Re: McCain on health care

As the campaigns for president grind along, one respite from the dreariness of debate-inspired superficiality is that candidates feel compelled to come out with plans for fundamental change. Those of us old-fashioned enough to believe that visions for the future ought to contain a modicum of substance are cheered by such talk. John McCain's latest announcement about health care is refreshing. It's an actual plan for change that's broad, interesting and helpful.

No plan is perfect, and his competitors have offered some good ideas, too. McCain's approach involves incremental changes that are more possible more quickly than some theoretical constructs. To start, he has a tax reform proposal to end the bias toward employer coverage. Insurance shouldn't be taxed differently if a corporation buys it than if an individual does.

He would also increase competition by allowing insurance to be purchased across state lines by individuals and smaller employers. This is a particular benefit to smaller states that have limited competition (New Hampshire, for example).

But what's truly revolutionary is the proposal to change Medicare to focus on care management. I've discussed this in a recent paper on the true drivers of health-care costs. Medicare in particular is outdated by focusing on an episodic care structure. The real costs of health care come from people with chronic conditions that must be managed rather than independent episodes that are fixed -- diabetes not broken legs. In Medicare 96 percent of costs are driven by chronic conditions. McCain would move toward the model started with Medicare Advantage plans and championed by Mark McClellan: managing a patient's health rather than being paid only for doing more things. I described this approach as a pro-growth approach to health care.

There are a lot of good ideas being broached in health care, but McCain is very forward-thinking and revolutionary in a good, free-market way. Unusual for a politician and quite refreshing.

Ron Paul: online Q&A

Republican Ron Paul was online today fielding questions from Washington Post, Concord Monitor and Cedar Rapids Gazette readers. The full transcript is here. A few excerpts:

How does your view on Roe v. Wade square with your passion for a limited state? Is there a right to privacy in the Constitution?

"Yeah, there's a a right to privacy for all individuals and all who have legal rights -- and that includes the unborn. If someone kills or harms a fetus they're liable in a court of law. Being opposed to Roe v. Wade has nothing to do with privacy, it has to do with state's rights. We don't deal with any other acts of violence at the federal level -- these are local and state issues and that's where these should be taken care of."

The Concord Monitor had an article asking you to move to New Hampshire to secure your win in the state. Would you consider commuting from the District to N.H. for the next 90 days?

"Not on a daily basis, but I'll be going there a lot more. The more I'm up there, the better we do in New Hampshire, and of course it could be the real event that could propel us into a much more viable position. It's good advice and I'm going to follow it to a degree, but literally moving there is not likely to happen."

Would you pledge not to use signing statements to avoid enforcing legislation with which you do not agree?

"Absolutely. If there was a bad piece of legislation I didn't like I would have to veto the bill. On a rare occasion, if it's the interpretation of a word or phrase that could go either way, I could see that as a use of a signing statement. But that shouldn't have the force of law -- the Congress writes the laws, not the president."

What makes you so popular?

"I think I'm secondary to a message that they've been hungry for. It's not new, it's a message of those ideas that made America great -- small government, self-reliance, peace, free trade. People think that makes a whole lot of sense -- it's American, it's not the extremists who have taken over, threatening war and nuclear attacks against countries that are no credible threat to us. I get a lot of credit for it but I think it's the message itself that's the draw."

Duncan Hunter: in his own words

Republican Duncan Hunter was online today fielding questions from Washington Post, Concord Monitor and Cedar Rapids Gazette readers. The full transcript is here. Excerpts:

On the relationship between government and the people:

"I think that the greatest quality of Americans is their spirit of independence, their rugged individualism, and I'd like to see an America more independent of government the day I leave the White House than the day I enter it. I'm reminded that when the Republicans reformed welfare in the 1990s, we found that the average welfare recipient had been on the rolls for 13 years. Today those rolls have been cut by 40 percent. Many of those former wards of the government are now productive citizens. The tragedy of this century would be the sliding of this great nation, full of energy and optimism, into the morass of socialism and dependence."

Do you favor strong military action against the terrorist government of Iran?

"We've all been hopeful that sanctions would compel Iran to abandon its weapons development. However, to date, it would be fair to say that Iran is not strongly inconvenienced by existing sanctions. Indeed, China and Russia -- both with an appetite for Iranian oil and money -- probably will blunt any effective sanctions recommended to international bodies by the United States. This leaves us with the prospect that preemptive action may be necessary. As president my commitment would be to deny Iran nuclear weapons capability. Preemptive military action has been used in the past to disrupt weapons programs. If necessary, I would use it.

"Besides Iran's nuclear program, their missile program and its Shahab 3 missile is capable of reaching Israel and other U.S. allies. This development compels us more than ever to continue, with substantial resources, America's missile defense program. Currently, we continue to develop theater ballistic missile defense systems that can handle the emerging theater threat such as that represented by the Shahab 3. Additionally we should continue to work with Israel to increase the effectiveness and wide deployment of their own missile defense program, known as Arrow. In the U.S. we presently have the start of a missile defense system with the deployment of a few interceptors in Alaska and on the Pacific Coast. This program should be continued with substantial resources. Lastly, the U.S. should take advantage of the Russian offer to cooperate on missile defense by pursuing a program to station Aegis missile defense warships in the Black Sea. This would place U.S. interceptors in the corridor that must be traveled by Iranian missiles that might be targeted at Western Europe."

Tom Tancredo: in his own words

Republican Tom Tancredo was online today fielding questions from Washington Post, Concord Monitor and Cedar Rapids Gazette readers. The full transcript is here. A few excerpts:

How can we depoliticize the Supreme Court?

"We can't. Regardless of the protestations of nominees that they come to a court without a political bias, that is not within the realm of possibility. Every president submits nominees based on the hope that if appointed, the judge will vote the 'right' way. From my point of view, the right way is a recognition that the Constitution is a limiting, not living, document."

What is your position on global warming?

"We very well may be experiencing the phenomenon known as global warming. Whether it is natural or man-made is disputed. However, I believe we can accomplish the goal of reducing carbon emissions by aggressively seeking alternative energy sources, especially nuclear. I think we must do so for national security reasons. In a way, it makes the debate about global warming and its cause moot. By the way, it is interesting to note that the single greatest cause of the imbalance in our trade account is the importation of oil -- not toys from China decorated with lead paint."

On tariffs and trade:

"There are trade agreements that reduced tariffs that I have supported. There are others I have opposed. My opposition is based on the fact that many of these agreements contain far more than trade-related issues. CAFTA (Central America Free Trade Agreement) was supposed to simply eliminate tariffs on goods produced and exported within six Central American countries and the United States. That bill could have been two pages long. In reality, it was more than a thousand! Much of it dealt with immigration-related issues. There's no reason why we can't have mutually beneficial trade arrangements that do not compromise national sovereignty."

Up next: Duncan Hunter and Ron Paul.

Richardson on education

From Bill Richardson's education speech today in Manchester:

"We must reject vouchers, which divert needed resources from our public schools. But we must also encourage choice by supporting charter schools. In New Mexico, this philosophy has made my state second in the nation for school choice. Charter schools work. Vouchers do not. We should not try to shrink our public school system -- we should be working to expand it. As president, I will provide universal access to quality pre-K programs to all 4-year-olds."

And: "We have to get parents -- all parents -- more involved in the education of our nation's students. Teachers cannot do it alone, no matter how good they are. Parental involvement is more important to a child's success than any test or book. As president, I will issue an executive order that provides all federal employees with eight hours per year of paid, one-to-one time with their children. And I will encourage businesses and the rest of the public sector to do the same. The Republicans can talk all they want about family values -- I will do something that actually promotes them."

McCain on health care

John McCain will say this later today in announcing his health care plan: "Democratic presidential candidates are not telling you these truths. They offer their usual default position: If the government would only pay for insurance everything would be fine. They promise universal coverage, whatever its cost, and the massive tax increases, mandates and government regulation that it imposes. I offer a genuinely conservative vision for health care reform, which preserves the most essential value of American lives -- freedom. Conservatives believe in the pursuit of personal, political and economic freedom for everyone. We believe that free people may voluntarily unite, but cannot be compelled to do so, and that the limited government that results best protects our individual freedom. In health care, we believe in enhancing the freedom of individuals to receive necessary and desired care. We do not believe in coercion and the use of state power to mandate care, coverage or costs."

UPDATE: Full text here. A few criticisms, but mostly high praise from the Wall Street Journal here.

The Ron Paul phenomenon

The disciples of Paul may not take to kindly to this debate. Are Ron Paul Revolution T-shirts "the libertarian answer to Che Guevara T-shirts"?

Incidentally, Ron Paul and the Wall Street Journal editorial page agree . . . sort of. Both want Mitt Romney to do some reading. Paul advises the Constitution, the Journal picks the Federalist Papers.

Barack Obama: in his own words

We've posted audio clips from Barack Obama's interview with Monitor editors and reporters here. [News coverage of the interview here.]

UPDATE: From today's Monitor editorial: "Obama met for nearly two hours Tuesday with the Monitor's editorial board. That meeting cleared up any question of whether the 46-year-old senator was a man of substance. He is."

Incidentally, in the book review referenced in this exchange, Maureen Dowd's quip -- "Stevenson is stuck on the same mental pedestal that Barack Obama is on — 'split between his desire to win and his desire to live up to the noble image of himself.' " -- can be found here.

Regarding Obama's style, a mix of perspectives here, here and here.

Sam Brownback: in his own words

Republican Sam Brownback was online today fielding questions from Washington Post, Concord Monitor and Cedar Rapids Gazette readers. The full transcript is here. A few excerpts:

On working with Democrat Joe Biden on a political plan for Iraq:

"I believe the military has done a fabulous job in Iraq, but we've had completely inadequate political solutions, starting really from Gen. Garner and Paul Bremer, our political solutions have not matched the commitment and performance of the soldiers on the ground. This is a way forward for Iraq and I absolutely believe this will be the ultimate structure of the country -- one nation, but most power and authority devolved to the regions. Really, it's to keep the country together and away from civil war."

[George Packer explores the Biden/Brownback idea here.]

On the prospect of a pro-choice Republican nominee and/or a third party candidacy:

"To support a third party will ensure a Democrat being elected to the White House. As I said last night, I will support the party's nominee. I believe firmly that that nominee will be pro-life."

On why he's still in the race:

"Lamar Alexander was at single-digits in 1996 two weeks before the Iowa caucuses and came in second. John Kerry was running fourth in Iowa in October before the caucuses. Jimmy Carter was unheard of at this point in time. But things change. It's my hope doing some different things in the campaign, like working with a Democratic presidential candidate in Iowa on an Iraqi solution, would generate some interest. The Republican side of the field is unsettled. It is not determined who will be our nominee -- far from it."

Up next in the series this week: Republicans Tom Tancredo, Duncan Hunter and Ron Paul.

A choice, not an echo

David Brooks suggests Republicans need to put more Edmund Burke back into their brand of conservatism. Brooks writes:

"To put it bluntly, over the past several years, the GOP has made ideological choices that offend conservatism's Burkean roots. This may seem like an airy-fairy thing that does nothing more than provoke a few dissenting columns from William F. Buckley, George F. Will and Andrew Sullivan. But suburban, Midwestern and many business voters are dispositional conservatives more than creedal conservatives. They care about order, prudence and balanced budgets more than transformational leadership and perpetual tax cuts. It is among these groups that GOP support is collapsing."

Brooks, who himself has issues with conservative orthodoxy, is a little off on the roots of conservatism and its appeal. While Big Business is content to manage regulation for competitive advantage, the small business core of conservatism prefers regulation go away and that it be left to run its business as free of paperwork and tax burdens as possible. The Midwestern and conservative mindsets generally subscribe to a Reaganesque view of the world that taxes are generally too high; a good job, not a good government program, is the American dream; and too often debates about "balanced budgets" are just an excuse to raise my taxes. The strongest GOP appeal and conservative appeal come from people who believe whatever government does won't help me but will help someone with a lawyer. They prefer to be left alone by government for that reason.

The problem conservatives have had with their brand is that big-government conservatism doesn't seem different from big-government liberalism. Inflation-adjusted federal spending increased faster under Bush than any president since Johnson. Discretionary spending (leaving out entitlement, defense, homeland security) went up 4.5 percent annually under Bush II, 2.1 percent under Clinton I. Under Reagan, it declined 1.4 percent annually.

It isn't conservative to merely agree socialism is right but we can be cheap about it. Voters still want a choice, not an echo.

The thinker

"Mr. Obama often seems to be thinking when he speaks, too, and this comes somehow as a relief, in comparison, say, to Hillary Clinton and President Bush, both of whom often seem to be trying to remember the answer they'd agreed upon with staff. What's the phrase we use about education? Hit Search Function. Hit Open. Right-click. 'Equity in education is essential, Tim . . .' You get the impression Mr. Obama trusts himself to think, as if something good might happen if he does. What a concept. Anyway, I've started to lean forward a little when he talks."

- Peggy Noonan, who's about had it with Clintons and Bushes in the White House: "These are not the Adamses of Massachusetts we're talking about. You've noticed, right?"

Romney's religion

What does Robert Novak have against Hugh Hewitt? Novak doesn't have to agree with Hewitt, but how he can write this column without even mentioning this book?

Ron Paul & The Supremes

During his interview at the paper, Ron Paul mixed in a lot of humor with his policy talk, and one of his best lines concerned the Supreme Court. It was clear from much of what he had said that he must have significant disagreements with all of the Supreme Court justices, not just those on the "left" or "right." So we asked him if he had a favorite justice.

He answered: "I like 'em all -- half of the time."

Asked how he would go about choosing a nominee to the court, he said: "I would make sure they understand freedom is one issue." In his view, most or all of the justices tend to emphasize one type of freedom -- personal liberty or economic liberty -- while failing to protect the other.

Asked if there are jurists he's aware of who do better on both scores, Paul named this eclectic trio: Andrew Napolitano, Bruce Fein and Jonathan Turley. The latter has a piece on the Second Amendment in USA Today.

Ron Paul: in his own words

On the day his campaign announced it had raised more than $5 million in the third quarter of this year (evidently this worked pretty well), Ron Paul stopped by for an editorial board interview. Here's a little of what he had to say:

Paul's foreign policy is considered a punch line (or an easy mark for scoring points in debates) by most of the other Republicans running for president (see here and here). So we asked him to respond to the characterization of his foreign policy as essentially "Be nice to the rest of the world, and they'll be nice to us." He replied: "If you're nice to people, personally, most likely the niceness is going to be returned for about 95 to 98 percent of the people. But you still have your concerns about the criminal element, whether it's domestic or your criminal element internationally, so you always have to be prepared. But the history is very clear that when you talk to people and trade with people, you're less likely to fight with people. And things get worse when you occupy their territory and try to force your will on them with military might. I believe in American goodness, probably as well as anybody else -- I want to spread it, too -- but I always want to spread our goodness by setting a good example."

Asked what he thinks of the assertion that the battle against jihadis is the great struggle of our time, one that will last a long time, he said: "It scares the living daylights out of me -- that they would do that, to talk about perpetual war."

Talking about the authorization to use military force in Afghanistan (after 9/11), Paul used phrasing not unlike what some Democrats now say about the authorization of military force in Iraq: "I voted for the authorization and I voted for the funding, and yet it was completely misused. . . . Even though I voted for this, I was deceived. Because I didn't vote to occupy and nation-build." Paul said we ought to have gone after bin Laden but not necessarily sought to topple the Taliban from power, let alone seek to remake the country.

UPDATE: From this morning's editorial: "At times, Paul seems to be campaigning on issues history discarded a century ago. But he does so with so much wit, concern for personal freedom and an absence of malice and ego that, rather than put people off who disagree, he makes them think. That's why his candidacy contributes so much to the race."

UPDATE II: From a New Hampshire Union Leader editorial: "Paul's idea that we can maintain peace by halting our projection of military strength has been proven wrong by history." (Note the length of the comment string that follows.)

Ask the candidates

For the second presidential primary campaign in a row, the Monitor is partnering with The Washington Post (and, this year, the Cedar Rapids Gazette) to host online discussions with the candidates. The Republican Q&As start next week, but you may begin submitting questions with the links below:

  • Duncan Hunter
  • Ron Paul
  • Tom Tancredo
  • Sam Brownback
  • Rudy Giuliani
  • Mike Huckabee
  • John McCain
  • Mitt Romney
  • Fred Thompson

UPDATE: On the Democrats' side, Joe Biden, Dennis Kucinich and Mike Gravel are the first candidates you may begin to send in questions for.

Here are some links to the discussions from October and November 2003:

  • John Edwards
  • John Kerry
  • Joe Lieberman
  • Howard Dean
  • Dick Gephardt
  • Wes Clark
  • Dennis Kucinich