The American Spectator

Alan Brooks| 3.24.09 @ 8:49PM

well, I lost all respect for Dubya and his clotheared, moonbooted Republicanism when he said in Canada last week:
"Obama deserves my silence". that is nonsense--
From The Toilet:
like saying "Laura deserves my Chicken McNuggets"

Alan Brooks| 3.24.09 @ 10:42PM

"I care more about my country than politics"

pshaw, the Shrub cares more about his acres in Crawford than he does about America. Maybe what the Bushclone MEANT by 'country' is his rural acres.

Bob| 3.25.09 @ 10:04AM

First of all, let me say that Obama's budget is too large and we should not have done any of the bailouts. On the other hand, Philip, it is just dumb to say "all of his magical health care and energy savings will kick in, in the fairytale future.".

If you've ever really looked at our country's competitiveness, you will notice that there are three big, long term issues we must address: infrastructure, energy, and healthcare. These will take decades to address and we need a plan. The "market" cannot address these as private enterprise can't accomplish the governmental requirements necessary. The Republicans ignore these things and have no alternative plan. Furthermore, if you've really taken a look at the budget, you'll notice in the out years it is medicare and medicaid that hurts more than any other item. In fact, if you add social security, these are 53% of the total budget. In 10 years this will move up to close to 60% of the budget as boomers retire (if they can). In fact, Obama's budget has a lower amount of discretionary spending than we've seen in recent history.

I don't hear Republicans talking about entitlement reform which is the only way to solve this issue and must be done. Healthcare is 16% of GDP and we compete against countries with costs at half of what we spend. We cannot be competitive in manufacturing and build jobs without significantly reducing health care costs.

These are the facts, Philip, and instead of just complaining, and short term thinking, why don't you get serious and talk about making a country where our children and grandchildren can survive and prosper?

Philip Klein | 3.25.09 @ 10:46AM

Bob, I agree that reducing health care costs is essential to getting the budget under control, but the important question is whether Obama's health care policies will be successful in reducing costs. I see no evidence of this. The price tag of his health care plan has been estimated at $1.5 trillion. Massachusetts, which tried a plan quite similar to the one Obama is proposing, is seeing costs explode. When I asked a top WH official to name one real life example in which the government saved money by expanding coverage, she couldn't. And it's unfair to say that I never offer solutions to these problems, I've done so repeatedly and at great length, but I can't reiterate my solution to the health care crisis each time I write a blog post while watching a live event. Also, Paul Ryan is a Republican who has come out with a comprehensive plan to solve the entitlements problem, but the media hasn't paid it any attention. See relevant links below.

On the $1.5 trillion number: http://www.washingtonpost.com/wp-dyn/content/article/2009/03/18/AR2009031800203.html?hpid=sec-health

On MassCare:
http://www.nytimes.com/2009/03/16/health/policy/16mass.html?hp

My exchange with the WH:
http://spectator.org/blog/2009/03/05/wh-official-declines-to-offer

My long article on health care, which offers an alternative reform vision:

http://spectator.org/archives/2008/08/21/learning-to-care-about-health

Paul Ryan's plan to solve the entitlements crisis:
http://www.house.gov/budget_republicans/roadmap3_roadmap_plan.shtml

Bob| 3.25.09 @ 2:19PM

Philip -- I've gone back and read your article. There are lots of problems with your "solution" -- but at least you've addressed it. Here are the big problems:

1. Free market solutions to insurance that require the high risk pool to be allocated are not workable. I worked in the group insurance business for a while. Margins are very thin and competition is based on the accuracy of the company census taken. If you now allocate a high risk pool to the insurance company, the cost for company group insurance will rise significantly. In essence, it is a transfer cost from government to private enterprise. Insurers will allocate this primarily to small businesses and entrepreneurs as large business group policies will no longer be competitive.

2. Tax incentives, vis-a-vis McCain, will not work from a pricing basis. When you price group policies for companies, you have a company history and company policies to lower costs. If you now allow employees to buy other policies, this changes the census and puts greater risk into group insurance rates as the very best risks will go outside of the company thereby increasing the per person cost of insurance. You need to talk to an actuary to understand this.

3. I could not find anything in your ideas that would enable preventative care among poor populations. One of the keys to lower health care costs is preventative care. Wealthy people get this care -- poor people do not. This stresses our health care system as the poor go to emergency rooms for care when the cost of treatment is several times what it would have been if preventative care was available. Emergency rooms are the most inefficient vehicles for medical care and are one of the main reasons our health care costs are too high.

3. Tort reform. Certainly this is the most possible alternative and I think we could agree on this.

4. The last year of a person's life is the most expensive. In fact, 50% of medicare costs are for people in their last year of life. In most countries, they let nature take its course. In this country, we keep people on machines, keep babies in expensive nurseries, perform tests that aren't necessary, and would rather see a person live on a machine than get off of that machine and have a good quality of life for the few days they have left. Can you convince social conservatives to let go? I doubt it.

I would move in a different direction. I would remove all employer based healthcare and let them provide a tax free payment to their employees to buy a healthcare plan on their own that the company would pay directly to the insurers. If an individual wanted a better plan, they could buy it. Then, I would also expand Medicare to be available to anyone at a breakeven price. However, I'd restrict medicare to preventative and basic medicine. People could buy a supplemental policy if they wanted more. Then people could choose which way they wanted to go and everyone would be covered -- at least at a basic level.

I would encourage you to study the Taiwan plan as it is the best that I have seen. It won't work precisely in the U.S., but they have a lot of good ideas already worked out and they provide care for everyone at less than half of the cost we have here.

There are lots of solutions to the entitlements issue but they all change eligibility ages and include means testing. Furthermore, the solution can no longer be regressive in nature as it is now.