The View from Right Field

Health Care: A Good Plan – Even Better

Let me follow up on my post "Health Care: A Good Plan." Senators Tom Coburn of Oklahoma and Richard Burr of North Carolina have introduced a health care plan that has features that may be even better than those in President Bush’s plan.

Among the key features of the Coburn plan is an annual tax rebate ($2000 for individuals and $5000 for families) to be used to buy health insurance. Providing for a tax rebate, instead of just a deduction, like in Bush’s plan, means that everybody, including people who do not pay taxes, will have the means to buy health insurance. And money that is not used for health insurance goes into a person’s or family’s own Health Savings Account to be used for things like deductibles and co-pays and over-the-counter medicines.

This does several good things. First, it gives everybody, or at least as many people as realistically possible, the means to buy their own health insurance. This should dramatically reduce the number of people without health insurance.

Second, the plan gives people more control over their health insurance. Instead of people just getting whatever insurance their employer gives them, they will now be able to pick out the plan that best fits their needs. Maybe they want a plan that only provides catastrophic coverage and lets them keep more money in a Health Savings Account for regular expenses that are not covered under any plan. Or maybe they might want a plan designed for people with young children or a plan for people without children. Coburn’s proposal would give people that choice.

Third, enabling and empowering people to buy their own health insurance will encourage competition in the health insurance market, and competition is a key to keeping costs down. Competition has been one of the reasons why the new Medicare drug plan for seniors, Part D, is costing less than originally estimated.* It is unusual for any government program to come in at budget, let alone actually cost less than predicted. But Part D is doing that, and one of the key reasons for this is that the program was designed to encourage competition among the companies providing drug plans to seniors.

Another important part of the Coburn program is that it makes the market for health insurance plans national instead of having it be divided up state by state. People would no longer be allowed to only buy health insurance plans available in their states. Instead, they would be able to buy an insurance policy offered in any state. This is a great idea for several reasons. First, it provides more options. People will have more plans to choose from. That will enable them to be able to pick the plan that is best for them.

Second, more people having more options means more competition, and that will keep costs down.

Most important, however, is that allowing individuals to buy plans offered in any state will counteract one of the biggest obstacles to affordable health insurance. Too often state legislatures pass laws requiring that all health insurance plans in that state provide more and more coverages. These requirements are usually framed as helping people by making sure their health insurance provides the coverage they need. And many people who favor these mandates do so because they really believe health insurance plans should provide these coverages. But these mandates are also promoted by people who want to make sure their specialty is covered by insurance so they can get more people to use them. Regardless of the motive, the result of these mandates is to drive up the cost of health insurance, which drives down the number of people who can afford to buy it.

Hopefully, allowing people to buy insurance from any state, instead of just the one they live in, will mean there will be at least some plans that will not be burdened down with requirements and mandates that push the cost of the insurance out of the range of the very people who need to buy it. (Those who really believe plans should be required to provide additional coverages, should make their argument at the national level. They should also provide for an increase in the annual tax rebate to cover the extra cost of those coverages and for how we will pay for the bigger rebate.)

There is one problem with Senator Coburn’s plan (and President Bush’s plan, for that matter): It will be complicated at the start. Consumers are going to be given lots of choices, and that can be daunting. Before, it was easy. People did not have to think. They got what was given to them, and they did not have to decide. But the old system is breaking down.

Things are going to change. People are going to have to get involved in their own health insurance. They are going to have to take control of their own health insurance and health care. They may not like it at first because it will be strange and new, but once they see how it works, once they see how more choices and more competition means better medical care at a lower cost, they will like it. That is what happened with Medicare Part D. In January of 2006, when the plan was starting, when all the complications were new and hard to understand, people did not like the plan.** But a year later, once people got used to the plan and they could see how it was working and how it was helping them, approval ratings turned around, and people liked the plan.***

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* David Wessel, "Once Unloved, Medicare’s Prescription-Drug Program Defies Critics, but Issues Remain," The Wall Street Journal, December 7, 2006.
** David Wessel, "Medicare Drug Plan Shows Pitfalls of Choice," The Wall Street Journal, January 5, 2006.
*** David Wessel, "Once Unloved, Medicare’s Prescription-Drug Program Defies Critics, but Issues Remain," The Wall Street Journal, December 7, 2006.

Facts Are a Transient Thing – #2

Following up on this post is an article in the March 26 issue of Newsweek: "Health: Can Exercise Make You Smarter?" According to this article, recent findings tell us that not only can aerobic exercise make you smarter, it can keep you smarter longer.

What makes this particularly interesting is that some of these discoveries are the exact opposite of what scientists thought just ten years ago. For example, the article notes that last week "researchers announced that they had coaxed the human brain into growing new nerve cells, a process that for decades had been thought impossible".

Similarly, "[u]ntil the mid-‘90s, scientists thought the loss [of neurons in the brain] was permanent – that the brain couldn’t make new nerve cells to replace the dead ones. But animal studies over the last decade have overturned that assumption".

This article reminds us how important it is to maintain a healthy skepticism when we are told that questions have been answered and nobody can disagree. The fact is what science "knows" today is some times wrong tomorrow.

Therefore, when it comes to acting on what science "knows," we need to be careful to stay within ourselves, especially when it comes to big programs over long periods with huge price tags. Money is not unlimited. We need to make sure the money we do spend does the greatest good for the most people at the lowest cost.

We need to remember that just because there is a problem does not mean we know the solution. While doing something may make us feel better, if the money is not spent wisely, other problems we know how to solve will go unaddressed because of a lack of money.

When we see a problem, it is not easy to not do something, to not rush off with a big solution to a big problem. But sometimes we have to. Global warming, anyone?

Feeling Good or Really Helping People

How do you help low-income people with housing? A recent comment by the new leader of the National Party in New Zealand (the more conservative of the major parties in New Zealand) focused attention on this question once again.

Until the 1990s New Zealand provided low-income people with low-rent state housing. In the 1990s the National government changed that policy. National charged market rents for state-owned housing but provided rent subsidies to people with low incomes. This policy was among the first to be reversed by Labour when it came into power in 1999. Now John Key, National’s new leader, has said: "I don't favour a move back to market-related rents and I don't think the party will support a move back."

The question is whether this is the right way to help low-income people. The problem with providing help by charging low rents for state housing is that only those in state housing get the help. If there is a waiting list for state housing (and there always is), those on the waiting list do not get helped. This results in the unfairness of some getting help and others not – unless there is enough state housing for all (which there never is) or a rent subsidy is given to those who do not get into state housing. But if you provide a rent subsidy to those people, why not just give a rent subsidy to everybody and get the state out of the housing business? That would make sense unless one thinks direct government action is the best way to help people. Or unless the point of charging low rents for state housing is more about making those who provide it feel good about what they are doing, instead of really helping low-income people.

Good People to Washington

Thomas Sowell has hit on a point relating to the Scooter Libby trial that has been missed by most other commentators but which may be more important than what the others are talking about. Sowell asks:

"More important, how are we to expect highly qualified people, with far better options than a government job, to risk being put through the Washington meatgrinder because of politics, media hype and special prosecutors who can create crimes in the course of an investigation, when there was none to begin with?"

Some will say that this is not a problem, that there is no shortage of people wanting to go to Washington. That may be true, but are they the people we want in Washington? Does the viciousness, the meanness, the criminalization of life in Washington, mean that the best people, the people who can do something else, will stay away? Will our Washingtons and Adamses and Jeffersons come to government today or will they stay away, to protect themselves and their families?

It used to be our leaders would pledge their sacred honor. Now it is taken from them by a politics of personal destruction, a politics that admits of no honest disagreement. Today’s politics of morality seems to mean calling those you disagree immoral, instead of being moral yourself.

If we want good people in Washington, we need to make Washington a place good people are willing to go. That means we must ratchet down our disagreements. We cannot expect good people to go to Washington if we call them bad or evil just because they disagree with us. In other words, to get good people to go to Washington, we have to treat them as we would want to be treated ourselves.

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Update (3/13/07, 12:45 p.m.): Not everybody follows this approach. One presidential candidate recently stated their approach in Des Moines: "When you're attacked, you have to deck your opponent." This person also said the following when some members of the other party were invited to a meeting: "What are you doing inviting those people … ? These people are our enemies. They are trying to destroy us."

For the Want of a Nail

In an article in today’s Chicago Tribune about Sammy Sosa’s comeback try with the Texas Rangers, Paul Sullivan wrote:

"Sosa's average with the Cubs had a steady decline, from .329 in '01, to .288 in '02, to .279 in '03, to .253 in '04 ….

He said the departure of hitting coach Jeff Pentland after 2002 factored in ….

‘I did miss Pentland,’ he said."

Why did the Cubs ever let Pentland go? He was Sosa’s Freddy Martin.* If you spend as much money as the Cubs did on Sosa, why would you get rid of the coach who helped make him a superstar? Why not spend a little more and keep the coach?

In a similar vein, it will be interesting to see how Mark DeRosa does this year. After five-plus years in the majors, DeRosa finally had a breakout year in 2006 under the tutelage of Texas Rangers hitting coach Rudy Jaramillo. Will DeRosa be able to keep it up this year in a new league with a new hitting coach? We will see.

And will Jaramillo be what Sammy needs to regain what he lost when Pentland left? We will see on that, too.

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* Freddy Martin was the minor league pitching coach who taught Bruce Sutter the split-fingered fastball. When Sutter got to the majors, Martin was there, too, whenever Sutter needed help. And it was worth it to the Cubs for Martin to be there because he kept Sutter the best there was.

Greg Maddux

From an article by Paul Sullivan in Friday’s Chicago Tribune:

Maddux, who was traded to the Los Angeles Dodgers in July and eventually signed a two-year deal with the Padres, said Thursday he has no regrets about his second go-round with the Cubs, despite their downward slide after the final-week collapse in 2004.

"Not at all," Maddux said. "I was glad I did it. I felt fortunate and privileged to do it. Everyone treated me great over there, a lot of great memories, made a few friends ... nothing but positives for me."

The Cubs didn't look at re-signing Maddux during the off-season and he joked that his friend Jason Marquis "took my spot" in the rotation. It was Maddux, of course, who advised Marquis to see pitching coach Larry Rothschild in the winter to help fix his mechanics.

"Did he take my locker too?" Maddux asked. "Good for him. Larry's real good. Pitchers would be wise to listen to what he has to say."

Was Maddux surprised at the Cubs' off-season spending binge?

"I didn't see it coming, but good for them," Maddux said. "Looks like they've made a lot of good improvements. How could you not root for these fans?"

How could you not root for a player like this?

2008 Election

With the terrible things occurring at Walter Reed Army Hospital and the Scooter Libby verdict yesterday, both following on the notable lack of success so far in Iraq, it would appear the 2008 Presidential race is half over. Actually, what I mean is that the Republican half of the 2008 Presidential race is over. The Republican half is over because the Republican candidate, whoever he or she may be, has no chance of winning. It is just a matter of which Democrat will win – and what the Republicans can do to minimize their losses in the House and Senate. And the Senate will be tough because 21 Republicans are up for reelection in 2008, as opposed to just twelve Democrats.

The problem with the Libby verdict and the mess at Walter Reed is that they cut at the heart of whatever strength Bush has left. The Libby verdict will be portrayed as proof that Bush misled us into the Iraq war with lies about weapons of mass destruction. That is not true, either about the trial (which was not about WMD in Iraq) or Bush lying about Saddam Hussein having MWD (in the sense of saying Saddam had MWD when Bush knew he did not), but it will be portrayed as such, and the lack of success in Iraq will make the claim seem plausible.

But as bad as the Libby verdict is, the situation at Walter Reed is worse. The last strength Bush had was that he really cared about the troops. Most Democrats do, too, but too many Democrats see support for the troops as a public relations ploy to be manipulated to get us out of Iraq (see here and here). But now, even that is gone. The Bush Administration will be seen, maybe appropriately, as failing the wounded troops, those who need our help and support the most.

It is hard to believe how bad George Bush has done. It is even harder to believe that the voters will let another Republican have a chance in 2008.

And that is too bad because it is going to give the Democrats a real chance, starting in 2009, to do what they want to do – which will not be good for the country. It is also too bad because there will be some good Republicans who are going to lose in 2008 for reasons totally outside of their control.

Finally, perhaps most importantly, it is too bad for the people of Iraq. It has taken Bush far too long to come up with the proper strategy in Iraq. Now that he has finally found it (in General Petraeus and the surge; see here), all of his other mistakes are going to reduce the chance this new strategy will have the time and support it needs in and from the United States to work. This may ultimately be Bush’s biggest failure; i.e., failing the people of Iraq and our troops who fought there by not getting it right until it was too late.

Choice in Education – #3: "Yes, Prime Minister"

In the 1980s "Yes, Minister" and, subsequently, "Yes, Prime Minister" were hits on British television.* The series portrayed the clash between politicians and the civil service in the British political system. One episode of "Yes, Prime Minister" dealt with the Prime Minister’s attempt to "do" something about the English education system.

Set forth below are two excerpts from that show. The first involves the Prime Minister, Jim Hacker, his wife, Annie, and his chief political adviser, Dorothy Wainwright, discussing a TV report about the Prime Minister’s visit to a local school that was doing a good job.

The second is from a little later in the show, when the Prime Minister tells Sir Humphrey Appleby, Cabinet Secretary, of his plan to reform education.

Though this episode aired over twenty years ago, these excerpts are still relevant today.

* * *

ANNIE HACKER: Oh darling, I’m not interested in your paranoia. I was interested in that school.
DOROTHY WAINWRIGHT: Yes, parents queuing up to get their children into it.
ANNIE: What a pity that can’t all get in. More coffee?
PRIME MINISTER JAMES HACKER: Mmm.
Annie: Why can’t more parents send their children there?
PM: No room.
DOROTHY: There is room actually. School numbers are falling.
PM: Yeah, but that would mean poaching the other schools
ANNIE: So what’s wrong with that?
PM: The other schools wouldn’t have enough pupils. They’d have to close.
ANNIE: Great. So St. Margaret’s could take over their buildings.
PM: Darling, you couldn’t do that. It wouldn’t be fair.
ANNIE: Who to?
PM: The teachers in the schools that have to close.
ANNIE: But the good teachers would be taken on by the popular schools. They’d be needed.
PM: What about the bad teachers? It wouldn’t be fair on them.
ANNIE: What about being fair on the children or are the bad teachers jobs’ more important?
PM: It’s. Never mind, never mind. Who’s to say who are the bad teachers? It just wouldn’t work.
ANNIE: Why not?
PM: Well, it wouldn’t work.
DOROTHY: Why not?
PM: What do you mean?
DOROTHY: Well, suppose schools were like doctors. After all under the National Health Service you can choose whatever doctor you like to go to, can’t you.
PM: Yes.
DOROTHY: And he gets paid per patient. Well, why don’t we do the same with schools? Have a National Education Service. The parents could choose the schools they want and the schools get paid per pupil.
ANNIE: Exactly.

* * *

PM: I’ve realized how to reform the educational system.
SIR HUMPHREY APPLEBY: Excellent, Prime Minister.
PM: I’m going to let parents take their children away from schools and move them to any school they want to.
SIR HUMPHREY: Well, you mean after application, scrutiny, tribunal hearings, and appeals procedures?
PM: No, Humphrey, just move them, whenever they want to.
SIR HUMPHREY: I’m sorry. I don’t quite follow.
DOROTHY: This Government is going to let parents decide which schools to send their children to.
SIR HUMPHREY: Prime Minister. You can’t be serious. But it’s preposterous.
DOROTHY: Why?
SIR HUMPHREY: Well, you can’t expect parents to make these choices. I mean how on earth would parents know which schools are best?
PM: Which school did you go to Humphrey?
SIR HUMPHREY: Winchester.
PM: Was it good?
SIR HUMPHREY: Oh, excellent, of course.
PM: Who chose it?
SIR HUMPHREY: My parents, naturally. [pause] Now, that’s different Prime Minister. My parents were discerning people. You can’t expect ordinary people to know where to send their children.
DOROTHY: Why not?
SIR HUMPHREY: Well, how could they tell?
DOROTHY: They could tell if their kids could read, write, and do sums. They could tell if their neighbors were happy with the school, and they could tell if the exams results were good.
SIR HUMPHREY: Exam results aren’t everything, Prime Minister.
DOROTHY: That’s true. And those parents who don’t want an academic education for their children can choose progressive schools.
SIR HUMPHREY: But parents have no qualifications to make these choices. Teachers are the professionals. Parents are the worse people to bring up children. They have no qualifications, no training. You don’t expect untrained teachers to teach. The same should apply to parents. {diversion into sex education]
SIR HUMPHREY: … But I’m being serious. It’s looking after children that parents are not qualified for. That’s why they have no idea which schools to choose. It couldn’t work.
DOROTHY: Then how does the Health Service work? People choose their family doctor without having medical qualifications.
SIR HUMPHREY: Ah yes, well that’s different.
DOROTHY: How?
SIR HUMPHREY: Well, doctors. Patients aren’t parents, dear lady.
DOROTHY: Oh, really. What makes you think that, Humpy?
SIR HUMPHREY: Not as such, in any case. As a matter of fact, I think letting people choose doctors is a very bad idea. Very messy. Much tidier to allocate people to GPs. Much fairer. Then we could even out the numbers and everyone has an equal chance of getting the bad doctors.

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* DVDs of both series are available on Amazon here.