McDonnell’s Idea of Health Care Reform


ith all the hub-bub about “Obamacare” and the new-found love of Republicans for balanced budgets after eight years of George W. Bush blow-outs, one wonders what Gov. Robert F. McDonnell is doing.

When it comes to health care, the Republican governor seems to have a deaf ear on medical care for the poor.
Consider that McDonnell is getting a big time rep as being a budget balancer by supposedly turning a deficit of $1.8 billion into a surplus of more than $400 million. Of he did so through some accounting tricks that would have gotten the CEO of a private firm in trouble, such as delaying scheduled payments on state employee pensions.
McDonnell also has achieved his supposed budget goals on the eyes of the poor. He cut $764,000 from Medicaid funds intended to help the needy get routine eye exams from optometrists. That has the Virginia Optometric Association up in arms since their doctors handle about 70 percent of all eye exams in the state.
The message seems to be that if you are poor, then you can just as well go blind. The state won’t help you.
But then, McDonnell doesn’t seem to cotton much to the needy. Take a look at the composition of his “Virginia Health Reform Initiative Advisory Council” which is supposed to help him deal with such features of Obamacare as setting up exchanges to help people meet their requirement to buy health insurance and also get unspent stimulus money available to help make medical records electronic.

McDonnell has appointed 24 people to the council. They include Managed Care executives,lawyers, physicians, a business school official, politicians, and, strangely, the COO of a pest control firm.
Noticeably absent from his council are people representing the poor, the elderly, labor unions or others who may not be in the business elite in crowd.
Of course, John A. Luke, chairman and CEO of MeadWestvaco, its headquarters newly relocated to Richmond, is on the council. But the paper and packaging firm has a dotty relationship with labor unions and one wonders how much Luke will recommend short-changing workers when it comes to health care. One must consider the bottom line.
The upshot is that McDonnell sees health reform as what is healthy and good for Managed Care. Actual patients can go wanting, especially if they are poor or elderly.
Peter Galuszka

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28 responses to “McDonnell’s Idea of Health Care Reform”

  1. Larry G Avatar

    good article Peter.

    I actually do listen to the Conservatives on these issues and I believe that there is room for agreement on some of these issues.

    The basic narrative is this:

    People who are poor but able bodied need to contribute to deserve their "entitlements".

    This means if someone needs "free" care, they need to earn it.

    And I am of the belief that many folks in this situation might actually feel better if they do contribute.

    The problem is we are not really set up to do this.

    We'd need to set up "accounts" for people that keep track of the dollar amount of how much they have consumed in entitlements and we'd need a clearinghouse of "available" work with earning values.

    Some folks will be incapable of anything because of their age or health but others would be and – here's a benefit.

    If you work for your entitlements, you have opportunity – because you establish a work record – a resume if you wish.

    Kids do this even in high school.

    Others do this by volunteering for groups for nothing – but in doing their resume and hopefully add to their character references.

    We need to switch from a culture of "entitlements" to a culture of "earned benefits".

    How's that for a flaming liberal philosophy?

  2. Anonymous Avatar

    Peter, the last time I looked, state budgets are passed by the two-house General Assembly and signed by the Governor. So anything in the Commonwealth's budget — for good or for bad — has been the working of both political parties.

    Larry's comments are well taken. There has been a strong proposal to place small, even token, co-pays on medical care for low-income people and some of those proposals include opportunities to work for the co-pay. Needless to say this has generally been opposed by the professional caring class and the left.

    Moreover, the program probably could have been saved with a few program consolidations and layoffs of members of the professional caring class. But just as Obama's stimulus was gauged to save those jobs, so too are too many programs in Virginia.


  3. Doesn't surprise me. When I got worked over by my insurance company the insurance comissioner pretty much told me the company has rights and I have none.

    Meanwhile< Maryland was suing the same company for the same proactices, now outlawed by Obamacare.

    At least in Virginia we are safe from Academics who have the temerity to study global warming.

    Larry, doesn't your plan for setting accounts for entitlements wipe out the insurance aspect of the plan? What's the difference between having an account for your entitlement and having a personal medical savings account?

    Most people can't begin to save enough for retirement, why woulod we think health care would be any different? And if it is a token account that has no requirement for a positive balance, what is the point?

    I can see certain classes of people bragging overtheir account balance: "I got $100,000 more out than I put in."

    I'd be a lot more in favor of personal responsibility if I thought there was any. I think a lot of people who self-righteously push the idea are only one piece of bad luck from being on the other side of the coin.

  4. Larry G Avatar

    keeping an accounting of what you have used is pro forma for auto, health, home, flood, etc.

    Why not for entitlements?

    Yes.. some will brag about how much they're ahead of the game but some folks will be reminded that they are getting an entitlement and how many work hours it represents for _someone_ who is actually doing the work to provide the entitlement.

    This is the part that is missing from the awareness realm of those who get entitlements – that someone else has to work to provide them – they don't come from a magic money tree.

    We need to instill that idea into everyone who receives entitlements in my view.

  5. Groveton Avatar

    "This is the part that is missing from the awareness realm of those who get entitlements – that someone else has to work to provide them – they don't come from a magic money tree.

    We need to instill that idea into everyone who receives entitlements in my view.".

    Dear Newt Gingrich:

    As a contributor to this blog I must advise you that using the established ID of a long-time liberal commentator is contrary to our rules. While we welcome the coments of those who believe that accountability should be more of a focal point in American governance we ask that you establish a regular and unique blogging ID.

    Some possibilities:


    TooMuchConservatism (TMC)



    However, please refrain from using LarryG's moniker. His random liberal brand has been developed over thousands of posts. Your effort to establish accountability dillutes that brand.

    Thank you.


    Groovy G. Groveton

    Note: In the slim chance that LarryG actually wrote that post … I say, "Welcome to the Tea Party, brother".

  6. Gooze Views Avatar
    Gooze Views

    You are a sick man. Are you seeing someone about it?


  7. keeping an accounting of what you have used is pro forma for auto, health, home, flood, etc.

    Why not for entitlements?


    You mean like free public education?

  8. Larry G Avatar

    Did I say we need to do that for schools also?

    Each parent receives an "invoice" for how much taxpayers have spent on their kids – year to date and kid to date (total over the years).

    I'd like to think of these folks with these "invoices" on their coffee tables where they can show them to their kids when the kids are agitating for more of the goodies for their good life.

  9. Groveton Avatar

    I believe that the government would do a lot better if it advertised some of the benefits that citizens receive from their taxes.

    Social security (assuming it still exists), Medicare (assuming it still exists), public education, unemployment benefits, etc.

    Given our deficits, it seems clear to me that taxes are going to go up – at least for the 54% of wage earners who actually pay taxes.

    EMR has written about the need for a new index of citizen happiness. Letting people know that they get something back from their taxes might be a good start.

  10. Each parent receives an "invoice" for how much taxpayers have spent on their kids – year to date and kid to date (total over the years).


    Why not give them a voucher while you are at it? They can spend it on whatever school they can afford that they think will give their kids the best education.

    It seems to me that you are redefining entitlement as to being "only what you put in". This defeats the meaning of an entitlement, besides, what happens to all the money from those that put in and never collect?

  11. James A. Bacon Avatar
    James A. Bacon

    Before drawing judgments about McDonnell's approach to health care reform, let's see what his health care reform commission comes up with. It could be interesting. If I have time, I will post on it.

  12. Anonymous Avatar

    Just to put things in perspective, see the article in the Washington Examiner that indicates Obama's stimulus spending was 15% more costly than the war in Iraq.

    I'm not trying to justify or vilify Bush's actions or the war itself.


  13. Larry G Avatar

    now how believable is a newspaper espousing objectivity when it's cut-line says:

    "Little-known fact: Obama's failed stimulus program cost more than the Iraq war"

    This is further evidence of the right-wing narrative ….

    the stimulus did not "fail" no more or less than the Iraq war "failed", eh?

    The stimulus was/is a once in a century attempt to mitigate what some thought could become a depression.

    We are not in a depression, (yet), at least so who is to say that the stimulus did help us avert one or not?

    The point is that the stimulus was not a policy where one would know exactly how much money to spend …to exactly calibrate it's effect.

    Using the Examiner's standard for "failure", how would we characterize Iraq or the Bush Tax Cuts or Hillary Clintons stint as Sec or State or Gates stint as DOD?

    When someone can "prove" that the Bush Tax Cuts did – or did not "work", then I might accept a similar "proof" for the stimulus.

  14. Gooze Views Avatar
    Gooze Views

    "Let's wait and see before drawing judgments on McDonnell's healh care.' My, but how patronizing. The panel won't make its report before 2011. Are we supposed to keep the "little people" such as advocates for the poor, consumers, the elderly and so on out of the picture and off the table until then?
    If the situation were reversed, would you be so inclined to take the "high road" and ask those not invited to wait?

    Peter Galuszka

  15. Anonymous Avatar

    If the Stimulus cost more than the Iraq War, informing the public about that fact seems pretty objective to me. Might the headline have a little slant? Possibly. But we are facing unemployment and under-employment at rates well above what the Administration projected. I think that this a fair shot, just as I think it was fair to note how the previous administration greatly underestimated insurgency in Iraq.

    Obama let the radicals in Congress write the Stimulus bill. The result has not been satisfactory to most people.

    Most people, except at both fringes, simply want results. We've saved some union jobs, but have created an environment where most businesses are sitting on cash, rather than investing to expand or hiring workers, because they don't trust Obama. These are not acceptable results. Money wasted at a cost of huge debt.


  16. Larry G Avatar

    Would you consider paying soldiers and civilian military support to be "stimulus"?

    What happens to unemployment and the NoVa economy if we "downsize" the military?

    Did Obama let "radicals" write THIS stimulus:

    " Economic Stimulus Act of 2008" ????

    do you consider the Bush Tax cut to be "stimulus" ?

    The "stimulus" is not a radical concept to many non-Obama loyal economists and an accepted strategy among many mainstream economists.

    Calling it a 'radical' concept put into place by a 'radical' President is pretty seriously coloring the realities in my view.

    Once again – I'm not defending Obama nor the stimulus – only the idea that more Presidents and economists before this President supported the idea of "stimulus" ….

    Obama did not invent it nor is it considered a "failure" but instead what most economists differ over is the form, size and length of it – not any/every use of it.

    Personalizing the "stimulus" to this particular President as an example of his "radical" policies is simply untruthful in my view.

    Criticism is fine but fudging the truth is not.

  17. Anonymous Avatar

    Larry, I guess we need to agree to disagree on the Stimulus bill.


  18. Larry G Avatar

    well… we'd need to disagree as to whether the stimulus by Obama was a radical and irresponsible act or not.

    I just do not believe that he picked an action totally unsupported by any economists an against most economists advice and implemented it.

    I think he had the support of, not all by any means, but a substantial group of economists in his actions.

    If he had done this by defiantly ignoring most every economist, then I would agree it would have been a radical an irresponsible act but that is not the case.

    to portray it as that – is simply ignoring the simply reality that quite a number of economists believe it was the correct response to the economic meltdown.

    Obama and his economic advisors could be wrong – but they did not go into this intending to implement something that had no support at all from any economists.

    the only thing I object to – is the portrayal of it as a radical an irresponsible act.

    I did and still does have support from a substantial number of mainstream economists who believe that had it not been done, we would now be in the throes of a depression.

    It's an arguable point, I agree but it's not an irresponsible and radical policy.

  19. Larry G Avatar

    TMT – I offer the following to you to illustrate that "stimulus" is not a radical Obama concept:

    " Many nations of the world have enacted fiscal stimulus plans in response to the global, on going recession. These nations have used different combinations of government spending and tax cuts to boost their sagging economies. Most of these plans are based on the Keynesian theory that deficit spending by governments can replace some of the demand lost during a recession and prevent the waste of economic resources idled by a lack of demand. The International Monetary Fund has recommended that countries implement fiscal stimulus measures equal to 2% of their GDP to help offset the global contraction."

    In 2008 the US Congress passed—and then-President Bush signed—a $152 billion stimulus bill designed to help stave off a recession.

    China- The Chinese State Council approved a $586 billion stimulus package in November 2008.[5]

    Japan- In April 2009 Japan announced a third stimulus plan of 15.4 trillion yen stimulus ($153 billion).

    South Korea- South Korea 14 trillion won ($10.8bn) stimulus package in November 2008.

    European Union – 2008 European Union stimulus plan
    The European Union passed a 200 billion euro plan with member countries developing their own national plans,

    Australia- In October 2008, the Rudd government implemented a A$10 billion stimulus package

    given the above – do you still stick to your views that the stimulus in the US is a radical Obama agenda?

    All I'm looking for here is something akin to fairness and objectivity and a rejection of a narrative that seeks to portray the stimulus as an unprecedented irresponsible and radical act undertaken only by this President and no others.

  20. Anonymous Avatar

    Larry, I think I owe you some clarification. I do not believe that Obama's Stimulus bill was radical per se or that government deficit spending to stimulate a bad economy is bad per se.

    I do believe, however, that Obama made a serious mistake when he let a more-left-than-the-nation group in Congress write the bill. I would classify some of those people, e.g., Pelosi, Obey, Waxman and Towns as on the radical (i.e., far left) side of the Democratic Party.

    I think the bill was designed to take care of special constituencies (teachers unions, activist groups, ACORN, etc.) than to stimulate the economy generally. I don't think the law did much to get the economy growing, employment up, and consumer confidence headed in the right direction. Obama might have been better off, giving a 9-month break from payroll taxes, with some targeted spending on physical infrastructure.

    Had Obama stayed with the economy instead of jumping into HCR and Cap and Trade, I think he'd be in a stronger position, with higher approval ratings, especially with independent voters.



  21. Larry G Avatar

    TMT – have you every visited the website for Virginia?

    for instance, here's Fairfax:

    can you look at this and tell me how it confirms your view?


  22. Anonymous Avatar

    Larry, this generally makes my point. There was some money for utility relocation in Herndon, but most of it seemed to be designed to keep government programs, irrespective of value, operating and public sector employees receiving paychecks. Fairfax County and Fairfax Schools managed to avoid virtually any reductions in force and were generally able to avoid making some citizen-recommended consolidations. For example, FCPS has a fantastic HR department that could be used for the county as well. On the other hand, the county's IT group runs circles around the Schools'. But Obama bucks postponed consolidation.


  23. Larry G Avatar

    re: " … to keep government programs, irrespective of value, operating and public sector employees receiving paychecks."

    if the goal of the stimulus was to avoid loss of jobs – as opposed to a goal of consolidation – and subsequent job loss…that would have taken us even deeper into recession..

    don't you think that would have been the opposite intended effect of a stimulus?

    It sounds like you wanted the loss of jobs instead of the stimulus?

    what would you have spent the stimulus on instead if you support the concept but disagreed with what it was spent for?

  24. Anonymous Avatar

    Larry, I would have spent some funds on physical infrastructure and some on a payroll tax holiday. This approach would likely have had more positive impact on the private sector. State and local government is already too big.


  25. Larry G Avatar

    TMT – just to keep straight on the Iraq War costs:

    " According to a Congressional Budget Office (CBO) report published in October 2007, the U.S. wars in Iraq and Afghanistan could cost taxpayers a total of $2.4 trillion dollars by 2017 when counting the huge interest costs because combat is being financed with borrowed money. The CBO estimated that of the $2.4 trillion long-term price tag for the war, about $1.9 trillion of that would be spent on Iraq, or $6,300 per U.S. citizen."

  26. James A. Bacon Avatar
    James A. Bacon

    Larry, That's an interesting idea. To calculate the true cost of an expenditure, assume that the money is borrowed, and that years of accumulating interest are incurred. Shall we apply that accounting method to other programs as well, or just the ones we don't like?

  27. Larry G Avatar

    I was wondering if you would catch that.

    short answer – all programs.

    I'm not one for double standards …

    certainly the stimulus is pure borrowed money…. also

    another one I looked at said that we owe about 90k per taxpayer now counting all debt including the wars and stimulus.

    that's a pretty breathtaking number… but hey… if we pay an extra $3K in taxes each years.. we can whack it down in 30 years , eh?

  28. Anonymous Avatar

    Control federal spendnig – require a super-majority to pass a budget. Grow the economy. Obama should fire his economic team. Change the tax code to favor long-term investment over short-term trading.


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