David Horsey takes a shot in his latest toon at Mitt Romney and his reaction to Hillary Clinton's health care plan. Horsey's argument, like others on the subject bandied about the new fangled Internets, is that any similarities between Romney's plan for Massachusetts and Clinton's plan for the country mean they're the same. Thus, Romney must be a hypocrite for not liking Clinton's.
The problem with that argument is that different solutions work for different governments, dealing with unique problems of unique populations. Tax cuts might be a great idea at times federally, but they might not make as much sense for some states at times for a multitude of reasons. Likewise, a governor or big city mayor might advocate school vouchers to deal with a truly troubled school system. But that same individual might not advocate the same solution for federal programs affecting schools.
In turn, there is a stark difference between addressing an issue for a medium-sized, comparatively homogeneous, middle class state like Massachusetts and addressing an issue through the federal government for our entire nation. Moreover, states set policies we accept at that level of government that are not going to happen federally, such as licensing vehicles, setting requirements for earning a high school diploma, and meting out punishments for non-federal crimes.
Romney's proposal at the federal level would empower states with more authority and flexibility to tackle the issue, just as he tried to do so creatively in a way that met Massachusetts's needs. A plan similar to Romney's may well work in a state like Washington. It probably wouldn't work so well in California or Louisiana where the needs of the citizenry and the issues of the local health care system are quite different.
More to the specific topic, states have been tackling the insurance market with varied success. Some suffer from over-regulation, excessive policy coverage mandates, etc. Many have also tried assorted purchasing pools and different approaches with issues like community rating. Given the varied success of those states, it's troubling that Hillary Clinton's plan essentially tries to federalize those regulations. Given how well the federal government has run Medicare, it's hard to envision how it would run a regulated insurance market in a productive manner.
Thus, much of the rub. Democrats have shown their true colors on SCHIP by trying to turn a good program for aiding poor children into a broader plan to woo middle class families onto the public dole. That's just part of the reason why Hillary's proposal to federalize individual health care is so alarming. And why Romney and the other GOP candidates are none too thrilled with it.
In the wake of the John Kerry flip-flop disaster of 2004 when he tried to have it both ways on the same Iraq war vote there are obviously some - especially Democrats and liberals - who would like to whip out the flag of hypocrisy at the drop of a hat. The trouble with actual policy debates - especially on policy issues so complex like health care it breeds its own stable of lawyers - it's not that simple...though it makes a cute cartoon, at which Horsey is darn good.
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Note: For more info, here's Romney in his own words after getting something accomplished in Massachusetts. Here's the conservative Heritage Foundation's take - they like and actually helped craft the plan. Here's that of the more libertarian Cato Foundation, which hates it. Good people can disagree about various components of it and like any complex plan it's not perfect, but the ultimate point remains Romney found a way to address the health care issue using conservative principles, while working with a heavily Democratic Legislature. Easier said than done.
Posted by Eric Earling at September 19, 2007 07:22 AM | Email ThisRomney is in the wrong party. He is a good, rational conservative who now has ot pander to the a radical minority living in an alternative reality.
Hillary or Obama could d worse than choosing him as a VEEP or head of HHS.
Posted by: SeattleJew on September 19, 2007 07:56 AMHe made a good point about Taxachusetts. He claims the liberals abandoned the Kennedy (RFK and Bobby) liberal model to form their own byproduct. In the process, the Kennedy model is almost conservative today. Kind of my thoughts too, regarding Jackson Democrats of Washington fame.
Regarding health care, the Democrats in this State ran several insurance companies out of the State with overregulation. Today, I am paying out of the nose because of the lack of competition.
Nearing retirement days, I, on one hand, embrace the idea that I will soon get free health care. On the other hand, I am very principled and revolt against it. The other hand, thankfully, is the dominant hand and I hope it stays that way.
Clinton is all screwed up if she thinks her extra cost figure is accurate, though. It is likely to be ten times what she thinks. But the "think" part is part of the problem for a socialist, isn't it?
Posted by: swatter on September 19, 2007 08:50 AMYou are correct thta there is a conservative .. we call it centrist .. wing of the party. You are also correct that this set of folks would be a rational focus for the GOP.
What ahs ahppened, however, is just the opposite. Bill Clinton's great success was moving his party away from its extremes. By and large, the dem party today spans from moderate left to centrist. "Socialist" ideas are generally eschewed.
The contrast with the Repubs. is very serious. Ti run foir Pres as a repub one needs to at least condone many doctrinaire right positions, some of which may be valid to the 20% or so of Americans who are fundamentalists but violate basic principles of science.
The result is not only that Scoop Jackson, if he were alive today, would still be a dem, moderate republicans are leaving the GOP. Jim Webb of Virginia is a close to Scoop as anybody you can find and he is hardly alone.
If you are interested I write regularly on this topic at my blog, SeattleJew under the heading "Right Flight."
A small example of this is your own post about the Clinton proposal. As I see it, she is beiong very conservative and is actually proposing the minimum that might work. Calling her plan socialist may be fair but it is patent nonsense to call the current system a free market.
We have evolved a cockamamie paste up for health care that has excess overhead and fails to provide the resources we need in reserve for a crisis. Drs. do not compete on price or quallty, Fees are set by the joint decsion of bureaucrats rather than afre markret.
Posted by: SeattleJew on September 19, 2007 09:30 AMIt is absurd to give a benefit to the rich or middle class. To make political progress, these parts should be cut out first. So let's propose a transition plan to the free market: Give the poor (means tested) a bare-bones health insurance policy, paid for by taxpayers. Maybe only the bottom 20% on income AND assets. The rest of us, well over 80%, get a total free market. Delete the tax-deductibility of employer-funded health insurance so you have portability and increased competition.
Liberals won't be able to attack our program, because it cares for the poor, and provides a social safety net. It's unconstitutional, of course, so we should have the states implement the policy.
Then, over time, we find ways for private charities to take over funding for the state-funded health insurance policies for the poor.
Oh, veterans get a better health insurance. They earned it with their service.
Medicare shouldn't give benefits to the wealthy of the future, so the elderly poor will eventually use the system I described above.
We need a transition period to this new plan, so that people who have paid in to the old programs can choose to stick with them until they die, but 20 year olds have to be in the new system.
This is creeping libertarianism, and would preserve the free market that provides better care, lower costs, and more innovation and new treatments.
Posted by: Bruce Guthrie on September 19, 2007 09:39 AMDo you think Clinton's success is moving the Dems to the center? Is this what you consider moveon to be (after all HRC never condemned the mean-spirited attack on Petraeus.)? I don't.
HRC will be exposed for what she is next year- a dyed in the wool socialist.
Based upon the front runners today, a moderate from the R party will be nominated. Will the far right of center accept they lost this particular battle and vote for their nominee? From discussions on this board, they refuse to admit they will vote R. Not a good sign.
The Rs have a big tent. Sometimes the far right candidate gets nominated and that has happened in the recent past. This time it appears the moderate side will win. Will the big tent hold up or will it fold? That is really the question.
Giuliani, and Romney to a lesser extent, have the potential to run the table.
Posted by: swatter on September 19, 2007 10:31 AMHillaryCare 2.0 is just another giveaway of tax subsidies to insurers, requiring everyone to buy insurance from the same companies that already do everything they can to avoid paying claims.
Private, for-profit insurers (who owe a duty to their shareholders) make money by taking money and denying care. That's a basic equation that's impossible to change.
Either expand Medicare to cover everyone or dismantle all forms of government subsidy for health care - what we have now is broken and what's being proposed by the leading presidential candidates (every last one in the pocket of the health-care lobby) is worse.
Posted by: insurance sop on September 19, 2007 10:38 AMGiulani is the nominee and Hillary is going down in flames!
Republicans in 2008!
Hoot Hoot Hoot!
Posted by: John Bailo on September 19, 2007 10:49 AMWhy is it that only Whores, Pimps and Lawyers run for political office!!!
I too like the idea of a healthcare safety net, though it needs to extend beyond the poor because the costs of catastrophic care are so high that one nees to be very rich or have unusually great insurance to survive such a challenge.
I also think there is danger in a socialized system that leaves the decision as to what is elective and what is not elective to a political process.
All that said, we come back to a very hard issue. Is it possible in modern emdicine to have a free market. Let me point out that NO civilized country, including the US, today has a free market. You and I would not want the health care in third world nations that come closest to a free market.
So, how could one develop a free market. I really do not know but a few rules seem clear:
1. health care should never be tied to employment. This was a major blunder of WWII. It makes no more sense than tieing housing, food, or education to employment.
2. Where a free market can exist, it should be created. The obvious example is th new effort by capitalists to recreate the old time GP now as "doc in a box" clinics in malls and drug stores. This saves hug amounts of money over the big clinic or ER model and seems idelaly suited toi a free market.
3. A safety net must prevent health care form being the cause of bankruptcy AND seperate the issue of long term care from the current rules that require impoverishment to receive etc.
4. recognize some parts of medicine as natural monopolies that need to be socialized or regulated.
5. create the competition, as much as possible, at the vendor level rather than the insurance level. Insurance is a poor level to create a free market because there is too much of a conflict of interest in the insurer. One result of this is an estimate that a third of the health care dollar in the US goes to administrative overhead.
6. We need to distinguish, as we do not now, between insurance and pre-paid health care. A large part of medical need is very predictable. Insurance ofr this makes no more sense than using insurance, rather than a service contract, to fund car maintenance or housing repairs. I would limit insurance to catastrophic issues and develop a service mechanism to deal with predictable health care. The service component might be able to function competitively.
That would be a start. The result would be individual or societal decisions, rather than corporate, as to a lot of the health care $$$.
My suspicion is that such a system would focus on childhood health care where prevention is essential. We might underwrite basic healthcare for kids in a number of ways but since much of that would be by the doc-in-a-box market, free market forces should work well as long as we provide an incentive to the parents to shop by having appropriate copays.
A the other end, such a system would likely socialize a lot of in hospital care simply because this level has become so expensive that it is a natural monopoly. I see little evidence that private monopolies (e.g. the old Ma Bell) are more efficient or less efficient than socialized entities (e.g. Seattle Lihjt}.
Fian
Why do you say that the US doesn't have a free market in "medicine" (by which I assume you mean health care)?
One can choose to have health insurance or not.
One can choose whatever healthcare provider he desires, if self-funded; possibly subject to some constraints if using a health plan.
One can choose where to have Rx's filled (and there is very active competition in this matter - note Walmart's $4 Rx cost for many drugs).
I submit that the current system is more like a free market than not.
Posted by: ewaggin on September 19, 2007 12:22 PMNow, fast forward a few years. I'm no particular fan of Rudy (as a candidate, anyway), but giving credit where it's due, he has the best healthcare plan so far of anyone running, as the center of his plan is essentially taking Uncle Milt's advice. Instead of removing tax-deductibility for employers, he instead provides the same tax-deductibility for individuals; this sounds kinder and gentler, while achieving almost the same thing. Additionally, the size of the tax break would not increase with the amount spent, providing additional incentive to shop around.
Romney would make out-of-pocket medical expenses tax-deductible, somewhat reducing the incentive to buy insurance for them, but there is no indication that he would level the playing field between employers and individuals. Furthermore, providing tax deductions for out-of-pocket expenses would presumably funnel more money into healthcare than there is now, raising prices. Two steps forward, two steps back.
Believe it or not, even with his big-government tendencies, Dubya beats them both by supporting both the levelling of the playing field and also allowing people to shop outside of their own state for an insurance. Rudy would allow this if they could show that nothing in their own state was feasible, but how many people are really going to jump through that hoop?
Then there's Hillary... God help us. She isn't being truthful about what she really intends to do to healthcare; like the UK, the results WILL BE higher costs and rationing, and people will die as a result. We will be able to look back and say, "Hillary lied, people died," but that's cold comfort.
Posted by: TB on September 19, 2007 12:48 PMThat is not true for many reasons in modern medicine. e.g.
1. many services are in eff3ct monopolies. High end pediatric care form Utah to Alaska mean COH,
2. The individuals running the vendors often are paid independently of the profit of their company.
3. Most healthcare in the US is provided by the employer who contracts with the insurer, not the provider. The free market, to the extent it exists, is between the employer and the insurer. Their mutual interests may have little to do with health care.
4. The effect if choice to have or not have healthcare, in our system, blocks a free market because under our laws even the uninsured MUST get care. The result is that the common, esentially socialized part of the market, bears an inordinate burden. The only out from this form a libertarian POV would be to allow those who are not insured to suffer the consequences. This is not likely to be accepted in our society but worse, it does not address the issue of insurance for dependents.
5. In the pediatric age range the most critical health care issues are preventitive without the sort of short term rewards usually needed to motivate a feree market. Worse, a kid who grows up ill because of bad pediatric care is very likely to become a burden on the entire society,
6. I agree that retail pharmacies are a great example of a free market. However, wholesale markets in the US are dominated intentionally by drig companies motivated to profit, as they should, from patent law. There is NO incentive to a drug company that owns the best drug in a category NOT to charge whatever it can. The effect, of course, is that our free market underwrites the cost of socialized markets world wide.
7. Ask any private doc how much freedom she has to compete on price. She will tell you almost none. That is because of the way the insurance companies, in the name of saving the employers money, heavily regulate the practice of medicine. One bizar outcome of this is that a numebr of new therapies are being developed outside the US where providers can do what they want for a patient as long as the cost stays within an annual budget.
8. All other issues aside, medicine has a special problem in a capitalist society because there is an irreducible minimum need for very high priced labor. Unlike making pins, there are very real limits to the productivity involved in health care delivery. Combined with the all too real costs resulting from the knowledge explosion, the cost of healthcare will inevitable rise to prohibitive levels for most folks unless there are some sorts of givernment control.
9, Many healthcare issues are ethical and moral, areas free markets deal with poorly. For example cigarettes. Did you know that cigarettes CYT the cost of heathcare?? This happens because of the age effect. The ore folks who live longer the greater the cost to the whole society. In a totally free market it is in the interest of insurance companies to encourage smoking!
Please understand, like you, I would like to see more free market in medicine. BUT, we do not know how to make such a thing work. Thats is one reason liberals oppose the Hillary/Romney approach as being too timid to solve the short term problems and not flexible enough to address the long term problems.
I am cross posting this at my site and depending how this thread ogoes you may want to "talk" over there because I am more free to bring in links, etc.
I will send my bill in the morning. $69 =OK?
Posted by: SeattleJew on September 19, 2007 01:07 PMUnfortunately, non of the proposed plans is going to work because the problem is too complex to solve in one fell swoop. What is needed is a long term plan and direction that optimizes the free marketable parts of the system.
As I said above, the first thing. a sin the Giuliani plan, is to sever health care from employment. Unfortunately the spinmeisters on both siodes will pillory anyone who goes that far.
Posted by: SeattleJew on September 19, 2007 01:13 PMA lot of smart folks are here and I would live to see rational threads lile this free or the usual Bullspin about why extremist Republican views matter. They may well matter, but neither party should have such a preoccupation with religious or other absolutist fixations, that real world issues can nto be discussed.
One thing I will do, over at SJ, is post for the conservatives here an explanation of how the NIH grants system, though federally funded, was deigned by the founder of NIH to follow a free market system.
I really am worried about the GOP's future. In that spirit, I ahve for some time now been posting comments at SJ under the title "Right Flight". If things go as they look now the GOP is going to be in danger of becoming a very minority party in 08. Then the issue will be who takes over? The national battle lines seem allredy to be emerging .. Hagel, Schwaznegger and .. I think .. Huckabee, on one side, Gingrich on another side, and the religious extremists on the third side. Bloody mess that could make long term harm to the GOP and the USA!
Stop sounding like a bitter Romney supporter:-)
Posted by: Don Ward on September 19, 2007 02:49 PMIt is my understanding that anything not expressly covered in the Constitution becomes the responsibility of the States.
Posted by: Douglas Aldrich on September 20, 2007 11:04 AMTruly, to the left, there's not 10 amendments in the Bill of Rights. Maybe four or five, tops.
Posted by: pudge on September 22, 2007 08:38 AMI really hope the so called "bipartisan consensus" or as I prefer to call it "Let them eat cake" approach to health reform, gets shoved back in Hillary and Mitt's faces as the colossally mean spirited and unamerican farce that it is.