Thursday, February 13, 2014

'Politics: What You Are Willing To Give Up. Policy: What You Want'

'Social Safety Net'...or
...'The Ladder of Opportunity'?
Chris Saxman, a friend of ours and a former member of the Virginia House of Delegates, had this to say about politics vs. policy recently:
'Politics is not about what you want; it's about what you are willing to give up.'
'Policy, on the other hand, IS about what you want.'
There is a lot packed into that statement, yes? We have spent 235 years of American history now trying to figure out what we want to be as a people, as a society and as an economy. We are not sure if we have answered it yet.

We may never answer it fully. One of the beauties, and frustrations, of American democracy is that we do tend to go along the pendulum swing of wanting more government to less government back to more government on a regular basis. At the state level, federal level and local level.

There is always that constant tension between individual freedoms and collective well-being, isn't there?

Keith Hennessey posted another wonderful insight exposing this tension, 'Ladder vs. Safety Net' that pretty much gets to the heart of the discussion about whether the ACA, or Obamacare, does more to widen the safety net for millions of Americans or whether it traps them on the lower rungs of opportunity which we all want for everyone.

We would like to take it a step further and point out why Obamacare did not 'reform' health care in any meaningful sense of the word. In fact, as each successive story comes out highlighting yet another problem with Obamacare from the rollout to the cancellation of millions of policies to the reduction of 2.5 million full-time job equivalents (FTEs) in the most recent CBO report, we think it is only a matter of time before the political pendulum starts to swing back against Obamacare and the majority of Americans support either its repeal or drastic restructuring.

President Obama is constantly doing the Australian backstroke every week it seems as he refuses to enforce the provisions of the signature law he pushed for in his first year as President. This week he said he was not going to enforce the mandate on medium-sized business.

Even the flipping WASHINGTON POST said President Obama is setting a very dangerous precedent for future Republican Presidents, mostly, to selectively decide which parts of federal legislation they will 'faithfully execute'...and which ones they won't.

Just try to imagine any future President 'selectively' saying: 'Oh, those protections on abortion coverage...I will just ignore them!' or 'Those environmental protection things passed by Congress...forget it, I am just going to ignore them and let everyone and any business pollute as much of our air and water as they want!' or something to that effect.

The nation would go bonkers. Why not with President Obama's unilateral actions on the ACA?

Getting back to the tradeoffs that Mr. Saxman mentioned must be in any good political compromise, there is absolutely nothing, nada, zero, zippo that the PPACA, now known just as the ACA, has done to arrest the upwards cost-drivers inherent in the American health care system. Professor Donald Taylor of the Sanford Public Policy School at Duke University has written about this in his blog and in his book, 'Balancing the Budget is a Progressive Priority' (2012)

In the context of Mr. Hennessey's work noted above, the ACA or Obamacare pretty much promised the world to everyone...and didn't tell anyone of any of the downside costs it would demand.

'All Safety Net, All The Time' should have been the tagline for President Obama and the Democrats who passed it in 2010, many of the same red-state Democrat Senators such as Mark Pryor (Ark); Mary Landrieu (LA) and Kay Hagan (NC) who are doing a vigorous backstroke to distant themselves from Obamacare every chance they can.

PriceWaterhouseCoopers produced a report in 2010 titled 'The Price of Excess: Identifying Waste in Healthcare Spending'.

They concluded, as many others have as well, that the definable 'wasteful spending' in the American health care system is about 50% of all expenditures across the nation.

There are 3 buckets of waste: Behavioral; Clinical and Operational. You can read the report yourself and fill yourself in on their findings.

We have pointed out the fact in previous posts that if everyone got serious about their own health and 1) lost 25 pounds; 2) quit smoking; 3) quit over-drinking; 4) stopped eating Twinkies and chips by the ton and 5) exercised 30 minutes per day, maybe 30%, perhaps 40% or even 50% of our health care costs related to diabetes, cancer and heart disease would evaporate into thin air.

So we agree with PriceWaterhouseCooper on their first point. The question is how to get there.

The other two points are where we think Obamacare failed miserably to wrench all of the clinical and operational waste out of the US healthcare system.

Further national and state tort reform would have been a good start but the trial lawyers were too strong of a lobby to defeat so the ACA skipped over that one like it was a hot potato. Missed opportunity #1.

Relieving doctors and administrators of the virtual mountain of paperwork and recording they have to do every day would have been a good start as well. However, according to some, physicians and providers spend over 25% of their day just doing paperwork....when they could be doing something more important like treating patients! Missed opportunity #2.

Tied in with more acute tort reform efforts is the thorny issue of 'defensive medicine'. Defensive medicine falls into the same category of interpretation being in the eye of the beholder not totally dissimilar from Justice Potter Stewart's famous observation that while defining hard-core pornography is hard to do, 'I know it when I see it!'

Some peg defensive medical costs at 5% of all medical costs today. Hundreds of doctors and healthcare providers told me personally during my two stints on Capitol Hill that they routinely prescribed 20% of their procedures solely to protect themselves from litigation later.

So who knows for sure. We do know that there is some substantial part of healthcare costs in America that were not unwound by Obamacare and in some cases, may have been exacerbated.

The point here is that President Obama is unwinding his own signature piece of legislation as we speak, mostly because it is unworkable and detrimental to so many millions of people and businesses, large and small.

The next effort to 'Reform Health Care in America' (and you know it has to happen soon) has to focus on wrenching every available dollar now wasted in current American healthcare spending first and foremost or else we will never get out of this healthcare maelstrom in which we find ourselves today.

Good legislation always entails what each side is forced to give up to get what they want.

Former Congressman Alex McMillan, for whom I worked many years, used to say when everyone went to the Rose Garden at the White House with big smiles on their faces, both Democrat and Republican:

'There's a terrible piece of legislation there. No one is unhappy with the outcome'

How true that is. The ACA was just the latest example of such dreamy-eyed and Alice in Wonderland thinking.

It is time for adults to come in and run our national government again by making the hard choices for us.

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