Month: May 2009

Rationing Common Sense

by digby

In case you thought health care reform was going to be easy, think again. Here are two fossilized Village Elders helping Frank Luntz frame the debate:

Joe Klein: There are two possible roadblocks here. One is that the Insurance companies and business may not play ball if the Democrats insist on a Medicare-like public option. That’s very much on the table in the House side, perhaps not so on the Senate side.

And then the other problem is the one you always have with entitlements and that is that the costs are going to be enormous. And you see the president doing something very courageous, I think, which is that he’s beginning to talk about limiting the sorts of operations that might be appropriate. The other day he talked about his grandmother who was given a hip replacement when she was a terminal cancer patient. Those are very, very difficult decisions, but they are going to have to be part an parcel of this plan.

Andrea Mitchell: That’s basically rationing. That’s what it’s going to come down to.

Klein: That’s right.

Between the well-insured Steny going on about sacrifice yesterday and the very well insured Mitchell and Klein blithely proclaiming that health care reform obviously leads to rationing, the Republicans don’t have to say a word. Luntz’s talking points are being ably carried by Democrats and the press — which is a big relief to the forces of the status quo, I’m sure. After all, Republicans have no credibility so they have to depend entirely on the media and the so-called centrists to carry their water. They are doing a very able job of it so far.

I have to say that Klein evoking Obama’s statement about his grandmother was particularly clever. Conservatives have been all over it. Here’s how the NY Times characterized the debate:

“I don’t know how much that hip replacement cost,” Mr. Obama said in the interview with David Leonhardt of The Times. “I would have paid out of pocket for that hip replacement, just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model is a very difficult question.”

He went on to say: “If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life, that would be pretty upsetting.”

At the heart of the health care debate that will soon occupy Washington is just that conundrum. As an intellectual matter, it’s one thing to say that it makes no sense for a country to spend so much on procedures that ultimately will do little to extend or improve the lives of those nearing death. But as a personal matter, it’s another to deny your own grandmother an operation that may at least make her last days more comfortable.

Some conservatives have cited Mr. Obama’s story to make the case that his plan to expand access to health care and reduce costs ultimately will result in rationing, of the kind that might have denied his grandmother the surgery unless she paid the bill on her own.

“To me, Obama is laying out the intellectual case for health care rationing while acknowledging the potential human costs of such a policy,” wrote Matthew Continetti on the Web site of the Weekly Standard magazine. “He’s saying that, in order to contain costs, under a universal health care program his grandmother might have been denied that hip replacement, or forced to pay for it herself. This is the natural consequence of a universal policy, which would bankrupt the country without some form of rationing care.”

Advocates on the other side of the debate reject the label. “I think Obama was trying to invoke the notion of tradeoffs more than rationing,” said Len Nichols, who directs the health care program at the New America Foundation, a Washington research organization. “Curative care for his grandmother was futile. Rationing is when efficacious care is denied to save money, perhaps to provide basic care to another, but nevertheless consciously denied.”

Drew Altman, president of the Henry J. Kaiser Family Foundation, said that nothing envisioned in the current health care legislation would take decisions about end-of-life care away from patients or doctors.

“One of the great lessons of the Clinton debate was not to scare the public that health reform would change their current medical arrangements,” he noted. “Health care is front and center again because of the problems average Americans are having paying their health care and health insurance bills in the middle of a recession, and that’s the core problem health reform legislation has to address.”

When I read that quote in the NY Times magazine on Sunday, I cringed. I wish he hadn’t said it. Yes, end of life expenditures are an issue. But if the administration agrees with Steny Hoyer that they can pass health care as a money saving measure and have the debate turn on which services will be denied, it’s going to be a much tougher battle.

Here’s the typical headline you can expect:

Obama’s health care reform is bad news for seniors

Frank Luntz spelled it out in his memo. There’s nothing surprising or new about it. It’s a gently tweaked version of the 1994 Kristol memo. Nobody should be surprised that they will fear monger.

But this beltway obsession with debt, sacrifice, cost etc — something that only seems to surface during Democratic administrations — will end up strangling reform if the Democrats don’t start disciplining their rhetoric and recognize that while it is evident that something must be done about health care, it is not evident to the public that “rationing” is inevitable. If it comes to believe that it is, the American people might just figure they’re better off with what they have.

I’m not really sure why so many Democrats feel it’s a smart thing to endlessly emphasize sacrifice instead of relief during a major economic crisis, but they seem to think it’s quite a clever approach. “Nothing to fear but fear itself” has been replaced by “the suffering has only begun” as a rallying cry.

But what do I know? Maybe it’ll work. These are political professionals. They must know what they’re doing right?

Don’t Make Me Save The Planet!

by dday

So those centrist House Democrats have bought into the myth that government can do too much, asking Nancy Pelosi to set aside their climate change bill in favor of health care – even though the Senate has managed the health care bill and the House the climate change bill, an appropriate division of labor. Pardon me for suggesting another reason – these centrists want to protect the polluting industries in their districts.

Democratic centrists are pressing House Speaker Nancy Pelosi to set aside a flagging climate change bill to focus on what they think is a more achievable goal: overhauling the nation’s healthcare system.

But those close to Pelosi (D-Calif.) say she is charging forward on cap-and-trade legislation, despite the potential defections of Democrats who represent states with industries that would be adversely affected by the bill […]

Democratic aides say the sentiment for putting healthcare first is felt most strongly among New Democrats.

“A lot of our members feel that healthcare has a higher likelihood, so getting that done first and then doing energy makes sense,” said an aide to a New Democratic leader.

“New Dems are in a tough spot,” said one Blue Dog member, explaining that New Democrats are more likely to have an environmental constituency at odds with their business constituency. Blue Dogs, by comparison, have more freedom simply to vote no on climate change legislation.

Whew, I wouldn’t want those Blue Dogs to feel conflicted about voting against doing something about a boiling planet! Thank Jeebus they have some “freedom.”

We hear plenty about the costs of action. Artur Davis (D-AL) says in this article, “in the throes of a recession, more of a burden on industry is not a good idea.” But inaction has a cost, too. Bills that quantify a certain change in policy must be scored and the costs must be announced. The cost of doing nothing can more easily be ignored. That would be a grave mistake.

The real cost of carbon emissions is far from zero. Each new scientific report brings proof of a changing climate that promises to disrupt agricultural patterns, set off a scramble for dwindling resources, raise sea levels, propel population shifts and require massive emergency spending as we try to react to the growing crises. These are the costs of inaction.

A smart climate policy can create a mechanism to put the right price on carbon, and rapid economic change will follow that firm price signal, along with reduced climate risks. Our work with more than 100 economists nationwide and at RealClimateEconomics.org demonstrates the weight of economic analysis supporting this point.

The whole point of climate legislation is to price externalities that we already spend. When children acquire asthma from pollution, when naval ships ensure safe passage for petroleum from the Middle East, when droughts affect farm crops, when houses flood and rivers pour over their banks, those costs come, at least in part, from burning carbon. We have several options for pricing those carbon emissions, but the most important thing we can do is employ a cap, to bend the curve of the increased costs from climate change in exactly the same way that we must bend the curve of increased health care costs by eliminating the hidden costs of the uninsured. The problems are exactly the same.

If we fail to cap carbon because some coal-state lawmakers refuse to take a tough vote, then in 5 or 10 years, we’ll return to Congress, talking about capping carbon after spending hundreds of billions as a result of making parts of the planet uninhabitable. The political system doesn’t deal with the future very well, sadly.

…I mean, if Max Frackin’ Baucus can figure this out…

Action would not be without cost. But the costs of inaction would be far greater.

.

Dung Beetles And Other Things

by tristero

Very cool. Seriously, don’t miss this podcast even if you’re not a science geek; it will blow your mind. Doug Emlen, an expert on dung beetles, gives a wonderful introduction to their amazing world. And he has some distressing news to impart about pre-ground canned coffee…

(Also, the segment on Westbound Records is worth a listen. Terrific music.)

And while we’re on the subject of science, it looks like more evidence is accumulating that H. floresiensis, aka the hobbit, really was a separate species.. The Times had a more detailed report yesterday. That’s one long foot for such a small creature!

Finally, unfortunately, it’s been a pretty bad few weeks for Mexican self-esteem. In addition to swine flu, turns out that the famous Chicxulub impact crater may not be directly implicated in dinosaur extinction at the KT boundary 65 million years ago. Bummer:

[As quoted in Greg’s blog]The newest research … uses evidence from Mexico to suggest that the Chicxulub impact predates the K-T boundary by as many as 300,000 years. “From El Penon and other localities in Mexico we know that between 4 and 9 metres of sediments were deposited at about 2-3 centimetres per thousand years after the impact. The mass extinction level can be seen in the sediments above this interval” says Keller.

Advocates of the Chicxulub impact theory suggest that the impact crater and the mass extinction event only appear far apart in the sedimentary record because of earthquake or tsunami disturbance that resulted from the impact of the asteroid.
‘The problem with the tsunami interpretation’ says Dr Keller, ‘is that this sandstone complex was not deposited over hours or days by a tsunami; deposition occurred over a very long time period’.

The study found that the sediments separating the two events were characteristic of normal sedimentation, with burrows formed by creatures colonising the ocean floor, erosion and transportation of sediments, and no evidence of structural disturbance.

As well as this, they found evidence that the Chicxulub impact had nothing like the dramatic impact on species diversity that has been suggested. At one site at El Peon, the researchers found 52 species present in sediments below the impact spherule layer, and counted all 52 still present in layers above the spherules. In contrast, at a site at La Sierrita which records the K-T boundary, 31 out of 44 species disappeared from the fossil record.

“We found that not a single species went extinct as a result of the Chicxulub impact…these are astonishing results that have been confirmed by more studies in Texas” says Keller.

Greg explains that it may not be as clearcut as Keller says. Then again, it may. Or even more likely, a little bit of both. Or not.

That’s what I like about science: unambiguous answers.

[Special note for the sarcasm-impaired: Of course, I know that’s not what science is about.]

[Edited and revised after initial posting.]

I Thought Duncan Was Just Snarking

by tristero

Seriously, I truly thought that Atrios was doing a “shorter NY Times idiots” when he posted this:

Opinion » The Conversation Who Will Replace Souter? Here’s hoping for someone Gail Collins likes, and David Brooks can live with.

Then I clicked the link he provided and saw this:

Jeebus.

Speechless

by digby

Adam Green has more.

Huckleberry Howls

by digby

We’re going to hell in a handbasket:

Sen. Lindsey Graham (R-S.C.) said Republicans would fight back hard if Democrats or liberal groups try to make the Supreme Court confirmation process about Sessions’ record, rather than about Obama’s nominee to replace Justice David Souter.

“If people try to go down that road, it’ll blow up in their face, because Jeff is a good guy,” Graham said. “My hope is that our Democratic colleagues — if you start listening to the bloggers — if we’re going to let the bloggers run the country, then the country’s best days are behind us.”

That’s so true. Everybody knows the country should be run by radio talk show hosts.

Put Up Or Shut Up, Weiner

by tristero

Bigot and homophobe Michael Weiner, whose nom de hate is Michael Savage [overcompensating a touch, are we, now?], is threatening to sue England’s Home Secretary because she has banned the sick clown from Britain’s shores. Personally, I don’t think England (or the US, or anywhere) should ban anyone for what they say, not even bottom-feeding slime like Weiner. But, like the infamous Richard Perle, who threatened to sue Seymour Hersh in England and never did, I don’t think Weiner has the guts to do it. He’d lose and he knows it.

Interpreting The Constitution Depends On Your Dating Preferences

by dday

Making Jeff Sessions sound like the founding member of the Center for Constitutional Rights, John Thune lays down a marker – none of them funny people in the Supreme Court, understand?

Gay-rights groups have voiced hope that Obama will select the first openly gay Supreme Court nominee, and the Gay and Lesbian Victory Fund has offered two suggestions: Kathleen Sullivan, a former Stanford Law School dean, and Pam Karlan, another Stanford professor.

But conservative leaders have warned the nomination of a gay or lesbian justice could complicate Obama’s effort to confirm a replacement for Souter, and another Republican senator on Wednesday warned a gay nominee would be too polarizing.

“I know the administration is being pushed, but I think it would be a bridge too far right now,” said GOP Chief Deputy Whip John Thune. “It seems to me this first pick is going to be a kind of important one, and my hope is that he’ll play it a little more down the middle. A lot of people would react very negatively.”

Of course, we’re in a society where discrimination no longer exists and only the white man bears the burden of this politically correct society. Thune’s just concerned about what others would think. Like “the children,” I assume.

Filibustering a Supreme Court justice because of their sexual orientation would really be a brilliant coda for the Republican Party. And despite some of the quotes in that article, they’d do it. They’d have to do it.

.

Legal Is In The Eye Of The Beholder

by digby

CNNs William Schneider says Americans don’t want torture investigations:

Schneider:Did the Bush administration torture suspected terrorists? President Obama says they did.

Obama: Waterboarding violates our ideals and out values. I do believe that it is torture.

Schneider: Do Americans agree? Yes. 60%. So does the public favor or oppose the Bush administration’s decisions to use those procedures? They’re split. That means that some people who believe the methods were torture favor their use against suspected terrorists. Call it the Jack Bauer mentality from the TV show 24.Nearly one in five Americans believe it’s torture and it’s ok.

Some congressional Democrats are calling for an investigation.

Leahy: There’s a lot more to find out and eventually we will. I think the sooner we do, the better for our country.

Schneider: President Obama opposes prosecution of the interrogators.

Obama: For those who carrid out some of these operations within the four corners of legal opinions or guidance that had been provided by the white house, I do not think it’s appropriate for them to be prosecuted.

Schneider: Nearly two thirds of Americans oppose a congressional investigation (57%). What if it were done by an independent panel? Still opposed.

The president is open to an investigation into those who authorized the use of torture.

Obama: With respect to those who formulated the legal decisions, I would say that is going to be more of a decision for the Attorney General within the parameters of various laws and I don’t want to prejudge that.

Schneider: A slightly smaller majority opposes an investigation of those who authorized the procedures, even by an independent panel.

The public seems to agree with President Obama:

Obama: I think that we should be looking forward and not backwards.

It is not surprising in the least that many Democrats agree with Obama and virtually all Republicans agree with President Bush — both of whom say exactly the same thing in exactly the same words: “America doesn’t torture.”

I like to think that Obama really means it, but then (with the exception of the ten percent of open sadists who think water boarding is torture and approve of Bush using it) so did Bush supporters, so it’s kind of hard to know what to think. I doubt they will do any more water boarding, but then it’s not really about water boarding, is it? There’s a whole array of immoral, illegal actions that took place which a majority of American people now believe should be swept under the rug and which our new president is asking him not to use. And like the good Bush supporters who don’t believe he authorized torture, we are supposed to believe the same of Obama. I guess it’s all we’ve got.

When asked if he thought the Bush torture regime was legal, Harry Reid said today, “legal, I guess it’s in the eye of the beholder.” There you have it.

I certainly hope that if Obama is continuing Bush’s non-torture policies, that the Republicans will be as generous with him when they take power. (I’m sure they will be, aren’t you?) At the very least we can be sure they will generously endow him with co-ownership of them.

And we’ll all be so much safer for the world believing that the United States sees torture, at worst, as some sort of misdemeanor, which any president can evoke at will.

Steny And Luntzy

by digby

So Frank Luntz is out with the approved talking points for the Republicans to tank health care reform. It is the usual Orwellian mishmash in which the insurance company whores (er .. Republicans) will threaten people with rationing and long waits, basically telling them that universal health care is going to kill them all in their beds. It’s kind of like Islamic terrorism, except without the head scarves.

Here are some suggested arguments for Republicans that Luntz calls “clear winners”:

—“It could lead to the government setting standards of care, instead of doctors who really know what’s best.”

—“It could lead to the government rationing care, making people stand in line and denying treatment like they do in other countries with national healthcare.”

-“President Obama wants to put the Washington bureaucrats in charge of healthcare. I want to put the medical professionals in charge, and I want patients as an equal partner.”

The usual.

The more interesting thing to me is the people who will be helping him with his little project:

eHouse Majority Leader Steny H. Hoyer (MD) delivered the keynote address at a Bipartisan Policy Center forum, “Unprecedented Federal Debt: Putting Our Fiscal House in Order,” hosted by former Senator Pete Domenici at the St. Regis Hotel. Below are his remarks as prepared for delivery:

“If I were to guess the single most lasting lesson of our economic crisis, and if I were to spell it out in just five words, I would say: this is what debt does.

“The recklessness we have seen from so many consumers, and from Wall Street, found an echo in the recklessness of the federal government. For years, our government has lived far beyond its means—and we see now that when we over-rely on debt, things can turn very ugly, very quickly. If a fiscal meltdown comes, there will be no one to bail out America.

[…]

“Our third response is, by far, the most important. That is the structural response—the actions we must take to confront the imbalance between our commitments and our revenues that are driving us deeper into debt every year. We will not bring our debt down if we do not reform entitlements and rein in the rapidly rising cost of health care.

“I am glad that we have a President who sees it that way. His talk of a ‘grand bargain’ that encompasses issues from entitlements to health care to taxes shows a clear understanding of the tradeoffs and sacrifices that will be necessary. Given the gravity of our situation, we cannot afford to take any options off of the table, either on the spending or the revenue side.

He reiterates his belief that we have to cut social security and believes that this will be an easy fix because Obama allegedly agrees with him. He says that health care will be hard because people are going to have to make big choices:

“We have pledged that, in the health care reform bill we will debate this session, we will pay for expanded access, so that health care reform does not add to the short-term deficit. But that is not enough. It is imperative that we slow the growth of health care spending over the long term. It’s important to remember that the American health care system is the most expensive per-capita in the world, and, compared to the rest of the developed world, it is not buying us better health.

“The health care debate must be about both controlling costs and expanding access. In fact, a focus on controlling costs is what will help us pass health care reform. But while expanded access will on its own help reduce unnecessary expenses, it isn’t a magic bullet for controlling costs; other options for doing so include electronic medical records and comparative effectiveness research. But reforming health care will also take many more long-term choices. Discussing the problem is important—but what we need from you even more is your willingness to actively support those who are willing to make those tough choices.

Now, it’s certainly true that containing costs is a major part of health care reform. But if Steny thinks that’s what the debate should be about, then he and Frank Luntz are obviously working hand in glove to ensure that it doesn’t pass. Luntz wants to scare people into thinking they’ll lose what meager coverage they have, if they are lucky to have it at all. And Hoyer wants to tell everyone they are going to have to “reduce unnecessary expenses” and make some tough “choices.” It’s hard for me to see how they aren’t on the same page. It’s certainly hard to see how that’s going to sell any kind of universal health care — they’re both saying that the cure is worse than the disease.

If the Democrats follow Hoyer on this, we can only conclude they aren’t serious about reforming health care at all. If the debate focuses on containing costs and reining in unnecessary spending (translation: rationing and long waits) we lose. People aren’t stupid. They figure they’ll end up worse off than they are already and they’d have good reason to think so. From what Hoyer is saying, the government debt is going to be retired by taking it out of the hides of the elderly and the sick, with a good portion of the middle class paying in worse health care than they have now. Why would anyone think that’s a good idea?

That’s why Hoyer and his pals at the Peterson Institute are pushing for a commission. They know that politicians have to answer to actual humans which renders this outrageously stupid plan to cut social security and medicare in the middle of a once in a lifetime economic crisis such a non-starter:

“The political challenges on Social Security, Medicare, and Medicaid are extraordinary. So I think it’s very possible that finding a solution will demand an extraordinary process. Some Members of Congress, including Congressmen Cooper and Wolf, have called for a Fiscal Future Commission—composed of Members of Congress and the Administration, experts outside the government, and those who would be directly affected by entitlement reform—which would propose solutions and send them to Congress for a vote. I think they make a strong case. A Fiscal Future Commission would help protect that process from the political attacks that have derailed it in the past. This is also a function that could be handled by the President’s Economic Recovery Advisory Board, chaired by Paul Volcker.

Paul Volcker certainly knows how to stick it to workers, I’ll give him that. Maybe he can take the same meat axe to the sick and old. Sounds like they’ve got it all worked out.

Hoyer closed with this:

“[B]oth parties must work together in good faith. Bipartisan compromise will build public confidence that the solutions we agree on are reasonable, and it will prevent either party from exploiting those solutions for political advantage. Quite simply, we have to understand one another’s fears—Republican fears that Democrats will merely raise revenues and then spend them on new entitlements, and Democratic fears that reform will undermine the security of those in need and weaken support for popular programs. Those fears are understandable—but they should be outweighed by the fear of what will happen if we fail, if our debts overwhelm us, and if the fiscal meltdown comes. Republicans fear that taxes will go through the roof and think that families and small businesses will suffer. Democrats fear that the programs we value will be slashed, and that those we most want to protect—the weakest, the least powerful—will suffer the most. Compromising now is the only way out of that worst-case scenario.

Apparently, the current economic situation is chopped liver.

Hoyer believes the government should be telling people that unless the government starts cutting social security and ensures that the only health care reform that happens is huge slashing cuts in medicare and medicaid, things are really going to get bad. There is no reasonable economic argument that says this is true, certainly not during a bad economic down turn, but Hoyer and his buddies believe that fear mongering about debt in the middle of a major recession is smart politics. And for them it is, since they seek to confuse and scare people into thinking that draconian cuts in retirement and health benefits (just as many of them have lost a huge chunk of their planned retirement income from falling home prices and the stock market crash) is absolutely necessary.

Hoyer and his fiscal scold pals want to use this crisis to ram through “entitlement” reform. And in order to get that done, they need to tank health care, which they clearly plan to do by reinforcing Republican talking points and fearmongering about sacrifice and cost cutting and making “choices.”

Keep your eye on Hoyer’s Blue Dogs. If they have their way, by the time we’re done, health care reform will be seen by the public to mean the choice between giving up the expensive and unreliable health care you have for standing in long lines to sign up for a heart transplant. They are already teaming up with Frank Luntz to make sure nobody sees health reform as something they would actually want unless they currently have no coverage at all.