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Imposing bureaucratic control on the expectation no one will understand you.
I’ve finally figured out what it is about liberals. They speak a different language. It’s a language not even meant to be understood by ordinary human beings but only by those in the know.
Let me tell you how I arrived at this. I read David Brooks’ column in the New York Times last week — he hasn’t completely succumbed to the Grey Lady yet — and Brooks suggested that anyone who wanted to “get fundamental” about healthcare should read a report called “Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth,” just put out by the Brookings Institution.
The authors have combed through the bills that are already out there. They’ve taken good ideas that are now in embryonic or neutered form. They show how the ideas would work if fully implemented.
So that’s what I did. The report is only 11 pages and accessible on the Internet.
Now let me say to begin that I know a little bit about healthcare. Fifteen years ago, in the middle of Hillary Clinton’s reform effort, I read John Goodman and Robert Musgrave’s Patient Power: Solving America’s Healthcare Crisis. The authors spelled out in clean and simple terms what was wrong with the health insurance system:
1) What we are calling “health insurance” is really pre-paid medical care. Existing company plans offer too much, giving first-dollar coverage for routine medical care. As a result, few players have any financial stake to conserve. Both doctors and patients are spending other people’s funds — insurance companies’, corporate health plans’, or ultimately taxpayers’ money.
2) Unions and large businesses have long collaborated in setting up a system where they are able to provide health insurance as a tax-free job benefit, giving large-company employees a huge advantage over people who have to buy insurance on the open market.
3) Since regulation of the insurance industry was given to the states in the McCarran-Ferguson Act of 1945, the states have limited competition and balkanized the system so that no national market for health insurance really exists.
4) At the state level, health provider groups — especially fringe therapies and techniques — have lobbied hard to get their practices mandated coverage. Chiropractors are always the bellwether. In the 1990s, New York State chiropractors gave Governor George Pataki a huge testimonial dinner after he got chiropractic mandated into insurance policies. This drives up costs because people have to buy coverage they don’t want.
5) The solution lies in deregulating insurance and getting everybody on the same level playing field. Give private purchasers the same tax advantages through tax-free “health savings accounts” that would allow them to buy real health insurance (with sizable deductibles and co-payments) and meet their routine medical expenses with tax-free money.
All this made absolute clear, logical perfect sense. I looked into the system and found it worked exactly the way Goodman and Musgrave described. (Fifteen years later, nothing much has changed.) I found the key was something that Goodman and Musgrave didn’t talk about at great length — the ERISA system (that stands for the Employee Retirement Income Security Act of 1973).
ERISA was one of those clubby little arrangements that big business and unions had set up for themselves with the help of Washington. After a few big pension funds went bankrupt in the 1970s, Congress decided to back all union pensions with federal money. Health benefits were thrown in because, as one bureaucrat told me, “the pension and benefit funds were essentially indistinguishable.” In order to make sure the federal government didn’t go bankrupt, Congress also threw something in saying “no state law shall become between a pensioner and his or her benefits.” That turned out to be important.
At the healthcare level, what this came to mean was that union health benefits were no longer subject to state regulation. Major companies could set up insurance plans without being burdened by mandates to include chiropractors, social workers, Rolfing therapists, and so forth. This made much insurance cheaper. The only problem was you couldn’t buy the insurance from an insurance company. Instead, companies had to self-insure, setting up their own risk pools, in order to avoid state regulations. Only the big companies and their unions could do this. So by the 1990s, 95 percent of corporations with more than 500 employees had ERISA plans.
Then the most amazing thing started to happen. As the states began to set up high-risk pools for the sick and the uninsured and pay for them by taxing private health insurance, ERISA plans argued they were exempt! Making contributions to a state high-risk pool would “come between the pensioner and his pension.” So all the costs of covering unhealthy people with pre-existing conditions fell onto people outside ERISA’s magic circle and buying in the private market. As a result, private insurance became even more insanely expensive.
What you had, then, was the two-tiered system you still have today — people in ERISA plans who get a whole variety of breaks and exemptions and people buying insurance on the private market and forced to carry all the extra burdens imposed by the states. It wasn’t even close. Someone in an ERISA company would pay $1000-2500 a year for coverage that would cost close to $10,000 on the open market. Yet nobody paid the slightest attention. At one point the New York Times editorial page was writing mealy-mouthed editorials of how health savings accounts should not be allowed because “they would enable healthy individuals to avoid the costs of paying for unhealthy people through high-risk pools and community ratings.” The editorial, of course, was written by editors who had all of the above exemptions through ERISA.
A man of faith in a godless age is hitting Americans where it hurts.
Mr. and Mrs. American Spectator Reader, let P.J. O’Rourke talk sense to your kids.
In Britain, defending your property can get you life.
The debacle of this president’s administration is both a cause and a symptom of the decline of American values. Unless Congress impeaches him, that decline will go on unchecked. An eminent jurist surveys the damage and assesses the chances for the recovery of our culture.
It won’t take long for conservatives to scratch this presidential wannabe off their 2008 scorecard.
The American Christmas, like the songs that celebrate it, makes room for everybody under the rainbow. Is that why so many people seem to be hostile to it?
Was the President done in by the economy, or by the politics of the economy?