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Thinking outside the Beltway box, Robert J. Samuelson has ideas on how to reform Medicare.
…Just imagine what the health-care debate would be like if it truly focused on controlling spending.
For starters, we wouldn’t be arguing about how to “pay for” the $1 trillion or so of costs over a decade of Obama’s “reform.” Congress wouldn’t create new benefits until it had disciplined the old. We’d be debating how to trim the $10 trillion, as estimated by the CBO, that Medicare and Medicaid will spend over the next decade, without impairing Americans’ health. We’d use Medicare as a vehicle of change. Accounting for more than one-fifth of all health spending, its costs per beneficiary, now about $12,000, rose at an average annual rate of 8.5 percent a year from 1970 to 2007. (True, that’s lower than the private insurers’ rate of 9.7 percent. But the gap may partly reflect cost-shifting to private payers. When Medicare restrains reimbursement rates, hospitals and doctors raise charges to private insurers.)
Medicare is so big that shifts in its practices spread to the rest of the delivery system. But changing Medicare, and through it one-sixth of the U.S. economy, requires more than a few demonstration projects of “comparative outcomes” research or economic incentives. What’s needed is a fundamental restructuring. Fee-for-service medicine — Medicare’s dominant form of payment — is outmoded. The more doctors and hospitals do, the more they get paid. This promotes fragmentation and the overuse of services.
We should move toward coordinated care networks that take responsibility for their members’ medical needs in return for fixed annual payments (called “capitation”). One approach is through vouchers; Medicare recipients would receive a fixed amount and shop for networks with the lowest cost and highest quality. Alternatively, government could shift its reimbursement of hospitals and doctors to “capitation” payments. Limited dollars would, in theory, force improvements in efficiency and effective care. …
Debra J. Saunders comments on Obamacare, including politicians’ unwillingness to grasp economic realities.
…Only in Washington do people assert with a straight face that they can expand who gets covered and what everyone gets – and it will be cheaper. And because many readers believe this fable, allow me to note that after Massachusetts passed a universal plan three years ago, already cost increases have led to cutbacks. …
…As I watched Pelosi on Tuesday, I thought: It’s the California Budget Mess all over again – with big promises of more government and more benefits and no across-the-board taxes to pay for the package. Democrats like to congratulate themselves for their noble intentions. But they have offered no plan to pay for them, and so they are bound to fail. …
Liberal Mitch Albom defends conservatives’ right to free speech.
I have no illusions about protesters at the recent town hall meetings on health care.
Some are fueled by angry conservative groups. Some are hopped up on radio hosts’ rants and ravings. Some are Barack Obama haters. Some use one piece of wrong information to smear an entire event.
And some just think the whole idea of government health care stinks.
But all of them — all of them — have the right to be there, and the right to their point of view. Liberal-minded thinkers who regularly speak up for the poor and underprivileged cannot suddenly yank the rug when it comes to free speech for others. …
Mark Steyn posts on the ultimate outsourcing.
My jaw doesn’t often drop, but this story had it heading for the basement:
Thousands of Canadians who are infertile in Canada have to place all their hopes on just 33 men who are Canadian sperm donors.
What? A nation of 30 million people has just 33 sperm donors? Apparently so. Now why would that be?
At one time Canada had two dozen sperm banks but when the Assisted Human Reproduction Act made it illegal to pay for sperm or egg donors they dried up in 2004. …
Byron York points out that the New York Times’ bias is showing.
The front page of the New York Times is filled with hope about the nation’s economic situation. The lead story, “Job Losses Slow, Signaling Momentum for a Recovery,” reporting a decline in the unemployment rate from 9.5 percent in June to 9.4 percent in July, begins by declaring that, “The most heartening employment report since last summer suggested on Friday that a recovery was under way — and perhaps gathering steam.”
“Employers are no longer in a panic,” one expert tells the Times. The paper reports that Obama administration officials “credited the stimulus package” for the improvement, and “some said” job losses would be far worse had the $787 billion stimulus not been passed. The paper quotes President Obama saying his administration has “rescued our economy from catastrophe.” …
…The Times hasn’t always been so optimistic when it comes to one-tenth-of-a-point declines in the unemployment rate. On this very day in 1992, in the midst of the presidential campaign between George H.W. Bush and Bill Clinton, the government also reported that the unemployment rate ticked downward by one tenth of a point, and the Times’ treatment was far more restrained.
“Jobless Rate Dips a Notch to 7.7% in Mixed Showing,” was the front-page headline of the August 8, 1992 Times. “The nation’s jobless rate improved marginally last month, edging down to 7.7 percent from 7.8 percent,” the Times reported. “But the improvement was not enough to signal a stronger economic recovery or to help President Bush as he heads into the Republican National Convention.” Even though the number of jobs actually went up in July 1992 (as opposed to the decline of 247,000 jobs in July 2009), the 1992 Times reported that the economic news “gave no suggestion that the economic recovery was breaking out of its painfully slow pace or, more important, that the job growth was picking up enough to push the unemployment rate down significantly before the election in November.” Pollster Peter Hart told the paper that, “There couldn’t be worse political news for George Bush.” …
A Chicago Tribune editorial tells how politicians in the City Council are trying to prevent the opening of a Wal-Mart during this recession.
…Construction of the store would create 200 jobs. The store, once it was running, would provide nearly 500 jobs.
But the City Council wants none of that, so all the Chicagoans who like to shop at Wal-Mart and all the Chicagoans who would like to work at Wal-Mart have to go to one of those dots on the map. They’re all in the suburbs, save the one Wal-Mart that has been allowed to open in Chicago.
When that Chicago store opened in 2006, it was flooded with applicants for 450 jobs. But the aldermen want to dodge a vote to allow another Wal-Mart — the first on the South Side — because they’re petrified over the influence of organized labor on local elections.
Organized labor doesn’t like Wal-Mart because Wal-Mart doesn’t have union jobs. It just has jobs (with an average hourly wage of $12.05 in Chicago).
The aldermen, of course, already have jobs. They get paid $110,556 a year and they figure that as long as they keep the labor unions off their backs, they’ll keep making $110,556 a year. Who says the City Council doesn’t generate jobs? If you’re one of the 50 aldermen, your unemployment rate is 0 percent.
But the unemployment rate for the rest of Chicago is above 10 percent….
Dennis Byrne also comments on the disgrace of allowing political pressure to triumph over the economic well-being of so many Chicago residents. But he says that the Chicago City Council is not just bowing to union pressure.
…But it would be a mistake to chalk this up solely to organized labor’s stranglehold on the City Council. Progressives, from their North Side enclaves, are full-throated in their opposition to a major job generator—elsewhere in the city. The liberal lakefront wards—44, 46, 48 and 49—all are home to some of the city’s strongest opposition. In stark contrast, the heavily black and lower-income wards on the South and West sides record the highest levels of support. Up on the Northwest Side, home to many blue-collar organized workers, support is weakest. What should be of some concern is the relatively weaker support for the new store in Hispanic wards; apparently minorities are not as unified as we are led to believe.
This column will inspire the usual howls of protest from “progressives,” who would have us believe that, from their distant perch, they only have the welfare of the oppressed and impoverished in mind. Even though their progressive roosts are blessed with an abundance of jobs and places to shop. They don’t have to get on a bus to travel outside the city to work or shop. From their roosts, they are comfortable and self-satisfied in their ideological hatred of Wal-Mart, brushing aside pleas from those most in need of jobs and access to shopping.
Progressives will portray themselves as guardians of those pleading for the Wal-Mart. Progressives say they are only are trying to “protect” those poor people from low wages, insufficient benefits and part-time work. Progressives have decided that for “those people” no jobs are better than jobs that they want and need. Progressives will cite their opposition to Wal-Mart as evidence of their compassion and, well, progressiveness. …