The Goal of My Political Activity

Last month, in response to a comment that:

more often than not it seems the only choice we have in our candidates is a choice between horrible and horrible.

I wrote back saying:

That means that you need to get in earlier in the process – before there are only two candidates left – because I agree that neither hanging nor the firing squad sound very appealing. Of course it’s possible to have more than two candidates and still have nobody who does not look like either a gallows, a firing squad, or a lethal injection chamber. . . In such cases we have to work as voters to encourage better candidates to get in the race. Long term we even have the option to plan ahead and run for office ourselves if we consistently cannot get decent choices. (emphasis added)

My goal in politics is to help illuminate current issues with timeless principles so that I and other will be able to recognize and support (and become when necessary) the kind of high quality candidates that are required to put this country back on the solid footing that it once enjoyed.

As my wife can attest, I am absolutely serious about that last part. Having seen many candidates for important office that I felt were unable to act as the kind of legislator that I am looking for, I have had many discussions publicly and privately about running for various offices. Last night I was talking to my wife about this and I finally was able to state my political goals succinctly – my goal generally is to put myself in a position where I can run for any office where there is no acceptable candidate and my goal for any given race is to find a good candidate that I can support – using myself as the candidate of last resort.

I would consider myself extremely successful politically if I always found solid candidates to support and never felt the need to run myself – especially if the candidates I supported won in most cases. Despite that definition of success I am preparing so that if I ever find myself unable to identify a quality candidate I can and will step in and run an effective campaign with a better than average chance of winning. (Evidence of my preparing is that I already own a campaign domain that I can use anytime I find it necessary to run and as I have time available I am working on developing that site in advance so that all I have to do is develop some graphics and campaign/office specific material in order to launch an effective campaign.)

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Medical Cultures

[quote]I have called David Goldhill’s How American Health Care Killed My Father a must-read for anyone who wants to speak up in the health care debate. The New Yorker also has a must-read article on the issue called The Cost Conundrum. In that article we are introduced to the town of McAllen, Texas where Medicare spends much higher than average amounts per capita than the national average ($15000 vs $8000) in an area with much lower than average per capita income($12000 vs $21500) and cost of living. Atul Gawande, himself an associate professor of surgery at Harvard Medical School, introduces us to the town and begins an attempt to discover why the costs of health care are so high in McAllen.

Are the people there less healthy? No, they have higher rates of some health conditions than average and lower rates than average of other conditions. Overall health fails to explain the cost differential.

Was the quality of health care being provided higher than average? While they were not lacking for available medical technology or facilities the quality of care was, once again, nothing unusual.

McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.

Gawande went to dinner with some McAllen doctors and showed them the data on health care costs in McAllen:

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

He then asked them why they thought the care was so costly there. One suggested the cost of malpractice insurance but then they admitted that since Texas had passed caps on malpractice lawsuits they had virtually no lawsuits to drive up the cost of care.

Finally a general surgeon among the dinner party declared that the issue in McAllen was overutilization.

Everyone agreed that something fundamental had changed since the days when health-care costs in McAllen were the same as those in El Paso and elsewhere. Yes, they had more technology. “But young doctors don’t think anymore,” the family physician said.

Anecdotal evidence and agreement is fine, but Gawande went in search of more concrete evidence.

To determine whether overuse of medical care was really the problem in McAllen, I turned to Jonathan Skinner, an economist at Dartmouth’s Institute for Health Policy and Clinical Practice . . . I also turned to two private firms—D2Hawkeye, an independent company, and Ingenix, UnitedHealthcare’s data-analysis company—to analyze commercial insurance data for McAllen. The answer was yes. Compared with patients in El Paso and nationwide, patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care.

Having identified the cause of the high costs the search was on for an explanation of why there was so much overutilization. The answer was in the culture of the medical practitioners in McAllen – they were very profit oriented rather than results oriented. I believe the one place that Gawande’s article falls short is that he stopped with exploring the cultures among the medical community and failed to examine whether the general community culture in McAllen helped to foster that inefficient mindset among the medical practitioners in the area. I’m willing to bet that such a short-sighted culture in the medical community might not need encouragement from the local culture, but could not survive if the local culture were one that actively discouraged a similar outlook in the community at large.

Talking to a surgeon from McAllen, Gawande concludes that whether we have a public option, single payer, or private health insurance will not matter if the culture in McAllen continues to become more common as it has been doing.

In contrast to McAllen, Gawande explores the cultures in the Mayo Clinic and the Medical community of Grand Junction, Colorado and finds that both of these low-cost, high-quality health care systems took very different approaches to each arrive at “accountable-care {organizations} . . . {where} leading doctors and the hospital system adopted measures to blunt harmful financial incentives  {and} took collective responsibility for improving the sum total of patient care.” He also lists four other high-quality low-cost health care systems each of which has a culture of accountable care – the Geisinger Health System, the Marshfield Clinic, Intermountain Healthcare, and Kaiser Permanente.

Whatever approach Congress tries to take to reform our health care system they and the American people need to understand that we cannot successfully plant a Health Care tree. The only workable approach will be to plant Health Care seed and help it to grow into a health new health care system.

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Too Rich to Go Bankrupt


photo credit: Stowe Boyd

By “too rich to go bankrupt” I don’t mean someone so rich that they never will go bankrupt. What I mean by that is someone so rich that them going bankrupt would destabilize our economy and thus they deserve a bailout if bankruptcy ever threatens them. (Think Bill Gates plus Warren Buffett plus everyone who gets a paycheck from Google.) More on that later . . .

In discussing the role of the federal government in an economic recovery Ronald Hunt and Charles D. brought up the issue of the role of corporations. Charles was good enough to provide links to a 2-part article by Richard Grossman from 1998 (Part 1, Part 2) that did a good job of discussing how corporations have turned into very unwieldy masters over “we the people.” I was amazed when I first realized that these articles, which are so pertinent to our situation of bailing out “too big to fail” institutions was written more than a decade before our massive Bush bailouts.

I especially enjoyed a couple of quotes from the second part of the article:

the Supreme Court of Georgia, in Railroad Co. v. Collins, wrote: “All experience has shown that large accumulations of property in hands likely to keep it intact for a long period are dangerous to the public weal. Having perpetual succession, any kind of corporation has peculiar facilities for such accumulations . . .” (emphasis mine)

And from the end of the first part:

In Richardson v. Buhl, the Nebraska Supreme Court in the late 19th century declared: “Indeed, it is doubtful if free government can long exist in a country where such enormous amounts of money are… accumulated in the vaults of corporations, to be used at discretion in controlling the property and business of the country against the interest of the public and that of the people, for the personal gain and aggrandizement of a few individuals.” (emphasis mine)

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A New Federal Role in Economic Recovery

My post on fundamental assumptions generated some good discussion which began waxing economic in flavor. As part of that discussion I had a new idea about a more reasonable approach the federal government could take to soften economic hard times without outright manipulating our expectations of reality as they do now.

I should start by clarifying my perspective on what the federal government does and what is economically realistic. Economic realism insists that we recognize the inevitability of economic downturns. They are going to happen. Unfortunately the assumption at the federal level seems to be that we must strive for perpetual economic growth – we might tolerate one or two quarters of a mild contraction but anything beyond that is unacceptable. As proven by our significant and now two year old recession sometimes the economy needs to undergo a much harsher adjustment – especially after the government has been pumping the supposedly healthy market with perpetual stimulus for years. (I know, they have not called anything they did stimulus until the stimulus bill in early 2008.)

Personally I think a better approach to the federal government smoothing the rough spots out would be to establish a baseline – let’s say 5% unemployment – where any state meeting that baseline would not receive any federal economic assistance to combat unemployment. Then they would look a the spread between the unemployment rate of various states and be allowed to give economic aid to any state with at least 5% higher unemployment than the state with the lowest unemployment. The upper limit of that aid would be equal to 1/3 of the difference in unemployment between the higher of 5% and the unemployment rate of the state with the lowest unemployment with the limitation that government aid cannot help one state leapfrog another. Let’s show what that would mean with current (October 2009) numbers.

The state with the lowest unemployment is North Dakota at 4.2% so any state with more than 9.2% unemployment could get aid from the federal government to help lower their unemployment. For the October 2009 numbers that would mean that only 21 states could get any federal assistance rather than having the federal government trying to jump start the economies of all 50 states. Of those 21 states Arizona, Missouri, and Washington (at 9.3% unemployment) could receive aid equal to 0.3% of their respective economies (they would not be allowed to leapfrog Idaho and new York which have 9% unemployment and cannot receive this federal aid because they are within 5% unemployment of North Dakota’s unemployment rate). In fact, 12 of the 21 states would receive enough aid to bring them equal to the 9% unemployment rate of Idaho and New York because that would be less than 1/3 of the difference between their actual unemployment rates and the magical 5% unemployment. At the other end of the scale Michigan, with the highest unemployment would have their rate cut below 12% from their current 15.1%.

If every state had unemployment rates over 5% the new benchmark would be the lowest unemployment rate of any state. If we imagine that lowest unemployment rate was 6.5% (adjusting all states up to 6.5% and leaving states with higher unemployment where they are) only states with unemployment over 11.5% would receive aid, six states in all, and only Michigan would get the full 1/3 of the difference between their rate and the base rate of 6.5% (leaving them with 12.2% unemployment).

If all states were below 5% unemployment or if they were all clustered between 3.5% and 8.5% unemployment then the federal government would not give unemployment assistance to any of the states. If anyone is curious to see them, I have all my numbers in a spreadsheet that you can download.

The fact is that of the economy of the entire nation is slumping then no government program can provide a solid foundation to real economic growth – all it can do is produce the illusion of economic stability. Real economic growth can only be build on fundamental economic change, not on the illusion of stability provided by printing money and manipulating interest rates. While committed free marketers would likely hate my proposal just like they hate the current government intrusions in the economy and while those who don’t object to socialism will find my suggestions very harsh on downtrodden regions of the nation, I think that my idea is much better at providing a cushion for the hardest hit areas while allowing the economy to shrink or grow towards whatever the realities of our national economy are which the government tries so hard to mask right now as if our perceptions were the only economic reality worth considering.

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What Are Your Fundamental Assumptions?


photo credit: quarksteilchen

In the midst of a recent comment the author revealed a fundamental assumption that he and I don’t share that clearly explains why we have differing views on government:

Federal mandates are about the only power the government has to prevent a race to the bottom. . . THE only way to get some states to do what needs to be done is to simply mandate it. The race to the bottom has got to end.

I should start by saying that federal mandates truly are the only power that government has to prevent a race to the bottom – also that I don’t think such mandates are sufficient to prevent such a race (in other words government is powerless to stop that race). After exploring the assumptions that serve as the foundation for that statement about a race to the bottom I quickly concluded that I could not accept that view of the world for myself.

The view that government must use federal mandates to prevent a race to the bottom seems to be built on the belief of Thomas Hobbes that people are basically selfish and evil. People who act as Hobbes expects will naturally engage in a race to the bottom on any issue. It is possible to believe that states will engage in a race to the bottom while still thinking the people are not basically selfish but to hold that combination of beliefs requires a belief that politics is basically corrupt and that it is mainly those who would engage in a race to the bottom who hold public office.

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A Fundamental Difference Between Conservatives and Progressives


photo credit: Marcin Porwit

Late in October a comment by Jason sparked my brain to recognize a subtle but fundamental difference between conservatives and progressives. Perhaps it should have been obvious simply by comparing the definitions for “conservative” and “progressive” but the implications seem to be  both subtle and profound.

The word “conservative” can be reduced to essentially seeking to maintain a static foundation. The word “progressive” can be reduced to essentially seeking to promote change from the status quo. Notice that, contrary to what some people believe, progressive and conservative are not antonyms. There are times when change from the status quo may be towards an earlier static foundation, but I think it is obvious why these two views would generally not be in harmony with each other.

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Return of the Food Tax

Curtis Haring is concerned about the possibility that the state legislature will reinstate the food tax that they repealed all too recently. Considering that the state is facing a budget shortfall in the neighborhood of 3/4 of a Billion dollars, it is a very legitimate concern for Curtis and a very legitimate consideration for the legislature.

I wish that I could provide a link to the poll Curtis cited showing that 68% of Republican political insiders who favor bringing back the tax on unprepared food. (Curtis has now provided the link to that poll – thanks.) On the other hand I can provide a link to a report from Senator John Valentine stating that Governor Herbert has submitted a budget devoid of any tax increases. I hope that budget is also free of numerous fee increases, but either way I recognize that it is the legislature and not the Governor who will ultimately pass a budget bill to deal with the shortfall.

Amazingly, amid his criticism of what he expects out of the Republican legislature, Curtis fails to mention even a hint of disappointment with Democrats despite his acknowledgment that the same poll showed that 81% of Democratic political insiders favored reinstating the food tax. (With the link to the poll Curtis also provided the correction that 81% of Democratic political insiders are against reinstating the food tax.) While I hold out hope that the food tax will stay dead, based on what Senator Valentine said about the Governors proposed budget, I am absolutely confident that if the food tax returns it will be the result of the democratic super-minority in the legislature being unwilling to make necessary cuts along with a good chunk of Republican legislators who do not have strong principles against government control of virtually everything. It will be the Democrats and these semi-principled Republicans who are unwilling to make unpleasant cuts in waste and some not-truly-critical programs who force the return of the food tax if it does come back to life.

Looking forward to the next legislative session I would give at least 50% odds that the food tax returns to Utah. If it does, I hope that final suggestion that Curtis makes – that any tax increases (and I would add fee increases) in the budget have a sunset clause built in so that the legislature is required to revisit those increases as the economy recovers in the next couple of years – is attached to the budget bill that finally passes.

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2074 Pages of Loopholes

With Thanksgiving weekend behind us all politically interested people can look forward to the Senate opening work on the healthcare bill. According to Senate Majority Leader Harry Reid:

. . . senators {will} work on weekends if necessary to hammer out compromises on thorny issues like a government-run insurance plan, abortion coverage and holding down costs.

“The next few weeks will tell us a lot about whether senators are more committed to solving problems or creating them,” Reid said.

I make no pretense that I have abandoned my day job and any semblance of a life to read through the entire 2074 pages of H.R. 3590 but I have read through the entire 13 page index of the bill and looked up a number of sections that either looked interesting or concerning to me. Of course my first question is how will this affect my health insurance situation (that may give some insight into the 12 sections I reviewed). The real question in this debate is whether there will be anyone who takes the time in the coming weeks (according to the story linked above we may expect up to 3 weeks of debate) to read the entire bill and break down what it actually means for consumers and the nation – going beyond the party-line soundbites that we will no doubt be subjected to constantly through the media for as long as the debate lasts.

After reading through my chosen sections I found seven that were interesting enough for me to write about them. (For anyone who is curious, there are approximately 350 sections to the bill – 50 times what I am doing today.) I will review them in the order they appear in the bill.
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Of Big Tents and Purity

It’s a busy holiday time so I’ll spend more time quoting and less time expounding. Back in May, Jim DeMint expressed the very opinion I still hold about How Republicans Can Build a Big-Tent Party by holding to one key principle:

There is a question Republicans do need to ask: What is it that binds our party together?

. . . Moderate Republicans are right to remind conservatives that they cannot build a center-right coalition without the center part. And conservatives are right to remind moderates that Republicans only succeed when we rally around clear principles.

The real mistake is that Republicans became more concerned with staying in D.C. than reforming it.

Despite notable successes at both ends of Pennsylvania Ave., it seems to me that Republicans in Congress and in the Bush administration forgot a simple truth. To paraphrase C.S. Lewis, if you aim for principled reform, you win elections in the bargain; if you just aim for elections, you get neither.

No Child Left Behind didn’t win us “soccer moms,” but it did cost us our credibility on locally controlled education. Medicare prescription drugs didn’t win us a “permanent majority,” but it cost us our credibility on entitlement reform. Every year, another Republican quality was tainted: managerial competence, fiscal discipline and personal ethics.

To win back the trust of the American people, we must be a “big tent” party. But big tents need strong poles, and the strongest pole of our party — the organizing principle and the crucial alternative to the Democrats — must be freedom.

(emphasis mine)

We’ve been discussing the ideas of purity, conservatism, inclusiveness, and intra-party division a lot in the last few months. I believe, along with many of you, that holding to principle and being inclusive are not mutually exclusive goals. There must be strong poles to hold the tent up, or to put it another way, there must be something in the tent that makes people want to enter. I agree with Senator DeMint that freedom would be a very enticing offering – but we have to find a way to articulate the vision of freedom and not allow the message to by framed in negative terms by those who disagree with our vision.

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Thanks for Great Comments

One of my favorite parts of blogging is getting comments and discussion. I really like the tone of discussion that we have here, and sometimes I get comments that really make an impression on me. I finally decided to find a way to show those “best of the best” comments so that people who may have missed a particular conversation can see the great contributions made by others to our various discussions.

I’m using a plugin called Best-Of Comments to display those comments I select in the sidebar with a link back to the original comment. Feel free if you see a great comment to go add to the discussion, even if it seems to have ended.

Think of it as a way for me to say “thanks” for everything that all of you add to this site.

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