Columnist.
Millions of people are out of work and can't find a job. Many of those who have jobs are being forced to work part-time instead of full-time. And those who have full-time jobs are in for a nasty surprise. Next year's take home pay is like likely to be smaller than what they earn right now. In all cases the reason is the same: Obamacare. Why can't people find a job? Three Federal Reserve Banks -- in Philadelphia, New York and Atlanta -- have released business surveys that confirm what many of us have been predicting. The new health law is discouraging a significant number of firms from hiring and is also pushing workers into part-time, rather than full time jobs.
Paul Ryan proposed a private health insurance alternative to Medicare for future retirees, liberal critics pounced. It's another scheme to undermine health care for the elderly by "privatizing" and "voucher-izing" the program, they said. Yet, almost one third of seniors are *already* in private health insurance plans. They are called Medicare Part C, or Medicare Advantage, plans. And you would be hard pressed to find any Democratic office holder who wants to abolish them. The reason? Seniors choose to be in these plans because they like them better than traditional Medicare.
Events in Ferguson, Missouri raise this question: Is the criminal justice system unfair to minorities, especially blacks? Liberal blogger Ezra Klein says it is. And libertarian Rand Paul agrees. Klein serves up these statistics: - Of people impacted by a SWAT deployment, at least 54 percent were minorities. - White and black people are similarly likely to use drugs, but black people are 3.6 times likelier to be arrested for drug use than white people. - Until 2010, triggering the mandatory 5-year sentence for cocaine, which is used more often in the white community, required possession of 100 times as much of the drug as for crack, which is used more heavily in the black community. After the 2010 reforms, the disparity was brought down to a (still huge) 18:1.
This should be a banner year for the Republican Party. Democrats are stuck with health care reform that most people don't like. Even among those who do like it, almost everyone admits the law has defects galore. Now for the surprise. What should be a cakewalk for Republicans in the fall is proving to be anything but that. Republicans aren't doing noticeably better in the polls, and they are especially failing to take advantage of the health care issue.
If you listened only to Barack Obama and his acolytes on TV talk shows you would think that the federal government's finances got a lot better last year. In fact, they got worse. Here is the latest White House spin: the official federal deficit is only 3% of GDP -- way below the 10% figure it reached only a few years ago. In terms of dollars and cents, the U.S. government's deficit is expected to be $514 billion this year, according to the Congressional Budget Office (CBO). That's the number you get when you look at cash flow. It means the government will spend $514 billion more than it takes in during the 2014 fiscal year.
Representative Paul Ryan has a bold, ambitious proposal "Expanding Opportunity in America," to completely remake the American welfare state. Along the way he would also change the federal government's approach to education, revamp what we are doing in our prison system and much more. Here is a surprise. Although Ryan's approach is based on well-known conservative ideas, some on the left are actually praising parts of the proposal -- including the editorial page of the Washington Post. Ryan's plan shows something I have believed for a long time. All the innovative thinking on how to solve public policy problems for the past 25 years has come from the right. Even ObamaCare started out as a conservative health reform before liberals in Congress completely botched it. Liberals just don't seem interested in solving problems any more.
Why is our recovery from the Great Recession so sluggish and so slow? Economists are increasingly focusing on Barack Obama's signature legislative accomplishment: the Affordable Care Act, popularly known as ObamaCare. Although generally thought of as a measure to insure the uninsured, health reform is affecting the entire labor market in negative ways. As I wrote previously, the employer mandate to provide health insurance will cost almost $6 an hour for family coverage. This health minimum wage (on top of the money minimum wage) raises the cost of labor and will almost certainly discourage hiring.
Paul Krugman and others on the left routinely sneer at the idea that you can actually increase government revenues by cutting tax rates. (Turns out most of the time you can't, but in some cases you can.) But there is a similar myth on the left. It's the idea that by spending more money on health you can reduce overall health care costs.
Everybody knows that the new health reform program is expensive. But just how expensive is it? Start with the direct costs. The Congressional Budget Office estimates that spending for all the different parts of ObamaCare (health insurance subsidies, Medicaid expansion, administrative costs, etc.) will come to about $2 trillion over the next ten years. That works out to about $2,000 for every household in America, every year. You won't get a bill for your share of all this, however. Most of the money is collected in hidden ways, such as taxes, health insurance plans, drugs, medical devices and even tanning salons. The cost to you will show up in higher prices, lower wages and (for the elderly) less access to medical care.
Coordinated care, integrated care, managed care -- these are just some of the buzz words surrounding the health insurance industry these days. This is what makes modern health insurance different from the indemnity insurance of years ago, when patients went to any doctor they liked and the insurer passively paid the bills. The modern insurer wants to be involved in your health care. At a minimum they want to steer you to providers and facilities that...well, that might have higher quality care, but for sure will cost less money.
I don't usually write about political parties and when I do, I don't make broad statements about their intelligence, character, etc. This is in contrast to Paul Krugman at The New York Times, who routinely tells us that Republicans are cruel, heartless, selfish and responsible for almost all our public policy problems. If only they would go away … well … hmmmm … what would happen if all the Republicans went away? There are places where there aren't any Republicans -- or at least there are very few. And I've noticed that one of two things happens. Fearful of how bad things might get, voters in some Democratic cities vote for Republicans anyway. That is, they elect mayors who either are Republicans or at least govern like Republicans.
There is a new book out, called Room to Grow. It is produced by the YG Network and has the implicit endorsement of the Republican leadership. The health care chapter is written by Jim Capretta. Here are the main elements: People who buy their own health insurance will be given a fixed sum tax credit, which averages about $6,000 for a middle aged family of four. The credit is more generous than the ObamaCare exchange subsidies for most individuals making more than about $20,000.
It's a 2,700 page bill. There are 20,000 pages of regulations. Major provisions seem to change every other week. And despite Nancy Pelosi's promise, four years after it passed most of us still aren't sure about everything that's in it. How can something like that possibly be fixed? It's easier than you might suppose.
Here's something that's really odd. Let's say at the end of last year there were almost 50 million uninsured people in the United States. Averaging over all the different estimates, let's say that 5 million of them have now acquired insurance because of ObamaCare. But now it's April and the open enrollment period is over. That means that 90% of the uninsured are still uninsured and *they won't be able to buy an individual insurance plan until next November.*
Have you ever wondered why ObamaCare is burdened with so much complexity? Here's the answer: Barack Obama. Obama? Yes, the president himself. He campaigned on the promise that he would put partisanship aside and unite the country behind sensible answers to pressing problems. Then he didn't. How could that possibly have worked in health care? Easy. Obama could have adopted the approach taken by his 2008 opponent, John McCain. In fact we now know that Zeke Emanuel and others on the White House staff were urging him to do just that. Also, before he became the president's chief economic adviser, Jason Furman wrote a paper in which he endorsed a McCain-type approach to health reform. Since McCain's approach was more progressive than ObamaCare, it would have been easy to garner support on the left. And how many Republicans would have opposed the plan, after campaigning for McCain and defending his health plan during the election?
Have you ever wondered why poor people are poor? It's not as though there aren't plenty of role models around. Millions of people live highly successful, productive lives in this country. So why don't people at the bottom of the income ladder copy the behavior of those several rungs above them and better their lot in life? As I wrote previously, the federal government's own pilot programs established conclusively from the very early days of the War on Poverty that the welfare state encourages people not to be married, not to work and not to invest in human capital.
What is most missing from the Republicans is not so much the lack of an alternative to ObamaCare. It is the lack of a clear vision. Even if you can understand what their various proposals (and friends and close allies often cannot), it is almost never clear why they want to implement them. Here is the sad truth: Even though the Affordable Care Act (ObamaCare) is a Rube Goldberg contraption that no one can explain and even though its rollout has been a complete disaster and even though the delay of one provision after another makes it seem as though the entire enterprise is coming apart…
In a free market, no one would ever purchase insurance coverage for contraceptives, any more than they would use health insurance to pay for seatbelts or airbags in automobiles. Because of their low cost almost everybody can afford contraceptives and if price is a deterrent they are available for free from local public health authorities or from such private organizations as Planned Parenthood. Further, how did anyone ever get the idea that people should give up their First Amendment rights when they incorporate? This issue goes far beyond the *Hobby Lobby* and *Conestoga Wood* cases now before the Supreme Court. I don't think the federal government should be able to put the executives at Pfizer in jail if they distribute an article from the New England Journal of Medicine describing an off label use of a Pfizer drug. Pfizer executives should have the same free speech rights as anyone else.
With last Sunday marking the fourth anniversary of the Affordable Care Act being signed into law, it's worth revisiting the initial purpose of the president's signature legislation: Universal coverage was the main goal. Four years later, not even the White House pretends that this goal will be realized. Most of those who were uninsured before the law was passed will remain uninsured, according to the Congressional Budget Office. Democrats also fixated on another goal: protection for people with pre-existing conditions. One of the first things the new law did was create federal risk pools so that people who had been denied coverage for health reasons could purchase insurance for the same premium a healthy person would pay. Over the next three years, about 107,000 people took advantage of that opportunity.
The American people realize that Obamacare is a very bad policy. But more and more conservatives agree that we need to offer a solid alternative before voters reject Obamacare root and branch. Recently, three prominent Republican senators -- Richard Burr (N.C.), Tom Coburn (Okla.), and Orrin Hatch (Utah) -- unveiled an alternative proposal. In this article, I would like to outline my own. The proposal I suggest would achieve four remarkable things: It would be more progressive than Obamacare, because it would involve more distribution from higher- to lower-income households. It would provide genuine protection for people who have a preexisting condition, as opposed to the bait-and-switch promises of Obamacare. It would provide genuine access to care for everyone, as opposed to leaving 30 million uninsured, as Obamacare does. And it would work in practice, primarily because it would confine the role of government to setting a few simple rules of the game, leaving individual choice and the marketplace to do the heavy lifting.
