The healthcare dance

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A Wisconsin Political Fix
not just another blog
November 15, 2009

By Bill Kraus

Two great political adages are at play in the prolonged, complicated, contentious attempt to put together a new health care system for this country.

The first is that no one should have to witness sausage or legislation being made.

The second is that when major, complicated legislation is in the making (which you shouldn’t have to witness) the important thing is to get Mathilda on the dance floor.

Turf wars are what the health care bill is about, and it is a virtual golf course.

For openers, health care spending is 17 percent of our gross national product. This means that people and companies who are in the health care business are getting paid that 17 percent. That is the status quo that is being protected by insurance companies that do the paperwork, doctors and their helpers who do the mostly fee-for-service healing, hospitals that house the ailing, drug and device manufacturers that provide the stuff of which medical miracles are composed, administrators and managers who orchestrate this melange, and a collection of bystanders and outsiders whose interests are improved or threatened by the health care system and practices.

My own views on this collection of sausage makers:

1.) Insurers don’t belong at the table.
2.) Fee-for-service incentives rarely if ever lead to less of either.
3.) Physical facilities need to be kept full.
4.) Drug companies produce and promote the things they invent and sell; the cost of the former is irreducible; the cost of the latter is arguable.

The outsiders are too numerous to list but a small sample is that the ideologues led by groups as diverse as the Catholic Bishops, the anti-immigrationists, and the free marketeers are weighing in on medical practice policy in ways and with demands that mostly make change almost impossible.

With the lobbying costs running in the neighborhood of $4 million a day (an amount that is added to the “cost” of health care) and with the job protecting legislators being threatened or seduced by money and votes, it is impossible to produce anything approaching an ideal sausage out of the box.

Which gets us to Mathilda.

If anything is to happen, it is going to have to be imperfect, even a half measure.

The judgment that will have to be made is whether what does come out of the box is better than the status quo ante.

It is hard to believe that it will not improve on a health care system that costs twice as much as what is available in every other first-world nation and that delivers results that are no better than average and in many categories very much worse.

So let’s take what we can get, and, over time, improve on and expand the inevitably flawed sausage that is being assembled.

We couldn’t do worse. We can get a small or even a significant step in the direction of lower costs and better results, and once on that path we can do better and better and better. We will probably never get the kind of perfection the purists insist on. As for me, I’ll settle for, at long last, getting Mathilda on the dance floor.


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A bird in the hand

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A Wisconsin Political Fix
not just another blog
November 8, 2009

By Bill Kraus


The Impartial Justice legislation that was passed in the closing hours of the recent fall legislation session is the first attempt in 30+ years to clean up and contain campaign spending.

It has the virtue of being attacked from both sides. Those who like the status quo think it goes too far. The all-or-nothing reformers don’t think it goes far enough.

The latter group contend that the spending limits and public funding award are not big enough to run a statewide campaign. It is inarguable that they aren’t big enough for the kind of full-blown, TV-based campaign to which we have recently been subjected. But if both candidates conform to the limits, it is enough to run the more traditional word-of-mouth, face-to-face judicial contest and spare us all a repeat of the recent atrocities.

The more serious criticism of the bill is that it doesn't deal with the issue ads that have recently become prominent in Supreme Court elections.

The authors of the bill took a pass on putting an issue ad disincentive into it to accompany the millionaire and parallel campaign disincentives that were included is the U.S. Supreme Court. The court is pondering a decision which could make issue ad inhibition unconstitutional.

If they rule the way they seem to be leaning, the whole Impartial Justice bill would be voided. This is not a risk the reformers are willing to take after decades of no action.

They point out that if the Supreme Court surprises us there is a full disclosure bill in the wings which could be enacted quickly to expose and discourage the people who are paying for issue ads.

The other thing that makes this shortcoming less threatening is that WMC, one of the issue-ad wielders in recent years has already backed away from participation in supreme court races. And WEAC has said they would if WMC would. That does leave the semi-anonymous organizations with secret funders and apple pie and motherhood names free to perpetrate their mischief.

Any campaigner worth his or her salt would love to be attacked by these kinds of organizations. It gives the “victimized” candidate the opportunity to ask, “Who are these people and why are they saying these nasty things about me?” and to suggest that something unseemly is being bought here.

The side effect of over-the-top issue ads is the opportunity they present to make a low-profile beauty contest into an issue campaign with the campaign itself and its questionable interlopers being the issue.

And, finally, the Impartial Justice proposal, if it works as hoped, can be a good example for the partisans who are addicted to the egregious campaign system which they hate and believe they can't live without.

If public funding and spending limits work here, they can work anywhere.


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Death by wedgie

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A Wisconsin Political Fix
not just another blog
November 1, 2009

By Bill Kraus

The Republican death spiral started with the unintended consequences of the Watergate reforms. The party went from the main slater and funder of the campaigns of Republican candidates to a sideshow. The money got loose from what Ody Fish described as “the kinder mistress” and campaigns became entrepreneurial. The new sources of money came with strings and went directly to the more beholden candidates and the professionals who ran their campaigns.

The game of keeping the party centrist and fighting off the anarchists and one-issue people who were always there but were kept on the margin by the moderate, mostly business people, who were in charge, was no longer worth the candle.

The spin accelerated when the professionals who replaced the moderate, volunteer, amateurs (in quotes) introduced a segmentation-marketing strategy: the wedges.

They started with the anarchists who had always been there, had always had an insatiable appetite for reducing the size and power of the public sector, and had been barking up a tree that had long ago grown to Sequoia size in this country.

The professionals added the one-issue zealots to this base and partisanized the goals of repealing Roe v Wade, protecting a religious rite, and putting AK47 weapons in every closet.

These objectives wholly contradicted the anarchists’ view of the world and should have been anathema to them. But they accepted these strange bedfellows as co-conspirators for reasons to which I am not privy.

What was soon evident is that this new coalition was composed of people who dominate instead of assimilating. The moderates who didn’t leave of their own volition because of their distaste for this distortion of the party’s agenda were pushed out because they didn’t conform. True believers do this.

This coalition, which is more notable for its volubility than its volume, starting losing elections.

But they persist. As recently as last week the unholy combination got rid of a moderate who was running for an open congressional seat because she would split the Republican vote in this once-safe district and cost the coalition’s troglodytic candidate a special election.

Will this radical revisionist lose this safe seat?

Will that register on the wedgers if he does?


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