A second chance to get health care reform right

I was intrigued to read an op-ed in this morning's Oregonian which is very similar in basic outlook to my most recent discussion of medical reform.

The author, Ron Mock, is an associate professor of political science and peace studies at George Fox University here in Oregon. With kind permission from Prof. Mock, I am posting his piece here. As he notes, "We do make similar points about the process, with enough differences that we won't be redundant to one another. "

A second chance to get health care reform right

By Guest Columnist
January 25, 2010, 9:00AM

By Ron Mock

I voted for Barack Obama in 2008 and celebrated his win. I rooted for Scott Brown this year in Massachusetts and am celebrating his win, too, because Brown's victory gives Obama a second chance to be what he promised to be.

Barack Obama won my vote because he was idealistic and pragmatic and trans-partisan. I believed him when he said he was committed to addressing the big issues where we had allowed things to drift into dangerous territory because of the flaws in our old politics: overdependence on special interests and growing polarization.

I believed Obama when he said he would appeal to our most fundamental human values and our most important overarching goals. He would help us see where we all -- Republicans and Democrats, blacks and whites and others -- shared ideals and dreams. Then he would help us develop the creative new ideas that would allow us to work together to face the big issues, not sidestep them.

Obama as a candidate in 2008 said health care costs were growing at a rate that would bankrupt our country. People without insurance were being left out of the system. All attempts to reduce government deficits were doomed to fail if health care costs continued to mushroom. He told us we needed to change the dynamics so health care would be accessible to all while consuming less of our national wealth, rather than constantly consuming more.

I agreed with all this. To get health care cost containment and expanded health care coverage, we needed a president who recognized the urgency of the issue, would go all out to address it, and would be able to create a trans-partisan creative environment in which the best ideas of each political faction could become resources for a new solution.

So far, Obama has not lived up to my hopes or our needs when it comes to health care policy. He didn't come equipped with a rock-solid vision for a new system that would work. He didn't look very far for ideas. He left the initiative to congressional leaders with truncated partisan perspectives. He endorsed a flawed approach. And worst of all, instead of presiding over trans-partisan creativity, he sat by while tawdry backroom politics were used to sell off favors in exchange for votes.

The current Democratic plan is hardly the product of a reality-based process. Health care costs are skyrocketing because so many of us use insurance paid for by someone else to fund most of our health care. We practically ignore the true costs of our health care, even if we pay modest co-pays and deductibles, because the most important costs are covered for us. As a result, neither those who consume health care, nor those who produce it, have any natural incentive to curb costs.

We are playing with a law of nature here. If people making choices about consuming health care are insulated from the costs of their choices, they will consume more health care. The more they are insulated, the more they will consume. Insulate them entirely -- make health care free -- and there will be no effective limit to how much they will consume, unless that limit is provided by some outside force.

The Democrats' insurance reform proposal will make insurance available to more people, but in every other way it will reinforce the dynamics that are inflating costs -- unless government officials start limiting our access to the system. Costs will go up faster or access will be limited by agencies beholden to the political system (with all the attendant opportunities for incompetence, indolence, corruption and abuse), or both. Most likely both.

I oppose the Democratic health care plan because I'm certain it will make problems worse, not better. But I also think good health care reform is possible. I have seen ideas with elements that, when combined, could do much better than the current plan. Oregon Sen. Ron Wyden proposed some of them last year. Martin Feldstein proposed another approach last fall in which every American would get vouchers with which to purchase health care insurance, with a deductible scaled to income calibrated to make consumers pay attention to costs but still be manageable under most families' budgets.

These aren't perfect ideas. But now that Scott Brown has been elected to the Senate, Obama will need to recalibrate his approach. If he can learn from the botched first attempt, open lines to all points on the political spectrum, and start mining them for ideas and cultivating them for allies, he has all the intellectual and personal tools to pull off real health care reform this summer, or maybe in 2011 -- and in the process establish his credibility to tackle the even bigger issues (our stagnant economy, global warming, terrorism) that lurk just beyond health care.

Ron Mock is an associate professor of political science and peace studies at George Fox University in Newberg.

The problem with public employee collective bargaining

I have just sent the following letter to the Cascade Policy Institute in Portland, Oregon. I think it raises questions which may be of general interest, and refers to a Wall Street Journal article and new book that may also be interesting to many readers.
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To: Cascade Policy Institute (selected people)

This morning's Wall Street Journal featured an article by the author of a new book: , Steven Greenhut. The article is "Public Employee Unions are Sinking California." The book is Plunder: How public employee unions are raiding treasuries, controlling our lives and bankrupting the nation. Read the article at [here].

I have long been pretty sure that Oregon schools were fully operational and fully staffed during the (I hope "the"!) Depression, unlike the recent times when days and staffing were cut during hard times. It seems to me (see op-ed article, below) that an important difference between then and now is that we now have public employee unions, making it difficult and sometimes impossible to save the needed money by cutting compensation while retaining all employees.

But I wonder: Has anybody done research on the extent to which teacher and other state employee compensation was reduced during the Depression? I know from my own family history that my father was earning $100 a month on a 9 month basis teaching high school over in Adrian, Oregon when I was born, which would equate to $13,804 a year according to the price level calculator at the Federal Reserve Bank. And he was considered fortunate to have a job.

Are there still records showing public employee compensation for particular people, including teachers, back that far? It seems to me that this might be a worthwhile research project for your staff or one of your associates.

Cordially,

Paul deLespinasse, Ph.D.
Corvallis, Oregon

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Copyright © 2004 by Paul deLespinasse. November 2004. This ran in the Corvallis Gazette-Times.

TIME TO END PUBLIC SECTOR COLLECTIVE BARGAINING?

The increasing rancor [ “Contract dispute turns ugly”, GT, November 10] in negotiations between local teachers and the Board of Education is very unfortunate.

Why has school finance become a can of worms? Even during the hard days of the Depression, Oregon schools were fully staffed and ran full-length years. What has changed?

Democratic government is inherently experimental. Some policies may sound attractive but turn out to have unanticipated problems. It is now clear that Oregonians made a terrible mistake several decades ago when we decided to allow teachers and other government employees to engage in collective bargaining.

The argument for collective bargaining with private employers is that it strengthens the hands of workers who otherwise might be exploited by high-handed and greedy corporations. This argument does not apply to government workers because the greater danger is that they will be overpaid, not that they will be underpaid.

Teachers and other government employees are substantial parts of the electorate in every political subdivision in the United States. Elections are often very close. No official wants to alienate a voting bloc that could determine whether he or she will be re-elected. Nor are the officials who would decide, in the absence of collective bargaining, what teacher and civil servant salaries would be, paying these people out of their own pocket. It is easier to be “liberal” with other people’s money.

If government were to set salaries too low it would be unable to attract sufficient numbers of qualified people to work for it, and would be forced to pay more. There is no similar mechanism that can force a correction when salaries are too high.

In the private sector union demands are moderated by competition, which can destroy a corporation paying its workers too much. We thus see pilots’ unions agreeing to major salary cuts from United Airlines, Delta, etc., because if their employer disappears, so do their jobs. Private sector union demands are also sometimes moderated by the danger that work will be outsourced to other countries.

The work performed by government employees is harder to outsource and not generally subject to competition. It is easy to understand why public employee unions are outraged by privatization and absolutely panicked by the concept of vouchers allowing parents to send their children to private schools (competitors!) with money provided by taxpayers. It is not so clear that it is in the interest of the general public to accommodate the unions in this matter.

Public officials have a duty to drive the best possible bargain on taxpayers’ behalf when setting the salaries and fringe benefits of teachers and other people doing the public’s work. They need flexibility to make changes when economic conditions change. Collective bargaining prevents our representatives from doing either of these things, and we should therefore give serious consideration to eliminating collective bargaining for government employees.

Of course it won’t be easy. But most worthwhile reforms aren’t easy. Oregon has often lead the United States in recognizing the need for reform, and perhaps the time has again come for us to march at the front of the line.
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Paul F. deLespinasse is professor emeritus of political science at Adrian College in Michigan. He can be reached at pdeles@proaxis.com.

Needed more than ever: a bipartisan commission on health care reform

President Obama's famous luck continues to run. He has been saved from having to sign the medical "reform" atrocity that was being ground out by congressional sausage-makers by last night's election of Republican Scott Brown to "Ted Kennedy's seat" in the U.S. Senate.

I was a nearly lifelong Republican who was converted to becoming a Democrat by George W. Bush's foreign policy, particularly the totally unnecessary Iraq war, and by the incompetent management of that war until implementation of the "surge" during Bush's second term. I voted for Obama in 2008 and do not regret doing so in the slightest, though he has not lived up to my admittedly optimistic expectations.

I believe that the key to successful health care reform lies, not with the Democratic Party, not with the current Republican leaders, but rather with those members of the electorate who consider themselves conservatives and/or Republicans. It seems to me that from the point of view of these people, much of which I share, a carefully-designed single payer insurance system would be a much better approach than the outrageously complicated, constitutionally-dubious scheme of mandating that individuals buy insurance.

It will not be possible to scale down the recent bills to just "reform insurance". To prohibit insurance companies from discriminating based on preexisting conditions without also mandating that everybody buy insurance or be covered by employer-purchased insurance would be to make the insurance business an impossible one. If we could wait to buy fire insurance until our house catches fire, fire insurance would have to cost as much as the repairs or replacement of the house-----in other words, it wouldn't be insurance.

If we are going to require everyone be insured, why not just insure everybody and pay for it with a broadly based tax (not just soak the rich!---there aren't enough of them).

President Obama should announce in his State of the Union message next week that he would like to create a bipartisan commission to study the health systems of all foreign countries that have them, analyze their strong points and weak points, and design a system for the U.S. that incorporates as many of the strong points and as few of the weak points as possible. This proposal would then go to Congress for an up or down vote.

I believe that a properly-designed public relations campaign could sell such a system to the American people in spite of efforts by self-interested groups like insurance companies, drug companies, and others to confuse the issue.

If public opinion, especially among conservatives and Republicans, came to favor a single-payer system, the congressional Republicans would come around and support that system . . . . or be thrown out on their ears. By analogy, remember how George Wallace, who won elections proclaiming "segregation forever," changed his tune completely when large number of black people started voting after enactment of the Voting Rights Act of 1965. I can foresee a similar miracle among Republican politicians when public opinion broadly comes to support single-payer.

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This article has run in the Adrian (Michigan) Daily Telegram.

I wish I had read more biographies, when . . .

This morning I finished reading an excellent new biography of Supreme Court Justice Louis Brandeis. Like other well-done biographies, the book gave me a lot of new insight into what was going on during lifetime of the subject.

Since I retired ten years ago I have turned to reading biographies in a big way, largely because of my dissatisfaction with the alternatives: fiction, and non-biographical non-fiction.

At our local library, I have had trouble finding novels that were not utterly predictable and boring and appparently written to formula. And much of the nonfiction I have tried is either loaded with details in which I am not interested or full of high level abstractions that sound good but which don't get me very far in my efforts to think things out.

Biographies, which are full of details, can make them interesting because they are the details of an individual human life, an intrinsically interesting thing. And of course life is much stranger, and therefore more interesting, than fiction.

In the last couple of years I have read biographies of Justice Scalia, Franklin D. Roosevelt, Eisenhower, Andrew Johnson, Andrew Jackson, James K. Polk, Prokofiev, Stalin, Yeltsin, Tony Blair, Booker T. Washington, and many others who do not presently come to mind. They all kept my interest and drew my attention to questions and issues that I had never thought about or noticed.

For example, the book about the impeachment of Andrew Johnson pointed out that the clause in the original Constitution in which slaves only counted for 3/5 of a person in calculating each state's representation in the House of Representatives was put in at the insistence of delegates to the Constitutional Convention from the north----the southern delegates wanted them to count the same as anyone else, which would have increased the south's clout in the House. (Of course, they had no intention of letting the slaves vote!)

And I had not realized that Franklin D. Roosevelt was fluent in French and German, had studied in Europe, and as a youth had gone on a bicyling tour of Europe with his tutor.

I now wish that I had read more biographies while I was still teaching, as I would have picked up countless anecdotes that would have interested my students and illustrated points I was making for them, as well as a much better understanding of the periods whose politics we were studying.

The unconstitutionality of the filibuster

Thomas Geoghegan, who is a lawyer, wrote a very interesting piece for the New York Times arguing that the filibuster is unconstitutional. Read it here and see if you agree with me that he makes a strong case.

There is a procedural problem in doing something about it, because the courts are reluctant to intervene in the internal operations of a co-equal branch of government. However such interventions have occasionally taken place, so we can't rule it out.

As a recent article picked up by CommonDreams suggests, some of the more outlandish parts of the health legislation sausage currently being ground out by Congress resulted from the need to buy up enough votes in the Senate to avoid a filibuster preventing enactment.

As the CommonDreams article notes, if the Republican wins Tuesday's election in Massachusetts, as now seems at least possible, the GOP will have enough votes to prevent the Senate from even voting on a final compromise with the House now being negotiated. In that event, says the author, Democrats might resort to the "nuclear option," passing the legislation in the form of a budget reconciliation measure which under Senate rules only requires 51 votes, one of which could be supplied by Vice President Biden. And, he says, this might allow most of the sweetheart deals (like the one involving Nebraska) to be deleted.

This is getting interesting. Stay tuned!

Constitutional challenge to special break for Nebraska in Senate health bill

I just watched a very impressive performance by Henry McMaster, South Carolina's attorney general, on C-SPAN. ( Seeing it was just one of several little dividends I have gotten from my temporary inability to ride my indoor bicycle while recuperating from yesterday's extraction of a wisdom tooth. Normally at this time of day I would be reading something while getting some miles. )

McMaster was speaking for 15 state (and territory) attorneys general who are complaining about the special treatment the Senate version of health care reform accords to Nebraska. The special provision was added to the bill in order to get Nebraska senator Nelson to provide the needed 60th vote to break the Republican filibuster preventing the bill from getting to a vote.

The bill now provides that all extra costs in Nebraska resulting from the bill's expansion of Medicaid will be paid by the federal government. Under the usual Medicaid rules program costs are shared by the federal government and the state governments, so expanding that program imposes unfunded mandates on the states for their percentage of the increased costs.

As McMaster pointed out, most state governments currently are under extreme financial pressure, and the last thing they need is additional unfunded mandates-----orders from Washington to spend more state money.

Under the circumstances, McMaster argues the lack of uniformity in treatment of the states makes the Senate bill constitutionally suspect. If his and others' efforts to get this changed do not succeed they will probably bring a lawsuit challenging the constitutionality if the bill becomes law.

McMaster telephoned Senator Nelson and reported that Nelson said he would have preferred that all states receive the same break Nebraska did. But of course if this were the case it would greatly increase the costs of the bill to the federal government and would push those costs past the limit announced by Congressional Democrats and by President Obama. Just helping Nebraska keeps the increased federal costs within those limits.

According to some sources, state authorities who are unhappy with the new unfunded mandate are being quietly told to keep quiet about it until the bill is passed into law, with the promise that they will then be taken care of like Nebraska. This would mean the additional federal costs would be tacked on to the bill only after it is too late to reject it because it surpasses the cost limits to which the President and his congressional allies have committed themselves.

Of course this is all very unseemly, and one can hope that a general awareness of these tactics will prevent the bill from enactment or that the courts will shoot it out of the water if it is enacted into law.

Talking about race is not, per se, racist

In this morning's papers we find an excellent analysis by Leonard Pitts, Miami Herald columnist. Read it here.

Pitts discusses the uproar over the private comment during the 2008 election season by Senate majority leader Harry Reid. an Obama supporter, that "the country was finally ready to elect a black man, especially one who, like Obama, is 'light skinned' and has 'no Negro dialect, unless he wanted to have one.'"

This statement represented, not any racist outlook by Reid, but his recognition that some Americans still are gripped by racial stereotypes and that this fact is reflected in voting. As Pitts notes, what Reid said is quite true. And the attempt by Republican chairman Michael Steele to equate this remark with the public comment that doomed Repubican senator Trent Lott is ridiculous. As Pitts notes, the trouble with Lott's comment was that it suggested "America would have been better off had an arch-segregationist (Strom Thurmond) been elected president in 1948."

Says Pitts, "To believe Reid did something wrong . . . is to buy the silly contention that talking abour race is, by itself, racist. .... No, Reid's sin was to be blunt, indecorous, impolitic. And right."

I had been thinking about writing an op-ed about this situation. Leonard Pitts has written exactly what I would have said, so he has saved me the trouble.

The inevitability of gradualism?

Today's Wall Street Journal has a fascinating article describing the experience of food companies that have been trying to reduce the sodium in processed foods such as soups. Unfortunately I cannot post a link, because the article is only available to WSJ on-line subscribers. Readers who have such a subscription probably already get the printed WSJ anyhow.

The main point is that soup makers, for example, have discovered that when they label their cans "low sodium" it turns off customers. Realizing that Americans are eating far too much salt, they therefore have turned to reducing the sodium in their regular soups so gradually that people don't notice the change, and not calling people's attention to this fact.

This reminds me of the approach of the Fabian Society in England, which was named after the Roman general Quintus Fabius Maximus. The successful general believed in delaying tactics and in "the inevitability of gradualism." Although the Fabians were socialists, they wouldn't have anything to do with the revolutionary Communists, but instead opted to approach socialism through a series of gradual reforms enacted democratically. They were the intellectual nucleus of the British Labor Party in the late 1800s, which later replaced the Liberal Party as the chief alternative to the Conservative Party.

As the soup makers indicate, sometimes going slow will get you there faster than trying to go faster than possible. People seeking to reform the American medical system might do well to think about this idea.

Free books!

Let me call attention here to my four books available on-line for free reading, linking, and even reprinting (for free or at-cost distribution):

Thinking About Politics: American Government in Associational Perspective(D. Van Nostrand, 1981).

This is a college textbook introducing students to American government with the aid of a novel set of concepts that tries to improve their ability to think systematically and in a principled way about politics. It was published in 1981 and is now long out of print. I don't think it is "dated" except that a few changes in American government have taken place since 1981. I modestly thought it was ahead of its time in 1981, and it probably still is.

Basic Political Concepts(1990).

This short 40 page work summarizes the novel set of concepts introduced in Thinking About Politics, and reflects an additional ten years of refining my ability to explain these concepts. It is strictly a "virtual" book.

This work was selected by the Global Text Project to be one of the works they converted to their format and made available on-line for free use by students in the developing regions of the world. Text book costs, as the Global Text people note, are even more of a problem for students in countries with very low per capita incomes than they are for students in countries like the United States.

The Metaconstitutional Manifesto: A Bourgeois Vision of the Classless Society(1998)

This book rests on and grows out of the concepts introduced in the previous two books,. However it does not assume that readers will be familiar with them. It develops a vision of the best possible socio-political-economic world, one characterized by market economcs (but not laissez faire!), democracy, the rule of law, and universal government. It agrees with Marx that the best possible society would be classless but disagrees sharply about what that society will be like and how to get there. This too is strictly a virtual book, as no editor to whom I offered this manuscript was willing even to take a look at it back in the early 1990s.

I put this book up on the World Wide Web in 1998, which was the 150th anniversary of publication of Marx and Englels' Communist Manifesto.

Wrong Turn: A Sympathetic Critique of the Civil Rights Movement (1999).

This manuscript, too, no editor would even look at, perhaps making the false assumption that my use of the word "critique" in the title meant that I was a racist. The fact that the book praises the civil rights movement about 90% of the time did not register, since none of the editors would look at the manuscript despite the fact that the title included the word "sympathetic."

This book is more than about the civil rights movement, as it casts some perspective on American history and politics and illuminates some aspects of government that are often not noticed or understood.