Category: Health Care

Stirring Incomplete Information from Michael Moore

I touched on this yesterday, especially in the comments, but Michael Moore has trouble with facts. I wouldn’t call him a liar, because he’s a skilled propagandist. The facts, out of context, are still the facts. Forget that such abuse of context fails to reveal anything intelligent about policy. As long as it’s a fact, it can be defended.

That’s his tactic today in challenging CNN’s reporting on Sicko, with the requisite omission of any context. For example, Moore praises Cuba’s health system, although the WHO ranks Cuba 39th compared to the U.S. ranking at 37. Moore rebuts this “gotcha” moment from CNN by stating that he put this figure in the movie. Fair enough; I don’t doubt that he did. He’s generally guilty of omission, not commission. He’s a propagandist, so no surprises.

What he fails to do is provide any context for those rankings. The latest link I can find describes it’s methodology in determining that ranking:

In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country’s system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country’s system has accomplished in comparison with those of other countries.

WHO’s assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs).

Broke new methodological ground. Oh, and employing a technique not previously used for health systems. Don’t forget comparing to what the experts estimate. Is it possible to have methodological flaws, or to at least draw irrelevant conclusions based on estimates?

But let’s get to the last two measures. For distribution of responsiveness, how many people in the United States are denied adequate health care, a question independent of whether or not they’ll face an economic burden from that health care? In the answer, would you rather be the average American or the average Cuban? I suppose if you believe that Moore’s visit to Cuba first-rate hospitals was more honest than mere propaganda from a Communist state, the answer isn’t obvious. But any answer other than the U.S. is wrong.

Of course, that doesn’t mean we have the financial burdens perfectly figured out, which is the last measure from the WHO. Again, no one is denied medical care, which should matter. Moore ignores that when he (apparently¹) fails to mention long waits and rationing for essential services in countries with single-payer health care. But specifically to funding, it’s not objective to decide that too many people face economic ruin (not a percentage of bankruptcies, as Moore states, but how many people?) from the system we have, so we should place the burden exclusively on taxpayers. That’s a pre-determined solution without concern for the actual problem, which is economic burden.

If we’re looking to reduce the economic burden from a health crisis, insurance to cover catastrophic medical care is the way to go. Have people pay for their own preventive care, or buy separate insurance for that, if they choose. But disentangle coverage for catastrophic events from coverage for routine care. The current situation we have where the two are co-mingled is largely a government-created problem. Fix the broken government incentive problem by removing improperly targeted incentives, such as tax-subsidized employer health insurance.

Instead we’re left with disingenuous framing of the problem while ignoring what would actually resolve the issues we face. This quote exemplifies focusing on wrong assumptions:

“It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance,” says [Dr Julio Frenk, Executive Director for Evidence and Information for Policy at WHO]. “Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich.”

Dr. Frenk’s opening sentence is fine, if he understands the true problem. The rest of his quote suggests he does not. If he understood, he would’ve stated that insurance against catastrophic medical events protects people from the catastrophic financial effects. He didn’t, offering only the empty, obvious fact that the poor pay a higher percentage of their income on heath care than the rich. Of course they do, just like the poor pay a higher percentage of their income on food, housing, gasoline, clothing, and every other generally necessary expense. This is not news, nor is it specific cause for government intervention through economic redistribution² and health care financing and provision, contrary to what Moore believes.

Moore also thinks the 20 to 30 percent of Canadians who disapprove of their waiting times for health care don’t matter. The minority never matters to a populist, or the liberty lost to mob rule. Now ask yourself if Moore’s comparison of American and Cuban infant mortality rates, for example, might have a bit more nuance than he’s letting on.

Link to Moore’s rant via Boing Boing. Moore’s rant on CNN here.

¹ Full Disclosure: I still haven’t seen Sicko. Viewing it isn’t necessary for my analysis here. Also, I have no respect for the WHO, since it promotes a gender bias in unnecessary, forced genital cutting, and it’s incapable of understanding that circumcision to prevent HIV infection is better suited for sexually active adults who volunteer for the procedure based on their own evaluation, rather than forcing the surgery on infants who will not be sexually active for well over a decade.

² I wonder what Dr. Frenk’s position would be on taxes to pay for health care. Would he be as distressed that the rich pay a (much) higher percentage of their income in taxes than the poor? If it’s about fairness in percentage, a little fairness in analysis might be useful.

Well, hello (again)

A few stories to catch up from my unplanned absence.

First, Don Boudreaux offered a fascinating comparison of Sen. Barack Obama’s fund-raising and economic populism.

… Last quarter Sen. Obama raised, as the Times puts it, “a whopping $31 million.”

These funds, of course, are all voluntarily contributed. The fact that I, personally, do not care for much of what Sen. Obama espouses is irrelevant: lots of people like what he says. They like it enough to contribute to his campaign. The result, designed by no one, is a huge campaign chest for Sen. Obama. He will be well-financed to pursue his ambition. (In my opinion, this ambition is an especially greedy and venal one, but that’s just my opinion.)

In May, however, the very same Sen. Obama called for Senate hearings into allegedly excessive pay for CEOs of corporations.

The rest of Mr. Boudreaux’s analysis is perfect. When someone earns achieves superior results through voluntary exchange, any action to alter those results by a third party is wrong. “Too much” success notwithstanding.

As I think I’ve mentioned before, I will not be voting for Sen. Obama if he wins the Democratic nomination precisely because he is an economic populist. I did not vote Democratic in the last election to institute economic populism. Severe displeasure at the current administration and climate should not be seen as an overwhelming desire to be economically stupid.

Next, I still think public money for this is questionable, at best, but I like the approach this writer uses to explain proposed funding for circumcision as an HIV prevention.

One of the suggested health campaigns reviewed by the Global Health Program is provision of adult male circumcision to decrease individual likelihood of sexually acquiring HIV infection. Some recently published studies performed in Africa suggest circumcision may offer an impressive 60 percent margin of protection against HIV infection, which is well below consistent condom use and complete sexual abstinence, but far better than any other currently available interventions for men. Ambassador Mark Dybul, who runs the PEPFAR program, told the Council that he would provide funds for circumcision programs if the governments of the 15 countries PEPFAR works with requested such support. But strong concerns have been raised regarding the quantity and skill level of medical personnel required to perform this bloody surgical procedure. Though the procedure itself is inexpensive, adult circumcision risks exposing both healthcare workers and patients to blood-borne infections, including HIV. Diverting scarce health talent to large circumcision campaigns could impede other public health and clinical efforts.

In that context, my only concern is the public financing. The writer mentioned all the key aspects of circumcision as an HIV prevention technique. It should be up to the adult male, it’s effectiveness is significantly outpaced by non-invasive methods, and there are considerable risks to be addressed before applying it to African countries facing a severe epidemic. Radical solutions should be tied to real-world facts, considerations, and consequences.

Speaking of radical solutions needing to be tied to real-world facts, I haven’t seen Sicko yet. I don’t make it a priority to pay for propaganda. Anyway, I’m fairly certain what my opinion will be when I get around to it. I imagine it’ll be something like Kurt Loder’s opinion. (Someone else deserves credit here, but I can’t remember where I saw this link.) The entire piece is worth reading, but I like this best:

Moore’s most ardent enthusiasm is reserved for the French health care system, which he portrays as the crowning glory of a Gallic lifestyle far superior to our own. The French! They work only 35 hours a week, by law. They get at least five weeks’ vacation every year. Their health care is free, and they can take an unlimited number of sick days. It is here that Moore shoots himself in the foot. He introduces us to a young man who’s reached the end of three months of paid sick leave and is asked by his doctor if he’s finally ready to return to work. No, not yet, he says. So the doctor gives him another three months of paid leave — and the young man immediately decamps for the South of France, where we see him lounging on the sunny Riviera, chatting up babes and generally enjoying what would be for most people a very expensive vacation. Moore apparently expects us to witness this dumbfounding spectacle and ask why we can’t have such a great health care system, too. I think a more common response would be, how can any country afford such economic insanity?

I guess we’re supposed to fall back on the argument that it’s somehow free. No need to trouble ourselves with economic laws or evidence that demonstrates those laws or even the nuances of any argument that millions of Americans don’t have health insurance. The facts, although interesting, are irrelevant. Right?

I will see Sicko at some point, if only to understand what stupid people are believing. I don’t really want to give Moore any money, but I’m thinking back to how people paid for a different movie and saw Fahrenheit 9/11 instead. It’s tempting as a “gotcha”, but I wouldn’t do it. Unlike Moore, I consider honesty an asset. Whatever small price he’ll get from my (matinée) viewing is surely worth remaining above his level.

Health care economics are not different.

Sebastian Mallaby is correct in explaining that Republicans have embraced economic stupidity surrounding globalization, as evidenced by its stance on immigration. Although the root cause appears to be more xenophobia than economic ignorance, the point is taken. However, Mr. Mallaby quickly loses any credibility when he switches to health care and Rudy Giuliani’s proposal to fix the system. His intro:

Giuliani is also spouting nonsense about health care — a challenge that the nation must address if it is to assuage middle-class anxiety about a turbulent globalized economy. As employers have stopped offering coverage, Americans have discovered that it’s almost impossible to buy decent insurance because the market for individual purchasers is plagued by a vicious cycle. At the start of this cycle, insurance premiums reflect the cost of covering the average person, so healthier-than-average people realize they are getting a bad deal and choose not to buy coverage. That leaves a sicklier group in the market, which forces premiums up, which drives more relatively healthy people to exit, which drives premiums up still more, and so on.

I’d like to see some statistics verifying that claim. I’m a healthy individual insurance purchaser, and I’ve found my premiums to be reasonable enough. That doesn’t mean I think my insurance shouldn’t and couldn’t be cheaper. I do. But I realize that the disincentive to switch to a robust insurance market devoid of a sole reliance on groups organized around individual employers is based on our flawed tax code, not Mr. Mallaby’s absurd theory:

This market failure is a basic fact of health-care economics. But Giuliani is oblivious to it. In an interview with the Wall Street Journal last week, he indicated that he wants to triple the number of people in the dysfunctional individual insurance market without taking the one step that might fix it, which is to force every American, healthy or not, to buy coverage. Depending on whether he understands how dumb this is, Hizzoner is either a coward or a lightweight.

There’s so much to challenge. Most obvious, he trips himself in the beginning. If “health care” economics (economics is a science, remember) states that society will see a race to the bottom where only sick people will have an incentive to minimize their risk through insurance, then how exactly is this adherence to economics a market “failure”? It sounds to me as if the market is behaving exactly as expected. Yes, we have to rely on Mr. Mallaby’s misunderstanding of economics, but in his worldview, market failure cannot happen according to “health care economics” unless insurance companies ignore profit incentives and offer health insurance at a loss. I don’t believe that’s happening, but maybe Mr. Mallaby has evidence to the contrary.

That could be our endpoint, as it’s enough to dismiss his argument. That wouldn’t be any fun. There’s so much more wrapped into one paragraph. Not getting the results we want? Blame the market without looking at all inputs in that market. Ideology over facts!

I don’t know enough about Guiliani’s plan to critique it fairly, but using what I have here, how would expanding the pool of candidates for individual health insurance, which would spread risk further across the client pool for the individual insurance companies, exacerbate the problem? If it would work with employers, what would be different?

The answer is obvious if you look not at intention (affordable health care) and look instead at intended action. Here Mr. Mallaby offers only force. He has no interest in incentives, only playing the role of central planner. His justification is obvious later in the essay:

Instead, the Democratic candidates are focusing on helping the economy’s losers without restricting trade, which is exactly what they should be doing.

Why does he show no concern for why there are economic “losers”? I assume he believes that our benevolent government can’t possibly create losers. That’s capitalism’s fault. Because capitalism is only “I win, you lose”. It’s a fascinating narrative, even though it’s 100% incorrect.

From the rest of that paragraph:

John Edwards, the contender who sounded most protectionist in 2004, seems to have turned over a new leaf. He has admitted that trade benefits poor countries and has declared that arguments over labor standards should not be an excuse to obstruct liberalization. Meanwhile, Edwards has proposed a thoughtful health-care reform that would require everyone to buy insurance. He supports market-minded social programs such as an expanded earned-income tax credit and housing vouchers.

Market-minded social programs is as informative as it is bone-headed. (Mr. Edwards shouldn’t get credit for proposing stupidity.) Mr. Mallaby wants a socialist solution with a few free market curtains to pretty up the proposal. It won’t work in the way he predicts. Incentives matter. You don’t fix a disincentive by encouraging the offending entity to create new misguided incentives.

HIV Conferences are dangerous to genital integrity.

Following up on my previous post, some typical and not-so-typical arguments appeared at the Third South African AIDS Conference earlier this week. First, the typical in describing the apparent risk-reduction from the recent HIV studies:

“The effect was long-lasting, there wasn’t disinhibition [increased sexual risk-taking], they didn’t screw around more, they didn’t use condoms less,” said Neil Martinson¹.

Remember that both circumcised and intact groups in the studies saw a more significant drop in their rate of HIV infection over their national HIV infection rate than the effect presumably provided by circumcision. But it’s easier to keep focusing on circumcision, because that (allegedly) removes the human factor from HIV prevention. Sure.

Next:

“There’s no question that we need a male circumcision programme, but a mass programme is more debateable. Operationalising it is going to be complicated,” said Professor Alan Whiteside of the University of KwaZulu Natal.

He advocated routine opt-out male circumcision at birth. “Thirty years from now we’ll be so glad we did it.” He believes that “if we’d started 25 years ago we wouldn’t be in this godawful mess.”
…

An audience member suggested that op-out circumcision should also become standard practice for adult males who attend sexually transmitted infection clinics.

…routine opt-out male circumcision at birth. When talking about saving for retirement, opt-out programs make sense. It involves only the person whose money will be siphoned off into a separate, presently untouchable account. There is a (mostly) objective rationale behind the requirement. It’s a form of “we know better what you should do”. But he can easily reject this. He can also reverse his decision later.

Routine opt-out male circumcision at birth requires a specific action from one group (parents) to avoid violating another’s (their male child) right to not have part of his genitals cut off without medical need. There is an entirely subjective reasoning behind the requirement. Parents could reject this, although they’d likely receive information with overblown, fear-based hysteria. The experts are counting on the well-intentioned parental desire to protect children, with a bit of residual goodwill toward the procedure if the father’s chosen it for himself. But the male child can never reverse this decision. This is little more than social engineering with children and their genitals as pawns for the public health nannys.

If African nations had started routine infant male circumcision 25 years ago, they might not be in this “godawful mess, but they’d also have a generation of cut males to demonstrate that HIV infection is still possible and that more effective, less invasive methods of prevention already exist. But don’t bother to learn from the United States the lessons that are inconvenient to learning what you want to learn from the United States.

Now, for a moment of respite from insanity, something non-typical:

However Professor Timothy Quinlan of the Health Economics and HIV/AIDS Research Division at the University of KwaZulu Natal was sceptical about the need for a mass programme, arguing that the evidence doesn’t justify it.
…

… he said, prevention needs to focus on the two factors known to have the biggest effect on HIV transmission rates: concurrent partnerships and high viral load during primary infection.

There’s a need for clearer messages to communicate these facts,” he said. “We need to promote serial monogamy.”

I know, that’s unworkable because it assumes some sense of personal responsibility and ability to learn among African men.

And now a return to the typical:

Audience members raised some of the practical issues that are likely to arise in the implementation of any sort of circumcision programme. Traditional healers in particular will need to be brought on board, said numerous speakers.

“Don’t talk about circumcision in isolation from the initiation processes going on in all the different cultures in South Africa,” said one male audience member.

But there was general agreement that traditional healers who carried out circumcision during the initiation of young males into adulthood had a captive audience for passing on important prevention messages, and that this potential wasn’t being exploited.

Yes, what about those traditional healers? Ahem:

A 22-year-old unregistered traditional surgeon was arrested for illegally circumcising two boys in Libode, the Eastern Cape health department said on Saturday.
…

Meanwhile, police were searching for another unregistered traditional surgeon who allegedly circumcised 24 under age boys in Mthombe.
…

Kupelo said three of the boys were taken to hospital with serious complications.

And:

2006 Eastern Cape summer-season circumcision deaths have declined markedly compared to 2005, Eastern Cape provincial health department spokesperson Sizwe Kupelo said, adding that only four would-be initiates had died so far this season, compared with 24 in 2005.

Of those four, only two were the result of complications of the circumcision operation. …

And. And. And.

This reliance on traditional healers is an acceptance that, among several challenges, the public health community doesn’t have the resources to provide full, clinical circumcision in Africa. Yet it pushes the notion that it must be done both “mass” and “soon”. Why is it so difficult to see how this will end? How many deaths are acceptable? Are we really ready to rely solely on the utilitarian argument that more lives will (probably) be saved with mass circumcision than will be taken through mass circumcision? I’m not, since I’m capable of understanding individual rights.

¹ To another point by Dr. Neil Martinson:

“It’s all about cold steel – it’s more akin to sterilisation, it’s not like giving people clean water, it’s not like breastfeeding that we can all get warm and fuzzy about.”

Promoting mass circumcision is primarily about giving advocates warm and fuzzy feelings that they’re doing something monumental. Otherwise, why the rush to circumcise infants based on three studies of voluntarily circumcised adult males? It also reassures parents with a warm and fuzzy feeling that they’ve “protected” their sons from HIV rather than violated his rights.

Also:

There was confusion about who would be targeted with messages about circumcision. Would it be young men, or would it be their parents? Or must their future sexual partners be targeted, “so that they say `I won’t sleep with you unless you’re cut’,” asked Neil Martinson?

“I won’t sleep with you unless you’re cut.” Let’s promote such non-thinking. Maybe, if we work at it enough, we can convince African women that they prefer, and sh
ould prefer, the aesthetic look of the circumcised penis. It’s okay if that implies that men should change themselves to meet a woman’s expectation. The reverse is sexist and unacceptable, of course, but we all know that’s okay.

History will wonder why all businesses employ 14 people.

Sen. Barack Obama hates liberty. And economics. And jobs. And health care. There’s no other way to describe the eventual outcome of his fantasy world where wishes lead to outcome.

Mr. Obama would pay for his plan by allowing President Bush’s tax cuts for the most affluent Americans — those making over $250,000 a year — to expire. Officials estimated that the net cost of the plan to the federal government would be $50 billion to $65 billion a year, when fully phased in.

The Obama proposal includes a new requirement that employers either provide coverage to their employees or pay the government a set proportion of their payroll to provide it. …

Obama advisers said the smallest businesses would be exempt from this requirement. The advisers said that those business might have under 15 employees, but that no number has been set.

And on it goes with the make-believe. Soak the rich. Corporations are evil. Government can solve every problem if given enough money. Why can’t progressives make some progress in understanding economics?

I’m sure I’ll have more later on this. For now, it’s late, so let it stand that this is a bad idea and will lead to reduced employment, less health care, and lower quality. That’s not a perfect trifecta for a man who wants to lead our country.

I can excuse a lot in voting, but I don’t let ignorance slide. Sen. Obama will not receive my vote in 2008.

National health care is not a charity.

Via Kevin, M.D. comes a fascinating look at reactions from Canadian journalists to Michael Moore’s new documentary film, Sicko.

Michael Moore is handing out fake bandages to promote his new film Sicko, an exposé of the failings of the U.S. health care system.

But he may feel like applying a couple to himself after the mauling he received yesterday from several Canadian journalists – present company included – following the film’s first viewing at the Cannes Film Festival.
…

We Canucks were taking issue with the large liberties Sicko takes with the facts, with its lavish praise for Canada’s government-funded medicare system compared with America’s for-profit alternative.

While justifiably demonstrating the evils of an American system where dollars are the major determinant of the quality of medicare care a person receives, and where restoring a severed finger could cost an American $60,000 compared to nothing at all for a Canadian, Sicko makes it seem as if Canada’s socialized medicine is flawless and that Canadians are satisfied with the status quo.

The Canadian journalist can’t be that naive. The Canadian certainly pays to have a severed finger removed. It makes no difference if he pays the hospital, his insurance company, or the government taxing authority. The amount he pays may be different, but that’s a matter of economic risk redistribution, not the allegedly-but-not-really free health care that nationalized systems provide. That’s before we discuss the economic rationing necessary for Canada to provide such a service “for free”.

I’ve never heard of an American not having his finger reattached due to lack of funds. I’m open to hearing about such stories, if they exist. Regardless, this issue is far more complex than some people don’t like paying “a lot” for health care.

Good luck getting the needle near me.

I can’t find an alternate source to verify this story, which I like to do when I read the types of claims made in the story. However, in this case, I think that has more to do with it being about Belarus than anything. The details are probably accurate. Regardless, they make for a good thought experiment if the facts don’t check exactly.

Officials from Belarus’ Ministry of Health on Friday formally rejected the idea of circumcising most men in the former Soviet republic as a means of controlling the spread of the HIV virus. “This is not something we are considering,” said Mikahil Rizhma, a government spokesman, according to a Korrespondent magazine article. “In our opinion using a condom is much more effective.”

That’s a wise move, and not particularly surprising¹. Countries without at least a history of routine circumcision (i.e. English-speaking countries) are unlikely to adopt such an irrational over-reaction based on a few recent findings. That’s not really news. This, however, is instructive:

News reports of a possible plan to mandate circumcision operations for most men had caused consternation in Belarus, as the state-run health system routinely administers flu vaccines en masse to government workers, whether they wish it or not.

Now let’s forget circumcision in the story and focus on forced preventive health care. Is it irrational to believe that the United States could take that path? We’re already seeing a trend to ban smoking and trans fats because they’re bad for health. “That’s bad for you” to “this will be good for you” is a short leap. What’s to stop health busybodies in a single-payer system from mandating (or at least trying to mandate) preventive health measures? Other than rationing based on inviolable economic laws, of course.

As the title of this entry suggests, I wouldn’t put up with it. I suspect many Americans would agree when it pertains to their body. The outcome will depend on the success of the statist busybodies in seizing control. But assuming they can’t get control, we still must get back to circumcision. As practiced in the United States, it rarely involves doing it to one’s own body. It’s almost always done to a child who can’t fight back. Considering how many don’t question the procedure now, resistance to mandatory circumcision will depend more on who makes the political decisions, not the economic waste (and ethical obscenity) of circumcising the healthy genitals of infant males.

¹ This is not good, though:

HIV-consciousness is low in the country, with most health officials treating the disease as an infection endangering intravenous drug users, but not the general population.

Cultural blind spot or potential flaw in a single-payer health system? It’s probably the former, but such blind spots could show up in the single-payer health system based on political pandering.

Fearing to Leave the Past Behind

From Malaysia:

Malaysian doctors have declared neckties a health hazard and called on the heath ministry to stop insisting that physicians wear them.

Amen. I hate ties. They serve no reasonable purpose other than to serve as an upside-down noose. I can’t wait for the day when they’re relegated to the past.

That said, this is fascinating:

But the Star quoted a ministry official as saying it needed more proof that neckties were a danger before it relaxed the dress code for doctors in hospitals.

I find it bizarre that anyone would submit to such authoritarianism that allows the government to impose a dress code for professionals. I wonder if we can expect something like that with nationalized health care in America. I doubt it, but we should never underestimate the power of bureaucrats to embrace stupidity and abuse of power.

Via Fark.

New meaning to “elective” surgery.

Does this sound like it’s based on principle or politics?

New York Sen. Hillary Rodham Clinton was part of the last significant effort to overhaul the system during her husband’s administration. That attempt failed, but the Democratic candidates said Saturday that the conditions exist to push for dramatic change.

But Clinton warned that getting there would still be difficult. “We don’t just need candidates to have a plan,” she said. “All of them have plans. We need a movement. We need people to make this the number one voting issue in the ’08 election.”

At least Sen. Obama had the decency to speak of “the need to solve the problem now,” although I’m sure his solution will involve the kind of theft proposed by John Edwards. Instead, Sen. Clinton made a transparent plea about getting elected above any need to debate the merits of this “problem.”

I can’t imagine any of these candidates getting my vote in 2008.

How is answering the question avoiding it?

I’m not sure I understand the furor here.

President Bush encouraged governors Monday to support his call for changing the tax code to help more people buy private healthcare insurance, but did not address their pleas to increase funding for a healthcare program that insures millions of children of the working poor.

Bush avoided the question. Except, not so much.

“I’m looking forward to working with Congress on health care. I firmly believe … that states are often times the best place to reform systems and work on programs that meet needs,” he said.

I don’t think he believes, or at least his actions do not support that statement. However, his statement in this context is correct. National reform is necessary, but in the opposite direction from what I suspect the governors want. Sure, it’d be nice to get all of the benefits of covering people for your state without paying the bill yourself, at least not directly. (I’m ignoring the public vs. private debate for the moment.) But that’s not happening without taking from one to give to another. If it’s appropriate at all, the state is the highest level where it should be done with this issue.

Essentially, it comes down to this statement, but understood through reality instead of wishful thinking:

Gov. Jon Corzine, a New Jersey Democrat, warned that the administration’s budget promised illusory savings. “You end up paying for this in other ways — uncompensated care, emergency rooms,” Corzine said. “This is pay me now or pay me later.”

Every spending decision faces the same test. The only issue at stake is who is willing to face that truth. Gov. Corzine should look at his own budget rather than pawning blame onto the Bush administration.