On Health Care...

By Marilinda Garcia on September 16, 2009

The country’s healthcare system is badly in need of reform – a reform that has sustainable solutions to improving access, affordability, and quality of care. During a global move toward consumerism, one must take into account the potential ramifications when reforming an issue that accounts for approximately 1/6th of America’s economy.

Republicans have shown a historical reluctance to focus on healthcare, instead favoring other issues at the forefront of the American consciousness. They all too often have passed the issue off to the Democratic Party to handle, or have discussed it solely as a cost center rather than as a value. However, with healthcare’s recent surge to the front of the national concern, the Republican Party has begun to clearly articulate what they view as necessary and immediate reforms that do not hinder choice and competition.

While the Republican and Democratic parties agree that every American should have access to affordable care, the Republican view is that the government should act as an organizer of the healthcare system – organizing an efficient market and securing its safety – rather than as an owner. The system should allow for greater choice and affordability for all while facilitating the development and sustainability of an efficient and patient-centered system of care. At the same time, it must be careful not to curb innovation.

There are a number of key points of reform that should not be delayed. First, the system should incentivize patient-centered, higher quality care; current reimbursement systems operate on a per-service basis and can spawn unnecessary tests and procedures, instead of targeting treatment toward the specific health needs of patients. Second, fraud and waste must be eliminated; for example, in 2007, $32.7 billion in Medicaid claims and payments were deemed improper. Third, innovation must be encouraged in areas such as health information technology. Most of the healthcare industry, specifically hospitals, still maintain outdated paper-based systems that result in a lack of communication and information sharing among providers. A high rate of medical errors is an unfortunate consequence (deemed the fifth leading cause of death in the U.S.). Fourth, the system must increase transparency for both cost and quality, wherein prospective patients are able to view infection rates across hospitals and choose where to receive treatment accordingly. Such transparency would help compel hospitals to meet standards of cleanliness and safety.

Other necessary reforms include promoting health care portability between jobs, focusing on prevention and wellness, ending frivolous lawsuits through tort reform, accepting applicants with pre-existing conditions, helping the poor by establishing a poverty line at the point of need, and encouraging the use of tax deductions, tax credits and health-savings accounts.

The most efficient way to create affordability is through reforms that improve the private market delivery of care and provisions of insurance. Many leading employers, such as Safeway, Whole Foods, Target and Wal-Mart are working to get better value for spending on health coverage for their employees. Allowing the private sector the freedom to adapt to best suit the needs of employees is crucial, but it is also true that current subsidies for job-based health insurance are not optimal in the way they discriminate against those with lower incomes. Because it is tied to the progressive income tax system, the invisible tax break for health insurance is most valuable to taxpayers in the highest tax brackets and least valuable to those in the lowest tax brackets.

Yet, the private sector is much more adept at innovation and evolutionary change than government dominated programs, and continued innovation is vital to progress in health care. The medical profession is moving toward patient-centered medicine, with micro-targeting of treatments tailored to the individual genetic code of individual patients. Advances in medical science demand that progress continue without being blocked by regulatory obstacles and restrictive payment services.

In the face of health costs that are supposed to double by 2017 and at the risk of squeezing out other public services provided by the federal and state governments, the challenges of expanding access to health coverage for the uninsured, modernizing our health care delivery system, and providing relief from rising health costs for private and public payers are enormous.

Confronting the systemic problems must not be delayed, but the approach to sustainable solutions must be careful and deliberate. Many nations, mostly smaller and more homogenous than the U.S., have found ways to provide healthcare to their citizens. While the U.S. can heed the successes and failures they have had, it would do well to remember that one size does not fit all and not be afraid to innovate and find unique solutions. As Michael Leavitt, former Secretary of the Department of Health and Human Services, said, “In a global market there are three ways to approach change. You can fight it and fail; you can accept it and survive; or you can lead it and prosper. We are the United States of America; let us lead.”

Simply expanding government involvement in the health care system is a short sighted and unreliable solution that does not play to America’s strengths, and it is not leadership. Leadership demands innovation and prosperity demands our continued commitment to free enterprise.

On Afghanistan...

The Republican Caucus at Harvard Kennedy School

by Scott Darnell, MPP'10 on September 30, 2009 in Dems v. Reps

We are living in a moment of great consequence with regard to U.S. foreign policy in Afghanistan. The Chairman of the Joint Chiefs of Staff has said the situation is “serious” and “deteriorating.” U.S. commanders have just told Richard Holbrooke, U.S. Special Representative for Afghanistan and Pakistan, that they do not have sufficient troop levels to combat Taliban and other insurgents who are becoming more sophisticated in their attacks and whose growing intensity challenges the legitimacy of Afghanistan’s national government.

Currently, the U.S. is attempting to quell an insurgency with one-third or fewer total military forces and half the number of security and police trainers than were needed to dispel the insurgency in Iraq. All of this is taking place in a country that is not only more populous than Iraq but which also maintains dangerous hideouts along its rugged border with Pakistan.
Rightly or wrongly, what Afghanistan looks like in 20 years will depend largely on the decisions President Obama makes in the weeks ahead. A future of continued tyranny and fear for the Afghan people, as well as increased instability in South Asia, are not impossible outcomes. The longer the U.S. waits to increase the number of troops in Afghanistan, the harder it will be for the country to be fully secure.

As Obama correctly noted when running for the presidency, “…the security of Afghanistan and America is shared.” He called the Afghanistan/Pakistan border the “wild frontier of our globalized world,” later remarking, “We cannot fail to act because action is hard.” Obama’s rhetoric about the importance of the war in Afghanistan must be quickly matched – not by politically palatable mini-surges or tactic shifts – but by a significant surge in forces (perhaps as many as 40,000 additional U.S. troops) that will display his clear and decisive commitment to ending the violent insurgency. This will serve as the necessary first step in achieving peace and progress in Afghanistan.

To this point, Obama has spoken words of support for a war that he hasn’t convinced the American people is winnable. He has lacked clarity in defining what ought to be America’s end goals in Afghanistan, namely to enhance U.S. security by gaining a democratic ally in a region that has become a hotbed of conflict, and to provide the approximately 28 million people of Afghanistan a chance to experience freedom, prosperity, and social progress.

There are many aspects of the fight against the insurgents in Afghanistan that differ from what the U.S. faced in Iraq prior to President Bush increasing troop levels there. That being said, as Michael O’Hanlon of the Brookings Institution astutely notes, “Basic principles of counterinsurgency and stabilization do have a general applicability across missions. The size of security forces always matters.”

It’s also becoming clear that an insurgency grows when the U.S. is distracted by other matters, and democratic, social, and economic progress is hindered until a violent insurgency is reigned in. We’ve found this to be true in Iraq, and this currently characterizes Afghanistan. A surge in armed forces would disrupt the confidence of the Taliban and allow for increased efforts to train Afghan security and police forces. A concerted effort to bolster local governmental authorities and work to legitimatize the national government could then be undertaken to achieve greater democratic stability.

Obama is in the political fight of his life over an ambitious and controversial domestic agenda that involves the U.S. government taking over aspects of the financial sector, auto industry, and healthcare system. Undoubtedly, he’d prefer not to face the potential political fallout of sending additional troops to Afghanistan. But he must understand that, so long as he believes the mission to be worthy and winnable, Americans will likely give his new strategy an opportunity to succeed.

From a political standpoint, Obama deserves no sympathy. If President Bush could successfully surge U.S. forces in Iraq two months after his party was trounced and thrown out of power in midterm elections while his approval ratings languished at 30 percent, then President Obama can surely survive any political fallout that might come from his ordering a significant surge of forces to Afghanistan.

Our strength can break the confidence of the insurgency; our reticence only bolsters it daily. The decision is on the president’s desk. For our soldiers in harm’s way and for the Afghan people who seek a brighter future, it’s time now to honor our commitment and send additional forces to Afghanistan.