Martin Feldstein: The president has emphasized the importance of limiting services to "health care that works." To identify such care, he provided more than $1 billion in the fiscal stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. That could morph over time into a cost-control mechanism of the sort proposed by former Sen. Tom Daschle, Mr. Obama's original choice for White House health czar. Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost.
In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as "too expensive."
Free Exchange: The . . . problem with the argument by rationing is that it seems to ignore how resources are allocated in a perfectly free market—by willingness or ability to pay. . .
The nub of the matter is this—government can afford to provide basic coverage to everyone, but it can't afford to provide every treatment everyone may want to everyone who wants it. It must therefore decide how to limit its expenses, and it can leave open the option of using a private practitioner to those who are denied care based on a cost-benefit analysis. Or government can provide coverage to no one, and those who cannot afford a treatment—effective or not—will go without.
Mark Thoma: The goal of Democrats is to lower costs without sacrificing the quality of care (which will allow coverage to be expanded). Whether that's achievable or not is a legitimate point to debate, I think the experience in other countries suggests there's quite a bit of excess in the system that can be removed without affecting the quality of care people receive, but accusing Democrats of intending to cut the quality of care or to ration care within particular segments of the population (or overall) mischaracterizes what they are trying to achieve.
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. . . So the birthers, the anti-tax tea-partiers, the town hall hecklers -- theseare "either" the genuine grass roots or evil conspirators staging scenes forYouTube? The quiver on the lips of the man pushing the wheelchair, the crazed risk of carrying a pistol around a president -- too heartfelt to be an act. The lockstep strangeness of the mad lies on the protesters' signs -- too uniform to be spontaneous. They are both. If you don't understand that any moment of genuine political change always produces both, you can't understand America, where the crazy tree blooms in every moment of liberal ascendancy, and where elites exploit the crazy for their own narrow interests. . .
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Interesting that Orrin Hatch (R-UT) voted for Ginsburg and Breyer--and against Sotomayor...Not only voted for, but suggested.
The ruling conservative faction still draws most of its support from such remote and religious strongholds . . .Why is this so often true, I wonder. Even in Albania, as I recall, the Communist party won the first free election in 1990-ish because of the rural vote.
But the quickening exodus of young villagers in search of jobs has challenged the traditional mind-set of residents of these communities. The young return on the weekends from nearby cities like Kashan and Qum, bringing back news of a changing world . . .
To Paul, the administration's health plan is simple and straightforward. To Keith, it is a nonstarter.
Why do these two smart commentators reach such opposite conclusions? The essence of the difference, I think, is that Paul is mainly concerned with universal coverage and is happy to put off discussion of the government budget constraint to another day, while Keith is focused on how the reforms will be paid for and, in particular, with the administration's claims that a major goal of health reform is to put the government on a more sustainable fiscal path.
The essence is really quite simple: regulation of insurers, so that they can’tcherry-pick only the healthy, and subsidies, so that all Americans can afford insurance.
Everything else is about making that core work. Individual mandates are a way to prevent gaming of the system by people who don’t sign up until they’re sick; employer mandates a way to hold down the on-budget costs by preventing a rush by employers to drop insurance; the public option a way to create effective competition and hold costs down further.
But what it means for the individual will be that insurers can’t reject you, and if your income is relatively low, the government will help pay your premiums.
That’s it. Any commentator who whines that he just doesn’t understand it is basically saying that he doesn’t want to understand it.
Here’s what Israelis need to understand: President Obama is not some outlier when it comes to Israel. His call for a settlements freeze reflects attitudes that have been building in America for a long time. For the last 40 years, a succession of Israeli governments has misled, manipulated or persuaded naïve U.S. presidents that since Israel was negotiating to give up significant territory, there was no need to fight over “insignificant” settlements on some territory. Behind this charade, Israeli settlers bit off more and more of the West Bank, creating a huge moral, security and economic burden for Israel and its friends . . .
For years, the Conference of Presidents of Major American Jewish Organizations and the pro-Israel lobby, rather than urging Israel to halt this corrosive process, used their influence to mindlessly protect Israel from U.S. pressure on this issue and to dissuade American officials and diplomats from speaking out against settlements. Everyone in Washington knows this, and a lot of people — people who care about Israel — are sick of it . . .
What about Mr. Obama? He has nothing to apologize for policy-wise. The president is working on a deal whereby Israel would agree to a real moratorium on settlement building, Palestinians would uproot terrorists and the Arab states would begin to normalize relations — with visas for Israelis, trade missions, media visits and landing rights for El Al. If the president can pull this off, it would be good for everyone.
MSNBC host Dylan Ratigan said Thursday morning that while President Barack Obama has “elevated the conversation” when it comes to health care, there’s a downside for cable executives and his fellow hosts: “Health care is bad for ratings.”
Discussing the previous night’s low-key news conference, Ratigan
said that “cable networks’ ratings go off a cliff” during the health care debate, which eventually “forces the conversation out of the TV.”. . . Fox’s decision not to air the presser paid off: The network won the 8 p.m. time slot with an episode of “So You Think You Can Dance.”
. . .
In trying to not get bogged down like President Bill Clinton in the ’90s, Obama decided to take the health care fight to a prime-time audience last week. But perhaps the biggest story coming out of the press conference had nothing to do with health care. Instead, it was Obama’s statement that the Cambridge, Mass., Police Department acted “stupidly” in its arrest of Harvard Professor Henry Louis Gates Jr.Yet, save for his emotional response to a question about Gates in the event’s final minutes, Obama got lukewarm reviews for his talking points on health care. “Snooze conference,” was the Philadelphia Inquirer headline; “Snoozer conference” was the verdict from MSNBC’s First Read.
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