DAILY TOL: Tree of Liberty

Like many Americans, I am more than a bit frustrated with the current debate surrounding healthcare reform.  It’s not the rancorous tone of the debate that bothers me.  America was born of rancorous debate; we are a rowdy lot.  If things aren’t rowdy, then enough folks aren’t paying attention.

No, my frustration comes from the near complete lack of integrity with which the debate is being held.  If the goal of affordability and accessibility were truly in the hearts of our legislators, we would not be in the current state of partisan paralysis we now find ourselves.  These noble goals have been subordinated to the desires of special intersts:  Labor, Big Pharma, Trial Lawyers, Insurance Giants, etc.

When you consider that the goals of these special interestes are often diametrically opposed to one another is it any wonder that we have a legislative disaster on our hands.  It truly is a shame that the President has not shown more leadership on this issue.  In my opinion there are two reasons for this.  First, his advisors over-learned the lessons from Clinton’s attempt at healthcare reform to the point where the Obama administration completely ceded the legislative process to congress.  A bad idea in the best of times and with Nancy Pelosi at the helm, its far from the best of times.  Second, President Obama’s own ideology works against him in crafting something that garners broad-based support.  It’s a shame because had he legislated from the center he really could have had a chance to do some good here.

Now, I’d like to stipulate that nowhere in our constitution is the right to healthcare enumerated.  That said, as a modern, compassionate society, we have a different view on the human condition that that of, say, Dickensian Britain.  However, lets not build our solution based on misinformation.  The 45 Million some claim are without health insurance, are not a homogeneous group.  They tend to break down into four primary categories.

1. Those that can afford insurance but choose to spend their dollars elsewhere
2. Those that cannot afford it and are eligible for existing programs but do not take advantage of them
3. Those that are here illegally and cannot afford it
4. Those that cannot afford it and are not eligible for any program.

Those who have read my other writings may be surprised, but I favor quasi-mandates for category 1 people.  A pure mandate on health insurance would be easier but the Libertarian in me cries out for an escape hatch.  Those in category 1 are strongly encouraged to carry health insurance and this encouragement takes the form of the following stick.  Should such individuals believe themselves indestructible and choose to “self-insure” then there must be consequences to such decisions.  When life proves them wrong in the form of an emergency room visit, they will either pay for service or have their wages and tax returns garnished using the same structures currently in place to recapture child support from deadbeat dads.  Today, these “indestructibles” retain the dollars others spend on insurance but often do not adequately absorb the risk associated with that decision.  This must end.

Category 3 people will receive subsidies from the government to ensure they have access to care.  Formalizing this approach will be more cost effective than having category 3 folks seeking primary care via costly emergency room visits.  In addition to funding this via cost savings described later, I’d recommend having a $5 checkbox at the end of every tax return.  Government often discounts the intense generosity of the American people.  They will be surprised at how many of those tax returns will come back with that $5 box checked.  Doing so would either reduce a refund or increase the amount owed

In return for swelling the ranks of their customers, Insurance companies must provide for portability while eliminating preexisting condition clauses.  State barriers must be lowered to allow the 1,300 odd insurance companies to compete nation-wide just like automobile insurance.  This will both drive down prices and ease portability.

Tort reform.  There are many different approaches to this topic and it is inexcusable that this sacred cow of the Democratic party has not be asked to sacrifice along with other stakeholders in our national healthcare ecosystem.  There are passionate opinions on both sides of the debate with respect to capping victim claims, so I’d suggest taking that off the table for the first round.  This first round should focus on lawyer fees rather than victim compensation.  Currently many fees are calculated as a percentage of the amount awarded to the victim.  This incentivizes a great deal of undesired behavior on the part of lawyers.  Allowing a percentage of the award up to a cap retains the contingency arrangement that is often the only way low income plaintiffs can gain representation.  A cap, above which only documented hourly rates will be compensated, greatly diminishes the benefits of seeking outlandish settlements, while protecting victims’s rights.

Gold Plated Plans.  Most folks are not even aware such plans exist, but there are healthcare plans that have no deductibles, no co-payments, and cover treatments from botox to swedish massage.  These gold plated plans should be taxed above a certain point.  For example, let’s assume the average plan has a value of $10,000 a year.  Applying a generous algorithm one could then set the maximum tax free value at something like $18,000.  Under such an approach, if someone had a gold-plated plan valued at $30,000, the first $18,000 would be tax free and the remaining $12,000 would be treated as ordinary income for tax purposes.  This approach would both increase revenue needed to fund subsidies and decrease demand thus freeing up much needed headroom to treat additional patients.

Finally, there are pharmaceutical costs.  Big Pharma proudly stood with President Obama during an earlier photo op, where they pledged to wring billions out of their cost structure.  However, this was only after receiving a promised quid pro quo in the form of a ban on mass drug purchases from Canada or overseas.  This is just cost shifting.  All drug plans should be able to purchase pharmaceuticals from anywhere in the world assuming the source passes safety protocols.

In summary, this common sense approach to healthcare insures all but those who are here illegally and those who have the means to purchase insurance but choose, instead, to self insure.  The insured are protected from preexisting conditions and have portability for their plans which they can purchase from a plethora of providers nationwide.  Tort reform drives costs out of the system by reducing both malpractice insurance and defensive medical tests.

This approach is simple, understandable, and makes pretty much everyone a little bit unhappy, except, of course, the American people.  Just as it should be.

The framer’s of our Constitution were a non-trusting lot.  Even a cursory examination of how the three branches of government interact shines a bright light on either their intense paranoia or inspired genius.  They knew that in man’s quest for power and control, the people would fear a government that did not fear the people.

The best way, they reasoned, to keep a government fearful of the people is by keeping that government from amassing too much power.  The first step to keep a government from amassing too much power is to split it into three parts.  Then, just to be sure, our framers interlocked the three parts in such a way that any stretch by one part to gain power would place stress on the other two and thereby maintain the desired equilibrium.  Paranoid…perhaps.  Genius…undoubtedly.

We have the Legislative branch where the raucous House of Representatives provides the closest link between the elected and the electorate to which they have to answer every two years.  It is in the House that passions flare and the inspired ideas of the people are often first given voice.  If the House is the cup in which our passions boil, the Senate is the saucer that protects the People from scalding coffee that sloshes over the side.  The Senate…where one lone voice can halt the entire body and where 60 must agree before a vote can even be taken.  It is in this most deliberative of bodies where the President must go for advice and consent when appointing those who have their hands on the levers of power.  This advice and consent provides accountability to the People indirectly through their elected Senators.

We recently witnessed one of the most crucial examples of advice and consent with the confirmation of our new Supreme Court Justice, Sonia Sotomayor.  This confirmation process isn’t optional.  It is clearly spelled out in Article II, Section 2 of our Constitution which states that all “high government positions,” are required to be confirmed.

How then is it that President Obama has more than 30 unelected, unconfirmed, high government positions currently filled with people answerable only to the Executive branch.  This is simply unacceptable and we must immediately demand that these positions either be confirmed by the Senate or explicitly require by Senate resolution that no appropriated funds can be used by, or in the service of, these Czars.

Because it is fashionable to place all Patriotic arguments in terms of Left and Right, Blue and Red, Donkey and Elephant, I include for your linking pleasure a pleathora of liberally inclined patriots who have taken serious issue with this egregious extension of power by the Executive branch.

• Salon
• Senator Byrd
  • CBS
  • NY Times
  • La Times
  • CNN
• CNet

Read for yourselves.  Become educated, which means doing more than mindlessly ingesting data without engagement or analysis.  This is our Republic.  Take responsibility for your role as a member of the electorate.  Hold your Senators accountable by demanding that these Czars, too, be held accountable.

Tomorrow I may be a CommonSensicrat™ just to keep things even.

First I’d like to thank Tol for giving me the opportunity to post on his site.  I don’t know how often I’ll have something to say, but I will certainly try to keep it well reasoned and pithy.

Today I’m writing about the Left-Right divide.

My lovely wife is a rabid conservative and one of her best friends is a left of center Democrat.  They love each other dearly but do tend to snipe.  Today I was struck that their sniping was more pointless than usual because they were actually on the same side of the issue.  However, the ideologues that owned their labels were, as usual, quite far apart.

This issue at hand was President Obama’s response to the increasing carnage in Iran and how those on the ideological left and right chose to react.

My wife, let’s call her Kate, correctly pointed out that Obama and many on his left were rather tepid in their support for Iran’s protestors.  Where was the outrage from the bastions of liberal thinking, asked Kate?  They cared more for the President’s poll numbers than for their ideals.  Her friend, let’s call her Edwina, took offense because many of her left of center friends had been openly supporting the Iranian protestors and encouraged a strong American show of solidarity.

In this case, both women were right…and wrong.

The disconnect arose largely because of semantics and context. Kate defines “The Left” as the vocal minority of talking heads and members of the permanent political intelligencia. In contrast, Edwina’s view was informed by left leaners in her personal circle. The Left establishment has power and doesn’t want to risk losing it so they are dipping their toes in an issue that represents great risk to their power if it ends badly. Their sin lies in a willingness to place politics above a clear moral choice involving the grave matter of life, death, and freedom.

The Right establishment does not have power and covets it, so they encourage ‘bold” action because, for them, there is much to be gained and little to be lost. Their sin is merely a dark reflection of those on the Left. The greater sin, IMO, lies with the establishment Left in that they espouse core beliefs that, in this case, they willing forgo to achieve political advantage.

In short, Edwina’s left-leaning friends have been acting on their ideals because those ideals are more important that US politics. Good for them!!  CommonSensicrats all.

The establishment Right has been saying the correct things in too strident a fashion and for all the wrong reasons.

The establishment Left has been doing the wrong things for all the wrong reasons, chief among them is fear and an unwillingness to do something the Right suggests, even when it’s correct.

To those that would defend Obama with the Hungarian example or simply the “meddling” defense, ignore that great swath of land called, “middle ground.”

There is no reason why our country couldn’t have said from the outset, “America stands now and forever with those who seek to obtain and protect Freedom. Our hearts are with the Iranian people in their peaceful pursuit and our eyes are on the Iranian Government with the expectation that, as a society of laws, it will respect and honor the wishes of its people.”

I am Thomas Paine and I reject the notion that our country is Red or Blue.  I reject the notion that ideologues who blather within their coastal echo chambers speak for me or can define the beliefs of my friends and family.  Let them excoriate each other while the wise among us note that they exist on a mobius strip of ideas where extremes of Left and Right are but a hair’s breadth apart, driving our nation to ruin.

I reject it all and I reject them…in favor of Common Sense.

Let me start with two basic premises: 1) Globalization and the Global Economy are realities at which one may feel free to rail, but doing so is a waste of energy and 2) Protectionism is not a balm that can be applied to #1.

That said, all bets are off when it comes to companies lining up to feed at President Obama’s public stimulus trough.

What do you think the public reaction would be if municipalities used stimulus money to purchase police cars that were foreign made.  To be clear, I’m talking about a foreign brand assembling cars using foreign workers in a foreign land.  I’m guessing that the UAW would have a thing or two to say about that.

Intellectual honesty suggests we apply the same outrage to the outsourcing of white collar jobs as we would to blue collar.  Over the past five years, IBM has been shedding U.S. based jobs at an alarming rate.  Perhaps taking a cue from Obama’s chief of staff, they seem be making the most of our current crisis to increase the rate even further.

I’m a capitalist and IBM operates, for the most part, an unregulated business so while I personally find their decisions distasteful, I acknowledge their right to put their shareholders first and do what it is they are doing…unless they do it on the backs of We the People.

Business week reports:

IBM is seeking a share of the $8 billion the U.S. plans to spend on high-speed rail and part of the $20 billion in the stimulus plan to digitizethe U.S. health-care system. Palmisano was one of 13 executives who met with President Barack Obama in January in an appearance aimed at pressuring the House of Representatives to pass the economic stimulus bill. He joined the CEOs of Xerox (XRX), Motorola (MOT), and Google (GOOG).

Kenney says the political climate may make IBM’s global restructuring touch raw nerves. Some economists have estimated that taxpayers are paying an average of $225,000 for each job created in the economic stimulus package. Says Kenney: “Taxpayers are saying, ‘I don’t want to give them money if they’re moving jobs offshore.’”

It’s an interesting article and I high recommend taking a moment to read it.

So what’s my suggestion?  I strongly believe that taxpayer money should be spent to benefit those who pay the taxes.  Seems pretty basic, but I have little interest in using tax money to help bolster IBM’s stock price.  Yes many Americans may have IBM stock as a part of their 401k and no we should not be protectionist.  However, while we might purchase steel from overseas to support infrastructure projects funded with stimulus money, we would never think to buy the whole bridge and have it shipped over for installation.

Our intellectual capital is a finished product as well.  IBM shipping off billions of hours of services work to digitize hospital records is no different than shipping off the building of a levee.  Under no circumstances should we be stimulating the Indian economy with debt financed U.S. stimulus dollars.

We need to view this from a macro perspective.  Yes, the work may be done cheaper if one employs the IBM model and that may be the primary consideration if you are procuring a new Point of Sale system for Walmart.  However the customer here is not Walmart; it is We the People.  So if IBM lays off 5,000 people as they did today and employs 5,000 folks from India, those newly unemployed Americans will now receive unemployment insurance, subsidized COBRA, and won’t be paying taxes.  Those costs must be added to the cost of the project IBM just shipped off and should put them at a competitive disadvantage when compared to a U.S. based small business employing all U.S. people.  To do otherwise creates an uneven playing field where large multi-nationals have an unfair advantage.  Beyond basic fairness; it’s really just stupid to use taxpayer dollars to encourage domestic layoffs and foreign hiring.

Spending taxpayer dollars to benefit taxpayers is not protectionist; it’s common sense.

Imagine my surprise, but one of the things I prize most in any discussion is intellectual honesty. To disagree with someone on a point simply because of their ideology or because you’ve disagreed with them on all previous points is simply intellectually dishonest.

Here’s the backdrop.  David Gregory has picked up the mantel of Meet the Press and clearly went to school on the man whose giant shoes he’s agreed to fill, the late Tim Russert. He does a good job and I recommend his program. Today, he asked Barney Frank why so many politicians fail to live up to the public’s expectations. I’m paraphrasing, but Rep. Frank said, “The voters do not hold us accountable enough.”

I couldn’t agree more. And let’s start with Rep. Frank. Why do the people of his district return him to Washington every two years? While he attempts to shift blame, he has Chaired the Financial Services Committee for over two years now. How is it in that time he never caught wind of the tsunami in which we now find ourselves. More, a year ago Rep. Frank was publicly proclaiming Fannie and Freddie fundamentally strong.

There are many issues on which Rep. Frank and I disagree, but that is not the point of this post. My point here is that until our representatives believe there are consequences for failure, their behavior will not change. Voter’s must enthusiastically cross party lines when their party’s incumbent fails to deliver. Democrats in Massachusetts should have gleefully sent Rep. Frank packing for his abject failure as Chairman.

Speaking for my lone vote, I have placed my Senators and Representative on notice, just because my state and district is Red/Blue, don’t be complacent. The people are roiling mad at your continued bickering and ineptitude. Your party affiliation will not protect you from incompetence, at least if I have anything to do about it.