Digby's Hullabaloo Posts

The American Health Care System

by digby

A friend of mine took this picture in Nebraska last summer:

I guess that’s one form of employer based health insurance.

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Take A Walk Outside

by digby

…It’s the 4th of July

And keep in mind that no matter how gloomy things may seem, at least this we don’t have to put up with this:

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Kumbaaya In A Box

by digby

From Ceci:

President Obama, strategizing yesterday with congressional leaders about health-care reform, complained that liberal advocacy groups ought to drop their attacks on Democratic lawmakers and devote their energy to promoting passage of comprehensive legislation. In a pre-holiday call with half a dozen top House and Senate Democrats, Obama expressed his concern over advertisements and online campaigns targeting moderate Democrats, whom they criticize for not being fully devoted to “true” health-care reform. “We shouldn’t be focusing resources on each other,” Obama opined in the call, according to three sources who participated in or listened to the conversation. “We ought to be focused on winning this debate.” Specifically, Obama said he is hoping left-leaning organizations that worked on his behalf in the presidential campaign will now rally support for “advancing legislation” that fulfills his goal of expanding coverage, controlling rising costs and modernizing the health system. In the call, leaders of both chambers expressed optimism that they will hold floor votes on legislation to overhaul the $2.2 trillion health system before Congress breaks in early August. For his part, the president vowed to use his strong approval rating with voters to continue making the case for sweeping reform, according to one congressional staffer with knowledge of the conversation. Obama also hinted that efforts are under way to discourage allies from future attacks on Democrats, according to the source, who did not have permission to speak on the record about the discussion.

God I hate it when politicians insult your intelligence right to your face. That simplistic kumbaaya bullshit is about as useful as telling us to join hands and think happy thoughts and then we’ll all have health care. I hated it when george W. Bush spoke to the public as if they were 5 year olds, but at least it was clear that he actually thought like a 5 year old himself. When Obama does it, it’s infuriatingly condescending. (These comments remind me of a month or so ago when the white house official was asked by a reporter why the insurance companies were offering up all these cost savings and replied, “because they’re good Americans.”)

All you have to do is read the paper to know that the people standing in the way of any workable health care reform are mushy, centrist robots and insurance company whores in the Democratic Party. We have the majority, the Republicans are imploding, there is no debate at the moment among anyone but Democrats. In the middle of this hot negotiation, putting ads on the air that say “let’s get some health care!” is a joke.

I suspect that the truth is that he thinks he’s clumsily triangulating. But the groups that he’s criticizing are actually trying to support his position on the public plan and attacking them undermines the public plan as well. (Of course, it’s always possible that’s the intention, but I hope not.)

The problem is that triangulation is for the purpose of positioning the president between two poles in the debate. He’s just set one of the poles as the public plan, which says to certain wobbly Senators that it’s negotiable. I would have thought the better way to deal with this is to assure these congressional twits (who gladly ate tremendous amounts of shit from right wingers for years, but get livid at the tiniest criticism from the left) that he isn’t endorsing any of these attacks, but that there’s not much he can do about it. It’s a free country. These waverers might just realize that he’s serious about getting a public plan without him having to explicitly tell them so.

By now it’s obvious that dismissing and humiliating the base is a conscious White House strategy and I’m sure it’s sometimes quite useful, even though it’s a distinctly unsavory political tactic (and one that erodes support over time.) But in this case, if they really want health reform, it’s counterproductive. He needs the outside groups to play this role and by publicly reprimanding them he’s undermining these groups with their already skittish donors — and the cause itself.

But again, that’s assuming that’s not exactly what they want to do. If they want to undermine the public plan then this is one good way to do it.

Update: FYI, I am aware of Ceci’s perfidious antics. I wrote about it just last week. She is a Village kewl kid through and through. But it pays to remember that the Village is now in Democratic hands.

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For Our Own Good

by digby

This is interesting:

The military officers who rushed deposed Honduran President Manuel Zelaya out of the country Sunday committed a crime but will be exonerated for saving the country from mob violence, the army’s top lawyer said.In an interview with The Miami Herald and El Salvador’s elfaro.net, army attorney Col. Herberth Bayardo Inestroza acknowledged that top military brass made the call to forcibly remove Zelaya — and they circumvented laws when they did it.It was the first time any participant in Sunday’s overthrow admitted committing an offense and the first time a Honduran authority revealed who made the decision that has been denounced worldwide. ”We know there was a crime there,” said Inestroza, the top legal advisor for the Honduran armed forces. “In the moment that we took him out of the country, in the way that he was taken out, there is a crime. Because of the circumstances of the moment this crime occurred, there is going to be a justification and cause for acquittal that will protect us.”

I think this is a natural outgrowth of the example the US has set over the past few years. People no longer believe that the rule of law is something they must adhere to as long as they can justify their actions as being done to “protect the country.” I suppose it was always so, but America has made a fetish out of this excuse through this decade so I think it’s taken on a new veneer of legitimacy. Certainly, it has made it impossible for any American leader to condemn this sort of thing with even the slightest bit of credibility.
This is the paternalistic view espoused by Henry Hyde during the Iran Contra scandal, in which he claimed that if the executive broke the law for the good of the country it wasn’t a crime. (He said this to justify his view that Reagan’s breaking of the laws was ok while Clinton allegedly lying in a deposition was an impeachable offense.) I suppose this concept is also an outgrowth of Nixon’s famous statement that if the president does it it’s not illegal. When President Nixon said that, however, it was shocking to average people. However obvious it was in practice that presidents routinely evaded the power sharing intent of the constitution, very few people thought it was a good thing that the president actually wasn’t required to follow the rule of law. I’m not so sure about that now. For the last several years, many people have been saying that the president has to do whatever’s necessary to keep the country safe. That’s what both Bush and Obama say to justify something like preventive detention and that’s what the Honduran military says it was doing when it deposed a democratically elected president. (Cap’n Ed called it a “military impeachment.”) And it seems to me that people are beginning to accept this idea — when it comes to national security, the president and the military must not be limited by such prosaic concerns as the constitution. Someone might get hurt and that must be prevented at all costs.
Once again, I think we have to ask why, as an individual American, that logic wouldn’t then apply to other things. Why should the government be hindered by the rule of law at all when lives are at stake? The police and the FBI and the DEA and the ATF and Homeland Security and the Border Patrol and any of the other agencies in the vast security state apparatus should not be hindered in their jobs to keep Americans safe any more than the president is hindered in keeping America safe from terrorists. Certainly, I can’t understand how you could take a chance that someone like Charles Manson or Tim McVeigh or some sociopathic gang member might be released back onto American streets, but the mere possibility that a terrorist suspect could be free anywhere in the world precludes them even having a trial. It makes no sense.
Implicit in the constitution is the understanding that we cannot be safe from all dangers — and that one of the gravest dangers to our safety is a government which does not respect civil liberties and the principles of democracy. This “protect at all costs” mentality stands that on its head. Once you say that the government doesn’t have to adhere to the rule of law for the good of the country, the whole thing loses its meaning — and unpredictable things start to happen. Like “military impeachments.”

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Ammo

by digby

The Urban Institute has released a study on the public plan option that should be of interest to those who are following this debate. They focus on the competition factor, particularly on the fact that consolidation and concentration have already made any complaints on that count moot, something we’ve written about here a few times:

This paper makes the argument that a public plan is important to health reform because it will contribute to cost containment, primarily by addressing problems caused by increased concentration in insurance and hospital markets. We describe how the public plan might be structured, how many people might be expected to enroll, and how much money the public plan might save. We discuss the most frequent arguments that are made in opposition to the public plan. We conclude that the private insurance industry would survive at about the same size but be more efficient and more effective in controlling health care spending.

Unfortunately, the debate over whether to provide a public health insurance option as a competitor to private plans under comprehensive health care reform seems to have become an ideological litmus test. Conservatives are fervently aligned against the option while liberals are as strongly in favor it. Those who oppose it fear that the public plan will have so many inherent advantages that private plans will be unable to compete, eventually leaving the system entirely in government hands by destroying a competitive insurance market. Supporters believe that a public plan is a critical fallback option in a universal system that would cover many high-need and low-income groups.

The arguments around the public plan too often ignore what we believe is the central reason for including a public plan as a component of reform: that health insurance markets today, by and large, are simply not competitive. And as such, these markets are not providing the benefits one would expect from competition, including efficient operations and consequent control over health care costs. We believe that the concentration in the insurance and hospital industries that has taken place over the past several years has been a significant contributor to this problem. The role of the government plan is to counter the adverse impacts of market concentration and, in doing so, slow the growth in health care costs.

In this paper, we first describe problems with competition in current insurer and provider markets, in particular focusing on the implications of consolidation in both markets. We then discuss how a public plan could help address these problems. Next, we examine how a public plan might be structured and how much money a plan might save. We address how large the public plan would be and what impact it would have on the current private insurance industry. We then examine the most common arguments against the public plan. We conclude by arguing that private insurance plans would survive but be more efficient and more effective controlling health care spending.

The survival of the insurance companies isn’t something I personally lose much sleep over, but this info might be useful to those who need to refute the idea that the insurance companies will all be driven out of business if they are forced to constrain their enormous profits and pay their CEOs less than 15 billion dollars in compensation.

* United Health Group
CEO: William W McGuire
2005: 124.8 mil
5-year: 342 mil

* Forest Labs
CEO: Howard Solomon
2005: 92.1 mil
5-year: 295 mil

* Caremark Rx
CEO: Edwin M Crawford
2005: 77.9 mil
5-year: 93.6 mil

* Abbott Lab
CEO: Miles White
2005: 26.2 mil
5-year: 25.8 mil

* Aetna
CEO: John Rowe
2005: 22.1 mil
5-year:57.8 mil

* Amgen
CEO: Kevin Sharer
2005:5.7 mil
5-year:59.5 mil

* Bectin-Dickinson
CEO: Edwin Ludwig
2005: 10 mil
5-year:18 mil

* Boston Scientific
CEO:
2005:38.1 mil
5-year:45 mil

* Cardinal Health
CEO: James Tobin
2005:1.1 mil
5-year:33.5 mil

* Cigna
CEO: H. Edward Hanway
2005:13.3 mil
5-year:62.8 mil

* Genzyme
CEO: Henri Termeer
2005: 19 mil
5-year:60.7 mil

* Humana
CEO: Michael McAllister
2005:2.3 mil
5-year:12.9 mil

* Johnson & Johnson
CEO: William Weldon
2005:6.1 mil
5-year:19.7 mil

* Laboratory Corp America
CEO: Thomas MacMahon
2005:7.9 mil
5-year:41.8 mil

* Eli Lilly
CEO: Sidney Taurel
2005:7.2 mil
5-year:37.9 mil

* McKesson
CEO: John Hammergen
2005: 13.4 mil
5-year:31.2 mil

* Medtronic
CEO: Arthur Collins
2005: 4.7 mil
5-year:39 mil

* Merck Raymond Gilmartin
CEO:
2005: 37.8 mil
5-year:49.6 mil

* PacifiCare Health
CEO: Howard Phanstiel
2005: 3.4 mil
5-year: 8.5 mil

* Pfizer
CEO: Henry McKinnell
2005: 14 mil
5-year: 74 mil

* Well Choice
CEO: Michael Stocker
2005: 3.2 mil
5-year: 10.7 mil

* WellPoint
CEO: Larry Glasscock
2005: 23 mil
5-year: 46.8 mil

* Wyeth
CEO: Robert Essner
2005:6.5 mil
5-year: 28.9 mil

TOTAL 2005: 559.8 mil

TOTAL 5-Year: 14.9 billion

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Bizarre

by digby

Gov. Sarah Palin will resign her office in a few weeks, she said during a news conference at her Wasilla home Friday morning.

Lt. Gov. Sean Parnell will be inaugurated at the Governor’s Picnic at Pioneer Park in Fairbanks the weekend of July 25, Palin said.

There was no immediate word as to why she will resign, though speculation has been rampant that the former vice presidential candidate is gearing up for a run at the 2012 Republican presidential nomination.

Palin made the announcement flanked by Parnell and most, if not all, of her cabinet.

Why not serve out her term? The presidential election doesn’t begin for at least another two years. Wouldn’t it be better to have a full term as governor of Alaska under her belt? In fact, I assumed she’d want to run for governor again so she could run for president as the second term Governor of Alaska. Give her a tiny bit of gravitas, which she badly needs.

I guess the base loves her so maybe all she has to do is run the megachurch and teabagger circuit for the next three years to get the nod. Who knows what the path to GOP leadership is these days? But whatever she does, it looks like she’s going to do it her way. It should be fascinating to watch.

Update: And by the way, to those who insist that Palin hasn’t governed as a social conservative, this pretty much proves otherwise.

And I don’t know if you saw her press conference, but I almost expected her to start babbling about soul mates and David and Bathsheba. The Republicans are getting more deeply weird every day.

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Talk And Action

by digby

Thank you all for being so generous with your time, comments and donations to Blue America’s Campaign For Health Care Choice and our project to tell Finance Committee Senator Blanche Lincoln that health care reform without at least a public plan is no plan at all. Now that the HELP Committee has released its report and all the Democratic Senators have committed to it, the action moves to Finance — and Blanche Lincoln is one of the only Senators on that committee who is up for reelection in 2010. Next week she’s going to be hearing from her constituents about her unwillingness to back a quality public plan.

You’ve been amazingly supportive and we appreciate it. You can still vote for the ad of your choice by clicking here.

But we aren’t the only ones doing this sort of thing. Change Congress is also pressuring Mary Landrieu to support a public plan. Landrieu has been pretty strident and explicit in her condemnation of the public plan choice, but needless to say, if there was ever a state that needs more support, not less, it’s Louisiana. It’s outrageous that she would stand in the way of health care reform:

And the PCCC, DFA and Move On are running an ad in Washington DC with the names of thousands of people who are asking for a public option. You can ad your name to the ad here.

Finally, MoveOn is running this one in California, which is giving Difi heartburn. (The other day she sniffed that it “wasn’t helpful,” which means, it wasn’t helpful to her. And that, of course, is the point.)

Adam Green has written about the various ad campaigns at Open Left today.

Obviously, nobody knows what’s going to come out of the legislative meat grinder yet. Everything is very fluid. (What happened to those co-ops?) The devil, as always, is in the details and the details are changing every day. But we’re hopeful that we can help guide the basic contours of the debate with this insistence on the inclusion of the public plan. We’ll see what happens.

It’s going to be a long hot summer.

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He Used To Be The Caucus Whip, Right?

by dday

Harry Reid explains why, I’m guessing, that was a bad fit for him:

Reid says he expects the tactic of gentle persuasion to work best, given the size of his Senate Democratic flock and the political divergences within it. “I don’t dictate how people vote,” he said in an interview this month. “If it’s an important vote, I try to tell them how important it is to the Senate, the country, the president … But I’m not very good at twisting arms. I try to be more verbal and non-threatening. So there are going to be — I’m sure — a number of opportunities for people who have different opinions not to vote the way that I think they should. But that’s the way it is. I hold no grudges.”

I’m sure that other Senate Democrats would say that this style works well – for them. They don’t get pestered into votes they don’t like to take, they don’t have any consequences for their actions on the floor of the Senate.

But Lyndon Johnson just came back from the dead, read this profile, and stabbed himself in the heart.

Democratic politicians of this age like to speak about raw numbers and votes and lament the lack of the same. Even in this age of 60 Democratic votes, Reid in particular has worked overtime to downplay the significance, in that gentle, not arm-twisting manner of his. Of course, the facts are that 60 votes are only required to end debate, not for every particular bill. And participation in the caucus should mean, almost by definition, not joining in filibusters from the other side.

If I’m not mistaken, there was at one time at least some power in the office of Majority Leader of the Senate, after all. There are committee assignments to dole out, and decisions on funding vulnerable incumbents, or appearing in their states, and legislation that wayward members might need to get to the floor, among other things. There are a whole set of incentives that can work in both directions – carrots and sticks, in the vernacular. Harry Reid’s a carrot man in a stick world. And the carrots haven’t exactly been enough.

The only person who seems to understand the power of the office of Majority Leader is someone who isn’t even in the party, Bernie Sanders, who gets that you can demand the caucus not to participate in Republican filibusters, which would necessarily end them. As soon as we get 40 or so more social democratic-leaning independents in the Senate, I nominate Sanders for Majority Leader. He seems to know what to do with the job.

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One From Column A

by digby

One of the best arguments in the health care debate is the one that says every American should get the same health plan that members of congress have. Taxpayers pay for it so why shouldn’t they be able to choose the same plan?

Just for informational purposes, for those who may not know, here’s a brief primer on what we’re already paying for:

As soon as members of Congress are sworn in, they may participate in the Federal Employees Health Benefits Program (FEHBP). The program offers an assortment of health plans from which to choose, including fee-for-service, point-of-service, and health maintenance organizations (HMOs). In addition, Congress members can also insure their spouses and their dependents. Not only does Congress get to choose from a wide range of plans, but there’s no waiting period. Unlike many Americans who must struggle against precondition clauses or are even denied coverage because of those preconditions, Senators and Representatives are covered no matter what – effective immediately. And here’s the best part. The government pays up to 75 percent of the premium.

That looks like a public plan worth having to me.

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