Tuesday, September 22, 2009
More on Afghanastan
On the same lines as the previous post, recommending Immanuel Wallerstein's piece, I also recommend reading the blog Tomgram: Ann Jones, Us or Them in Afghanistan?. Ann Jones , who has written a book about her experiences in Afghanistan, suggests that the Afghan "Army" that America has been paying billions to assemble is in fact largely a figment of our imagination, and always will be.
Recommended: The Firestorm Ahead
As always, Immanuel Wallerstein's views differ from Washington's "conventional wisdom". His September article The Firestorm Ahead is worth reading, though it won't be very comforting. He argues that American efforts in the Middle East are about to come to pieces, and that the cascading consequences from Iraq to Afghanistan to Pakistan will cause a political firestorm in American politics in the next two to three years.
His core facts are correct - (a) the American military is finding it hard to work under the existing Status of Forces Agreement (SOFA) with Iraq. Not much of this makes the evening news, but it certainly is clear if one reads the military journals and soldier's blogs from Iraq. (b) the Afghans and the Pakistanis both would like to see America out of their affairs, despite the public statements of their leaders to the contrary. Whether the conclusions he draws from these core facts are accurate we will know soon enough.
His core facts are correct - (a) the American military is finding it hard to work under the existing Status of Forces Agreement (SOFA) with Iraq. Not much of this makes the evening news, but it certainly is clear if one reads the military journals and soldier's blogs from Iraq. (b) the Afghans and the Pakistanis both would like to see America out of their affairs, despite the public statements of their leaders to the contrary. Whether the conclusions he draws from these core facts are accurate we will know soon enough.
Recommended: Job One
John Judis, a senior editor at The New Republic, has written an interesting piece entitled Job One: The only way Obama can pull his presidency back from the brink. He argues that despite the furor over health care, and more recently over whether to send more troops to Afghanistan, the real driver for the fortunes of President Obama and the Democratic majority is the economy, and specifically the unemployment rate.
Judis looks at the popularity of Roosevelt and Reagan as they both handled economic difficulties. Here is a fascinating graph from his article that makes the point that disapproval ratings track pretty close to unemployment trends -- when unemployment increases, so does the proportion of the nation disapproving of the president and his party. When unemployment improves, disapproval ratings drop:
It has seemed to me that this administration has had its priorities wrong. Certainly health care reform is important, but repairing the economy is far more important. While all this fuss over health care has been going on, Congress has done little to attack the underlying problems that led to this recession. Banks are still in dire straits, there is still a mass of toxic assets on their books, credit default swaps are still unregulated, the federal deficit is ballooning at an alarming rate, and unemployment continues to rise. Job one (and two and three) should have been to focus on these issues first and leave health care and carbon caps and other issues until this first probelm was truly under control.
Judis looks at the popularity of Roosevelt and Reagan as they both handled economic difficulties. Here is a fascinating graph from his article that makes the point that disapproval ratings track pretty close to unemployment trends -- when unemployment increases, so does the proportion of the nation disapproving of the president and his party. When unemployment improves, disapproval ratings drop:
It has seemed to me that this administration has had its priorities wrong. Certainly health care reform is important, but repairing the economy is far more important. While all this fuss over health care has been going on, Congress has done little to attack the underlying problems that led to this recession. Banks are still in dire straits, there is still a mass of toxic assets on their books, credit default swaps are still unregulated, the federal deficit is ballooning at an alarming rate, and unemployment continues to rise. Job one (and two and three) should have been to focus on these issues first and leave health care and carbon caps and other issues until this first probelm was truly under control.
Recommended: Afghan Agony - More Toops Won't Help
Ralph Peters is one of the nation's leading military strategic thinkers. A retired Army Lieutenant Colonel, he has authored a number of excellent books on military strategy (some are listed in my book list – see sidebar), as well as a few pretty good military novels. So when he speaks out on our military policy in Afghanistan, it is worth listening.
His article Afghan agony: More troops won't help in today's New York Post is excellent. In essence, he argues that the Obama administration, like the Bush administration before it, has set an impossible goal in Afghanistan - to turn a poor, fragmented, tribally-oriented collection of people into a modern democratic nation in a matter of a few years. As more than one historian has noted, Afghanistan has been the graveyard of empires throughout history, from Alexander the Great and the Persians in ancient times to the British and the Soviet Union in modern times. The degree of hubris inherent in Washington's belief that it can succeed were so many other have failed is astounding - or perhaps politicians just don't know history.
Peters argues that we should redefine the mission to the simple, narrow goal of tracking down and eliminated or at least seriously crippling al Qaeda and its allies, and forget about nation-building in Afghanistan. Sounds like a valid argument to me.
His article Afghan agony: More troops won't help in today's New York Post is excellent. In essence, he argues that the Obama administration, like the Bush administration before it, has set an impossible goal in Afghanistan - to turn a poor, fragmented, tribally-oriented collection of people into a modern democratic nation in a matter of a few years. As more than one historian has noted, Afghanistan has been the graveyard of empires throughout history, from Alexander the Great and the Persians in ancient times to the British and the Soviet Union in modern times. The degree of hubris inherent in Washington's belief that it can succeed were so many other have failed is astounding - or perhaps politicians just don't know history.
Peters argues that we should redefine the mission to the simple, narrow goal of tracking down and eliminated or at least seriously crippling al Qaeda and its allies, and forget about nation-building in Afghanistan. Sounds like a valid argument to me.
Monday, September 21, 2009
Recommended: Dmitry Medvedev’s Article, Go Russia!
Fareed Zakaria interviewed Russia's president, Dmitry Medvedev, on his GPS program this past Sunday. It was a fascinating interview, very cordial in tone. But Fareed, as usual, asked all the hard questions. Medvedev is clearly a bright and engaging guy, but just as clearly, he is Russian first and foremost, with a Russian view of the world.
Just a few days before this interview was taped, Medvedev wrote an article that has been widely reprinted. You can read a translation of the article here. It is an extraordinary piece to come from a Russian leader. It speaks quite frankly and intelligently about Russia's domestic problems, and it give some insight into how Russian's current leadership sees the world and Russia's place in this world.
I strongly recommend reading it. Russia is not the global superpower it once was, or at least aspired to be. But it is nevertheless a major player on the world scene, and we in the Western world have got to learn how to live with Russia, and how to be sensitive to its concerns, if we want Russia to help us with issues like Iran's nuclear program.
Just a few days before this interview was taped, Medvedev wrote an article that has been widely reprinted. You can read a translation of the article here. It is an extraordinary piece to come from a Russian leader. It speaks quite frankly and intelligently about Russia's domestic problems, and it give some insight into how Russian's current leadership sees the world and Russia's place in this world.
I strongly recommend reading it. Russia is not the global superpower it once was, or at least aspired to be. But it is nevertheless a major player on the world scene, and we in the Western world have got to learn how to live with Russia, and how to be sensitive to its concerns, if we want Russia to help us with issues like Iran's nuclear program.
Recommended: Belatedly, Egypt Spots Flaws in Wiping Out Pigs
The Law of Unintended Consequences is always in operation. Along those lines I recommend the piece Belatedly, Egypt Spots Flaws in Wiping Out Pigs by Michael Slackman in the Sept 20, 2009 New York Times. The Egyptians acted with the best of intentions, though with a flawed understanding of the problem, and got a worse problem as a consequence.
Is there a lesson in this for our current administration as it deals with financial problems, Iraq, Afghanistan, and health care reform? Certainly previous administrations have seen the same effect -- we helped the Afghan mujahideen defeat the Russians, and inherited Osama bin Laden and a core of experienced terrorists as a consequence. Congress (largely liberals, by the way) encouraged home ownership among those who really couldn't afford it and created subprime mortgages for that purpose, and as a consequence we inherited the current fiscal crisis, kicked off by growing defaults in subprime mortgages. We entered Iraq to remove a tyrant, and ended up stuck in the brier patch.
One might want to keep this in mind as Congress tinkers with major issues like carbon caps and health care reform. Whatever they do, and however pure their motives, the Law of Unintended Consequences WILL be in operation.
Is there a lesson in this for our current administration as it deals with financial problems, Iraq, Afghanistan, and health care reform? Certainly previous administrations have seen the same effect -- we helped the Afghan mujahideen defeat the Russians, and inherited Osama bin Laden and a core of experienced terrorists as a consequence. Congress (largely liberals, by the way) encouraged home ownership among those who really couldn't afford it and created subprime mortgages for that purpose, and as a consequence we inherited the current fiscal crisis, kicked off by growing defaults in subprime mortgages. We entered Iraq to remove a tyrant, and ended up stuck in the brier patch.
One might want to keep this in mind as Congress tinkers with major issues like carbon caps and health care reform. Whatever they do, and however pure their motives, the Law of Unintended Consequences WILL be in operation.
Sunday, September 20, 2009
Recommended: The Truth About Bureaucracy
I recommend Matt Bai's piece today in The New York Times entitled The Truth About Bureaucracy. Government does some wonderful things for us, but it is not an unmixed blessing. Anyone who has had to deal with the IRS or argue with some distant and anonymous Medicare bureaucrat about coverage has had a taste of the problems with government agencies that have little or no accountability to the public.
I agree with him - this legacy of distrust is certainly a factor in the public concern about the administration's health care overhaul.
I agree with him - this legacy of distrust is certainly a factor in the public concern about the administration's health care overhaul.
Saturday, September 19, 2009
A really dumb move…
President Obama promised at the last G20 meeting to “refrain from raising new barriers to investment or to trade in goods and services”. Then a week ago he slapped a 35% tariff on imported low-end tires from China. Why? The American tire makers didn’t complain about Chinese tire imports, and they don’t support the new tariffs. American tire makers don’t even make low-end tires – if they offer them at all it is through joint ventures with (wait for it) Chinese manufacturers.
So who lodged the complaint that set this off? The United Steelworkers, who don’t even represent most of the workers in American tire manufacturing. Apparently, despite campaign promises and public pledges to other nations not to raise trade barriers during this worldwide fiscal crisis, and despite wonderful campaign promises not to let special interests rule government policy, when the United Steelworkers speak, the president kowtows.
President Obama argued that he was just doing what the law required, but in fact that was a weak excuse, since the previous administration opted not to act on a number of such complaints (and Obama chastised the Bush administration for that during his campaign). The administration is not required to act on every complaint, and would be wise to be a lot more selective on the ones it does pursue.
This will be a big mess. China has filed a complaint with the World Trade Organization (WTO), and they will almost certainly rule against America on this issue. More than that, we need the Chinese on our side because they own a very large amount of our public debt, and if they stop rolling over our Federal bonds when they come due we would be in a world of hurt.
And all for what? To appease the United Steelworker’s Union. This is a no-win situation, and the administration was really, really dumb to get sucked into it.
So who lodged the complaint that set this off? The United Steelworkers, who don’t even represent most of the workers in American tire manufacturing. Apparently, despite campaign promises and public pledges to other nations not to raise trade barriers during this worldwide fiscal crisis, and despite wonderful campaign promises not to let special interests rule government policy, when the United Steelworkers speak, the president kowtows.
President Obama argued that he was just doing what the law required, but in fact that was a weak excuse, since the previous administration opted not to act on a number of such complaints (and Obama chastised the Bush administration for that during his campaign). The administration is not required to act on every complaint, and would be wise to be a lot more selective on the ones it does pursue.
This will be a big mess. China has filed a complaint with the World Trade Organization (WTO), and they will almost certainly rule against America on this issue. More than that, we need the Chinese on our side because they own a very large amount of our public debt, and if they stop rolling over our Federal bonds when they come due we would be in a world of hurt.
And all for what? To appease the United Steelworker’s Union. This is a no-win situation, and the administration was really, really dumb to get sucked into it.
Thursday, September 17, 2009
Health care gaps
So here are some of the gaping holes or senseless proposals in the current health care bill:
1) Under pressure from Republicans, the bill has language to exclude illegal immigrants from coverage. It sounds nice, but it is meaningless. Studies estimate that some 60% of illegal immigrants have forged social security cards (easy to buy on the black market), or legal social security numbers obtained with false birth certificates (easy to buy on the black market), so how are health providers to sort the illegal from the legal applicants? Anyway, a filter doesn’t help the cost problem at all, because uninsured illegal immigrants typically go to emergency rooms for help, where they are treated for free if they can’t pay – meaning the rest of us end up paying for their care anyway.
2) The bill expands coverage by covering more lower-income people with Medicaid. But Medicaid costs are shared with the states, and in this recession many of the states are already facing bankruptcy, and don’t have more funds to put into Medicaid – in fact many can’t pay their current Medicaid shares. So all we have is yet another “unfunded mandate” from Congress that tries to solve a federal budget problem by simply moving it to the states.
3) The bill encourages the formation of insurance “cooperatives” – a sop to the Democrats who want a government-run insurance option. There is no evidence that insurance cooperatives will be successful, or that they will draw many customers. A few successful ones exist, but it is not a model that has been so successful that it has spread throughout the nation, and there is probably a reason why that its so.
Of course, if they put the government-run insurance option back into the bill, we simply have another problem – yet another new government agency with more bureaucracy and more cost. There is nothing in history to suggest that the government is any good at running such things.
4) The bill does nothing effective about capping the outrageous malpractice scams. It allocates a little seed money to states who want to “try” new approaches, but that will do almost nothing to solve the problem. Well, Congress is full of lawyers, and lawyers are some of the biggest donors to the Democratic Party, so why would Congress interfere with their well-paying work?
5) The bill includes nothing that would significantly cap or even slow the rising cost of health care. It doesn’t tinker with the incentive structure at all. Medicare and Medicaid are still the doctor’s and hospital’s “customers”, not patients. There is still little or no incentive for patients to control, or even ask for, the costs of the services they are being provided.
1) Under pressure from Republicans, the bill has language to exclude illegal immigrants from coverage. It sounds nice, but it is meaningless. Studies estimate that some 60% of illegal immigrants have forged social security cards (easy to buy on the black market), or legal social security numbers obtained with false birth certificates (easy to buy on the black market), so how are health providers to sort the illegal from the legal applicants? Anyway, a filter doesn’t help the cost problem at all, because uninsured illegal immigrants typically go to emergency rooms for help, where they are treated for free if they can’t pay – meaning the rest of us end up paying for their care anyway.
2) The bill expands coverage by covering more lower-income people with Medicaid. But Medicaid costs are shared with the states, and in this recession many of the states are already facing bankruptcy, and don’t have more funds to put into Medicaid – in fact many can’t pay their current Medicaid shares. So all we have is yet another “unfunded mandate” from Congress that tries to solve a federal budget problem by simply moving it to the states.
3) The bill encourages the formation of insurance “cooperatives” – a sop to the Democrats who want a government-run insurance option. There is no evidence that insurance cooperatives will be successful, or that they will draw many customers. A few successful ones exist, but it is not a model that has been so successful that it has spread throughout the nation, and there is probably a reason why that its so.
Of course, if they put the government-run insurance option back into the bill, we simply have another problem – yet another new government agency with more bureaucracy and more cost. There is nothing in history to suggest that the government is any good at running such things.
4) The bill does nothing effective about capping the outrageous malpractice scams. It allocates a little seed money to states who want to “try” new approaches, but that will do almost nothing to solve the problem. Well, Congress is full of lawyers, and lawyers are some of the biggest donors to the Democratic Party, so why would Congress interfere with their well-paying work?
5) The bill includes nothing that would significantly cap or even slow the rising cost of health care. It doesn’t tinker with the incentive structure at all. Medicare and Medicaid are still the doctor’s and hospital’s “customers”, not patients. There is still little or no incentive for patients to control, or even ask for, the costs of the services they are being provided.
Wednesday, September 16, 2009
The liberal's problem - the conservative tide
Liberal Democrats, led by the likes of House Speaker Nancy Pelosi, have been having a field day in Congress now that they hold a majority on both houses and have a liberal president. And of course the Republicans have been happily self-destructing under the leadership of their talk-show demagogues. But I predict that the liberal party will be short-lived, despite the Republican incompetence. A recent Gallup poll looked at how many people in this nation label themselves "conservative". Here is the map:
The whole story of the poll can be found here. Conservatives and moderates are overwhelmingly the largest groups in the country, and the fiscal excesses of this liberal Congress are beginning to worry them a lot.
Perhaps the Republican strategy of just saying "no" and refusing to play will work after all. If Republicans just sit on their hands, the liberal wing of the Democratic party, free to spend as much as it likes, may self-destruct all on its own.
The whole story of the poll can be found here. Conservatives and moderates are overwhelmingly the largest groups in the country, and the fiscal excesses of this liberal Congress are beginning to worry them a lot.
Perhaps the Republican strategy of just saying "no" and refusing to play will work after all. If Republicans just sit on their hands, the liberal wing of the Democratic party, free to spend as much as it likes, may self-destruct all on its own.
Hypocrisy is alive and well in Congress
Rep. Joe Wilson was chastised by the Democratic majority in a House "resolution of disapproval" for his short outburst during President Obama's health care speech. Wilson's outburst was certainly rude, but I find it interesting that all those Democrats who were so offended by it didn't find the boos that accompanied some of President Bush's speeches to Congress at all offensive -- indeed the boos came from Democrats. Apparently outbursts you agree with aren't rude, but those you disagree with are. Hypocrisy is alive and well in Congress.
PS. I have acquaintances who claim Democrats never booed President Bush. For those with conveniently short memories, President Bush was booed loudly and repeatedly by a number of people from the Democratic side of the House during his February 2, 2005 State of the Union speech.
PS. I have acquaintances who claim Democrats never booed President Bush. For those with conveniently short memories, President Bush was booed loudly and repeatedly by a number of people from the Democratic side of the House during his February 2, 2005 State of the Union speech.
The Senate Health care proposal
The Senate Finance Committee health care bill is now out. (The text can be found here). This is the bill which will probably be the framework around which the House and Senate try to build a bill they can both pass. The language of the bill has certainly moved to the center relative to the very left-wing bills the three House committees reported out. And it does include a number of concessions to Republican and moderate Democrat concerns.
But it still has two very, very big problems:
1) It contains no provisions that seem likely to really reduce health care costs. The promise that "more efficiencies" will reduce costs is no more likely to be real here than the perennial campaign claim that "reducing government waste" will reduce government costs. There is no persuasive evidence in government that such measures have ever reduced costs.
2) It will add a huge additional debt to a government budget already tottering under a skyrocketing debt. The Congressional Budget Office cost estimate for this bill is about $850 BILLION over the next ten years, and much more after that. History suggests that the real cost of a new government program will be in the range of 2-3 times the initial Congressional estimate, so the real cost is almost certainly somewhere in the TRILLIONS.
President Obama's promise that this bill will not add a dime to the national debt is good political rhetoric, but it is a promise that will be almost impossible to keep. Logically there is simply no way to simultaneously extend coverage to millions more people, provide everyone else with at least their current level of health care at their current cost, and not spend any more government money. It might just be possible to achieve any two of the three, but it's simply not possible to achieve all three simultaneously.
But it still has two very, very big problems:
1) It contains no provisions that seem likely to really reduce health care costs. The promise that "more efficiencies" will reduce costs is no more likely to be real here than the perennial campaign claim that "reducing government waste" will reduce government costs. There is no persuasive evidence in government that such measures have ever reduced costs.
2) It will add a huge additional debt to a government budget already tottering under a skyrocketing debt. The Congressional Budget Office cost estimate for this bill is about $850 BILLION over the next ten years, and much more after that. History suggests that the real cost of a new government program will be in the range of 2-3 times the initial Congressional estimate, so the real cost is almost certainly somewhere in the TRILLIONS.
President Obama's promise that this bill will not add a dime to the national debt is good political rhetoric, but it is a promise that will be almost impossible to keep. Logically there is simply no way to simultaneously extend coverage to millions more people, provide everyone else with at least their current level of health care at their current cost, and not spend any more government money. It might just be possible to achieve any two of the three, but it's simply not possible to achieve all three simultaneously.
Tuesday, September 15, 2009
Recommended: Misreading the Iranian Situation
I recommend another thoughtful STRATFOR article, Misreading the Iranian Situation. This is not a comforting piece, but it does paint an interesting picture of the international chess match over Iran.
Monday, September 14, 2009
Recommended: Fact-Checking the President on Health Insurance
There is no question that President Obama's health care speech was a masterful piece of political showmanship. But despite the brilliant oratory, apparently some of his facts just don't stand up to scrutiny. I recommend Scott Harrington's piece Fact-Checking the President on Health Insurance in the Sept 14 issue of The Wall Street Journal. The two cases of insurance company abuse he mentioned were certainly heart-wrenching. Too bad that apparently they weren't accurate.
Friday, September 11, 2009
Recommended: Kill the Rhinos!
I just found a wonderful David Brooks piece on health care reform. It was published as an Op Ed in the New York Times on July 24th, entitled Kill the Rhinos! It seems to me he is right on target - our health care system is a bunch of stampeding rhinos, and Congress is attacking it with popguns!
Tuesday, September 8, 2009
Silly Season?
One of the hallmarks of an authoritarian society is the suppression of all opposing views. We all see it clearly enough in other nations, from the Middle East to some of the former Communist nations to some of the South America nations. The militant suppression of those we don’t agree with is the beginning of dysfunctional authoritarian rule.
So now here in America we have a duly-elected president, graduate of Columbia University and Harvard Law School, onetime editor of the Harvard Law Review, for 12 years a professor of Constitutional Law at the University of Chicago, who wants to give a simple address to the nation’s school children about staying in school and taking responsibility for their lives, and people all across the nation are deluging teachers and school officials with rabid objections and demands that their children be removed from the classroom during the speech.
Why? There certainly haven’t been any such objections when previous presidents addressed the nation’s school children (Roosevelt, Reagan, and the senior Bush all gave such addresses). Is it because they object to the message of personal responsibility and staying in school? Is it because President Obama is a liberal, and conservative parents live in dread that their children might be “infected” by hearing a liberal speak for a few minutes, even if it isn’t on politics? Is it because he is black and we are all still closet racists? Or is it because a significant fraction of the nation is in thrall to the conservative talk-show demagogues?
Whatever the reason, it is worrying that in a nation supposedly founded on the right of free expression, this sort of silliness can take hold.
So now here in America we have a duly-elected president, graduate of Columbia University and Harvard Law School, onetime editor of the Harvard Law Review, for 12 years a professor of Constitutional Law at the University of Chicago, who wants to give a simple address to the nation’s school children about staying in school and taking responsibility for their lives, and people all across the nation are deluging teachers and school officials with rabid objections and demands that their children be removed from the classroom during the speech.
Why? There certainly haven’t been any such objections when previous presidents addressed the nation’s school children (Roosevelt, Reagan, and the senior Bush all gave such addresses). Is it because they object to the message of personal responsibility and staying in school? Is it because President Obama is a liberal, and conservative parents live in dread that their children might be “infected” by hearing a liberal speak for a few minutes, even if it isn’t on politics? Is it because he is black and we are all still closet racists? Or is it because a significant fraction of the nation is in thrall to the conservative talk-show demagogues?
Whatever the reason, it is worrying that in a nation supposedly founded on the right of free expression, this sort of silliness can take hold.
Sunday, September 6, 2009
Health Insurance vs Health Coverage
There seems to be a lot of confusion in Congress and among the public between health care insurance and health care coverage. Politicians often seem to consider these two terms interchangeable, but they are not.
Think about it. We don’t expect our auto insurance to pay for gasoline or tires or routine maintenance. We expect it to pay for rare and expensive events like accidents. We don’t expect our home insurance to pay for window cleaning or painting the siding. We expect it to pay for rare and expensive events like fire or a tree falling on the roof.
So why do we expect health insurance to pay for routine medical services, like annual physicals or an office visit for a minor cold? Medical insurance should cover rare and expensive events like hospitalizations, non-elective surgery, accidents, and major or chronic illnesses. We should expect to pay for routine medical services out of our own pocket. If we did (a) insurance costs would be a lot lower, and (b) since we were paying for it ourselves, we would ask a lot more questions about whether treatments were really needed and whether the most expensive treatment or drug was really what we needed.
Of course employers could offer full medical coverage as part of an employee’s wages, and there is something to be said for encouraging people to participate in screenings and to get annual physicals, so perhaps there is economic justification in covering those as well. But in general, universal insurance coverage ought to seek to protect everyone from catastrophic medical bills, NOT ordinary everyday medical expenses. If Congress took that approach, it might cost a lot less than the $1 trillion+ that the current proposals appear to cost.
The overall objective ought not to be to pay every medical bill for everyone – it ought to be to protect everyone from catastrophic medical costs.
Think about it. We don’t expect our auto insurance to pay for gasoline or tires or routine maintenance. We expect it to pay for rare and expensive events like accidents. We don’t expect our home insurance to pay for window cleaning or painting the siding. We expect it to pay for rare and expensive events like fire or a tree falling on the roof.
So why do we expect health insurance to pay for routine medical services, like annual physicals or an office visit for a minor cold? Medical insurance should cover rare and expensive events like hospitalizations, non-elective surgery, accidents, and major or chronic illnesses. We should expect to pay for routine medical services out of our own pocket. If we did (a) insurance costs would be a lot lower, and (b) since we were paying for it ourselves, we would ask a lot more questions about whether treatments were really needed and whether the most expensive treatment or drug was really what we needed.
Of course employers could offer full medical coverage as part of an employee’s wages, and there is something to be said for encouraging people to participate in screenings and to get annual physicals, so perhaps there is economic justification in covering those as well. But in general, universal insurance coverage ought to seek to protect everyone from catastrophic medical bills, NOT ordinary everyday medical expenses. If Congress took that approach, it might cost a lot less than the $1 trillion+ that the current proposals appear to cost.
The overall objective ought not to be to pay every medical bill for everyone – it ought to be to protect everyone from catastrophic medical costs.
Recommended - 10 Things I Hate About Health Care Reform
I strongly recommend Dr. Arthur M. Feldman's article 10 Things I Hate About Health-Care Reform in today's Washington Post. He really lays it on the line about what really is needed to reform health care, and how the current Congressional proposals address none of the real issues.
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