Joe Klein on Obama, McCain & Health Care

In a recap of the second McCain-Obama debate, Joe Klein offers his thoughts on the role of government generally and in health care in particular.  Excerpts and comments follow:

Obama began his response with a simple declarative sentence: “I believe that health care is a right for every American.”

Health care is a bundle of goods and services.  Treat health care like a “right,” and watch it disappear

The rest of his answer could be used as a template for how to deal with a complex issue in a town-hall debate. He began with a personal story: his mother, dying of cancer at age 53, having to fight her insurance company, trying to prove that her disease had not been a pre-existing condition.

Obama has said his mother ”had been diagnosed just as she was transitioning between jobs.”  Neither candidate can claim that their health plan would have saved her life.  But McCain can claim that the federal government created an employer-based health insurance system that routinely strips people of coverage right before and right after they get sick.  In its attacks on McCain’s health-insurance tax credit, I haven’t once heard the Obama campaign acknowledge that McCain’s plan would have spared Obama’s mother that deathbed worry.

He broadened that into a general proposition about the proper role of government: “It is absolutely true that I think it is important for government to crack down on insurance companies that are cheating their customers.”

Government should crack down on cheats.  If an insurance company commits fraud or breaches its contracts, let ‘em have it.  One senses that Obama means something else, perhaps that insurance companies “cheat” any time they deny coverage for anything?  Maybe because he thinks health care is a right? 

And finally, he transformed the issue into a metaphor for the entire campaign: “That is a fundamental difference that I have with Senator McCain. He believes in deregulation in every circumstance. That’s what we’ve been going through for the last eight years. It hasn’t worked, and we need fundamental change.”

Regarding Obama’s silly attacks on McCain’s proposal to deregulate health insurance, click here.

Obama’s gamble is that the public — worried at the beginning of the campaign, terrified now — is ready for greater government support and regulation of the health-insurance system. That assumption has always been a sure loser in American politics. Republicans have perpetually and successfully waved the bloody flag of “socialized medicine.”  But the employer-provided-health-care system is fraying, costs to average families are rising, and almost everyone has a friend with a horror story.

Indeed.  If only Klein and the Republicans recognized that socialized medicine is the root cause of those horror stories.

McCain’s plan is a half-baked vestige of Reagan-era ideology: it tilts the incentives away from employer-provided health insurance and assumes that people will act in their enlightened self-interest if they are thrust out into a free market. That’s absolutely true when it comes to buying refrigerators. But health insurance is complicated and scary; most people don’t have the time or expertise necessary to make wise choices.

Health insurance is complicated; illness is scary.  It would be nice if health insurers won customers by making health insurance simple and taking away patients’ fears of illness and financial ruin (rather than focusing on employers’ fears of absenteeism and rising labor costs).  For that, the individual customer has to control the money.

They rely on their employers to make sure they’re getting a good deal — and to fight for them if the insurance companies try to cheat them. And with many employers slouching away from that responsibility, the public seems ready to turn to the government for protection. In a collapsing economy, government regulation — forcing insurers to cover everyone at reasonable rates — sounds more comforting than stultifying.

Employers are shirking – but the government won’t?  Even when Obama gives them a jillion more things to do than enforce contracts and prosecute fraud?  And reasonable rates??  Does Klein know nothing about Medicare?

Shed No Tears for State Government Employees

The Pew Center on the States maintains an online news service called Stateline.org, which recently ran an article on the burgeoning plight of state government employees in the current economic downturn.

From Stateline:

But with the economy in a doldrums — only three years after states had emerged from the last recession — the hiring and salary freezes and benefit cuts that occurred earlier this decade are making a comeback as states struggle to meet their budgets.

The most galling aspect of this statement is the fact that it contradicts the Pew Center on the State’s own recent research.

From the Pew report:

In the late 1990s and early 2000s, when half the states’ pension plans were fully funded, many states reacted by increasing benefits…Legislatures responded in 1999 and 2000 by shortening vesting periods, increasing the multipliers used in determining benefit amounts, decreasing the age at which employees could receive full retirement benefits and shortening the years of service needed to qualify.

According to the same report, “…public sector employees are far more likely to receive retirement benefits—and the gulf between private and public sectors continues to grow.”  Pew found that (1) 90% of government employees have a defined benefit compared versus 20% in the private sector; (2) the median pension in 2005 was $17,640 (public) versus $7,692 (private); and (3) 82% of government employees have a retiree health care benefit compared with only 33% in the private sector.

Moreover, future state and local government employee benefit obligations are a ticking time-bomb for taxpayers.  See previous Cato work on this topic here, here, and here.  The Stateline article also says that state government salaries compare unfavorably with the private sector.  Cato has already pointed out that this isn’t necessarily the case either (see here).

My own experience in state government led me to conclude that much of it amounts to one big “jobs program.”  The truth is the typical state employee faces a relatively shorter work day, more generous benefits, and absurd job protections.  I would contend that one of the most dangerous places on the planet is a state employee parking garage at closing time, which in my state is 4:30 pm following a 7 1/2 hour workday.

Federal Student Aid: Our Disaster in Microcosm

I should have posted this yesterday, but was busy with other things, including a terrific discussion about higher education featuring Charles Murray, author of the new book Real Education: Four Simple Truths for Bringing America’s Schools Back to Reality, and St. John’s College, Annapolis, President Christopher Nelson. (The video should be up shortly if you’re looking for a little enlightenment.)

Anyway, there was, as many in the edublogosphere have been lamenting, almost no mention of education in Tuesday night’s debate. There were, however, quick, periodic mentions from Senator Obama of the need to make college affordable, something he plans to do by throwing yet more cash into already overflowing federal student aid streams. Unfortunately, no education commentators looking to latch onto our current economic woes and be heard have made this clear connection (probably because they don’t want to): Federal student aid is our current, government-driven, economic disaster in microcosm. Washington has been buying middle-class votes with ever-greater loads of student aid for decades, but rather than making college more affordable it has wasted hundreds-of-billions of taxpayer dollars, driven tuition higher and higher into the stratosphere, and made colleges richer and fatter. It’s a perfect example of how government “help”–such as Fannie and Freddie buying sub-prime loans like they were plastics–only truly helps politicians get re-elected, special interests wealthier, and everyone else stuck with huge bills.

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.