Saturday, August 29, 2009

We already ration health care. We do.

We Ration. We Ration. We Ration. We Ration.
By Ezra Klein
August 28, 2009 Washington Post

"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."

So do we. This is not an arguable proposition. It is not a difference of opinion, or a conversation about semantics. We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.

I've used these numbers before, but let's repeat them. A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. This, Americans will tell you, is the true measure of our system's performance. We have our problems. But at least we don't sit in some European purgatory languishing without our treatments. That's rationing.

There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can't afford medical care at all, versus only 6 percent of Canadians. And the American numbers are understated because if you can't afford your first appointment, you never learn you couldn't afford the medicine or test that the doctor would have prescribed.

We ration. And if the numbers and the surveys don't convince you of the point, this is what it looks like when we ration.

Wednesday, August 26, 2009

What caused this year's fed deficit?

What Caused the Budget Deficit?
By Matthew Yglesias
June 10, 2009 Think Progress

David Leonhardt has a nice article breaking down the sources of the growth in the budget deficit. Since Leonhardt works for The New York Times rather than USA Today, they didn't see fit to illustrate his article with a pie chart, but I made one myself:

— "The first category — the business cycle — accounts for 37 percent of the $2 trillion swing."
— Second, Bush-era legislation "like his tax cuts and the Medicare prescription drug benefit, [that] not only continue to cost the government but have also increased interest payments on the national debt."
— Third, "Obama's main contribution to the deficit is his extension of several Bush policies, like the Iraq war and tax cuts for households making less than $250,000 [...] 20 percent of the swing."
— Fourth, "About 7 percent comes from the stimulus bill that Mr. Obama signed in February."
— Fifth, "only 3 percent comes from Mr. Obama's agenda on health care, education, energy and other areas."

In other words, the very high deficits are not Obama's fault according to any normal way of assessing political blame. That said, large deficits aren't a moral failing that we need to hold someone accountable for. Rather, they're a potential future practical problem that will have to be solved. Doing that will probably require a mixture of higher taxes, somewhat more hard-core health care reform that is likely to pass in 2009, and reductions in defense and possibly Social Security outlays. I don't really find it especially surprising or alarming that nobody wants to vote for any of those things in 2009. After all, nobody who has to stand for election really wants to do any of that stuff. And the deficit isn't a problem in 2009 and almost certainly won't be in 2010. The main issue is whether Congress will be prepared to take tough measures when and if doing so actually proves necessary. Meanwhile, the health reforms being debated in Congress will get us some of the way to where we need to be, and also hopefully lay the groundwork for further measures if the best hopes about what's currently on the table don't wind up materializing. The simple fact of the matter, after all, is that nobody really knows what the impact of something like comparative effectiveness research will be. It could save a lot of money, or it might not—we might just get healthier while spending a similar amount of money. But if we get it in place sooner rather than later, we'll know and be in a position to act.

Expert: 'Cash for Clunkers' a $25 B success

This auto industry expert Jesse Toprak debunked 3 big myths about the "Cash for Clunkers" program:

1) It "borrowed" car sales from future months;

2) Buyers could not get approved for financing;

3) Car manufacturers boosted production too much in response.

The net economic impact of the CfC program was "easily north of $25 billion -- if not much higher," he said.

Q&A: Was Cash for Clunkers a Success?

By Joseph R. Szczesny

August 26, 2009 |


Re: How D.C. will spend our taxes

Interesting analysis by this Heritage dude. Let's go on the assumption that his figures are correct.

If you take out Social Security, which is fully funded by payroll taxes, that leaves $24,462 in federal spending to fund. Take out the bailouts, which are a one-time deal (I hope), and that leaves $18,134 per household in spending to fund. Then take out half the unemployment benefits ($491) because this amount of spending is temporary and recession-related: $17,643 per household. (But leave in the interest payments on this recession-related spending). Then cut defense spending by half, because we don't need two foreign wars and all those boondoggle weapons: $14,718 per household. Finally, take out federal highway spending, since this is almost totally financed by drivers' fuel consumption, not income taxes or debt: $14,189.

$14,189 per household (about $5,457 per person) in federal spending sounds like a pretty reasonable figure to me. I feel like I'm getting my money's worth. Viva el Grande Gobierno!

By Brian Riedl

August 19, 2009 | Bradenton Herald

You get itemized bills from your doctor, your car mechanic and your cell-phone provider. Why not from the federal government?

Washington will spend $33,880 per household in 2009 — the highest level in American history (adjusted for inflation), and nearly $8,000 per household more than last year.

The federal government will collect $18,277 per household in taxes. The remaining $15,603 represents this year's staggering budget deficit per household, which, along with all prior government debt, will be dumped in the laps of our children.

Washington will spend this $33,880 per household as follows:

n Social Security/Medicare: $9,418. The 15.3 percent payroll tax, split evenly between the employer and employee, covers most of these costs. This system can remain sustainable only if there are enough workers to support all retirees, which is why it risks collapsing under the weight of 77 million retiring baby boomers. If nothing is done, taxes eventually will need to rise by $12,000 per household (adjusted for both inflation and rising incomes) to pay all promised benefits.

n Financial Bailouts: $6,328. Most of this $746 billion tab comes from the Troubled Assets Relief Program, which President Obama wants to double in size. In addition, $100 billion will bail out Fannie Mae and Freddie Mac, and $100 billion will be spent by the Federal Deposit Insurance Corp. to guarantee bank deposits at failing banks.

n Defense: $5,850. The defense budget covers everything from military paychecks to operations in Iraq and Afghanistan to the research, development and acquisition of new technologies and equipment. Lawmakers drastically reduced defense spending after the collapse of communism in the early 1990s. The 9/11 attacks reversed this trend, and the inflation-adjusted $2,332 per household increase since 2001 has returned defense spending closer to its historical levels (but still lower than during previous wars).

n Anti-poverty programs: $4,745. Nearly half of this spending subsidizes state Medicaid programs that provide health services to poor families. Other low-income spending includes: Temporary Assistance for Needy Families, food stamps, housing subsidies, child-care subsidies, Supplemental Security Income and low-income tax credits. Anti-poverty spending has surged since 2001: George W. Bush became the first president to spend 3 percent of GDP on federal anti-poverty programs, and President Obama will top 4 percent of GDP this year. State and local governments add an additional 2 percent of GDP.

n Interest on the federal debt: $1,210. The federal government is $12.9 trillion in debt. It owes $8.5 trillion to public bond owners, and the rest to other federal agencies (mostly to repay the Social Security trust fund, which lawmakers raid annually). Record-low interest rates have recently held down these costs. However, an avalanche of new debt and higher interest rates are set to quadruple annual net interest costs by 2019.

n Federal employee retirement benefits: $982. This spending funds the retirement and disability benefits of federal employees, including the military.

n Unemployment benefits: $902. Unemployment costs have doubled this year due to the recession.

n Veterans' benefits: $819. The federal government provides income and health benefits to war veterans. Spending is up 58 percent since 2001.

n Health research/regulation: $699. This spending is up 54 percent since 2001, and much of this growth is concentrated in the National Institute of Health. The category also includes the Food and Drug Administration and dozens of grant programs for health providers.

n Highways/mass transit: $529. Most highway and mass-transit spending is financed by the 18.4 cent per-gallon federal gas tax. Washington subtracts an administrative cost and sends this money back to the states with numerous strings attached. Some economists suggest it would be more efficient to let states collect this tax and decide how to spend the money themselves.

n Justice administration: $452. Justice spending includes federal attorneys and prisons, as well as law-enforcement grant programs. New homeland security costs have added $100 per household to justice spending.

n Education: $415. Education spending is primarily a state and local function; 9 percent of the total comes from Washington. Between 2001 and 2010, federal education spending will have doubled. Most federal dollars are spent on low-income school districts, special education and college student financial aid.

The programs listed above cover $32,349 per household.

The remaining $1,531 is allocated to all other federal programs, including natural resources, the environment, international affairs, regional development, farm subsidies, social services, space exploration, air transportation and energy.

Taxpayers — and the next generation that will be paying nearly half of the bill — must decide for themselves if they're getting their money's worth.

Brian Riedl is the Grover M. Hermann fellow in federal budgetary affairs in the Roe Institute for Economic Policy Studies at The Heritage Foundation.

Tuesday, August 25, 2009

What's really in the health care bill - Part 1

Let's all admit that nobody has read the 1,000-page health care bill (it would be only about 300 pages if were printed in book form, not for legislative markup) and that we're relying on other people to tell us what's in it.

So we might as well rely on this guy.

Preview: nothing in there about "death panels" or "rationing"... yet.

By Milt Shook
August 24, 2009 | Please Cut the Crap!

Monday, August 24, 2009

Forbes: Amazing stat on rising health costs

I found this statistic amazing:

"In a separate letter, Reps. John Dingell and Sander Levin, both Michigan Democrats, asked the chief executive of the state's Blue Cross affiliate to provide details about the company's recently approved premium hikes and its top executives' pay. According to the congressmen, employer-sponsored health insurance premiums in Michigan rose 78.2% from 2000-07; wages in the state rose by just 4.6%."

Inquiring minds want to know why!

Ire Over Insurance

By Brian Wingfield

August 23, 2009 |


JHU study: U.S. health care most expensive, with 'average' outcomes

This is what I've been saying all along: "Be entrepreneurial about looking at what works," "and then figure out why does it work for them." Then pick and choose the best from everywhere! We've already wasted so much time and energy trying to scare and enrage each other. Let's educate ourselves instead. Wake up, Amurica!

Expensive without the results: Health care in the U.S. costs the most, not the best in the world

By Michael Saul

August 23, 2009 | NY Daily News

What nation offers the best health care on the globe? Answer: Not the United States.

The U.S. health care delivery system is by far the costliest on the planet, but comparison studies consistently show Americans get second-rate results by nearly every benchmark.

"We're twice as expensive as most other industrialized countries," said Gerard Anderson, professor of health policy and management at the Bloomberg School of Public Health at Johns Hopkins University.

"But we have outcomes that are typically about average, and we're not improving as quickly as other countries are improving," he said.

Last year, a study comparing preventable deaths in 19 industrialized countries placed the U.S. dead last. France was first, followed by Japan and Australia.

In the U.S., one in three chronically ill patients says the health care system needs to be rebuilt completely. Only one in 10 feels the same way in the Netherlands and the United Kingdom.

Foes of President Obama's push for universal coverage are quick to find fault with foreign systems, and some complaints are legitimate. In Canada, for example, a typical patient seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, one study showed.

But nonpartisan, scholarly studies show that for the most part, universal systems work well. And the key numbers, from infant mortality to life expectancy, show those countries are doing something right.

"No one is suggesting that we adopt another country's health care system," said Robin Osborn, vice president and director of the international program in health policy and practice at the Commonwealth Fund, a nonprofit.

"We should be open-minded, and we should be entrepreneurial about looking at what works," she said.

Universal care has long been the norm in many countries, accepted by political parties and their followers from both the left and the right.

Of the 30 industrialized countries in the Organization for Economic Cooperation and Development, only Mexico, Turkey and the United States fail to achieve universal coverage.

"There's a solidarity that operates in these other countries in terms of social values, a sense that people are entitled to health care," Osborn said. "In these countries, the idea of someone going bankrupt because of medical bills, it just does not exist."

In the United Kingdom, for example, there is no out-of-pocket cost to see a primary care physician or a specialist. Adults can fill prescriptions, no matter how new, rare or advanced the drug, for about $12.

Australia gives high priority to promoting access to primary care physicians. Patients in the United States spend, on average, about one-third the time that Australians spend in minutes per year with their primary care doctor.

People do better in countries that encourage regular primary care visits, in part because they get frequent counsel to follow healthy habits.

Obama has pointed to the Netherlands as a model closer to what he would like here. Dutch residents are required to purchase private health insurance coverage. And insurance companies must accept every resident in their coverage area.

Other countries are also further along than the United States in using information technology and employing a team approach to manage chronic conditions and coordinate care.

"It's really valuable to look at how other countries do it," Osborn said. "The issue is to look around and see what's good and what works, and then figure out why does it work for them."

Interesting analysis on 'Cash for Clunkers' $ return

This is the kind of thing I like to see. Critics should put up their own numbers, or shut up.

The "Cash for Clunkers" idea originally came from Germany, where it was very successful, then copied in the UK, France, and USA. Germany is now technically out of its economic recession.

Car dealers have made 489,269 sales under the CfC program as of Friday, August 21. The Dept. of Transportation will shut it down as of Monday, August 24 at 8 p.m., because the extra $2 billion appropriated for it has apparently been used up.

August 15, 2009 | Terella Media, Inc.

"I pledge allegience to Gene's shirt and to the republic for which it stands..."

And if Gene wasn't there, I bet they would have dug up some blue & red crayons and paper and drawn a flag, then pledged allegiance to it!

"God bless Amurica!"

August 23, 2009 | Windy City Watch

Sunday, August 23, 2009

Carbon Disclosure Project

The Carbon Disclosure Project (CDP) is a registered charity set up by 385 institutional investors managing more than $50 trillion in assets. In 2008, 1,550 companies from the S&P 500, Global 500, and FTSE 350 voluntarily reported to the CDP their CO2 emissions accounting, and emission-reduction strategies.

Why are they volunteering this information? According to PricewaterhouseCoopers: "Increasingly, [industry] analysts are placing a premium on information provided about environmental, social, and governance issues, expecting greater visibility into the performance of supply chains."

Moreover, smart companies are not waiting for gov't regulation on CO2 emissions. They are getting out ahead of regulation and their competition. They are measuring their emissions (and their suppliers' emissions) and finding ways to reduce them, and then reporting this data voluntarily to investors and other stakeholders. Emissions of any kind, after all, are wastes, which represent inefficiencies and hence opportunities to cut costs and/or increase productivity. Smart companies realize that belching gases into the air and spewing toxic liquids into our soil and waterways create hidden costs for society, which we are increasingly less willing to tolerate; but companies also recognize that these wastes represent direct costs to the company. Thanks to the "lean" movement in manufacturing and supply chains, we know that any kind of waste is a drain on profit.

Thus, when we do a proper accounting of costs and lost opportunities, we see that there is very little opposition between environmentalists who lobby for reduced emissions, and businessmen who strive for bigger profits. But if an industry is inherently, hopelessly inefficient, it will be overtaken by competitors using more more efficient processes and technologies.

Saturday, August 22, 2009

News flash: Conservatives are angry!

I'm going to surprise you Repubs and go ahead and disagree a little bit here with Waldman. Just a little. Because liberals were pretty angry at Bush for a long time. Not at this level of spitting, red-faced rage straight from the get-go of his presidency, mind you, but we were pretty angry too. The question Waldman asks, that is fair to ask, is: Will you guys calm down just a little after you "win" the health-care battle in Congress? 'Cos it looks like you're gonna get your way: state co-ops, no public option, no single payer, no mandatory coverage, only voluntary cost-cutting measures from Big Pharma, etc.

Check your pulse and blood pressure before & after. If there is no change, then maybe your anger is due to things you don't have a right to be angry about.

His comments about Glenn Beck are dead-on though. That guy is a shameless turd. A turd that makes itself cry.

All the Rage Over Health-Care Reform
By Paul Waldman
August 11, 2009


Russian journalists reported on plant explosion, face jail

Don't you love the New Russia, so much like the Old Russia?

Eerily reminiscent of the Kursk tragedy at the beginning of the Putin Era, in this hydroelectric plant there's a chance that dozens are still alive, trapped in an underground room, but they might as well be dead because the Russian authorities don't want to attract any more media attention to the accident.

It's useful to know that if another Chornobyl disaster happened today, the Russian authorities' reaction wouldn't be much different: cover it up, and if anybody talks, throw 'em in jail.

August 21, 2009 | Committee to Protect Journalists

Thursday, August 20, 2009

Uthman: Dems took a dive on health reform

Dems 'lose' again on health care

By Allan Uthman

Issue #138 | The Beast

Man. It's been years that I've forced myself to observe, with muted horror, the degeneration of political discourse in America. Occasionally, I've even had the pleasure of taking part in it. But it seems I'm never quite cynical enough to predict the depths we're willing to plumb as a nation.

I thought I was going to write a piece about how stupid it is that the right argues a public option is unfair because private insurance companies can't compete against it. I mean, it really is an insane position, that we can't have a public insurance option because it would provide better service for less money. And it's equally insane to assert that private insurance companies need to make money more than Americans need access to health care.

But things have spiraled ever downward from there. It's pointless to even attempt a cogent argument on this subject, when the other side of the debate are running around with their hair on fire, their leaders promoting obvious, absurd lies about "death panels" and… I don't know, something about Hitler? Shamelessness does have its advantages, apparently. Certainly, no one has to ask Sarah Palin or Newt Gingrich if they have any shame, as was asked old Joe McCarthy, because the answer is obviously no. In a saner country, this "death panel" madness would be the end of Palin's political ambitions forever. But then, a saner country would have tossed her into the ocean a year ago.

Anyway, it's a foregone conclusion that whatever the hell gets through the Senate will be labeled Health Care Reform, or Health Insurance Reform, or just Health Reform as they've been calling it lately. And it's equally clear that it will be pretty much useless, maybe even worse than useless. At best, it might solve the problem of impossible prices the same way Bush solved high drug prices: by making the government pay private businesses top dollar for it.

That's how we compromise with industry now. As much as the Democrats are vilifying the insurance companies (and yes, they are villains in this story), the insurance companies will support the horribly mutilated bill that emerges for Obama to sign. Why? Because they will make more money than ever. Instead of a public option, people who can't afford health insurance will be forced to buy private insurance, the poorest of us subsidized by the government. I suppose, if you have no insurance, that's better than nothing. But it sure as hell isn't much good.

To be fair, there are other good points, supposedly: A ban on rejecting people for preexisting conditions, for instance. But the public option, itself a paltry shadow of what a single-payer system could do for the country, is pretty much dead. It probably won't survive the Senate process, even in a hollowed-out, meaningless form. Why? Because it would work. It would provide better service for lower costs. And the insurance people can't have that.

The problem isn't that the Democrats are spineless compromise fetishists, as many seem to think. Any smart negotiator knows that you start from a position your opponent deems unacceptable—in this case, a UK-style single-payer system, which would actually reduce costs dramatically and provide decent care for everyone.

Say Obama had started there. First of all, polls have consistently shown a majority of Americans support a single-payer system, as well as a majority of doctors. When politicians argue it's not politically viable, they're referring to staunch corporate opposition, not voter opposition, regardless of a few hundred aged, bewildered Glenn Beck drones shouting "keep your government hands off my Medicare" (actual quote). Secondly, even if it isn't viable, starting from a single-payer position would ensure that any eventual compromise would be closer to a decent plan than what we're going to wind up with, now that the Obama administration has started negotiating from an initial position of compromise. Instead, they're compromising the compromise.

Why is this? No, it's not that Democrats are wimps. They're dive artists. Obama promised health care reform, but do he and his DLC inner circle actually want to weaken the stranglehold medical profiteers have on the public? Or do they just want to make a good show of losing the struggle?

The case for a single-payer system is rock solid and easy to explain. A single payer bill could be short enough to read in a few minutes—in fact, there is a single-payer bill floating around (doomed by the "too-liberal" names Kucinich-Conyers), and it's a little over 4,000 words long. Instead, we have a bill that's over 1,000 pages long, written in typically inscrutable legalese, so dense and obscurantist that Republicans can assert nearly anything about it, from death panels to forcible sterilization, and say "read the bill!" with full knowledge that nobody will, nor could they understand it if they did.

Perhaps this explains Obama's complete failure to actually describe the plan, aside from painfully vague references to "reform". It's suspicious that a group of people with the kind of supernatural message discipline they exhibited during the presidential campaign can't muster any kind of reasonable explanation of what the plan is. Why is opposition to the health care bill rising? Not because conservatives don't want it; they never did. It's because liberals are starting to smell the bullshit, and recognize that what they're trying to foist on us is not reform, but a massive boondoggle, just another way to funnel cash to donors. And make no mistake, all of the interested parties in this disgusting extortion racket we call a health care system have thrown mountains of cash at all of the important Democrats involved. Why, after all have pharmaceutical companies committed to spend hundreds of millions promoting the bill in a disturbing backroom deal with the White House, if it isn't a simple boondoggle? Why has the AMA, a longstanding opponent of any form of socialized medicine, come out in favor of it? Because, unfortunately, and despite the constant refrain from the paranoid rednecks, there's nothing socialist about it. And it might be baffling, if you don't understand where the real power is in the Party.

Put it this way: After eight years solid of Republicans proving themselves to be dishonest, corrupt and incompetent, what if the Democrats provided universal health coverage and paid for it by taxing the rich? I'll tell you what: They wouldn't lose another election for decades. It is actually in the party's self-interest to do these things. And yet, they don't. Why? Because there's one thing even more important to politicians than votes, and that's money. Hell, even if Max Baucus loses his next election, his income level will skyrocket, thanks to the profiteers he's protecting now.

Less than a year ago, Republicans were handed their walking papers, and the national consensus was that they were worse than worthless. And yet they are controlling this debate? With transparent lies and spooky stories—about the kind of health care system that the entire first world enjoys, and nobody seems to regret? Bullshit. Even with the help of Frank Luntz, the GOP's talking points suck, and could be effectively rebutted—even by Harry Reid, let alone Obama. Health care rationing? Bureaucrats between you and your doctor? Life-saving procedures denied or delayed? All of these are already rampant in the private system. For every isolated horror story the Right can find in Canada or England, there are hundreds in your own neighborhood. And national health care never leaves individuals destitute or with impossible debt.

The Democrats seem to be throwing this thing on purpose. The public option is DOA and was probably always meant to be. And it's not because they're wussy or incompetent. It's because they're corrupt. It's because all they are is the sock puppet on the left hand of corporate hegemony. Bribery is legal in this country—we call it campaign finance. That's why we can't have a single-payer system, and that's why this bill devolving into yet another massive theft of taxpayer money was a foregone conclusion. In the end, maybe some poor people will be able to get treatment when they couldn't before, but only in the weakest, most costly and corrupt way conceivable. And if that's the only way we can do it, then I guess I'm for it.

Gallup: America reddening?

Can't believe I missed this one. And I can't believe you Repugs didn't rub this in my face!

For 79% of Americans, "liberal" is still unfortunately a four-letter word. That's why I'm all in favor of re-branding us as progressives, although I'm proud to be a big, stinking, bleeding-heart liberal.

So how the hell did Obama get elected and the Dems win Congress, huh? Jeez, the Republicans must really suck, when conservatives have an inherent 2:1 lead over liberals. (We all know conservatives aint gonna vote for no Democrats.) Oh yeah, there's still that 35% of Americans who call themselves "moderates." I guess the Republicans are just really good at alienating moderates. Sometimes you don't have to be competent to succeed, you just have to be less incompetent than everybody else....

"Conservatives" Are Single-Largest Ideological Group

Percentage of "liberals" higher this decade than in early '90s

By Lydia Saad

June 15, 2009 |


UPDATED with my comments to actual conservatives!

Did you follow that link? For example, 54% of Americans favor legal unions for gays. Is that conservative? Or have you seen the polls about the 77% of people who want a public option in the health care bill? Is that conservative? Or the pretty high number -- 39% now, but it was 50% in 2007 when Dubya was in office -- of Americans who favor stricter gun control laws, and the only 15% of people who want current gun laws to be less strict? Or, worst of all, the polls that show steadily about 60% of Americans continue to support Roe v. Wade.

Once you get down to the issue level, the ideological labels break down. That's why the zealots on either side try to label pragmatic reforms as too "conservative" or "liberal" to whip those self-identified people back in line, in terms of, "Oh, if they're saying this bill is too liberal, I can't support it, because I'm a conservative." This is Rush Limbaugh and FOX's bread & butter, you know: they are like sheepherders/enforcers trying to keep all their sheep in the flock, not straying on any single issue. But we all know that most people do stray occassionally, they don't stay in the ideological flock, and they do have minds of their own. They even change them! (Rarely).

* * *

But why do you cling to the labels "conservative" and "liberal" if they are not reliable indicators of how Americans feel about the important issues? (I know, I'm the pot calling the kettle black). If it gives you some special satisfaction to know you're in the self-identified majority, so be it. I wouldn't mind if every last American called himself a conservative Republican if we had national health care, stricter gun control, legal unions for gays, more equitable taxation, etc., etc. If I get a "win" on my issues, I'm happy.

These labels are a convenient shorthand for discussion and analysis, sure, but we shouldn't assign principle significance to them, when the real information we want lies deeper.

And for the record, liberals are slowly winning -- at least liberal policies are, which is why you all complain about the U.S. going to hell in a handbasket, "the culture war," and so on. We are going to have more equitable taxation, we will have a tax on carbon emissions, we will have stricter gun control, we will have a more active government when it comes to energy and education, etc.. These things are happening and will continue to happen, because at the end of the day people -- conservatives and liberals -- want them to. They want government to do more and pick up the slack that nobody else is pulling -- not charities, not corporations, not states or municipalities. That's our pragmatism. That's what's going to save us. That's why I'm optimistic.

Finally, it's too easy to dismiss polling as always poorly worded or biased. We all know polls matter, and we ignore polls at our peril. Just ask polling extraordinaires Karl Rove and Dick Morris.

Wednesday, August 19, 2009

Forbes: Good summary of health debate

Conservative Forbes gives a pretty good summary below of what the various health care bills in Congress do and don't say. And although Forbes uses the term "Obamacare" incessantly, it admits that Obama has only laid out 3 broad goals for reform; and in response, the House and Senate have proposed several different versions of health care reform.

I understand why Republicans latched onto the term "Obamacare" -- because labelling Hillary's health care bill "Hillarycare" in the 90s really helped kill it. However, unlike Hillary, Obama never came up with a bill in secret, he never plopped a bill in front of Congress and said, "Pass this." He just laid out the goals.

Obama's laid-back approach, however, has probably been his undoing.

This $1 trillion figure (which included a public option -- which Obama has since caved on) from the CBO sounds like a lot, but as Forbes points out, that's only $3,333 for every man, woman and child over 10 years, or $333 per person per year. For many of us, $333 is less than the cost of one month's insurance premium. (It's less than half of mine). $1 trillion still sounds like a scary number, until you consider that the U.S. will spend about $2.5 trillion on health care in 2009 alone, accounting for 17.6 percent of GDP. By 2018, the annual cost of health care is estimated to more than double to $4.4 trillion. Over the last decade, employer-sponsored health insurance premiums have increased 119 percent. Today, the average employer-sponsored health premium costs $13,000 for a family of four, or $3,250 per person, and employees pay 30 percent of that cost, or $3,900 per year, on average. Does that $3,333 estimate over 10 years still sound so scary? Furthermore, the CBO (yes, the same CBO that gave us that scary $1 trillion figure that Republicans have pounced on) estimated that employer-based health costs for an average family of four will reach $25,000 per year by 2018.

So, at the same time you're considering the cost of reform, weigh the intolerable cost of doing nothing. Oh, and by the way, conservative Forbes says that health cooperatives won't increase the number of people who get insurance. But co-ops probably will be included in the final bill. Sorry.

Health Care Checkup
By Brian Wingfield and David Whelan

August 18, 2009 |

Feeling a bit lost in the debate over health care reform? It's understandable.

America's health care system was already confusing even before Congress' ideas for changing it. Now, special interests have made things yet murkier. The White House has backed away from its initial support of a government-run insurance program; town hall meetings are brimming with scorn for the ideas on the table, and health care chatter has consumed the airwaves.

Lawmakers will determine this fall what's in the final bill, but as the debate rages this summer, here's a guide to help you get up to speed and back to the beach as quickly as possible:

What's been proposed?

President Obama wants to see reform that includes, among other things, coverage for all Americans, allows people to choose their providers and lowers the growth in health care costs. Congress has to figure out the dicey details.

In July, leaders in the House of Representatives proposed a bill that would create a government-run insurance plan, or "public option," to compete with private insurers. It requires individuals to have coverage and mandates that large businesses provide it or pay a tax to the government. To help pay for the public option, it would increase taxes on the wealthy. Several House committees have produced their own, slightly different, versions of this bill.

The Senate's health committee also proposed a plan in July, and it too includes a public option and individual and employer mandates. However, the Senate Finance Committee, which determines how to pay for the Senate proposal, is deliberating until at least mid-September.

For this reason, "ObamaCare" doesn't really have a formal definition. It's basically still a handful of proposals.

What's still on the table?

Technically, everything; but in fact, a lot has been cut out. Most recently, the White House has backed off from its support of a public option, the most expensive part of reform and an idea that might not pass the Senate. The idea of taxing the wealthy is also probably gone. And the president doesn't support the idea of killing a tax subsidy for employer-provided coverage because it might raise taxes on the middle class.

So what's left? Proposed cost reductions in Medicare, Medicaid and prescription drugs. Perhaps a plan for health insurance to be provided by nonprofit cooperatives instead of the government. The main thing that remains: the problem of figuring out how to insure an additional 46 million people without adding to the deficit.

What's likely to get done, if anything?

Democrats in control of Congress and the White House aren't going to walk away from this battle without being able to claim victory, so expect some type of health care reform to happen this year. Much depends on what the Senate Finance Committee determines.

Reform will most likely cost less than $1 trillion, paid for by entitlement savings and various tax increases. It will likely expand health insurance, though probably not as much as the president hopes. And it seems increasingly likely that it won't include a public option.

What's it likely to cost?

With a public plan, the bill is projected by the Congressional Budget Office to cost just under $1 trillion over 10 years. That's $3,333 for every man woman and child. Take out the public plan completely and that drops by $773 billion, so the administration will have more room to spend that money on other proposals, like health co-ops or expanding Medicaid eligibility, promoting electronic health records or comparative effectiveness research. Removing that cost could also allow the final bill to include fewer Medicare cuts to hospitals or doctors.

What would it mean to the way I get medical care?

If you are part of the demographic that right now is not well served by the private insurance market and you don't qualify for Medicaid, Medicare or S-CHIP--you could suffer without a public plan option. The public plan would be ideal for small businesses that can't afford double-digit annual premium increases or low-to-middle income individuals with preexisting conditions who, in many states, can't even find an HMO to buy a plan from.

Co-ops could provide another option for these patients, but where they already operate, there's no evidence that they solve the uninsured and under-insured problems.

If you work at a big company, have Medicare or qualify for Medicaid, likely your medical care will not dramatically change, though the long-term fiscal pressures on the government plans will likely lead to cost-cutting and tax increases down the road.

What happens next?

Supporters of the public plan will likely make a push to ensure it's in the final bill. If they succeed, the final passage will happen, but it will be a bruising battle until the end. Expect more angry town halls. And forget about beer and car ads during football season. It will be all health care all the time.

If they don't get it back in, it will be much easier to get congressional support from moderates and even Republicans--but the president and the original band of reformers will face criticism that they didn't accomplish what they set out to do.

Monday, August 17, 2009

Obama caves to GOP, nixes 'public option'

See? Why were you Repugs worried about Obama? All along, it's the liberals like me who should have feared he was a corporate sellout. And now it's happened (again). Money and power did their thing. Obama caved.

So, the compromise deal will probably include state health insurance co-ops. Once those fail, and if Obama is re-elected to a second term, then we'll have another shot at real reform. If Obama isn't re-elected, then we'll have to wait another 4-8 years. So, long story short, we're talking about a four- to 10-year delay of the inevitable "public option." Meanwhile, all you Repugs get to high-five each other for enraging and scaring the crap out of America; and you can rejoice in the continued millions of uninsured and their needless, avoidable suffering. And four to 10 years from now, we liberals will get to say, "I told ya so." Gee, sounds like a great deal.

Making legislative sausage aint pretty. The sight of it can even make you sick.

White House appears ready to drop 'public option'

By Philip Elliot

August 16, 2009 | (the George Soros-funded and controlled) Associated Press

Bowing to Republican pressure and an uneasy public, President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.

Facing mounting opposition to the overhaul, administration officials left open the chance for a compromise with Republicans that would include health insurance cooperatives instead of a government-run plan. Such a concession probably would enrage Obama's liberal supporters but could deliver a much-needed victory on a top domestic priority opposed by GOP lawmakers.

Officials from both political parties reached across the aisle in an effort to find compromises on proposals they left behind when they returned to their districts for an August recess. Obama had wanted the government to run a health insurance organization to help cover the nation's almost 50 million uninsured, but didn't include it as one of his core principles of reform.

Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.

With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.

"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."

Obama's spokesman refused to say a public option was a make-or-break choice.

"What I am saying is the bottom line for this for the president is, what we have to have is choice and competition in the insurance market," White House press secretary Robert Gibbs said Sunday.

A day before, Obama appeared to hedge his bets.

"All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform," Obama said at a town hall meeting in Grand Junction, Colo. "This is just one sliver of it, one aspect of it."

It's hardly the same rhetoric Obama employed during a constant, personal campaign for legislation.

"I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices and assure quality is a public option that will force the insurance companies to compete and keep them honest," Obama said in July.

Krugman: 'Obamacare' based on successfull Swiss model

The Swiss Menace

By Paul Krugman

August 16, 2009 | New York Times

It was the blooper heard round the world. In an editorial denouncing Democratic health reform plans, Investor's Business Daily tried to frighten its readers by declaring that in Britain, where the government runs health care, the handicapped physicist Stephen Hawking "wouldn't have a chance," because the National Health Service would consider his life "essentially worthless."

Professor Hawking, who was born in Britain, has lived there all his life, and has been well cared for by the National Health Service, [and is still alive! - J] was not amused.

[Investor's Business Daily is the Right's answer to Pravda. It is a total throwaway of lies and distortions. Reading it will make you dumber. Seriously. - J]

Besides being vile and stupid, however, the editorial was beside the point. Investor's Business Daily would like you to believe that Obamacare would turn America into Britain — or, rather, a dystopian fantasy version of Britain. The screamers on talk radio and Fox News would have you believe that the plan is to turn America into the Soviet Union. But the truth is that the plans on the table would, roughly speaking, turn America into Switzerland — which may be occupied by lederhosen-wearing holey-cheese eaters, but wasn't a socialist hellhole the last time I looked.

Let's talk about health care around the advanced world.

Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken.

In Britain, the government itself runs the hospitals and employs the doctors. We've all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs.

The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That's how Canada and, in a more complex fashion, France do it. It's also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are.

Again, you hear a lot of horror stories about such systems, most of them false. French health care is excellent. Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts. And Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program.

Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can't discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.

In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some "Swiss" aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

So where does Obamacare fit into all this? Basically, it's a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

If we were starting from scratch we probably wouldn't have chosen this route. True "socialized medicine" would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That's why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

So we can do this. At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.

After stimulus, Japan's recession ends

Japan emerges from recession

August 17, 2009 |

Japan has joined the growing number of major economies that are back in black.

Japan's economy grew 3.7 percent on an annualized basis from April to June this year, the first time the world's second largest economy has seen positive growth in 15 months.

The announcement of preliminary figures by Japan's Cabinet Office comes after France and Germany surprised economists last week by posting 0.3 percent growth for the second quarter of the year.

The news that Japan has rebounded -- the hardest hit of the major economies because of its reliance on exports -- gives economists cautious optimism that the worst of the global recession is over.

"The economy has seen a bottoming out of global demand, which has pushed out net exports ... especially in high tech industries and basic materials, such as chemical, steel and so on because of Chinese demand," said Hiromichi Shirakawa, chief economist in Japan for Credit Suisse.

Japan's GDP grew just under 1 percent during the three-month period and trade increased 1.6 percent.

The uptick marks the end of the worst recession in Japan since the end of World War II. Japan's GDP fell at a record pace during the January-March quarter, when GDP was 15.4 percent lower than the same time period last year.

The Japanese economy was buoyed by a historic ¥15 trillion ($150 billion) stimulus package in May, which included unemployment benefits, aid to struggling companies, promotion of green industries and a variety of tax breaks.

"There are many times in the past when tax breaks and fiscal stimulus were offered and failed, but this time around, it worked," Shirakawa said.

Economists expect GDP to continue modest growth through the rest of the year, especially with an expected rebound in global auto sales this quarter. But whether the recovery can continue into the new year after the stimulus package runs its course remains a question.

"Japan's economy still is quite sensitive to global demand ... and for consumer demand to grow on a self-sustained basis still seems unlikely," Shirakawa said.

AdAge: How Obama lost control of health-care debate

By Michael Bush
August 17, 2009 |

For a president and an administration that seemed to play the PR and communications game better than almost any that preceded them, President Barack Obama and his staff appear to have lost control of the messaging in the health-care reform debate, the first big policy test of his administration.

A woman holds a sign as President Barack Obama speaks at a town hall meeting about health care reform in Portsmouth, N.H.
A woman holds a sign as President Barack Obama speaks at a town hall meeting about health care reform in Portsmouth, N.H.
And according to a number of communications professionals, the irony in all of this is that the president's opponents have managed to define the issue and take control of the conversation with tools -- such as grassroots marketing and e-mail communications -- that he used to near perfection during the election. Lesson learned for the Republicans.

"The Republicans and industries lining up [to block] reform have been good about doing what Obama used to be good at, like getting people to attend town halls and forums," said Mark Hass, CEO and partner of MH Group Communications. "Everywhere the proponents of health-care reform go, they get into these shouting matches with people. The ability of the GOP to get people to attend these town hall meetings and shout has turned the news coverage into this chronicle of emotional debate. Republicans are doing what he did so well, using e-mail and grassroots organizing techniques around social networks effectively to get people out and to make this debate confusing."

No clear definition of bill
There are a number of issues at play that have put the administration in the unenviable position of having to scramble to regain control of the situation, according to the industry professionals who spoke with Ad Age. Foremost among them is that
with three separate bills floating through Congress, there is no clear and definitive explanation of what the bill actually says. The administration essentially committed the biggest mistake it could from an issues-management perspective: It failed to define the issue before its opponent did.

"The Republicans have done a good job at capitalizing on the vagueness of the bill," said Nick Ragone, partner at Omnicom Group's Ketchum. "The administration made a little bit of a misstep in delegating the details to Congress. That's given the Republicans the ability to read into the bill what they want and communicate that to the broader public. You hear the president talk and it's very vague and uncertain, and that has worked against him."

Mr. Ragone said this "by far" has been President Obama's first major misstep. "He misjudged the country's mood and it's been too vague," Mr. Ragone said.

Eric Dezenhall, CEO and co-founder of Dezenhall Resources, doesn't necessarily believe the Republicans have been masterminds, but instead lucked into a misstep by the administration. "The Republicans are massively disorganized and are essentially lucking into Obama's recent troubles," he said via e-mail. "While Democrats would like to believe that all of this pushback is orchestrated, my sense is that it's largely organic and through nobody's genius."

Ame Wadler, exec VP-global health care at Interpublic Group of Cos.' MWW Group, said the administration has done a terrible job of explaining the package to the public. But she also lays blame at the feet of Congress, which she thinks will end up damaging the president in the long run.

A partisan approach?
"President Obama promised there would be a more bipartisan and less political approach to his presidency and the leaders of the House and Senate are communicating and demonstrating partisan approaches," she said. "There is a clear arrogance toward the constituencies they serve. In fact, it seems they've forgotten that they are public servants and that they are representative of what people want, not what they think people need. There's a clear paternalism to the congressional communications and, frankly, an approach that is dismissive of the American people and as a result, while I think he is somewhat of an island because of his charm thus far, this will ultimately have a negative effect on Obama."

Mr. Hass doesn't feel any of this has had any negative influence on the president yet, but if "he doesn't come out of this with some type of victory or something he can claim as a victory, it will affect his personal brand."

Ms. Wadler doesn't like what she's seeing or hearing in the shouting matches between congressional leaders and their constituents at town hall meetings. Some congressional leaders have called those speaking out at the meetings un-American and debates have broken out over "authentic" grassroots efforts vs. "Astroturf" efforts. "That's one way to take the focus off of the issue by calling people rude and un-American instead of answering their questions," Ms. Wadler said.

And while she thinks those citizens shouting at members of Congress could face their own backlash, she said if that's what it takes to get heard, then so be it. "If it requires that you shout to get heard, then get heard," she said.

The second factor is the notion that Mr. Obama and his administration were resting on the laurels of what was a largely overwhelming sentiment throughout the presidential run -- that health-care reform must happen.

Torod Neptune, global PR leader at Waggener Edstrom, said it's clear this "full-scale legislative fight" is new territory for a lot of people in the administration and they were caught off guard. "It's the difference between campaigning and governing," Mr. Neptune said. "The ability to understand how quickly public sentiment can change and then being able to pivot and stay in front of that public sentiment is the holy grail for those of us in issues management and public affairs."

Mr. Neptune said in "brass knuckles-type" Washington policy discussions, rhetoric will not carry a person through, and engaging in a policy-specific battle is new to this administration. "At some point, you have to establish and frame the rationale and benefit of that issue," Mr. Neptune said. "That's the jump that has not been made as clearly and quickly. But they are clearly trying to make it now. It's not a battle of rhetoric, which is what we saw in the campaign and the first couple of months of the administration. Now you're getting down to the brass tacks of a specific policy legislative battle."

Rush was a mistake
The other contributing factor in this is the president's desire to quickly get another major bill passed before the August recess. Some say this may have been one too many for the public, who so far have already watched the multibillion-dollar stimulus bill and bailout plans expedited through Congress earlier this year.

Mr. Dezenhall thinks this was an enormous mistake on the part of the administration and Democrats in Congress. "Not only does the administration appear ill-prepared, they also appear arrogant and entitled, which may be even worse," Mr. Dezenhall said. "It's as if they believed they were destined to pass health care by virtue of some kind of kingly mandate. Being known for walking on water is a huge asset until you start believing it."

Ketchum's Mr. Ragone said rushing it through has also made people uneasy. "People are nervous, and rightly so," he said. "The stimulus package was rushed through with seemingly little payoff -- it has not gone the way it should have, and their follow-up to that was to rush health care through. That was a tactical misstep."

MWW's Ms. Wadler said the lack of clarity in the communication of what the bill entails coupled with the rush to get it passed was a bad cocktail the public doesn't want to swallow.

"By trying to rush it through without making an honest attempt to outline what it would mean in terms of costs and care, they made the public skeptical," she said. "It looked as if they were trying to rush something through so that people couldn't ask questions and couldn't challenge their assumptions."