Indiana governor Mitch Daniels’s policy director, Lawren Mills, Grace-Marie Turner of the Galen Institute, and Bob Goldberg of the Center for Medicine in the Public Interest take exception to my NRO article “Mitch Daniels’s Obamacare Problem.” In brief, the trio believes that Daniels’s expansion of government-run health care is a conservative triumph. I can’t believe we’re even having this conversation.
Advertisement
To recap, the Healthy Indiana Plan, which Daniels signed into law in 2007, bears the following similarities to Obamacare:
1. Both expanded Medicaid, which crowds out private insurance — Obama to 138 percent of the federal poverty level, Daniels to 200 percent.
2. Like Obamacare, the Daniels plan raised taxes to pay for part of its expansion of government-run health care. (Daniels’s 126 percent hike in Indiana’s cigarette tax mirrors Obama’s 159 percent hike in the federal cigarette tax.)
3. Like Obamacare, the Daniels plan pushes part of its cost onto other states. Taxpayers in other states bear two-thirds of the spending burden (through the portion of Medicaid funding that comes through Washington, D.C.), and Daniels has proposed making other states pay even more.
4. Just as Obamacare will cost more than projected, an independent review found that Daniels’s cigarette-tax hike hasn’t kept pace with Indiana’s share of the spending, and further spending overruns may be on the horizon.
5. Both Obamacare and the Daniels plan contain a “slacker mandate.” Obamacare mandates that insurers cover “children” on their parents’ policies up to age 26. Daniels mandated that insurers do so up to age 24. (A similarity I overlooked in my original article.)
Turner says the Daniels plan “could not be more different” from Obamacare. I’ve just listed five ways that it could. And it gets worse:
6. Daniels has accepted Obamacare grants and is implementing an Obamacare “exchange” in Indiana — something he is under no obligation to do, contrary to what Turner claims.
That’s enough to cause problems for the repeal effort were Daniels to be the GOP’s presidential nominee.
Mills, Turner, and Goldberg defend the Daniels plan with an argument that boils down to this: Daniels expanded Medicaid with health savings accounts, and that makes it okay.
In fact, it may seem counterintuitive, but if anything, the fact that Daniels used HSAs makes his Medicaid expansion worse.
I support HSAs because they allow workers to reclaim control over a portion of their health-care dollars, and I support expanding them so workers can control all their health-care dollars. Within the context of Medicaid, however, the advantages of HSAs are actually a problem. Medicaid is welfare. By offering Medicaid enrollees the freedom and opportunity for wealth accumulation that HSAs create, the Daniels plan makes Medicaid more attractive, and thereby lures more people out of private insurance and into dependence on government.
Turner writes, “Cannon calls this a ‘taxpayer-funded health savings account’ and makes it sound like the state is handing out cash. It’s not. He needs to get his facts straight.” Actually, I wrote, “the government hands out coverage plus something a lot like cash.” Which is true: Enrollees can spend their HSA funds on any provider they choose, and whatever they don’t spend rolls over. That makes Indiana’s Medicaid HSAs a lot more attractive than either traditional Medicaid (which few doctors accept) or Medicaid managed-care plans (which limit coverage to a provider network). The only ways these taxpayer-funded HSAs are unlike cash is that enrollees can spend them only on medical care and must forfeit them if they leave the program. The incentive to remain enrolled in Daniels’s Medicaid expansion is therefore greater than in the rest of Medicaid. And if you do leave, there’s a use-it-or-lose it incentive to spend the taxpayers’ money before you go, which runs completely counter to the whole idea of HSAs. “It sounds to me,” Turner writes, “like Governor Daniels got the incentives right.” Really?
I always like to state this because it bears repeating:
When I was working at Edward Jones there was a moderately conservative colleague whom I was discussing Obamacare with. It had not yet passed and we was discussing its potential implications. I told him that if Obamacare is passed it must be immediately repealed. He asked why that was case. I told him that if it weren't immediately repealed that it conservatives would lose the will to fight against it and help implement it, thus ensuring it never gets repealed. He didn't like that answer, but that isn't my problem.
Conservatives are as culpable for the mess that we're in as are the progressives, but at least the progressives, both with and without subterfuge, admit what is they're end game: total government management of the economy. Conservatives like to think that the solution to more government is less government, but government is government, which is why we always end up with more government.
I agree with Cannon. I thought Daniels everyman image would be the perfect anti-Obama in 2012, but even he adopts a big government approach. Daniels big government solutions may be more consumer friendly, at least at first, but liberals will turn that into bureaucrat control every time.
I'm VERY disappointed that conservatives are not taking a stand against any expansion of government into health insurance.
Republican candidates MUST take a solid stand against Obamacare.
1. Daniels plan has absolutley no obligation for people to sign up.
2. It actually lowers all of our healthcare costs by allowing people who would otherwise go to an emergency room uninsured and get 'free' care passed on to us through higher costs to cover the uninsured.
3. Daniels plan has budget limits that do not flex and make sure it is covered by in the Indiana Budget (thus the waiting list).
4. You claim that other states fund this with $2 for every $1 dollar of Indiana money......just like Indiana money funds other states medicaid/medicare plans as well. It's a national trade off, we all support eachother's costs through our payroll deductions. Daniels has just found a way to make it more efficient.
5. We (taxpayers) at some level will be funding a medicare/medicaid plan. Doesn't it make sense to do that the most effective and efficient way possible? If you think that medicaid/medicare will be fully defunded (or should for that matter) anytime soon, you're a fool (which cannot think you are.)
6. Daniels is on record multiple times stating that Obamacare should be repealed. Please site sources that he is now implementing Obamacare in Indiana.
And, let's assume that you can site these credible sources. I don't know what state you live in, but I'm glad Daniels is at least entertaining the idea that the Supreme Court could actually side with the Administration and Obamacare would need to be implemented at the state leve. If so, Daniels would have some say as to how that implementation looks where as your state (if unprepared) will have to deal with whatever program the administrators at the federal level decide to implement since your Gov. did not prepare ahead of time.
Let this argument go. You're critique is shaded with "wishful thinking" instead of whole truths.
Chrisbotssr NAILED it. What the heck happens to conservatives once they get into power? Is it that the Liberals incessant activism wear them down? If so, we need more conservative activist group pronto. Ala enviornmental groups. Ruthless.
And so it begins (or continues). Mitch Daniels gets attacked and smeared from the Right for not being an appropriate ideologue. Anyone who actually understands the Indiana health care situation understands that it is in NO WAY Obamacare, not the least of which is it being a State based plan rather than a national mandate, but why let facts get in the way.
Go ahead...nominate Huckabee/Palin and enjoy another four years of Obama.
Without an individual mandate to force the uninsured to enroll into the IN HSA Medicaid program, the analogy the author creates between it and Obamacare begins to break down.
And when one realizes that one cannot simply enroll in this program and start to receive benefits right away, but must instead wait on a very long list to be approved, the author's analogy further decomposes.
Next, if one considers the actual dollar value leaving the government treasury for what the government is paying for, Obamacare mandates a certain minimum amount of coverage that actually is well beyond a catastrophic-only plan, making it that much more expensive than it otherwise would be to fund each additional insured.
All I've read about the plan in Indiana, including notably from this author, suggests that is not so in Indiana. At least, given how tightly wound Mr. Cannon seems to be, I can't fathom that he would forgo making additional arguments in "round 2" of his logic game, seeing as though he added to his arguments between the first and latest installments.
Then, when one stops and considers that any additional insureds in Indiana will be using an HSA instead of a traditional cash transfer, the analogy withers totally.
To say that the "use-it-or-lose-it" provision encourages further waste of taxpayer money rests on two false premises: 1) the amount of taxpayer money initially at their disposal in their HSA (or added incrementally) equals the amount of taxpayer money which funds alternative plans under Obamacare (false); 2) that people use health care for things they don't really need or never considered, simply because money is sitting in an account that will evaporate from them if they leave the plan (false).
In my neck of the woods, people HATE going to a doctor, and they HATE even more even the most routine dental cleaning. People don't rack their heads thinking of "purchases" to make at the Dr.'s office.
I concede that provision would encourage some NOT TO LEAVE THE PLAN, but that's after they've qualified and slid off the waiting list into the program. Plus, Mr. Cannon, as the CATO guy on these thingies, can study and render a paper on how many people forgo public benefits for which they are otherwise qualified.
People who have their children removed from them often prolong the reunification effort by forswearing any public benefits. A large percentage of the impoverished suffer more from misplaced pride in certain circumstances than they do from poverty.
The author is against adding even one additional person onto any government-funded insurance program, however it may be funded or administered. Me, too, but that hardly warrants an hyperbolic diatribe to paint Daniels's plan as "Obamacare II".
Mitch Daniels has never been, is not now, nor will he ever be a "movement conservative", and he never claimed to be, either. For some of the foot soldiers in the conservative movement, that makes him thoroughly unacceptable as a GOP candidate for President. That's what this and other attacks on him are about - real politic.
That is all fine and good. May the most politically savvy win out. But before we single out Mitch Daniels for particular blame for advancing the left's agenda for them, I'd like to offer my own personal lament that so many of the professional foot soldiers in the conservative movement (Mr. Cannon not necessarily included) put up 1/2 the fight to Bob Dole's and George Walker Bush's nomination campaigns, that they are waging now against a still-undeclared candidate.
The conservative movement does NOT get a pass from me for placating the moderation of the GOP politicians who were claiming to represent them for the past 30 years (or more).
And by the way, Mitch Daniels is twice as conservative than other presidential hopefuls that Mr. Cannon voted for in the previous THREE presidential election cycles.
I guess for some, the GOP's next nominee must be an actual Tea Party organizer, or an immediate descendant of one. This country has not adopted socialism overnight. And if some in the conservative movement take a no-holds-barred approach to undoing it all, their efforts will sink under their own weight.
ALL of the current prospective GOP candidates for president have a MAJOR electability problem, most notably the conservative movement's darling, Sarah Palin. She has a NEGATIVE 150% chance of winning more than 12 states (each with a pittance of electoral votes). I'll vote for her in a heartbeat, but not with any delusions that she'll win.
For Daniels nationally, his electability problem stems ONLY from his personal appearance. Evidently, Mr. Cannon is nonplussed by any of that "electability" talk, because he equates Daniels to four more years of Obama. I propose he review how to solve problems that contain more than one variable and no coefficients.
The differential between our two equations could not be wider. My observations lead me to calculate that, in some profoundly important ways, Mr. Daniels is more conservative than Reagan ever was.
Newt was 1,000% correct - the GOP has a Reagan problem! But I guess that's off on a tangent . . .
People in the comments section will take either side in this debate, but one thing is telling.
Those against the premise of the author are missing the key point. This isn't about the individual mandate as the straw men argue (and the author didn't say that it was). This is about a governor implementing something that a government has no business in - expanding or meddling with the market in heath care issues.
The author points out how Daniels' program is like ObamaCare, while others point out how it isn't. But the bottom line is that the Indiana government has a larger role in health care and insurance after the arrival of Daniels.
At least some commentors are "out of the closet" when they admit that the critical remarks about Daniels comes from actual conservatives. Well duh; Daniels is no friend to conservatives. Expect him to get scrutinized at the site of a conservative magazine!
Romney (and even Obama) have their apologists, and it appears that Daniels does too. Good governors find ways to shrink the governments role in health care and insurance. They don't tell their grass roots to hit the "mute button", vanish when your party tries to pass a right to work bill, over-ride a super majority of your state's legislature to give judicial appointments back to the governor (instead of a panel of liberal attorneys), and chair the CBO under one of the worst republican spending administrations in history. And they sure as heck don't push for an expanded government role in health care and insurance.
The issue of the individual mandate is not a "straw man" when the key tenet of the author's article was to draw an EXACT analogy between the IN plan and Obamacare, because the individual mandate is the lynch-pin to the latter. That mandate, therefore, is central to this discussion of the author's point that you for some reason wish to thoroughly gloss over. That you dismiss it as irrelevant and the author ignores it completely is y'alls problem, not ours.
You should steer away from condescending to those with whom you disagree - "duh?" Really, Steve - duh? And, um, well, duh! Have you seen how many conservative NR and NRO contributors (forget the comments) are either not opposed to the idea of a Daniels candidacy or further, support his running for the office? That # far outpaces, at least here and the print version of this publication, the opposite side.
Of course, might does not make right, but your notion of the linear nature of your logic that OF COURSE conservatives would oppose Daniels amounts to this: "If someone disagrees with me about Mitch Daniels, one is not a conservative."
Well, Steve - duh! That is not an argument. That's a juvenile exclamation.
And Steve: the person making an allegedly obfuscating argument - like ignoring the central piece of Obamacare (the MANDATE) when analogizing that to other health insurance programs - is not the "straw man". The "straw man" is the argument itself. Um, duh?
At least you admit that the author ignores the key ingredient to Obamacare (the indiv. mandate) as he analogizes that legislation to ANYTHING. Any such analogy would logically HAVE TO start there.
You: (i) misstate the author's central point; (ii) confuse entirely the concept of a straw man argument; (iii) like the author, use a straw man argument as your central tenet (see (i), supra, and (iv), infra); (iv) fully ignore (as he does) the key ingredient to a plan that is analogized to other plans (which lack that component); (v) condescend to those with whom you disagree, AND (vi) are thoroughly clueless as to how many NR and NRO contributors support Daniels' job as Governor of Indiana.
On that last: Have you seen the GRASSROOTS conservative action groups that have praised Daniels for being the best governor in the country? Your notions of how many conservatives agree with you astound.
But you go even further, right, Steve? It would be lucky #7:
You are clueless on what Daniels was doing in the Bush Administration. Daniels, as a member of that admin., was nowhere near the Congressional Budget Office. He was director of the Office of Management and Budget. NOT THE SAME DIFF, right, Mr. Duh?
And you apparently have done ZERO homework about his proposals he made to his boss in that capacity. He was known as "The Slasher." So was W - for slashing Daniels's proposals before submitting the budget to Congress.
But, to refresh your dormant memory, you should check the deficit figures for the two short years that Daniels was serving in that capacity. His fingerprints are NOWHERE to be found on a present deficit of 1.6 TRILLION dollars, Steve, even if one blames HIM for Congress's and his BOSS's budget (that Daniels didn't draft).
But, if you are satisfied with "duh" as argument, why would you let facts get in the way? Here again, your argument is: "Daniels worked for Bush, so he is not a conservative." Does that same circular argument apply to Dick Cheney, the most conservative politician ever to serve in the White House since Warren Harding (including Reagan)?
I won't be voting in the GOP primary, because as an alleged "outed moderate" who is a lifelong (since age 18) member of the Conservative party here in NY, and who HAS NEVER been a GOP registrant, I'm not even eligible to vote in the more moderate party's primary, but thanks anyway for the grossly inapt classification you offered me.
Just remember one thing: if you participate in a GOP primary, for ANY office, you become inherently more moderate than me.
So Steve, I hate to do this, but might I recommend ketchup for your toe cheese?
I appreciate this dialogue regarding Daniels. So few pundits have examined what he has accomplished here in Indiana, and I suppose they find that writing him off as some type of a RINO is the path of least resistance. It must be easier to focus on rhetoric than results.
A fact based approach to Daniels record as Governor would show that he approaches government as though it was a business: look for efficiency, cost savings, quality control, outsource poor performing areas, take ownership of problems, etc.
HSA accounts for people who normally would be on traditional Medicaid has saved Indiana millions. It is a pragmatic, consumer-based approach. Individuals contribute to the account, and therefore are more likely to use cost saving generic drugs, and opt for preventative care (instead of the default option: expensive emergency room visits).
Whether he runs for president or not, he is seen by many governors as an example on how to fix their state. Many of the tough choices currently being faced in Wisconsin, Ohio, New York, and New Jersey were implemented years ago in Indiana, and we now have one of the most attractive business climates in the country. Daniels made this possible.
Well, I'm glad I hit refresh before posting since Maddy did a much better job than I of rebutting Steve's knee-jerk comment. I will only add this:
The government has business in anything that the people say it has business in, at least in a putative democracy. We can lament all we want about whether our brothers and sisters want the government in health care and try to convince them that they are wrong, and we can enshrine prohibitions against government involvement in our lives within the Constitution, but if you want to hold your breath until the government gets out of health care and insurance, be prepared for passing out (and losing any election in which you insist on that as a premise).
Our problems were not created over night. They've taken at least 75 years to get to this level...we ain't going back over night.
In the meantime, if we could spend less, spend wisely, lower taxes, increase access to and quality of education, balance the budget, give back money to the people that goes unspent, all while not causing a violent sit-in at capitols around the country, I count that as a win.
You said, "Good governors find ways to shrink the governments role in health care and insurance. They don't tell their grass roots to hit the "mute button", vanish when your party tries to pass a right to work bill, over-ride a super majority of your state's legislature to give judicial appointments back to the governor (instead of a panel of liberal attorneys), and chair the CBO under one of the worst republican spending administrations in history."
1. Who did this? Point to the Governor who cut their Medicaid/Medicare budgets to their constituents.
2. Truce does not mean conceed your position. In this case it means lets fix the elephant in the room issue before we quit talking to each other on issues that won't matter if the elephant drowns us out. How many churches/charities/non-profits/pro-life organizations tank if the economy doesn't recover? People can't support these causes if they aren't making money.
3. If the Repubs had a super-majority in Indiana then Right-to-Work would have been fine to address. However, since Daniels knew it would tank the session to introduce it without the means to force it through he asked that it be shelved until it was vetted with the voters. Now, Repubs may not get the issues they campainged on passed......how do you think that plays in 2012?
4. Daniels headed the OMB not the CBO.....he also had no vote on the budget or capability to sway opinion on what was included in the final version of the budget that was subsequently passed by the President and both Legislatures.
It's becoming increasingly apparent that a large bloc of voters in a moderate political party - the GOP - will be voting for a candidate in their presidential primary who didn't really do anything for the one (err, 1/2) term of higher office the person served.
No offense - there was so little time for accomplishments prior to premature resignation and the inane investigations swirling around that caused it.
How easy it is for politicians to portray themselves as conservative when they don't challenge themselves to tackle society's most difficult dilemmas.
If the Mayor of Searchlight, Nevada, opens a twitter feed, do we think that person will next run for the most powerful political office in the free world?
If she's on the general ballot, she gets my vote in the blink of an eye. I just wish the GOP primary voters - moderates, they - actually value defeating Obama to some significant degree. Sadly, it appears otherwise.
A governor who is participating in the Florida lawsuit (that's declaring PPACA unconstitutional) but is implementing a state exchange is weakening the case for the lawsuit.
It's probably safe to say most governors and legislators have always been on an employer plan and do not understand the individual, private marketplace and how it will be adversely affected by a government exchange. They don't understand that exchanges are not a health insurance clearing house like they have been described. They are not an ehealth.com. Not even close.
Ehealth functions like a travelocity or kayak for the private health insurance industry. Some consumers in the private market prefer to purchase a portable policy this way, while most like to apply online with the assistance of an agent/broker (at no additional fee)who will walk them through the differences in benefits, assist them with the underwriting process and with any claims issues after the policy is approved.
Those who shop for an individual policy find that they can select the benefit package and network of doctors with a premium that fits their budget. Health issues matter when first applying but once one is approved, the rates cannot be raised based on personal claims.
This marketplace will be drastically changed with an exchange.
For example, my 27-year-old son Adam pays $58 monthly for a full major medical, private, portable policy. His rates would be substantially higher on the exchange for 3 reasons. A) his healthy lifestyle choices will no longer give him a better rate since policies are not risk rated, B) he will pay more due to the elimination of "gender bias" (females are currently charged more because they have a higher risk of claims), C)he will pay even more because the list of mandates that the federal government is requiring in the exchange is longer than the list offered by his current carrier and he can't opt for fewer mandated coverages.
My son would choose to keep his plan, but the exchange rules say that the plans outside the exchange will have to follow the same guidelines and rates as those within the exchange or people like Adam would cause adverse selection in the exchange.
Even if Adam is one of the 49% of Kansans who will qualify for a subsidy. All subsidies must go through the exchange and do we really want to subsidize a higher premium for Adam when he was insured and paying for his coverage before this government take over occured?
I serve on the "exchange working group" in KS. My fellow committee members have discovered the many details "yet to be determined" by HHS and we have more questions than answers to the issues that we are asked to address. Why are we doing this?
Let's tell the federal govt. how many Kansans will be adversely affected. We should give back the early innovator grant and stop doing the federal government's work for them by working on the exchange. I recommend Indiana and Gov. Daniels do the same.
We must send a clear statement to the federal government and the courts that this law is unconstitutional, will add to the state budget by dumping more people on Medicaid, will cause a provider shortage, and will adversely affect those currently in the private marketplace.
I urge you not to use the federal dollars to buy the rope and construct the gallows that will strangle the private market.
I'm glad Mr. Cannon responded to Mitch Daniel's press guy. Mitch Daniels is nearly as bad as Romney on the healthcare issue, and we need a candidate who can take it to Obama on this issue and win a mandate for repealing Obamacare. Mitch Daniels does not seem like the man to lead the repeal effort.
I do laugh when I see a Mitch Daniels supporter asserting that he runs government like a business. What business gets tax revenue, including tax revenue from people in OTHER states?
In response to the typical spin that one Mitch Daniels fan puts forth here that Daniels did not run on implementing a Right to Work bill to excuse his working against the bill, why didn't he talk about a right to work bill in his campaign? That kind of seems like a basic conservative position to me. He's stated that Indiana loses potential businesses because closed shop uniozation is allowed, yet he doesn't think this is a signifant issue to run on? Even if Daniels is the conservative his fans insist he is, I think it's hard to deny he's weak on a lot of issues.
Michael Cannon is without a doubt the best source on health care issues and policy.
I cannot even begin to explain and express how utterly disgusted and infuriated I am with the Republican Party, the so-called "Conservatives", and even the members of the media who should know better (those that should sound like Cato and Heritage but end up sounding like MSNBC and CNN).
Mitch Daniels, Mike Huckabee, Mitt Romney, and (dare I say it) Chris Christie should be ashamed and disgusted with themselves. All are either silent, complicit, or two-faced on the issue of health care. The American people have spoken and we don't want much - WE WANT YOU TO REPEAL UNAFORDABLE, UNFAIR, DISASTROUS, AND DANGEROUS HEALTH CARE TAKEOVER THAT YOU FAILED TO PREVENT FROM HAPPENING. THAT IS IT. CAN'T DELIVER?? TIME FOR RETIREMENT, AND MIGHT AS WELL RETIRE NOW WHILE SOCIAL SECURITY AND MEDICARE ARE STILL SOLVENT. THANKS FOR NOTHING.
"………but if you want to hold your breath until the government gets out of health care and insurance, be prepared for passing out (and losing any election in which you insist on that as a premise).
Our problems were not created over night. They've taken at least 75 years to get to this level...we ain't going back over night.
In the meantime, if we could spend less, spend wisely, lower taxes, increase access to and quality of education, balance the budget, give back money to the people that goes unspent, all while not causing a violent sit-in at capitols around the country, I count that as a win."
Everything you mentioned: spending wisely, lowering taxes, increasing access AND quality of education (AND healthcare I might add), balance the budget, give money back to the people (there will be no money given back to the people, as all of it will surely be spent); however all of this requires the federal government to GET OUT of healthcare and education. Definitely won't happen overnight as you mentioned, since Medicare will need to slowly unwound by way of extending the age (perhaps every 5 years the age of eligibility goes up 1 year, for everyone under the age of 45) and will need to be "sun-setted" completely. This won't happen overnight - and most of it will take our entire lifetime - however THIS IS WHAT NEEDS TO BE DONE. The uninformed need to be informed that socialist central planning from EITHER party will destroy us. Period. We need to convey this message and not stop until it is recognized, realized, and the individual is given back what should have always been theirs to begin with: Choice.
Informative and interesting which we share with you so i think so it is very useful and knowledgeable. I would like to thank you for the efforts. I am tiring the same best work from me in the future as well.
