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December 17, 2011

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Posted: 17 Dec 2011 12:06 AM PST

"Competition Hasn’t Worked in Health Care"

Posted: 16 Dec 2011 06:24 PM PST

Ezra Klein:

Competition hasn't worked in health care, by Ezra Klein: Republicans and Democrats have the same problem with the Congressional Budget Office: it refuses to score competition between health-care plans as a surefire way to lower the cost of health care.

This annoyed Democrats during the health-care reform debate... It's annoying Republicans now, as it means their Medicare-reform plans need to impose blunt spending caps if the CBO to certify them as deficit reducing.

But the CBO is in the right here: No matter how much sense competition makes in theory, no matter how obvious it is that it will drive down the price of health care, the fact is that it keeps failing when we put it into practice.

When I asked Sen. Ron Wyden to give me examples of programs that made him confident that competition could work, he mentioned the Federal Employee Health Benefits Program (FEHBP) and the California Public Employees Retirement System (CalPERS). Rep. Paul Ryan has also pointed towards the FEHBP... The only problem? Neither system controls costs...

That leaves us without a clear example of a competition-based program substantially cutting costs. As I wrote yesterday, I hope that's simply because we haven't yet cracked the code on competition. Cutting costs through competition comes with far fewer downsides than cutting costs through government price controls. But cutting costs through competition has not yet worked. Cutting costs through price controls, conversely, has worked, as even the most cursory analysis of international health-care systems proves:

Internationalhealthcosts1[1]
(Kaiser Family Foundation)

The reality of our health-care debate right now is that both parties keep trying different versions of a cost control strategy that hasn't worked because they're uncomfortable with the cost control strategy that has.

"Obama's New Populist Tone Gets Its First Test"

Posted: 16 Dec 2011 09:28 AM PST

Fail:

Obama's New Populist Tone Gets Its First Test, by David A. Graham: Coming hot on the heels of the White House's decision not to veto controversial new measures on terror detainees, Democrats are poised for another defeat in Congress after Senate Democrats dropped their demand for a new surtax on millionaires as a means of paying for extending the payroll tax cut...
That's two major concessions in just a couple of days. ... It's a Washington truism that the current crop of Democrats are terrible negotiators. But this time, they really seemed to have it in the bag. They were calling for a tax cut, after all, and they had Republicans tying themselves in knots explaining why the party of Reagan and Tea didn't want lower taxes. All the Democrats wanted in exchange for extending the reduction was a small increase in how much the wealthy paid -- a position that was widely popular among voters. Even RedState's Erick Erickson was grudgingly impressed. "I never thought I would see the day, but Democrats are outmaneuvering Republicans on a tax cut," he wrote.
But Obama's Democratic allies in the Senate say they have now abandoned the millionaires' tax... And the White House does not appear to be pressing the case. ...
There isn't much point in asking, for the umpteenth time, why Republicans are so much better at this than Democrats. What's interesting here is the timing. Last week, Obama went to Osawatomie, Kansas, and delivered a stemwinder of a speech on inequality. The reaction was swift: left and right alike announced that the president was taking his cue from Occupy Wall Street and was adopting a stridently populist message focused on income inequality. More broadly, the speech seemed to be an indication that he was ready to shed the quiet, conciliatory demeanor and adopt a more pugilistic stance.
But the Democrats' two caves suggest Obama's new rhetoric isn't likely, for the foreseeable future, to be much more than posturing.

I really don't like that my choices in the upcoming election will be between one candidate who will betray the things I believe in, civil liberties, progressive taxation, etc., etc., etc., and a crazy person from the other side (take your pick) who will be even worse.

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