Debating health care

Paul Krugman has been correct about the recent rightward drift of the Obama campaign, especially on health care, as the Illinois senator attempts to separate himself from Hillary Clinton and John Edwards and potentially draw in some independents. And Krugman is right that health care is probably the most important domestic issue of this campaign.

But, as this post from Scarecrow on FireDogLake demonstrates, the Clinton and Edwards plans are only partial fixes, better than Obama’s incomplete plan and everything that has been offered by the GOP.

A key point is that “mandates” require penalties, and you need economic experts to design a “good” penalty system that will lead companies (or individuals) to make rational decisions that are consistent with the result you want to achieve, without adding significantly to the total cost.

Individuals also face these kinds of choices. If they confront a “mandate,” the rational thing to do is to consider the “penalty” for non-compliance versus the cost and benefits of complying. In Massachusetts, the Legislature was leery of imposing tough penalties on the uninsured, so the first year penalties are quite small — only a fraction of what it would cost to purchase insurance on your own. Result: many people are deciding, quite rationally, not to purchase insurance.

Finally, there’s the state subsidized pool. The rational thing for employers and individuals to do is to avoid providing/paying for insurance on their own, pay the small penalty, and move those who choose this route to rely on the subsidized insurance pool. Perfectly rational; perfectly predictable; and that’s what’s happening.
Because of the incentives, thousands of people are winding up in the state subsidized pool, and the Legislature is looking at $150 million or more in unanticipated costs. And that apparently has been the pattern in other states that have tried “mandate” approaches to universal coverage, but gave up because they weren’t willing to raise taxes to cover the rising costs of state subsidies. You need a broad tax base for that, and progressive taxation.

And that’s OK, as far as it goes. But penalties and taxes — especially when taken together — leave the insurance companies in place. Despite what Krugman says about there being a public option, mandate-based programs still rely on insurance companies to cover the bulk of Americans — while also creating a potential situation in which the poorest people are forced into the public portion of the program. That could raise the cost of a public program artificially, making a move to a full public system difficult down the road.

And make no mistake, if we are to ensure that all Americans have adequte insurance — and the issue isn’t just about the 47 million without coverage, but also about the millions who are underinsured — then we need to move to a single-payer system.

Unfortunately, only Dennis Kucinich among the presidential hopefuls is talking about this. And he isn’t being taken seriously by the news media, meaning that single-payer has been removed from the table.

South Brunswick Post, The Cranbury Press
The Blog of South Brunswick

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Number’s game on MOM

NJ Transit released a new set of ridership figures that have supporters of the Monmouth Junction variant of the MOM Line crowing.

The figures show that the line running through Monmouth Junction would likely attract 27,450 riders per day, while the Matawan line would attract 24,050 riders and the Red Bank line would attract 16,800 riders. A study from 2005, which assumed a Newark terminus, projected that the Matawan route would have the most riders at 10,900 daily trips, followed by Monmouth Junction at 9,000 trips and Red Bank at 7,900 trips.

The change, according to NJ Transit, was based on two new assumptions: a change in destination from Newark to New York, thanks to a proposed new tunnel under the Hudson River; and new population estimates that go out an extra five years to 2030, which increases anticipated population in western Monmouth County.

I won’t dispute the numbers — NJ Transit didn’t provide a lot of background this week — but focusing solely on the ridership numbers, as Monmouth Junction supporters have been doing creates a misleading picture of the MOM debate. There also are the cost estimates, which peg the South Brunswick line as the most expensive to build and run. The Monmouth Junction alignment would cost $860 million to construct and $49 million to operate, compared to $600 million and $42 million for the Red Bank option and $730 million and $45 million for the Matawan option, according to a 2005 N.J. Transit study.

So consider this: The Monmouth Junction line would serve about 14 percent more riders, but cost about 18 percent more to build than the Matawan line.

In a time of tight budgets, the money should be an important factor — as should the concerns of the people in Middlesex County who would have to live along the route.

For southern Middlesex County, the Monmouth Junction alternative still makes no sense.

South Brunswick Post, The Cranbury Press
The Blog of South Brunswick

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Exactly who are the cynics, anyway?

Glenn Greenwald makes a pretty salient point today in discussing the Beltway tendency to dismiss “anyone who aggressively objects to the Bush administration’s extremism, and especially its lawbreaking,” as “either fringe, unSerious, overly earnest losers,” or “simply pretending to be bothered by such things in order to rouse the rabble and exploit them for cynical political gain.”

Anyone who disrupts Beltway harmony in order to hold the Bush administration accountable — anyone who seems actually bothered by the rampant lawbreaking — is thus easily dismissed as an annoying radical or a self-promoting fraud.

Greenwald’s issue is with the manner in which Senate Majority Leader Harry Reid, though a staffer, attacked Connecticutt Sen. Chris Dodd, a fellow Democrat, because Dodd refused to go along with Reid’s — and most of the rest of the Democrats’ — support for granting telecom companies immunity for their involvement in the Bush eavesdropping scandal.

After all, it can’t possibly be the case that Dodd actually believes in what he’s doing and saying. He can’t really care if telecoms are protected from the consequences of their years of deliberate, highly profitable lawbreaking. Clearly, Dodd’s just doing all of this to prop up his flagging presidential campaign, just a cynical ploy for attention, not because he has any actual convictions that there is something wrong with granting such an extraordinary and corrupt gift to lawbreaking telecoms. No Serious person would ever actually get riled up about anything like that.

Greenwald connects the Reid attack on Dodd to similar dismissals of Russ Feingold, the Wisconsin Democrat, last year.

Feingold was one of the few voices on the national political scene who actually objected meaningfully to the fact that the President was deliberately breaking our laws in how he spied on Americans ever since October, 2001. Feingold spent the year espousing what ought to have been the uncontroversial proposition that for Congress simply to look the other way and to ignore these revelations of illegality would be to reward lawbreaking and eviscerate the rule of law. But his motives were impugned by the Beltway establishment exactly as they are doing now to Dodd.

In March 2006, when Feingold introduced his Resolution to censure the President for breaking our laws, the super-sophisticated punditocracy, GOP Bush apologists, and the highly responsible Betlway Democratic establishment all jointly scoffed at Feingold, oh-so-knowingly dismissing his little outburst as nothing more than a cynical ploy to shore up the “leftist base” as he prepared to run for President. After all, nobody could really take seriously the idea that Bush shouldn’t be allowed to break our laws. The only possible motive for pretending to care is that Feingold wanted to scrounge up support for his presidential campaign.

Feingold announced in November, 2006 that he wasn’t running for President, yet he continued to pursue these matters with exactly the same tenacity and intensity as before. There he was this week, standing with Dodd against warrantless surveillance and telecom immunity, even though — as a Senator from a far-from-blue state — there is little political benefit and some risk in his doing so.

So perhaps Feingold was sincere all along, maybe he does genuinely believe that the President and the telecom industry shouldn’t be permitted to break our laws with impunity. But that thought is beyond the reach of our Establishment guardians. Because they believe in nothing other than their own petty Beltway rituals, they assume everyone else is similarly barren and empty, bereft of any actual convictions about anything.

The point here is that the entire political culture of Washington has become enamored of its own cynical games. The folks at the center of it — the politicians of both parties, the media (both print and broadcast) and the various paid consultants, lobbyists and assorted hangers-on — have lost sight of what matters. Everything is about advantage, money and power and those politicians who are willing to act on something more noble like Dodd and Feingold — and like Ron Paul and Chuck Hagel on the Republican side — are deemed to be rabble rousers of the worst sort and shunted to the outside of the process.

Dodd’s quixotic presidential bid — you have to know that he knows he’s tilting at windmills — offers him a platform on which to make his case about FISA in the same manner in which Bill Richardson is using his platform to agitate for withdrawal from Iraq and John Edwards is using his to draw attention to the nation’s economic disparities.

Might there be ego involved? Of course. I have never met a politician at any level that did not have some inflated sense of himself. But there has to be more to it than ego and cynicism. And if there is not, then we are waging an unwinnable war to save our democracy.

South Brunswick Post, The Cranbury Press
The Blog of South Brunswick

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