Health care debacle

By Ricardo Alonso-Zaldivar, Associated Press, May 11, 2011

WASHINGTON – President Barack Obama's main idea for getting quality health care at less cost was in jeopardy Wednesday after key medical providers called his administration's initial blueprint so complex it's unworkable.

Just over a month ago, top officials released long-awaited draft regulations for "accountable care organizations," networks of doctors and hospitals that would collaborate to keep Medicare patients healthier and share in the savings with taxpayers. Obama's health care overhaul law envisioned quickly setting up hundreds of such networks around the county to lead a bottom-up reform of America's bloated health care system.

But in an unusual rebuke, an umbrella group representing premier organizations such as the Mayo Clinic wrote the administration Wednesday saying that more than 90 percent of its members would not participate, because the rules as written are so onerous it would be nearly impossible for them to succeed.

 So why should we be surprised, when the rules were written by a bunch of Congressional lawyers, staffers, and agency bureaucrats, almost none of whom have the slightest experience in the real day-to-day health care field?

Recommended: Tiger Mom: Here's how to reshape U.S. education

Here is a great article by Amy Chua, the author of the controversial book Battle Hymn of the Tiger Mom. It is entitled Tiger Mom: Here's how to reshape U.S. education.  She points out that Asian countries are beginning to realize that their rote training isn't as effective as some things the US does, but nevertheless

The average American child spends 66% more time watching television than attending school. We have alarming rates of teenage substance abuse and the highest teenage pregnancy rate in the developed world. In the recent Program for International Student Assessment (PISA) tests, American high school students ranked 17th in reading, 23rd in science and 31st in math — with Asian nations taking top marks. This is a problem across the board. Even America's top math students rank poorly compared with top performers elsewhere.

Clearly we have been doing some things right in the past, and clearly we are doing some things wrong now.  It occurs to me that the public education system of the past was well suited to producing hard-working factory workers, but is ill suited to producing the highly innovative technical workers needed in today's world.

US Corporate Tax Rates

Continuing the thought from the last post, the Reuters site has an interesting chart comparing US Corporate tax rates to those of the rest of the developed world:

As one can see, the US Corporate tax rate is already higher then most developed countries. But of course many corporations don't pay anywhere near these tax rates, since the current tax code gives many of them all sorts of exemptions and credits -- which is another argument for reforming the tax code.

Nonetheless, major corporations these days are global in reach.  If we tax them significantly more than other nations, they will just export their factories -- and their jobs -- to nations with a lower tax burden. In the long run, if we want more jobs in this nation (certainly a key issue these days), we need to keep an attractive tax structure for corporations.

Taxes: Raise them or not?

Democrats seem to have finally come around, very reluctantly, to admitting that the federal budget needs to be cut, though they still are wildly unrealistic about how much it needs to be cut, and they still persist in the delusion that the fiscal problem can be solved without touching entitlements.

Republicans have taken a stand that taxes should not be raised, because, they argue, increasing taxes is the last thing one wants to do in an weak economy. This is a more difficult issue to understand. On the one hand, more federal revenues would certainly help the fiscal problem, though it is by no means certain that raising taxes would increase the revenue much -- it might just depress the economy more, and it will certainly encourage corporations and wealthy individuals to put more of their money in offshore investments or tax-free bonds.

On the other hand, raising taxes seems to me just an easy out for all those in Congress who can't seem to face cutting the federal budget.  In any case, one can't raise taxes enough to make much of a dent in the deficit, so tax increases (especially on the rich) are just pandering to the base, not solving the problem.

On balance, I think major (draconian) cuts in the federal budget are the essential step to solving the problem, painful as they will be.  The only real issue is how to make them so the pain is relatively even all around.  And I think rather than raising federal taxes, Congress needs to bite the bullet and FINALLY revise and simplify the tax code, so that it doesn't have thousands of special interest exemptions, and it doesn't take a lawyer to understand the 20,000+ pages of the federal tax code.

So after thinking about it, I guess I agree with the Republicans, who are indeed probably just pandering to their own base, but are nevertheless probably right to focus on spending cuts rather than tax increases.

The definition of chutzpah

I find it interesting that Osama Bin Laden's sons today are reported to be upset that he was buried at sea, and that he didn't get a trial. They complain that a man as important as he was should have been shown more dignity 

Funny, Bin Laden himself didn't seem to think it was important that any of his thousands of victims should be buried with dignity, or given a trial. It's a new level of Chutzpah.

Recommended: High Noon in Pakistan

It seems almost impossible that Osama Bin Laden could have lived for many years in an upscale neighborhood in a major Pakistani city, surrounded not only by retired military officers but within walking distance of Pakistan's premier army training center - their "West Point" equivalent - without anyone in the Pakistani government or military or ISI intelligence agency being aware of it.  The interesting question is whether this absurd situation is due to Pakistani complicity or simple incompetence.

Walter Russel Mead has an interesting assessment of this question, and of the ramifications of this whole issue, in his American Interest piece High Noon in Pakistan.  Pakistan is, of course, only a small chess piece in the whole "great game" between China and India and the US, but it is an important piece because of it's nuclear capabilities, and because it plays a key role in keeping Afghanistan and Iraq unstable and volatile, and keeping India occupied.

Satisfying as it was to finally get the 9/11 mastermind, far more important is how the administration handles, or mishandles, the subsequent relationship with Pakistan.

A fundamental social issue

Beneath the mindless political ideology, the childish Democrat vs Republican point-scoring, and the insincere promises that makes up Washington’s political theater these days there lurk some real, fundamental national and even cultural philosophical questions worth pondering.

One of these is the question of how much responsibility a culture owes to people who don’t take responsibility for themselves.  In a primitive tribal culture living with little or no surplus, the answer is clear.  The culture when possible takes care of those who can’t take care of themselves – children, orphans, the old and the sick.  Everyone else is expected to contribute to the pot, and if they don’t then they don’t eat.

Now in our culture we actually have two kinds of people; (1) those who through no fault of their own are unable to take care of their needs, and (2) those who, though their own life choices, have chosen paths that don’t give them enough to take care of their needs.  There is no question but that a culture like ours should support the first class – those who were perhaps born impaired, or through accident or illness not due to their own fault or habits have left them unable to help themselves.

But what about the second class of “poor”? Those who made conscious choices that put them into these circumstances? People who dropped out of school and now don’t have employable skills? People who are just lazy?  People who blew their minds or crippled their bodies with alcohol or drugs?  People who chose to overeat all their lives, or chose to be couch potatoes and now have expensive health problems?   People who chose to spend every penny they made, rather than save some of it for their old age? Do we who didn’t make such bad choices have an obligation to support those who did?

Years ago I was involved in an organization which gave self-help workshops.  Among those who came to the workshops were “hippy” types who lived in a commune. These people were forever arguing that there ought to be a sliding scale of fees for the workshops, and that those who lived in the commune and chose not to make much money ought to get a fee reduction (recovered, of course, by charging those of us with real 9 to 5 jobs more). This never seemed right to me.  These people were arguing for a free ride simply because they chose not to do the hard work of keeping a regular paying job.

Now the fundamental problem is this: if we don’t offer assistance to people who made bad choices they are going to suffer the natural consequences of their bad choices – consequences that are sometimes hard for us to watch (think homeless people and starving in the streets).  But if we do save them from the natural consequences of their own bad decisions we create a moral hazard – why should people be more prudent if the society will always save them from their bad decisions?

This is the fundamental dilemma that we ought to be thinking about as we create social policy in our nation.  Personally, I think the ultimate touchstone for such decisions is the long-term survival of the culture, civilization, or nation.  If our social policy doesn’t help us survive, than it is dysfunctional.  In that light, social policy which doesn’t encourage hard work and prudent decision-making, with real and painful consequences for poor life choices, is probably not in the long-term interests of our nation.

Edward Gibbon argued in his monumental Decline and Fall of the Roman Empire that it was the loss of such civic virtue among the Romans that led to the eventual dissolution of their mighty empire.  I think that argument might apply just as well to our current American empire, which was founded by hard-working people who looked out for themselves, but has evolved in recent decades toward what seems to me a much more permissive – not to say unrealistic -- approach toward bad life choices.