Wednesday, November 25, 2009

The bottom line on health care reform

Whether you argue health care reform is really about moral values or the fact that the current system is literally going bankrupt, it's difficult to logically oppose changing the system. A recent analysis by Ron Brownstein in The Atlantic finds that health care economists across the political spectrum agree that the Reid bill being debate in the Senate is the best shot we have at fixing the broken system:
When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won't succeed unless it "bends the curve" in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

"I'm sort of a known skeptic on this stuff," Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. "The bottom line," Nichols says, "is the legislation is sending a signal that business as usual [in the medical system] is going to end."
More from Steve Benen at Political Animal.

PS: Republicans love criticizing the length of the bill, as if that's a valid argument. Legislative bills are printed up with huge margins, large font, numbered lines and double spacing. This causes them to be much lengthier than typical reading material. A recent analysis by the AP finds that the length of the healthcare reform bill is actually about 209 normal pages:
Actually, Leo Tolstoy's tome [War and Peace] is longer than either bill. Full translated versions are nearly twice as long.

The bill passed by the House is 319,145 words. The Senate bill is 318,512 words, shorter than the House version despite consuming more paper. Various versions of Tolstoy's novel are 560,000 to 670,000 words. Bush's education act tallied more than 280,000 words.

By now, the full draft of Reid's bill that had circulated in the corridors and landed so prominently on Republican desks has been published in the Congressional Record in the official and conventional manner.

The type is small and tight. No hernias will be caused by moving this rendering of the bill around. Unfurling it on the Capitol steps would not be much of a spectacle.

It's 209 pages.
That's less than Palin's new 400+ page book.

Monday, November 23, 2009

Follow actual principles, "centrists"

Given the fact that the Republicans are already going after supposedly "centrist" or "moderate" Democrats, painting them as wild-eyed liberals hell-bent on destroying America, perhaps their penchant for ass-covering and concern for election prospects need a new perspective. The idea that they'll win over "moderates" by supporting a Republican filibuster on healthcare reform is insane. The people who want them to support a GOP filibuster are the same people who will vote Republican anyway. I think that all of the "Blue Dogs" and the center-right Dems in the Senate should do a simple thing: support reform behind-the-scenes by voting for cloture and progressing a bill through the legislative process, and turn around and attack opponents from the left side of the debate.

Attacking Republicans from the right, or, insanely, attacking Dems from the right, will not net these Democrats a single vote. And liberals like me don't want to support candidates who act and sound more like Republicans than Democrats.

Steve Benen lays out what I think is a much smarter strategy for vulnerable Congressional incumbents:
Matt Yglesias raises a good point: "A lot of members of congress spent 1993 and '94 spiking the Clinton legislative agenda and then went down to defeat in November 1994 anyway. Wouldn't it make more sense to turn the 111th Congress into a substantive success, hope you can persuade the voters that these are good ideas, and if you fail at least manage to have gone down fighting accomplishing something important?"

If I were a campaign strategist for Blanche Lincoln, I'd go a little further -- I'd encourage her to become the biggest champion of bold, progressive health care reform in the Senate. I'd urge Lincoln to show some major leadership, get out way in front, and position herself as a Kennedy-like guardian of those suffering under the status quo.

Look, Lincoln isn't going to out-conservative the Republican candidates in Arkansas. No matter how she votes on reform, the entire Attack Machine is going after her as some kind of radical leftist. It doesn't matter if it doesn't make sense, and it certainly doesn't matter if she votes with Republicans on the big issues of the day for the next year.

So why not go big? Why not announce that too many Arkansas families are being screwed right now by a dysfunctional health care system and Blanche Lincoln has decided to do something about it? Why not run ads saying, "I don't care what the insurance companies and their candidates say: I'm fighting for the families who can't afford their premiums, the workers who can't get coverage, the Arkansans with pre-existing conditions, the small businesses that can't afford insurance for the employees...."?

In other words, show some confidence. Voters can recognize fear, so stop being defensive. Arkansas has a high percentage of low-income families, struggling to get by, who are terrified of their health care situation. They're not going to vote Democratic on cultural and/or social issues, but they're open to the Democratic message on economic policy -- looking out for working families' interests. A candidate who positions herself as a populist people's champion has a better shot than an apologetic Democrat who hopes Republicans won't mind her party affiliation.

When Republicans accuse her of supporting an overhaul of a broken system, Lincoln might want to try saying, "You're damn right I do. Why don't you?"
Exactly.

Saturday, November 14, 2009

Framing health care reform

So Republicans now use the phrase "government takeover" to describe changes to the private insurance industry's practices of denial of coverage based on pre-existing conditions, rescission during sickness and offering a voluntary public option (a Medicare-like plan) to a small segment of the population. The logical and evidential problems with their arguments don't even matter to opponents of reform. It's as simple as, "Government = bad. Reform = government. Reform = bad!"

It seems many CEO's aren't so stupid:


From the BRT report:
"The report also shows that reform done wrong ... could make a bad situation much worse, in which case Business Roundtable could not support the bill," Eastman Kodak (EK.N: 行情) Company Chairman and Chief Executive Antonio Perez said in a statement accompanying the release of the report.

Obama said it was further evidence that the U.S. healthcare system is broken.

"If we don't pass comprehensive reform, the report finds, health care costs that are already squeezing our businesses will continue to rise, and in 10 years, employment-based spending on health care for large employers will be fully 166 percent higher per employee than it is today," the president said in a statement.

"The yearly health insurance costs for the average employee will rise to a staggering $28,530," he added, citing a finding by the report.

Companies represented by the Business Roundtable, which includes such giants as Verizon Communications Inc. (VZ.N: 行情), The Boeing Company (BA.N: 行情) and Exxon Mobil Corp. (XOM.N: 行情), provide health insurance to more than 35 million workers and their families. The group has been a major force behind the healthcare overhaul push.

Of course, the fact that businesses support real reform doesn't help the lies and propaganda effort to kill change by the GOP, so they're pretty pissed about it.

Friday, November 13, 2009

Thursday, November 12, 2009

Anybody have a puppy who can talk?

I was sent two videos to watch by my very conservative, Faux-News-watching mother in an email: part 1, part 2. She wrote:
You wonder why we are worried regarding the health care bill. If you can't look at how the govt. has handled medicare, etc. and be afraid of this I don't know what it would take. My premium raised to 624. monthly with higher deductibles and copays so I am quite aware of the fact that reform is needed. I would start with buying ins. across state lines and tort reform. I would not throw out the baby with the bath water. If you have an open mind, I dare you to read this. Remember, you, * and * will be seniors one day. Also, I don't think this can be paid for. But you probably won't listen just like you never want to hear the other side, only send me links regarding your side which I do listen to and read. Double dog dare you. Triple dog dare you, love mom
As I watched it, I was immediately struck by how this old man talking "from the heart" about health care reform reminded me of Rep. John Shadegg's (R-AZ) use of a baby the other day during a floor speech. In both cases, the people have terrible arguments and try to compensate for that via emotional appeal.

Anyway, I started to compose a reply after watching the video but realized it would do nothing to persuade her of her folly. I tried when she sent me Christian Nation bull crap emails and she just flatly refused to acknowledge the facts. People like this don't let the facts get in the way of a strong belief. That's why they're religious too. So I decided instead to post my reply here:
Generally speaking it isn't very effective to call someone narrow-minded and then use "dares" to goad them into reading or watching something that represents a different point of view than their own.

I feel sorry for Bill Crawford. His rambling was incoherent.

Starting at the beginning...

He was taught to unquestioningly respect "leaders" like a dog rather than expect them to earn respect. That's definitely present in religious thinking. Yes Medicare has problems but I'm quite sure Bill doesn't bother to worry about those problems every time he uses his "government run" insurance. He also repeats a GOP talking point that the government is "taking over" health care and that a bureaucrat will "get between you and your doctor"...let's see Bill...when you use your Medicare do they call a government agent and ask them for permission to take care of you? Um, no. As it is right now, though, my private insurance requires "pre-authorization" for certain medical care. A private insurance agent gets "between me and my doctor" right now.

Bill is also confused about the name calling. The people likening health care reform to Nazism, death camps, etc., are *all* opponents of reform trying to scare old people like Bill. Glenn Beck loves to compare Obama to Hitler, Stalin, Lenin. It worked, obviously, and confused him. Who exactly called seniors names? I'd love it if he could point out one Democratic legislator calling opponents to reform Nazis. Perhaps he's referring to Speaker Pelosi's factually-accurate observation that some people are bringing "swastikis and symbols like that to town halls".

Bill is exactly right that people can "get health care" by going to the ER and that all of us have to foot the bill for it. One catch, though: the only guaranteed care is "life-threatening". Which is what an ER is for. Not getting antibiotics and preventative care and screenings...Which is a good reason to want to change the system. This means that those without insurance end up often having to wait until their problems become catastrophic before being able (or willing) to go to the ER.

Bill is full of shit about not getting heart transplants and cancer treatments. Period. Spin it however you want, but a lie is a lie. There is nothing, *nothing* in any bill that says that you will get "death counseling in lieu of treatment"...it's just complete hysterical nonsense from a frightened old man. Find a way to make sense of that lie. I'd love to hear it. The "death panels" BS that idiots pass around is just sad. The bill provides a reimbursement to doctors for *voluntary* counseling as a service. End of story.

If you want to read the language of the bill that just passed the House regarding this counseling, here it is (HR 3962 Section 1233):
`(3) An individual may receive the voluntary advance care planning care planning consultation provided for under this subsection no more than once every 5 years unless there is a significant change in the health or health-related condition of the individual.

`(4) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that effectively communicates the individual's preferences regarding life sustaining treatment, is signed and dated by a practitioner, and is in a form that permits it to be followed by health care professionals across the continuum of care.'.

(b) Construction- The voluntary advance care planning consultation described in section 1861(hhh) of the Social Security Act, as added by subsection (a), shall be completely optional. Nothing in this section shall--

(1) require an individual to complete an advance directive, an order for life sustaining treatment, or other advance care planning document;

(2) require an individual to consent to restrictions on the amount, duration, or scope of medical benefits an individual is entitled to receive under this title; or

(3) encourage the promotion of suicide or assisted suicide.
But yet the myths continue because propaganda outlets that Bill trusts continue to promote falsehood under the pretense of "giving time to both sides of a 'debate'..."

Like many people, Bill is angry and confused and needs to be consoled. That doesn't mean that he makes any valid points.

The GOP alternative that was voted down just hours before the House bill passed was pretty funny. Did you read about it? No requirements to protect people from "pre-existing conditions" clauses. No protections from rescission. No real improvement for people who are uninsured.

As for your premises about why health care reform "can't be paid for"...think again. A lot of people use very poor logic in asking the question, "How can you spend money to save money?" That's like me arguing that if you want to save on energy costs in the long term the only solution is to cut down the thermostat. If this isn't possible, or a good option, you could invest in energy-efficient windows and a central air system. Although it requires up front investment, you save money over the long term. That's the case with health care...

We're already bankrupting the system because of the issue of how the system is right now. The government already pays 46% of all health care expenses in the US. The private insurers pay about 37%. The rest is out-of-pocket.

The entitlements problem will continue to grow with our top-heavy population chart (more old people than young). But if we can reign in health care costs by overhauling the system then we can possibly prevent total fiscal collapse. This is a problem that Republicans kicked down the road every single time they held office and could do something about it. Everyone knows our entitlements are literally headed for failure and something must be done about it. No Republican has had the courage to face the issue since Newt Gingrich's proposal for drastic cuts in Medicare in 1995.

Let's assume the House bill passes the Senate just like it is (it won't). Paying $1.2 trillion over 10 years works out to approximately two-thirds the cost of the Bush tax cuts, half of the long-term cost of the Iraq War (including long-term health care for vets, not just the annual supplementals to the budget), and about 15% of our defense budget. That's right, we pay about $1 trillion dollars or more *every year* in defense spending, a *huge* part of that right now for two wars, the rest of which largely ends up as pork and wasteful spending and research for technologies that are completely useless (think missile defense, "Star Wars"...). Meanwhile, over 45,000 people die annually in the US from lack of access to basic medical care, ten times the casualties on 9/11. A new Harvard study estimates even higher numbers, that every 12 minutes someone dies from lack of adequate care, meaning every three weeks more people die from lack of health care than from 9/11.

Yet I definitely don't remember hearing that we couldn't afford the Bush tax cuts, or the Iraq War, and we don't hesitate to throw billions and billions of dollars at a remote possibility that a few thousand people *might* die from a terrorist attack. And of course if you don't support every facet of a defense bill, including ordering planes that cost a billion dollars each to make and research on laser weapons then you're a cowardly liberal who hates their country. Or something.
I could write more but I got tired. I think I'll teach my baby how to read from posterboards and talk into a camera so I can make my own propaganda videos.

Wednesday, November 11, 2009

Term limits

I'm not sure how I feel about Congressional term limits. At first the idea is immensely appealing: get rid of entrenched politicians who seem most liable to corruption and influence peddling. But can't we do that via the election process? The counterargument seems to be that some people are really good at representing our interests and we should be able to keep them if we want them.

And the hilarity is how Jim DeMint is the principal sponsor of the bill, limiting House Reps to 3 terms (6 years) and Senators to 2 terms (12 years).

...DeMint served in the House from 1999 - 2005 and he's been in the Senate ever since. Think he should step down if he really believed in his own "ideals"? Want to bet whether he will?