Entries from June 2009

Obama, Cairo & Jerusalem

David Frum June 13th, 2009 at 12:57 pm 4 Comments

My weekend National Post column parses the president’s Cairo speech for evidence of his intentions on Jerusalem and reaches this conclusion:

Characteristically, Obama is trying to find an intermediate position between two opposing points. But also characteristically, this intermediate position is not exactly in the middle. Obama will pressure Israel to surrender something it has — control over Jerusalem — in exchange for the Palestinians surrendering something they want. Similarly, the outcome the President appears to seek — internationalization of the central city — will likely be less favourable to Israel, since international bodies can be expected to show much greater deference to the sensibilities of their many Arab and Muslim members than to their sole and single Jewish member.

The President’s preference is not of course the last word. But it is a powerful word — and it presents Israel with another in the daunting series of challenges and dangers from this audacious President.

You Read It Here First

June 13th, 2009 at 5:51 am 5 Comments

Back in February, patient here at FrumForum.com, treat David Frum argued for downsizing our cities and pulling down homes in abandoned or depopulated neighborhoods:

Think of it as “exurban renewal” – a 21st century counterpart to the slum clearances of the 1940s and 1950s…

Now, the Daily Telegraph reports that the Obama administration is considering plans to bulldoze abandoned neighborhoods in depopulated cities.  The strategy, first adopted in Flint, Michigan, would help troubled cities survive by concentrating their services to a smaller, more viable area.

Again, you read it first at FrumForum.com.

Green Bay Makes The Case For Federalism

June 12th, 2009 at 7:31 am 9 Comments

Yesterday, see Barack Obama visited Green Bay, Wisconsin, to tout that city’s successful efforts to rein in the costs of healthcare.  Obama used the occasion to make the case for federal healthcare reform, modeled on the success of Green Bay and other cities like it.  But Green Bay’s experience teaches a very different lesson: when the federal government butts out, state and local governments can experiment creatively.  This, rather than a national health policy, has the potential to ultimately solve our country’s vexing healthcare-related challenges.

Picture this: a room full of a hundred bureaucrats in the Department of Health and Human Services in Washington, D.C., tasked with evaluating the costs and benefits of a particular medical procedure.  Most have been in the department for twenty or thirty years, while others have volunteered for rotations in other government agencies like the Department of Education or the Department of Transportation.  None has spent any significant amount of time in the private sector.  None has lived outside of the D.C. area in decades.  Few have direct experience in thehealthcare industry.

Now picture this: fifty different states, each with dozens of municipalities, formulating healthcare policy at a local level.  Some of these policies are objectively superior and constituencies in other states and cities can apply pressure on their elected representatives to adopt the same reforms.  Other policies are simply more appropriate to the circumstances of that particular state.  Either way, there is room for customization, trial and error, and emulation.

Which of these two scenarios is likely to yield more innovation and better results for patients? 

This was one of the Founders’ central insights.  They argued that a federal system allows for a diversity of approaches, making it more likely that somebody somewhere will discover the approach that works best.  Justice Louis Brandeis later articulated it thusly: “It is one of the happy incidents of the federal system that a single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.” 

Put differently, federalism provides at the governmental level what the free market provides in the private sector.  It fosters competition, resulting in a dialectic process that enables good ideas to clash openly with bad ideas.  The bad ideas can be discarded along the way, while the good ideas can be honed and replicated.  There are other ways to achieve progress, butmillennia of human experience suggest this is the best.          

Green Bay provides concrete evidence in support of this theory.  The city’s health system has implemented electronic medical records, limited access to certain procedures that it has deemed costly and ineffective, and promoted treatments that reduce the prevalence of conditions that require expensive medical care.  In doing so, it has attracted attention from other cities in Wisconsin and other states throughout the country, some of which are already incorporating elements of Green Bay’s healthcare reforms.  This is precisely how federalism is meant to work.

Levin Reviewed

David Frum June 12th, 2009 at 5:15 am 152 Comments

I promised last week to read and review Mark Levin’s Liberty and Tyranny. A little tardy, but here it is. Just follow this link over to the Bookshelf.

Eli Lake Gets The News

David Frum June 12th, 2009 at 4:05 am 3 Comments

In today’s Washington Times, Eli Lake has a serious scoop. Lake reports that Israeli Prime Minister Benjamin Netanyahu will deliver a major speech on Sunday accepting the concept of a Palestinian state, subject to terms protecting Israeli security: 

• Any Palestinian state must be demilitarized, without an air force, full-fledged army or heavy weapons.

• Palestinians may not sign treaties with powers hostile to Israel.

• A Palestinian state must allow Israeli civilian and military aircraft unfettered access to Palestinian airspace, allow Israel to retain control of the airwaves and to station Israeli troops on a future state’s eastern and southern borders.

• Palestinians must accept Israel as a Jewish state, a nod to the hawkish side of Mr. Netanyahu’s governing coalition that has raised concerns that the Palestinian Authority, which nominally governs the West Bank, does not recognize Israel as a Jewish state.

Horseraceblog’s Jay Cost Handicaps The Healthcare Fight

June 11th, 2009 at 1:57 pm 1 Comment

Listen: NM’s Jeb Golinkin talks with Jay Cost, author of RealClearPolitics’ HorseRaceBlog about the politics of health care reform.  Jay also tells Jeb why he thinks Michael Steele should resign.  

Listen on Itunes here, or download here.

Business Will Sell Out GOP On Healthcare

June 11th, 2009 at 12:43 pm 47 Comments

Several weeks ago, seek I argued here that Republicans would be wise to abandon their pro-business inclinations, pharm and attack the business community in an effort to shift the health care debate.

In short, recipe the relevant stakeholders are colluding with Democrats on a health care package, lest their business become the “pay for.” Republicans should make clear that these businesses, in seeking to protect themselves, are willing to accept and promote a health care bill that would lead to more expensive and lower quality care for the middle class Americans who have and enjoy health insurance.

This collusion has now broken into the light of day.

Yesterday Roll Call reported that Senator Max Baucus had called an emergency meeting of Democratic lobbyists informing them that they should instruct their clients not to meet with Republicans.  Specifically, the Chairman of the Senate Finance Committee made it clear that a meeting organized by Senator John Thune to discuss the financing of massive new entitlements was off limits.

One lobbyist gave away the game, telling Roll Call that Baucus’ staff warned “If your clients attack the process or the product, it’s going to be hard to work with you.”

In other words, if you attempt to work with the Republicans, other than to coerce them into supporting a Kennedy-Baucus product, we will ruin your business.

Understandably, Republicans could use the assistance and dollars of the business community in arguing against the Democrats’ proposals.  But with the clock ticking, it is well past time to inform the American people of this cozy relationship between government and the business community that threatens the quality of care for the middle class.

The Immigration Problem Gets Bigger

David Frum June 11th, 2009 at 9:56 am Comments Off

The Center for American Progress, headed by former Clinton White House chief of staff John Podesta, has become the hottest Democratic think tank in a Democratic town.

Consider it an early warning signal of liberal assaults to come: While President Obama is directing the current battle, CAP is massing over the horizon for the next.

On June 3, Podesta joined a press conference with labor and ethnic leaders to launch a big new push toward further relaxation of America’s immigration laws—or, to borrow Podesta’s language, to “drive progressive change on one of the most pressing issues facing our country today.”

Immigration is a strange subject. It’s intensely controversial and yet—unlike health care reform or Guantanamo
or Mideast policy—there is remarkably little disagreement over basic facts.

Immigration confers a very small net benefit on the U.S. economy overall—there’s not much dispute about that. That small net benefit is aggregated from a very large benefit to certain constituencies (primarily the immigrants themselves, but also upper-income earners and owners of capital assets) and a very large harm to other constituencies (primarily less-skilled native-born workers).

At the same time, current policies impose very large burdens on taxpayers, especially state and local taxpayers. Immigrants, being mostly low-paid, pay relatively little in taxes. They are, however, heavy consumers of health services, education services, roads and prisons. It’s been authoritatively estimated that current immigration policies cost every California household about $1,200 per year in higher state spending.

Nor is there much disagreement that current policy allows longer-term problems to fester. The largest single group of immigrants to the U.S. comes from Mexico. While first generation immigrants work very hard, second-generation immigrants manifest all kinds of ominous behaviors: very high out-of-wedlock birthrates, low high-school completion rates, and—increasingly—disturbing rates of crime. Even third- and fourth-generation Mexican immigrants attain surprisingly low educational levels

It is above all current immigration policies that have caused the Education Testing Service—the authors of the SAT—to predict that the American workforce of 2030 will be less literate and less skilled than the workforce of 2000.

As I said, there is not much dispute about these facts. If asked, John Podesta himself would have to acknowledge them.

Happily for him, however, he can be confident he will not be asked. For if there is not much debate about immigration facts, there is equally little debate about immigration policy. Yes, there is fulmination on talk radio. But in the halls of power, everybody from Sen. Ted Kennedy to Sen. John McCain tacitly or explicitly agrees that the situation cannot be fixed and thus the only thing to do is continue on our current path. It’s really very striking that the Center for American Progress’ “progressive” immigration plan matches almost exactly the “compassionate conservative” approach advanced by President George W. Bush in 2001, 2005 and 2006: Both include a guest worker program, an amnesty in all but name and a promise of better future enforcement of immigration laws and labor standards.

It is as if nobody can imagine an alternative to McCain-Kennedy-Bush-Podesta. Well I can. Imagine this:

We should require all employers of any business of any appreciable size to use the government’s new and effective E-Verify program to check the work status of employees.

We should institute aggressive fines for employment of illegals. The maximum fine for even multiple violations of hiring illegal aliens was raised in 2008 to $16,000. By contrast, violations of the Clean Water Act can be fined up to $125,000 per offense per day. Plus, in immigration cases the government must prove the offender “knowingly” violated the law, generally an impossible standard. With environmental laws, by contrast, offenders are strictly liable: if you pollute you pay, even if you say you had no idea the sewage was leaking. It’s your job to know—and so it should be with immigration laws.

Then beyond that—do nothing.

Don’t build a border fence: It will trigger prolonged environmental litigation, cost tens of billions of dollars, take a decade to complete and poison relations with Mexico. In addition, it ignores the problem of visa over-stays—people who arrived legally in the first place but failed to return home when their visas expired—which are responsible for one-quarter of the illegal population. (The 9/11 hijackers for example all entered the United States legally-but 5 of them had fallen out of legal status at the time of the attack.)

Don’t grant amnesty by any name or form to the existing illegal population. In this economic crisis, they are returning home to Mexico in large numbers. In the first quarter of 2009, more Mexicans returned to Mexico from the U.S. than entered the U.S. from Mexico-net outmigration. Blogger Mickey Kaus points out that enrollment in Los Angeles schools has dropped seven percent since 2003, again very likely because of outmigration.

Through the first decade of the 2000s, illegal immigrants arrived in the U.S. at a rate of perhaps 750,000 per year. In other words, 750,000 of an estimated 12 million illegals have been present in the U.S. for less than 12 months! Maybe a million and a half have been in the country for less than 24 months. These people do not have deep roots in the U.S., and under a regime of more effective enforcement, many will voluntarily repatriate themselves.

On the other hand, many illegals probably will stay. Their children born on U.S. soil will be citizens. Those illegals who do not return home under pressure of stricter enforcement will either find a way to regularize their living and work arrangements (typically through marriage) or else will carry on living more or less as they do now. That’s not an intolerable outcome for them—they will have chosen it—and it is less bad for the U.S. than an amnesty that will only invite more illegal immigration. If the illegal flow can be blocked by more effective enforcement, the passage of time will resolve the problems caused by the presence of a residual illegal population.

Don’t raise total immigration numbers. Because U.S. law favors relatives of recent immigrants over all other categories, the legal immigrant population shares many of the characteristics of the illegal population: low levels of skill and education. For that reason, it would be wise to tilt the balance of immigration policy in favor of more highly skilled immigrants, as Canada and Australia successfully do. Failing that, the current rate of legal immigration is too high.

Finally: Don’t make unfulfillable promises to America’s Latino minority. Most of the survey data we have suggests that immigration is actually a relatively low priority for Hispanic citizens (as compared to professional activists). However, Hispanics like anybody will understandably resent having a benefit offered and then snatched away. A large majority of Americans reject the Bush-Kennedy-McCain-Podesta approach to immigration. It probably cannot pass Congress. But the passions triggered in such a debate could well alienate Hispanic Americans from the American mainstream for a generation or more.

It is important to all Americans that Hispanics settle into their new American identity and loyalty—that they become a typical American ethnic group, interblended with others, as the Germans, Irish, Italians, Poles and many others have done before them. It is vitally important that Hispanic Americans overcome their social problems, stabilize their families, improve their educational levels, and accumulate assets to catch up to the native-born. That will take time, probably multiple generations, and it will not be easy.

The current approach to immigration follows one of Donald Rumsfeld’s famous maxims: “If you cannot solve a problem, make it bigger.” Turns out, that’s not a very good maxim. Let’s try something different.

Originally published in The Week.

Gop: Obamacare Will Destroy The Best Health Care System The World Has Ever Known

June 11th, 2009 at 8:30 am 54 Comments

On Sunday, pharm a senior Senate Republican made his case against the Democrats’ plan for a “public option” for health insurance.

He explained that the public option would “be the first steps in… destroying the best health care system the world has ever known.”

There are very good arguments against the health care proposals being advanced by the Democrats.

This is not one of them.  And with only weeks before the full Senate considers a comprehensive health care reform package, rx such talking points will only undermine the Republicans’ efforts to challenge and improve upon the Democrats’ efforts.

As FF contributor David Gratzer has ably argued in the New Atlantis, the Democrats’ modest sounding public option would in fact deal a fatal blow to the private health insurance most Americans enjoy.

Disincentivize employer-provided group insurance through an employer-mandate and the taxation of benefits.

Establish politically motivated benefit packages with coverage mandates, that along with guaranteed issue and community rating, will drive up the cost of insurance.

And create an individual mandate with generous government subsidies.

It is clear where this will wind up.  With nowhere else to turn and no serious proposals for “bending the growth curve,” American taxpayers will be on the hook for another growing entitlement that will be paid for either by tax increases or government rationing of care.

Not a pretty picture.

But one way to guarantee that we wind up with a triumphant signing ceremony for comprehensive health care reform is to argue that America has the best health care system on earth.

While certainly decent compared to the alternatives, objectively speaking our health care system is a mess.  The government subsidizes the care of the elderly by stiffing doctors, who then pass along those costs to the privately insured.  In a post-industrial national economy, individual insurance decisions are subject to the regulations of 50 state insurance commissioners, undermining portability.  The government provides massive and regressive subsidies to employer-provided coverage, while providing practically meaningless tax breaks to those who seek care in the individual marketplace.

In other words, the system is pretty lousy and needs work.  Conservatives helped to make this case, first in the think tanks, then in President Bush’s proposal for health care reform, and finally during Senator McCain’s campaign.

It may be that the vast majority of Americans with private health insurance are satisfied with their coverage.  But they certainly worry, particularly in this economy, about a health insurance system that largely ties your opportunity for coverage to your employment. And they understand that their share of coverage is consuming an ever larger portion of their income.

In other words, they might be satisfied with the system, but they aren’t ecstatic about it.

They might have real concerns about who will wind up holding the bag for the Democrats’ reform.  But there is no special place in their heart for America’s insurers and pharmaceutical manufacturers.

And if Republicans’ opening shot is that the Democrats’ plan will undermine the greatest health care system on earth, Rahm Emanuel is somewhere smiling.

Welcome To The Waiting Room

June 11th, 2009 at 8:29 am 24 Comments

As the health care debate heats up, lawmakers are devoting their attention toward “extending coverage.”  While reducing the number of uninsured Americans is certainly a laudable goal, making this the first goal of healthcare reform is to put the horse in front of the carriage.  There are not enough primary care physicians to meet the demand for care among the existing insured population.  Adding 46 million patients without addressing the shortage of care options will overwhelm an already strained healthcare system.  Expanding coverage without expanding care will make an already inefficient health care system much, much worse.

Merritt Hawkins and Associates recently published the results of the “2009 Survey of Physician Appointment Wait Times” which it conducted to determine the average time that new patients must wait before they can see a physician in a variety of large metropolitan areas.  The study found that average wait times had increased by an average of more than a week since the last time they conducted the same survey in 2004.  As the study notes, “The survey is intended to gauge patient access to medical services and may be taken by healthcare professionals as one indicator of the current state of physician supply and demand in select markets and in select medical specialties.”  The vast increase in average wait times is a clear indication that there are simply not enough physicians to meet the demand for care that currently exists.

How bad is it?  On average, wait times have increased by 8.6 days per city. Boston had the longest wait, averaging 49.6 days, followed by Philadelphia with 27 and Los Angeles with 24.2. Residents of Washington looking for care could expect to wait an average of 22.6 days.  In the survey’s conclusion, the authors make no bones about what the survey’s results tell us:

Despite having a high number of physicians per capita, many of these markets are experiencing appointment wait times of 14 days or longer. The survey was conducted during a historic economic recession when physician utilization and hospital admissions are reported to be down. An economic recovery may be expected to increase physician utilization and extend appointment wait times. Boston, a city in a state that recently expanded access to healthcare coverage, shows the longest average times to schedule an appointment. These long wait times serve as a sign of what could occur nationally if access to healthcare is made more generally available through healthcare reform.

Although “Romney Care” (the 2006 health reform initiative that mandates that nearly every Massachusetts resident have health insurance) has not reigned in costs, none other than Massachusetts Senator Teddy Kennedy recently introduced legislation that copies the “Romney Care” measure of requiring Americans to own health insurance.

Adding 46 million people to the existing coverage pool without significantly increasing the amount of care available is nothing short of insanity.  Dr. Richard Cooper, a Professor of Medicine at Penn, pointed out to USA Today that the government is restricting education spending which restricts the supply of doctors yet the government is ambitiously moving to expand insurance coverage and access.  In other words, the government is suppressing supply while aggressively fueling demand.  As Cooper told USA Today, “This [expanding coverage] will demand more physicians. It’s like preparing for a war having previously decided to stop training soldiers. Madness.”

If President Obama and Democratic lawmakers go forward with their plans to create universal coverage without first addressing the already stretched supply of primary care physicians, we can expect to see wait times skyrocket nationwide just as they did in Boston.  If that happens, we are going to find out the hard way that individuals are not going to be willing to wait 50 days; instead, they will go to the emergency room… and when this starts happening, well if you think health care costs are out of control now, you ain’t seen nothin’ yet.  To have coverage without care is to have no care at all.