Category: Domestic issues

Categories
Barack Obama Health care Politics

Our Unhinged Debate on Health Care Reform

Or, Large Majorities of Americans Support the Specific Reforms Obama Is Proposing, But the Debate Going On Now Has Confused Them Into Opposing It

[digg-reddit-me]Andrew Sullivan provides a pretty good summary of the policy questions at stake in the health care debate – slightly modified by me to make it a list:

  1. Should we demand that insurance companies provide policies to anyone regardless of pre-existing conditions?
  2. Should we help the working poor buy that insurance with subsidies?
  3. Are competitive exchanges for health insurance a good or bad thing?
  4. Would a public option or a co-op help bring down healthcare costs?
  5. Does it make sense for the government to study the effectiveness of various treatments as a guide for doctors?

These are the basic questions Democrats are trying to answer. The only real presumption Democrats made in creating these policies is that the government can be effective. The proposals on the table now are modest – tinkering even – in which market mechanisms, government regulation, and a government plan together are designed with three goals:

  • to provide more security and choice to those Americans already covered by banning abusive insurance company practices and allowing individuals to buy insurance on a health care exchange;
  • to institute certain incentives that will hold down the growth of health care costs – using market mechanisms in the Health Insurance Exchange, spreading information with the Independent Medical Advisory Committee, and with the public option;
  • to cover the 47 million Americans without health insurance (whose use of health care, which we already provide as a matter of right, creates a de facto $1,100 tax on each individual).

The various bills under consideration are so long and complicated because they attempt to make slight adjustments to the system we have – and to remain true to Obama’s promise that if you like your health insurance you can keep it.  They prohibit certain practices by insurance companies, they set up a Health Insurance Exchange, they may or may not allow citizens to choose a publicly run health care plan, they subsidize individuals who currently cannot afford insurance, they set up committees to study best practices. What they certainly do not do is attempt radical change.

This isn’t about the free market versus communism, or radicalism versus moderation. The anger at Obama’s health care reforms has little to do with what he or other Democrats are proposing. There are those with reasoned objections. But the Republican Party has instead embraced and encouraged the inchoate rage of people frustrated with the direction our country is headed, with the various moral dilemmas George W. Bush left for his successors, with the massive failure of the markets that caused our current recession, with the failures of the visceral politics and policies of George W. Bush. On Slate’s Political Gabfest today, this exchange captured pretty well the essense of the hyperbolic debate going on now:

DAN GROSS: In college, we had the primal scream where at a point in time people would open their windows and just yell randomly. It was done to relieve stress but you weren’t yelling a set of statements about how your workload was too high. You were simply yelling. And it strikes me…that the things they are yelling are not the reasoned case for doing health care reform in a different way. They’re saying things like, “Let’s take our country back!” or “Lies, lies, and socialism, communism, fascism.”

JOHN DICKERSON: Yea – it is a sort of Tourette’s of the political…

I want to repeat that there are reasoned cases to make against the various policies Obama is proposing – but aside from an odd blog post by a libertarian economist every now and then, I don’t see them made. Instead, we get the approach Jon Stewart described: “You know, the individual mandate is going to hurt small businesses by…aw, fuck it: YOU’RE ALL GOING TO DIE!!!”

That’s what we’re dealing with: cynical manipulation of an inchoate public anger by entrenched interests and the primal screams of a minority of people frustrated with the direction of the country – both of whom are trying to scare the majority into indecision and intimidate the Democrats into submission. Then there are the many – some of whom are wary of action on health care right now; some of whom are concerned about government spending;  some of whom support reform, but aren’t clear on the issues; some of whom are frustrated with Obama’s moderation. Very little of the public debate has to do with the issues addressed above. Instead, we have anonymous lies spread by email, we have right-wing organizations claiming that “Obamacare=Gov’t Funded Abortion and Euthanasia,” we have Sarah Palin claiming Obama would make her son go before an evil “death panel,” we have Senator Jim DeMinto comparing America under Obama to Germany under Hitler, we have people on the streets and in town halls  and on the radio claiming that Obama is instituting Nazi policies, we have protestors deliberately trying to shut down debate (pdf) and silence those in favor of reform. And I’m not cherry-picking the most egregious examples here – these are the tactics used by mainstream opponents of health care reform.

The response and the debate going on now is unfortunately unhinged from reality and has very little to do with any bill being considered. Americans started out in favor of Obama’s health care proposals – expressing support for both him and the policies he had campaigned on. Polling shows they still support the policies: 72% of Americans are in favor of the public option; 74% of Americans believe that health insurance companies should not be allowed to exclude those with pre-existing conditions; 71% of Americans believe that the fact that 47 million Americans are uninsured is a “very serious” problem, with 49% willing to accept higher taxes to cover these individuals. When Obama’s plan was described in neutral terms, 56% of Americans still supported it today (with 38% opposed). But as Obama and Republicans and Blue Dog Democrats all raised concerns about deficit spending and soaring health care costs, many in the public became wary of increased spending. And as Republicans and entrenched interests began to spread rumors of the health care reforms being proposed, Obama’s support dropped.

But now this debate has broken out into the open – and amid  all the accusations of Nazi policies and “death panels” and rationing and socialism! and “killing Granny” the American public can see what is really going on. Republicans will soon learn the truth of Abraham Lincoln’s aphorism:

You can fool all of the people some of the time, and some of the people all of the time, but you can’t fool all of the people all of the time.

[Image not subject to copyright.]

Categories
Health care Politics

The AARP Pushes Back Against What It Calls Crazy Rumors About Health Care Reform

Late last week, I was forwarded this email in which the AARP – which has not endorsed Obama’s health care reform plan, or any other plan – deliberately pushed back against the what it called crazy rumors. They encouraged their members to email, Facebook, or tweet the truth about health care reform.

Here’s the full text of the email:

From: Barry Jackson, AARP [mailto:[email protected]]
Sent: Wednesday, August 05, 2009 4:02 PM
To: *****@**********
Subject: MUST READ: Don’t believe them

Dear [Name of AARP Member],

If your inbox is anything like mine, you’re getting a lot of emails about how SCARY health reform is. From allegations about rationing care to wild reports of government-sponsored euthanasia, the rumors just keep getting crazier.

And I’ve had enough. Enough of the fear-mongering. Enough of the myths and unfounded rumors. Enough of the interest groups twisting the truth to stop health reform.

I’m fighting back – and I’m asking for your help!

Below I’ve debunked some of the common myths going around. Will you forward this email to your friends and help get the truth out about reform?

The truth is real reform is at risk because opponents are using scare tactics and slogans to gin up fear and misunderstandings. Don’t let that happen.

Sincerely,

Barry Jackson
AARP Online Advocacy Manager

P.S. Let’s make sure everyone gets the truth. After you’ve forwarded the message below, please share these myths and facts on Facebook if you have an account, or post them on other networking sites. If you’re active on Twitter, please tweet the truth now.

******Delete the text above and forward this message to friends and family ******

Hi,

My inbox has been flooded with emails spreading crazy rumors about health reform so I wanted to share some facts from AARP about what’s really going on. Please join me in forwarding these facts to everyone you know. Print them out and pass them around at your social gatherings and other places where people are discussing the issues of the day.

FACT #1: Medicare will not be ended, and no benefits or services will be cut.

Your services will not be ended, nor will your benefits be cut. AARP’s position on this could not be clearer. And we have sent this message loud and clear to Congress. While the current proposals include savings in Medicare by cutting out fraud, abuse, waste, and inefficiency, we’re standing up and making sure benefits for Medicare recipients are not only fully protected, but are improved.1

FACT #2: No legislation currently in Congress would mandate the rationing of care. Period.

Our staff has read all of the legislation circulating in Congress and there are no provisions in these bills that would ration care for our members. None. If any ever did, we would vigorously fight to stop that legislation.2

FACT #3: There is no provision of any piece of legislation that would promote euthanasia of any kind.

The rumors out there are flat out lies. Right now Medicare does not cover counseling for end-of-life care. The portion of the bill in question would simply provide coverage for optional end-of-life consultations with doctors, so that the patient can be aware of all of the treatment options on the table. It is not mandatory and it has nothing to do with euthanasia.3

FACT #4: We have not endorsed President Obama’s plan.

In fact, we haven’t endorsed any plan. We are supporting reform of our health care system, something that AARP has pushed for many years. We’re working closely with Republican and Democratic members of Congress to lower health care costs and to ensure quality affordable coverage for older Americans – and we want reform legislation passed and signed by the president this year.4

So what is AARP fighting for in health reform?

  1. Stopping insurance companies from charging older Americans unaffordable premiums because of their age.
  2. Ending the practice of excluding people from insurance because of pre-existing conditions.
  3. Holding down health costs and making insurance coverage more affordable for all Americans.
  4. Making prescription drugs more affordable by narrowing the Medicare doughnut hole, bringing generics to market faster, and allowing Medicare to negotiate better drug prices.

Find out more and take action at HealthActionNow.org.

Thanks,

[First name of AARP member]

——————————————

1. “AARP to Congress: Don’t Make Medicare More Expensive,” AARP, July 30, 2009 http://www.aarp.org/aarp/presscenter/pressrelease/articles/rand_medicare_statement.html

2. “Debunked: Health Reform Means Rationed Care For Seniors,” AARP, August 4, 2009 http://blog.aarp.org/shaarpsession/2009/08/debunked_health_reform_means_r.html

3. “AARP Responds to Health Reform Scare Tactics,” AARP, July 24, 2009 http://www.aarp.org/aarp/presscenter/pressrelease/articles/mccaughey_statement.html

4. “Obama Vows No Cuts To Medicare Benefits,” AARP, July 29, 2009 http://bulletin.aarp.org/yourhealth/policy/articles/
obama_fields_tough_questions_on_health_care_reforms_at_aarp_tele_town_hall.html

[This image is believed to be trademarked. It is being used to identify the organization AARP, a subject of public interest.]

Categories
Barack Obama Health care Politics The Bush Legacy The Opinionsphere

Gog et Magog, Hypomania in the White House, Reuters!, The Most Interesting Man in the World, and the NRLC

1. Gog and Magog. James A. Haught breaks some news – at least in American papers – explaining one line of “reasoning” George W. Bush attempted to use to convince Jacques Chirac to support the invasion of Iraq:

Gog and Magog are at work in the Middle East… The biblical prophecies are being fulfilled… This confrontation is willed by God, who wants to use this conflict to erase his people’s enemies before a New Age begins.

Chirac was so confused by this reasoning that he actually called in a Swiss theologian to explain. Just last week, Chirac confirmed this in an extended interview in France.

2. Hypomania in the White House. John Gartner for Psychology Today profiles Rahm Emanuel and the Emanuel family that shaped him. He describes Emanuel as hypomanic – which he stresses is not a psychological disorder, but a condition. Some of the more interesting tidbits:

Emanuel says f*ck more frequently than “if, and, or but,” insists political scientist Larry Sabato. Obama himself regularly jokes about Emanuel’s profanity: “For Rahm, every day is a swearing-in ceremony.”

Gartner also discusses how Emanuel’s family shaped him:

Stuck with each other, the brothers created their own subculture—unlike most gifted high-energy kids, who must deal with the confusing feelings that come with being different. Like the X-Men at the Mutant Academy, the brothers felt most normal in one another’s presence, where they could be themselves—with a vengeance.

The brotherhood may have been instrumental in curbing another hallmark of hypomania. If you’re hypomanic and gifted, you always have the feeling of being the smartest guy in the room. But if you have two other guys just as smart and aggressive in the room who say, “That’s a stupid idea” and start to pound you, it’ll knock some of the grandiosity out of you.

And this:

While Rahm has called the verbal combat that took place there “gladiatorial,” Zeke described it to me as more of a Talmudic debate—the Jewish tradition of argument where one’s opponent is viewed as an ally in the search for truth. “It’s a sign of love to take someone’s view seriously,” says Zeke, who has fostered at NIH a style modeled directly on the Emanuel dinner table; he calls it “combative collegiality.”

3. Reuters! Reuters believes in a link economy. Suck on that AP.

4. The Most Interesting Man in the World. I was going to link to an article at AdAge by Jeremy Mullman on Dos Equis’s spectacularly successfuly “Most Interesting Man” campaign – but as the article went viral, AdAge has apparently attempted to limit its distribution and now placed it behind a firewall. Google does have a cached version here. For now. It’s an interesting story of how the ad campaign broke all of the rules of beer advertising – and led Dos Equis to buck the trend of declining imported beer sales and actually notch a double digit rise.

5. The NLRC: Not about abortion any more. William Saletan explains why certain pro-life Democrats are having their loyalty questioned by the National Right to Life Committee despite their unchanged anti-abortion stance:

In 2007, Ryan began to flunk the scorecard because the scorecard was no longer primarily about abortion. It wasn’t Ryan who changed. It was NRLC.

[Image by me.]

Categories
Health care Politics

Zeke Emanuel on the Health Insurance Exchange

Noam Scheiber profiles the man he calls the nicest Emanuel brother, the eldest,  Zeke. Zeke is one of the nation’s leading bioethicists and works – along with Cass Sunstein and Peter Orszag in the Office of Management and Budget. Even with all the intellectual firepower in that normally staid department, Zeke stands out – and as someone who has been working for health care reform his entire life, he is one of those taking the lead on this issue. His focus – unlike most progressives – is not on the public option, but on the Health Insurance Exchange:

[N]ot surprisingly, Emanuel digs deepest into his healthy reserve of enthusiasm for the parts of the plan that dovetail with his own ideas. At the top of this list is a so-called insurance exchange – a regulated market in which people who lack coverage through their employer (and maybe people who work at small companies, though that’s still being negotiated) could choose from a variety of private plans, which would offer at least a minimum level of benefits and could not discriminate by health status. “He’s a key thinker on the exchange. How it operates. How it interacts with insurance market reform,” says the administration official.

On the one hand, the exchange is absolutely central to the Obama plan–it’s how the uninsured get covered. So it’s worth having Emanuel’s considerable brainpower on the problem. On the other hand, one can imagine a future in which the employer-based system gradually withers away, leaving everyone to purchase insurance on the exchange. Though Emanuel scrupulously avoids such discussions, it’s hard to believe the thought has never occurred to him.

I’d like to hear more about his thinking on “How [the exchange] operates. How it interacts with insurance market reform.”

Categories
Health care Politics

A Jumble of Health Care Related Points

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.]

Categories
Barack Obama Domestic issues Health care Politics The Opinionsphere

Lies About Health Care Reform

[digg-reddit-me]The August War for Health Care Reform has begun. The forces for health care reform and those against it (working with those who are against it right now) have both begun to wage the battle for public opinion and to influence Congress. Many on the pro-reform side are not sure if they are happy with the plans being considered – and are frustrated with what they see as the lack of forthrightness in selling the plan. There are currently multiple versions of the legislation in Congress – and the president has yet to state what he will require to be in the bill. This all seems part of a strategy, but it makes organizing more difficult. In the end, there is little choice but to trust that if given the proper space and pressure politically, Obama and the Democratic Congress will do the right thing.

But while this may be frustrating what has become very clear is that the opponents of reform are willing to lie outrageously in order to turn the tide in this fight. And those people who favor reform must beat back these complaints vigorously. Here’s a roundup of recent lies told by the opponents of reform:

1. Last week in an opening volley, I received a charming email from Townhall.com stating that “ObamaCare=Gov’t Funded Abortion and Euthanasia.” This is clearly not true.

2. Then, this morning, I opened up the Drudge Report and found as his main link a heavily edited video claiming that it showed Obama “IN HIS OWN WORDS” saying his health care plan will eliminate private insurance. Even in its heavily edited version, it didn’t show this. Instead it showed Obama endorsing the generally accepted idea that we should gradually end our employer-based health insurance. Obama’s views on single-payer health insurance have been gone over repeatedly. His campaign website gave three examples of him using the same formulation – which incidentally he also used in at least one debate that I recall:

If you’re starting from scratch, then a single-payer system’-a government-managed system like Canada’s, which disconnects health insurance from employment-‘would probably make sense. But we’ve got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that’s not so disruptive that people feel like suddenly what they’ve known for most of their lives is thrown by the wayside.

So, what we have is a obviously edited video of Obama at various times in the past ten years saying that he supports a single-payer system (cutting out the second half of the statement) and his admission that he believes we should move away from employer-based health insurance. The video though is being promoted as proving that Obama is admitting that his plan would secretly impose government insurance on everyone. The video very clearly shows no such thing.

Yet, even so, the Libertarian sub-reddit was fooled and promoted the video.

The White House has helpfully provided the videos with some context in what I think is an excellent effort to combat this smear.

3. The hysteria over Obama’s health care reform even bled over into my walk home through Midtown Manhattan. On the way, I passed a booth run by the LaRouche PAC with a picture of Obama with a Hitler mustache (similar to this one) and an older black woman explaining to passers-by that Obama was seeking to kill older Americans just like Hitler did. Everyone knows the LaRouchites are a bit crazy. But how different is this from what Rush Limbaugh says? Or Fox News? I took a flyer from the women – though not before telling the person she was preaching to that Obama really wasn’t actually trying to kill her. The flyer explained (the PDF linked is slightly different version from what I received):

U.S. President Barack Obama delivered a nationally-televised press conference at 8 p.m. on July 22nd, in which on five separate occasions he called for health reform legislation featuring the establishment of “an independent board of doctors and health care experts” to make the life-and-death decisions of what care to provide, and what not, based on cost-effectiveness criteria – exactly the infamous “T-4” policy imposed by Adolf Hitler in 1939, for which the Nazi regime was tried and condemned at Nuremberg.

Lyndon LaRouche commented, within minutes of Obama’s remarks:

“President Obama is now impeachable, because he has, in effect, proposed legislation which is an exact copy of the legislation for which the Hitler regime was condemned in the post-war trials. This is an impeachable offense: to propose such a thing in this time, is an impeachable offense. The time has come that the President of the United States deserves impeachment. With this statement from him, the President now deserves impeachment.”

On how many levels is this ridiculous? The independent board of doctors and health care experts would replace MedPAC – a board that currently provides guidance to Congress in setting Medicare rates. Instead of advising, Obama’s new board – the IMAC – would make recommendations as to levels of pay that would be sent to the president and, if then endorsed by him, would be subject to the approval of Congress. They would also do studies of the comparative effectiveness of different types of treatments. Does this sound like a euthanasia program to you?

4. There is also an email is circulating that makes all sorts of outrageous claims about the bills under consideration on health care reform – including many of the above claims – and pretends to cite the pages and lines of the bill that mandate what it describes. Like many of these viral email lists of lies, it relies on the laziness and gullibility of the American people – trusting that people will pass it on rather than check the truthfulness of the claims themselves. The email was pretty thoroughly debunked by Linda Bergthold, a health care policy consultant and researcher who has been working in the field for 25 years, and Politifact, an arm of the St. Petersburg Times that analyzes the truth of political statements.

A lot of this stuff is hard to believe – but as Bill Maher pointed out last week – if you let even stupidest arguments stand unchallenged, they will take root and destroy even one’s best efforts. Which is why I’m going to try to make a point of calling bullshit on these outrageous lies as they come by…and you should too…

[Image by criswell; used without permission, but hopefully he’ll respond and give it to me soon.]

Categories
Health care

Krugman Summarizes the Health Care Problem

While researching a few facts about health care, I came across this excellent Paul Krugman article on health care in the New York Review of Books from 2006. Anyone who wants a good overview of the debate should check out the article in full – but here are a few highlights.

Krugman sees the growth of health care costs as being driven by new technology but exacerbated by aspects of our private system. He includes this informative graph to demonstrate the significance of health care spending:

He points to a study which quantifies the difference in spending between private and public health care plans:

For example, a study conducted by researchers at the Urban Institute found that

per capita spending for an adult Medicaid beneficiary in poor health would rise from $9,615 to $14,785 if the person were insured privately and received services consistent with private utilization levels and private provider payment rates.

He points to another study which tracked the changes in the growth of spending in Medicare and private insurance:

Comparing common benefits, says the Kaiser Family Foundation,

changes in Medicare spending in the last three decades has largely tracked the growth rate in private health insurance premiums. Typically, Medicare increases have been lower than those of private health insurance.

He makes a good point (with his wry wit) about the fragility of Medicaid:

Unlike Medicare’s clients—the feared senior group—Medicaid recipients aren’t a potent political constituency: they are, on average, poor and poorly educated, with low voter participation. As a result, funding for Medicaid depends on politicians’ sense of decency, always a fragile foundation for policy.

Krugman also points out yet another study which demonstrates how a market-based approach does not necessily lead to better health results – or even cheaper results – as bad choices in the short-term often lead to expensive treatments in the long-term:

A classic study by the Rand Corporation found that when people pay medical expenses themselves rather than relying on insurance, they do cut back on their consumption of health care—but that they cut back on valuable as well as questionable medical procedures, showing no ability to set sensible priorities.

Finally, Krugman continues to make the case that our health are system is simply not the best one out there:

The data in Table 1 show that the United States does not stand out in the quantity of care, as measured by such indicators as the number of physicians, nurses, and hospital beds per capita. Nor does the US stand out in terms of the quality of care: a recent study published in Health Affairs that compared quality of care across advanced countries found no US advantage. On the contrary, “the United States often stands out for inefficient care and errors and is an outlier on access/cost barriers.”

Categories
Barack Obama Health care Political Philosophy Politics The Opinionsphere

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

[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.

Continue reading “What Do Matt Yglesias, Ezra Klein, and Che Guevera Have in Common?”

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Health care Politics The Opinionsphere

Best Line of the Week

Goes to Ezra Klein describing Peter Orszag’s response to the Congressional Budget Office’s analysis of IMAC:

That paragraph reads a bit like a very angry Data trying to hurt Spock’s feelings.

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Barack Obama Criticism Green Energy Health care Politics

Is Obama Leading Us To A Technocratic Dystopia?

[digg-reddit-me]Implicit in many of Obama’s policy proposals and programs is an assumption shared by many reformers (from here to here to here): 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. I’m not sure that they’re wrong – but I’m wary of the decision made by the Obama administration to focus on creating a technocracy to manage these areas.

In many of Obama’s programs and proposals, there is a bureaucratic independent or quasi-independent agency that is designed to manage whatever process is relevant to the program and that receives from the Congress authority to make decisions on its own. To the technocrats’ credit, in most cases, although the decision-making is outsourced to these agencies, Congress has some sort of limited veto over them. The appeal of outsourcing authority to these institutions comes from the fact that they are theoretically insulated from politics and are capable of making minor decisions over a long period of time which – if managed properly – can effect significant changes. The idea is that – rather than forcing through a controversial and wholesale change – you set up an independent agency that will gradually manage things in order to achieve the changes needed. This makes a great deal of sense politically – as the agency can be tasked with some anodyne goal that everyone can agree on – and as it makes controversial decisions,  politicians can distance themselves from each individual decision while still supporting the independence of the organization (as you often see with the Federal Reserve). They can say they didn’t vote for this or that specific proposal – and that they oppose it – but that given the authority of this independent agency, there’s little they can do. On a policy level, this also makes sense – as any attempt to push through wholesale reform is limited by one’s knowledge at the time the legislation is drafted. Better to experiment and try various small steps and set up different incentives to accomplish the same thing than to attempt to impose some pre-made solution. It’s also worth noting that these technocratic institutions are often supported on a bipartisan basis – while specific reforms are generally opposed by one side or the other. The appeal is obvious – yet the anti-democratic impulse is disturbing.

One example of these organizations is the IMAC (or Independent Medical Advisory Committee) which would be a technocratic institution that would set the pay rates for reimbursement of various Medicare programs and eventually perhaps for all government-sponsored insurance (as MedPAC does now) and also compare and evaluate what treatments work best to treat different conditions and make recommendations. Unlike MedPAC which simply advises Congress, IMAC would make annual recommendations which would take effect if accepted by the president and not vetoed by the Congress. The White House has been selling this plan as a way to take the politics out of Medicare reimbursements and restrain costs. A similar approach helps explain why Obama is pushing for the Federal Reserve (the organization to which the IMAC is most often compared) to be the regulator of those institutions that are “too big to fail” as well as tracking and regulating various other systematic risks – despite their role in the collapse that just occurred. What the Federal Reserve is known for is its independence from political pressure and its technocratic bent, thus making it the perfect vehicle for Obama’s efforts to reform the financial industry even though it clearly failed so recently. There is the proposal for a National Infrastructure Bank which would direct federal transportation money – again, independent of political concerns. The cap-and-trade program would likewise gradually institute dramatic reforms by giving authority over to a technocratic institution that would manage carbon emissions – distancing these actions from politically accountable leaders.

On each individual proposal, the solution seems compelling, but as an overall trend, it is disturbing. When Obama was elected, many claimed that there was a similar feeling of hope and progress to when John F. Kennedy was elected – and as then, when Kennedy gathered “the best and the brightest,” Obama has reinvigorated the idea of public service. But the downfall of these Kennedy men was their belief that they could “control events, in an intelligent, rational way.” Obama’s technocrats do not seem to have this same hubris. Their hubris is of a different variety: they believe that they can best manage complex areas and achieve needed reforms not through political action but by creating bureaucracies onto which they put the difficult political decisions.

But what kind of system do we end up with then? As rules and regulations are created by technocrats and then merely accepted or rejected by the elected officials. This system seems to resemble an oligarchy with democratic checks. With the Federal Reserve along with other less independent agencies already deputized to take care of most government responsibilities, we have already started down this road – but it doesn’t seem wise to double down on this approach. Unfortunately, I do not offer a solution – only a concern.

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