Tuesday, September 29, 2009
I'm off to Toronto for a long day, so blogging will be catch as catch can. I do, however, have three health care reform links to pass along. The first two were recommended to me as particularly influential or useful by a Washington lobbyist working the issue, and the last is the Atlantic cover story last month, which I have previously linked and thought was spectacular.
Bill Frist and Dick Armey have a good little debate going about the virtues of an individual mandate, as exemplified in their respective pieces in US News.
Frist makes a good argument for an individual mandate, focusing on the economic costs of not covering all citizens. In response, Armey argues the insurance industry would be the only party loving an indivdual mandate, and he also points out, in an obviously true rejoinder, that if the GOP compromised on a deal (as Frist argues in favor of), the compromise will not end the debate, but it will instead become the merely beginning of endless new debates, as Democrats compete into the future to see who can add legistatively required coverage to any agreement. The argument will go on forever. Or, as any good fiscally responsible person would tell you, it'll go on until we're bust.
The GOP argument is that entitlements already cost way beyond projected levels and are driving the country into the poorhouse. We simply do not have the money to pay for what we already do. Adding a new entitlement would be insane.
Moreover, any new entitlement would require taxes and the economy is teetering on the edge of a 1930's style drop into the abyss. Taxing whats left of the productive economy, to pay for the mother of entitlements, is nuts.
Lastly, conservative scholars have argued, any individual mandate is a Bill of Attainder and specifically prohibited by the Constitution. An amendment will be required to make any law reality.
Therein lies the compromise. If we're amending the Constitution, as we should if we're passing a mandate, then the coverage limits conservatives so justly seek can be included in the amendment. Not the specifics of tests, equipment etc (language that will, hopefully, be quickly outdated as medicine advances!), but a statement whose wording all sides can agree on that limits the mandate to the "catastrophic coverage" concept Frist advocates.
Then, to protect us against endless debate forever on this subject and continual legal efforts by advocacy groups to erode the limits through "legislation" from willing courts, all sides should agree that the Commerce Clause will be defined even more precisely than it already is, to refer only to actual commerce between two parties where money changes hands. That will close the loophole the Supreme Court has used in the past to expand all sorts of legislation, and will protect us from federal expansion of this compromise.
There is a compromise available, one that many Americans could support, and one the Blue Dogs would also support legislatively.
Even the president might be happy to support it, since it would give him the chance to get his signature legislation passed.
NRO published an unsourced claim that Medicare and Social Security are, taken together, more than $100 trillion dollars underfunded.
I had to type that out to see what a number that big looks like.
Anyway, that number doesn't include the unfunded liability for federal pensions, the unfunded liability for the Veterans or BIA health programs, the unfunded liability for health insurance for federal employees and probably a couple of dozen other federal benefit commitments.
Before the stupid Congress goes one step further I'd like them to let us, their loyal subjects, know how much they've already got us on the hook for.
With all compromises, though, you still have to deal with private sector issues. Among those is overuse of medicine, and I really recommend the aricle TH posted on "What a Texas town can teach us". Great piece.
It's worth noting that the elections in Germany signal a shift there to the right ... and that Japan has voted to re-shuffle their political deck entirely. Both have been dealing for years with the burden of an aging population -- which is what we're now facing. They got there earlier than us because of the demographic effects of WII. On a relative basis, their burden will always be heavier than ours.
I expect at some point we'll either shift to the right -- a Rudy in NYC mild fascism -- or totally shuffle the deck -- but it's unclear to me when and exactly how it'll play out -- timing is everything.
Right now we can expect years of no growth and high unemployment -- we would have had a rough patch anyway but Obama & Co are making it far worse. There is no light at the end of Obama's tunnel. I expect unemployment to stay at or over 10% -- especially after the sugar rush of 2010 ends. Like the old joke about "European Heaven and Hell," we seem intent on copying different parts of the European model but we only pick the ones that suck -- including permanent double digit unemployment. Can the Republicans hang unemployment on Obama? Developing ...
The bill of attainder concept shouldn't be relevant here at all. If you want to throw someone in jail for not buying insurance, you just need to provide a right to trial for it to be constitutional. The fact that jail threats are in draft bills at all is more concerning ... Congress is worried that a million -- or even ten million of us -- may purposefully flout the law.
Back in the 1930s Social Ssecurity was redrafted to be a tax and spend "pay as you go" program to pass muster constitutional muster. It was upheld as constitutional because beneficiaries have no vested rights -- hence it's not insurance ... because it's a tax!. That's why the draft version of the healthcare individual mandate is literally an amendment of the Internal Revenue Code.
I can't see the current Supreme Court overturning any healthcare legislation that's well-drafted. Even Scalia's a whore for federal power.
The $100 trillion number is unrealistic. Things will blow up long before we hit 2070 or 2100 on current trends. We can afford Social Security, and we can afford our current levels of collective spending on healthcare. But we can't afford the growth rates. Expanding coverage as the Democrats want is insane. If we want to cover more people, then we have to scale back what they get. If we care about our kids and our nation we need to do this. I'd sign on to the idea that past 75 all you get is the nurse of your choice and all the morphine (Viagra?) you want. We're a rich country but we're already broke in the sense that we can't tax our way out of the deficits we already have coming over the next decade. Congress needs to cut spending dramatically but won't.
The canary in the coal mine for where we're headed is the Big Three auto companies. They were managed to cover their pension/healthcare nut -- not to make the best cars at the most profit -- and look where it got them.
First there needs to be an amendment to the Doctor's Oath, something along the lines of I will not put my profits above the welfare of my patients nor the Medical Community.
Second it needs to be understood that private individual efforts will always produce better results than government efforts or programs.
Can you see the addition of dozens upon dozens of more government agencys to administer or regulate Health care would actually make it better or cheaper for anyone?
Look at any of the other dozens of government agencys and how they spend billions every year to no good result and to the determent of Americans in most cases.
Look at the VA health care. If you think it is good or acceptable, you don't know any Vets.
The Medical community needs to hire it's own cops to keep the doctors and insurers in line. The government needs to spend it's time and money in the administration of Medicare and Medicaid in making sure that the Medical community is doing it's job of keeping crooks and malpracticers out.
And laws regulating tort need to be updated and expanded, but not to the extent that quacks can kill you and get away with it.
There needs to be competition among the medical communities. Towns and cities need to advertise and boast of the best facilities, doctors and home health care, and make it so.
But the last thing we want is what Obama and Congress are going to shove in whatever orifice that they can.
Talk about timing, I just got this in an email:
Congress must think we are morons.
The U.S. Postal Service was established in 1775 - you have had 234 years to get it right; it is broke.
Social Security was established in 1935 - you have had 74 years to get it right; it is broke.
Fannie Mae was established in 1938 - you have had 71 years to get it right; it is broke.
War on Poverty started in 1964 - you have had 45 years to get it right; $1 trillion of our money is confiscated each year and transferred to "the poor"; it hasn't worked.
Medicare and Medicaid were established in 1965 - you've had 44 years to get it right; they're broke.
Freddie Mac was established in 1970 - you have had 39 years to get it right; it is broke.
Trillions of dollars in the massive political payoff called the TARP bill of 2009 shows NO sign of working.
So with a perfect 100% failure rate and a record that proves that " services" you shove down our throats are failing faster and faster, you want Americans to believe you can be trusted with a government-run health care system? 15% of our economy? Are you crazy?
Truly, the wheels have come off the trolley and the trolley's off the tracks. ITS BROKE.
"First there needs to be an amendment to the Doctor's Oath, something along the lines of I will not put my profits above the welfare of my patients"
Such a clause is already in there in the "modern" verion of the Hippocratic Oath. To wit:
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
Of course, the modern version dropped the clause forbidding abortion and euthenasia, although the version that I took at Hopkins in 1975 still had those restrictions in there. A few people in the class refused to take it. Most of us thought they were assholes.
I still do.