Improving Accountability in Congress

Published October 1, 2001

I must admit I had my doubts about George W. Bush leading the country as our new President. His opposition to the Kyoto Protocol and to the ergonomics rules began to give me some confidence in his leadership abilities.

But nothing comes close to his strong, disciplined leadership in the wake of the terrorist attack on our nation. He demonstrated his courage by putting the whole ugly issue before every American. He has told us this new war won’t be easy, won’t be quick, won’t be cheap, and will, of necessity, sometimes be fought in secrecy. He has proven himself a leader up to the formidable task of marshaling all our human and material resources in defense of a free society.

There will be numerous tests for him and us in the long battle ahead. Today my doubts are gone. George W. deserves our confidence and complete support.

I hope we will learn some hard lessons here, not the least of which is that we can all get along much better if we understand just how fragile our liberties are. It would be prudent to protect them from enemies both foreign and domestic. We must remain steadfast in the belief our freedom is not free if we are subjected to all manner of troubling legislation set forth as “needed” in order to keep us a free and secure nation. We will not sustain freedom by taking it away in little pieces.

You might ask, what is the role of Health Care News in these times? None, some would say. My reaction is to follow the President’s request to get back to work and show our resolve. As I see it, our work is the business of reporting health care news and analysis, and our resolve is in continuing the effort to preserve the values of independence and free markets in health care. Anything less and the terrorists win!

Medicaid Flexibility

Well before September 11–it seems like forever now–President Bush announced he would allow states greater flexibility in setting guidelines for Medicaid coverage. He said doing so would streamline an overly complex system, make it more responsive to local citizens, and save millions of dollars that could be used to expand coverage for uninsured lower-income Americans.

Bush’s high regard for states’ rights did not go down smoothly with those who seek to centralize control over social policy in the District of Columbia.

A hurricane of gloom-and-doom predictions erupted from Democrat representatives and senators home during the August break. Judging by their rhetoric, you might think Bush is the grinch who stole the entitlement Christmas tree.

The situation illustrates how our political system allows the worst type of demagoguery to flourish. As the Wall Street Journal recently editorialized, “In a democracy, the antidote to demagoguery is accountability. Unfortunately, that accountability has been undermined as contentious public issues have been moved from the legislative process–and the public debate that occasions–to back-room regulation. In doing so, Congress is let off the hook.”

Democratic Congressmen, in other words, are free to denounce Bush initiatives in the most colorful of terms, but never have to vote against them or for a better alternative. Stated this way, a solution to the problem becomes apparent: Congress should be asked to vote for or against every regulation whose economic impact exceeds $100 million, and the vote should be made public.

Congressional Review Act

The good news is such a rule already exists. President Ronald Reagan issued an executive order requiring the Office of Management and Budget (OMB) to study the impact of all regulations before they could be approved. In addition to this, the 1996 Congressional Review Act (CRA) gave Congress a 60-day window during which to review any regulation.

President Bill Clinton modified the order by shifting the balance of power from the OMB back to the agencies and limiting reviews to those rules and regulations with an impact of $100 million or more. According to a recent Competitive Enterprise Institute report, “10,000 Commandments: A Policymaker’s Annual Snapshot of the Federal Regulatory State,” there are 158 $100 million-plus regulations. Since its passage, the CRA has been invoked only once: over Clinton’s ergonomic rules. Congress voted to revoke those rules months ago.

The flaw in these otherwise-sensible approaches to accountability–OMB review and CRA– is that the decision to use the rules is left up to Congress. Unless the President campaigns for Congress to act, this “fox and the hen house” arrangement gives Congress little incentive to do anything.

Case in Point

If the Health Insurance Portability and Accountability Act (HIPAA) had been put to the test of CRA, it seems to me the reasonable men and women of the U.S. Congress may well have concluded the bill’s benefits were not worth its billion dollar price tag.

HIPAA contains so many regulations–guaranteed issue, guaranteed renewal, and medical privacy mandates–that it drives the cost of health insurance premiums well beyond the $100 million dollar threshold, by at least ten-fold. And that doesn’t count the cost of consumers suing their HMOs, or the cost of implementing a “unique identifier” system for every man, woman, and child.

President Bush would do the American people a tremendous service by asking for a joint congressional resolution on every bill, thereby putting all members on record voting for or against real bills. The ratio of accountability to demagoguery would receive a much-needed boost.

This may not stop all manner of bad social policy, but it will provide for a more enlightened citizenry before legislation is passed. We’ll be better voters, too, with more information before us when we exercise our right to vote the rascals out of office.