Friday, August 28, 2009

The Worst Reasons

If you are a parent then your child must have desperately wanted something impractical. It didn't matter how you explained things, your child still wanted it. If you asked why your child wanted it you probably got the answer, "I just want it." or "The other kids have it." When my daughter was very young this could lead to a red-faced crying fit.

The Democrats are like this about health care. They've been wanting it so long that they don't remember why, they just want it. You can hear this in the different cases they have made. "All the other countries have it," is high on the list. In fact, that and variations on "fairness" pretty much make up the list. All of the talk about reducing costs or "bending the curve" are disingenuous since the current legislation is guaranteed to drive costs up instead of down.

This is also why the Democrats are so confused at the growing resistance to health care reform. They assumed that the entire country has been stewing over the issue since it failed under the Clintons.

Now the Democrats are adding a new reason - it should be passed as a memorial to Ted Kennedy. This is the worst of the reasons since it asks principled Republicans and Blue Dog Democrats to pass something that will affect the entire country against their better judgment as a memorial. Go ahead and name a building after him but don't reshape a big portion of the nation's economy as a memorial to one man. No one was that important and sentiment should not determine the shape of the US economy.

Tuesday, August 25, 2009

FDR, Reagan, and Obama

Last year, Obama said that he wanted to be a transformational president like FDR or Ronald Reagan rather than a caretaker president. At the time it looked likely. His campaign bordered on a religious crusade and he was the most ideological candidate in years. His followers were expecting great things from him. His party won Congress with a wide majority.

So, eight months later, how is the transformational part working out? Not so well.

FDR set a standard during his first 100 days but his real changes came about during his follow-up, the so-called Second New Deal. That's when Social Security passed. The first 100 days were all about stabilizing the economy.

Reagan's first actions were similar. He got tax cuts and budget cuts (technically they were cuts in growth) passed even though the Democrats controlled the House. He continued the deregulation that had started under Carter. He also beefed up the military.

In contrast, Obama's successes so far have been pretty meager. He ran on changing America, not on economic recovery but most of his early actions were economic. He signed a patchwork stimulus bill and a pork-laden spending bill. He took over the banks and two domestic auto makers. None of these were part of his platform nor were they particularly popular. The White House modus operandi has been to push bills through Congress fast and sign them quickly before the opposition has a chance to resist. This has worked against him. Credit card reform and the expansion of SCHIP passed before most people were even aware that they were being debated. Obama's approach garnered him little credit and no new political capitol.

Obama tried the same approach with health care reform, breaking several promises about transparency, but found that it was too big to push through quickly. Currently it is languishing with major portions still being debated.

This doesn't sound like a transformative president to me. What happened?

The first problem is that Obama has no message. Hope and Change are nice vague terms for winning an election but they don't give much of a mandate. Obama did make specific promises - over 500, more than twice the typical candidate's platform. This further watered down his mandate. Were people voting for him because he promised health care reform or because he promised to get the troops out or Iraq?

FDR had a strong message - "Competition is keeping prices too low. We need to reduce the number of businesses so that the remaining ones can charge higher prices. At the same time we will strengthen the unions so that they can demand higher wages."

Reagan had his own strong message, "Competition is good. It keeps prices down. We need more businesses and less burden from government and unions so that the demand for workers raises wages."

Both men expressed their visions in no uncertain terms. If they had problems getting their legislation through Congress, they appealed to the American people to pressure Congress.

Obama probably agrees with FDR but he has only hinted at it. In fact, whatever his personal beliefs are, he only hints at them. When he does make unguarded comments they reflect badly on him. Obama will never pass legislation while expressing his beliefs about bitter people clinging to guns and religion.

Both FDR and Reagan inspired generations of followers. In fact, they defined the current debate about the proper role of government (FDR=more, Reagan=less). During the campaign, Obama was so coy about his beliefs that most Libertarians voted for him thinking that he would be a pragmatic centrist.

In order to be a transformative president, you have to have a clearly defined philosophy. Without that, you are a caretaker administration.

Now, there's nothing wrong with being a caretaker. Most presidents are. That's why only four of them were carved on Mount Rushmore. The country can't handle new transformations every 4-8 years. It's hard enough to be a successful caretaker president. In the last 50 years, only three presidents have managed to serve a full two terms. The others are usually counted as failed presidencies. Even Kennedy who probably would have been reelected couldn't translate his popularity into political results.

So where does that leave Obama? He has two choices. He can define exactly what his vision is and try to win the country over to it, then use that, as Reagan did, to push his favored legislation through Congress. This will be tough. Defining visions are what campaigns are all about and Obama has three years before his next campaign starts in earnest. In the meantime, trying to sell a message without a campaign is nearly impossible. The White House has already tried to mobilize its campaign to sell health care. They failed. There is the additional problem that the country might not like what Obama is selling. The Democrats are have moved to the left but polls show that most of the country is still conservative. Admitting that he is a radical might hurt more than it helps.

The other option is to take the Clinton approach. Move to the center. Steal ideas from the right. The left will hate him for it (as they did Clinton) but it is a proven way to salvage a presidency.

Monday, August 24, 2009

Defaming the Dissidents

Ever since protesters started showing up at town hall meetings, the left has been belittling them. First they were paid "Brooks Brothers" protesters. Then they were a threat to free exchange of ideas.

More recently the left has focused on two things. One is that several protesters carry signs calling President Obama a Nazi. This has caused an uproar from the left. "How dare you compare the President to someone so evil?"

The other thing has been that a few protesters had guns. One was carrying a gun illegally. Others were carrying legally. The left's take on this is that it is meant as intimidation. MSNBC showed one protester with an AR-15 across his back and talked about racist white militia members. The protester in question was black but they had only shown close-ups of his back so that this was not obvious.

One way to react to this is to dismiss it as simple hypocrisy. The left never had any problems with paid protesters. MoveOn seriously considered running an ad during the Superbowl that showed President Push morphing into Hitler. No one on the left complained that this was over-the-top. Democrats don't believe in guns but last November, members of the New Black Panthers stood outside a polling place carrying clubs and shouting racial epithets. Again, no reaction from the left.

So is this just a matter of the left objecting to its own tactics when they are the subject? I don't think so.

I think that this is a concerted, if ineffectual, effort to discredit the protesters. This is a page from Saul Alinsky. It is easier to attack an individual than his ideas. If the left can make the protesters seem like a bunch of nuts then they don't have to defend their health care proposals. They are the ones trying to shut down the debate...

Protester: According to the CBO, your health care proposal will bend the curve up instead of down.

Democrat: You're ugly.

New York Times Columnist: These protestors are ugly so we shouldn't listen to them.

Tuesday, August 18, 2009

Centerpiece or Sliver?

President Obama insists that the public option was only a "sliver" of health care reform. The reaction from the left makes you wonder. New York Times columnist, Bob Herbert, seems to think that without a public option, the reform will only make things worse.

Giving consumers the choice of an efficient, nonprofit, government-run insurance plan would have moved us toward real cost control, but that option has gone a-glimmering. The public deserves better. The drug companies, the insurance industry and the rest of the corporate high-rollers have their tentacles all over this so-called reform effort, squeezing it for all it's worth.

Meanwhile, the public — struggling with the worst economic downturn since the 1930s — is looking on with great anxiety and confusion. If the drug companies and the insurance industry are smiling, it can only mean that the public interest is being left behind.

I could quote others but their complaint is always the same - we have to have a public plan or we will not have real health care reform. What is there about a public plan that is so appealing?

The obvious starting point is that the left hates to see anyone make a profit and hates it worse if they are making a profit from human misery. Obama describes it this way:

{...} a system that often works better for the health-insurance companies than it does for them.

But if that was all there was to it then why create a government-owned and controlled competitor? The government just passed sweeping reforms on what banks can and cannot do with credit cards. Why not do the same thing with health coverage? After all, health care reform is being rebranded as insurance reform. Is there more to this?

The right has been afraid that the public plan was a backdoor way of passing single payer. From the reaction on the left, they thought so, too.

Monday, August 17, 2009

Obama and the Public Plan

Yesterday's top story was that the White House was backing off of the requirement that insurance reform include a public plan. My reaction was that if this was true, it meant that Obama would get his package. By today the message it more mixed. It may be off the table. It may still be on the table. It may even be on the table but hidden to be revealed at the last second.

If the public option is not dropped and Obama's health care plan passes then this will be the biggest reason for the failure. Pundits will talk about death boards and town hall meetings but the public option is the real reason that health care is in trouble.

To conservatives and insurance companies, the public option is a back-door way of implementing single-payer. Conservatives don't want the government running such a large portion of the economy and the insurance companies are sure that they will be forced out of business. There is good reason for these fears. European countries that offer the public/private mix have the majority of the population enrolled in the public plan. The private plans sometimes exist only for the wealthy and government workers.

If you think that the public plan will be comparable to private coverage then explain why the Democrats have consistently rejected amendments that would force them and their staffs to switch to the public plan?

Here's another factoid - when it passed, Social Security only covered around half of the population. Once government programs start, they tend to expand.

Obama's justification for the public plan is that private, for-profit insurance companies can't be trusted. They need competition from the government to "keep them honest". Other, high-ranking Democrats have admitted that the public plan is a back-door to single-payer, just as the other side fears. They tend to say this quietly. I have seen them quoted but I couldn't find and of the quotes when researching this post.

So, by including a public plan, the Democrats have energised conservatives who are willing to work against the reform package. They have also mobilized the insurance companies who are providing the financing. In the meantime the drug makers are funding the pro-reform movement in exchange for not being subject to price controls.

If Obama dropped the public option for real then much of the opposition would vanish. He could make a deal with the insurance companies. They stand to gain millions of new customers from the universal coverage requirement. If they switched sides then the conservatives would find themselves heavily out-spent and missing one of their central arguments against reform.

It shows how heavily Obama was influenced by Saul Alinsky and other socialists in his youth that he is willing to give up easy passage because of an innate distrust of for-profit companies.

There is one possibility why the White House is being so coy about the public plan. Howard Dean suggested that both Houses of Congress pass a measure without a public plan then insert it during the budget reconciliation process. This would only require 51 votes instead of 60 to pass the Senate and wouldn't give health care opponents enough time to re-mobilize. That would be a betrayal of Obama's promises of open government but he turned his back on that one with the first bill he signed.

Thursday, August 13, 2009

Clunkers and Winners

Last weekend I was camping in Indianan. Someone else at the event had his brakes go bad on the drive there from Wisconsin. He had his van checked. The master cylinder and the brake lines needed replaced. The van was a Chevy Astro and GM hasn't made replacement parts for it in years so he would have to find parts from a junked Astro. He decided that this was going to cost way more than the van was worth. Instead he planned to donate the van to a local charity, drive home in a rental car and buy a new car there.

After talking with his family they decided on a different plan. His father-in-law would drive down with a truck and haul the van back home. Then the would trade the van in for Cash-For-Clunker money.

There are several winners and losers here. The big winner was the owner of the van. He was going to get a government check for several times the worth of a van that would have ended up scrapped, anyway.

The losers are the charity that would have gotten the van. They wouldn't have gotten much for it but now they will get nothing. Multiply this by thousands to see the true effect on charities.

I'm not sure about the rental industry. They rented a truck for a round trip instead of a car for a one-way trip. One-way rentals are expensive for the renter and inconvenient for the rental agency. I'll call this one a wash.

Astro owners in general are slight losers. That's one fewer Astro to be broken down for spare parts. Instead it will be crushed. One van doesn't make much difference but multiply that by thousands and you are setting up for a spare parts shortage for years to come.

I don't know if the automobile industry will come out ahead or break even. They were going to sell a new car, regardless. They might sell a more expensive one because of this. Or they might not.

The biggest loser is the US taxpayer. We subsidized a transaction that would have heppened anyway. We paid several times what the van is worth to no real effect since it would likely be scrapped anyway.

Wednesday, August 12, 2009

Death Panels, Nazi symbols, and the Health debate

August is traditionally the month for crazy news stories. Normally Congress is out of session and the president is on vacation and there is little actual news to report on so reporters fill the air with stories about shark attacks and anything else they can find.

This year the politicians may not be in Washington but they are not on break. They are trying to drum up support for Health Care Reform. At the same time, opponents are trying to stop them. This is leading to all sorts of irrelevancies. For example:

Death panels. Sarah Palin talked about the establishment of death panels that would rule on who got to live. While her language is colorful, she was probably referring to something like Britain's NICE standards. These attempt to rate cost against quality of life in deciding what treatments will be allowed. When a woman at a town hall asked President Obama about a pacemaker for her then-100 year old mother, she was referring to this sort of cost benefit. Obama's answer wasn't comforting. I assume that Governor Palin was under this sort of pressure when she was pregnant with her son Trig to have an abortion.

While we might see something like this eventually established, it is not part of the current bills.

Nazi Symbols. Nancy Pelosi claimed to have seen protesters carrying Nazi symbols outside a town hall meeting. CNN checked. There was a sign with a swastika that had a circle and a line through it. In other words, it was a "no Nazi" sign. There was also a sign with Obama sporting a Hitler mustache. Pelosi gave the impression that the protesters were neo-Nazis when that's what they were calling her side.

Organized protests. The left has been insisting that the protests are organized and packed with people from outside the district. This is an attempt to discredit the protesters. To date, all that anyone can find is that anti-reformers have sent out email alerts and urged protesters to attend these meetings. This is exactly the tactic used by the supporters. This doesn't matter. The important thing for the Democrats is to get out a message. They know that few people will bother to look for the truth.

ReBranding. Most people are already insured so they rightly wonder what is in it for them? The two points that Obama is insistent on are universal coverage and the government option. Neither of these will help people who are already insured and they know it. Obama finally figured this out and launched a new message - that the whole thing is nothing more than an insurance bill of rights. If that was true then it would have already passed and been signed. This is only a small part of the reform bills. Similarly, Obama tried telling people that he is actually thrifty and will not sign a bill unless it is deficit neutral. While the White House is still trying to convince people that the bill will be paid for through increasing efficiencies in the system, this is an exaggeration (and I'm being kind). There will be a tax increase as part of it and it will hit most of the population.

Health Care Crisis. Obama insists that we are in a crisis. He tosses around the figure of 46 million without insurance. What he doesn't mention is that this includes 10 million illegal aliens. When asked, the Democrats insist that they will not be insuring illegals. So why include them in the count of the uninsured? To make the number scarier. In truth, a large percentage of the uninsured are gambling that they will not need coverage. They prefer to keep their money rather than spend it in insurance premiums. If asked, they would probably prefer to be left alone but they have to be included, also. The bigger the number the more the perceived urgency.

In his first few months in office, Obama took over the financial sector and the big three car makers. Now he is trying to take over energy and health care. People are rightly asking what he will be taking over next year? The speed that Obama is using to take over portions of the economy is scaring people. It doesn't help that the Demcrats made a big thing out of being Progressives and that the fascists rose out of the early-20th century Progressive movement. In pushing a bill that isn't even written yet, Obama is scaring otherwise reasonable people. I've said before that he should be spending his time on the economy. Health Care Reform is something for a country that feels financially strong, not one reeling under mounting debt and unemployment.

Monday, August 10, 2009

President Bush Saves the World

According to Paul Krugman, the country, and by extension the world, has been saved from a repeat of the Great Depression by big-spending government. He dances around the subject quite a bit and gives credit to Obama's stimulus but that isn't really credible. The stimulus has barely started spending any money and reports show that it is not being targeted very well.

So what did save the economy? It must have been Bush and the TARP. That's what kept the banks in business and TARP money was used to bail out GM and Chrysler. Obama's actions have been more follow-up than leadership on these issues.

Of course, Krugman would rather chew off his right leg than credit Bush with doing anything right so he is left with applauding Obama for a yet-to-be-spent stimulus package.

Since Obama has spent most of his time in the White House complaining about the "mess" that Bush left him, it would be nice to hear something nice about the Bush administration. Not that this will ever happen.

Thursday, August 06, 2009

Stifling Debate

An official starts to address a gathering of people to explain his position. Suddenly a protester stands up and starts making a disturbance. Is this a danger to democratic society? Something that must be suppressed? Or is it an example of constitutionally protected free speech?

Not so strangely, it depends on who is being interrupted. Currently the Obama administration is upset because tea party protesters are disrupting town hall meetings on health care. Several points should be considered:

First, this sort of behavior is nothing new. The left has been doing it constantly for decades. Speakers such as David Horowitz can expect that any time he gives a talk on campus, the front row will be filled with hecklers who have no intention of letting him speak.

The left had a blind spot about this. Talking Points Memo recently debated if they ever did this. Some people felt that they had done it during the Bush proposal for Social Security reform. Others felt that it hadn't happened since the 1960s. No one seemed to realize that it happens regularly.

The second point is that the White House is attempting to stifle the debate on their own terms. The whole purpose of the town hall meetings was to put out a controlled message. The President's town hall meetings are stacked with ringers from his campaign. They are trying to keep opponents from being heard. They even set up a special email address for people to forward anything that looks "fishy" to. It is unclear if this will be used to formulate responses or to threaten people who are disseminating the wrong message. Regardless, with the Democrats controlling the White House and Congress and a sympathetic press controlling CBS, ABC, NBC, CNN, and MSNBC, it is not surprising that people are copying tactics from the left to get their message out.

The third point is that the administration is spreading a lot of misinformation. The protesters are justified in calling them liars when they are not telling the truth. When the President of the United States tells lies on prime time, then what are average citizens to do? (The same thing that they did when no WMDs surfaced in Iraq.)

Finally, the left is insisting that the disruptions are being caused by paid agitators but has so far failed to find any. The closest that they have come is an overlap in volunteers.

For the record, here are a few statements that are being put out:

If you are satisfied with your doctor or health plan then no one will make you change it. Truth - Assuming that your current plan meets the new standards, it is up to your employer whether you will keep it or switch to a different plan or the public one.

Health Care Reform will cut health care costs. Truth - the current proposals are more likely to push future costs up than down.

You will not be forced to pay for abortion. Truth - a news story yesterday said that the public plan probably would include abortion.

This will not lead to single-payer. Truth - Based on other countries such as France, it will probably lead to a de facto single-payer covering 80%-90% of the population.

Tuesday, August 04, 2009

The Automotive Model

President Obama says that we need health care reform in order to "bend the curve down." By this he means that we need to do something to keep health care costs from rising faster than inflation. The trouble is that none of the proposals being debated really address this. That's why we have all of the talk about rationing. As costs go up, the amount of services available to individuals will have to be reduced.

Will Obamacare solve this? No. France and Germany are close to the various public/private models being debated for Obamacare. They also come in after the US in the amount spent per capita on health care and they face the same problem with rising costs that we face. They also get less for their money. The survival rates for the most cancers range from slightly better in the US to much better for prostate cancer.

There is some talk about cutting Medicare but simply allocating less money means more rationing. This leads to human-interest stories about people being denied care and a return to previous funding.

Obama insists that the problem of rising costs is caused by greedy doctors who order too many of the wrong type of test (and not enough of the preventative tests that Obama insists will lower long-term costs). In his rush to find villains, Obama overlooks the fact that greedy insurance companies are not going to pay for unneeded tests. Obama's distrust of free markets makes him look for him to see rising costs as an indicator of insufficient government control. There are other factors, many of them byproducts of government policy.

One factor is the cost of malpractice insurance and the cost of "defensive medicine" - tests done in case of future lawsuits. Obama announced early on that malpractice reform would not be part of health reform. This kept the trial lawyers happy and they are one of the Democrats' biggest sources of money. It also eliminated a major tool in controlling costs.

A big problem with insurance is how it is handled. Most people do not buy insurance. Their employer buys it on their behalf. This came about mainly due to the progressive tax rates prior to the Reagan administration. The tax rates were not indexed to inflation so it was very easy for a cost of living increase to push someone into a higher tax rate and result in less actual take-home pay. At the time, most benefits were deductible so applying a cost of living increase to a benefit was a way of beating inflation. This gives individuals an incentive to run up their insurance costs. I know people who believe that a benefit is wasted if it isn't used so they try to get as much out of their insurance as they can.

With most people covered through their employer, insurance companies didn't have any incentive to sell to individuals. There is more profit in group sales than individual sales. This makes it harder for individuals to get insurance. This is also where a big part of the 47 million uninsured figure comes from. Anyone who is unemployed for any length of time is included in this figure.

One solution that I have seen being talked about in conservative circles is to treat health insurance like automobile insurance. You are responsible for buying your own instead of it being bought on your behalf by your employer. You would choose the options and amount of coverage that you need and can afford. Many regular things either would not be covered or would have a deductible. You don't expect your insurance to pay for oil changes, brake jobs, or new tires. Why should insurance pay for check-ups?

Many people are already doing this. They buy cheap catastrophic-coverage and pay other expenses out of pocket. This is one way of bending the curve down. If a doctor says that your headache is probably just that but that you could have a CAT scan to be sure, you are much more likely to agree if the test is covered by insurance.

This is the opposite from Obamacare. The President says that he wants more poeple being tested and that he does not want any co-pay for these tests. This represents two different points of view of medical tests. One side wants to leave the choice to the individual. The other side does nto trust the individual to make the correct choice and wants to test everyone.

Complicating this is the fact that most people are healthy so most tests are not needed. Worse, some tests produce a high number of false positives. This can lead to unneeded treatment. The PSA test for prostate cancer is an example of one that has a high number of false positives. It also detects any cancer, no matter how small. Since prostate cancer is slow-growing, a man can have it for decades without needing treatment. A review of PSA tests found that positives were often followed up with unneeded agressive treatment.

All of this should be part of the national discussion. Instead the debate is centered exclusively on insuring the most number of people and regulating minimum coverage.

Why 3 cents?

One proposal to help pay for medical reform is a $0.03/can tax on soft drinks. Why three cents?

It's a bribe for the soft drink companies. Vending machines don't take pennies. Amounts have to be divisible by increments of five cents. If a three cent tax is imposed, they will raise prices a nickel and pocket the difference. All complaints will be directed at the government.

The White House and Congress are already fighting the insurance companies. They don't need new enemies.