Commentary Magazine


Topic: Bureau of the Census

Morning Commentary

It looks like President Obama has finally found some backbone in his diplomatic spat with Hugo Chavez. The Venezuelan president rejected the U.S.’s choice for ambassador to Caracas and dared Obama to cut diplomatic ties with the country. Today Obama responded by kicking the Venezuelan ambassador out of the U.S.

Americans are still displaying a lack of confidence in both political parties, according to a new poll released by CNN/Opinion Research Corporation. While pundits from all parts of the political spectrum have lauded President Obama’s successes during the lame-duck session of Congress, a plurality of Americans remains skeptical about the president’s ability to push his policies, according to the survey. And even though a majority of the public agrees that GOP control of the House will benefit the country, that optimism isn’t necessarily due to increased trust in the Republican Party. Only a quarter believe that the Republicans will do a better job running Congress than the Democrats.

The U.S. State Department has come out strongly against the Palestinian Authority’s newest effort to push through a UN Security Council resolution condemning Israeli settlement construction, suggesting that the Palestinians may be alienating the best friend they’ve had in the White House for years. However, State Department officials still haven’t commented specifically on whether the U.S. would veto the resolution.

The Huffington Post reported recently that the number of uninsured Americans has soared to “over 50 million.” But is that really the case? At the Weekly Standard, Jeffrey H. Anderson notes that the numbers come from a recent report published by the Census Bureau, which even the bureau has admitted was largely inaccurate: “The Census report also admits within its own pages that recognition of its inaccuracy led to ‘a research project to evaluate why CPS ASEC estimates of the number of people with Medicaid are lower than counts of the number of people enrolled in the program from CMS’ — in other words, to evaluate why the CPS ASEC lists millions of Americans as being uninsured while the Centers for Medicare and Medicaid Services (CMS), which runs Medicaid and keeps the official tally of enrollees, says that these people are on Medicaid.”

Islamists are apparently still having trouble getting over that Danish Mohammed cartoon from six years ago. Five terror suspects were arrested in Denmark and Sweden yesterday for plotting to attack the Jyllands-Posten newspaper headquarters, which published the cartoon in 2005.

With the rest of the world unwilling to combat the growing problem of Somali pirates, the transitional federal government of Somalia has finally taken the problem into its own hands by creating a paramilitary force to fight piracy. Sources say that the militia is being funded by donors in Muslim countries, including the United Arab Emirates.

Ron Radosh joins the growing ranks of writers criticizing New Yorker editor David Remnick’s hostile rant against Israel last week. Radosh also highlights the insidious anti-Israel sentiment among today’s liberal Jewish intellectuals: “Today’s New York intellectuals are a pale imitation of their ancestors. The original group had a fidelity to the truth, and to bold assertions  they believed to be true, regardless of whom they offended. Today’s group, of which Remnick is most typical, runs to join their fellow leftist herd of no longer independent minds in Britain, assuring them of their loyalty to the influential [among] journalists and opinion makers, and if they are Jewish, making their assurance known by joining in the stampede to dissociate themselves from defense of Israel.” Jonathan Tobin discussed Remnick’s Israel problem in CONTENTIONS on Sunday.

It looks like President Obama has finally found some backbone in his diplomatic spat with Hugo Chavez. The Venezuelan president rejected the U.S.’s choice for ambassador to Caracas and dared Obama to cut diplomatic ties with the country. Today Obama responded by kicking the Venezuelan ambassador out of the U.S.

Americans are still displaying a lack of confidence in both political parties, according to a new poll released by CNN/Opinion Research Corporation. While pundits from all parts of the political spectrum have lauded President Obama’s successes during the lame-duck session of Congress, a plurality of Americans remains skeptical about the president’s ability to push his policies, according to the survey. And even though a majority of the public agrees that GOP control of the House will benefit the country, that optimism isn’t necessarily due to increased trust in the Republican Party. Only a quarter believe that the Republicans will do a better job running Congress than the Democrats.

The U.S. State Department has come out strongly against the Palestinian Authority’s newest effort to push through a UN Security Council resolution condemning Israeli settlement construction, suggesting that the Palestinians may be alienating the best friend they’ve had in the White House for years. However, State Department officials still haven’t commented specifically on whether the U.S. would veto the resolution.

The Huffington Post reported recently that the number of uninsured Americans has soared to “over 50 million.” But is that really the case? At the Weekly Standard, Jeffrey H. Anderson notes that the numbers come from a recent report published by the Census Bureau, which even the bureau has admitted was largely inaccurate: “The Census report also admits within its own pages that recognition of its inaccuracy led to ‘a research project to evaluate why CPS ASEC estimates of the number of people with Medicaid are lower than counts of the number of people enrolled in the program from CMS’ — in other words, to evaluate why the CPS ASEC lists millions of Americans as being uninsured while the Centers for Medicare and Medicaid Services (CMS), which runs Medicaid and keeps the official tally of enrollees, says that these people are on Medicaid.”

Islamists are apparently still having trouble getting over that Danish Mohammed cartoon from six years ago. Five terror suspects were arrested in Denmark and Sweden yesterday for plotting to attack the Jyllands-Posten newspaper headquarters, which published the cartoon in 2005.

With the rest of the world unwilling to combat the growing problem of Somali pirates, the transitional federal government of Somalia has finally taken the problem into its own hands by creating a paramilitary force to fight piracy. Sources say that the militia is being funded by donors in Muslim countries, including the United Arab Emirates.

Ron Radosh joins the growing ranks of writers criticizing New Yorker editor David Remnick’s hostile rant against Israel last week. Radosh also highlights the insidious anti-Israel sentiment among today’s liberal Jewish intellectuals: “Today’s New York intellectuals are a pale imitation of their ancestors. The original group had a fidelity to the truth, and to bold assertions  they believed to be true, regardless of whom they offended. Today’s group, of which Remnick is most typical, runs to join their fellow leftist herd of no longer independent minds in Britain, assuring them of their loyalty to the influential [among] journalists and opinion makers, and if they are Jewish, making their assurance known by joining in the stampede to dissociate themselves from defense of Israel.” Jonathan Tobin discussed Remnick’s Israel problem in CONTENTIONS on Sunday.

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How About a Competent Replacement for Summers?

Larry Summers is heading back to Harvard. His tenure as head of the National Economic Council was marked by escalating unemployment, a flood of red ink, and an assault on employers. The Obama team, we are told, is out looking for a “female CEO.” Aside from the irony (Summers got in hot water for suggesting that the relative paucity of women in the sciences isn’t due to discrimination but to some innate inability and lifestyle preferences), this is yet another instance in which the Obama team seems obsessed with the wrong things.

What about someone — woman or man — who knows what the heck she/he is doing and doesn’t view American business as the enemy? How about someone who thinks raising taxes in a recession is a horrid idea? The short list includes such non-CEO types as “Rebecca Blank, a Commerce Department official who oversees the Census Bureau and Bureau of Economic Analysis” and Laura Tyson, who has split her time between government and the University of California at Berkeley (not kidding). In other words, the CEO part is optional; the female part is not. There are also some real CEOs on the “only gals need apply” list.

This females-only-for-the-economic-team-captain gambit is ludicrous — the type of overt discrimination that, if evidenced in the private sector, would be illegal. It once again reveals that politics and groveling to special interests are much more important to the Obami than is sound governance.

Larry Summers is heading back to Harvard. His tenure as head of the National Economic Council was marked by escalating unemployment, a flood of red ink, and an assault on employers. The Obama team, we are told, is out looking for a “female CEO.” Aside from the irony (Summers got in hot water for suggesting that the relative paucity of women in the sciences isn’t due to discrimination but to some innate inability and lifestyle preferences), this is yet another instance in which the Obama team seems obsessed with the wrong things.

What about someone — woman or man — who knows what the heck she/he is doing and doesn’t view American business as the enemy? How about someone who thinks raising taxes in a recession is a horrid idea? The short list includes such non-CEO types as “Rebecca Blank, a Commerce Department official who oversees the Census Bureau and Bureau of Economic Analysis” and Laura Tyson, who has split her time between government and the University of California at Berkeley (not kidding). In other words, the CEO part is optional; the female part is not. There are also some real CEOs on the “only gals need apply” list.

This females-only-for-the-economic-team-captain gambit is ludicrous — the type of overt discrimination that, if evidenced in the private sector, would be illegal. It once again reveals that politics and groveling to special interests are much more important to the Obami than is sound governance.

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The Budget Fudge

In a portion of last night’s speech that rankled many conservatives, Obama pointed the finger at defense spending as the cause of our fiscal woes: “We have spent over a trillion dollars at war, often financed by borrowing from overseas. This, in turn, has short-changed investments in our own people, and contributed to record deficits. For too long, we have put off tough decisions on everything from our manufacturing base to our energy policy to education reform.” This is hooey.

The Washington Post explains:

Federal domestic spending increased a record 16 percent to $3.2 trillion in 2009, the Census Bureau reported Tuesday, largely because of a boost in aid to the unemployed and the huge economic stimulus package enacted to rescue the sinking economy.

The rise in spending was the largest since the Census Bureau began compiling the data in 1983. The Washington region was among the biggest beneficiaries of the government’s spending.

With congressional elections looming this fall, the spike in federal spending has emerged as one of the nation’s most contentious political issues.

Many Republicans accuse President Obama and his Democratic allies of being reckless spenders who are harming the nation’s long-term economic prospects by inflating the deficit.

It doesn’t appear that defense spending is the problem:

Overall, the largest chunk of federal spending – about 46 percent of the $3.2 trillion – went to Medicare, Medicaid and Social Security, entitlement programs that are projected to swell as the population ages.

Pay for federal employees accounted for nearly $300 billion of the spending and nearly half of that went to the Defense Department payroll.

In July, Gary Schmitt debunked the idea that defense spending is driving our deficits:

Right now, Defense’s share of federal outlays—including those for Iraq and Afghanistan—is 18 percent.  That’s the same level it was at during the Clinton years.  In contrast, mandatory spending eats up some 56 percent of federal spending, while discretionary non-defense spending is 19 percent.  Core entitlement spending (Social Security, Medicare, Medicaid) is now double that of defense. And while entitlement spending and debt service will continue to explode, the Pentagon’s share of federal spending will be shrinking to 15 percent within the next few years. While the Obama administration has already cut some $300 billion in defense programs, it has been spending nearly $800 billion to (supposedly) stimulate the economy.

This is yet another example of two Obama traits. First, he makes stuff up. Really, what he said last night is not remotely true no matter how you do the math. And second, he stretches the truth to sustain an ideological preference: he wants to spend more and more on domestic programs, so he’s anxious to trim as much from our defense budget as possible. And to do that, we can’t make open-ended commitments.

In a portion of last night’s speech that rankled many conservatives, Obama pointed the finger at defense spending as the cause of our fiscal woes: “We have spent over a trillion dollars at war, often financed by borrowing from overseas. This, in turn, has short-changed investments in our own people, and contributed to record deficits. For too long, we have put off tough decisions on everything from our manufacturing base to our energy policy to education reform.” This is hooey.

The Washington Post explains:

Federal domestic spending increased a record 16 percent to $3.2 trillion in 2009, the Census Bureau reported Tuesday, largely because of a boost in aid to the unemployed and the huge economic stimulus package enacted to rescue the sinking economy.

The rise in spending was the largest since the Census Bureau began compiling the data in 1983. The Washington region was among the biggest beneficiaries of the government’s spending.

With congressional elections looming this fall, the spike in federal spending has emerged as one of the nation’s most contentious political issues.

Many Republicans accuse President Obama and his Democratic allies of being reckless spenders who are harming the nation’s long-term economic prospects by inflating the deficit.

It doesn’t appear that defense spending is the problem:

Overall, the largest chunk of federal spending – about 46 percent of the $3.2 trillion – went to Medicare, Medicaid and Social Security, entitlement programs that are projected to swell as the population ages.

Pay for federal employees accounted for nearly $300 billion of the spending and nearly half of that went to the Defense Department payroll.

In July, Gary Schmitt debunked the idea that defense spending is driving our deficits:

Right now, Defense’s share of federal outlays—including those for Iraq and Afghanistan—is 18 percent.  That’s the same level it was at during the Clinton years.  In contrast, mandatory spending eats up some 56 percent of federal spending, while discretionary non-defense spending is 19 percent.  Core entitlement spending (Social Security, Medicare, Medicaid) is now double that of defense. And while entitlement spending and debt service will continue to explode, the Pentagon’s share of federal spending will be shrinking to 15 percent within the next few years. While the Obama administration has already cut some $300 billion in defense programs, it has been spending nearly $800 billion to (supposedly) stimulate the economy.

This is yet another example of two Obama traits. First, he makes stuff up. Really, what he said last night is not remotely true no matter how you do the math. And second, he stretches the truth to sustain an ideological preference: he wants to spend more and more on domestic programs, so he’s anxious to trim as much from our defense budget as possible. And to do that, we can’t make open-ended commitments.

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Flotsam and Jetsam

It took too long, but the myth of Obama’s competence is crumbling: “The WH political shop leaves much to be desired. Take your pick as to which is worse: The fact that Pres. Obama’s team opened itself up to GOP ridicule over feelers it put out to Rep. Joe Sestak (D-PA) and ex-CO House Speaker Andrew Romanoff (D); the fact that those feelers didn’t actually work, displaying an ineptness absent during George W. Bush’s tenure; or the fact that the WH has gone more than a week without being able to move past the story.”

It took too long, but the Obama spin on the economic “recovery” is no longer carrying the day: “Private employers did little hiring last month, undermining hopes that the economic recovery was gathering pace and helping send U.S. stocks down more than 3% on the day. The Labor Department said Friday that 431,000 jobs were added in May. But the vast majority were temporary workers hired by the government to conduct the 2010 Census. Private-sector employment rose by only 41,000, the smallest monthly increase since January. Without faster private-sector job growth, the U.S. faces a bumpy recovery restrained by households with little income to spend.”

It took too long, but even the New York Times has stopped shilling for Obama with respect to the economy: “President Obama tried to put a gloss on the jobs report, telling workers at a trucking company in Hyattsville, Md., that the numbers showed an economy that was ‘getting stronger by the day.’ Mr. Obama mentioned that Census Bureau hiring accounted for most of the new jobs, but he added that the nation had added jobs for each of the last five months. ‘These numbers do mean that we are moving in the right direction,’ he said. ‘There are going to be ups and downs.’ In fact, the May figures suggested a job market wheezing after months of more vigorous growth.”

It took too long, but the Washington Post is calling for transparency on the Joe Sestak and Andrew Romanoff job offers:”Is President Obama comfortable with the actions of White House officials in dangling federal jobs as political inducements? An episode involving former Colorado House Speaker Andrew Romanoff (D) is more troubling than the previously disclosed incident involving Rep. Joe Sestak (D-Pa.). . .  White House press secretary Robert Gibbs said that Mr. Obama did not know about the Romanoff overtures in advance, and Mr. Gibbs blew off questions about his reaction by saying he hadn’t discussed the matter with the president. That’s not sufficient. The American people deserve to hear directly from the president about whether he is happy with this behavior.”

It took too long, but an advocate for Israel emerges in the administration: “Biden’s instinctive embrace of Israel at a moment it was under fire from the international community was the most vivid example yet of Biden’s emergence as the West Wing’s most prominent public supporter of the Jewish state. ” Too bad Obama isn’t and he ignores most of what Biden says.

It took too long, but foreign-policy gurus across the political spectrum are complaining that “when it comes to the question of democracy in the Muslim world, many see a U.S. administration more keen to reinforce status quo support for authoritarian regimes than to push for meaningful political reform.”

It took too long, but cranky Republicans are admitting that, “after this Obama nightmare, the Bush brand is looking pretty good.” (The occasion was a New York GOP convention at which Jeb Bush stole the show.)

It took too long, but there is a is a brilliant novel of teenage angst other than (and smarter than) Catcher in the Rye. (The most insightful review is, of course, in this month’s COMMENTARY.)

And with plenty of time to spare, Mitch Daniels emerges as a potential 2012 contender: “He is at once so visible and so self-effacing that he seems to have sunk into a black hole of personal magnetism and come out the other side, where the very lack of charisma becomes charismatic. He is the un-Obama. Republicans — notably some wealthy and powerful ones who have decided he should be president​ — seem to like that.”

It took too long, but the myth of Obama’s competence is crumbling: “The WH political shop leaves much to be desired. Take your pick as to which is worse: The fact that Pres. Obama’s team opened itself up to GOP ridicule over feelers it put out to Rep. Joe Sestak (D-PA) and ex-CO House Speaker Andrew Romanoff (D); the fact that those feelers didn’t actually work, displaying an ineptness absent during George W. Bush’s tenure; or the fact that the WH has gone more than a week without being able to move past the story.”

It took too long, but the Obama spin on the economic “recovery” is no longer carrying the day: “Private employers did little hiring last month, undermining hopes that the economic recovery was gathering pace and helping send U.S. stocks down more than 3% on the day. The Labor Department said Friday that 431,000 jobs were added in May. But the vast majority were temporary workers hired by the government to conduct the 2010 Census. Private-sector employment rose by only 41,000, the smallest monthly increase since January. Without faster private-sector job growth, the U.S. faces a bumpy recovery restrained by households with little income to spend.”

It took too long, but even the New York Times has stopped shilling for Obama with respect to the economy: “President Obama tried to put a gloss on the jobs report, telling workers at a trucking company in Hyattsville, Md., that the numbers showed an economy that was ‘getting stronger by the day.’ Mr. Obama mentioned that Census Bureau hiring accounted for most of the new jobs, but he added that the nation had added jobs for each of the last five months. ‘These numbers do mean that we are moving in the right direction,’ he said. ‘There are going to be ups and downs.’ In fact, the May figures suggested a job market wheezing after months of more vigorous growth.”

It took too long, but the Washington Post is calling for transparency on the Joe Sestak and Andrew Romanoff job offers:”Is President Obama comfortable with the actions of White House officials in dangling federal jobs as political inducements? An episode involving former Colorado House Speaker Andrew Romanoff (D) is more troubling than the previously disclosed incident involving Rep. Joe Sestak (D-Pa.). . .  White House press secretary Robert Gibbs said that Mr. Obama did not know about the Romanoff overtures in advance, and Mr. Gibbs blew off questions about his reaction by saying he hadn’t discussed the matter with the president. That’s not sufficient. The American people deserve to hear directly from the president about whether he is happy with this behavior.”

It took too long, but an advocate for Israel emerges in the administration: “Biden’s instinctive embrace of Israel at a moment it was under fire from the international community was the most vivid example yet of Biden’s emergence as the West Wing’s most prominent public supporter of the Jewish state. ” Too bad Obama isn’t and he ignores most of what Biden says.

It took too long, but foreign-policy gurus across the political spectrum are complaining that “when it comes to the question of democracy in the Muslim world, many see a U.S. administration more keen to reinforce status quo support for authoritarian regimes than to push for meaningful political reform.”

It took too long, but cranky Republicans are admitting that, “after this Obama nightmare, the Bush brand is looking pretty good.” (The occasion was a New York GOP convention at which Jeb Bush stole the show.)

It took too long, but there is a is a brilliant novel of teenage angst other than (and smarter than) Catcher in the Rye. (The most insightful review is, of course, in this month’s COMMENTARY.)

And with plenty of time to spare, Mitch Daniels emerges as a potential 2012 contender: “He is at once so visible and so self-effacing that he seems to have sunk into a black hole of personal magnetism and come out the other side, where the very lack of charisma becomes charismatic. He is the un-Obama. Republicans — notably some wealthy and powerful ones who have decided he should be president​ — seem to like that.”

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Flotsam and Jetsam

A disappointment to leftist civil rights groups? “The issue of race is one reason some liberals fear Kagan’s confirmation would actually tug the court to the right, particularly on voting rights, immigration and racial profiling cases that could come before the justices.”

A coward on the issue of Islamic fundamentalism? “Holder, who last year called America ‘a nation of cowards’ for refusing to talk frankly about race, plainly didn’t want to say what is plain to everyone else, that Faisal Shahzad, back from five months in Waziristan, launched his terror attack because of his Islamist beliefs.”

A sign of the administration’s obliviousness? “[T]he State Department’s showcasing of the Dar al-Hijra Islamic Center in a film about Muslim life in America — despite the mosque’s longstanding ties to the Muslim Brotherhood, its virulent Islamist ideology, its support for the murderous Hamas organization, its notorious Islamist imams and elders (including al Qaeda recruiter Anwar al-Awlaki), and the ties of some of its worshippers to the 9/11 attacks and the Fort Hood massacre. Then, we learned that the federal government has struck a deal to pay Dar al-Hijra a whopping $582K just for this year (i.e., about one-tenth what it cost the Saudis to build the place), purportedly because the Census Bureau needs work space — y’know, because there are like no federal facilities anywhere near Falls Church, Virginia.”

A preview of what is to come? “A British chemicals firm is involved in a secret MI5 inquiry into the illegal export to Iran of material that could make a radioactive “dirty bomb”. HM Revenue & Customs (HMRC) raided the Essex home of the firm’s former sales manager after a tip that potentially lethal chemicals, including cobalt, were sold to Iran last summer.”

A reminder that Richard Goldstone had the choice not to facilitate evil? “Frederik van Zyl Slabbert, 70, who helped South Africa chart a peaceful way out of apartheid by leading fellow whites into talks with exiled black leaders, died May 14 at his home in Johannesburg after being treated for a liver-related complication, Reuters reported. … As a political figure, he symbolized the emergence of a new breed of Afrikaner: urbane, articulate and committed to racial equality. … Mr. Slabbert tried to lead, leaving behind an early career as a sociologist in academia to enter politics. He represented the Progressive Federal Party, a precursor to the current opposition Democratic Alliance, in parliament during the apartheid years. He resigned as party leader and left parliament in 1985, during a crackdown on black activists, saying the whites-only legislature was no longer relevant.”

A nail biter in the Democratic Pennsylvania primary? The last tracking poll had Joe Sestak and Arlen Specter tied at 44 percent each.

A character witness he (and the rest of us) could do without?: “Woody Allen has restated his support for fellow filmmaker Roman Polanski, who is in house arrest in connection with a 33-year-old sex scandal. Allen said Polanski ‘was embarrassed by the whole thing,’ ”has suffered’ and ‘has paid his dues.’ He said Polanski is ‘an artist and is a nice person’ who ‘did something wrong and he paid for it.'” I must have missed the jail time Polanski served for raping a 13-year-old.

A disappointment to leftist civil rights groups? “The issue of race is one reason some liberals fear Kagan’s confirmation would actually tug the court to the right, particularly on voting rights, immigration and racial profiling cases that could come before the justices.”

A coward on the issue of Islamic fundamentalism? “Holder, who last year called America ‘a nation of cowards’ for refusing to talk frankly about race, plainly didn’t want to say what is plain to everyone else, that Faisal Shahzad, back from five months in Waziristan, launched his terror attack because of his Islamist beliefs.”

A sign of the administration’s obliviousness? “[T]he State Department’s showcasing of the Dar al-Hijra Islamic Center in a film about Muslim life in America — despite the mosque’s longstanding ties to the Muslim Brotherhood, its virulent Islamist ideology, its support for the murderous Hamas organization, its notorious Islamist imams and elders (including al Qaeda recruiter Anwar al-Awlaki), and the ties of some of its worshippers to the 9/11 attacks and the Fort Hood massacre. Then, we learned that the federal government has struck a deal to pay Dar al-Hijra a whopping $582K just for this year (i.e., about one-tenth what it cost the Saudis to build the place), purportedly because the Census Bureau needs work space — y’know, because there are like no federal facilities anywhere near Falls Church, Virginia.”

A preview of what is to come? “A British chemicals firm is involved in a secret MI5 inquiry into the illegal export to Iran of material that could make a radioactive “dirty bomb”. HM Revenue & Customs (HMRC) raided the Essex home of the firm’s former sales manager after a tip that potentially lethal chemicals, including cobalt, were sold to Iran last summer.”

A reminder that Richard Goldstone had the choice not to facilitate evil? “Frederik van Zyl Slabbert, 70, who helped South Africa chart a peaceful way out of apartheid by leading fellow whites into talks with exiled black leaders, died May 14 at his home in Johannesburg after being treated for a liver-related complication, Reuters reported. … As a political figure, he symbolized the emergence of a new breed of Afrikaner: urbane, articulate and committed to racial equality. … Mr. Slabbert tried to lead, leaving behind an early career as a sociologist in academia to enter politics. He represented the Progressive Federal Party, a precursor to the current opposition Democratic Alliance, in parliament during the apartheid years. He resigned as party leader and left parliament in 1985, during a crackdown on black activists, saying the whites-only legislature was no longer relevant.”

A nail biter in the Democratic Pennsylvania primary? The last tracking poll had Joe Sestak and Arlen Specter tied at 44 percent each.

A character witness he (and the rest of us) could do without?: “Woody Allen has restated his support for fellow filmmaker Roman Polanski, who is in house arrest in connection with a 33-year-old sex scandal. Allen said Polanski ‘was embarrassed by the whole thing,’ ”has suffered’ and ‘has paid his dues.’ He said Polanski is ‘an artist and is a nice person’ who ‘did something wrong and he paid for it.'” I must have missed the jail time Polanski served for raping a 13-year-old.

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Wanted: Female Justice with Small Children (Pets a Plus)

Another Supreme Court nomination is in the works, so it’s time for another round of inanity on court appointments. The latest dose of condescension comes from Peter Beinart, who thinks it’s time for not just a woman but “a mom with kids.” (Is three better than two? What about a single mom? A divorced dad with sole custody?) Why does this matter — so they can decide cases in favor of women? No, really: he wants a woman justice “because female justices, on average, will be more sensitive to the problems women face. Since they will have likely encountered gender bias themselves, they will be more likely to support government action to remedy it.” In other words, they will violate their oath of office and give the gals a break. And then there is the old standby: we need more tokenism:

It’s not just that they may alleviate gender injustice through their rulings; they may alleviate it through their example as well. Just as Barack Obama empowers African-American kids to believe that there are no limits to what they can achieve, female Supreme Court justices send the same message to young women. As anyone who has ever watched their daughter eye a Barbie Doll can attest, role models matter.

Not Sarah Palin as VP, mind you. And Madeleine Albright, Condi Rice, and Hillary Clinton don’t suffice. Neither do the two women currently on the Court. More role models! But what’s with the kids? Beinart explains it’s the role models (again):

It’s important because otherwise, the message you’re sending young women is that they can achieve professionally, or they can have a family, but they can’t do both. And without quite realizing it, that is the message our government has been sending. According to the Census Bureau, 80 percent of American women over the age of 40 have children. But look at the women who have held Cabinet posts in the last three presidential administrations. Only two of the Clinton administration’s five female Cabinet secretaries had kids. (Attorney General Janet Reno got her job only after two women with children, Zoë Baird and Kimba Wood, were dinged for hiring illegal immigrants as nannies). In the Bush administration, the figure was two of seven. In the Obama administration, so far, it is two of four. And if Obama chooses Elena Kagan for the High Court, the figure there will be one of three.

There’s nothing wrong, of course, with appointing childless women (or men, for that matter) to high office. But our government is actually doing a pretty good job of providing role models for the 20 percent of American women who don’t want kids. Where it’s failing is in providing role models for the 80 percent that do.

But Sandra Day O’Connor had three children. Ruth Bader Ginsburg has two children. Don’t they count? Well, maybe they have to be young. So what we need is  a woman justice with at least two children under the age of 10 so that other women with children under the age of 10 will know that they too can be on the Supreme Court. Thunk.

Beinart is a smart fellow. So maybe this is a sly parody of the rampant racial and gender preferences that have overtaken Supreme Court selections. They have turned these into embarrassing “diversity” rackets in which the White House searches for the person most likely to tip the scales for this or that interest group or to bolster the self-esteem of some key demographic. So if Beinart meant to show up all that and urge us to get back to the old-fashioned notion of merit, then bravo! If not, he should be embarrassed.

Another Supreme Court nomination is in the works, so it’s time for another round of inanity on court appointments. The latest dose of condescension comes from Peter Beinart, who thinks it’s time for not just a woman but “a mom with kids.” (Is three better than two? What about a single mom? A divorced dad with sole custody?) Why does this matter — so they can decide cases in favor of women? No, really: he wants a woman justice “because female justices, on average, will be more sensitive to the problems women face. Since they will have likely encountered gender bias themselves, they will be more likely to support government action to remedy it.” In other words, they will violate their oath of office and give the gals a break. And then there is the old standby: we need more tokenism:

It’s not just that they may alleviate gender injustice through their rulings; they may alleviate it through their example as well. Just as Barack Obama empowers African-American kids to believe that there are no limits to what they can achieve, female Supreme Court justices send the same message to young women. As anyone who has ever watched their daughter eye a Barbie Doll can attest, role models matter.

Not Sarah Palin as VP, mind you. And Madeleine Albright, Condi Rice, and Hillary Clinton don’t suffice. Neither do the two women currently on the Court. More role models! But what’s with the kids? Beinart explains it’s the role models (again):

It’s important because otherwise, the message you’re sending young women is that they can achieve professionally, or they can have a family, but they can’t do both. And without quite realizing it, that is the message our government has been sending. According to the Census Bureau, 80 percent of American women over the age of 40 have children. But look at the women who have held Cabinet posts in the last three presidential administrations. Only two of the Clinton administration’s five female Cabinet secretaries had kids. (Attorney General Janet Reno got her job only after two women with children, Zoë Baird and Kimba Wood, were dinged for hiring illegal immigrants as nannies). In the Bush administration, the figure was two of seven. In the Obama administration, so far, it is two of four. And if Obama chooses Elena Kagan for the High Court, the figure there will be one of three.

There’s nothing wrong, of course, with appointing childless women (or men, for that matter) to high office. But our government is actually doing a pretty good job of providing role models for the 20 percent of American women who don’t want kids. Where it’s failing is in providing role models for the 80 percent that do.

But Sandra Day O’Connor had three children. Ruth Bader Ginsburg has two children. Don’t they count? Well, maybe they have to be young. So what we need is  a woman justice with at least two children under the age of 10 so that other women with children under the age of 10 will know that they too can be on the Supreme Court. Thunk.

Beinart is a smart fellow. So maybe this is a sly parody of the rampant racial and gender preferences that have overtaken Supreme Court selections. They have turned these into embarrassing “diversity” rackets in which the White House searches for the person most likely to tip the scales for this or that interest group or to bolster the self-esteem of some key demographic. So if Beinart meant to show up all that and urge us to get back to the old-fashioned notion of merit, then bravo! If not, he should be embarrassed.

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Texas Bloom

The Census Bureau has come out with its annual state-by-state head count and it makes for interesting reading. There is no one better than Michael Barone at the art of looking at numbers and bringing them to life. He notes that Texas had the highest population gain (and third highest in percentage terms) and thinks he knows why:

Texas had above-average immigrant growth, but domestic in-migration was nearly twice as high. There may be lessons for public policy here. Texas over the decades has had low taxes (and no state income tax), low public spending and regulations that encourage job growth. It didn’t have much of a housing bubble or a housing price bust. Under Govs. George W. Bush and Rick Perry, it has placed tight limits on tort lawsuits and has seen an influx of both corporate headquarters and medical doctors.

Because of its population growth, Texas is likely to gain four new House seats in 2012. Florida, Utah, Arizona, and Nevada will each gain one. For the first time since it became a state in 1850, California will not gain any seats in the House, and New York, Massachusetts, New Jersey, Pennsylvania, Michigan, and Illinois will all lose a seat and Ohio will probably lose two.

No wonder the Obama administration is in such a hurry to lock in its far-left policies. As Barone explains, “Americans have been moving, even in recession, away from Democratic strongholds and toward Republican turf.”

The Census Bureau has come out with its annual state-by-state head count and it makes for interesting reading. There is no one better than Michael Barone at the art of looking at numbers and bringing them to life. He notes that Texas had the highest population gain (and third highest in percentage terms) and thinks he knows why:

Texas had above-average immigrant growth, but domestic in-migration was nearly twice as high. There may be lessons for public policy here. Texas over the decades has had low taxes (and no state income tax), low public spending and regulations that encourage job growth. It didn’t have much of a housing bubble or a housing price bust. Under Govs. George W. Bush and Rick Perry, it has placed tight limits on tort lawsuits and has seen an influx of both corporate headquarters and medical doctors.

Because of its population growth, Texas is likely to gain four new House seats in 2012. Florida, Utah, Arizona, and Nevada will each gain one. For the first time since it became a state in 1850, California will not gain any seats in the House, and New York, Massachusetts, New Jersey, Pennsylvania, Michigan, and Illinois will all lose a seat and Ohio will probably lose two.

No wonder the Obama administration is in such a hurry to lock in its far-left policies. As Barone explains, “Americans have been moving, even in recession, away from Democratic strongholds and toward Republican turf.”

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From COMMENTARY: Health Care in Three Acts

As President Bush prepares to address the issue of health care in his State of the Union address, COMMENTARY is fortunate to have a trenchant analysis of the wider problem, “Health Care in Three Acts,” by Eric Cohen and Yuval Levin, coming out in the February issue. Here is an advance look.

Americans say they are very worried about health care: on generic lists of voter concerns, health issues regularly rank just behind terrorism and the Iraq war. And politicians are eager to do something about it. To empower consumers, the White House has advanced the idea of Health Savings Accounts; to help the uninsured, it has explored using Medicaid more creatively. Senator Edward Kennedy of Massachusetts, the Democrats’ leader on this issue, has backed “Medicare for all.” The American Medical Association has called for tax credits to put private coverage within reach of more Americans. A number of recent books have proposed solutions to our health-care problems ranging from socialized medicine on the Left to laissez-faire schemes of cost containment on the Right. In Washington and in the state capitals, pressure is building for serious reforms.

But what exactly are Americans worried about? Untangling that question is harder than it looks. In a 2006 poll, the Kaiser Family Foundation found that while a majority proclaimed themselves dissatisfied with both the quality and the cost of health care in general, fully 89 percent said they were satisfied with the quality of care they themselves receive. Eighty-eight percent of those with health insurance rated their coverage good or excellent—the highest approval rating since the survey began 15 years ago. A modest majority, 57 percent, were satisfied even with its cost.

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As President Bush prepares to address the issue of health care in his State of the Union address, COMMENTARY is fortunate to have a trenchant analysis of the wider problem, “Health Care in Three Acts,” by Eric Cohen and Yuval Levin, coming out in the February issue. Here is an advance look.

Americans say they are very worried about health care: on generic lists of voter concerns, health issues regularly rank just behind terrorism and the Iraq war. And politicians are eager to do something about it. To empower consumers, the White House has advanced the idea of Health Savings Accounts; to help the uninsured, it has explored using Medicaid more creatively. Senator Edward Kennedy of Massachusetts, the Democrats’ leader on this issue, has backed “Medicare for all.” The American Medical Association has called for tax credits to put private coverage within reach of more Americans. A number of recent books have proposed solutions to our health-care problems ranging from socialized medicine on the Left to laissez-faire schemes of cost containment on the Right. In Washington and in the state capitals, pressure is building for serious reforms.

But what exactly are Americans worried about? Untangling that question is harder than it looks. In a 2006 poll, the Kaiser Family Foundation found that while a majority proclaimed themselves dissatisfied with both the quality and the cost of health care in general, fully 89 percent said they were satisfied with the quality of care they themselves receive. Eighty-eight percent of those with health insurance rated their coverage good or excellent—the highest approval rating since the survey began 15 years ago. A modest majority, 57 percent, were satisfied even with its cost.

Evidently, though, this widespread contentment with one’s own lot coexists with concern on two other fronts. Thus, in the very same Kaiser poll, nearly 90 percent considered the number of Americans without health insurance to be a serious or critical national problem. Similarly, a majority of those with insurance of their own fear that they will lose their coverage if they change jobs, or that, “in the next few years,” they will no longer be able to afford the coverage they have. At least as troubling is what the public does not seem terribly bothered about—namely, the dilemmas of end-of-life care in a rapidly aging society and the exploding costs of Medicare as the baby-boom generation hits age sixty-five.

All of this makes it difficult to speak of health care as a single coherent challenge, let alone to propose a single workable solution. In fact, America faces three fairly distinct predicaments, affecting three fairly distinct portions of the population—the poor, the middle class, and the elderly—and each of them calls for a distinct approach.

For the poor, the problem is affording coverage. Forty-six million Americans were uninsured in 2005, according to the Census Bureau. This is about 15.9 percent of the population, which has been the general range now for more than a decade, peaking at 16.3 percent in 1998.

But that stark figure fails to convey the shifting face and varied make-up of the uninsured. On average, a family that loses its coverage will become insured again in about five months, and only one-sixth of the uninsured lack coverage for two years or more. In addition, about a fifth of the uninsured are not American citizens, and therefore could not readily benefit from most proposed reforms. Roughly a third of the uninsured are eligible for public-assistance programs (especially Medicaid) but have not signed up, while another fifth (many of them young adults, under thirty-five) earn more than $50,000 a year but choose not to buy coverage.

It is also crucial to distinguish between a lack of insurance coverage and a lack of health care. American hospitals cannot refuse patients in need who are without insurance; roughly $100 billion is spent annually on care for such patients, above and beyond state and federal spending on Medicaid. The trouble is that most of this is emergency care, which includes both acute situations that might have been prevented and minor problems that could have been treated in a doctor’s office for considerably less money. The real problem of the uninsured poor, then, is not that they are going without care, but that their lack of regular and reliable coverage works greatly to the detriment of their family stability and physical well-being, and is also costly to government.

For the middle class, the problem is different: the uncertainty caused in part by the rigid link between insurance and employment and in part by the vicissitudes of health itself. America’s employment-based insurance system is unique in the world, a product of historical circumstances and incremental reforms that have made health care an element of compensation for work rather than either a simple marketplace commodity or a government entitlement. This system now covers roughly 180 million Americans. It works well for the vast majority of them, but the link it creates between one’s job and one’s health coverage, and the peculiar economic inefficiencies it yields, result in ever-mounting costs for employers and, in an age of high job mobility, leave many families anxious about future coverage even in good times.

The old, finally, face yet another set of problems: the steep cost of increasingly advanced care (which threatens to paralyze the government) and the painful decisions that come at the limits of medicine and the end of life. Every American over sixty-five is eligible for at least some coverage by the federal Medicare program, which pays much of the cost of most hospital stays, physician visits, laboratory services, diagnostic tests, outpatient services, and, as of 2006, prescription drugs. Established in 1965, Medicare is funded in part by a flat payroll tax of 2.9 percent on nearly every American worker and, beyond that, by general federal revenue. Most recipients pay only a monthly premium that now stands at $88.50, plus co-payments on many procedures and hospital stays.

But precisely because Medicare is largely funded by a payroll tax, it suffers acutely from the problems of an aging society. In 1950, just over 8 percent of Americans were over sixty-five. Today that figure stands at nearly 15 percent, and by 2030 it is expected to reach over 20 percent, or 71 million Americans. Moreover, the oldest of the old, those above the age of eighty-five, who require the most intense and costly care, are now the fastest growing segment of the population; their number is expected to quadruple in the next half-century.

For Medicare, therefore, just as for Social Security, the number of recipients is increasing while the number of younger workers to pay the bills is declining. But Medicare faces a greater danger still. Its costs are a function not only of the number of eligible recipients but of the price of the services they use. Over the past few years, health-care spending in America has increased by about 8 percent each year, most steeply for older Americans who have the most serious health problems. As these costs continue to rise much faster than the wages on which Medicare’s funding is based, the program’s fiscal decline will be drastic, with commensurately drastic consequences for the federal budget.

Three different “crises,” then, each of a different weight and character. The crisis of the uninsured, while surely a serious challenge, has often been overstated, especially on the Left, in an effort to promote more radical reforms than are necessary. The crisis of insured middle-class families has been misdiagnosed both by the Right, which sees it purely as a function of economic inefficiency, and by the Left, which sees it as an indictment of free-market medicine. And the crisis of Medicare has been vastly understated by everyone, in an effort to avoid taking the painful measures necessary to prevent catastrophe. In each case, a clearer understanding may help point the way to more reasonable reforms.

In the case of the uninsured, the best place to begin is with the solution most frequently proposed to their plight: a government-run system of health care for all Americans.

Under such a system—which exists in some form in most other industrialized democracies—the government pays everyone’s medical bills, and in many cases even owns and runs the health-care system itself. The appeal of this idea lies in its basic fairness and simplicity: everyone gets the same care, from the same source, in the same way, based purely on need. In one form or another—actual proposals have varied widely, with Hillary Clinton’s labyrinthine scheme of 1993 merely the best known of many—this “single-payer” model remains the preferred health-care solution of the American Left. But it is ill-suited to the actual problems of America’s uninsured, and adopting it would greatly exacerbate other problems as well.

Everywhere it has been tried, the single-payer model has yielded inefficient service and lower-quality care. In Britain today, more than 700,000 patients are waiting for hospital treatment. In Canada, it takes, on average, seventeen weeks to see a specialist after a referral. In Germany and France, roughly half of the men diagnosed with prostate cancer will die from the disease, while in the United States only one in five will. According to one study, 40 percent of British cancer patients in the mid-1990’s never got to see an oncologist at all.

Such dire statistics have in fact caused many Western democracies with single-payer systems to turn toward market mechanisms for relief. The Swedes have begun to privatize home care and laboratory services. Australia now offers generous tax incentives to citizens who eschew the public system for private care. To send a message to the government, the Canadian Medical Association recently elected as its president a physician who runs a private hospital in Vancouver, actually illegal in Canada. “This is a country in which dogs can get a hip replacement in under a week,” the new president told a newspaper interviewer, “while humans can wait two or three years.”

Defenders of the single-payer concept often point out that, despite patient complaints about the quality of care, overall measures of health in countries with such systems are roughly equivalent to those in America. That may be so, but the chief reason lies in social and cultural factors—crime rates, diet, and so forth—that make life in many other Western nations safer and healthier than life in America, and that would not be altered by a single-payer health system. Besides, citizens in those other nations benefit enormously from medical innovations produced and made possible by America’s dynamic private market; if that market were hobbled by a European-style bureaucracy, their quality of care would suffer along with ours.

And quality of care, it is important to remember, is one thing that most Americans are happy with. Any reform that promises to replace immediate access to specialists with long waiting lines, or the freedom to choose one’s own doctor with restrictive government mandates, is certain to evoke deep hostility, and thereby to cut into public support for efforts to help the uninsured.

On this score, proponents of socialized medicine would do well to consult the cautionary example of the health-maintenance organization (HMO). HMO’s are insurers who contract directly with providers, often for a flat fee, reviewing physician referrals and medical decisions in order to prevent unnecessary procedures or expenses. By the mid-1990’s, this capacity for cost-containment had made HMO’s very attractive to policy-makers and families alike. And they delivered on their cost-cutting promise. In those years, as David Gratzer notes in his recent book The Cure (Encounter, 325 pp., $25.95), private health-care spending per capita grew by just 2 percent annually (today the figure is nearly 10 percent, though the reasons for this, as we shall see below, go beyond just the decline of HMO’s).*

But the public soon chafed under the authoritarian character of a system in which case managers were entrusted with decisions that often seemed arbitrary, while doctors resented having their medical judgment questioned by bureaucrats. Participation soon declined, and HMO’s themselves began to take on the characteristics of traditional insurance plans. By the middle of this decade, they had joined the bipartisan list of stock American villains: in the 2004 presidential campaign, President Bush accused Senator John Kerry of getting “millions from executives at HMO’s,” while Kerry pledged to “free our government from the dominance of the lobbyists, the drug industry, big oil, and HMO’s—so that we can give America back its future and its soul.”

In a single-payer government system, everything Americans dislike about HMO’s would be worse: rationing, top-down control, perverse incentives, and, for patients, very little say. As has happened in Europe, a single-payer approach would also turn health-care costs entirely into government costs, grossly distorting public spending and threatening to crowd out other important government functions. The result would be a political, fiscal, and social disaster.

There is a better way to assist the uninsured: not universal government health care but universal private insurance coverage. Such an effort could begin by identifying the populations in need. Those who are uninsured by their own choice could be offered incentives to purchase at least some minimal coverage, or be penalized for failing to do so. Those who cannot afford insurance could be given subsidies to purchase private coverage based on their level of income, and then pooled into a common group to give them some purchasing power and options. Their coverage would still not equal that available to people in the most generous employer-based plans, but it would offer reliable access to care without destroying the quality and flexibility of the American system.

Although such a plan might not be cheap, it would not be nearly so expensive or complex as a single-payer system. The money for it could be taken, in part, from Medicaid funds now used to pay doctors and hospitals for care already provided to the uninsured, with such “uncompensated-care” programs gradually transformed into a voucher system for purchasing private coverage. But though it might rely on some federal dollars, the reform itself would best be undertaken and managed at the state level. After all, health insurance is regulated by the states, Medicaid is largely managed by the states, and different states face different challenges and possess different resources.

In Massachusetts and Florida, ideas like these are already being tested, although it is too early to judge the results. The federal government can help other states try this more practical approach by clearing away regulatory obstacles and by providing incentives for experiments in creative reforms.

This brings us to the health-care anxieties of middle-class Americans. Although these concerns are in most respects much less pressing than those of the poor, they are real enough. Middle-class families are, besides, the heart and soul of America’s culture and economy, as well as the essential political force for any sober assessment and improvement of America’s health-care system.

Generally speaking, the worries expressed by these Americans stem from the peculiarities of our employer-based insurance market. It is, indeed, a very odd thing that more than 180 million Americans should be covered by insurance purchased for them by their employers. The companies we work for do not buy our food and clothing, or our car and home insurance. They pay us for our labor, and we use that money to buy what we want.

No less odd is the character of what we call health insurance. Insurance usually means coverage for extreme emergencies or losses. We expect auto insurance to kick in when our car is badly damaged in an accident, not when we need a routine oil change; homeowner’s insurance covers us after a fire, flood, or break-in, not when we need to repair the deck or unclog the gutters. But when it comes to health, we expect some element of virtually every expense to be covered, including routine doctor checkups and regular care.

America’s insurance system is largely a historical accident. During World War II, the federal government imposed wage controls on American employers. No longer able to raise salaries to compete for employees, companies turned instead to offering the lure of fringe benefits, and the era of employer-based health care was born. Thanks to a 1943 IRS ruling allowing an exemption for money spent by employers on health insurance, an enormous tax incentive was created as well. Rather than giving a portion of every dollar to the government, employees could get a full dollar’s worth of insurance through their company.

Of course, wage controls are long gone, but the system they inadvertently created, including the tax exemption, remains in place. Although this system has served most Americans very well, it has two significant drawbacks. First, by forging a tight link between one’s job and one’s health insurance, it makes losing a job, or changing jobs, a scary proposition, especially for parents. Second, it lacks any serious check on costs. Because insurance often pays the bulk of every single bill (instead of kicking in only for emergencies or extreme expenses), most American families do not know, or attend to, the actual cost of their health care.

Any car owner can tell you the price of a gallon of gas or an oil change. But what is the price of knee surgery? Or even a regular doctor’s visit? Does one hospital or doctor charge more than another? Most patients pay only a deductible that, while often not cheap, bears almost no relation to the price of the service they receive. As a result, they do not behave like consumers, shopping for the best price and thereby forcing providers to compete for their dollar.

Inured to such issues, families worry most about the lack of portability of their insurance, leaving it to economists to worry about the distorting effects of price inefficiencies. To gain the support of middle-class parents, any reform to the system would therefore need to address the former issue first.

Policy-makers on the Left have tended to understand this, but have over-read the anxiety of families, seeing it as a broad indictment of America’s free-market health care. They have thus offered the same bad solution to the problems of the insured as they do to the problems of the uninsured: a government-run system that will replace our present one. As for conservative policy-makers, they sometimes tend to overlook the concerns of middle-class families altogether, focusing on inefficiency before portability.

The conservative health-care solution of the moment is the health savings account, or HSA. It has two components: a savings account to which individuals and employers can make tax-free contributions to be drawn on exclusively for routine health-care costs, and a high-deductible insurance plan to help pay for catastrophic expenses.

Since individuals can take their HSA’s with them when they change jobs (provided the new employer allows it), this option can indeed help promote insurance portability. But, generally speaking, that is neither its foremost aim nor its effect. Instead, it is seen by its proponents as helping to level the playing field by giving to individuals the same tax breaks that employers get in purchasing coverage, and as helping to train people to think like consumers, since in spending their own money they will have an incentive to spend as little of it as possible. In short, proponents of the HSA want to use market mechanisms to achieve lower costs and improved quality.

This is certainly a worthy goal—but does it meet the concerns of most Americans? David Gratzer, an advocate of the HSA, tells the story of a woman who used such an account in exactly the desired way. Needing foot surgery, and impelled to spend her own money wisely, she

took charge of the situation and thought about what she really needed. When a simple day-surgery was suggested, she looked around and decided on a local surgery center. She asked about clinic fees and offered to pay upfront—thereby getting a 50-percent discount. When she found out that an anesthetist would come in specifically to do the foot block, she asked her surgeon just to do it. She also negotiated the surgeon’s compensation down from $1,260 to $630. Finally, she got a prescription from her doctor for both antibiotics and painkillers, but only filled the former. “In the past, my attitude would have been, ‘just have all the prescriptions filled because insurance was paying for it, whether or not I need them.’”

Although Gratzer offers this as an ideal example, it will surely strike many people as a nightmare. Haggling with doctors, ignoring prescriptions, bypassing a specialist to save money—is this the solution to middle-class health-care worries? Who among us feels confident taking so much responsibility for judgments over his own health, let alone over the care of his children or his elderly parents?

If the HSA is to have wide appeal, it must be sold first and foremost as a means not of efficiency but of portability—and as part of a broader effort to expand the portability of health insurance generally. Nor should such an effort be aimed, at least at first, at undoing our employer-based system. Perhaps, given a blank slate, no sensible person would ever have designed the current system. But we do not have a blank slate. We have a system providing care that the vast majority of insured Americans are quite happy with—and that has also helped America resist the pressure for government-run health care of the kind for which every other developed nation is now paying a heavy price.

We have, in other words, a system that works but is in need of repairs, most notably in the realm of improved portability. Making this happen will require better cooperation between state and federal policy-makers. An exclusively national solution would require federalizing the regulation of health insurance, which is both undesirable and politically unachievable. Instead, states should be encouraged to develop insurance marketplaces like the one now taking shape in Massachusetts. Mediating between providers and purchasers, these would allow employers, voluntary groups, and individuals to select from a common set of private options. Whether working full-time, part-time, or not at all, individuals and families could choose from the same menu of plans and thus maintain constant coverage even as their job situations or life circumstances change. For those who cannot afford insurance and do not receive it from an employer, Medicaid dollars could be used to subsidize the purchase of a private plan.

The federal government, meanwhile, could ensure that Medicaid dollars allotted to states can be used to support such a structure of subsidies. It could also pursue other, smaller measures, like extending or eliminating the time limit on the COBRA program, which allows individuals leaving a job to keep their employment-based plan by paying the full premium. As states begin implementing marketplace reforms, the federal government could also find ways to encourage regional and eventually national marketplaces, which would enable the purchase of insurance across state lines.

In any such scheme, Health Savings Accounts would surely have a place. So would other measures of cost containment like greater price transparency. But the key to any large reform must be its promise to address the real worries of insured American families by preserving what is good about the current system while facing up to its limits and confronting its looming difficulties.

Unfortunately, when it comes to paying for the health care of older Americans, there are few attractive options. Costs have risen steeply in recent years, while the economic footing of the Medicare program has been steadily eroding. Nor are demographic realities likely to change for at least a generation; to the contrary, they may only worsen. So the solution must involve some form of cost containment.

This will not be easy. As Arnold Kling points out in Crisis of Abundance (Cato Institute, 120 pp., $16.95), costs are rising not because of increasing prices for existing medical services but because of a profound transformation in the way medicine is practiced in America. Between 1975 and 2002, the U.S. population increased by 35 percent, but the number of physicians in the country grew by over 100 percent. The bulk of these were specialists, whose services cost a great deal more than those of general practitioners. New technologies of diagnosis (like MRI exams) have also become routine, and not just for the old, and the number and variety of treatments, including surgeries, have likewise increased. We spend more because more can be done for us.

All of this spells heavier demands on the Medicare budget, to the point where the program’s fiscal prospects have become very bleak. Already accounting for roughly 15 percent of federal spending, Medicare will be at 25 percent by 2030 and growing. In David Gratzer’s words, “Medicare threatens to be the program that ate the budget.”

Worse yet, one of the most expensive and complicated burdens of an aging society is not even covered by Medicare. This is long-term care, involving daily medical and personal assistance to people incapable of looking after themselves. The Congressional Budget Office estimates that Americans spent roughly $137 billion on long-term care in 2000, and that by 2020 the figure will reach $207 billion. Longer lives, and the high incidence of dementia among the oldest of the old, are bound to impose an extraordinary new financial strain on middle-income families, whose consequent demand for government help will only worsen our already looming fiscal crisis.

Medicaid, which covers health care for the poor, does pay for some long-term care in most states. To qualify for this, and to avoid burdening their children, a growing number of the elderly have opted to spend down their assets when the need arises. But this ends up burdening their children anyway, if less directly. States already spend more on Medicaid than on primary and secondary education combined; if Medicaid comes to shoulder the bulk of long-term costs in the coming decades, it will bankrupt state coffers and place enormous strains on the federal budget.

Of course, the challenges of an aging society reach well beyond economics. As more and more Americans face an extended decline in their final years, elderly patients and their families will confront painful choices about how much care is worthwhile, who should assume the burdens of care-giving, and when to forgo additional life-sustaining treatment. Compared to this profound human challenge, fiscal dilemmas can seem relatively paltry. But they too necessitate hard and unavoidable choices.

One way or another, the Medicare program will have to be adjusted to a society with radically different demographics from the one it was designed to serve. If “seventy is the new fifty,” as a popular bumper sticker tells us, then the age of Medicare eligibility must begin to move up as well. That will inevitably impose a hardship on those who are already not vigorous in their sixties, as well as on those whose jobs are too physically demanding for even a healthy sixty-five-year-old. So hand in hand with raising the age of eligibility will need to go programs encouraging (or requiring) health-care savings earlier in life. At the same time, Medicare benefits will gradually have to become means-tested, so that help goes where it is most needed and benefits are most generous to those with the lowest incomes and fewest assets.

More fundamentally, the structure of the Medicare program will have to change. Its benefits now increase in an open-ended way that both reflects and drives the upward movement of health costs; if Medicare is to remain sustainable, constraints will gradually have to be put in place, so that benefits grow by a set percentage each year. The program will also need its own distinct and reasonably reliable funding source, which will require an adjustment in the design of the payroll tax.

Any such reforms will be politically explosive, to put it mildly. No politician in his right mind would run on a platform of limiting Medicare eligibility and capping its benefits. And yet, a decade from now, caring for aging parents will have become a burning issue for a great swath of America’s families as parents find themselves squeezed between the needs of their own parents and the needs of their children. Every politician will be expected to offer a solution, and will be subject to dangerous temptations: promising limitless care at the very moment when fiscal responsibility requires setting limits, or promising to “solve” our fiscal problems by abandoning the elderly. The least that responsible policy-makers can do now is to familiarize Americans with the realities of our aging society, so that when the time comes for difficult choices, we will not be blind-sided.

Understanding America’s three distinct health-care challenges, and the deficiencies of conventional responses to them, is the first step toward reform. Any approach we take will assuredly cost the taxpayers money. Already, nearly a third of the federal budget is spent on health-care, and that portion is certain to grow. The choice, however, is between paying the necessary price to ameliorate our genuine problems or paying far more to satisfy ideological whims or avoid politically painful decisions.

Neither socialized medicine nor a pure market approach is suited to America’s three health-care challenges, while the bipartisan conspiracy to ignore the looming crisis of Medicare in particular will return to haunt our children. Coming to grips with the true nature of our challenges suggests, instead, a set of pragmatic answers designed to address the real problems of the uninsured, of middle-class families, and of the elderly while protecting America’s private health-insurance system and looking out for the long-term fiscal health of the nation.

Even as we pursue practical options for reform, however, it behooves us to remember that health itself will always remain out of our ultimate control. Medicine works at the boundaries of life, and its limits remind us of our own. While our health-care system can be improved, our unease about health can never truly be quieted. And while reform will require hard decisions, solutions that would balance the books by treating the disabled and debilitated as unworthy of care are no solutions at all. In no small measure, America’s future vitality and character will depend upon our ability to rise to this challenge with the right mix of creativity and sobriety.

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