Talk To Me Ron Paul

October 15, 2007

Washingtonpost.com is featuring an online chat with a different candidate every Friday. This week, it’s Joe Biden. Last week it was Ron Paul. If you want to take a break from complaining about candidates not having to answer the tough questions, submit a question and check these out. Ok, now start complaining about how candidates can easily evade tough questions in online forums.

But check out the Free-wheelin Ron Paul:

Philadelphia: As a physician, you have operated in the increasingly regulated private sector of medicine and in the government-run VA hospitals. Can you speak more in-depth on the problems with our current semi-private health care system and compare and contrast the two possible options — namely, more government involvement or less government involvement? Thank you.

Rep. Ron Paul: That’s easy for me — less government involvement. Government got involved in the early ’70s and directed medical care be delivered by corporations, which is failing and nobody is happy and it’s very costly. We need a lot less government and to have confidence that in a free society medical care can be delivered as well as computers are. We have to restore confidence that the marketplace can deliver services as well as it can goods. In Washington if we have a bill come up for a prescription drug program, it’s the corporations, not the people lobbying for it. You don’t need the government or huge corporations out of Wall Street between patients and doctors. We need to make sure that people can save all the money they spend on medical care by getting it back from their taxes, by reducing their tax burden.

Ok, he eventually makes sense: his plan is based on tax-credits and getting government completely out of the picture, which will then get the corporate lobby completely out of government. No doubt that is a perfect model, but come on: any reduction in Government regulation short of complete deregulation will mean more room for corporate lobbyists. And my biggest beef with Paul here: “We need a lot less government and to have confidence that in a free society medical care can be delivered as well as computers are.”

Can someone tap Mr. Paul on the shoulder and whisper two words - ‘digital divide.’ Now I know what Mr. Paul is trying to say here, that health care should be a good, like computers. But computers, like health care, are also enormously beneficial to social welfare, and decidedly beyond that of most goods. Which is why the market for computers is not completely free and there are plenty of programs, benefits, incentives, and other market interferences that represent attempts to distribute computers beyond market constraints.

I believe Ron Paul is very smart and holds a special place in my heart as the Reason(able) candidate for 2008, but he should at least use examples that comport to his world view.

1 Comment | Health Care, Ron Paul | Permalink
Posted by Andrew Bennett

Health Care Punditry

October 12, 2007

Why is it so hard to reform health care in the U.S.? One reason is that there is too much interest in it. I mean, health is in high demand, so pretty much everyone has something to say about how it should be delivered and at what cost. And that means critics have no problem rallying folks behind the op-ed pages that serve to simply rip into pretty much anything anyone proposes.

I give you not one, but two examples from today’s Wall Street Journal (that’s right, they’re still pay to play, so no links):

President Bill Clinton famously declared that the era of big government is over — after the ill-considered scheme to remake American health care his wife helped to cook up in 1993 helped Republicans retake Congress in 1994. Now Hillary Clinton is back, touting an “American Health Choices Plan.” Like the earlier fiasco, Sen. Clinton’s current scheme would explode government spending — the plan’s initial price tag is $110 billion — expand bureaucratic regulation, and threaten the health and financial security of millions of Americans.

For sure, Sen. Clinton won’t make the mistake of releasing 1,300 pages of details, as was done in the 1990s. Yet even in outline form, it is clear that under the plan the government will tell insurance companies how to design their plans and who they must accept as customers. Businesses will be told that they have to spend money on a benefit that they and their employees may or may not value. Individuals will be told that they have to spend their money on health insurance, the price of which will explode past its already too-high level.

The American Health Choices Plan, based on mandates — including community rating and guaranteed issue for insurance companies — more regulation and increased taxes, is not a recipe for cost control but for disaster. For proof, you need look no further than Massachusetts.

Last year, then Republican Gov. Mitt Romney and a Democratic legislature enacted a health-care plan with very similar elements to the one proposed by Sen. Clinton. Everyone has to purchase insurance. The government regulates the product design. Companies cannot deny a policy to anyone (guaranteed issue) or charge rates based on health or lifestyle (except for smokers). Businesses must offer insurance to employees or pay a fine. Low-income residents receive completely free or highly subsidized plans.

While Mr. Romney has moved on, Bay state residents are still feeling the aftershocks. Of the 115,418 people who have enrolled in the new plans, more than 90,000 have signed up for the 100% free option — free to the enrollee, if not to taxpayers. The plans for which people must pay close to full freight have been about as popular as wool sweaters in August. As of Sept. 1, only 7,164 people had signed up for these new plans, despite the July 1 mandate; that’s a mere 4% of the estimated eligible uninsured population.

Experts predicted that upwards of 70% of enrollees in the plans with subsidized premiums would be under 45, and fewer than 15% older than 55. In fact, 27%-40% were older than 55, depending on the plan. This is not surprising, since older people are more likely to be heavy users of health insurance. The flood of these enrollees is called adverse selection. This causes costs to spiral upward and coverage to dwindle.

This problem was supposed to be addressed by the universal mandate, but when the bureaucrats actually began implementing the plan they discovered health insurance is expensive because health care is expensive. Since they couldn’t repeal this reality they repealed the universal mandate, exempting 20% of the uninsured from the mandate.

Doesn’t matter what party you’re from, chances are the author, Sally Pipes,  isn’t gonna like your plan. Which is fine - after all, she is an adviser to Giuliani - but is Romney even getting a fair shot on his work in Massachusetts that is essentially only a few months old in terms of implementation? Doesn’t matter, when it comes to health care any reformer is a moving target. In fact, Romney was just a detour in a column mainly aimed at criticizing Bill and Hillary’s past and planned efforts in regards to health care.

And on the facing opinion page, the Journal’s Collin Levy takes shots at Romney as well:

On the campaign trail, he’s talked a good game. He’s pledged a continuation of the Bush tax-cut policies — making the tax cuts permanent, eliminating the death tax and so on. The Bad: He refused to endorse the same Bush tax cuts in 2003 as governor, and loudly opposed the flat tax. The Ugly: He raised fees and closed “loopholes” in the business tax code, effectively increasing the tax burden in Massachusetts. And his biggest accomplishment was a dubious one — passing a state health-care plan that strikes a lot of Democrats as a good national model.

…….the Massachusetts governor gave national Democrats a free preview of Hillarycare. But it’s also fair to note that Mr. Giuliani, while citing the Constitution, was protecting New York City’s interest in federal pork. Mr. Romney’s health-care plan, on the other hand, seemed more like a ploy to raise his presidential profile in the national media.

This is just a peek at the environment in which candidates will have to attempt to gain support for their health care policies.

And of note: The Wall Street Journal is clearly gearing up to endorse Giuliani.

No Comments » | Clinton, Giuliani, Health Care, Romney | Permalink
Posted by Andrew Bennett

Rove Digs Scars

September 18, 2007

Karl Rove is among the “people in Washington” I had in mind when I posted this morning about Hillary Clinton’s challenge in selling America on her health care plan. Predictably, Rove was more than ready to begin firing back at Hillary’s plan this morning and the Wall Street Journal (predictably) allowed him space for it:

 All around America, families are grappling with health-care concerns. They wonder if they’ll have insurance at a price they can afford. They worry about how much out-of-pocket health costs take from the family budget. They question if they’ll be able to pick their own doctor. Some feel trapped in jobs they don’t like out of fear of losing their health insurance.

As the latest government-heavy plan announced by Hillary Clinton yesterday once again shows, the answers politicians offer on health care highlight the deep differences between liberals and conservatives. This is a debate Republicans cannot avoid. But it is one we can win — if we offer a bold plan. Conservatives must put forward reforms aimed at putting the patient in charge. Increasing competition will ensure greater access, lower costs and more innovation.

Liberals see the concerns of families as a failure of private insurance, and want the U.S. to move toward a government-run, single- payer model. This is a recipe for making problems worse. Socialized medicine inevitably leads to poor quality, inefficiency, rising taxes and rationing. The waiting lines and poor care that cause people from other countries to come here for treatment are not the answer…

…Mrs. Clinton may think Americans want to trade freedom and innovation for the illusory security of government regulation and surrender control of their health decisions to government bureaucrats. My bet is 2008 will teach us something different if Republicans make health care a centerpiece issue.

[Note: WSJ, unlike the New York Times still has a vault, so no link to this article]

The bold above is mine, the subtle jabs at a Hillary-specific plan are Karl’s. Most of what he has to say is what we would have expected and he lays out a plan himself that he does a good (though predictable) job of contrasting with the Democrats. But the real takeaway should be how Hillary offers a little something extra (”scars” as she calls them) for him to jab at.

1 Comment | Clinton, Health Care, Republicans | Permalink
Posted by Andrew Bennett

The Scars To Show For It

September 18, 2007

We’re all well-aware that Hillary Clinton has dabbled in health care reform before, but what we may not know is whether voters associate Senator Clinton with the issue as negatively as those inside the beltway. The Christian Science Monitor explores:

Now, the former first lady is seeking to turn that failure into a positive – and, so far, is succeeding. A recent poll by the nonpartisan Kaiser Family Foundation shows that, among all the presidential candidates, voters see Clinton as placing the biggest emphasis on healthcare. She tops the list with a plurality of 27 percent, followed by Sen. Barack Obama (D) of Illinois with 6 percent. Among Democrats, Clinton is also by far the candidate seen as best representing their views on healthcare, with 35 percent. Among Republican voters, former New York Mayor Rudolph Giuliani was the top choice, with 8 percent.

“Senator Clinton starts off with an edge on health,” says Dean Altman, president of the Kaiser Family Foundation. That’s “not because the voters have scrutinized the details of anyone’s plan, and obviously she’s only released pieces of hers so far, but just because they so closely associate her with the issue.”

On the stump, Clinton herself often refers to her abortive healthcare reform in the ’90s, a failure that played a significant role in the voters’ rebuke of her husband during the 1994 midterms, when the Republican Party seized control of both houses of Congress. But she tries to spin that failure into a positive, telling voters that her efforts show how deeply she cares about the issue and that she has “the scars to show for it.”

Clearly Clinton’s betting that these are the impressive type of scars, not the scary type. What a conundrum for the voters, it’s like deciding whether to hire someone who was fired by your competitor…I’m sure there are plenty of dating analogies too…

Whatever voters decide though, you have to respect Clinton’s straightforward approach and clever brinkmanship on an issue that she knows could bite her. I think most people in Washington assumed health care would in fact haunt Clinton and would make easy fodder for her opponents. But Clinton’s numbers on the issue may prove pretty resilient, 27% identification and 35% approval on the issue are huge and may be proof that voters dig scars.

1 Comment | Clinton, Health Care | Permalink
Posted by Andrew Bennett