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Should Democrats mount more primary challenges?

This man can help you disappear.

• Conservatives try and criticize the French health-care system and wind up praising it accidentally.

Mike Rorty interviews banking expert Perry Mehrling.

The best and clearest Waxman-Markey analysis I've seen.

Is Obama's Health IT initiative doomed to fail?

I haven't watched a second of today's Sotomayor hearings. How's she doing?

By Ezra Klein  |  July 13, 2009; 6:40 PM ET
 
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Comments

"Conservatives try and criticize the French health-care system"

I don't even think it's that. They're just throwing crap at the wall, not to see if it sticks, but to make other people clean it up.

Posted by: pseudonymousinnc | July 13, 2009 7:40 PM | Report abuse

Cap and Trade is a simple concept. You cap the amount of x that you want to limit. Then, in order to allow the economy some leeway to deal with the problem, you allow companies to exceed the limit by purchasing an exception from another company that is falling below the limit. Now, it's important to understand this this plan is itself a compromise. You could simply tax the x or ban it, and be done with it. Instead, cap and trade allows variation in order to help businesses survive.

Now, since it's already a compromise, any added conditions must be to help particular businesses. This is called lobbying or interest group influence. The more of it you have, the less well the original plan will work. Of course, you can tighten the exceptions later, or, as well, continue to loosen them. In any case, you've damaged the simplicity and effectiveness of the plan by fiddling with it.

All the added complexity and expectations are bad news. It has future fudging written all over it. Yes, I support it, but let's not lose track of the fact that it's going to take an incredible amount of effort to monitor. Hopefully, I'll be proven wrong.

Posted by: DonthelibertarianDemocrat | July 13, 2009 11:38 PM | Report abuse

Ezra,
Your endorsement of Durning's analysis of Waxman Markey led me to read it more closely but I came away unimpressed. I believe the cap and trade paradigm is ultimately corrupt. Unfortunately there are a lot of well-intentioned people including the author of that post caught within it. I notice, for instance that he didn't comment on one of the most disturbing aspects of the Waxman-Markey bill which is its prohibition of having the EPA directly regulate C02 which would be the most effective and fastest way to cut emissions (coal moratoria, anyone?). We know via the Clean Air Act and other regulations that direct regulation works, we don't really know if cap and trade will work. Durning is caught within the cap and trade paradigm.

Both carbon taxes or direct regulation are far preferable to cap and trade which is a policy that creates a huge carbon derivative market that distracts from and can disrupt the real market for carbon emissions reduction solutions/technologies. Martin Weitzman, whose work formed the basis for cap and trade believes that carbon taxation is superior to cap and trade. Cap and trade was selected by the Clinton administration because they wanted to run away from their BTU tax fiasco. Unfortunately the world was sold on this intellectual hobby horse that provides a lot of work for idle intellectuals in analyzing its vagaries. Simply regulating emissions sources directly, assigning a price to emissions directly via taxation, or promotion of clean energy technologies are all simpler, more direct and will do the job much faster. It would put a lot of commentators out of work who have mastered the unique but ultimately worthless language of cap and trade and now offer their expertise.

Posted by: michaelterra | July 14, 2009 1:43 AM | Report abuse

How's she doing? Today is more revealing than yesterday, obviously, because she has to answer questions. The verdict is in: this is not someone who can think quickly on her feet, or quickly draw upon a background of case knowledge! She is stumbling under the questioning of Orrin Hatch. She is repeating boilerplate, answering in generalities rather than specifics. For those who remember the impressive Roberts hearings, wow, what a difference.

Posted by: truck1 | July 14, 2009 11:43 AM | Report abuse

"The verdict is in"

Yes, you're guilty of being a hack.

Posted by: pseudonymousinnc | July 14, 2009 2:20 PM | Report abuse

Not a great article on Healthcare IT. A few quibbles:

• Only 1.3% of all hospitals might have integrated IT systems, sure, but using one of the author’s examples of a good system (Epic) (though I question his use of the term ‘proprietary’, somewhat), has 70 million lives, or over 20% of all human beings. And that’s just one system.

• The article breaks these all down as proprietary systems and, in so much as they are separate, they are all following the same electronic format – HL7. That includes the VA’s system too. That’s like saying Bank of America’s ATM’s are terrible and should try to be more like Wells Fargo’s ATM’s. Sure, that’s an argument you could make, but it’s worth noting that they speak the same electronic language. And the ARRA Healthcare IT money is going to make the HL7 the standard language so all of these systems are already on their way to being compliant. They are proprietary in that they aren’t open source, but it’s not like they’re wholly concocted out of the basements of the IT companies; they’re based on existing standards.

• Open source seems out of place as a healthcare IT solution. Healthcare format and transactions are groaning under the weight of regulations and standards. Maybe I’m wrong, but I can’t see the open source crowd rushing to download the ANSI ASC X12 Implementation Guides. The Cerner example just seems like poor contract management instead of an argument against closed code (which, the author partly agrees with as he points to many successes with other closed code products). It’s like the author is ‘thinking’ about Mozilla and trying to cobble together an argument using two poorly-fitting examples that the world should be Mozilla; when this is a world that can’t be that loosey-goosey.

• Also, one of the specific objections to proprietary software is that is lack of interoperability; which is precisely what the ARRA money is to address.

This:
“The group is now deploying its lobbying clout to persuade regulators to define "meaningful use" so that only software approved by an allied group, the Certification Commission for Healthcare Information Technology, qualifies. Not only are CCHIT’s standards notoriously lax, the group is also largely funded and staffed by the very industry whose products it is supposed to certify. Giving it the authority over the field of health IT is like letting a group controlled by Big Pharma determine which drugs are safe for the market.”

-Is really, really apples and oranges. The certification is less like regulation and more like someone certifying the successful passing of beta-testing of a product following test module.

And the final desire to ‘take time to figure out the details,’ doesn’t really offer any substantial path on how to do that beyond trite platitudes.

Posted by: ThomasEN | July 14, 2009 4:56 PM | Report abuse

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