Commentary by Dave Durenberger – February 14, 2013


This comes during an historic week in which, among other events, Pope Benedict XVI became the first head of the Catholic Church to resign his office since 1415.  And for reasons everyone seems to have applauded.  To Catholics and others who are Christians there is an often quoted description of love in Paul’s first letter to the Corinthians chapter 12:31-13:13 which was part of the February 3rd liturgy this year. No one has expressed it to me in contemporary terms as well as the pastor of St. Raphael’s Mission Church (founded by Fr. Junipero Serra in 1817) who began his homily with a survey of what 4th and 5th graders most want to hear from their mothers, starting with “I love you” followed by “yes” and “Time to eat”.  It’s what Fr. John Balleza has to say after that I “heartily” recommend to your reading. (Click here for the homily)


It is the one annual event that brings our government leaders together in the same chamber in Washington D.C.  Who would expect that this speech is anything but political and that, as national politics becomes more polarized, the speech would be non-partisan?   So the President positions himself to the left or right of the current policy agenda.  The opposite party, by its body language, its official broadcast response, and its congressional members’ efforts at memorable one-liners, does the opposite.   There are also the theme props for the speech.  Warren Buffet’s secretary for the tax reform theme and the victims of gun violence this year.

Who is the audience for the speech?  They are Americans who are interested enough to tune in, among them, those associations of Americans with a special interest in legislative or regulatory policy.   Whose lobbyists eagerly await a “mention” of their issue in the speech, as an indication that they are worth what they are being paid. The speech is also a source of the words and phrases which can be turned into sound bite materials. To be used for the “reactions” that play to members’ supporters in forums large and small.


In his first State of the Union address in his second term, President Obama suggested to members of Congress and their constituents that a lot of progress had been made in four years in improving the state of the nation.  And much, much more (an hour’s worth) remained to be done.  Then, with the constituents in mind, the President asked:   “What’s it take to do it?  And suggested the answer should be as obvious to them as it was to him and, by implication, to their constituents.  “It requires us.  Working together.” 

Senator Marco Rubio (R-FL) was chosen by Republicans to respond to the President because he is their fly trap for Latino voters and he did what they expected of him.  Laying out a philosophy of economic liberty to guide government’s  response to the many challenges  Americans face, he asked average Americans to believe they had to make a choice between two starkly different views of the role of government.  By implication, there is no room to accommodate the differing views of Democrats like the President and of Republicans in Congress.  

You and I are left to ask ourselves what the President and his party in Washington, and the Republicans in Congress have in common -other than the “God Bless America” ending to their speeches.  Where is the common ground and those willing to stand on it necessary to balance the federal budget, reduce the federal deficit, and incentivize economic growth?


President Obama was at his most eloquent Tuesday evening in describing the unique role of representative government and the responsibility of the elected which our founding fathers intended.  Republicans reacted to the President’s assessment as more government. To which, of course, the typical Republican has been elected to say, “Government is the problem, not the answer.”  And quoting President Clinton’s second term State of the Union speeches to that effect.

But suppose we think of “government” as our elected representatives, in both legislative and executive branches of government, at the national, state and local government level.  Not as government that taxes, government that spends, government that regulates; nor as government entitlement programs.  Define government as our founders defined it.  Governments in this country are the men and women whom we elect to assess our commonly experienced needs, and what it is that “we” can do about them.  We are a self-governed nation.  We should assess the quality of the people we elect by the quality of the results they, along with others, produce.

It may have been too subtle for many, but the President aptly expressed this view of the role of government as the way in which “we look out for our fellow Americans the way they look out for each other.” What role should those in Washington play, and what role should be played by others?  State and local leaders.  Leaders in business, the professions, government and in the voluntary sector.


Obama spoke to health reform and changes that can be agreed upon in our current policy and programs and even in Obamacare.  If leaders of both parties were willing.  In elementary, secondary, and higher education.  In energy, transportation, the environment, housing finance, and national security.  Some of this requires major tax reform, he said, if leaders of both parties are willing. Some of it requires entitlement reform to the extent both parties are honest. Are Republicans willing to do “common cause?”   Who knows?  We have come to know over the last four years what Republicans in Congress and in state government are against.  What are they for?


We elect people like us to serve us.  How well do they represent us?   Obama gave them a couple tests.  One of these is on voting rights.  Why should that be contentious?  Everyone should have the right to vote.  So the President is appointing a commission led by two men from his campaign and Governor Romney’s to define some of the problems surrounding the vote in America.  Not all of them by a long shot.  But at least it’s a start at bringing us together.  Is this possible?  Who knows unless a President who cannot run for re-election commits to try.


The second test of Congressional Republican willingness to do common cause is national legislation to   lessen   gun violence in America and to change the uniquely American gun culture.  Coming at the end of his hour-long speech on the State of the Union, nothing could match the emotional appeal of the right we all have to ask every single elected representative to vote on the various proposals to deal with protecting Americans as well as protecting their Second Amendment rights. 

No single issue group in America has the power of the gun lobby called the National Rifle Association.  No single issue should determine anyone’s right to a seat in the United States Senate or its House of Representatives.  This is the time to determine who each of these 535 people represent.   I hear that’s a tough vote for old time Democratic politicos like Harry Reid and Pat Leahy.  Well, make them take that vote, along with everyone else, on every single legislative proposal.  We the people are more important to the future of America than is their re-election.

If this “they deserve a vote” campaign is successful, maybe we can put pressure on both Democratic and Republican leaders of the U.S. Senate to change the filibuster rules and  the rights of any Senator to put a “hold” on the consideration of any legislation or any Presidential nomination that have cleared the Senate committee of jurisdiction.  Wouldn’t that be something?


In Carpe Diem Nation, David Brooks 2-12-13 speaks to how Americans in what he calls “a nation of futurity” have changed over the last several generations. “Today Americans have inverted this way of (future) thinking.  Instead of sacrificing the present for the sake of the future, Americans now sacrifice the future for the sake of the present.”   Since helping Congressman Jim Jones (D-OK) start Americans for Generational Equity in 1984, this is exactly how I think about the so-called “entitlement programs.”

Not simply the social insurance income transfers from payroll taxes to Social Security, Disability, and Medicare payments, but the $500 billion a year in tax free spending on health care and the similar tax spending programs that prefer home ownership over rental housing, and non-means tested access to free education, food stamps, agriculture subsidies, closure-free useless military bases and a long list of other programs Americans can’t seem to do without.


Do you care about entitlement reform?  Enough to plot your own strategy for going way beyond the two trillion or even the four trillion dollars President Obama talked about Tuesday?  Then go to a bookstore and pick up: Bruce Bartlett’s The Benefit and the Burden and learn how to reform taxes; and WSJ columnist David Wessel’s Red Ink, on the politics of the federal budget.  Where the trillions come from, where they go, and why inaction imperils your/our future.  Clear, concise, researched and very simply written by two of the experts on the subjects.


So far this year that happens to be in the Senate, which is not legislating as much as it is engaged by the Republicans in filibusters over the qualifications of most all the President’s nominations.  Since Republican leader Mitch McConnell declared war on President Obama in early August of 2009, it is the principal means chosen to discredit the presidency, to dilute its leadership potential, destroy its policy effectiveness, and blame the result on Mr. Obama. 

Senate majority leader Harry Reid is catching deserved heat for not changing the Senate rules regarding the “rights” of the minority and the “rights” of any Senator to bring any Senate action to a halt.  There is no longer any comity between the party leaders on anything.  Comity at the party leader level has always been the prerequisite for productivity in the “greatest deliberative body in the world.”   So the public approval of Congress is at an all-time low, as it has been since November 2011, but no one seems to give a darn!   Most members seen to have concluded that the only public opinion that counts is their elections.


With Sen. Jay Rockefeller (D-WV) I authored the 1989 prospective payment reform of Part B of Medicare as a follow-on to the DRG hospital payment reform the Congress authored in 1983.  The primary goal was to restrain the rapid growth in Part B which resulted from (1) the changes in Part A which reduced utilization of hospitals, but increased Part B doctor visits services; and (2) the escalation in physician sub-specialization which meant more patient visits to more highly paid doctors incented to see more/do more.

On recommendation from the Bush 41 White House and its HCFA (now CMS) director Gail Wilensky, we added volume performance standards to reduce payments to all docs if the national service volume exceeded the rise in average medical inflation.  A much tougher volume test – the SGR – was substituted in BBA 1997 and Congress for the last decade has been forced to offset the impact by supplemental payments.


CBO recently revised its cost estimate for a reformed SGR from $300 billion to $138 billion over ten years.  A new reform bill was introduced Feb. 6th.  A National Commission on Physician Payment Reform convened by the Society of General Internal Medicine and co-chaired by Dr. Bill Frist (former Senate Republican leader) and Dr. Steve Schroeder is also reporting recommendations to address the “doc fix” and bundled payments in Washington on March 4th

Other reformers seek a more permanent fix in making Medicare Advantage a more attractive and effective approach to paying for performance rather than for discreet services as traditional, Medicare has done.  This brings us to the not so radical suggestions Republicans like Cong. Paul Ryan (R-WI) have made that health insurance for the elderly and disabled be financed by a combined social insurance and income tax subsidy of private insurance premiums. 

This would require two important bipartisan political decisions:  (1) Bring the essential benefit and cost-sharing structure of Medicare into the 21st century; and (2) Agree on the formula for the premium support which favors performance enhancement by providers and discourages inappropriate and unnecessary service utilization.

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