Month: June 2009

The Aristocrats

by digby

Atrios wondered earlier why I had taken to calling William Saletan “Lord Saletan” years ago and his memory is correct. It was particularly for his snuff-sniffing, aristocratic attitude toward messy partisanship, which he often characterized as some sort of lower activity fit only for the lower orders. If you’re interested, this rather long winded post is the one that coined the name, (I think.)

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Am I Hallucinating?

by digby

Jonathan Alter went on MSNBC and spoke village heresy today. It started off with a typical snotty observation from one of the interchangeable hostesses:

Snotty Hostess: The first question I have is, is this the worst thing that could happen to Obama politically? To have folks on the left grousing that he’s not liberal enough? I mean isn’t that kind of his dream come true in terms of the general election?

Alter: Well, It always helps to be positioned in the center when you’re in politics. But he doesn’t have an election coming up right now. I think it’s very helpful for him to be pushed a little bit from the left so that he doesn’t cave too quickly in the hurly burly of making a deal on health care. The big issue for the left is the so-called public option. Will he fulfill his campaign promise and allow Americans to buy into a government health care program similar to medicare, the kind of thing that congressmen are able to get? Should all all Americans be entitled to buy into that?

That’s a big liberal priority and it’s very, very important, not just for getting a good bill Savannah, but for cutting costs in the long run because only with some competition will the insurance companies restrict costs. So that’s a point that the president has been making in the last few days, but it’s important for liberals to hold his feet to the fire with it.

transcript by me — d

Cokie’s Law Is Still On The Books

by digby

*Sigh*

The CBO’s findings, however, are for an incomplete piece of legislation, making the cost-per-coverage estimates much worse than they will ultimately be. Republicans on the committee knew this, according to Democrats. But they pushed for the bill to be studied by the CBO now. And when poor results came back, they ran with them. “The reality is there are still some outstanding issues, including employer responsibility and a public insurance option,” said a Democratic aide to a committee member. “Those are two outstanding issues. So what we did in a good faith effort to find bipartisan consensus, we did not include those elements because we are trying to find common ground. But Republicans wanted there to be a score even though, the reality is, if there is an incomplete bill you will have an incomplete statement.” Another Democratic aide to the HELP Committee member concurred, adding that Sen. Ted Kennedy’s office, in an effort to “find bipartisan consensus with Republicans colleagues” filed the bill and allowed it to be scored by the CBO — not expecting it to be used as partisan fodder.

I just don’t know what to say about that. Aside from the thirty years of GOP bad faith and dirty tricks weren’t they at least aware that this happened just a couple of months ago?

Reports of a recent study by the Congressional Budget Office, showing that the vast majority of the money in the stimulus package won’t be spent until after 2010, have Democrats on the defensive and the GOP calling for a pullback in wasteful spending. Funny thing is, there is no such report. “We did not issue any report, any analysis or any study,” a CBO aide told the Huffington Post. Rather, the nonpartisan CBO ran a small portion of an earlier version of the stimulus plan through a computer program that uses a standard formula to determine a score — how quickly money will be spent. The score only dealt with the part of the stimulus headed for the Appropriations Committee and left out the parts bound for the Ways and Means or Energy and Commerce Committee. Because it dealt with just a part of the stimulus, it estimated the spending rate for only about $300 billion of the $825 billion plan. Significant changes have been made to the part of the bill the CBO looked at. The CBO numbers were given to a small number of congressional Democrats and Republicans, but were not posted online because they’re not an official CBO product. (Media outlets, while reporting widely about the “report,” have declined to post it online. Here’s the whole thing.) Democratic aides say they are certain that the GOP leaked it to the Associated Press in order to undercut the spending portion of the stimulus.

I guess it’s “fool me once, fool me twice and just keep fooling me because I’m a fool.”

The CBO’s findings do create politically bad optics. In the end, however, the situation could be remedied when a full analysis is released sometime in the next week. Once the bill is scored with a stronger individual and/or employer mandate for coverage, as well as various other details, HELP Committee members fully expect the cost-per-coverage breakdown to improve significantly. For now, progressive activists in the health care debate are holding their breath, hoping that the next CBO findings have more resonance.

Let’s hope so. But Cokie’s Law says “it doesn’t matter if it’s true or not. It’s out there.” I’ve already got trolls in the comment section, dripping with sanctimony, citing the lack of coverage as a reason not to support Health reform.

Campaign For Health Care Choice

by digby

Watching the health care debate unfold is frustrating and predictably enervating. These kinds of debates are often followed by a deepening of public apathy and a sense that government can’t help solve the big problems. And this plays into conservative hands since they are the ones who want to stoke that belief so that the citizens don’t get it into their heads that they can get an equal shake with those who think they own this country.

We can’t let that happen with health care. It is just too important on every level, for individuals, business and the country at large. It’s time to get involved. To that end Blue America is launching a campaign to raise money to run some television ads. We’ve got to get these wavering Democrats off the fence about a public plan choice or this thing is going to fall completely apart before it even starts.

Please go to our Blue America Act Blue Page a to give what you can

Campaign For Health Care Choice

Nothing is more important to the American people than passing health care reform that reduces costs and provides security and coverage for everyone. The economy and the nation’s competitiveness will not recover if this isn’t done and this may be our last chance to get it done for another generation. Since single payer was taken off the table before the debate even started, the only way to reduce costs and increase coverage is to create a quality public plan choice that will keep the insurance companies relatively honest.

There are several Senators who are resisting this necessary reform and either backing toothless substitutes that will do nothing to rein in the medical industry’s unnecessary waste and outrageous profits or looking for excuses to do so. Senator Blanche Lincoln of Arkansas, who sits on the finance committee and is running for office in 2010 is one. She has so far equivocated, saying that she’s concerned that “if all Congress comes up with is a government-backed plan, then there will be very little incentive for the private industry to be able to be competitive perhaps in the plans they will be offering and the individuals they will be offering.” That’s just nonsense. The only incentive these insurance companies will have to stop gouging their patients and hobbling the entire economy is to be forced to compete with a health plan that puts patients over profits.

Perhaps it’s not surprising that Lincoln is showing so much compassion for the poor insurance companies. She’s taken hundreds of thousands of dollars from them over the years. In fact, she’s already received the second highest total of campaign contributions from the industry of any senator up for re-election next year. And the only reform they support is reform that will get the taxpayers to pay the overpriced premiums for the 47 million uninsured without having to change their ways. The fact is that insurance companies are not in any danger of going out of business because of the public plan choice unless they continue the kind of practices that have brought us to this crisis.

A quality public plan is the only way we can ensure that health care reform will reduce costs and increase coverage. It’s imperative that Senator Blanche Lincoln get off the fence and support it.

Blue America needs your help to run some ads in Arkansas to persuade her that selling out to her insurance company supporters just won’t do. We need for people to tell her that she must stand with the American people who are desperate for real health care choices that will reduce costs and increase coverage.

Please donate what you can to our campaign.

According to Open Secrets, Blanche Lincoln has taken $1,815,241.00 from the health and insurance industries in her career. That’s a lot of money and they didn’t give it to her because they want her to hold fast on Cuba policy. They have an agenda and they expect her to protect their interests.

But so do the American people and voters in Arkansas have a right to ask her who she thinks she was elected to the US Senate to serve.

Help us out if you can. A few bucks from a lot of people will give us enough to put some ads on the air in Arkansas and make her have to answer to her constituents on this issue and not just the fat cat lobbyists and CEOs in the Medical Industrial Complex.

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Scoring An Error

by digby

Observing major legislation like health care is confusing even if you are able to see it close up, which most of us aren’t. It’s looks less like a chess game and more like little kids playing tag on the playground. There’s lots of energy and lots of shrieking but nobody knows how the game is going to end.

This news about the CBO scoring of the health plan is bad news. It’s not because it has any bearing on reality.(Here’s Ezra explaining that it is more a matter of bad communication than bad numbers.) The reason it’s a problem is because the opponents of reform will demagogue the hell out of it and help shift the debate from need to cost, which fits exactly with their plan. This was a big error. They are printing up the bumper stickers as we speak and there won’t be a wingnut in the land who won’t be robotically repeating the company line by the end of the day.

Allowing the congress to take the lead on this was understandable. But it’s possible that they have, as politicians and generals are wont to do, over learned the lessons of the past. Allowing the dysfunctional congress to run this initiative was probably a mistake. The Democrats have not yet figured out how to lead and their strategic and rhetorical skills are lame, to say the least. Something this big needs at least some direction and I don’t see it. At this point, I would have to guess that the fiscal scolds have the better case.

One of the sadly ironic things about health care reform is that because we have an employer based system, unless we reach a critical mass of people being out of work or worried about being out of work, there is usually not enough political energy for taking on the massive Medical Industrial Complex. But that happens at the exact moment when the government is losing tax revenues and the fiscal scolds can jump in on behalf of the plutocrats and aristocrats and demagogue deficits. It’s a problem. But it’s not one that shouldn’t have been anticipated. Any discussion of costs should have been very, very carefully dealt with and it doesn’t look as though that happened here.

All isn’t lost of course. This is still early in the game. But the advocates of health care reform just handed the industry a powerful weapon for no good reason.

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Center-Right Wrong

by digby

I saw this latest Gallup Poll on “conservative vs liberals” ID and thought to myself “David Broder just got a big thrill up his leg.” Not that it will matter one iota to the villagers who are wedded to the idea of a “center-right” nation no matter what it means, but they really should think again. Here’s Ed Kilgore:

As part of the endless efforts of conservatives to treat the last two election debacles as aberrations in a “center-right nation” (or as somehow-conservative reactions to that godless freespending liberal George W. Bush), you can expect some reaction to the latest Gallup survey of the ideological self-identifications of Americans. It shows a slight uptick in “conservative” self-identification during 2009, up to 40% from 37% last year. But it’s basically the same findings almost always found in recent decades when voters are offered the three choices of “conservative,” “liberal” and “moderate.” Self-identified “conservatives” have been bumping around 40% since 1992, with “liberals” around 20% and “moderates” holding the balance. Moreover, Gallup confirms the very old news that Republicans are heavily conservative (73% “conservative,” 24% “moderate” and 3% “liberal”), while Democrats are more ideologically diverse (40% “moderate,” 38% “liberal” and 22% “conservative”).

There’s no real evidence here that anything’s changed since November of 2008.

And as always, the C-M-L choice doesn’t seem to tell us as much as more nuanced measurements of ideology. The big recent Center for American Progress study released in March, State of Political Ideology, 2009, added “libertarian” and “progressive” to the usual menu of self-identification options, and after pushing leaners, found that 47% of Americans think of themselves as progressive or liberal, while 48% self-identify as conservative or libertarian. The CAP survey also found that when you probe deeper in terms of more specific statements of values and beliefs, there’s a reasonably solid progressive majority when it comes to most matters of international and domestic policy. The conservative “brand” may still be relatively strong, but it doesn’t always translate into issue positions, much less voting behavior.

These numbers have been so similar for so long that I think liberals should just start calling themselves conservatives and blow the wingnuts’ little minds. Clearly, the terms have no real meaning so why not?

Update: more here on this subject in the fascinating post about a new book on the subject.

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Competition For Dummies

by digby

Just think. This man could have been president:

On CNN earlier today, Sen. John McCain (R-AZ) rejected the public option as “a non-starter.” He admitted that the current “competition” between “1,300 health insurance companies in America today” is not successfully driving down costs — but insisted that a government plan could never be more cost efficient:

MCCAIN: Look, if we have a government option, then sooner or later it will dramatically increase the cost, it will crowd out private health insurance. And if you’re doing it in the name of competition, we have 1,300 health insurance companies in America today. They’re competing but they’re not getting the kinds of health care costs under control that is necessary. CNN: Yeah. Do you think that is absolutely necessarily so? That if you have a competing government system, that invariably what will happen is that you will drive some of the private health insurers out of the business? MCCAIN: I don’t think there’s any doubt about it. Over time you’ll drive them all out, and the idea that somehow the government can administer health care in a more efficient fashion than the private sector I think flies in the face of examples of other countries that have done so.

McCain is simply wrong. The United States ranked last in terms of efficiency among five other nations with universal health care, according to a Common Wealth study. In fact, the purely government-run Great Britain ranked first:

Compared with five other nations — Australia, Canada, Germany, New Zealand, the United Kingdom — the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.

One needn’t even look abroad: The government-run Veterans Administration health care system is the most effective health care system available, not just on results but on cost efficiency as well

Sadly, this is the result of misguided American exceptionalism (and years of convenient Republican gibberish.) Even people who by all rights should be well informed about the issues of the day just simply can’t wrap their minds around the fact that our health care system is not only bad by our own measurements but that it is far worse than the systems in other industrialized countries. Foreigners cannot possibly have better health care than America. This is the greatest country the world has ever known or ever will know! It’s impossible!Except it’s true.

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Down To The Wire

by digby

Jane sez:

Jane and the FDL gang and Brave New Films and a whole bunch of others have done some really great work here. They could use your help in the stretch. If the leadership has to pull this vote it’s the first sign that the progressives are going to have a real voice in this government. And wouldn’t that be something?

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Consulting With The Doctors

by digby

I have had too many conversations with doctors complaining about how they just can’t make ends meet while standing next to their Beamer M6 convertible to feel too much sympathy for their arguments. But I do realize that these Westside of LA types are not representative and that there are plenty of doctors who recognize the need for health care reform that goes beyond paying for their Aspen vacation.

Jonathan Cohn at The Treatment writes about Obama’s speech to the AMA today:

“You entered this profession to be healers,” Obama said, “and that’s what our health care system should let you be.”
They were stirring words. And yet the audience remain decidedly unstirred. They reacted not as high-minded champions of health and the public interest, but like any other interest group, focused entirely on their narrow economic interests. Fixing malpractice. Ending the annually scheduled reduction in Medicare payments. And even then, the approval was qualified. Once Obama made clear he didn’t want to cap malpractice awards, as the AMA has long desired and Republicans usually promise, the clapping stopped. A few people actually booed. I suppose this isn’t surprising. Among other things, the AMA represents an ever-shrinking portion of the physician population. And, by all appearances, it represents the profession at both its most craven and conservative. Remember, this is the organization that funded pro-tobacco candidates even as its top public health priority was to reduce smoking. And, remember, this is the orgnaization that in 1995 endorsed Newt Gingrich’s plan to savage Medicare by, among other things, forcing beneficiaries to pay more for their care. What convinced the AMA to make this deal? Chiefly, it was Gingrich’s agreement to strike a provision that would have cut physician fees. Of course, not all physicians agreed with the AMA back then. The American College of Physicians, a more liberal group, protested the cuts because of what it would mean for the elderly. And the same is true today. Smaller, more liberal physician groups are lining up behind reform. They want malpractice relief and a Medicare fix, too. But they also want what’s best for their patients–and their country. They want to help construct a deal, one that works for everybody.[…]
Physicians say they have a higher obligation than other professions, that they are healers and not just tradesmen looking to make a buck. And many really believe that, I know. Now is the time to show it.

It sure is. Doctors are key to this, both because their patients will be asking about them about it and because they are one of the few popular players who can wield some real clout in the political debate.
It was good for Obama to fully lay out his principles and outline for reform in detail in front of the AMA. I just hope he isn’t expecting anything from them and is looking for allies among doctors elsewhere. The AMA has stood in the way of every health care reform ever contemplated and they aren’t likely to change now.
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Conrad The Genius

by digby

Here is a good explanation of the necessity for a public plan option by Jacob Hacker:

In the fast-moving debate over health care, no idea invites more admiration or ire than the “public health insurance option”–or what I’ve been trying to get people to describe as “public plan choice”. The idea is overwhelmingly popular with Americans, garnering 85 percent support in a new independent poll from the Employee Benefit Research Institute. It’s also compelling and simple: If you don’t have coverage from your employer, you can choose from a menu of health insurance products that includes not just a range of private health plans but also a public insurance plan provided on the same terms nationwide.

The argument for this new public plan is that it would have lower administrative costs; greater leverage to hold down prices; and the transparency, broad patient data, and incentives for long-term investment in health to improve the quality and efficiency of care. Along with new regulations, it would also be the primary check on a private insurance industry that has, for too long, neglected both quality and efficiency, focusing its creative energies instead on new ways to shift costs onto and screen out the sick.

The idea of public plan choice was part of all the leading Democratic candidates’ health plans, Senator Max Baucus’ November 2008 White Paper, and the vision of reform articulated earlier this year by key congressional Democrats. All with little attention outside health policy circles–until conservatives, health insurers, and some provider groups decided the public plan was public enemy number one. And so, the misinformation campaign began: A public plan available alongside private plans only for Americans without workplace insurance was suddenly described as a “government takeover” of medicine, the “road to rationing,” and (that old standby) “socialized medicine.” Republicans drew their lines in the sand, and Democrats started their favorite parlor game: compromising among themselves even before the real debate begins.

Read the whole thing. He goes on to explain just why this supposed “compromise” by Kent Conrad about health co-ops is unworkable and counterproductive to the fundamental purpose of the public plan. It’s a good idea unto itself, but it will do nothing to bring down costs and keep the insurance companies honest.

I posted the interview Ezra Klein conducted with Kent Conrad the I failed to highlight something that’s quite illuminating:

Where did this idea come from? I’ve done a fair amount of health care reporting, and this is the first I’ve heard of it. I guess it came out of conversations in my office after we were asked to see if we couldn’t come up with some way of bridging this chasm. Part of it is that we’re so used to cooperative structures in my state. They were begun by progressives, they came out of the progressive era. And they’re so successful in our state. So I can’t really say we came up with some brand new idea. We just thought about our own experience.

I think he thinks that’s very clever, but it’s actually quite frightening. This issue, of all issues, requires expertise not uninformed bull sessions in Kent Conrad’s office after hours. These ideas have been hashed out and debated for years and the idea that old Kent and his staff can just “solve the problem” one night by applying his own experience in North Dakota is downright insulting.
I saw Conrad on TV over the week-end and he characterized this as a pragmatic necessity because there are at least three Democrats who won’t vote for a public plan. That’s ridiculous. This is only the beginning of the debate and the “Gang of 8” ar entering the negotiations capitulating to the insurance companies. There is absolutely no reaqson to bargain away the only thing left that will guarantee that the reforms won’t make the crisis worse by mandating that the uninsured buy insurance without any cost controls.
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