President Obama’s health-care reform appears to be in increasing trouble. The costs, as scored by the Congressional Budget Office, would be horrendous, public support is collapsing, and Congressional Democrats are at each other’s throats over the issue. It appears increasingly unlikely that either house will hold a vote before the August recess, and that recess is likely to be a time when members of Congress will get an earful from the home folks telling them they hate the whole idea.
Congressional Republicans should probably follow Woodrow Wilson’s admirable advice to “never murder a man who is committing suicide.” But once ObamaCare implodes, the loyal opposition will likely be ready with an alternative. I don’t mean an alternative overarching, comprehensive, fix-everything-instantly plan that’s impossible for the layman to get a handle on (that’s what’s wrong with ObamaCare). Rather, we need a set of reforms that will each help mightily to fix what is really wrong with the American health-care system: the fact that no one — doctors and patients alike — has any incentive to care what things cost. Because they can be enacted independently, only one ox would be gored at a time and thus only one set of lobbyists would be fighting each reform instead of banding together to fight for the status quo.
A few suggestions:
1) Fix the fee-for-service structure of compensation for hospitals and doctors. When you get paid for every procedure you perform and every test you order, there is, obviously, a big incentive to do more procedures and more tests. But when doctors are on salary, as at Bassett Hospital in upstate New York, costs are much lower. At Bassett, costs are below those of 90 percent of hospitals in New York State, while care is in the top 10 percent nationwide. The famous Mayo and Cleveland clinics are structured the same way. The AMA loves fee-for-service.
2) Fix the malpractice system. The whole system of tort law in this country has been corrupted by a small segment of the American bar while the ABA has stood by and done nothing. (Check out Walter Olson’s www.overlawyered.com.) Huge malpractice-insurance costs are passed on to patients and insurance companies while doctors and hospitals are forced to practice “defensive medicine,” ordering unnecessary tests and procedures to avoid being second-guessed by medically ignorant juries happy to spend other people’s money. Special federal health courts, modeled on bankruptcy courts, would be a big improvement. But nothing would help more than getting rid of the “American rule,” in which each side pays its own court costs regardless of outcome. This creates a heads-I-win-tails-you-lose situation in which the American legal system is used as a means of extortion (“pay us $100,000 to go away or spend a million to successfully defend the lawsuit”). Adopting the so-called English rule (which is actually the rest-of-the-world rule), where the loser pays court costs, would save billions that now go into the pockets of lawyers and expert witnesses for hire. Tort lawyers love the legal status quo.
3) Immunize drug companies from lawsuits if the drug companies have met all FDA requirements (and no fraud is involved, of course). If the FDA fails to do its regulatory job to uncover problems before a drug is licensed, those injured should be compensated from a trust fund funded by a small tax on prescription drugs. Those injured are now compensated by a large tax on prescription drugs disguised as malpractice insurance premiums for drug companies. And a large percentage of the compensation goes to lawyers and expenses, not the victims. Tort lawyers love this one too.
4) Federalize insurance regulation. Insurance is regulated by the 50 states, although we have had national insurance markets for over a hundred years. Having one set of regulations instead of 50 would lower costs dramatically. Requiring insurance companies to offer a defined set of policies, from high-deductible, catastrophic policies designed for those at low risk (such as the healthy young, who make up a large percentage of the uninsured), to medical-savings-account policies, to all-the-bells-and-whistles policies for those older and more affluent. People buying insurance would then be able to compare prices, forcing insurance companies to compete on the basis of price. When there’s price competition, prices go down. State governments and insurance companies will hate this one.
5) Eliminate the deductibility of health-insurance costs for companies and provide tax credits for individuals to buy insurance instead. This was John McCain’s excellent suggestion last year, and Barack Obama shamelessly demagogued it. But making people ask the magic question “How much is this going to cost?” will drain billions out of the cost of insurance. Those used to gold-plated policies at someone else’s expense won’t like this one bit.
6) Incentivize people to watch costs. Safeway, the large supermarket chain, has brought health-care costs under control by making it in the interest of their employees to, once again, ask the magic question “How much will this cost?” while making sure the cost doesn’t bankrupt them if it’s inherently high. Safeway found that the cost of a standard colonoscopy in medical facilities within 30 miles of the corporate headquarters varied from $700 to $7,000. Only in an economic situation where no one cares what things cost is such a disparity possible. Give people a reason to care (such as the use of medical savings accounts) and require facilities to publish prices, and those prices will quickly converge toward the low end of the range. Hospitals and out-patient clinics will oppose this, as will people who have been used to not caring. It is estimated that waste, fraud, legal costs, overcharging, and cost-shifting add about $700 billion a year to the country’s medical costs. If we could eliminate half that, it would be equal to buying every uninsured person in the United States a $7,500-a-year medical insurance policy. And it wouldn’t destroy the most innovative and accessible medical system in the world by turning it over to bureaucrats who don’t care about either patients or costs.
Gore One Ox at a Time
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Expect the impossible.
If the 2016 presidential election cycle demonstrated anything, it was that Republicans suffer from a crippling lack of imagination. That ordeal should have established that the unprecedented is not impossible. Even now, Republicans seem as though they are trying to convince themselves that their eyes are lying to them, but they are not. The tempo of the investigation into President Trump is accelerating, and a nightmare scenario is eminently imaginable. Only congressional Republicans can avert disaster, and only then by being clear about the actions they are prepared to take if Trump instigates a crisis of constitutional legitimacy.
The events of the last 36 hours unrolled like a cascade. Late Wednesday, the New York Times published an interview in which Trump delivered a stinging rebuke for Attorney General Jeff Sessions, scolding him for recusing himself from the investigation into the campaign’s ties to Russian operatives. In that interview, Trump appeared to warn special counselor Robert Mueller not to dig too deeply into his personal finances, or else.
Hours later, Bloomberg News revealed that Mueller’s probe was investigating Trump’s business transactions and tax records—a leak surely made in response to Trump’s arm-twisting. More leaks from the investigation confirmed that former Trump campaign manager Paul Manafort was being investigated for involvement in a money-laundering scheme, a revelation made more discomfiting by the discovery that he owed pro-Russian interests $17 million before joining the Trump campaign.
With the noose tightening, the lead attorney on Trump’s personal defense team, Marc Kasowitz, and the legal team’s spokesperson, Mark Corallo, resigned. The Washington Post reported that “Trump has asked his advisers about his power to pardon aides, family members and even himself in connection with the probe.” Trump’s spokespeople insist the president has no intention of pursuing the dismissal of the special counsel investigating his campaign, but his every action indicates that this is a lie.
Prominent Republicans reacted to all this incredulously. “There is no possible way anybody at the White House could be seriously thinking about firing Mueller,” Sen. Bob Corker insisted. “We all know the president,” said Sen. Orrin Hatch. “He makes some of these comments that he really doesn’t mean.” Sen. Susan Collins was willing to go a bit farther: “It would be catastrophic if the President were to fire the special counsel.”
Off the record, however, Republican lawmakers are far less circumspect in relaying their fears about what the president is capable of doing to the republic. “Any thought of firing the special counsel is chilling. It’s chilling,” an unnamed GOP senator told CNN. “One gets the impression that the President doesn’t understand or he willfully disregards the fact that the attorney general and law enforcement in general—they are not his personal lawyers to defend and protect him,” another added.
These tepid comments for the record, with courage reserved only upon condition of anonymity, expose how Republicans in Congress have again failed to meet the measure of the moment. These are dangerous days, and it is incumbent upon Donald Trump’s party in Congress to deter the executive branch from overstepping its authority. The only way to do that is to be clear about what the consequences for that kind of transgression will be.
The Congressional Research Service defines how the president could execute a nuclear option against the independent counsel’s office. The Attorney General has recused himself from campaign-related investigations, so Trump would have to insist Deputy Attorney General Rod Rosenstein remove Mueller. If Rosenstein declined, his resignation would likely be on offer, and his acting replacement (Associate Attorney General Rachel Brand) would have to field the same request. At this point, the comparisons between the Trump White House’s behavior and that of the Nixon administration ahead of the 1973 “Saturday Night Massacre” are no longer hyperbolic.
In lieu of any ability to contain or control the special counsel’s office, Trump’s defenders have mounted a public relations campaign designed to undermine its authority and discredit its members. That will rally Trump’s diehard supporters, but the president remains unsatisfied. National Review’s Rich Lowry speculated convincingly that Trump would have little choice but to move against Mueller. Sooner rather than later, the conditions the president said would force his hand—a probe of Trump’s personal finances—will be met. Lowry observed that Trump seems to believe his tax records and business practices should be off limits and his experience has taught him “that fortune favors the recklessly bold.”
Republicans in Congress must stop comforting themselves with the notion that the worst cannot happen. They have to summon the courage to state publicly what they so freely tell reporters on background. If they are so concerned that the norms and traditions that have preserved the rule of law in this republic for 240 years are in jeopardy, they must say so. And they must say what the consequences will be for Trump, his associates, and his family if he goes too far. Republicans in office are disinclined to pursue a course of action against Trump that might jeopardize their standing with the voters who love him. None of that matters. Prioritizing their parochial careerist considerations over the best interests of their party and their country is how they got themselves into this mess.
Republicans may dislike the prospect, but it’s fast becoming time for them to start saying the “I” word if only to save the president from his most reckless impulses. The longer they tell themselves that the unthinkable is impossible, the more likely it becomes.
Are the warplane's secrets safe?
The F-35 Joint Strike Fighter is the newest generation air platform for the U.S. Air Force, Navy, and Marines. Lockheed-Martin, which builds the F-35, describes it as “a 5th Generation fighter, combining advanced stealth with fighter speed and agility, fully fused sensor information, network-enabled operations and advanced sustainment.” For both diplomatic reasons and to encourage sales, Lockheed-Martin subcontracted the production of many F-35 components to factories abroad. Many program partners—Australia, Canada, the United Kingdom, Denmark, for example—are consistent U.S. allies.
Turkey, however, is also part of the nine-nation consortium producing the plane, which gives Turkey access to the F-35’s technology. “As a program partner, Turkish industries are eligible to become suppliers to the global F-35 fleet for the life of the program. In total, F-35 industrial opportunities for Turkish companies are expected to reach $12 billion,” the warplane’s website explained. “Turkey plans to purchase 100 of the F-35A Conventional Takeoff and Landing variant. Its unsurpassed technological systems and unique stealth capabilities ensure that the F-35 will be the future of Turkish national security for decades to come.”
But is the F-35 safe with Turkey? In recent years, the Turkish government has leaked highly-classified information to America’s adversaries in fits of diplomatic pique. Back in 2013, for example, Turkey leaked to the Iranians the identities of Israeli spies in Iran. Danny Yatom, former head of the Mossad, told USA Today that the incident would damage U.S. intelligence efforts, “because we will be much more reluctant to work via Turkey because they will fear information is leaking to Iran… We feel information achieved [by Israel] through Turkey went not only to Israel but also to the United States.”
On July 19, the Pentagon criticized Turkey’s state-controlled news agency for exposing ten covert U.S. bases in Syria in a way that can enable both the Islamic State and Iranian-backed forces to target Americans. Bloomberg reported that the leak also detailed aid routes and equipment stored at each base.
Both these incidents raise serious questions about whether Turkey can be trusted with the F-35, especially given Turkey’s growing military and diplomatic ties to Russia, and the wayward NATO state’s recent cooperation with China as well. The United Kingdom’s Ministry of Defense is rightly concerned about the security implications of a plan to service its F-35s in Turkey, but such concern should only be the tip of the iceberg.
Should Turkey even receive F-35s and, to the extent the program relies on Turkish factories, is it time to stand up quickly a Plan B? To do otherwise might squander the billions of dollars already spent on the program, risk increasing President Recep Tayyip Erdoğan’s ability to blackmail the West, and potentially land America’s latest military technology on Kremlin desks.
Too many martyrs make a movement.
If the GOP is to be converted into a vehicle for politicians who evince Donald Trump’s brand of pragmatic center-right populism, Trump will have to demonstrate his brand of politics can deliver victories for people other than himself. Presidential pen strokes help to achieve that, as do judicial appointments. Nothing is so permanent, though, as sweeping legislative change. On that score, the newly Trumpian Republican Party is coming up short. If the passive process of transformational legislative success fails to compel anti-Trump holdouts in the GOP to give up the ghost, there is always arm-twisting. It seems the Republican National Committee is happy to play enforcer.
The RNC’s nascent effort to stifle anti-Trump apostasy by making examples of high-profile heretics has claimed its first victim: New Jersey’s Lieutenant Governor Kim Guadagno. The Republican is running to replace the nation’s least popular governor, Chris Christie, and the effort has been a struggle. Trailing badly in the polls and facing the headwinds associated with trying to succeed an unpopular outgoing GOP governor in a blue state, Guadagno needs all the help she can get. That help won’t be coming from the RNC. According to NJ Advance Media, the committee’s objection to helping Guadagno isn’t the imprudence of throwing good money after bad. It’s that she was mean to President Trump in 2016, and she must be punished.
“[The president] is unhappy with anyone who neglected him in his hour of need,” said a source billed as an RNC insider. The specific complaint arises from an October 8 tweet from the lieutenant governor said that “no apology can excuse” Trump’s “reprehensible” conduct on the infamous “Access Hollywood” tape. “Christie was not as stalwart as some people in the party, but at least he didn’t go against him the way she did,” the insider added.
This source’s version of events was supported by former two-term New Jersey Governor Christine Todd Whitman. “She went down there, and the (Republican National) Committee was reluctant to back the campaign in the way one would have expected,” she said. “The implication was, ‘Well you were not a Trump supporter in the primary, and so don’t expect much money.'”
This is almost certainly a pretext. Republicans are facing stiff competition and an unfavorable political environment in November’s gubernatorial elections in Virginia and New Jersey. In 2017-2018, 27 GOP-held seats are up for grabs, nine of which are in some jeopardy of falling to Democrats. Republicans are going to have to husband their resources and triage their officeholders. That’s a forgivable, if demoralizing, condition. Declaring Guadagno to have offended the leader and to be cut off from the font of Republican goodwill is not only unjustifiable, it’s terribly foolish.
If Republican women are to be punished for saying that Trump’s comments about sexually assaulting unsuspecting females were unacceptable, there are going to be a lot fewer Republican women. Moreover, the RNC has invited the perception that there is a double standard at play here. A slew of Republicans called on Trump to drop out of the race after that tape, but the RNC is unlikely to withhold support for Senators Rob Portman or John Thune when they need it. Among those calling on Trump to drop out was his own chief of staff, Reince Priebus—a fact the president reportedly won’t let Priebus forget.
Cults of personality can be bullied into existence, but they rarely outlast the personality around whom they form unless that personality can claim some lasting achievements. In lieu of any compelling rationale, the effort to remake the GOP in Trump’s image by force will only create dissidents. The ideological conservatives who once dominated the Republican Party are unlikely to make peace with the ascendant populist faction at gunpoint. And the RNC is not solely to blame for this boneheaded move. Even if the notion that Guadagno is being punished for disloyalty is a pretense, it is a response to a clear set of incentives promoted by this White House.
Maybe the most intriguing question of the present political age is whether or not conservatives in the GOP will come to terms with a man they once saw as a usurper. A heavy hand will only catalyze resistance, and Trump needs his own party as much or more than they need him. Guadagno’s gubernatorial bid is on no firmer ground today than it was yesterday, but the Republican candidate’s allies can now legitimately claim persecution at the hands of personality cultists. Too many martyrs make a movement. The White House and the Republican National Committee should tread lightly.
Podcast: Conservatism in shackles while O.J. goes free?
On the second of this week’s podcasts, I ask Abe Greenwald and Noah Rothman whether the health-care debacle this week is simply a reflection of the same pressures on the conservative coalition Donald Trump saw and conquered by running for president last year—and what it will mean for him and them that he has provided no rallying point for Republican politicians. And then we discuss OJ Simpson. Give a listen.
Don’t forget to subscribe to our podcast on iTunes.
Hyperbole yields cynicism, not the other way around.
Newly-elected French President Emmanuel Macron surprised almost everyone when he invited President Donald Trump to celebrate Bastille Day with him in Paris, especially after the two leaders’ awkward first meeting in Brussels in May. After all, between now and then, Trump withdrew the United States from the Paris Climate Change Agreement, and Macron has become perhaps the most vocal critic of Trump among European leaders.
In hindsight, Macron’s reason for embracing Trump might have been to get the president to reverse course on the Paris agreement. From the Associated Press:
French President Emmanuel Macron says his glamorous Paris charm offensive on Donald Trump was carefully calculated — and may have changed the U.S. president’s mind about climate change…. On their main point of contention — Trump’s withdrawal from the landmark Paris climate agreement — Macron is quoted as saying that “Donald Trump listened to me. He understood the reason for my position, notably the link between climate change and terrorism.”
According to Macron, climate change causes droughts and migration, which exacerbates crises as populations fight over shrinking resources. If Macron really believes that, France and Europe are in for some tough times.
First, droughts are a frequent, cyclical occurrence in the Middle East, the Sahel, and the Horn of Africa. The difference between drought and famine is the former is a natural occurrence and the latter is man-made, usually caused by poor governance. Nowhere is this seen more clearly than in the Horn of Africa, where the same drought might kill a few dozens of Ethiopians but wipe out tens of thousands of Somalis.
Second, the common factor in the wars raging in the Middle East today is neither climate change nor extreme weather, but brutal dictatorship, radical ideologies, and the militias supported by the Islamic Republic of Iran. Yemen could be a breadbasket. Its terraced fields rising up thousands of feet in the mountains grow almost every fruit imaginable. Yemen also catches the tail end of the monsoon. If Yemenis planted exportable crops like coffee rather than the mild drug qat, which does not bring in hard currency, they might be fairly prosperous.
It is not climate change that denied the Syrian public basic freedoms and liberty for decades, nor was it climate change that dropped barrel bombs on civilian neighborhoods, tortured and killed 13-year-old Hamza Ali al-Khateeb, or used chemical weapons. For that matter, when it comes to radicalization, the problem is Syria was less climate and more decades of Saudi-and Qatari-funded indoctrination and Turkish assistance to foreign fighters.
Regardless of all this, another obvious factor nullifies Macron’s thesis: When drought occurs in regions outside the Middle East, the result is seldom suicide bombing.
Terrorism does not have a one-size-fits-all explanation but, generally speaking, when it comes to Islamist terrorism, ideology plays a key role. Most terrorists are educated, middle class, and relatively privileged. Islamic State caliph Abu Bakr al-Baghdadi, for example, has a Ph.D. Many of the 9/11 hijackers were educated. In the Gaza Strip, Hamas recruits inside schools. Simply put, there is no linkage between climate change and terrorism.
Not only would Trump be foolish to buy Macron’s argument, but environmentalists who believe climate change puts the Earth in immediate peril should be outraged. It is hyperbole. Moreover, it is the casual invocation of climate change as a catch-all cause for every other issue that breeds the cynicism that leads so many to become so dismissive of everything climate activists say. Macron may look down up Trump as an ignorant bore, but Macron’s own logic suggests he is also living in a world where facts and reality don’t matter.