Planet Utah

Uh...what?

I'm not sure what the hell is going on with Tim Pawlenty.

First, he can't bring himself to say that he's happy to have Olympia Snowe in the GOP. (With Republican members of Congress less popular than bone spurs, Pawlenty should be thankful for any national officeholder who's willing to admit he or she is a Republican.)

Next, he takes partial credit for Chris Christie's victory in New Jersey, saying he's "thrilled our historic team effort paid off." (This is like the kid who played triangle for the Patridge Family demanding an equal share of the royalties.)

Most recently, at a speech to a gathering of Iowa Republicans, he refers to his wife Mary as "red hot, smoking." (You want to know how that went over? Imagine taking a date to a Manhattan cocktail party and saying, "This is my fiancee, Mary. She was George W. Bush's liaison to the pro-life community.")

I used to like Pawlenty because he seemed like a straight shooter. But a straight shooter who's politically tone deaf is just an embarrassment.

One last thing to remember about health care reform

I don't expect to be blogging much about health care reform in the next few weeks. The reason? Unless someone drops an interesting amendment and it passes, I think the substance of the assorted policy proposals has been discussed to death--here and elsewhere. At this point, therefore, the only thing that remains to be seen is whether the Democrats will pass something.

If they do end up passing something, I think it's important that everyone understands the following: There are lots and lots of reasonable people--people who actually want health care reform to succeed, people who want universal coverage, people who aren't even particularly troubled by the idea of a public option--who believe, right now, in advance of anything happening, that reform of the sort that Democrats are talking about will: (a) put upward pressure on premiums, deductibles, and co-pays; and (b) make the federal government's fiscal situation worse, not  better. And we believe this not because "government screws everything up," not because "if government can't make Amtrak profitable, how is it going to run health care?", but for very specific reasons.

Just remember that fact five years from now when people like Barney Frank say, "Look, no one could have anticipated that insurers would...and that costs would...and that revenues would...and that state governments would...and that employers would..." Wrong. Lots and lots of people could have anticipated it, and did. They just weren't able to stop it.

Footnote: Of course, if skeptics turn out to be wrong, then we'll need to step up and admit it. And really, nothing would make me happier. I mean, if the federal government can expand coverage to everyone, improve the quality of care, end the most pernicious practices of insurance companies, and slow the growth rate of costs for both government and the consumer, all without pushing federal debt accumulation to an even higher trajectory, that would be the best news this country has seen in a long, long time.

Anklenote: There are lots of issues/problems that people are worried about with respect to reform. The two I've mentioned--consumer costs and federal obligations--just happen to be foremost in my mind.

Twenty years later, still no comeback

I was just reading a Washington Post article about the Berlin Wall coming down, which of course got me thinking about this: "Mr. Gorbachev, tear down this wall!"

That, in turn, got me thinking about great 1980s sound bytes, which leads one inevitably to Lloyd Bentsen's upbraiding of Dan Quayle: "...you're no Jack Kennedy."

That was a pretty devastating smackdown, and Quayle's response--a blank expression, followed by a scolding of Bentsen for engaging in rhetoric that was "uncalled for"--was lame. 

Over the years, I've tried to think of an adequate comeback--something that at least would diminish the sting, and even better, would put Bentsen in his place.

The best framework I've seen is something along these lines: "Fair enough, but at least I'm not...either," or a slightly different version, "Fair enough. I guess I should just be thankful I'm not...either."

The question is what name to put where the ellipsis is.

If you want to stick with the Kennedy theme, you could say, "Fair enough. I guess I should just be thankful I'm not Teddy, either."

That might be considered more of a cheap shot at Teddy, though, than a real zinger. And given that Quayle and Kennedy were Senate colleagues, it probably wasn't a realistic option. Plus, it doesn't put Bentsen in his place.

And what would put Bentsen in his place? Well, at the time, the knocks against him were that: (a) he was too old to be VP; and (b) he was a typical Washington insider, peddling influence in exchange for campaign contributions. Ideally, then, Quayle could have said, "Fair enough, but at least I'm not so-and-so, either," with the so-and-so being someone old and/or corrupt, someone to whom Quayle would have been comparing Bentsen.

Twenty years later, I still haven't come up with a good so-and-so.

Footnote: This one's always been fun to fantasize about: "Then I guess you won't have to worry about me boning John Gotti's girlfriend."

Health care: what's in it for me?

I'm a member of the second most put-upon group when it comes to health care: individuals who do not receive their health care through the government or an employer, and who must purchase it themselves from a private carrier. The only group in worse shape than mine is people who don't have health insurance at all. But, while it's clear how reform will help those people--they'll have coverage they didn't have before--it's not clear how reform will help people like me.

There are three arguments on that score.

First, there's the argument that insurers will no longer be able to deny coverage based on pre-existing medical conditions, nor will they be able to rescind policies based on technicalities.

This is definitely good stuff (other things being equal, an assumption I will address in a moment). I've had my insurance for almost 10 years, and I developed some serious health issues a couple of years into my policy term. I can tell you from experience that because of those health issues, I can't get coverage from a new insurer (or even change policies with my existing insurer). I'm a bad risk; one that insurance companies don't want to take. And who can blame them? They're in business to make money.

The consequence for me, though, is that I'm stuck with the policy I've got, like it or not. If the government changes the rules, I'll be able to switch policies, even switch companies, if I think that would work better for me.

HOWEVER, I'd expect the new policy to cost me much more. It's simple business; if insurers are required to take everyone who comes in the door, sick or healthy or somewhere in between, then they are going to be paying out more to health care providers; if insurers are paying more to health care providers, they're going to have to charge more in premiums, co-pays, and deductibles to cover those new costs.

So, for people like me, there's an upside and a downside. The upside is that I can change policies and companies whenever I want. The downside is that I'll be paying an as-yet-undetermined premium for that privilege. Would I be willing to pay $75 more per month for the privilege? Probably. How about $250? No. So, whether or not reform turns out to be a good deal for me depends on how much my costs go up. 

As far as costs go, keep in mind that the requirement that insurers take all comers isn't going to be the only thing creating upward pressure. Insurance companies will have to stop selling policies that don't meet the new federal standards for coverage, and will have to upgrade the list of covered services. That will add to insurer costs, which means it will probably add to my costs. Bringing tens of millions of new consumers into the system will shift the demand curve to the right, while the supply curve remains stable--at least in the short run. That will probably add to medical provider fees, which in turn will add to insurer costs, which means it will probably add to my costs. Finally, if the government does succeed in carving some savings out of Medicare reimbursements, medical providers may seek to make up those losses by charging private insurance patients more. Again, that looks like it will make my wallet skinnier, not fatter.

The second argument has to do with subsidies: "Well, your costs may go up, but the government will be subsidizing those costs under the reform law, so your net costs--including the subsidy--might actually go down."

Subsidies, however, only apply to people whose income is up to 300% of the poverty line. And even for that group, no one is sure whether the amount of the subsidy will be large enough to offset any increase in the cost of insurance. For me, though, that's a moot point. I don't qualify for a subsidy.

The third argument is that state insurance exchanges will foster competition in the market, which will bring down prices.

That might be true in some places, but I live in Texas. I just did a quick request for health insurance quotes for someone in my demographic (43 years old, non-smoker, 78741 zip code, movie star looks, etc.), and I got back estimates from nine companies offering a total of 134 plans. Do I need any more competition than this?

I don't know how typical my case is, and I'm certainly not basing my appraisal of health care reform solely on whether or not it's good for me. But if I had to guess about the consequences of reform, my guess would be that: (a) it would bring a lot more people into the system, which is good; but   (b) it will accelerate health care cost increases for both government and the private sector (especially people like me, who don't have any leverage because we're not part of a group); and so (c) we'll have to reform health care all over again within about five years, once it's clear that the costs are going to bankrupt us much more quickly than we thought.

A balanced budget amendment, reluctantly

Some time late last week I heard the camel's back snap. I can't point to a particular straw that caused it, but I know it was something in the combination of: (a) Democrats' apparent determination to go forward with a new health care entitlement the country can't afford; (b) the decision to override Social Security's COLA formula and give seniors a $16 billion increase in their allowance (because there's been no inflation this year, sticking with the COLA formula would have meant no boost in seniors' monthly check--God forbid their income should stay flat when their cost of living stays flat); and (c) the move to (yet again) defer scheduled cuts in doctors' reimbursements under Medicare, even though those cuts are supposed to provide about one-quarter of the cash to finance health care reform.

Somewhere in the midst of all of this, I said, "There are no statesmen/stateswomen left. Our politicians are NEVER going to get our country's fiscal situation under control unless we, the people, make them."

So, I started looking around at different ways I could get involved and try to make a difference. There are lots of do-gooder organizations such as the Concord Coalition, the Committee for a Responsible Federal Budget, and the Peter G. Peterson Foundation that have been on this issue for a while. That's my concern, though...they've been doing their thing for years, but the problems they're trying to address are worse than ever. God bless these groups for trying, but their inside/outside strategy (lobbying policymakers, educating the public) somehow isn't getting the job done.

And why not? Because there are hard choices to be made in which the costs are clear, immediate, and concrete, and the benefits are unclear, distant, and abstract. These are the kinds of choices that politicians hate to make, and will avoid making if at all possible.

Recognizing that, I ended up here. The only way to force politicians do the hard thing is not to give them a choice, that is, to require that the federal budget be balanced.

I say this reluctantly because: (a) I don't like messing with the Constitution; (b) a balanced budget amendment is a very blunt instrument; and (c) any reasonable amendment will have "opt out" language that politicians may very well abuse.

But I don't see any other way, do you?

Footnote: It's not supposed to be easy to get an amendment to the Constitution considered, let alone passed, but the easiest way is to have Congress refer the amendment to the states. Why, though, would the same members of Congress who would vote against the spending cuts and/or tax increases needed to balance the budget vote for a balanced budget amendment? Voting for spending cuts and/or tax increases is not rewarding politically, for the reasons noted above: The costs are clear, immediate, and concrete. Voting for a balanced budget amendment, on the other hand, is all benefit and no cost: You show yourself to be committed to fiscal responsibility without actually having to vote for specific cuts or tax hikes. Then, if the amendment actually clears the states and you have to vote for tax hikes and/or spending cuts, you can say to aggrieved constituencies, "What choice did I have?" You've got political cover that wasn't available before.

Susan Collins making a ridiculous amount of sense on health care

Sen. Susan Collins from Maine is your classic "squish," the kind of Republican that conservatives don't like and don't trust (because she does things like vote "aye" on the stimulus bill). She's also among the last of a dying breed: Republican members of Congress from the northeast. For both reasons, she's not in the mainstream of the GOP congressional caucus. And for that reason, I've never paid much attention to her.

Today, however, I ran across this video clip of her talking about health care reform. I'll be damned if she didn't say exactly the sorts of things I think Republicans ought to be saying.

This is potentially important for two reasons. First, she and Olympia Snowe are the Democrats' favorite Republicans. These are people that the left takes seriously, rather than dismissing them as "wing nuts." I expect that the Dems will try to win Collins' vote on their Senate bill. If that's the case, maybe she can have some positive influence.

Second, Sen. Collins is probably smack dab in the middle of the ideological distribution within the U.S. Senate. To get to 60 votes on health care, the Senate will need a big chunk of senators sitting in the center, right next to Collins. If what she says in the video is broadly representative of what Senate centrists think about health care reform, maybe Democrats will have to come even further to the center/right than I was hoping.

Footnote: The one thing I wish Sen. Collins would have said in the video is that, based on recent congressional history, the proposed Medicare cuts are unlikely ever to take place.

Watch for this development

In a recent column, Dick Morris described the features of health care reform that would sharply increase insurance premiums. He then wrote this: "And who do you think the voters will blame for the hike in their premiums? The Democrats who passed the bill."

Actually, I think voters will blame the insurance companies. (I mean, come on. You think Joe Sixpack is going to open up his insurance bill this time next year, see a much bigger number, and say, "God damn that Harry Reid!"?)

The next thing that will happen, of course, is that Congress will haul health insurers before assorted committees and say, "Explain yourselves, price gougers!" The more courageous among the insurers will say, "With all of the new mandates and taxes you passed in 2009, we're looking at a dramatically increased cost of doing business. When that happens, we have to raise premiums."

And what do you want to bet that not a single Democratic member of Congress will hear that and say, "Oops."?

The rumors are true...and not that upsetting, really

I had heard about Britain's National Health Service assigning a dollar value to human life, but what I heard sounded dramatically oversimplified. It went something like this: "If it costs more than $45,000 to save your life, they won't do it. If it costs $45,000 or less, they will."

Well, this is how Time magazine describes things:

Is it true that NHS bureaucrats put a price tag on life?
The short answer is yes. The NHS has a body called the National Institute for Health and Clinical Excellence (NICE) that decides which new treatments and drugs the NHS should pay for. One of the factors NICE considers when deciding whether to approve funding for a new treatment or drug is cost-effectiveness. To determine the dividing line between what is cost-effective and what isn't, it must set a threshold. Taking its lead from Britain's Department of Transport — which has a cost-per-life-saved threshold for new road schemes of about $2.2 million per life, or about $45,000 per life year gained — NICE rarely approves a drug or treatment that costs more than $45,000 per life year gained. In short, NICE does not want the NHS to spend more than $45,000 to extend a citizen's life by one year.

At first blush, that seems very disturbing...but what's the alternative, really? More from Time:

While NICE's decisions have angered some doctors and patient groups — particularly some oncologists who say they are unable to prescribe expensive, life-extending cancer drugs — mainstream politicians, the media and most Britons accept NICE's rare rejections as a necessary compromise to keep universal coverage affordable in the face of rising health-care costs. As NICE chairman Sir Michael Rawlins recently told TIME, "All health-care systems have implicitly, if not explicitly, adopted some form of cost control. In the U.S., you do it by not providing health care to some people. That's a rather brutal way of doing it."

He's right, though there are a couple of other ways around this. First, you can cover everyone and not impose the kinds of cost controls they have in the U.K., if the government doesn't do much else. The feds would have to say, basically, "We can afford national defense, the Post Office, unlimited healthcare for everyone, and that's it. If you need anything else, you'll have to provide it yourself, or talk to your state government, your employer, your friends and family, or private charity."

The second option, suggested here, is a dedicated health care tax. The revenue generated by the tax would establish the limits on how much health care the government could buy. If people wanted more health care, they could urge their representatives to raise the tax. If people thought the tax was too high, they could urge their representatives to lower it--recognizing, though, that the government would then have to buy less health care. This would be just another form of rationing, but at least the public would have a voice in it.

Why Harry Reid?

Is this guy really the best that Senate Democrats can do? He called George W. Bush a "liar" and a "loser." He said that Alan Greenspan was a "political hack." He said that Capitol Hill tourists smell. He said that town hall protesters were "evil mongers." And, worst by far, he said very publicly that the Iraq War was lost. (That was a rare, single-statement hat trick for Reid: demoralize our troops, encourage our enemies, and make the wrong call on the most important foreign policy issue of our time.)

Even if, for some crazy reason, the Democrats think Harry Reid is good for them, they might want to think about whether keeping him as majority leader is good for America.

"This year's prize for military action without U.N. approval goes to..."

After yesterday's shocking Nobel Peace Prize news, it occurred to me that conservatives like me ought to just shut up and start our own, competing prize (maybe the Ronald Reagan Peace Through Strength Prize). We've done that in other areas: the Bradley Prizes, Fox News, the Washington Times, George Mason University, talk radio, the Heritage Foundation, Charlton Heston, SUVs, peanut M & Ms, and so on. So why stop there? Any prominent institution, organization, ceremony, association, WHATEVER, with a leftist bent should have a counterpart on the right. (I've long thought, for example, that there should be a Hollywood movie studio devoted solely to family fare, films with religious/conservative themes, and documentaries about how fat Michael Moore is.) And then, whenever their lefty counterparts are getting ready to do their thing, the conservative versions should do theirs...the day before.

Footnote: There's a legitimate strategic question here as to whether you want to have a conservative counterpart to everything liberal, or whether you want to have a centrist counterpart. If you have a conservative counterpart, you could make sure that conservatives get their say. If you have a centrist counterpart, conservative ideas wouldn't figure nearly as prominently, but you might enjoy more success in marginalizing the leftists. Tony Woodlief and big brains at the Bradley Foundation, I'm kicking this can over to you.

Anklenote: By the way, when do I get my Bradley Prize? I spent the money about five years ago.