Posts Tagged ‘Health care’

Buck Up, Democrats!

Monday, January 25th, 2010

Andrew Sullivan, who was largely responsible for derailing Bill Clinton’s 1994 health care reform, likewise urges Obama and the Democrats to seize the moment:

[Obama should] tell the American people that he understands their anger and frustration (hence the big swipe at the banks last week), but that he refuses to stand by and do nothing. If the American people want nothing, they should support the opposition. If the American people want something, they should back the president they just elected in implementing a health reform plan he campaigned on.

Jonathan Bernstein explains why the “safe” choice of trying to appease your partisan opponents has little effect:

Democrats can be assured that Republicans will attack them, regardless of what they do.  Democrats could eliminate the estate tax permanently, slash the capital gains tax, repeal the Clean Air and Clean Water Acts, invade Iran, and pass a Constitutional Amendment outlawing abortion, and Republicans would still attack them — with exactly the same vehemence and vigor that Republicans have now.  That’s politics.  It’s how partisan politics is played.  It is absolutely impossible to avoid attacks from one’s opponents; nothing you do gives them license to attack, because they will attack whatever you do.  Oh, and this isn’t partisan; Democrats are going to attack Republicans, whatever the Republicans do.

Don’t believe me?  Republicans are attacking Democrats for taking away people’s guns, even though the Democrats basically surrendered on that issue fifteen years ago.  They are attacking Democrats for cutting Medicare and for allowing Medicare to grow so fast that it’ll bankrupt the nation — sometimes in the very same speech (I’ve seen it in the same paragraph)…

My advice to Democrats unsure about what to do is this: think about the actual bill, and what its effects would be if it became law.  If in your judgment those effects would be bad for your constituents, then odds are they will dislike it, blame you for it, and you’ll be in trouble.  If those effects would be good for your constituents, then vote for it.  Then figure out how you’re going to sell the thing and yourself, based on that vote.  But don’t back off of it because you think it will open you up to attacks; you’re wide open right now, and you’ll remain wide open regardless of what you do.

Jonathan Cohn writes a letter to the House Democrats who are considering not voting on the Senate bill:

I don’t want to mislead you: You could pass the Senate bill, which you may really not like, and still lose reelection. But passing health care reform would seem, if anything, to improve your odds of political survival. And if it doesn’t–if you’re doomed to lose anyway–enacting health care reform would give you a meaningful accomplishment in your record.

Think of everything you could do while serving in Congress. Would any single act be bigger than this? However imperfect, it will make a huge difference in people’s lives–and, quite likely, the evolution of the American social welfare state. You’ll be sparing financial or physical hardship for thousands of Americans every year, while delivering peace of mind–and safer, higher quality medicine–to literally millions of others. You’ll be saving the American economy and, along the way, helping people to stay healthy.

You can be a part of this moment in history–and, if you play your cards right, stick around in Congress long enough to enjoy it. It just takes some common sense–and maybe a little mettle.

In other words: Vote for the Damn Bill!

An idea for a new health care public service announcement

Thursday, July 9th, 2009

Are The Pieces Aligning on Health Care?

Wednesday, June 17th, 2009

David Brooks’s column is quickly becoming one of the most insightful, inside looks at the larger plans of the Obama administration (which suggests a column kneecapping Obama is forthcoming so Brooks can maintain his conservative cred). His latest column is practically gushing – but it certainly paints a plausible picture of what the Obama administration sees as it’s game plan on health care. Brooks starts his piece with this half-jesting, half-admiring set-up:

Let’s say that you are President Obama. You’ve inherited a health care system that is the insane spawn of a team of evil geniuses from an alien power. Pay is divorced from performance. Users are separated from costs. Rising costs threaten to destroy your nation and everything you hold dear.

You also know that [the only] two approaches [to actually fixing this] have one thing in common. They are both currently politically unsellable. Others have tried and perished. There are vast (opposing) armies arrayed against them. The whole issue is a nightmare.

You are daunted by the challenges in front of you until you remember that by some great act of fortune, you happen to be Barack Obama. This calms you down.

He then goes on to describe a strategy which runs like this:

  1. Table-setting. Court everyone – get everyone to the table and agreeing on some basic meaningless “pablum.”
  2. Congress. Ask Congress to put something together, keeping your distance as they investigate and write many competing proposals.
  3. The Long Tease. Refuse to rule anything out or commit to anything – thus keeping all the interest groups at the table.
  4. The Scrum. At the end of the summer session, when Congress actually begins to assemble health care in a series of all-night sessions, take a stronger role. But be willing to compromise. This scrum needs to end quickly – and send the bill off to be passed before the interest groups have time to realize who has and hasn’t been taken care of.
  5. MedPAC. Include in the bill this medical equivalent of the Federal Reserve – an independent, technocratic body to oversee the industry. This is where the real reform will stem from.

This scenario sounds plausible – although a David Brooks column explaining it would seem to undermine the strategy itself.

So far, the Obama administration has been extremely impressive in how it has managed the health care debate. They make it seem as if things really are going according to plan so far – an extraordinary thing given the history of Washington and health care. For example, Ezra Klein provided some insight into why the American Medical Association quickly retracted it’s direct opposition to a public option in the health care debate, citing this Roll Call piece:

Top aides to Senate Finance Chairman Max Baucus (D-Mont.) called a last-minute, pre-emptive strike on Wednesday with a group of prominent Democratic lobbyists, warning them to advise their clients not to attend a meeting with Senate Republicans set for Thursday.

[Meeting] with a bloc of more than 20 contract lobbyists, including several former Baucus aides…“They said, ‘Republicans are having this meeting and you need to let all of your clients know if they have someone there, that will be viewed as a hostile act,’” said a Democratic lobbyist who attended the meeting.

“Going to the Republican meeting will say, ‘I’m interested in working with Republicans to stop health care reform,’” the lobbyist added.

Ezra Klein explains what this means:

They’re saying that you’re either with health reform, or you’re against it. And if you’re against it, you can’t expect to be taken care of in the final legislation. They’re not going to save your seat at the table while you’re trying to burn down the room. And the AMA, it seems, got the message.

This hardball strategy with interest groups plus the extraordinary wooing of legislators by the Obama administration that Matt Bai described in a piece this Sunday, the general agreement among most Americans including business interests that our health care system is broken, the impending deficit crisis, Obama’s mandate, and the unusual role ultra-conservative Orrin Hatch appears to be willing to play to help his good friend Teddy Kennedy achieve a dying wish (Suzy Khimm in The New Republic describes it as, “a particularly senatorial way to pay tribute to a dying friend.”) – with all of these pieces falling together, the Democrats may finally be able to achieve what Harry Truman started all those years ago.

[Image by JonathanHannpberger licensed under Creative Commons.]

Fascinating Fact of the Day

Wednesday, October 29th, 2008

From the New York Times op-ed written by Billy Beane, Newt Gingrich, and John Kerry:

Starbucks pays more for health care than it does for coffee.

My first question is – who the hell actually wrote this piece and thought that these were the three guys to get together to sell it? The Kerry-Gingrich thing works. But where does Beane come in, aside from thematically? I presume all three must be on some board together.

Fun Fact About John McCain #12: He Wants to Tax Your Health Care Benefits

Monday, September 29th, 2008

McCain wants to tax my heath care benefits!

Actually true. But wait, there’s more. As people won’t be able to afford individual health insurance plans…

McCain wants to open “up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking…”

An actual quote [PDF]. So – McCain wants to tax my health care benefits provided by my employer – so that my employer will eventually force me to get health care on my own – which will be easier to get because he will be deregulating the health insurance market and removing consumer protections that exist on the state-level – just like we did with banking in the past 10 years. This sounds like a brilliant idea!

Obama v. McCain on Health Care

Sunday, September 7th, 2008

Obama sees his health care plan as part of an attempt to soften the effects of globalization.

His plan calls for every American who wants to preserve their health insurance plan to be able to keep it. His plan even includes incentives that reward employers that do provide health insurance and penalizes employers that do not (with exceptions for small businesses.) In addition to this, Obama’s plan will open up the government health care plan used by members of Congress to allow consumers – in a free market – to opt into it. Obama’s plan is designed to create incentives within our current system to gradually close the huge holes in insurance coverage and over time bring down costs. It’s a conservative plan, in the best sense of that word.

John McCain’s health care plan is radical. McCain says he wants to:

Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage

In other words, McCain wants employers to stop providing health insurance coverage. He proposes to include the cost of health care in each employee’s taxable income – and to offset this by offering a $2,500.00 tax rebate for individuals and $5,000.00 for families. This isn’t enough to purchase health insurance coverage in many states, so in addition, McCain proposes to effectively deregulate the insurance market and allow insurance to be sold across state lines – eliminating the consumer protections states provide, including protections for those with pre-existing conditions.

The theory behind the McCain plan is that we already have too much health insurance coverage and are going to the doctor too often because we don’t have to pay every time we do. So he proposes that every individual – or family – purchase individual or family health insurance – a radical change, and one that places much greater power in the hands of the insurance industry. As a matter of fact, it would be accurate to say it is exactly what the health insurance industry is asking for.

Holding a Grudge Against the Bank of America (Part 1)

Friday, August 22nd, 2008


[Photo by Steven Rhodes licensed under Creative Commons.]

Corporations are considered individuals by the law. Yet they have no conscience to guilt; they have no eternal soul to damn1; they have no empathy, no compassion – no emotion of any sort; they cannot be sent to prison; they can live forever; their single purpose is to make money – and they are legally obligated to make as much money as possible. Yet despite the fundamental differences between corporations and human beings, corporations have been given all of the rights of human beings. They have the right to free speech, the right to assemble, the right to be free from unreasonable searches and seizures – and all those other rights we mere humans take for granted.

Is it any wonder then that all large corporations – once they are no longer the responsibility of a single individual – begin to act as if they have no conscience or compassion – exploiting legal loopholes and damaging society at large? Insurance companies derive enormous profit from denying legitimate claims and every claim that they possibly can. Oil companies lobby and erect barriers and do anything they can to eliminate the possibility of alternative energy sources being developed. Manufacturers externalize the costs of their pollution – spewing toxic chemicals into streams and lakes and the air and the ground – and after paying some negligible penalty, the government (with the people’s money) takes responsibility for cleaning up the mess.2 Big lenders and bankers take unwise risks that allow them enormous profits in the short term – and the American people then pay to bail the companies out of the deficits they find themselves in.3

The companies survive – they thrive. It is the people who work for them and who are their customers – the people that are fired, and the people that get sick, and the people denied coverage. Then to top it all off – it is these same people who have to pay when companies that are too big to fail end up failing due to their own recklessness.

I don’t believe that corporations are inherently good or inherently evil – they are tools that are used for many purposes. But when we discuss economics and public policy it is essential that we acknowledge the limits of corporations. This inevitably leads to certain positions:

  • If corporations, by their nature, attempt to externalize as many costs as possible – forcing problems onto the public such as pollution – then government regulation is necessary to force corporations to deal with these externalized problems.
  • If corporations have no conscience or compassion, we cannot necessarily trust them to take care of us in times of need. Although random acts of kindness and charity occur more often than is sometimes acknowledged, they do not change the scope of the problem.
  • If corporations do not take affirmative steps to protect public goods and institutions – such as the national infrastructure, education, political institutions, and the nature of our society – someone must. Today, corporations are radically altering our society on many fronts – and as such they are a threat to its cohesiveness – by encouraging mass immigration and sexual immorality from a conservative perspective, and by creating vast inequities between the rich and everyone else from a liberal perspective.

Liberals, progressives, and Democrats have come to a broad agreement in recent years on some general steps that need to be taken to protect our economy and our country in an increasingly globalized world. (Some deeper critiques and potential solutions from a liberal perspective can be found in William Greider’s The Soul of Capitalism.)

This includes raising the tax rates on those making over $250,000.00 a year and on corporations to the same rates as at the end of Bill Clinton’s term; focusing on developing a clean energy industry to replace traditional manufacturing; increasing funding for infrastructure maintenance and development; protecting the foundations of the internet through net neutrality; and taking various steps to reform our educational and health care systems. (A thoughtful piece in this weekend’s New York Times by David Leonhardt delves into Obama’s economic worldview.)

Health Care

The best insight into the Democratic consensus on these issues comes from the issue of health care.

Barack Obama has said that if he were to design a health care system from scratch, the system would be single-payer. At this time, however, Obama believes we need to work within the system that we have. As with most issues, what Obama proposes here is to tinker with the current system to try to reduce the problems immediately and gradually move towards a better solution. On health care, this means working with the current employer-based system – and creating incentives to reduce the number of people not covered. These incentives incude a mandate for children, tax incentives for those who seek their own health insurance, penalties for large companies that do not provide health insurance (in the form of payroll taxes), the expansion of existing programs, and support for small businesses to assist them in providing health care for their employees.

In addition to the above and more short-term solutions, Obama proposes to open up the health care plan used by members of Congress to the public – and to create a “National Health Insurance Exchange” focused on assisting people who wanted individual or family insurance plans while providing rules and guidelines for participating companies. In the long-term these two changes have the potential to remake the field of health care. If the government program is able to provide better services for less cost than it’s competitors, then if the market works as it should, more and more people will move over to the government plan – unless other health insurance companies are able to take steps to compete.

This combination of freedom of choice for citizens/customers, government regulation for companies wishing to get into a potentially lucrative market, government competition against private companies, and letting the market decide who wins in the long-term – this combination may be too clever to work. But it has far more potential than the giveaways to health insurance companies that the Republicans are proposing.

What does all of this have to do with holding a grude against the Bank of America?, you might ask. That’s coming up in Part 2.

  1. if you go for that sort of thing []
  2. Much of the analysis and examples given in these first two paragraphs is inspired by The Corporation by Joel Bakan – as well as the documentary of the same name. I do not entirely accept the conclusions of the film or book, or the methods they use to come to their conclusions. The book and the film are both extremely useful and worthwhile but are ultimately limited because they are polemics that do not seek to give a fair analysis but to persuade. Sometimes, the tools they use to persuade are a bit too blunt – as when in the documentary, the filmmakers say that the corporation as a type of instituition was responsible – in part presumably – for the Holocaust and other atrocities – when it is easier to blame “the government as an institution.” As a matter of fact – most of the criticisms of “the Corporation” can be equally applied to the State as an institution. []
  3. This is obviously references specifically the Fannie Mae, Freddie Mac, and Bear Stearns deals which the Financial Times of London called the most deceitful kind of socialism. []