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The Publius Papers is an exploration of the fundamental dynamics of our Republic and how they are adrift. Our nation can be strengthened with thoughtful and contemplative discussion.

Let us move away from political rhetoric and no longer see "R" vs "D" or "left vs right".

We The People must first learn to cut loose from TV's Political Cult of Personalities, the latest party propaganda and "Talking Heads" in order to rediscover The Republic for what it truly was ment to be.

Only then can We The People restore The Republic.




Saturday, February 27, 2010

One Term President?

February 27, 2010

History teaches that those presidents who are able to move from the extremes of campaign mode, to governing in a more balanced manner early in their first term, have a better chance of being a two term president. In many instances, this required a departure from the previous administration’s path to something more in line with the American mood. During an interview with Diane Sawyer on January 25th, President Obama stated “I’d rather be a really good one-term president than a mediocre two-term president.” Interesting comment. One could interpret that to mean his current ideology’s policies, unpopular as they are, will remain for the next three years. Will he learn from history? Will he learn from members of his party, recent elections, polling results and the popular mid-term candidates giving incumbents some difficulty? Does he understand the American appetite for less extremes and a path towards the center?

Recently, Arkansas Democrat Blanche Lincoln got a sense of how potentially harmful this “really good one-term president” can be for her 2010 re-election. In step with her own epiphany on the mood of the country, she lamented that it would be best if the President, and his administration, distance themselves from “people who want extremes…and seek to find “common ground” with Republicans. Especially if promoting legislation which provides a “certainty” for jobs creation. Obama responded with “the price of certainty is essentially for us to adapt the exact same proposals that were in place leading up to the biggest economic crisis since The Great Depression…the result is going to be the same.” To Obama, moving to the center where the nation would like its leaders to be means emulating George W. Bush. Apparently, to President Obama, politically, good ole’ “W” was a two-term looser. If President Obama is unable, or unwilling to listen to members of his own party, he may end up a one term mediocre president. He seems not to understand that America would prefer a move to the center. Fifteen months ago he had a 70% approval rating. Recent Gallop Polls show him running even with a theoretical “centrist” (i.e. George W) in a 2012 election bid.

President Obama misses all of this and the reasoning behind his drop in popularity. When taking office after President Bush, he did not take a path that “avoids repeating the failed policies of the past.” He joined in with Pelosi’s Congress and continued the spending he so earnestly attacked “W” for. Only the spending has been exponentially more. The spending, as it was presented, was to prop up the economy. However, Congressional Budget Office reports indicate the majority of the money as discretionary and earmark in design. Where is the departure from the past?

History shows that bold moves by presidents towards the prevailing view of the American people often leads to success. FDR made a bold move from Herbert Hoover’s direction and increased government’s presence in America’s daily business. Ronald Reagan moved away from Jimmy Carter. But in 1982 President Reagan’s approval rating was lower than President Obama’s is now. Simultaneously, the Republicans lost significantly in the mid-term elections. However, by 1984 The Great Communicator won a second term with a 49-state landslide. Ten years later President Clinton overcame a similar scenario.

These presidents listened and learned that the mandate given to them was not their extreme ideological desires, but the populist sentiment Of and For The People. They took off the campaign-mode persona and went to work on the fundamentals of governing FOR The People. As President Reagan was fond of saying: “get the government off the backs of the people”. President Clinton charged up the nation by compromising and accepting Republican initiatives that the populist wanted: balanced budget; tax cuts; welfare reform; etc. And today, the populist sentiment continues the tradition of signaling where it would like its leaders to move. Americans have a theme song they’d like to see Obama download to his I-Pod. The simple, clear, catchy, easy to dance to tune of less spending; less government; less taxes; leave the healthcare system alone.

So far, the song has attracted some impressive results. Virginia Democrats giving way to the Republicans in the top offices of Governor, Lt. Governor and Attorney General. In New Jersey, Chris Christie saw the largest victory for a New Jersey Republican in 25 years by his win over Corzine. And recently, the latest Cinderella story of Mr. Brown defeating Ms. Coakley in Massachusetts. A Quinnipiac poll suggesting a 45% disapproval rating of the President’s governing seems to reflect his fallen “American Idol” status. As the mid-term elections begin to organize, some surprising individuals are making a move down a different path. Inexperienced, but they understand what President Obama and the Washington establishment do not seem to grasp. To name a few: Jim Ward of Arizona (former President of LucasArts); Jon Runyan of South Carolina (Offensive tackle for the San Diego Chargers); Todd Yound of Indiana (Attorney); Stephen Fincher of Tennesse (Farmer); Brian Rooney, Michigan (Businessman); Scott Rigell, Virginia (Car Dealership Owner). Six Republicans running in Democrat establishments with notable early results. None of them having held office before.

They’re singing what President Obama’s I-Pod won’t play…Americans seeking distance from his extremes. We await Barack Obama’s mark on Presidential history.

Publius

Sunday, February 7, 2010

Healthcare Delivery

February 7, 2010



For roughly the past 15 years, one of the responsibilities I have had in my job has been working with insurance brokers on negotiating healthcare plans. Naturally I’ve stayed in touch with the ObamaCare development. It’s not too hard to get caught up in the drama. Mostly I’ve found folks repeating the latest slogans and talking points from political propaganda: “death panels”; “socialized medicine”; “higher taxes”, etc. To be sure, some of that may well be true. But such a debate misses the fundamentals of the issue.

Recently, my physician and I discussed a procedure that we both agreed was time for me to do. We discussed various options, reasons, risks, etc. One key question I had was “where?” Should I go with the one local specialist? Should I travel an hour to a larger teaching hospital loaded with some of the top specialists in New England. Being a business person, I weighed the costs and benefits. I wonder how many people have such a discussion with their physician. Were similar discussions going on with ObamaCare?

The first group to jump on the ObamaCare bandwagon was the insurance industry. They came because they understand the true fundamental to healthcare costs...the delivery system. When you break the healthcare world down, it’s really a patchwork of cottage industries made up of small provider practices in non-competitive markets. Insurance companies and hospitals on average achieve about 2-3% margins. Yet, of every premium dollar, 85 cents goes to the cost of care, providers, suppliers, medical centers, prescriptions, etc. The 2% margin for 2009 of the entire healthcare insurance industry would cover the costs for two days of the nation’s healthcare expenses. When ObamaCare reached the beginning of its end with Scott Brown’s victory in Massachusetts, President Obama responded predictably by castigating the insurance industry by saying…”I mean, to be fair, the status quo is working for the insurance industry, but it’s not working for the American people.” Not a statement that is helpful to building a relationship with your first ally.

To be honest, its health insurance reform, not healthcare reform. ObamaCare focuses not on healthcare delivery, but standardizing benefits and eliminating the relationship between the amount an insurer is allowed to charge and the true cost of the care. Insurers would be required to offer “guaranteed issue” (accept everyone on the plan) with limited ability to adjust premiums based on actual business / utilization costs. So if actual care of a patient is where 85% of the cost sits, how will ObamaCare impact the overall cost of healthcare?

A number of congressmen (Republicans and Democrats) asked the same question. WellPoint, one of the largest healthcare insurance companies, provided a model based on its’ own actuarial data. They found ObamaCare would nearly triple premiums for most of their customers. The response from the Obama Administration? WellPoint is no better than those evil tobacco companies.

The U.S. healthcare system offers choice and the most advanced treatments and technology in the world. Yet, its’ business practices are outdated. Nearly every sector of the U.S. economy has evolved their managerial and delivery practices resulting in some of the highest productivity and quality available. To be competitive, consumer products, service industries, banking, etc. have to be mindful of costs. The healthcare industry is not structured so that providers have incentives to control costs. And no incentives for insurers, (medicare one of them), to reimburse costs realistically. There is a lack of competition where needed. And a lack of strategic provider-insurer partnerships as well. In this regard, the Obama Administration is missing an opportunity by not seeing that insurers add value if they are part of that delivery system. By having information from my insurer about the cost and quality of that procedure my physician and I agreed on, I was actually making an informed decision within the market.

Healthcare costs are negotiated between providers and health plans. But in a true market costs are driven by competition. But the cost-control provisions of ObamaCare exempt the doctors and hospital, (the 85 cents of every healthcare dollar), from being involved in managing cost. It appears Pennsylvania Avenue is having a hard time hearing this message.

Publius