health care

Nate Silver shows that Arlen Specter firmly believes in whatever position will get him elected.  Specter certainly has principles; and if you don't like them, he has others.

During the August recess, Republicans will ramp up the Tea Parties and other protests in an effort to influence conservative Democrats not to vote for the Democratic health care legislation.

If the grassroots really want to influence the swing votes on health care, they should be organizing behind conservative Democratic primary opponents.

Paul Krugman makes some legitimate points about why the market for health care is very inefficient.  Greg Mankiw makes a more compelling argument, summing up the central dispute between Left and Right over health care.

Perhaps a lot of the disagreement over healthcare reform, and maybe other policy issues as well, stems from the fundamental question of what kind of institutions a person trusts. Some people are naturally skeptical of profit-seeking firms; others are naturally skeptical of government. ... I tend to distrust power unchecked by competition. This makes me particularly suspicious of federal policies that take a strong role in directing private decisions. I am much more willing to have state and local governments exercise power in a variety of ways than for the federal government to undertake similar actions. ... Most private organizations have some competitors, and this fact makes me more comfortable interacting with them. If Harvard is a bad employer, I can move to Princeton or Yale, and this knowledge keeps Harvard in line. To be sure, we need a government-run court system to enforce contracts, prevent fraud, and preserve honest competition. But it is fundamentally competition among private organizations that I trust. ... A central question in this and perhaps other debates is, Whom do you trust?

Even now, nearly 50% of health care spending is done by government, and the other 50% is sharply regulated and burdened by government-imposed barriers.  There is little doubt that our health care system is inefficient, full of perverse incentives and in need of reform.  However, the central fear of the Right is that a greater government role will have the same results it has everywhere else: inefficient spending (Defense), corporate welfare (Agriculture), regulatory capture (Commerce), theater (Homeland Security), interest group pandering (Education), Do-Gooderism (Justice), and so forth and so on.

Those problems do not have to be written into the legislation.  There is plenty of precedent to the idea that politicians have perverse incentives, and government does not do benign interference.  Government is a monopolist. 

Even the New York Times has had a stomach full of the hypocrisy Chris Dodd is ladelling our from his sweetheart ties to the drug industry.

Hey, there's nothing to see. Just the media blitz , the $1,500/head fundraiser, or the $80,000 in board fees his wife got from a Canadian based drug maker.

But even as Mr. Dodd attempts to distance himself from these special interests, he is clearly relying on their help as he prepares for his re-election, a reality seized upon by his Republican critics.

He has not only benefited from the hundreds of thousands of dollars in advertisement courtesy of the pharmaceutical industry and Families U.S.A., a health-care advocacy group the industry teamed up with. But a few weeks ago, Mr. Dodd attended a $1,500-a-plate campaign fund-raiser sponsored by lobbyists representing U.S. Oncology, a provider of cancer drugs and services.

You think Chris, we don't think the folks on the receiving end of a trillion dollars in new government spending aren;t gonna protect their sugar daddy--and you aren;t encouraging them?

Still selling that bridge, eh?

In other news, here's the front page of today's Courant on the Countrywide mortgage controversy, which is out of remission and aggressively attacking the Senator's health.

More Heat For Dodd

 

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Despite their denials, Democratic Sens. Kent Conrad and Chris Dodd were told from the start that they were getting VIP mortgage discounts from one of the nation's largest lenders, the official who handled their loans has told Congress in secret testimony.  Read more...

Like I said, there's no drug that cures hypocrisy. No matter how much you grease the pharmas with taxpayer's money.

I am a strong proponent of the idea that candidate recruitment is the ultimate futures market of elections. Collectively, the decisions made by candidates on both sides tell a lot about where politicos on the ground see the political environment headed in the next year to 18 months. It was not surprising that in 2006 and especially in 2008, candidate recruitment on our side sucked wind. Only one Senate race -- Louisiana -- was even remotely considered a Republican pickup opportunity in '08.

For 2010, the story is different. We are by and large getting our top-tier recruits in Senate races, and in more and more House races. And the White House is not getting theirs. The bumper crop of good candidates we had in the 2002 and 2004 cycles appears to have returned. 

Though it's early -- I don't think people thought 1994 could be a really big year until at least February of that year -- I do think we have to prepare for the idea that 2010 could be a big, big year that could put us back within striking distance in both the Senate and the House. Normally, I wouldn't want to raise expectations -- but going back to that candidate recruitment futures thing: if you are remotely thinking of running for office in the next few years, 2010 could be your best shot, and here's why:

• The horrendous 2006 and 2008 cycles have depressed Republican totals in Congress to far below the historical mean. Though the fact that there were two successive 20+ seat losses in the House and 5+ seat losses in the Senate in the House is historically unique,  collectively they equal one 1980 or 1994-style wipeout -- after which Democrats finally began to recover.
• The unique confluence of youth and African American turnout for Obama padded vote totals for Congressional Democrats by about 4 points -- and in a midterm -- I'm sorry -- those votes won't be there. We saw this pretty clearly in the Georgia Senate runoff. In 2012, however, those voters might be back -- making 2010 an opportune moment for a promising Congressional challenger to gain a foothold.
• The Democrats are now clearly responsible for everything, and trying to blame Bush and the GOP wears thinner and thinner by the day. Even if the economy recovers somewhat, and with massive job losses still on the horizon, I don't see people feeling that recovery, let's remember that the economy was in a clear recovery by 1994 but that didn't help Clinton and Democrats.

On a micro-tactical level, Obama may be taking great pains to avoid Clinton's fate on health care, as Ezra Klein details in Sunday's Washington Post, but the broader optics are starting to converge for Obama and Clinton: young, energetic change agents who are being proven ineffective, overexposed, and prone to ADD (Clinton held 38 press conferences his first year, drawing this comparison to Obama's first few days in office).

In many ways, the proving ground for this hypothesis won't be Congress, but the states. There we have 50 distinct political cultures than run in parallel to Washington. And, as Michael Barone notes, the mood there seems to point in the direction of belt-tightening and more humble government, not grandiose new infrastructure or health care schemes.

See what I say say 57 seconds into this video.

(Make sure you click on the video report to the left of the text report.)

Cahnman out.

We now have a pattern on our hands. When the math behind Barack Obama's health care plans doesn't work, Obama attacks math. Now, he doesn't do it directly. He gets Peter Orzsag to debase his intellect for Obama's political ends. First, he did it with the IMF score. Then this week he pressured the CBO scorers early this week after their math provided defeat after defeat to his healthcare dreams. And then this weekend, Orzsag has attacked Doug Elmendorf, the CBO director.

Case 1: The IMF. At a G-20 meeting earlier this year, Barack Obama came away empty-handed. The only success was to send money to the IMF. $100b. This wasn't going to pass on its own, so they attached it to the Supplemental that paid for our troops. And claimed that $100b leaving the treasury costs nothing. According to the Politico, Orzsag had a totally unprecedented meeting with the OMB scorers putting political pressure on them to cook the books. Only a little comment at the time. Oh ... and no one bought Orzsag's nonsense, and the amount became a focus of attention as a bailout of European banks.

Case 2: CBO Whitehouse meeting. Earlier this week, the President meant with the Director of the CBO. According to Jake Tapper, there was a lot of pushback against the unprecedented nature of the meeting:

Said Senate Minority Leader Mitch McConnell, R-Kentucky: "I noticed that the CBO director was sort of called down to the White House yesterday. It strikes me as somewhat akin as the owner of the team asking the umpires to come up to the owner's box."

McConnell said that "if the CBO is to have credibility, they're the umpire. They're not players in this game."

CBO is tasked with providing “objective, nonpartisan, and timely analyses to aid in economic and budgetary decisions on the wide array of programs covered by the federal budget.”

Case 3: Keith Hennessey puts it nicely, "CBO Kills the President's Medicare Comission Proposal". You see, the CBO found that Obama's great plan to limit costs was to create a commission only saved $2b. One half of one percent of the total cost. So what happens? Orzsag goes after Elmendorff in all but name:

A final note is worth underscoring. As a former CBO director, I can attest that CBO is sometimes accused of a bias toward exaggerating costs and underestimating savings. Unfortunately, parts of today’s analysis from CBO could feed that perception. For example, and without specifying precisely how the various modifications would work, CBO somehow concluded that the council could "eventually achieve annual savings equal to several percent of Medicare spending...[which] would amount to tens of billions of dollars per year after 2019." Such savings are welcome (and rare!), but it is also the case that (for good reason) CBO has restricted itself to qualitative, not quantitative, analyses of long-term effects from legislative proposals.  In providing a quantitative estimate of long-term effects without any analytical basis for doing so, CBO seems to have overstepped.

What is going on is crystal clear. The CBO is not caving to extended political pressure. After weeks of Pelosi "scolding" and Baucus aides "expressing frustration" it has come to open attacks on the CBO, its director, and the institution's integrity.

Well. I have to say, finally Barack Obama is bringing change I can believe in. Chicago-style change.

 Dear “Naive Americans,”

I’m ecstatic about universal healthcare, electronic medical records, and government oversight. 

First, universal healthcare. TRICARE, a private and public partnership, of government funded military healthcare is universally substandard. When was your last visit to a military, veterans or state hospital? I’m delighted to know that the known substandard healthcare “system” you’ve required soldiers and the poor to endure, is a long overdue for the rest of you.

Second, electronic medical records will ensure the perpetual revision of your records to conceal medical negligence, delete all records of off label use of drugs not approved by the FDA, and genetic profiles and history will determine whether or not you receive treatment, and you live or die based on the a bureaucrats entry of the words “unsuitable,” “complex history,” and “pre-existing conditions,”  -- there is after all a duty to die for the greater good, ask any veteran.

Third, government oversight, You’ll be surprised to find that in order to get universal healthcare and the twin evil of electronic medical records, you’ll have to waive your right to sue for medical negligence, even intentional, willful, and malicious medical malpractice. Please do join the million plus war veterans backlogged seeking medical treatment and related disability benefits. Did you know that less than 10% of disabled veterans are due to combat? Or that most of the 90% others, are victims of indifferent medical negligence and malpractice? Ask any disabled, destroyed, and destitute veteran that you avoid eye contact with while they languish on your streets, begging for food, work and change. Flying a flag while ignoring your veterans is offensive. 

After all the soldier through blood, sweat, tears and shattered minds, bodies and destroyed futures and families, fought to ensure your equality. It’s high time you were made equal.

Sincerely yours,

“Ecstatic”

Ben David (stole from a Dr. letter to the editor ) 

The Right is floundering in the healthcare “reform” debate. It’s complicated, but it need not be. How do you make the water cooler case? Tell ‘em “before we let them do anything stupid, we could fix healthcare in 5 easy steps”:

1. Let people buy health insurance across state lines. I live in North Carolina. If folks in my state could buy insurance in Idaho, we would cut our premium almost in half. New Yorkers could reduce premiums by about 2/3 buying in other states. Everyone would have access to the lowest rates in the country. Competition would bring costs way down. Why won’t the government let us?

2. Give poor and working class people tax credits (vouchers) to buy insurance. It’s not hard. Help the poor. Keep the competitive market, too. But for goodness sake, don’t make us pay for rich people’s healthcare and bankrupt private insurance all at once. (A high-risk pool can help people with pre-existing conditions, btw.)

3. De-couple health insurance from our jobs. (Change the tax code.) This coupling is an artifact of WWII wage controls. When your company chooses your insurance, it limits competition and choices. It's very costly, but you don't see the cost. And under the current system, you lose your insurance if you lose your job. Wealthier, employed people get subsidized to get insurance. Unemployed or independent contractors get nothing. 

4. Give greater access to health savings accounts for use on the small stuff. They can save money for old age, or purchase out-of-pocket healthcare. They’ll be more careful with their spending. We’ll eliminate much of the “split-the-check” effect where people over-consume and cost-shift. (For example: Prilosec OTC costs $15 at the store. Prescription Nexium costs a $15 copay (but $150 in reality). These drugs are almost identical. Yet people choose Nexium without a second thought. Why shouldn’t they? Still, $135 unseen gets dinged to the risk pool, so premiums go up.)

5. Stop driving up costs with regs and mandates. In some states, the government forces insurance companies to charge everyone the same rate whether they’re young and healthy, or sick and old. This is terribly costly. High rates mean young people go uninsured. Also, forcing companies to insure people after the fact is not “insurance” and drive up costs even more. Again, carrots for consumers to get insurance are far better than sticks against insurance companies and employers. Of course, consumers pay for those sticks, anyway.

On No 5, the Left has consciously been using these kinds of regulations to drive up costs. This limits people’s “access.” They don’t care. They want medical socialism no matter the cost. The plan is, and always has been, either to hasten the destruction of the insurance market and/or to drive up costs so we’ll cry uncle. Once we cry uncle, they’ll usher in the age of bureaucare. Functionaries will make our healthcare decisions. Bureaucrats will decide if and when you need a drug. You will wait in medical bread-lines for care. Innovation will dry up. Just go to a Cleveland hospital. Find Canadians getting MRIs because Canada has made them wait. 

Paul Krugman, 2005, saying universal health care would make us more like GM...

Why should we be a country in which hard working people aren't guaranteed health care if they need it? ... But the problem is that ... our economy is starting to look more like Wal-Mart and less like General Motors in the good days. The share of workers who get benefits at all is declining and the quality of the benefits.

Wal-Mart is very profitable. GM filed for bankruptcy.

Given his aversion to the bubble of the presidency, willingness to admit when he screws up, and experience as a professor of constitutional law, it seems fair to conclude that while Obama may disagree with you on a particular issue, he's at least conversant with the counterarguments. Indeed, it's said that a good lawyer—and Obama graduated from Harvard Law magna cum laude—can argue both sides of a case. As such, I think the President would be open to the following question, which I submitted this morning for his upcoming online town hall meeting on health care:

What do you think—without caricature—is the strongest, most serious objection to your health care proposal, and how would you reply?

YouTube says the winning questions will be among the most popular ones, so if you're interested in which conservative criticism is most cogent, why not watch and share the above 16-second video? Let's see if we can replicate what Patrick Ruffini did in 2007 with YouTube's "10 Questions" contest.