Category: Health care

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Barack Obama Criticism Domestic issues Health care Politics The Opinionsphere

Health Care Reform is the most significant effort at cost control in a generation, if not ever.

[digg-reddit-me]Once health care reform passes, the White House has signaled it will begin to focus more specifically on the deficit. (Also, on jobs, cap and trade, and financial regulation.)

But as the Obama administration presented it initially: Health care reform is deficit reduction. (Ezra Klein, health care policy wonk, blogger, and columnist for the Washington Post, has been making this case all along, as have many other technocratic types and policy wonks and health care experts.) That’s why Peter Orszag made the phrase, “bend the curve” into a buzzword, referring to the attempt to bring down the rate of growth of health care spending. Here for example is a graph of our projected budget deficit as a percentage of GDP based on current growth rates, lowering those growth rates, and adopting measures to have Britain-like growth rates:

While any bill that might get past Congress at this point won’t live up to the early wet dreams of policy wonks (It won’t even bring us to the level of the blue line in the above graph), it would – to quote Ezra – still “represent the most significant effort at cost control in a generation, if not ever.” (my emphasis.) (He specifically refers to three provisions in the Senate Finance Committee bill: the excise tax on high-cost insurance plans; the newly empowered Medicare Commission; and various delivery-system reforms.) In fact – again according to Ezra – the “health-care reform bills currently under consideration in both the Senate and the House actually cut money from the deficit.” Despite this, the same Republicans (often the exact same individuals) who 6 years ago cast “a vote to add about $400 billion to the deficit in the first 10 years, and trillions more in the decades after that,” with Medicare Part D are now criticizing the current bill which would decrease the deficit as “fiscally irresponsible.”  Ezra:

It’s like watching arsonists calling the fire department reckless.

This constant obstructionism by the Republicans – on both matters of fiscal stimulus and health care – is gradually eating away at the public will to act and is therefore undermining confidence in America’s economy and long-term fiscal situation, and by undermining this confidence, making a disaster more likely. Noam Scheiber of The New Republic describes how the struggle to enact meaningful health care reform is a concern for the largest holders of American debt, the Chinese:

To his surprise, when Orszag arrived at the site of the annual U.S.-China Strategic and Economic Dialogue (S&ED), the Chinese didn’t dwell on the Wall Street meltdown or the global recession. The bureaucrats at his table mostly wanted to know about health care reform, which Orszag has helped shepherd…”At some point, if you refuse to contain health care costs, you’ll go bankrupt,” says Andy Xie, a prominent Shanghai-based economist, formerly of Morgan Stanley.

The efforts at cost control proposed by the Democrats might fail, as Republicans suggest. But it is irresponsible not to try, and to obstruct any attempts to try. Republicans have begun to demagogue the bills before Congress both for cutting Medicare and for increasing the amount of health care spending. They are not willing to give the Democrats any political cover to take any fiscally responsible measures. This partisan refusal to work towards solving long-term problems has been the key to Republican successes from 1994 to the present. (Not so for the Democrats, many of whom joined George W. Bush in passing his No Child Left Behind act, his tax cuts, and his Medicare Part D bill, but undoubtedly, both sides bear some blame.) This has created a political culture in which Washington has two directives:  “spend money on things I like and don’t raise my taxes.” This isn’t solely a Republican problem. It is more that the Republicans, by remaining stubbornly united, have made these flaws evident. Klein again:

The issue isn’t that some storm will unexpectedly slam into the economy and there will be nothing anybody can do, but that the storm will hit and Congress will choose to do nothing

The biggest danger America faces is not rising health-care costs or global warming or the budget deficit. It’s the political system’s inability to act on these issues, even though the solutions are generally quite clear.

Take a moment and read the articles linked to – especially the three Ezra Klein posts from the past two days. (On the Senate Finance Bill’s cost control measures; On Medicare Part D; and On Our Political System’s Inability to Act.)

Keep in mind that Obama’s proposals are not “radical leftist” but essential and moderate tinkering that incorporates Republican as well as Democratic ideas. The Tea Party-ers may be outraged at the imaginary specters of death panels and government-mandated abortion. But it is the rest of us who should be outraged at the inability of our political system or our politics to address these long-term issues responsibly.

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Barack Obama Criticism Health care Politics The Media The Opinionsphere

Fisking Camille Paglia

[digg-reddit-me]Camille Paglia’s Salon weekly Salon column seems a product of a different time. One of the consequences of this is that she neglects to provide links sourcing some of the more bizarre claims she makes. At the same time, Paglia’s ideologically-applied contrarianism leads her to make quite a few of these bizarre statements. Her columns read like a caricature of media attempts to be “objective” and “independent” dreamed up by Glenn Greenwald rather than a sentient mind. Paglia seems determined to make sure neither Democrats nor Republicans, neither conservatives nor liberals feel comfortable with what she was to say. Thus, she endorses every criticism made by one side of the other, and credits no one with solutions. The defining element of her style is to take seriously the hypothetical or actual criticisms of various groups whom she then stereotypes in the crudest manner possible:

Steel yourself for the deafening screams from the careerist professional class of limousine liberals when they get stranded for hours in the jammed, jostling anterooms of doctors’ offices. They’ll probably try to hire Caribbean nannies as ringers to do the waiting for them.

Paglia uses these stereotypes to demonstrate her disdain for and independence from those whose criticisms she is adopting. Her vaunted independence then serves only to mask an inability or unwillingness to differentiate between true claims and false ones as she navigates through policy issues without endorsing any coherent approach.

And today, she applies her mind to the health care debate. The result is predictable.

Paglia rather quickly demonstrates her complete ignorance of the basics of health care policy arguments by endorsing “portability of health insurance across state lines” as “the most common-sense clause to increase competition and drive down prices.” Paglia doesn’t see any reasons why Democrats might oppose this “common-sense” reform – so she presumes there must be some “covert business interests,” that Democrats are protecting. A simpler explanation might be that allowing the portability of health insurance across state lines would effectively deregulate the entire health insurance industry. Or at least, it would create a race to the bottom as health insurance companies would relocate to the state with the least regulation, after which states would compete to deregulate to attract this industry. Or maybe the Democrats are really in the pocket of some secret business that Paglia imagines.

Paglia goes on to ask “why are we even considering so gargantuan a social experiment when the nation is struggling to emerge from a severe recession?” She answers her own question without pausing: “liberals are starry-eyed dreamers lacking the elementary ability to project or predict the chaotic and destabilizing practical consequences of their utopian fantasies.” The idea that this moderate bill – which resembles nothing so much as the Republican’s counter-offer to Bill Clinton in 1993 – is actually a liberal “utopian fantasy” is an easy straw man. Instead, this bill explicitly seeks to stabilize our status quo.

As to the question of, “Why now?” – Paglia might have taken the basic step of listening to any presidential address on this or read almost any liberal op-ed from before August. The presented explanation was that health care reform has to be the first step in entitlement reform. And entitlement reform is the first step towards fiscal solvency. And with the bond market and the Chinese government getting nervous about America’s solvency in the long-term, steps to bring the long-term deficit (which is almost entirely driven by the rising health care costs) into line were necessary. You couldn’t read a liberal op-ed on health care without seeing the Peter Orszag phrase “bend the curve” until this August when concerns about “death panels” and “killing Grandma” became paramount.

Speaking of which, Paglia makes sure to trot out these charges yet again – warning of imminent rationing and the “gutting” of Medicare:

How dare anyone claim humane aims for this bill anyhow when its funding is based on a slashing of Medicare by over $400 billion? The brutal abandonment of the elderly here is unconscionable.

Truly, to brutally abandon individuals to live without health insurance is unconscionable. To forcibly ration by government fiat is certainly not anything most Americans would support. Perhaps because of this, neither of these is anywhere in any proposed health care legislation. The “slashing of Medicare by over $400 billion” was described slightly differently by Washington Post reporter T. R. Reid yesterday. He called it, a typical Washington spending “cut” – in that Medicare costs were budgeted to rise by $800 billion in the next 10 years, but now would be restrained to rise by half that. Medicare spending would still rise significantly. Washington is one of the few places where you can spend far more and still call something a “cut.” This reduction in the rate of spending would come from various places – one of which would be the Medicare Advantage program which would be subject to “a competitive bidding process that is designed to lower spending on the program.” What Paglia – along with most right wing critics – fail to understand is that health care reform is not about reducing spending, but about reducing the rate of growth of spending. If Paglia calls this “brutal abandonment,” one wonders how she might describe the state of the uninsured if she felt compelled to look to them!

Paglia’s other claims are similarly shallow – equal parts histronics and ignorance. The modest bill proposed does not “co-opt[…] and destroy[…] the entire U.S. medical infrastructure” nor create a “huge, inefficient federal bureaucracy.” In fact, because the bill makes great efforts not to co-opt or destroy the hybrid health insurance system we have that it creates a maze of small bureaucratic institutions to manage the maze of hybrid models that make up our system. They key innovation of the current bill is not any set of bureaucratic institutions but the creation of a managed marketplace, the health insurance exchange.

Paglia’s take on health care demonstrates a complete failure to differentiate between true claims and false ones, as she demonstrates independence not only from partisan forces but from any objective reality.

[Image by Ann Althouse licensed under Creative Commons.]

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Barack Obama Conservativism Criticism Health care Politics The Opinionsphere

Health Care Reform and Its Unintended Consequences

[digg-reddit-me]I said I was going to make a point of noting solid criticisms of the Obama administration by mainstream conservatives and right wingers.

Mona Charen of the National Review wrote a solid piece that didn’t resort to blatant falsehoods as far as I could tell that made a solid case against health care reform. Her basic point is that she doesn’t trust the Democrats:

Every single page [of the health care bill] proclaims something that is dubious — that the Democrats know what they are doing.

Rather than talking about death panels, she points out that electronic recordkeeping has overwhelmed doctors with information they are not used to having to sort through – and thus has made hospitals less efficient. (She cites no study, but it is certainly plausible that this would be a short term effect.) Preventive care, she explains, while probably saving lives could end up costing more – as “more and more of us are tested for more and more diseases.”

Her big point is that this health care reform is “brought to you by the same people” who brought you Medicare and Medicaid – and that the costs of these programs were vastly underestimated. As she points out:

In 1965, Congress predicted that by 1990, Medicare would be costing $12 billion. The actual cost — $90 billion.

Long term forecasts of government spending – or really anything – are a fool’s game, and Charen is right to point this out. On a macroeconomic level, there are too many factors to take into account – and that’s not even counting “black swans” that change everything. In this case, the major factor causing the government health care costs to be so off was the explosion of health care inflation in the 1980s which has only gotten worse since. But it’s not clear that Medicare or Medicaid played any role in this – especially as their costs have been below that of private insurance.

Bill Clinton made a similar point to Charen’s yesterday in trying to make the case for why the health care reform should be passed:

There is no perfect bill because there are always unintended consequences…

Yet, Clinton maintained:

The worst thing to do is nothing.

As Steven Pearlstein writing for the Washington Post described the price of doing nothing (and was later echoed by Barack Obama):

Among the range of options for health-care reform, there’s one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That’s the option of doing nothing…

This is the answer Democrats give to the sensible concerns of Charen and those like her: there inherent uncertainty in any attempt to change a macroeconomic trend, but given where we are headed if we do nothing, it’s worth trying.

The only other option is to give up.

This is exactly the sort of sensible criticism that – in my opinion – conservatives should be making. However, the answer should not be to do nothing, but to “tinker” instead of instituting massive top-down changes, and to adopt the measures that work after tinkering. For the most part, this is exactly the approach the current bills take – which is a testament to the fundamental insights of the conservative movement of the past few decades. To take into account this fundamental insight while promoting a liberal agenda is in fact the essence of Obama’s approach: It’s why 40% of the stimulus was tax cuts; it’s why the key health care reform is to create a market that allows individuals to make decisions based on information that is more transparent; it’s why the answer to global warming is a cap-and-trade program that decentralizes authority and whose main mechanism is a market. That this has been Obama’s approach is what has forced the right wing opposition to him to become so unhinged.

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Domestic issues Health care Politics The Opinionsphere

America’s Schizophrenic Abortion Politics

[digg-reddit-me]The Stupak amendment has brought out the least attractive side of many progressive pundits:  a doctrinal, ideological, visceral disregard for opposing views. Right wingers regularly accuse liberals and progressives of this, and perhaps I cannot see it on most issues as I am firmly in the liberal camp. Or perhaps on abortion, there is an element of ideological certainty which is different than on other issues. I don’t see the same knee-jerk dismissal of opposing views as I do on the issue of abortion with regards to government intervention in the society or economy,  various social issues, or American empire. It was fair to say, as most liberals did, that opposing the stimulus was madness, and the arguments against it were often fatally flawed. It was fair to label the “enhanced interrogation techniques” torture, for that is what they were. It is fair to see homophobia as the greatest motivator of opposition to gay marriage, even if it is not the only one. It was fair to call much of the opposition and debate over health care reform “unhinged” – as the debate bore little relation to the moderate bill being proposed.

Yet, as someone who grew up a Catholic, who went to Catholic schools all my life, who has read and wrestled with Catholic doctrine and thought, I get frustrated reading the ignorant and arrogant ramblings of many pro-choice pundits as they discuss the real motivations of the pro-life movement. By ignoring the stated motivations, these pro-choice pundits are able to attribute the opposition to abortion to an anti-woman animus. It seems to me such dismissals are meant to avoid tackling the core question, which is difficult, and nearly impossible to resolve or even discuss. As such, abortion is perhaps the subject least subject to the type of technocratic solution that most Democratic politicians and policy wonks seem to favor.

(Side note: The attempt by the Obama administration to work on this issue was commendable though – attempting to reduce abortion through contraception and education. Unfortunately, the Catholic bishops scuttled this deal as they oppose contraception as well as abortion – a longstanding position. As if to prove their clueless-ness, Matt Yglesias and Atrios at that point stated that this proved that the Catholic Church didn’t really think abortion was murder – because if they did, they would set aside their silly opposition to contraception. While I agree that the Church’s position on contraception (as well as sex in general) is silly, only someone who knows nothing about the Catholic Church would be surprised at this or think it calls into questiontheir opposition to abortion, as I explained at the time.)

In the midst of the fallout from the Stupak amendment, pro-choice pundits once again demonstrated that they misunderstand the politics of abortion. Atrios, for example, tweeted:

2010’s gonna be a bloodbath if dems vote to take away abortion rights

This impression – that support for keeping the status quo on abortion rights is popular – is in fact now, and has long been, untrue. A majority of the country does favor keeping abortion legal, but much of the same majority believes it should be harder to get abortions and supports significant conscience opt-outs regarding abortion. This majority includes a majority of women. Most people do not see abortion as simply “a medical procedure,” but as a profound act. Matt Yglesias dismisses this distinction made by the majority of Americans as “arbitrary” and as merely part of an effort to delegitimize abortion.

Yglesias, a favorite blogger of mine, wrote a similarly clueless post – in which he suggested that nothing was achieved with the Stupak amendment – as Republicans continued to oppose it, the National Right to Life continued to oppose it, and the Catholic bishops only supported the amendment rather than the whole bill. Of course, Yglesias ignores the clearest goal of the Stupak amendment – to get pro-life Democrats on board, without whom the bill wouldn’t have passed. As to the groups Yglesias addressed, the National Right to Life committee gives the pro-life movement a bad name – as it has become entirely co-opted by the Republican Party and now merely distributes propaganda for the party. But the bishops had previously said they would not support any specific legislation, even as they supported the goals of this health care reform. Their only reason to oppose the bill was whether or not it would be “abortion-neutral.” The Stupak amendment removed their opposition – and even lead Cardinal Francis George to call Republican Minority Leader Boehner to make sure “the GOP didn’t play any games,” blocking health care reform on the pretense of a pro-life position. Yglesias failed to take these into account because they interfered with the point he was trying to make: that pro-lifers are insincere in their opposition to abortion and instead just oppose the Democratic Party and the rights of women.

What Democratic politicians realize – but progressive pundits do not – is that Democrats will only win if they can with the Catholic vote. And the largest impediment to winning the Catholic vote is the issue of abortion, for which Catholics bear a great deal of the blame for the schizophrenic position of the majority. There is a hard core of conservative Catholics, but they are a small portion of America’s largest religious group, which includes almost all of the fastest growing ethnic subset, Latinos. They are also the ultimate swing vote, having voted for the presidential candidate who won the popular vote (and except in 2000, the winner), in every election since 1960 save Richard Nixon’s 1968 win.

At the same time, the attitudes of younger Americans have also moved away from the Democratic Party line, as the young favor gay marriage, the legalization of marijuana, and restrictions on abortion.

If Democrats do not figure out how to either convert pro-life voters to pro-choice voters, or to soften their opposition, they will not hold onto power. So, what are Democrats to do? To win over the Catholic vote – and a significant percentage of the younger pro-life vote, there are a few simple steps:

  • Respect. They can stop using the propagandistic terms “anti-choice” or “anti-woman” to describe those who disagree with them on abortion. They should be consistent and either refer to both sides by the terms they prefer: pro-choice versus pro-life; or describe the issue more precisely as anti-abortion and pro-abortion rights.
  • Civility. They can stop questioning the motivations of their opponents and accept the rationale offered. Nothing turns off someone who disagrees with you on one issue, but agrees on most others more than claiming that their opposition is based on something they claim it is not.
  • Dialogue. Rather than dismissing concerns about abortion as “arbitrary,” take some time to think through the issue from the beginning. I find it somewhat incongruous to consider a zygote a full human being. It’s much harder though to distinguish between a fetus who has not yet taken a breath of air from one who has. That border does seem quite arbitrary. Consider – for a moment – whether or not pro-lifers are actually only concerned with keeping women in their “proper place.” Consider that they may be wrong, but that they are raising some valid arguments. Any political philosophy is successful to the extent it can deal with and subsume the arguments opposing it. On abortion, the Democrats are failing miserably.
  • Common ground. Keep working on reducing the number of abortions. The Catholic Church and thus most pro-life organizations may continue to oppose such measures, but it will win over the center. In fact, better yet, just pass a bill that reduces the number of abortions without worrying about whether or not you have their support. Make the Democratic Party the party that will fight to keep abortions legal, but will help reduce them as it was under Bill Clinton.
  • Attack partisan groups. If – when – the National Right to Life committee and other pro-life groups continue to shrilly oppose the Democratic Party, isolate and attack these groups as not attempting to find a solution to this issue.

Coincidentally, this bears a great deal of resemblance to the approach Obama has taken to his political opponents generally, including on the issue of abortion – using respect and civility as a potent weapon. And this is why both serious Democratic candidates in 2008 sought to soften their pro-choice stands.

[Image by Steve Rhodes licensed under Creative Commons.]

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Domestic issues Environmental Issues Health care Politics The Opinionsphere

Nancy Pelosi’s Essential Leadership

[digg-reddit-me]At this point, whatever you think of Nancy Pelosi’s policies – or her personality – you have to admit this: she’s ruthlessly pragmatic, knows how to wield her power effectively, has excellent political instincts, and is one of the more effective Speakers of the House in recent memory. In an interview with Ezra Klein, Pelosi described her legislative philosophy:

“You get the votes,” she said, balling one hand into a fist, “and you take the vote,” and she punched her other hand. “Because you never know what can happen.”

Pelosi’s 11th hour compromise Saturday night – accepting the Stupak amendment – proved she was willing to do what it took to get the health care “bill that no one loved but almost everyone still believed in” passed. The Stupak amendment brought two key constituencies on board: the Catholic bishops and pro-life Democrats. As Minority Leader Boehner prepared to use legislative maneuvers to scuttle the bill on the grounds it would make everyone in the health insurance exchange pay “an abortion premium” – Pelosi’s acceptance of the Stupak amendment lead Cardinal Francis George, the president of the U.S. Conference of Catholic Bishops, to call Boehner to make sure “the GOP didn’t play any games,” blocking health care reform on the pretense of a pro-life position. At the same time, the Stupak amendment also allowed the bill’s sole Republican supporter to sign on, Congressman Anh Cao. The fallout among the pro-choice Democrats has been severe – but Pelosi must assume it’s manageable. Given the fact that this provision will likely be stripped from the final version of the bill, it seems a small price to pay to pass this historic legislation.

At the same time, Klein points out that Pelosi’s decision to push cap and trade legislation through months ago looks prescient today:

I’m not saying that cap and trade has great odds this year, but whatever chance it does have is a function of Pelosi passing it back in June. She got the votes, and she took the vote.

The House has now passed two bills tackling two major issues that have been growing worse for the past two decades but Washington has been unable to address due to partisan gridlock. Obama deserves much of the credit. But Nancy Pelosi has proven to be a formidable pol – and it is her leadership most of all that has gotten this legislation as far as it has.

Now, all eyes turn to the Senate – for both health care and cap and trade. In the coming months we will find out whether or not Washington is able to deal with either of these issues, or to once again put them off, drawing closer to the moment that is too late. But in the meantime, Nancy Pelosi has done her job.

[Image by Public Citizen licensed under Creative Commons.]

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Criticism Foreign Policy Health care History Politics The Opinionsphere

Health Care Graphs, Cold War Deer, Evaluating Hillary, An Armey of Tea Baggers, and Rubio

Kaiser Permanente. Ezra Klein interviewed Kaiser Permanente CEO George Halvorson this week – and got two fascinating posts out of it so far (with the second part of the interview still to come.) The most interesting post for me was the one that included a number of graphs, including this one.  Ezra bills these charts as “An insurance industry CEO explains why American health care costs so much” – which comes down to this fact: in other countries, government set medical fees.

The Cold War Lives On. Cecilie Rohwedder of the Wall Street Journal tells the fascinating story of how several herds of deer still seem to be stuck in the Cold War.

Evaluating Hillary. Joe Klein has a balanced and insightful evaluation of Hillary Clinton’s tenure as Secretary of State. It is a bit early – as he acknowledges. But while the piece is worthwhile, he gives too little credit for the positive progress made by Hillary and the Obama administration in checking the deterioration of U.S. interests around the world, especially with regards to public diplomacy.

Armey of Tea Baggers. Michael Sokolove for the New York Times Magazine has a nice profile of Dick Armey, in the news of late for his Freedom Works organization and the tea parties they’ve been organizing. The difference between Armey the public speaker and Armey the man comes out in the story, as Armey the man seems like a bit of an ass, but a reasonable fellow; while Armey the public speaker is a demagogue, for example stating:

Nearly every important office in Washington, D.C., today is occupied by someone with an aggressive dislike for our heritage, our freedom, our history and our Constitution.

The trick of the organizing Armey is attempting is that he extols the virtues of the individual while trying to unite these individuals into a collective “we” who will fight to protect “our heritage, our freedom, our history.” He is speaking the language of a member of a beleaguered minority – while claiming majority support. Political pressure in the right way should relatively easily disturb the balance he is now able to so effortlessly achieve.

Marco Rubio. NPR profiles the man who – if I were betting – is the future of the Republican Party, after it escapes the Sarah Palin death spiral: Marco Rubio. (Listen to the audio of the story if you can.) He’s very conservative – and makes many political mistakes in positioning himself against common sense, which by all rights should come back to haunt him when he is chosen as a Vice Presidential nominee – for example, coming out against the fact that government spending can stimulate the economy. This betrays a basic disregard for macroeconomics, at least when put as unsubtly as Rubio does. But he keeps well within the mainstream of Republican positions on these issues, so as unhinged as those positions may be, he will be insulated from charges of kooky-ness.

But he’s Hispanic; his wife is a former cheerleader for the Miami Dolphins; he’s a darling of the far right, but seems smart enough to tack to the center in a general election campaign – and the fact that he’s already accepted by the far right means he will be able to get away with it; he speaks convincingly of America as a nation of “go-getters;” he seems to have a natural charisma and charm, and is at ease with those who disagree with him; and finally, he’s ambitious as hell and has enough self-regard to believe he can beat the extremely popular Governor Charlie Crist for his Senate seat.

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Barack Obama Domestic issues Energy Independence Environmental Issues Green Energy Health care Political Philosophy Politics Romney The Opinionsphere Videos

Limbaugh claims Obama is a radical leftist because he supports programs Republicans proposed a generation ago.

[digg-reddit-me]Rush Limbaugh, Dick Cheney, Glenn Beck, Sarah Palin, Charles Krauthammer, and other right wingers have begun to converge on a unified theory of Obama – a systematic critique of who he is, what he stands for, and what he is trying to do. Part of this theory – one of the core themes being developed – is that Obama is the most far left American leader ever. Rush Limbaugh expresses this as well as anyone – and I’ve spliced together two clips from his interview this past Sunday with Fox News. (Full interview here.)

Let’s take two of these quotes out for a moment:

We’ve never seen such radical leadership at such a high level of power…

I don’t know of any Republican who would try to take over one sixth of the U.S. economy. I don’t know one Republican who would put forth this…this…irresponsible cap and trade bill. I don’t know one Republican who would actually do that.

To understand why this is such a bizarre thing to say you need to look at some history.  It illustrates what I mean when I call the Republican Party and the right wing – and much of our public debate as it attempts to find the middle ground between the right and left – unhinged. Take a minute to look at the history of the policy proposals regarding the two examples Limbaugh cites – health care and cap and trade.

Health Care

The plans moving through Congress now have an historical precedent in most of their aspects in the two serious Republican attempts to reform health care after LBJ’s introduction of Medicare and Medicaid – Richard Nixon’s health care proposal in 1974 and the Dole-Chafee bill in 1993. Between the two bills, they contained a technocratic institution to reign in health care spending by looking at medical practices – similar to the IMAC that Sarah Palin called a death panel (Richard Nixon’s proposal); an individual mandate, an extension of Medicaid eligibility (the Dole-Chafee plan); an end to insurance industry abuses – for example, banning people with preexisting conditions, subsidies or vouchers for individuals who couldn’t afford health insurance to purchase it, and the creation of a standard minimum level of benefits for health insurance plans (both plans.)

Those who developed the base model that of health care reform now – used these models as the base onto which they grafted a health insurance exchange and a public option. They combined market forces with decentralized decision-making – the exchange on which private companies would offer health insurance – with a more top-down centralized approach – the public option which would compete with the private companies. Clearly, though the plan is distinctly liberal, it was developed by people who have a deep appreciation for some of the central conservative critiques of government planning and New Deal/Great Society-style liberalism. The plan is also clever politically – as a great majority of the American people, in their wisdom, see great value in having a choice between public option and a private one. Michael F. Cannon of the libertarian Cato Institute accidentally justified the rationale behind this popular sentiment:

Any payment system creates perverse incentives…which is why we need competition between different payment systems to temper the excesses of each.

Unlike the Dole-Chafee bill which sought to undermine the current system with the hope that something else would develop, the plans working through Congress now are more conservative as they seek to preserve the status quo while introducing an alternative model that people could opt into if it works.

You wonder how far to the right the Republican Party Rush imagines is if he claims he doesn’t know any Republican who would propose anything like this.

How about Mitt Romney, Bob Dole (who incidentally endorsed a version of the bill currently moving forward), Richard Nixon?

The one thing that makes this plan distinctly liberal is the public option. Yet, if anyone believes that after dropping it, the Republicans would support a health care bill, they haven’t been paying attention.

(For more on the similarities on health care, see this post from yesterday.)

Cap and Trade

On climate change, the story is even more dramatic.

Cap and trade started out as a hair-brained scheme to solve the problem of acid rain thought up by a Reagan administration lawyer, C. Boyden Gray. Environmentalists and liberals hated the idea. They saw it as a license to pollute, a “morally bankrupt” “license to kill,” or more reasonably as a “scheme for polluters to buy their way our of fixing the problem.” They preferred the more “command-and-control” approach of top-down regulation. Regulators resisted the idea – as it forced them to surrender “regulatory power to the marketplace.” Industry opposed it, claiming it “was going to shut the economy down.”

But George H. W. Bush thought that free market principles could realign the incentives to fix this problem – and he wanted to placate the Canadians who were bearing the brunt of the acid rain.

So he pushed through a cap and trade scheme to eliminate acid rain over these strong objections. It beat all expectations. Eventually environmentalists came around and industry continued to thrive. This Republican success on solving a major environmental issue without top-down regulation made cap and trade a popular, bipartisan idea. Eventually, Bill Clinton saw it as a way to tackle global warming. But as a significant minority of Republicans continued to question whether or not global warming was real and whether or not it was man-made (along with every other scientifically moot question that industries raised) any possible deal was postponed. Still, as late as 2008, the Senate had strong bipartisan support for a cap and trade program – with Joe Lieberman and John McCain taking the lead. Now McCain is a major opponent of the cap and trade legislation, complaining about the lack of support for nuclear reactors in the bill as a reason to oppose it. This when as late as a year ago, he reiterated his statements of the past eight years in saying that global warming demanded “urgent attention” – that we must “act quickly” to “dramatically reduce our carbon emissions” with a “cap-and-trade” program.

As I said regarding health care, if anyone thinks that McCain will come around to support this legislation that is so similar to what he supported as essential a year ago if the Democrats just tossed some more money into nuclear energy, then you haven’t been paying attention. McCain will likely start calling it a “power grab” and a “government takeover” of the world, echoing Cheney and Krauthammer by the time the bill is up for a vote.

Conclusion

In both cases, Republicans proposed ideas based on core conservative principles – on a respect for the free market, on avoiding rapid change, on avoiding top-down regulation. And now Democrats led by Barack Obama have taken up these proposals – amending them somewhat to take into account liberal ideas such as a distrust of large corporations and a concern for community goods – hoping to pass bipartisan legislation.

What they are met with instead is screams of “Socialism!” and “Government takeover!” and “Unprecedented!” “Attacks on liberty!” and “Why do you hate America?”

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Domestic issues Health care McCain Politics The Opinionsphere

What Would Republican Health Care Reform Look Like?

Edit: I see a few people have linked to me since Obama’s little debate with the House Republicans in which he backed up the point I’m making here, that his health care plan is:

similar to what many Republicans proposed to Bill Clinton when he was doing his debate on health care.

That’s the point I was making with this post as well. But some people have apparently taken this post as some sort of evidence of Obama’s nefariousness – as proof that he’s selling out. pm317 wrote on Hillaryis44 that people should, “Tell your bluest of blue friends who are still supporting Obama to read this little piece…” I think they should read this piece – but it stinks of partisanship to presume any Republican suggestion is wrong.

This piece points out that Obama has adopted much of the Republican framework for dealing with health care – picking up on the work of liberals such as Jacob Hacker and Peter Orszag. This framework was broadly endorsed by John Edwards, and then Hillary Clinton, and then Barack Obama during the campaign. The plan Obama is pushing attempts to combine the best elements of the conservative Republican plans with the goals and certain important elements of liberal alternatives. As a liberal, I acknowledge that this plan is modest – tinkering even – but this is its strength rather than weakness.

———————-

[digg-reddit-me]Yesterday, the Republicans released their health care plan. However, as Ezra Klein points out it isn’t an actual plan to fix health care as much as a plan to get people to stop asking them what their plan is:

The bill is framed in terms of Republican attacks on the Democratic bill, not in terms of its own aims or methods. Which is fine, and to be expected. If I were a Republican, I wouldn’t spend my time crafting a health-care reform plan, either. Republicans don’t have the votes to pass a bill, and they know it.

So what is the Republican approach to health care reform?

In an interview with the German weekly Der Spiegel, Charles Krauthammer gives a typical response, lecturing Obama:

On health care, the reason he’s had such resistance is because he promised reform, not a radical remaking of the whole system.

Though this is a common claim by right wingers attacking Obama, it clearly isn’t true. Obama’s health reforms take great pains to preserve the current system – and is indeed based largely on two conservative attempts to reform health care in the past. The hope of liberals is that this reform could establish a structure: health insurance market with a public option, that could gradually be opened up to the rest of the population if it was successful. But that isn’t what we’re talking about now.

Given that his criticism of Obama’s health care position is that it is “a radical remaking of the whole system,” you would think Krauthammer would offer a few conservative measures. But if that is what you think, then you have misunderstood the right wing. Krauthammer proposes to entirely tear down the current system: “It is absolutely crazy that in America employees receive health insurance from their employers,” he says, and proposes we gut this system by eliminating the tax break for health insurance and eliminate the prohibition on interstate insurance (which would effectively strip any regulation from insurance companies as the state with the least regulation could attract these companies in a race to the bottom…) By any standard, and whether you agree with them or not, these are radical measures that would completely remake our system of health insurance – and they were also the two cornerstones of the proposal by the McCain campaign.

What Krauthammer either doesn’t know or attempts to elide is that Obama’s health care plan has two prominent historical predecessors: Richard Nixon’s proposal in 1974 and the Dole-Chafee bill sponsored by the Republicans as an alternative to Bill Clinton’s approach in 1993. If you want to figure out what Republican health care reform might be, this is where to look. One of the key things to realize when looking at these plans is that we currently have a hybrid system: with the elderly, veterans, and the poor receiving government-provided health insurance; many of the employed receiving employer-provided health insurance; and those left out either without health insurance or using the much more expensive and less stable individual health insurance market.

1974: Nixon’s Plan

At the crest of the liberal era, Richard Nixon attempted to reform health care. He called his plan CHIP, or Comprehensive Health Insurance Plan, and its goal was to solidify the hybrid system that existed. He proposed expanding eligibility for Medicaid, expanding Medicare to cover prescription drugs, subsidizing the poor to get insurance, incentivizing employers to provide health insurance, and eliminating discrimination on the basis of preexisting conditions.

Specifically, Nixon’s plan included:

  • A form of the Indepedent Medicare Advisory Council called the Professional Standards Review Organization, both being independent technocratic bodies composed primarily of doctors which would be charged with ensuring quality care while “helping to bring about significant savings in heath costs,” to use Nixon’s phrase. (Under Obama, this group would be significantly checked by Congress, and Obama has specified one way that excess treatments could be minimized – by compiling medical knowledge about best practices into a non-binding database.)
  • A commitment that health insurance would “cost no American more than he can afford to pay,” in Nixon’s words, which specifically meant subsidizing health insurance for the poor who could not afford it and were not provided it through their employers.
  • A commitment to build “on the strength and diversity of our existing public and private systems of health financing” and to harmonize “them into an overall system,” as Nixon said.
  • The banning of discrimination on the basis of preexisting conditions.
  • The standardization of a basic level of health insurance including setting maximim out of pocket costs per year and setting a minimum level of what would be covered.
  • A federally issued “Health-card” which would be “similar to a credit car” and “be honored by hospitals, nursing homes, emergency rooms, doctors and clinics across the county” and would include “identity information on blood type and sensitivity to particular drugs.” (Obama’s plan contains no such thing, probably to avoid concerns of federal overreach and the hysteria which accompanies talk of a national identification card.)

One of the great regrets of Ted Kennedy’s life was that he did not take the deal Nixon offered him on health care. It’s also noteworthy that Nixon at this point was insistent on strengthening the employer-provided health insurance system and the government-provided health insurance system. He also pushed the idea of HMOs which Bill Clinton’s plan was later demonized for encouraging as well.

1993: The Dole-Chafee Bill

In 1993, some Republicans believed they needed to come up with an alternative to Bill Clinton’s health care plan (in contrast to the, “Just Say No” approach advocated by Will Kristol at the time, and again today) – with 20 Republican Senators eventually introducing to great fanfare the Dole-Chafee bill. This bill was flawed and politically impossible to get through Congress given the many interests it offended – from labor to the elderly to big corporations. This was because it’s main goal was to undermine the employer-provided health insurance system and to a lesser degree the government-provided health insurance system. The Republicans saw these as distancing individuals from the cost of their health care decisions and thus as two of the main drivers of increasing costs – though they did not acknowledge or attempt to fix any of the problems which made the individual health insurance market untenable for most. This bill included:

  • An individual mandate enforced by a penalty imposed on those who did not comply.
  • A government voucher to purchase health insurance for individuals to up to 240% of the poverty line. (Which is more generous than the Senate Finance bill which only offered subsidies for families up to 200% of the poverty line.)
  • A cap on how much health insurance could be deducted as a tax credit (similar to what the Senate Finance Committee proposed recently, which Republicans denounced as raising taxes.)
  • The removal of the tax credit for all private health insurance plans that did not provide a “federally guaranteed package of health care benefits.” (Which is more radical than anything Obama is proposing – and a greater reach of the government into the private sector.)
  • The elimination of discrimination on the basis of preexisting conditions.
  • Financing through cuts in Medicare Part B and the limits in tax credits discussed above.

“Obamacare”

Compare the above to the plans now circulating in Congress and backed by Obama.

They have many of the same goals:

  • reducing the growth of health care spending;
  • eliminating the holes in our insurance system and insuring the uninsured;
  • eliminating abuses by the health insurance industry.

They have some similar mechanisms to achieve these goals:

  • regulation of health insurance industry;
  • individual mandate;
  • subsidies for those who cannot afford insurance;
  • technocratic panels.

The health care reforms being proposed today are based on the same framework as the two Republican plans of the past with one main exception: they provide a mechanism to allow the individual market to work more effectively. The health care reforms today attempt to preserve the current system – which is deteriorating year by year as more and more people are priced out of health insurance – while alleviating the worst problems and providing a separate and regulated market in which individuals could choose between different health insurance models.

While both the Nixon and Dole-Chafee bills sought to change the health insurance industry through pure government regulation and intervention. The Democratic proposal working its way through Congress now adds two elements – one from the left and one from the right. They propose creating a Health Insurance Exchange – a market for health insurance. On this exchange, one could choose a publicly-run insurance plan.

The model the Democrats are working on now clearly owes a great deal to these two Republican attempts at health care reform. It’s a shame that Republicans have now taken to demonizing Obama’s plan on many of the very grounds that would necessarily be at the core of an actual conservative attempt to tackle health care.

[Image by Civil Rights licensed under Creative Commons.]

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Criticism Health care Politics The Media The Opinionsphere

Lieberman Ready To “Stick the Knife” In Health Care Reform

[digg-reddit-me]Ezra Klein doesn’t seem to believe Lieberman’s threat to filibuster health care reform will stand:

Lieberman’s argument against the public option is simply false. “I think a lot of people may think that the public option is free,” he says. “It’s not. It’s going to cost the taxpayers and people who have health insurance now, and if it doesn’t it’s going to add terribly to the national debt.” Soon enough, he’ll be looking at Congressional Budget Office numbers saying the exact opposite. The public option costs taxpayers nothing, adds nothing to the debt and saves everyone money. Lieberman won’t be able to hang onto this argument for very long, and then what? [my emphasis]

That seems to be almost willful naivete – as if facts get in the way of insisting something is true! Lieberman can – and probably will – continue to insist that the public option will cost tons of money and add to the deficit no matter what any “independent” body says – and if anyone in the media confronts him on it, they’ll let him off easy as he blows smoke in their face and talks about how, “Nothing is for free.”

The conversation will go like this:

Media guy: Independent estimates show that the public option will save money. The CBO – which you have often cited as a quality source – has said it will cut health care costs by $____ billion dollars. Yet you oppose the public option because you claim it will cost money. How can you do this?

Lieberman: Nothing is free, [name of media guy.] And a report came out just last week that showed how the public option would add $___ million trillion to the deficit. [Neglecting to mention that it was funded by some from for the health insurance industry.] With the public option, health care costs will skyrocket! Nothing is for free. And the public option will lead to rationing of care.

Media guy: Well enough on that, let’s move on to Iran.

Or perhaps Ezra just assumes Lieberman is a good guy who has genuine concerns that are based on policy, but just hasn’t taken the time to take an even cursory look into the main item of controversy in the major policy issue for the past three or so months.

I don’t think that is that likely. Which is why I think Jonathan Chait’s read on Lieberma’s motives is more accurate than Ezra’s:

[Lieberman is] furious with the party, resentful of President Obama (who beat his friend in 2008) and would relish a Democratic catastrophe…My guess is that ultimately he’ll vote for reform, but he’ll do so because the Democrats will scale back their plan and win over Olympia Snowe, making Lieberman’s opposition academic. Lieberman won’t join a futile filibuster, but if he has the chance to stick in the knife and kill health care reform, I think he’d probably jump at the chance.

[Image adapted from a photo by TalkRadioNews licensed under Creative Commons.]

Categories
Domestic issues Health care Politics

A Vote To Debate Health Care Is A Vote for Democracy

According to reporting by David M. Herszenhorn and Robert Pear for the New York Times:

The Senate Republican leader, Mitch McConnell of Kentucky, said that in his view a vote to debate the legislation would be tantamount to supporting it, which he said would raise taxes and increase health care costs.

Such a vote, Mr. McConnell said, “will be treated as a vote on the merits of the bill.”

Obviously, McConnell can say whatever he wants, but isn’t anyone in the Senate willing to stand up for the basic principle of democracy: majority rule. Minority rights must be protected, but when a minority is able to even prevent official debate on a law, things have gone too far. Strategically, McConnell has no choice – but by forcing the Senate to have a supermajority to even consider pressing legislation, he undermines the institution of the Senate itself. (And this supermajority requirement whereby any individual simply by threatening to filibuster can prevent debate isn’t part of the original balance of powers – but is a new development.)

You’d hope a bunch of Senators would take that into consideration.