McCain’s Medical Plans Make Matters Worse For the Insured and Medicare Patients While Failing To Help The Uninsured

There’s already been a lot of criticism of John McCain’s health care plan around the liberal blogosphere, including these posts from Steve Benen and Ezra Klein. One peculiar thing about McCain’s plans is that he manages to both ignore addressing the real problems of those who have lack affordable coverage and makes things worse for those who do.

McCain does briefly mention the problems of those who cannot obtain affordable insurance in the individual market but offers no real solutions. This is where the most serious problems arise. There are certainly problems which need to be addressed for those who receive coverage through employers, but those having the most serious problem are those who have to buy insurance on their own, especially if they are older or have illnesses which the insurance companies would prefer to avoid covering. Not only does McCain fail to address these problems, but he wants to throw even more people into the individual market by taking away employer supplied health care. The tax breaks he offers to individuals will hardly replace their coverage, or allow those without coverage to be able to afford it.

Not only does McCain’s plan manage to make matters worse for those with employer-paid insurance, but he also wants to worsen coverage for those on Medicare. He is very vague but whenever he has spoken about Medicare he describes a plan which sounds like moving from fee for service to a capitated plan. Fee for service is far from perfect as it includes incentives to perform too many procedures if each is paid individually, but as Winston Churchill has described democracy, this is the worst form except the others which have been tried.

Megan McArdle criticized McCain’s plan by writing:

The problem is, it’s heavier on theory than practice. Every health care economist in the country wants to pay for health rather than treatments. The problem is, health is very hard to measure–as David Cutler told me, “Health care and education are the two fields where output is hardest to measure. It’s not surprising that costs in those areas are increasing much faster than inflation.” When output can’t be measured, input will be.

Medical care, like education, is also dependent on inputs from the clients. You will have a frantic political battle from doctors against any proposal that makes their income dependent on how many of their diabetics really give up the corn chips.

Capitated plans which pay a fixed amount per patient as opposed to paying for each procedure have been a disaster. They have had mixed results when dealing with young, healthy patients but have been a failure in dealing with elderly patients. Megan is correct that one problem in payment based upon outcomes is that factors such as noncompliance with medical advice increases the cost. If we must deal with a noncomplaint patient who winds up developing more problems we naturally expect to be paid more for the extra work–not less as under McCain’s plan.

The problem goes beyond matters of compliance. In the Medicare population, elderly patients with chronic medical problems inevitably age and get worse. Or else they die. McCain’s plan encourages health care systems to avoid covering people as they get older and sicker, or to allow them to die. Naturally doctors who would prefer to treat sick patients tend to feel uncomfortable dealing with such plans–and patients should feel even more uncomfortable with such a system.

Changing Medicare in such a way would also greatly exacerbate the problem of a shortage of primary care physicians. Capitated plans typically pay primary care doctors a set fee per patient but are more often forced to pay specialists, who often are not involved in the case on a continuing basis, on a fee for service basis. Such a change in Medicare will make doctors even more reluctant to practice primary care. Instead they would prefer to be the cardiac surgeon who is still paid well for doing the bypass surgeries for the patients who require heart surgery because they could not afford or find sufficient primary care and preventative services.

Democrats who have proposed changes in health care have often faced scare tactics from the right. As the vast majority of people, rightly or wrongly, are happy with their insurance coverage, it has been effective to make people fear that change means losing what they now have. McCain’s horrible health care ideas provide an opening for Democrats to now win this debate as it is McCain who proposes making things worse for those who now have employer-paid insurance or Medicare.

Creationist Claims Science Kills People

The Anti-Defamation League has issued a statement condemning the creationist movie Expelled:

New York, NY, April 29, 2008 … The Anti-Defamation League (ADL) today issued the following statement regarding the controversial film Expelled: No Intelligence Allowed.

The film Expelled: No Intelligence Allowed misappropriates the Holocaust and its imagery as a part of its political effort to discredit the scientific community which rejects so-called intelligent design theory.

Hitler did not need Darwin to devise his heinous plan to exterminate the Jewish people and Darwin and evolutionary theory cannot explain Hitler’s genocidal madness.

Using the Holocaust in order to tarnish those who promote the theory of evolution is outrageous and trivializes the complex factors that led to the mass extermination of European Jewry.

John Derbyshire provides an example of what those behind this movie are claiming:

In an interview with the Trinity Broadcasting Network, Ben Stein said the following amazing thing in an interview with Paul Crouch, Jr.

Stein: When we just saw that man, I think it was Mr. Myers [i.e. biologist P.Z. Myers], talking about how great scientists were, I was thinking to myself the last time any of my relatives saw scientists telling them what to do they were telling them to go to the showers to get gassed … that was horrifying beyond words, and that’s where science — in my opinion, this is just an opinion — that’s where science leads you.

Crouch: That’s right.

Stein: …Love of God and compassion and empathy leads you to a very glorious place, and science leads you to killing people.

Crouch: Good word, good word.You can see the whole shameful thing here. It’s a pity Crouch didn’t invite the Rev. Jeremiah Wright into the studio for a three-way conversation. It would have elevated the tone.

I also recently quoted Derbyshire’s comments on Expelled here. P.Z. Myers presents this video in response to Stein’s view that “science leads to killing people.”


Obama Takes Lead in New Jersey Poll

Barack Obama lost to Hillary Clinton by ten points in the New Jersey primary, but since then support has shifted towards Obama. A Monmouth University/Gannett New Jersey poll shows Obama now leading by seven points.

This doesn’t change the results of the primary but it does counter the idea that momentum has shifted towards Clinton. This also seriously undermines Clinton’s big state argument by which she claims to be more electable due to having won the primaries in several large blue states. This helps demonstrate that having lost to Clinton in a primary does not mean Obama cannot become successful in the state. The poll also shows that both Obama and Clinton would beat John McCain.

Why Obama Joined Trinity

Obama’s decision to join Wright’s church has turned into a political problem. Norm Scheiber looks at why Obama probably did join this church as opposed to other, more conservative churches in the area. He quotes from David Mendell’s biography of Barack Obama:

Wright remains a maverick among Chicago’s vast assortment of black preachers. He will question Scripture when he feels it forsakes common sense; he is an ardent foe of mandatory school prayer; and he is a staunch advocate for homosexual rights, which is almost unheard-of among African-American ministers. Gay and lesbian couples, with hands clasped, can be spotted in Trinity’s pews each Sunday. Even if some blacks consider Wright’s church serving only the bourgeois set, his ministry attracts a broad cross section of Chicago’s black community. Obama first noticed the church because Wright had placed a “Free Africa” sign out front to protest continuing apartheid. The liberal, Columbia-educated Obama was attracted to Wright’s cerebral and inclusive nature, as opposed to the more socially conservative and less educated ministers around Chicago. Wright developed into a counselor and mentor to Obama as Obama sought to understand the power of Christianity in the lives of black Americans, and as he grappled with the complex vagaries of Chicago’s black political scene. “Trying to hold a conversation with a guy like Barack, and him trying to hold a conversation with some ministers, it’s like you are dating someone and she wants to talk to you about Rosie and what she saw on Oprah, and that’s it,” Wright explained. “But here I was, able to stay with him lockstep as we moved from topic to topic. . . . He felt comfortable asking me questions that were postmodern, post-Enlightenment and that college-educated and graduate school-trained people wrestle with when it comes to the faith. We talked about race and politics. I was not threatened by those questions.” …

But more than that, Trinity’s less doctrinal approach to the Bible intrigued and attracted Obama. “Faith to him is how he sees the human condition,” Wright said. “Faith to him is not . . . litmus test, mouth-spouting, quoting Scripture. It’s what you do with your life, how you live your life. That’s far more important than beating someone over the head with Scripture that says women shouldn’t wear pants or if you drink, you’re going to hell. That’s just not who Barack is.”

Scheiber concludes:

So, if you buy Wright’s account–and it rings pretty true to me–it was his intellectualism and social progressivism that won Obama over. Certainly it’s hard to imagine that someone like Obama, who came from a progressive, secular background, would have felt genuinely comfortable in a socially conservative, anti-intellectual church. The problem for Obama is that the flip-side of these virtues was a minister with a radical worldview and a penchant for advertising it loudly.

Obama’s decision to join the church had nothing to do with Wright’s more controversial views, regardless of which sermons Obama actually heard. The radical views expressed by Wright have nothing to do with Obama’s views or how he would govern and should not be a factor in the election.

Indiana Independents and Republicans May Decide Primary

The Howey-Gauge Poll suggests that the Indiana Democratic primary will be decided by independents and Republicans as Democrats are evenly split, with independents favoring Obama and Republicans backing Clinton:

There appears to be two kinds of Republicans: the “Obamacans” as the Illinois senator likes to call them – earnest Republicans deeply disappointed in their own party’s performance on the budget, economy, social issues and the Iraq War – and the Rush Limbaugh Republicans who are planning to crossover to vote for Sen. Clinton because they perceive her to be the weakest rival to U.S. Sen. John McCain in the November election.

Howey-Gauge shows that self-identified Republicans favor Clinton 50-44 percent, while independents favor Obama 54-38 percent. “The Democratic primary is going to be decided by non-Democrats,” said Gauge Market Research pollster Holly Davis. “To be determined is which group – Republicans or independents – are going to decide this race.” An indicator as to the kind of havoc Republican voters could create comes on the Iraq War issue. Those favoring immediate withdrawal favor Obama 49-46 percent. Those favoring the current troop levels favor Clinton 58-39 percent, but, Davis notes, “That number is strongly influenced by Republican crossovers.”