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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:
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.
But we cannot achieve that goal without government taxes, mandates, and coercion. Which brings us to . . .
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?
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.
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.
I mean, it [Medicare Part D] was painful. I was opposed to it then  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 also
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?
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.