C-SPAN BFD: Complaints about the Dems failure to televise or otherwise open up the House/Senate health care negotiations seem near-completely hollow (as were Obama's promises during the campaign). Real legislative deals are always most efficiently cut behind closed doors, where the principals can be candid and concession-minded without fear of embarrassment, and where they can't grandstand. ... That's life. It's not like we don't know what the issues are , or that we won't find out how they've been resolved ....If the Dems let C-SPAN cover the negotiations they'd just have to find another room nearby in which to hold the real negotiations first. ...
In essence, understandably desperate Republicans (aided in this case by MSM reporters looking for a bit of cheap, non-ideological adversarialism ) have now adopted, for tactical reasons, one of the most immature goo-goo liberal fantasies: the idea that "open meetings" on high-profile issues produce actual legislative transparency (as opposed to another layer of fake transparency). Next they'll be complaining the negotiators don't exhibit enough race and gender diversity. ...
Who’d have imagined it? But then, who in the UAW of the 1970s and 80s imagined that GM would one day be bankrupt? Like so many of the internal problems that brought GM down, labor issues were largely a product of GM’s sheer size and dominance in the market. The same arrogance that led GM to squander its technological edge and commitment to quality led GM’s UAW workforce to believe that the gravy train would always be there, and that the primary goal was to get a bigger cut of the pie. That sense of certainty that GM would always be a dominant player in the industry has died hard, but with bankruptcy the lesson seems to have been learned. [E.A.]
This seems like a convenient liberal fallback fantasy: First line of defense --the UAW didn't help bankrupt GM. Second line of defense-- OK, sure, the UAW helped bankrupt GM. But these "labor issues were largely a product" of the attitudes engendered by "GM's sheer size and dominance in the market," not by, say, New Deal-style unionism itself. But wasn't the impending end of GM's dominance clear a couple of decades ago? Why couldn't the spirit of cooperation have effectively taken hold a few months, or even years, before bankruptcy and the resulting bailout? ... Alternative view: GM's labor issues were, and are, largely a product of the labor laws that structure labor relations in America's unionized industries . In other words, the Wagner Act. It will always be less efficient to produce cars in a regime of adversarial negotation and legalistic grievance-filing and rulemaking, especially in an industry where (like virtually all industries these days) you have to be constantly making lots of little changes. If GM somehow survives, and the "gravy train" returns, the Wagner Act will still be there to make sure it goes away again. ... 11:10 P..M.
One day I'll read a persuasive article describing how we can "bend the curve" on health care costs without reducing care. Hasn't happened yet! The latest addition to this massive Archive of the Unconvincing is the NYT's David Leonhardt's piece on what he forthrightly calls "rationing" of medical capacity in Richmond, Virginia . Basically, Virginia limits the number of hosptial beds. South Dakota doesn't. The idea seems to be that without the limits, medical entrepreneurs build more capacity, and then doctors order patients to use that capacity, running up costs without improving care. This would seem to require doctors to order up treatments they should know are flat out not effective--not just cost -ineffective-but that's the argument. So how does the Richmond vs. Dakota comparison come out?
1. In Richmond the number of beds per 1000 residents fell from 4.8 in 1996 to "about three." You would now expect Leonhardt to unleash a string of stats showing that medical care in Richmond has gotten better despite these limits. You would be wrong. Care in Richmond is "better than in most American metroplitan areas," says Leonhardt. OK, but what was it like before? Maybe it was better than nearly every metro area before. Richmond hospitals do a "better-than-average job of treating heart attacks," Leonhardt says. OK, but were they much-better-than-average before? Anyway, that's just heart attacks. ... Oh, and a patient named Janet Binns--actually, a patient's daughter--feels there is "nothing cheap about the care." Well, all right then! ....
But wait a minute:, Leonhardt later notes that "[S]ome of Richmond's hospitals do poorly on Medicare's metrics." But that's "kind of the point," he assures us, because it just proves that Medicare in Richmond is just like the rest of the country. Huh? I thought the point was that Richmond's cuts hadn't reduced the excellent quality of care, not that they'd lowered it to the national average. ... And why doesn't he tell us more about those underperforming "metrics"?
2. South Dakota, meanwhile, lifted its regulatory caps on hospital beds. As a result, a health care company named Bon Secours went on "an expansion binge. ...Suddenly, southeastern South Dakota had vastly more medical capacity than just a few years earlier." You would expect Leonhardt to now demonstrate that all this expensive new medical capacity didn't translate into healthier South Dakotans. You would be wrong. He just drops the subject. For all we know, the Bon Secours spending binge revolutionized prarie health care the way LBJ's rural electrification program revolutionized life in the Texas hill country.
3. Some "doctors and hospitals" told Leonhardt that Virginia regulators had become "lax" in their rationing of hospitals beds recently. You would expect Leonhardt to then demonstrate that this rumored relaxation had in fact happened--with the number of hospital beds per thousand rising, perhaps. You would be wrong . Yet Leonhardt uses the rumored, unsubstantiated laxity to explain why Richmond's "spending growth had ... accelerated" recently. Yikes.The curve is coming unbent! Instead of 39th cheapest in the country, Richmond is now only 69th. But wait--a dozen paragraphs earlier Leonhardt had tried to convince us that rationing worked in Richmond by brandishing the "39th" figure. If that was merely an ephemeral success, why didn't he tell us at the time? Alternative explanation : Rationing works for a while. Then it stops working and costs start rising because it starts to impinge on care (which prompts regulators to become "lax" and allow new facilities).
4. Richmond is one city in Virginia. What's happened in the rest of the state?
5. Some 37 states have a program like Virginia's requiring hopsitals to get permission to add beds, etc. What's happened in those other states?
6. Indeed, if so many states have this program, then isn't it part of the status quo? In other words, it's not "our future." It's our present. Whatever savings the regulations may produce, they are part of the profligate spending curve that Obama confidently tells us he'll bend further .
7. Leonhardt's articles in general would be more convincing if he didn't seem a puppet of the
Orszagist agitprop bureau"Dartmouth researchers" he constantly cites. It's almost as if they're ...I don't know ... feeding him the stats he says he needs. Too bad they didn't feed him some better ones.