Y’all know I tend to be a fan of Lindsey Graham, but sometimes I just can’t go along.
The healthcare plan he’s touting is one of those times.
Yeah, I appreciate that he’s been dismissive of what other Republicans have been putting up in their desperation to be able to say they “repealed Obamacare.” And I like that he says “federalism” a lot in advocating for it. And that it’s really, really different from anything the GOP leadership in Washington has come up with yet.
But that’s about it.
Basically, he wants to turn it all over to the states: Have the feds give the states block grants, and let the states decide for themselves what kind of system they want. His plan for getting it through an Obamacare-repeal-weary Senate is to enlist governors to help him push it — he says our own Henry McMaster likes it.
There are a couple things about it that bug me. First, the whole idea of having 50 little systems instead of one big one. To my mind, that throws away one of the greatest advantages of having a governmental system — a gigantic national system that includes everybody (which you’d have if you had real mandates with teeth) gives you economies of scale, and the mother of all bargaining positions when it comes to negotiating costs down.
I asked the senator about that at a press availability he had at his Columbia office today. He replied that costs have risen dramatically in the Medicare and Medicaid systems, so my principle doesn’t work.
This was a general availability for working press, so I didn’t do what I would have done in an editorial board meeting: argue with him. I didn’t say, How do you know costs wouldn’t have risen much higher with 50 separate systems? Nor did I say, if there’s any reform that might lower costs or slow increases, wouldn’t it be easier to implement nationally than in 50 different systems?
And I didn’t get into the essential unfairness of forcing Americans to leave their homes and move to another state if their state doesn’t provide the health benefits they need.
Which seems a scenario South Carolinians would likely face. I ask you, what sort of system do you think we’re likely to get in a state that said “no” to Medicaid expansion — to a deal under which the feds would have covered the whole additional cost for the first three years, and 90 percent of it thereafter? How savvy was that? Do you want the same elected leaders who turned that down designing a system?
I may have voted for John Kasich last year (partly because the decision he made to expand Medicaid), and would do so again given the same primary choice, but I wouldn’t want to have to move to Ohio to get decent coverage. Would you?
Some other topics Graham covered at the presser:
- Charlottesville. He said Trump missed a big opportunity Saturday to “jump on hate with both feet.” He said the white supremacists think they have an ally in the president, and “Donald Trump’s job is to persuade them that he is not their friend.” He gives Trump credit for saying good things Monday, but that must be followed by action. The administration needs to “come down like a hammer” on hate groups. He wants to see Sessions prosecuting what happened aggressively. “Don’t let these people drag us back into the darkness.”
- The abandonment of SCANA and Santee Cooper’s nuclear project. Setting aside the fact that what he said may now be out of date, I liked what he said. He said if these two plants and the one in Georgia all fail, “that’s the end of the nuclear renaissance.” And that’s bad news for anyone who cares about global warming or energy independence. He points to France as a country that wisely gets most of its power from nuclear, and notes with satisfaction that at 50 percent, South Carolina already gets a higher proportion of its power from that source than any other state. He doesn’t want to see us, or the nation as a whole, lose that advantage, and asks, “What has happened to our industrial base that we can’t do big things anymore?”
- “I don’t think war is imminent with North Korea.” But he does worry about the future if Kim is not stopped. He worries less, though, about a direct attack on the United States — he thinks Kim’s generals can restrain him — and more about a future when Kim has the H bomb, and is in a position to sell it to others who may use it. And he puts the onus on North Korea’s big neighbor, saying “China is 100 percent responsible for North Korea.” Without Chinese support, he said, there is no Kim regime.
In fairness to the senator, so you can read his idea in his words, here’s a PDF of the two-page handout they gave me at the presser.
You’ll note that he touts his idea as superior to “having a one-size-fits-all solution from Washington.”
Politicians love that phrase, used to damn all sorts of ideas: “one-size-fits-all.” It can be relied upon to make voters go, “Ooh, I don’t like the sound of THAT!”
But here’s the thing: Personally, I’d LIKE to know that the medical coverage available to me is just as good as what they have in California.
“…How do you know costs wouldn’t have risen much higher with 50 separate systems? Nor did I say, if there’s any reform that might lower costs or slow increases, wouldn’t it be easier to implement nationally than in 50 different systems?” – Brad W.
Think about it, Brad, what is more likely to provide a reform that slows cost increases: the experiments of 50 separate state with more accountable political leadership or the dictates of a central bureaucracy rarely guided by either Democrat or Republican congressional oversight?
In a transparent attempt for job security, both congressional parties have gradually ceded their historical oversight responsibilities to faceless bureaucracies given larger budgets and declining accountability.
Consequently the ‘single payer’ universal healthcare system you and Bud dream about will quickly evolve into a huge, byzantine, VA-like system as opposed to a top-ranked, world-class service currently provided by tiny Denmark or Luxemburg.
“Think about it, Brad, what is more likely to provide a reform that slows cost increases: the experiments of 50 separate state with more accountable political leadership or the dictates of a central bureaucracy rarely guided by either Democrat or Republican congressional oversight?”
I think that sort of a priori speculation shows the pervasive lack of attention to real data and experience the doctrinaire Republican party has adopted to support its priorities.
The ACA HAS bent the medical inflation curve downward. I was in the private insurance market for 40+ years before the ACA. I had twice yearly premium increases at double-digit amounts for the three years prior to the ACA, and over 10% increases per year from the mid 1980’s before that. Look at the data from the CBO and Kaiser health Foundation.
If you want to consider governors and state legislatures accountable for outcomes, you must live outside SC. Blue Cross throws enough money around to practically own the statehouse. Monied interests have kept working poor people from access to adequate health care for decades. The legislature characteristically left federal Medicaid money on the table every year by not providing enough match going back until before the Republicans took control. Many states are hotbeds of favoritism and corruption.
I neglected to use this quote from the senator about the shutdown of the nuclear project. I liked it:
“To close the thing down costs four billion dollars, and what are we buying? A hole in the ground.”
By the way, The State’s Bristow Marchant took a different tack in reporting on Graham’s event: “Sen. Graham advises SC Gov. McMaster to sell state-owned Santee Cooper ‘if he needs to’.”
I didn’t have that in my notes, and didn’t include it. I don’t even remember hearing it, although I may have and didn’t attach importance to it, seeing as how the issue was outside the purview of a senator. Also, “if he needs to,” sounds pretty noncommittal to me. As Graham said, he was more interested in the national implications of the shutdown, and so was I. I share The State‘s version in case you disagree.
Next time we’re at the same event, I need to introduce myself to Mr. Marchant and ask him about his family. We’re almost certainly kin. My first cousin twice removed Kathleen Morrah (1890-1971) married a Marchant…
I guess his comments about Trump and Charlottesville happened before Trump went off script this afternoon and totally negated everything he begrudgingly said yesterday.
I just dont know how anybody who ever supported him can rationalize this anymore unless they just are morally bankrupt too. I really dont think alot of the people that begrudgingly voted for him are as morally challenged as he is. Now would be the time to say so.
Yep, Trump’s eruption came later…
Scout, with regard to what Trump said Tuesday, Graham put out this release this morning:
Grahamcare. A few thoughts. Our last three governors. Closing rural hospitals in states that didn’t expand Medicare. States experimenting with people’s lives. The highest, by far campaign contributor in SC – Blue Cross. Migration across state lines of poorer people seeking better coverage. ALEC. Governors and legislators that won’t raise money to fix roads having more “no strings attached” money. Sending New York money to South Carolina with few guidelines or requirements. Big business in small states. No adequate management in place. One issue voters electing phony politicians to manage and set guidelines for big systems they don’t even believe in (eg Medicaid). Whipsawing the whole medical system every few years by the latest electees. Leave it alone, Lindsey. You have nothing but ideology in your tool bag here.
Oops. I meant Medicaid in line 2.
Lindsey is borrowing a page out of Mitt Romney’s 2012 playbook. Romneycare served as the model for Obamacare but as the GOP nominee for POTUS he couldn’t support it. So he thrashed around to try and find a (faux) reason to oppose it. So he came up with this “one size doesn’t fit all” meme. Didn’t work for Romney and Lindsey is unlikely to get much support either. Anything that relies on a “states” approach leaves me cold. State borders are nothing but artificial dividing lines and shouldn’t be construed as barriers when we discuss national issues. I’m about ready to get rid of state borders for all issues. That’s what gave us Trump.