Politics, et Cetera
A publication from The Political Forum, LLC
Tuesday, October 25, 2016
They Said It:
The very fact that crowds possess in common ordinary qualities explains why they can never accomplish acts demanding a high degree of intelligence. The decisions affecting matters of general interest come to by an assembly of men of distinction, but specialists in different walks of life, are not sensibly superior to the decisions that would be adopted by a gathering of imbeciles. The truth is, they can only bring to bear in common on the work in hand those mediocre qualities which are the birthright of every average individual. In crowds it is stupidity and not mother-wit that is accumulated. It is not all the world, as is so often repeated, that has more wit than Voltaire, but assuredly Voltaire that has more wit than all the world, if by “all the world,” crowds be understood.
Gustave LeBon, The Crowd, 1895.
HILLARY CLINTON AND THE SINGLE-PAYER DREAM: GOOD LUCK WITH THAT.
As we begin to think past the election and about the shape and the form of the likely Clinton restoration, two names come to mind. The first is Bilal Abdullah, and the second Robert Rubin, both of whom will affect the early Clinton presidency in ways that most observers have yet to grasp.
For those of you who may not remember, Robert Rubin represents the initial nexus between the Clinton Crime Family and Wall Street. Rubin was the co-chairman of Goldman Sachs until he left the firm to go to work as Bill Clinton’s first Secretary of the Treasury. After that, he went to work for Citigroup for a few months, where he helped secure Citi’s massive government bailout, before walking away with more $100 million in “compensation.”
For the likely far greater group of you who may not remember Bilal Abdullah, he is an English-born Iraqi man, who couldn’t get into a decent medical school in England and therefore attended school in his ancestral homeland. Upon his returned to the UK, he was granted a limited registration to work for the National Health Service, and then repaid his fellow Brits for their institutional generosity by trying to kill as many of them as possible, ramming his Jeep Cherokee into the main terminal at the Glasgow Airport on August 2, 2007. Abdullah is currently serving two life terms in prison.
Now, we know that it probably doesn’t make much sense superficially for us to link these two wildly different men as likely influences on the upcoming Hillary Clinton presidency, but if you’ll bear with us for a few minutes, we’ll try to explain.
As you may have noticed, the current presidential campaign has been remarkably light on the discussion of actual, substantive issues. We’ve talked a great deal about bipartisan groping. We’ve talked a great deal about bipartisan corruption of charitable foundations and the like. And we’ve talked a great deal about personal character – or lack thereof. What we haven’t done is talk a great deal about the challenges that will face the next president on all sorts of fronts, domestic and foreign.
To a certain extent, this is a shame because this campaign is rife with real-life issues that are absolutely vital and that need to be discussed. Moreover, ALL of these issues – from the failure of the economy to recover satisfactorily from the Great Recession to the complete shambles of American foreign policy – should, at least in theory, favor the Republican in this race. Of course, the Republican happens to be Donald Trump, who has not only steadfastly refused to focus on the issues, but, even in the rare case that he takes a break from conspiracy mongering, has taken positions that fall sadly short of taking full advantage of his possible edge.
In the past few weeks, one issue that has emerged as critically important is health care. This should surprise no one. In 2010, the erstwhile defeated and broken GOP swept back into the Congressional majority largely on the strength of its opposition to Obama’s health care reform law. Then, in 2014, the again-erstwhile defeated and broken GOP took control of the Senate and held onto the House, once again largely on the strength of its opposition to Obama’s health care reform law. Obama considers the law to be his signature achievement and his legislative legacy, which it may well be. But it has also been the proverbial albatross around his neck.
The problems – or should we say, the “new” problems? – with the law began earlier this year when United Health Care announced that it had lost enough money on Obama’s behalf and would no longer offer ACA (Affordable Care Act, i.e. “Obamacare”) plans on the private insurance market in most states. As it turned out, United was the first, but not the last insurer to withdraw from the Obamacare marketplace. Nationally, 28 plans have withdrawn from the Obamcare exchange for 2017. As a result, those unfortunate consumers who will be forced to buy health insurance in the individual market next year will have significantly fewer choices than they did previously. One in five consumers will have only one plan from which to “choose.” Even in some major metropolitan areas, like Philadelphia, choices of plans will be extremely limited.
Not long after United’s announcement, other insurers began revealing expected premium hikes for next year. As the Obama administration was just forced officially to acknowledge this week, nationally, the average premium increase will be on the order of 25%. Most sentient people can now see that the law has been a disaster both for most insurers and for most private insurance customers, meaning that the only winners in the game are the bureaucrats and politicians, who all pretend that they have done something wonderful and magnanimous for “the people.”
In the weeks and months since the price hikes became clear, several analysts and even a handful of politicians have concluded that the once-vaunted “reform” is proving somewhat less than ideal. Earlier this month for example, Minnesota’s DEMOCRATIC Governor, Mark Dayton, lamented that the Affordable Care Act, is simply “no longer affordable.” Naturally, this made Dayton the subject of much derision among his fellow Democrats. But it also brought the discussion of the law’s unintended-but-easily-foreseen consequences into greater focus during this election season, even as the two major-party presidential candidates have been unable to muster up much enthusiasm to join that discussion.
Last week, Obama himself took to the campaign trail, giving a speech about the “successes” and benefits of his signature legislation at an event in Miami. Notably, the success of which he is most proud and for which he takes the greatest credit is the expansion of health insurance coverage to millions of previously uninsured Americans. What he failed to mention, however, is that the overwhelming majority of those who have insurance today but did not have it six years ago are now covered under Medicaid. All of which is to say that Obama could have achieved much the same end, but without all of the contention and economic disruption, if he had simply proposed an expansion of Medicaid. Never mind that, though. The President was back in campaign mode last week, which means that everything was the Republicans’ fault and everything could be fixed if the Republicans would just be more like him, which is to say, wonderfully wonderful.
For their part most Republicans have generally been smart enough not to take Obama’s bait. After all, in two short weeks, the guy will be the lamest of ducks. And that means that he can trot around the country telling people how great he is and how despicable the Republicans are, while being totally irrelevant in terms of politics and especially policy.
Unfortunately for those same Republicans, Obama’s predecessor as the architect of health care reform is also his likely successor as the President of the United States. In 1993 and 1994, Hillary and her health reform task force flamed out spectacularly, leaving her husband’s early presidency crippled and helping hand control of Congress over to his Republican opponents for the first time in nearly half a century. When she (likely) enters the White House next January, however, the heavy lifting will be done, which is to say that she will have the opportunity to “tweak” existing legislation, making it more acceptable to consumers and turning it into a much more faithful recreation of the century-old leftist fantasy. Or at least that’s what most observers on both the Left and the Right seem to think.
Some of Hillary’s old nemeses from the original health care wars have reemerged of late to explain what she will do if she is elected and to make the concomitant case that she should therefore not be. Last week, for example, the Wall Street Journal ran a piece by the former economics professor and U.S. Senator Phil Gramm detailing Hillary’s likely course of action as president. He put it this way:
ObamaCare’s plan was always to cook the frog slowly. It didn’t immediately close the individual market or shut down the small-group market as HillaryCare did. President Obama granted substantial flexibility in implementation, such as suspending penalties for individuals and employers, waiving income-verification requirements and easing the premium shock on young enrollees by administratively adjusting the community-rating system. But the result of delaying the coercion ObamaCare requires has been an explosion in health-care premiums and massive losses by insurers.
Except for the fact that it is occurring right before the elections, the four largest national health insurers dropping out of ObamaCare is not a problem. This is the plan. Eliminating the facade of private insurance is how ObamaCare “morphs” into HillaryCare and ultimately into a single-payer plan like Medicaid or Medicare. This is exactly what Mr. Obama and the Clintons wanted to begin with. Right on cue, they are now campaigning for a Bernie Sanders-type nationalized health-care system.
For the ObamaCare of today to be transformed into the HillaryCare of 1993 and finally into a nationalized health-care system, a president is needed who has the willpower to impose the coercive details, nail down hard deadlines and unleash agencies to tighten controls and squeeze the life out of private insurers. In 1993 Hillary Clinton unapologetically proposed to do just that. If she is elected president she will have the unilateral power under ObamaCare to do it. The loss of what remains of Americans’ health-care freedom is an election away.
We have no idea whatsoever whether or not Gramm is right about Obama and the Clintons planning this all along. That may be true. It may not be. We don’t know. But then, we don’t really care. In the end, we honestly believe that Phil Gramm is just flat wrong here. Yes, indeed, Hillary, Bill, Obama, Sanders, and the rest of the lefties definitely want a single-player health-care. About that, there can be no doubt. But they’re not going to get one. They just aren’t. And if they want to spend all of their political capital trying to do so, they will destroy Hillary’s presidency like they almost destroyed Bill’s and like they almost destroyed Obama’s. More power to ‘em. In our opinion, they will fail and take her down with them.
How, you ask, can we be so confident in this prediction? Well, here’s where Bilal Abdullah and Robert Rubin come in to play.
As we noted above, Bilal Abdullah, was a physician, trained in Iraq and signed, like all foreign-trained doctors, to a “limited” registration contract with Britain’s National Health Service. Now, when we say “all” foreign-trained doctors, please note that we are talking about a great many physicians. Great Britain has more foreign-trained doctors than almost any developed country in the world. Indeed, according to the Organization for Economic Cooperation and Development (OECD), Britain has the most foreign-born doctors of any major OECD nation. Only Ireland, Norway, New Zealand, Australia, and immigrant-reliant Israel have a greater percentage.
Now, a big part of the reason that Britain has so many foreign doctors is because it NEEDS them. You see, British kids don’t dream of growing up to be doctors. Yes, the nation has a rampant shortage of physicians, but being a doctor in Britain’s NHS isn’t exactly what you’d call a glamor job. The last Labor government’s contract with its doctors promised them that would no longer be forced to offer “out-of-hours” services, which is to say that doctors will no longer have to work evening or weekend hours. The reason the Labor government made this promise, of course, is because it had to. The NHS is desperate to keep its employees happy, and it really has nothing else to offer them.
Worse still, the NHS’s problems recruiting and retaining doctors have helped create the conditions for a pretty nasty set of outcomes. Britain, you see, makes it easy for foreign-trained doctors to emigrate, set up shop, and begin practice immediately, without having to do very much to prove their abilities or their knowledge. Two years ago, University College London conducted a study and found that a shockingly high percentage of foreign-trained doctors are incompetent or, at best, not-yet competent. As London’s Telegraph noted, the study “found that half of [the foreign-trained doctors] lack the qualifications that are expected of domestically trained practitioners.”
In reviewing the study, the Telegraph’s editors tried desperately to explain why Britain needs so many foreign-trained doctors in the first place, settling, unsatisfyingly, on “poor planning” as the culprit. It may, indeed, be the case that the government and its NHS planned poorly. But they also pay poorly. Or at least they pay poorly given the difficulty and the liability of the job.
To put it another way, Bilal Abdullah was a doctor in Great Britain because he could be. He was not especially skilled or especially smart. In order to receive his medical degree, he had to go to Iraq to be taught and to be RADICALIZED. But what choice did the NHS have? It needed – and still needs – warm bodies to play doctor. Bilal Abdullah is, in many ways, the result of a single-payer health care system.
Aha, you say, but America imports a great many of its doctors as well. In fact, the United States is not all that far behind Great Britain in the employment of foreign-trained doctors.
No doubt, that is true. But we’d argue that America’s foreign-trained doctors are quite different from Britain’s, in that they are not drawn from the same pool. Unlike Britain, you see, the United States pays its doctors quite well. Indeed, American doctors are the best paid in the world, both in absolute terms and relative to the rest of the national population. Of course, the reason that American doctors are so well paid is they are, in large part, well trained and expensively trained.
As most of you know, one cannot simply graduate from medical school in the United States and start practicing medicine. There are residencies and internships and fellowships. There’s more study, more practice, considerably more work and guidance. Bilal Abdullah was 27 when he attacked the Glasgow Airport, and he was nearing the end of his first contract with the NHS. In the United States, your average 27 year-old doctor is still five years away from “practicing” medicine. In fact, the “average,” doctor in this country spends four years as an undergraduate, four years in medical school, and roughly six years in residencies and fellowships. Add it all up, and that’s fourteen years – fourteen very expensive years – before a doctor in this country is afforded the privilege of becoming a junior partner at some practice.
Not surprisingly, as things happen to work out, the training and licensing requirements in the United States actually serve as a disincentive to foreign-trained doctors, causing a great many would-be immigrant doctors to abandon their erstwhile chosen field. What this means, therefore, is that the foreign-trained doctors practicing in this country are the ones who really want to practice medicine and who are generally smart enough and talented enough to make the arduous process worthwhile. If you have an Indian-trained doctor in the UK, good luck to you. But if you have an Indian-trained doctor in the United States, lucky you!
Now, you take all of that and you add it to the fact that the average doctor graduates from medical school with some $200,000-plus in debt, and you start to get an idea of why America’s doctors are so highly paid. You might also start to get an idea of why any suggestion that they be paid less – considerably less – is likely to meet with serious and, frankly, justified resistance. And yet that’s precisely what any plan for a single-payer health system would have to do, pay doctors considerably less than they are making right now – FOREVER.
In his essay on Hillary Clinton’s single-payer dreams, Phil Gramm noted that most Americans don’t really get too worked up about the costs of such a system. They care instead about their freedom. We don’t doubt that. But then, when it comes to health care reform, doctors aren’t “most Americans.” And neither are nurses. And neither are physicians assistants. And neither are radiology techs. And neither are sonographers. And neither are . . . well, you get the picture. ALL of these people, in all of these health care jobs are paid salaries commensurate with their educations and with their expectations. And ALL of them would have to take serious pay cuts in order to work in a single-payer system.
And that’s just the half of it.
Two years ago, Vermont – the leftiest of lefty states and home to the socialist Senator Bernie Sanders – was all set to implement a single-payer system under the exemptions granted it by the HHS under Obamacare’s rules. Suddenly, however, the plans were scrapped. And they were scrapped because Vermont simply couldn’t afford the plan. Think about that for just a minute. Vermont was all set to raise its taxes to the highest levels in the country. It was going to tax everyone for everything and then some. And it still couldn’t afford a single-payer system. In a series of pieces for Bloomberg, the inimitable Megan McArdle explained why. The following is from a December 23, 2014 piece, written just after Vermont abandoned its single-payer dream:
I concede that single-payer systems may well allow you to control the rate of health-care cost growth, thanks to government price controls on supplies and services, along with rationing or denial of expensive treatments. What it doesn’t allow you to do is easily cut the rate of health-care spending. None of the single-payer systems that are frequently held up as models for the U.S. have ever managed sustained cuts in health-care spending. All they’ve done is prevent it from growing so fast.
The problem . . . is that America doesn’t have a health-care cost-growth problem; we had a health-care cost-growth problem. Right now, our health-care cost growth is right in the middle of the OECD pack. . .
Our spending is indeed high compared with the rest of the world, but that’s because it started high. And while restraining government spending is easy, it is a walk in the proverbial (government-funded) park compared to actually cutting spending. Cutting spending means that a number of people are going to lose income and employment. They will have trouble paying their mortgages, car loans and little Johnny’s bill for travel soccer. Then they are going to get organized and march on Washington and vote against the politicians who cut their jobs.
Path dependence is a running theme around here, and in no other area of public policy is it more troublesome. Health-care jobs are steady and well-remunerated compared to whatever else those workers could be doing. And that’s not just true of the much-derided “specialists” who do too many procedures and charge too much; it’s true of everyone in your hospital and doctor’s office, from your beloved family physician to the woman who draws your blood. All those people have spent long years working to get where they are. If you suddenly change the rules and take that all away, their rage will burn with the righteous fire of a thousand suns.
So even if we could have had a much cheaper health-care system if we moved to single payer in 1970, that doesn’t mean that we can get the same happy results by doing so now. Today we’d be building a single-payer system with the price schedule of our current health-care workers. Which means it would cost an absolutely breathtaking amount of taxpayer money, as Vermont just found out.
In short, you can’t there from here. And you can’t get there because it would cost too much, WAY too much. In Vermont, the costs of a single-payer system, even considering the cheeriest and rosiest of cost-cutting forecasts was staggering. The estimated cost was nearly what the state currently collects in tax revenue, $2 billion vs. $2.7 billion.
The same, by the way, holds true for other proposed plans. Colorado, for example, has a single-payer constitutional amendment on the ballot this November. The amendment has been losing support steadily, as more and more Coloradans learn about its costs. As McArdle notes, if passed, building this new entitlement would cost more than 140 percent of the total current state budget.” And all of that would be to cover an estimated additional 300,000-plus Coloradans who don’t currently have health insurance (76% currently vs. 83% after implementation). It’s no wonder that all of the state’s most prominent Democratic politicians, including Governor John Hickenlooper, have tried to distance themselves from the amendment. They know it’s a loser.
Now, imagine, if you will, taking this same notion that was abandoned in Vermont and that will almost certainly be rejected by voters in Colorado and trying to implement it on a national scale. True, there would be some cost savings relative to the states since the federal government already has a nation-wide health insurance system set up in the form of Medicare, which is precisely why people like Bernie Sanders argue that a single-payer system should take the form of “Medicare for all.” But if you have Medicare – and unfortunately for the future of our business, a great many of you do – you know that finding a good doctor who will take Medicare is nigh on impossible. You want a Medicare doctor in New York, for example? Let us know how that works out for you. The only way to make a “Medicare for all” plan feasible would be either to force doctors to participate at drastically reduced compensation or to increase the reimbursement rates to doctors, thereby raising the cost of the program through the roof.
And it’s this latter point – the costs that would necessarily associated with adopting a single-payer system – that brings us, at long last, to second of the names mentioned at the top of this piece, Robert Rubin. Way back in 1994, The Washington Post’s Bob Woodward wrote a book about the early days on the Clinton presidency (and pre-presidency, as it turns out). Among other things, Woodward recounted the mugging that Bill received at the hands of reality in January 1993, a few weeks before assuming office. A good part of that mugging came courtesy of Rubin.
The opening scene is a gathering of the soon-to-be-installed Clinton economic team at the Governor’s Mansion in Little Rock on the morning of January 7, 1993. Our hero, Rubin, whom Woodward describes as the “master of ceremonies” of the meeting, opens the discussion with some dire predictions about the coming explosion in the budget deficit. Laura Tyson, who was soon to become the chairwoman of the Council of Economic Advisers, follows with some highly gloomy remarks about prospects for economic growth.
Next to speak was Alan Blinder, Tyson’s soon-to-be-deputy and an economics professor at Princeton. Blinder introduced a theme that would haunt the early days of the Clinton administration. Or as Woodward put it:
Blinder’s forte was the large issues of taxes, spending, and budgets, so-called macroeconomics, that were traditionally the focus of the CEA chairman . . . Why were they hearing that the federal deficits needed to be reduced? Blinder asked. Why was that goal important? Lowering the deficits would help the national economy, he said. It was not just to clear the decks or because the founding fathers were Puritans . . . The worst-case scenario, Blinder continued, “is a recession no worse than George Bush enjoyed” . . . Clinton had promised to “grow the economy” and create more and better jobs. The irony was palpable. Blinder realized he was presenting Clinton with a political loser. . .
Clinton recognized that it was the exact argument that Greenspan had made to him the previous month: Deficit reduction could mean lower long-term interest rates.
“But after ten years of fiscal shenanigans,” Blinder quickly pointed out, referring to the unrealized promises of Reagan and Bush to cut the deficit, “the bond market will not likely respond.”
At the president-elect’s end of the table, Clinton’s face turned red with anger and disbelief. “You mean to tell me that the success of the program and my reelection hinges on the Federal Reserve and a bunch of f…ing bond traders?” he responded in a half –whisper.
Nods from his end of the table. Not a dissent.
Clinton, it seemed to Blinder, perceived at this moment how much of his fate was passing into the hands of the unelected Alan Greenspan and the bond market.
The next scene in this tale takes place in the White House’s Roosevelt Room, just three weeks after Bill’s inauguration. The Clinton team is discussing a plan to cut $140 from the budget deficit by 1997 and the positive impact that reducing this debt might have on the bond market. Included in the group this time was Howard Paster, newly chosen by the President to be his chief lobbyist to Capitol Hill. Woodward continues:
“How many votes does the f…ing bond market have?” Paster asked. “We’ve got to win votes on the Hill, not Wall Street. If it looks like Jimmy Carter’s water projects all over again, we’re dead”. . .
“Okay,” Tyson said, “I am going to say this because it’s my role in this room . . . I can’t prove to you that there is anything magical about the $140 billion. There is a point where the bond market will take your program seriously. I don’t know where that point is. Maybe it’s at $135 billion or $140 billion or wherever. I can’t tell you.” . . .
Clinton looked taken aback. The hawks pounced. Bentsen, Panetta, and Rivlin said the plan was going to be debated heavily in Congress; it would be a political debate of some intensity. Congress did not like pain, and the president’s position would certainly be trimmed back, they reiterated. Bentsen had not disclosed the sensitive fact that the $140 billion was Greenspan’s recommendation . . .
We could go on . . . and on . . . and on. Woodward’s book is full of all sorts of great stories about how Bill Clinton learned about the realities of governance, debt, and the messes that too much debt could create. Rubin and the rest of the Wall Street crowd introduced Clinton to these truths, and, in the process, killed Bill’s much-ballyhooed Baby-Boomer dreams.
These same truths will all but certainly kill Hillary’s dreams as well. The only catch here is that she is neither as smart nor as politically nimble as her husband. She will fight back because that’s all she knows to do. And in the end, everyone will get bloody.
As things stand today, the global economy is shaky at best. The American economy appears relatively sound, but is still sluggish and will, obviously, be affected by global events.
It almost goes without saying, we suppose, that we’re not economists. Nevertheless, even we know that the world’s central banks are, more or less, out of bullets. What this means, of course, is that when the next recession hits – or even if the current sluggishness becomes too unbearable – monetary policy will be of absolutely no value whatsoever in weathering the storm. Janet Yellen appears determined to keep interest rates at zero forever, but eventually, that will cause problems – serious problems.
In the alternative, then, world governments – including the government of the United States – will have to turn elsewhere for economic stimulus. And that “elsewhere” will be fiscal policy. President Hillary (or President Donald, if events play out that way) will have no choice. She will have to try one of two things, either spend her way to prosperity as advised by Keynes or cut taxes enough to have an effect on the supply side. And you and we know that she won’t do the latter.
We have a tendency these days to think that the federal debt load doesn’t really matter. Obama has piled up debt over the last eight years, without repercussion. But if you want to see the Ed Yardeni’s old Bond Vigilantes reborn, just wait until Hillary tries to stimulate the economy with even more debt. The old saw “shit or go blind,” comes to mind.
Given all of this, is there a sane person anywhere in the world who would dare to argue that health insurance can be nationalized and turned into a government-funded single-payer plan at the same time? The entire idea is ludicrous. Increase spending – perhaps doubling the federal budget; create a new entitlement at precisely the time that the old entitlements are starting to exert their influence over the budget; cut jobs and pay for medical professionals in the midst of a struggling economy; and, above all, turn America’s health care system into a national nightmare akin to Britain’s NHS, with its excessive wait times, incompetent doctors, and inefficient and repugnant hospitals; all while trying to set yourself up for reelection. At the risk of repeating ourselves, let us be blunt: Not. Gonna. Happen.
And for the record, this logic applies not just health care, but to any and all of the leftist fantasies that Hillary and others have embraced on the campaign trail this year. Free college tuition? Not gonna happen. Student loan debt forgiveness? Not gonna happen. Etc., etc.
What this means is that the Republicans – God help us – are going to have to figure out how to manage the health care debate next year and guide it in the direction of less, not more government control. We’re not sure that they’re up to the task, obviously, but they will have no choice. The Democrats have only one plan, and that plan is deeply flawed and will be economically disastrous. If the Republicans can’t offer a plausible alternative, they will, yet again, have earned their fellow partisans’ animosity.
As Kipling might put it: As surely as Water will wet us, as surely as Fire will burn, The Gods of the Copybook Headings with terror and slaughter return!
The gods of the Bond Market too.
Copyright 2016. The Political Forum. 3350 Longview Ct., Lincoln NE 68506, tel. 402-261-3175, fax 402-261-3175. All rights reserved. Information contained herein is based on data obtained from recognized services, issuer reports or communications, or other sources believed to be reliable. However, such information has not been verified by us, and we do not make any representations as to its accuracy or completeness, and we are not responsible for typographical errors. Any statements nonfactual in nature constitute only current opinions which are subject to change without notice.