One of the little discussed but probable consequences of making health care both universal and less rewarding monetarily for doctors is an inevitable shortage of doctors. The UK has had such a problem for years. They recently raised compensation for doctors by 50% in hopes of attracting more (the average salary is now 108,000 pounds). They also hoped that the raise in pay would see more British doctors working the odd shifts and weekends.
Apparently the opposite has happened:
The NHS is having to rely on doctors from overseas because a lucrative new contract for British GPs has resulted in more than 90 per cent opting out of responsibility for their patients in the evenings and at weekends.
Consequently, one-third of the primary care trusts (PCT) are flying in foreign doctors (from Poland, Germany, Hungary, Italy, etc) to treat patients “off hours” and on weekends. That obviously drives up costs, and the exhausted doctors have been killing patients, unfortunately.
So there’s a lot of hand wringing going on about the use of foreign doctors. But for anyone who has studied markets, what has happened there is a natural reaction to centrally imposed salaries. If the average is now 108,000 pounds and it is a 50% raise, you can figure that doctors previously were making less than a good auto mechanic. Why spend the time and effort to become a doctor for such mediocre compensation?
Probably more interesting is the fact that the same doctors now making better money for their type of work, have opted not to participate more in “off hours” and “weekends” figuring they’re still not being compensated enough to do that. Call it a passive but effective way of protesting their wages.
The NHS feels that its increase in wages will help solve the problem of the internal doctor shortage:
A spokesman for the Department of Health said: ‘The NHS has always used professionals trained abroad because until recently we did not train enough for our own needs.
The phrase “until recently” implies that now they are. And it stands to reason the new wage will attract more to the profession than the old wage did. However, will they be “enough”? And will they too “opt out” of “off hours” and weekend care? If so, the problem remains – central planning will decide their work is worth “X”, the doctors will decide it is worth “Y” and until they get “Y”, they will continue to opt out.
That of course means the importation of foreign doctors will continue to grow as it has in recent years. The money that could be going to British doctors will go to the foreign ones. And British doctors will continue to refuse work on off hours and weekends while foreign doctors kill their patients.
A lovely system, wouldn’t you say?
The Republican Party is hopeless.
Given a meta-issue from heaven (smaller government, less intrusive government, less taxation, less spending) and a building mandate as exemplified by the anger at townhall meetings, they manage to fumble it completely.
Instead of actually addressing the problem (see meta-issue) they pander and play politics. Instead of talking about market solutions and less government, they decide to establish government health care as a civil right.
The Republican Party issued a new salvo in the health debate Monday with a “seniors’ health care bill of rights” that opposed any moves to trim Medicare spending or limit end-of-life care to seniors.
Intended as a political shot at President Barack Obama, the Republican National Committee manifesto marks a remarkable turnaround for a party that had once fought to trim the health program for the elderly and disabled, which last year cost taxpayers over $330 billion.
What Republicans would commit us to by making this guarantee is debt your grandchildren, and perhaps their grandchildren will have to pay to the tune of 58 trillion in unfunded liabilities. In other words, the promised benefits for Medicare are underfunded by 58 trillion in the outlying years and the Republicans have just guaranteed them. With what is anyone’s guess, but certainly not with “less taxes and less spending”.
The other thing they do, apparently unwittingly, is make health care a “civil right” (how else do you interpret something the Republicans would call a “seniors health care bill of rights?”).
That is all the opening the left needs to, at some point, throw it back in the Republican’s lap and ask why such a right exists for one group of citizens but not another. The “fairness” police will have a field day with this and the Republicans will have no answer.
If this move is indicative of the level of intelligence and leadership within the Republican party, I say go hire any random person off the street to run the party. They could not do any worse. They have a political opponent in the middle of self-destructing, and they make a dumb move like this.
As they say, you can’t fix stupid.
Today Paul Krugman attempts to make the case that “government intervention isn’t always bad”. However, he says such an argument has a tough time establishing itself because the “zombie ideas” of Reaganism just won’t die, i.e.”government intervention is always bad.”
You know, I don’t remember it that way at all. In fact, few will argue that all government intervention is bad, to include Ronald Reagan. Reagan did say that most times not only is government not the solution, but it is the problem. But I’m not sure that translates into what Krugman is claiming.
As we’ve said many times, the primary function of government is to protect the rights of its citizens and it does so by protecting them from force or fraud. That obviously requires some level of government intrusion and intervention. I don’t think Reagan saw it any differently. As I recall, he, unlike Krugman, just didn’t see government as the solution for the vast majority of problems we encountered.
So what Krugman has erected is a strawmen argument. Most see some role for government that they’d deem necessary and legitimate. But not necessarily in all areas. What Reaganism said was that there are areas of our life and economy which are much more efficiently run by the private side. Government should stick to the protection game – something it actually does relatively well – and leave the rest to private enterprise.
That, of course, doesn’t sit well with the “government is always the answer” crowd. It is a battle they’ve been fighting – and losing – for decades. What is really bothering Krugman is he is seeing it happen again at a time when he believes it should finally be clear sailing for the government intervention crowd.
This how Krugman begins his argument today:
The debate over the “public option” in health care has been dismaying in many ways. Perhaps the most depressing aspect for progressives, however, has been the extent to which opponents of greater choice in health care have gained traction — in Congress, if not with the broader public — simply by repeating, over and over again, that the public option would be, horrors, a government program.
You have to appreciate his choice of wording. Krugman has come right out and said that he sees the public option as one that could “evolve” into what he prefers, single-payer. Yet within two sentences, he tries to brand those who are against the public choice trojan horse as “opponents of greater choice in health care”. Nice try, but no cigar, Mr. Krugman.
He then launches into a fairly incoherent attempt at “proving” Reaganism (as he’s defined it) failed.
But in fact, it didn’t fail. People remember the ’80s and the prosperity they brought with some fondness. It’s one of the reasons voters were willing to give an uninspiring Republican VP a shot, before turning him out of town for another smooth talking Democrat who promised “change”. But what should you believe, Krugman’s version or your own lying eyes?
Krugman transparently attempts to erect this strawman of Reaganism, declare it thoroughly discredited, further declare its “zombie” ideas to be worthless and proclaim that since he’s destroyed the zombie, the opposite (don’t try to apply logic here) must be true – i.e. government intervention is good. And if government intervention is good, then it follows it must then be good in all areas, to include health care.
Of course even Krugman’s hero, Barack Obama, in a Freudian moment, mentioned that it wasn’t UPS or FedEx constantly in financial trouble, no siree – it was the good old, government run USPS that couldn’t quite cut the mustard.
But some of the blame also must rest with President Obama, who famously praised Reagan during the Democratic primary, and hasn’t used the bully pulpit to confront government-is-bad fundamentalism.
My goodness, you’d think praising Reagan was akin to praising some fascist who made the trains run on time, wouldn’t you? But for those who are deacons in the church of “government intervention is good”, that’s probably a valid comparison. Because everyone knows history is rife with examples of government intervention success stories . That’s why people are constantly trotting them out instead of attempting to discredit arguments about government that were never made.
Honduras continues to refuse to buckle to international pressure to restore constitutionally ousted leader Manuel Zelaya. The latest rejection came from the Honduran Supreme Court:
Honduras’s supreme court has rejected a Costa Rica-brokered deal to restore ousted President Manuel Zelaya to power and ordered his arrest if he returns.
The ruling also affirmed the legitimacy of the government of interim leader Roberto Micheletti.
The move comes on the eve of a planned visit by a delegation from the Organisation of American States (OAS), which backs the Costa Rican proposal.
It is unclear if the court ruling will affect the delegation’s plans.
The court reminded Mr Zelaya that he faces several charges – including crimes against the government, treason, and abuse of power – and would be subject to trial if he re-entered the country.
Citing their own constitution, the court declared Zelaya’s ouster legitimate and Micheletti’s ascension to power as “constitutional succession”.
I know this has been tough sledding for Honduras, but I have to admit a sense of pride in a country which sticks up for its constitution in such a way and refuses to be intimidated by those who would be happy to see it torn up and ignored.
Dave Schuler, via Cassandra, provides the best counter to the emerging argument on the left meant to reframe the health care debate. That of a supposed “moral obligation” to provide it through government.
As I’ve said before, I don’t believe that there’s a right to healthcare nor have I seen a coherent argument made that it is, merely a claim. However, bear with me.
Is it possible to make a coherent argument that government-provided healthcare is a moral obligation but that our obligation doesn’t extend to people in Zambia? I don’t think it is but I’m willing to listen to the arguments.
As am I. Because what Schuler lays out there in question form is the logical extension of such a “moral obligation”. It is either a universal one (government has the obligation to provide health care to everyone), or it is no moral obligation at all – just another bit of cheap political rhetoric designed to appeal to your emotions.
And that brings me to the attempt this past week by Obama to enlist religious leaders into his campaign by claiming such a moral obligation (MichaelW has written about it here) and framing it in such a way that the inevitable “What Would Jesus Do” questions emerge.
Well, quite frankly, Jesus wouldn’t say anything about the state, much less anything about the state providing aid and comfort to the people. As is clear to even those with just a passing familiarity with Jesus’s ministry he implored individuals to care for their friends, neighbors and even strangers in need.
But the state was never a part of his ministry or his exhortations to help the poor. In fact he made a distinct separation between the two noting that the state was of this world and his ministry was of the divine.
Ironically, if George Bush had said some were out there were “bearing false witness”, or called his effort “40 days to health care reform”, or had told religious leaders that he felt that it was a “moral obligation” to provide health care (through government) the left would have exploded. We’d have seen references to separation of church and state and claims we were headed into a “theocracy” from the usual suspects.
Yet so desperate is the left right now to push government run health care that even the sort of appeal for religious support that would have initiated a veritable feeding frenzy with the anti-Christian zealots among them has solicited barely a whisper of dissent.
In a free country if you feel you have a moral obligation to provide health care to others, no one will stop you from acting to provide it. However, in a free country, no one will force you to act on what they arbitrarily choose to define as a “moral obligation” and with which you don’t agree.
For the first time since 1975, Social Security recipients will not get a cost of living allowance increase in their Social Security check. Another in a long line of ominous indicators that, to quote President Obama’s favorite disavowed preacher, the fiscal “chickens are coming home to roost.”
We seem to have been living in a dream world for the last few decades where the majority of Americans ignored the reality and believed we could continue to increase the size of the welfare state forever with no ill consequences. The small coterie of realists claiming that it was indeed a fantasy world we were living in were declared alarmists who were using scare tactics and dismissed by the politicians.
Now, with huge deficits, we’re about to see the US go from one of the least-indebted developed nations to one of the most indebted. The IMF reports that for the US, general government debt as a percentage of GDP will rise from 63 percent in 2007 to 88.8 percent this year and to 99.8 percent of GDP next year.
That’s huge and, with the revised deficit of almost 10 trillion over 10 years, getting larger.
Even without the numbers and reports, Americans have increasingly come to understand that the government we have and the programs it funds through our tax dollars and massive borrowing are unsustainable. And, as I’ve pointed out, that realization has been brought to a head by the recent financial problems we’ve suffered and government’s reaction (under both the Bush and Obama administrations) to that problem. And yet the supposedly tuned-in Obama and the Democrats simply don’t seem to understand that, or, perhaps worse, don’t want to believe it, given the agenda they’ve undertaken. Matt Welch lays it out well:
After 11 months of federal bailouts and freakouts, Americans have become bone tired of panicky power grabs from Washington. It’s the big government, stupid.
The message of the various Tea Party protests, which predated this summer’s ahistorical media panic over town hall “lynch mobs,” has been pretty simple, says Matt Kibbe, president of FreedomWorks, the nonprofit that has helped organize the protests, told Reason magazine this spring. “It was: stop spending so much money, stop borrowing so much money, and stop bailing out people who were irresponsible.”
It’s a reality that surely haunts the politically sensitive Obama administration: Ever since George W. Bush first tried to cram the Troubled Assets Relief Program (TARP) down the throats of largely unwilling citizens, bailouts of failed institutions, from AIG to American Axle, have been enormously unpopular.
What Obama and the Democrats are left with then, when pursuing an agenda that is a naked attempt at even more government expansion, is a natural resistance that has been building since before this administration took office. Either the Democrats and Obama completely misread the election results and assumed a mandate that wasn’t at all present, or their natural hubris left them believing that even if that was the country’s attitude, they would be able to allay the fears and talk them into supporting more big government.
As is obvious, it’s not working. And the mood of the country seems to be at a point where it is swinging in exactly the opposite direction.
You have some Democrats who are realizing that – Senator Kent Conrad (D-SD) among them – who are talking about a vastly scaled back health care bill (I stick by my claim that Democrats realize they must pass something called “Health Care Reform” or the Obama presidency is DOA). But that too flies in the face of polling which says that a majority of Americans would like to see this version scrapped and for lawmakers to start over. The obvious implication of that poll result is the public is not happy with the size, depth of intrusion and cost of the current proposals.
Bill Clinton once famously said that the era of big government was over. And most cheered. But that turned out to be a mirage as Republicans took over, became Democrat-lite and expanded government yet again. Big government came back with a vengeance. As pointed out by Welch, the Tea Parties, which were the first public evidence of discontent within the country, began under George Bush and had absolutely nothing to do with Barack Obama.
If, as with most protests, the protesters represent the tip of the iceberg, we may be seeing the political sea change that many government minimalists have been hoping for for decades.
The winning political issue is out there for the politician and party smart enough to grab it. Smaller and less expensive and intrusive government.
Who will grab it and how will turn it into a winner is at this point unknown. But Americans are very uneasy right now and their anger at being marginalized by their politicians and ignored is mounting. Not only is 2010 going to be a very interesting year, but depending on who emerges on the right and how they approach addressing this anger, 2012 could be equally as interesting.
In this podcast, Bruce and Dale discuss the top stories of the past week.
The direct link to the podcast can be found here.
The intro and outro music is Vena Cava by 50 Foot Wave, and is available for free download here.
As a reminder, if you are an iTunes user, don’t forget to subscribe to the QandO podcast, Observations, through iTunes. For those of you who don’t have iTunes, you can subscribe at Podcast Alley. And, of course, for you newsreader subscriber types, our podcast RSS Feed is here. For podcasts from 2005 to 2007, they can be accessed through the RSS Archive Feed.
Right about what? Well, in this case, the 10 year budget estimate. Remember this chart first seen in March?
This was the difference between the Obama administration and the CBO estimate based on the Obama administration’s 10 year budget. At the time the CBO said that the budget estimate would raise the debt by 9.1 trillion dollars. The Obama administration said, at the time, that the CBO was wrong.
Quietly, at 7pm this last Friday night, the Obama administration raised its estimate of what their budget would add to the debt by the 2 trillion the CBO had said was always there. What that means for the chart is you can ignore the pastel red bars – the Obama estimate – in favor of the dark red bars.
The administration claims that its change in the estimate is due to things which have apparently changed since March, but of which they were just unaware might happen:
Obama administration officials have concluded the economy was much worse last year — and tax revenues much lower — than they had initially assumed, which means that the estimated budget deficit will increase from $7 trillion to about $9 trillion over the coming decade.
This has to give you all sorts of confidence in other White House cost estimates not to mention their denials of the CBO’s accuracy on things like cap-and-trade and health care in favor of their own.
They didn’t know enough to make an accurate estimate. But the CBO did.
So when the administration says that health care reform will save money and the CBO says it will “bend the cost curve upward”, what should this example lead us to believe?
The cost curve is going to bend upward.
UPDATE: James Pethokoukis thinks this is a prelude to CBO kicking their estimate up a notch:
Expect the CBO to also crank up its forecast, which will be higher than the administration’s. Also, this is further evidence that the common wisdom that people don’t care about budget deficits (no matter what the polls say) is wrong. C’mon, leaking such news on a late Friday afternoon?
Remember the uproar on the left about “rendition” and how that sort of thing was simply “un-American”, unconstitutional and a legal travesty? I’m not going to pretend I don’t agree with many of the arguments made then. But that’s not the point of this post.
The point is how the left was again punked by the man in the White House. Recall this from the Obama campaign website:
“From both a moral standpoint and a practical standpoint, torture is wrong. Barack Obama will end the use torture without exception. He also will eliminate the practice of extreme rendition, where we outsource our torture to other countries.”
As a candidate last year, President Obama vowed to end “the practice of shipping away prisoners in the dead of night to be tortured in far-off countries.”
And 7 days after his inauguration, President Obama signed an executive order prohibiting the CIA from conducting “extraordinary rendition”.
But last week a Lebanese man was snatched by the FBI in Afghanistan. His claims sound faintly familiar. He charges he was stripped naked, subjected to a cavity search and photographed among other things:
In court papers, Azar said he was denied his eyeglasses, not given food for 30 hours and put in a freezing room after his arrest by “more than 10 men wearing flak jackets and carrying military style assault rifles.”
Azar also said he was shackled and forced to wear a blindfold, dark hood and earphones for up to 18 hours on a Gulfstream V jet that flew him from Bagram air base, outside Kabul, to Virginia.
Before the hood was put on, he said, one of his captors waved a photo of Azar’s wife and four children and warned Azar that he would “never see them again” unless he confessed.
“Frightened for his immediate safety . . . and under the belief he would end up in the prison camp at Guantanamo Bay or Abu Ghraib to be tortured,” Azar signed a paper he did not understand, his lawyers told the court.
His crime? Terrorism? A Taliban leader? A person making terroristic threats? Someone who had engaged in combat against Americans?
Well sort of – he apparently inflated some invoices. And the Obama administration was out to serve warning that they just weren’t going to put up with that.
Now, I recognize that we only have his word about what was done to him, and he could certainly be embellishing certain aspects of his incarceration for effect, but the FBI admits to part of it apparently feeling that this invoice padder was a threat on a par with Osama bin Laden and should be treated accordingly:
Prosecutors, however, said that Azar was “treated professionally,” kept in a heated room, offered food and water repeatedly and “provided with comfortable chairs to sit in.”
They said he was photographed naked and subjected to a cavity search to ensure that he did not carry hidden weapons and was fit for travel. Court records confirmed that Azar was shackled at the ankles, waist and wrists and made to wear a blindfold, hood and earphones aboard the plane.
Prosecutors also said that FBI agents read Azar his rights against self-incrimination on three occasions, and that he “voluntarily” waived them.
The FBI agent in charge, Perry J. Goerish, denied in an affidavit that Azar was “told he would never see his family again unless he confessed.”
Additionally an accomplice who was arrested with him has not made similar charges, but has pled guilty to those charges.
But the bottom line is a foreign national was snatched in Afghanistan, shackled, blindfolded and whisked off to an undisclosed location (it ended up being the US) and, in effect, treated just like the terrors suspects the CIA had taken previously.
Yet the LA Times decides:
Their case is different from the widely criticized “extraordinary renditions” carried out after the Sept. 11 attacks. In those cases, CIA teams snatched suspected Al Qaeda members and other alleged terrorists overseas and flew them, shackled and hooded, to prisons outside the United States without any arrest warrants or other judicial proceedings.
Ah, well, there you go – this apparently was legal, so, you know, that makes it all okay. Pretty much exactly the same thing except this time there was a legal veneer to help everyone, to include the LA Times, declare this case is “different”.
Yeah? Seems just like old times to me.
From a friend, a little humor to start your Sunday:
(10) Your annual breast exam is done at Hooters.
(9) Directions to your doctor’s office include “Take a left when you enter
the trailer park.”
(8) The tongue depressors taste faintly of Fudgesicles.
(7) The only proctologist in the plan is “Gus” from Roto-Rooter.
(6) The only item listed under Preventative Care Coverage is “an apple a
(5) Your primary care physician is wearing the pants you gave to goodwill
(4) “The patient is responsible for 200% of out-of-network charges,” is not
a typographical error.
(3) The only expense covered 100% is, “embalming.”
(2) Your Prozac comes in different colors with little M’s on them.
AND THE NUMBER ONE SIGN YOU’VE JOINED OBAMA’S HEALTH CARE PLAN
(1) You ask for Viagra, and they give you a Popsicle stick and duct tape