Megan McArdle doesn’t understand the politics of this health care bill:

“No bill this large has ever before passed on a straight party-line vote, or even anything close to a straight party-line vote.  No bill this unpopular has ever before passed on a straight party-line vote.  We’re in a new political world.  I’m not sure I understand it.”

Perhaps some of the handouts for particular states, detailed by the New York Times today, help to explain the seeming political suicide some congressman are willing to make. Apparently the bill has some vague provisions where “beneficiaries are identified in a cryptic, mysterious way”. I find “cryptic” and “mysterious” to be troubling descriptions in this context.

David Axelrod doesn’t deny the existence of such handouts, arguing that

…the provisions benefiting specific states, like Nebraska, and favored constituencies were a natural part of the legislative process.

“Every senator uses whatever leverage they have to help their states,” Mr. Axelrod said on the CNN program “State of the Union.” “That’s the way it has been. That’s the way it will always be.”

Well as long as it’s a natural part of the legislative process….

Some of the provisions are obviously inefficient. For instance, medicare payments will be increased for states where 50% of the counties are “frontier counties”, meaning they have a population density of less than 6 people per square mile. Is there any reason whatsoever that it would be done this way rather than simply increasing medicare payments to all counties with some given population density? What about the “frontier counties” in other states? Should their hospitals receive less medicare payments than those in Billings, with it’s population density of 2,500 people per square mile? Oh right, doing it this way buys the maximum political support from Montana, North Dakota, South Dakota, Utah, and Wyoming.

Like spoiled children with too many presents on Christmas morning, the amount of handouts in the bill must have been so overwhelming that congressman began to lose track of what gift  is for who. For instance, one particular hundred million dollar gift seems to be generating some confusion:

Another provision would give $100 million to an unnamed “health care facility” affiliated with an academic health center at a public research university in a state where there is only one public medical and dental school.

Senators and their aides said on Sunday that they were not sure who would qualify for this money or who had requested it.

The problem with these handouts is that they are going to generate even less complaints than defense handouts do, because it’s a lot harder to get mad about $100 million for a health care facility than it is for a $100 million space laser or some failed helicopter project. I mean, who is going to complain about money going to medical treatment for workers exposed to asbestos in a vermiculite mine? Similarly, can you picture anyone angrily declaring “the government is building another childrens’ hospital!? My god, this is what my tax dollars are going to? Curing diseases for children!?” And to a certain extent, there’s a good reason why few people would make that complaint; we obviously want to cure sick childrens’ diseases, and we want there to be enough health care facilities.  But there is such a thing is too much of this stuff,  and there is an unlimited supply of lobbying for it, which suggests to me that we will be getting quite a bit more than “enough” health care facilities in the future.

Has anyone coined the phrase health-care-industrial-complex yet?

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