Category: Health care

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Barack Obama Criticism Domestic issues Health care Politics The Opinionsphere

Ezra Klein: Health Care Blogger Extraordinare

Ezra Klein has been my essential read during the health care debate. Today, he makes a few important points:

  1. Regarding Obama’s Campaign Health Care Plan. “The health-care bill that looks likely to clear the Senate this week is not very close to the health-care bill most liberals want. But it is very close to the health-care bill that Barack Obama promised.”
  2. Regarding Senate Collegiality. “Another example came last night, when the ailing Robert Byrd was wheeled in at 1 a.m. to break a filibuster on the manager’s amendment. Byrd’s presence was not required, especially considering that he’d clearly telegraphed his intention to vote to break the filibuster. But Republicans forced him to travel to the chamber. Indeed, shortly before he arrived, Sen. Tom Coburn headed to the floor to propose a prayer. ‘What the American people ought to pray is that somebody can’t make the vote tonight,’ he said. ‘That’s what they ought to pray.’ “
  3. Contra Jane Hamsher’s 10 Reasons to Kill the Bill. “Some of the list is purposefully misleading and is clearly aimed more at helping activists kill the bill than actually informing anyone about what is in the bill. Some of it points out things that really should be changed in the bill but aren’t central to the legislation itself, and are simply being leveraged to help activists kill the bill. But maybe there’s some utility to putting the document in context.”
  4. Citing the Creator of the Public Option, Jacob Hacker. “As weak as it is in numerous areas, the Senate bill contains three vital reforms. First, it creates a new framework, the “exchange,” through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted. Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans. These are signal achievements, and they all would have been politically unthinkable just a few years ago.”
  5. Regarding the President’s Role in Shaping Legislation. “The Obama administration has played a seriously inside game here, acting more as an accessory of the legislative branch than as the great figure of health-care reform that many of its supporters had expected. That is, in my view, the right way to understand the president’s role in the system, but it’s left a lot of the campaign’s supporters feeling a bit betrayed, particularly given that the Obama campaign was uncommonly aggressive on presidential pomp and dramatic speeches. Obama’s supporters don’t feel like the president lost to Lieberman along with them. They feel, instead, like the president cut them and their hopes loose.”
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Barack Obama Criticism Health care Politics The Opinionsphere

Paul Krugman Attempts to Fill Ted Kennedy’s Shoes

[digg-reddit-me]Ezra Klein had a smart bit of analysis about the role Ted Kennedy could have played on health care were he still with us:

If you know the health-care debate really well, it means a lot to say that Jay Rockefeller and Sherrod Brown support this bill. If you don’t know the debate very well, it means virtually nothing. Kennedy was the only liberal with the stature to sell a painful compromise to the base. [my emphasis]

There aren’t many liberals out there with that kind of stature and with the trust of those to the left, and you only get to use your position this way a limited amount of times. But Paul Krugman today took on this task with his op-ed, largely echoing arguments made by me yesterday, as well as Ezra Klein. First, is from me:

So, to my brethren on the left posting at reddit, and on progressive blogs around the nation, remember this: Be angry the bill has been undermined. Be angry that various interest groups have gotten their way at the expense of the majority. But keep perspective, and see which direction the bill moves us. And ask: Does it create a framework of exchanges and subsidies that can improve our health care system? Does it bring us closer to universal health insurance? Will it be easier to add a public option to this structure in the years ahead if, as seems likely, the health insurance industries continue their abusive behaviors, than to start anew?

The answers are clearly, Yes, Yes, and Yes.

As a progressive, as a liberal, you don’t have to be happy about supporting this bill. But you should support it.

And now Krugman:

A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

[Image licensed under the GNU Free Documentation License.]

Categories
Domestic issues Health care Politics The Opinionsphere

Harry Reid’s Heroism

I’ve said it before, but I’m saying it again:

If you’re trying to follow the ins and outs of the health care debate, there’s no better source than Ezra Klein. But for the moment, I wanted to cite one particular post of Klein’s citing Matt Yglesias:

[L]iberals have rarely found themselves hailing Reid’s leadership. But the fact of the matter is that there’s almost no precedent for the legislative mission he’s been asked to accomplish of turning 59 Democrats, one loosely Democrat-aligned Independent, and two slightly moderate Republicans into 60 votes for a package that’s simultaneously a dramatic expansion of the welfare state and a measure that reduces both short- and long-term deficits.

On top of the intrinsically difficult nature of the task, he’s facing a really ugly political situation back home. Because Beltway mores dictate that you can never hold a member of congress morally culpable for actions undertaken in the name of raw politically self-interest, it must have been very tempting for Reid to get distracted. But he’s stayed on point and focused, dealt with the timid members of his caucus, dealt with the ignorant members of his caucus, dealt with the egomaniacal members of his caucus, and dealt with the all-too-typical Senatorial combination of policy ignorance, egomania, and political cowardice among some members. For his troubles it looks like we’re going to get a bill that liberals feel churlish about at best. But it’s really an extraordinary achievement.

Categories
Barack Obama Economics Financial Crisis Health care Politics The Bush Legacy

Real Fiscal Responsibility & Deficit Politics: Democrats

[digg-reddit-me]This is part 3 of a 4-part series of posts. Part 1 provided an introduction and description of the groups that benefit from the government spending status quo: the elderly, the military, the poor, and big corporations in that order. The overall societal status quo clearly favors all these groups except the poor. Part 2 described the main political dynamics behind what the Republicans are doing, along with their solutions; it explained why Republicans oppose government intervention in principle, and yet protect the status quo because it benefits those interest groups that support their party – the elderly, the military, and the big corporations. The solution to this political dilemma is to “starve the beast,” to protect the status quo until it becomes so catastrophically unstable that it has to be dismantled; which explains why, when in power, Republicans have both cut taxes and increased spending – protected today’s elderly at the expense of tomorrow’s elderly while trying to force Democrats to take responsibility for the undoubtedly unpopular solutions to the deficit problems created by Republican administrations.

Given this, the next question is: what is the Democratic approach? Do they seek to dismantle the programs that benefit the Republican interest groups? Have they figured out the political answer to the politics of “starving the beast” that so benefit the Republican Party? In short, the answer to both is no. Social Security and Medicare do benefit the elderly – who were the only demographic group to go Republican, even in the aftermath of Bush – but they are historic Democratic programs. They represent in some sense liberalism at its best* – an attempt to soften the roughest edges of capitalism, to ensure that our grandparents and parents are taken care of in their old age. It’s not clear that the Democrats have the political will to go about rescinding subsidies of various sorts to big corporations or to dramatically cut military spending. This doesn’t simply motivate Democratic voters, but the backlash caused by doing so could hurt the party. And the Obama administration’s approach of blaming the short- and mid-term deficit on Bush’s irresponsibility is of decreasing political utility, even if it has the benefit of truth.

What the Democrats offer is at best a partial solution in the hope that before the time is too late, the Republicans will abandon their destructive “starve the beast” strategy. In short, the Democrats are finessing the issue – to avoid the hard clashes that the Republicans claim are inevitable, and that Republicans while in power have made almost inevitable.

What the Obama administration offers now is a 3-part plan – one that is, to some degree, a Hail Mary pass, a desperate attempt to ease long-term deficit before it is upon us.

Step 1: Keep the Economy Going. Part of the urgency for the stimulus early in Obama’s term was the knowledge that if the economy was not growing, then the staggering short term deficits incurred by the Bush administration could prove crippling to the economy. The only way to pay off the debt without causing significant social problems at home or defaulting on the debt is to have a growing economy. This is how stable nations have gotten out of deficit holes such as the one we are in, and how we almost painless paid off massive debt following World War II, following the stagflation of the 1970s, and again in the 1990s. (A constantly growing economy also happens to be an implicit part of the social bargain at the heart of the American dream.)  The stimulus was needed because keeping the economy growing was essential to easing the fiscal pressure on America’s mid-term debt.

Step 2: Health Care Reform. Policy wonks – led by Office of Management and Budget Director Peter Orszag – have seen this fiscal timebomb coming for some time. They can see the two root causes of the rapid growth in projected federal expenses:

(1) the aging of our population and

(2) the rapidly rising cost of health care, which has been growing faster in America than in any other nation in the world for the past several decades.

As they cannot change the former, they decided to address the latter. The Obama administration has made clear that their primary goal is reducing the growth of health care costs, even at the expense of extending coverage, and the plans consist mainly of a hodge-podge of measures that would tinker with how health care is paid for and how people obtain health insurance, using some previous Republican proposals which focused on cutting costs as models.

As a necessary precondition for rationalizing our current system, the plan would also significantly extend health insurance – following Milton Friedman’s observation that as health insurance approaches universality, political incentives change to allow for more cost control (even in wholly private systems.) In part this explains how the current health care bills has become not only the most significant effort to expand coverage, but the most significant attempt at cost control in a generation. Mark McClellan, director of the Center for Medicare and Medicaid Services under George W. Bush, for example, called the bill “the right direction to go” while suggesting medical malpractice reform would also be good. (However, as Ron Brownstein observes, “since virtually, if not literally, none of [the Republicans] plan to support the final health care bill under any circumstances, the package isn’t likely to reflect much of their thinking.”) The bill includes pilot projects for almost every other cost control program that those interested in health care believe has promise.

The hope is that if we act now before the imminent wave of Baby Boomer retirements, we will soften the impact of the fiscal timebomb that is entitlement spending. Then, programs can be adjusted without being slashed – as proponents of the “starve the beast” approach would prefer. Our debtors, including the Chinese government, have thus taken a keen interest in the steps we are taking to curtail the growth in health care costs. As one prominent Chinese economist has said, “At some point, if you refuse to contain health care costs, you’ll go bankrupt.”

Step 3: The Grand Bargain. These first two parts were the easy ones. This part is where it gets tricky. If the first two parts of the plan work, the pressure for massive change will be relieved. The mid-term deficit incurred during Bush’s term and during the early Obama years will be less painful in the face of a growing economy. The long-term deficit will still be a problem, but not an insurmountable one if health care costs stop growing so rapidly. Each of these will take tremendous pressure off of our fiscal situation – but neither are enough to make the status quo sustainable. At this point, Obama has said he hopes to strike a “grand bargain,” putting everything on the table, and engaging in a frank discussion of tax reform and entitlement reform, of how America collects money and what it spends the money on. At the moment, with the idiocrats dominating the public debate, this doesn’t seem a very promising route.

Tackling these issues would be many times more explosive than health care as so many groups have a stake in maintaining the status quo. And the biggest flaw in the plan is that by relieving the pressure, the Obama administration may simply put off the day it will be dealt with – no matter how determined they are to deal with these issues. But breaking the grip of the idiocrats was at the core of the promise of Obama’s campaign. And these are core issues Obama was elected to address.

*Contemporary Democrats do not – contrary to the caricature Republicans push – think government and centralized control is the solution to everything; but they do believe that government can be a force for good, that through democracy we can make modest steps and institute policies that improve our society. And despite an organized campaign to suggest otherwise, history has demonstrated this to be true, from the the founding of our nation, the building up of our infrastructure, to that giant social engineering project called abolition, to Social Security and bank regulation, to the Civil Right Movement.

Categories
Conservativism Health care Political Philosophy Politics The Bush Legacy

Real Fiscal Responsibility & Deficit Politics: Republicans

[digg-reddit-me]See Part 1: An Introduction here. Parts 3 and 4 discussing the Democratic approach and then lessons from this moment of “welfare scleroris/imperial overstretch” coming tomorrow and Friday.

Republicans have called themselves, and are once again trying to position themselves, as the party of fiscal responsibility. This is the pendulum swing of deficit politics in its second repetition – as Republicans run up massive deficits during their time in power and then attempt to pass off the blame for raising taxes or cutting programs onto the Democrats who succeed them in office.

The political challenge the Republicans face is intriguing. Their ideology holds the solution to the deficit is to shrink the size of the government. Yet the Republican base consists of corporate America, the military, and the elderly – the largest beneficiaries of current government spending. Given this, it’s not surprising that while in power Republicans have expanded rather than shrinking government. Bush expanded Medicare further than anyone since LBJ created it all while cutting taxes and engaging in two wars and allowing Congress to engorge itself with discretionary spending increases never before allowed. Bush was not an isolated example. Like his apparent role model, Ronald Reagan, he saw deficit spending as a way to win politically in the short term as you gave everyone what they wanted – and protected those interest groups who supported you – while in the long term the incredible irresponsibility would force government to shrink, and perhaps even discredit the idea of a competent or sustainable government program. In other words, deficits were the way to “starve the beast.”

Republicans did not jettison this approach along with Bush when they began to repudiate his legacy. John McCain – for all his talk of fiscal rectitude – offered more of the same in his campaign agenda. He proposed dramatic tax cuts without commensurate spending cuts (while masking this by proposing the elimination of pork barrel spending which represents a minuscule portion of the federal budget.) As an alternative to the stimulus, McCain and the Republicans attempted the same trick – attacking the plan for adding to the deficit with spending while proposing a plan that would add even more to the deficit through tax cuts (which the Congressional Budget Office determined was a less effective way to stimulate the economy.) For Republicans, increasing the deficit by cutting taxes is “fiscally responsible” – while increasing the deficit with spending is “generational theft.”

What’s tricky is how Republicans position themselves with regards to the looming fiscal crisis. The business conservatives who make up an influential portion of the Republican base tend to propose pragmatic but politically impossible solutions like cutting spending to the other core Republican constituencies – the elderly and the military, and sometimes, even the tax and other subsidies to big corporations. The other groups seem primarily concerned with ensuring that their own government dollars continuing to grow. The past two times a liberal has taken office following several terms of extreme fiscal irresponsibility by a Republican though, a semi-independent movement has sprung up, thus changing the political dynamics in the Republican party. This movement of citizens concerned about the size of government, of government debt, and especially of liberals being in charge of this government (which suddenly seems more intrusive now that it is in the control of those they don’t sympathize with) was incarnated in Ross Perot’s two presidential campaigns, the 1994 Republican Revolution, and today, the Tea Parties. In each instance, this movement has coalesced around an inchoate frustration with the way things are coupled with the remarkably fixed position of opposing everything the Democrats do, opposing tax increases, and supporting the reduction of the deficit. Though this logically must lead to cutting government programs, which programs will be cut always remains vague which works well enough until a Republican gets in power.

To balance and rally these constituencies while out of power – the anti-tax fiscal hawks, the elderly relying on government programs, the military reliant on government spending, and the corporations who profit from government favors – Republicans have adopted a framework whereby they condemn any new spending as “generational theft” while protecting the status quo. Within this framework, Republicans claim their protection of the status quo which is screwing over my generation is actually about protecting my generation. This language also comforts the elderly who don’t wish to see any reduction in their benefits. Under the Republican approach, the only elderly who will see a reduction in benefits under the Republican plan are the eventual elderly of the younger generations – as the government programs they are now paying for cease.

The challenge Obama has given to the Republicans though is to propose a solution to the looming fiscal crisis through health care reform. Republicans have responded by claiming that the plans will add to the deficit (contrary to the Congressional Budget Office) while at the same time they have been attacking any measures in the plan which might actually cut costs. For example, Senator Coburn has said, “If you’re a senior and you’re on Medicare, you better be afraid of this bill” – which is a difficult position to maintain while at the same time holding that any deficit spending today is “generational theft.” But it is of course, the only political answer they have.

The Republicans – for short term political expediency – are creating an interesting political dynamic (and an impossible situation for the country.) They are telling the elderly that any spending that adds to the deficit is stealing from their grandchildren and children – while telling them to be afraid of any cuts to the programs they like. Meanwhile, as they filibuster any attempts to alleviate the situation, they inculcate the belief among the younger generation that the government cannot do anything right – pointing to the approaching fiscal disaster as proof. The hope must be that if they are correct that this disaster cannot be averted, their obstruction of any attempt to avoid it will be forgiven, especially if the disaster itself discredits the government, thus bringing the younger generation ideologically closer to the Republican position.

Thus is the logic of deficit politics and starve-the-beast governance.

Categories
Barack Obama Health care Politics The Opinionsphere

Political Number Games

A more proper post coming later, but for the moment, I wanted to provide you with two graphs and one poll result.

First, from the always insightful Nate Silver of FiveThirtyEight.com, who points out that all these polls touting the fact that Americans are almost evenly split on the health care legislation before Congress, 12% of those counted against the bill are those that want it to move farther to the left:

By “left,” Silver means those who think the bill doesn’t go far enough to reform health care – though I suppose those could be people on the right as well. Either way, breaking down the data like this gives a lot more insight than the headline numbers.

Via Andrew Sullivan, an enterprising individual mapped out the “geography of the recession,” with the mounting job losses per county places on a map of the United States and animated over time.

Finally, in a rather misleading piece of analysis, Andrew Malcolm of the LA Times uses recent poll data to suggest that Sarah Palin has a shot in an electoral race against Obama. Rather than looking at head-to-head polling results, he looks at the favorability ratings of Sarah Palin, Barack Obama, and Dick Cheney. He points out that Obama’s are dropping and Palin’s and Cheney’s are rising. Perhaps this has something to do with the fact that these last two individuals have no power and thus those favoring them are only supporting the vague promise of an individual. But – on the other hand – this does demonstrate that Palin and Cheney have become the voice of the Republican Party, and does bode well for my prediction that at least one of the two will be on the Republican ticket come 2012. Those suggesting we write them off and ignore them because they represent fringe views are engaging in wishful thinking.

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Barack Obama Health care Politics The Opinionsphere

The Republican’s Generational Warfare

[digg-reddit-me]All the blogosphere (and indeed, the political conversation of which it is a part) is abuzz with outrage over Obama’s Afghanistan decision – from those towards the left who believed Obama has betrayed them by escalating this war (despite the fact that it was a campaign promise to escalate the war) to those others on the left who just oppose the war to those on the right who (with a few exceptions) have decided to attack the decision as weak, not Churchillian, and to paint Obama once again as a weak, anti-American thug. Then there a significant chorus of the voices of reason – who acknowledge that to withdraw seems perhaps as bad of an option as to escalate; both of which in turn could be less worse than the way things are now. Some of these voices are opposed to escalation; some are in favor; many seem weary of the discussion entirely.

But while all of these pixels are being devoted to Afghanistan, we are taking our eyes off a far larger issue – the one that we have never quite bothered to look at despite months purportedly focused on it. The Republican Party has now declared war on this cute baby! Along with me, probably you, and the rest of the younger generations. Paul Krugman today issued a call to arms that was – to adopt a metaphor of the right – virtually Churchillian in its starkness, if not in its vivid imagery:

For America can’t get control of its budget without controlling health care costs — and this is our last, best chance to deal with these costs in a rational way.

Krugman – in typically Churchillian fashion – does not mention that many of the best options to control costs have already been stripped from the bills being considered – from a public option pegged to Medicare rates to a more open health insurance exchange. Instead, the bill’s potential would be with a strong public option trigger or the many, many experiments in the plan any of which may or may not be able to bend the curve of health care spending growth downward. As important, as even the foremost free-marketeer Milton Friedman acknowledged, our rapidly escalating costs are the result of our hybrid system but that “once the whole population is covered…attention turns to holding down costs.” None of the bills under consideration would achieve universal health care either – but they would make significant progress to this goal.

In short this bill will not be enough to fix our problems, but when the House and Senate bills are merged, the resulting bill will almost certainly be the most significant attempt at cost control in a generation if not more. And it is long past due. As Krugman points out: our long-term fiscal outlook is dire. The tax cuts and deficit spending during our years of plenty under Bush aren’t the primary reason for this. The stimulus spending by Bush or Obama isn’t the main cause either. The primary reason for this impending disaster is that our population is getting older and health care costs are growing exponentially. Thus the only way to avoid drastic cuts in the future is to slow down the rate of growth today.

Part of reducing the rate of growth today is restraining the growth of spending in Medicare and other government programs. In other words, a vote to not cut a dime in Medicare today is a vote to make sure my generation doesn’t have Medicare at all. Back to Krugman:

[T]he G.O.P. has focused more and more on an effort to demonize cost-control efforts. The Senate bill would impose “draconian cuts” on Medicare, says Senator John McCain, who proposed much deeper cuts just last year as part of his presidential campaign. “If you’re a senior and you’re on Medicare, you better be afraid of this bill,” says Senator Tom Coburn.

If these tactics work, and health reform fails, think of the message this would convey: It would signal that any effort to deal with the biggest budget problem we face will be successfully played by political opponents as an attack on older Americans.

For once, Krugman understates things. The G.O.P. is waging a generational war on the younger generations. While they complain of stimulus spending to get the economy moving (which the younger generation, especially those just graduating college desperately need), these old men are demagoguing cost control today such that tomorrow, when I am too old to continue working, there will be no safety net. If it sounded a bit off to you that these Republicans who not long ago were looking to dismantle Medicare and Social Security (and whose patron saint warned that Medicare would lead to socialism and the end of freedom in America) are now defending these institutions against any any cuts, perhaps you haven’t heard of “starving the beast.” This right-wing fiscal-political strategy explicitly subscribed to by Ronald Reagan and George W. Bush (who not coincidentally each ran huge deficits) uses “budget deficits via tax cuts to force future reductions in the size of government. The term ‘beast’ refers to government and the programs it funds, particularly social programs such as welfare, Social Security, and Medicare.” In other words, those who subscribe to this strategy would rather drastic cuts in the future that would eliminate Medicare for me than moderate cuts today that would make the system sustainable. This is nothing less than an attempt to make war on my generation in the name of ideology.

Krugman, in issuing this call to arms, must know that this bill is not ideal. But he also knows that it holds promise, and that its success would lead to more serious efforts. Its failure though would mean that yet again the “fiscal conservatives” whose goal is to “starve the beast” will have won yet another battle in the war on the younger generations, and the Baby Boomers who have for too long subjected us to their petty distractions will be the last generation to enjoy the benefits of the programs their parents created.

If these starve-the-beasters get their way, America’s power will be diminished and our society less just, and us younger generations who have paid into will not be able to benefit from this safety net.

[Image by tandemracer of her baby’s six-month doctor visit licensed under Creative Commons 2.0]

Categories
Barack Obama Health care National Security Politics The Opinionsphere The War on Terrorism

The Un-American Pledge, Nietzsche (Republican), Islamists, Anti-Statism, Health Care Reform (again), and Abortion Politics

Today, I present to you an early addition of the best reads for the long Thanksgiving weekend…

1. The Un-American Pledge. Michael Lind explains why the Pledge of Allegiance is un-American.

2. Nietzsche was a Republican. The Economist’s Democracy in America discusses Medicare and Nihilism. As it is undeniable that America’s population is aging, and that this accounts for the massive projected deficits in the future, and as everyone also acknowledges that such deficits are unsustainable, something must be done. The health care plans proposed by the Democrats include – along with various experimental measures to restrain health care spending – a Medicare commission “empowered to make decisions that automatically become law unless Congress comes up with equivalent savings” that will reduce spending as much. Republicans and the blandly smiling wise men and women of the pundit class have made it a point of conventional wisdom that Congress won’t be able to push through the cuts, and will find a way to circumvent this mandate. DiA, echoing a point Ezra Klein has been making repeatedly for the past few weeks, challenges those criticizing the plan to come up with something better:

If you don’t think an independent Medicare commission empowered to make decisions that automatically become law unless Congress comes up with equivalent savings will do the trick, then you have a responsibility to suggest something that will. Otherwise you’re just placing a bet that America’s government is going to self-destruct—a tenable argument, certainly, but not very helpful.

3. Learning from former islamists. Everyone else seemed to recommend this article a few weeks ago when it came out, but I just got to it recently myself. Johann Hari interviewed a number of former islamists who have recently renounced islamism and have begun to fight for their version of a “secular Islam” in Great Britain. He portrays this group as a vanguard. One of the islamists, Maajid Nawaz was a recruiter for an islamist group in Egypt for a time. Nawaz’s description of factors affecting recruitment seems to coincide with both intelligence agencies’ and liberals’ judgments, and to contradict the right-wing understanding:

“Everyone hated the [unelected] government [of Hosni Mubarak], and the US for backing it,” he says. But there was an inhibiting sympathy for the victims of 9/11 – until the Bush administration began to respond with Guantanamo Bay and bombs. “That made it much easier. After that, I could persuade people a lot faster.”

Eventually, Nawaz was imprisoned in Egypt. He was abandoned by the islamist group that he was working for. The only forces protecting him, as a British citizen, were forces he considered “colonial” and corrupt:

“I was just amazed,” Maajid says. “We’d always seen Amnesty as the soft power tools of colonialism. So, when Amnesty, despite knowing that we hated them, adopted us, I felt – maybe these democratic values aren’t always hypocritical. Maybe some people take them seriously … it was the beginning of my serious doubts.”

4. Anti-Statism: As American as Apple Pie. John P. Judis of The New Republic delves into the undercurrent of anti-statism in the American psyche.

5. Getting depressed about the public option. Timothy Noah depressed me more than anyone else with his ruminations on the public option.

6. Feeling better about health care reform. These pieces by Ron Brownstein and Andrew Sullivan though have made me feel much better about health care reform in general. Brownstein’s piece is especially helpful in looking at the various cost-cutting measures in the bill, and has a rather optimistic take. President Obama has apparently made that post “required reading” among White House staff. I’ll be following these posts up at a later date.

7. Abortion politics. The New Yorker had an extraordinary interview about abortion politics with Jon Shields. Shields seems to be, himself, pro-choice, but he seems to have reached an understanding of abortion as an issue which contradicts the propagandistic rhetoric that passes for most liberal commentary on abortion, which presents its opponents as being mainly concerned with keeping women in their place.

[Photo by road fun licensed under Creative Commons.]

Categories
Barack Obama Criticism Health care Politics Videos

NBC’s Dr. Nancy Defends Doctors in Breast Cancer Debate: “We are on the verge of becoming a scientifically illiterate country”

[digg-reddit-me]One of the main competitions in our politics, aside from the liberal versus right-wing, and the establishment versus anti-establishment, is the the competition between technocrats and idiocrats. While technocrats may be ascendant in Obama’s Washington, as policy wonks and experts attempt to solve intractable problems with technical solutions and brainpower and science, the idiocrats, who try to get their agenda through by fooling enough of the people enough of the time, still have a solid hold on the political discussion.

Idiocrats take advantage of that old adage, “Where there’s smoke, there’s fire,” and make sure smoke obscures any issue in which they want to get their way. Rather than respond to their opponents on the merits, they simply describe their opponents and their agenda as the fulfillment of the idiocrat’s worst fears: “Nazi!” “Socialist!” “Communist!” Terrorist!” “America-hater!” “Death panels!” “Government-mandated abortion!” “Reparations!” “Secret Muslim!” “Radical!” For those who are not paying enough attention to the issue to sort through all the competing claims, this extremist rhetoric, while not convincing them, causes them to assume something bad is going on, even if it isn’t as bad as is being claimed.

For example, even as the health care plan Obama has proposed is largely based on previous Republican proposals, and seems to take into account conservative critiques of big government while still making progress towards liberal goals, idiocrats have condemned it in the harshest terms possible, raising every possible fear – from government kidnapping your children and indoctrinating them into socialism, to rationing by death panels, to runaway spending bankrupting the country, to abortion mandates, to the destruction of the employer-based health care system, to the destruction of Medicare. It makes little difference that it is hard to imagine a plan that both rations care brutally and leads to runaway spending, or that everyone acknowledges our current system is on an unsustainable course, or that the measures included in the bills under consideration represent the most significant attempt at cost control in a generation.

Last week, as part of a continuing effort to generate smoke to obscure real issues, the Wall Street Journal editorial board started a deliberate lie to undermine the health care reforms in Congress by claiming (without evidence and contrary to news reports as well as the the recommendation itself) that the U.S. Preventive Services Task Force – a independent, technocratic organization of doctors started by Ronald Reagan – had changed its recommendations regarding breast cancer prevention as part of Obama’s push to reduce the health care costs. This explosive claim became the focus of the public debate, instead of the recommendations of the report itself and their rationale.

On Sunday, Meet the Press had a typically “even-handed” debate between their own Dr. Nancy Snyderman and Ambassador Nancy Brinker, founder of an organization dedicated to fighting breast cancer. The whole 12 minute segment is worth watching (transcript), as you can see Brinker acknowledging that the task force might be right on the science, but at the same time suggesting that we shouldn’t show any weakness in our war against cancer by suggesting mammograms might not always be a good thing. She made a few valid points, giving certain circumstances in which mammograms would be better than alternatives, but she couldn’t and didn’t dispute the task force’s medical conclusions.

But the piece is truly worth watching for “Dr. Nancy” took on the idiocrats who were muddying the issue and defended the scientific conclusions of the doctors:

DR. SNYDERMAN: [O]ver 1900 women screened over a 10-year period of annual mammograms, one life is saved and there are a thousand false positives, which means ongoing, unnecessary tests.  Now remember, the scientists who did these numbers, their role is, as scientists, to take the anecdotes and the passion and the emotion out of it.  And I recognize that’s hard as part of the message.  But they’re to look at the public health issues of how we screen. And we’ve always known that mammography for women in their 40s has been fraught with problems.  It is not as precise for older women [She meant younger here].  On that Nancy and I have great agreement.  So what their consensus was is that there are a lot of unnecessary screenings for that one life.  Now, if you’re that one life, it’s 100 percent.  I get that.  But their charge as an independent body was to look at the cumulative research as scientists.

Later, as Ambassador Brinker tried to simultaneously politicize the issue while claiming not to be, Dr. Nancy interjected with a righteous defense of science:

The key line that got me:

I would argue that we are on the verge of becoming a scientifically illiterate country if we don’t at times separate [science and politics]…

In a large measure, the promise of Obama, the hope he held out, was to break the hold that idiocrats have over our political debate. Thus far, this is a battle he does not seem to be winning.

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Criticism Health care Politics The Opinionsphere

That’s What You Get For Trusting a WSJ Editorial

[digg-reddit-me]Yesterday, the Wall Street Journal had an editorial that got passed around as if it were a news story, insisting that the decision of a board of doctors and scientists to recommend that biannual breast cancer screening only for those between the ages of 50 and 75 “is a sign of cost control to come.” The editorial cited this fact:

But the panel—which includes no oncologists and radiologists, who best know the medical literature—did decide to re-analyze the data with health-care spending as a core concern.

Yet this isn’t what news articles are reporting:

Panel members said politics and questions of cost were never part of their discussions of the risks and benefits of mammograms — in fact they are prohibited from considering costs when they make guidelines.

Or this:

In reaching its recommendations, the task force of doctors and scientists determined that early and frequent mammograms often lead to false-positive readings and unnecessary biopsies, without substantially improving the odds of survival for women under 50.

And it is not the rationale given by the report itself:

The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman’s lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.

Adequate evidence suggests that the overall harms associated with mammography are moderate for every age group considered, although the main components of the harms shift over time. Although false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups.

There is adequate evidence that teaching BSE is associated with harms that are at least small. There is inadequate evidence concerning harms of CBE.

That hasn’t stopped this from becoming a right wing talking point nor from causing concerns among independents uncertain about whom to believe – the statements of the board itself, claiming they focused on science, or the speculating opinions of right wingers, playing into people’s worst fears.

I have some advice for those people on the fence: Read the damn report if you don’t trust the media. Don’t put your blind faith in the often discredited Wall Street Journal editorial page.