Posts Tagged ‘Health Care Reform’

Must-Reads During This Week: Perfect Storm for Health Reform, Making Controversy, Cyberwar, Limiting Government, Liz Cheney’s Al Qaeda Connection, George Will, and the Coffee Party

Monday, March 8th, 2010

In lieu of a substantial post today (as I’m having trouble getting back into the blog-writing habit), here’s a few links to worthwhile articles.

1. Perfect Storm. Marc Ambinder of The Atlantic explains that a “Perfect Storm Nearly Killed Health Reform; Another Storm May Save It.” However, what Ambinder describes as the “perfect storm” that might save health reform seems to be more properly called Obama’s willingness to wait out bad news cycles.

2. Controversy. Ezra Klein opines usefully on “how to make something controversial“:

The media is giving blanket coverage to this “controversial” procedure being used by the Democrats. But using reconciliation for a few fixes and tweaks isn’t controversial historically, and it’s not controversial procedurally. It’s only controversial because Republicans are saying it is. Which is good enough, as it turns out. In our political system, if Democrats and Republicans are yelling at each other over something, then for the media, that is, by definition, controversy.

3. Cyberwar? Ryan Singel of Wired‘s Threat Level reported some of the back-and-forth among the U.S. intelligence community, explaining why Republicans want to undermine and destroy the internet for national security as well as for commercial reasons. The Obama administration’s web security chief maintains in an interview with Threat Level that, “There is no cyberwar.”

4. Limiting government. Jacob Weisberg of Slate always seems to be looking for the zeitgeist. His piece this week is on how Obama can embrace the vision of limited government.  While all the pieces are there, he doesn’t quite make the connection I want to make: that government is absolutely needed even as it must be limited and its power checked. A post on this line has been percolating in my mind for some time, and now that Weisberg has written his piece, I feel its just about time for me to write mine.

5. Liz Cheney, Al Qaeda Sympathizer? Dahlia Lithwick slams Liz Cheney for her recent ad calling the Justice Department the “Department of Jihad” and labeling some attorneys there the “Al-Qaeda 7″:

Given that the Bill of Rights pretty much evaporates once you’ve been deemed a jihadi lover of Bin Laden, you might think Liz Cheney would be super-careful tossing around such words They have very serious legal implications…Having worked for years to ensure that the word jihadist is legally synonymous with guilty, Cheney cannot be allowed to use it casually to describe anyone she simply doesn’t like.

6. George Will: More Partisan Than Independent? Ezra Klein catches George Will out in a rather telling fit of procedural outrage over the Democrats’ use of reconciliation in the Senate. Plus, Klein uses this nifty chart to illustrate that dramatic change that George Will doesn’t happen to comment upon:

7. Coffee Party. I’m intrigued by this idea, though I don’t know how workable it is.

[Image taken by me over the weekend.]

Stop ObamaCare Before Obama Murders Your Comatose Wife and Infant Daughter!

Wednesday, July 29th, 2009

I received an email this morning from Townhall.com entitled, “ObamaCare Equals Government Funded Euthanasia” with the above image. I’m sort of curious why they couldn’t have just shown a picture of Obama with a gun to the baby’s head. It would have been more effective at getting their message across. But then again, they might be concerned about losing the white male gun owner vote – ’cause after all, its hard to maintain that Obama is both a liberal pansy (who’s the next Hitler and therefore is going to take away your guns) and that he carries a Glock around so he can take out any infants he sees.

But I take this email to demonstrate that the right is now stepping up its blizzard of lies about the Democratic health care reform bill over the August recess. Here’s some context for the photo:

Everyone knows that nationalized healthcare is a terrible idea but everyday we unearth even more awful details in what is in the proposed government-run plan.

A nation of Terri Schiavos with a National Euthanasia Bill?

In 2005, a COURT ordered the removal of a feeding Tube from Terri Schiavo. It outraged a nation. If the Government takes over health care, bureaucrats will decide who lives and dies in America. In the name of “creating efficiencies,” they will delay – or deny – treatment to critically ill patients because it costs too much.

We will have a NATION of Terri Schiavo’s, with a faceless Federal Bureaucracy pulling the plug instead of a Court.!

Sound crazy? It happens every day in Great Britain.

You can STOP what will in effect be government sponsored euthanasia in America if you ACT NOW.

If you care about the Sanctity of Life, the proposed Government Takeover of Health Care is an attack on your values.

It’s quite interesting that Town Hall would bring up Terri Schiavo – the pinnacle of right-wing overreach that helped alienate libertarians from the Republican camp – and that led the public to near unprecedented levels of agreement over the matter. 62% of Americans favored removing the feeding tube – and 82% of Americans believed that Congress and the President should have stayed out of the matter. Yet Town Hall – speaking only to its base – sees Schiavo as a rallying cry. And not just to their base – they claim that the removal of the feeding tube, “outraged a nation.” I wonder what it accomplishes to lie to your base and tell them that they are the real majority, aside from radicalizing them and alienating them from the American system.

But getting back to the substance of what they are claiming, they bring up a repeated right-wing canard – that:

If the Government takes over health care, bureaucrats will decide who lives and dies in America. In the name of “creating efficiencies,” they will delay – or deny – treatment to critically ill patients because it costs too much.

So many inaccuracies – as, to start, the Democratic health care reform doesn’t lead the government to take over health care. At worst, it would lead to a government-provided health insurance. And any health insurance – private or public – will deny treatment on occasion due to expense. The problem with our status quo is that rationing occurs both by cost – depending on what insurance plan you have and by health insurance company bureacrats whose job it is to deny as many treatments as possible and/or to rescind your policy if they can’t deny the treatments. That sounds a lot less like rationing and more like a war that health insurance companies are waging against the sick of America – a war in which their goal is to maximize their profits regardless of the cost to society or their paying customers.

As to the Democratic health care reforms endorsing government-funded abortion and euthanasia, I truly wonder who actually buys this load of crap. Clearly, it is an attempt by Town Hall to manufacture outrage – but who is stupid enough to believe this? Too many people, I’m sure.

Edit: On reddit, criswell improves the image, writing:

Man, look at his eyes! Obama sure hates that baby!

That pic is all kinds of win…. But it could be better… It may be too subtle for your average American… It needs… something….. Hmmmm….

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Our Wall-Street Run Health Care

Friday, July 24th, 2009


There are quite a few ways to explain what is causing our health care and health insurance costs to skyrocket, but in terms of crude political terms, there are really only two possibilities: either health care costs are skyrocketing because the government is involved in a major way – with Medicare, Medicaid, the prescription drug benefit, the subsidy for employer-based coverage, etc.; or the market for health care and health insurance is inefficient independent of government interference.

I don’t have the expertise to resolve the issue – but to me it is telling that the costs of health care and health insurance began to rise exponentially not shortly after Medicare and Medicaid were begun, but during the early years of the Reagan administration with his derogatory fervor. Then the medical loss ratio began to decrease – as health insurance companies began to squeeze as much profit as they could from their businesses. In other words, the prices for health care and health insurance began to rise precipitously as Wall Street began to take a more assertive role in running the economy including health insurance. At the same time, the costs of government insurance has risen slower than that of private insurance companies.

Economists long ago discovered that health care markets are not efficient on their own – as most individuals do not treat health care as a typical service. Rather if people have a choice, they avoid using the service until they absolutely need it – and then are willing to pay whatever is necessary to get better. This also is demonstrated by the fact that despite the fact that America spends far more on health insurance than nations with similar health care systems, statistics show our overall level of care is generally lower than in these countries (fewer doctors per patient; a lower life expectancy; etcetera). At the same time, most individuals treat some level of health care as a right. Even right-wingers – as they decry the attempts to make health care a right in America – implicitly treat it as one when they tell the anecdotes about the 21-year old alcoholic who was denied a liver transplant under Britain’s system because the bureaucracy in place required him to prove he would not endanger his new liver. But unless getting medical treatment to extend this young man’s life is a right, why would anyone be outraged over it?

Because of these various factors, health care operates as an inefficient market as demand does not appreciably respond to changes in price. This helps explain how the health insurance industry began to fall under the sway of Wall Street and take on the telltale characteristics of a Wall Street-run corporation that exists primarily to generate exorbitant profits instead of to provide a service or product. When Wall Street focuses on an indursty, there follows certain predictable steps:

  • as a precondition, there needs to be a market inefficiency that Wall Street can exploit; for example, the inflexibility of demand for a product or service allows the creation of a rapidly inflating bubble in costs;
  • the pay of top corporation executives rises exponentially above that of most employees;
  • increasingly, these executives began to make decisions that benefit their shareholders in the short-term so as to maximize their paychecks and keep their jobs;
  • the product or service is degraded as corporations turn their focus to creating mass short-term profits;
  • the inefficiences present initially are exacerbated;
  • most important, many major risks and costs are deliberately externalized to the public so as to maximize private profits;
  • at some point, this becomes unsustainable and the bubble bursts.

This is exactly what we saw in Exxon’s massive profits during the surge in oil prices in 2008; and it is very similar to what we saw in the housing market; and it is also clearly what we have seen with health care in America for the past twenty to thirty years as the inflation in health care costs far outpaced all else.

I actually don’t like the idea of blaming everything on Wall Street – but the telltale signs are here:

  • health care demand is generally inflexible, although when costs are paid can be shifted as most people see health care as a right and medical facilities and doctors swear an oath to provide care to everyone;
  • health insurance companies – rather than maintaining their large dollar profits as prices skyrocketed in the 1980s and 1990s instead began to increase their percentage of the profit – as a Wall Street-run company always does, thus exacerbating the inefficiencies already present;
  • rather than seeking to reduce the costs of care while providing the best service possible, they sought to exclude as many sick individuals as possible and to cancel coverage for as many individuals who got sick as possible and to use other means of artificially lowering their costs without lowering the price of their service;
  • by refusing to pay for so many sick individuals, many of these costs are externalized to the public; by refusing to cover those who have preexisting conditions – and thus those who are more likely to need to use health care resources – the costs of taking care of these individuals is put upon hospitals and the public; while doing all of this, the insurance industry sought greater and greater government subsidies.

The toxic effect of this inflating cost bubble coupled with the attempts to externalize as many costs as possible have created the twin problems of a growing number of uninsured Americans and rapidly growing federal deficit fueled almost entirely by health care costs.

This is the status quo that we need to change. As Steven Pearlstein explained:

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…

Doing nothing means leaving our Wall Street-run health care in place; and while right-wing critics focus on the specter of rationing by government bureaucrats and government bureaucrats in between you and your doctor and complain about the complex system the Democrats are proposing – they fail to acknowledge that this Wall Street-run health care rations care by cost and interjects bureaucrats reporting to CEOs imbued with the culture and ethos of Wall Street as they attempt to exploit every inefficiency in our current extremely complex system as much as possible, externalizing as much cost to the public as they can.

If the problem with our current system is not that the government is too involved – as right-wingers assert – but that the market is inefficient in providing health care – and that these inefficiencies are being exploited by Wall Street-run health insurance companies – and if with the economy still fragile from the bursting of the bubble in home prices and with radical changes not feasible or desired – then you turn to the various plans that the Obama administration and Democratic Congress are looking at which attempt to introduce various processes and incentives that will gradually shape the health care system into a more rational market – creating regulated markets for individuals to buy health insurance; eliminating abusive practices that artificially decrease medical costs for insurance companies; creating a public option to compete with these private companies; empowering an independent body (MedPAC) to regulate Medicare prices and practices; creating a body to look at and disseminate information on the comparative effectiveness of treatments and medicines.

It’s clear that our Wall Street-run health care industry isn’t working. More of the same – more deregulation as the Republicans propose – isn’t going to fix this problem. We need change. We need to take back our health care from Wall Street and make it responsive to consumers again. Our system won’t be perfect – and it won’t happen overnight – but the Democrats are clearly working to reform this system. The Republicans are merely seeking to obstruct.

The Option of Doing Nothing on Health Care

Thursday, July 23rd, 2009

Steven Pearlstein began his much-remarked column yesterday morning with a basic observation that most deficit-hawk opponents of Obama’s “experiment” with health care reform don’t seem to acknowledge:

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…

I have yet to see any opponent of health care reform acknowledge that our current health care system is unsustainable and getting worse, or to acknowledge that the situation has reached a point where it undermines the very legitimacy of America’s model of the state.

Opponents of any of the Democratic health care reform proposals often argue that they are actually in favor of reform – just not this “fast” and not any of the plans being considered at the moment. They don’t have much of a response as to why they showed no concern for this issue when those more inclined to accept their ideas were in power. There have been some attempts to come up with an alternative health care reform, but it doesn’t seem like any actual plan will be offered. For example, Representative Roy Blunt, head of the GOP’s Health Care Solutions Group, is suggesting that no plan will be offered by the Republicans as he asks rhetorically:

[W]hy start diverting attention from this really bad piece of work they’ve got to whatever we’re offering right now?

This is good politics – as long as you’re not serious about reform. As long as your goal is to “break” Obama rather than to fix health care and our growing deficit problem.

I try to take things that people I disagree with politically seriously, assuming their good faith on the issue. But if opponents of the reforms on the table now don’t offer an alternative, talk about “breaking” the Democrats, and refuse to acknowledge the basic fact that the status quo which their opponents are trying to reform is leading to a disaster – all while simultaneously blaming Obama for this looming disaster – what other explanation is there for this behavior than “bad faith”?

The Lesson of 1993/1994

Wednesday, July 22nd, 2009

Like a lingering odor, the failure of Hillarycare in 1993 is hanging over this perilous moment in Obama’s presidency. It’s true that Clinton’s health care plan never got this far legislatively.  By presenting a complicated plan to Congress and trying to bully it through, the Clinton administration made a huge tactical blunder. But it is clear that both sides sense that this is the moment when health care reform could be derailed. While the Democrats and Obama have long been planning on pushing through health care, what is going on now is pure political blood sport. This is a zero sum game. This is a Democratic attempt to prove that they can accomplish something that is popular and helps the middle class and which they have been trying for sixty years with only moderate success to enact. This is the Republican attempt to protect the status quo and to slingshot their way back to power as they did in 1994.

Bill Kristol has said that this is the week to stop health care reform – to not worry about being obstructionist or trying to appear constructive:

There will be a tendency to want to let the Democrats’ plans sink of their own weight, to emphasize that the critics have been pushing sound reform ideas all along and suggest it’s not too late for a bipartisan compromise over the next couple of weeks or months.

My advice, for what it’s worth: Resist the temptation. This is no time to pull punches. Go for the kill.

Beneath the veneer of policy disagreement that Kristol is using, it’s clear he is advocating pure obstructionism. He senses opportunity. Which is why he and many other Republicans are now all repeating the same talking points: Obama’s health care reform is an “experiment” with your health; it will ration health care; you will lose the insurance you have now; the government will impose itself between you and your doctor; socialism! These rather familiar refrains are being thrown about for one purpose – and it has little to do with health care.

As Senator Jim DeMint rather infamously declared in a secret call to anti-reform advocates:

If we’re able to stop Obama on this it will be his Waterloo. It will break him.

Newt Gingrich echoed this point:

This could be the bill that drags his whole presidency down and they look back on it and suddenly the whole thing is unraveled.

And the Democrats seem to agree – as the former Organizing for America sent out DeMint’s statements to rally supporters – and Mark Kleiman, a Democratic blogger said, “This bill is make or break for the Democratic Party.”

The Republicans are trying to break the Obama presidency – as they did Clinton’s. Clinton came back, but he never had the same political support.

Meanwhile, moderates play an interesting role in this political blood sport. They decry both sides for being mean – and suggest everyone get along. They talk about bipartisanship, suggest the Democrats move slowly, and they feel queasy at the prospect that the Democrats – by actually governing and doing what they promised they would do – might be overreachingMatt Yglesias ably responded to this point:

It’s not as if what happened in 1994 was the congress passed Bill Clinton’s big health reform package, then the public didn’t like it, then in revulsion they turned against Democrats. Nor did congress pass the proposed BTU tax, then the public didn’t like it, and then in revulsion they turned against Democrats. The noteworthy thing about the first two years of the Clinton administration was the lack of ambitious progressive programs put in place. And you could say the same about Jimmy Carter. Whatever it is people reacted against in 1978, 1980, and 1994 it wasn’t actually existing left-wing governance.

Ezra Klein – on the same theme – explained the lesson one of the key architect’s of Obama’s strategy learned from 1993:

Emanuel has carried that lesson with him into the Obama White House. “The only thing that’s not negotiable is success,” he likes to say. The worst outcome for the party — in part because it’s the worst outcome for its marginal members – is defeat. Voters punish defeat.

If the Democrats succeed – as Bill Kristol explained in 1993:

It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle-class by restraining the growth of government.

Despite this moment of peril, Obama’s strategy to get health care through is still intact. His administration has learned the lessons of 1993- 1994 well – perhaps too well.

But make no mistake as you see the charges thrown about by both sides in these next few weeks. This battle is no longer about policy for either the White House or the Republican Party. (Though the right policies will be essential to its long-term success.) Right now this is political blood sport – it is about whether or not the Obama administration will be broken by obstructionist elements. The short-term success of the administration will be determined by whether or not they succeed in the next few weeks to pass something substantial; their long-term success will depend on the policies they are able to include.

[Image not subject to copyright.]

Health Care Reform To Stimulate the Entrepreneurship

Tuesday, July 21st, 2009

Paul Gigot of the Wall Street Journal editorial page makes the same argument many Obama critics have been making – beginning with Rush Limbaugh who attempted to blame the financial collapse on the fear markets had at the prospect of an Obama victory in the 2008 election to the present, as Gigot attempts to blame any lingering effects of this financial collapse – and its economic aftereffects – on fear of “the Obama agenda.”

But neither Gigot nor Limbaugh nor any other right-wingers seem to give any consideration to those drags on risk-taking that our current status quo creates.

Gigot apparently thinks that raising taxes on a handful of powerful individuals has a greater effect on reducing risk-taking than the prospect of global warming, than the lack of a health care safety net has on potential entrepreneurs.

The difference between Gigot and myself is that Gigot is concerned that this handful of powerful people will be less likely to take risks with their vast sums of money – along with a dozen or so major corporations having less ability to generate major profits by externalizing costs for pollution and health care to the society at large. If a corporation has to pay for the damage it causes, then it is – by Gigot’s standards – less free. This is true only in the sense that a tyrant is less free than an ordinary citizen because he is no longer able to impose his way upon others.

If one wants to stimulate the economy by encouraging small businesses and entrepreneurship, there are few better ways to do it than to pass some sort of health care reform that makes it cheaper and more available outside of large employers. As Daniel Gross, financial columnist for Newsweek and Slate, explains:

An affordable national health care policy, which could allow people to quit their jobs and launch businesses without worrying about the crippling costs of premiums or medical costs, might be a better spur to risk-taking than targeted small-business loans.

I say this as a former small business owner and entrepreneur myself. One of my biggest concerns in working outside of an established business was that I was not able to get my health care through my job – which meant astronomical monthly premiums for a service I did not use – but which I could not be sure I would not badly need.

Gigot and other right-wingers are not focused on small business and entrepreneurs – although they does invoke them as a fig leaf for political reasons. If they were they could see the advantage of a public health care option. Instead of defending the free market, Gigot and other right-wingers seek to defend a corrupt status quo in which decisions are made by a princely few rather than being made in the competition and varied decision-making bodies of a free market. Health care reform – if done right, with a public option – will remove a major obstacle to individuals taking their own risks, starting their own businesses; it will be a small step to diversifying decision-making and creating a more free market.

Gigot – by taking the dogmatic position he does – proves he is not serious about protecting the free market; he is only interested in protecting the interests of his cronies among the monied elite.

Obama’s Grand Bargain

Tuesday, February 3rd, 2009

From Obama’s Inaugural Address:

There are some who question the scale of our ambitions — who suggest that our system cannot tolerate too many big plans. Their memories are short. For they have forgotten what this country has already done; what free men and women can achieve when imagination is joined to common purpose, and necessity to courage.

What the cynics fail to understand is that the ground has shifted beneath them — that the stale political arguments that have consumed us for so long no longer apply. The question we ask today is not whether our government is too big or too small, but whether it works — whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward. Where the answer is no, programs will end. And those of us who manage the public’s dollars will be held to account — to spend wisely, reform bad habits, and do our business in the light of day — because only then can we restore the vital trust between a people and their government.

This brings to mind what George Stephanopoulos was so excited about last Sunday on This Week:

(Yes, I need to work on improving my DVR to computer quality.)

It seems that Obama is preparing to bet his presidency on a Grand Bargain – that will allow him (and us) to rewrite the social contract in a more extensive way than any president since Franklin Delano Roosevelt. Even during Obama’s campaign, he spoke of tackling the challenges that were necessary – and not putting off hard discussions about our country’s long-term stability. But the financial crisis – which at first prompted the endlessly parroted conventional wisdom that whoever won would need to cut all of their projects and focus narrowly on the crisis itself – has instead proved to be an opportunity.

The amount of spending needed to stimulate the economy is enormous – with the numbers being thrown around today dwarfing that of any previous government intervention (save perhaps for our major wars). What Obama understands is that this type of spending, while necessary in the short-term, poses a serious long-term threat. Which is why he is now speaking of the second step – after the financial crisis has passed – of tackling entitlement reform and tax reform, and finally putting America on sound financial footing after years of prolifigacy.

None of these insights are exceptional. What is exceptional is how Obama is already shaping the arch of his first term, using this crisis to set up his next objective, and shaping the conventional wisdom.

The problem I see though is that the Obama administration has not done a good job of conveying to the public the place this stimulus bill has within Obama’s agenda. The word is that in the next week or so, Tim Geithner will present “a ‘comprehensive’ plan that [he] hope[s] will command market confidence.” My hope is that this comprehensive plan will lay out a broad legislative agenda based on Obama’s campaign. Based on the campaign plans and signals sent during the transition, here’s what I see:

Step 1 (The First 100 Days)

  • Release the rest of the funds from TARP.
  • A large stimulus package to demonstrate the government’s commitment to addressing the crisis, especially in alleviating it’s effects on the majority of Americans.
  • A banking and mortgage bill that takes whatever steps are necessary to shore up these sectors of the economy, including new regulations, new oversight, and possibly additional funds.
  • An infrastructure bill that would create a National Infrastructure Bank.
  • Health care reforms that would extend health care benefits and attempt to control the escalating health care costs.
  • A combination of a cap-and-trade program and funding for green energy.

The goal of this first period would be to begin to make both short-term and long-term investments into those sectors that will lead to long-term growth – which will stimulate the economy in the short-term. This is the spending stage. After this burst of legislating, Obama would be able to focus on tinkering with education programs and seeing what works, as well as addressing the simmering foreign policy issues which are constantly threatening to take over the agenda.

Step 2 (Post-Crisis)

  • Entitlement reform (Social Security, Medicare, Medicaid.) Everything is on the table.
  • Tax reform. Not much has been said about this. This will certainly be a wild card – but Obama has criticized our corporate tax rate for its irrationality. It’s very high – but due to the enormous number of exemptions and credits, the effective rate for those businesses able to lobby for benefits, it is very low. This should be rationalized.
  • Universal health care.
  • Education reform.

This is the “cutting back” stage and consolidation stage. The goal of this second stage would be to put America on a solid financial footing again – to eliminate the unsustainable domestic policies that undermine our stability and power.

This is obviously an enormous agenda. And it’s far from clear that Obama can accomplish this. But if he does not lay out the vision – which I have pieced together from numerous statements – then it’s hard to see how he can accomplish it. Of course, Geithner was just confirmed last week – and Obama’s only been in office for two weeks – so he does have a bit more time to lay this out. But he doesn’t have long.

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