Month: August 2009

Stealing From Grandma

by digby

This seems like a promising place to find some savings in health care, but until today, I haven’t heard a word about it:

Lawmakers eager to broaden health care coverage while holding down costs are examining the institutional market for medical supplies, a largely unseen $60 billion-a-year realm where things like bedpans and heart implants change hands.

Senators from committees like finance, judiciary and aging are investigating the practices of companies that represent big networks of hospitals, nursing homes and other institutions. These group purchasing organizations select “preferred” manufacturers and negotiate the prices of medical products, which are a closely held secret. They then use a variety of carrots and sticks to make sure their hospitals buy those brands at the contracted price.

The senators are concerned that these groups’ practices may be inflating health costs at taxpayer expense. Much of the cost is borne by the government, as it reimburses hospital expenses through the Medicare program.

On Wednesday, the senators sent letters to the seven biggest group purchasing organizations, known as G.P.O.’s, demanding detailed information about their business practices, including how they are paid, what services they perform besides picking brands and negotiating prices, and how their revenues are affected when an affiliated hospital buys supplies on its own instead of using the group contract.

The senators also asked for copies of contracts, something not normally made public.

For years, there have been complaints that the buying process is opaque and unfair. The purchasing companies’ operating expenses are usually paid by the manufacturers sitting across the bargaining table, leaving them open to accusations of steering huge blocks of institutional business to the vendors willing to pay the most.

Guess what? This is because of a piece of sweetheart legislation from years ago:

Normally, Medicare’s law against kickbacks would bar vendors from paying the companies that award them contracts, but Congress granted the industry a special “safe harbor” many years ago, in the belief that volume purchasing saved money. The senators seem to want to test that belief and perhaps change or abolish the safe harbor, something that would turn the industry on its head.

Read the whole article and you’ll see that this is a totally corrupt form of government contracting that is costing taxpayers a mint which keeps honest suppliers from being able to compete, which should, in a rational world be something that “free market” fetishists should be incensed about as well. Why this isn’t highlighted as part of the “waste fraud and abuse” argument is beyond me.

We need money for health care. Perhaps they should look for it.

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Maybe If Obama Changes His Party Registration

by dday

Maybe then we can get those nice Republicans to go along with the White House’s plans. Apparently what Kent Conrad made up in the middle of the night during a staff brainstorm session isn’t really their cup of tea, either.

“PUBLIC OPTION” BY ANY OTHER NAME IS STILL GOVERNMENT-RUN HEALTH CARE

SO WHAT IS A “CO-OP”?

Co-Ops Would Be Funded By Federal Government. “Senator Kent Conrad, a Democrat, proposed creating nonprofit, member-operated health cooperatives to compete with insurers … The government would offer start-up money — Conrad said $6 billion would be needed — in loans and grants to help doctors, hospitals, businesses and other groups form nonprofit cooperative networks to obtain and provide healthcare.” (“Q&A – Co-Ops In Focus In U.S. Health Care Debate,” Reuters, 7/30/09)

Co-Ops Would Be Regulated By Federal Government. “Advisory board makes recommendations to HHS Secretary who makes final decisions about approvals of business plans … Business plans must meet governance standards, and eligible applicants must meet the standard for non-profit, participating mutual insurance.” (“Senate Finance Committee Draft Proposal,” 6/19/09)

Co-Ops Would Force Individuals Who Want To Join To Go Through State Governments. “Co-op membership would be offered through state insurance exchanges where small businesses and individuals without employer-sponsored plans would shop for health coverage.” (“Q&A – Co-Ops In Focus In U.S. Health Care Debate,” Reuters, 7/30/09)

Federal Government Would Use Co-Ops To Monopolize Health Insurance. “[T]hese co-ops sound a lot like a health-care Fannie Mae and Freddie Mac, which Congress created because there was supposedly no secondary mortgage market. The duo proceeded to use their government subsidy to dominate the market and drive out private competitors.” (Editorial, “Fannie Med,”The Wall Street Journal, 7/30/09)

The leader of the Republican Party said basically the same thing today, actually admitting that “there is no reason to have this kind of liberal reform without a public option.”

Who could have predicted? Why, it’s almost as if it’s not the particulars of the bill at all that upset the GOP, but the very act of passing a bill at all. In this environment, it seems so perfectly sensible to try to fashion compromises with Senators who won’t vote for any bill even if they get everything they want out of it.

I think the White House should really mull over the party-switch idea. After all, it would show the President’s commitment to post-partisanship. Sure, some of the more officious Democrats may be disappointed, but think of the great David Brooks op-eds!

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Some Light

by digby

I had a chance to spend some time talking to Mike Lux at Netroots Nation and he mentioned this to me and it made me, if not optimistic, at least able to see a path to victory, if certain things happen. I have no idea if any of this will come to pass, and there is always good reason to believe that progressives will fold, particularly if the president himself writes off the public option and twists their arms to capitulate. But with the right combination of activist stubbornness, political acumen and presidential commitment, this could be a way this plays out:

Conrad is accurate that there are not currently 60 votes in the Senate for a public option. But what conventional wisdom ignores is that there are 64 House members who are unequivocally on record as saying they will not vote for a health reform bill that has no public option, way more than enough to take that possibility off the table. So there are two possibilities right now:

* If both sides of this equation hold tight, no bill passes at all
* Something happens to change the dynamics

The conventional wisdom says that while it is entirely possible that the first scenario happens, that if the second scenario happens it will be because House progressives fold. There seem to be no other possibilities to all the expert prognosticators.

Now, I will admit that progressives have been known to fold before, as Chris Bowers wrote today. But let me suggest that there are other possibilities here, scenarios that are actually within the realm of the possible. If progressives in the House hold their ground, if they hang tough on the public option, what happens next will go something like this:

1. The House will find the votes to pass a comprehensive bill with a public option soon after they get back from August recess. That will be reasonably easy, because Pelosi will be able to peel off a reasonable number of Blue Dogs, many of whom have said they would support a public option, to vote for the bill.

2. The Senate will find the votes to pass a convoluted, tortured, unworkable bill, not only with no public option but so messed up and compromised to be unworkable anyway. This is less certain than number one, but Democrats will probably find a way to pass something.

3. The conference committee will sit for several weeks as Senators like Conrad say we will never pass a public option, House progressives says we will never pass something without a public option, and the White House, Pelosi, Reid, and conference committee members work out details to try to get something passed.

At that point, there are a few possibilities. One is that Democratic leaders just give up and declare health care reform dead. That seems unlikely to me, given the high stakes. Another possibility is that House progressives just fold up. That is more likely given recent history, but given their clear promises and the strong pressure on them not to, they might just hold this time. So let’s assume for the moment that they do hold strong. Here are a couple of possibilities for getting a bill passed:

A. The first is that conservative Senators are given a fig leaf compromise on the public option, so that they can say to people they forced a compromise, and then are brought over with all kinds of other incentives that make them more comfortable with the bigger bill.

B. The second is that the conference committee simply breaks the bill in half, one half being the less controversial part that everyone agrees upon, the other being the public option and the financing, both of which can go through the reconciliation process. Then Obama and Reid muscle the 50 votes they need for support.

None of this is easy, and none of it is pretty, but having been through a ton of these kinds of issue fights, both from inside the Clinton White House and from the outside, I can tell you that all of this is doable. These kinds of rhetorical logjams happen all the time, where it looks like the House and the Senate are both unalterably dug in, and then magically deals get done. On important bills, effective Presidents and Congressional leaders find some tough-to-thread-the-needle sweet spot, or they use some uncomfortable or inelegant legislative tool, and things that matter can get done. The media and establishment conventional wisdom, which always tends toward the dire and toward the conservative scenarios, is sometimes proven wrong. So ye of little faith, do not give up hope. The worst thing sometimes happens, but not always. Politicians sometimes sell people out, but not always. Keep fighting for the public option.

This all depends upon progressives keeping their noses to the grindstone and fighting for the public option even if it feels futile. This is a negotiation and nothing is final until the votes are cast. It’s vitally important to keep up the pressure however we can. As long as there is a possible scenario like this one, I refuse to completely give in to pessimism. Sometimes the good guys do win one.

Speaking of good guys, Anthony Weiner was on TV today kicking ass about the public option. If you feel like giving him an attaboy for fighting the good fight, I’m sure he would appreciate knowing that people out here have his back. (Phone numbers at the bottom if you’d like to call his home office.)

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The Lesson

by digby

Following the post below, Charlie Cook said this earlier on Hardball and USA Today‘s Susan Page agreed. Liberals have been taught a lesson and none too soon:

Page: I actually think that one helpful thing for the administration from these raucous town halls we’ve seen is that liberals who might be very upset by losing the public option may think that health care is in some trouble because it is getting a lot of pushback, and may be more willing to accept a co-op instead of a public option as opposed to getting nothing.

Matthews: So it’s kind of like a rope-a-dope in a weird way, stretching the comparison between Mohammed Ali getting hit until the other guy runs out of juice, the idea that he’s getting hit so hard teaches the left that maybe they’re lucky to get a bill.

Page then went on to also say that it was very important for Democrats to have a bill because they will all suffer if the party has a 60 vote majority in the Senate, a huge majority in the House and a Democratic president and can’t pass this signature bill. Matthews replied, “then they all ought to vote for it.”

This is correct, although not in the way Matthews thinks it is. The Democrats will rise and fall as a party on health care. There is no margin in failure for any Democratic politician in this country, including Blue Dogs. And that is why the progressives, the safest Democrats in Washington, should stand firm and say they will not vote for a plan without a public option. If the administration understands that they will have no plan otherwise, they will have to accommodate their base and twist the arms of enough Blue Dogs and Senate Corporate lackeys to pass it.

The “lesson” of doing otherwise is that all the right has to do is unleash the teabaggers with a pile of unadulterated bullshit and the administration will cave. I know that sounds perfectly reasonable to these villagers, because the teabaggers are what they perceive to be average Americans, but here in the real world, that is a very dangerous lesson indeed.

I can’t speak for other liberals, but the lesson I’m learning from all this is that the administration doesn’t understand that they need to use their majority to pass policies that work for average Americans, which has nothing to do with rope-a-dope, and everything to do with political competence. Here’s the scorecard so far:

Budget: excellent on paper. Who knows what will happen to it.

Stimulus: Punk’d in the congress, empowered presidents Nelson and Collins, w/probably have to come back for more. Expect shrieking teabagging.

Civil liberties and accountability: nearly total sellout

National security: escalation in Afghanistan, faux withdrawal from Iraq, trillions more in spending.

Environment: watered down cap and trade, probable death in the senate

Health care: strategically compromised, wimpering in the face of teabagging, possible sellout.

Immigration and civil rights: one supreme court justice, push off reform until God knows when

Everything listed there, whether as a matter of principle, future political advantage or long term party building is a disappointment so far. I am not looking for perfection and I didn’t expect to get it. But I did think they realized that they needed to get a clear and unambiguous progressive victory on at least one of those things to maintain any kind of fiction that they were fulfilling their promise of change.

The wingnuts are right in one respect. Health care really is his Waterloo. The question is whether he’s Wellington or Napoleon.

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Winning By Losing

by digby

Charlie Cook just said something very profound (which is unusual.) Chris Matthews asked whether or not the Democrats would lose the House next year and he said he didn’t think so, but that they might lose 20 seats. And then he said this:

But arguably the people they would lose would be the Blue Dogs who aren’t voting with [the president] anyway.

I would love to hear anyone tell me why I shouldn’t be cheering for that outcome.

Cook said it would “reflect on” the president, but from my perspective it would reflect well on him. And if it happens because he rammed through meaningful health care reform instead of some watered down bucket of warm spit and the administration managed to get unemployment down, I think he will very likely have Morning in America in 2012.

To hell with Rahm and his appease the Blue Dogs at all costs strategy. What good is it if the president fails in 2012? If Cook is right and the Dems maintain their majority while losing a bunch of these reactionary wingnuts, I couldn’t be happier. And the Democrat should be happy too because it means they can pass successful legislation for a change.

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If They’ve Lost WalMart

by digby

Good news:

Eight more Glenn Beck advertisers, including Wal-Mart – the world’s largest retailer – have confirmed to ColorOfChange.org that they pulled their ads from the controversial Fox News Channel broadcaster’s eponymous show. Allergan (maker of Restasis), Ally Bank (a unit of GMAC Financial Services), Best Buy, Broadview Security, CVS, Re-Bath, Travelocity and Wal-Mart join the dozen other companies who previously distanced themselves from Beck.

Twenty companies have pulled their ads from Beck’s show in just the last two weeks. The moves come after the Fox News host called President Obama a “racist” who “has a deep-seated hatred for white people” during an appearance on Fox & Friends. Previous companies who pulled their ads include ConAgra, GEICO, Lawyers.com, Men’s Wearhouse, Procter & Gamble, Progressive Insurance, RadioShack, Roche, SC Johnson, Sanofi-Aventis, Sargento, and State Farm Insurance.

“We are heartened to see so many corporate citizens step up in support of our campaign against Glenn Beck,” said James Rucker, executive director of ColorOfChange.org. “Their action sends a clear a message to Glenn Beck: Broadcasters shouldn’t abuse the privilege they enjoy by spewing dangerous and racially charged hate language over the air. No matter their political affiliation, hate language doesn’t belong in our national dialogue.”

“Walmart [sic] today confirmed the retailer pulled ads from the Glenn Beck show on August 3rd,” said David Tovar, a spokesperson for Wal-Mart, in an email to ColorOfChange.org.

And even one person can make a difference. Here’s my pal Spocko who relentlessly works to get advertisers to boycott right wing radio in San Francisco:

I thought folks on our side would appreciate hearing some success stories when it comes to pushing back on the right-wing media.

Last week Beach Blanket Babylon and LifetimeTV agreed to stop advertising on KSFO.

The removal of their ads was prompted by letters that I sent at the end of July. (Link to Beach Blanket Babylon letter here) I documented the host’s verbal attacks on gay rights activists. I also documented how the host Brian Sussman actively works to deny gays equal rights. In addition, in my LifetimeTV letter, I pointed out the history of violent rhetoric from the various hosts that were directed toward liberal women.

The advertisers sent a message back to the station. We will not financially support this kind of talk.

Here is an authorized quote from the producer:

“Beach Blanket Babylon will never advertise on any station, like KSFO, that attacks the LGBT community (or any community for that matter) and actively works to deny anyone equal rights.”

Jo Schuman Silver, Producer

This stuff works.

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Mandate For Backlash

by digby

Dean Baker raises a very important point about health care reform without a public option: what happens to the mandate? He argues that for political reasons, if they jettison the public plan, the Democrats should not include mandates either, since they will only line the pockets of the insurance companies until the political pressure becomes so great that a public option will have to be formed anyway. The best thing would be to get rid of mandates now and bring that day closer.

In my view the Democrats are playing with fire in the worst way if they institute mandates without offering any option for reasonably priced insurance. In effect, they will be telling all the people who are currently uninsured that unless they buy unaffordable policies upfront (for which they may receive some money back at the end of the year when they file their taxes) that they must not just live in fear of getting sick — they are now criminals. I can’t think of a more politically inflammatory thing to do at a time like this. And the right will demagogue this thing in a way that makes Sicko look subtle by comparison.

I’ve always thought it was a political risk to create a new law that forced people to give money to insurance companies. It’s worked in auto insurance, but there’s a completely different set of risk factors involved and the costs are much more manageable for the average person. To get rid of the cost control mechanism while keeping the mandate is a recipe for political backlash.

Baker says to drop them:

We know that it will be necessary to revisit health care in the not too future in any case. The lack of mandates will help to ensure that this date comes sooner. Then we can talk about measures that will allow us to control costs, like a robust public plan.

But, if we can’t get a public plan in this round, why should progressives be pushing for a regressive tax that will go into the pockets of the insurance companies and their overpaid CEOs? Let the insurance companies try to make a living in the market, when they grow up and feel strong enough to compete with a public plan, then we can have mandates.

And, if it is necessary to agree to mandates to get insurance reform through this round, then we should at least be clear what is going on. The insurance companies’ employees in Congress will insist on taxing workers to line their bosses pockets.

That’s certainly how it will be framed by the right — and I can’t see how anyone could argue with them. Insurance “reform” will end up being defined as the government acting in concert with the insurance companies to force Americans to buy their expensive product — and it will play perfectly into the right wing populist argument that’s gaining currency. Without a public plan as a low cost option, this thing looks a lot less like reform and a whole lot more like a shake down. I could see the new Newtie Populist Republicans using that against all these Blue Dogs and Corporate Senators in their districts next time and taking them out. Personally, I’d be hard pressed to say they were wrong.

It was never going to be easy to sell mandates, but they are making it substantially harder if they tank the public plan. They’re another bullshit compromise anyway, made before anyone even got to the table, just like single payer — health care should be paid for by higher taxes on the wealthy scumbags who are the only ones winning in this godforsaken economy anymore and the elimination of health insurance’s obscene profits. But in the interest of “going to the middle” the reformers went with mandates and now, without the public option, they’ll be stuck with a regressive tax that’s going to be very politically difficult to defend.

If the administration and the congress can’t be bothered to stick on the public plan, I see no reason why the left should stick with mandates.

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Shoutout

by digby

… to my friend and awesome writer, Batocchio, for filling in last week. Be sure to visit his blog Vagabond Scholar regularly for more words of wisdom.

Update: And, like Mike Stark, I’d like to give a shoutout in solidarity to our union friends who reached out to the netroots this year. It’s an alliance of which I’m proud to a part.

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A Chip They Should Not Bargain

by dday

Everyone’s freaking out about Kathleen Sebelius’ statements about the public option on CNN over the weekend. I’m actually quite pleased that the conversation is moving back toward this, rather than the media obsessing over old conservatives shouting or people holding signs that confirm their ignorance. At least we’re back to the policy. And talking about a health care reform with or without a public option in some way presumes a health care reform law. So maybe the teabagger protests have outlived their theatrical usefulness and everyone’s ready to move on.

As to the specifics: Sebelius said that the public option was “not the essential element” in any reform. Which is of course true, based on the legislation they crafted. A bill where the public option would be an essential element would be a single payer bill. The bill that the White House and Congress put together relies far more on mandates and regulation, with a weak, walled-off public option that can only attract customers from the individual market and select small businesses thrown in to allow for “choice and competition,” in their parlance. It’s MassCare, which, depending on who you talk to, doesn’t constrain costs enough or works pretty well. And MassCare does not have a public option. That part of reform was pretty much always designed as a bargaining chip, in the context of this legislation. And the White House has been bargaining with it consistently over a number of months.

As far as I can tell, there’s been no change in the administration’s position. It has always supported a public plan option. It has never claimed it essential, or the only path to competition in the insurance market. The one deviation came in July, when Obama said the words “must include” in a sentence that also had the words “public option.” But it’s not clear whether he was talking about the health insurance exchange or the public option. And that only happened, to my knowledge, once. That statement, not this one, was the deviation.

Try as we might to pin them down, the White House will never, ever, ever view a public insurance option as essential to passing a bill. Or anything else, for that matter, other than abstractions about “controlling costs” and “providing affordability.” They want something to pass. Something they can call health care reform and tout as a victory after 40 years of defeats. If they think the best path to getting that through Congress is dropping the public option, they’ll enthusiastically endorse such an approach. If they think it’s not dispensable because 64 liberals in the House won’t pass a bill without it, they’ll have to keep it. The space in between, where the House doesn’t compromise any further below a public option and the Senate doesn’t allow anything beyond co-ops, is what Matt Yglesias describes as the legislative dead zone. This is basically the question House progressives must ask themselves:

If it comes right down to it and the senate is prepared to pass a bill that:

(a) subjects insurance companies to tough new restrictions,
(b) taxes employers who don’t provide decent health insurance to their employees,
(c) creates a new regulated marketplace in which individuals and small business employees can buy quality health insurance,
(d) expands Medicaid eligibility, and
(e) offers subsidies to ensure the affordability of insurance for middle class families

I have a hard time believing that House liberals will really kill the bill. But maybe they will.

This is where Mr. Krugman comes in today, comparing the plan on offer to what is occurring in Switzerland, where everyone must buy insurance, lower-income residents get subsidies, and the insurance companies have very strict regulations by which they must abide.

So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

If we were starting from scratch we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

(One thing nobody who endorses this type of plan talks about is the fact that we have no national regulatory framework for health insurance companies, and the regulatory vigor in the states, where they are now regulated, varies widely from one to the other, so the plan on offer would either have to create a large new bureaucracy to accompany that regulation of insurers, or rely on the balkanized state approach. Neither is ideal.)

The public option could be an element of a Swiss-style system, but not the essential one. In essence, there’s very little daylight between what Krugman says and what Sebelius said yesterday. So, what is one to think?

Those trying to minimize the importance of a public option are only looking at the one currently up for discussion, which is not available to anyone who gets coverage through an employer. That’s not really a big enough market to change insurance company behavior anyway, which is why I favor the kind of plan offered by Ron Wyden, where employees can opt out of their coverage and buy into the insurance exchange. In fact, we have historically seen a government program like the public option refined and tweaked once it came into existence, from Social Security to Medicare. So we should not view it as static.

Which is why it’s important to include it now. Sure, the public option could be added in future years as a deficit reduction element, much as MassCare is considering going to fee-for-service medicine after getting their universal system in place. But we’re having the conversation now, and including a government-managed element in isolation down the road would allow everyone to train their guns very directly. This will not be the last health care reform bill in the history of America, but it’s certainly the one with the most potential to codify something like a public option into law. And all the action for doing that is in the Senate – the White House will go along with whatever can pass.

…also, too: this is bigger than health care reform, it’s about the progressive wing of the party being credible on standing their ground. That has implications on a host of issues.

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Deny Me Health Care or Give Me Death

(or, Nazi Commie Illegal Space Aliens are Going to Kill White Grandmas)

by batocchio

(Read the full comic here. Digby’s featured it before, but ya can never get too much Tom Tomorrow. Oh, and be warned this is a long-ish post.)

Angry conservatives are fighting against their own interests, they’re unappeasable, and dishonest politicians are fanning the flames. Yet national Democrats seem terribly shocked by this, as does the media – who then give angry conservatives the microphone. The more liberal perspectives are often lost in the shuffle, of course. We’ve seen this basic story before, although this time it does seem uglier and more dangerous.

I’m curious as to the exact breakdown – how many of the eager mob are birthers? How many believe in death panels? How about internment camps? Where do they draw the line? How many of them supported Bush to the bitter end? How many would score high for authoritarian traits? I would guess there’s significant overlap, but the particulars might be interesting. Is there a guy out there somewhere who’s saying, “Whoa, of course Iraq had WMD and Obama’s a Muslim born in Kenya, but death panels? That’s just crazy!”

During the Bush presidency, some conservatives eventually acknowledged he was a disaster and jumped ship. Others, when pressed, would admit he was horrible, but they remained convinced that those damn Democrats would do far worse. Some conservatives, when pushed, will even admit that Rush Limbaugh exaggerates and sometimes outright lies (Al Franken used to have his childhood friend and dittohead Mark on the radio and present him with Limbaugh’s latest BS). On the other hand, some conservatives think Stephen Colbert is a conservative. And authoritarians will often defend directly opposing beliefs, or insist on a belief in the face of strong contradictory evidence, even when a simpler explanation is available (see Bob Altemeyer’s The Authoritarians, especially pp.120-121). At least one study found that when conservatives were presented evidence suggesting one of their beliefs was wrong, it actually reinforced their convictions. (Perhaps it’s just that social dynamics – the “oh yeah?” reaction – is stronger than empiricism, but conservatives apparently have a stronger affinity for that.)

Social conservatives often put a premium on what they view as the natural social order. Get the right kind of people with the right “values” in charge, and all shall be well (or at least better than it will be otherwise). Authoritarians tend to define right and wrong mainly based on group identity – torture is right when we do it, wrong when done to us, and so on. Re-read Ron Suskind’s classic article on “Faith, Certainty and the Presidency of George W. Bush” and you’ll see similar dynamics. That approach does make decisions much easier, and absolute certainty is comforting in a way the “reality-based community” may not be.

Rush Limbaugh doesn’t provide information as much as flattering confirmation bias for his fans. Most of them probably wouldn’t believe – or simply wouldn’t care – that he just makes shit up. He offers rituals to share grievance and reaffirm tribal superiority. Limbaugh delivers the psychological equivalent of comfort food to the rabid faithful, only in an extended version of the Two-Minute Hate.

To the conservative, right-wing base, Obama is both a socialist and a fascist, and simultaneously a weak appeaser to foreign rulers but a ruthless dictator domestically. Bush’s monarchial power grabs were just fine with them, and anyone who spoke out then was a traitor, but now that Obama’s president, America’s being ripped asunder. Internment camps were once a swell idea, but not now. Elections have consequences, but for the right-wing, only Republican politicians have legitimacy. There’s a range of sincerity to the craziness, of course – Betsy McCaughey’s a vile hack, Sarah Palin’s more of a demagogue, while many in the rank and file believe every evil tale they’re told (and invent new ones). Regardless, they’re bad news, and the conservatives trying as usual to blame their own craziness on liberals and Democrats are particulary loathsome. Journalists pretending that “both sides” are somehow equally hostile, irrational and dishonest is sadly not surprising, but it is highly irresponsible. The ‘Deny Me Health Care or Give Me Death’ movement is fascinating from a psychological standpoint, and may make for good headlines, but oddly enough, the republic doesn’t work very well when the stupidest, meanest, greediest and most dishonest citizens get to set the agenda.

Michael Savage and other conservatives of some prominence are shilling conspiracies about internment camps, but I’m more intrigued by an example Sadly, No caught. Go over and read the piece, but basically, on an airplane flight, a right-wing pastor/blogger sees what he thinks are internment camps. He’s heard some people say they’re for holding illegal immigrants, but he reasons this can’t be, because the government has shown it doesn’t care about that. “To think that the federal government intends to place thousands of illegal aliens in internment camps borders on lunacy,” is probably the best sentence, since the author also imagines the camps may be intended for those the government is suspicious of: “Christians, conservatives, people who support the Second Amendment, people who oppose abortion and homosexual marriage” and so on. Of course he works in a reference to Nazi Germany and concentration camps. At the risk of mischaracterizing his specific flavor of paranoia, I find his assumption about internment camps and illegal immigrants fascinating, and very much in line with many other paranoid right-wingers. I think the mindset is self-feeding, and goes something like this, however unconsciously: Obama can’t be trusted because he doesn’t hate the right people. And surely Obama must hate us as much as we hate him.

As Digby’s pointed out, euthanasia conspiracy theories have been around for some time. Similarly, while I don’t want to diminish what a singular piece of counter-factual, idiotic, craven crap Jonah Goldberg’s Liberal Fascism is, accusing liberals of being Nazis is also a pretty old game. Another Sadly, No post, “Godwin Shrugged,” (Feb. 2009), looked at the The Washington Times’ habit of comparing liberals to Nazis. The specific cause was an uncredited op-ed attacking the Democrats. It claimed that efforts to use computers and standardize medical records were really a “chilling” invasion of privacy designed to spy on Americans. (I’ll note that editor Tony Blankley penned an op-ed, “Yes, we need censorship,” about the dangers of allowing civil liberties – including privacy – the very next goddam day. Yes, they have no coherence, nor shame.) The health care op-ed also suggesting that the Democrats were proposing something “fully in the spirit” of the Nazis’ “euthanasia” program. I’ll get to that in a moment, but Sadly, No’s Gavin M. made some excellent observations:

What we learn today from the Washington Times is that medical records must not be digitized as the Obama plan proposes, but can only exist in paper form because YOU KNOW WHO LIKED EFFICIENCY HITLER THAT’S WHO…

But it’s also the case that these tantrums represent something different to the wingnut mind than to the clinically normal one. To the wingnut mind, or according to the wingnut assessment of what would shock and upset liberals (a nearly identical consideration), the notion of the totalitarian dictator naturally refers to Barack Obama, and to a chain of previous images of Obama-as-cult-leader, Obama-as-false-prophet, Obama-as-Manchurian-Candidate, as usurper, as dictator, as “chosen one,” as false Christ. “Imagine,” the editorial is saying, “If Obama could access our medical records. What would stop him from euthanizing the weak, the so-called ‘unfit,’ or the ‘politically incorrect?’”

It’s not that wingnuts literally believe such things (or care what happens to the weak). They don’t really believe anything in the ordinary sense of the term, but rather make instrumental, conditional use of certain kinds of beliefs, much in the way that other kinds of people make use of thrill sports or porn.

The attraction of extremist politics is that it allows its devotees to indulge irrational, basically infantile impulses; and while the American conservative movement has in a sense chained itself to the devil in becoming a willful gratifier of such impulses, it’s also the case that the wingnut type has no fundamental affinity for conservatism per se, and will switch to any flavor of extremism that will cater to its needs. Wingnuts only care about the drama.

The elements of the wingnut drama are outrage, spite, self-pity, and gloating; and any irresistible fact or narrative will hold the possibility of at least two of these, together or in sequence…

I think there’s a great deal of truth to this, although I would argue that authoritarianism strongly lends itself to conservatism, and both are reactionary to social and economic change, whereas liberals seek change in the name of a more fair society. Additionally, modern movement conservatism is pretty obsessed with gaining and maintaining power, outward displays of aggression and strength, dominating an unequal socioeconomic structure and attacking even basic diplomacy and cooperation as dangerously feminine. Real men bomb the shit out of brown people in foreign lands, because who can tell them apart anyway, and even if they didn’t do anything, they were thinking about it. Plus, surely the ungrateful foreigners we’re “liberating” must hate us as much as we hate them. (And one of them somehow got in the White House, in the greatest conspiracy since global warming!) So, yes, there are definitely crazies who aren’t conservatives, and conservatives who aren’t crazy, although the right-wing political ideology does not have much merit nor integrity. However, especially in contemporary America, it’s not accidental that angry zealots trend conservative.

I did want to address the op-ed’s specific claims about Democrats, Nazis and health care, especially since we’re seeing similar crap these days. Read the whole of “Health ‘efficiency’ can be deadly,” for yourself, but here’s the thrilling conclusion:

There is no telling what metrics will be used to define the efficiencies, but it is clear who will bear the brunt of these decisions. Those suffering the infirmities of age, surely, and also the physically and mentally disabled, whose health costs are great and whose ability to work productively in the future are low. And how will premature babies fare under the utilitarian gaze of Washington’s health efficiency experts? Will our severely wounded warriors be forced to forgo treatments and therapies based on their inability to be as productive as they once might have been? And will the love between a parent and child have a column on the health bureaucrats’ spreadsheets?

Consider the following statement: “It must be made clear to anyone suffering from an incurable disease that the useless dissipation of costly medications drawn from the public store cannot be justified.”

This notion is fully in the spirit of the partisans of efficiency but came from a program instituted in Hitler’s Germany called Aktion T-4. Under this program, elderly people with incurable diseases, young children who were critically disabled, and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the “unproductive” members of society in the most expeditious way possible.

The program was publicly denounced in 1941 by Clemens Galen, the Catholic Bishop of Muenster, who said in a sermon, “Here we are dealing with human beings, with our neighbors, brothers and sisters, the poor and invalids … unproductive – perhaps! But have they, therefore, lost the right to live?”

The efficiency-based approach to health care reform is a betrayal of the compact between those who are most capable of work and those who are least capable of defending themselves. And we have come a long way from what was supposed to be a “targeted, timely and temporary” stimulus bill.

This is shameless fear-mongering, even if The Washington Times portraying itself as the voice of compassion is laughable. Civil rights are very important, but some people don’t care about such things only when a Democrat is president, and the day before they argue against rights. Accusing the Democrats of mistreating returning troopers is especially brazen and hypocritical. Of course, those monstrous Democrats will also destroy the bond between “a parent and child.” Is nothing sacred? Still, I must say portraying as evil efforts to make our horrible health care system more “efficient” is pretty ingenious propaganda. The Nazi analogies are particularly appalling, though.

It just so happens I have a post on the Nazi T4 “euthanasia” program right over here. (it was for International Holocaust Remembrance Day, 2008.) For the Nazis, euthanasia and “mercy killings” were really murder, of course. They started with sterilization of ‘undesirables,’ then moved to murder, with the T4 program providing a ghastly test run for the later series of death camps and methods of murder such as gassing. They used propaganda, including a number of films, to try to sell murder to the public (alas, I could only provide two clips). Invoking the Nazis and their “euthanasia” program does not ultimately work in conservatives’ favor. For one thing, in their propaganda, the Nazis deliberately conflated voluntary euthanasia (suicide or assisted suicide) with involuntary “euthanasia” (their murder program). For another, they warned of the dangers of “inferior” people out-breeding “higher quality” people. Additionally, they continually expressed outrage over the cost of caring for the supposedly inferior, as in: “60,000 Reichsmarks is what this person suffering from hereditary defects costs the People’s community during his lifetime. Fellow German, that is your money too.”

Our current political battles are very different, of course. But if we must make comparisons, it’s not really a secret which side is conflating personal end-of-life decisions with murder, who’s talking about white people being outbred, who’s expressing outrage over the cost of providing health care for the uninsured, who’s talking about the country being tarnished by the unworthy, who’s for letting people die in the street and who’s praising Hitler as a role model. Obviously, conservative opponents of health care reform are not Nazis or anywhere near as bad. Screaming that a living will is a murder plot, that some people deserve to die or fighting to deny Americans health care is callous, unconscionable and even evil, but it’s nowhere near the evil of state-sponsored murder and genocide. (I’ve also got an older post about the value and limitations of Godwin’s Law, if that’s a concern.) Invoking the Nazis shouldn’t work in conservatives’ favor – but it’s not likely it will stop. And as long as that prevails, and the craziness and demagoguery continues, it’s important to call it out, from the usual skullduggery to hate speech to proto-fascist stirrings. We might not be “there” yet, but standing up for civil rights, good government and decent treatment of everybody tends to head it off at the pass. The current insanity shouldn’t go unchallenged.

The diehard right-wingers view Obama as a dangerous usurper – they can all agree on that. The only real question among themselves is what boxes they check off on their hate list – Democrat, liberal, black, Muslim, foreign-born, socialist, fascist, trying to take your guns, trying to kill grandma, trying to put conservatives in camps, trying to give the unworthy health care on your dime… It’s just slightly different flavors of bullshit from the hacks and varying flavors of batshit from the zealots.

However, far more Americans can agree that our current health care system is often atrocious, and many people know someone with a health care horror story, or have their own. Their stories should be told. Every “death panel” lie should be called out, and countered with a piece on Remote Area Medical or something similar. Instead of phantoms and paranoia ruling the day, attention must be paid to this struggle’s many human faces.

I don’t say he’s a great man. Willie Loman never made a lot of money. His name was never in the paper. He’s not the finest character that ever lived. But he’s a human being, and a terrible thing is happening to him. So attention must be paid. He’s not to be allowed to fall in his grave like an old dog. Attention, attention must finally be paid to such a person.