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From OMB director Donald Rumsfeld Peter Orszag's recent blog post explaining the deficit estimate increase:
... the Administration is insistent that health care reform not only be deficit neutral over the next ten years, but also incorporate changes that will help reduce the deficit thereafter.
a) Isn't it pretty clear that these "changes that will help reduce the deficit" after ten years are the very changes that have scared seniors and others out of supporting Obama's health reform? I thought the plan was not to talk about them any more. ... b) Please tell me you're not going to veto a health care reform that is "deficit neutral over the next ten years" just because it doesn't also include those longer term defcit-cutting "game changers." You're not going to veto it--everyone knows this--but mightn't this be a good time to reassure us that you are not insane? ... 12:03 P.M.
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From Resilience to Delusion: Is Christopher Hitchens really offering up the most ancient, cliched rationalization of infidelity in defense of his friends, Elizabeth and John Edwards?
In the unequal battle between life and death (as she understood in her father's case), Eros has its part in warding off Thanatos, and if this really was--as I believe--her husband's first lapse, it might have been partly because of the death-haunted context in which, for all his money and charm, he found himself.
'Thanatos made me do it.' This was also Warren Beatty's rationalization in Shampoo, if I remember right. ... P.S.: I think there is actually a significant possibility that Hitchens really believes Rielle Hunter was John Edwards' "first lapse"--that he's not just trying to be kind to his friends. He should stop being a fool. ... Update: Alert reader E emails--
John Edwards had never strayed before. I guess he'd been waiting 30 years for someone to say the magic words, "You're so hot!" ....
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Test Your Tomato IQ: Lots of delicious U.S.-grown tomatoes in L.A. supermarkets last week. Weren't they supposed to be rotting in the fields due to lack of low-wage illegal immigrant labor? ... 10:22 P.M.
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Do we really need angry outsider Pat Caddell to tell us that Edward Kennedy's absence left a "vacuum of leadership" in the Senate? (He "knew how to get things done" and "worked across aisles"!) How is David Broder supposed to earn a living? ... P.S.: Caddell also says that health care "probably would have been a done deal if [Kennedy] was around," which seems like pretty much 100% BS, unless Kennedy would have cajoled Obama into pursuing a different strategy. ... 10:51 P.M.
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Jonathan Cohn's "defense" of Obama's emphasis on Orszagistic curve-bending--against what he perceives as the looming Blame Orszag CW--isn't really a defense at all. Cohn assumes it was a big mistake, and basically argues "who knew"?
Obama surely has made mistakes, among them focusing so heavily on how reform would reduce the cost of medicine. Had he spent more time reminding voters that reform would provide them with the security they now lack--security from financial ruin and medical catastrophe, the type private insurance too rarely provides--he probably would have been better off.
But I'm not so sure this was obvious a few months ago, when Obama kicked off his campaign for health reform. ... [E.A.]
Oh, yeah? ... Backfill: Dick Morris saw the GOP's opening. ...
P.S.: Cohn even takes as mitigating evidence the proliferation of puffers on Orszag himself:
I seem to remember quite a few writers and television commentators gushing over how Obama and his advisors aggressive approach to the cost problem. Remember, these were the days when Washington feted Budget Director Peter Orszag as a celebrity and turned “bend the curve” into a bumper sticker.
And if Obama had a Budget Director who'd said, "Security First, We'll Bend the Curve Later," the press wouldn't have sucked up to him too? ...
P.P.S.--Orgy of Recrimination, Please! Before we get to the unconvincing contrarian pieces defending (or explaining) Obama's mistake, let's have a decent CW interval in which we bash him for it, OK? Otherwise he might make it again. It's a "teachable moment"! ...
Least poll-tested argument: Cohn combats the idea that it doesn't matter so much if we spend more of our GDP and our budget on health care:
But the money spent on medicine is money not spent elsewhere--it's government dollars that didn't go into schools or public housing;
"Public housing"! Now there's a government expenditure with a good track record. By all means, let's spend less money treating sickness and disease and more money on the beloved public housing program. ... Suggested bumper sticker: "Less Healing, More HUD!" ... I mean, how could these guys be losing the debate? ...
Update--Orszag's Won Time Magazine! Cohn's very civil response. He defends the substance of "curve-bending," not the (disastrous) politics. ... Michael Grunwald, in a Time piece that reads like it was written in May, is still making the Orszagist case. "[R]eform won't be worth selling if it doesn't include real cost restraints ..." he announces. Why? Why does everything have to be done at once--the Comprehensivist Fallacy? We can give security now and try to bend the curve over the long run, as Uwe Reinhardt recommends. ... 2:35 A.M
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kf is falling behind its self-imposed 15-items-per-week quota. ... Time to play catch-up!** ...
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Everyone hates the teachers' unions now. ... 5:42 P.M.
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I thought tomorrow was the ideal day to bury embarrassing news: "It was killed in Washington." 5:44 P.M.
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Fear of karmic retribution prevents me from quoting the unfortunately very funny part of this Pareene post. ... Update: Gore Vidal showed up yesterday at the Nixon library. So there. ... 5:45 P.M.
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Creepiest kicker of the week? Year? ....5:50 P.M.
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Jennifer Rubin spots K-Street Make-Work ... on her side of the cap-and-trade issue. ... P.S.: My old boss Charles Peters would say this scare-your-client/save your client theater is a form of "Washington Make-Believe"--and that, in Washington, "Make-Believe = Survival." ... I mean, imagine you're the poor lobbyist hired to fight "cap and trade" on behalf of industry. You've accidentally won, only 6 months into the administration. But you still have kids to put through college. What to do? ... 6:11 P.M.
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**-- If I start posting items from my twitter feeed you'll know things are really desperate. ...
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What would be the best thing that could happen to Obama? Losing Congress in 2010, argues Red State's Erick Erickson of Red State. It worked for Bill Clinton! Think how popular Obama would be if he was standing up against mean GOP legislators instead of trying (or pretending to be trying) to pass unpleasant bills like cap & trade, immigration legalization and "card check." ... Even better: Pass a health care bill and then lose Congress in 2010. ...
Minor Hmms: 1) As things stand now, Erickson says, "Barack Obama cannot work the center." Hmm. I'm not so sure about that. He could be working the center a lot harder than he has been on education, welfare, the auto bailouts and the CIA, to name four. (And he probably thought he was working the center when he focused his health care pitch on curve-bending cost-control. Goes to show it's not enough to mindlessly triangulate.) ...
2) Erickson speculates that if Obama lost Congress he'd still get immigration reform through, thanks to moderate GOP senators like Grassley and Bennett. Hmm, again. Isn't immigration more likely to remain another one of those Washington Mirage Issues where you can technically count enough votes for legalization, but (because legislators are rightly skittish) the vote somehow magically never takes place? ...
3) Erickson even speculates that Obama, recognizing the utility of a loss in 2010, will "start" to undermine the Blue Dogs in swing districts. Really? "Start"? What would he do to undermine the Blue Dogs that he's not doing already? ... Hmm. 6:21 P.M.
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Barack got your tongue? Yesterday's post by formerly prolific OMBlogger and kf Designated Fall Guy Peter Orszag was his first in three weeks. ... 6:52 P.M.
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Matt Yglesias throws Orszag (or at least Orszagism) ... under the bus!
"I don't know to what extent the Obama Administration was being naive or what, .. 'cause they very much led with this kind of cost-control argument, which I think they thought was going to be appealing to Republicans when, in fact, the fact that the argument is unpopular is even more appealing to Republicans ..." [E.A.]
I thought "Blame Orszag" would be CW by Sept.14. My mistake. I should have said by next Tuesday. ... 3:25 P.M.
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Don't mess with Rabbi Saperstein! ... 3:22 P.M.
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Jon Alter's latest column--calling for health care to be treated as a "civil right"--brings up an underdiscussed question: In a single payer plan, would health care be treated as a constitutional entitlement that couldn't be taken away without "due process" under the Warren Court's so-called "New Property" doctrine? My Con Law knowledge is a few decades out of date--but the doctrine covered welfare benefits, guaranteeing a hearing to individuals before they could be denied. Why not health benefits? ...
Isn't it possible, then, that rules produced by Orszag's cost-cutting IMAC board preferring some treatments over others, or some patients over others, would be hamstrung by constitutional proceduralism? Maybe sick patients who want disfavored Treatment X would sue and demand an individualized hearing before their "right" to that treatment could be denied.
And if the "New Property" operated to constitutionalize treatment rights in a single payer system, would the same doctrine apply to a so-called "public option" plan that competed with private plans in a health insurance "exchange"? If not, maybe a government-run "public option" would have an efficiency advantage over government-run single-payer. It wouldn't have to worry about all those hearings.
In fact, the more I think about the "public option" idea, the more it appeals to me--not because it's the "thin end of a wedge that will move the system" towards single payer, as Clive Crook summarizes it, but because it seems superior, in some respects, to single-payer.
1) Obama sells the "public option" as a way to "keep the private insurers honest." But the converse effect might be more important: the private insurers in the "exchange" would keep the "public" plan honest. Sure, in this marketplace the government plan will probably get the lion's share of customers. It will offer more security, for one thing. But if it starts to provide lousy service, or excludes too many treatments, the private plans might start to lure some of those customers away. Private insurers would provide an escape valve--an "exit"--unavailable in single-payer government monopoly. The obvious analogy is to private "charter" schools competing with public schools.
2) Likewise, if the public insurers managed succumbed to cost-bloat--if all the people who washed the laundry in hospitals became unionized, for example, and politicized government plans blithely passed the giant resulting bill on to their customers (not wanting to anger the SEIU and other good Dem supporters)-- the private sector might underbid the public plan and 'bend the cost curve' down! Again, that's something that probably wouldn't happen in a single payer scheme; and
3) As discussed, "public option" might help avoid having every "we won't pay for this treatment" decision become a constitutional issue in a way a universal, single-payer entitlement couldn't.
I'm not saying all the differences between the two sorts of plans would cut against single payer--some days it seems completely appropriate to handle treatment decisions as a constitutional matter, since lives are at stake. If a single payer plan is, as a result, less able to deny treatments, that could be a feature, not a bug.
I'm just saying the differences between the two forms of "government" plan have been blurred (mainly by the right), that some of those differences may favor the "public option," and that Obama may be missing a bet in failing to defend the "public option" by pushing off against government-run single payer plans of the left rather than by pushing off against the greedy, evil private insurance companies.
Triangulation--something that lets Obama seem a centrist--helps at this point, right? Or are voters worried that he's insufficiently fond of unchecked government dominance? ... 3:18 A.M.
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If 1000 Twittering Rabbis Swear ...: I was wrong, so wrong to entertain even mild doubts about Ben Smith's report that Obama had told a group of rabbis "We are God's partners in matters of life and death." Smith has now followed up with several of the rabbis. They deny the statement was grandiose, calling it either "mainstream" or "inspirational" or "pablum." But they don't dispute that Obama said it. ... Rabbi Josh Yuter says, "My guess is he didn't really mean it in the way it came out." ... Rabbi David Saperstein translates it as "we are God's partners in preserving life and delaying death," which does take the sting out of it! ... Words to inscribe over the door of the death life! panel. ... ..
P.S.: Smith didn't talk to any of the notorious twittering rabbis, who--according to Saperstein--broke an off-the-record stricture.** ...
P.P.S.: Even the Obama-skeptical rabbis Smith interviews seem to bend over backwards to get Obama off the hook on the "partners" quote. Perhaps they were lulled into cooperating by the soothing melody of "Deutschland Uber Alles," which played while Obama's audience was on hold. ... That was one of the rabbinically twittered details that made the whole account seem too good to check. But it was checked, and it's still good! ... [stolen from Sheffner]
**--Saperstein is not a master of brevity. Twitter gains fresh appeal. ...
Update: Rabbi Yuter, whose substantive post-call blog post is here, emails to say, "I did not recall President Obama making the statement. When asked by a Washington Post reporter for confirmation of the quote, I had to defer. I do not deny that he said it but I've trained myself to ignore such statements." ... Of course, last week Press Secretary Gibbs mentioned that there was a transcript of the call and said he'd have to check it. If Obama didn't say what the twitterer said he said, and what even his defenders seem to assume he said, you'd think Gibbs' office would have pointed to the transcript by now, no? ... 11:24 P.M.
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The idea of postponing health care reform--until, say, the economy improves-- doesn't seem appealing to many Democrats now.** But it might soon. The problem, as Michael Goodwin's recent column points out, is that the issues waiting in the wings--should health care leave the stage--are even worse, from the Democrats' political perspective. Cap and trade, immigration legalization, "card check"--these are not what you'd call confidence building appetizers leading up to the main course of Obama's presidency. Plus the Afghan War! At least a clear majority of the public wants something done about health care....
It's easy to forget that, even if Obama's health care effort is bogging down, the effort itself still serves his presidency as a crucial time-waster, tying up Congress and giving him a reason to postpone (or the public a reason to ignore) those other divisive, presidency-killers. Obama needs some excuse for putting off unpopular Democratic demands; health care's a good one. If he keeps failing to pass health care until spring, that might not be such a bad outcome. In fact, even quick passage was maybe never in his interest. There are things more unpopular than struggling. ...
P.S.: Clinton recovered after his health care failure by turning to welfare reform and deficit reduction. You'd think a focus on the deficit (apart from health care) might perform the same centering, rehabilitative function for Obama. .... Orszag types will point out that you can't solve the long-term deficit without taking measures to bend the health-care cost curve. That may be true. But it may also be true that you can't pass measures to bend the health care cost curve (or raise taxes) until you've assured seniors that you've taken the fat out of everyplace else in the budget. Today, after the stimulus bill, Obama can't provide that assurance. ...
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**--That is not quite what Senator Lieberman proposed yesterday on CNN. He apparently wants to pass "health delivery reform and insurance market reforms" while postponing expensive coverage extensions. It's not clear to me that this makes any sense at all. a) Won't insurance market reforms, in themselves, raise the price of coverage (by eliminating "preexisting condition" exclusion, for example)? Without expensive subsidies, won't that just mean millions more uninsured? b) Isn't "health delivery reform" exactly what's frightening seniors with fears of rationing? Why would passing just the scariest part of the bill be easier? Better to follow Uwe Reinhardt's advice and pass insurance market reforms, plus subsidies, and leave the long term "delivery reform" for the long term. ... 2:05 A.M.
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So you have illegal aliens in that basket! Mark Krikorian, whom I've found trustworthy on these matters, explains that illegal immigrants will too get health insurance under the current Democratic proposals. They're technically not eligible, maybe--but their eligibility probably won't be verified. And Dems have rejected amendments to require verification. (Illegal immigrants aren't technically eligible for jobs either, but they get them.)
I also think Krikorian is right that the Democrats, facing public pressure, will eventually accede to a serious verification requirement. But the cost to Obama's credibility, in the meantime, could be high and perhaps fatal. The President has gone on radio twice in recent days to assure voters that the bill wasn't "designed to provide health insurance to illegal immigrants" and that "[i]llegal immigrants would not be covered." [E.A.] When it turns out that these are carefully-crafted phrases designed to offer false assurance about what would actually happen, what will people believe about Obama's other assurances? As with the "death panel" rebuttals that have failed to calm seniors' "not entirely irrational" fears of rationing, it's almost worse to offer sweeping denials that are only 90% accurate than not to offer them at all. The 10% proves the distrusting paranoids were right. And in this case it's more than 10%, given that illegals constitute a big chunk of the uninsured.
Liberals went through a similar, politically devastating, process with welfare. Year after year, decade after decade, they would assure Americans that welfare recipients were actually required to work. See, it says so right in the legislation! There's a "work requirement"! The voters never believed this, and took it out on Democrats at the polls. Eventually it became common knowledge, even among the well-informed, that the "work requirements" were riddled with loopholes. Only with Clinton's 1996 reform did the Democrats put a tourniquet on this wound. Now they're opening another one.
Why not just skip the Kabuki/BS phase where Congressional Dems try to sneak de facto health care for illegals through while showily saying the opposite, and just immediately agree to verification--avoiding the bleeding interval in which the ruse is sniffed out by the Right? Isn't that what a White House that was in charge of the process would insist on? Or did Obama's aides underestimate public anger on the health-care-for-illegals issue? (They don't any more, not after the August town halls.) Or--Alternative #3-- does the White House know what a hot button this is but feel it has to try to placate the Latino caucusers (since the immigrant legalization they want ain't happening anytime soon)? Or--#4--did they actually think they could get away with it? ... 11:24 P.M.
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If You've Lost Robert Pear ... : From Maguire:
Old New York Times reporting: "Death panel" rumors "false," the product of a familiar network of anti-reform "pundits and conservative media outlets":
There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.
New New York Times reporting: "[F]ears ... about possible rationing" are "not entirely irrational":
The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing, which could affect access to the most expensive services in the final months of life.
Next thing you know, the NYTers will be grabbing the mike at town halls. ...
P.S.: At least when voters are having notentirelyirrationalfears that Obama would have the state play god by exercising yes/no power over life-ending medical decsions, he didn't go and say something creepily extravagant and provocative like "we are God's partners in matters of life and death." ... Whew! ... Oh.. ... [also via Maguire] ... Update: I'm now having mild, but gnawing, doubts as to the epistemological status of that Obama quote. Politico reports it (twice). It seems to come from the real time twitter feed of a rabbi who was in on the phone call. (The rabbi has since deleted the tweet, giving an odd explanation.) Press Secretary Gibbs was asked about the quote Friday, didn't deny it, but said he'd have to check the transcript.... 5:10 P.M.
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Groopman vs. Gawande? I missed New Yorker contributor Dr. Jerome Groopman reaming President Obama on the magazine's July 23 podcast. Groopman accuses the President of "happy talk" that pretends the problem of long-term cost control will be painless. He also claims the "current" reform propoals will "build a huge bureaucratic superstructure around things that are not gonna save money and probably aren't going to improve quality."
Groopman's critique isn't mine--he thinks "rationing is going to be inevitable" and fees for doctors hospitals and drug companies have to be radically reduced. But his arguments certainly sit uneasily with the implication of the famously influential article by his fellow New Yorker doc, Atul Gawande--which is that, hey, if we only crack down on the wasteful McAllen, Texases of the world we can dramatically cut costs relatively painlessly. ...
P.S.: I obviously agree with Rick Hertzberg, who argues you have to give everyone the "goodies" (of universal coverage) first, and then whatever hard choices are necessary become easier. And I don't quite understand why the choice has to be Euro-style rationing (Groopman's view) if we're willing to make the alternative hard choice of raising taxes (or cutting other spending) to pay for avoiding it. ... 1:20 A.M.
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Gawker says that the National Enquirer has "has been 100 percent right about everything on this story"--a now-common MSM overreaction. I'd say the Enquirer has been more like 95% right--still better than anyone else. Their main blind spot is a refusal to say anything bad about Elizabeth Edwards, presumably for fear of offending their readership who prefer the story line of St. Elizabeth the Resilient Victim. (Enquirer editor David Perel: "She's been hurt. She lashed out. ... [T]here's some places I don't want to go.") Fortunately, HuffPo's Lee Stranahan is still around to chronicle Elizabeth's dissembling. ...
P.S.: Bonus Google gold! ... 1:19 A.M.
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Systemic Change at Dreidl HQ: Marc Ambinder now sticks in a 'to be sure' graf before selling us the optimistic WH spin. Today's good news for Obama? He's "about to go on vacation"! .... 1:03 A.M.
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kf Gets to Yes! I tend to favor a public option--at least it seems worth trying. Meanwhile, private insurance companies think it will put them out of business. But why is this fight not susceptible to a tradtional hack form of compromise: let half the states** try a public option, if they want, the rest stick with the private sector or co-ops? Then liberals are happy and the insurance companies are happy. The issue can be revisited in a few years when we see what happens. ... You're welcome. ... Now we can move on to the more presssing problem--getting Orszag's disturbing treatment-denying "game changers" out of the bill so public support doesn't collapse so completely that passage of anything becomes impossible. ..
**--or states representing half the population. 5:59 P.M.
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Getting to Know the Public Option As It Disappears: Steven Pearlstein argues that the "public option" isn't necessarily a good way to keep down health costs. He notes that, unlike Medicare, "public" insurers would have to bear the costs of collecting premiums, managing care and marketing. Administrative expenses would inevitably be significantly higher than Medicare's 2-3 percent. Plus, the "public" plans wouldn't necessarily have much market leverage in areas where a single dominant hospital, for example, just has to be in your network.
But Pearlstein is assuming that the purpose of the "public option" is to control costs! What if, as Jacob Hacker and Rhul Rajkumar note, it is also designed to serve as a "crucial backup for those ill served by private plans"? Security, not cost. (Pearlstein asserts that a public option wouldn't be "the long-awaited safety net for the uninsured," but never backs it up with an explanation.)
And why do I get the disquieting sense that if the Obama administration had needed a strong defense of the "public option," Pearlstein could have written it the other way?
P.S.: Hacker and Rajkumar produced a generous and highly useful set of answers to my questions about the "public option" that they've championed. My initial reactions:
1) H & R note that when it comes to "community rating"--requiring insurers to charge the same rate to sick and ill people--there will likely be a "cat and mouse game" as insurers try to avoid the rules. But when it comes to preventing private insurers from gaming the system by attracting only healthy patients (even if they charge everyone the same rate) H& R rely on the effectiveness of regulation. (I don't see how competition from "public" plans will help out regulators in the latter case . Will a public option discipline private insurers that engage in "cherrypicking"? The availability of a public option seems what is likely to allow private firms to get away with cherrypicking--the victims denied insurance can always get it from the public plan. That also seems likely to decrease the incentive for regulators to prosecute.)
2) Won't sick people flock to the secure public option? H &R say such "adverse selection" will be "modest,"--and that "extreme adverse selection that really jacks up the cost of the public plan" is "unlikely." But nobody knows, right? And H & R's fallback solution to this problem--"risk adjustment," requiring those who enroll healthy customers to pay money to those with less healthy customers--seems like a solution that proves too much, as lawyers likely say. If "risk adjustment" reallly works, won't it solve all problems of private insurer cherrypicking--indeed, virtually all the problems of health insurance? Yet obviously H & R think there will be continuing cherrypicking, if only on a "cat and mouse" level.
3) Why will the public plan "create a strong competitor that pushes plans to focus on controlling costs and improving value"? As Pearlstein notes, the public plan will have to do most of the things private plans now do--in fact, they will probably farm the administration out to private contractors. To the extent the public option cuts costs by aggressively managing care, doesn't that defeat the purpose of having it as a Medicare-like backup that doesn't aggressively manage care? Won't the public plan be more vulnerable than private plans to anti-managed-care lobbying by voters? So the pro-public argument on costs basically amounts to an antitrust argument: competition in some markets is weak, and this will add another competitor. .
4) The public option is a strange hybrid of Medicare and faux-competitor, apparently. It could emphasize security or cost-cutting depending on who is running it. It seems worth a shot. But I'd feel better about the whole private/public combo if some of my conservative friends would explain to me just what it is that private insurers do that makes them worth preserving. The central problem, sketched by David Cutler in his book Your Money or Your Life, is that the free market does not reward insurers who provide excellent care. The market punishes insurers who provide excellent care, because the people who will be most attracted by excellent care are sick people, the very people who will drive insurers into bankruptcy. If private firms want to make a profit, at least in the indivudal market, the surest way to do it is to think up innovative ways to screw buyers--deny care to those likely to need it, write complicated clauses into policies that allow the insurer to weasel out of paying, etc.. Everyone agrees private insurers do these things. What do they do that's so great that makes up for it? [Keep out unions?--ed Good point! But Medicare eliminates the private insurance middlemen and doesn't seem, yet, to have forced unionization upon hospitals, etc. Of course Dennis Rivera and the Democrats aren't done with their work yet.]
On H & R's final point, I'm still not convinced that if there is no public plan, and the health insurance market becomes a hell of "unraveling choices, runaway costs, and rampant health insecurity" that there will be no political will to intervene later (because we've missed our "once in a generation chance"). Why isn't health care politics more like the environmental politics--you make some changes one year, and then if you win an election you make some more changes next year? (For a contrary argument, see my colleague Timothy Noah, who thinks the insurance lobby will be more powerful than ever after a reform mandating that everyone buy their product.)
P.P.S.: Reader D.C. submitted his own thorough set of answers to my public plan questions. Here is his explanation of why he thinks a public plan would attract enough healthy people to avoid a vicious circle in which it attracted the sickest people and had to raise premiums, further deterring the healthy:
[T]here are many ways for the public option to attract healthy workers, including:
-- peace of mind that you won't lose your job, your insurance, or your sanity when you get sick
-- a much larger pool of doctors to choose from (you get to choose your doctor, as opposed to most HMO's) [True?-MK]
-- portability if you move to a different state
-- ease of customer service (yes, it's the government, but compare the status quo)
-- fewer shenanigans trying to deny coverage based on technicalities
-- better preventative coverage [why?--MK]
-- coordination with state and local health providers
Seems logical enough, though I can't vouch for D.C.'s credentials. Offering security might not unequivocally raise costs, because security attracts the healthy as well as the sick. Still, if that were the predominant effect, wouldn't private insurers be offering a lot more security than they do know?
At bottom, there clearly still seems to be an uneasy, ongoing tension between a public plan's cost-cutting purpose and it's security-for-those-who-get-sick purpose. Hard to see how it can do 100% of both at the same time. And I still don't think H & R know which of those two forces will win out.
Not that this is a fatal objection--one reason to try would be to find out. Unlike Pearlstein, I wouldn't be troubled if "security" won decisively at the expense of "cost-cutting." ... 8:42 P.M.
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Bob Wright on Colbert Report, discussing Evolution of God. "I don't believe in any of these three religions." Colbert (as Colbert) is not receptive. ... 10:35 P.M.
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Jeff Toobin, wrong again? 11:03 P.M.
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Thinking Through The Pubic Option: John Edwards is "tired of all the lies"! ... [via Gawker] 11:39 P.M.
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Kareem wants to coach the Lakers. ... 4:17 P.M.
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Kf welcomes Howard Fineman to the Blame Orszag Club:
Orszag's fantasy
Every president wants to reconcile frugality and generosity, and there is always an ambitious and clever aide willing to tell him it can be done. In Obama's White House it is Budget Director Peter Orszag, who confidently told Obama that carefully administered universal health coverage would save the government money in the long run. ... [snip]
Obama doesn’t like to make enemies, and he loved the idea — fueled by the likes of Orszag — that he could fight the reform battle on conservative turf: that we need to completely change the system because otherwise we will go bankrupt as a country.
But that was a tactical mistake on two fronts. First, Elmendorf undercut it with three devastating CBO reports.
And even if the proposals did save the government money, Republicans in Congress weren’t going to care!
For two generations, they were on the receiving end of Democratic fear-mongering how the GOP wanted to “throw grandma in the snow.” Now they are relishing the chance to accuse Obama of the same thing.
Prediction: CW by September 14. ... 9:49 P.M.
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Do the folks over at NRO's The Corner realize that The Man Who Shot Liberty Valance is a Marxist movie? Forces of production (sheepherders, farmers) meeting fetters (cattle barons, Lee Marvin). Bourgeois freedoms (Jimmy Stewart) the product not of incremental progress but of a violent revolutionary moment (John Wayne). Etc. ... 10:57 P.M.
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'Little GM, You Used to Be So Big': Harry Shearer has written Fresh New GM!'s theme song. ... It even has a bridge. ... Downloadable Sept. 8, apparently. ... P.S.: TTAC's thorough review of GM's uninspiring future product plans (mainly a flood of ... Buicks) suggests that Shearer has the tone about right. ... P.P.S.: I'm not predicting New GM! will fail. But it's hard to see it succeeding without the immediate labor cost advantage that Ron Bloom and Steve Rattner failed to negotiate for them, or an infusion of outside a---kicking executives that hasn't happened either. ... Plus: Some anti-Lutzism. ... It looks as if the one American plant where UAW workers built Toyotas--the NUMMI joint venture with GM in San Jose, started in 1984--will close. NUMMI's products had a good reputation, but apparently it was only profitable "for a single year." ... 11:47 P.M.
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Ross Douthat wants the GOP to stop defending grandmas against Orszagist curve-bending and
stand for the principle that Medicare can't pay every bill and bless every procedure
As a Democrat, I applaud this long-overdue attempt to return Republicanism to its historic mission. It will be comforting to see Douthat's party reclaim its its traditional image as skinflints attempting to deny the poor and elderly compassionate medical treatments and benefits that might prolong their miserable lives. It's been getting confusing lately! ... Maybe we can trade them Orszag for a pro-life big spender to be named later. ... 11:51 P.M.
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Everything's Under Control! I missed Ezra Klein's latest optimistic spin last week on the health care debate. Klein notes that Obama isn't talking about "bending the cost curve" on the stump, and that Republicans have gained traction, not with arguments about cost and the long-term deficit, but with fears of cost-cutting and rationing. So far, so good.
But Klein says the administration always intended its "curve bending" arguments as a means of building "Washington support" and passing a bill by August ("the plan was to keep this in Washington"). Now that this effort has failed,** "the argument moves to the country" where the administration's pitch will be different, focusing on stories of insurance injustices. "You don't win appealing to the wallet, you win by grabbing the gut."
This reeks of making-the-best-of-a-bad-situationism:
1) Did the administration really think it was going to pass a bill reforming the entire health care system without winning the "outside" battle for public support? If so, someone drew the wrong lesson from the "stimulus" bill. (The stimulus bill was intended to address an acute crisis.)
2) Did the administration think that Obama could run around talking obsessively about his plans to "bend the curve" of health costs (including in a nationally televised press conference), giving interviews to the New York Times about the need for a "very difficult democratic conversation" on restricting end-of-life care and the news would stay in Washington? Note: They've invented the telegraph!
3) Most important, does the adminsitration think it has plenty of time now to move on to win the argument in "the country"--as if this were a stately, well-ordered two-stage fight, a formal legal appeal to a higher court of public opnion? Does anyone really believe this? I doubt even Ezra Klein believes it--though I guess every great spinner believes his own spin. (And Klein, unlike Ambinder, seems like a spinner rather than a spinnee.)
What he breezily glosses over is the possibility--increasingly, the actuality--that they've already lost the public opinion battle for the near future. If they now need public opinion to pass the bill in the fall, they aren't going to pass a bill. It turns out you may only get one chance to roll out a giant legislative initiative. You can't roll it out with a cost-cutting rationale and then switch cunningly and seamlessly to a security-providing rationale without addressing the fears raised by the first set of arguments.
Specifically, a few "gut"-grabbing insurance horror stories aren't going to calm the "rationing" fears of those now covered by Medicare (who don't worry about their insurance, or didn't until Obama came along). The best defense is not always a good offense (cf. Dunkirk). In this case, what's required would seem to be more a dramatic repudiation of the administration's own cost-bending, treatment-discouraging rhetoric.
Obama can't fire himself, but he can fire the curve-bending wonks who convinced him that talking about end-of-life issues was a good way to sell universal care. He can find himself a health-care Petraeus. And he can ditch the closest thing to a "death panel" in the legislation--the IMAC board. The more traumatic and high-profile the intra-administration upheaval, the more space Obama buys to relaunch his plan as a rationing-free coverage extension.
That would be a Plan B. ...
P.S.: Maguire mocks the NYT's effort to bury, under a layer of anti-yahoo sneering, the evidence in its own pages of Obama talking about restricting end-of-life treatments to save money. ...
**--See Lori Montgomery's wildly unconvincing argument that health care reform has to drive down the long-term cost curve (not just be "paid for") in order to pass. Maybe if the vote was taken by the respectable, responsible newspaper editors who order up hothouse pieces like Montgomery's. As Klein notes, the "curve-bending" argument didn't even carry the day inside the Beltway, while provoking active hostility outside. ... 3:49 P.M.
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Dropping the public option:
a) A little early, no? Quite apart from whether it reeks a bit of panic--Politico notes that the public option was a useful threat to hold over the insurance industry when negotiating the rules insurers will have to abide by;
b) Moving toward compromise on this issue already seems to be helping the administration with the inside game--i.e., getting enough moderates on board to, in theory, pass a bill. But the inside game is not the administration's biggest problem. The problem is the outside game--public support for the bill out in the country--where it has been losing fairly decisively. If the public ends up 60-40 against a bill, it's probably not going to happen even if Sen. Conrad is on board.
Will dropping the public option help with the outside game too? Maybe a bit: it reduces fear of a government takeover. But it does little to reduce legitimate fears of rationing in the existing, huge govenrment program--Medicare. To calm those fears, the provision to drop is Peter Orszag's precious IMAC commission, which Obama himself has seemingly promoted as nudging the system in the direction of denying care toward the end of life. ...
P.S.: Pulling Back from the Public Option? This is a Job for The Dreidl! Atlantic's Marc Ambinder declares "the President never insisted that a health care bill contain a public plan." Huh? Is Ambinder being spun so fast he can't read? The Obama address he links to says this:
That's why any plan I sign must include an insurance exchange: a one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans - including a public option to increase competition and keep insurance companies honest - and choose what's best for your family. [E.A.]
That annoying word, "must." Sure reads to me like the President insisting that a health care bill contain a public plan. ...10:47 P.M.
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Mike Murphy is not a fan of Sarah Palin. ... 11:07 P.M.
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From Public Option to Pubic Option! Pigeon O'Brien thinks she knows why the delay in the rumored Edwards paternity admission. ...11:07 P.M.
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Hmm. WRAL reported that Edwards would publicly admit paternity at some point, but he hasn't actually done it yet, you know? Is he a) getting cold feet about the admission after seeing the nontrivial and hostile coverage the story has been getting; b) waiting until the grand jury clears him, as part of the bury-bad-news-under-good strategy previously suggested in this space; or c) planning to admit paternity privately but not put out any public admission, leaving the press with rumors and future leaks? The Third Way! ... I have no dog in this hunt--I've already gloated, and I don't think he's going to be Attorney General any time soon--but my guess is still (b). WRAL only said the admission "could come before the end of the criminal investigation." ... You would think at this point that option (c) potentially prolongs the drama during a slow news period. But since most people already think he's the father--it's "old news" in the classic Clinton formulation--then maybe the best PR result for Edwards is if the truth about any admission sort of dribbles out over the next few weeks. ... If past Edwards performance is a guide, the one option that won't be considered is telling the truth unembalmed in a thick layer of narcissistic dissembling. ... 2:27 P.M.
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Edwards' Second Edifice of Lies Collapses: Just when you are no longer all that interested in the John Edwards love child story--because the truth is kind of obvious--he goes and reportedly decides to admit paternity, allegedly after a DNA assesment. The grim dynamics of the Web now require some sort of hit-catching gloatfest. OK. Here goes.
1) Historic Gallery of Kossack Krap: Here's Jerome Armstrong proclaiming the original accusation "just a total bullshit story" in 2007--love the tags!--and Markos Moulitsas months later still sneering
... I can't believe this is even subject to debate, but for the crazies, no source is too disreputable if it validates their warped world view. Although in a perverse sense, the more energy they spend on b.s. like this (and Obama's supposedly forged birth certificate), the less energy they're spending on smearing Obama.
Is Moulitsas so dumb he didn't know the truth in July of 2008? I don't think Moulitsas is dumb, as a general proposition.
2) The National Enquirer has been vindicated (though I think they are still congenitally soft on Saint Elizabeth). HuffPo's Sam Stein kicked the story off. And always trust content from kausfiles. ... But this latest development vindicates no more than half of Monday's kf rumor item. I also speculated that the paternity admission would be part of a PR strategy designed to roll out after the grand jury failed to charge Edwards. I still expect that to happen--certainly you wouldn't think that Rielle Hunter went out of her way to damage him before the grand jury if he was going to admit paternity, do you? But to the extent Edwards simply had to talk to prosecutors-Fifth Amendment notwithstanding--then it might not have been so much a PR strategy as making the best of a bad situation;
3) Please do not forget that in his August, 2008 Nightline 'confession,'--"I take full responsibility"--Edwards didn't just deny paternity but said paternity was "not possible" because the affair with Hunter was over when the baby must have been conceived. To do otherwise would have interfered with his carefully crafted modified limited story about the affair--that it involved "a short period in 2006" and ended before Elizabeth's cancer recurred and before he went galavanting around the country advertising his fidelity and good character. If Edwards is in fact the father this entire fallback edifice of BS crumbles. ... It's worth reading the transcript of the ABC interview--practically every sentence out of Edwards' mouth is a lie. He doesn't know who the baby was in the Enquirer's photos, suggests the photos were doctored, doesn't know whether Andrew Young, the aide who took the fall, is the father, says Rielle Hunter's hiring as a videographer had nothing to do with the affair, etc.. And he does it all sanctimoniously.
4) Why construct this fallback line of lies? There are several possibilities, discussed here. My guess: The idea was not to fool his wife but to preserve his political viability as much as possible. Just a short mistaken affair! He slipped! Happens all the time! I also suspect St. Elizabeth was in on this second set of lies just as she went out and helped him try to preserve the first set of lies (i.e., that there was no affair at all and it was all just tabloid trash).
5) Why admit paternity now? Possible (speculative, not-proven) theories: a) He needed Hunter's testimony to be as friendly as possible; b) Disaffected Fall Guy Andrew Young's tell all book forced the issue; c) Edwards was going to be asked by the prosecutors; d) Somehow this helps keep the sex tape bottled up; e) It had to happen at some point. Rielle wants to be Mrs. Edwards, or at least to have the paternity of her child acknowledged. He couldn't keep her happy forever. f) He wants the story to get buried in all the excitement about Netroots Nation! ...
6) Remaining questions: Who was Enquirer's big source? Can it not have been Hunter? Why wouldn't Edwards agree to pay child support but negotiate a clause requiring everyone to keep it secret? Why her? What if he'd been elected? What about the enablers? Mudcat? Prince? Palmieri? Which ones were willing to put the party at risk? ... 12:06 A.M.
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My friend Bob Wright posts a persuasive "partial list" of the "false and misleading things" he argues a recent New Republic book review said about The Evolution of God.
If [reviewer Jerry] Coyne wants to write a devastating review of my book-and there can be little doubt that he wants to-he's going to have to start over.
The disputes are grouped into six substantive issues. My guess is that #4 and #5 are the hottest areas of contention. ... My own non-devastating attempt to grill Wright on his view of Islam comes toward the end of this interview. ... 9:54 P.M.
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So You Have A Death Panel in That Basket! Tom Maguire digs further into that April Bloomberg story--and the David Leonhardt NYT interview behind it--and discovers that Obama came a lot closer to talking about "death panels" back in April than I'd thought. Here's the key passage [emphasis added by Maguire]. It comes as Obama is talking about the hip replacement his grandmother got a few weeks before her death:
THE PRESIDENT: ... I don't know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn't have a hip replacement and she had to lie there in misery in the waning days of her life - that would be pretty upsetting.
LEONHARDT: And it's going to be hard for people who don't have the option of paying for it.
THE PRESIDENT: So that's where I think you just get into some very difficult moral issues. But that's also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
LEONHARDT: So how do you - how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now.
Yikes. ... I'm sure the "not determinative" part was very important to Obama. Still! He's talking about a panel of independent experts making end-of-life recommendations in order to save costs that have an effect at an individual level. And he thought it would be in the bill that emerges. ... It's also pretty clear that something like the "IMAC" panel is what he has in mind. Whether or not the IMAC would actually do this--Harold Pollack says end-of-life issues are well down the curve-bender's list, for example--Obama thought it would do it. . .
And if health care advisor Ezekiel Emanuel believes there's actually not that much money to be saved on end-of-life care, he hadn't gotten the message to the President back in April. ...
P.S.: Hmm. If, say, Peter Orszag led Obama down the fatal path of talking about end-of-life-savings, and if Ezekiel Emanuel thinks Orszag is wrong about this, then who is Ezekiel's own brother going to recommend throwing overboard when if health care reform stalls? Just speculating! ...
Update: Timothy Noah argues that you really need all three parts of Uwe Reinhardt's "three-legged stool" to make insurance reform work. 1) Insurance companies accept all comers; 2) Individual mandate to buy insurance; 3) Subsidies so poor people can fulfill that mandate. Fine. Let's do those three things! They pointedly do not include Peter Orszag's long-term game-changers, or Obama's "very difficult democratic conversation" about end of life care. Even Reinhardt, who supports the long-term Orszag agenda, doesn't think it's something we can do in this round of reform--that's "a much longer-run effort that may take an entire decade or more." Why didn't someone tell that to Obama (who actually pledged to veto a bill that didn't do the long-term curve-bending that Reinhardt says can't be done)? 'Sir, we can achieve universal coverage.' 'No, let's have a very difficult democratic conversation first." ... P.S.: Orszag's politically disastrous "game changers" are also the piece of Obama's reforms mysteriously left off Ezra Klein's list of health care areas of agreement and disagreement. ... 9:52 P.M.
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A second talented editor leaves the L.A. Times Entertainment section in as many weeks. Kate Aurthur, who's going to the Daily Beast, was--according to kf's well-informed source--
the one top editor with any sense of innovative spirit, creativity or awareness of the internet left in the Calendar section.
Do Times employees not find Entertainment chieftain Sallie Hofmeister's leadership inspiring? ... P.S.: I used to enjoy mocking the LAT, but it's so doomed there's no point anymore. If there were a death panel for newspapers, it would issue a DNR order. ... 9:48 P.M.
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The Wages of Being Spun: Yesterday, Atlantic's Marc Ambinder told us how the loud town hall protests against Obama's health care plans were discrediting and damaging the Republican position, especially among independents.
Today, a USA Today/Gallup poll delivers what seems like swift and brutal punishment to desperate Rahmesque spin Ambinder's analysis:
WASHINGTON - The raucous protests at congressional town hall meetings have succeeded in fueling opposition to proposed health care bills among some Americans, a USA TODAY/Gallup Poll finds - particularly the independents who tend to be at the center of political debates.
In a survey of 1,000 adults taken Tuesday, 34% say the sometimes heated protests at sessions held by members of Congress have made them more sympathetic to the protesters' views; 21% say they are less sympathetic.
Independents by 2-1, 35%-16%, say they are more sympathetic to the protesters now. ...
Dreidel, dreidel, dreidel. ... [Thanks to alert reader M]
Update: Gallup's fuller results here. ... The real test is whether support of the reform goes up or down after the town halls, not what people say they think of the protesters or their views. Still, it's hard to look at this poll and conclude that support will go up, or that opponents have been "discredited." ... 3:52 P.M.
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On Obama's Portsmouth Town Hall:
a) I don't think the now-famous end-of-life consultations are what Palin was referring to by "death panels," contrary to what Obama claims at the beginning of the meeting. If she was referring to any actual, existing proposal it would be to the IMAC panel, or what she fears the IMAC panel might turn into--as Obama himself admits at the end of the meeting; ... Backfill: Ezra Klein made the same mistake on Monday. ...8/13 Update: Er, Palin makes the same mistake on Wednesday. Somebody should maybe tell her what she was talking about! Her latest Facebook post focuses on the end-of-life consultations. She does say, "Of course, it’s not just this one provision that presents a problem." ...
b) Here's Obama's full answer on rationing:
Now, in fairness, the underlying argument I think has to be addressed, and that is people's concern that if we are reforming the health care system to make it more efficient, which I think we have to do, the concern is that somehow that will mean rationing of care, right? -- that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health care dollars. And this is a legitimate concern, so I just want to address this.
We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits. The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get a $177 billion of taxpayer money to provide services that Medicare already provides. And it's no better -- it doesn't result in better health care for seniors. It is a giveaway of $177 billion.
Now, think about what we could do with $177 billion over 10 years. I don't think that's a good use of money. I would rather spend that money on making sure that Lori can have coverage, making sure that people who don't have health insurance get some subsidies, than I would want to be subsidizing insurance companies. (Applause.)
Another way of putting this is right now insurance companies are rationing care. They are basically telling you what's covered and what's not. They're telling you: We'll cover this drug, but we won't cover that drug; you can have this procedure, or, you can't have that procedure. So why is it that people would prefer having insurance companies make those decisions, rather than medical experts and doctors figuring out what are good deals for care and providing that information to you as a consumer and your doctor so you can make the decisions?
So I just want to be very clear about this. I recognize there is an underlying fear here that people somehow won't get the care they need. You will have not only the care you need, but also the care that right now is being denied to you.
Hmm. Better. But there are two separate problems Obama's discussing: a) stopping the rationing being done by insurance companies; b) promising that Medicare won't start rationing any more than it does now, especially in the years after the 10 year window Obama discusses, when the boomers will need lots of treatments. Obama addresses (a), but what does he really do to reassure those anxious about (b)? Medicare recipients don't worry about insurance company rationing (there's your message!). So telling them that Lori, who isn't on Medicare and isn't getting private coverage, will now get it doesn't really answer their concern. ..
I still don't quite understand why Obama can't bring hmself to say some variation of a) "There won't be rationing" or b) there won't be rationing under the Kinsley definition--"Any treatment that I, the President, would get you will get," or c) "Medicare doesn't ration now and won't ration in the future, period. There will be no change in how Medicare decides what treatments to pay for. The goal is to get it to pay for more, not less." Read My Lipitor!** No New Rationing. ...
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**--Obama's answer to a questioner who had to "go through two different trials of other kinds of drugs" before being allowed by Medicaid to go back on brand name Lipitor (which he'd been taking for years) was basically that the outcome was good because "once it was determined that, in fact, you needed the brand name, you were able to get the brand name." Spoken like a lawyer! (So you had to fight for a few months or years? You won didn't you? Process costs don't count.) ... 1:32 A.M.
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"Conservatives are blowing it" on health care. So argues Marc Ambinder. Republicans are turning town halls into general "anti-Obama venting sessions," he twittered on Sunday. All that shouting-down was turning people off. "[T]his trend favors the left." It certainly wasn't going to cause the Blue Dogs, whose votes are crucial to reform, to vote against it.
Ambinder elaborated on Sunday's instant analysis today:
At this same hour last week, several of the President's top political advisers were meeting in a White House conference room to discuss the appearance, over the first weekend in August, of a coordinated effort to scare Democratic lawmakers who planned to attend town hall meetings into a state of panic. A week later, and the Atlantic's tricorder readings are picking up much calmer electromagnetic energy from the White House. ... Democrats are beginning to notice that opponents of health care reform have discredited themselves. They ramped up much too quickly. When smaller, conservative groups Astroturfed, they inevitably brought to the meetings the type of Republican activist who was itching for a fight and who would use the format to vent frustrations at President Obama himself. ...[T]the loudest voices tended to be the craziest, the most extreme, the least sensible, and the most easy to mock. ...
A coherent, organized effort would have recognized that the moment the media began to take sides was the moment that the entire enterprise could be damaged. The media, being a collection of different megaphones, reported on the town hall meetings in one of two ways, both damaging to Republicans. Either they credulously reported the louder, angrier voices (inherently damaging to Republicans in this case) or they reported on the political architecture of the town hall meetings, which plays down the substance of the protests.
Remember, the target audience for Republicans is Blue Dog Democrats in Congress. They won't panic unless they perceive organic anxiety. The White House's goal was to prevent the Blue Dogs from panicking. The swing constituents in these congressional districts aren't angry Republicans, and the Blue Dogs know this. They're political independents for whom the sanctity of the process is important. .... Unrestrained, these town hall meetings are going to turn off the type of voters Republicans most need to pressure Blue Dog Democrats -- independents who don't have red genes or blue genes.
These are good points--possibilities, at least. They're the possibilities you'd want to emphasize if you were, say, a Democratic aide talking to Marc Ambinder. But are they the most important possibilities? For example, anti-Obama activists indeed seemed uncouth and even thuggish in some early townhall MSM coverage. But how many people watch the MSM in the middle of August? (And anyway, Obama has now shown that these meetings aren't that uncivil!)
The bigger picture is whether support for health care, already too weak, builds over August or shrinks, no? Does Ambinder really think it's going to build simply because GOPs ramped up too quickly and got too loud last week? Doesn't the latter criticism, however valid, have the half-life of either a twitter item or Rahm Emanuel's attention span, whichever is shorter?
Ambinder seems to be operating on the premise that all Obama needs to do is convince a finite number of Blue Dogs to vote with him and a "comprehensive" health reform will pass--the way a few more delegates once enabled him to lock up the nomination. But lawmaking isn't that cleanly mathematical. When the general public sours on a bill, it affects more than a few swing votes. Unpopular bills have a way of magically bogging down in Congress even if a majority technically favors them and regardless of what happens with Senators and Congressman whose votes were once considered "crucial." (There were crucial swing Senators on Clinton's health care reform too, at one point. And on "comprehensive" immigration reform in 2007.) The White House aides whose temperature Ambinder's taking certainly have an interest in making it all seem like simply a battle for the Blue Dogs, because that seems more like a battle they can win.
If Ambinder were any easier to spin, he'd be a dreidl. ... Update: See also Patrick Ruffini. ...
P.S.: Ambinder says the GOP effort was not "coherent, organized." Doesn't that undercut the left talking point that it was secretly, centrally controlled by sophisticated DC corporate lobbyists? ...
P.P.S.: A more interesting, though equally spinnish, Ambinder post makes some subtle points about the real views of Obama health care adviser Ezekiel Emanuel (Rahm's brother).
a) For example:
Hospice care costs more than hospital care in most circumstances, Emanuel found -- and so the end-of-life counseling that a doctor provides has little to do with saving money.
But if that's true, then why doesn't Obama calm everyone down by ostentatiously dropping the end-of-life- oriented parts of the bills? ...
b) I knew it was all Michael Sandel's fault! On Ezekiel Emanuel's "communitarian" world view:
Emanuel sketches out a "civic Republicanism" telos -- that is -- our health care decisions as a society should be yoked to a system that "promote[s] the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic." He notes that such a system would deny "services provided to individuals who are irreversibly prevented from being or becoming participating citizens."
Emanuel is setting up a contrast: our health care system today treats everyone equally -- as if they ought to have equal access to every possible procedure or treatment. To most of us, the status quo seems intuitively right. Everyone is equal -- equal under God -- Emanuel doesn't say this, but he might as well -- and therefore it would be evil to make distinctions. What Emanuel is arguing, here, is that this liberalism substitutes one goal -- equality -- for another -- a healthy society -- and that substitution may be responsible for the limited choices that policy-makers confront. [E.A]
Well, if you put it that way ... I'm for equality! For a health care system that "treats everyone equally," even if it's expensive. Against a system that would deny "services ... to individuals" who won't ever achieve "full and active participation .. in public deliberations."
Like I said, Sarah Palin had a point. ...
P.P.P.S.: Who said social equality would always be cheap? ... 8:59 P.M.
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Eugene Robinson of WaPo:
But reform is being sold not just as a moral obligation but also as a way to control rising health-care costs. That should have been a separate discussion. It is not illogical for skeptics to suspect that if millions of people are going to be newly covered by health insurance, either costs are going to skyrocket or services are going to be curtailed. ...
[snip]
Yes, it's true that doctors order some questionable procedures defensively, to keep from getting sued. But it's a cop-out to blame the doctors or the tort lawyers. We're the ones who demand these tests, scans and surgeries. And why not? If a technology exists that can prolong life or improve its quality, even for a few weeks or months, why shouldn't we want it?
That's the reason people are so frightened and enraged about the proposed measure that would allow Medicare to pay for end-of-life counseling. If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending. It's irresponsible for politicians, such as Sarah Palin, to claim -- outlandishly and falsely -- that there's going to be some kind of "death panel" to decide when to pull the plug on Aunt Sylvia. But it's understandable why people might associate the phrase "health-care reform" with limiting their choices during Aunt Sylvia's final days.
We should be having two debates. One should be about the obligation to ensure universal access to health care, which will directly benefit millions of struggling families and make this a better society. The other -- a more complicated, difficult and painful discussion -- should be about the long-term problem of out-of-control health-care costs, which would be a looming crisis even if President Obama had never uttered the word "reform."
Conflating the two has made the nation's nerves jump and its skin itch. And now, anything can happen. [E.A.]
Right. A debate on long-term cost control and end-of-life care--especially an emotional and acrimonious debate--is a highly useful debate to have. But it's not a useful debate to have right now. Right now it is killing Obama's universal care plans. ... And it wasn't a debate we had to have right now. It's a debate Obama has brought on himself by framing health care as an attempt to "bend the curve" of long term costs decades from now. He could have just said "Here's how I would guarantee health security for everyone. And here's how we're going to pay for it for the next ten years." ... P.S.: If, as Harold Pollack argues, "rationing of life-saving or life-extending care" would not really be a priority for the "effectiveness" panels--such as the Obama-endorsed IMAC--then it was all the more stupid to bring the topic up, no? Here's the first graf from a Bloomberg account of an early Obama health care foray back in April:
April 29 (Bloomberg) -- President Barack Obama said his grandmother’s hip-replacement surgery during the final weeks of her life made him wonder whether expensive procedures for the terminally ill reflect a “sustainable model” for health care.
Gee, where could the misinformed town hall crazies have gotten the idea that Obama was thinking about saving money by denying expensive procedures toward the end of life? ... [via Dish] ... 1:49 P.M.
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Fresh New GM! reveals product plans. TTAC says "Caddy is so screwed," ... 2:43 P.M.
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In the 2008 primary, I was always a bit leery of the "love child" aspect of the John Edwards/Rielle Hunter cheating story--it seemed like the perfect setup, which would have gone like this:
Edwards would openly deny paternity, giving implicit permission for the press to report on the scandal. The press would do its part, excitedly reporting charges from Edwards' enemies that of course he's the father, the baby really looks like him, he was seen with the mother, on such and such a date, etc.. Paternity tests are ordered. ... The gossip world waits on tenterhooks. ... The tests come back and the verdict is ... he's not the father! Edwards takes a victory lap, vindicated. In acknowledging his innocence of the sensational paternity charge, the press and public would overlook the less sensational, but still damning truth--which is that he'd been cheating on his cancer stricken wife after basing his campaign in large part on his faithfulness.
That didn't happen, of course. I think we can guess one reason why! But now there is a credible rumor of a similar PR sleight of hand in the works that would, in theory, allow Edwards to slink away from his (hypothetical) guilt on the issue the paternity tests would have resolved. It would go like this (I'm paraphrasing):
When the grand jury investigating Edwards on campaign finance charges (e.g., did he illegally use campaign money to pay Hunter?) comes back with "not sufficient to press charges," Edwards will in short order admit it's his kid. The idea is that the grand jury's "insufficient evidence" finding will start refurbishing his image, and that this news will overwhelm his admission of paternity (even though he specifically denied paternity was even possible** in his BS-riddled 2008 Nightline "confession").
It's just a rumor, remember!
The key to the rumored PR scenario would be that the respectable MSM is allowed to care about criminal charges while it still pretends not to care about mere sex. So the grand jury findings will get unjustified play, relative to the paternity admission.
It's a brilliant plan! And if this brilliant plan really is the plan ... well, if Edwards thinks it will work he's deluded.
**--Exact quote: "I would welcome participating in a paternity test. Be happy to participate in one. I know that it's not possible that this child could be mine because of the timing of events, so I know it's not possible. Happy to take a paternity test, and would love to see it happen." [Emphasis added] Transcript here. 4:50 P.M.
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Lehanism's Biggest Failure? Here's a thought: What if Obama said, to the health care protesters and worried seniors, "I understand your concerns" instead of letting his press secretary and party allies sneer at them (for being "well-dressed" or thugs or dupes who don't know "the facts," etc.)? Isn't that more the Obama Way, as opposed to the Lehanist "fight club" way? Obama might even fire Orszag order up a few changes in the proposed legislation to alleviate some of the seniors' worries. ... P.S.: We can always control long term costs in the long term--i.e. later--just as Orszag's curve-bending schemes, even if they pass intact, could always be repealed by a new Congress and President. These are all things that will happen at least ten years from now! They aren't worth blowing universal health care over. ... P.P.S.: Hillary Clinton's plan, if I recall, did not make the mistake of making a big deal of long-term medical cost control. Maybe if she were still in the Senate she'd be making that point. ...
Backfill: Marc Ambinder may want some of his twitters back one day. ... 10:32 P.M.
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Change in Blog Dress Code: Effective immediately, readers are requested not to read kausfiles in a suit. We are trying for a more artistic atmosphere. This ban also applies to the fancier kind of pajamas--you know, the ones with the piping. Thank you for your cooperation. 10:16 P.M.
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Sarah Palin had a point! [via JTlol] 1:30 A..M.
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Chuck Lane: House health bill's free end-care "consultations"--not so innocent! A subsidized and scripted "nudge" toward a DNR order from a white-coated authority figure. ... 1:28 A.M.
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WaPo: "[B]arely one-third of seniors support a health-care overhaul, several polls found." Why? They like Medicare as it is, they're scared of Obama's changes, and Obama has conspicuously failed to reassure them. ... But the Post's Ceci Connolly seems (at least at one point) to assume, Beltway-style, that seniors' fears must be due to the $563 billion in Medicare savings over the next decade, as opposed to Orszagist curve-bending after that. ...
P.S: Connolly reports the White House is considering "reaching out to skeptical seniors" through a ''myth-busting' Web site." That'll do it! Game over! ... Even assuming a web site could have a big impact, "myth-busting" sites don't tamp down paranoia,in my experience. They stoke it. If an answer is only 85% satisfying, the other 15% suddenly seems very significant. Take Obama's recent attempt to reassure Karen Tumulty on the "rationing" question:
[T]his is my point, I think that there's this perception that you either have rationing that is very stringent and sort of makes you wait for months before you can get your cancer treated or you can never get your knee replaced, right, all the horror stories you hear from the British model or the Canadian system that people who are opposed to reform always trot out. Or, alternatively, you just have this bloated system in which we don't even try to make it rational, we just sort of live with what we have. And what I'm trying to suggest is, is that there's this huge space in between where we could make the system much more efficient, much more cost-effective, make people much healthier, and still not have to resort to some of the rationing that people are fearful of. ..
So we don't go all the way to Britain. We go halfway to Britain! ... Obama can't bring himself to say we won't ration. But we won't resort to "some" of the rationing. ... Reassuring! ... 1:26 A.M.
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For @jayrosen_nyu: What was so bad about the L.A. Times' "wikitorial"? How was it "arrogant"? My impression is they shut it down because they got hacked, not because it wasn't a potentially interesting experiment. ... Update: Rosen's response. ... Who's arrogant again? ...
P.S.: Actual kf Twitter feed is here. ...1:25 A.M.
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Friday, August 7, 2009
Twitter seems to be down. That doesn't stop the All-Platform Journalist! Here's what I would have posted:
Friday afternoon shocker! http://tinyurl.com/ks7f7g 4:44 P..M.
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Lloyd! Before you let them call Lou Dobbs "immigrant-hating" in your intro you should maybe come up with at least one (1) example of Dobbs hating immigrants. Don't let The Beast turn you into a cliche ball of lib elite prejudices! ... 1:47 P.M.
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A good campaign song for practically any Democrat. Ignore lame intro. ... 1:46 P.M.
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Not my finest two minutes on Bloggingheads. ... I guess the short answer I couldn't come up with is that our system is biased against change. It's easier to block something by populist demonizing than it is to enact something by populist demonizing. ...Plus, at this point, the "demons" voters are most scared of are not insurance companies but Obama's own oh-so-rational cost-cutters. ... 1:45 P..M
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Thursday, August 6, 2009
Mary Katharine Ham does a pretty thorough job of undermining the basis for Rachel Maddow's influential piece claiming that health care protests are "astroturfed." ... Maddow also had a couple of what looked like videotaped instances of geniune thuggishness, though the right-wing memo she cites as orchestrating the "hooliganism" actually says "Don't carry on and make a scene, just short, intermittent shout-outs ..."
P.S.: If an "astroturfing" campaign gets real people to show up at events stating their real views, isn't it ... community organizing? ... 5:04 P.M.
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Tim Noah has a terrific, opinionated page of health care links, including a putdown of kf. But he seems a bit Orszag-skeptical himself. ... 5:02 P.M.
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Incoming: Chuck Lane on two things that might change the health care CW (which holds that Dems will pass something): a) if the delayed mid-session budget review--now due later this month--shows a much-worse-than-expected deficit b) if Dems lose big in the NJ and Virginia elections ... 5:00 P.M.
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From out here on the West Coast, it sure looks as if OMB Director Peter Orszag is the Donald Rumsfeld of the looming health care quagmire, in the sense that a) it's his strategy that's failing--at least failing to win over public opinion; and b) it's hard to see how the strategy changes with him in the position he's in, and c) he's a logical fall guy in any case. ... What did he do wrong? His insistence on--and insistence on talking about--long-term cost-bending successfully scared off a large segment of the American electorate by raising the issue of rationing. Hearts and minds. And it was all unnecessary, if (as he claims) health care reform can be deficit neutral over the next ten years without the curve bending. If the curve can be bent it can be bent later. Or at least more quietly ... P.S.: I'm told Orszag's possible departure was a hot rumor over at one of the cable TV channels--just a rumor, and not broadcast as far as I can see, and also the logical rumor to make up. Still, Kausfiles is applying the old Nader principle:** If you hear that something might be about to happen, call a press conference and demand it! ...
**--Attributed to Nader by one of his admirers, in any case. ...12:16 A.M.
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Tuesday, August 4, 2009
Jonathan Alter, pretending he's for the health care status quo to show how absurd that is, touches on the reason why I'm also attracted to government-run health care: because it will be less stingy with treatments and procedures than private insurers.
Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the insurance companies—not doctors—decide what's reimbursable. After all, the insurance companies know best.
The problem, of course, is that if the government won't second guess your doctor in the name of saving money, then how is it going to "bend the cost curve" as Obama promises it will? Won't more treatments cost, you know, more? At the very least, Alter's desire sits uncomfortably with Obama's cost-cutting rationale. And it sits very uncomfortably with Obama's concrete proposal to establish a commission of cost-cutting bureaucrats-- government bureaucrats rather than private ones--whose purpose is precisely to "decide what's reimbursable" even if your doctor might disagree. ... I suppose you could argue that Obama's expert cost-cutters will be so brilliant that you'll get all the treatments the evil insurance companies would deny you and be denied only treatments--duplicative X-rays, etc.-- you really wouldn't want anyway, with the net result of a huge cost savings. That seems a tough sell, though. ... [You have better solution?-ed The solution is to not expect pretend that health care security will save money.] ... 11:30 P.M.
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If the Cash for Clunkers program was insidiously rigged to steer people toward SUV purchases, it doesn't seem to be working. Seven of the top 10 cars purchased are small sedans. One is a midsized sedan. One is the Ford Escape, a small SUV. The 10th is the Dodge Caliber, which is a sedan pretending it's sorta kinda an SUV. .. 4:05 P.M.
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Is it possible that Dem politicians are in for an August of furious town hall feedback so brutal that it all becomes absurd and breeds a grim, amused fatalism that actually steels them to proceed on health care? Just asking. ... If you're going to die, might as well die having enacted universal health care. ... Remember how Tom DeLay and the GOP reacted to their drubbing at the polls in 1998 on the impeachment issue? (They went ahead and impeached.) ... 4:04 P.M.
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Monday, August 3, 2009
Rep. Lynn Woolsey still seems to be threatening 60 liberal votes to sink the House health care bill unless it has a "robust public option" with "rates based on Medicare rates." Nobody believes her, which is why people at a recent Pelosi press conference were laughing at her. .... House liberals would be lucky, at this point, to get the Blue Dog deal, inferior though it may be. ... Isn't there some introductory Welcome to Congress course where they tell you that threatening something you obviously won't deliver is a way to lose respect and power? But Woolsey has been there a long time. ... 11:16 P.M.
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Want a Grant? Get a "Partner": John Rosenberg reads the House Energy & Commerce health bill and finds that there is a whole lot of "coordination of diversity and cultural competency programs" going on. He sees future funding streams for leftish community organizers in the bill's requirement that when it comes to cultural competency program coordination,
the Secretary shall give preference to entities that have a demonstrated record of the following:
(1) Addressing, or partnering with an entity with experience addressing, the cultural and linguistic competency needs of the population to be served through the grant or contract.... [E.A.]
That's in the version of the bill that Rep. Woolsey says she won't vote for because it's not liberal enough. Where are the Blue Dogs when you need them? ... P.S.: Was the big, program-establishing New Deal and Medicare legislation festooned with these little Dem interest group time bombs? If not, that may be why it got passed.** ...
** Admittedly, it was a big liberal time bomb in the New Deal legislation, allowing cash payments to children in families with an "absent" breadwinner, that eventually produced the welfare explosion of the 1960s. ...
Preexisting Meshugas: Frum notes the University of Chicago Chicago School of Professional Psychology** has a
“Center for Latino Mental Health,” based on the proposition that American Hispanics have “unique” mental health needs.
Kind of undermines the social-egalitarian everyone-in-the-same-waiting room rationale for universal health care, doesn't it? Though I suspect the Center for Jewish Neuroses will be heavily utilized. ...
**--Sentence corrected 8/6. [Thks to reader J.S.] ... 11:03 P.M.
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A Sunday NYT "Week in Review" piece ridicules the famous Dem think tank Third Way for predicting a "crime wave" due in part to "the lengthening shadow of illegal immigration"--when, in reality, illegal immigration receded and crime ... went ... down. ... Hmmm. ... Maybe broken immigration laws are a bit like broken windows, a contagious sign of disorder. Just a thought! ... P.S.: The Times piece also does not discuss the reduced-lead theory, which would seem to roughly fit the trend of permanent lower crime, no? ... 11:03 P.M.
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Sunday, August 2, 2009
Tip for Dems: If you don't want people to think that subsidized, voluntary end-of-of-life counseling sessions are the camel's nose of an attempt to cut costs by limiting end of life care, then don't put them in a bill the overarching, stated purpose of which is to cut health care costs! ... I mean, did that provision have to be in the bill? If it really was just an added "benefit" for patients that had nothing to do with cutting costs (which I don't believe for a minute), did it even belong in the bill? Isn't there some group of Congressional Democrats--let's call them "the leadership"--whose job it is to prevent their co-partisans from inserting into major legislation relatively minor provisions that will have the effect of sinking the whole package? ...
Update: Clive Crook notes that Obama has managed to get all the political grief that comes with incessantly talking about cutting costs without doing much to cut costs! The missed alternative: Simply "sell access and health security as things worth paying for." Seems almost like an easy sale now, doesn't it? ...11:26 P.M.
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Last week's twitters today at kf:
Next CW: Is delay so bad for health reform? Economy recovers. Obama, Dems get more popular. Pass health care then (2010).4:37 PM Jul 30th from TweetDeck
Dutch welfare state breeds Smart-tipping hooligans http://tinyurl.com/nz5do 23:07 PM Jul 30th from TweetDeck
Patterico thinks he can make out what Gates is saying on that 911 tape. http://tinyurl.com/lsggqq 6:29 PM Jul 27th from TweetDeck
Cong. misses pre-recess health reform deadline. Does anyone seriously think there'll be a vote when they get back in Sept? Didn't think so 2:30 AM Jul 26th from web
10:03 P.M.
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