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    The Trouble with Sasse

    01/29/2014

    He supports the basic principles of Obamacare

    Ben Sasse has been running an aggressive and imaginative campaign for United States Senate in Nebraska.

    Although I personally favor a different candidate in that race, I will be the first to acknowledge that Sasse, a former senior official in the Bush Administration, is a very impressive man who comports himself as a gentleman.

    When it comes to policy, he’s without question the most knowledgeable candidate in the race on the intricate details of health care law and regulation at the federal level -- a true plus in the Age of Obamacare. That knowledge – plus his out-of-this-world fund-raising prowess – has won him the favor of many national conservatives.

    So far, so good. But there’s a problem. Mr. Sasse, a wealthy former business management consultant with a long list of health industry clients, is positioning himself as a staunchly “anti-Obamacare” candidate; but that doesn’t square with his past record, a careful review of which reveals four things:

    1. He supports the basic principles of Obamacare, if not all the details.
    2. While Obamacare was being drafted, he offered its authors advice on how to improve it.
    3. After Obamacare became law, he prospered by advising health care companies how to implement it.
    4. He wants to replace it with what may fairly be described as “ObamaCare Lite.”

    What makes me think this? His record.

    What are the basic principles of Obamacare? 1) A societal goal of universal health insurance coverage; 2) a government mandate (or other form of coercion) on all individuals to obtain health insurance coverage; and 3) generous taxpayer-funded “premium support” subsidies to hide the true costs of the goal from the insured.

    Sasse supports all three of these things.

    1) Sasses favors a societal goal of “universal health insurance coverage.” He has said:

    I think we should have a universal, a shared cultural or societal goal, of universal health insurance coverage.”  

    But we cannot achieve that goal without government taxes, mandates, and coercion. Which brings us to . . .

    2) Sasse supports an Individual Mandate. While he appears to have been careful never to publicly say he supports Obamacare’s individual mandate — which is understandable, it being so overwhelmingly unpopular — reading between the lines it’s clear he does. The first piece of evidence is that Sasse has spoken of ObamaCare’s individual mandate as a “good idea,” in a context where no opponent of the idea would do so.  In 2009, while ObamaCare was still being drafted by Nancy Pelosi’s and Harry Reid’s Democratic Congress, Sasse wrote:

    Take the idea of the ‘individual mandate,’ which would require all citizens to have health insurance. There’s an emerging consensus that this might be a good idea. But in the various bills (and the incomplete piles of paper parading as bills), it’s unclear how the mandate would be enforced or what fines would be appropriate.

    In context (the quote comes from a piece titled, “Health-Care Reform: The Rush to Pass a Bad Bill”), the remarkably gentle tone of this criticism implies that the author doesn’t personally regard the mandate as wrong in principle, he just thinks the public deserves to have more information about it before Congress votes on it. That’s true enough, I suppose. But why not also mention the moral and constitutional principles at stake?

    You cannot achieve the goal of “universal health insurance coverage” without a mandate. The alternative is to hike spending and taxes to near-World War II levels, which presumably Sasse, as a self-described conservative, would oppose.

    Incidentally, the individual mandate penalty in Obamacare will have to be made much harsher than under current law, if we ever want to achieve “universal coverage.” Experts agree Obamacare as it now exists will leave about 30 million Americans uninsured in perpetuity. To achieve truly “universal” coverage, the mandate will have to be made much more severe. Would Sasse support that?

    3) Sasse supports “premium support.” The purpose of “premium support” is to facilitate the goal of “universal health insurance coverage” by creating a mechanism wherein everyone can obtain government-regulated insurance but its true costs can be hidden from the insured. Sasse has made clear that he thinks premium support – a government-dominated pseudo-market system -- is the only alternative to single-payer, which is totally government-dominated. He doesn’t seem to acknowledge the possibility of free people in free markets providing the health care everyone needs at a price most can afford (with private charitable assistance buying the remainder into the market). He has said:

    I think we're ultimately going to end up with a single-payer system, or a more market-oriented premium support model that actually delivers higher-quality, lower-cost care.

    One of the most prominent examples of “premium support” is Medicare Part D.  Part D is a prescription drug benefit program enacted in 2003 for Medicare beneficiaries that creates a government-run pseudo-market. Nearly all Medicare beneficiaries have opted into it. But that’s not because it’s so wonderful, it’s because it includes its own version of an individual mandate: a severe penalty for “late enrollment,” combined with a lack of alternatives. If you don’t sign up, you go without.

    Conservatives rightly opposed Part D at the time of its enactment, and have no reason to regret that opposition. Part D was an unaffordable government boondoggle that has added trillions to the nation’s astronomically high unfunded liabilities. 

    Sasse now claims to have opposed Part D, but the record shows he  was for Part D before he was against it. In 2009, he viewed it as an ideal model for the Democrats to use in overhauling the nation’s health care system. He actually extolled Part D as “a policymaker’s dream.” In an article titled, “Why Medicare Part D is the Answer to Health Reform,” he called the new entitlement “enormously successful,” adding:

    Medicare Part D is (or should be) a policymaker's dream: a government program that efficiently delivers high-quality services, and does so under budget.

    He went on to lament:

    Unfortunately, throughout this year's healthcare reform debate, Part D's success has been at best ignored and at worst maligned.

    But since hitting the campaign trail, his tune has changed. Last year, he told a reporter:

    I mean, it [Medicare Part D] was painful. I was opposed to it then [2003] and I’m opposed to it now. The mechanism of Part D is less bad than any other government payment methods, but it's still fundamentally an entitlement program that wasn’t paid for, and we can’t afford them. … So I think Medicare Part D was fundamentally flawed because it wasn’t paid for. There could have been ways to have a different conversation about a prescription drug benefit being added into an old Medicare structure of Part A and B, but it should have been done in a way that holds actual cost savings in the system.  

    Is that the “opposition” of a man who thinks it was a fundamentally bad idea to put government in charge of seniors’ prescription drugs?

    Not only did Sasse offer Democrats public advice about how to improve and pay for their government takeover of our health care (in a piece titled, “Why Medicare Part D Is the Answer to Health Reform”), he also offered the Democrats advice on how to help pay for the government takeover.

     In a 2009 Health Affairs article, he and several co-authors wrote:

     Congress and the Obama Administration are seeking agreement on ways to reform the U.S. health care and insurance system and to expand coverage to the uninsured. One unresolved and controversial issue is where to find the $800 billion to $1.6 trillion that could be needed to finance comprehensive reform over ten years. … One approach under consideration is to redirect federal spending on the Medicaid disproportionate-share hospital (DSH) program to help pay for coverage expansion. … This paper considers several options to reform the Medicaid DSH program. … [Our recommended] approach could produce as much as $44 billion in federal savings in the program and also address the wide federal DSH funding variations across states.”  

    Why would the chest-pounding Obamacare hater of 2014 have offered the Democrats advice on how to pay for it in 2009?

    Will the real Ben Sasse please stand up?

    Conclusion

    The test of any candidate’s health reform principles is not just what he opposes  — every Republican candidate claims to want to rip Obamacare out by the roots — it’s what he'd replace it with. What are his basic reform principles?

    In light of Sasse's lengthy public record, it seems rather clear that what he wants. He wants Obamacare Lite.

    He supports the basic principles of Obamacare – universal coverage, individual mandate, premium support – he just wants it to be less complicated, less top-down, more efficient , and presumably more patient-friendly. That’s all great. But why settle for that?

    Why not get government out from between patients and doctors? Instead of a government-run, pseudo-market "premium support" plan, why not true, market-driven, patient-centered health care?

    My sense is Ben Sasse is not what he claims to be. I think he's a Mitt Romney-style technocrat masquerading as an anti-ObamaCare firebrand for temporary political purposes.

    Having devoted a good part of my adult life to fighting not just the actual realities but the underlying principles of Obamacare, I find that appalling.

    I think honesty demands that Mr. Sasse either acknowledge his real views publicly — or repent of them.

    Will the real Ben Sasse please stand up?

    Dean Clancy is FreedomWorks Vice President for Public Policy. He has spent two decades working for health care freedom.

    4 comments
    Starwarsfreedom's picture
    Drew Sullivan
    02/27/2014

    Here are the facts. Sasse was taking issue what Congress was doing in 2009 and laying out the political realities. He stated:
    “As Washington continues its shouting over health reform legislation, too often it seems as if our only choice is between the status quo and the creation of an expensive new entitlement with politicians defining all the details of our health insurance.”

    Sasse goes on to explain how the market mechanisms in Medicare D were driving costs down but Congress was ignoring these facts and passing legislation to drive costs up. He stated:

    “Instead of striving to find similar ways to stimulate aggressive competition to create value for consumers and taxpayers, the bill passed by the House of Representatives seeks to reduce choices and increase government controls by mandating specific coverage levels through Part D's so-called "donut hole." In spite of CBO's estimate that this move would drive Part D premiums up 20 percent—and even though 9 out of 10 seniors are happy with their current plans—Congress is advocating more central planning.”

    Sasse concludes:

    “…when you identify a specific problem, build a competitive market that motivates the private sector to solve it, and provide incentives for consumers to make rational cost decisions, everyone wins. These are the solutions that could—and should—be applied in the health reform package currently being considered in the Senate. We don't need more central planning. We don't need more government price-setting and mandated coverage levels. There is very good reason to believe that patient-empowering solutions work better.”

    So how could anyone miss that conclusion in the US News & World Report article? Perhaps it is because you have to click the link to the second page of the article but that would be a very generous assumption.

    Starwarsfreedom's picture
    Drew Sullivan
    02/24/2014

    Dean was appointed by Bush and served six years as the Executive Director of Council on Bioethics and worked for six years as a health care advisor to the House Majority Leader Dennis Hastert from 2001 to 2007. Medicare D was passed in 2003 during the Hastert Congress during the Bush Administration. Dean's attack ignores Sasse's strategy to a free market system. Furthermore, even if Dean was right, which he is not, it does not justify FreedomWorks endorsement of Shane.

    brianlink's picture
    Brian Link
    02/14/2014

    test

    Starwarsfreedom's picture
    Drew Sullivan
    02/21/2014

    You jump to conclusions which simply are not there.

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