the Next Right - Health Care Challenge: Eliminate the Government as a Stakeholder

The Next Right posted on health care, and how conservative feelings/actions can be classified. Of course, this prompted discussion in comments section about what health care changes should be pursued.

I thought I would include my two cents.

To me it seems that there are a few problems with our health care system that need to be tweaked. However, coverage is not one of them. Anyone who has a problem can walk into any emergency room and receive care.

The real problems are ones of cost, portability, and choice.

Anyone who has followed the growth of Medicare knows that the government is not very good at containing costs. Politicians want to get re-elected, and want to play to their respective constituent's interests. One example: If a politician has pharmaceutical companies in their district, then they are less likely to prefer changes to the system that encourage the use of generics in formularies.

The current employer based system involves companies who choose health care for their employees based on the plan that fits their business model, as opposed to what fits an individual employee's needs.

Also, the current employer based system means that care is based on continued employment with that employer (less a brief overhang via COBRA - which can be expensive in it's own right).

Holland has revamped their health care system to go from a hybrid private pay - single pay (single pay for the lower wage earners, private for everyone else). The problems that they had were a lack of efficiency at the single payer level, and general lack of control over costs. In 2006, they went to an all private payer system. From a growth rate of costs at 4.5% above inflation the last year under the old system, the Dutch dropped to about 3% above inflation during the first year in implementation.

Besides containing costs, the Dutch system allows portability.

They have the same pool of patients as they had before the change. They have the same pool of doctors. In fact, if you want to break the changes down to the most fundamental level, what they have done is eliminate the government as a stakeholder.

I thought that the McCain plan addressed many of those issues. The household credit of $5,000.00 could be used to buy coverage for a family of five through Kaiser for $4,560.00, with a $1,700.00 deductible. This is a total cost of $6,260.00 (less co-pays). The annual out of pocket costs would be $1,260.00 (again - less co-pays), or a monthly cost of $105.00 per month. This is a lot less expensive than most family's of five pay through their mandatory contribution (read: deduction) out of their paycheck.

Of course, this isn't free, nor do we want it to be. Many economists believe that services are rendered more efficiently if the recipient is involved in the cost.

Libertarians among us may ask what do we do with the segment of the public that desires to opt out and not carry coverage. The simple answer is that person does not get the tax deduction. The more complicated situation is when that person shows up with their five year old son at the emergency room, and that son has a serious illness and - due to dad's choice - no coverage.

In a perfectly libertarian society, we would say "cash on the barrel head, or no services". In our real world society, we have to ask ourselves if we want to deny health care due to the father's choices. The answer, on a practical level, is probably not. We would need a mechanism to allow health care, as well as allow the provider to collect.


Then final question, then, is enrollment. Right now, most employer based systems offer periodic open enrollment. We could do the same for this system: once a year, people may enroll regardless of preexisting conditions.

It is not a perfect system that I propose, but then again, we are not proposing government involvement in gold plated health care. Nor should we.

If individuals desire the gold plated plan, they can purchase it on the open market. Rather, I am proposing a more cost efficient way to deliver the fundamentals, while leaving open the option of extra care for those who wish to pay for it.

I think this is important to pursue, because the single payer fans not only operate on the misguided idea that the government can deliver care cheaper than the private markets (and the private market profit margins), they also believe that a single payer system can rid health care of inequities such as gold plated plans. If you want them, you will still be forced to pay into the single payer system, and then you will have to buy your gold plated coverage fully above and beyond that.

Under the plan I have discussed, individuals can use the tax credit towards the gold plated plan, and then make up the difference themselves.

I believe that something will be done on health care, and that the type of system I have proposed gives the best possibility of using market forces to control costs, as well as giving choice about health care to the consumer. if we do not have our own proposal available as an alternative, we will be stuck with the Democrat's solution.

Hugh Hewitt at the Orange County Central Committee meeting

Last night I attended the Orange County (California) Central Committee meeting as a visitor. The keynote speaker was Hugh Hewitt, who gave a brief commentary on the election just passed.

In particular, he wanted to highlight a few troubling things.

The Youth Vote

As Hewitt noted, young voters didn't turn out in the numbers that some pundits predicted, but they did vote for Obama 66% to 32%. Young voters eventually turn into middle aged voters, and so on, and so on. If we do not figure out win a greater percentage of the young vote, the future will be that much more difficult for Republicans. The middle aged voters of today (according to historical voter trends) voted for Reagan and Bush (41). Reagan did well with the youth vote, so it isn't merely the age of the candidate - it is also the message.

The Latino Vote

John McCain won only 33% of the Latino vote. Given the demographic trends, if we do not figure out how reach out to Latino voters, we will be in the wilderness for a generation. It is impossible to win on the Electoral Map for a Republican without the Mountain West and the South. Latinos were a key demographic for Obama in Florida, Nevada, Colorado, and New Mexico. Keys to our outreach are the recruitment of Latino candidates, as well as focus on social issues and entrepreneurial issues. We also need to find away to talk about border security, as well as develop a strategy for those who are here illegally. Hewitt said that if Obama and the Democrats are smart, they will bring up immigration in the new Congress, and let the Republican Party tear itself to pieces.

Technology

The GOP had the edge in 2004 and 2000 in utilizing technology for identifying potential voters wit the Voter Vault system. This changed drastically. Obama was better at using new technologies such as social networking sites, twitter and texting. He was also able to perform better in non traditional media. Whereas Republicans held an edge in talk radio, Obama dominated on the internet through sites such as TPM and Kos. Republicans have got to get better at utilizing hardware such as iphones (he had several dedicated iphone apps), and blackberries.

Talk Radio

Despite the edge in talk radio, the Republican effort didn't utilize the medium as well as possible. For instance, Palin did not appear on Hewitt's show for nearly a month after she was announced.

Candidate Recruitment

The Democrats have excelled at recruitment for the past two cycles. It is time for the GOP to catch up.

Redistricting

The "Chicago Crowd" will come loaded for bear. The GOP better be ready to play, especially in regards to statewide races that will be realigned from safe seats under the new guidelines set in the election past.

All in all, Hewitt gave a thoughtful - if brief - synopsis of the challenges facing the GOP going forward out of this election.

Blurring distinctions on the three G's

One of the more fascinating aspects of this election cycle has been the ability of Obama to neutralize what has been the bane of Democrats in the last two presidential election cycles: the three G's of God, Guns, and Gays.

Clearly Obama is a man of faith, and has not been labeled as a sceptic of religion and faith. Yet on Gays and Guns his views have been a little bit more blurred. He proclaims to support Second Amendment rights, yet he has made statements that he would allow local authorities ("communities") to define to what extent the Second Amendment should be extended.

He has stated that he is opposed to gay marriage, and has been forceful in pointing this out on the stump. Yet this weekend, two and a half days before the election, his image is being used in an advertisement by the No on 8 campaign (see here). I guess that a talented talker (and Obama is certainly talented), could thread the needle and say that opposition to gay marriage and support of an initiative that would curtail gay marriage are not one and the same, and that the personal is not necessarily the policy.

It seems to me that Obama's statements on this subject are being tailored to a socially conservative audience that has been wary of Democrats that they perceive as being too liberal on social issues. It also seems to me that Obama intended for this audience to infer from his statements that his policy on gay marriage would not be any different than his personal beliefs.

It appears that this audience has been duped. However, Obama and the media will probably say that this audience is the victim of nuance they couldn't understand.

Certainly, if Obama is elected, there will be a great number of groups disappointed to find that he made opposing promises to both sides of an issue, and that one side will be left out in the cold. Yet shouldn't the media be demanding some reconciliation on some of these topics before the election, so the voters understand which Obama they are getting?

$150,000 in clothes, crickets, and the aftermath

You may have seen the story of the clothes here, or here, or here, or maybe even here.

I did a little research, and it seems that the first inkling of this came in the Page 6 column of the September 17 New York Post. New York Magazine followed up in their blog "the Cut". Both publications noted that the McCain camp had hired stylists who had encouraged "the governor to purchase pricey designer clothes to wear at public events.

At this point it is unknown whether Palin or the stylists were the ones making the purchases.

What is known, however, is that the media and the blogosphere are having a field day with this. Strangely, though, all we have heard from the Democrats is the sound of crickets.

One explanation could be that the media is doing such a great job they do not feel that they can top it. This doesn't sound like a political campaign though.

Could the Democrats have their own problem?

First, comparing the wardrobes of men to women is not quite apples to apples. The closest the Democrats have to Palin is Hillary. What, you may ask, can we deduce about Hillary and her spending habits in regards to clothes?

As a subscriber to the LA Times, I seemed to remember that there had been an article around the conventions about one of Hillary's designers. A quick Google search, and there it was.

"Turns out that many of Clinton's signature campaign suits were stitched on the first floor of a boutique in the heart of Beverly Hills by Susanna Chung Forest, who has made a name -- and a sizable business -- for herself by dressing female execs of Fortune 500 companies and Holmby Hills socialites."

I would guess that the blue collar voters of Ohio haven't been doing too much shopping here. If they couldn't make the drive, perhaps they would be be able to purchase remotely? Maybe if they can get another mortgage on the house:

"The clothes aren't cheap. Jackets are about $3,000, shirts run to $1,350 and pants hover around the $2,000 mark. For first-time clients, there is a minimum three-suit requirement, simply because it costs so much to make the mannequins."

So the suits start at $6,350.00, and go up from there. What could make the price go up? From my experience with menswear, I know that custom features such as changes to collars and lapels (remember some of her suits had a "Elvis at the Sands" look), details such as hand sewn pick stitching, and different types of fabric can affect the cost. For menswear, fabric upgrades can increase the price by up to $1,000.00. For women, the increased options of fabrics that are considered acceptable for a women's suit expand the potential price greatly (colors like the tangerine she wore to the convention can get especially pricey due to the cost of dyeing).

So lets say that, with some upgrades, her average suit costs $7,850.00 ($1,000 for fabric and additional materials such as trim, $500.00 for details such as collar changes, and labor to stitch trim - remember, this is Beverly Hills). The next question is how many did the Senator purchase?

"For first-time clients, there is a minimum three-suit requirement, simply because it costs so much to make the mannequins."

So this means that an estimated first time order would be in the neighborhood of $23,550.00.

Did she purchase more? Well, the designer wouldn't say exactly how many, but the story did say:

"Forest continues to send packages containing three or four suits at a time to Clinton on the road. She is finishing a bright red silk suit and has already sent along a black ensemble with a skirt instead of pants."

Each package of four would run about $31,400. Adding skirts to the suits (as mentioned in the quote) would be about $1,400.00 per skirt.

So lets just run a theoretical tab for the initial order, and four additional orders of four suits each (we'll assume no skirts for this calculation), and we come up with: $149,150.00

This may explain two things. First, it may explain why the Democrats are being quiet. Second, it may explain why the RNC, the McCain campaign, and the stylists felt emboldened to spend a little on Palin's style. They might have figured that with the money that Hillary was throwing around, the order of the day was designer candidates. Furthermore, they might have felt that there would be no blow back, especially from a mainstream media (I think that the LA Times qualifies as MSM) that was practically fawning over Hillary's couture.

However, they should have seen the risk developing in "the Cut" piece that talked about the criticism the Cindy McCain received; noted the stylists fears of having the high end shopping discovered; and the concluded that, "if we were running for vice-president, we'd like to think we'd defer to tastefulness and restrain ourselves in These Economic Times, despite Valentino's powerful forces (and we mean powerful)."

Was there a double standard in how this was treated by the media relative to how Hillary's spending and couture were treated? Yes. Could the initial reporting in the Politico on this have been more balanced, and included context on Hillary's purchases? Yes (Google "hillary clinton pantsuits", and the third item is the LA Times story).

However, the McCain camp had long ago concluded that the press wasn't going to give them a fair shake, and $150,000.00 is an awful lot of money to explain away to a press corp that is not inclined to treat you fairly.

A bigger question might be: How did Hillary pay for her purchases?

Beginnings

Well, people had encouraged me to blog on politics for a while, and I finally decided to do it today.

What a day to choose for a beginning: the $150,000.00 shopping bill.