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Wednesday, August 12th, 2009

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.

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What Do Matt Yglesias, Ezra Klein, and Che Guevera Have in Common?

Friday, July 31st, 2009

[digg-reddit-me] Answer: Not much.

But Democracy in America’s anonymous blogger seems to think that some of liberal bloggers Ezra Klein’s and Matt Yglesias’s recent posts suggest a new and profound (indeed revolutionary) disenchantment with our means of governance. DiA cites Klein who recently wrote:

[Health care] like climate change, is a litmus test for our government. Both are serious, foreseeable and solvable threats to our society. One threatens to bankrupt the country. The other threatens irreversible damage to the planet we live on. Responding to such threats is the test of a political system. And our system will fail it. We will not avert catastrophic climate change. We will not protect ourselves from health-care inflation.

Yglesias recently wrote this post I’ve noted before explaining how our current media-political system can be manipulated so easily by people acting in bad faith – and how that leads to bad policy outcomes.

DiA tries to summarize this generation of pundits and policy wonks – led by Klein and Yglesias:

Mr Klein exemplifies the generation of young left-leaning policy wonks, journalists and activists who have been formed politically by the reaction against Bush-era conservatism, and for whom the Obama presidency represents the first experience of wielding political power. Like Mr Klein, many of these young progressives are fundamentally moderate, process-oriented wonks who, long before the Obama campaign even began, had accepted that the pragmatic limitations of real-world American politics rule out any utopian, or even first-best, solutions to most public-policy problems. They have happily dedicated themselves to figuring out what kinds of reform are possible within the constraints of corporate and interest-group lobbying, ideological and partisan divisions, and America’s kludgey, creaking 220-year-old machinery of government.

But now, DiA suggests, they have abandoned this moderation and want a revolution – that they have become disillusioned about our media-political processes due to Obama’s lack of success.

Certainly, Klein and Yglesias are extremely critical of the processes by which policy is created and by which the public views and understands policy debates. They believe that this system is broken. But both believed this before Barack Obama’s recent troubles – as Yglesias himself pointed out in response to DiA.

What DiA is missing is that reformists (towards both the right and left, but here I will look only at the left) have long been extremely critical of our media-political process works. Just two days ago, in The American Prospect, executive editor Mark Schmitt wrote:

[T]he idea that America’s “existing democratic institutions are strong enough to deliver accountability ” flies in the face of all observed reality. For at least eight years, those institutions consistently failed to deliver accountability, and the Department of Justice and courts likewise failed to punish some of the greatest abuses of power in our history…

As Al Gore wrote in his book describing The Assault on Reason:

American democracy is now in danger—not from any one set of ideas, but from unprecedented changes in the environment within which ideas either live and spread, or wither and die. I do not mean the physical environment; I mean what is called the public sphere, or the marketplace of ideas.

It is simply no longer possible to ignore the strangeness of our public discourse. I know I am not alone in feeling that something has gone fundamentally wrong.

Or look at Lawrence Lessig’s lecture on Corruption – which eloquently makes the case for “disinterestedness” as one of America’s key founding principles which has been since lost. Read Glenn Greenwald’s blog – which constantly points out the deep and serious faults in our media-political processes. Obama himself made a number of these arguments. Virtually every intellectual reformist has a “theory of what’s wrong” – and what none of them seem to disagree with is that something is wrong.

While in other times, reformers may have focused more on accomplishing something regarding important issues – temperance, Wall Street greed, environmental issues, discrimination – today, the central problem facing reformers is how to reform the system itself. This is the essence of the reform movement today – from Obama to Gore, Lessig to Yglesias, Klein to van Heuvel.

Reformers have presented compelling critiques of how the media presents issues; of how Congress deals with issues; of how long-term problems such as an increasing number of uninsured, spiraling health care costs, climate change, copyright expansion, and many others are ignored or marginalized because any attempt to address these issues involves significant obstacles and risks in the present for an uncertain future benefit. One of the key beliefs that makes reformers reformers today is their understanding that America’s political system is broken and that our traditional democratic institutions just aren’t up to the job of managing serious and difficult areas and making rational, long-term decisions when the payoff only comes after policy-makers are out of office.

This idea was the basis of my post yesterday discussing Obama’s focus on outsourcing authority to independent, technocratic institutions as a way of getting around our broken media-political system.

(more…)

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