Via Dave Weigel, an unusually useful poll from Rasmussen Reports:
Given a choice of three options, just 24 percent of voters can correctly identify the cap-and-trade proposal as something that deals with environmental issues. A slightly higher number (29 percent) believe the proposal has something to do with regulating Wall Street while 17 percent think the term applies to health care reform. A plurality (30 percent) have no idea.
The political press has a very strong structural bias toward overestimating the extent to which the public has real opinions about hot political issues. I wish more pollsters would put these kinds of polls in the field that do something to probe the extent of public ignorance. Polls that attempt to directly probe the public’s views about cap and trade wind up measuring a lot of pseudo-opinion. As you can see right in this result, people are incredibly unwilling to admit that they “don’t know” something or other. Thus 46 percent of the public says they know what cap and trade is about even though they don’t, in fact, know what it’s about.
mcjoan (Daily Kos):
This absolutely is the "tremendously good omen" that Krugman says it is, in the sense that these private stakeholders recognize that reform is coming and that they have to be on the train. For those of us involved in the Clinton reform effort, who saw it killed by the insurance industry's "Harry and Louise," it's pretty remarkable. That said, we all, including Krugman, have our suspicions.
While the White House officials on yesterday's call repeatedly said that there was no quid pro quo in this initiative--that a public option was still among President Obama's goals, there's plenty of concern that these private stakeholders are going to attempt to use the leverage they are gaining by becoming partners with the White House to kill it. On the other hand, politically, what they've done effectively isolates the Republicans in the debate and, ultimately, signals that health care reform will happen this year.
But this is just the beginning, ...
Ezra Klein: UNADULTERATED GOOD NEWS ON HEALTH REFORM.
Benen: PATIENT-DRIVEN RATIONING....To counterbalance the crankiness of the previous post, Peter Orszag's announcement that the administration is not only continuing to support is $635 billion health care fund, but actually adding pieces to it, is important news. The key issue in health care reform is, quite simply, financing. Right now, the policy exists. The money doesn't. In fact, when the Senate passed its version of the budget, the specific financing provisions in the administration's health care reserve fund were deleted entirely.
Eventually, that money will have to come back. And so it's good to see the administration sticking behind its proposals, even the ones that got a little beat-up in the previous round. They've kept, for instance, the idea to limit the itemized deductions of the richest Americans, even though that took some flack when it was initially announced.
This gets to the administration's larger theory on revenues: They have a habit of offering up financing ideas well in advance of the financing discussion. Their health care financing ideas, for instance, came long before anyone had seen a draft of the Finance Committee's health care policy. They came long before any legislators actually needed to make tough choices on how to pay for health care.
As such, the proposals just got beat up by the people who didn't want to see their taxes lift. But the administration didn't see that as a loss. They're not expecting their financing ideas to achieve a quick adoption. Rather, they're familiarizing the political system with these proposals. That's not a pleasant process. But if the ideas are good and the counterarguments tinny, then, when legislators actually need to figure out how to pay for things, the expectation is that they'll come back to some of these concepts. It's as the old saying goes: "First they ignore you, then they mock you, then they fight you, then you win."
Best health care in the world.In hindsight, maybe Jesse Ashlock shouldn't have walked out of the New York emergency room last summer, only a couple hours after being knocked unconscious in a Brooklyn bicycle crash.
Medical crews told him he needed a blood test, chest X-rays and probably a CT scan to check for head injuries. And he certainly should have had treatment for major road rash, including raw scrapes on his face, neck and hands.
But the 31-year-old editor for a design magazine was between jobs, briefly without health insurance and afraid of being stuck with a sky-high hospital bill. The doctor on duty dismissed Ashlock's questions about cost, telling him she was "a physician, not an accountant," he said.
So Ashlock stalked out of Woodhull Hospital without treatment, becoming part of a small but growing number of patients turning down emergency care because they fear they can't afford it.
In Ashlock's case, he had to make a decision. On the one hand, he was afraid of the hospital bill. On the other hand, he was afraid to go to sleep, since if he had a concussion, he could slip into a coma. He decided the fear of the hospital bill was more intense, so he went home. (He's fine.)
The MSNBC report is a little fuzzy on specifics, but said physicians are finding stories like this increasingly common. A growing number of patients are refusing certain treatments, tests, and exams, which they suspect will cost too much. It is, in effect, patient-driven rationing.
Dr. Sara L. Laskey, who who works in the emergency department of MetroHealth Medical Center in Cleveland, Ohio, told MSNBC about a woman with bronchitis and pneumonia with life-threatening oxygen levels. She refused treatment -- even after Laskey tried to arrange for an oxygen kit to be sent to the woman's home -- because she didn't have insurance.
"She refused, saying she would share her husband's oxygen," Laskey said. "Ultimately she left without the oxygen or an admission."
When patients are more afraid of medical bills than life-threatening ailments, there's a problem.
McJoan (Daily Kos): President Obama Announces Private Health Care Cost-Control Plan
President Obama just publicly announced the new private partnership for health care reform introduced last night.
The full transcript will be available at Daily Kos TV, but here's a snippet:
Their efforts will help us take the next and most important step -- comprehensive health care reform -- so that we can do what I pledged to do as a candidate and save a typical family an average of $2,500 on their health care costs in the coming years. Let me repeat that point. What they're doing is complementary to and is going to be completely compatible with a strong, aggressive effort to move health care reform through here in Washington with an ultimate result of saving health care costs for families, businesses and the government. That's how we can finally make health care affordable, while putting more money into the pockets of hardworking families each month. These savings can be achieved by standardizing quality care, incentivizing efficiency, investing in proven ways not only to treat illness but to prevent them.
This is a historic day, a watershed event in the long and elusive quest for health care reform. And as these groups take the steps they are outlining, and as we work with Congress on health care reform legislation, my administration will continue working to reduce health care costs to achieve similar savings. By curbing waste, fraud, and abuse and preventing avoidable hospital re-admissions and taking a whole host of other cost-saving steps, we can save billions of dollars, while delivering better care to the American people.
The basics of this partnership are to reduce the rate of increase in health care costs by 1.5 percentage points over the next 10 years, amounting to $2 trillion in savings. Note, as President Obama stressed in his remarks, this is not a health care reform plan. This is not a substitute for the legislative reform being shaped now in Congress. (For some thoughts on that side of the equation, don't miss David's post at Congress Matters).
The White House has also released a fact sheet [pdf] and the letter [pdf] these groups wrote to President Obama, announcing the partnership. The meat, thus far, is in the letter:
We are committed to taking action in public-private partnership to create a more stable and sustainable health care system that will achieve billions in savings through:
- Implementing proposals in all sectors of the health care system, focusing on administrative simplification, standardization, and transparency that supports effective markets;
- Reducing over-use and under-use of health care by aligning quality and efficiency incentives among providers across the continuum of care so that physicians, hospitals, and other health care providers are encouraged and enabled to work together towards the highest standards of quality and efficiency;
- Encouraging coordinated care, both in the public and private sectors, and adherence to evidence-based best practices and therapies that reduce hospitalization, manage chronic disease more efficiently and effectively, and implement proven clinical prevention strategies; and,
- Reducing the cost of doing business by addressing cost drivers in each sector and through common sense improvements in care delivery models, health information technology, workforce deployment and development, and regulatory reforms.
This absolutely is the "tremendously good omen" that Krugman says it is, in the sense that these private stakeholders recognize that reform is coming and that they have to be on the train. For those of us involved in the Clinton reform effort, who saw it killed by the insurance industry's "Harry and Louise," it's pretty remarkable. That said, we all, including Krugman, have our suspicions.
While the White House officials on yesterday's call repeatedly said that there was no quid pro quo in this initiative--that a public option was still among President Obama's goals, there's plenty of concern that these private stakeholders are going to attempt to use the leverage they are gaining by becoming partners with the White House to kill it. On the other hand, politically, what they've done effectively isolates the Republicans in the debate and, ultimately, signals that health care reform will happen this year.
But this is just the beginning, and as Ezra points out, some of these players actions on reforms that are on the table now contradict what they say they will do.
What we have, in other words, are promises of future cost containment that exist alongside concrete and continued opposition to the cost containment ideas that are actually on the table. And for good reason. A 1.5 percentage point decrease in health spending is a 1.5 percentage point decrease in medical industry profits. This commitment doesn't contain any examples of concessions that will reduce a participant's revenue streams. Conversely, every time legislators have proposed a reform that will actually cut industry profits -- and thus cut health spending -- the industry has howled in pain and anger. It's hard to sync that with promises to cut spending by $2 trillion over the next 10 years by implementing a set of unspecified reforms.
This isn't the magic bullet to a health care reform or to a system that adequately covers every American. It's an extremely significant step, mostly politically, but the real action is still going to be happening in the Senate, and those are the levers we're going to have to be paying the most attention to.
Sully: Quote For The DayI just got off the phone with Andy Stern, head of SEIU. For the past few years, Stern has been manically building coalitions. This, it seems, was the payoff: The ultimate health care coalition. Every major industry group. And SEIU was at the table with them.
Stern acknowledged that the early release is light on specifics. But that, he argued, was a function of it being early. "We set a deadline of June 1st to try to provide real proposals that can be costed. It'll be complicated to decide what goes in the legislation. But we'll have competent people providing verifiable savings." That deadline is important. June is when the Finance Committee's first bill drops. So if these stakeholders want to see their proposals in that bill, then they need to move quickly.
Asked about the possible flashpoints in the discussions, Stern said that "there was more of a recognition that we weren't going to agree on certain things. People came to the table with an admission that there were lines -- like the public plan, for SEIU -- that weren't going to be crossed and so weren't going to be a part of this conversation. Instead, we focused on what we could agree on on."
"I thought there was a level of seriousness on both sides about really finding the right way to cut costs, to look at health care as a system, and not just a system for payments, but a system for actually keeping people healthy," he continued. "So far, everyone has exceeded expectations."
"As a child in Tibet, I was keenly curious about how things worked. When I got a toy I would play with it a bit, then take it apart to see how it was put together. As I became older, I applied the same scrutiny to a movie projector and an antique automobile. At one point I became particularly intrigued by an old telescope, with which I would study the heavens. One night while looking at the moon I realized that there were shadows on its surface. I corralled my two main tutors to show them, because this was contrary to the ancient version of cosmology I had been taught, which held that the moon was a heavenly body that emitted its own light. But through my telescope the moon was clearly just a barren rock, pocked with craters. If the author of that fourth-century treatise were writing today, I'm sure he would write the chapter on cosmology differently.
If science proves some belief of Buddhism wrong, then Buddhism will have to change. In my view, science and Buddhism share a search for the truth and for understanding reality. By learning from science about aspects of reality where its understanding may be more advanced, I believe that Buddhism enriches its own worldview," - the Dalai Lama.
Ezra Klein: EXTREMELY TRUE STOCK MARKET COMMENTARY.
Ryan Avent -- demonstrating once again that some enterprising publication should hire him immediately -- offers the smartest commentary you'll read on the stock market today:
Today’s conventional wisdom seems to be that the recent market rally has hit an apex. My assessment is that it has either hit an apex or hasn’t, in which case it will go up or down.
This is 100 percent true. By contrast, analyses of today's stock market drop that do not say this are not 100 percent true.
Yglesias: Looming Credit Card Bust?
The credit card industry’s business model is basically a disaster waiting to happen. If people pay their bills in a timely manner, the credit card companies don’t make much money. And if people default on their bills, they lose money. So the correct strategy is to try to get people to carry heavy month-to-month balances that charge usurious interest rates without ever quite tipping over the brink into default. So far, it’s worked out pretty well for them, but Eric Dash and Andrew Martin observe that the happy days may soon be over:
ut if unemployment breaches 10 percent, as many economists predict, the rate of uncollectible balances at some banks could far exceed that level. At American Express and Capital One Financial, around 20 percent of the credit card balances are expected to go bad over this year and next, according to stress test results. At Bank of America, Citigroup and JPMorgan Chase, about 23 percent of card loans are expected to sour.
Even the government’s grim projections may vastly understate the size of the banks’ credit card troubles. According to estimates by Oliver Wyman, a management consulting firm, card losses at the nation’s biggest banks could reach $141.5 billion by 2010 if the regulators’ loss rate was applied to their entire credit card business. It could top $186 billion for the entire credit card industry.
Fortunately for the credit card firms, federal regulators have made it pretty clear that forebearance and bailouts will allow them to slink away from bad loans without too much trouble. But whatever the opposite of “green shoots” is, this could be that.
Meanwhile, it strikes me as a bit of a problem for neoclassical economics that if market interactions worked the way they say they do, the entire credit card industry would barely exist. People would understand the true cost of failing to pay off their full monthly balances and would almost never do so. And credit card companies would compete with one another to offer consumers a better deal on lending terms rather than competing to get more-and-more clever about tricking people into taking out loans that ill-serve their interests.
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