Monday, November 30, 2009

Talking Turkey Over Health Care Reform

The Senate is back in session this week, and will begin its work on hammering out the new bill they put forth before the Thanksgiving recess on Health Care Reform. Here is a reminder of Senator Reid's presentation of the new bill:

Who wants to place bets on whether or not Charles Krauthammer will have to eat his hat given the dollars Reid claims will be saved by this particular Health Care Reform bill? I will go out on a limb and say I think Dr. Krauthammer's hat is safe.

What, then, is to be done? Well, Dr. Krauthammer thinks both bills should be killed, and we need to start all over again:
The United States has the best health care in the world -- but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes -- such as the 118 new boards, commissions and programs -- is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony.

The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

-- You'll find mandates with financial penalties -- the amounts picked out of a hat.

-- You'll find insurance companies (who live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third -- numbers picked out of a hat.

-- You'll find sliding scales for health-insurance subsidies -- percentages picked out of a hat -- that will radically raise marginal income tax rates for middle- class recipients, among other crazy unintended consequences.

Okay, I already have a headache just reading this. No wonder Krauthammer reaches this conclusion:
The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.

Then do health care the right way -- one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

First, tort reform. This is money -- the low-end estimate is about half a trillion per decade -- wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.

The rest is wasted within the medical system in the millions of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits -- resources wasted on patients who don't need them and which could be redirected to the uninsured who really do.

In the 4,000-plus pages of the two bills, there is no tort reform. Indeed, the House bill actually penalizes states that dare "limit attorneys' fees or impose caps on damages." Why? Because, as Howard Dean has openly admitted, Democrats don't want "to take on the trial lawyers." What he didn't say -- he didn't need to -- is that they give millions to the Democrats for precisely this kind of protection.

Tort reform has been a common refrain for what is glaringly absent from this Health Care Reform bill, and one component conspicuously absent. But that's not the only problem:
Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines.

Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn't, oranges would be extremely expensive in Wisconsin, especially in winter.

And the answer to the resulting high Wisconsin orange prices wouldn't be the establishment of a public option -- a federally run orange-growing company in Wisconsin -- to introduce "competition." It would be to allow Wisconsin residents to buy Florida oranges.

But neither bill lifts the prohibition on interstate competition for health insurance. Because this would obviate the need -- the excuse -- for the public option, which the left wing of the Democratic Party sees (correctly) as the royal road to fully socialized medicine.

That's an interesting take on it. And still more:
Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenues -- the largest tax break for individuals in the entire federal budget.

This reform is the most difficult to enact, for two reasons. The unions oppose it. And the Obama campaign savaged the idea when John McCain proposed it during last year's election.

Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method -- a $1 trillion new entitlement of stupefying arbitrariness and inefficiency.

The better choice is targeted measures that attack the inefficiencies of the current system one by one -- tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000 -- and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.

I tend to agree with Krauthammer - I think we need to deep-six these two bills and start over. Additionally, I do not want anything in these bills that has NOTHING to do with Health Care Reform. No pork, no bribes, nothing that is not strictly related to issues of health care reform. But that's just me. At the very least, both houses need to start over, and do it right this time, not throwing together whatever they can in the shortest amount of time possible. This is a serious issue, and merits serious consideration, not political expediency.

If Congress does THAT, starts completely over, leaves out the pork, does what's best for American citizens and not their respective political parties, I'll eat MY hat...


Logistics Monster said...

Let me know what you think...

Rabble Rouser Reverend Amy said...

You bet, friend - and you don't need to give me your address, DT - honestly, I read your blog every day! :-)