Monday, June 22, 2009

Health Care - Time for Action

Time for action folks. If we want meaningful health care reform in this country, and the polls overwhelmingly say we do, then we are going to have to make our elected reps serve our interests instead of moneyed special interests. - Get involved. Call and write your representatives. If a march can be organized in DC, be there.

Karen Tumulty: When Health Insurance Isn't Health Insurance (Cont'd.)

Paul Begala took note of our post the other day about some terribly tragic health insurance stories that had been told before the House Energy and Commerce subcommittee on oversights and investigations. And he pointed out something else:

It was as dramatic as congressional testimony gets. Yet it got no airtime on the networks, nor, as far as I can tell, on cable news, although did run a story. Time's Tumulty was all over it, as was Lisa Girion of The Lost Angeles Times. But the story did not make The New York Times.

Nor The Washington Post, which found space on the front page the morning after the hearing for a story on the cancellation of Fourth of July fireworks in Shippensburg, Pennsylvania, but not a story on the cancellation of health insurance for deathly ill Americans who've paid their premiums.

Stupak, and the Energy and Commerce Committee chairman, Henry Waxman, D-California, did their job. Why didn't the media do its? Why were the outrages uncovered by Stupak and Waxman un-covered by most of the media?

The more I thought about it, the more I realized what a missed opportunity this had been. There's no way I could possibly tell Robin Beaton's story nearly as powerfully as she did herself. So I asked C-SPAN's omnipotent Howard Mortman to dig up the clip out of their video library. Please watch this. It could happen to you or to someone you love.:

Christy Hardin Smith: Healthcare And The Economy: Time To Put The Public Back In The Policy

Digby points to a Catherine Rampel piece at NYTimes. In it, Rampel underscores a universal political truth:

According to two recent polls from The New York Times/CBS News and The Wall Street Journal/NBC News, Americans appear very worried about controlling the federal deficit.

...that most Americans put a higher priority on keeping the budget deficit down than on spending more money to stimulate the economy.

Creation of perception makes your political reality come to life, including through carefully Luntzian-crafted questions and manipulation of the after-messaging, regardless of the underlying facts and hard numbers.

Rinse, lather, repeat.

But only if we let it, as Digby aptly points out:

The fiscal scolds don't stop when the numbers turn around. They keep up the fear mongering because it isn't really about balanced budgets or paying down debt. It's about keeping government from bringing positive results to the people. As long as they can keep people focused on debt, whether it exists or not, they always have the rationale to stop any sort of government action that could empower average citizens.

And thus we come back to the question I find myself asking over and over again when mouths yap up and down about the "good of the country" and "too big to fail" and "the market will sort it out" -- what's in it for the person whose gums are flapping?

What skin do they have in the game? What promotional interest or PR ploy or electoral backscratch is involved on the down low?

Krugman has a piece on the health-care-palooza traveling carnival show we've all been watching. And Paul asks the question I keep asking myself:

If I had to guess, I’d say that what’s really going on is that relatively conservative Democrats still cling to the old dream of becoming kingmakers, of recreating the bipartisan center that used to run America.

Bipartisan zombies must go.

At what point does the public's interest get put back into the policy? As Yglesias says, the public option still has overwhelming support from the...public.

From the Blue Dogs, the well-heeled lobbyists, the suits and well-bonused fatcats....the elected officials who seem more interested in "what's in it for me" and whether the public gets the shaft? That's pretty much an empty bench when it comes to the public's interest these days, isn't it?

I don't know the answer on how to fix this, but I'm sick and tired of just being so pissed at the wasteful, self-serving bullshit.

John Anderson's wonderful piece on the Pecora Commission keeps haunting me:

To an extraordinary degree, in the halls of Congress, the conspiracy of silence continues to protect sinners on both sides of the aisle. That it is patently obvious that there are more sinners on one side of the aisle than the other doesn’t seem somehow important enough to alter the equation.

And so, as it was not quite 80 years ago, and as it was again in 1973, someone—some one man, some one woman—must break the logjam if ever we are to get at the truth.

I'm sick of waiting for the man (YouTube). Let's find a way to force the public back into the policy. Now.


On CNN yesterday, Sen. Dianne Feinstein (D) of California commented on the state of the debate over health care reform: "To be candid with you, I don't know that [President Obama] has the votes right now." She added, "I think there's a lot of concern in the Democratic caucus."

In context, Feinstein wasn't exactly lamenting the current state of affairs. In other words, she wasn't suggesting, "There's a lot of concern among Democrats, but I hope to convince them that reform efforts are sound and necessary." Rather, Feinstein made it sound as if she's discouraged by the entire initiative.

Paul Krugman made it clear in his column today that it's senators like Feinstein who will either deliver on reform or kill it. Republican lawmakers, by and large, do not even want to play a productive role in the process. Progressive Democratic lawmakers are moving forward with a strong plan, which includes a public health insurance option that competes with private insurers and keeps costs down. And then, there are the "centrists."

The real risk is that health care reform will be undermined by "centrist" Democratic senators who either prevent the passage of a bill or insist on watering down key elements of reform. I use scare quotes around "centrist," by the way, because if the center means the position held by most Americans, the self-proclaimed centrists are in fact way out in right field.

What the balking Democrats seem most determined to do is to kill the public option, either by eliminating it or by carrying out a bait-and-switch, replacing a true public option with something meaningless. For the record, neither regional health cooperatives nor state-level public plans, both of which have been proposed as alternatives, would have the financial stability and bargaining power needed to bring down health care costs.

Whatever may be motivating these Democrats, they don't seem able to explain their reasons in public.

Thus Senator Ben Nelson of Nebraska initially declared that the public option -- which, remember, has overwhelming popular support -- was a "deal-breaker." Why? Because he didn't think private insurers could compete: "At the end of the day, the public plan wins the day." Um, isn't the purpose of health care reform to protect American citizens, not insurance companies?

Over the weekend, we learned that the idea of a public option enjoys 72% support -- including 50% of Republicans -- in the latest NYT poll. It followed an NBC/WSJ poll that showed 76% of Americans believing that it's important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." What's more, a D.C. policy think tank conducted a poll, financed in part by previous opponents of health care reform, which found 83% of Americans favor a public plan.

The president is ready. The House is ready. The public is ready. The times demand that Senate Democratic "centrists" step up. Will they answer the call?

  • Joe Sudbay (DC) adds:
    Krugman deconstructs the blather coming from Senators Ben Nelson (D-NE) and Kent Conrad (D-ND), concluding:
    Honestly, I don’t know what these Democrats are trying to achieve. Yes, some of the balking senators receive large campaign contributions from the medical-industrial complex — but who in politics doesn’t? If I had to guess, I’d say that what’s really going on is that relatively conservative Democrats still cling to the old dream of becoming kingmakers, of recreating the bipartisan center that used to run America.

    But this fantasy can’t be allowed to stand in the way of giving America the health care reform it needs. This time, the alleged center must not hold.
    Something happens on Capitol Hill that makes people lose all sense of reality. As Chris noted yesterday, the latest NY Times/CBS poll showed "72% support" for the public option. That's very significant. But, Democratic Senators, like Ben Nelson, Kent Conrad, Max Baucus, Joe Lieberman and Mary Landrieu, would rather make friends with Republicans than provide the American people a decent system for health insurance. That's despicable -- and they're going to undermine a key piece of the Democratic agenda. The American people actually expect elected officials to deliver on campaign promises.
DougJ: Rich enough for tax cuts, too poor for health care

The Official Washington Talking Point against health care reform seems to now be that it is too expensive (here; here). Krugman points out:

Yes, the Congressional Budget Office’s preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts.

The CBO numbers ($1.6 trillion) were also about half of the estimated long-range costs of the Iraq war.

Don’t get me wrong, I think that it’s very important that health care reform be fiscally responsible, but where the hell was all this consternation when we were invading Iraq (even at the time, some experts were estimating costs as high as $1.6 trillion—see James Fallows’ definitive “Blind Into Baghdad“)? Where was it when we were running $300 billion deficits during an economic expansion?

Liberals have often claimed complained that our government has plenty of money for tax cuts and wars, but never enough for education and health care. And it’s easy to turn that into an a preachy slogan or bumper-sticker.

But at a certain point, everyone should admit that it is true.

Karen Tumulty: The Health Care Co-Op Idea
This idea has gained some traction on Capitol Hill as an alternative to a public plan. Kate Pickert takes a look at how health care cooperatives might work, and discovers that their experience in the real world isn't very encouraging.
  • Yglesias: Schumer: Co-Ops are No Substitute for Public Option

    CBS News reports that some Democrats are feeling emboldened by recent polls showing overwhelming public support for providing people with a public-sector alternative to for-profit health insurance.

    Behind-the-scenes attempts to get a deal with Republicans on nonprofit co-ops as an alternative to a public plan have led only to frustration, complains a key Democrat. He and his colleagues may have to go it alone, said Sen. Chuck Schumer. The co-ops were seen as perhaps the last hope for compromise on a contentious issue that threatens any remaining prospects of bipartisan support for President Obama’s sweeping plan to remake the health care system.

    “I don’t think I could say with a straight face that this (co-op proposal) is at all close to a nationwide public option,” Schumer, D-N.Y., told The Associated Press on Sunday. “Right now, this co-op idea doesn’t come close to satisfying anyone who wants a public plan.”

    I think this is arguably the virtue of having different kinds of bills wending their way through congress. I think a robust public option is very important. But there are a lot of moving parts to health reform, and it’s not the only important thing. The bill the Senate Finance Committee’s written, which has no public plan but does have a lot of virtues, provides an important test. Will Republicans actually flock to support the bill? If they will, then that’s something worth thinking about. A public plan is important, but if you could get leading Republicans to sign on to the idea of tough new regulations on insurers, on an expansion of Medicaid, on subsidies to ensure that insurance is affordable for everyone, and on higher taxes to pay for the whole thing that would be no small achievement. You’d have to think seriously about whether it isn’t worth cutting a deal. But thus far, for all the whining about the public plan I’m not seeing the evidence that they’re actually willing to embrace the rest of the health reform agenda, either. In which case, you may as well go forward with a robust public plan. And I think it’s important for Democrats to stop hiding behind Republicans on this. People who say they’re leery of a public plan because they want a bipartisan bill need to either produce some Republicans who are willing to support their ideas, or else admit that it’s they themselves who are blocking the public option.

  • Steve Benen adds:

    Schumer has not always been a consistent progressive champion, but by all appearances, he's showing some real leadership on this issue right now. To his credit, Schumer even rejected the co-op proposal gaining steam among Republican and "centrist" Democrats: "I don't think I could say with a straight face that this (co-op proposal) is at all close to a nationwide public option. Right now, this co-op idea doesn't come close to satisfying anyone who wants a public plan."

    What's more, the recent polls are giving Schumer a hand in pressing his colleagues: "The polling data backs up our subjective view that to make health care reform work, you need a public option."

    It leads to a test for the Senate caucus: back an effective plan that enjoys public support, or pursue an inferior bipartisan alternative.

    We know Senate Republicans have said a plan option is a step they are simply unwilling to take. We also know that for Democratic "centrists," GOP opposition has them scrambling for plausible alternatives.

    But E.J. Dionne recently posed some questions that these "centrists" should ponder: "Where did we get the idea that the only good health-care bill is a bipartisan bill? Is bipartisanship more important than whether a proposal is practical and effective? And if bipartisanship is a legitimate goal, isn't each party equally responsible for achieving it? ... It's one thing to compromise to pick up votes, which, one hopes, is what Baucus is doing. It's another to compromise in exchange for nothing at all. The first is bipartisanship with a purpose. The second is the bipartisanship of fools."

A friend offers the following perspective:
Three points about “health care reform”:

First, no one is talking about how many Americans are ALREADY on Federal health care, with the government as payer. These would include ALL US military and their families, ALL retired US military and their families, ALL federal employees and their families, active and retired whether Executive, Legislative, or Judicial branches, ALL Medicare and Medicaid recipients, ALL Federal prisoners.

Toss in ALL state and local government employees, and it's a heck of a large number. NO ONE IS TOTALLING THIS CROWD!

If you put the UNINSURED on ONE side, and the GOVERNMENTALLY INSURED on the other, who's left? Let's see the numbers!

Second, the President has already endorsed the Federal Direct Student Loan Program, originated and operated by civil servants in the Department of Education. This is because it's simpler, cheaper, and probably fairer. The parallels with single payer health insurance are PALPABLE, but NO ONE is talking about them. Why not?

Third, and very important, SENATORS AND CONGRESSMEN receive VERY GENEROUS health care benefits, and are not taxed for them, and they're paid for BY THE GOVERNMENT, and WHO ARE THEY to deny similar benefits to others? Are they THAT MUCH BETTER THAN WE ARE??

It is important to keep mentioning all three points, especially the last, because we need to open the OVERTON WINDOW to a wider public discussion! Check it out! Get with it!!
  • From Wikipedia: Overton window
    The Overton window is a concept in political theory, named after its originator, Joe Overton, former vice president of the Mackinac Center for Public Policy. It describes a "window" in the range of public reactions to ideas in public discourse, in a spectrum of all possible options on an issue. Overton described a method for moving that window, thereby including previously excluded ideas, while excluding previously acceptable ideas. The technique relies on people promoting ideas even less acceptable than the previous "outer fringe" ideas. That makes those old fringe ideas look less extreme, and thereby acceptable. The idea is that priming the public with fringe ideas intended to be and remain unacceptable, will make the real target ideas seem more acceptable by comparison.
Ezra Klein: Public Wants Fewer Jobs, More Severe Recession

The NBC/Wall Street Journal poll that emerged last week got a lot of attention for finding that 76 percent of Americans think the choice of a public plan is important for health reform. That cheered progressives, for obvious reasons. But looking through the whole poll, there's actually quite a bit that augurs poorly for Obama's agenda. Check out this bit on priorities, for instance:


Elsewhere, 58 percent think that "the President and the Congress should worry more about keeping the budget deficit down, even though it may mean it will take longer for the economy to recover." Fifty-three percent think the government was wrong to bail out Chrysler and GM. A 39 percent plurality thinks the stimulus was a bad idea.

This isn't, of course, the first time that the American people have had pretty terrible opinions about how to handle the economy. Paul Krugman dug up some striking numbers from 1935 showing that 70 percent of Americans wanted the Roosevelt administration to balance the budget, and the White House, heeding public opinion, promptly contracted its economic policy and tossed the country into the brutal 1937 recession.

Which is to say, there are three ways of reading this poll. One is to say that Americans are concerned with federal spending and government intervention. Another is to say that Americans don't understand macroeconomics. And another is to say that Americans want a radically higher unemployment rate and a much more severe recession.

Which gets to one of the difficulties posed by this sort of poll. The obvious way to report the results is that the public is growing skeptical of Obama's agenda. But for all that, the public is pretty likely to also respond negatively to an economic collapse. A poll can tell you a lot about what a voter doesn't like in this reality. It's not always so good about distinguishing between the relevant alternatives. That, in theory, is David Axelrod's job.

digby: 1996

Over at the Economix blog at the NY Times, Catherine Rampell took a look at the correlation between actual government deficits over the years and how the public perceived them, according to the Gallup poll:

If public worries about the nation’s fiscal health were perfectly related to the nation’s actual fiscal health, these two charts should be near-mirror images of each other.

That is, when the deficit represents a higher percentage of G.D.P. (i.e., the red bars pointing downward get longer), you should see more people naming the federal budget as the country’s most pressing issue (i.e., the blue bars going upward should also get longer).
Read the whole post for a long explanation and many caveats about these numbers and why they should be taken with a grain of salt, even if they are interesting.

I am interested more in the fact that the public obsession with the deficit tracks very closely with the rise of the anti-tax conservative movement, actually peaking at a time when the deficit was in very serious retreat and turning into surplus. Large numbers of people still believed it was rising.

The fiscal scolds don't stop when the numbers turn around. They keep up the fear mongering because it isn't really about balanced budgets or paying down debt. It's about keeping government from bringing positive results to the people. As long as they can keep people focused on debt, whether it exists or not, they always have the rationale to stop any sort of government action that could empower average citizens.

It's no mystery why George W. Bush was so anxious to spend that surplus he inherited as soon as possible, or why Alan Greenspan actually said that surpluses were dangerous to the economy. Their whole program is undermined if people aren't living under the impression that the economy is hamstrung by so much debt that the whole thing is in danger of coming apart at the seams if they don't (perversely) keep cutting taxes and cutting spending. People hear that enough, they just absorb it and it becomes conventional wisdom.

Deficits are an abstract concept that people end up using it as a proxy for "financial responsibility" which is extremely imprecise, since the government is responsible for a whole lot of things besides the budget. But until somebody comes up with something that makes more sense to average folks, the deficit boogeyman will be a powerful symbol that can be used by both parties to keep the government from challenging the status quo.

No comments:

Post a Comment