David Goldhill, a media exec, has written an excellent article in The Atlantic on what’s really wrong with health care. He does a fantastic job of identifying some of the real underlying problems with our system:

A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing.

As I stare a at a surprise $2,000 bill for a bone scan, I can completely resonate with most of what Goldhill writes. It’s sad, but we get better service from our auto mechanics than we do from the health care system.

He argues for changes that make the patient the customer:

The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.

If you really want to know what we should be doing about health care reform – read this article.

Umair Haque, from Harvard Business, has an excellent post that shows how we spend more and get less for our health care dollar.

It’s scary how much more we spend than others. He brings in some other data as well that shows the US having lower life expectancy and infant mortality rates. Although, there is some analysis which shows we might not actual be very different in terms of outcomes when you adjust for fatal injuries like accidents and homicides.

And the higher infant mortality rate is likely due to low birth weight driven by higher rates of teen pregnancy.

In any case, we do spend a LOT more than everyone else and don’t seem to get much for the extra cash.

This graphic from the NY Times says it all.

I hate bad test questions. I was working with my daughter to help her get ready for her finals. On the test prep package we ran into a problem were there is no right answer based on the facts presented.

The problem went something like this:

Jason can do the job in 5 hours. Sloan can do the job in 3 hours. How long will it take them to do the job together?

Totally unsolvable. It completely depends on the nature of the job. Can the job be split? Is it a linear problem (eg filling a pool with water) or a non-linear problem (eg counting money)? If it’s non-linear, how evenly can it be broken down into sub-tasks?

You don’t know enough to solve the problem, yet it asks for an answer.

I hated these kinds of questions when I went to school. I used to take them to the teacher and tell them why it could’nt be solved. It’s totally unfair to kids who are taught there should be a “right” answer.

Teachers and schools should know better, given all the money we spend to test what kids have learned.

Obama and Biden are doing a great job of scaring the Hell out of the market. Obama’s. “spread the wealth” comment was about as dumb as I’ve seen, with perhaps the exception of Biden’s comments that if Obama is elected America will be tested.

No wonder thing market is tanking even further despite the credit crunch easing. Spreading wealth is a loser econ policy and a crises is a sure downer for the market.

Obama and Biden should stop talking before they destroy our 401ks completely and blow their chance of winning.

The price of oil has dropped a lot since the financial markets tanked.  I’m sure there’s a lobbiest arguing for a nice oil company bailout.  Woulnd’t be surprised to see one either.

I thought more about health care reform after the debate last night.  It is troubling to see Obama so against meaningful change when it comes to health care.  We’ve already have big government health care programs and they are no more efficient than the rest of the system.  You can deliver health care that way and make it work if you’re willing to ration care, which is what happens in the UK, Canada and the rest.

Our current health care system is so regressive.  Why don’t they see it.  The only people who get health care tax free are people who work for an employer that provides health care coverage, with the exception of the self employed or very small business who don’t get the deduction.  So who pays taxes on health care insurance(if they can get it or afford the bloat the state mandates require),  the unemployed, the self employed and anyone who works for a company that doesn’t provide health care.

The other big problem is the impact on US corporate competitiveness.

In countries with state provided care, the cost of care is spread across everyone.  In the US, it is borne by the company.  It’s a major reason GM and Ford are dying.  They can’t afford keep paying for the cost of health care for former employees.

Something has to change.  Moving to a system where everybody was eligible for a fair level of tax relief and the ability to buy policies they want,  not those mandated by the state is a much better way to move forward than more big government health care IMO.

Democrats should be pushing for something more progressive that enables everyone choice and a level/fair approach to taxation on health care costs.  I don’t understand why Obama doesn’t stand for change in health care.  It’s change we desperately need.

He just needs to talk to his own senior economic policy advisor Jason Furman.  Who says:

…Replacing the current tax preference for insurance with an income-related, refundable tax credit has the potential to expand coverage and reduce inefficient spending at no net federal cost.  But such an approach by itself would entail substantial risks, so complementary reforms to the insurance market are essential to ensure success

…The fourth category of health tax reform is proposals to reform, replace, or even repeal the existing tax benefits for health insurance. These proposals range from making employer contributions to health insurance taxable above some cap (and potentially using the savings to finance other health reforms) to making employer contributions entirely taxable and giving a separate tax benefit to encourage people to purchase insurance through either the individual market or their employers.This approach has the potential to remedy many of the downsides of the other three types of tax reforms. Unlike all three categories of reform described above,reforming or replacing the existing employer exclusion need not cost any additional money and could even be designed to save money. As a result, proposals along these lines have the potential to have effectively infinite bang for the buck by reducing the number of uninsured people at no budgetary cost. Another upside is that this approach is likely to reduce health spending and thus premiums for those who already have insurance, although a well-designed policy would have the deliberate effect of raising health spending by the newly insured…

…A more radical approach would be to make existing contributions to employer coverage entirely taxable and instead give everyone who purchased insurance either a standard deduction (as proposed by President George W. Bush in his FY 2008 budget), a uniform refundable tax credit (as proposed by Sen. John McCain [R-AZ] in his 2008 presidential campaign), or a sliding-scale credit that falls as income rises (the de facto approach of theWyden-Bennett bill).29 There are several advantages to all of these approaches over capping the deductability of health insurance premiums. First, they target assistance at those who probably need it most and thus would have a larger effect on coverage for any given amount of funds available for subsidies. Second, such proposals use all of those dollars to subsidize people going from no insurance to minimally acceptable insurance and none of those dollars to subsidize people going from minimally acceptable insurance to anything more. As a result, it provides more incentive to purchase insurance than the current system or even a capped exclusion and less incentive to purchase more generous, expensive insurance.

Source: Health Reform Through Tax Reform: A Primer by Jason Furman  (highlights are mine)

Pelosi’s actions today were totally negligent.  She should never have brought the bill to the floor if she didn’t have the votes.  Her tirade didn’t help either, and if that caused anyone to change their vote and surprise her then the calls for her resignation should be even loader.

Bringing the bailout bill to the floor without the votes to win led directly to the sell off on Wall Street. Her negligence led to $1.2 trillion dollar loss in equities.

I really feel for retirees.  Anyone who pulls out today will have lost a lot and if they don’t they may risk more.  AARP should lead a campaign for her removal as Speaker.

I wish Obama’s performance was not so disappointing. I thought McCain was the clear leader in the debate, driving the discussion his way. If it weren’t for the fact that McCain appeared to be a grumpy old guy who would not even look at Obama he would have won the thing hands down. American’s don’t like it when our presidents look mean. They’re supposed to represent us and if they look mean then we look mean.

If Obama comes out ahead in the polls for the debate, it was because McCain looked mean, not because Obama put forward a vision for a better America. It is so disappointing.

Stop agreeing with McCain already. Tell us how you are going to put the shine back on the city on the hill. The Republicans have tarnished the city beyond all belief. Tell us what the Democrats can do to put things right.

Just look at the last eight years,  we’ve had 9/11, Katrina, two un-popluar wars, a complete melt down in the credit markets, runaway federal spending, unimpeded destruction of our environment, oil prices beyond reason, an out of control deficit(which is a huge hidden tax burden  on our children) and a general trampling of civil rights in the name of patriotism.  The list of ways the Republican party has tarnished the once shiny city on the hill goes on and on.  The beautiful vision has gone all fuzzy thanks to the horrible job the Republicans have done running the country.  Reagan would be horrified.

And yet Obama is tied with McCain.  How can he not be up by 10 points or more?  So disappointing.

Obama needs to stop acting like the professor and start acting like a guy with a vision.  A vision that’s not some vague thing about change.

He needs to tell us that he will put an end to the Republican’s hidden tax on our children, win the war on terror and bring our soldiers home, make companies more competitive by reforming health care, and put some sensible regulation in place so that our financial markets work once again.  He’s the guy who should be claim the reform, prosperity and peace mantel, not McCain.

Tell us your proud to be a Democrat.  Tell us what it means.  Tell us that the party that cares about jobs, civil rights, and balanced budgets is back.  Tell us how you can put the shine back on America.  Paint us that vision and I think America will stand with you.

But if you can’t, America will stand with John McCain and hope the grumpy old guy can make good on his mantel of reform, prosperity and peace.

It’s not often I find two editorials right next to each other that seem so right on in there advice to Obama and McCain, but today’s WSJ provided the good stuff.

Karl Rove, of all people, had the advice for Obama – He should focus on selling himself, not attacking McCain.  While I’m sure he should spend some of his buckets of cash on bashing McCain (it’s only fair that he does his share of mudslinging), I think he would gain greatly if he would just help us envision what an Obama presidency would look like.  Right now, the only change I imagine under Obama is that the government will get even bigger and more bloated, my taxes will go up and we will get to listen to someone articulate in the Whitehouse.  If he was smart, he would call the Bush tax cuts a tax on our children.  He should say we have a moral responsiblity to balance our budgets.  He should get businesses on his side to fix health care – it’s a matter of international competition.  If our companies bear the burden here and governments do it elsewhere it makes it hard to compete.  He should stop with the platitudes and give us something concrete.  And he should stop with the no opinion bs on things like AIG bailout, it makes him look weak.  He needs to make me believe he would be a good, solid president, not just some well spoken guy in a suit.

On the McCain front, DAniel Henninger had an excellent article titled Will McCain Waste Palin.  He argues that McCain should take his reform concept and run with it for all he’s worth.  I could not agree more.  Washington is a sea self dealing, envelope stretching, loophole maneuvering BS.  At the end of his convention speach he said he would fight and asked people to join his fight.   So far, his words about reform feel like platitudes, aside from his I will veto earmarks comments.  He should get specific.  Go for the line item veto.  Attack the stupidity of our farm and corn based ethanol subsidies, the no bid contracts, and the un-real bailouts of the rich, but stupid banks.  We’re all pissed at Washington.  He should put some themes into his reform positioning that make it real, make it relatable and make it feel like the revolutinary change we need.

Whoever does a better job with the advice above is likely to win IMO.