Month: June 2011

What’s The Best Way To Cut Medicare?

Room For Debate wrestles with the question. Carol Levine recommends redefining what is medically necessary:

Emergency surgery after a hip fracture is clearly medically necessary. The insertion of a feeding tube in a severely demented person with advanced cancer is medically unnecessary and fails to meet ethical standards of beneficence — doing good or at least doing no harm.

Robin Hanson wants to copy the British:

The United Kingdom, where, on average, people live longer than in the U.S., spends only about 9 percent of gross domestic product on medicine, compared with our 18 percent. … My solution: admit we are cost-control wimps, and outsource our treatment evaluation to the U.K. Pass a simple law saying Medicare (and Medicaid) won’t cover treatments considered but not positively appraised by the Britain's national health institute.

Alex Massie doesn't expect "this idea to catch on." Austin Frakt places his faith in the ACA reforms, but admits he's engaging in wishful thinking:

If we can’t just whack spending and expect better outcomes, what can we do? The answer must lie in more nuanced reforms to payment policy, towards a system that rewards the good performance we seek. That is, we need a scalpel, not a hatchet. That’s an obvious conclusion, neither helpful nor controversial.

Slightly less obvious – if you don’t know the research – is that there is no evidence that beneficiaries know how to select good performance even when they’re required to pay for it on their own. When they economize, they cut both helpful, necessary care and wasteful, useless treatment in about equal amounts. To continue the metaphor, beneficiaries don’t know how to use scalpels. This is the fatal flaw in the Republican plan for Medicare.

Sizing Up The Dark Mares

Assuming Palin isn't running, Chait talks up Michele Bachmann:

[W]hile Bachmann may be even crazier than Palin on questions of public policy, she seems to manage to hold things together as a candidate. She can answer questions from the news media. She is putting together a professional campaign rather than relying on amateur advisors. She takes care to point out frequently that she is a former tax lawyer, and she does not engage in Palin's visceral anti-intellectualism, giving herself the aura of a plausible president, at least in the minds of Republican voters. Bachmann may well combine Palin's most powerful traits without her crippling organizational failures.

I've heard surprisingly flattering reviews of Bachmann from a few Villagers lately – related to her sincerity and her smarts and her admirable fostering of so many children. But if being an anti-anti-intellectual still means a belief that New Hampshire is where the American Revolution took off, then the standard is set pretty low. And then there are those wide staring eyes.

Dissents Of The Day

A reader writes:

Andrew, you are too quick to call for a pox on both their houses regarding Medicare reform. Yes, the Ryan Plan is risible nonsense. However – the Democrats have not only "proposed a serious alternative" – they've already put one into law. It is called the Affordable Care Act – perhaps you've heard of it? The pay-for-performance portions kick in in October. Real reform, happening now, and without putting granny adrift on an ice floe so the Koch brothers can have another tax cut.

I refer to my post earlier today. Another points to an analysis from CAP "that projects the % of GDP assumed by total Medicare spending to be considerably lower thanks to the ACA's provisions." Another elaborates:

Obamacare includes provisions immediately saving hundreds of billions in projected Medicare spending and implements the IPAB to limit Medicare cost growth, which can only be overruled by a Congressional supermajority or a Congressional proposal limiting growth to a similar extend. Opponents have said this doesn't count because future Congresses will overrule the panel's recommendations – so what? This is true of any law, including Ryan's proposals. In fact, he's not even proposing a supermajority requirement to protect his plan.

The fact is that Obama has proposed and pushed through a law that saves trillions over the coming decades relative to Medicare as it stood when he entered office. If Congress doesn't get in the way and some modest cost control measures are added, this is sufficient to deal with the fiscal dilemma posed by Medicare. Combine this with axing the Bush tax cuts, eliminating the payroll tax exemption, and removing some counterproductive tax subsidies and you've got a sustainable budget for many decades. This is the Democrats' plan and for the most part it's already law.

Now, I'd prefer we adopt one of several health systems proven to provide better care at half the cost in other countries. National healthcare would eliminate a large majority of the debt problem as well as addressing the increasing number of companies and state governments unable to meet their pension obligations because of unforeseen healthcare cost inflation. It wouldn't be fair to a lot of people – companies that can't support their retirees would be bailed out, hospitals would be nationalized, health insurers would become much smaller, drug companies would no longer survive on America's insistence on paying more than anyone else, no more subsidized scooter commercials, and health workers would be paid less. If the debt is really as severe a problem as you think it is, though, are these consequences really so severe?

“So That No One Can Say Later That I Didn’t Say Anything”

Meir Dagan, the man who until very recently headed Israel’s Mossad, now embraces the Saudi peace plan of 2002:

In a forthright contradiction of the position of the Israeli Prime Minister, Benjamin Netanyahu, that a withdrawal to 1967 borders posed an unacceptable security risk, Mr Dagan said Israel ”must present an initiative to the Palestinians”. ”We must adopt the Saudi initiative,” Mr Dagan said.

‘We have no other way, and not because [the Palestinians] are my top priority, but because I am concerned about Israel’s wellbeing and I want to do what I can to ensure Israel’s existence. If we don’t make proposals and if we don’t take the initiative, we will eventually find ourselves in a corner.”

Dagan has also described Netanyahu’s desire to strike Iran as insanely reckless. And compare Dagan’s sanity with the hysteria from the likes of Krauthammer, Hannity, Ailes, Palin, Romney, AIPAC, et al. Dagan is also open-minded and skeptical about the Fatah-Hamas agreement.

Some questions for the Washington pro-Israel faction. How can you dismiss Dagan as not knowing enough to have an opinion on the two-state solution? Do you regard him as a self-hating Jew? Or as a delusional peacenik? Ben Caspit in Maariv writes:

In really closed talks, Dagan says in a loud and clear voice, that the Netanyahu-Barak duo is dangerous for national security. He uses even stronger language that I don’t intend to print. He promised, upon his release, that from now on they would hear from him a lot, and he is keeping his promise, big time… These are not just ordinary red warning lights, these are enormous projectors that have been lighting up the black sky above us for quite a few months now. Nothing would make me happier than to discover that these three prophets of doom are wrong. The problem is that I have a more than a slight concern that it could very well be that they are right.

Notice that Dagan is willing to cede more territory than Obama proposed. There are no land-swaps in the Saudi peace deal. So, Mr Romney, has the former head of the Mossad just thrown Israel under the bus? And Mr Bret Stephens, is Dagan an “anti-Israel” head of the Mossad? Or was the hysteria of the last month entirely manufactured to prevent an Obama second term and buoy Netanyahu’s support at home? There is no strategy for Israel in the AIPAC mindset. Just knee-jerk defensiveness and a major role in leading Israel to self-destruction.

Are Jews Abandoning Obama?

No. Greg Sargent puts the non-story in context:

[I]t’s important to recall that the claim that Jews are on the verge of breaking with Obama has been a frequent refrain for literally years now. Back in 2008 — after Obama said that “nobody’s suffering more than the Palestinian people,” and after Obama suggested he’d be open to unconditional talks with Iranian president Mahmoud Ahmadinejad, who has called for the destruction of Israel — there were reams of stories about how McCain would be able to make successful inroads with this core Democratic constituency. In the end, according to exit polls, Obama won around 78 percent of the Jewish vote.

Quote For The Day II

"Poor George Will. He's got a huge boehner in his boxers for Jon Huntsman, but he can't — try and fantasize as he might — see a path for his chosen love to the White House.

The reason for Will's frustration is quite simple. His party, the once grand old one, has been hijacked by the petty young thing of profound unseriousness: a seething, tempestuous horde of geezers and bigots and thumpers and temperamental medievalists and Hayekian hayseeds who prefer to soar blissfully on the goofweed of ideological purity than swoon over a candidate's dignified record of accomplishment," – PM Carpenter.