Monthly Archives: August 2011

David Frum’s Outline For A Health Care Plan Looks An Awful Lot Like…ObamaCare

I found Frum’s piece via Matt Yglesias who says Frum, “seems to me like a man who’s slouching toward single payer”.  To his credit, Matt knows a like minded fellow when he sees one.

Frum basically argues for less consumer choices and greater government regulation (sounds familiar, right?) while demonstrating a total lack of understanding about how the current system actually works.

The basic grammar of the American healthcare system is: sellers have market power, buyers don’t. Insurers, the middlemen, are stronger than buyers but weaker than sellers. So they respond to seller demands by squeezing the buyers: feeding costs through, raising premiums and copays, seizing upon opportunities to withdraw coverage altogether from patients who get sick.

But what if we could build a different marketplace, where the middlemen had more power. Could we induce them to squeeze the sellers instead, forcing costs down through the system?

In FrumWorld insurance companies don’t try and squeeze costs down on the provider side? This will surely comes as news to, well everyone.

First, it seems as if Frum has never heard of “Preferred Provider Organizations

Perhaps after familiarizing himself with that concept, Frum could call the folks in Alabama and tell them insurance companies don’t “squeeze” providers.

When UAB Health System and UnitedHealthcare parted ways late last year, the split highlighted the ongoing tension between insurance carriers and healthcare providers over reimbursement rates.

Last fall, UAB gave the insurance company 90 days notice that without higher reimbursement rates, it was terminating its contract. Negotiations did not result in a compromise, and the contract terminated at the end of November.

His associate, Certified Coder Lisa Warren, explains that “a doctor can decide he wants to charge $100 for an office visit, but if [an insurance company] decides they’re going to pay $45, then that’s what you get, period. With inflation, the overhead is increasing dramatically, but the payers are not increasing what they’re paying the doctors — in fact, they’re cutting it quite frequently.”

Or maybe he could explain “reality” to doctors who think they need to learn how to effectively bargain with insurance companies.

Does Frum really think it never occurred to executives in the insurance industry to try and save money on payouts to providers? That somehow this potential source of savings and profit was some how just sitting in front of them until they read Frum’s piece and that as we speak they are slapping themselves on the forehead saying, “Why didn’t we think of this sooner?”

Here’s the gist of Frum’s basic ideas:

-“If we had 5 or 6 big insurers operating in a single united marketplace, we’d tilt the balance of market power away from providers.”

-“Instituting a more vigorous approach to regulation at the federal level. Once insurers get bigger and stronger, we need to break them of their current habit of relying on adverse selection to maximize profit. They have to be reoriented to a new mission: haggling with providers over prices.”

-“Generating and publicizing health outcomes quality data….Consumers need to see and know the truth of these claims: “75 year olds who sign up with ACME report greater satisfaction with their sex lives than people who sign with any other insurer.”

In other words, consolidate the industry and regulate the hell out of it at the federal level…in other words, turn health insurance into a federally administered public utility. Where have I heard that idea again? Oh right.

This is somehow supposed to spur innovations and gigantic cost savings. Of course nothing serves as an incentive to drive cost down than government regulations and a built in guarantee of corporate survival no matter what (7 insurance companies nation wide? The term to big to fail comes to mind).

How can anyone think a government created oligarchy that limits competition is going to create nimble and cost sensitive companies?

As for the idea of breaking insurance companies, “of their current habit of relying on adverse selection to maximize profit” what he means there is instituting universal coverage and an individual mandate. “Adverse selection” isn’t “a habit”, it’s the way insurance companies measure risk and charge customers accordingly. If we are going to break that “habit”, then we are going to fundamentally change how insurance companies do business. In order to treat all customers the same, you have to have a large enough pool of healthy people who pay premiums in but don’t pull money out of the system in the form of health care services. The only way to ensure a large enough pool is…a government mandate that forces everyone to buy insurance.

This is ObamaCare, unconstitutional mandate and all.

You would think a self professed conservative like Frum would at least mention consumer choice, increased competition, and personal responsibility which would include ensuring patients have an economic stake in their health care transactions. Yet none of the basic conservative principles make an appearance in Frum’s outline.

Frum rushes to his conclusion in a state of ecstasy over the possibilities of what could be if only people would listen to him! In reality he’s a cocky wide-receiver who thinks he’s home free and celebrates only be tackled short of the end-zone.

And we need a bonfire of all regulations and antitrust restrictions that impede insurers from discovering innovative ways to promote health. Health insurers might want to offer members free gym participation. They might want to offer frequent flyer points for members who lose weight.

Does Frum really not think this is already happening? I’ve seen more than a few commercial for local health insurance companies offering just these kinds of incentives. Are they in violation of some federal laws or is Frum as clueless about this as he is about so much of how the health insurance industry currently works?

Sadly Frum is not done. No he has one more kicker for us to savor.

Their [insurance company’s] job should be to keep us alive and well as long as possible – by any innovative means they can discover.

If Frum or anyone else thinks an insurance or any other company for that matter has any “job” beyond providing services at a price that generates a return on investment, they really haven’t a clue how the world works. And Frum thinks the key to getting a company to care about how long you live is a massive program of government regulation and bureaucracy, then he’s strayed far from conservatism and worse, reality. That’s not the kind of person we should be listening to about reforming health insurance or quite frankly anything.


George Pataki And SEIU- A Love Story

It looks like George Pataki is going to run for the GOP presidential nomination.

I’ll pause for a second while you either a-Stop laughing or b-Ask, “Who is George Pataki?”

For the folks in Category B, Pataki is the former Governor of New York who a long, long time ago rid the state of the decaying Cuomo administration. For that I, as a life long New Yorker, will always be grateful.

At the time, he was a little known state Senator who was remarkably conservative (if you grade on a curve, this is New York after all). By the end of his time in office however, Pataki had morphed into a rather liberal figure who had destroyed what he, along with his guru Bill Powers, had built the NY GOP into.

The crowning “accomplishment” of this transformation was a deal he cut with the powerful Local 1199 of SEIU prior to his last bid for reelection in 2002. The union got $1.8 BILLION in raises, Pataki got their endorsement and an army of “volunteer” workers, and of course the taxpayers of NY got…stuck with the bill.

Why did SEIU do something so out of character as to endorse a Republican? Here’s then union President Dennis Rivera in his own words.

The tremendous gains in our recent League contract, still fresh in the minds of most of us, could never have happened without $1.8 billion in state funding made possible by Gov. Pataki and other Albany leaders.

But that triumph for the people of this state was just the latest in a long series o f moves George Pataki has made to protect health care and health care workers.

George Pataki supported Child Health Plus, a measure that provides health care coverage to 540,000 previously uninsured low-income children.

George Pataki worked for Family Health Plus, which gives 700,000 uninsured New York adults access to quality health care.

George Pataki provided hundreds of millions of dollars for health care training and upgrading programs, including the CUNY/1199SEIU Nurse and Healthcare Employee Training Center in the Bronx.

George Pataki backed such additional health care measures as affordable access to prescription drugs for seniors and Medicaid expansion to cover the working disabled and low-income women with breast or cervical cancer.

George Pataki has supported worker protection laws that include safe needles, whistle-blower protection from retaliation for workers who report on unsafe conditions, and card-check and neutrality for employers using the State Employment Relations Board.

Appearing March 18 before our 94-member Executive Council, which voted unanimously to endorse him, Pataki expressed pride that New York was the first state to pass card check union recognition, which protects workers from the management intimidation or coercion that too often accompanies union election campaigns.

Pataki might disavow his liberal past and his marriage to SEIU to the few interested and willing to listen but New Yorkers know you have to ignore what Pataki says and focus on what he actually does.

There’s plenty more, good and bad, that can be said about Pataki for President but he’s really not worth the effort.

Now if good old George wants to run for the Senate against Kirsten Gillibrand, that would be worth talking about. Yes, he’d be an annoying RINO but in a Senate with a Republican majority the mischief he could do would be limited. Plus stealing a seat in a deep blue state like NY would be worth the occasional headache. Alas, Pataki’s delusions of grandeur seem to preclude that possibility.

Perry On Bernanke And Obama

Not everything is bigger in Texas. The national media spotlight on a top tier presidential candidate is unlike what any governor has to deal with at the state level. Today Team Perry is going to have their first chance to deal with a mini-blowup over a couple of things Perry said yesterday.

First, Perry on Federal Reserve Chairman Ben Bernanke

“If this guy prints more money between now and the election,” Perry said, “I don’t know what y’all would do to him in Iowa, but we — we would treat him pretty ugly down in Texas. Printing more money to play politics at this particular time in American history is almost treacherous — or treasonous in my opinion.”

He added, “We’ve already tried this. All it’s going to be doing is devaluing the dollar in your pocket and we cannot afford that. We have to learn the lessons of the past three years that they’ve been devastating. The President of the United States has conducted an experiment on the American economy for almost the last three years, and it has gone tragically wrong and we need to send him a clear message in November of 2012 that new leadership is  coming.”

The second part of that answer is really good but thanks to the incendiary nature of the first part, no one will pay any attention to it.

Just because you disagree with the Fed’s monetary policy doesn’t mean it’s “near treasonous”. It’s ruinous but treasonous? That’s just silly. Yeah it’s a bit of political hyperbole but there are some lines you can’t cross, not just because they are ultimately self defeating (which this is) but because they are beyond the pale. Charges of treason (or near treason) shouldn’t be thrown around lightly by serious candidates for President like they are on blogs.

The bigger issue is Perry’s implicit threat that Bernanke might be harmed if he went to Texas if her pursued another round of Quantitative Easing. There’s simply no place in American politics for the threat or even hinting at the threat of violence. Perry and he supporters may say he was simply talking about protests or verbal disagreements but let’s be honest, that’s not the image of Texas Perry was playing off, nor is “strongly worded letter to follow” exactly how Perry is portraying his leadership style.

The “near treasonous” stuff is a rhetorical gaffe of an over exuberant candidate new to the trail. The “treat him pretty ugly” line is something Perry needs to walk back (Update: But he won’t). Most importantly, he needs to be sure not to go there again.

Perry’s other remark that is causing a stir is his response or really non-response to a question about whether or not Obama loves America.

“I think you want a president who is passionate about America — that’s in love with America,” Perry said during a visit to the Iowa State Fair on Monday.

At a Republican Party event Monday night, a reporter asked Perry whether he was suggesting that President Obama does not love America.

“You need to ask him,” Perry responded. “I’m saying, you’re a good reporter, go ask him”

This of course has the Obama Defense Committee (aka the mainstream media) in a tizzy.

I don’t buy into this media created notion that every Republican must vouch for Obama on things like his religion and love of country. That’s Obama’s responsibility. The fact that they are so often under question says more about Obama, his life story and most importantly, how he communicates with the American people than with voters and Republican politicians. If after 3 years he hasn’t closed the deal on that, well, that’s on Obama, not the GOP.

I’m also not that interested in being lecture to on this stuff by people who just spent a month calling congressional Republicans and their supporters “terrorists”.

Still, this is simply a tactical mistake on Perry’s part. What he basically did was make himself the issue and not Obama’s failed presidency. I think a better answer would have been, “Of course the President loves America or more precisely his vision of America. I just happen to think most Americans don’t share his  vision of America where we pile crippling debt on future generations, violate the Constitution to force people to buy health insurance and side with repeatedly side with our adversaries over our friends.”

A campaign is like a sales pitch and what do we know about sales? “Always be closing. always be closing“. Yes, we’re still in the primary and yes Perry has to introduce himself but any question about Obama is a chance to knock Obama…always be closing.

This idea that Obama doesn’t love America is popular within conservative circles so it’s not bad primary material but I don’t think there’s any reason to believe it plays well beyond that. Most Americans want to think their President is a loyal American and will have a hard time swallowing the insinuation that he’s not. This is especially true of voters in swing states who voted for Obama but are now disillusioned with him.

The time to make case that Obama didn’t really love America was in the ’08 campaign when voters didn’t know him and he could be defined. Now, it’s simply too late to try. The trappings of the presidency alone swaddles a President in so much iconic American imagery it’s beyond the imagination of all but the true believers that Obama is not pro-America.

Running against an incumbent President is always an uphill fight. The key is to make sure the focus is on his dismal record as President. The challenger only has to be seen as a credible alternative, a safe vehicle for them to express their displeasure with Obama.  Perople are disposed to suffer the Devil they know than the one they don’t, especially if the alternative unknown is fairly radical for a major party candidate. Given some of his policy positions on what are still pretty settled issues (Social Security isn’t know as the Third Rail for nothing), his base pleasing but odd sounding passing reference to secession, and constant talk about the Tenth Amendment,  Perry isn’t a clear cut, safe option for most Americans. At least not yet.

No GOP candidate is ever going to win over the media, nor should they try. If it wasn’t these quotes, they’d find something else about Perry to harp on. But surely there’s a way to be a genuine conservative without veering off into territory that only annoys and even repels potential voters or converts to the cause. A candidate who is the walking, talking embodiment of every conservative blog comment bait post is exciting for the choir but un-moderated, potentially a long term danger.

I like Perry and he’s my leading choice for the nomination at the moment but I hope he realizes that not everyone is culturally in synch with him. He might consider that toning down some of his instincts a bit would go a lot further than daring those people to support him. Bottom line, I don’t think either of these things are anywhere near fatal on their own but Perry needs to tighten up his rhetorical range going forward.

Tim Pawlenty Is In Big Trouble Tonight

I wanted to like Pawlenty, I really did. I mean he was willing to take on some sacred cows (imperfectly but still) and he’s a hockey player. A pretty good start for a candidate. Sure he had some weak spots in his record but any candidate that actually has a record will have those. With candidates, you take the good with the bad and see where it goes from there.

One of the knocks on Pawlenty was he’s just too darn nice. In a cycle when a lot of GOP voters want someone who will take the fight to Obama, Pawlenty seemed a little to bland. One of his first shots a Obama was, in my opinion a misfire but worse, it showed that when a nice guy tries to act like a tough guy, he can seem forced and fake. When all is said and done, candidates are people and they are who they are. All the coaching and positioning can’t change that over the long run.

Pawlenty also stumbled with his refusal to back up his “ObamneyCare” “attack” on Romney. I thought the line was pretty silly but his refusal to engage Romney when the guy is three feet away when you were willing to smack him around rhetorically on national TV was, well, cowardly. Pawlenty’s decision to then say a few days latter that he should have done it while once again attacking Romney from a distance was puzzling, to put it mildly.

All of that brings us to tonight’s debate a few days before the Ames Straw Poll which has surprisingly become a big deal for Pawlenty’s chances to capture the nomination. After the New Hampshire failure to attack Romney, Michele Bachmann became the new darling of a lot of primary voters. Pawlenty suddenly faced a challenge to his position as the “Not Romeny” of the field and turned his attacks on the surging Bachmann.

Here’s Pawlenty’s diliema…when he’s asked to identify which candidate he thinks has no record and  who exactly he had in mind when he said, “Any bobblehead can stand up here and spout out the Republican talking points”. He’s either got to admit what everyone knows, he’s talking about Bachmann, or refuse to name any names. (I suppose he could say he’s talking about Ron Paul or some BS but that would lead to other problems.)

If he dodges, he’ll forever be the guy who is too cowardly to say to someone’s face what he’ll say about them when he’s not in the same room. Where would that leave him with voters? Well, if he can’t stand up to Mitt Romney or Michele Bachmann face to face, why would anyone think he’ll go after Obama in person the way he does in his ads (YouTube auto-play link), let alone a guy like Vladimir Putin?

If Pawlenty does stand by his statements and goes after Bachmann then he’ll be a-the guy who will go after a woman but not another man and b-the RINO squish who is attacking a tea party star. Also, you can bet Bachmann has a prepared response or two that will sting.

Pick your poison Tim but whatever way you go, it’s going to hurt.