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8/11/2010
Shown: Jim Doyle's Case for repealing Health Reform - now
After passage of the Obama health care reform, I argued that Republicans would be making a tactical mistake to argue for repeal now. If the law turns out as bad as some of the predictions, support for repeal or reform will eventually be broad-based and overwhelming. This would take some time though, since many of its provisions don't begin until 2014.
Instead I argued that a national campaign for tax simplification might be better for the country and better politics. I'm beginning to wonder if perhaps I was wrong.
It's none other than Wisconsin's Democratic Governor Jim Doyle that's got me second-guessing myself, and he wasn't even talking about health care at the time.
During a recent press event highlighting stimulus funds for the high speed rail line, Doyle had this to say as reported by Wisconsin Public Radio July 30th:
[Doyle] discounted the possibility that a Republican governor if elected would kill the project. Doyle says “to me it's unthinkable that a governor would come in and say, all you guys working on those land bridges out there, take off your hard hats, go home it's not going to happen, and by the way we're going to have to repay the federal government the money they have given us to build this."
So it's unthinkable that a major government undertaking would be stopped once it's begun. I guess that wouldn't be a problem if at the same time the government didn't have such a poor track record when it comes to predicting the long-term costs of new programs. This is particularly true of health insurance programs. Below are numbers The Washington Times reported in late 2009:
In 1965, the House Ways and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.
In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion.
On the one hand Doyle makes it clear that successive administrations will find it difficult, if not impossible, to stop expansions of government. At the same time, we can look at a history of long-run cost projections that turn out to be far too low. Taken together, these items make a case for working to repeal or reform the new health care law sooner rather than later.
Jeremy Shown blogs at Rhymes with Clown and frequently hits on politics and economics in Wisconsin and the U.S.
COMMENTS
**Doyle makes it clear that successive administrations will find it difficult, if not impossible, to stop expansions of government**
***Doyle says “to me it's unthinkable that a governor would come in and say, all you guys working on those land bridges out there, take off your hard hats, go home it's not going to happen,***
Ya know this is really a streach. Finishing a project like a road is not expanding government.
Makes me wonder how much government is OK with you...I think of less and less government devolving into rule by warlords.
Dean Weichmann (Wed Aug 11 05:44:55 2010)
Dean, ObamaCare is indeed terrible and I for one would support its repeal. It was bought and paid for with $125 million in campaign contributions (bribes) and insurance stocks went up the day after passage. No wonder. Even Obama took $20 million in bribes. But this system will soon cost 25-30% of GDP instead of today's 17.5%. Stupid, stupid, stupid.
But what I would favor in its place -- single payer Medicare-for-all -- would get zero support from right-wingers. They think Medicare is terrible, and indeed it's not perfect. But it is more efficient than the private insurance system that drains 31% from our total health care costs and denies care to millions. Plus it burdens businesses and costs jobs.
I've written about this at Medicare-for-all *IS* a jobs bill! and How many more jobs must Wisconsin lose?
One day we'll have it and even the Righties will wonder why we waited so long.
Jack Lohman (Wed Aug 11 10:07:49 2010)
So simplistic to look at the cost of Medicare and say it was forecast to cost $9BB and instead cost $67BB. Big deal. The real question is if Medicare didn't exist what would be the cost of medical care provided otherwise and medical care not provided in the society. So, you want to say government should save all these health care dollars. Where in the heck is the care going to come from? Unless you want to not provide medical care (which I believe is the real intent of simplistic posts like this one) Someone pays for care and the overhead cost of Medicare is a heck of a lot less than private industry. So go ahead, try to repeal the health care bill and continue to waste 30% of every dollar on overhead. At least with the health care bill the American people will truly see what our dysfunctional system costs and maybe want to do something about it. Otherwise the costs are buried inside the employer income statements while everyone goes on their merry way to health care bankruptcy.
dave allen (Wed Aug 11 10:10:50 2010)
Dave, the two posts do not represent a simplistic approach, but to go further and clutter Jo's blog was not appropriate.
I am on Medicare and I see the same doctor I've seen for twenty years. He just sends his bill to a different payer. Medicare is not as good of a money-maker as the private insurers are, but that's the whole point. He makes only 5% profit rather than the sometimes 400% with private, but he also has no charity care or bad debt to offset. Roughly 60% of doctors support a Medicare-for-all system. Those who are ripping off the current system do not.
Before retiring I owned an independent diagnostic testing facility (IDTF) for 25 years. We provided mobile echocardiogram and cardiac monitoring services to hospitals and clinics. We did not see patients directly, only when referred to us.
Medicare doesn't pay "as little as possible," they pay what is "needed" to offset labor, technology and overhead, and they adjust it for locality. It is "fair," but it is just not as extravagant as the private "usual and customary" system that pays up to four times the amount.
For 15 of my 25 years I provided a mobile echocardiogram service in which I charged $300 per patient. After interpreting the echo the doctor billed and was paid $400 (less the 20% co-pay). But some doctors billed the privates $1800 for that same test and got away with it. Yes, some doctors had built their patient load to the point that they could hold out for only the privates, but if they only had Medicare and didn't over-bill, they'd take home essentially the same money.
We competed with other IDTFs, but when we cut our costs and prices, none of that was ever seen by the patient. It only added to the profits of our customers, the clinics and hospitals.
See http://www.pnhp.org for more details.
Jack Lohman (Wed Aug 11 10:34:02 2010)
It is astonishing to me that some people just don't get it. We can take away all the financial and economic arguments for and against the Health care bill and still there is nothing - no argument that can be made whatsoever - that can show this bill to be in line with the United States Constitution. Does anyone unserstand anymore what a constitution IS? It lays out, specifically, the structure and function of a body - in this case the governing body that is the Federal Government. It specifically lays out provisions as to how it may be amended. It is the highest law of the land - every law and action of the Federal government hinges on the Constitution.
Now, I have heard the argument that the Constitution is a "living" document subject to interpretation. If one READS the document, there isn't much room for interpretation. And if you'd like to think there is, then just be honest and throw the whole thing away, because it doesn't mean a thing.
The Constitution doesn't provide "guidelines" or "suggestions." It specifically ascribes and denies various powers to the three branches of government. Read along with the Federalist Papers - which go into great detail as to the nature and intent of its provisions, one either has to be a complete ignoramus or a cunning profligate to accept or defend on legal terms the Constitutionality of the Health Care law and whether indeed it is binding on the States and on the people. Enforceable? Perhaps - with threats to your well-being, financial or otherwise. But legally binding? Not a chance.
If the wealthiest man on the planet agreed to fund the entire enterprise so that not a penny would come out of the peoples' pockets, the law is still in direct defiance to the Constitution. And if that doesn't matter to anyone, than forget whatever legal protections you have in place for your lives, your estates, your fortunes, and your freedoms. Every one of them is built upon the laws that form the very basis of our entire legal structure. Do away with them, and watch the entire thing come tumbling down.
If you will forego PRINCIPLE, you have nothing whatever to say of lasting import. Your VALUES may subvert, obscure, and deny principle, but principle will always come back to haunt you - because principles, unlike values, never, ever, ever change. They are simply either observed or ignored.
Andrew Ellis (Wed Aug 11 11:20:03 2010)
Andrew, I understand the Constitution and agree that the mandate will likely fail if it goes to the supreme court. But beyond that I am not so naive as to believe that these Founders -- two centuries ago -- were so brilliant as to foresee all possible societal problems. Hell, they didn't even foresee that freedom of speech would protect political bribes.
Aside from that we must look at "common good," and a Medicare-for-all system is exactly that. For those that want to deny it, they have all the right to opt out and buy care the old-fashioned way, with cash dollars. Have at it.
Jack Lohman (Wed Aug 11 11:31:56 2010)
Jack - they weren't that brilliant, but they were brilliant enough to know they weren't that brilliant. Which is why they included precise and careful provisions on how the Constitution is to be amended. It's a slow process for very good reason.
You want a Medicare-for-all system? Be my guest. But follow the rules, or don't expect anyone else to. And the rules are very clear - amend the Constitution or your system is non-binding and a usurpation of States' and the Peoples' rights.
The "common good" is best served by not setting precedents and making exceptions. Don't let your fervor for short term success tempt you to undermine and the destroy the foundation for the long-term. The "common good" argument is precisely what sold so many on the health care bill - an emotional incentive that either blinded or induced many to ignore the proper legal process. Most people seem to have excellent motives. It is the means to the end that is ultimately destructive.
George W. used the same argument for the PATRIOT Act. Fellow conservatives argued that there were extenuating circumstances and accepted the massive power grab. That power has changed hands, and now, according to the US Department of Homeland Security, I am qualified as a white supremacist racist terrorist because I am actively involved in the effort to protect the innocent human lives threatened by abortion - sanctioned by the Supreme Court. I doubt I've gotten "loud" enough yet to "get noticed," but thanks to the appeal for the "common good" under George W., the DHS may, if it so chooses, tap my lines, monitor my email, and incarcerate me with no recourse to self defense as an "enemy combatant."
Again: PRINCIPLE versus VALUE. The premise of law is the former, not the latter, except by tyrants intent on seizing the moment to secure more power.
And no, I'm not a conspiracy theorist. Just an American who loves his country, and who hates to see it's greatness squandered by bumbling, selfish idiots and the clever fiends they elect.
Andrew Ellis (Wed Aug 11 11:58:22 2010)
Thanks Jack, I agree with you on Medicare for All.
Dean Weichmann (Wed Aug 11 12:00:49 2010)
Jack, regarding your comment on Medicare for all, that people would have all the right to drop out ... who do you think you're kidding? What right do I have to "drop out" of Social Security, Medicare, the Food Stamp program, or any other? Can I say, "I'm not going to pay the portion of my taxes that goes to these programs, and I will accept no benefits as a consequence?" You know darn well it will never work that way. The 'benefits' portion can be made optional, but never the 'paying' portion.
Tom (Wed Aug 11 12:17:32 2010)
The DHS document, if anyone is interested in my point of reference:
http://www.fas.org/irp/eprint/rightwing.pdf
Andrew Ellis (Wed Aug 11 12:20:51 2010)
The Constitution is indeed a superb document and I understand that amendments were purposely made difficult to accomplish. But you and others must get out of your heads that this is just a constitutional issue, it is political corruption by corporations that want in your pocket, paid off your politicians to get there, and will also control the amendment process.
What we battle is corporate rule, and if you want corporations calling our every shot, we have it. That's what won us ObamaCare. Live with it (if you wish).
I am somewhat surprised that Medicare and Social Security have not been challenged on the constitutional grounds the right-wing promotes. Maybe that will come.
But I (personally) do not favor going back to shoot-outs on the street. We need rules and regulations, and admittedly Medicare approaches socialized medicine. But allowing young bucks to opt out until they are faced with a costly and deadly disease, and then opt in because no for-profit insurer will have them, is somewhat stupid.
And here you are wrong: The "common good" argument DID NOT win us ObamaCare, $125 million in campaign bribes did. Isn't free speech great?
Let's not let PRINCIPLE blind us.
Jack Lohman (Wed Aug 11 12:21:59 2010)
Tom, you cannot opt out of national infrastructure costs, and that's what Medicare and Social Security are. Even defense costs. Or would you prefer an ala carte menu for taxation? Someone once said, "taxes are what you pay for civilization."
My problem is that political bribes allow those taxes to escalate to benefit the Fat Cats who fund the elections, but that view is not welcome here.
Jack Lohman (Wed Aug 11 12:28:45 2010)
Jack,
if I understand your post then you prove my point. That is that just because something costs money and is paid for by the government doesn't mean it is bad value relative to what the private market would otherwise provide. The public disclosure of costs (which Medicare does for better or worse) is a much better system than the current system. No other country in the world does it the way we do it. I do agree with you on the constitution. There was a time when the Supreme Court said that all men weren't created equal on constitutional grounds then, 100 years later they moved towards the opposite pole. The fact is that Scalia is wrong, the constitution is not "dead" as he says it is. Otherwise this country cannot survive in a ever changing modern world. I have sat in the Supreme Court and read various opinions and it is my opinion that the court in fact follows public opinion or sometimes leads it or sometimes goes it's own way. Anyone who assumes that the Court (or the founding fathers) are Godlike infallible providers of wisdom or law is naive. The Court is and has been run by imperfect men and women who sometimes move the country forward and sometimes back. If this country is to be run by a "strict" interpretation of the Constitution then we don't need a Court the whole country will be run as it was in 1787 plus a few amendments.
dave allen (Wed Aug 11 13:34:10 2010)
Dave, the government spends a lot of money, hopefully only on "good" values. Indeed some of those good values could be better provided through privatization, but under our current political corruption we'll never know which ones. Right now we have even privatized national security (See HERE, * Some 1,271 government organizations and 1,931 private companies work on programs related to counterterrorism, homeland security and intelligence in about 10,000 locations across the United States.).
We agree 100% on the Supreme Court.
Jack Lohman (Wed Aug 11 13:51:16 2010)
Jack, the campaign bribes you speak of are very real, and very abusive. But what they buy, precisely, is advertising dollars - advertisements that make appeals to the "common good." Advertisments that appeal to people on an emotional level. Advertisements that hone in on the "value" of the moment and completely obscure or deny principle. Ever look at Lady Justice? She wears a blindfold to represent the observance of objective principle, not obscured by the emotional sentiments that often drive people to make poor decisions, or poor judgements.
I don't argue that this is strictly a Constitutional issue. And yes, it is entirely true that corporations presently weild massive influence in politics with money. I don't know anyone, left or right, who wouldn't agree with that. Unfortunately a great many people tend to be lemmings when it comes to how those advertising dollars are spent, because it "feels good" to help people, nevermind that you're doing it by stealing from someone else.
I spent some time with people who were actively promoting support for Obamacare. They were people with excellent motivations - to help the less fortunate. I was the mean guy because I couldn't justify robbing Peter to help out Paul. I'm not blind to Paul's predicament.
And by the way, yes - Medicare, MedicAid, Social Security, and a whole HOST of other behemoth travesties can be challenged on Constitutional grounds.
I don't favor shoot-outs in the street, either. But you can only back a people so far into a corner before they've got to resort to less diplomatic means of self-defense. And the pressure is getting pretty darn high. We'll see what transpires this November. Failing that a solid reversal of our current course, I fear what it would then come down to.
Andrew Ellis (Wed Aug 11 13:54:29 2010)
Dave, if you're referring to slavery, it was Congress that "defined" who was a person and who wasn't, and it came to the fore as a consequence of a battle for votes.
Interestingly, just a few decades ago, the Supreme Court arbitrarily decided that another class of people weren't persons, and legislated by judicial fiat.
You're corrent in that no one is perfect, including the founding fathers. But what they had straight was that - knowing this to be the case - it is necessary to observe the unchanging principles. That is a piece of wisdom that is apparently entirely lost on the modern American. And I'd like to thank another unConstitutional body for that - you know, the one that steers the course and minds of future generations in the classroom.
Andrew Ellis (Wed Aug 11 14:02:40 2010)
I agree with much (but not all) of what you write, Andrew, but I'm 72 and don't have a lot of time to finese this. I must cut to the chase. Our system is broken precisely because of the corruption in politics. It is stealing from me and my family (and you and yours) and giving to the Fat cats that fund the elections. Get the cash bribes out of the system and these jerks will run the country in the best interest if the people.
Yes they will get (declining) pressure from unions and from corporations alike. But they'll overall make decisions that both you and I like. They are stealing your taxes because they are being paid to steal your taxes. That must stop. Only getting the bribes out of the system will cure it. Right now there are only two kinds of money; public and private. What would you recommend?
Jack Lohman (Wed Aug 11 14:09:54 2010)
Andrew:
"Unchanging principles" as determined by whom? The Constitution, like the Bible is subject to contradictions and interpretations by human beings. Like I said before, today's contemporary Supreme Court determines what today's values are based on their personal makeup balanced with their profession. Yes, Congress defined a citizen (slave being 3/5ths I believe)but it was the Supreme Court that determined that it was Constitutional to do so. If the values of the nation are such that Gay Marriage is acceptable or National Health Care than it is the Court's responsibility to determine that it is Constitutional unless there is so much conflict (and harm) with the Constitutional rights of others. In short, I believe the Constitution should be a mechanism to protect people and encourage fairness and Justice, not a mechanism to prevent change. Otherwise we as a people are dead in addition to the Constitution.
dave allen (Wed Aug 11 20:22:36 2010)
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