Saturday, August 22, 2009

Health Care Saturday: High Comedy Edition

Marshall: Hmmm. That's Interesting
Turns out "Chris", the guy who brought the assault rifle to the Obama event in Arizona, is a member of the same far-right political organization as the guy who brought the gun to the Obama event in New Hampshire.
Ackroyd on Froomkin
Dan summarizes the state of play on health care reform.

What is most extraordinary, and extraordinarily irksome, is that we seem to be on a path toward an individual mandate, with no cost controls and massive insurance company subsidies. The various "reform" measures are pretty close to toothless in the absence of competitition. Even provisions like "no rescission" still require the person who has just been denied coverage to appeal the decision.

I just don't remember hearing Obama promise that during the campaign.

Beutler (TPM): Poll: Baucus Popular in Montana on Health Care...with Republicans

Happily for reformers, the member of Congress with the most power to influence health care legislation is a man who a). has a higher approval rating on the issue in his state among Republicans than among Democrats, and b). is willing to ignore the stated preference of a plurality of his constituents.

According to a new Research 2000 poll commissioned by DailyKos, Sen. Max Baucus (D-MT) a minority--33 percent--of Montana Democrats approve of Baucus' actions on health care compared to 55 percent who disapprove. Compare that to Republicans, 49 percent of whom approve and 38 percent of whom disapprove. A clear plurality of Republicans think he's doing a bang-up job on health care.

On the public option, a plurality of Montanans (47 percent) support "creating a new public health insurance plan that anyone can purchase". Forty-three percent oppose. Of course Big Sky Democrats strongly favor the public option (78-15), while Montana Republicans strongly oppose it (66-23). But 23 percent Republican support for a public option ain't too shabby.

Of course, the Senate Finance Committee has ruled out endorsing a public option.

  • Benen: CROSSTABS OFFER THE WHITE HOUSE GUIDANCE...
    We talked earlier about the new Washington Post/ABC News poll, which shows President Obama's approval rating staying strong, but a drop off in support for health care reform and the president's handling of the issue.

    Specifically, the poll showed 46% of Americans approving of Obama on health care, with 50% disapproving. In general, this isn't an especially helpful measurement -- it's too broad. The group that rejects the president's handling of the issue includes ardent supporters of single-payer, those who like the Democratic approach but don't like Obama's political strategy, Tea Baggers who think reform is tantamount to the Nazi Holocaust, etc. Simple "disapproval" lumps together people who may strongly disagree with one another.

    More important is who is shifting from support to disapproval. Greg Sargent talked to WaPo polling analyst Jennifer Agiesta, who found in the crosstabs that the White House is slipping with its base.

    The numbers tell the story: In three key cases where Obama has dropped significantly, he's also dropped by sizable margins among Dems and liberals. Let's take the major findings driving the discussion today, and compare them with his drop among Dems and libs.

    The president's slip isn't entirely the result of frustrated liberals and Democrats, but their aggravation is clearly having an effect. The number of liberals who are confident that Obama will make the right decision, for example, has dropped from 90% to 78%. Liberals who approve of the president's handling of health care has dropped from 81% to 70%.

    These almost certainly aren't people expressing disapproval because they're watching Fox News or buying into McCaughey's lies -- these are progressive supporters who disapprove of unhelpful concessions to conservatives and overly-cautious centrists.

    I can imagine that some of the president's aides may find this dynamic frustrating. Some on the right think Obama is too far to the left. Some on the left think Obama is too far to the right.

    That said, if the White House political office wants to see these numbers improve, these poll results offer a pretty big hint. It's not complicated -- take a firm stand in support of the already-articulated principles, stand up to obstructionist Republicans, and tell centrists that the days of slow-walking reform are over.

    Get a good bill through Congress, and the polls will look far more encouraging for the administration. This isn't rocket science.

Democrats decide: lead, follow or get out of the way Aug. 21: Rep. Anthony Weiner, D-NY, joins Rachel Maddow to talk about what Congressional Democrats must do to pass health care reform given the obvious obstinance of their Republican counterparts.

Benen: CRAZY LIKE A FOXX...
Rep. Virginia Foxx (R) of North Carolina has already contributed so much to the health care debate. It was Foxx, after all, who argued a month ago, "There are no Americans who don't have healthcare. Everybody in this country has access to healthcare." She added that reform would "give the government control of our lives."

A week later, Foxx insisted that health care reform would "put seniors in a position" in which they may be "put to death by their government."

And Thursday, Foxx was at it again, this time making a constitutional argument.

"The Constitution doesn't grant a right to health care, and most of us are living as much by the Constitution as we can. It also doesn't give the federal government the authority to deal with health care. As you may know, the 10th amendment, it says if it isn't mentioned in the Constitution to be done by the federal government, it's left to the states or the people."

Obviously, facts haven't played much of a role in the right's opposition to reform, so this kind of nonsense isn't surprising. But in case anyone's tempted to take this seriously, the Constitution empowers Congress to "lay and collect taxes, duties, imposts and excises," to "provide for" the "general welfare" of the United States, and to "make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other Powers vested by this Constitution in the government of the United States, or in any department or officer thereof." As Matthew DeLong recently noted, "I'm no constitutional scholar, but enacting laws to reform the health care system to help provide insurance to the roughly 45 million Americans currently going without sounds like it might be covered under a reasonable reading of the 'general welfare' clause."

Ian Millhiser summarized the larger context nicely: "It's important to note just how radical Bachmann's theory of the Constitution is. If Congress does not have the power to create a modest public option which competes with private health plans in the marketplace, then it certainly does not have the authority to create Medicare. Similarly, Congress' power to spend money to benefit the general welfare is the basis for Social Security, federal education funding, Medicaid, and veterans benefits such as the VA health system and the GI Bill."

That said, I'd like to encourage Foxx to pursue her beliefs sincerely. If she believes her own rhetoric, Foxx should use her role as a federal lawmaker to pursue the dictates of her constitutional scholarship. In other words, it's incumbent on Foxx to file legislation to dismantle Medicare and Social Security. That, or she should assemble a legal team and challenge the programs' constitutionality in federal court. Go big or go home. Put up or shut up.

If Foxx means what she says, and she takes constitutional law seriously, this is the obvious course of action. If she doesn't mean what she says, Foxx probably ought to stick to the usual right-wing nonsense and skip the 10th Amendment argument.


Benen: COMPARING COSTS....
At the town-hall forum at the DNC yesterday, an Organizing for America volunteer asked President Obama about the costs of health care reform. He responded:

"Now, one thing that's very important to remind people, because you notice there's been a talking point from opponents -- 'trillion-dollar health care bill' -- they love repeating that. 'Trillion-dollar health care bill.'

"First of all, it's important to remind people that when they say 'trillion dollars,' they're talking about over 10 years. So this -- we're talking about $100 billion a year -- which is still a significant amount of money. But just to give you a sense of perspective, I mean, the amount of money that we're spending in Iraq and Afghanistan is -- what's the latest figure, Debbie? You figure $8 billion to $9 billion a month, right?

"So for about the same cost per year as we've been spending over the last five to six years, we could have funded this health care reform proposal, just to give you a sense of perspective."

I don't recall hearing the president make this argument before, and it's an interesting one.

There are limits to how one can use these cost comparisons, but as a rhetorical matter, it raises a compelling point. Conservatives have said they're entirely comfortable with spending at least $100 billion a year on wars in the Middle East. Indeed, these same conservatives have said price is no object when it comes to military conflicts. How much of that money is added to the national debt, to be paid for by future generations? Every single penny. This, according to the right, makes perfect sense, fiscally and strategically.

In contrast, the idea of spending $100 billion a year on health care is, according to these same conservatives, outrageous. For many Americans, health coverage is also a matter of life or death, but the price tag has nevertheless been deemed offensive. Indeed, according to the center-right members of the Gang of Six -- who have had very little to say about debt-financed funding for Iraq and Afghanistan -- the principal focus now has to be on making health care reform even cheaper.

If reform does cost as much as $100 billion a year for 10 years, how much of that money is added to the national debt, to be paid for by future generations? According to Democratic policymakers, not one cent. This is, of course, the exact oppose of the approach the Bush/Cheney administration embraced for the wars in the Middle East, not to mention the Bush/Cheney Medicare expansion that cost hundreds of billions of dollars, all of which was added to future generations' tab.

That Republicans claim the high ground on fiscal responsibility and debt reduction continues to be a source of great comedy.

James Fallows: McCaughey on the Daily Show
Well, my TV-owning neighbors were all away last night, so I couldn't watch the McCaughey-Stewart showdown by peering through their windows and had to see it just now on the web. Clips below, starting with the first segment of the interview as broadcast. Three conclusions:

The Daily Show With Jon StewartMon - Thurs 11p / 10c
Betsy McCaughey Pt. 1
www.thedailyshow.com
Daily Show
Full Episodes
Political HumorHealthcare Protests


Conclusion one: I have been far too soft on Betsy McCaughey. Even when conferring on her the title of "most destructive effect on public discourse by a single person" for the 1990s. She is way less responsible and tethered to the world of "normal" facts and discourse than I had imagined.

Conclusion two: The exchange is significant, because it demonstrates that there is indeed a way to "handle" Jon Stewart. You simply have to ignore what he says, interrupt and talk over him, and keep asserting that you're right. You even can try to usurp his role as host by mugging at the audience and rolling your eyes in a shared "there he goes again!" joke with the viewers.

In retrospect, this is the crucial weakness that in their different ways both Bill Kristol and Jim Cramer revealed in their appearances on the show. They listened to Stewart and -- even Kristol!!?! -- revealed through their bearing that they recognized there was such a thing as being caught in an inconsistency or presented with an inconvenient fact. McCaughey did none of that. She is just making it up, as anyone who has followed her work over the decades will know. She was not even minimally prepared for her appearance on the show, flipping aimlessly through the giant briefing book (of legislative clauses) she brought on stage. But she didn't let it bother her. The exchange demonstrated that if the guest reveals no self-awareness or does not accept the premise of factual challenge, Stewart can't get in his normal licks. Future guests will study this show.

Conclusion three: A good point Stewart made, albeit not registered by McCaughey, concerns the unbelievable inconsistency of attention to "incentives" built into health care systems, today's and tomorrow's.

That is: when McCaughey admits that there is no literal "death panel" provision in the new health care provision, she goes on to say something similar to what other conservatives, most recently Charles Krauthammer in the Washington Post today, contend: that the very act of reimbursing doctors for a discussion about "living wills" and end-of-life care will have a subtle bias in favor of an euthanasia-like outcome.

On the merits of this claim, I vehemently disagree. Having had, along with my siblings, first-hand, extended, and very painful experience with this process during my own father's decline and death last year, I would put reimbursement schemes for living-will discussions at the very bottom of the list of factors that make such decisions so wrenching for everyone involved.

But let's assume I'm wrong (though you'll never convince me of that) -- and that there is some third-order ripple-effect bias that comes from paying doctors for these every-five-year discussions. Why is the potential skewing effect of that payment the only thing we notice -- and not the thousand other life-and-death, rationing-and-queuing incentives that are built into every detail of the medical system now? And that David Goldhill -- no supporter of the Obama plan -- goes into so thoroughly in his cover story in this month's magazine? Yesterday I spent more than an hour on the customer "service" line for my own health insurance company, trying to get the answer to a simple "is this covered?" question. At the end of the hour, when I'd reached the queue to talk to a human agent, I got this recording: "Due to circumstances beyond our control, your call cannot be completed at this time. Please call again later." This has a kind of rationing/skewed incentive effect of its own -- even for someone fortunate, like me, to have good health insurance coverage. So, yes: I will listen to arguments about the hypothetical, subtle, psychological biasing effect of encouraging discussions about end-of-life decisions -- but only if they're in the context of the far more blatant, perverse, and destructive incentives built into today's system.

But see for yourself.

Second part of McCaughey's interview as broadcast.

The Daily Show With Jon StewartMon - Thurs 11p / 10c
Betsy McCaughey Pt. 2
www.thedailyshow.com
Daily Show
Full Episodes
Political HumorHealthcare Protests


Extended interview, with outtakes, part 1, is here; extended interview part 2 is here.

No comments:

Post a Comment