1. “C
rowding out” sounds like
a bad thing. The Bush
administration uses that
fearsome term in denying recent
requests by Louisiana, Ohio, Okla-
homa and no doubt other states
to expand Medicaid to families
not considered poor. Bush argues
that opening the government pro-
gram to middle class people would
prompt many to drop their private
coverage.
Where’s the problem?
It’snotaboutjus-
tice. For-profit in-
surers drop fami-
lies when a mem-
ber becomes sick,
and Washington
looks the other
way.
It’s not new.
When Medicare
was created, the
governmenthealthplanreplacedalot
of private insurance coverage bought
by the elderly.
And it’s not about preserving
quality health care. You don’t hear
Medicare beneficiaries clamoring
for a return to private coverage, do
you?
More than a few medical provid-
ers, meanwhile, would love to see
the private insurers “crowded out.”
The following story illustrates why:
St. Joseph Health Services is a
Catholic nonprofit that cares for
many poor people in Rhode Island.
Last year, UnitedHealthcare of New
England tried to cut the hospital
group from its provider network.
The reason? After years of seeing lit-
tle or no increases in payments for
services, St. Joseph had demanded
that the insurer raise its reimburse-
ment levels.
UnitedHealthcare played hard-
ball. It proceeded to threaten its
customers with a huge 58 percent
compounded hike in premiums if it
had to start writing bigger checks to
St. Joseph.
During the angry standoff, St.
Joe’s chief revealed these interesting
numbers: In 2006, the former CEO
at UnitedHealth Group (the parent
company in Minneapolis), William
McGuire, made $124-million. That
was one-and-a-half times the entire
payroll of St. Joseph’s 2,000 employ-
ees. That’s right, one pooh-bah at
one insurance company pulled in
150 percent of what everyone at
St. Joe’s three health care facilities
made put together — not only the
nurses, orderlies, administrators
and floor-swabbers, but also the
executives and surgeons. Everyone!
William McGuire may be a famil-
iarname.Lastmonth,hewasforced
to give back $418-million worth of
UnitedHealth stock options on top
of nearly $200-million in options he
already surrendered. That was pun-
ishment for joining in an unseemly
scheme to backdate the options.
Waste no tears on “Dollar Bill.”
McGuire holds another $875-million
in options (though a judge has fro-
zen them, pending further review).
And as top boss at UnitedHealth
from 1991 to 2006, he raked in half a
billion, which he definitely keeps.
You see, health care has become
just another racket by which clever
operators can scoop up fortunes.
There’s a ton of money to be made
nickel-and-diming doctors and hos-
pitals while making sure you don’t
sell insurance to sick people — and
that’s the legal part. Once govern-
ment offers coverage, it’s game over
for the manipulators — and more of
our health care dollars go for health
care.
And so here’s another way to look
at the “crowding out” issue. Rather
than create unfair competition for
insurance executives, government
can be seen as freeing the public
and medical caregivers from their
claws.
(That’s not to say that private
interests shouldn’t play a role. A
Canadian-style single-payer system
— where government is the only
insurer — has problems that allow-
ing private coverage options would
ease. The best government-run sys-
tems, such as France’s, are multi-
payer. They allow participation by
private insurers, but keep them on
a leash.)
The Bush administration’s fight to
keep moderate-income families out
of Medicaid resembles its successful
battle last year to stop the expansion
of the State Children’s Health Insur-
ance Program. It used the crowding
out argument back then.
But when you see the insurers in
action, “crowding out” doesn’t seem
so evil or even the right term for
what’s happening. “Throwing out”
may be more like it.
©ProvidenceJournalCo.
Ditching
private
insurers
notallbad
Opinion >
tampabay.com/opinion
froma
harrop
WASHINGTON
T
he big lie of campaign 2008 — so far — is
that the presidential candidates, Demo-
cratic and Republican, will take care of our
children. Listening to these politicians, you might
think they will. Doing well by children has now
passed Motherhood and Apple Pie as an idol that
all candidates must worship.
“We will do whatever it takes
to make America a better coun-
try, to give our kids a better
future,” says Mike Huckabee,
winner of the Republican Iowa
caucuses.
“We will deliver for our chil-
dren, our grandchildren and
our great-grandchildren,” claims
Sen. Barack Obama, the Demo-
cratic winner.
“We’re going to reclaim the future for our chil-
dren,” says Democratic Sen. Hillary Clinton.
Actually, these are throwaway lines, completely
disconnected from reality.
Our children face a future of rising taxes,
squeezed — and perhaps falling — public ser-
vices, and aging — perhaps deteriorating — pub-
lic infrastructure (roads, sewers, transit systems).
Today’s young workers and children are about to be
engulfed by a massive income transfer from young
to old that will perversely make it harder for them
to afford their own children.
No major candidate of either party proposes to
do much about this, even though the facts are well-
known.
Spending for Social Security, Medicare and Med-
icaid — three programs that go overwhelmingly to
older Americans — already represents more than
40 percent of federal spending. A new report from
the Congressional Budget Office projects these pro-
grams could equal about 70 percent of the present
budget by 2030. Without implausibly large budget
deficits, the only way to preserve most other gov-
ernment programs would be huge tax increases
(about 40 percent from today’s levels). Avoiding
the tax increases would require draconian cuts in
other programs (about 60 percent). Workers and
young families, not retirees, would bear the brunt
of either higher taxes or degraded public services.
Similar pressures, though less ferocious, exist
at the state and local levels. Schools, police, librar-
ies and parks will be squeezed by the need to pay
benefits for retired government workers. A study
by the Pew Charitable Trusts found that states
have promised retired workers $2.7-trillion in pen-
sion, health care and other benefits during the next
three decades. Only about $2-trillion has been set
aside; the rest would come from annual budgets.
Medicaid, a joint federal-state program with
states paying about 40 percent of the costs, repre-
sents another drain; about two-thirds of its spending
stems from the aged and disabled. Roads, water and
mass transit might also be shortchanged. States and
localities pay about three-quarters of their costs.
But facing these facts would expose candidates
to three daunting problems.
First: Lightening the burden on the young
requires cutting retirement benefits for the old —
raising eligibility ages, being less generous to richer
retirees and making beneficiaries pay more for
Medicare. Simply increasing taxes or cutting other
programs won’t work. The problem is not just clos-
ing the budget deficit.
Second: We can’t wait. Ideally, prospective retir-
ees would have received several decades’ warning;
but we’ve delayed too long. We need to cut benefits
for baby boomers and even some existing retirees.
They are the source of mounting costs.
Third: Even if retirement benefits were cut, pres-
sures for higher taxes and lower public services
would remain. Social Security and Medicare are
part of the nation’s social fabric. Although individu-
als’ benefits can be responsibly trimmed, the growth
in the elderly population (a doubling by 2030) and
rapidly rising health costs would still expand spend-
ing. The increases would simply be smaller.
A moral cloud hangs over our candidates. Just
how much today’s federal policies, favoring the old
over the young and the past over the future, should
be altered ought to be a central issue of the cam-
paign. But knowing the unpopular political impli-
cations, our candidates have lapsed into calculated
quiet.
They pay lip service to children but ignore the
actual programs that will shape their future. The
hypocrisyisespeciallystrikinginObama.Hecourts
the young, promises “straight talk,” and offers him-
self as the agent of “change.” But his conspicuous
omissions silently endorse the status quo.
The insidious nature of this problem is that
because the spending increases for the elderly
occur gradually, the pressures on taxes and other
government programs will also intensify gradually.
A crucial moment to clarify the stakes and compel
politicians to make choices probably won’t occur
until it’s too late.
The longer we delay — and we’ve done so now
for several decades — the more likely that eventual
“solutions” will be unfair to both young and old.
To acknowledge that and to come to grips with it
would constitute genuine “change.”
©WashingtonPostWritersGroup
Givingour
kidsbetter
futurenot
happening
Robert
Samuelson
A moral cloud hangs over our
candidates. Just how much today’s
federal policies, favoring the old
over the young and the past over the
future, should be altered ought to be
a central issue of the campaign.
I
went to see Sweeney Todd
last week and the high point
was after the movie when I
headed for the men’s room, pass-
ing a long line of women wait-
ing to get into the women’s, and
when I got inside the men’s, a
tall woman in a long black coat
emerged from a stall and walked
out. She didn’t run or skulk or
sneak, she simply walked pur-
posefully out of the men’s toilet,
having done what she needed
to do, and didn’t linger to hold
a press conference or wash her
hands. A couple of men glanced
back from the urinals and
noticed her and were very cool
about it. “Was that a woman?”
one of them asked. “Yes, she
was,” I said.
As for the movie, oh well. The
funny lines mostly get lost and
after a while you get tired of the
colorgray.It’snicewhenthebod-
ies of dead customers slide down
the chute and drop into the cel-
lar and land on their heads, oth-
erwise a long two hours.
But an American woman who
steps out of line in a simple ur-
gentrevoltagainststupidtoiletin-
equality — that is worth the price
of admission. Men’s and women’s
toilets are roughly of equal size,
whichisafalseequality:whatmat-
tersisthetimespentwaiting.Men
require 3 square feet and 15 sec-
onds to pee, and women need 15
square feet and have more to un-
hitch and pantyhose to deal with
andthentheyneedtohangoutand
talk about feelings. So the line ex-
tendsdownthehallandaroundto
the popcorn stand. Why is this al-
lowed to exist? Because architec-
ture loves sym-
metry, I sup-
pose, and so it’s
uptowomento
step out of line.
Did I forget
to say that this
was in New
York? It was
in New York,
on the Upper West Side, the
National Liberal Refuge & His-
torical District — and now you’re
asking, “How do you know she
wasn’t a transvestite?” Because
she had small feet, that’s why.
Anyway, I came down the hall-
way crowded with about 57
openly disgruntled New York
women, seething, muttering,
glaring at the men sweeping
past them, and I strolled into
our clubroom as the interloper
loped past me on her way out,
and the coolness of the male
patrons was interesting.
At Benson School in 1952, a
girl in the boys’ toilet would’ve
been an international incident,
but in New York, men smiled,
went about their business,
zipped up, washed their hands,
and went off to dinner as if noth-
ing had happened.
The country wants change.
Here’s how it happens. People
talk it to death for decades and
then somebody crosses the line
and suddenly the line doesn’t
exist anymore. Men would
not accept women in manage-
ment and then, lo and behold
— Women in Management!
Accepted. (THUMP.) The coun-
try is not going to elect a black
man president until one day it
does and we all wake up the next
morning and go to work and
that’s that.
Okay, so it wasn’t the Mutiny
on the Bounty, but if women
breech the door marked MEN
and enter the last male preserve,
what then? The men’s toilet
today is a sort of church, a place
to drop your public face and be
a mammal for a moment, and
women will change that. You will
stand at the trough in this most
private of moments and a lady-
like hand claps you on the shoul-
der and says, “Move over, bud.”
And she stands next to you. You
do not look down. You dare not
look. Your eyes are glued to the
wall ahead.
“I remember you, you jerk,”
she says. “We hung out at Cross
Lake that summer. We were an
item. Then I never heard from
you again. I cried my eyes out
over you. Nobody ever treated
me that way before. I’m still not
over it.”
“No, no, no, it ain’t me, babe,”
you’re thinking, but it was you
babe. You can run but you can’t
hide.
The sign says MEN but so
what? Call the cops, tell it to the
judge, start a movement (Amer-
icans For Dignity), open a Web
site, talk until you’re blue in the
face — what I saw is the future,
babe. Unless …
Architects, back to the draw-
ing boards. Make the women’s
40 stalls, make the men’s 20
urinals and two stalls. What-
ever they want. Mirrors, the
works.
©GarrisonKeillor.Allrightsreserved.
Crossinglegs,
crossinglines
Garrison
Keillor
Photos.com