Wednesday, June 24, 2009

Iranian Unrest, Disappearing Governor, and Don't Ask-Don't Tell

This has been the most interesting two weeks of the year so far...

1. Mahmoud Ahmadenijad is re-elected as President of Iran?

Amid widespread fervor for a reform candidate by the name of Mousavi, the little man (I call him "brown Dubya"), overwhelmingly wins re-election by a 2-to-1 margin. Huh? Well, maybe. Although we don't know the exact circumstances of the election, something fishy is going on. The Supreme Leader of Iran is banning communication and ordering wholesale slaughter of anyone protesting the election results. Dissent is being squelched on a level that an American can hardly imagine. On the upside, fissures in the ruling class are being exposed, and the roots of a new revolution are being seen.
Not to be outdone by President Obama, many Republicans such as John McCain (and his adopted son Lindsay Graham) are calling for a Reagan-style "...tear down this wall" type speech as if it would be a good idea. Imagine, if you will, the "Great Satan" U.S. preaching to the ruling class of Iran and trying to position itself with Mousavi in a sponsoring role. The fissures now evident among the clerics would be erased, Mousavi would probably be imprisoned, and protesters would have to fight an even steeper uphill battle against the ruling class to be heard. I for one am really glad Mr. McCain did not win the Presidency.

2. Oh, Gov. Mark "I thought the Appalachian Mountains were in Argentina" Sanford

Granted, Mr. Sanford is not the first person in power to try and get away with an extramarital affair while in office, but this guy has some cajones to leave his office for five days without telling his staff or other government officials (like the Lt. Governor) where he was going or how to contact him. He essentially created a constitutional crisis in South Carolina because he had an imperative from the Mrs. to get the hell out of the house. Then, instead of going hiking on the Appalachian Trail--as was believed by his staff, he went to Argentina to supposedly meet with or "break it off" with his mistress. What the ....

3. Finally, Obama is dragging his feet on Military policy on openly-gay servicemen and women.

Is this the 21st Century? Gays in the military is not as controversial a subject as it once was. It turns out, even though a change of law IS required to overturn "Don't ask, don't tell," the President has the unique ability as Commander-in-Chief to direct military policy. In other words, he can suspend any active policy of the US military including the enforcement of discharge policies regarding sexual orientation. It's the right thing to do and Obama needs to stop pussy-footing around and get it done.

Sunday, June 14, 2009

Health Care Addendum:

Let me speak to my idea (although I can't claim credit) of a "triple-payer" health care system.

First of all, the term "triple-payer" is a direct restructuring of the term "single-payer." Neither single nor triple-payer systems are adequately described by those terms.

Here's the basics...See what you think.

1. The federal government would not provide health insurance coverage, simply create the nations largest health care group with very specific coverage. Many states and localities already do this to keep down costs.

2. Private and "public" health insurance providers would send blind bids (along with "capacity statements"*) to a central Health Care office for review.

3. The third lowest "per capita" bid (could be neither the highest or lowest bid) from across the nation would be chosen. An offer to buy coverage up to the capacity limit set forth by the individual health insurance providers would be sent by the federal government. Companies would then accept or reject participation in the program. Providers, whether or not they participate, could still sell insurance as a supplement privately.

4. Individuals would then "buy" insurance from the provider of their choice (certain regions would have limited options). Premiums would be based on income, payable to the federal government, and there would be a maximum contribution. Coverage would be mandatory (for those of you keeping track, I've changed my position here).

5. Ideally, the plan would be free from deductibles although a co-insurance of 10-20% would be reasonable for all procedures. Every person would receive one free physical and three urgent care visits per year. Insurance would be individual and portable. No pre-existing conditions.

Pros: Obviously, a health care plan based on income makes this truly Universal and affordable. There would not be an inordinate amount of increased taxation. Employers could still cover workers by paying the "premium tax" on behalf of the employee as part of a salary package. Private insurance companies would not be shut down or made illegal, thereby salvaging a major portion of the economy from collapse. A co-insurance policy allows doctors and hospitals some leeway in the amount of charges. No more Medicare.#

Cons: It's not a "free" system based on a progressive tax model like other countries offer. It is possible that insurers could learn to work together and "game" the system during bidding, driving up overall costs to the government. Regions lacking in accepted bids would likely be "farmed out" to providers in other regions (technology makes this less of an issue, however). Oh yeah, no more Medicare.#

Overall, I think it's a good plan. It takes what is best about the American health care system and tries to incorporate a level of price control and cooperative buying to save the taxpayer trillions of dollars. Like all health care plans, it has faults, but I hope members of Congress and the President seriously consider something like it.

* A "capacity statement" simply estimates the number of people a provider can reasonably cover. It should also include business statistics like workforce and years in service.
# Medicare is a beautiful idea but a horribly inefficient bureaucracy. This new plan takes over the job with few real changes to the individual. No income = No premium.
WHOA!! Universal Health Care?

Here's the thing...

President Obama is taking on every possible issue in his first year in office. The problem is that he and many Democrats in the Senate seem to think they are still out of power. Why did the stimulus package have tax cuts? Oh yeah, capitulation to the Republicans. That was an extra 250+ billion that could have been used to confront some other issues. Now we are going to have an extended presence in Iraq for the next year. We're getting bogged down in Afghanistan and Pakistan, virtually eradicating any savings we might expect from a "draw down" in Iraq. Now, my party, the party of "Inclusion" is walking on egg shells when it comes to Health Care.

The first problem I have with the preliminary impressions of Obama's health plan is coverage. Voluntary coverage, though it appeals to the American sense of independence, is not good enough. Again, details are hard to come by. Perhaps health coverage of some sort will end up being required by the federal government. Who knows?

Another problem is perception. Regardless of whether this plan passes, and regardless of how good and inexpensive the coverage is, it may be difficult to get a significant part of the population to buy into it. Think about public transportation. In areas where affluent or middle class people use public transportation, it thrives and is able to grow in service quality and coverage. If the only people using public transportation are poor, the local government ends up throwing "good money after bad" in an effort to keep it available. The same could happen to a voluntary public health care plan.

Democrats will have to step up and ask for single payer health care or some similar idea (like my triple-payer plan), or they will be at the forefront of a potential failure that only lends credibility to the Republican arguments about government intervention and efficiency. It could be several election cycles before we recover from that.

Think hard Dems! We need leadership on this issue. In addition to health care, we need to confront immigration, tax policy, education, and environmental issues. Don't waste your time on a health care plan that will fail to win over the American people. It will cost you political capital on everything else you try to do.