The conspiracy-minded blogs have been abuzz about President Obama’s Executive Order granting Interpol certain privileges and immunities. Fears of the loss of national sovereignty lead the pack with some going as far as saying this opens the door to Americans being kidnapped to appear before the World Court. The calmer voices have been saying it only grants “diplomatic immunity” to members of Interpol operating in this country. Both explanations are wrong.
Jake Tapper at ABC News has provided an explanation, complete with the history of the special classification:
The International Organizations Immunities Act, signed into law in 1945, established a special group of foreign or international organizations whose members could work in the U.S. and enjoy certain exemptions from US taxes and search and seizure laws.
Experts say there are about 75 organizations in the US covered by the International Organizations Immunities Act — including the United Nations, the International Atomic Energy Agency, the International Monetary Fund, the International Committee of the Red Cross, even the International Pacific Halibut Commission and Inter-American Tropical Tuna Commission.
(These privileges are not the same as the rights afforded under “diplomatic immunity,” they are considerably less. “Diplomatic immunity” comes from the Vienna Convention on Diplomatic Relations, which states that a “diplomatic agent shall enjoy immunity from the criminal jurisdiction of the receiving State.” That is NOT what the International Organizations Immunities Act is.)
President Reagan granted Interpol some protections in 1983, then President Clinton expanded them in 1995. But because Interpol did not have a permanent office in the US, the full protections of the International Organizations Immunities Act were not needed. Tapper reports he has been told Interpol established permanent offices in the US in 2004.
Individual officers of Interpol are still subject to our criminal and civil laws, and do not enjoy diplomatic immunity. The protections afforded Interpol by President Obama are the same as those given to other international organizations, including the International Pacific Halibut Commission.
With the historic passage of a partisan health care insurance reform measure, the US Senate Majority Leader Sen. Harry Reid kept his most recent promise to pass the bill by Christmas. Differences with the House version means that the bill will almost certainly require reconciliation and another 60-vote “filibuster override” in the Senate in 2010.
Heritage.org lists the “significant differences” between the two bills as including differences on the idea of a public option, size and reach of new federal taxes, scope of the employer mandate, penalties for the constitutionally-questionable individual mandate, Medicare expansion, and taxpayer funding for abortion. More detail on the differences is provided in the link.
The House may compromise on taxes, employer mandates and, being members of a major political party and no stranger to government coercion, the individual mandate (a court test on this matter would not come until after the bill is signed into law). But the public option and abortion question could prove to be sticking points.
While the hard work continued over the last few months in the Senate, the American people found more and more to dislike with the Democrat’s plan. Pollster.com’s average of all polls shows nearly 52% of Americans oppose the plan and only 40% support it in December.
House Democrats may be a bit edgy in the new year; a mid-term election that historically loses seats for the majority party looms in November. National polls still show the Republicans with higher negative numbers, but Democrats will dismiss the anti-incumbent attitude at their peril. As MSNBC notes:
For the first time, Obama’s overall job approval rating has fallen below 50 percent (to 47 percent). In addition, for the first time since Sept. 2007, a plurality (45 percent) sees the Democratic Party in a negative light. And the percentage believing the country is on the wrong track (55 percent) is at its highest level in the Obama presidency.
“This survey underscores what I consider a dramatic and unmistakable change in the political landscape,” said Democratic pollster Peter D. Hart, who conducted the survey with GOP pollster Bill McInturff. “For Democrats, the red flags are flying at full mast.”
The same poll, commissioned by NBC and the Wall Street Journal, showed that the ambitious health care plan was a factor. While not mentioned in the MSNBC story, the Wall Street Journal did cite the statistic:
Democrats’ problems seem in part linked to their ambitious health-care plan, billed as the signature achievement of Mr. Obama’s first year. Now, for the first time, more people said they would prefer Congress did nothing on health care than who wanted to see the overhaul enacted.
The questions and statistics are provided in this pdf file, and they show that the public’s preference for Democrats over Republicans is down to 2 points, a slide from 9 points in April, and within the poll’s margin of error.
But its not a slam dunk for Republicans. The Tea Party movement, derided regularly in the media with porn-influenced smears, is more popular than either the Democrat or Republican party, with 41% of the people saying they were very positive or somewhat positive about the movement. That means Republicans may find themselves in trouble as well. The political winds seem to be favoring fiscal conservatives now but with a more limited government view. Libertarians hope that means eschewing government intervention in either the marketplace or the bedroom. Yet recent votes in New England and the mid-Atlantic states seem to favor the GOP in both leadership positions and social issues like gay marriage.
Its clear that catching the anti-incumbent tide will take a lot of paddling for a candidate of either party. A Republican challenger doesn’t have the millstone of the 2009th Congress around their neck, and the burden of the Bush years is getting lighter all the time. Especially since the Obama policies regarding Iraq and Afghanistan seem mirror images of the pilloried Bush policies.
Political uncertainty is sure to fester in the minds of Democratic House and Senate members as they work to reconcile the two approaches to health insurance reform. The majority may feel lonely without any members of the opposing party to help share the blame in a bi-partisan manner. The echos of promises past may haunt them, as more details that some of the initial goals are not met. “Bending the cost curve in the right direction” is not the same as “reducing costs”, and providing “insurance for all” is reduced to “insurance for 60% of the uninsured.” The whispers of the estimated 20 million still uninsured probably won’t bother them, but the loud voices of the American electorate probably will. Will 60 votes be there for Sen. Reid in the spring?
CMS, the Centers for Medicare and Medicaid Services, part of Health and Human Services, has provided some analysis of the new senate plan forwarded by a group of Democratic senators and majority leader Reid.
The “estimated financial effects” include some that may cause some moderate Democrats to withdraw support. An estimated 5 million Americans are expected to be dumped into the government plan by employers, while still leaving 24 million legal residents without insurance at all. Medicaid rolls would swell by 18 million, putting further pressure on state budgets that are already hurting. And overall health care spending would be increased by 11 billion dollars due to increased taxes and fees passed on to consumers.
New and increased taxes of 29 billion dollars and proposed cuts of 493 billion in Medicare help offset the costs of the plan, but have some problems of their own: reductions in payment to providers could result in less choice for seniors, a politically risky proposition. In some areas, losing a Medicare provider could result in the loss of all services for that area.
Net costs, after proposed cuts in spending and increases in taxes, is estimated to be an increase of 234 billion dollars. The report hedges its bets, though, with this statement, appearing right after the cost estimate:
The actual future impacts of the PPACA on health expenditures, insured status, individual decisions, and employer behavior are very uncertain. The legislation would result in changes in the way that health care insurance is provided and paid for in the U.S., and the scope and magnitude of these changes are such that few precedents exist for use in estimation.
The Senate plan relies on cuts and taxes that are unlikely to remain in the bill as horse-trading begins to gain passage, reducing further the “accuracy” of the CMS estimate.
Sen. Joe Lieberman told Senate Majority Leader Harry Reid Sunday that he couldn’t support a new Medicare proposal floated as a compromise to the public option, a development that complicates the bill’s path towards passage before the end of the year.
In a meeting in Reid’s office just off the Senate floor, aides said the Connecticut independent reiterated his concerns with the public insurance option and told the Nevada Democrat that he couldn’t support a new plan to allow people as young as 55 to buy into Medicare.
Missouri Democratic Sen. Claire McCaskill declared she would “absolutely” vote against any bill that increases the deficit, as President Obama has promised to veto any such measure. And even senate liberals have reservations:
And it’s not just moderates who have problems with the Medicare buy-in. On Friday, a group of 10 Democratic senators, including Wisconsin’s Russ Feingold and Vermont’s Patrick Leahy, wrote to Reid, worried that expanding the program without changing the rates Medicare pays to doctors would curtail seniors’ access to care. The letter came a day after a report by the Centers for Medicare and Medicaid Services found that the bill’s Medicare savings “may be unrealistic.”
After boldly announcing that a compromise had been reached, Reid saw his party’s senators “walk back” the statement. The compromise was only to send the proposal to the CBO for financial impact score, they said, most adding they remain committed to the idea of a deficit-neutral bill. The Politico article sums up the situation from Sen. Reid’s perspective:
If he kills a public option or the Medicare buy-in plan, he could lose the support of Sanders and several of the more liberal members of the Democratic conference. But keeping either of those plans, or one that would “trigger” a public option if private insurers don’t hold down costs, would lose Lieberman – forcing Reid to find at least one moderate GOP senator to advance the proposal.
To win the most likely potential GOP defector, Sen. Olympia Snowe (R-Maine), Reid would likely have to make modifications and slow the debate down since she’s signaled that the Senate needs to take more time to deal with the expansive issue.
Initially promised as a “bridge” between moderate and liberal Democrats, majority leader Reid’s plan to extend Medicare benefits to those 55 and older who cannot obtain private insurance is running into resistance. From Politico:
Senate moderates who are the linchpin to passing a health care reform bill raised fresh worries Thursday about a proposed Medicare expansion, complicating Majority Leader Harry Reid’s hopes of putting together a filibuster-proof majority for the legislation in the coming days.
Two days ago, the Medicare proposal appeared to be the elusive bridge between liberals, who were being forced to give up a public health insurance option, and moderates, who said they couldn’t vote for a bill that included one.
While Republicans have been completely locked out of the process, moderate Democrats are concerned that none of the details have been provided. Senator Reid is evidently waiting for cost estimates from the CBO before releasing the details (Politico):
Reid will not release details — even to senators — until he receives the CBO analysis, which isn’t expected until early next week. At that point, Reid has less than two weeks to tweak the plan if the price tag is too high, brief his caucus, lock down the votes and clear a series of procedural hurdles for final passage.
Republicans worry that the plan is simply another step in the direction of a single payer system as the Wall Street Journal editorialized. The fear is that no or low cost coverage in Medicare quickly eliminates competition and starves the private sector plans.
Polling shows support for the Democrat’s plan is eroding, with CNN’s poll showing only 36% supporting, a 10 point drop from the same question a month ago. Fox pegs the favorable number at 34%, noting that the all-important independent voter matches that number precisely, with 66% opposed to it (Democrats favor the plan by 66%, but only 22% of Republicans favor it).
The White House and liberal think tanks insist that health care reform will lower costs, but the public isn’t buying it – and for good reasons.
Practically every aspect of the bills Democrats are considering – from covering the uninsured to taxes on providers, insurance reforms and Medicare cuts – will result in higher premiums for those with insurance.
And unless Congress is willing to impose stricter cost controls than presently contemplated, many experts think there’s little chance of “bending the curve” of national health outlays or premiums.
Politics abhors a vacuum, and speculation rushes to fill it. By drafting the legislation in the proverbial smoke-filled back room, Reid has increased uncertainty. Kondracke, who supports the idea of a private industry option to provide health insurance to everyone, notes the support in polls for the general concept of providing health insurance availability:
The Quinnipiac poll, like most others, shows that the public favors – 56 percent to 38 percent – “giving people the option of being covered by a government health insurance plan that would compete with private plans.”
My guess is that the words “option” and “compete” elevate support for government-run health insurance, but in any event, it’s dead in the Senate. Negotiators have substituted a system like the Federal Employees Health Benefit Program that relies on negotiation with and competition between private companies.
That should be the design for the whole of U.S. health care reform, modeled on successful programs in Switzerland and Holland, and Republicans would be smart to propose it.
The Swiss system has been recommended as a model for the US. It requires participation, and the basic coverage must be offered on a non-profit basis. Share of costs can be chosen by the participant with corresponding premiums, with a maximum out of pocket cost at 8% of income (government subsidies make up the difference for the poor). Residents are able to buy additional insurance products if they wish, but basic medical care and hospitalization are covered by the plan. The plans are managed by each canton (state), which meshes nicely with our federalist system. The New York Times reported on it in September of this year:
“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.
“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”
Details are still sketchy, but the Senate compromise on health care is described by the Washington Post in this morning’s edition:
The short answer — subject to Senate revisions — is that those without employer-provided insurance would have more options for buying coverage, but if they are younger than 55, their money would go to a private insurer, no matter what. Rates would be more competitive than what they are offered now, but possibly less so than under a “public option.” And if they are between 55 and 64, they might be able to buy into Medicare early, though at what prices remains to be seen.
As congress moves toward health care reform the comparison between private health care insurance firms and the existing government programs like Medicare becomes more important. While many private health insurance companies are already non-profit, the administrative expenses in private firms are said to be from 10 to 20% of total expenditures. Medicare is quoted at under 6%, or 8 to 9% when assistance from other government agencies is included.
The premium cost for someone 55 and older buying into the Medicare system has not been determined, but it is expected to be equivalent to the cost of private group insurance. Guaranteed eligibility would attract those who cannot obtain private insurance due to pre-existing conditions. It is possible that the premium cost could offset the extra expenditures for the younger group of people. And I expect subsidies to be in place for low to moderate income people.
I have never been able to determine the exact accounting rules used to calculate Medicare’s administrative costs; private companies generally use something like GAAP (Generally Accepted Accounting Principles), a set of accounting rules used to prepare, present, and report financial statements. But the government does not; financial details are reported on a cash basis, and administrative costs are often allocated to a program based on its share of total government expenditures. There is an argument that Medicare’s administrative costs per person are higher than in the private insurance business, as Robert Book has noted at Heritage.org:
Medicare patients are by definition elderly, disabled, or patients with end-stage renal disease, and as such have higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of relative efficiency. Administrative costs are incurred primarily on a fixed or per-beneficiary basis; this approach spreads Medicare’s costs over a larger base of patient care cost.
But you can slice and dice the numbers a lot of different ways. One long and detailed paper supporting the idea of a public plan, written before the current administration took office, is provided by Jacob Hacker (pdf file). Hacker uses Medicare’s lower administrative costs as a reason for implemention:
The CBO study suggests that even in the context of basic insurance reforms, such as guaranteed issue and renewability, private plans’ administrative costs are higher than the administrative costs of public insurance. The experience of private plans within FEHBP carries the same conclusion. Under FEHBP, the administrative costs of Preferred Provider Organizations (PPOs) average 7 percent, not counting the costs of federal agencies to administer enrollment of employees. Health Maintenance Organizations (HMOs) participating in FEHBP have administrative costs of 10 to 12 percent.
Note that FEHBP, the Federal Employees Health Benefit Program, is rumored to be the model for a national private insurance exchange for those under 55. Unlike a government “public option”, this exchange would be an array of private company plans administrated by the federal government. Minimum requirements for the plans are set by the government, and employees are able to choose among providers. Historically, rate increases for the FEHBP generally exceed those of private group plans administered by employers, running at 7 to 8% per year as opposed to 5%.
One advantage of extending voluntary Medicare coverage to those 55 and older is that many people entering the system at 65 are in frail health, with undiagnosed diabetes or heart disease. If preventative care is started at 55 overall program costs could be reduced. The problem is that making the system the “insurer of last resort” would mean that only those in poor health or unable to pay for private insurance would take advantage of it. It remains to be seen if overall savings would result.
