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Why the Health Care Law is so Complicated / Gerald F. Seib

Why New Health Law Is So Complicated

http://on.wsj.com/1byWoH

The rollout of the Affordable Care Act is in trouble, functionally and politically, and the simplest critique of the new health law is that it’s simply proving too complicated. Indeed, its complexity—the need for multiple pieces to work in harmony from the outset—is the single best explanation of why its introduction has been so problematic.

What’s less recognized is why the new law is so complex in the first place: It represents what may be the biggest attempt ever to weave together big-government impulses with free-market forces.
 
That is what sets Obamacare apart from other big efforts at social engineering. The effort to improve health care would be much simpler—though no less controversial—if it instead took the form of the dream system that either liberals or conservatives would love to create.
 
For liberals, that ideal would be a single-payer system in which the government simply bypasses the health-insurance system and provides coverage for everyone. For conservatives, the dream system would place health care firmly in the hands of the private sector, with insurers and doctors handling decisions and the government providing aid directly to those without the resources to buy their own coverage.
 
In that sense, it is an even grander experiment than commonly recognized. Whether it ultimately works or is seen as a hopeless Rube Goldberg machine may well determine whether such an effort, on such a scale, will be attempted again.
 
To see the challenge, consider how the Affordable Care Act incorporates elements of both worlds. It is built on the back of the current, private employer-based insurance system.
 
Two of its fundamental components—health-insurance exchanges and the individual mandate—actually began as Republican ideas, conceived as ways to better put market forces and the conservative notion of personal responsibility to work in the health sphere.
 
Exchanges are simply health-insurance marketplaces that, while organized by law, are meant to foster competition within the private sector by bringing together multiple insurance companies and their policies to jockey for consumers’ business.
 
Early exchanges were created by two Republican governors, Jon Huntsman in Utah and Mitt Romney in Massachusetts.
 
And the idea of an individual mandate—that every individual be required to acquire health insurance to improve the efficiency and fairness of the broader system—was advanced in a 1989 publication by the Heritage Foundation, a conservative think tank. It argued that requiring every household to have coverage would ease the burden on businesses, and prevent any household from placing an undue obligation on society to provide it with health care.
 
If exchanges and the individual mandate represent two pillars of Obamacare, the others come out of the playbooks of Democrats and liberals.
 
The dream of insuring millions more Americans is possible only with significant expansion of a classic government benefits program, Medicaid. It provides government health coverage directly to the poor and many of the elderly—and is the very route by which the largest number of Americans are taking advantage of the new law. Other coverage expansion comes through direct government subsidies to the working poor.
 
In addition, the dream that health care be made not merely available but robust for all is to be achieved through a basic liberal impulse, which is to simply impose new standards that all health policies have to meet.
 
This regulatory impulse, of course, is what pulled President Barack Obama into a nasty trap over the past two weeks, and it presents a classic illustration of why it is so hard to reconcile market forces and regulatory impulses at the same time.
 
The idea, oft articulated by Mr. Obama, that “if you like your insurance you can keep it” under the Affordable Care Act neatly captures the free-market impulse behind the plan: No, the government isn’t supplanting your private insurance. And in theory it isn’t. But the law’s imposition of standards for acceptable policies—and the unavoidable reality that some people will lose policies that don’t meet them—sends government mandates running smack into free-market impulses.
 
Is it possible to weave together big-government ideas and free-market forces? In smaller ways, it has been done. States already intervene in both the health and auto-insurance markets, though in more limited ways.
 
The explosion of 401(k) retirement programs is, in a sense, also an example of government power and market forces working in tandem: Government sets the rules and provides the incentives, but private investment firms handle the money, the risks and the rewards.
 
Can merging the two impulses be done successfully on this scale? That’s the big question hanging over Obamacare, and the answer will determine its fate.
 
Write to Gerald F. Seib at jerry.seib@wsj.com

Jon Huntsman’s departure from the 2012 elections … or not?

NPR’s Jon Elving has raised the question of whether the recent news about Jon Huntsman’s departure from the race for the Republican nomination is really the last we’ll see of him. He wonders whether Huntsman could emerge as the nominee for the Americanselect.org. Americans have spent the last year asking themselves, “who is Jon Huntsman?” Now the question is, “what is Americanselect?” And could Jon Huntsman be on the ballot this November if he is nominated at Americanselect’s convention? That convention is an online effort to get an alternate candidate elected whose nomination will come from real people and not through either of the major parties, Republican or Democrat. Check out the following link: http://youtu.be/Tp3Hn6BSy5s to learn more.

Americanselect is a secure process that will allow voters to use the internet to nominate candidates. It was started by one wealthy investor and has been supported by others whose names have so far not been disclosed. With 40% of voters identifying as Independents this year, this is already shaping up to be an interesting year. But this concept of a digital revolution that circumvents the media and traditional nominating process, could make it a radical one.

NPR on Huntsman’s departure from the race for the Republican nod

40% of voters identify as Independents

 

Ouch! Can Rick Perry recover?

Ouch! Can Rick Perry recover?

I have a new theory about the Republican cast of presidential characters, I mean candidates.  I’ve suspected for a while that the reason the GOP has let Rick Perry and Michelle Bachmann on stage is that they make Mitt Romney look so good.  In the past, Romney just wasn’t able to light a spark with the general public.  Now as each of his competitor’s crashes and burns, Romney’s liabilities look like major assets.  Boring?  I would say stable.  Too smooth?  He’s never forgotten the names of the federal agencies he’s planning to trim.  A flip flopper?  I would say he is smart enough to evolve on positions that matter and that he isn’t someone so inflexible that he won’t admit if he’s changed his mind.   I don’t mind people evolving on issues.  At least it shows some measure of thought.  I still like Jon Huntsman (I think he’s funny. And every campaign should be punctuated by moments of wit like when he said Romney was “scared mittless.”) but there is no denying that Romney is looking absolutely presidential.  He is being totally forthright about the reality that Medicare is going to have to be reformed, he has been steadfast about the need to stop the ballooning federal debt, the fact that he wanted to insure the uninsured in Massachussets is a plus to socially liberal Republicans, and he has experience creating jobs, our country’s top priority right now.    I think a successful businessman like him might have more luck prodding businesses to use the cash they’re sitting on to create jobs than our current President who has lost his credibility on matters financial.

The GOP debate: 6 takeaways

The candidates wave before the Michigan debate. | Reuters

Answers by Cain and Romney are footnotes after Perry’s epic onstage meltdown. | Reuters Close
By MAGGIE HABERMAN | 11/10/11 1:26 AM EST Updated: 11/10/11 6:14 AM EST

In a season of memorable debates, the non-mudfest in Michigan made instant history.

Questions to Herman Cain about sexual harassment allegations and to Mitt Romney about letting banks foreclose on people’s homes were largely footnotes after Rick Perry experienced an epic onstage meltdown.

Below, six takeaways from the two-hour CNBC-sponsored event.

The “oops” heard ‘round the world

It’s hard to overstate how badly damaged Rick Perry is after the debate, one in which he overall performed more or less well — save for about 50 seconds.

That was how long it took the Texas governor to concede he couldn’t recall the third federal agency he’d eliminate as president.

In what at first seemed like light-hearted self-parody, Perry grasped desperately for agency names: “Commerce, Education and the uh…..the third agency of government I would do away with… Education, the, uh, Commerce, and…I can’t. The third one, I can’t. Sorry. Oops.”

Moderator John Harwood interjected at one point with, “Seriously?”

Later, on a different question, Perry said he had been searching for the Department of Energy — an agency he has no trouble remembering when he gives his stump speeches.

But the damage was done.

Twitter lit up with mocking commentary, and Perry supporters emailed that they suspect his candidacy — already reeling from self-inflicted wounds — is now being removed from the machines keeping it alive. The damage was so clear that Perry himself went to the post-debate “spin room” to own the mistake with reporters and try to make light of it (he was glad he wore his boots because “I stepped in it.”)

Indeed. His campaign spokesman Ray Sullivan told reporters and interviewers that Perry was right on “substance” if not “style,” and he took a clear, if veiled, shot at Mitt Romney as a “robot.”

It’s conceivable that reports of his immediate demise may be overly pessimistic, in such a volatile year. And plenty of people on Twitter, amid the derision, expressed sympathy for a stumble that many people go through routinely, albeit not on such a big stage.

But Perry’s already been struggling to fundraise in recent weeks after his poor debate performances and sinking poll number. With the moment playing on a cable news network blooper reel, this won’t help.

Perry’s problem for weeks has been a sense that he can’t handle himself in a debate, can’t think on his feet, can’t illustrate depth, and can’t take the rigors of a campaign. Wednesday night’s performance will essentially cement that view for GOP primary voters, just as he was hoping to woo them back with a positive, “I’m-one-of-you” message in Iowa.

The brain bubble would have been problematic regardless, but it was particularly so because Perry has spent the past two week answering questions about whether he was on something when he gave an over-animated speech in New Hampshire.

His best hope, sadly, is that the cable TV nets focus so heavily on Penn State coach Joe Paterno’s child-sex abuse scandal that the visual of his brain freeze moment doesn’t get as much air time.

That’s not much to hang his campaign’s future on.

Read more: http://www.politico.com/news/stories/1111/68047.html#ixzz1dJ191Hks

Are you dialing in to the debates?

According to CNN, 3.6 million people watched the Tea Party Express Republican Presidential Debate on CNN last night, 1.1 million of them in the coveted age bracket between 25 and 54.  What is interesting to me is that means 2.5 million of them were either under 25 (unlikely) or over 54.  My guess is it was the over 54 crowd that tuned in in a big way to hear about Medicare, Medicaid and Social Security.  Social Security was one of the dominant topics.  While Gov. Rick Perry has referred to it as a Ponzi scheme in the past, he said Monday night that it will be there for anyone who has paid in.  Mitt Romney gets the bold stroke award for having the guts to come out and say it will be there for those now drawing benefits but it probably won’t be there in its current form for those in their 50s and young people just starting to pay into the system.  Don’t forget the Congressional Budget Office has already said Social Security will be paying out more than it gets by 2016. 

In the meantime, I thought I would highlight some of the better quotes from the debate.

Newt Gingrich quoting Ronald Reagan, “Turn up the light for the people so they can turn the heat up on Congress.”

Jon Huntsman on Mitt Romney on Social Security, “Gov. Romney called it a fraud.  Don’t know if that was written by Kurt Cobain.”  Kurt Cobain?  As in Nirvana?  Hmmm.

Michelle Bachmann, “It’s easy to turn around this economy.”  You don’t really think that, do you?

Jon Huntsman, “We have a heroin like addiction to foreign oil.”

Newt Gingrich, “We can balance the Federal Budget.  Be smart rather than cheap and actually modernize the Federal Government.”

 http://www.washingtonpost.com/blogs/fact-checker/post/fact-checking-the-cnn-and-tea-party-express-debate-in-tampa/2011/09/12/gIQAPCkXOK_blog.html

http://www.politico.com/news/stories/0911/63445.html

Are 8 minds always better than 1?

Are 8 minds always better than 1?

Politicians are breaking out all over this week as the 2012 Presidential Election is officially on.  First, there was the Republican Presidential Debate hosted by Brian Williams at the Ronald Reagan Library.  Then Obama’s pitch to Congress to pass his more than 400 billion dollar job creation package NOW.   You can go deep on both by following the links below and in the Daily Dose but just to get your attention – did anyone else notice that Michelle Bachmann wore the same blouse in Simi Valley that she wore for the debates in New Hampshire?  (A nod to austerity or a suspicion her campaign was about to be short lived?) Or that Ron Paul’s stylist needs to tell him to pull the seat of his jacket down so the gap between the back of his neck and the collar of his jacket isn’t an even wider gulf than the US debt?  I admit we have far bigger problems to worry about but on a totally superficial note, there seemed to be a “too worried to pay a tailor or stylist” air to the whole line of ’em.. 

So, who won the Republican debate?  I think it was Mitt Romney – and not by a little but by a lot.  Romney is fighting … and finally cutting through.  He looked positively presidential next to a slightly goofy Rick Perry who was beaming and giving the thumbs up, a little like an 11 year old being praised by his teacher, when Romney mentioned his book, “Fed Up.”  Perry is telegenic and came out slugging but never seemed as cerebral or convincing as Mitt Romney.  His arguments about job creation in Texas did fall flat when you consider his state also has among the largest populations without health insurance and that no other state has as many workers making at or below minimum wage.  And if Americans already thought Republicans were mean, I don’t think it helped when Rick Perry told Brian Williams he hasn’t lost any sleep over the 234 criminals executed under his watch as governor of Texas… and the crowd broke out in cheers!  The exchange that everybody loved was when Perry told Romney Michael Dukakis created jobs 3 times faster than he did and Romney shot right back, “Well, George Bush created them a lot faster in Texas than you did.”  That’s the Romney people have been waiting to see.  Just for fun, I went back and watched the New Hampshire debates and Romney was practically mute that night compared to this debate’s “Mitt This” approach.

The “not wild enough to be a wild card” Jon Huntsman continues to be a favorite if for no other reason, because he is so earnest.  I loved when he beefed up his internationalism by saying he would like to address the Chinese people with a speech he would give in China IN CHINESE.  He also gets kudos for being a Republican who takes global warming seriously – something his rival Romney doesn’t.  And Huntsman gets points for chiding Romney about his aggressive stance on renegotiating trade deals by saying, “It might not be a good idea to start a trade war in the middle of a recession.”

As far as Pawlenty and Santorum, I’m afraid they are morphing into the same candidate for me.  The whole time Gingrich was talking, I couldn’t get the song, “I’m still Standing” out of my head!  He has a sort of pasty, days of old look on his face but if you get past his likeability factor, he is saying some really smart things, like that this campaign has to be about more than the Presidency, it has to be about electing legislators who will support the President’s agenda to address our economic woes.  And that NASA needs to get out of the way and let private industry innovate and execute the future of space.  And you can mock Herman Cain’s candidacy but you have to appreciate his one liners.  I’m still laughing at “the Stimulus Plan didn’t stimulate diddly.”  But I loved last night’s 9-9-9 tax plan (9% income tax, 9 % corporate tax, 9% sales tax) because if 10% is good enough for God, 9 percent should be good enough for the Federal Government. 

http://www.washingtonpost.com/politics/gop-debate-at-the-ronald-reagan-presidential-library/2011/09/07/gIQAmBJQAK_gallery.html

http://www.usatoday.com/news/politics/story/2011-09-07/News-analysis-Perry-GOP-frontrunner-under-fire-at-debate/50307818/1?csp=34news