Thursday, July 23, 2009

Health Care Thursday

QOTD, John:
I think this encapsulates nicely our modern media environment.

President Obama, even before he was president, has always been good at explaining complex ideas in an accessible way, without talking down to his audience. When it comes to the debate over health care reform, that's a valuable skill, but it's already being tested.

For the tens of millions of Americans with no insurance, it's an easy, straightforward pitch -- they want coverage, and they'll get it. For the millions of Americans covered by a government program (Medicare, the VA system), reform may not seem entirely relevant. And for the rest of the country, many of whom are asking "what's in it for me" right now, selling reform is arguably trickier than it sounds.

The NYT's David Leonhardt, who's done some terrific work on the reform debate, had another interesting piece on this today, noting that most Americans may not have the first idea what reform will mean to them personally, except that it might cost their government more to cover those who are currently lacking insurance. Leonhardt makes the case that these folks may not realize what they're already paying for.

Our health care system is engineered, deliberately or not, to resist change. The people who pay for it -- you and I -- often don't realize that they're paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.

The doctors, hospitals and drug makers use the money to treat us, and we of course do see those treatments. If anything, we want more of them. They are supposed to make us healthy, and they appear to be free. What's not to like?

The immediate task facing Mr. Obama -- in his news conference on Wednesday night and beyond -- is to explain that the health care system doesn't really work the way it seems to. He won't be able to put it in such blunt terms. But he will need to explain how a typical household, one that has insurance and thinks it always will, is being harmed.

The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It's about $6,500 more than in other rich countries, on average.

We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.

In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste -- bureaucratic and medical.

One thing we don't get is better health than other rich countries, whether it's Canada, France, Japan or many others.

Ezra Klein has more on this, noting that the employer tax exclusion has "created a fractured, expensive, inefficient health-care system. But people think they benefit from this subsidy. And why not? It's countertintuitive to say that something that's making your health-care coverage cheaper than it would otherwise be this year is also making it everybody's health-care coverage, including yours, a lot more expensive over time. The key to explaining all this, Leonhardt says, is connecting it to stagnant wages."

The White House hasn't really tried to make this case to the already-insured Americans wondering what reform will mean for them. Maybe tonight we'll start to hear more about this.

Krugman: Professor in chief

I found Obama’s health care presentation so impressive — so much command of the issues — that it had me worried. If I really like a politicians’ speech, isn’t that an indication that he lacks the popular touch? (A couple of points off for “incentivize” — what ever happened to “encourage”? — but never mind.)

Seriously, it’s really good to see how much he gets it.

Update: So Howard Fineman was unimpressed. And Fineman knows presidential greatness when he sees it:

He’s the Texas Ranger of the world, and wants everyone to know it. He’s the guy with the silver badge, issuing warnings to the cattle rustlers.
  • DougJ adds, re The school playgrounds of West Texas

    My favorite topic for blogging—actually, my favorite topic of any kind—is all the dumb shit the media said about George W. Bush before Katrina. So I was pleased to find a link to this 2002 gem from Howard Fineman in Krugman’s post on the Obama presser:

    George W. Bush likes big belt buckles: shiny silver ones. Back in Texas, he sported one from the Texas Rangers—not the baseball team he’d helped run, but the elite police of the Lone Star State. More recently, in a Vanity Fair cover portrait with his terror-fighting posse, there was Bush, suit coat open, showing off his newest silver buckle, one bearing the presidential seal.


    Bush II, whose early years were spent in Midland, Texas, at Sam Houston Elementary and San Jacinto Junior High, is wired differently. He likes to call people names. That’s practically the first thing you do: Call someone out. You name something for what it is: evil. His speech of last Sept. 20, contained the toughest talk imaginable—we would do nothing less than banish terrorism from the world—and the American people loved what they heard. They still do.


    Woofin’ is often the prelude to deal. There was never a deal to be cut with the Taliban or Al Qaeda. But, despite Powell’s call for a “regime change,” I can see the administration accepting the half-measure of renewed U.N. inspections in the meantime. That, at least, has been the pattern in Bush’s legislative dealings, both in Austin and in Washington.


    But there was something about Putin that Bush recognized from the school playgrounds of West Texas: a guy from a proud, gigantic and rather untamed country, a guy with a touch of swagger, a gift for blunt gamesmanship and a belief in the business of doing business. Putin has warned Bush against unilateral military action in Iraq, which owes Russia $10 billion. But that leaves Bush plenty of room to maneuver.

    Bush is a cowboy because he went to junior high-school in West Texas. And he’d never do something as stupid as launching an unprovoked war without international support.

    Tonight, Fineman accused Obama of playing “three card monte”.

    What else is there to say?

    Update. More Fineman on Obama, from March:

    By recent standards—and that includes Bill Clinton as well as George Bush—Obama for the most part is seeking to govern from the left, looking to solidify and rely on his own party more than woo Republicans. And yet he is by temperament judicious, even judicial. He’d have made a fine judge. But we don’t need a judge. We need a blunt-spoken coach.

    Obama may be mistaking motion for progress, calling signals for a game plan. A busy, industrious overachiever, he likes to check off boxes on a long to-do list. A genial, amenable guy, he likes to appeal to every constituency, or at least not write off any. A beau ideal of Harvard Law, he can’t wait to tackle extra-credit answers on the exam.

Sen. George Voinovich (R-Ohio) appeared on CNBC's "Squawk Box" this morning for the kind of softball interview one might ordinarily associate with Fox News. One of the two hosts, for example, thanked the Republican "for his leadership" because "we're headed off a fiscal cliff."

The interview wrapped up with this interesting exchange.

Host: Senator, one question, before we go, on health care. How much of this disagreement with the administration is about the policy of health care and how to fix it, and how much of it is Republicans' obviously understandable desire to declaw the president politically. How much does that fit into the equation?

Voinovich: I think it's probably 50-50.

Putting aside the obvious slant of the question, Voinovich's candid response was nevertheless interesting. At least half of the Republican opposition to health care reform, according to a sitting Republican senator, is nothing more than partisan politics.

Good to know.

  • Think Progress: Kit Bond says DeMint’s attack on Obama was ‘way off base.’
    Sen. Jim DeMint (R-SC) has been aggressively attacking President Obama recently, saying his efforts to reform health care will be his “Waterloo” and that it will ultimately “break him.” He’s also said the health care debate is “a real showdown between socialism and freedom.” When asked about DeMint’s charges during a conference call with local reporters, Sen. Kit Bond (R-MO) called them “way off base.” The Hill reports:

    I didn’t like particularly the way that Sen. DeMint said it,” Sen. Kit Bond (R-Mo.) said in a conference call with Missouri reporters when asked if he agreed with DeMint’s sentiments on stopping the president’s spending.

    I think he was way off-base in his attack on the president,” added Bond, who is retiring from the Senate at the end of this term.

    Rep. Eric Cantor (R-VA) also distanced himself from DeMint’s “Waterloo” comment yesterday saying, “I don’t think that’s a good way to look at it.”


Passing health care reform in the Senate with, say, 52 votes would be viewed as something of a failure. Passing reform with 58 votes, the conventional wisdom tells us, would make the vote "partisan." Passing reform with 61 or 62 votes, Sen. Chuck Grassley (R) of Iowa said recently, wouldn't be quite good enough, because it would mean only a couple of Republicans sided with the majority.

As of today, Grassley has a new number in mind.

The final healthcare reform bill to make its way out of the Senate should have as many as 80 members voting for passage, one of the lead Republican negotiators of the health package said Wednesday.

Sen. Chuck Grassley (R-Iowa), the ranking member of the Senate Finance Committee, said it's his preference to see the vast majority of his colleagues on board with a final healthcare bill.

"It ought to be from 80 people in the center of the Senate, I would think," Grassley said during a news conference with Iowa reporters.

That's not a typo. Grassley told reporters reform ought to have 80 votes, which would come from his idea of what constitutes the "center."

That'd be quite a feat, given that Republicans want to use health care to "break" the president, make this Obama's "Waterloo," and by one GOP senator's own admission, at least half of Republican opposition to reform is based on nothing but partisan politics.

Also note the extent to which Grassley is hung up on process. What matters is the size of the majority, he says, not what's in the bill.

I'm reminded of a recent item from Matt Yglesias, on the "recursive loops" of Grassley's "bipartisanship."

By definition any bill that 60 Senators vote for has broad legislative support, which one assumes is the virtue of a bipartisan bill. And yet despite that fact, a new consensus is emerging that for a bill to be "really" bipartisan, it's not good enough to acquire the vote of the 41st-most-conservative Senator (Ben Nelson) or even the 40th- and 39th-most-conservative Senators (Susan Collins and Olympia Snowe). You also need an additional even more conservative Senator. And now we have Chuck Grassley signaling that his commitment to this weird principle is so strong that he would vote against a bill of which he otherwise approves unless a Senator who even more conservative than Grassley agrees to vote for it.

But what's the point of this? Who does this help? The way bipartisan bills happen is that you forge a compromise with the moderate members of the other party. As it happens, there are only two moderate Republicans in the Senate. But that should be understood as the GOP's problem, not the Democrats' problem. If the GOP ran more moderate nominees, there might be more Republican Senators and then, as a matter of course, bipartisan legislation would require a broader coalition.

That was when Grassley was saying a 62-vote majority isn't good enough. Now he's throwing around 80.

Benen: BABY STEPS....

The House Energy and Commerce Committee was scheduled to consider health care reform yesterday, but the committee's chairman, Rep. Henry Waxman (D-Calif.), pushed off the vote. Dems have a 36-23 edge in the committee, but Waxman has seven Blue Dogs, and their opposition to reform would give the GOP enough votes to prevail.

So, instead of a vote, committee Democrats went to the White House for a chat. By all accounts, it went relatively well.

Moderate House Democrats and a key committee chairman emerged from a three-hour meeting at the White House on Tuesday with a tentative agreement to give an outside panel -- rather than Congress -- the power to make cuts to government-financed health care programs.

OMB Director Peter Orszag called it "probably the most important piece that can be added" to the health care bill in the House, and the deal between the Blue Dog Coalition and House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) was the first positive development Democratic Party leaders could claim since the American Medical Association endorsed their bill last week.

Rep. Mike Ross (D) of Arkansas, the Blue Dogs' point man on health care, called the MedPAC agreement a "significant breakthrough" and evidence that policymakers are "making progress." He added, however, "[W]e've got a long way to go."

Dems on the Energy and Commerce Committee will continue talking today, but probably won't resume formal work on the bill until tomorrow, making the pre-recess deadline that much more of a challenge, though Speaker Pelosi told her caucus yesterday the chamber is still on track. She added that "this is the biggest thing we will do in our lives."

Rep. John Larson of Connecticut, the fourth-ranking Democrat in the chamber, suggested action on the House floor is likely July 29, a week from today.

As for the Senate Finance Committee, Chairman Max Baucus (D-Mont.) said the panel had made "significant progress" on a bipartisan proposal, No word, though, on if/when we'll actually see a Finance bill.

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