Tag: Ezra Klein

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Barack Obama Health care Politics The Opinionsphere Videos

Senator Grassley Talks Out Of Both Sides of His Mouth On Health Care Reform

[digg-reddit-me]Watching the above clip on CNN earlier this week, I am amazed at Senator Chuck Grassley’s cojones!

This is the same Chuck Grassley who told MSNBC that he wouldn’t vote for a health care bill that only had items which he agreed with!

And this is the same Chuck Grassley who last week began fundraising against the health care reform he is allegedly negotiating over!

The same Chuck Grassley who fanned the rumors about death panels “pull[ing] the plug on Grandma!” And who then blamed Obama for making him endorse false rumors about health care.

This same guy is now blaming the President for making things “partisan” and for breaking his promise and undermining bipartisan compromise that he thinks is best on MSNBC while he spreads rumors about “death panels” to crowds opposed to the bipartisan reforms he is pushing and fundraises while demonizing the plans he supposedly is working towards.

It seems that this point from last night’s speech could be seen as directed primarily against Grassley – both carrot and stick:

It’s a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.

But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

Obama’s message to Grassley is: You don’t get to help shape the legislation if you’re demonizing it every time you step away from the negotiating table.

Yet it’s also worth noting that many informed commenators have said that Obama’s proposal last night is closer to the Gang of 6 bill that Grassley has been helping create than the four already finished versions in the House and Senate.

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Barack Obama Domestic issues Health care Politics The Opinionsphere

A Health Care Plan More Impressive Than Perfection: Something That Might Pass

[digg-reddit-me]Ezra Klein – as expected – has the best summary of what Obama accomplished last night. After voicing a few critiques of the policies promoted by the speech and some of the rhetoric on wonkish grounds, Klein concludes:

But if Obama hasn’t created the perfect plan, he’s created something arguably more impressive: a plan that actually might pass. That plan might not do enough to change the system, and it may not spend enough to protect everybody, but there is plenty in the proposal that will better the lives, health coverage, and financial security for millions of real people. It will insure around 30 million Americans and protect tens of millions more from insurer discrimination, medical bankruptcy and rescission. It will bring more evidence to medicine and more competition to the insurance market. That may not be perfection, but it is improvement. And it is achievable.

Klein also helpfully links to the plan posted by the White House and posted the transcript of the full speech (though I’ve included the New York Times link.) For those who missed it, this interactive video from the Times is useful as well. Andrew Sullivan meanwhile provided his useful reax (and a part ii) from notables around the blogosphere.

It is certainly too soon to declare victory – but last night’s speech accomplished what Obama needed – to give the media a peg to turn around their coverage. Through August the sizzle and dazzle came from the opponents of reform who finally were able to take on Obama and knock him down a few pegs. They were the sexy new story after months of that post-election glow. The White House fought back – but stayed largely above the fray. They continued to push reform behind closed doors. They searched for a deal that could pass. And they took punches. A lot of them. Andrew Sullivan dubbed this Obama’s rope-a-dope strategy (and here) back during the campaign – and it has emerged as a theme. Bill Clinton was the “Comeback Kid” who would get himself into some awful jam, but them miraculously pull himself out – often with the help of the overreach of his enemies. It was entertaining. But Obama’s approach is different. He lets his opponents attack him for a long time – enough to bring down his numbers and to make his agenda unpopular – and they get to the point where they sense victory, all the while positioning himself for where he wants to be at the decisive moment. And then he hits back. This has happened before: during the scandal over Reverend Wright; during the long summer of the 2008 campaign; when Sarah Palin was nominated; during the fight over the stimulus; and now, on health care. The game plan is the same – as I wrote earlier about the stimulus fight:

Sun-Tzu advised to “accommodate yourself to the enemy until you can fight a decisive battle.” This seems to have been Obama’s strategy – to allow his campaign to take hits and play defense, sticking to an overall strategy that would gain him a final decisive victory rather than exhausting his staff fighting every daily flair-up. Sometimes, this led to awful weeks – such as the long lack of a complete response to the Rev. Wright fiasco. But Obama ended up winning because, though he lost a thousand daily battles over Rev. Wright, he took the long view and gave a subtle, personal speech about race. He won that war not by fighting back charge after charge but by changing it from a war into a reflective national moment. It’s hard to describe how extraordinary that is – how rarely that has happened in history, and how difficult it was to imagine this was even possible, especially in the frenetic media environment that has existed since 1992.

Clinton’s strategy allowed him to survive personally, but was a disaster for the Democratic Party as a whole. Obama’s strategy seems to offer something better – a chance to win policy battles. (Of course, the zeitgeist of the times also plays a role in the fate of Democratic policies under Clinton versus Obama as well.)

It’s too soon to count the health care fight as won – but the administration is well-positioned to achieve what Teddy Roosevelt, Harry Truman, John F. Kennedy, Lyndon Johnson, and Bill Clinton all set out to achieve (and even what George W. Bush set out to achieve on tort reform.) And it is so positioned because of Obama’s clear strategic vision.

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History

Defending the Use of Reconciliation on Health Care

[digg-reddit-me]A meme among left wing bloggers in recent days (spawned no doubt on JournoList) has been variations on a particular defense of the use of the reconciliation process to achieve health care reform. Here’s Ezra Klein for example (though Matt Yglesias made an almost identical point):

Reconciliation began as a limited way to expedite passage of the budget bill that came at the end of each year. It did this by limiting debate and short-circuiting the filibuster. But year by year, administration by administration, it’s becoming more significant. It was used to pass much of Reagan’s economic agenda. Clinton expanded it to balance the budget, reform welfare and change the tax code. George W. Bush used it for tax cuts, trade authority and drilling in ANWR.

I wasn’t aware of this history when I wrote this earlier post suggesting it wasn’t the best option. But I think the political analysis still stands. Unless there is some hook that makes a certain set of facts stick, it will do nothing to derail the impression that most Americans barely attention get that health care reform was only able to get through a Cognress with a strong Democratic majority by trickery. This is a bad thing – though not worse than no bill at all in my opinion. I suggested:

A show of force whereby Obama pushes the Democrats to forthrightly endorse a bill would be – and play – much better in my opinion. Shenanigans – while legal – can be forgotten in time if the legislation proves popular; but a show of force would be more effective on almost every other level.

Of course, Obama would need to find some leverage to push people like Senator Ben Nelson – and it’s unclear at the moment what that would be. The best rationale though for pushing the reconciliation process is that it will make such a process unnecessary – as Ezra Klein explains:

If Republicans can kill the bill, that’s their first-best outcome. But if they can’t kill the bill, the second-best outcome, at least for some of them, may be to deal on it. If there’s going to be legislation, Snowe and Collins and Voinovich and a few others might want to see their priorities included rather than simply content themselves with a protest vote against the legislation. Reconciliation might actually get you to 60, because it ensures the endgame includes a bill rather than a failure.

[Image by Greg from Cobb Mountain licensed under Creative Commons.]

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Health care Politics

Health Care Lie #494: Health Insurance Companies and Their Allies Are Blocking Reform

[digg-reddit-me]I’ve come to see it as a sign of dishonesty – of political manipulation – to portray the insurance companies as the primary villains in the problems with health care. As for example in this editorial in the Washington Post from the weekend:

[T]he campaign must focus attention on the insurance companies that are primarily responsible for the health-care mess. This means organizing public events across the country that can articulate Americans’ frustrations with the current health insurance system and polarize public opinion against the insurance companies and their allies. [my emphasis]

Of course – as those paying attention to the fight over reform know – the insurance companies stand to benefit from many of the provisions in the plan – if not from others such as the public option – and they seem to have realized in advance that they needed to get behind reform so they could shape it. Perhaps behind the scenes, they are trying to block it – but I haven’t actually seen any indication of it. (And neither has Ezra Klein who has been following this more closely and for much longer than I have.)

Health insurance companies are such an easy target though – as they seem to add little real value. Their secondary purpose – aside from spreading the impact of health risks – is to restrain costs – and in this they have failed miserably. Their aggressive culling from their rolls of all those who actually need the service they provide have undermined their primary purpose. They have adopted horrendous practices and seem to treat their customers in bad faith as a matter of course. They are such easy targets that they knew they needed to get behind reform early – and remain behind it though they are being made the public villain by the reformers. In a lot of ways, they should be: they are profiting from a faulty system that is hurting many Americans and is unsustainable; as prices skyrocket, their profits do as well. Statistics such as the medical loss ratio demonstrate that these companies are trying to do everything possible to avoid providing the service they are in business to provide. But I’m not sure you can make the case that spiraling health care costs are the fault of health insurance companies (though they have contributed in various ways.) And health insurance companies aren’t behind the various lies – from the allegations of a government takeover of the economy to death panels. They may be trying to scuttle the public option, but they stand to benefit from much of the plan – and it’s better for them to reduce the uncertainty and deal with legislation passed than to continue with an unsustainable system.

In other words, in this reform effort – which is mostly about health insurance reform – health insurers aren’t the primary obstacle.

[Image by Steve Rhodes licensed under Creative Commons.]

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Health care Politics The Opinionsphere

Health Care Lie #493: Rationing

[digg-reddit-me]Ezra Klein does a pretty good job taking down the rhetorical slights of hand Republicans are using on this issue. His approach might not be the most effective politically – but it has the virtue of being honest. Rather than proclaiming there will be no rationing – he points out that we already do ration.

We prioritize botox for the rich over cancer treatments for the poor. This is the status quo that we have that is so incredibly expensive. The debate over health care should be focusing on two questions:

  1. How much of our national wealth are we going to choose to spend on health care?
  2. How do we want to allocate our limited health care technology and services?

We can agree to spend a lot of our national wealth on health care. After all, we need to spend it on something. The rate of growth is too much now – but we don’t need to reduce our levels of health care spending to that of Great Britain. (They spend 41 cents on the dollar that we spend for better overall results as measured by life expectancy, infant mortality, as well as overall patient satisfaction.)

Then – to the second question – how do we allocate access? Right now, we provide emergency treatment to everyone; those with the most money get any treatment they like without significant waits; the rest of us wait, but at least are treated if we have insurance coverage. There’s a reason why rich people from around the world travel to America – and it’s not just because we have great doctors. It’s because they get to cut the line and get treated ahead of those with less financial status because our system rations by money.

For the rest of us, the health care reforms being discussed now won’t reverse this privileged position for the rich. What Obama is proposing is not anything so radical. But rather he seeks to accomplish several things, to moderately improve our current system:

  • it will eliminate the fear that your insurance company will drop your coverage once you get sick – putting you on the fast road to being poor and at the bottom rung of our society and in our health care system at the same time;
  • it will – through incentives, tax breaks, and mandates – ensure that everyone has a base level of coverage;
  • for the many who already do have coverage, it will provide a sense of security – a peace of mind – that even if you lose your job, you will still be able to get affordable health insurance; and
  • finally, for a small number of Americans to start, and then perhaps for a larger portion if the program is successful, it will provide a choice of health insurance plans in a functioning and transparent market for individuals which our current mish-mash of Wall Street-run health insurance companies and hodge-podge of regulations isn’t able to provide.

This moderate plan bears little resemblance to the “government takeover of health care” that critics are directing their fire at. It isn’t about “rationing.” In fact, what it seeks to do is address the rationing our system already does. In this way, the attacks on the plan are Rovian in the most diabolical sense – they take the strength of the plan, and try to turn it into a weakness.

[Image by Aaron Edwards licensed under Creative Commons.]

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Barack Obama Health care Politics The Opinionsphere

“Fixing” The National Conversation

Obama with correspondence

[digg-reddit-me]Ezra Klein gives his dispiriting prognosis of the health care reform debate:

[E]ven if…the media has made some admirable efforts to combat specific lies, they — we — have allowed lies and chaos to emerge as the subject of the health-care reform debate.

He writes this while pointing out that more than half of polled Americans believe that the plans at issue now would amount to a “government takeover of health care” and would give coverage to illegals – despite the fact that both are untrue. Large percentages of Americans likewise believe that it would lead to government-financed abortions and the government “pulling the plug on grandma.”

What this suggests is that our national conversation truly is broken – that once you go negative enough, and negative consistently – you will have won. This obviously creates rather perverse incentives and leads to a system in which only changes that can be passed quickly – and without opposition from entrenched forces – will be effected. It would be a system in which only those regulations and reforms and changes that have concentrated benefits for a minority and disperse costs on the majority will pass. That’s basically the system we have now – as people from most ideologies can recognize.

But there are a few glimmers of hope. Barack Obama was the object of such a campaign of lies – but he still won a majority. And it must be true that the same tactics used repeatedly have a diminished effect.

I would argue though that the best way to “fix” the national conversation at this point would be for the Democrats to pass a health care bill with every demagogued position, make sure it would benefit a large majority of Americans in clear ways, make the implementation transparent, and let the lies meet the truth of the legislation passed. Once our politics takes this into account – that lies can be proven false by action and transparency – this particular tactic will no longer be effective.

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Barack Obama Health care Politics

Health Care Lie #492*: A Government Takeover of 16% of the Economy

*I’ve stopped counting, so that number is made up.

[digg-reddit-me]We’ve all heard this claim – that Obama’s health care reform – specifically the public option – is really a stealth attempt to socialize America and have the government take over a significant portion of our economy.

This claim isn’t true. However, unlike the fearmongering that is the invocation of “death panels,” there is a bit more substance to this accusation. But like so much of this debate, it has little to do with the bills currently under consideration which have rather weak public options. What this claim is based on are the hopes of progressives that the public option could prove to the country how great and effective government health care is and thus lead to a single-payer, Medicare For All type system.

According to Mark Schmitt of The American Prospect, the public option was latched onto by progressives early on as a potential “stealth” tool to gradually move America into a Medicare-for-all type system – as they assumed that given the choice, most citizens would prefer government-run health care. As Ezra Klein summarized Schmitt’s piece:

The reason the idea managed to catch the liberal establishment’s imagination was that it was sold as a way of achieving single-payer, or something close to it, within the current constraints of the political system.

Those on the right wing saw the fervor that accompanied discussions of the public option and soon identified it as a potential target. But the public option wasn’t designed to work as a stealth tool. Its main designer and earliest promoter, Jacob Hacker saw his policy “as an alternative to single payer” and “as a competitive alternative to private insurance” – in other words, as a way to maintain some of the advantages of the system a large number of Americans currently have while offering a different model of competition to keep insurance companies honest. The initial design of the public option – which remains intact today – would create a self-sustaining, non-profit agency that competes with private plans on a Health Insurance Exchange. Perhaps the best explanation of why this would work comes from Michael F. Cannon of the Cato Institute who – while trying to attack the possibility of a public option – made this observation:

Any payment system creates perverse incentives…which is why we need competition between different payment systems to temper the excesses of each. So if Kaiser Permanente is skimping on care, which is the perverse incentive its payment system creates, there are fee-for-service insurers on a level playing field that can lure patients away from Kaiser. That tempers the rate at which Kaiser succumbs to those perverse incentives…

This understanding of how markets work – and how a competing payment system could improve health care for all – is exactly the reason so many people were in favor of a choice between a public option and private ones before the current fear-mongering campaign.

Hacker’s policy is what President Obama has decided he wants in a public option, as he explained Time‘s Karen Tumulty:

It shouldn’t be something that’s simply a taxpayer-subsidized system that wasn’t accountable, but rather had to be self-sustaining through premiums and that had to compete with private insurers.

Tumulty later described Obama’s position on the public option:

Obama has never presented the public option as anything other than a means to an end — one that he would be perfectly willing to achieve through other avenues if necessary. His goal is twofold: to provide a low-cost alternative to the private system that already exists and to assure competition in a health-care market where it is generally lacking.

Further demonstrating that the goal of Obama’s health care reform is not to stealthily push America into a Medicare For All program, he has signalled he would be willing to accept a co-op in place of the public option. However, while Republicans had promoted the idea of co-ops as an alternative to the public option, they now are quickly moving away from this position. Ezra Klein explains:

This is a dynamic we saw in 1994. A compromise is offered, and after great anguish and infighting, Democrats grudgingly move toward it. Then the compromise is yanked away. The famous example of this is Bob Dole voting against two bills that had the name “Dole” in the title.

Someone here is acting in bad faith and has a secret agenda. It doesn’t seem to be the Democrats.

Conclusion: The public option could become a stealth path to single-payer. Just like Medicare could. Or Medicaid. Or S-Chip. Or any other legislation that has ever dealt with the serious problems in our market for health insurance. But what we’re seeing now isn’t a stealth option – as much as both progressives and right wingers may want to pretend it is. If our nation is moving towards a single-payer Medicare-for-all-system, this legislation isn’t what will get us there. That fight will come later.

And for what it’s worth: the public option isn’t the most important part of health care reform. The Health Insurance Exchange (on which the co-op or public option would sit along with private companies) is more important – as are the various reforms of the health insurance industry.

(Some other resources on the public option are this Slate magazine piece from 2006 and this report by Jacob Hacker on the advantages of allowing the public to choose a public option.)

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Categories
Barack Obama Politics The Opinionsphere

The Caricature of Rahm Emanuel

I thought it was pretty amusing that Zeke Emanuel didn’t seem ready to play along with Ezra Klein’s last farcical questions about his brother, Rahm:

What is your brother Rahm’s favorite food?

Good question. I don’t know, actually.

I’ve heard it’s the still-beating hearts of his enemies.

Oh, my brother is a lovely person. He doesn’t do any of that.

Perhaps this has something to do with the fact that Ezekial is still smarting from the ongoing campaign to paint him as a “Dr. Death” who wants to euthanize those who aren’t productive enough. (This despite the fact that he has been on record as opposing euthanasia since at least a decade ago.)

Of course, this Times piece over the weekend by Peter Baker and Jeff Zeleny profiling Rahm Emanuel has a much lighter take on the most powerful chief of staff in memory:

The caricature of Mr. Emanuel as a profanity-spewing operative has given way to a more nuanced view: as a profanity-spewing operative with a keen understanding of how to employ power…

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Categories
Health care

The Smearing of Britain’s National Health Service

[digg-reddit-me]Alex Massie is probably right that there are “two essential truths in international health policy,” namely that:

No-one sees fit to copy the National Health Service and no-one sees fit to copy the American system.

But even given this, the right wingers have taken smearing Britain’s National Health Service too far. Chuck Grassley claimed, for example, that “Sen. Edward M. Kennedy would be refused treatment for his brain tumor in England.” As Matt Yglesias pointed out:

[T]here’s actually a two-fold lie here. First Grassley falsely implies that congressional Democrats are proposing to create an NHS-like system. Second, he lies about how the NHS operates. And he pays no price for it.

And despite what Cassandra over at Villainous Company has to say, Grassley is lying. Calling Yglesias an “evil-monger” and saying that “Google is not Matt Yglesias’s friend,” she claims that the drug Senator Kennedy is being prescribed for his tumor is prohibited by the National Health Service. Her source? An “expert” quoted by NewsMax – who forgets to mention that the drug – Temodar – was invented in Britain and has been prescribed by the National Health Service since 2007 2005. The “expert” also claims, the drug would be “available to every American.” Which is true. Every American who can pay for it. And the same was true in Britain even when the National Health Service did refuse to prescribe the drug. Now, of course, in Britain, the drug is actually available to everyone in that country – whether they have the money to spare or not.

This two-fold lie about the National Health Service  is one of the pillars of the right wing smears against the proposed Democratic health care plan – most disasterously used of course by the Investors Business Daily in discussing Stephen Hawking. Hawking later told the Guardian:

I wouldn’t be here today if it were not for the NHS,

But that’s still not the point. This whole conversation about Britain’s National Health Service is a distraction. Very few Democrats or liberals or progressives want anything resembling the British system. What is at issue is a plan to improve upon the system we currently have – modest steps. Though, as Ezra Klein explains, the modesty and popularity of what the Democrats are proposing is the reason Cassandra, Senator Grassley, Sarah Palin, Rush Limbaugh, and other right wingers are pretending the Democrats have proposed something else:

In part, that’s why the debate has had to move toward fear-mongering and lies: There just aren’t that many scary elements in the bills, because the legislation is oriented toward preserving the existing system and avoiding points of controversy.

And so, we face this unhinged debate about totalitarianism – a fearful fantasy – instead of a reality-based discussion of the system we have and how it can be improved upon. Which is why the right wingers spreading these lies and smears and distractions just so they can achieve a political victory and slingshot their way back into power as they did in 1994 should be ashamed.

Categories
Health care Politics The Opinionsphere

4 Points on Health Care

There’s just too much going on in health care – too many important points to make and second. So, here’s another hodge-podge post on health care.

Zeke Emanuel. Alex Koppelman addresses the irony of the fact that Ezekiel Emanuel – Rahm Emanuel’s brother and a member of the Office of Management and Budget – is one of the centers around which the conspiracy theories about death panels and such are flying. As a leading bioethicist, he has written academically about many hypothetical scenarios – and now, they are being taken out of context to suggest he is in favor of all sorts of Nazi-like practices. In fact, Emanuel is not even in favor of physician-assisted euthanasia:

[Zeke Emanuel] is actually one of the country’s leading medical ethicists, a forceful defender of people approaching the end of their life. Indeed, he opposes even voluntary euthanasia and physician-assisted suicide.

The Eight Point Plan. Matt Yglesias had an important post today – pointing out that though most of the attention on health care reform is being given to the public option (and to a lesser degree the Health Insurance Exchange), neither of these will affect the health insurance received by most Americans. (Though if done right, the public option and exchange would provide a measure of security to Americans as they realize they could lose their job as well as health insurance.) Instead, Yglesias says :

For those of us outside the exchange, the core of health reform is this eight point plan to make health insurance better by blocking dirty tricks by private insurers.

The Purpose of the Public Option. Jacob S. Hacker defends the public option in a white paper [pdf]  written describing the purpose of the public option in the Health Insurance Exchange:

The public Medicare plan’s administrative overhead costs (in the range of 3 percent) are well below the overhead costs of large companies that are self-insured (5 to 10 percent of premiums), companies in the small group market (25 to 27 percent of premiums), and individual insurance (40 percent of premiums).

What if the right “wins”? David Frum asks what it would mean for conservatives and right-wingers to “win” the health care fight. This Republican’s answer:

We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.

Risk Adjustment in a Health Insurance Exchange. DiA asks a few questions of health care blogger Ezra Klein. Klein makes a point I hadn’t realized – that the legislation as currently written does not include a “risk adjustment fund” without which insurers could simply race to the bottom in creating plans. Without this, the Health Insurance Exchange would seem to offer nothing like an “ebay for health insurance.”

DIA: The House health-care bill includes universal community rating. But it doesn’t have a risk equalisation fund to compensate insurance companies who get stuck with the riskiest and least healthy clients. Doesn’t this ensure a race to the bottom in terms of the benefits companies offer, in order to discourage the unhealthy from signing up with them? Won’t they all just offer the minimum possible benefit package they can under law? (The point of the REF system, used in Germany and the Netherlands, is that companies actually offer extensive benefits and compete with each other to cover the older and less healthy, because they draw in more government compensation that way.)

Mr Klein: A risk adjustment fund is crucial, and, happily, a lot of senators understand that. I’d expect some form of risk adjustment to be added into the bill by the end. But you’re right: Without risk adjustment, the exchanges can’t really work, which means they can’t really grow, which means we won’t have changed much of anything at all.