Monday, May 25, 2009

Obstacles to health care reform

A Wisconsin Political Fix
not just another blog
May 25, 2009

By Bill Kraus

As the protectors of the status quo gather their forces to keep the “it works for me” current system intact and prove again NY Times colmunist Bill Safire's prediction from 30 years ago that we were headed for a political condition best described as hardening of the arteries, one incongruity is evident.

A dramatically changed health care system worries the organized doctors and probably the other organized medical people like nurses, and technicians of all kinds as well.

Hospitals, clinics, and other organizations with physical facilities made their investments assuming that the status quo would pretty much stay intact too.

The pharmaceutical business seems to be thriving--if its advertising expenditures are any indication of how well its doing.

All of these people and companies deliver the health care product.

The insurance companies that are expected to line up with them do not. What they deliver is a payment process for the deliverers and a cost-control function for the organizations and people who pay them to pay the deliverers.

They are in the middle of the process clipping the money as it goes by to its own corporate advantage it appears.

It was not always so. When I got a bleacher seat in an entry-level job in the insurance business several decades ago Harry Truman was president and the British had invented what is now described as socialized medicine. The Brits were having some problems with the demands put on their plan by the worried well, but the idea still had enough bounce to convince President Truman that it would work here and should be enacted.

My recollection is that the opposition to this proposal was led by the doctors’ American Medical Association and the country’s dominant business organization, the U.S. Chamber of Commerce.

They convinced the insurance industry that to save the country from socialism or worse, companies would have to offer an alternative medical care payment plan based on employer funded health insurance.

I can only speak for the insurance company that I worked for, but I recall that we answered the call reluctantly. We didn’t know anything about this kind of insurance. We even wondered if we were dealing with insurable risks in the traditional sense. Worse yet, we were sure that we would lose money on the deal. Insurance companies at that time kept something like 30 percent of the premiums they collected to do all the things insurance companies do. The way this new health insurance business was being structured, they would get about a third of that. Not enough.

What insurers obviously have figured out in the ensuing 60 years is either a way to get a bigger piece of the pie or to make money at whatever level they are able to charge.

What they have also become, which gives them a seat at the table of the organizations likely to resist major changes in the health care system, is the naysayers. They set reimbursement policy. They decide what to pay and which medical procedures to pay for.

This is something far short of the free market that operates in other sectors of the economy, but since insurers are not government agencies this is not regarded as “socialized medicine,” even though that is what it looks like.

Whatever it is, I do wonder why those who are working on modifications still give the money-shuffling insurance industry a seat at the table and a full say in the deliberations.

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Sunday, May 17, 2009

Old thinking in a new economy

A Wisconsin Political Fix
not just another blog
May 17, 2009

By Bill Kraus

The state’s responses to the great recession, or whatever label one chooses to apply to the current malaise, is predictably bureaucratic. Hunker down. Cut fat, maybe a little muscle. Keep the process intact. Protect the system. Assume that this too shall pass and that there will be a return to most of the status quo ante later if not sooner.

What if these assumptions are wrong?

What if we not only have moved into a needs economy instead of the prior wants economy, but we’re going to stay there for a very long time?

The signs pointing to the future are never particularly clear, but they exist, and it would be hard, even foolish, to ignore them. A few come to mind:

This is not going to be an automobile-driven economy. Cars and trucks will be purchased because we need them not because of fashion or even technology.

It is unlikely that we can afford our free-market health care system. The results aren’t all that spectacular. The costs are non-competitive in a global economy. We’ve all known for a very long time that General Motors’ Blue Cross bill is larger than its bill for steel. The reality is that we have universal health care. We just have it in the most inefficient, costly form imaginable.

Even after we recover from a seriously overbuilt housing market (Milwaukee is a shrinking city, which is part of the problem, but anyone trying to sell a condo there is told that it will take seven years to clear the current inventory) it is hard to believe that we will ever buy and sell houses like we buy and sell stocks and bonds again.

While a lot of the troubles in the financial sector are due to the ineradicables of greed and stupidity, it is hard to imagine a return to the kind of unregulated fiscal adventures that suborned so much of the unconscionable debt that the feds are trying so desperately to detoxify or demolish.

The world, in short, seems to have changed in major ways, and the response to those changes has to change as well.

The governor and Legislature are reducing outlays to established programs and trying to not add to the citizens’ economic troubles by adding to their taxes.

Not easy. Not enough. Worse yet, maybe not responsive.

One of the things that has distinguished Wisconsin throughout most of its existence, and particularly early in both the 20th century and the New Deal, is creativity, imagination, and the daring to innovate when faced with novel problems.

I assume and hope that we have not lost those attributes and that the creative juices are flowing on both ends of State Street.

We’re all waiting.

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Monday, May 11, 2009

Wedge reform

A Wisconsin Political Fix
not just another blog
May 11, 2009

By Bill Kraus

To steal from an old song title, “It’s beginning to look a lot like Italy” in Wisconsin.

We have the Wedgers’ GOP, which operates on the absurd premise that if they stack up enough single-interest groups they will get the general interest. Lately they don’t even get a majority which will win elections.
We have the anti-taxers, who are really anarchists in disguise.

We have the Wisconsin Prosperity Network, which does what the Republican Party was organized to do but does it independently, outside of, alongside of, and in competition with the party or something.

And, of course, we have the party itself which, despite the energetic efforts of its new chairman, seems to have been abandoned to or taken over by the pro-life, anti-gay, pro-gun sideshows.

This rush to fragmentation seems to have been inspired by misreading the success of the Democrats with their One Wisconsin Now, Greater Wisconsin Committee and Advancing Wisconsin organizations.

A couple of things seem to have been overlooked.

First, the Republicans longest recent run in power was under the aegis of Big Tent Tommy Thompson, who welcomed all the interests and was beholden to none.

Second, the Democrats’ success in 2008 was clearly due to the ability of Barack Obama to unite the incompatibles within that party and to attract large numbers of unaffiliated newcomers plus a lot of the disaffected, unorganized “former Republicans” who felt they were not leaving the party but the party had left them.

My suggestion to the GOP was to rebuild the big tent party, reunite the factions, support their new pragmatic centrist leader, and marginalize the sideshow single social-issue groups.

To do this on a scale large enough to put the party in its once dominant position it will be necessary to get the money flowing back to the proprietors of the big tent.

A way to do this was proposed in 1980.

1. Prohibit political action committees from contributing directly to individual campaigns.

2. Reduce the limit that individuals (including the candidates themselves) can contribute to candidates.

3. Raise the limit that political action committees can contribute to political parties.

Is there a candidate or a potential candidate who wants to unify instead of segment the voters?

If so, please step forward before the Wisconsin Republicans are divided into so many camps that they make Italy look monolithic.

Footnote: the speech outlining the reasoning behind these 1980 proposals and what enacting them was intended to do can be found in the State Historical Library. I also have a copy, and will forward it to anyone who can show me how to scan it into my computer.

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Monday, May 4, 2009

Getting the Party started

A Wisconsin Political Fix
not just another blog
May 4, 2009

By Bill Kraus
The Republican Party has to deal with two barriers to revival. One is shared by the Democratic Party.

The parties both need to get a major role in the election process. Due to a series of miscalculations compounded by the immutable law of unintended consequences, the power to slate, fund, and run elections has become the province of legislative leaders at that level and of entrepreneurs at the executive level.

The activists who might be attracted to politics are not going to put out the time and money to win a game that isn’t worth the candle. So the parties play a diminished role.

There are ways to restore them to their previous eminence. No one who has the power to do this seems to be interested.

The other barrier, the one that gets most of the rhetoric and attention, is the image that has been part and parcel of the tactics the wedge-addicted mercenaries have brought to the recent campaigns, particularly Republican campaigns.

Like it or not, true or not, the Republican image is that the party is a creature of or led by the anti-choice, anti-gay, pro-gun factions that are said to be its base.

If this is so, if this is what being a Republican is all about, it is a major departure from the traditional core values of the party--frugality, competence, free markets, personal responsibility, opportunity.

A young woman at the recent Wisconsin Republican convention was quoted as saying it would be a mistake for the party to move away from the anti-abortion anti-gay marriage voters who are the party’s biggest voting group.

What she overlooks is that this voting group has not and cannot win elections, and cultivating those causes and that image repels the moderates and independents who could otherwise be attracted to the traditional core values of the party. They might even come in large enough numbers to win elections.

Too risky?

Never been done?

Except in 1948, when Harry Truman won an election against three opponents, two of whom--Henry Wallace and Strom Thurmond--led major factions within his own party.

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