Why Wait for a Bill To Micro Manage Healthcare?

Hey guess what?
“These cuts will force cardiologists and oncologists to limit care to their Medicare patients, withdraw from treating Medicare patients altogether or require their patients to pay more out of pocket to make up the difference in the cost of these services.” (HT: Instapundit)

Where did I hear this type of thing before?

400 Economists (incl. 5 Nobelists) Support Romney's Economic Program

Here (h/t Mark Perry).  I case you were wondering, Krugman is not among the 5 Nobelists.  Check it out, pretty powerful stuff.

We enthusiastically endorse Governor Mitt Romney’s economic plan to create jobs and restore economic growth while returning America to its tradition of economic freedom. The plan is based on proven principles: a more contained and less intrusive federal government, a greater reliance on the private sector, a broad expansion of opportunity without government favors for special interests, and respect for the rule of law including the decision-making authority of states and localities.
Applying these principles, Governor Romney would:

• Reduce marginal tax rates on business and wage incomes and broaden the tax base to increase investment, jobs, and living standards.
• End the exploding federal debt by controlling the growth of spending so federal spending does not exceed 20 percent of the economy.
• Restructure regulation to end “too big to fail,” improve credit availability to entrepreneurs and small businesses, and increase regulatory accountability, and ensure that all regulations pass rigorous benefit-cost tests.
• Improve our Social Security and Medicare programs by reducing their growth to sustainable levels, ensuring their viability over the long term, and protecting those in or near retirement.
• Reform our healthcare system to harness market forces and thereby reduce costs and increase quality, empowering patients and doctors, rather than the federal bureaucracy.
• Promote energy policies that increase domestic production, enlarge the use of all western hemisphere resources, encourage the use of new technologies, end wasteful subsidies, and rely more on market forces and less on government planners.

In stark contrast, President Obama has failed to advance policies that promote economic and job growth, focusing instead on increasing the size and scope of the federal government, which increases the debt, requires large tax increases, and burdens business with many new financial and health care regulations. The result is an anemic economic recovery and high unemployment. His future plans are to double down on the failed policies, which will only prolong slow growth and high unemployment.
President Obama has:

• Relied on short-term “stimulus” programs, which provided little sustainable lift to the economy, and enacted and proposed significant tax increases for all Americans.
• Offered no plan to reduce federal spending and stop the growth of the debt-to-GDP ratio.
• Failed to propose Social Security reform and offered a Medicare proposal that relies on a panel of bureaucrats to set prices, quantities, and qualities of healthcare services.
• Favored a large expansion of economic regulation across many sectors, with little regard for proper cost-benefit analysis and with a disturbing degree of favoritism toward special interests.
• Enacted health care legislation that centralizes health care decisions and increases the power of the federal bureaucracy to impose one-size-fits-all solutions on patients and doctors, and creates greater incentives for waste.
• Favored expansion of one-size-fits-all federal rulemaking, with an erosion of the ability of state and local governments to make decisions appropriate for their particular circumstances.

In sum, Governor Romney’s economic plan is far superior for creating economic growth and jobs than the actions and interventions President Obama has taken or plans to take in the future. This November, voters will make a fundamental choice between differing visions of America’s economic future.

And yet MSM doofi like Ezra Journolist Klein will still publish things like "Romney vs. the Economists".  Although I warn you not to go to Klein's Wonkblog, the obsessing over Paul Ryan is a bit nauseating.  Paul Ryan appears to be to Ezra Klein as Sarah/Trig Palin was to Andrew Sullivan.

Cool: I Might Be Able to Skip the ObamaCare Mandate

Sorry 99%ers.  I know that you are still smarting over the fact that you are going to help me, an off and on 1%er (some years are better than others!), buy a nice house, but I have some more unwelcome news.

I might be immune from the ObamaCare mandate penalty/tax/whatever thingy.  Yup.

Under normal circumstances, the IRS has broad powers to collect taxes from those who don't pay what they owe. It can charge civil and criminal penalties, impose liens, and seize assets and bank accounts.

But ObamaCare specifically blocks the IRS from using these enforcement tools when it comes to collecting any unpaid ObamaCare tax penalties.

These restrictions "make it unlikely the IRS can effectively enforce the individual mandate," according to a detailed analysis of the tax penalty by Jordan Barry and Bryan Camp, law professors at the University of San Diego and Texas Tech University, respectively.

"The individual mandate," they conclude, "may not actually be mandatory after all."

Naturally, I'm going to get some tax advice on this, but it looks like all the IRS can do to enforce the ObamaCare mandate is withhold refunds.  For those whose tax circumstances are such that they are never in a position to claim a refund (owners of LLCs are usually never getting a refund), it might be possible to skirt the mandate penalty/tax thingy.

Chances are I am going to buy health insurance anyway.  I've already been notified that my policy is going to be cancelled due to ObamaCare, but not to worry, because they have a nice, compliant policy for me that is only 6% more expensive.  (That is only the case because I live in New York.  Us New Yorkers were getting screwed well before ObamaCare came along, so the sticker shock post-Obamacare is less than in other states.)  It's not a good deal for me, but it is not egregious enough yet for me to self-insure.  That could change however. I might decide to put aside a nice tidy sum as a reserve against healthcare spending, take my chances, and keep the dough should we all stay healthy.  Knowing that I could skirt the penalty might be the deciding factor in such a decision.

Now, before you get all critical on me (look at the greedy 1%er sabotaging ObamaCare!) this is the same situation with the expansion of Medicare at the state level.  ObamaCare was either sloppily written and/or written the way it was so that it could pass constitutional muster. States choosing not to expand Medicare are within their rights to do so as the law  is written (the LAW OF THE LAND, I might add).  States have no obligation to account for sloppily written law and/or cede a constitutional prerogative if they don't have to.  The individual mandate is written as it is and its constitutional survival is dependent on a precise SCOTUS interpretation.  I have no obligation to account for a sloppily-written law and/or to cede a constitutional right by handing over a check that I don't have to.

Sorry if this makes you mad.  Maybe there should have been more thought put into this thing...

Democrats Propose Enslaving Doctors

I foresaw that doctors would refuse Medicare patients en masse in the wake of ObamaCare, and I forsaw that this would be a major policy problem for the statist left in terms of healthcare policy.  I said they'd likely resort to their least attractive political instinct, coercion.

What is the government's response when a large chunk of the very best doctors tell patients who carry a government insurance card to beat it? Can the government demand that these doctors treat patients? Is this practical, let alone constitutional? I doubt it.

Well, it looks like Dems are revving up the coercion machine as ObamaCare hits the skids.

As a sign of what may be to come as ObamaCare crumbles before our eyes, a Democratic candidate for the House of Delegates in Virginia has suggested legislation to force doctors to treat Medicare and Medicaid patients. 

And, of course, we know what this policy really is...slavery.

UPDATE:  More here, and it won't surprise that Reagan was way ahead on this notion.

Not "Death Panels" but "Overhauling End-of-Life Care"...

Oh, but that idiot Sarah Palin is an idiot for saying "death panels"...

See if you can spot all the euphemisms for "letting old people die and not using up our healthcare dollars" in this gibberish...

The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.

“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a co-chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want and is also more costly.”

But some recommendations, like changing the reimbursement structure so that Medicare would pay for home health services instead of emphasizing hospital care, and so Medicaid would have better coverage of long-term care for the frail elderly, would require congressional action. 

It calls for a “major reorientation and restructuring of Medicare, Medicaid and other health care delivery programs” and the elimination of “perverse financial incentives” that encourage expensive hospital procedures while growing numbers of very sick and very old patients want low-tech services like home health care and pain management. 

You see, those damn old and sick people take up hospital beds and doctors' time when they could be at home, drugged-up, with one of those useless home healthcare professionals (ever talked to your average home healthcare professional?).

Hey, here is a radical idea, why not let patients decide what they want...expensive hospital-based healthcare or home healthcare and "pain management" (perhaps my favorite healthcare euphemism!). 

And why does healthcare have to be a "system", why is it not a marketplace, a series of capabilities and options available to people based on their preferences and choices???

I Said Doctors Would Quit, and They Are

Let's fire up the wayback machine to when Obamacare was just a glimmer in Nancy Pelosi and Barack Obama's eyes.  I asked readers to engage in a little thought experiment

Here is a thought experiment. You are a 55 year old vascular surgeon and you've been practicing medicine for 25 years. You went to medical school, did years of internships, studied and passed the boards. You have done hundreds if not thousands of carotid endarterectomies, bypass surgeries, and stent implantations. Over the years you've made alot of money as this is complex and critical stuff this vascular surgery (cardio-vascular disease is one of the five diseases that account for 75% of healthcare spending). You've raised kids and now have grandkids. For the near miracle of a carotid endarterectomy, which can add years onto someone's life, you used to get paid a couple thousand dollars. As Medicare has tried to put a lid on costs, that figure has gone down to less than a thousand bucks, say $900. The success rate of such surgery has gone up, so it should be more valuable, as should your own value since you've performed so many of them, but nonetheless you are earning less for this surgery. Now ObamaCare passes and in order to "bend the cost curve" reimbursement for carotid endarterectomies falls further - either through direct mandate Medicare lowers its reimbursement rate or the "comparative effectiveness" folks determine that this is a costly procedure based on some "quality of life adjusted years" formula. Let's say it falls to $600. What do you do? Here are some options:
1) Keep practicing this highly complex and special skill you have for the price a plumber would charge to install a sink (call this the "suck it up" or the "public spiritedness" option);
2) Retire to spend time with the grandkids, or do just about anything else given that you have more than enough money to retire (call this the "live your life" or "Go Galt" option;
3) Refuse any patients in need of a carotid endarterectomy that can't pay you in cash an amount more reflective of the free market price for the procedure, say $2500 (call this the "demand fair payment for your services" option);
4) Refuse to perform any carotid endarterectomies at any price and solely perform elective cosmetic vascular surgeries like repairing middle-aged women's vericose veins, where you make more money? (call this the "Half Galt" option)
5) Sue the government, maintaining that forcing you to perform carotid endarterectomies for $600 represents a "taking" of your private property, your expertise and training (call this the "fight City Hall" option).

Hmmm.  Now we learn that 83% of doctors considered quitting practice in the wake of ObamaCare.

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

And here is a representative letter to the editor in today's WSJ:

I retired earlier than necessary because of the inadequate pay for government programs and too much government paperwork. People don't get the care and time they deserve, and physicians don't get the satisfactions that made medicine a noble profession, even when we worked for free. I opted out and I suspect others will, too, as the program continues to intrude.

Firth S. Spiegel, M.D.

Healthcare Thought Experiment

Here is a thought experiment. You are a 55 year old vascular surgeon and you've been practicing medicine for 25 years. You went to medical school, did years of internships, studied and passed the boards. You have done hundreds if not thousands of carotid endarterectomies, bypass surgeries, and stent implantations. Over the years you've made alot of money as this is complex and critical stuff this vascular surgery (cardio-vascular disease is one of the five diseases that account for 75% of healthcare spending). You've raised kids and now have grandkids. For the near miracle of a carotid endarterectomy, which can add years onto someone's life, you used to get paid a couple thousand dollars. As Medicare has tried to put a lid on costs, that figure has gone down to less than a thousand bucks, say $900. The success rate of such surgery has gone up, so it should be more valuable, as should your own value since you've performed so many of them, but nonetheless you are earning less for this surgery. Now ObamaCare passes and in order to "bend the cost curve" reimbursement for carotid endarterectomies falls further - either through direct mandate Medicare lowers its reimbursement rate or the "comparative effectiveness" folks determine that this is a costly procedure based on some "quality of life adjusted years" formula. Let's say it falls to $600. What do you do? Here are some options:
1) Keep practicing this highly complex and special skill you have for the price a plumber would charge to install a sink (call this the "suck it up" or the "public spiritedness" option);
2) Retire to spend time with the grandkids, or do just about anything else given that you have more than enough money to retire (call this the "live your life" or "Go Galt" option;
3) Refuse any patients in need of a carotid endarterectomy that can't pay you in cash an amount more reflective of the free market price for the procedure, say $2500 (call this the "demand fair payment for your services" option);
4) Refuse to perform any carotid endarterectomies at any price and solely perform elective cosmetic vascular surgeries like repairing middle-aged women's vericose veins, where you make more money? (call this the "Half Galt" option)
5) Sue the government, maintaining that forcing you to perform carotid endarterectomies for $600 represents a "taking" of your private property, your expertise and training (call this the "fight City Hall" option).

Hmmm. Interesting thought experiment, no? Think option 2 isn't realistic? Watch this. Think option 4 is nuts? Read this. Think option 3 is crazy? Read this. Think option 5 is nuts? Read this. Might I suggest that the only nutty option here is option 1? So what will "bending the cost curve" do for our healthcare system if it is indeed achieved through lower reimbursements to doctors? Plenty to ponder there. Thanks for playing along.

Lib: Yes, We Lied, But Righties Are Still Wrong, Because They're Mean

Jonathan Chait has discovered why conservatives don't like ObamaCare…and it is refreshingly not the fact that the Lightworker is black.  James Taranto reveals the big reveal…

Chait imagines that he's found out his ideological adversaries. His big reveal:

But at least conservatives are now representing their true bedrock position on Obamacare. It is largely a transfer program benefitting people who either don't have enough money, or pose too high a health risk, to bear the cost of their own medical care. Conservatives don't like transfer programs because they require helping the less fortunate with other peoples' money.

Wait, ObamaCare is just a big wealth redistribution scheme!  Who knew?  I didn't, after all, it wasn't proposed as such.  It was a way to improve healthcare, to lower costs, and to fix a "broken" system.  If I had known it was just to take money from some people and give it to others in the form of healthcare services, then I could have pointed to Medicare and Medicaid and said, "Wait, we already have such programs, one for the elderly and one for the poor, why do we need another?"

Which, of course, would have led to uncomfortable debates about Medicare and Medicaid's inferior health outcomes and on top of their cratering fiscal outlooks.  And the Obamacrats weren't out to have that discussion, they were simply out to sell a shiny new thing to a citizenry ready to buy whatever because of that nice seeming (and black) salesman.

Bottom line, we were right in analyzing ObamaCare for what it really was, but wrong for having done so; and, lefties weren't wrong for lying because what they lied for was right, in their view?  Sounds about right.

Healthcare Thought Experiment II

In my first "Healthcare Thought Experiement" post back in August, I used the example of a vascular surgeon and the procedure of carotid endarterectomy. Specifically, I asked what sort of decision-making process would a seasoned, older vascular surgeon undertake when faced with a government directive to perform carotid endarterectomies for well below the market price, using approximate number - say $800 versus $3500. I suggested that there are alternative things doctors can be doing with their time to practicing their skill at what they will surely view as insufficient compensation.

Today I would like to address a different slice of the same group, vascular surgeons, the top eschelon of that population. Surely, vascular surgery, indeed most complex medicine, isn't a commodity; there are those surgeons who are more experienced, or more skillful, or more responsive to patients or whatever. These criteria and others are often boiled up into analyses such as this. So let's imagine that you fall within the top 20% of all vascular surgeons, what then is your reaction to federal directives to "bend the cost curve" that will result in substantially less compensation for specific procedures such as the carotid endarteredtomy? Remember, you are the best of the best. Are you going to:

1) Keep practicing this highly complex and special skill you have for the price a plumber would charge to install a sink;
2) Refuse to accept government insured patients for whom you would have to accept insufficient compensation, and only accept patients who can pay, personally or through private insurance, prices that evolve among top-ranked vascular surgeons (aka via the free market).

These are really the only two options as federal rules state (and this certainly will be preserved and/or expanded to any public option) that if a provider accepts one Medicare patient, they must accept all Medicare patients - so once you take from the system, you are bound to the system. So how do you go about deciding what to do, if you could devote 100% of your capacity to carotid endarterectomies. Perhaps if you chose option two you would lose most of the opportunity to perform as many of these procedures as you would like as patients opt for providers who accept the mandated price, hurting your earning potential. However, since you are an elite provider, perhaps not. Perhaps there is enough demand for procedures from people willing to pay the best doctors full price, in which case your earnings potential is not diminished. There is also the possibility that demand falls to somewhere between the mandated price and the free market price. Perhaps that demand means you can only do a percentage of the possible procedures. Well, using our numbers from above, you can make the same money even if your decision results in an 77% reduction in procedures that you perform. So as far as carotid endarterectomies are concerned, you can withstand an 77% decline in demand for your services and still make the same money. With the increased time, you can apply the same calculus to bypass surgeries, stent implantations, etc. to arrive at your optimal income. There are pretty decent odds you could fill your schedule doing procedures for market rates, shunning all government patients and not dent your earnings potential too much.

Next question, let's say many of the top 20% of doctors in any critical field opt for something like option two. What is the government's response when a large chunk of the very best doctors tell patients who carry a government insurance card to beat it? Can the government demand that these doctors treat patients? Is this practical, let alone constitutional? I doubt it.

So, we could have a combination of older doctors and elite doctors opting out of a government healthcare system altogether...is this good for the healthcare system?

A Move Worthy of Slick Willie

Having pissed off seniors to a fare-thee-well with massive Medicare cuts and "Quality Adjusted Remaining Life Years" (the Orwellian mechanism which liberals will use to deny granny care [we know because they've said it] and get very defensive about when normal citizens call them what they are) Obama attempts a cynical bribe, and, frankly, not a very good one. Give $12 billion with one hand while taking $300 billion with another. Smooth.

UPDATE: Gigot & Co. nail it (bonus: hilarious title).

Another Warning We Probably Won't Heed

I touched on this before, but it looks like the New Jersey state pension scandal is turning out to be a whopper. The state apparently failed to make payments into the system to the tune of $8.1 billion. In addition, it wasn't like they just, er, forgot, there was a chronic failure to contribute funds over ten years. The current funding gap could be as high as $56 billion. Turns out that the SEC is looking into it, as there may be some fraud involved in how the state represented its finances to prospective bondholders. Furthermore this is not the only public pension scandal around. If San Diego's $1.7 billion hiccup is "Enron by the Sea" how will we term NJ's $56 billion mess? This would make Enron look like a kid stealing a twinkie from the corner deli. Of course the MSM will never decry the public corruption and mismanagement of the state of NJ with the same fervor and volume as they decried the corporate cupidity ala Enron. Not only that, this will be seen as an anomaly, a strange occurence, when it is in fact the norm. This is not unusual. State pensions, city pensions, the federal budget, state budgets, Social Security, Medicare, welfare, Katrina relief, Iraq contracting, etc. All corrupted, all grossly mismanaged, and all completely foreordained - the increasing size and scope of the state will inexorably move toward greater instance of corruption (see the quote one paragraph down).

And we are dabbling with the notion of ceding our healthcare system to the government? It is an eternal mystery. Why do the majority of people demand more government?

BaucusCare Would Incent Me to Dump My Plan

I've been thinking about the Baucus plan and maybe I'm missing something, but it could work out pretty good for me and many others like me. Let me walk you through this. Because we essentially already have ObamaCare here in New York state, I pay through the nose for my insurance, on the order of $20,000 (actually, I got a notice today that it is going up 20% in 2010). Unless someone in the Baseball household has a major procedure, the cumulative Baseball family healthcare spending comes nowhere near that, so we lose money, but we get the insurance value (which, of course, Anthony Weiner doesn't understand). So, Baucus (he who either lies or doesn't understand basic finance) is going to slap me with a penalty if I don't buy a government-dictated insurance policy that will almost certainly not be to my specific needs. That penalty ranges but let's say I get hit with the maximum that I've read, $3,800. Why would I not dump my insurance, pay the penalty, and have roughly $20,000 left over for out of pockets and "self-insurance"? I'm still pretty young, so aside from getting hit by the proverbial bus, statistically I've got several years of decent health in which to pay Baucus's silly fine and bank some reserves. Assuming I don't spend all the savings on getting drunk, I could bank $250,000 by the time I hit 50. In the meantime, I can take my cash horde to all the doctors that will opt out of BaucusCare, the same way they have opted out of Medicare, and negotiate privately. Medicine will be more expensive and innovation will suffer, which I am not happy about, but at least I won't be competing with and waiting in line behind all the rubes with their BaucusCare plan cards!

UPDATE: Now I read that the fine will max out at $1900. All the better for me to purchase healthcare services with cash on the barrel.

More Bad ObamaCare Fallout That Was Predicted

Whoa, apparently there could be a "mass exodus" of doctors from the Medicare system.

Really?  No shitting me?

Gee, I think I predicted that, although it was so long ago, it's hard to remember...let me check...

OK, yup, there it is...yes, I did predict it.

It's Official, Geithner Is Batty

Wanna hear the latest economic wisdom from the guy who said that the Obama administration doesn't have a fiscal rescue plan, but they know they don't like the Republicans' plan? Of course you do.

Take it away TurboTax Timmy:

"There is no economic or financial case for using the fear of future deficits to cut as deeply into core functions of the government, to weaken the safety net or fundamentally alter Medicare benefits as do the Republican proposals," Geithner said."

Read it again and understand that this statement comes after three years of $1.3 trillion deficits, which has become the standard Obama run rate. Boiled down to its essence TTT is saying there is no economic or financial logic against spending more money than you have. TTT is saying that a Greece can't happen. Who in their right mind would buy a US Treasury bill after hearing that?

With Apologies to Chief Justice Roberts, "The Way to Make Government Smaller Is to Make Government Smaller."

I've notice here and there around the rightosphere a call to make suggestions on how the GOP can right itself and regain some electoral competitiveness. This is silly, of course, because the answer is easy, stop being Democrats. Still, in the spirit lighting a candle rather than cursing the darkness, I resurrect a post from 2006 where I lay out a plan that, if boldly championed, will light the fires of the armies of small government voters. Since I had maybe five readers in 2006 and easily have 10-15 readers now, my proposal will clearly have double or triple the impact that it had then. So without further Adoo...


Thinking Ahead to 2008

OK, time to begin building the policy platform for 2008. Republicans need to really convince small government types, Libertarians and Reagan Republicans alike, that they will walk the small government walk. How? In addition to keeping the flame for reform - Social Security reform, tax reform, tort reform, free-market healthcare reform, drilling for domestic energy - forgo namby-pamby goals. Think big, make splash. Here are a few starting points:

The Department of Education's budget is $89 billion. Cut it in half. Yes, half. Abandon all federal mandates and aid to states. Retain only those programs that benefit the lowest income Americans, say bottom 5%. The Department of Education has no bearing on the quality of education in this country.

The Department of Health and Human Service's budget is $700 billion most of which is Medicare and Medicaid. Those are separate issues. For now, cut in half the approximately $70 billion of HHS's budget that is discretionary. Meals on Wheels? Nice in theory, but leave it to states and private citizens.

The Department of Housing and Urban Development's budget is $31 billion. Kill the entire department. Yes, kill it. HUD is a patchwork of subsidies and grants that make housing more expensive and urban areas more dependent on the federal government. Devolve the responsibility to states.

The Department of Energy's budget is $23 billion. Kill it. Biggest waste of money there is. Alternative fuels? Leave it to venture capital and the private sector. We'll have more, better, and cleaner energy as a result.

The Department of Commerce's budget is $9. Small potatoes, but cut it in half anyway. Plenty of subsidies and protection that can and should go poof.

The Department of Defense's budget is $400+ billion. Defense is important and cannot be done by the private sector. But there is ALOT of fat. Freeze the budget for 5 years, force the department to prioritize necessary projects over fat.

The Department of the Interior's budget is $10 billion. Small spuds but kill it anyway. Let states steward their natural resources. Nobody cares for the land like the locals.

Much of this will shift fiscal burdens to states. Fine. Cut federal taxes so that citizens have more money to pay state tax increases and let the 50 states compete to provide efficient government. Bloated, inefficient state governments will lose residents, economic and political power. Efficient ones will win.

This advice is easy applicable to Democrats as well. Americans want honest government first and foremost and less government ultimately. If you want to keep this majority, you will need to show at least some propensity to admit the ineffectiveness and unnecessariness of certain government activities. Two to four years of "we are going to take things away from you for the common good" will land you back in the wilderness.

Docs Have Their Own "Doc Fix"

It's called "Cash, Visa, Mastercard or American Express." The warnings were there. It was basic logic and common sense. I was just one among many who said it would happen - and it is happening, doctors are bolting Medicare in massive numbers. Stay tuned because soon we'll be hearing the same thing about any insurance coverage that comes out of the exchanges tied to Obamacare. Doctors will not provide life saving care for plumbers' wages.

Yes, Bubba Is THAT Good...Add Bowles to the Clintonite Death Squad

The Obama campaign's big early salvo against Romney was his career at Bain Capital.  That was crushed by a Clintonite, (many Clintonites actually, one actually named Clinton).

Next beachhead for a major Obama assault is Medicare, hoping to paint Paul Ryan as that mythical evil budget zeroing Republican.  That effort is running into major obstacles (or shortly will) at the hands of another figure who can reasonably be called a Clintonite.

Now, if only there was an influential Clintonite businessman attacking Obama for his miserably disastrous economic policy...oh wait...

What is it with all these Clintonites creating havoc for the Obama campaign?  Yeah, you better believe it, baby.  I'm waiting for the grande finale.  Just how will Bubba make his heroic appearance at the DNC as a putative white knight for Obama, somehow not work out for Obama?  The suspense I tell ya' !!

America Is Stuck On Stupid

This could be an enormously long post, but I will try to keep it brief.

Let's face it, America is stuck on stupid.

I've laid out so many nuggets on this blog and so many other blogs have the widely dispersed evidence.  For instance, just go to Instapundit and search the term "the very best of hands."  But it is more than the idiocy of our leaders, it is that combined with inertia and an unresponsive politics.  For some reason we can't get things done we can't change things.  Although I am indisputably conservative/libertarianish, I think that a liberal/progressive would share such a feeling, witness the frustration/outrage over the failure to enact any sort of gun control legislation at the federal level (although lefties have gotten several big wins on the state level).  But gun control is not an issue they I would hold up as an example of "stuck on stupid."

Stuck on stupid means we are plumbing the depths of idiocy and irrationality that, if allowed to continue, will be our destruction.  We won't self-destruct if we don't close the "gun show loophole."  We will self destruct if we run trillion dollar deficits by giving the wealthiest cohort of individuals to ever walk the Earth free artificial joints and unneeded retirement income, which is what Medicare and Social Security amount to.

I'm talking first principles.  Why do we do things?  At the basic level.  Why?

Why do we spend billions  of dollars on the least efficient form of energy and prejudice the most efficient form of energy all for a speculative theory, especially when the more efficient energy that actually serves our purpose based on that phony theory?  Stuck on stupid.

Victor Davis Hanson has some bracing clarity along these lines today based on our most recent national tragedy.

Is America so short of manpower that we need a Tamerlan Tsarnaev, his brother, his mother, or his father in the United States?

Seriously.  Why were the Tsarnaevs even here?  Compassion, right?  They were refugees.  Really?  Refugees from something so terrible that...they went back to visit.

Why give asylum to folk such as the Tsarnaevs if many of these endangered “refugees” eventually return to live in, or to visit, the supposedly hostile place that was the basis for their origin claims on our asylum?

And we subsidize their radicalization.

Sure we have an honorable tradition of accepting immigrants.  But everybody?  What skills did the Tsarnaevs have that we need?  Do we not even ask who we want or what we need here anymore?  It looks like we have, in the Tsarnaevs and no doubt many like them, some folks with not alot to offer, who aren't really refugees, who live off of taxpayer money, and wind up inflicting mayhem upon our society like we rarely ever see.  Like I said, stuck on stupid.

Petty, infantile insults to our greatest allies.  Naive and hopeless overtures to sworn enemies.  Stuck on stupid.

NASA outreach to Muslims.  Air traffic furloughs while the FAA spends $400 million on women's issues.  Stuck on stupid.

One eighth of the country on food stamps.  Stuck on stupid.

Getting back into the business of socially engineering the housing lending market.  Calling terrorism by the Orwellian term "man-made disasters."  Stuck on stupid.

2000 page laws that no lawmaker reads but that votes for anyway.  Stuck on stupid.

Mad?  Don't worry, we won't be stuck on stupid for too much longer.  We don't have the time and we don't have the money.  Common sense is coming back, no matter what we do.  It's coming back.  It has to, despite our most fervent wishes.

We won't be stuck on stupid for too much longer.

Josef Stalin for Sugeon General!

Great timing. Just as I thought to establish my Healthcare Clearinghouse posts, Prof. Mankiw promptly provides fodder to add to it by linking to David Leonhardt's dishonest and stunningly blind column where he advocates universal healthcare coverage.

The article opens reasonably enough, talking about broad variations in the instance of certain medical procedures across geographies. Indeed there are such variations and, in theory, there shouldn't be - medical knowledge ought to disperse throughout the profession fairly quickly and diagnoses and treatment ought to be fairly uniform. The reality is quite different. To begin with, some doctors stay scrupulously current with the medical state-of-the-art. Others do not. Some doctors are philosophically inclined to recommend surgery, others to council against it. Differences in the demographic characteristics of local population can also result in wide variations in surgical incidence. A young population is more likely to have higher proportion of certain surgeries than a retirement community as young people can handle the trauma of surgeries better than older people. Young people also opt for elective surgery more often, as they have more years ahead of them in which to reap the benefits. In addition, certain cities get a reputation for leadership in certain fields, sometimes simply becase a renowned surgeon chooses to live there, or a local wealthy donor establishes a center of excellence in a field (example here). My point is that there are complex reasons for these variations. To interpret these numbers as evidence of wasteful consumption of healthcare is preposterous. Furthermore, Leonhardt's example of Idaho Falls is a thin reed. Idaho Falls has roughly 53,000 residents (Bonneville County close to 100,000), implying that there may not be more than 5 or 6 neurosurgeons there who can do lumbar fusion procedures. One especialy renowned surgeon residing there can skew the numbers drastically.

This is not to say that wasteful medical spending does not occur. It does. Alot. There is a vast and well-established economic literature on overconsumption and the economics profession has identified a reliable culprit of overconsumption, the presence of a third party payer - precisely what Leonhardt advocates. It is evidence of messianism that Leonhardt omits any discussion of the well-known effects of a third-party payer on oversonsumption, even more so that he tries to pin the source of the problem on local communities.

Now that Leonhardt has set up his reader with a dishonest premise, he can get into the nitty-gritty, his third party payer policy nirvana - universal healthcare coverage. His preferred approach is, well, stunning:
"Along these lines, the three leading Democratic candidates have quietly come up with nearly identical ideas. Deep inside their health care plans, Mrs. Clinton, Mr. Edwards and Mr. Obama have each called for the creation of a national institute to figure out which kinds of medical care actually work. This institute would sort through the scientific research on, say, spinal fusion and help people understand when it may make sense and when it’s likely to be just another big medical expense that doesn’t solve anything."

Got that, it's an "institute." Not a government bureaucracy, but an institute (although given the vast size and complexity of the medical world, can anybody reasonably claim that this institute would not become another large bureaucracy). This institute would determine what treatments are approriate and not appropriate for you and me, and it would dictate prices to that other large government bureaucracy, Medicare, and the private market (we know, quite clearly, what centralized price-setting results in - shortages at worst and misallocation of resources at best). What is stunning about this is how closely it resembles the fascination that economists of FDR's day had with Soviet central planning:
"The group was dazzled by the Soviets' economic planning. Stuart Chase, a founder of Consumers' Research (which would become Consumer Reports), reported that "sixteen men salt down the whole economic life of 146 million people for a year in advance as calmly as a Gloucester man salts down his fish...and...the actual performance for the year 1928 will not be so very far from the prophecies.... One suspects that even Henry Ford would quail before the order."
Finally, this institute is redundant. It exists today, except that it is not one institute but many institutes and institutions that do exactly what Leonhardt feels needs to be done. The difference is that they compete to deliver the most reliable output. One would have to be ignorant or blind to the last 50 years of economic thought and actual history to think that centralizing the authorization process for medical procedures would result in optimal healthcare outcomes. It clearly wouldn't and Leonhardt doesn't make claims that it would, it's all about expunging costs from the system. The word for this is rationing. What Leonhardt wants is a large bureaucracy engaged in rationing on a massive scale, indifferent to the particular circumstances of your and my health.
Leonhardt ends with this: "The simple truth is that medical spending can’t continue to rise at its current rate. Somehow, we need to make choices."
What he means, of course, is that he and a small band of elitists needs to make choices. Choices for you and me.

Finally Someone Other Than Me: Stop Coddling the Elderly

"Stop coddling the elderly" says Bob Samuelson, the very not-right-wing economic columnist.

It has long been obvious that the 65-and-over population doesn't fit the Depression-era stereotype of being uniformly poor, sickly and helpless. Like under-65 Americans, those 65 and over are diverse. Some are poor, sickly and dependent. Many more are financially comfortable (or rich), in reasonably good health and more self-reliant than not. With life expectancy of 19 years at age 65, most face many years of government-subsidized retirement. The stereotype survives because it's politically useful. It protects those subsidies. It discourages us from asking: Are they all desirable or deserved? For whom? At what age?

Kinda like when I said that we are going bankrupt buying hip replacements for the richest cohort of people to ever walk the Earth.

We will self destruct if we run trillion dollar deficits by giving the wealthiest cohort of individuals to ever walk the Earth free artificial joints and unneeded retirement income, which is what Medicare and Social Security amount to.

I'm talking first principles.  Why do we do things?  At the basic level.  Why? 

Short answer:  AARP.  Once upon a time, they were a smallish lobbying group mostly representing an actual and somewhat deserving constituency.  Now, they are a near impervious back-room power player run by a bunch of professional lefty redistributionists with only a tangential motivation in serving their nominal constituency's best interests.