McCan’t and McShouldn’t

At a Kansas City forum, John McCain and Mitch McConnell show why bipartisanship on health care is impossible.

John McCain

“Nothing makes me more angry,” said Sen. Mitch McConnell at a health care town hall in Kansas City today, “… than the suggestion that America does not already have the finest health care in the world.” Sen. John McCain, appearing alongside him, agreed: “The quality of health care in America is the best in the world.” Contrast that with what health care journalist T.R. Reid writes in his new book comparing various global health care systems: “Today, any U.S. politician who dared to make that claim … would be hooted out of the room.” Reid clearly has yet to visit Kansas City.

At the hourlong forum this morning, McConnell and McCain laid out the GOP’s closing arguments against health care reform and showed why the chances of health care bipartisanship are fast approaching zilch.

The first problem is that Republicans and Democrats can’t even agree there’s a problem. McCain and McConnell say we’re No. 1 in health care, while Democrats agree with the World Health Organization that we’re more like No. 37. Democrats say there are 47 million uninsured Americans. McCain and McConnell, meanwhile, are skeptical. “I don’t question that number in summary,” McCain said, “but I think when you break it down it gets more interesting.” For example, he said, 5 million are college students, 9 million are people making $75,000 a year or more, 10 million are noncitizens, 11 million are eligible for Medicaid or S-CHIP but haven’t enrolled. “So really, we’re talking about 12 to 15 million who are uninsured today.”

McCain and McConnell also questioned the Democrats’ plans for an ambitious government overhaul of health care, emphasizing “incremental reform” instead. “Let’s tackle this with precision,” said McConnell, “rather than massive overreach.” What would those precise, targeted policies be? McCain talked about wellness and fitness, outcome-based treatment (i.e., doing what works), and eliminating waste, fraud, and abuse—all components of the Democrats’ health care plan. McCain also mentioned tort reform, which he estimated would save $100 billion a year. But he and McConnell drew the line at creating a “massive, audacious” government-run system.

Who’s right? Again, depends whom you ask—or, rather, when you ask. As McCain pointed out during the town hall, the Congressional Budget Office said in July that the House version of the health care bill would add to the deficit during the next 10 years—not reduce it. Another CBO estimate, also in July, said that a public option alone would net $150 billion over 10 years. The CBO has yet to score the cooperative model being hammered out by the Senate finance committee.

Even if Republicans and Democrats did agree on the solution, they don’t agree on how to pay for it. McCain and McConnell repeatedly stated that the Obama plan would be paid for on the back of small businesses. By this, they mean that raising taxes on the top bracket, as Democrats have proposed, would hurt small-business owners who pay business taxes as personal income tax. But the House legislation carves out an exemption for small businesses, and Obama has argued that reform would help small businesses by offering plans with lower rates.

McCain reminded the audience of his campaign proposal to pay for reform by capping the employer tax exclusion—that is, requiring that health care benefits received through your employer be taxed just like benefits you buy on your own. This, the CBO recently said, would save about $250 billion, which could help pay for reform. Politically, though, taxing employer benefits would never fly. Unions would object, businesses would start dropping coverage, and Obama would indirectly break his promise that “if you like your plan, you can keep it.”

As closing arguments go, “It’s too expensive” is pretty strong for the Republicans. It capitalizes on anxieties about the spending explosion of Obama’s first seven months: McCain rattled off the costs of the stimulus bill, TARP, the budget, the auto bailout. It prevents the party from having to provide concrete alternatives to the Democrats’ plan. (“Do less” is easier than “Do this instead.”) And it returns the GOP to its small-government roots—never a bad thing, post-Bush.

This approach all but precludes bipartisanship. If they can’t agree on the health care problem, how to fix it, or how to fund it, that doesn’t leave much room for common ground. In a Sunday New York Times op-ed, Bill Bradley argued that a bipartisan compromise is “obvious: Combine universal coverage with malpractice tort reform in health care.” He, too, has yet to visit Kansas City.