Thursday, December 24, 2009

Kudos to the Senate for Approving its Healthcare Reform Bill

My congratulations to the U.S. Senate and particularly the Democrats for passing healthcare reform legislation. The House and Senate must reconcile their differing bills but hopefully that will occur rapidly.

Is this imperfect legislation? You bet it is. For the left, the Senate bill has no public option. Liberals fear that insurance companies will continue to rake in the profits with insufficient cost controls and competition, particularly now that 30 million more Americans will need insurance. Conservatives fear that the legislation will give rise to another government bureaucracy and entitlement program and lead to greater deficits. All of these concerns have some legitimacy but the alternative was that this great country would continue to limp along without universal or near universal healthcare for its citizens and that the current healthcare system, which almost all consider inadequate, would remain in effect with no end in sight.

I truly believe that twenty years from now most Americans will view this healthcare reform as having been the right and the smart thing to do and wonder why so many opposed it so vigorously.

Yes, there will be bumps in the road and perhaps worse. Costs need to be contained. But the notion that a country as wealthy, developed and powerful as the United States should still have a healthcare system that has excluded so many from being able to afford decent healthcare and limited so many more through exclusions such as pre-existing conditions is absurd. Today there are still naysayers when it comes to Social Security and Medicare but very few. Yes, Social Security has expanded far beyond the original conception but most recognize its significance in providing a safety net for senior citizens and having a stabilizing impact on the economy. And yes, Medicare costs need to be controlled but few dispute that the program has been a life saver for countless older Americans who otherwise would have quickly deteriorated in health. Has each of these programs somewhat reallocated wealth among Americans? Yes. But what community — be it a family, a tribe, a religious organization or a polity — doesn’t reallocate wealth to at least some extent to best serve the collective interests of that community? I don’t know of any.

Will this society have to make some choices as we move forward as to the allocation of healthcare dollars and the availability of medical procedures? I should think so. Critics rant about death panels but how is the allocation of healthcare dollars handled under the present system, for no one should delude him or herself into believing that we don’t currently limit access to certain medical procedures. In the present system those with wealth can select any treatment, even if it means going overseas, but those without the means either can’t afford costly procedures, or find themselves at the mercy of insurance company bureaucrats who decide which medical procedures are necessary and appropriate, or must find charities to support them. Talk of death panels is nothing but a scare tactic. But there will be a need for effective public policy that defines the allocation of scarce medical resources just as today there are policies governing kidney and other organ transplant processes because of their scarcity.

There is always room for improvement and we are likely to see changes in this legislation not only before it is finally promulgated but also before its major provisions go into effect in 2014.

Sunday, December 20, 2009

On Obama At Almost One Year In Office

On his way to the presidency, the economy collapsed. Obama campaigned on healthcare reform, attacking global warming, realigning America’s relationships with allies and the world, ending American involvement in the Iraq war, preserving civil liberties while fighting global terrorism, and many other issues. But an economic meltdown of the magnitude that eventually gripped America and the world wasn’t part of his planning until after he had essentially secured his party’s nomination and the full scale of that meltdown wasn’t really apparent until after the election, even if economists and politicians eventually backdated its beginnings.

Obama had no choice but to try to deal with the economy and he has, with mixed success. In many ways he has continued the policies of his predecessor in focusing more on rescuing the banks and Wall Street than on directly assisting consumers, the unemployed and the rest of Main Street. More of trickle economics or a recognition that, whether one is a devout capitalist or not, the credit markets were a key to stimulating economic activity and that meant focusing on the institutions with the greatest and most immediate impact on credit?

But Obama refused to divert all of his attention and energies toward righting the economy. Some might argue that even if he had it would not have improved things more than they have improved; that the depths of the meltdown were such that considerable time would have to pass before businesses not only started to make profits but also decided to re-employ workers. Others argued that the federal government should have stayed out of the picture entirely and let market forces work, whether or not that might take unemployment to 20% or not. In any case, the economy seemingly continues to limp along and my own view is that Obama’s fall in popularity to under 50% is primarily a function of the stalled economy.

Obama chose to pursue other policy objectives that had been more central to his successful presidential campaign of change. He vowed to close the Guantanamo Bay detention camp, pursue his policy objectives in the area of healthcare reform, and move aggressively to mobilize the world against global warming. Many, even among supporters, cautioned that he was spreading himself too thin. He and his staff rejected that notion and pressed forward.

This weekend, Obama and his allies seem prepared to claim success in two major areas, the fight against global warming and healthcare reform legislation. But has Obama succeeded? Will his achievements turn around declining popular support for his presidency? And what do the current outcomes in these two areas and others tell us about Obama, his style, and his presidency?

I’ve been as critical as others over Obama’s failure to provide more overt, passionate leadership on the issues he himself has either chosen to highlight or, in the case of the economy, has been required to address. His approach seems to have been to let Congressional supporters carry the ball, shape the legislation, and negotiate compromises, with the White House providing pressure here and there in the backrooms. Then when enough support appears to have been garnered for a particular bill, Obama has emerged, embraced it and celebrated its passage. This appeared to be his approach to the stimulus package and appears to be his approach to healthcare legislation.

In a well written news analysis in today’s (December 20, 2009) The New York Times entitled “Obama, Denied Full Victory on Two Issues, Takes Validation,” Peter Baker discusses Obama’s pursuit of his objectives vis-a-vis global warming and healthcare reform, and refers to comments made by Rahm Emanuel:

‘In an interview, Mr. Emanuel said the developments showed that Mr. Obama “sets out the North Stars for us” in terms of broad and ambitious goals, but is willing to let his staff and allies haggle over the specifics. “He doesn’t negotiate the ends,” Mr. Emanuel said. “He’s very open to discussing alternative routes.”’

He doesn’t negotiate the ends? On first blush, and maybe second, that sounds ridiculous!

But, if we don’t take Emanuel’s comment about the ends literally, it may be that Obama’s approach has made more sense than the one I and many others have thought he should follow. I felt he should have been using the bully pulpit from the outset and all along to set forth his model for healthcare legislation, to mobilize public support, assert his framework for legislation, pressure others to join in, negotiate compromises and show leadership. But would that approach have achieved Obama’s objective or would he still have failed to obtain the support of the 58 Democrats and two independents in the Senate needed to break a Republican filibuster? And if the latter, and I suspect he would not have succeeded in bringing Lieberman or Nelson to his side, might Obama have looked so weak that the current coalition might have unraveled further? Hard to say. But now that the Senate bill has seemingly taken shape and its provisions are being publicly explained, I have to say I’m impressed with many of its provisions although I am somewhat concerned about cuts to Medicare.

The outcome at Copenhagen is even less impressive, however. First reports suggest that the breakthrough was extraordinarily limited and that, as often is the case, the devil is in the details, which were certainly not worked out in a three page agreement. At least, however, something positive emerged if only a non-binding agreement on broad principles that included India and China among the participants. But Obama’s second trip to Scandinavia within a month’s time is no more likely to win him increased support than his first to receive his Nobel Prize for Peace. While, unlike his severest critics, I support his efforts to fight global warming and pursue a "just peace," I don’t think events in Scandinavia moved either prospect very far, if at all, along.

Despite finding myself wanting more from Obama, I nonetheless believe that the economy he inherited has extracted a heavy price in his popularity and ability to focus attention on other issues. While I think the stimulus money has not been spent fast enough and in some instances was directed toward pork rather than in ways more likely to prime the pump, under the circumstances I believe the President has played an important role in helping to avoid further economic deterioration and in turning things in a more positive direction.

I am, however, angry and frustrated over the news that Wall Street profits are booming again while at the same time unemployment hovers nationally at 10% and remains above 12% in California. I don’t begrudge Wall Street and I much prefer it be profitable than in dire straits. But what is alarming is that Wall Street profits are booming, the firms are running to return TARP money in order to loosen the controls placed on them, and they seem once again to be readying themselves to pay out enormous bonuses, while the taxpayers who underwrote Wall Street’s survival and recovery are not only not getting a share of the profits but are continuing to find themselves unemployed and facing foreclosure in large numbers. This is not right in my book. Does that make me a socialist? No. In fact, I believe in preserving private property. But these banks and firms should be paying back not just the dollars given them but a percentage of the earnings flowing from those taxpayer “investments.” As well, financial regulatory reform, which Obama is pursuing, is vital so that we minimize the likelihood of a repetition of this meltdown. American taxpayers cannot afford banks and other economic entities that are “too big to fail.” To rein in such entities is not socialism but rather a responsible regulation of capitalism so that it does not destroy itself and take the rest of society with it.

Frankly, I believe in private property. At heart I am more a pluralist than a liberal or democrat. I believe that freedom and liberty are best protected in a society where power is divided and no one group or social institution is able to dominate all others. And I believe that private property helps support centers of power apart from the government, a necessary condition for pluralism to thrive. But limits on the private accumulation of wealth and its deployment are as necessary to maintain pluralism and the freedom and liberty which flows from it as are limits on government.

Obama needs to redouble his efforts to help the economy improve. This doesn’t necessarily mean another stimulus bill or diverting unspent or returned TARP money toward easing unemployment. It does mean assuring that the existing stimulus money is spent quickly but prudently, that Wall Street shares its new riches that might never have been accumulated but for taxpayer financial support, and that the President not divert his attention in too many other directions. A return to real economic growth, a significant diminution in the unemployment rolls, including those not counted because they have given up hope of finding work, and a decline in our mounting debt whether owed to China and others or to future generations, will strengthen America, restore a belief that we are moving in the right direction, and, as a consequence, improve Obama’s standing among the electorate.

As President Obama approaches one year in office, I remain a supporter. Has he made mistakes? Absolutely. Has he spread himself too thin? Yes. Has he regrettably reversed himself on some positions that he took in the campaign? Yes. Has he unavoidably compromised on some positions he took in his campaign in order to build a necessary coalition to secure more limited objectives? Thank goodness yes. Would I like to see him display more passion and spontaneity in his public appearances and pronouncements? Indeed. But, overall, I give him high marks. You should too!