Romney Has His Own Bad Ideas

    In the GOP race there is currently a struggle for who can come up with the worst ideas. Herman Cain had 9-9-9, Perry had the 20 % flat tax. My vote-for worst plan-is Cain's though there is plenty to hate about Perry's as well.  Cain of course also has the lead in worst conduct towards women, always a stiff race for that in a GOP primary.  Perry merely opposes their right to choose.

    Romney clearly has his work cut out for him. While he is the presumptive favorite-clearly the favorite of the GOP establishment which becomes clear every time, for example, Karl Rove opens his mouth-there is a sense among the Republican voters that he is the least conservative and desirable of the three. Of course I'm ignoring Gingrich's possible come back. Gingrich too fills the void of the "not Romney" conservative voters, though if anything Romney should be preferable to social conservatives over Newt at least going by his personal life. While no charges of the level of Cain exist against Romney he did make the rather creepy joke at a campaign stop when a waitress served him he acted like she had grabbed his butt. That should keep him competitive.

    Policy wise he now has a new bad idea that maybe will get him some mileage. He is going after the health benefits of veterans. Krugman had the story.

     http://economistsview.typepad.com/economistsview/2011/11/paul-krugman-vouchers-for-veterans.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EconomistsView+%28Economist%27s+View+%28EconomistsView%29%29

      http://www.nytimes.com/2011/11/14/opinion/krugman-vouchers-for-veterans-and-other-bad-ideas.html?_r=1

     As Krugman says, "American health care is remarkably diverse. In terms of how care is paid for and delivered, many of us effectively live in Canada, some live in Switzerland, some live in Britain, and some live in the unregulated market of conservative dreams. One result of this diversity is that we have plenty of home-grown evidence about what works and what doesn’t."

    Like that line that some of us live in Canada, Switzerland, or Britain where others of us live in the conservative dream of the unregulated market-ie, Albania. An interesting question is where Romney or for that matter Paul Ryan live?

    "Naturally, then, politicians — Republicans in particular — are determined to scrap what works and promote what doesn’t. And that brings me to Mitt Romney’s latest really bad idea, unveiled on Veterans Day: to partially privatize the Veterans Health Administration (V.H.A.)."

     "What Mr. Romney and everyone else should know is that the V.H.A. is a huge policy success story, which offers important lessons for future health reform."

      Krugman makes the important point that V.H.A. was a really poor system prior to an overhaul by the Clinton Administration in the 90s

       "Many people still have an image of veterans’ health care based on the terrible state of the system two decades ago. Under the Clinton administration, however, the V.H.A. was overhauled, and achieved a remarkable combination of rising quality and successful cost control. Multiple surveys have found the V.H.A. providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers. Furthermore, the V.H.A. has led the way in cost-saving innovation, especially the use of electronic medical records."

     The use of electronic medical records is a major key as it allows for much greater integration.

      "What’s behind this success? Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it. So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense. And because V.H.A. patients are in it for the long term, the agency has a stronger incentive to invest in prevention than private insurers, many of whose customers move on after a few years."

     Yet Romney is advocating a Paul Ryan style health care system for veterans where they are under a voucher system. Sounds like Albania and not so much like Canada or Switzerland. Again where does Mr. Romney live? I doubt it's Albania, even less that it is a voucher system.

     As Krugman notes, Republicans have a thing about vouchers and claim that private competition will reduce medical costs. Where ever they may get this idea it is not empirically measurable experience. The reality that in health care the more privatized the more costly.

     "we have a lot of evidence about how private-sector competition in health insurance works, and it’s not favorable. The individual insurance market, which comes closest to the conservative ideal of free competition, has huge administrative costs and has no demonstrated ability to reduce other costs. Medicare Advantage, which allows Medicare beneficiaries to buy private insurance instead of having Medicare pay bills directly, has consistently had higher costs than the traditional program"

     "And the international evidence accords with U.S. experience. The most efficient health care systems are integrated systems like the V.H.A.; next best are single-payer systems like Medicare; the more privatized the system, the worse it performs."

   "To be fair to Mr. Romney, he takes a somewhat softer line than others in his party, suggesting that the existing V.H.A. system would remain available and that traditional Medicare would remain an option. In practice, however, partial privatization would almost surely undermine the public side of these programs. For example, one problem with the V.H.A. is that its hospitals are spread too thinly across the nation; this problem would become worse if a substantial number of veterans were encouraged to opt out of the system."

     I got to finish off with Krugman's joke that as all Republicans are out to destroy government programs that work we should go for Perry as he may not remember which ones those are.