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Wednesday, August 26, 2009

The Last Lion of the Senate

Ted Kennedy's life and work in the Senate, I hope, should be a lesson to its 'blue dogs' amok, that they will not be remembered by their countrymen, when they hold up progress.

Teddy was one of the few left who could 'take the floor'.

A few years ago he dusted-up the place on hate crimes, with an impassioned speech. Nothing you'd ever hear out of today's media-savvy, TV-conscious soundbiters. The bulk of that is not on youTube, but the introduction of the bill is:

Here is Kennedy, with words that seem prophetic given what we now know about how far King George "The Decider" was willing to go:

The Economics of the New Healthcare

Paul Krugman says it's Switzerland, more or less, that's on offer. I understand the point.

Yet, under the new scheme, what keeps healthcare companies, profit maximizers, from hiking their prices?

Afterall, you see the proposal to drop inter-state regulations for insurance companies. So, could we end up with an American healthcare oligopoly? We dropped inter-state bank regs and got giant banks. How'd that work out? (I mean, will Bernanke's Fed drop a study comparing all the putative consumer cost savings of bank mega-mergers with the cost of the our current bank-oriented bailout, priced in trillions, now, in deficit and lost output?).

Compare also how telecom deregulation helped consumers, with fierce, beneficial price competition. Today's Comcast price of phone-internet-TV: $109/month. Today's FIOS price of phone-internet-TV: $109. Yes, that's right, there is no price competition at all going on, at least in my local market. (Out of pocket European costs are a fraction of that, so ...).


Well, if everyone is forced to buy your insurance product, then it stands to reason you put all your profits into marketing, until you reach an oil-market like cartel power with just two-or-three other providers. Large companies will buy from the largest insurers - we wouldn't expect "IBM" to buy insurance from a new entrant to the market, with a low price. That behavior will hasten the path to consolidation, one could argue (unless large accounts are profitless for health insurers - I don't know). What's more, instead of paying for healthcare, consumers will be paying for ... insurance marketing. (!)

Maybe I'm wrong. Afterall, Switzerland does have many sellers of basic insurance.

But, they tier the market and charge based on 'individual risk' for all tiers, including the right to refuse insurance beyond the "basic sickness" contract. Put another way, there seems to still be a Swiss role for insurance companies to compete on how well they manage their risk pools.

Change needs to come, and these questions are not a clear indictment of HR3200.

Maybe it is a non-issue, because it is already an issue? For the small business, they already face significant oligopoly (someone should brief Kathleen Sibelius on just how little competition there is in this critical marketplace, one that everyone seems to target):

The five largest [insurance] carriers, when combined, represented three-quarters or more of the market in 19 of the 34 states supplying information, and they represented more than 90 percent in 7 of these states.

Better minds than mine, hopefully, have been in on designing what looks like a minimum standards health contract, that will pass for 'systemic reform'.

But, it would pay to have leading economists (and lawyers) give an idea of how they think insurance companies will respond to changes in their regulatory environment, of the kind proposed. At a minimum, it would be nice to know whether premiums really will come down in the near term, under the proposed give-get.

Last, if running an American health insurance oligopoly is the price to pay for universal care (10% of the total US healthcare bill is hundreds of billions), it would be nice to see that there is some thought to how that formulation actually drives administrative costs out of the system ...

Monday, August 24, 2009

Secular Mullahs Among Us

Christopher Hitchens has provided great fun, skewering what he often calls the charlatans of the Christian faith, money grubbers who set themselves up in the worst possible ways. Dawkins isn't far behind.

But, keep an eye out for the secular mullahs, the secular charlatans, too.

They exist.

Look at this 'birther movement' closely. Have a look at how the regional Republican party is able to ... er, transcend fact-based analysis, on so many topics ('death panels', murderous immigrants stealing healthcare benefits, ...). They can even mobilize an army of 'believers', of quasi brown shirts, pretending to be independently motivated, concerned citizens at town hall meetings. (It wasn't just Roman emperors who paid for crowds, clearly).

There are plenty of secularists who are willing to exploit ignorance and superstitions. One doesn't have to single out the faith community or imply that it contrasts with a better world, one lead by 'secular reason'. It's plain that's an incomplete comparison, n'est pas?

Give and Get: A Mandate For a Public Plan


In the House Bill 3200, everyone will pay for healthcare. Those 'voluntarily without' will be taxed. The full power of the government will be used to collect money from them - you cannot discharge taxes or escape the taxman.

...if you are going to force people to have a plan - or to pay taxes if they do not - you should at least give them a high-quality, public, not-for-profit plan to choose,
It seems to me if you are going to force people to have a plan - or to pay taxes if they do not - you should at least give them a high-quality, public, not-for-profit plan to choose, even over their employer provided under-insurance plan. That's the real give-get.

Otherwise, you are just passing out big treats to the wealthy, who will no longer be subsidizing hospital care for the have-nots, and to the insurance companies, who will get a huge boost in enrollments, from the government mandate (as well as an implicit profitability guarantee from forced buyers).

If there are Senators, like Leiberman, who cannot stomach doing that, if one wants to 'start small' as Hillary once opined, but with reasonably big and far-reaching impact, then just start with dental. Offer up a public dental plan that everyone can opt into, re-directing their employer dollars, if they choose. The plan should refuse none and provide at least as good dental as the Senate gets, in terms of caps and co-pays.

The cards will fall in line after that.

Hey, a small, on-target start is better than a bad plan, I think.

The Democrats should be fighting for consumer choice, no matter how much some of them have forgotten. Something like what I've described would really put The People in charge of their healthcare.

Sunday, August 23, 2009

Bush Moves Beyond Dereliction of Duty

Someone needs to get Christie Todd Whitman and Tom Ridge in a room together.

For a long time, the worst charge that could be leveled against the Bush administration, including Rumsfeld, was dereliction of duty, for their lack of "A Plan for a Future Iraq". (Paid for in American lives, including the dereliction in Afghanistan, btw).

I doubt many seriously believe that Christie Todd's EPA was going to be allowed to shut down a good part of lower Manhattan. But she should talk to Tom Ridge and see if they can't have a confessional tour, given that Ridge is suggesting that the Administration was indeed interested in subverting the functions of government to political ends, in some of the worst possible frauds on the public.

They outsourced torture. They outsourced assassination, possibly.

And George the senior honestly thinks his son served or was serving honorably. The mind boggles.

Just as the National Security Archives are revealing what Nixon was doing to undermine Chile, perhaps someday we will also find out what Bush authorized for Venezuela.