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Monday, December 21st, 2009

Ezra Klein has been my essential read during the health care debate. Today, he makes a few important points:

  1. Regarding Obama’s Campaign Health Care Plan. “The health-care bill that looks likely to clear the Senate this week is not very close to the health-care bill most liberals want. But it is very close to the health-care bill that Barack Obama promised.”
  2. Regarding Senate Collegiality. “Another example came last night, when the ailing Robert Byrd was wheeled in at 1 a.m. to break a filibuster on the manager’s amendment. Byrd’s presence was not required, especially considering that he’d clearly telegraphed his intention to vote to break the filibuster. But Republicans forced him to travel to the chamber. Indeed, shortly before he arrived, Sen. Tom Coburn headed to the floor to propose a prayer. ‘What the American people ought to pray is that somebody can’t make the vote tonight,’ he said. ‘That’s what they ought to pray.’ “
  3. Contra Jane Hamsher’s 10 Reasons to Kill the Bill. “Some of the list is purposefully misleading and is clearly aimed more at helping activists kill the bill than actually informing anyone about what is in the bill. Some of it points out things that really should be changed in the bill but aren’t central to the legislation itself, and are simply being leveraged to help activists kill the bill. But maybe there’s some utility to putting the document in context.”
  4. Citing the Creator of the Public Option, Jacob Hacker. “As weak as it is in numerous areas, the Senate bill contains three vital reforms. First, it creates a new framework, the “exchange,” through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted. Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans. These are signal achievements, and they all would have been politically unthinkable just a few years ago.”
  5. Regarding the President’s Role in Shaping Legislation. “The Obama administration has played a seriously inside game here, acting more as an accessory of the legislative branch than as the great figure of health-care reform that many of its supporters had expected. That is, in my view, the right way to understand the president’s role in the system, but it’s left a lot of the campaign’s supporters feeling a bit betrayed, particularly given that the Obama campaign was uncommonly aggressive on presidential pomp and dramatic speeches. Obama’s supporters don’t feel like the president lost to Lieberman along with them. They feel, instead, like the president cut them and their hopes loose.”

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The Un-American Pledge, Nietzsche (Republican), Islamists, Anti-Statism, Health Care Reform (again), and Abortion Politics

Wednesday, November 25th, 2009

Today, I present to you an early addition of the best reads for the long Thanksgiving weekend…

1. The Un-American Pledge. Michael Lind explains why the Pledge of Allegiance is un-American.

2. Nietzsche was a Republican. The Economist’s Democracy in America discusses Medicare and Nihilism. As it is undeniable that America’s population is aging, and that this accounts for the massive projected deficits in the future, and as everyone also acknowledges that such deficits are unsustainable, something must be done. The health care plans proposed by the Democrats include – along with various experimental measures to restrain health care spending – a Medicare commission “empowered to make decisions that automatically become law unless Congress comes up with equivalent savings” that will reduce spending as much. Republicans and the blandly smiling wise men and women of the pundit class have made it a point of conventional wisdom that Congress won’t be able to push through the cuts, and will find a way to circumvent this mandate. DiA, echoing a point Ezra Klein has been making repeatedly for the past few weeks, challenges those criticizing the plan to come up with something better:

If you don’t think an independent Medicare commission empowered to make decisions that automatically become law unless Congress comes up with equivalent savings will do the trick, then you have a responsibility to suggest something that will. Otherwise you’re just placing a bet that America’s government is going to self-destruct—a tenable argument, certainly, but not very helpful.

3. Learning from former islamists. Everyone else seemed to recommend this article a few weeks ago when it came out, but I just got to it recently myself. Johann Hari interviewed a number of former islamists who have recently renounced islamism and have begun to fight for their version of a “secular Islam” in Great Britain. He portrays this group as a vanguard. One of the islamists, Maajid Nawaz was a recruiter for an islamist group in Egypt for a time. Nawaz’s description of factors affecting recruitment seems to coincide with both intelligence agencies’ and liberals’ judgments, and to contradict the right-wing understanding:

“Everyone hated the [unelected] government [of Hosni Mubarak], and the US for backing it,” he says. But there was an inhibiting sympathy for the victims of 9/11 – until the Bush administration began to respond with Guantanamo Bay and bombs. “That made it much easier. After that, I could persuade people a lot faster.”

Eventually, Nawaz was imprisoned in Egypt. He was abandoned by the islamist group that he was working for. The only forces protecting him, as a British citizen, were forces he considered “colonial” and corrupt:

“I was just amazed,” Maajid says. “We’d always seen Amnesty as the soft power tools of colonialism. So, when Amnesty, despite knowing that we hated them, adopted us, I felt – maybe these democratic values aren’t always hypocritical. Maybe some people take them seriously … it was the beginning of my serious doubts.”

4. Anti-Statism: As American as Apple Pie. John P. Judis of The New Republic delves into the undercurrent of anti-statism in the American psyche.

5. Getting depressed about the public option. Timothy Noah depressed me more than anyone else with his ruminations on the public option.

6. Feeling better about health care reform. These pieces by Ron Brownstein and Andrew Sullivan though have made me feel much better about health care reform in general. Brownstein’s piece is especially helpful in looking at the various cost-cutting measures in the bill, and has a rather optimistic take. President Obama has apparently made that post “required reading” among White House staff. I’ll be following these posts up at a later date.

7. Abortion politics. The New Yorker had an extraordinary interview about abortion politics with Jon Shields. Shields seems to be, himself, pro-choice, but he seems to have reached an understanding of abortion as an issue which contradicts the propagandistic rhetoric that passes for most liberal commentary on abortion, which presents its opponents as being mainly concerned with keeping women in their place.

[Photo by road fun licensed under Creative Commons.]

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Posted in Barack Obama, Health care, National Security, Politics, The Opinionsphere, The War on Terrorism | 3 Comments »

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

Wednesday, August 19th, 2009

*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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Posted in Barack Obama, Health care, Politics | 48 Comments »

A Jumble of Health Care Related Points

Thursday, August 6th, 2009

I’ve been collecting a number of interesting points regarding health care that I haven’t yet found a way to incorporate into a post. So to stop lugging this paper around, here’s a jumble of different facts, arguments, and stories:

Robert Borsage explains one argument for “going all in” on health care reform. He explains that bringing everyone into the health insurance system would remove the hidden tax the uninsured levy on the rest of society:

This removes the hidden charge – estimated at $1,100 per person – we each pay for the 47 million who aren’t insured and are forced to use the emergency room as their doctor, often putting off treatment that results in higher costs when the untreated illness becomes critical.

The Boston Globe points out that the Romney-backed health reform there is actually working, despite headlines that seem to suggest the contrary:

In the myth that these critics have manufactured, this state’s plan is bleeding taxpayers dry, creating nothing less than a medical Big Dig.

The facts – according to the Massachusetts Taxpayers Foundation – are quite different. Its report this spring put the cost to the state taxpayer at about $88 million a year, less than four-tenths of 1 percent of the state budget of $27 billion. Yes, the state recently had to cut benefits for legal immigrants, and safety-net hospital Boston Medical Center has sued for higher state aid. But that is because the recession has cut state revenues, not because universal healthcare is a boondoggle. The main reason costs to the state have been well within expectations? More than half of all the previously uninsured got coverage by buying into their employers’ plans, not by opting for one of the state-subsidized plans.

Ezra Klein follows up to say that the Massachusetts plan “has come in at about the cost predicted” and – in the most important point for him: “Doing coverage actually pushed Massachusetts to begin addressing cost.”

Greg Mankiw questions the need for a public option in an interesting post.

Several progressives have pointed out the irony of seniors angrily telling Congressmen to “keep the government’s hands off of their Medicare.” Harold Pollack in taking on the euthanasia scare tactics of the right muses:

The irony of yammering to seniors about the evils of government-financed care is always notable, as is the selfish appeal. In 1965, liberals enacted Medicare, perhaps the most radical social engineering project in American history.

Paul Waldman in The American Prospect makes a similar point:

Forty-four years after its passage, the success of Medicare — just to review, a big-government program that has provided health care to tens of millions of seniors who would not have otherwise had it, does so more efficiently than private insurance, has seen costs grow at a slower rate than private insurance, and is smashingly popular with its recipients — has not seemed to fundamentally alter the public’s receptiveness to anti-government arguments. Ditto for Social Security. Ditto for the Veterans Administration, which is the only truly socialized health-care system in America, and one that is considered by many health-care experts to provide the best health care in the country.

Ezra Klein points out that our media-political system does not respond in the same way to all types of grassroots pressure – and that the right is benefiting from this now. He explains how single-payer advocates are organized, loud, and present (and have been present) at these town hall meetings and other health care events for years. Yet no one seems cowed by them – and they get virtually no media coverage. On the other hand, complain about socialism and you’re the story of the day… Klein reflects:

[It’s] worth keeping in mind as people begin to focus on the anti-health-care tea parties. The political system does not have some sort of consistent reaction to grassroots pressure. Rather, it picks and chooses when it wants to listen to the views of the very, very non-representative groups of people who sit through at town halls and panel discussions

Paul Krugman details a story with a similar message:

I was tentatively scheduled to be on a broadcast dealing with — well, I won’t embarrass them. But first they had to find someone to take the opposite view. And it turned out that they couldn’t — which led to canceling the whole segment.

In a way this goes beyond my original point, which was the unwillingness of the news media to referee a controversy by actually reporting the facts. Now it seems that a fact isn’t worth reporting unless someone is prepared to deny it.

And finally, I’ve already linked to this post by Ezra Klein maybe two or three times, but I haven’t cited this passage yet which almost but didn’t quite fit into my the Health Insurance Exchange is like ebay post:

The Health Insurance Exchange, combines the benefits of choice that are theoretically available on the individual market with the bargaining power and scale that’s generally accessible only in large employers (and the exchange will, in theory, have more bargaining power than even the largest employers, as it will have a much larger base of customers). You also have a space to test out innovative ideas that might make the market better, like Sen. Jay Rockefeller’s (D-W.Va.) insurance rating agency, or the public insurance option. You can standardize billing and payment methods and force the adoption of electronic medical records.

[Image by romanlily licensed under Creative Commons.]

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Posted in Health care, Politics | 46 Comments »

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