deceptions

Or the folly of the desperations,

The health care bill passing

Or just after.


Snowmounds filled the Capitol steps

With muddy puddles.

The shadow of the health care bill

Passed them, to and fro.

The mood

Traced in the shadow

An unfathomable doom.


Oh wise men of Congress,

Why do you dream of wonder cures?

Do you not see that the health care bill

Stoops beneath the feet

Of the system around you?


I know high premiums

And frightful, inescapable long lines;

But I know, too,

That the health care bill is involved

In what I know.


When the health care bill moved out of sight,

It marked the start

Of one of many scandals.


At the sound of health care bills

Read into the deep night,

Even the frauds of K Street

Would cry out sharply.


He flew over Connecticut

In a white bird.

Once a fear pierced him

In that he mistook

The shadow of his presidency

For health care bills.


Obama is speaking.

The health care bill must be losing.


It was evening all afternoon.

It was snowing

And it was going to snow.

The health care bill sat

In the Speaker’s chair.

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Or, How Nancy Pelosi Made Me a Better Man.

As all four of my regular readers may have noticed, I’ve got a bit off the radar lately in the blogging world.  My absence was regrettable, but it was also for good reason — I simply didn’t have very much to say, or at least I wasn’t prepared to say it.  Over the past few months, I’ve had some very humbling realizations in my own life, and I’ve seen some good friends humbled, as well.  Advice that I’ve given has been ill-advised; I’ve done damage where I didn’t intend it.  No, I’m not in any trouble here — Mom, no need to call — just a bit more humbled by life than usual.

None of these realizations are very conducive to political blogging.  What we’re about here, after all, is offering our thoughts and opinions about matters of public concern.  If you don’t feel especially confident about your thoughts on matters of private concern, though, it’s hard to confidently project yourself into the public sphere.  I can certainly tell you what I think of Obamacare, or Holder’s brigade of Gitmo lawyers, or the obliteration of 200 years of Congressional rules and courtesy that took but two weeks to undermine.  But those battles are being fought, with or without me, and I should come prepared for the fight if I am going to join it.

Interestingly, it is this very meditation on human frailty that has brought me back to Marque’s Letters.  Over the last several weeks of the health care debate, we have witnessed incredible hubris on the part of the Democrats.  They are utterly convinced that their cobbled-together mess of a Senate health care bill is going to heal the sick, solve the deficit, and usher us all into a new era of post-partisan social bliss.  They truly believe that, even if it doesn’t quite work the way they think it will, they — in their infinite wisdom and their superior compassion — will solve it through more regulation, more legislation, better policymaking.  Insurance companies will be better once they are virtual zombies borne of the state, because smart liberals will be the ones in charge.  Treatment will be better, cures will be found, and doctors and nurses will be plentiful and cheap now that Washington has answered the call and taken over.

Of course, it doesn’t stop with health care.  Auto companies will be successful once the government and their union confederates are directing them.  Wall Street firms are evil when they don’t pay their executives what the government’s “pay czar” deems to be fair; they are sainted when they contribute to Democrat campaigns and support liberal causes.  Students are better off when their loans come from the government, rather than profit-taking bankers.  No one need learn the DOJ’s reasoning for releasing Gitmo detainees — the legal experts (not the stupid, warmongering Republicans) are in charge, and they should be trusted.  Al Gore and his scientist allies have spoken on the link between greenhouse gases and global warming, and all those who question even the most obvious untruths are agenda-driven deniers, worthy only of your scorn.

The common link, the underlying attitude, is a prideful audacity.  There is no humility here.  They cannot conceive that they might be wrong about what the people want or need.  Even when the world — in the form of polls, or elections, or town hall demonstrators — intrudes on the Democrats’ self-absorption, it is rejected as uninformed, or misled by venal critics, or even just unworthy of attention.  Dissenters must not be confronted – they must go.  How else can you explain these comments?

Robert Gibbs: “I hope people will take a jaundiced eye to what is clearly the Astroturf nature of so-called grassroots lobbying … The Astroturf nature of grassroots lobbying, which is largely the term for, you know, this is manufactured anger.”

Pelosi and Hoyer: “These disruptions are occurring because opponents are afraid not just of differing views — but of the facts themselves.  Drowning out opposing views is simply un-American.”

President Obama: “I don’t want the folks who created the mess to do a lot of talking.  I want them just to get out of the way so we can clean up the mess.  I don’t mind cleaning up after them, but don’t do a lot of talking.”

John Dingell: “The harsh fact of the matter is when you’re going to pass legislation that will cover 300 [million] American people in different ways it takes a long time to do the necessary administrative steps that have to be taken to put the legislation together to control the people.”

Nancy Pelosi: “But we have to pass the bill so you can find out what’s in it.”  [Emphasis added]

What’s amazing, of course, is that these are the same folks who said that if we didn’t pass their stimulus bill, we would have 10 percent unemployment.  Faced with 10 percent unemployment after spending nearly $800 billion on their stimulus bill, they were no less confident about their economic projections on health care, or cap and trade, or even the “Son of Stimulus” jobs bill.  Democrats have an entirely different spin on the phrase “past performance is not indicative of future results” — rather than warning us against unreasonably high expectations, they assure us that all the past failures have nothing to do with the current empty promises.

Faced with such heedless arrogance, what is a humble blogger to do?  Certainly not what I’ve been doing for the past three months.  In fact, the arrogance of Pelosi, Reid, Obama & Co.  have led me to cast a more introspective eye on myself, my conservatism, and its potential for the same sort of  pretentiousness.  What I found was edifying.

Conservatism, at its heart, is a humble philosophy.  Consider, for example, conservatives’ confidence in free markets.  The market is essentially a mechanism for establishing value.  It is an acknowledgment that none of us, or at least very few of us, have the knowledge necessary to make perfectly rational decisions about the value of most goods.  Most of us, if asked to make value decisions in a vacuum, would probably make big mistakes.  Ask a hungry person what he would pay for a banana, and he might offer $50.00.  Ask someone who hates bananas and he might say $0.01.  Ask a banana grower what he’d like to sell them for and he’d say $100.00 a piece!  None of these are what one would pay for a banana at the grocery store, of course.  Instead, that price has been set through the process of all of us — consumers, suppliers, all over the world — deciding at what price we are willing to buy a banana, and what price we are willing to sell one.  We let this process happen because we humbly acknowledge that none of us, on our own, have the knowledge or position to set The Price.  And, through this mysterious exercise of humility and communication, we set the price together.

Consider, in counterpoint, the liberal alternative.  Liberals believe that they know how much a banana “should” cost.  They believe that government, through the exercise of price controls, punishing taxes, broad-based subsidies, and comprehensive regulation, they can coax, cajole, or simply order the banana system into shape.  If at first, they don’t succeed in getting The Price for everyone, they will merely twist the screws tighter, push different buttons, pull different levers.  But the idea that perhaps the don’t really know what a banana “should” cost never crosses their mind.  The concept that the present cost is already distorted by past government attempts at setting The Price is anathema.  Even if that is acknowledged — a rarity — the response is not a chastened humility, but a redoubling of effort.  Usually this involves identification of corporate villains who themselves are trying to set The Price (who, not being government liberals, are unworthy).  Of course, corporations are no more capable, without the help of the market, of setting prices and determining value than government — and they don’t show up with guns if you refuse to pay them.

Market policy is only one facet of this dichotomy.  Liberals are outraged that the Supreme Court won’t let them regulate the speech of corporations; conservatives believe that no one has all the answers, and the more voices in every debate, the better.  Liberals believe that a unified set of “global community values,” espoused by their anointed among the “international community,” should govern international affairs; conservatives reject the notion that any elite knows what is best for the world and promote democracy to allow self-determination and unique national interest to govern foreign relations.  Liberals believe that regulators know the right amount of risk — medical, environmental, personal, what have you — we should each bear, and keep pushing the bar lower to punish those who refuse to keep us “safe”; conservatives agree that a reasonable expectation of safety should be established, but that individuals should be free to choose to accept more or less risk in their lives above that line.

To be sure, conservatives can exercise their own form of arrogance.  When they rule dissent out of bounds, they are no better than their liberal counterparts.  When they impose their own view of international norms out of a sense of paternalism, rather than promote peaceful change through moral suasion, they are just as condescending as the liberal global elite.  And any time conservatives convert their preference for traditional values to a legally-enforceable code of conduct, they are ignoring the fact that the Judeo-Christian source of those traditions is grounded in an assumption of human frailty.

The honorable intentions of the governing elite have rarely been an issue in the history of American social change.  Only at the end of the colonists’ argument with England did the mother country’s intentions turn hostile.  At the beginning, Parliament’s taxes were an attempt to seek the common good — their rich colonies were just paying their fair share toward the Empire’s many responsibilities.  The colonists first revolted not because they doubted Britain’s intentions.  They simply rejected its idea of what was good for them, and the notion that a distant elite could define it and enforce it with the power of the state.  Their answer was not to set up a local elite — instead, it was to put themselves, the people, in charge of their own welfare.

The Democrats in Congress are making the same mistake as Parliament in the 1770s.  They simply cannot imagine how their subjects could doubt that they have their best interests at heart.  They assume the public will figure it out and come along for the ride.  They may even seek to punish those who are intransigent.  They don’t understand that their actions, not their intentions, are at issue, and they only compound the matter when they attack those who just want them to listen.  Fortunately, this time, their lack of humility will be judged by the ballot rather than the bullet.

I am but a humble political blogger.  I do not know what is best for you.  You may have just lost your job and would rather send your kid to college than pay for health insurance.  You may be absurdly wealthy and would rather pay for your health care by selling a few thousand shares of Coca Cola stock.  You may be a middle class parent who can’t imagine life without a generous health insurance policy.  All of these choices are valid, and they are all part of being an American.  Were I to tell the unemployed man that he must buy health insurance, I am an arrogant ass.  Were I to tell the rich woman that not only must she buy health insurance, but she must pay taxes to buy it for others, I am an audacious fool.  Were I to tell the middle class parent that she can have her health insurance, but not the nice policy she has now — that would be greedy — I am a self-deluded prig.  Of course, I have not told any of these people they are wrong.  But a majority of our elected representatives have.

It is thus my duty as a humble American blogger to not only call our leaders what they are, but also to do my part to liberate my fellow Americans from these presumptuous entrapments that threaten to upend our entire political experiment.  In doing so, I am not placing myself above my fellow citizens, or issuing edicts from on high.  I am but one voice in a chorus of voices that, together, will set the price of our freedom.  I only hope that we are willing to pay it.

Lately, I have been reminded of the consequences of arrogance in my own life.  It is all too easy to believe that our best intentions are enough to justify our actions.  Unfortunately, no amount of goodwill can counteract the harm caused by a reckless deed, or even a well-considered one.  Far better, then, that we share our thoughts, acknowledge our limitations, and struggle through this life together without illusions.  To my friends, who I have wronged in my arrogance, and my fellow bloggers, who I have briefly abandoned, I ask your forgiveness, and promise you my best.  Now let’s get after it.

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Chuck of Head Muscle has kindly hustled me back to the ol’ blog, so you can thank him for the pearls of wisdom herein imparted:

  • When last I wrote, Republicans had 40 votes in the Senate, health care reform was still inevitable, and the President was planning to preempt Lost with his State of the Union address.  That was less than a month ago.  Since then, Scott Brown has preempted health care reform, Republicans have 41 votes in the Senate and more seem inevitable, and the President looked lost in his State of the Union address.  Ain’t democracy grand?
  • Let’s all remember, come the next government shutdown crisis, that when the federal government shut down for at least three days in mid-February 2009, we all did just fine, thanks.
  • Jim Geraghty spotlights one of those critically-underappreciated data points and the way it can creep under the skin of the American electorate.  It’s easy to forget that, aside from the enduring unemployment tragedy, there is also a lot of frustration among the employed.  Each year, millions of Americans leave their jobs not because they are forced out, but because they find greener pastures.  Right now, those pastures are looking pretty brown and chewed over by the millions of people looking for jobs full-time.  Add to that a national craving for economic security, which shows up in statistics ranging from the savings rate to the fury at government interventionism, and leaving the acceptable, stable (if unfulfilling) job for the potential dream job isn’t sounding so great right now.  So if you’re a smart, capable, hard-working American feeling stuck in yesterday’s job, making yesterday’s wages, how do you feel when you find out that the federal government bureaucrat living in Arlington makes more — a lot more — than you do, and more than he did before the recession began?  And this is the schlub that’s supposed to need more of your money to turn the economy around?  Even some of those government workers who are benefiting from such largesse are outraged.  Watch this.  It’s exactly the kind of apolitical, gut-level backlash that Washington cannot see coming until it hits the ballot box.
  • Speaking of Washington, I’ve been pleasantly surprised by the low-key approach taken by Washington Republicans in the wake of Scott Brown’s victory.  Sure, they’ve felt emboldened to state the obvious – that President Obama ignores the people at his peril – but there’s been little petty triumphalism of the sort that often overtakes a party in need of good news.  That said, national Republicans must maintain that discipline throughout the next ten months if they’re to lead the independents that are currently inclined to follow them.  President Obama is doing his level best to draw Republicans into small-ball fights that will make them, rather than him, look intransigent and haughty.  Kudos to McConnell, Boehner, Paul, Cantor, et. al. for being cautious, speaking equally with force and respect, and for refusing to compromise core principles for the appearance of “bipartisanship.”
  • The importance of the defeat of President Obama’s NLRB nominee, SEIU lawyer Craig Becker, cannot be understated.  One year ago, it was considered a fait accomplit that unions would soon be able to bypass the secret ballot and impose favorable contract terms through arbitration on recalcitrant employers.  Unions were so convinced of their impending empowerment that they began training their employees on how to operate in this new regime.  There was word that an army of union organizers was being prepared to be unleashed on hundreds of previously union-free workplaces, radically transforming the American workforce.  But Becker — who famously believed that employers should “shut up” during the union campaign process — is the latest symbol that another element of the inevitable liberal revolution will not come to pass, at least not anytime soon.  Sure, Obama may still make a recess appointment and elevate him to the post, but Harry Reid’s inability to obtain cloture on the nomination sent an unmistakable signal to the Administration — now is not the time to “remake” America’s employers.

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My general interest in the debate surrounding the health insurance mandate led me to a post written by David Dranove of the blog Code Red the other day.  While David is generally supportive of the mandate, he posed a few good questions to conservatives and liberals who object to it.  As a non-lawyer, he tacitly set aside the constitutional issues, which I’ve addressed earlier and which I still think rule out further discussion of the idea.  That said, I agree that the impulse behind the mandate (prevent free-riding in the health care system) is a fair-minded one.  Rather than ask everyone to visit David’s blog (although I still recommend it) to read my comment, I thought I’d re-post my thoughts here.

The question David put to conservatives opposed to the mandate was this:

Are you going to mandate that providers stop treating the uninsured? Or are you going to mandate charity? If neither, then the uninsured are going to receive care and free ride on the rest of us. Government has every right to act on the behalf of the majority and limit the free riding. Look at it this way. Conservatives endorse the right of the government to raise taxes to pay for the national defense, lest those who do not want to pay their share free ride on the rest of us. Just as the national defense protects all of us, so do our medical providers. The parallel to health care is close to exact.

This is a fair question.  No one believes that doctors will stop caring for the sick, even if they are uninsured.  We wouldn’t want them to do that, anyway — there’s some minimal moral expectation that those who are in need should be able to expect help from our medical system.  So, since the care will be provided, who will pay?  And if it’s not the government — essentially, a collective responsibility assumed by the public — who else could it be?  The solution, to my mind, is through a series of changes rather than a single one (or a single payer).

First, in the case of non-emergency care, we empower medical providers to require proof of ability to pay prior to receiving care.  That can come in any number of forms: cash up front, traditional insurance, enrollment in government health programs (VA, Medicaid, Medicare), or the posting of a bond. That’s a lot of options for anyone, and any truly indigent person would be taken care of by Medicaid. Those not eligible for government programs but without traditional insurance would be able to pay on a fee-for-service basis, or to post a bond. The bond option isn’t really available today, but that’s mostly because anyone can get medical care without showing any ability to pay at your average hospital.  If a bonding option was necessary for some uninsured Americans to get treated, and it was affirmatively supported by government policy, it would flourish.  Since that bond would only be intended to cover the specific treatment sought, the required payment would be at a considerable discount to traditional insurance, but not so low to encourage routine use of the option.

If the individual is receiving emergency care, obviously there won’t be an opportunity to address payment before care is received. In this case, for uninsured indigents, hospitals should be allowed to administratively enroll them in Medicaid. You might argue that this is the same as an insurance mandate, but this is different in two ways. First, it is the hospital, not the government, that is taking the action as a condition of providing care. Second, the states could implement this requirement, and the general police power of the states includes the ability to require such things — not the Commerce Clause of the U.S. Constitution.  This simple rule would protect the hospital from a large fraction of uncompensated emergency treatment cases.

For the uninsured that are not indigent but can’t pay their emergency bills (college students, the unemployed without COBRA, etc.), I’d recommend that the government establish a “one-strike-and-you’re-out” risk pool.  This risk pool would serve to pay for the emergency care costs only (not follow-on expenses when the individual is capable of making his/her own health decisions). The risk pool would pay on two conditions: 1) the individual agrees to pay over time a means-tested proportion of his care expenses at a subsidized interest rate and 2) the individual obtains basic health care insurance (high-deductible, no bells and whistles) and maintains it for a period, maybe five years.  This system protects the medical provider from the risk of nonpayment, it creates a constitutional means for requiring the uninsured-by-choice to pay their bills, and it limits the government’s liability to a smaller set of health transactions.

If an uninsured individual doesn’t want to avail himself of the risk pool, he must pay his bills out of his pocket. For those who don’t, Congress should create a much more streamlined and powerful means of collections for health care providers. Such a system, which could operate out of the same Magistrate Court system that hears most Social Security appeals today, would empower health providers to recover their own money, rather than take the financial hit and pass the cost onto paying customers. It’s not as if hospitals WANT to raise costs on paying customers — it’s just that the transaction costs of recovering the funds through current channels are far too high to make it worthwhile. Reduce the transaction costs and those incentives would change, benefiting the rest of us that don’t try to free-ride the system.

This system only works if guaranteed issue is also mandated, since an individual exiting the emergency room may not be able to obtain coverage under the current system. But since guaranteed issue is a given in every health reform bill I’ve seen, I don’t consider it too controversial.

Note that none of these changes restrict one’s liberty to choose how to pay for health care — so long as one doesn’t put others on the hook for health care. Once the uninsured individual does that, his liberty is constrained, but in a manageable and humane way. Why take an unconstitutional, coercive route when you can reach the same result without dramatically increasing costs for the insured population and still get the doctors paid?

What other ideas do folks have to avoid free-riding in our system without a mandate?

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One of the Democrats’ chief criticisms of the Bush Administration, one that sometimes had merit, was that it refused to alter its strategy or message in the face of new facts.  In foreign affairs, that meant it took us three years to react to the Iraqi insurgency in a manner beyond “staying the course.”  On the domestic front, that meant allowing several appointees to serve far longer than their records justified (Gonzales, McLellan, Powell, Rumsfeld) and establishing a bunker mentality in response to press criticism.

The Obama Administration struck at this central failing of the last regime by promising pragmatism and common-sense straight from the “reality-based community.” No longer would partisan bias cloud the White House’s response to the nation’s challenges.  Spin would be replaced by transparency.  Facts would drive policy, not the other way around.

But one year into the politics of hope and change, and we are seeing a pattern develop about how this crowd handles inconvenient facts.  All summer, the economic facts rolled in that the stimulus bill had done little to create jobs or improve the economy, and that the “shovel-ready” projects so urgently needed were figments of the Democratic imagination.  Rather than change course and respond with an alternative strategy, Joe Biden repeatedly claimed that the stimulus was working, and that things were better than they would have been.  Only recently, when the Administration wanted to pass a new stimulus, was it willing to acknowledge the grand failure that was spending $787 million billion for 2.5% fewer jobs.

When the mullahs of Iran bungled its election fix this summer, the Obama State Department first abetted it, then ignored it, then begrudgingly decried it before returning to full appeasement mode.  Iranians were left to shout a remarkably Bushian line at our President – “Obama, are you with us or are you against us?”   But the answer was clear — the White House was choosing to ignore a pro-freedom Iranian revolution in hopes for a deal with the despots.  Even so, deadline after deadline was ignored, deals were cut and then broken, and Ahmedinejad continues to promise death to Israel.  All the while, Team Obama has refused to acknowledge what even France has acknowledged — Iran is just playing out the clock while it builds a nuclear bomb.

On the eve of the global warming summit, stunning revelations about the science underlying the alleged global-catastrophe-in-waiting should have led a pragmatist to take a step back and review the facts before committing a country in the red to billions more in federal aid.  A pragmatist might have also postponed announcement of a sweeping regulatory decision based on that same science, which threatened to impose billions more in environmental compliance costs on a seriously wounded economy.  In an Administration committed to “restoring integrity to U.S. science policy to ensure that decisions that can be informed by science are made on the basis of the strongest possible evidence,” one might expect that getting the science right would be of the utmost concern.  Such an Administration, and such a pragmatist, is not in residence at 1600 Pennsylvania Avenue, however.

Public doesn’t want Guantanamo closed?  Ignore them and do it anyway.  Released terrorists are returning to the war on terror?  Deny the war, release more terrorists.  Health care bill doesn’t bend the cost curve, which you required of any bill you’d sign?  Say it does anyway, and deny you ever required it to do that.  Islamic terrorists attack the U.S. three times in one year?  They’re lone wolves – we’ve got it all under control – but please stand in line another hour at the airport, just in case.

Carol Lee of Politico goes into greater depth about the P.R. tactics the White House has used to ignore the facts that threaten their worldview, but I’m more concerned about the worldview itself.  We have a president who ran exclusively on the idea that he was no ideologue, that he had no dog in the partisan fights that plague Washington, and that his Administration would rise above the pettiness and do what was necessary to reform and protect America. Given these facts, the pragmatist in me says there are only two ways to react to Year One of Obama: either our President is a lying ideologue, or he’s very, very bad at knowing what is necessary to reform and protect America.

The facts themselves are clear, however.  The President will be judged by the voters in November based on how he responds to the hard facts in Iran, the muddled half-truths of climate change, the plain facts of a falling dollar, a rising debt, and a nation out of work.  Rhetorical flourishes cannot change them.  I just hope our political leaders are prepared to face them.

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Much has been written comparing the present health care reform effort to prior struggles for the same thing.  But this week’s passage of the Senate’s version of Obamacare brought to mind another recent political circumstance that, for me, says more about the political risks in play than does the failure of Hillarycare in 1993.

I speak of the impeachment of President Clinton, 1998. Of course, the process and the subject matter have nothing to do with health care.  But the politics do.  You may remember that the House vote to impeach President Clinton was the last thing Congress did before adjourning for Christmas in 1998.  I recall this distinctly, because I was driving south to Georgia from Washington with two of my friends and fellow Congressional staffers, listening to the debate and then the vote in favor of impeachment on a scratchy car radio.

It was a moment full of mixed emotions.  We wanted to be happy, because we all felt strongly that Clinton’s presidency should end after a year of lying and political manipulation.  We also knew that the public wasn’t so sure.  Polls had shown for months that Americans were largely against impeachment, but Republicans had resolutely pushed forward, certain that their solid factual and legal case against the President would carry the day in the end.  In fact, there was almost a morose, melancholy, martyred feeling to it all — while Republicans felt they were doing what they had to do, and that it was in everyone’s best interest, those who should be the most appreciative were instead rejecting them.  Even members of their own party were beginning to question the wisdom of impeachment.  In the midst of the Christmas season, the  impeachment managers’ doomed quest took on a bit of a religious tinge.

Compare this to today’s mood in Washington and the country at large.  In Washington, Democrats are throwing themselves victory parties, trying to gin up public support for a plan that average Americans have considered a boondoggle since September.  Democrats have long since given up saying that the public wants what they are selling (setting aside Harry Reid, of course, whose brain is so fried he voted against his own bill).  Instead, they insist on extolling the historic moment, promising that great things will come of this, even if Americans don’t agree with them today.  It also became obvious that Reid was desirous of a Christmas Eve vote, to give his caucus the chance to talk of the Senate’s present to the nation.

The impending political consequences of the two big votes are also similar.  While neither the impeachment vote in the House nor the Senate’s passage of Reid’s bill could independently yield practical results, they both presaged the focus of debate in Washington in the coming year.  In 1998, new political organs, like Moveon.org, were emerging to fill the void left by months of Democrats’ stunned silence in the wake of the Lewinsky allegations.  Those groups, which would become the dominant liberal political force in the country for the next decade, were already promising electoral armageddon against the House impeachment managers.  Even rank and file Democrats had begun to find their voice after months of feeling chastened by their unchaste President’s peccadilloes.  No one believed that impeachment, regardless of how it came out in the end, would benefit Republicans at the polls in 2000.  The only question was whether the Senate would compound the Republicans’ political error.

Health care, by comparison, has mobilized conservatives in ways considered unthinkable in early 2009.  New groups, such as the Tea Party movement, took up the slack in the beginning when Republicans were overcoming their post-Bush hangover.  Now, those groups appear ready to fund and support serious candidates and causes in the coming year.  At the same time, Republicans have retaken the mantle of fiscal sanity, and independent voters have rallied to them.  No one believes that health care reform, whether successful or no, will be a boon to Democrats next November.  The question remaining is whether Obama and Congress will push too many too far out on the plank so as to lose the majority entirely.

As a final comparison, I’d remind us all of what was being ignored in both cases.  At the same time impeachment was dominating the Washington scene, Osama bin Laden was plotting to take down the World  Trade Center.  The last seeds were being sown for the tech bubble to burst in 1999 and 2000.  And the poisonous atmosphere that developed in the wake of impeachment gave license to both sides to unleash a wave of ethics investigations, smear campaigns, and over-the-top theatrics that continue to dominate our politics.

Here we are, 11 years later, and after a year of campaigning on an end to such tactics, Democrats are using every trick in the book to pass what amounts to a regulatory takedown of one-sixth of the American economy on a party-line vote.  Rather than seeking to bring the country together, Democrats are content to go it alone, castigating those in their own party who refuse to go along.  All the while, unemployment hovers around 10%, real estate appears headed for a second collapse, the dollar is falling precipitously, and no one appears to know how to solve our budget crisis.  The selfsame Osama Bin Laden continues to plot his next attack.

I do not present this comparison as a way to suggest that impeachment was right, or even that health care is wrong.  Instead, it is a worthwhile reminder that sometimes doing what one party believes is right doesn’t mean it’s right for the moment, for the nation, or even for the party itself.

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