In Washington, it seems history always repeats itself. That's what's happening now with health-care reform. This is an unfortunate turn of events for Americans who are legitimately concerned about the skyrocketing cost of a basic human need.
In 1993 and 1994, Hillary Clinton's health-care reform proposal failed because it was concocted in secret without the guiding hand of public consensus-building, and because it was a philosophical over-reach. Today President Barack Obama is repeating these mistakes.
The reason is plain: The left in Washington has concluded that honesty will not yield its desired policy result. So it resorts to a fundamentally dishonest approach to reform. I say this because the marketing of the Democrats' plans as presented in the House of Representatives and endorsed heartily by President Obama rests on three falsehoods.
First, Mr. Obama doggedly promises that if you like your (private) health-care coverage now, you can keep it. That promise is hollow, because the Democrats' reforms are designed to push an ever-increasing number of Americans into a government-run health-care plan.
If a so-called public option is part of health-care reform, the Lewin Group study estimates over 100 million Americans may leave private plans for government-run health care. Any government plan will benefit from taxpayer subsidies and be able to operate at a financial loss--competing unfairly in the marketplace until private plans are driven out of business. The government plan will become so large that it will set, rather than negotiate, prices. This will inevitably lead to monopoly, with a resulting threat to the quality of our health care.
Second, the Democrats disingenuously argue their reforms will not diminish the quality of our health care even as government involvement in the delivery of that health care increases massively. For all of us who have seen the Federal Emergency Management Agency's response to hurricanes, this contention is laughable on its face. When government bureaucracies drive the delivery of services--in this case inserting themselves between health-care providers and their patients--quality degradation will surely come. House Democrats seem willing to accept that problem to achieve their philosophical aim--the long-term removal of for-profit entities from the health-care landscape.
Third, Mr. Obama's rhetoric paints a picture of a massive new benefit that will actually cost average Americans less than what they pay today. The Democrats want middle-class taxpayers to believe they won't feel the pinch of this initiative, even as their employers are assessed massive new taxes. They might as well try to argue that up is down. The analysis of the Democrats' proposal by the Congressional Budget Office shows that it will not reduce government spending on health care, and that it will substantially increase the federal deficit--and this despite all the tax increases.
I served in the U.S. House with a majority of the current 435 representatives, and I am confident that if given the proper amount of legislative review, they will not accept the flawed Pelosi plan that is currently stuck in committee. Yet there is general agreement among Republicans and Democrats that we need health-care reform to bring costs down. This agreement can be the basis of a genuine, bipartisan reform, once the current over-reach by Mr. Obama and Mrs. Pelosi fails. Leaders of both parties can then come together behind health-care reform that stresses these seven principles:
Consumer choice guided by transparency. We need a system where individuals choose an integrated plan that adopts the best disease-management practices, as opposed to fragmented care. Pricing and outcomes data for all tests, treatments and procedures should be posted on the Internet. Portable electronic health-care records can reduce paperwork, duplication and errors, while also empowering consumers to seek the provider that best meets their needs.
Aligned consumer interests. Consumers should be financially invested in better health decisions through health-savings accounts, lower premiums and reduced cost sharing. If they seek care in cost-effective settings, comply with medical regimens, preventative care, and lifestyles that reduce the likelihood of chronic disease, they should share in the savings.
Medical lawsuit reform. The practice of defensive medicine costs an estimated $100 billion-plus each year, according to the American Academy of Orthopaedic Surgeons, which used a study by economists Daniel P. Kessler and Mark B. McClellan. No health reform is serious about reducing costs unless it reduces the costs of frivolous lawsuits.
Insurance reform. Congress should establish simple guidelines to make policies more portable, with more coverage for pre-existing conditions. Reinsurance, high-risk pools, and other mechanisms can reduce the dangers of adverse risk selection and the incentive to avoid covering the sick. Individuals should also be able to keep insurance as they change jobs or states.
Pooling for small businesses, the self-employed, and others. All consumers should have equal opportunity to buy the lowest-cost, highest-quality insurance available. Individuals should benefit from the economies of scale currently available to those working for large employers. They should be free to purchase their health coverage without tax penalty through their employer, church, union, etc.
Pay for performance, not activity. Roughly 75% of health-care spending is for the care of chronic conditions such as heart disease, cancer and diabetes--and there is little coordination of this care. We can save money and improve outcomes by using integrated networks of care with rigorous, transparent outcome measures emphasizing prevention and disease management.
Refundable tax credits. Low-income working Americans without health insurance should get help in buying private coverage through a refundable tax credit. This is preferable to building a separate, government-run health-care plan.
These steps would bring down health-care costs. They would not bankrupt our nation or increase taxes in the midst of a recession. They are achievable reforms with bipartisan consensus and public support. All they require is a willingness by the president to slow down and have an honest discussion with Americans about the real downstream consequences of his ideas. Let's start there.
#1
This article does not mention the unmet prior commitments by the gov't to financing health care for some beneficiaries. Fundamental reforms necessary before the gov't bites off yet more than it can chew: (1) stabilize Medicare financing for the next 20 years (2) adequately fund & support the Indian Health Service (3) odds & ends such as replacing the VA hospital at New Orleans, closed & forgotten since 2005. I'm sure there are many other neglected reforms.
#4
There is no magic formula to make top quality health care available to everyone. The one thing that is certain is that any attempt by government to create one such magic formula is doomed to fail.
If they are really serious in improving health care they will cut the elephant up into chewable - and understandable - bites. Some bite-sized pieces I would suggest would include:
1) Price transparency - the buyer should be able to know ahead of time what the price would be and be able to compare prices.
2) (More) local 'store-front' clinics offering basic services for basic prices (and I'll even subsidize as long as there is some co-pay.) And have them substitute for expensive Emergency Rooms for Emergency Room triage.
3) Increase the supply of medical products and services, especially at the low end. Maybe de-monopolize accreditation and certification. Offer more strings-attached scholarships.
4) Prohibit conflict-of-interest ownerships and partnerships between labs, hospitals and doctors.
5) Malpractice reform.
Some of us had said it all along: Obama would be little better than Bush for Pakistan -- regardless of how he may be for the rest of the world. And so far we have seen nothing to prove us wrong! It is not just the recycled politicians he has surrounded himself with, it is also the old-wine-in-new-bottles' policies he is dishing out. The sheer arrogance of the US political mindset seems to cross all party lines. Therefore it should not have been surprising to find Obama try and suddenly seek the moral high ground over the issue of the Taliban releasing the video of their American military prisoner.
Obama thundered away that releasing the video was against all norms of international law and that it revealed the barbarity of the Taliban. What a farce! So the US has rediscovered international law again, but what about the prisoners displayed in shackles at Guantanamo Bay? Was that not against all international law and even minimal civilised behaviour? What about renditions and the prisoners suffocated to death in airless containers? What about the Bagram base prisoners? In fact what about Abu Ghraib and the growing privatisation of security by the US in Iraq and Afghanistan which allowed the firm Blackwater to give vent to all its seemingly pent-up psychotic anger against Muslims since 9/11? Were, and are, these activities on the part of the US state not against all international law? And then there are the US drone attacks on Pakistani territory which is as clear a violation of the principle of state sovereignty as ever there was -- unless the US has declared war against this hapless country? Or is Obama remembering international law selectively?
Yes, certainly parading prisoners of military conflict is against the laws of war but the US has set new standards of abuse of these laws in all the instances mentioned above so why should it expect the Taliban to observe the moral high ground in the Afghan conflict where many Pushtuns see the US as an occupying force regardless of what some foreign-based Pushtun origin analysts may state! As a child I remember the memorable words in the book, "The Water Babies": do as you would be done by. Perhaps it should be compulsory reading for all Americans aspiring to become politicians.
The Water Babies? Seriously? That's like basing foreign policy on Winnie the Pooh or Mary Poppins! Really -- I've read them all, and absolutely nothing in any of them applies to the byzantine self-destructiveness of Pakistan. Not even, in another example of the same period and literary genre, Peter Pan's famous Captain Hook.
While on the issue of international law that Obama seems to have suddenly discovered, let us not forget the recent revelations about the US assassination squad created under the previous Vice President Dick Cheney, which were not under the CIA has had been the case when such squads had existed earlier. Instead, Cheney had placed the squad under the Joint Special Operations Command (JSOC) in the Department of Defence --which is why it was being compared to the Vietnam War's Phoenix Programme in which Vietcong leaders were identified and then assassinated. Now Obama has appointed General McChrystal from the JSOC to Afghanistan so he is almost going overt with these assassination squad operations. Some of us have been writing for some time about small odd groups of Americans attempting to look like locals in terms of dress and beards roaming around the Tarbela area and Balochistan so one really will need to examine very carefully cases of targeted killings in Pakistan. But for more on the assassination squad and its linkages to the US military one can read up the Wayne Madsen Reports. Suffice it to say, that this is simply one more instance of the US simply bypassing all norms of international law.
Clearly the Americans are suffering from an overdose of arrogance, especially when it comes to Pakistan and Afghanistan and no one exemplifies it better than Holbrooke who shows no interest in learning anything about Pakistan or its people, but comes over far too frequently to push our compliant leaders into doing US bidding or simply to show the imperial colours. While Hillary Clinton happily agrees to sell all manner of hi-tech offensive weapons systems to India as well as agreeing to two nuclear power plants' sites to built by US firms, we are being short changed again by the US even as our soldiers are being compelled into the quagmire of FATA to match the US/NATO mess up in Afghanistan.
However, we have no one but our leaders to blame for their continuing subservience to the US. It seems the only thing they ever seem to learn is the arrogance displayed by Washington, so that even as they bow before Yankee diktat, they treat their own nation with an arrogant disdain. This seems to have little to do with whether we are being ruled by a dictator or a democrat -- especially in the post-9/11 environment. Musharraf's blustering was attributed to his "commando" fixation, but what about our present set of democratically-elected rulers? We have a president who sees the country as his personal fiefdom exemplified by his constant use of the word "I" and "My" -- especially when going around with the begging bowl. Worse still, the presidency and the capital have become more like party headquarters with no one paying much attention to norms and rules of conduct.
Perhaps the most absurd is the unanimously elected prime minister who is inflicting burden upon economic burden on the people he is representing -- simply in order to please foreign entities like the IMF. Is this why we are desperately seeking loans from this notorious body -- to break our own nation's back? The most recent incident is that of the immoral inflated GST on POL products where the dealers, the oil companies and the government make money -- but the ordinary Pakistani is crippled. The prime minister declares, "I want to make history" in a most arrogant fashion; but does he realise he is making history already?
Never have we seen such huge increases in indirect taxation; never before have we seen such huge raises in the money for legislators; never before have we seen such brazen side-stepping of rules and institutional norms and procedures -- especially in terms of appointments. The most glaring are in the diplomatic field, but tales of similar diktat in other fields' also abound.
Our leaders are also continuing to make history in kowtowing before the US that began after 9/11, so that we now have US personnel supervising all our policies on the pretext that they need to see how their aid money is being spent! This is apart from the covert operations US personnel are involved in within Pakistani territory -- all being supervised by the dubious General McChrystal in Afghanistan. Are the deaths of our soldiers in FATA and the mayhem brought to this country post-9/11 not a sufficiently visible quid pro quo for the Yankee paymasters? As if all that was not enough, the US insists on "training" our military in the art of counterinsurgency -- a field in which their own record is hardly commendable -- whether one looks at Iraq, Afghanistan or Vietnam! Incidentally, the arrogance of McChrystal seems to know no bounds as he goes about his "win them over or kill them" approach! Perhaps he ought to revisit the recent history of what happened to the Soviet Union in Afghanistan!
As I write this, I sit with my children in Istanbul looking at the wonderful Bosphorus gleaming a seductive blue, witnessing my daughter Imaan turn sixteen. Here in Turkey with its intense history of empires rising and crumbling, the ephemeral nature of power in the universal construct is almost palpable in the environment, but how many remember this when actually in power? Perhaps if the successive rulers of the powerful and the weak realised this, we would witness a little less of the dangerous temerity and arrogance that presently has the power wielders in its grip!
I'm going to continue sitting here with my children, safely far from the excitements of home, and stamp my little feet furiously while pontificating about how everyone is picking on Pakistan, including the rulers we continue to allow to lord over us.
Posted by: john frum ||
07/22/2009 00:00 ||
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#1
Notice she is in Turkey where her daughter runs less risk of being "married" and raped before execution.
#4
memorable words in the book, "The Water Babies": do as you would be done by.
I'm thnking that phrase has a substantially earlier origin - Jesus in the book of Luke used something like that a couple of thousand years ago and he seems to have picked it up from Leviticus (Thou shalt not avenge, nor bear any grudge against the children of thy people, but thou shalt love thy neighbour as thyself: I am the LORD), perhaps a couple of thousand years earlier still. Mazari's recommendation to read Kinglsey's words is not bad advice.
#5
So the US has rediscovered international law again, but what about the prisoners displayed in shackles at Guantanamo Bay?
You mean the international law [Geneva Convention] that stipulates that combatants must adhere to standards to be entitled to the protection of the law and that most of the individuals in Gitmo do not qualify and should have been just shot on the field of battle? Or the ones who violate the basic tenet not to us civilians as shields? /rhetorical questions.
#1
This is an all time classic! I'm not retired but This sounds fun!!!
Posted by: 49 Pan ||
07/22/2009 0:22 Comments ||
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#2
An elderly man in North Carolina had owned a large farm for several years. He had a large pond in the back, fixed up really nice, along with some picnic tables, horseshoe courts, and some apple and peach trees. The pond was properly shaped and fixed up for swimming when it was built.
One evening the old farmer decided to go down to the pond, as he hadn't been there for a while, and look it over. He grabbed a five gallon bucket to bring back some fruit.
As he neared the pond, he heard voices shouting and laughing with glee. When he came closer, he realized it was a bunch of young women skinny-dipping in his pond. He made the women aware of his presence and they all went to the deep end to shield themselves.
One of the women shouted to him, "We're not coming out until you leave!"
The old man frowned and replied, "I didn't come down here to watch you ladies swim naked or make you get out of the pond naked." Holding the bucket up he said, "I'm here to feed the alligator."
Moral of the story: Old men may move slow but can still think fast.
A multi-volume chronology and reference guide set detailing three years of the Mexican Drug War between 2010 and 2012.
Rantburg.com and borderlandbeat.com correspondent and author Chris Covert presents his first non-fiction work detailing
the drug and gang related violence in Mexico.
Chris gives us Mexican press dispatches of drug and gang war violence
over three years, presented in a multi volume set intended to chronicle the death, violence and mayhem which has
dominated Mexico for six years.
Rantburg was assembled from recycled algorithms in the United States of America. No
trees were destroyed in the production of this weblog. We did hurt some, though. Sorry.
