Obamacare, Ryancare, it's the Same Damn Concept!

I was listening to an episode of the Diane Rehm Show today (because I’m a senior citizen of course) and the topic was Paul Ryan’s budget.  They got into a discussion about Medicare and the “premium support” plan that Ryan’s budget would eventually implement where elderly individuals would be given a stipend to purchase insurance in health exchanges which would be regulated by the government.  You know, the policy that would “end Medicare as we know it”.  Predictably the Republican in the discussion, Grace Marie Turner of the Galen Institute, voiced strong support for Ryan’s plan, while the Democrat in the discussion, Jared Bernstein of the Center on Budget and Policy Priorities, voiced opposition.   Later on in the discussion, the topic switched to Obamacare, a plan that would give poor individuals a stipend to purchase insurance in health exchanges which would be regulated by the government.  The roles were reversed.  Jared Bernstein touted this plan, calling it “the right way” to solve America’s health care problems, while Grace Marie Turner expressed concern over Obamacare’s drastic cuts to Medicare service providers.  

Since Paul Ryan was selected as Mitt Romney’s running mate, Democrats have worked to expose the bad parts of Ryan’s premium support plan.  It will ruin the existing system as we know it and will lead to higher deficits in the future.  What are the arguments Republicans have long made against Obamacare?  That it will ruin the existing system as we know it and will lead to higher deficits in the future.  

How can we as Democrats defend Obamacare but condemn Ryancare? This doesn’t make sense to me.  Democrats rail against Ryancare about how the cost of the support stipend won’t increase each year at the rate of medical inflation, which will lead to seniors having to pay out-of-pocket for coverage they used to get for free.   But the rate of increase of the Obamacare stipend for poor people in the exchanges is tied to the poverty rate, which does not increase at the rate of medical inflation, and everyone is paying out-of-pocket for coverage already.  You know what one difference is between the two plans is?  Ryancare actually has a public option in its exchanges (Medicare).

So Paul Ryan seeks to get rid of a system with a guaranteed benefit in order to replace it with a system of government-regulated capitalism.  And Barack Obama seeks to get rid of a system of exploitative corporate shadiness in order to replace it with a system of government-regulated capitalism.  I can see that each party is motivated to defend the direction in which the proposed systems are moving, but they’re both ending up defending government-regulated capitalism using basically the same arguments for and against.  

As Ezra Klein points out, "[this] has left the two parties in a somewhat odd position: Democrats support the Republicans’ old idea for the under-65 set but oppose it for the over-65 set. Republicans support the Democrats’ new idea for the over-65 set but oppose it for the under-65 set."

This leads to confusion and hypocrisy.  Here’s the hypocrisy: the aforementioned Grace Marie Turner defends “programs that give us a great model” featuring “seniors making choices from among competing private plans”, but she also thinks Obamacare’s exchanges, which feature people making choices from among competing private plans, features too many “complex and onerous bureaucratic rules” that throw up “barriers to competition and consumer choice”.   And on the other side: Barack Obama has labeled the system that joins a mix of private insurance options with one public option (Medicare) as “thinly veiled social Darwinism”, but when he proposed creating a health insurance exchange joining a mix of private insurance policies with one public insurance policy (the Public Option), he characterized it as a system that would “provide more choice and more competition,” one that would “keep the policies affordable”.  

Is it possible for people to be both for market-based health care reforms and against market-based health care reforms?  I guess so, because everybody is. 

Individual Freedom and the Birth Control Debate: Finally, a Man's Perspective

This whole recent debate about birth control has been truly one of the worst examples of how we Liberal and Conservative Americans talk to one another. There has famously been a whole lot of name calling, but not a lot of listening. And it definitely has been cutting both ways.

Terrible things have been said by Rush Limbaugh regarding Sandra Fluke's testimony about birth control to Congress, and he has been rightfully excoriated by the mainstream media to the point where his advertisers are having a hard time justifying their sponsorship of his program. But while it is fun and a little bit cathartic to jump on the anti-Rush bandwagon, I think we've lost what is a legitimate concern for right-wing types: why should birth control be subsidized by taxpayers and not by users of birth control?

Limbaugh's tirade came on the heels of an earlier discussion that was kicked off by the Secretary of Health and Human Services Kathleen Sebelius when she announced that women needed to be granted free birth control coverage by insurance companies, and that there would not be a religious exemption granted for religious-owned organizations that did not primarily serve a religious clientele. Catholic Church members and social conservatives pointed out that this was an unprecedented government infringement on the separation of church and state. But too often their concerns were blown off as just the same old anti-choice womyn-hating bluster by establishment media.

There are legitimate concerns about government overreach and freedom of religion at the heart of these debates, and I think these concerns need to be acknowledged and addressed.

However, I also think that the concerns of Liberals aren't getting the proper amount of attention. Advocates of free birth control for women are not advocating taxpayer-funded guilt-free sex for sluts. Their concern is the relationship between cost and access to birth control, especially for the poor, and that by expanding access to birth control, poor women would be able to define their own economic destiny more easily. But no one is making this argument. Those who should be making this argument are too often making the argument that Conservatives are bullies and pigs and should be ignored.

One thing all of us Americans should be able to agree on is that the right of an individual to be able to choose things in life (religion, career, products and services) should be preserved whenever pragmatic. That's why it's so annoying to me to see these arguments where the Conservatives are the only ones who are pointing out the government infringement on an individual's right to choose, be it a pious employer or an outraged taxpayer. By choosing to upbraid Rush Limbaugh, liberal media types leave the link between lack of money and lack of choice unexposed, which is surprising considering the success that Occupy Wall Street had in raising awareness at the advantages that wealthy people have in a capitalist society.

And just in case Liberals are thinking that they don't need to address these arguments because the public is on their side, they should really take a look at this recent New York Times / CBS poll (page 22) that shows that 51% of Americans believe that not just religious organizations but all employers ought to be able to opt out of offering insurance that covers birth control if it violates their conscience, compared to just 40% that say employers shouldn't be able to. The numbers go to 57% / 36% when only religious organizations are counted.

We may be winning the Battle of Rush Limbaugh, but we are definitely losing the War of Insurance Coverage for Birth Control (note: we'll probably need to come up with a better name for this war).

Senator Brian Bingman = Admiral Ackbar

The federal health care bill, lovingly referred to as Obamacare by most Republicans, stipulates that every state needs to set up a health insurance exchange where consumers can access information about cost and coverage of every insurance carrier in the state. It is a free-market idea, one that makes comparing different plans easier and expands consumer choice. But a fully functioning exchange would require some additional investment in information technology infrastructure, which is why the federal government is giving away millions of dollars worth of grants to the states to help them set their exchanges up.

Enter Senator Brian Bingman (R-Sapulpa), the president pro-tem of the Oklahoma Senate. He told reporters that a bill passed by the state House of Representatives that helps establish a state health insurance exchange would not be considered by the Senate. "We're concerned about actually falling into the trap ... of adopting the Obamacare, which is really what we're against," said the Senator, who last month released a joint statement with Governor Mary Fallin and House Speaker Kris Steele (Republicans all) saying he supported the federal grant. Steele and Fallin both still support getting free money from the federal government to better the lives of their fellow Oklahomans. And it's not like these people could ever be described as liberals.

"My hope is that the federal health care bill will either be ruled unconstitutional by the Supreme Court or that Congress might take up legislation to repeal it and replace it with other free-market health care reform initiatives," Fallin said. "But whether that happens or not, the federal health care bill is still the law of the land."

If Oklahoma fails to take action to establish its own health insurance exchange, Fallin warned the federal government will impose its own system on the state.

"I don't think it's helpful to the state of Oklahoma not to have a plan in place," Fallin said. "I also think it puts us on a dangerous path of the Obama administration being able to come in and force a federal exchange on our state."

So Fallin fears a trap just as much as Bingman does. She is just responding a little bit more proactively than he is.

Oklahomans passed a bill last November allowing Oklahoma to opt out of any federal health care law due to a fear of government intrusion (and therefore socialism). The Senate president pro-tem thinks that accepting money from the federal government would trap the state into accepting government intrusion (and therefore socialism). The Governor thinks that not creating an exchange would lead to government intrusion (and therefore socialism).

Our governor, our state leaders, and the majority of state voters are all a bunch of Admiral Ackbars, too blinded by right-wing dogma to see that the whole point of Obamacare is to offer choices to consumers to get us a step closer to universal health insurance coverage.

Friday Post: the Red Shift of 2010

In 2006, Republicans were melons being evaluated for ripeness. In 2010, Democrats were given a floor treatment to seal out moisture. But instead of accepting the defeat and moving on, some Democrats are finding small victories on which to console themselves. Ooh, many (not all) of the Tenthers (Republicans who think that most things the federal government does is unconstitutional) lost! Hey, Jim Inhofe said Republicans were going to control the U.S. Senate. Joke's on you! The Tea Party actually cost Republicans control of the Senate! And look, now we don't have to worry about pacifying those pesky blue dogs anymore!

No, all of that stuff isn't important. The 2010 midterms showed that the country was unhappy with Democrats generally. The top two issues were the economy and the new federal health care law. We lost because the economy sucks and people are scared of Obamacare.

Here's the actual good news for Democrats: the economy will get better, and most of the health care provisions will be tough to repeal. The economy is already getting better, as evidenced by this morning's jobs report. The results until now had been less noticeable because it is harder to perceive benefit from a saved job as it does from a created job, even though they both take the same amount of capitalistic energy.

And as we've all heard, the individual provisions of the health care law poll much better than the comprehensive, easy-to-slander whole. Lawmakers will tinker with it, because that's what lawmakers do. But now that it is law, it will be very difficult to find enough votes to take away key provisions like policy rescision, college students on parents plans, and the closing of the prescription plan doughnut hole. And if future speaker John Boehner is serious about closing the deficit, he won't be able to rescind or delay the mishmash of taxes and spending cuts that make Obamacare a net surplus for the country. Two years of legislative dominance for Democrats clearly wasn't enough, but it's not like those two years didn't bear any Progressive fruit.

And now that the Republicans have gained a chamber of Congress, they will have more stake in governing. They won't be able to simply snipe from well-secured positions in the bunkers of Fox News anymore.

Perhaps the best news of all: Republicans don't actually control much. President Obama still wields executive control and with it a veto pen. Harry Reid will amazingly still be majority leader of the Senate and will use his power to schedule bills for a floor vote like Project Runway contestants use the Piperlime.com wall: thoughtfully. Most likely any successful legislation that comes out of the House of Representatives will have to be either a) moderate, or b) mostly irrelevant. Which means sweeping legislative change is probably out for the next two years. And if it leads to questions like "what the fuck has Obama done so far?", well, there's a website that can answer that.

State Questions!

Last night the League of Women Voters of Norman hosted a forum to discuss the 11 state questions that Oklahoma voters will encounter on the ballot in November. The panelists were Rick Tepker, a constitutional law professor at the University of Oklahoma; Rick Farmer, director of communication of the Oklahoma House of Representatives; and David Morgan, emeritus professor of political science at the University of Oklahoma. The moderator was Helen Duchon.

I thought the forum was extremely informative. I learned that apparently, unlike the constitution of the United States, which is short and vaguely-worded, the Oklahoma constitution is complicated and long, and that no one really knows what's in it. Rick Farmer said that a printer at the capital had to be manually shut off because it was being tied up by an aide who wanted a copy of the entire constitution and had been printing for hours. The panelists all shared a laugh at the expense of a state lawmaker who wanted print services to make a pocket-sized version of the Oklahoma constitution that he could carry with him. Rick Tepker posited that such a document would have to have such a tiny font that the whole thing would appear to the naked eye to be page after page of black sheets, as if the whole document was some redacted version of itself.

All this levity about the length of the Oklahoma constitution was in response to questions from the audience primarily about state questions 744 and 754. State question 744 is a measure that would constitutionally require Oklahoma to fund k-12 education at the same per-pupil level as all six of the states that share a border with Oklahoma, regardless of the status of the rest of the budget. In other words, a predetermined constitutional formula based on how much other states spend on education. State question 754 is a measure that would revoke all such predetermined constitutional formulas and formulas based on how much other states spend on anything. The constitutional law professor Tepker said that if either or both of these pass, the result will be litigation. Lots of it. Because no one really knows if legally these two questions can peaceably exist within the same state constitution. And apparently no one knows how state question 754 affects other previously-passed statutes, statutes which may or may not exist, and if they do exist, there may be something like 20 of them, but no one can say for sure because the constitution is so long and, apparently, unprintable.

There also may be a relevant statute to this question, brought up by both Farmer and Tepker, that states that if both of these conflicting statutes pass, then the one with the most votes will be law and the other one would be, I guess, S.O.L. And one other aspect to state question 754 is that it cannot be repealed or amended if it is adopted. And we know this only because that's what it says about itself. Whether a law can make itself unrepealable is still a matter of debate and will certainly be decided in the courts, says Tepker, who is of the opinion that most of the state questions are terrible for the public but would be great for the employment of lawyers.

State question 744 deserves some extra attention because it is, according to Tepker and most everybody who follows these things in Oklahoma, the most important measure on the ballot. It mandates a substantial spending increase for education (close to 20% of the education budget, or $1.0 to $1.7 billion per year, according to Tepker) without any sort of plan to increase the state's revenues to pay for it. The website for the proponents of 744 claims that it can be paid for by eliminating legislator perks and pork barrel projects; or in other words, stuff that will never be eliminated by any legislature anywhere (sorry to break it to you, Tom Coburn). Tepker was asked how the proposal would be funded if it were to pass, and Tepker replied that since the Republicans would likely be in charge of the legislature, a tax increase would be even more unlikely than usual, and that the legislature would have to find ways to cut spending in other areas of government. Some critics of the measure claim that a 20% cut would be necessary across the board. And there are no strings attached to the money, beyond that it has to be spent on instruction costs, not debt relief or construction of new buildings. In other words, no new academic standards or testing would be required. Rick Tepker said that Oklahoma would become California in terms of fiscal gridlock if 744 passed, which isn't likely, according to poll numbers conveyed by panelist David Morgan. Only 27% of people support 744 now, which is down almost 40% from a poll in July. I brought with me to the forum a whole bunch of questions that I had planned to ask about the details of education funding from other states, and how it would fit in with local and federal mandates, and all kinds of arcane things that aren't really that relevant now that I see that 744's support is dwindling.

But there are plenty of other half-thought-out measures that apparently are very popular in the Sooner state. State question 751 is a measure that will allow the state to conduct its business in English only, if it wants. There are some exceptions for federal forms and for tribal languages, but the measure says that if passed, it would prevent the state from being sued for not providing non-English documents. According to Rick Farmer, a woman in Jenks sued the state because the state refused to offer her a drivers license test in Farsi. The lawsuit was quickly thrown out of court. By passing state question 751, the lawsuit could apparently be thrown out of court more quickly, according to Rick Farmer. The English-language-only state question has the support of 85% of the citizens of Oklahoma.

There is a voter ID law on the ballot. State question 746 would require voters to present a valid government issued photo ID in order to vote. 3 other states have tried this, and the Supreme Court threw out a challenge to a similar law in Indiana (which I have previously talked about and made made a graph for). The usual arguments for and against were conveyed by David Morgan (who, I must say, has an excellent voice for radio and public speaking): it could disenfranchise a number of poor or elderly people, but it prevents fraudulent voting to a certain extent. According to Morgan, the editorial board of the venerated Daily Oklahoman claims that if the measure prevents even one fraudulent vote, then it would be a worthy law, no matter how many people (Democrats) it disenfranchised. Most of those in attendance last night were not sympathetic to the Oklahoman's opinion, but a poll puts those in support at 43% and against at 35%.


The question that got constitutional law professor Rick Tepker riled up the most was state question 755. SQ 755 would prohibit Oklahoma courts from using or considering international law or Sharia law when deciding cases. Tepker called it "offensive" with language that is "overbroad." He pointed out that it would also remove any basis for consideration of English common law, the historic root of the U.S. Constitution; and also for the ten commandments, which are popular 'round these parts. But it is all moot anyways; all that state question 755 could do would be to uphold the oaths to uphold the constitution that judges must swear to do already.

Another pointless headline-grabbing state question deals with "Obamacare". State question 756 would prohibit forcing any person or employer to participate in the federal health care law. Rick Tepker railed against this question as well, saying that "if it passes, it does nothing, I repeat, nothing to make the [federal] health care law unconstitutional," and it also does nothing to make it constitutional. Since the U.S. Constitution's Supremacy Clause trumps whatever our state does, the law will have no effect except to be reported on by the "lamestream" media. Tepker believed that the law would be deemed "null and void" immediately upon passage, which would mean no disruption in Medicare funding for Oklahomans. He compared it to the city council of some town in Vermont declaring that the war in Iraq is unconstitutional; a plea for attention worth nothing.

The rest of the measures on the ballot are not overtly controversial, but they still reflect the political composition of the conservative legislature that put them on the ballot. State question 747 would put term limits on all the statewide elected offices that don't already have term limits, such as lieutenant governor, attorney general, treasurer, labor commissioner, corporation commissioner, state auditor, and the state schools superintendant. And you thought entrenched interests only existed among politicians whose name you had heard of. Brad Henry, our term-limited Democratic governor, opposes the measure (sour grapes?). David Morgan revealed that 69% of voters were in favor of this measure, which Rick Tepker complained would take away the ability of the voters to elect the best person for the job if that person had already served 8 years.

State question 750 is a measure whose effect is to lower and make relatively consistent the number of signatures required to get a state question on the ballot. Currently in Oklahoma, one needs to collect a number of signatures equal to a certain percentage of the voters in the previous statewide election, held every 2 years. State question 750 would set the threshhold at the same percentage of voters, but count the voters for the statewide election for governor only, an election that always features a lower turnout than the one for president. It's a complicated explanation for a state question, David Morgan said, which is why there is no polling data on it. When asked if there was anything in the measure to prevent frivolous petitions, Morgan replied that silly questions would still be allowed, and that state question 750, if it would have any effect, would probably result in more state questions on ballots in the future. Another related question led to a lecture by Rick Farmer about the history of state questions. A third of state questions have come from people circulating a petition, but were less likely to pass than the two-thirds of state questions that have come from the legislature. The eleven state questions on the ballot this year (state question 744 from petition, all others from the legislature) are in fact a new record.

The apportionment commission is the subject of state question 748, and if you've never heard of this commission, it might be because it has never, in the entire history of statehood, actually convened a meeting. The apportionment commission is set up to meet if and only if the legislature fails to act on redrawing state house, state senate, and congressional districts in the legislative session following the decennial national census. The apportionment commission would be changed from a commission controlled by possibly-partisan statewide office holders (attorney general, state superintendant, treasurer) with no skin in the map-redrawing game, to a commission controlled by the governor, the speaker of the state house, and the president pro-tem of the senate. Legislators put state question 748 on the ballot as a measure that would give legislators more power (but only theoretically) over decisions that affect legislators, in the event that legislators cannot act on the matter before then. David Morgan said that there was no polling data on this question.

A shift toward legislative branch power is also the point of another ballot measure about a commission most people don't care about. State question 752 adds a couple of people and a couple of rules about the existing people on the Judicial Nominating Commission, which meets to select a list of nominees that the governor can appoint to the state supreme court. Currently the commission is composed of 13 people, with 6 non-lawyers appointed by the governor. State question 752 would add two more people, chosen by the house speaker and president pro-tem of the senate; and it would also mandate that the six non-lawyers must also not have a lawyer in their immediate family. In addition to making me ineligible to be one of the governor's choices on the commission (oh drat!), state question 752 also has the effect of shifting power ever so slightly away from the American Bar Association and towards the state legislature, according to Rick Farmer. Farmer recommends that if one is pro-ABA, one should vote no on this measure, and if one is anti-ABA, one should vote yes on this measure.

The one remaining state question involves the state's Rainy Day Fund, which has a more formal name that I forgot to write down when I was taking notes. State question 757 would raise the limit on the Rainy Day Fund from 10% of the budget to 15% of the budget. Oklahoma topped out the Rainy Day Fund for a couple of years before the recession of 2008, according to Farmer, and the fund has apparently helped out with the economic situation in the state since then. Rick Farmer characterized three positions from the political left, right, and center. He says the left would look at surplusses as evidence that the government should spend more, the right would look at it as evidence that the government should tax less, and centrists would look at it like a savings account where the state could tuck some money away for, as they say, a rainy day. Savings accounts are popular with many people in the center, according to Farmer, and indeed, poll numbers show support for the measure at 53%, compared to 29% against, according to David Morgan.

After the question and answer session, moderator Helen Duchon asked the panelists if there were any state questions that they would actually vote yes on. Rick Tepker answered first and advised skepticism generally for all state questions. He loathes with a passion state questions 755 (Sharia Law) and 756 (Obamacare), and he wouldn't vote yes on any of them, with the possible exception of 752 (Judicial Commission) and 757 (Rainy Day Fund). David Morgan pointed out tactfully that many of the questions were intended to get "a certain political party's base" out to the polls to vote. He too would vote no on all of the measures, except for maybe the unimportant ones. Rick Farmer ended by saying, "I am an at-will employee of the speaker of the house," and then gave out the recommendations of speaker Chris Benge (R-Tulsa): no on 744 (Education Funding), yes on everything else. This elicited gasps of displeasure from the audience.

___

A numeric guide to the state questions on the 2010 Oklahoma ballot:

744 = public education funding (the big one)
746 = voter id law
747 = term limits for low-profile statewide offices
748 = apportionment commission, the one that's never met
750 = petition signature threshhold
751 = English only
752 = judicial nominating commission, the one with all the lawyers
754 = no predetermined constitutional formulas, or, the anti-744
755 = no Sharia law
756 = no Obamacare
757 = rainy day fund increase

Health Care Concerns: Interstate Commerce Clause

As far as I can tell, 100% of the non-spamming readers of this site have law degrees. So I need your help with these two questions: does the government really have the power to force people to buy a private insurance plan, and is a tax on the uninsured an overreaching form of discrimination?

I was listening to an interview with the Attorney General of Virginia Ken Cuccinelli on NPR the other day, and his gripes with the new health care law seemed to be well-thought-out and well-articulated (unlike his gripes with homosexuals). Ken Cuccinelli is suing the government because he believes the law is unconstitutional because it compels all citizens to buy a product from a private marketplace. And honestly, I can't immediately think of a private good or service required by all individuals, not just car-owners or house-owners or business-providers.

Another worry of mine about the health care bill is the prospect for the private insurers in the exchanges to jack up prices. They will no longer be allowed to rescind policies or deny policies to people, but as far as I can tell, there's nothing that says they have to provide a policy at a low price. And, like so many Republicans have argued, there is nothing in the health care law to control costs of medical service. So rising insurance premiums will surely keep rising without any market control method of the size that only a government could provide. This was the rationale behind the extinct public option, after all. (Hell, it's the rationale behind single payer coverage too).

It was thought to be the news in California of Anthem Blue Cross's 39% rate hike that steeled the nerves of Democratic lawmakers and helped them finally pass the health care law. But what is the method by which this new law would be able to stop rate hikes like this? Increased competition? There are many health insurers with many plans in California already. It doesn't stop them from raising rates. The market for health insurance contains too much friction for people to be able to switch insurance policies. And because of measures that strengthen employer-based health insurance policies, the health insurance market should continue to operate opaquely.

I don't like the private-insurance-only health care bill, but only time will tell if it makes the country better or worse.

A State's Guide to Qualifying for Higher Medicare Payments

From a NY Times article:

Another item in the package would increase Medicare payments to hospitals and doctors in any state where at least 50 percent of the counties are “frontier counties,” defined as those having a population density less than six people per square mile.

And which are the lucky states? The bill gives no clue. But the Congressional Budget Office has determined that Montana, North Dakota, South Dakota, Utah and Wyoming meet the criteria.

This is an interesting wrinkle in the health bill, and since it falls at an intersection of two of my interests (the health care reform bill and trivial U.S. geography), I felt the urge to comment.

What is interesting to me is that the extra money for Medicare payments does not go to the least populous states (bottom five: Wyoming, Vermont, Alaska, North Dakota, South Dakota), nor does it go to the states with the least population density (bottom five: Alaska, Wyoming, Montana, North Dakota, South Dakota). It goes to the states with the highest number of counties that fall under a certain threshhold of population density. Why so arcane? I'm guessing by having it tied to counties, the provision was designed to screw Alaska, the least population-dense state by far, but a state without counties. (Take that, Sarah Palin!) But in it's stead, the provision rewards Utah, the 10th least population dense state in the country, and just as rosy red. It's two senators are no more likely to vote for the provision than they are to vote for a pro-gay marriage law. States that have less population density than Utah include swing states New Mexico and Nevada, as well as the swing-senator-Ben-Nelson-containing state of Nebraska. Utah has 29 counties, and it just so happens that the lines have been drawn so that 15 of them have a population density of less than six people per square mile.

But have no fear, sparse states! You can qualify for this additional Medicare payment just by doing a little redrawing of your maps. All you have to do is some combination of merging populous counties together while splitting less populous counties in two or three parts. For instance, New Mexico currently contains 14 counties out of a possible 33 that have a population density of under six people per square mile. Therefore, all that New Mexico would need to do was to merge six counties together that have population densities over 6 per square mile. For instance, by merging Lea, Eddy, Roosevelt, Otero, Curry and Chaves counties together into one mega-rancher-haven county, New Mexico could qualify for extra Medicare payments. (14 out of 28 counties).

There's nothing that says every state in the union can't do this. I suggest Oklahoma get in on this deal too. Keep the panhandle counties. Merge every other county together. 2 out of 4 counties would get Oklahoma some Medicare money. The state could even designate the existing counties in the main part of Oklahoma as some kind of special jurisdictions (parishes? boroughs?) so that county-level services like courthouses and rural roads don't need to be compromised geographically. But under this plan, Oklahoma would only officially have four "counties".

Health Care Reform - It's Gonna Suck

…Health care has been moving target for republicans …. the Democrats will shift, thinking they have something that the Republicans will go for, and then the Republicans will shift further. And [the Republicans] make a big deal about something that distracts and frightens the voters like those so-called death panels, then the Democrats drop that and Republicans find something else to object to.

Cokie Roberts, NPR’s Morning Edition, August 17, 2009.

Health care reform, as I want it (legitimate socialized medicine, with doctors employed by the government) has always been doomed. Health care reform, as I would accept it (mandatory single-payer government baseline insurance with plenty of room for supplemental insurance policies) has also been doomed for a long time. But it's looking more and more like health care reform, as the President originally wanted it (public "option" insurance) will also be doomed. If a final bill makes it all the way through both chambers of Congress this year, that bill would be generously described as "watered-down" and more accurately described as "gutted". Both Democrats and Republicans will claim victory, both for the actual passage of the bill and for the holes shot into it. Bipartisanship in action.

But even I can't dismiss all of the points that have been made by conservative analysts in the media over the last month. One in particular that I've heard only a couple of times is this: you can't expect to have a government option on health care, or provide semi-universal coverage, without raising taxes. This is true. For any meaningful reform to take place, it's going to take a lot more efficiencies than just computerizing medical records. A lot of inefficiency comes from the complicated method of filing and paying insurance claims, and fighting with insurance adjusters for money, which is mostly done by people in the doctor's office. Like any other marketplace, health care works more efficiently when there isn't market friction caused by complicated rules, policies, procedures, and differences in plans; and substantial savings could be derived by simplifying the terms of all insurance plans, or of course by having a baseline plan for which the rules about what is covered and what isn't are widely known and accepted (socializing medicine, for instance). But the inefficiency involved is paid for by the private marketplace; no public savings could be achieved by such a reform. It would benefit society as a whole, but at an expense to government (and therefore to taxpayers). And yet no Democrat wants to admit this.

Another Republican-derived point is that it would be unfair to the upper 5% of income earners to be taxed to pay for a service that gets used entirely by the lower 95% of income earners. I sort of agree with this. I understand progressive taxation, but on a government program as expensive as a proposed Medicare-for-all, I would want it to be paid for like Social Security is now (or for that matter, like Medicare is now); that is, as a social contract with everybody so that everybody pays a little bit and everybody gets to use the service. I'm saying I'd be in favor of tax increases on everyone if I got to have a medical insurance program that everyone got to use. Mr. Obama, please raise my taxes.

As usual, the problem with having politicians in charge of social programs is that politicians play politics all the time, and only consider the good of society if the good of society is popular at the moment. What's popular at the moment is views from "Main Street, America" of people angry about the government paying for things they can't afford, and are feeling like outsiders, which pays dividends for the Republican congressmen who believe they too are outsiders. The lock-step-feel of Congressional Republicans is back now that they've been put back into their comfortable roles as outsiders from beyond the Beltway. And as the Obama administration wastes more and more time trying to get a weak health care bill passed, the Republicans may use the time to get another Newt Gingrich-like movement going.

Private Insurance Makes Nick's Law More Expensive

Since the election in November, both the state House and state Senate of Oklahoma are now controlled by Republicans for the first time in roughly forever. And while the House and Senate have only been in session for one month, they've already started kowtowing to corporate interests, especially in regards to health care coverage.

"Nick's Law" was a bill that would require health insurers in the state of Oklahoma to cover the diagnosis and treatment of autism in children. On Tuesday the state House Economic Development and Financial Services Committee voted 10-5 along party lines against a motion to send the mandate bill to the House floor. And if killing this bill wasn't enough, they then voted 9-5 for a "do-not-pass motion that under House rules will prevent the mandate idea from being considered again until a new Legislature is seated in 2011", metaphorically shooting the bill a couple extra times in the head just to make sure it's really dead. Elsewhere though there are 18 states with similar autism mandates and many more with legislatures considering mandates right now, which follows the advice Rep John Carey, D-Durant, will be giving to parents of autistic children: "...move to another state."

According to that article, there was a study performed for the state House that said an autism mandate would increase health insurance rates by at least 7.8% and possibly as high as 19.8%. 7.8% to 19.8%!? Without being privy to the methodology of that study, I think that sounds really high and I would like to quibble with it.

According to that article, one mother of an autistic child said that therapies cost $30,000 a year, and another father of an autistic child said he spends up to $5,000 a month, which could be as high as $60,000 a year. For the sake of this back-of-the-envelope calculation, let's use $45,000 a year. And a well-known statistic from autismspeaks.org states that 1 out of 150 children are affected by autism. All other data will come from the Kaiser Family Foundation's statehealthfacts.org.

If there are 971,331 children in Oklahoma, autism could be expected to affect about 6,475 of them. This would make the cost of all treatments for all autistic kids in Oklahoma $291 million per year. There are about 3.5 million people in Oklahoma, only 2,845,529 of them with health insurance coverage. If we assume all autistic kids will have 100% of their therapies covered by health insurance, then we can expect only the 2.8 million people in the state with health insurance will have to pay any more in premiums. This works out to an average of $102 increase per person per year. Currently, the average premium for an individual in Oklahoma is $3,967 ($635 paid by the individual on average, the rest by his/her employer). If the average premium increased $102, the new average due to autism coverage would be $4,069 ($651 paid by the employee), an increase of 2.6%. For the insured employee, the cost of the autism mandate would be on average $1.33 a month. If you told me we could cover autism diagnosis and therapy for all autistic children in Oklahoma and I'd only have to spend roughly a dollar a month extra, I'd totally be down.

Ah, but of course I'm thinking about this from a not-for-profit and governmental sort of viewpoint. It's fine to think about averages and cost spreading in these terms when your pool of customers is as large as an entire state, but if you're only insuring a few hundred thousand people just like 20 other private insurance companies in the state, you have to be prepared for more statistical anomalies. Like what if for some reason autism just happens to affect 1 in 50 children in your particular pool of customers? This could be within one or two or three standard deviations of the 1:150 rate. In order to break even in such a scenario, you would have to increase rates three times higher than the statistical average calculated in the previous paragraph. Now we're up to a 7.8% rate increase for private insurance simply because private insurers can't spread risk like a government insurer could.

Plus, as an insurance company, you don't simply break even with treatments. There are a lot of claims adjusters and management types to pay, and the probably-publicly-traded company needs to earn a profit for its shareholders. Add a few more percentage points to that total, and you could be up to somewhere like 13% increase in premiums. Oh, and the CEO really likes travelling to exotic getaway vacations, corporate meetings in Switzerland, and owning a few houses and boats, and really, who wouldn't? So if you can squeeze just a bit more out of the pool of insured customers, say to the tune of 19.8%, you could have your shareholder meetings in Tahiti, and of course you'd deserve it because you just figured out a way to turn a mental ailment into ungodly sums of money for your company.

So the cost of "Nick's Law" may in fact be a 7.8% to 19.8% increase in private insurance premiums. This is all the more reason why we need universal health insurance. (Maybe after that we can tackle that cost of $45,000 per year per child by putting socialized medicine in place. But first things first.)

(For more, visit nickslawok.blogspot.com)

Health Care Reform Article Number 142,857

With very few potatoes to quibble with recently and little time for thorough investigation of current political events, I'm just going to post a health care article that more clearly explains why our free market health care system does not produce better health.

Why Automaker Bailouts are Bad, Except for Maybe the One I Propose in this Post

Allow me to be the 80 millionth person to put in my two cents against the proposed U.S. automaker bailout. This is one of those issues where I strip off all my Democratic/Socialist clothes and swim in Ron Paul's kool-aid. But I'm completely in agreement with all the most curmudgeonly conservative politicians on the issue of federal bailouts. If a business is about to fail because it can't adapt to the current market, because it made poor choices in the past about how to spend its capital to yield the greatest profitability, or because it's in deeper debt than it can possibly ever pay back, the bad business should just be allowed to fail, regardless of how many people the bad business employs or what percentage of market share it has. People will find a way to replace whatever the bad business produced with something more efficient. This is capitalism doing its thing with its invisible hand. As Ron Paul said, "An essential element of a healthy free market is both success and failure must be permitted to happen when they are earned."

People give many reasons why the "Big 3" have arrived at this point where they need to beg Congress for money. The American automakers don't make cars that Americans want to buy. Reliability and quality have been demoted down from job 1 to job 347 or so. They didn't foresee how high gas prices would lower demand for their large energy-inefficient vehicles. They pay people not to work all day. They pay high health care, high wages and high pension costs because they are unionized. They have too many brands and too many dealerships to be efficient. The interest in the debt they have already accumulated is dragging down the companies. These reasons are all absolutely true. So why should the federal government hand these companies a free Christmas bonus for a job so poorly done? It's going to take some massive restructuring to turn GM and Ford around (Chrysler should just cease to exist), restructuring that can only happen under Chapter 11 bankruptcy. Delaying the Chapter 11 filing with a federal bailout is like setting $25 billion dollars ablaze, equivalent to the average annual salary of 370,000 GM employees.

There are many arguments put forth in favor of the U.S. government giving money to the automakers. Some say that going into Chapter 11 bankruptcy would cause consumers to avoid Detroit's products because of a fear that their warranty would not be upheld. I believe bankruptcy is unavoidable, but consumers don't buy cars for the warranty anyways. If they did, the Big 3 automakers would have a much larger market share than Toyota since the American automakers' warranties are usually much better than those of foreign manufacturers. In other words, people prefer buying cars that are reliably built and don't even need warranties.

Many put forth the argument that the American automakers are such a large part of our economy that their failure would be devastating (the same argument used two months ago for the financial services industry). These people also frequently use inflated employment numbers that count people who deal not only with the Big 3 but also with foreign automakers. And it assumes that all 240,000 people directly employed by American carmakers and the other million or so in businesses reliant on the Big 3 wouldn't be able to find other jobs in industries that aren't tanking. But it is true that no member of the United Auto Workers would be able to find a job with such sweet benefits, and as cushioned as their salaries and benefits are, it would still produce many undue hardships on those employees.

I may not be in favor of handing GM and Ford free money to spend however they want, but I am in favor of helping out GM and Ford tackle some of these union benefits. Okay, so here's my plan: I propose the federal government assumes responsibility for the health care benefits and pension benefits enjoyed by UAW members. Instead of asking for wage concessions from UAW, I propose that the automakers be allowed to set wages based on the market, like the foreign automakers operating in America do. I would also propose eliminating by executive fiat the state franchising fees that make it difficult to eliminate car brands and dealerships that aren't profitable, like Pontiacs, Mercuries and everything Chrysler makes. In exchange, I would raise corporate taxes on the Big 3 as well as personal income taxes on their employees in order to offset the costs of the medical care and pension benefits. If they choose to continue making vehicles that drive consumers to purchase more reliable higher quality foreign brands, the Big 3 should be allowed to fail.

Since this whole system would be inherently unfair to the hard-working foreign-owned manufacturers here in the United States, I would offer the same deal to them: health care and pension benefits in exchange for higher taxes. And then when it becomes clear that this gives an unfair advantage to employees in the auto manufacturing industry, I would extend health care coverage, pensions and higher taxes to every citizen of the U.S. Then when it would become clear that health insurance is horribly inefficient, I would urge the government to use its massive leverage to reform the health care system so that hospitals and health clinics, like schools and fire departments, are owned and managed by the government on a not-for-profit basis.

Now that's a bailout!

The Failed Policies of George W. Bush

According to almost every news source in America, the Democratic Party will win big on November 4. Presidential candidate Barack Obama is far from the only Democrat who will ride into Washington on the coattails of bad feelings for President George W. Bush. Almost every Democratic candidate for office in America, fairly or not, has enjoyed a bounce in popularity by campaigning on a platform of being anti-Bush, or by linking his/her opponent to the "failed policies of the Bush administration". Indeed, George W. Bush has never had a lower approval rating than right now, partly because of the recent financial crisis. But what these Democratic candidates are not doing is reminding people what it is that is so bad about the "failed policies of George W. Bush" in the first place. If the American public remembers that it can't stand that Bush guy but can't remember why, then the "failed policies" will surely be repeated by elected members of the Government. So to serve as a reminder mostly to myself, I've jotted down 33 "failed policies" that I think have made our country worse off thanks to the 43rd President of the United States of America.

1) "The United States doesn't torture." Except when it does. George W. Bush vetoed anti-torture bills, watered down water-boarding by referring to it as an interrogation technique (like how rape is just a sexual technique), and flauted the Geneva Conventions time after time when confronted in interviews or press conferences.

2) Unfounded wars on sovereign nations. Bad intelligence that should have been ignored about WMD and yellow cake fissile material led to a war against Iraq. The previous sentence was the best-case, most P.C. explanations for George W. Bush's intentions in the Middle East. Speculation abounds as to his real reasons for war with Iraq, most of which would be inconceivable if you told it to anyone eight years ago.

3) Secrecy. Over-classification of classified documents.

4) The Patriot Act

5) Bullying. Bullying of foreign nations for support for the above unjust Iraq war. Bullying of congressional leaders for support. Bullying of the U.N. to pass the war resolution, or else. It's called negotiating when there's a give and a take, and it's called persuasion when there's a well-explained and well-grounded rationale for action. It's called bullying if threats are made and fear is induced in entities that should be our allies.

6) Over-simplification of foreign viewpoints. You don't have to be either "for us or against us".

7) "Axis of evil". Well so much for negotiation.

8) Isolating North Korea to the point that they needed to build an atomic weapon to get any bilateral negotiation with the U.S.

9) War on terror. How does one win a war against extremism? You can't kill 'em all. There are always fringe elements in even the most tightly regulated societies, like gay people in Iran, bloggers in China, and terrorists in America.

10) Pre-emptive wars. The "Bush Doctrine", I think. Even police *should* have to wait until a crime is committed to detain people. And speaking of detaining people...

11) Guantanamo Bay. And more importantly, the lack of trials for prisoners there. (I hesitate to call them "detainees".)

12) Oh wait, not "prisoners" or "detainees". "Unlawful Combatants".

13) "Extraordinary renditions". They lead to "erroneous renditions" in the absence of the law.

14) Over-reaching of executive power to facilitate illegal wiretapping. FISA courts are just not necessary anymore.

15) The Alberto Gonzales Department of Justice. Attorney firings for partisan reasons, mealymouthed testimony by most Department of Justice officials including the Attorney General himself on several occasions, the approval of warrantless wiretapping, and the attempted repeal of Habeas Corpus.

16) Incompetent "loyal Bushies" like "heckuva job" Brownie.

17) Highly competent yet highly evil "loyal Bushies" like Dick "Overlord" Cheney.

18) Anti-choice-ism

19) Anti-intellectualism

20) Anti-Europeanism.

21) Right-wing judicial nominees. I'm not talking about Roberts or Alito, which almost any other Republican president would have nominated. I mean all the other judicial appointments to lower courts that add unfounded legitimacy to an extreme right-wing judicial viewpoint by giving high-level careers to cronies. This will lead to future right-wing judicial nominees to the Supreme Court who should have gotten rejected long ago for their lack of objectivity being seen as legitimate. These juditial nominees also nearly tore up the rules of the Senate.

22) Federal Marriage Amendment. So glad that one didn't get anywhere.

23) Stem cell research. Not so much for the position (federal funds only for "existing" stem cell lines) but for the process of letting the church's viewpoint into a science decision.

24) Not signing the Kyoto protocol for anti-UN reasons.

25) While we're at it, John Bolton.

26) Sabotaging the EPA to the point where entities are now suing the EPA because it's not strict enough in regulating emissions.

27) Trying to privatize social security. How's that stock market idea looking now?

28) Increasing the national debt from about $5 trillion to about $10 trillion. This riles me up so much, I'm going to need some more bullet points about the budget.

29) Tax cuts benefitting the wealthiest of our society at a time when we were finally getting Reagan's debt under control.

30) Massive non-mandatory spending increases primarily benefitting the military industrial complex. We've got loads of money for super advanced fighter jets, but we're losing wars against people who make explosives out of pvc pipe and wire.

31) Making war spending separate from the budget. This would make sense only if the expenses were unforseeable.

32) Not addressing health care at all. Seriously, during a decade in which health care spending rose faster than any other industry, how was health care almost completely ignored by the Bush administration?

33) Well, he did address one thing. He vetoed SCHIP.

I'm sure there are plenty more policies I dislike, and I know there are plenty more policies that others dislike (No Child Left Behind, immigration). But none of this stuff gets specifically talked about by any of the Democratic candidates. We need to remember this so that we can hold future administrations accountable.

Let's Bailout Capitalism!

Over the weekend the treasury department put forth a bill now winding its way through the U.S. Congress that would allow the U.S. government to buy bad debt from several Wall Street firms in order to allow those Wall Street firms to continue to function. The number put out by the treasury department is "$700 billion". This is a huge sum the magnitude of which probably eludes most people.

$700 billion. That's $2,295 if every single American contributed. If $700 billion of debt was a GDP, it would be ranked 17th in the world behind the Netherlands and ahead of Turkey. We would need at least 12 Bill Gates's selling off their entire holdings to make it up. $700 billion is equivalent to 1,750 bridges to nowhere. If you laid 700 billion dollar bills end to end, the chain would stretch from the earth to the sun. On the plus side, it only adds 7% to our astronomically high national debt.

And this goliath of a sum of money is going from the taxpayers' pockets directly to the vaults of huge banks who are now seeing the downside of risky lending. In other words, not to the people who defaulted on mortgages and were foreclosed upon, but to banks which transfer more money every hour than you and I make in a lifetime and which practically define capitalism. I'm all for socialism of some things, but socialism of capitalism is a little too red for me. Our constitution guarantees lots of things to lots of individuals, but the right not to go bankrupt is not one of them. I mean, these banks took on these bad mortgage-backed securities knowing that they would be worthless unless enough homeowners were able to make payments: in other words, they took on risk, an essential part of capitalism.

Which brings up two good points from the NY Times:

"How is it that the administration and Congress, which have not tried to find huge amounts of money to, say, improve the nation’s health insurance system or repair bridges and tunnels, can now be ready to come up with $700 billion to rescue the financial system?"

Yeah! About health care: banks made poor decisions that could have been avoided. Lots (not all) of medical bills stem from conditions that cannot be avoided (breast cancer, lupus, fractured arm, sinus infections, autism, etc.). But we're supposed to pony up for banks and not for patients? And the other quote:

“Treasury’s 840-word legislative bailout proposal comes to more than $830 million per word,” Stephen Ellis, the vice president of Taxpayers for Common Sense, a fiscal watchdog group, said in a statement on Monday, adding that “when they come up with a title, that will drive the average dollar per word down.”

Oklahoma's Terrible Health Care Legislation Obviously Influenced by Lobbyists

You may hear some ranting liberal go on about health insurance company lobbyists being the scumsucking scourge of the legislative process in America, but sometimes it's hard to pinpoint the end result of all the influence peddling. However a new bill passed by the Oklahoma House of Representatives erases any doubt as to the end result of all that congressional backscratching.

Health insurance companies don't really cover all health care needs. The insurance companies are always trying to get out of covering people for certain tests or procedures regardless of the benefit received from those tests and procedures (even if they can save lives) because they can get rather expensive. Health insurance companies aren't interested in health; they're interested in making money. In order to coax health insurance companies into covering the tests and procedures that they should be covering anyways, the state legislature has created mandates in the past to force any insurance company wanting to do business in the State of Oklahoma into covering certain procedures. The legislature's list of 14 mandates includes coverage for prostate exams, mammograms and treatments for diabetes and certain types of mental illness. The state had to create these blanket mandates because it is impossible for an individual to negotiate medical coverage a la carte, and insurance is worthless if it doesn't cover whatever your particular ailment happens to be.

House Bill 3111 solves a problem that never existed. The bill requires that any future mandate legislation be accompanied by a cost-benefit analysis to be paid for not by the state legislature but by the organization requesting the additional coverage. But the really pernicious clause of the bill calls for a limit on lawmakers introducing and passing a bill mandating coverage unless the bill is introduced in an odd-numbered year and then may be acted upon by legislatures in an even-numbered year. There are a couple of ways of looking at the effects of this proposed bill. It could kill half of the proposed mandate legislation, legislation that only exists because the government cannot rely on private insurance (or the free market in general) to look out for what's best for the people of the state, since the amount of time that a bill can be introduced is slashed in half. Or it could simply create a couple of extra unnecessary bureaucratic steps; a couple more hoops to jump through before anybody could be screened for ovarian cancer, for example. It doesn't eliminate the legislature's ability to pin a mandate on the tail of the insurance companies, it just blindfolds the legislature and spins it around a few times. One thing is for certain though; the insurance companies will save a lot of money while the mandate tightrope walk is slowing down legislative efforts. And you must be a Republican or a lobbyist to believe those savings will be passed down to you the consumer.

House Bill 3111 was passed by the Republican controlled House 53 to 46, with no Democrats voting in favor, and two Republicans (one of whom is the only medical doctor in the House) voting against. There are some good quotes from pissed-off Democrats in the state House in this article, such as the one from Scott Inman, D-Del City: "What this bill was all about was the insurance industry saying we want more time to be able to kill any mandate bill that comes down the pike." Or these from Ryan Kiesel, D-Seminole: "It is repugnant that an insurance company that takes your dollars won't cover an exam that can save your life.... We're not asking insurance companies to do something that's out of the ordinary. We're asking them to do something that they should be doing already."

Two more quick points:

1. This bill is a perfect example of the process by which individual rights and freedoms are taken away by those in power. Curtailing freedom is never done in one fell swoop; it's always a long road that starts out with limits, then restrictions, then obstacles, then narrowly viewed readings, until finally whatever right was there is effectively gone and nobody notices that they don't have it anymore. Now, medical insurance may not be a right like free speech or not having your stuff illegally searched and siezed, but the process is the same.

2. The talk of the nation shouldn't be about "Universal Coverage" or "Covering the Uninsured" because insurance doesn't take care of you, doctors and nurses and hospitals do. Getting sick isn't something that can be planned, and it isn't limited to certain people, and it isn't cheap. That's why if our government exists to protect and serve the people over which it rules, and if it believes that a healthy population is in the interest of the state, the government should be the entity that dispenses the health care, not the health insurance.