Paul Vallas and roads not taken


Paul Vallas is, for readers outside Chicagoland, one of the 14 candidates for mayor in the election that’s coming up in a couple weeks.

I don’t really have much of a sense of the outcome of that election, what with frontrunner Cook County Board president Toni Preckwinkle tainted by connections to Burke, and unwilling to pledge the abolition of aldermanic privilege as the others have, but nonetheless advantaged by name recognition, deep union support and, along with BIll Daley, a substantial pot of money for TV commercials. (See the most recent Chicago Tribune article.) I would like to believe that Chicagoans would be dissuaded by her Machine connections, but I don’t know that it matters enough to enough people, especially when the large number of candidates, and of viable candidates with significant resumes, means that the final results can be a bit unpredictable.

Separately, in my last article at Forbes, I wrote that Paul Vallas was the candidate who appeared to be taking the pension funding crisis most seriously (though, to be sure, I also give Bill Daley a ton of credit for being willing to put pension reform on the table). Do I have a comprehensive understanding of how he compares to the others on other issues important to city residents, such as education, crime/police conduct, economy development in struggling neighborhoods, etc.? No, not really — and in particular I can’t claim to really be able to put myself in the shoes of a Chicagoan.

But if I were a Chicagoan, Vallas would have my vote. Partly that’s a matter of looking at his resume, for example, as detailed at Wikipedia. He was not a traditional politician, climbing the ranks, building clout, doing favors for others and getting favors in return, but instead built a track record as CEO of Chicago Public Schools, then moving on to Philadelphia and the Recovery School District of Louisiana. I don’t know if he would use the phrase, “facts don’t care about your feelings,” but you don’t build that resume without having a solid understanding of, well, facts. Besides which, of course, his website is chock-a-block full of policy proposals that go well beyond a few bullet points and assertions of care and concern and professions of social justice and hometown pride.

But here’s something from — well, long enough ago that it predates not only my blog, but blogging in general. Seems to me that at the time we still had a dial-up internet connection — not that I had much time for the internet, anyway, with a toddler already and a second baby on the way. Yup, I’m talking about the 2002 gubernatorial election, when Paul Vallas fell short by a mere two percentage points in the three-way Democratic primary, which Rod Blagojevich won and where Roland Burris had a strong third-place showing. (Again, see Wikipedia for a recap.)

On the Republican side, Attorney General Jim Ryan swamped his opponents in the primary, but Blago won the general election by 7 percentage points. Did Ryan really stand a chance? Checking Wikipedia again to aid my memory, the bribery indictment occurred after the election, but it seems to me that it was already widely understood that outgoing governor George Ryan was a crook, and let’s face it, it’s a tough sell to ask the people of Illinois to elect a man from the same party, with the same last name, as the outgoing crook-governor. (How many voters thought he was that man? How many intellectually knew otherwise but still couldn’t get past it? Should party leaders have taken Jim Ryan aside and said, “look, man, you either have to change your name or accept that as a stroke of bad luck, you simply can’t run because you won’t make it in the general election?” Maybe it only became more apparent after the primary how crooked George Ryan was.)

So instead Illinois got its next crook-governor.

Why did Democratic voters choose Blago over Vallas? (Remember it was 36.5% vs. 34.5%, not exactly overwhelming margins.) Again, my memory fails me. A Google link tells me that one factor, at least, was that Vallas simply failed to campaign downstate to nearly the same degree as Blago, which makes sense, or at any rate, I can picture Blago excelling at the retail politics aspect of the whole thing.

And, of course, we know what followed. A pension obligation bond. Blago playing Savior of the Elderly by demanding that Chicagoland mass transit give all over-65s not just reduced-priced but free rides as a precondition for a dedicated sales tax. Blago expanding state-paid kids’ health insurance to middle-class families, without regard for the state budget and, in fact, using all manner of gimmicks to nominally balance the budget when in fact he brought the state further into debt without even an excuse of a poor economy. Accusations of pay-to-play that were never quite proven. And then, of course, the “f***ing golden” attempted sale of a Senate seat that made Illinois the laughingstock of the nation.

All of which means that, yes, near as I can tell, Paul Vallas is the best candidate in the election. But here’s where I also admit to some sentimentality: for him to win the election would be some bit of redemption for the path the state took instead in 2002.

Image:
https://commons.wikimedia.org/wiki/File:University_at_Buffalo_voting_booth.jpg; public domain

Fun fact: the rest of the world does not have “Medicare for All”

“Medicare for All” is in the news again, with Kamala Harris’s statement yesterday that she backs the proposal, even to the point of eliminating private insurance altogether. And this topic always brings up comments along the lines of, “in every other civilized countries, the government provides healthcare for everyone.” So, because in my old job I worked not only with pensions but also with employee benefits, comparatively across countries, I wanted to dig out an article I wrote at Patheos a couple years ago which I think is still relevant. I called it “Your handy-dandy guide to health care outside the United States.”

The original article referenced a 2012 OECD table on public vs. private healthcare spending. Here’s that table, updated to 2015, from the OECD publication, “Health at a Glance“:

OECD Health at a Glance

Now, to be honest, I’m not certain what’s going on with the differention between “government schemes” and “compulsory health insurance” for the United States, this is the first year that they’ve split these categories out this way, and the U.S.-specific report doesn’t explain further. It is not, however, the case that the 23% refers to exchange-purchased or Obamacare plans, because in the old 2012 chart, pre-Obamacare, the numbers were split in much the same way. My guess is that this may be treating Medicare as its own independent program.

There are also countries showing very small percentages of “voluntary health insurance” where this doesn’t seem right relative to my understanding and I’m wondering if some of this is classified as “out of pocket.”

But here are some other noteworthy countries (text cribbed from my prior article and updated):

The U.K.

Yeah, 20% non-public spending isn’t huge, but it’s not nothing:  middle-management and higher-level employees are provided private health insurance by their employers.  Not for them the NHS horror stories!  They have access to private clinics and treatments, and “upgraded” spots at public hospitals, whenever NHS is insufficient, has too long a wait list, doesn’t cover a treatment, or is just generally icky.

Switzerland

They’re actually the most Obamacare-ish country:  a standardized basic level of private insurance is mandatory, with subsidies for the poor.  No practice of employer provision — you just buy it on your own.  The catch?  They’re the second-highest-spending country, and are struggling with growing costs.

Germany

Health insurance is managed through regional quasi-public entities, which set (very low) reimbursement rates.  How low?  When we lived there, there was a protest march by doctors upset at their low pay.  But hey — medical school was free.  It’s paid for by a payroll tax.  But if you make over a given income level (I think about 50K-ish), you have the option to opt out of the payroll tax and buy your own insurance, with the stipulation that you’re then obliged to continue buying private insurance, rather than switching back and forth.  In addition to potentially cheaper coverage, private insurance gives you such benefits as top-tier doctors and the ability to select a private, rather than three-bed room at the hospital.

France

Employer-provided health insurance is customary (and I think not just for management but in general); it picks up the not-trivial copays.  In addition, the reimbursement levels provided by the national health insurance are low enough that providers often have a surcharge which the private insurance covers.  This system of surcharges at the “good doctors” and private clinics, paid for by private health insurance, is, it seems to me, fairly common, say, in Italy, as well.

Canada

Historically, insurance was not permitted to pay for any service that the national healthcare system covered, so that you couldn’t use it to get coverage at a private provider to skip waiting lists.  It seems to me that I read recently that this has changed.  In any case, what private health insurance does do is cover everything that the national healthcare system doesn’t:  prescription drugs primarily, and upgrades from ward to semi-private or private rooms, and various sorts of therapists and other providers that aren’t covered otherwise.  In addition, private insurance covers out-of-country treatment, and policies specify either all out-of-country treatment or only in cases of emergencies.

Australia

Again, single payer, but with a policy of encouraging upper-income folk to buy private insurance — it doesn’t allow you to opt out of payroll tax contributions, but does give you a modest rebate.

Korea

Yeah, they’ve got a large percentage of private spending; it seems to me that this is because the State healthcare provision has a lot of holes, copays, etc., which private insurance, routinely a part of employee benefits, covers.

Mexico

Strictly speaking, there’s comprehensive medical coverage.  But in practice, well, it’s like being obliged to use Cook County hospital for everything.  Again, salaried employees expect to have insurance provided by their employer, to get them access to private, first-world hospitals.  Same with Brazil, which is a huge health insurance market for white collar employees,  and I think even blue collar employees at large employers, in order to escape the poor quality and wait times of the “free” national healthcare system.

One more, also not on the table — Singapore

Singapore’s system gets frequent mention by supporters of “market-based” systems, because one component is a “savings account” similar to the HSA savings accounts that accompany high-deductible plans in the U.S.  See this older post, for instance.  The reality is that “universal” coverage has a lot of copays and employer-provided insurance fills these gaps.

So there you have it:  a world tour of health insurance.

Image:
http://www.dodlive.mil/2017/10/03/usns-comfort-how-the-hospital-ship-helps-during-disasters/(U.S. Air Force photo by Staff Sgt. Courtney Richardson)