The irreversible consequences of Senate passage of a national health care bill

Should the Senate maintain their 60 votes through this week and pass the current health care bill, we will have seen an historic event presaging the very end of the American experiment in a Constitutional federal republic comparable to the repeal of the 17th Amendment and other events that opened a hole in the Constitution to allow the growth of an all-powerful central government.

Here is what is unprecedented:

1) Both houses of Congress have voted that to annex from states and individuals responsibility for and control of the provision of health care to every American citizen. This is a breathtaking expansion of the Federal government’s claims over the citizens and individuals that will irreversibly alter the balance of power between the Federal government and the states or people, putting a nail into the coffin of limited central government. Having reached a critical mass of power, there will be no limit to future expansions of federal power.

In other words, Congress (in conjunction with the Executive Branch) have now laid claim to health care as its exclusive province.

And as history demonstrates time and time again, once the Federal government accrues and arrogates power unto itself, it does not willingly surrender it back to the people (or states). The flow of power almost always runs towards greater centralization at an accelerating rate.

Essentially we have now essentially rewritten the 10th Amendment to state all rights reside in the Federal government, except for those (ever diminishing) areas that the Federal government expressly deigns to not exercise at this time but leave in the hands of states or individuals – and they reserve the right to take control of those areas at any time.

2) Regarding health insurance, these votes mark a seismic shift in the center of gravity in health care decision-making and allocation of resources – taking them out of the hands of states and individuals and the free market and henceforth making all such decisions political decisions of the Federal government. Having now moved the center of gravity to Washington and decreeing that all decisions relating to health care find their origin as political decisions of the Federal government, there will be no way to shift this control out of the Federal government’s grip.

And that is because all the health institutions (e.g. health care providers, hospitals and other health facilities, insurers and other third-party reimbursement agents, drugs companies and equipment manufacturers and medical supply manufacturers, research and development, corporate and non-corporate) will be reoriented to revolve around the Federal government, as their continued existence and level of viability will rest on the political and administrative decisions of the Federal government and its agencies – which means that all their administrative structures will be transformed to interact with and conform to government direction rather than market forces, scientific advances, or consumer demand.

3) What that means is that there will be no way to go back to a pre-national health care system, because all these transformed institutions will create an inertia for a national health care approach that will make impossible attempts to go back. In other words, as with most of the New Deal or Great Society programs like Medicare, once we have substantial numbers of voters and institutions dependent upon Federal largess and regulation, the relationship becomes mutually parasitic and inseparable.

That is, all the institutions that resisted the Federalization efforts – and that could only be overcome by corruption and co-option and self-delusion – will now line up to protect the new status quo.

Instead, just as we’ve seen with Social Security and Medicare (even among many “conservative” Republicans), the debate no longer is around whether or not these institutions will continue (remember the radioactive response to efforts to privatize part of the Social Security program) – rather, when problems arise, the debate centers around how to reform or improve the system. That is, when the multitude of problems and failings of current legislation become evident, the debate will be to figure out some (probably incremental) fix the system rather than scrap it – especially since these flaws will come up piecemeal and there will be woefully insufficient force to undo a national system. This is even more certain to happen given the clever timeline for implementation of the bill’s provisions.

(And this realization is the most likely reason that the left will work to ensure passage once they realize that time will be on their side to go the rest of the way – they just have to be willing to be patient enough.)

4) The glue to this irreversibility will be the lobbying money that this health care nationalizing will draw to Washington, as the various interest compete to dominate the political process behind health care decisions. (This by the way is what puts the lie to assertions that government-run programs will save money through low administrative costs – instead these expenditures are moved off-books and or shifted to lobbying and regulatory process expenses)

And as this money and whole new lobbying industries spring up to meet this need – and at a scale that will dwarf even existing structures – our legislators will be further insulated from responsiveness to the voters and even more dependent on their donors to cover the costs of winning reelection. Worse, challengers facing a growing mountain of campaigning costs will have to fight fire with fire and depend upon alternative lobbying interests who have been the losers in previous rounds. Not to mention that as the economy deteriorates, ordinary citizens will have increasingly less money to spend on election donations as their income and savings are bled dry by the new taxes and higher costs of the new health care programs, among other sources of exsanguination – and increasingly look for government to rescue them (forgetting that government can only do so by cannibalizing). A classic vicious cycle.

5) In brief, the scale and sheer size of this capture threatens to make this action the threshold to a runaway Federal government that will subvert – and ultimately scrap – Constitutional constraints. I see some interesting analogies to the end of the Roman republic, most notably the corruption of the Senate members and the willingness of factions to sacrifice foundational rules and procedures for short-term advantage that opened the door to despotism.

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So why am I writing this as we see impending Senate passage rather than wait to see if the bill will get through Congress in the end? Here are several key reasons:

1) On the tactical side, the dynamics of Conference is totally different than getting the House and Senate to pass bills. Before passage, there is always the chance of significant amendment and/or the bills not passing for lack of sufficient support.

But once both have passed a bill, this indicates that a majority of both houses have given their stamp of approval to the concept behind the bill. There is a real prospect that the House will pass the Senate bill intact and end the legislative process. But even if the House does not accede to the Senate bill, the momentum and pressure of the Conference process will be to finds a way to find something acceptable. Sharp lines will be blurred and legislators will be pressured to sacrifice their objections to the greater good.

Not to mention that the minority will be under pressure to throw in the towel and try to cut the best deal rather than to stand firm. If that dynamic develops, all it lost.

As the old story goes, once you’ve established that you can be bought, you can no longer convincingly maintain your purity – the discussion shifts strictly to price.

Similarly, once the House and Senate have established that they can be bought to support national health care, the whole debate moves to finding the right price for the act, not whether they are willing to turn a trick.

2) Even if by some miracle, we are able to prevent final passage, nonetheless, we still face the changed landscape that the precedent has been set – that our representatives in Congress consider health care to fall under their purview, and that will affect the course of future legislation and discussion.

That is, even if they don’t get the whole enchilada, future debates will still start from the starting point that health care is ultimately the business of the Federal government. Which means that Congress will increasingly involve itself in directing health care matters going forward, though perhaps in a more incremental fashion as various component aspects of this bill get reshaped and advanced as future legislation.

And this is the genie that you can’t stuff back into the bottle, regardless of what happens to this particular bill.