Category: Domestic issues

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Barack Obama Health care Politics The Opinionsphere

Political Number Games

A more proper post coming later, but for the moment, I wanted to provide you with two graphs and one poll result.

First, from the always insightful Nate Silver of FiveThirtyEight.com, who points out that all these polls touting the fact that Americans are almost evenly split on the health care legislation before Congress, 12% of those counted against the bill are those that want it to move farther to the left:

By “left,” Silver means those who think the bill doesn’t go far enough to reform health care – though I suppose those could be people on the right as well. Either way, breaking down the data like this gives a lot more insight than the headline numbers.

Via Andrew Sullivan, an enterprising individual mapped out the “geography of the recession,” with the mounting job losses per county places on a map of the United States and animated over time.

Finally, in a rather misleading piece of analysis, Andrew Malcolm of the LA Times uses recent poll data to suggest that Sarah Palin has a shot in an electoral race against Obama. Rather than looking at head-to-head polling results, he looks at the favorability ratings of Sarah Palin, Barack Obama, and Dick Cheney. He points out that Obama’s are dropping and Palin’s and Cheney’s are rising. Perhaps this has something to do with the fact that these last two individuals have no power and thus those favoring them are only supporting the vague promise of an individual. But – on the other hand – this does demonstrate that Palin and Cheney have become the voice of the Republican Party, and does bode well for my prediction that at least one of the two will be on the Republican ticket come 2012. Those suggesting we write them off and ignore them because they represent fringe views are engaging in wishful thinking.

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Barack Obama Health care Politics The Opinionsphere

The Republican’s Generational Warfare

[digg-reddit-me]All the blogosphere (and indeed, the political conversation of which it is a part) is abuzz with outrage over Obama’s Afghanistan decision – from those towards the left who believed Obama has betrayed them by escalating this war (despite the fact that it was a campaign promise to escalate the war) to those others on the left who just oppose the war to those on the right who (with a few exceptions) have decided to attack the decision as weak, not Churchillian, and to paint Obama once again as a weak, anti-American thug. Then there a significant chorus of the voices of reason – who acknowledge that to withdraw seems perhaps as bad of an option as to escalate; both of which in turn could be less worse than the way things are now. Some of these voices are opposed to escalation; some are in favor; many seem weary of the discussion entirely.

But while all of these pixels are being devoted to Afghanistan, we are taking our eyes off a far larger issue – the one that we have never quite bothered to look at despite months purportedly focused on it. The Republican Party has now declared war on this cute baby! Along with me, probably you, and the rest of the younger generations. Paul Krugman today issued a call to arms that was – to adopt a metaphor of the right – virtually Churchillian in its starkness, if not in its vivid imagery:

For America can’t get control of its budget without controlling health care costs — and this is our last, best chance to deal with these costs in a rational way.

Krugman – in typically Churchillian fashion – does not mention that many of the best options to control costs have already been stripped from the bills being considered – from a public option pegged to Medicare rates to a more open health insurance exchange. Instead, the bill’s potential would be with a strong public option trigger or the many, many experiments in the plan any of which may or may not be able to bend the curve of health care spending growth downward. As important, as even the foremost free-marketeer Milton Friedman acknowledged, our rapidly escalating costs are the result of our hybrid system but that “once the whole population is covered…attention turns to holding down costs.” None of the bills under consideration would achieve universal health care either – but they would make significant progress to this goal.

In short this bill will not be enough to fix our problems, but when the House and Senate bills are merged, the resulting bill will almost certainly be the most significant attempt at cost control in a generation if not more. And it is long past due. As Krugman points out: our long-term fiscal outlook is dire. The tax cuts and deficit spending during our years of plenty under Bush aren’t the primary reason for this. The stimulus spending by Bush or Obama isn’t the main cause either. The primary reason for this impending disaster is that our population is getting older and health care costs are growing exponentially. Thus the only way to avoid drastic cuts in the future is to slow down the rate of growth today.

Part of reducing the rate of growth today is restraining the growth of spending in Medicare and other government programs. In other words, a vote to not cut a dime in Medicare today is a vote to make sure my generation doesn’t have Medicare at all. Back to Krugman:

[T]he G.O.P. has focused more and more on an effort to demonize cost-control efforts. The Senate bill would impose “draconian cuts” on Medicare, says Senator John McCain, who proposed much deeper cuts just last year as part of his presidential campaign. “If you’re a senior and you’re on Medicare, you better be afraid of this bill,” says Senator Tom Coburn.

If these tactics work, and health reform fails, think of the message this would convey: It would signal that any effort to deal with the biggest budget problem we face will be successfully played by political opponents as an attack on older Americans.

For once, Krugman understates things. The G.O.P. is waging a generational war on the younger generations. While they complain of stimulus spending to get the economy moving (which the younger generation, especially those just graduating college desperately need), these old men are demagoguing cost control today such that tomorrow, when I am too old to continue working, there will be no safety net. If it sounded a bit off to you that these Republicans who not long ago were looking to dismantle Medicare and Social Security (and whose patron saint warned that Medicare would lead to socialism and the end of freedom in America) are now defending these institutions against any any cuts, perhaps you haven’t heard of “starving the beast.” This right-wing fiscal-political strategy explicitly subscribed to by Ronald Reagan and George W. Bush (who not coincidentally each ran huge deficits) uses “budget deficits via tax cuts to force future reductions in the size of government. The term ‘beast’ refers to government and the programs it funds, particularly social programs such as welfare, Social Security, and Medicare.” In other words, those who subscribe to this strategy would rather drastic cuts in the future that would eliminate Medicare for me than moderate cuts today that would make the system sustainable. This is nothing less than an attempt to make war on my generation in the name of ideology.

Krugman, in issuing this call to arms, must know that this bill is not ideal. But he also knows that it holds promise, and that its success would lead to more serious efforts. Its failure though would mean that yet again the “fiscal conservatives” whose goal is to “starve the beast” will have won yet another battle in the war on the younger generations, and the Baby Boomers who have for too long subjected us to their petty distractions will be the last generation to enjoy the benefits of the programs their parents created.

If these starve-the-beasters get their way, America’s power will be diminished and our society less just, and us younger generations who have paid into will not be able to benefit from this safety net.

[Image by tandemracer of her baby’s six-month doctor visit licensed under Creative Commons 2.0]

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Domestic issues Economics Politics The Opinionsphere

National Review: “Soak the Rich!”

[digg-reddit-me]The National Review gives Conrad Black some space to somewhat incoherently go after Barack Obama on economic issues. He writes with the accumulated resentments and reduced expectations of an old man – and one imagines one is meant to receive this incoherence as hard-won wisdom.

Black has formed his opinion of Obama’s health care plan without taking the time to understand it – as his one-sentence description makes clear: “the administration claimed that it would reduce medical costs by taking over the insurance of those already covered.” His simple health care plan simply calls on the Democrats to go after their interest groups – trial lawyers and unions – and ignore the rest of the factors undermining our health care system. A convenient position to take while writing for a right-wing publication.

He dismisses the consensus of economists (“The whole concept of stimulus is bogus”) with a single clause (“as the borrowing of the money consumes at least as much stimulus as it generates.”) He suggests Al Gore is an eco-terrorist and calls the plans to stop exacerbating climate change, “insane.” In short, Conrad Black throws every bit of feces he can – working off of the standard right-wing playbook.

But finally, he has a few interesting things to say – after spending the bulk of his piece proving his right-wing bona fides. He suggests a few taxes to raise – and here is what I find interesting. His first two ideas are standard: a strong gasoline tax and a tax on financial transactions. Both of these are much favored by those who know something about policy, but face serious obstacles in terms of the politics of getting them done. But his last idea is interesting and new (or at least new to me.)

[A] small, self-terminating wealth tax could be imposed on very large fortunes, to provide funds for those taxpayers to engage in legitimate anti-poverty projects they would devise themselves and have certified, like charities. The tax would decline as sensibly defined poverty declined, and would evaporate when poverty did. The greatest commercial minds in the private sector would have a vested interest in eliminating poverty and would produce a variety of imaginative methods of doing so.

I’m not sure how well this idea would work – but it is quite interesting. It seems to be an idea very much based on right wing presumptions but to have a traditionally liberal goal: using government policy to reduce poverty. And Black certainly has a personal history that leads him to understand the very wealthy he is attempting to manipulate with this tax. That said, it addresses itself not to the escalating divide between the rich and poor, but merely to reducing poverty. It presumes the rich are “the greatest commercial minds” when it seems evident to most liberals (including to me) that chance and luck play as great a role in success as mental skill. What is intriguing is that it attempts to marry the self-interest of the rich with the reduction of poverty. Whether this is the best means or not, it is a worthy goal.

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Barack Obama Health care National Security Politics The Opinionsphere The War on Terrorism

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

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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Barack Obama Criticism Health care Politics Videos

NBC’s Dr. Nancy Defends Doctors in Breast Cancer Debate: “We are on the verge of becoming a scientifically illiterate country”

[digg-reddit-me]One of the main competitions in our politics, aside from the liberal versus right-wing, and the establishment versus anti-establishment, is the the competition between technocrats and idiocrats. While technocrats may be ascendant in Obama’s Washington, as policy wonks and experts attempt to solve intractable problems with technical solutions and brainpower and science, the idiocrats, who try to get their agenda through by fooling enough of the people enough of the time, still have a solid hold on the political discussion.

Idiocrats take advantage of that old adage, “Where there’s smoke, there’s fire,” and make sure smoke obscures any issue in which they want to get their way. Rather than respond to their opponents on the merits, they simply describe their opponents and their agenda as the fulfillment of the idiocrat’s worst fears: “Nazi!” “Socialist!” “Communist!” Terrorist!” “America-hater!” “Death panels!” “Government-mandated abortion!” “Reparations!” “Secret Muslim!” “Radical!” For those who are not paying enough attention to the issue to sort through all the competing claims, this extremist rhetoric, while not convincing them, causes them to assume something bad is going on, even if it isn’t as bad as is being claimed.

For example, even as the health care plan Obama has proposed is largely based on previous Republican proposals, and seems to take into account conservative critiques of big government while still making progress towards liberal goals, idiocrats have condemned it in the harshest terms possible, raising every possible fear – from government kidnapping your children and indoctrinating them into socialism, to rationing by death panels, to runaway spending bankrupting the country, to abortion mandates, to the destruction of the employer-based health care system, to the destruction of Medicare. It makes little difference that it is hard to imagine a plan that both rations care brutally and leads to runaway spending, or that everyone acknowledges our current system is on an unsustainable course, or that the measures included in the bills under consideration represent the most significant attempt at cost control in a generation.

Last week, as part of a continuing effort to generate smoke to obscure real issues, the Wall Street Journal editorial board started a deliberate lie to undermine the health care reforms in Congress by claiming (without evidence and contrary to news reports as well as the the recommendation itself) that the U.S. Preventive Services Task Force – a independent, technocratic organization of doctors started by Ronald Reagan – had changed its recommendations regarding breast cancer prevention as part of Obama’s push to reduce the health care costs. This explosive claim became the focus of the public debate, instead of the recommendations of the report itself and their rationale.

On Sunday, Meet the Press had a typically “even-handed” debate between their own Dr. Nancy Snyderman and Ambassador Nancy Brinker, founder of an organization dedicated to fighting breast cancer. The whole 12 minute segment is worth watching (transcript), as you can see Brinker acknowledging that the task force might be right on the science, but at the same time suggesting that we shouldn’t show any weakness in our war against cancer by suggesting mammograms might not always be a good thing. She made a few valid points, giving certain circumstances in which mammograms would be better than alternatives, but she couldn’t and didn’t dispute the task force’s medical conclusions.

But the piece is truly worth watching for “Dr. Nancy” took on the idiocrats who were muddying the issue and defended the scientific conclusions of the doctors:

DR. SNYDERMAN: [O]ver 1900 women screened over a 10-year period of annual mammograms, one life is saved and there are a thousand false positives, which means ongoing, unnecessary tests.  Now remember, the scientists who did these numbers, their role is, as scientists, to take the anecdotes and the passion and the emotion out of it.  And I recognize that’s hard as part of the message.  But they’re to look at the public health issues of how we screen. And we’ve always known that mammography for women in their 40s has been fraught with problems.  It is not as precise for older women [She meant younger here].  On that Nancy and I have great agreement.  So what their consensus was is that there are a lot of unnecessary screenings for that one life.  Now, if you’re that one life, it’s 100 percent.  I get that.  But their charge as an independent body was to look at the cumulative research as scientists.

Later, as Ambassador Brinker tried to simultaneously politicize the issue while claiming not to be, Dr. Nancy interjected with a righteous defense of science:

The key line that got me:

I would argue that we are on the verge of becoming a scientifically illiterate country if we don’t at times separate [science and politics]…

In a large measure, the promise of Obama, the hope he held out, was to break the hold that idiocrats have over our political debate. Thus far, this is a battle he does not seem to be winning.

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Criticism Health care Politics The Opinionsphere

That’s What You Get For Trusting a WSJ Editorial

[digg-reddit-me]Yesterday, the Wall Street Journal had an editorial that got passed around as if it were a news story, insisting that the decision of a board of doctors and scientists to recommend that biannual breast cancer screening only for those between the ages of 50 and 75 “is a sign of cost control to come.” The editorial cited this fact:

But the panel—which includes no oncologists and radiologists, who best know the medical literature—did decide to re-analyze the data with health-care spending as a core concern.

Yet this isn’t what news articles are reporting:

Panel members said politics and questions of cost were never part of their discussions of the risks and benefits of mammograms — in fact they are prohibited from considering costs when they make guidelines.

Or this:

In reaching its recommendations, the task force of doctors and scientists determined that early and frequent mammograms often lead to false-positive readings and unnecessary biopsies, without substantially improving the odds of survival for women under 50.

And it is not the rationale given by the report itself:

The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman’s lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.

Adequate evidence suggests that the overall harms associated with mammography are moderate for every age group considered, although the main components of the harms shift over time. Although false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups.

There is adequate evidence that teaching BSE is associated with harms that are at least small. There is inadequate evidence concerning harms of CBE.

That hasn’t stopped this from becoming a right wing talking point nor from causing concerns among independents uncertain about whom to believe – the statements of the board itself, claiming they focused on science, or the speculating opinions of right wingers, playing into people’s worst fears.

I have some advice for those people on the fence: Read the damn report if you don’t trust the media. Don’t put your blind faith in the often discredited Wall Street Journal editorial page.

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Barack Obama Criticism Domestic issues Health care Politics The Opinionsphere

Health Care Reform is the most significant effort at cost control in a generation, if not ever.

[digg-reddit-me]Once health care reform passes, the White House has signaled it will begin to focus more specifically on the deficit. (Also, on jobs, cap and trade, and financial regulation.)

But as the Obama administration presented it initially: Health care reform is deficit reduction. (Ezra Klein, health care policy wonk, blogger, and columnist for the Washington Post, has been making this case all along, as have many other technocratic types and policy wonks and health care experts.) That’s why Peter Orszag made the phrase, “bend the curve” into a buzzword, referring to the attempt to bring down the rate of growth of health care spending. Here for example is a graph of our projected budget deficit as a percentage of GDP based on current growth rates, lowering those growth rates, and adopting measures to have Britain-like growth rates:

While any bill that might get past Congress at this point won’t live up to the early wet dreams of policy wonks (It won’t even bring us to the level of the blue line in the above graph), it would – to quote Ezra – still “represent the most significant effort at cost control in a generation, if not ever.” (my emphasis.) (He specifically refers to three provisions in the Senate Finance Committee bill: the excise tax on high-cost insurance plans; the newly empowered Medicare Commission; and various delivery-system reforms.) In fact – again according to Ezra – the “health-care reform bills currently under consideration in both the Senate and the House actually cut money from the deficit.” Despite this, the same Republicans (often the exact same individuals) who 6 years ago cast “a vote to add about $400 billion to the deficit in the first 10 years, and trillions more in the decades after that,” with Medicare Part D are now criticizing the current bill which would decrease the deficit as “fiscally irresponsible.”  Ezra:

It’s like watching arsonists calling the fire department reckless.

This constant obstructionism by the Republicans – on both matters of fiscal stimulus and health care – is gradually eating away at the public will to act and is therefore undermining confidence in America’s economy and long-term fiscal situation, and by undermining this confidence, making a disaster more likely. Noam Scheiber of The New Republic describes how the struggle to enact meaningful health care reform is a concern for the largest holders of American debt, the Chinese:

To his surprise, when Orszag arrived at the site of the annual U.S.-China Strategic and Economic Dialogue (S&ED), the Chinese didn’t dwell on the Wall Street meltdown or the global recession. The bureaucrats at his table mostly wanted to know about health care reform, which Orszag has helped shepherd…”At some point, if you refuse to contain health care costs, you’ll go bankrupt,” says Andy Xie, a prominent Shanghai-based economist, formerly of Morgan Stanley.

The efforts at cost control proposed by the Democrats might fail, as Republicans suggest. But it is irresponsible not to try, and to obstruct any attempts to try. Republicans have begun to demagogue the bills before Congress both for cutting Medicare and for increasing the amount of health care spending. They are not willing to give the Democrats any political cover to take any fiscally responsible measures. This partisan refusal to work towards solving long-term problems has been the key to Republican successes from 1994 to the present. (Not so for the Democrats, many of whom joined George W. Bush in passing his No Child Left Behind act, his tax cuts, and his Medicare Part D bill, but undoubtedly, both sides bear some blame.) This has created a political culture in which Washington has two directives:  “spend money on things I like and don’t raise my taxes.” This isn’t solely a Republican problem. It is more that the Republicans, by remaining stubbornly united, have made these flaws evident. Klein again:

The issue isn’t that some storm will unexpectedly slam into the economy and there will be nothing anybody can do, but that the storm will hit and Congress will choose to do nothing

The biggest danger America faces is not rising health-care costs or global warming or the budget deficit. It’s the political system’s inability to act on these issues, even though the solutions are generally quite clear.

Take a moment and read the articles linked to – especially the three Ezra Klein posts from the past two days. (On the Senate Finance Bill’s cost control measures; On Medicare Part D; and On Our Political System’s Inability to Act.)

Keep in mind that Obama’s proposals are not “radical leftist” but essential and moderate tinkering that incorporates Republican as well as Democratic ideas. The Tea Party-ers may be outraged at the imaginary specters of death panels and government-mandated abortion. But it is the rest of us who should be outraged at the inability of our political system or our politics to address these long-term issues responsibly.

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Barack Obama Criticism Health care Politics The Media The Opinionsphere

Fisking Camille Paglia

[digg-reddit-me]Camille Paglia’s Salon weekly Salon column seems a product of a different time. One of the consequences of this is that she neglects to provide links sourcing some of the more bizarre claims she makes. At the same time, Paglia’s ideologically-applied contrarianism leads her to make quite a few of these bizarre statements. Her columns read like a caricature of media attempts to be “objective” and “independent” dreamed up by Glenn Greenwald rather than a sentient mind. Paglia seems determined to make sure neither Democrats nor Republicans, neither conservatives nor liberals feel comfortable with what she was to say. Thus, she endorses every criticism made by one side of the other, and credits no one with solutions. The defining element of her style is to take seriously the hypothetical or actual criticisms of various groups whom she then stereotypes in the crudest manner possible:

Steel yourself for the deafening screams from the careerist professional class of limousine liberals when they get stranded for hours in the jammed, jostling anterooms of doctors’ offices. They’ll probably try to hire Caribbean nannies as ringers to do the waiting for them.

Paglia uses these stereotypes to demonstrate her disdain for and independence from those whose criticisms she is adopting. Her vaunted independence then serves only to mask an inability or unwillingness to differentiate between true claims and false ones as she navigates through policy issues without endorsing any coherent approach.

And today, she applies her mind to the health care debate. The result is predictable.

Paglia rather quickly demonstrates her complete ignorance of the basics of health care policy arguments by endorsing “portability of health insurance across state lines” as “the most common-sense clause to increase competition and drive down prices.” Paglia doesn’t see any reasons why Democrats might oppose this “common-sense” reform – so she presumes there must be some “covert business interests,” that Democrats are protecting. A simpler explanation might be that allowing the portability of health insurance across state lines would effectively deregulate the entire health insurance industry. Or at least, it would create a race to the bottom as health insurance companies would relocate to the state with the least regulation, after which states would compete to deregulate to attract this industry. Or maybe the Democrats are really in the pocket of some secret business that Paglia imagines.

Paglia goes on to ask “why are we even considering so gargantuan a social experiment when the nation is struggling to emerge from a severe recession?” She answers her own question without pausing: “liberals are starry-eyed dreamers lacking the elementary ability to project or predict the chaotic and destabilizing practical consequences of their utopian fantasies.” The idea that this moderate bill – which resembles nothing so much as the Republican’s counter-offer to Bill Clinton in 1993 – is actually a liberal “utopian fantasy” is an easy straw man. Instead, this bill explicitly seeks to stabilize our status quo.

As to the question of, “Why now?” – Paglia might have taken the basic step of listening to any presidential address on this or read almost any liberal op-ed from before August. The presented explanation was that health care reform has to be the first step in entitlement reform. And entitlement reform is the first step towards fiscal solvency. And with the bond market and the Chinese government getting nervous about America’s solvency in the long-term, steps to bring the long-term deficit (which is almost entirely driven by the rising health care costs) into line were necessary. You couldn’t read a liberal op-ed on health care without seeing the Peter Orszag phrase “bend the curve” until this August when concerns about “death panels” and “killing Grandma” became paramount.

Speaking of which, Paglia makes sure to trot out these charges yet again – warning of imminent rationing and the “gutting” of Medicare:

How dare anyone claim humane aims for this bill anyhow when its funding is based on a slashing of Medicare by over $400 billion? The brutal abandonment of the elderly here is unconscionable.

Truly, to brutally abandon individuals to live without health insurance is unconscionable. To forcibly ration by government fiat is certainly not anything most Americans would support. Perhaps because of this, neither of these is anywhere in any proposed health care legislation. The “slashing of Medicare by over $400 billion” was described slightly differently by Washington Post reporter T. R. Reid yesterday. He called it, a typical Washington spending “cut” – in that Medicare costs were budgeted to rise by $800 billion in the next 10 years, but now would be restrained to rise by half that. Medicare spending would still rise significantly. Washington is one of the few places where you can spend far more and still call something a “cut.” This reduction in the rate of spending would come from various places – one of which would be the Medicare Advantage program which would be subject to “a competitive bidding process that is designed to lower spending on the program.” What Paglia – along with most right wing critics – fail to understand is that health care reform is not about reducing spending, but about reducing the rate of growth of spending. If Paglia calls this “brutal abandonment,” one wonders how she might describe the state of the uninsured if she felt compelled to look to them!

Paglia’s other claims are similarly shallow – equal parts histronics and ignorance. The modest bill proposed does not “co-opt[…] and destroy[…] the entire U.S. medical infrastructure” nor create a “huge, inefficient federal bureaucracy.” In fact, because the bill makes great efforts not to co-opt or destroy the hybrid health insurance system we have that it creates a maze of small bureaucratic institutions to manage the maze of hybrid models that make up our system. They key innovation of the current bill is not any set of bureaucratic institutions but the creation of a managed marketplace, the health insurance exchange.

Paglia’s take on health care demonstrates a complete failure to differentiate between true claims and false ones, as she demonstrates independence not only from partisan forces but from any objective reality.

[Image by Ann Althouse licensed under Creative Commons.]

Categories
Barack Obama Conservativism Criticism Health care Politics The Opinionsphere

Health Care Reform and Its Unintended Consequences

[digg-reddit-me]I said I was going to make a point of noting solid criticisms of the Obama administration by mainstream conservatives and right wingers.

Mona Charen of the National Review wrote a solid piece that didn’t resort to blatant falsehoods as far as I could tell that made a solid case against health care reform. Her basic point is that she doesn’t trust the Democrats:

Every single page [of the health care bill] proclaims something that is dubious — that the Democrats know what they are doing.

Rather than talking about death panels, she points out that electronic recordkeeping has overwhelmed doctors with information they are not used to having to sort through – and thus has made hospitals less efficient. (She cites no study, but it is certainly plausible that this would be a short term effect.) Preventive care, she explains, while probably saving lives could end up costing more – as “more and more of us are tested for more and more diseases.”

Her big point is that this health care reform is “brought to you by the same people” who brought you Medicare and Medicaid – and that the costs of these programs were vastly underestimated. As she points out:

In 1965, Congress predicted that by 1990, Medicare would be costing $12 billion. The actual cost — $90 billion.

Long term forecasts of government spending – or really anything – are a fool’s game, and Charen is right to point this out. On a macroeconomic level, there are too many factors to take into account – and that’s not even counting “black swans” that change everything. In this case, the major factor causing the government health care costs to be so off was the explosion of health care inflation in the 1980s which has only gotten worse since. But it’s not clear that Medicare or Medicaid played any role in this – especially as their costs have been below that of private insurance.

Bill Clinton made a similar point to Charen’s yesterday in trying to make the case for why the health care reform should be passed:

There is no perfect bill because there are always unintended consequences…

Yet, Clinton maintained:

The worst thing to do is nothing.

As Steven Pearlstein writing for the Washington Post described the price of doing nothing (and was later echoed by Barack Obama):

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…

This is the answer Democrats give to the sensible concerns of Charen and those like her: there inherent uncertainty in any attempt to change a macroeconomic trend, but given where we are headed if we do nothing, it’s worth trying.

The only other option is to give up.

This is exactly the sort of sensible criticism that – in my opinion – conservatives should be making. However, the answer should not be to do nothing, but to “tinker” instead of instituting massive top-down changes, and to adopt the measures that work after tinkering. For the most part, this is exactly the approach the current bills take – which is a testament to the fundamental insights of the conservative movement of the past few decades. To take into account this fundamental insight while promoting a liberal agenda is in fact the essence of Obama’s approach: It’s why 40% of the stimulus was tax cuts; it’s why the key health care reform is to create a market that allows individuals to make decisions based on information that is more transparent; it’s why the answer to global warming is a cap-and-trade program that decentralizes authority and whose main mechanism is a market. That this has been Obama’s approach is what has forced the right wing opposition to him to become so unhinged.

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Domestic issues Health care Politics The Opinionsphere

America’s Schizophrenic Abortion Politics

[digg-reddit-me]The Stupak amendment has brought out the least attractive side of many progressive pundits:  a doctrinal, ideological, visceral disregard for opposing views. Right wingers regularly accuse liberals and progressives of this, and perhaps I cannot see it on most issues as I am firmly in the liberal camp. Or perhaps on abortion, there is an element of ideological certainty which is different than on other issues. I don’t see the same knee-jerk dismissal of opposing views as I do on the issue of abortion with regards to government intervention in the society or economy,  various social issues, or American empire. It was fair to say, as most liberals did, that opposing the stimulus was madness, and the arguments against it were often fatally flawed. It was fair to label the “enhanced interrogation techniques” torture, for that is what they were. It is fair to see homophobia as the greatest motivator of opposition to gay marriage, even if it is not the only one. It was fair to call much of the opposition and debate over health care reform “unhinged” – as the debate bore little relation to the moderate bill being proposed.

Yet, as someone who grew up a Catholic, who went to Catholic schools all my life, who has read and wrestled with Catholic doctrine and thought, I get frustrated reading the ignorant and arrogant ramblings of many pro-choice pundits as they discuss the real motivations of the pro-life movement. By ignoring the stated motivations, these pro-choice pundits are able to attribute the opposition to abortion to an anti-woman animus. It seems to me such dismissals are meant to avoid tackling the core question, which is difficult, and nearly impossible to resolve or even discuss. As such, abortion is perhaps the subject least subject to the type of technocratic solution that most Democratic politicians and policy wonks seem to favor.

(Side note: The attempt by the Obama administration to work on this issue was commendable though – attempting to reduce abortion through contraception and education. Unfortunately, the Catholic bishops scuttled this deal as they oppose contraception as well as abortion – a longstanding position. As if to prove their clueless-ness, Matt Yglesias and Atrios at that point stated that this proved that the Catholic Church didn’t really think abortion was murder – because if they did, they would set aside their silly opposition to contraception. While I agree that the Church’s position on contraception (as well as sex in general) is silly, only someone who knows nothing about the Catholic Church would be surprised at this or think it calls into questiontheir opposition to abortion, as I explained at the time.)

In the midst of the fallout from the Stupak amendment, pro-choice pundits once again demonstrated that they misunderstand the politics of abortion. Atrios, for example, tweeted:

2010’s gonna be a bloodbath if dems vote to take away abortion rights

This impression – that support for keeping the status quo on abortion rights is popular – is in fact now, and has long been, untrue. A majority of the country does favor keeping abortion legal, but much of the same majority believes it should be harder to get abortions and supports significant conscience opt-outs regarding abortion. This majority includes a majority of women. Most people do not see abortion as simply “a medical procedure,” but as a profound act. Matt Yglesias dismisses this distinction made by the majority of Americans as “arbitrary” and as merely part of an effort to delegitimize abortion.

Yglesias, a favorite blogger of mine, wrote a similarly clueless post – in which he suggested that nothing was achieved with the Stupak amendment – as Republicans continued to oppose it, the National Right to Life continued to oppose it, and the Catholic bishops only supported the amendment rather than the whole bill. Of course, Yglesias ignores the clearest goal of the Stupak amendment – to get pro-life Democrats on board, without whom the bill wouldn’t have passed. As to the groups Yglesias addressed, the National Right to Life committee gives the pro-life movement a bad name – as it has become entirely co-opted by the Republican Party and now merely distributes propaganda for the party. But the bishops had previously said they would not support any specific legislation, even as they supported the goals of this health care reform. Their only reason to oppose the bill was whether or not it would be “abortion-neutral.” The Stupak amendment removed their opposition – and even lead Cardinal Francis George to call Republican Minority Leader Boehner to make sure “the GOP didn’t play any games,” blocking health care reform on the pretense of a pro-life position. Yglesias failed to take these into account because they interfered with the point he was trying to make: that pro-lifers are insincere in their opposition to abortion and instead just oppose the Democratic Party and the rights of women.

What Democratic politicians realize – but progressive pundits do not – is that Democrats will only win if they can with the Catholic vote. And the largest impediment to winning the Catholic vote is the issue of abortion, for which Catholics bear a great deal of the blame for the schizophrenic position of the majority. There is a hard core of conservative Catholics, but they are a small portion of America’s largest religious group, which includes almost all of the fastest growing ethnic subset, Latinos. They are also the ultimate swing vote, having voted for the presidential candidate who won the popular vote (and except in 2000, the winner), in every election since 1960 save Richard Nixon’s 1968 win.

At the same time, the attitudes of younger Americans have also moved away from the Democratic Party line, as the young favor gay marriage, the legalization of marijuana, and restrictions on abortion.

If Democrats do not figure out how to either convert pro-life voters to pro-choice voters, or to soften their opposition, they will not hold onto power. So, what are Democrats to do? To win over the Catholic vote – and a significant percentage of the younger pro-life vote, there are a few simple steps:

  • Respect. They can stop using the propagandistic terms “anti-choice” or “anti-woman” to describe those who disagree with them on abortion. They should be consistent and either refer to both sides by the terms they prefer: pro-choice versus pro-life; or describe the issue more precisely as anti-abortion and pro-abortion rights.
  • Civility. They can stop questioning the motivations of their opponents and accept the rationale offered. Nothing turns off someone who disagrees with you on one issue, but agrees on most others more than claiming that their opposition is based on something they claim it is not.
  • Dialogue. Rather than dismissing concerns about abortion as “arbitrary,” take some time to think through the issue from the beginning. I find it somewhat incongruous to consider a zygote a full human being. It’s much harder though to distinguish between a fetus who has not yet taken a breath of air from one who has. That border does seem quite arbitrary. Consider – for a moment – whether or not pro-lifers are actually only concerned with keeping women in their “proper place.” Consider that they may be wrong, but that they are raising some valid arguments. Any political philosophy is successful to the extent it can deal with and subsume the arguments opposing it. On abortion, the Democrats are failing miserably.
  • Common ground. Keep working on reducing the number of abortions. The Catholic Church and thus most pro-life organizations may continue to oppose such measures, but it will win over the center. In fact, better yet, just pass a bill that reduces the number of abortions without worrying about whether or not you have their support. Make the Democratic Party the party that will fight to keep abortions legal, but will help reduce them as it was under Bill Clinton.
  • Attack partisan groups. If – when – the National Right to Life committee and other pro-life groups continue to shrilly oppose the Democratic Party, isolate and attack these groups as not attempting to find a solution to this issue.

Coincidentally, this bears a great deal of resemblance to the approach Obama has taken to his political opponents generally, including on the issue of abortion – using respect and civility as a potent weapon. And this is why both serious Democratic candidates in 2008 sought to soften their pro-choice stands.

[Image by Steve Rhodes licensed under Creative Commons.]