If you want a preview of President Obama's health care "reform," take a look at Massachusetts. In 2006, it enacted a "reform" that became a model for Obama. What's happened since isn't encouraging. The state did the easy part: expanding state-subsidized insurance coverage. It evaded the hard part: controlling costs and ensuring that spending improves people's health. Unfortunately, Obama has done the same.
Like Obama, Massachusetts requires most individuals to have health insurance (the "individual mandate"). To aid middle-class families too well-off to qualify for Medicaid -- government insurance for the poor -- the state subsidizes insurance for people up to three times the federal poverty line (about $66,000 in 2008 for a family of four). Together, the mandate and subsidies have raised insurance coverage from 87.5 percent of the non-elderly population in 2006 to 95.2 percent in the fall of 2009, report Sharon Long and Karen Stockley of the Urban Institute.
People have more access to treatment, though changes are small. In 2006, 87 percent of the non-elderly had a "usual source of care," presumably a doctor or clinic, note Long and Stockley in the journal Health Affairs. By 2009, that was 89.9 percent. In 2006, 70.9 percent received "preventive care"; in 2009, that was 77.7 percent. Out-of-pocket costs were less burdensome.
But much didn't change. Emergency rooms remain as crowded as ever; about a third of the non-elderly go at least once a year, and half their visits involve "non-emergency conditions." As for improvements in health, most probably lie in the future. "Many of the uninsured were young and healthy," writes Long. Their "expected gains in health status" would be mostly long-term. Finally -- and most important -- health costs continue to soar.
Aside from squeezing take-home pay (employers provide almost 70 percent of insurance), higher costs have automatically shifted government priorities toward health care and away from everything else -- schools, police, roads, prisons, lower taxes. In 1990, health spending represented about 16 percent of the state budget, says the Massachusetts Taxpayers Foundation. By 2000, health's share was 22 percent. In 2010, it's 35 percent. About 90 percent of the health spending is Medicaid.
State leaders have proven powerless to control these costs. Facing a tough re-election campaign, Gov. Deval Patrick effectively ordered his insurance commissioner to reject premium increases for small employers (50 workers or less) and individuals -- an unprecedented step. Commissioner Joseph Murphy then disallowed premium increases ranging from 7 percent to 34 percent. The insurers appealed; hearing examiners ruled Murphy's action illegal. Murphy has now settled with one insurer allowing premium increases, he says, of 7 percent to 11 percent. More settlements are expected.
Attacking unpopular insurance companies is easy -- and ultimately ineffectual. The trouble is that they're mostly middlemen. They collect premiums and pay providers: doctors, hospitals, clinics. Limiting premiums without controlling the costs of providers will ultimately cause insurer bankruptcies, which would then threaten providers because they won't be fully reimbursed. The state might regulate hospitals' and doctors' fees directly; but in the past, providers have often offset lower rates by performing more tests and procedures.
A year ago, a state commission urged another approach: Scrap the present "fee-for-service" system. The commission argued that fee-for-service -- which ties reimbursement to individual services -- rewards quantity over quality and discourages coordinated care among doctors and hospitals. The commission recommended a "global payments" system to force hospitals, doctors and clinics to create networks ("accountable care organizations"). These would receive flat per-patient payments to promote effective -- not just expensive -- care. Payments would be "risk adjusted"; sicker patients would justify higher payments.
But the commission offered no blueprint, and efforts to craft consensus among providers, consumer groups and insurers have failed. State Senate President Therese Murray, an advocate of payment change, has given up for this year. "Nobody is in agreement on anything," she told The Boston Globe.
All this anticipates Obamacare. Even if its modest measures to restrain costs succeed -- which seems unlikely -- the effect on overall spending would be slight. The system's fundamental incentives won't change. The lesson from Massachusetts is that genuine cost control is avoided because it's so politically difficult. It means curbing the incomes of doctors, hospitals and other providers. They object. To encourage "accountable care organizations" would limit consumer choice of doctors and hospitals. That's unpopular. Spending restrictions, whether imposed by regulation or "global payments," raise the specter of essential care denied. Also unpopular.
Obama dodged the tough issues in favor of grandstanding. Imitating Patrick, he's already denouncing insurers' rates, as if that would solve the spending problem. What's occurring in Massachusetts is the plausible future: Unchecked health spending determines government priorities and inflates budget deficits and taxes, with small health gains. And they call this "reform"?
I'm not sure the same thing is happening in W Africa.
Posted by: lord garth ||
07/19/2010 11:53 Comments ||
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#3
lord garth,
Where do you think Nigeria is? West Africa and it is the richest most populous and already has a muzzie v. christian feud from centuries underway.
Posted by: Jack is Back! ||
07/19/2010 13:34 Comments ||
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#4
I should have been clearer.
While the conflict between Christianity and Islam is palpable in all of Africa, the success of Christianity in attracting converts from Islam was only reported (in the Peters article) in E Africa.
Posted by: lord garth ||
07/19/2010 14:46 Comments ||
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#5
The conflict in Nigeria is also being precipitated by Christians appearing in the Muslim North.
Posted by: Frozen Al ||
07/19/2010 15:52 Comments ||
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#6
"The conflict in Nigeria is also being precipitated by Christians appearing in the Muslim North breathing."
FTFY, Al.
Posted by: Barbara Skolaut ||
07/19/2010 21:20 Comments ||
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Newport Beach, Calif.—Carly Fiorina, 55, has been contending with chemotherapy and radiation treatments and reconstructive surgery because of breast cancer, so she is understandably undaunted by the relatively minor challenge of winning a U.S. Senate seat in this state that last elected a freshman Republican senator in 1982, that has not supported a Republican presidential candidate since 1988, and that has not elected a right-to-life candidate in statewide voting since 1998. This race will test the power of the rising Republican wave.
Fiorina might surf it from here to Capitol Hill because her opponent, Barbara Boxer, 69, is the Senate’s fiercest liberal, and California is an intensely unhappy laboratory for liberalism—high taxes, opulent entitlements, thick regulations, and subservience to government employees’ unions.
During 10 years in Congress, Boxer represented San Francisco suburbs where many residents consider the city’s liberalism too tepid. She is used to having the wind at her back. In 1992, California’s “year of the woman,” she ran for the Senate in tandem with Dianne Feinstein, who won the final two years of the Senate term Pete Wilson left when he became governor. Boxer was reelected in 1998 when California was luxuriating in the tech boom. In 2004 she won when John Kerry was trouncing George W. Bush in the state by 10 points. Now the 28-year Washington veteran seeking a fourth term is running into headwinds.
Three years ago, global warming was one of the top issues for Californians. Now it has dropped off the radar in a state with actual, rather than hypothetical, problems. Unemployment is at least 15 percent in 21 of the stateÂ’s 58 counties. Of the 13 U.S. metropolitan areas with unemployment that high, 11 are in California, which has lost more than 400,000 jobs since passage of the $862 billion stimulus. Like Barack Obama as he campaigns in what he calls Recovery Summer for more stimulus (because the first did not ignite recovery), Boxer is vexed by the fact that CaliforniaÂ’s unemployment rate is 2.2 points higher than when stimulus was passed. When she said the stimulus was responsible for 100 jobs at a Los Angeles lithium-battery factory, the owner demurred, saying the stimulus had nothing to do with the jobs.
Boxer is stressing Fiorina’s tempestuous tenure as CEO of Hewlett-Packard, the computer company, during which Fiorina sent some jobs abroad. Fiorina’s response is that having coped with the basic fact of globalization—“any job can go anywhere”—she has the experience to create and protect California jobs.
Boxer voters may be energized by a November ballot initiative that would legalize marijuana. Fiorina favors and Boxer opposes another ballot measure that would suspend California’s new anti-global-warming taxation and regulation regime until the state’s unemployment rate—currently 12.3 percent—has been no higher than 5.5 percent for four consecutive quarters.
California has 308 plants and animals—including a fly—on the endangered-species list. Government-ordered solicitude for one, the delta smelt, has caused water supplies to be curtailed in the Central Valley—the pumping of water somehow menaces this fish. The costs of its safety include dead orchards, fallow acres, and high unemployment, particularly among Latino farm workers.
Fiorina’s right-to-life stance may not matter much this year because economic anxieties have largely eclipsed other issues. Besides, it is theoretically impossible to fashion an abortion position significantly more extreme than Boxer’s, which is slightly modified infanticide. She supports “partial birth” abortion—the baby, delivered feet first, is pulled out as far as the neck, then is killed. And when asked during a Senate debate whether the baby has a right to life if it slips entirely out of the birth canal before being killed, she replied that the baby acquires that right when it leaves the hospital: “When you bring your baby home.” Fiorina believes that science—the astonishing clarity of sonograms showing the moving fingers and beating hearts of fetuses; neonatal medicine improving the viability of very premature infants; the increasing abilities of medicine to treat ailing fetuses in utero—is changing Americans’ sensibilities and enlarging the portion of the public that describes itself as pro-life.
Polls show the race is quite close. If Fiorina can capture this seat, in 2012 Democrats might, for a change, at least have to spend precious resources to keep its 55 electoral votes. If, however, a candidate like Boxer can survive in a year like this, California really is irredeemably blue.
#4
SF Bay area and the L.A. basin outweigh the rest of the state, and gerrymandering has made the district structure impossible to overcome.
Yes it is, despite the possibility of a relapse to sanity this year against Boxer and Brown. Long term, CA is circling the drain, and it's time to bail out. Unfortunately, my plans have been delayed by this pesky economic thing and 30% property devaluation.
#5
As goes NoMoreBS, so goes the rest of CA's non-unionized middle class. Really, unless you're a techie employed in Silicon Valley or the biotech precincts of So. SF and San Diego, or a creative or a suit working in the entertainment industry, there's no good reason to stay in California.
CA is rapidly beooming a latin-style oligarchy: huge state with massive and powerful public unions combined with a few anti-growth gazillionaires at the top of the pyramid and a massive and soon-to-explode (when Congress takes up and passes amnesty legislation aka "immigration reform" after Nov 3) illiterate Mexican underclass on the bottom.
And hundreds of thousands of middle class families will get the h*ll out of CA as soon as their property values get above water again.
CA's social structure used to resemble a diamond: small at the top and bottom, huge in the middle. It's now becoming an hourglass.
If the GOP doesn't forcefully and quickly halt this trend-- and that means hunting, killing, eating the Amnesty beast, asap-- then CA will resemble Mexico or Brazil in due course. Can't blame the Dems alone for that.
#6
Fwiw, I have no intention of leaving. I hate what our political class has done to this beautiful and extraordinary place. It is unthinkable that it should be allowed to descend into the status of a POS latin banana republic. Time to stand and fight.
Edmund Burke: "The only thing necessary for the triumph of evil is for good men to do nothing."
Government-ordered solicitude for one, the delta smelt, has caused water supplies to be curtailed in the Central Valley—the pumping of water somehow menaces this fish. The costs of its safety include dead orchards, fallow acres, and high unemployment, particularly among Latino farm workers.
Just an interesting note. I drove both directions of the San Joaquin Valley this summer via the I-5. All the gov't induced dustbowls (as the signs say) have all been planted in new crops. Huge new grape vineyards have been planted, along with other crops. And the Shasta Lake area's water level is as high as I've ever seen it. Article is slightly behind the times, unless someone's just created a Potemkin village.
#9
I used to work in Livermore. Loved the area, loved the mixture of cattlemen cowboys and vineyard entrepreneurs. Loved the wines. Liked the people. In general though, I disliked the larger cities. I think California as a whole is lost, a sad thing.
Posted by: Whiskey Mike ||
07/19/2010 14:44 Comments ||
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#14
GolfBravo's video tells it all: the Ghost of CA Past (the older, educated, worldly lady) pandering to the Ghosts of CA Future (illiterate children of illiterate campesinos).
If that sounds harsh, consider that per publicly-available STAR test results data, in the CA public schools, "latino" or "hispanic" children fail at a rate of 75-80%, and that this demographic now accounts for HALF of all CA public school students, which share is rising by about 1 percentage point EACH YEAR.
This combination of extreme failure and extreme numbers is why various business groups are projecting that CA will, unbelievably, have a shortage of college graduates-- not engineers, not scientists, not well-educated grads but simply college grads overall-- within a decade.
Simply criminal. Who imposed this underclass on my state? Why has this been allowed to happen.
#15
Whiskey Mike - I live in Danville (next town west for those not local). Livermore is still a great town that has undergone a gentrification of the downtown area. Still got ranchers and more vinyards (and a fav gun shop of mine). Sadly the rest of the area (SF, LA) is an upholstered cesspool of liberalism. I don't know if CA can be saved, but if not now...when? and if not us...who? We're quickly running out of runway...
D *** NG IT, I SWEAR THE MAMAS-N-PAPAS once verified to America = Amerika that "ALL THE LEAVES ARE BROWN, + THE SKY IS GRAY", + "ON A WINTER'S DAY" too!
#17
I lived in Oakland, Fremont and Palo Alto over the last 3 decades. And loved each one. But, ultimately I saw no hope and still don't. I don't know how a middle class family can or will be able to afford to raise a family in LA or SF. That means only rich and poor with each getting more so. The union thugs control government and the tipping point has been reached, in my opinion, with more voters at the government's teat than not. Things will only be righted by Prop 7.62 and I'm too old for out of doors politics. Good luck in the big one.
#20
California is not all blue, but the red party seems incapable of finding and supporting true conservative candidates who are articulate and attractive. When the state has a choice between a firm Democrate and a RINO it votes for the honest Democrat. A Ronald Reagan could still get elected in CA if he could get the partying party members and the big business party members to support him the way they do the wimpy RINO's - at least that is my take and what I hear from teh people in my circles.
Posted by: Donald McConnell ||
07/19/2010 20:11 Comments ||
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#21
Talk about whistling past the graveyard. California is irredeemable. Whether or not it will for for A republican matters not.
Posted by: Mike N. ||
07/19/2010 20:11 Comments ||
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#22
In my opinion California is a closer thing then people are realizing. Meg and Carly are flawed but will win because Boxer and Brown are terrible and the only thing on the ballot to get Democratic turnout this year is the legalize pot measure and potheads are likely to be unreliable and not in enough numbers as a gay rights or pro-choice measure would garner.
#3
Half the dopes in the Senate are senile.
This is politics, it's not about competency, its about showmanship, mudslinging, campaign dollars spent, etc.
The first Islamic college in the U.S. opened this summer in Berkeley, CA. Conservative critics have already lambasted Zaytuna College as a center for "indoctrination," but its founders say it's about time the millions of Muslims in the United States have a center for religious studies.
#1
At Berkeley? I guess they can learn to smoke pot.
Posted by: Mike Ramsey ||
07/19/2010 7:44 Comments ||
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#2
Let's examine the place and the staff for the quality of scholarship -- course descriptions, research, publications, the usual metrics. Compare it to the more prestigious centers of Islamic studies at various universities around the country. See here for a list.
Or is this meant to be a madrassah for adults to spend a year or several memorizing Quran, hadiths, and sunna, before competing with imams supplied by Pakistan, Malaysia, and Saudi Arabia?
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.
If you want a preview of President Obama's health care "reform," take a look at Massachusetts. In 2006, it enacted a "reform" that became a model for Obama. What's happened since isn't encouraging. The state did the easy part: expanding state-subsidized insurance coverage. It evaded the hard part: controlling costs and ensuring that spending improves people's health. Unfortunately, Obama has done the same.
