Wednesday, September 03, 2014

Paul Ryan's Way Forward

To take the measure of this uncommonly interesting public man, begin with two related facts about him. Paul Ryan has at least 67 cousins in his Wisconsin hometown of Janesville, where there are six Ryan households within eight blocks of his home. And in his new book, “The Way Forward: Renewing the American Idea,” he says something few politicians say, which is why so many are neither trusted nor respected. Ryan says he was wrong.

At a Wisconsin 4-H fair in 2012, Ryan encountered a Democrat who objected to what then was one of Ryan’s signature rhetorical tropes – his distinction between “makers” and “takers,” the latter being persons who receive more in government spending than they pay in taxes. He had been struck by a report that 60 percent of Americans were already – this was before Obamacare – “net receivers.” But his encounter at the fair reminded him that, for a while, he and many people he cared about had been takers, too.

The morning after a night “working the Quarter Pounder grill at McDonald’s,” Ryan, 16, found his father, who had been troubled by alcohol, dead in bed. Janesville’s strong sinews of community sustained Ryan and his mother; so did Social Security survivor benefits. When GM’s Janesville assembly plant closed, draining about $220 million of annual payroll from a town of 60,000, many relatives, friends and constituents needed the social safety net – unemployment compensation, job training, etc.

“At the fair that day, I realized I’d been careless with my language,” he writes. “The phrase gave insult where none was intended.” He has changed his language and his mind somewhat but thinks the fundamental things still apply.

“Society,” Ryan writes, “functions through institutions that operate in the space between the individual and the state,” and “government exists to protect the space where all of these great things occur.” Hence government has a “supporting role” as “the enabler of other institutions.” Progressive government, however, works, sometimes inadvertently but often deliberately, to subordinate or supplant those institutions. This depletion of social capital is comprehensively injurious to the culture. And “all the tax cuts in the world don’t matter much if you don’t get the culture right.”

Progressivism aims to place individuals in unmediated dependency on a government that can proclaim, as Barack Obama does: “If you’ve got a business, you didn’t build that. Somebody else made that happen.” Meaning, people depend on government for what they are and have.

Few of today’s progressives are acquainted with their doctrine’s intellectual pedigree or its consistent agenda. Progressivism’s founders, however, considered it essential that the nation make progress, as they understood this, beyond the Founders' natural rights philosophy, which limits government by saying (in the Declaration of Independence) that it is “instituted” to “secure” these rights.

Hence Woodrow Wilson, a progressive who understood his doctrine’s premises, urged Americans to “not repeat the [Declaration’s] preface.” Progressivism preaches that rights do not pre-exist government, that they are dispensed and respected by government as it sees fit and to fit its purposes. Those purposes grow unconstrained by the Constitution that progressives construe as a “living” – meaning infinitely elastic – document.

Since 1999, when he became its second-youngest member, Ryan has been an intellectual ornament to the House of Representatives – and a headache for risk-averse Republican Party operatives. They pay lip service to electing conservatives who will make the choices necessary to stabilize the architecture of the entitlement system and unleash the economic growth that must finance the system’s promises. But they want to let voters remain oblivious about the choices required by that architecture’s rickety condition.

Such Republicans are complicit with Obama, who demonstrated the self-destructive nature of his now-evaporating presidency by his contemptuous, and contemptible, treatment of Ryan on April 13, 2011. After he loftily aspired to teach Washington civility, the White House invited Ryan to sit in the front row at a speech in which Obama gave an implacably hostile and mendacious depiction of Ryan’s suggestions for entitlement reforms. Obama thereby repeated his tawdry performance in his 2010 State of the Union address, when, with Supreme Court justices in the front row of the House chamber, he castigated them for the Citizens United decision, which he misrepresented.

Both times, Obama’s behavior bespoke the insecurity of someone who, surrounded by sycophants, shuns disputations with people who can reply. Ryan, however, has replied with a book that demonstrates Obama’s wisdom in not arguing with a man who has a better mind and better manners.



Eric Holder as a cry-baby & Obama as a perpetual adolescent

ATTORNEY GENERAL and all around scum-bucket Eric Holder felt it imperative to rush off to Ferguson, MO, to toss in his two cents worth of gas on a burning fire. He could have pointed out that the reason there is 50% unemployment among the black males in town, men who have nothing better to do than cause mischief for the benefit of the TV cameras, was because three-quarters of them never even finish high school. Instead, he took the opportunity to let them know he shared their grievances against the police because twice in his younger days, he, too, had been – oh, the humanity! -- stopped by traffic cops.

The odd thing is that I am a white man roughly 10 years older than Holder, and I was stopped by cops about a dozen times between the ages of 13 and 21. The first couple of times, I was stopped by Beverly Hills cops because we lived in an apartment just outside the city border, and, so, if I were spotted walking or riding my bike at dusk, on my way home from the playground or on my way to a book store, I would find myself being questioned by the guys in blue. Nobody, they would explain, exaggerating only slightly, walked or rode a bicycle in Beverly Hills after sunset.

Once I began driving, I was stopped on a regular basis even by L.A. cops because I looked too young to be driving legally. Finally, by the time I was going to UCLA, and work on the Daily Bruin would occasionally keep me on campus until late at night, I was often stopped and questioned by those same Beverly Hills cops on my way home. But now it was because, as they pointed out, nobody rode a motorcycle before or after dusk in Beverly Hills.

Whether or not Mr. Holder believes me, I never took it amiss. I did not think they were picking on me because I was young or short or Jewish. I believed they stopped me because I looked suspicious to them, and I figured they were just earning their salaries, and that if I had their job, I, too, would be stopping me and asking a few questions.

What Holder doesn’t mention is that, as a young man, he had been an Afro-haired college activist who had been part of a student uprising at Columbia University that took over and held an ROTC building for five days in 1970. Because even back then, college administrators were a gaggle of cowards, he wasn’t booted out on his butt, but allowed to hang around and get a law degree.

Only someone as race-fixated as Barack Obama would have appointed Holder in the first place or stood by while his attorney general refused to indict the Black Panthers for intimidating white voters in Philadelphia.

Speaking of Obama, the thing I have come to understand about him is that in addition to being a leftist with a scary agenda, a bigot and a narcissist, he is an adolescent. That’s why he’s so lazy. Sometimes, students are bored because they’re very bright and grasp a subject so quickly that they tend to doze off while waiting for their fellow classmates to catch up. Other times, students are bored because they are those other classmates and simply can’t grasp the lesson.

And sometimes, as I believe is the case with Obama, it’s because their minds are so lazy and self-absorbed that the only things they can manage to focus on for any length of time are those amusements such as golf and basketball or attending galas, that simply don’t call for mental discipline.



NLRB goes rogue against small business

Labor Day provides the opportunity to evaluate those government agencies that impact the workplace, and gauge if they are helping or hurting the employment situation in America.

In the six Labor Days since President Obama took office, his appointees have gone to outrageous lengths to compel the 93 percent of the private-sector workforce who don't belong to an organized labor union to become dues-paying members.

While the Labor Department and the National Mediation Board have each pushed hard to create rules that overwhelmingly favor union organizers over those employees who oppose unionization, it is the National Labor Relations Board (NLRB) which has taken the most outlandish actions in their attempt to tip the balance toward primary Democratic Party funders in Big Labor.

Few need to be reminded of the NLRB's general counsel's failed attempt to compel Boeing Corp. to remain in union-friendly Washington state, rather than relocating to South Carolina. After garnering national headlines and sending Congress into a frenzy, the NLRB backed down from their attempt to stop the aircraft manufacturer's move to the right-to-work state. But the audacity displayed by the agency — that they believed they could dictate company relocation or expansion decisions — made this obscure entity a national talking point of big government gone wrong.

The general counsel, at the same time, filed a lawsuit against two states whose voters had affirmed the right to secret ballots in union elections through their state constitutional amendment processes. The uproar in the states being sued was real, but this NLRB threat largely faded away as Big Labor's attempt to do away with secret elections through congressional action failed.

Now, the NLRB is going off the rails again. They have decided to destroy business franchise/franchisee agreements by allowing the corporations that spin out thousands of small businesses using their name, business model and products to be sued over the alleged actions of a few of the small, independent business.

This strikes at the heart of the independence of almost 1 million locally owned franchise businesses. If the actions of a few franchises can drag the corporate partner into legal action, then the cost of operating this small business model rapidly escalates, and the advantages of splitting profits with local, independent store operators rapidly disintegrate.

If the left wants to change the franchise laws, that is their prerogative. They need to go to Congress and seek to change the law, not go to the rogue, Big Labor-controlled NLRB to rewrite the law.

It's three strikes and you're out for the NLRB's ability to play investigator, prosecutor, judge, jury and executioner when it comes to our nation's labor laws. Legislation by Rep. Austin Scott (R-Ga.) that would rein in the NLRB's outrageous, one-sided behavior by stripping away the NLRB's adjudicatory authority, returning it to the federal justice system where it belongs.

It is time to rip the power over our nation's labor laws from this rogue body's grip and give it back to Congress and the federal court system. It is time for the House of Representatives to pass Austin Scott's Protecting American Jobs Act.



Price transparency lowers healthcare costs

A study recently published in Health Affairs describes how price transparency drove down the cost of MRIs by almost twenty percent from 2010 to 2012. Compared to patients who did not have the advantage of transparent pricing, patients who knew what their MRI procedure would cost saw a cost reduction of $220 per procedure. Further, price transparency was associated with a significant shift from hospitals to outpatient facilities.

This result is just the beginning. It was not a result of true consumer-driven health policy, but an intervention by an insurer. When a physician referred a patient for an MRI, the insurer required prior authorization before paying for it. When the patient called for prior authorization, the customer-service rep was able to give the patient the choice of a lower-cost provider in the same area. Importantly, the insurer’s rep was able to tell the patient how much he or she would save by using the lower-cost provider.

This is something that healthcare providers resist mightily—for obvious reasons. As a consequence, more expensive providers, especially hospitals, dropped their fees significantly. This resulted in a 30 percent compression of prices.

It is a step in the right direction. The Health Affairs article notes that government dictating price transparency has no effect—as discussed previously at this blog. Nevertheless, there is a lot further to go. For example, one-third of the patients had zero co-pay or deductible, and so were completely insensitive to price. Also, it still requires too much bureaucratic intervention. Why should a patient have to call the insurer to figure out the best price for the service?

For reducing costs, imaging is probably low-hanging fruit. Nevertheless, this experience teaches valuable lessons. Prior authorization alone (when an insurer simply makes a yes or no decision on whether it will pay for a procedure) is a cause of irresolvable conflict between payers and providers. Because the patient remains insensitive to price, if the physician decides to do the paperwork for prior authorization, it does not reduce costs. This was confirmed for Medicare in a Congressional Budget Office estimate in 2013.
However, introducing price sensitivity to prior authorization “softens up” the decision for both patient and insurer: The patient understands that the insurer is trying to get the best bang for the buck, not just prevent access to diagnosis.

What are the next steps?

    Private insurers can make prices of credentialed providers even more transparent, by posting fees on their websites and clearly informing patients about how much money they will save by going to low-cost providers.

    Private insurers can design ways to financially reward patients who have no co-pays or deductibles to make price-conscious decisions also.

    Medicare can also design ways to reward beneficiaries for making cost-saving imaging decisions (likely through Medigap plans, which often cover beneficiaries’ co-pays).

This is still a long way from consumer-driven health care. However, like reference pricing for surgery, this experience should motivate insurers to continue experimenting with letting patients know, understand and respond to the prices of medical care.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten.

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