Month: July 2009

This is Good

by digby

Nothing is worth doing in America anymore unless somebody’s making a profit off of people who can’t afford it:

California “IOU” recipients can turn to credit unions and check-cashing storefronts if a state budget deal does not appear by Friday and if three major banks refuse to accepting the notes beyond Friday as planned, analysts said on Tuesday. The willingness of the smaller institutions to take IOUs from the cash-strapped state should also stop the development of a secondary market for trading them, although individuals could end up paying hefty fees to get their hands on cash. […]Three major banks are currently accepting the IOUs, but only through Friday. After that recipients may turn to credit unions to cash them or, perhaps, to check-cashing storefronts. Their cashiers could see more than $3 billion of the IOUs at their windows this month should the state budget crisis persist and big banks hold to their Friday cut-off for processing them. Check-cashing storefronts are especially well poised to score IOUs, said Daniel Penrod, a senior industry analyst at the California Credit Union League. “I could see a lot of bank customers turning to a third-party source and losing a lot of their paycheck,” Penrod said.

So, the IOU recipients get a pay cut anyway, but the money will go to payday loan sharks instead of the state, which will continue to go broke. These free markets are just awesome,

.

We’ll Take Care Of Ya

by digby

It’s interesting watching the fallout from the Washington Post pay to play scandal, but I have to say that I’ve not seen anyone address what was my first concern about such arrangements: the effect of such salons on the press. Everyone’s acting as if the only problem is that the Post was compromised because it was taking money from people with a vested interest in the outcome. This is a problem, to be sure, but it’s not exactly the only one. Montag in the comments asks the right question, in my opinion:

These “salons” have another effect on the press. In a sense, in such situations, they’re the captive audience, and they mostly get to hear the corporate arguments, so what they end up reporting is one-sided. Weymouth wasn’t also inviting grassroots groups with a decidedly different take on legislation than corporate whores or contribution-dependent legislators, so, those views will be largely absent from any reporting coming out of such gatherings. Therefore, even if the reporters attending convince themselves that they’re not being compromised, that they’re still independently reporting, they’re still getting a stilted and tilted view of the overall picture–which is precisely the point in Weymouth’s inclusion of her own reporters in her little pay-to-play get-togethers.

I wondered from the beginning when the the Post and unnamed members of the administration (who I had assumed to be in discussions about this) had invited any grassroots groups, unions or public interest organizations to attend these salons and add their perspective. They were not. And this is because their reflexive assumption is that the only “stakeholders” in this are industry and government.

This is the Village — a small, powerful, insular group of elites with most of those in the media and all politicians among them perpetuating a myth that they are common folk with the same parochial interests as the rest of us. And that is why it never occurred to anyone that only inviting politicians, reporters and industry lobbyists to a salon to talk about health care reform was not going to result in a well rounded view of the issue. In their minds, they are “the people.”

I actually respect the industry lobbyists the most. They, at least, know whose interests they represent. The rest of the villagers are far more deluded — or dishonest.

.

The Plot Thickens

by digby

Roll Call – Reid to Baucus: Stop Chasing GOP Votes on Health Care

DAVID M. DRUCKER and EMILY PIERCE

Tuesday, July 7, 2009

Senate Majority Leader Harry Reid (D-Nev.) on Tuesday ordered Finance Chairman Max Baucus (D-Mont.) to drop a proposal to tax health benefits and stop chasing Republican votes on a massive health care reform bill.

Reid, whose leadership is considered crucial if President Barack Obama is to deliver on his promise of enacting health care reform this year, offered the directive to Baucus through an intermediary after consulting with Senate Democratic leaders during Tuesday morning’s regularly scheduled leadership meeting. Baucus was meeting with Finance ranking member Chuck Grassley (R-Iowa) Tuesday afternoon to relay the information.

According to Democratic sources, Reid told Baucus that taxing health benefits and failing to include a strong government-run insurance option of some sort in his bill would cost 10 to 15 Democratic votes; Reid told Baucus it wasn’t worth securing the support of Grassley and at best a few additional Republicans.

Wow. He can count. Good news.

Update: And the progressives in the House weigh in:

The Honorable Barack Obama
President of the United States
1600 Pennsylvania Aye, N.W.
Washington, D.C. 20500

Dear Mr. President,

I read with alarm and dismay the article in the July 7th edition of the Wall Street Journal, “WhiteHouse Open to Deal on Public Health Plan”. In particular, White House Chief of Staff Rahm Emanuel stated in the article that one of several ways to meet your health care reform goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own.

I want to be crystal clear that any such trigger for a strong public plan option is a non-starter with a majority of the Members of the Progressive Caucus (CPC). As the CPC has repeatedly stated, its Members cannot support final passage of any health care reform bill that does not include a robust public plan option, akin to Medicare, operating alongside the private plans.

Public opinion polls show that 76° o of Americans want a robust public plan option and I will stand in solidarity with them. Moreover, I consider it unacceptable for any of the cost savings that you are negotiating with hospitals and other sectors of the health care industry to be madecontingent upon a robust public plan option not being included in the final legislation.

Thank you for your thoughtful consideration.

Sincerely,

Raul Grijalva

.

Trigger Finger

by digby

So, the latest scuttlebutt is that Obama walked back Rahm’s “trigger” comments to the Wall Street Journal today by saying that he still thinks a public option is the best way to get to serious health care reform.

But it looks to me as if we are seeing the trigger being set up as the “compromise.” I don’t know that, of course, but it’s highly doubtful to me that Rahm was totally off the reservation. But it would probably be a good idea to get the trigger off the table sooner rather than later. The trigger is a reform killer.

Update: I’m told that this isn’t really considered a threat because everyone knows that a trigger isn’t a public option and that the left will walk away. That’s good news. But someone should get the president to confirm that he isn’t backing it.

Update II: Sanders and Dean speak out against the trigger — and Sanders says that progressive Dems are ready to buck the finance committee, which is good news:

Two major progressive voices in the health care debate took White House Chief of Staff Rahm Emanuel to task on Tuesday for suggesting that a public option with triggers could be a potential compromise on reform. One of those voices, Sen. Bernie Sanders (I-Vt.) went so far as to insist that some Senate Democrats would vote against any proposal that didn’t include a strong government-run option. Even the bill being crafted by Democrats on the Senate Finance Committee, Sanders noted, might not get the caucus’ full support because it could stray too far away from an effective overhaul of the health care system. “I think that it is fair to say that there are a number of us who would not be voting for anything resembling a Baucus-type plan as we understand it right now,” the senator told the Huffington Post, referring to Finance Committee Chairman Max Baucus’ effort at constructing a reform bill. In separate interviews, Sanders and his fellow Vermonter, former DNC Chair Howard Dean, both took umbrage with comments Emanuel made in an interview with the Wall Street Journal that was published Monday evening. The White House chief of staff did not deviate fully from the administration’s line, suggesting that all prospects for reform remained on the table. But Emanuel added something that health care operatives said they hadn’t heard from the White House to date: a statement of support for a health care insurance compromise based on a public option with triggers. The president would, hours later, issue a statement reiterating his support for a “public option that will force the insurance companies to compete and keep them honest.” Progressives, fearing in part that the frame of the health care debate would be irrevocably shifted, pushed back. “I think that a public plan with triggers is not a real public plan and it is going to be a trillion dollar failure,” Dean said. “Anyone who thinks a trigger is going to lead us to a good place five years from now is wrong… It is not a sensible policy compromise.”

Blue America is starting its ad campaign tomorrow asking Democratic Senator Blanche Lincoln, a member of the finance committee who says she is leaning toward the completely unworkable co-ops, to back the public plan . I realize that centrist Democrats think this “unhelpful” but at this point it looks to me as if the public option needs all the help it can get.

.

Removing The Obstacles

by digby

Ezra Klein has posted an interview today with my congressman Henry Waxman in which they discuss one of the most fundamental problems we face in trying to pass needed legislation:

KLEIN: … Even with a popular new president and a large House majority and 60 Democrats in the Senate, it seems unlikely we’ll actually solve these underlying problems. We might get legislation. But it’s not likely to avert the existence-level fiscal threat from health-care reform or the existence level environmental threat from climate change. But if not now, then when? And if Congress can’t respond to challenges of that magnitude, doesn’t it suggest that something is quite wrong? WAXMAN: I think we need to be open-minded and think about the possibility in changes of process as well as policies. We shouldn’t be so burdened by the past that we can’t face the future. The seniority system in the House was traditionally dictated by members who didn’t like the speaker having so much power over the committees. But when I came to Congress, if you were the senior member, you became chairman no matter how competent you were, no matter how in sync you were with the majority caucus. That was enormously advantageous for many of the Dixiecrats who remained Democrat for that reason, to take advantage of the seniority, but who aligned themselves on policy with the Republicans, and created a situation where even when Democrats had large margins, there was this sort of Southern Democrat-Republican coalition that ruled. The fight by Sam Rayburn to allow the Rules Committee to be controlled by the leadership was an enormous and brutal fight, but a necessary one. The chairman before that time was Judge Smith from Virginia, who wouldn’t let civil rights legislation go to the House floor because he was a segregationist himself. That meant that even when the Judiciary Committee proposed a bill for civil rights, members of the House couldn’t vote on it. There are anti-democratic rules that need to be changed. In some ways, the filibuster is an issue we might want to look at more closely. It is a two-edged sword. But I come from California, where to pass a budget you need a two-thirds vote. And they’ve been unable to pass a budget for years now able to deal with the fiscal problems. And it has thrown the state into chaos because they can’t get the two-thirds vote. The filibuster used to be a two-thirds requirement, and it wasn’t until 1975 that they changed it to 60 votes. Well, that was a move in the right direction. For sure

Ezra points out that the filibuster affects legislation in more ways than one because the House anticipates the the Senate’s reaction as well.
The filibuster and other arcane undemocratic processes are issues that should be addressed. if we can assume that we are entering an era of progressive possibilities, and knowing that we saddled with a conservative judiciary, it becomes important to have the legislative branch working with fewer impediments.

.

Holding Back The Tide

by dday

The White House has done a pretty good job of rolling out these deals with the health care industry. They made the main announcement of $2 trillion in savings months ago, and that got a large news hit. Then they’ve been dribbling out each element of the industry and their pledges to lower costs. We haven’t reached $2 trillion – in fact, we haven’t come close – but every time they do it, the White House gets another news hit. It’s pretty brilliant.

The latest is an agreement with the hospital industry to give back $155 billion in profits over a decade, on the heels of an $80 billion dollar agreement with the drugmakers to help fill the dreaded donut hole for prescription drugs for seniors. Because of the way in which Max Baucus (who is brokering most of these deals) and the White House have done it, assenting to changes in how they are paid, this money can be used to help pay for reform, unlike the $2 trillion, which was outside the purview of the CBO. But they seem to be bargaining, like the drug industry, for the best deal they can get, instead of designing the policy and forcing the various industries to accept it.

Still, you have to wonder: Could these industries be giving up more? The drug deal, at least, doesn’t look all that great–except, perhaps, to the drug industry. My reading of the agreement–and, to be clear, there’s still a lot of ambiguity here–is that the drug industry has agreed to kick in some of its own money to help fill in the “donut hole” in the Medicare drug benefit.

That’s very nice and will, I think, make it easier for seniors to afford their drugs. But it also seems that, as part of the deal, seniors have to buy more drugs from name-brand manufacturers rather than generics. It’s entirely possible that the name-brand drug industry–that is, the companies represented by PhRMA–could actually come out ahead […]

The expected hospital agreement seems may be more signfiicant–and, for liberals, more encouraging. Although it’s impossible to know without seeing the details, $155 billion is a decent chunk of change. That could represent a serious sacrifice on the part of the hospitals.

On the other hand, it’s not clear whether, perhaps, this is an example of some hospitals effectivelly cutting a deal that hurts others. Insofar as the savings come from reduced payments for charity care–payments that now flow through Medicaid–is this a case in which suburban and speciality hospitals actually do just fine but charity hospitals take a hit?

Perhaps the most important question to answer is what these industry groups are getting in return. Changing payments to the health industry isn’t simply about generating savings that can finance expansions of insurance coverage. It’s also about changing the behaviors of these industries–and, in so doing, creating a health care system that offers better quality care for less money.

To accomplish that, reform should ideally include measures like strengthening the hand of the Medicare Payment Advisory Commission (MedPAC), developing more data on comparative effectiveness (CE), or building a strong public insurance plan. But hospitals don’t like the idea of a stronger MedPAC, drug makers are pretty hostile to good CE, and insurers (among others) hate the idea of a public plan. When the industries cut these deals, are they prying promises from Baucus–or the White House–not to push too hard on these levers?

The effect has been to set a ceiling for what the drugmakers and the hospital industry and the other stakeholders will accept, brokered through the most conservative and industry-friendly committee in Congress, Max Baucus’ Senate Finance Committee. Any committee that seeks more savings from industry immediately gets attacked, even though they never made such an agreement.

Having struck a bargain with Senate Finance Committee Chairman Max Baucus (D-Mont.), the industry is aggressively targeting individual House Democrats, warning of repercussions in the 2010 elections if they go along with a tougher set of savings advocated by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.).

PhRMA, the powerful Pharmaceutical Research and Manufacturers Association lobby, is openly playing one chairman against the other. Billions of dollars are at stake; a politically sensitive population, the elderly, is caught in the middle. With House Democrats expected to finalize their bill this week, President Barack Obama could face pressure to come off the sidelines and spell out better where he stands.

What Baucus agreed to specifically in his June 20 bargain is still in some dispute. But PhRMA is bluntly telling House moderates that the senator will oppose the rebates demanded by Waxman and that the smart move is to kill that provision outright and save themselves political pain in 2010.

Then there’s the effort in the Senate Finance Committee to deny women legal medical services inside any insurers operating inside the Health Insurance Exchange:

The Senate Finance Committee has been writing a health care reform bill and struggling to create legislation that will have bipartisan support. Chairman Max Baucus considered several compromises to win Republican support, so they can claim it is bipartisan legislation. One of these potential compromises comes in the form of an abortion exclusion, which would prevent abortion services from being covered by some or all insurance plans in the Health Insurance Exchange. We fear that members of the Senate Finance Committee are considering such a compromise.

Remember, most of the groups inside the insurance exchange are private companies. I thought conservatives didn’t want to put a government bureaucrat between the patient and the doctor. I guess when it comes to reproductive choice, that’s OK.

The Senate HELP Committee’s favorable budget score raised hopes that a workable solution was on the way, which was affordable and used a public health insurance plan to increase that affordability. But there’s a whole maze of committees and votes to maneuver through. And the Senate Finance Committee is really building a dam to hold back the tide of a legitimate overhaul. Must be all of that industry money.

,

Here We Go

by digby

I’m surprised he didn’t whisper this one to Ceci:

It is more important that health-care legislation inject stiff competition among insurance plans than it is for Congress to create a pure government-run option, White House Chief of Staff Rahm Emanuel said Monday. “The goal is to have a means and a mechanism to keep the private insurers honest,” he said in an interview. “The goal is non-negotiable; the path is” negotiable. His comments came as the Senate Finance Committee pushed for a bipartisan deal. To help pay for the package, the committee planned to announce an agreement Wednesday with hospitals and the White House for $155 billion over a decade in reductions to Medicare and charity-care payments for hospitals, according to a person familiar with the agreement. That will help pay for the legislation, expected to cost at least $1 trillion over 10 years. One of the most contentious issues is whether to create a public health-insurance plan to compete with private companies. Mr. Emanuel said one of several ways to meet President Barack Obama’s goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect. Mr. Obama has pushed hard for a vigorous public option. But he has also said he won’t draw a “line in the sand” over this point.

Using the prescription drug plan as an example is brilliant. Pharma loved it. And they really loved Billy Tauzin, the man who rammed it through. Good times.Dday wrote about the “trigger” in this post:

A trigger mechanism is simply absurd. The insurers have had decades to provide decent coverage and have demurred every time. They have shown themselves to be untrustworthy that entire time, including just last month, when they backpedaled on the cost controls they vowed to offer. Mike Lux, who has seen these battles up close, senses that this is the big proxy fight right now.

The insurance lobby has had multiple tactics for stopping the public option idea, which they despise because they know if regular folks have choice to go to a public option, insurance companies won’t have the same ability to treat their customers like garbage when they get sick. The first tactic was just to try to kill the public option outright, and the good news is that they appear to have failed at that. This so-called trigger proposal is the second tactic: the idea is to write a “trigger” that will allow for a public option only under certain conditions, but write the legislation so that those conditions would never get met in the real world. It’s a classic DC tactic, right up there with calling for a commission to study something. Olympia Snowe is carrying the insurance industry water on their trigger proposal, proposing triggers that would only get tripped in some fairyland none of us have ever visited.

The great thing for the insurance companies in a tactic like this is that it gives “centrist” Senators (centrist in Washington, DC usually means those who have taken massive amounts of campaign contributions from the affected industry) an excuse to help the insurance industry while looking like they are open to the public option that their constituents have been demanding.

It’s always possible that Emanuel is playing 45 dimensional chess. Gosh I sure do hope so.

.

Packaging

by digby

I’ve been meaning to post on this “packaging” problem confronting the Obama administration in their quest to find “common ground” on … contraception. Yes, that’s right. Now that the mushy abortion reduction crowd has convinced the Democrats that social conservatives will vote for them in droves if they will only stop treating abortion like a right and instead treat it as tragic female irresponsibility, it seems the right isn’t altogether impressed. I know this will come as a shock to you, but while they are perfectly happy to have the government help women bring their unwanted pregnancies to term, they insist that any efforts to “reduce abortion” with birth control is unacceptable. Who’d have thunk, huh?

As I said, I was going to write about this and was working on one of those boring posts about the “pincer” strategy and overton window blah,blah,blah, but when I came across this, by Charles Piece, I just decided to lift it:

Matthew Y is a very smart young man, especially now that he apparently has given up on the Sisyphean task of explaining why the Washington Wizards ever will be any good. But this, alas, is unicorn-shopping at its most gullible. While I have no doubt that it is remotely possible that the nice lady across the street with the pro-life bumper stickers on her car may very well not give a damn who’s buying condoms where, and how old the people are who are buying them, the organized political structure of the pro-life movement has been demonstrably anti-woman and anti-sexuality from the very first mailings it ever sent out. It has been financed and organized by religious organizations devoted to a truncated and joyless view of human sexuality. It has as its formal legal basis a philosophy for which the true target never has been Roe, but Griswold. It does not believe in a constitutionally guaranteed right to privacy in any sphere, abortion just being the most obvious and inflammatory one. And, most important, none of this will change. Ever.

No it won’t. Ever.

And this common ground effort is designed to advance socially conservative policy, period.

.

Going With The Floe

by digby

A couple of weeks back I made a weak joke about health care reform and putting people on the ice floe. It’s nothing worth remembering. Today, Kevin Drum highlights two conservative op-ed pieces on health care in the LA Times, one of which seriously advances the idea that health care reform will result in putting old people on the ice floe:

Charlotte Allen, conversely, thinks that in order to free up some much needed healthcare cash, Barack Obama wants to take all our old people and set them adrift on ice floes to die. Do you think I’m engaged in some bloggy exaggeration for rhetorical effect? Let’s roll the tape:

The Eskimos used to set their elderly and sickly adrift on the ice or otherwise abandon them during times of scarcity, and that, metaphorically speaking, is what Obama would like us all to start doing. ….The scarcity of resources to pay for expensive medical procedures will only increase under a plan to extend medical benefits at federal expense to the 47 million Americans who lack health insurance. So why not save billions of dollars by killing off our own unproductive oldsters and terminal patients, or — since we aren’t likely to do that outright in this, the 21st century — why not simply ensure that they die faster by denying them costly medical care?

Setting aside the illogical hysteria of this entire piece, somebody really needs to point out toCharlotte Allen that other countries all over the world are able to deliver better outcomes at less cost to all their people than we are. She doesn’t seem to have read even the most rudimentary primer on what health care reform is supposed to accomplish.

But the really mindboggling part is this, which Kevin describes here:

Most weirdly of all, though, at the end of the piece the conservative Charlotte Allen herself seems to suggest that Medicare should be funded with infinite amounts of money and there should never be any restriction on how it’s spent. Either that or she doesn’t realize that Medicare is the way most old people in America get medical care. Or that Medicare is a government program. Or something. I can’t really make sense out of it.

Seriously, it’s the oddest thing. Read it for yourself.

This is why Republicans are irrelevant to the health care debate and everyone is only concentrating on Democrats. If any of them were even slightly coherent on the subject, there would be a grave danger of them actually impacting legislation. But at this point they are just babbling about ice floes and tax credits and the corporate Democrats have to cary the insurance companies’ water all by themselves. It’s clarifying, but amazing nonetheless.

.

Health Care, Lobbyists and Journalism

by dday

Happy to be on the opposing side of a lobbyist/access scandal rather than in the middle of it, today the Washington Post writes about the hundreds of former politicians and staffers-turned-lobbyists for the health care industry, fighting tooth and nail against systemic reform.

The nation’s largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.

The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post’s analysis.

Did that analysis come from the newsroom or the guest list for one of Katherine Weymouth’s salons?

Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

This has turned lobbying sessions in the major committees into office reunions, where former staffer get together with the politicians for whom they once worked. It begs the question about those pay-to-play sessions: why would any health care company want to pay up to $250,000 for access to the lawmakers making the biggest decisions on health care, when they all have people on their lobbying staff who already know how that lawmaker takes their coffee, and can surely use the knowledge gained through work experience on Capitol Hill to further their employer’s agenda? Aside from the unseemliness of it all, the “salon” idea seems like another bad business model.

The use of insiders who move from politics to K Street has a damaging effect on the whole debate, using the journalist/source model as an interesting parallel:

Suppressing your instinct to trust a former chief of staff and legislative director is a hard thing to do. Refusing to return the calls of favored staffers and colleagues goes against every social grain in our bodies. It should be easy to separate professional responsibilities and personal feelings. But it isn’t.

Journalists consistently use this to our advantage: When you hear that someone is well-sourced, it generally means they have good personal relationships that make it more likely that insiders will tell them things. A big part of the job is leveraging social pressures to gain access to protected information. And, somewhat amazingly, it works. But the relationship between a journalist and a longtime source is nothing compared to the relationship between a senator and a longtime staffer. One of the secrets about lobbying in Washington is that money doesn’t buy access. It buys people who already have access. And that makes it much more insidious.

Relating this to the pay-for-play scheme, I think we can surmise why corporate insiders would use the media as a pass-through for access, whether it’s The Washington Post or The Atlantic (that’s quite a good article from Zachary Roth about their long history of corporate-sponsored “salons”). The question lies with who is being bought – the politicians, the lobbyists, or the media itself. I would argue the latter. By facilitating the relationship, they become compromised within it. They start to hedge a bit. They adopt a worldview that aligns pretty perfectly with the forces of the status quo on which they are supposed to report. They interweave themselves into the system and become partners within it. And the establishment thus speaks with one voice.

.