Topic: Government and Politics

The Freedom to Pay for Only the Features You Need

After listening to the second McCain-Obama debate the other night, I saw an ad for Progressive.com that promised to reduce your auto insurance premiums by letting you pay for only the features that you need.  It was as though the Invisible Hand had just watched the candidates discussing health care, and quickly whipped off an ad to tell Obama how stupid is his plan to force people to buy insurance coverage that they don’t need.

All of which inspired an oped that appears in today’s New York Post.  An excerpt:

Wouldn’t it be nice to be able to choose the features of your health policy, just like your auto insurance?

John McCain proposes to let you do just that, simply by letting you choose a plan available in another state. With the power to choose a policy regulated by a state with fewer mandated benefits and no community-rating laws, you could knock $1,000 off the price of a $7,000 plan.

This would boost coverage, too: A recent study by economists at the University of Minnesota suggests that McCain’s proposal could cover an added 12 million Americans.

But Obama sees choice as dangerous. He fears that “where there are no requirements for you to get cancer screenings,” no insurers would offer such coverage. The New Republic’s Jonathan Cohn echoes, “Less cancer screening under McCain’s plan? Actually, yes.”

Nonsense. California doesn’t mandate colon-cancer screening, yet Kaiser Permanente of Northern California is a leader in such research and boasts the most aggressive screening program in the country.

Michigan doesn’t mandate prostate or cervical cancer screening, yet six of the University of Michigan’s seven insurance offerings cover both. That’s where Cohn gets his insurance, so I’ll bet him a fancy dinner that he has coverage for both, even without a mandate.

If anyone from my senior-year calculus class is out there (what were there, six of us?), you may recognize the reference to a horrific chapter from my academic career.

McCain and the Military Budget

John McCain likes to hold himself out as a fiscal conservative, and compared to Barack Obama there is no comparison. McCain expresses concern over the mountains of debt that George Bush and his willing accomplices in Congress have left for future generations, and has put forward modest plans for reversing these ominous trends. For example, the Republican pledges to freeze some government spending – with the notable exclusion of the military budget, veterans benefits, and entitlements – and perhaps to eliminate certain federal agencies, although in last night’s debate he didn’t stipulate which ones. Obama will not commit to similar steps to halt the runaway train of federal spending, and his tax increases are unlikely to generate nearly enough revenue to offset his proposed spending increases, and may well make the fiscal imbalance worse by stifling entrepreneurship and job creation.

But McCain’s specific proposals don’t add up to considerable savings. For example, last night he cited his opposition to the Boeing tanker deal, which he claimed saved taxpayers $6.8 billion (back in June, McCain put the figure at $6.2 billion). He has mentioned his opposition to earmarks, which total $18 billion. In the previous debate, he suggested that eliminating cost-plus contracts would save money in the Pentagon, but he didn’t venture a guess as to how much. Such modest proposals invited Obama counterattacks: the Democrat noted that the costs from the Iraq War, which McCain has pledged to continue until we achieve “victory,” would erase McCain’s vaunted earmark savings in less than two months.

Beyond sparring over Iraq War costs, however, the two candidates have not been pressed to justify their plans for military spending.

Personnel costs constitute roughly one third of the total defense budget, and are likely to grow in 2009 regardless of who wins next month’s election. Both McCain and Obama support President Bush’s decision to increase the size of our ground forces by 92,000 men and women over a five-year period. It is curious that Obama, a man who wears his opposition to the war in Iraq like a badge of honor, would support such increases. If Obama gets his wish, and removes most U.S. military personnel from Iraq over a 16-month period, he will presumably have more than enough troops to surge some into Afghanistan, while still reducing the burdens on our men and women in uniform, and their families. So, why the need for still more troops? Where else would a President Obama send them? Darfur? Congo? Burma? Georgia? He hasn’t said.

But leaving that aside, the scheduled increases are not nearly enough for John McCain. Writing in Foreign Affairs late last year, McCain pledged, “As president, I will increase the size of the U.S. Army and the Marine Corps from the currently planned level of roughly 750,000 troops to 900,000 troops.” If McCain gets his wish, these two branches will be nearly 40 percent larger than they were prior to 9/11.

And how much will these additional troops cost? By my estimates, nearly 10 times what McCain would save if he eliminated every single earmark.

In April 2007, the Congressional Budget Office estimated that Bush’s plan to grow the force would cost an additional $108 billion through 2013. Backing out those figures – $108 billion / 92,000 – equates to $1,173,913 per additional man or woman in uniform. Applying that same number to McCain’s additional 150,000 troops comes to $176 billion.

Don’t take my admittedly crude, back-of-the-envelope estimate as gospel. According to earlier Army estimates, every additional 10,000 soldiers cost about $1.2 billion a year, so the costs of McCain’s proposal to grow the force by another 20 percent might ultimately total less than $176 billion. But if CBO pegged the earlier Bush increases at $108 billion over six years, then it seems logical to conclude that McCain’s additional 150,000 will cost still more than that.

And McCain is proposing to increase that portion of the military budget that has already witnessed considerable cost growth in recent years. The military has boosted bonuses to entice new recruits to join, and to keep those already in the service from leaving. Health care costs have also risen for the military, just as they have in the private sector. If anything, the CBO’s projections likely understate the true costs of the additional troops, because they consider only the incremental expenses associated with adding 92,000 new personnel to the system, but do not fully account for the long-term costs of keeping these troops paid, fed and equipped over the course of their military careers. Then there are the additional expenses associated with caring for more military retirees.

In two successive debates, moderators Jim Lehrer and Tom Brokaw have tried to pin the candidates down on what they would do to control spending, and both times the candidates have evaded the question. CBS’s Bob Schieffer gets his shot next week in the third and final debate. Rather than an open ended “What would you cut?” question, he might ask them how much their different plans for increasing the size of the military will cost the taxpayers.

Obama to Deploy Troops to America’s Health-Care Sector

From last night’s presidential debate:

Barack Obama: So one of the things that I have said from the start of this campaign is that we have a moral commitment as well as an economic imperative to do something about the health care crisis that so many families are facing…

Tom Brokaw: What is the Obama doctrine for use of force that the United States would send when we don’t have national security issues at stake?

Barack Obama: Well, we may not always have national security issues at stake, but we have moral issues at stake.

You’ve been warned.

The Real Problem with the Debate

Arnold Kling offers a strange remark about last night’s presidential debate:

If the candidates were out to correct economic ignorance instead of pandering to it, the debate would not resemble last night’s in any way.

If the two candidates had corrected economic ignorance throughout their careers instead of pandering to it, they would not be the two major candidates for the presidency.  Two other politicians who affirmed economic ignorance and pandered to it would have participated in last night’s debate.

You could say that both Obama and McCain have let their ambition get the better of them, but they are politicians and that is like saying, as many now are, that investors should not seek profits. Both candidates believe spouting economic ignorance provides an apt means to winning the presidency.

Question for the class: what does all this tell us about American democracy?

“Ponytail Guy” and the Presidency

Ah, the town-hall debate format: that wonderful Oprah-style arrangement in which a hand-picked audience of allegedly normal Americans gets to lob questions at the candidates, who perch awkwardly on directors’ chairs, trying to look warm and approachable. What could be phonier?

Well, maybe a town-hall debate with rules like the ones in force tonight (hat tip Matt Yglesias):

–The questions will be culled from a group of 100 to 150 uncommitted likely voters in the audience and another one-third to come via the Internet. Brokaw selects which questions to ask from written queries submitted prior to the debate.

–The Gallup Organization makes sure the questioners reflect the demographic makeup of the nation.

–An audience member isn’t allowed to switch questions and will not be allowed a follow-up either. His or her microphone will be turned off after the question is read and a camera shot will only be shown of the person asking — not reacting.

–The moderator may not ask followups or make comments.

–McCain and Obama will be provided with director’s chairs, but they’re also allowed to stand. They can’t roam past their “designated area” marked on the stage and are not supposed to ask each other direct questions.

Even so, these things occasionally give rise to memorable moments. My favorite, in terms of revealing how far we’ve drifted from the Framers’ modest, limited conception of the president’s role, was the “ponytail guy” incident from a 1992 town-hall-style debate. This chopped-up YouTube clip will give you a little sense of what that was like.

But to really do it justice, you’ll need the transcript (or, better yet, the book):

The demand for presidential salvation hit its rhetorical nadir in the 1992 presidential debates, when a ponytailed social worker named Denton Walthall rose to ask Ross Perot, Bill Clinton, and President Bush the following question:

“The focus of my work as a domestic mediator is meeting the needs of the children that I work with, by way of their parents, and not the wants of their parents. And I ask the three of you, how can we, as symbolically the children of the future president, expect the two of you, the three of you to meet our needs, the needs in housing and in crime and you name it….”

“You name it,” indeed. Walthall followed up by asking,

“Could we cross our hearts; it sounds silly here, but could we make a commitment? You know, we’re not under oath at this point, but could you make a commitment to the citizens of the United States to meet our needs, and we have many, and not yours. Again, I have to repeat that, it’s a real need, I think, that we all have.”

Denton Walthall came in for a fair amount of criticism on the op-ed pages and talk radio airwaves. Yet under the hot lights, none of the candidates risked chastising him, however gently, for having an overly capacious view of presidential responsibility. Instead, they accepted his premise. Ross Perot said he’d take Walthall’s pledge, “no hedges, no ifs, ands and buts.” Governor Clinton argued with Perot about who was more authentic and less dependent on “spin doctors,” and noted that as governor, he’d “worked 12 years very hard… on the real problems of real people.” “It depends on how you define it,” President George H.W. Bush stammered his reply to Walthall,

“… I mean I – I think, in general, let’s talk about these – let’s talk about these issues; let’s talk about the programs, but in the Presidency a lot goes into it. Caring is – goes into it; that’s not particularly specific; strength goes into it, that’s not specific; standing up against aggression, that’s not specific in terms of a program. So I, in principle, I’ll take your point and think we ought to discuss child care, or whatever else it is.”

It’s hard to blame H.W.’s stammering on the Bush family’s notorious difficulty with words. Sad as it is to contemplate, the Bush-Walthall colloquy accurately described what by then had long been the dominant conception of the president’s role in modern American life. That role contains multitudes: it’s “not specific”; it’s “strength” “caring” “housing” “crime” “standing up against aggression,” “child care—or, indeed, “whatever else it is.” It’s a conception that’s fundamentally incompatible with limited, constitutional government.

Is Barack Obama’s Health Plan a Prescription for Socialized Medicine?

Barack Obama’s health plan would enroll more than 50 million Americans in new and existing government health programs, effectively doubling the Medicare rolls.  It would increase taxes on nearly all workers.  It would give the federal government near-total control over health insurance, by letting Washington control prices and dictate the content of every private health plan in the country.  It would create a new government agency whose research would help government and private insurers ration medical care.  Harvard University and Harris Interactive recently polled Americans who claim to know what socialized medicine is, and found:

  • 79 percent believe that universal coverage equals socialized medicine,
  • 73 percent said that socialized medicine exists when “the government pays most of the cost of health care,”
  • 60 percent consider Medicare to be socialized medicine, and
  • 57 percent believe Obama supports socialized medicine.

Obama has repeatedly voiced his support for a single-payer health care system – the type of plan most people have in mind when they use the term socialized medicine.  Many who support Obama’s health plan, such as New York Times columnist Paul Krugman, do so because they believe the Obama plan would lead to socialized, single-payer system. 

So is Obama’s plan a prescription for socialized medicine? 

Somehow, respectable folks at the Urban Institute, The New York Times, The Washington Post, FactChecker.org, and National Public Radio still say no.  Their reasons boil down to these:

  • It’s only socialized medicine if the government employs the doctors and provides health insurance directly.  But that can’t be right.  There is little functional difference between health care system A, a public program through which the government taxes and spends your money on its health care priorities, and health care system B, a completely “private” system in which the government forces you to spend your money on identical priorities.  What matters is not whether health care is nominally “public” or “private,” but who controls the resources.  Even Center for American Progress scholar Jeanne Lambrew acknowledges that a (nominally) private sector is no barrier to socialized medicine: “the government role in socialized medicine systems [can include] public financing of private insurance and providers.”
  • It’s only socialized medicine if there’s government rationing.  But that can’t be right, either.  Barriers to access occur when the government limits spending below what is required to meet patients’ demand for medical care. To say that socialized medicine only exists when there are waiting lists or other access problems is to make the rather curious argument that socialized medicine would disappear if the government wrote bigger checks.

I offer a more reasonable definition:

Socialized medicine exists to the extent that government controls medical resources and socializes the costs.

In a Cato Briefing Paper released today, I use that reasonable definition of socialized medicine to show how America’s health-care sector is already more than half-socialized, and how Obama’s health plan would take us the rest of the way there.

False or Misleading in Every Particular

Barack Obama currently has the following health-care ad in the field. 

It’s an effort to make Obama’s health plan appear moderate.  That’s quite a trick, considering the plan might give Washington more control over the health-care sector than the Clinton health plan.  So pretty much the only way they could create the appearance of moderation was to write a script that is false or misleading in every particular.

The ad begins:

Health care reform.  Two extremes.  On one end, government-run health care, higher taxes.  On the other, insurance companies, without rules, denying coverage.  Barack Obama says both extremes are wrong. 

Those are not opposing extremes.  In fact, Obama pursues government-run health care, higher taxes, and insurance companies denying coverage, all at once. 

  1. Obama expands government-run health care.  Obama proposes to create a new government-run health care program modeled on Medicare for people under age 65.  One estimate suggests that program would enroll 45 million Americans.  He also proposes to expand Medicaid and the State Children’s Health Insurance Program.  Those expansions would enroll at least another 6 million Americans in government programs.  He also gives government a great deal more control over private-sector health care.  (See below.)
  2. Obama pursues higher taxes.  Funding those government programs will require higher taxes.  Obama admits he would raise taxes on those earning more than $250,000 per year, but that’s just the tip of the iceberg.  Obama would increase taxes on (nearly) all workers.  His proposed “pay or play” employer mandate would take money out of workers’ paychecks before workers even see it.  Finally, Obama would require insurance companies to charge healthy 18-year-olds the same premiums as 55-year-olds with multiple chronic conditions.  That constitutes a further tax on young and healthy workers that would force them to pay far more in premiums than they generate in costs. 
  3. Obama encourages insurers to deny coverage.  If the average 18-year-old makes $1,000 in claims per year, the average 55-year-old makes $20,000 in claims, and each pays a premium of $12,000, whom will insurance companies court, and whom will they avoid?  By requiring insurers to charge everyone the same average premium, Obama guarantees that insurers will avoid and provide lousy care to the sick whenever possible.  That problem already exists in states with community-rating laws and the Medicare program.  It doesn’t even matter if insurers deny care to the sick deliberately or not; Obama would reward them even if they do so unintentionally.  Finally, Obama proposes a new federal agency whose very purpose is to help insurers deny care.

The ad continues:

His plan.  Keep your employer-paid coverage.  Keep your own doctor.

Actually, once Obama gives himself the power to dictate the price and content of every health plan in the nation, his first act would be to eliminate the most affordable 30-50 percent of health plans currently on the market.  At the same time, his National Health Insurance Exchange would set off the ol’ adverse selection death spiral, which numerous studies suggest would eliminate comprehensive health plans from the market.  An awful lot of Americans would have to switch health plans, and would lose their doctors in the process.  Those who go from private to Medicaid coverage are going to have an awful time finding a doctor.

Take on insurance companies to bring down costs.  Cover pre-existing conditions and preventive care.

Nothing in the Obama plan would “take on insurance companies to bring down costs.”  Covering pre-existing conditions would increase costs.  Obama proposes to force insurance companies to spend less on administration and more on claims, but that too would increase costs.  The insurance companies will just game and lobby Congress until Obama’s plan works to their advantage. 

Obama claims he would boost preventive care.  Yet his National Health Insurance Exchange would let people switch plans every year, giving insurers absolutely no incentive to invest in consumers’ long-term health.

Common sense for the change we need. 

Um, yeah.

“I’m Barack Obama, and I approved this message.”

Well, I suppose that part is true.

There is one ray of hope.  The beginning of the ad says that Obama thinks that “government-run health care [and] higher taxes” are “wrong.”  Maybe, with enough persuasion, we can turn him against his own health plan.