Tread Carefully Into The Morass Of Medical Insurance Reform

One thing I know for a fact about medical reform efforts in America and the world is that they invariably cost more than advertised, produce less benefits than advertised and generate numerous unintended consequences.

Via Memorandum, comes a very well written and documented inquiry into the ten main reasons provided by the Obama administration and other advocates for the necessity of radical reform of our health care system, and the savings and benefits expected. The author is Bruce Kessler at a site called Maggie's Farm.

Key quote:

George Bernard Shaw warned “Beware of false knowledge; it is more dangerous than ignorance.” The major overhaul of American health care pursued by President Obama and his supporters is based on many false premises and is excessive and likely to do more harm than good. Tuning up and improvements already always dynamically occurs. Instead, ObamaCare is aimed at dramatically changing one-sixth of the US economy in ways that are untested or tested and found wanting, primarily involving huge increases in government direction of health care.

The details of ObamaCare are largely being left to Congress, the same body that stuffs the federal budget with earmarks, waste, and other programs that are not requested. ObamaCare is premised on claims for drastic changes in health care and major increases in government programs being necessary. Those claims are largely specious.

Below, the top ten specious premises for ObamaCare are discussed:

1. Comparing US Health Care To Other Developed Countries
2. US Health Care Spending Is More Than We Can Afford
3. Reform Overhaul Will Yield Major Savings
4. Increased Evidence-Based Medicine And Health Information Technology Will Significantly Improve Care and Reduce Costs
5. Present Administrative Costs And Insurer Profits Are Too High
6. US Consumer Dissatisfaction Requires Drastic Health Care Changes
7. Health Care Costs Are So High They Are A Major Cause Of Personal Bankruptcy
8. The Number Of Uninsured Is So Large That Drastic Health Care Changes Are Necessary
9. More Preventive Care Will Better Serve Consumers And Save Costs
10. Health Care Consumers Are Being Served By Drastic Health Care Changes

(More could be added, such as that government restraints on prescription drug prices will not impede incentives for innovations, but they are so transparently false that the list below dwells on other ObamaCare premises more misleading.)

Kessler then proceeds to provide chapter and verse about why each of these sacred given truths just ain't necessarily so. Important reading for the time when the President finally succeeds in appointing Gov. Sibelius as a Secretary of H.H.S. and this effort really gets under way. Let us not go blindly into this massive rescrambling without careful questioning.

Voting With My Heart and My Head

I have just returned from voting. For the record, I voted for Barack Obama.

It felt very satisfying. It felt like crossing a major river in our still short journey as a nation. From our beginnings as a republic of slave owners and disenfranchised slaves and former slaves to the probable election of an African American man as our President. Have we confronted our national original sin, acknowledged it and now put it behind us? I hope so. In any event, it is a moment well worthy of celebration.

This year I got the election I asked for. Of all the potential candidates who presented themselves over the last seemingly endless two years Obama and McCain were the finest people available. McCain is one of the most honorable men to have survived a political career with the better part of his integrity in tact. His personal history of bravery is unimpeachable.

Obama is perhaps the best spoken and, apparently, the most intelligent man to run for the office in my lifetime. His calmness and analytical coherence are impressive and much needed. His campaign, the only substantive clue we have of his leadership skills, has been the best in generations. Be honest, who among us believed two years ago that he could get past the vaunted Clinton machine to the Democratic nomination, much less be on the cusp of history tonight. This did not happen by accident.

Early in the primary season, Obama made noises that were calculated to endear him to the "progressive" wing of the Democratic electorate and blogosphere. But over time the careful listener could detect a clear tack to center. Troops would be withdrawn from Iraq in 16 months, but only responsibly and with the advise of the military on the ground. Health care, which was initially presented as a thrust for universality and justice, was later amended to more closely resemble those changes that will actually be achievable and affordable.

The bottom line for me is that I have placed my hopes in this man. My gut about him is that he will be calm and sound and thoughtful and inspiring and strong as President. Soon we will begin to see the early signs of his Presidential style. Who makes up his transition team, how they operate and who his early appointments are will tell us a good deal. Will he choose a rabid partisan like Rahm Emanuel for his Chief of Staff, or a more balanced person to manage the White House? Perhaps a person like Emanuel is better taken off the stage afforded him in Congress and better put to work focusing on making Obama's program happen and taking steps behind the scenes to assure his reelection. Only Obama can judge if he can be loyal to his President or can only exercise his hatred of Republicans to the detriment of a unifying presidency.

Notice I absolutely assume an Obama victory. All the numbers and my gut instincts point in that direction. I also am assuming an Obama presidency that will try to bring Americans together on the many things we agree about rather than continue to tear us apart in some bizzaro Rovian counterpoint.

Those, I confess, are my hopes. More than that, it is what I demand of the next President. I have not imbibed the koolaid. Obama is a human being. For the next four years I will be watchful as well as hopeful.

Finally, voting against John McCain was not easy. He is one of the people I admire most in public life. Sadly, his campaign was not very competent. It lurched in fits and starts from one attempt to pull a rabbit out of a hat to another. Sara Palin, suspension of the campaign to deal with the economic crisis, "Billy" Ayers (as he was called in a Weather Underground manifesto from the 60's), and others. But more than any other event, it was his apparent inability to lead in the Senate or Congress as a whole in the development of the economic "rescue" plan and his sloppy assertion that the fundamentals of the economy were sound. The old maverick McCain would have sounded an alarm. He would have looked at that legislation and its endless list of added pork for what it was and voted against it. McCain the candidate for President lacked the courage to do so or to stand for any but the commonly held wisdom on the subject. For that matter, what was to be the guiding ethos of a McCain presidency? I have no idea. Vetoing pork and taxing existing health benefits do not an overarching philosophy make. Sad but true.

Yet he does deserve our great admiration for choosing not to use the Rev. Wright against Obama. He could have done so very easily. It is reasonable to question Obama's twenty years of membership and close relationship to his minister. But what festering sores of our racial history would such a campaign tactic have picked at. Would it have taught us anything about Sen. Obama except that he worked the political base he needed to have credibility with in order to get elected in Chicago. John McCain's finest act of service to America may well have been his decision to not take that road. We owe him a great debt for this.

Obama/McCain: No Big Whoop

Although I have not blogged for some time and not at all since the finalization of the Presidential race, I now feel the urge to say why I've had such a lack of interest.

The shared media wisdom, repeated in a endless feedback loop by the pundits and bloggers is that this is THE most important election in modern American History. How else can they convince us to tune in to CNN regularly to touch base with Wolf in his news war, er, situation room.

It may be less crucial than some claim, but it is certainly the one I hoped for.

Barrack Obama seemed to me best and the brightest that his party had to offer. John McCain is a man of honor and decency. During the primary phase of this election, each sought to play to the passions of the activists in the key states.

But now having won the nominations, both are sounding more alike than they are different. This is part of the natural progression of Presidential elections. If you can't win the middle, you can't win. But, importantly, it is also a function of the realities on the ground, both abroad and in the canyons of lower Manhattan.

In 2009 in Iraq either man will begin the process of withdrawal and our troops will substantially be out of there in 16 - 24 months. An insubstantial difference. The only thing that matters is that it be done smartly.

In the face of today's economic crisis, neither man will be able to truly solve the issues of medical insurance, Social Security, education, or any of a dozen very expensive issues that Americans tell pollsters they care about.

Here's how Peggy Noonan put it the other day:

A final point. Do you ever have the passing thought that the presidential election doesn't matter as much as we think? Whoever wins will govern within more of less the same limits, both domestically and internationally. A New York liberal leaning toward Mr. McCain told me this week he has no fear that Mr. McCain may be a more militant figure than Mr. Obama. We already have two wars, "we're out of army." Even if Mr. McCain wanted a war, he said, he couldn't start one.

I wonder if we follow the election so passionately because we're afraid. We're afraid a lot of our national problems are intractable, and the future too full of challenge.

We cannot tolerate feeling this way. So we make believe the election can change everything. And we follow it passionately to convince ourselves its outcome will be decisive and make everything better. We reassure ourselves with pictures of the cheering crowds at the rally. We even find some comfort in the latest story of the latest dirty trick. But deep inside we think: Ah, that won't work either.

Some part of me thinks we are all making believe this is a life-changing election because we know it's not a life-changing election. Ever have that thought? Me too. Then there's a rally or a scandal or a gaffe, and it passes.

Today, Ross Douthat had this to say today:

All Presidential elections are important, of course, and they're usually important for reasons that nobody sees coming during the election itself. But given the evidence presented to date - the enormous constraints on American action abroad, a fiscal situation that more or less ensures that neither candidate's boldest ideas are likely to get off the ground, and the unimaginative, substance-averse politicking of the candidates themselves - there's good reason to think that the outcome of this election won't be nearly as transformational as many people seem to think. Partisans on both sides claim that we're staring into the abyss: If you listen to some conservatives, you'd think that John McCain and Sarah Palin are all that stands between turning over U.S. foreign policy to William Ayers and Jeremiah Wright; if you listen to some Obamaphiles, you'd think that a vote for McCain is a vote for fascism, or theocracy, or the Putinization of America. But if you watch the candidates themselves, and listen to them, the stakes seem much, much lower.

It is interesting that only those on the right of the pundit class have so far acknowledged this state of affairs. Perhaps those on the left feel the inexorable pull of anger at the past eight years and their failure to turn Bush out earlier. But let's make a small wager. The real problems America will face in the next four years are not now on the table, at least in a highly visible way and the die is already cast about the problems that currently fire our passions. At the end of the next President's term, we will look back and have to concoct an entirely new set of issues to fire up the masses.

That doesn't mean that appearances don't matter. They do. The election of an African American will go a long way towards repairing the country's original sin. That would be a good thing. And it may be that Obama is just plain smarter that McCain. As Warren Buffet said the other day about investment strategy, "I bet on brains."

Advice equally relevant to our choice for the White House.