Month: February 2010

Equally Earnest

by digby

I’m not questioning the CBO’s quality, I’m questioning their reality. Representative Paul Ryan.

As a good liberal political junkie I watched the summit today and saw Democrats staying within the bounds of reality in discussing the various ideas on the table and I saw the Republicans making things up. The president was in command of the facts, competently defended the Democratic position and successfully batted back many of the GOPs misrepresentations. The Republicans were effective in repeating their usual talking points and non-sequitors.

However, if I were to tune in to this summit without having a fairly good grasp of the politics in play, I’m afraid I might come away from it thinking that both sides are equally earnest in trying to fix the problems with our health care system and they both have equally good ideas. After all, they told us that all day and the picture of these people all sitting around a table politely exchanging ideas creates that appearance. But the fact is that the substantive disagreements between the two parties represent more than an abstract philosophical difference of opinion. They represent a hardcore, political impasse.

Much, as always, depends on how the media chooses to frame this summit, but I’m afraid that many people are nonetheless likely to be left with the impression that problems passing this bill are the result of Democrats refusing to put all these neat Republican ideas into the mix — and if they can just agree to do that, we can all hold hands and sing kumbaaya. This is, of course, nonsense. Republicans do not want to pass any health care reform that will be signed by President Obama and even if he agreed to implement their ideas in whole cloth and call it day, they still wouldn’t vote for it. In fact, even if a Republican president were in charge, conservatives of both parties don’t want health care reform except to the extent it reduces the current inadequate safety net and loosens existing regulations. They basically say that the answer to this problem is to eliminate physician liability, allow people to buy insurance across state lines, require Americans to get healthier and make them shop around for cheaper services in order to bring down costs. There’s really not much more to it than that. (Senator John Barasso, a medical doctor, even said that patients who have only catastrophic insurance are the best patients because they have to consider whether or not they can afford tests when they get sick.)

The fact remains that Republicans and certain conservative Democrats are bad faith players in this process. They have no serious plan to fix the health care system but this summit’s optics may have led people to erroneously believe they do. And rather than helping speed the momentum to pass the plan through reconciliation by sharpening the differences, I am afraid that this meeting may have slowed it down. And that may, unfortunately, lead inexorably to “Plan B.”

We’ll have to wait to see what the mainstream media highlights to know if the unctuous disingenuousness of the Republicans will be obvious for all to see. Let’s hope so.

Update: Gergen just said that the Republicans just had the best intellectual day they’ve had in years, especially our cutest li’l Randian, Paul Ryan. Oy vey …

Update II: Cilizza thinks the Republicans did pretty well — except for McCain, of course, who is the new GOIP sin-eater.

And Ryan really is the new “it boy.” It must be the village’s version of “going Galt.”

Update III: Media Matters has collected Republican comments to the media throughout the day. Here’s one example:

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Nothing But A Dirty Stinking Blogger

by digby

Gawker breaks the news:

Erik Wemple nailed down WaPo editor Marcus Brauchli’s decision on this after yesterday’s exciting “Will Sally Quinn Totally Get Canned, Please Lord?” rumorizing. Wemple says Brauchli was pissed that Quinn’s latest “Let me tell you some stuff about my family” column ran, and has now declared that in the future her column “will appear online at ‘On Faith,’ a section of washingtonpost.com that Sally guides.”

I’m looking forward to her posts about proper pajama attire and delicious cheeto canapes.

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Steele Trap

by digby

C&L made a great catch:

STEELE: This whole dog and pony show that we’re about to witness today is something that should have taken place a year ago, when the administration first came in last February and laid out its agenda for health care. This is how you should have started it – bipartisan, public forum, CSPAN, your cameras rolling to capture this and to capture, most importantly, what the American people want. And right now, they want us to start over, and I think we should.

TODD: Chairman Steele, in fairness to them, I mean, it was a year ago that they actually had a summit.

GUTHRIE: On March 5th.

TODD: And it wasn’t just the legislative leaders. They brought in folks from the industry as well. And that one was televised. So…does that one not count? I’m just curious.

STEELE: Well, apparently it didn’t. Because we don’t have health care.

Ayeyayyay.

He has a point about us not having health care. But I think the bigger one is that holding these summits doesn’t automatically translate into legislation. And if they are dull and lifeless, they don’t translate into public persuasion either.

Perhaps today will be different, though. The gasbags seem to be fixated on McCain and Obama’s spat, but that might end up being a good thing if it illustrates hows batty and combative the Republicans are in contrast to the president.

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Howzit Going?

by digby

I have been watching the health care summit all morning and I think Obama has been quite effective in parrying the combative Republicans while staying above the fray. On the overall optics of the event, I’m not sure it’s going to move anyone. The anti-HCR people will cheer their leaders for standing up while the other side will praise theirs for holding fast.

Louise Slaughter’s speech was impassioned, which I thought was refreshing. She simply related instances in which the government has had to intervene over the years in order to change inequities in the health care system. She used examples pertaining to women’s health but the broader point about government’s role was even more powerful.

In all the talk today about “philosophical differences” Slaughter was one of the only participants who really got beyond the soundbites and expressed how the liberal philosophy works in action. It’s always good to tell personal stories and anecdotes, but it would be very useful if more Democrats could tell this kind of anecdotes as well — instances of government stepping in to fix systemic institutional problems. More of this please.

Naturally, the pundits are all obsessing on the McCain exchange, which IMO only helps the president since it seems that nobody likes McCain anymore, not even his constituents. (It was very enjoyable watching that exchange on the Sunlight Foundation site, in which McCain railed against the sweetheart deals and big money influence as his major donors scrolled down the page next to him.)And Obama was right to put a stop to his pontificating by pointing out that the election is over. He may be a fixture on the Sabbath Gasbag shows, but he is just another Senator in this meeting.

So far so good, at least on the optics. As for the substance? Well … it wasn’t really designed for substance, now was it?

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The Prevention Fallacy

by digby

There’s a liveblog happening over at HuffPo (in which yours truly is participating) that featured this observation by Jay Bhattacharya, M.D., Ph.D. Associate Professor of Medicine, Stanford University:

The unfortunate fact is that, according to the health economics literature, even if we expanded prevention substantially and according to the best available evidence, total health care expenditures would not decrease and in many cases would increase.

This is for two reasons. First, preventative interventions, by their very nature, needs to be applied to a broad population to be effective. Most of that population will derive little benefit from those interventions because they would never get the disease even in the absence of the interventions. Childhood vaccines are a good example of this. Of course, the extent to which is true depends on the particular intervention being considered, but the principle applies to all preventative activities. In order to prevent one person from getting sick, we need to apply the intervention to more than that one person. This fact greatly increases the costs of prevention.

Second, no matter how successful prevention is in reducing disease, no such intervention confers immortality. Everyone will eventually die of something. This obvious point has an important corollary, which is best illustrated with an example. Suppose we could find a way to prevent cancer entirely. Such an intervention would without a doubt increase the incidence of heart disease since more people would be alive to get heart attacks. This consideration is obviously most important for prevention applied to older people. In some simulation work that I have done, I have found that even if we found a way to prevent all cancers for free (and we are far from such an incredible technology), Medicare costs would fall by only a small amount.

None of this should be taken to mean that we shouldn’t expand prevention. It’s just that the benefits of such an expansion, which in some cases could be considerable, will not come for free.

Of course prevention is a good thing in its own right. Any less suffering or fewer early deaths is a good thing. But it won’t cut overall health care costs because everyone is going to die of something eventually.

This was Tom Coburn’s big cost saving idea (along with eliminating waste fraud and abuse.) But we should keep in mind that Dr Coburn believes that the answer for sick people who’ve been left to fend for themselves should beg their neighbors to help them because the government is never the solution.

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Who Needs Health Care Reform?

by digby

Hey, no hurry. This kind of thing only affects a few million losers in the private insurance market so to hell with ’em:

Executives from California health insurance giant Anthem Blue Cross, under fire for scheduled rate hikes of up to 39%, insisted Tuesday that their premiums were fair and legal, and they told lawmakers they expected that the increases would go forward.

Appearing before the state Assembly’s health committee, the officials said that they believed rate increases for individual health insurance policies, delayed until May 1 while being reviewed by the Department of Insurance, would survive scrutiny by regulators.

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Livestream Of The Summit

by digby

And this brilliant app from the Sunlight Foundation should be very helpful. As each participant speaks, it shows who their donors are.

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Skin In The Game

by digby

Those on the left side of the dial often find themselves on the defensive and believe they have to “move right” in order to win. The question becomes which issues will they choose to make their move with. Unfortunately, the easiest one seems to be to appease the conservative church and stick it to the women. Here’s a good case in point, if a little extreme:

As Marxist rebels in the 1970s and as a revolutionary government in the 1980s, the Sandinistas championed women’s rights – including limited abortion rights.

After losing power in 1990 their veteran leader, Daniel Ortega, embraced Catholicism. When making a comeback in a tight 2006 election he joined conservative foes in backing a church-led iniative for a total abortion ban. There are no exceptions for rape, incest or health risks to the mother. Even an anencephalic or ectopic pregnancy, which are incompatible with life, must be carried to term.

Women’s rights are often deemed to be a necessary bargaining chip. You know, sometimes, you just have to be willing to sacrifice for the greater good.

Oh, by the way, here’s the result of Ortega’s political tack to the right:

Nicaraguan authorities have withheld life-saving treatment from a pregnant cancer patient because it could harm the foetus and violate a total ban on abortion.

A state-run hospital has monitored the cancer spreading in the body of the 27-year-old named only as Amalia since her admission on February 12 but has not offered chemotherapy, radiotherapy or a therapeutic abortion, citing the law.

The decision has ignited furious protests from relatives and campaigners who say the woman, who has a 10-year-old daughter and is 10 weeks pregnant, will die unless treated. The cancer is suspected to have spread to her brain, lungs and breasts. They have petitioned the courts, government and the pan-regional Inter-American Commission on Human Rights to intervene.

It’s a shame she has to take one for the team, but at least this way they didn’t have to sacrifice the really important items on Ortega’s agenda.

Speaking of which, here’s the latest from Amy Sullivan on Stupak and what it’s going to take for us to get health care reform. It’s funny, but I haven’t heard anyone pounding Stupak for being selfish for putting his personal beliefs before the needs of all the millions who will benefit from HCR. How odd.

h/t to Americablog

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Ew

by digby

Limbaugh goes kinky. Again:

It all started when Rush took a call from another fan who was mad at him for “going after Glenn Beck,” something Rush hotly disputed. See, Rush has had a flood of calls and emails recently from fans who are disappointed that he hasn’t realized that the GOP is as bad as the Democratic Party. Rush expressed his extreme frustration that this faction of his fans think he’s gone astray. In order to solve the problem, Rush did what he assumed this faction of his listeners want to do to him: he spanked himself. Rush promised that it was going to be a treat for those of us watching the ditto cam, but we at the Limbaugh Wire are here to say: It. Was. Not.

Never one to waste a moment of sexism, Rush added that he “could have done that while looking at a photo of Hannah Storm.”

Not that I care what consenting adults enjoy in their own private kinky world. But remember, this is a guy who thought the Abu Ghraib horrors were “blowing off steam.”

Thank God there’s no video of him spanking himself. I just ate.

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Paying With Fairy Dust

by digby

Over at Salon John Sides has posted a graph illustrating an important point about what someone has dubbed the “conflicted conservatives,” people who say they believe in cutting go government spending but who can’t name a program they would cut.

Very few conservatives said they favored reducing (or cutting out altogether) spending on any program. The least popular program proved to be childcare — with a grand total of 20 percent of conservatives saying they’d slash it. The most popular is highways; only 6 percent want to cut spending there. Even bugaboos like welfare and foreign aid fare well, attracting the ire of only 15 percent of conservatives. Amazingly, the survey found that, on average, 54 percent of them actually wanted to increase spending.

Political scientist James Stimson has suggested that a fifth of the country consists of what he calls “conflicted conservatives,” those who might respond positively to a broad appeal like Pawlenty’s, but not once specific windows start getting smashed.

I think this may be one situation where “welfare reform” deprived these people of a much needed boogeyman. I think had this been done a couple of decades earlier a much larger percentage of these same people would have chosen it. It’s just that it’s getting harder to find programs that benefit the “lazy and undeserving” poor, mainly because they’ve been eliminated during this period of conservative rule. Now these questions hit closer to home. Even nice law abiding white people would be harmed.

I think calling them conflicted is being a little bit too polite. The proper term for these people is “free lunch” conservatives. The one thing these people really care about is taxes, which they think are evil and believe they should never have to pay. They actually like the spending on programs from which they all benefit, which is why they are so gleeful about these “fleecing of America” earmark stories — there’s some spending which clearly benefits someone else and so it is safe to call it “wasteful.”

Maybe we could be a bit more polite and just call them “magical thinking” conservatives, but “conflicted” would imply that they feel some sort of dissonance, and it’s quite clear that they do not. They truly believe that government should provide all the services they use but that nobody should have to pay any taxes to support it.

I believe it’s the central economic difference between liberals and conservatives. We all like the welfare state and want more of it. They just think it should be paid for with fairy dust and we think progressive taxation is the more logical choice. Sadly, the political system has chosen to go with fairy dust. It’s more marketable.

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