Morning Health Care: Max's Edition

AARP's ad.


Yglesias on Socialized Medicine

Avedon Carol asks “Did you know that aside from Denmark and Luxembourg, the country that spends the most tax money on healthcare per capita is the United States?”

I actually did know that. But it’s worth noting that in addition to all this direct public sector spending on health care, we have a very large set of hidden subsidies in the tax code. Basically, when a company gives you health insurance as part of your compensation, the firm can deduct that as one of its costs. Which makes sense, because it’s a cost. But you don’t pay taxes on the benefit, even though the benefit is clearly part of your income. That creates a pretty strong incentive, at the margin, for firms to pay people lower wages and offer them more generous health care benefits than they otherwise would. That’s good for some people and bad for others, and most of all is a large subsidy for the entire health care industry. But it’s hidden from view when people scrutinize the public accounts.

And there’s rather a lot of this sort of thing going on in the United States. Part of the high price of our political system’s insistence on relatively low levels of taxation is massive reliance on tax subsidies and regulatory mandates to do work that could be better done through taxes and public disbursements of funds.

Thers on The Other Side

P O'Neill (whose blog you should read) has a post up about some of the spillover of the nutty US "health care debate" on the discourse in other lands. I'd quibble that the Canadian system comes in for more goofy bashing in the US than the NHS, though. Also, I'd say that while P is right to wonder about the wisdom of US wingnuts cluelessly alienating what would seem to be their "natural allies," i.e., their halfwit ideological counterparts in allied countries abroad, the question of why they'd risk this answers itself -- US conservatives are know-nothing insane. You'd think that, as P says, this would mean that "With enemies like these, maybe Barack Obama doesn't need friends," and fair enough, except that, of course, for reasons nobody can rationally explain, there exists an American legislative body known as the "US Senate."

Obama was not in '08, nor is now, my messiah, but, like, when it comes to health care, or any other domestic policy initiative, how do you solve a problem like Max Baucus?

If we don't get a good health care bill, yes, Obama deserves garbage-pelting. But let's be clear: we have a legislative system that is undemocratic, dysfunctional, and flat-out ridiculous. The only thing it will actually DO as far as spending goes is authorize stupid wars.

Speaking of Baucus, here's Ezra Klein: Max Baucus's Unpleasant Position

About a year ago, when Max Baucus was hosting his "Prepare to Launch" event and holding the first hearings on comprehensive health-care reform, it was pretty clear that he saw this as his moment of greatness. Passing health-care reform would make him a legislative giant. He would not only join the pantheon of great Finance Committee chairmen -- Russell Long, Bob Dole, Daniel Patrick Moynihan, Lloyd Bentsen, Bob Packwood -- but exceed them, having achieved the one priority they could never pass. He would be a hero.

Fast forward a year and he's been dubbed Captain Ineffective, which wasn't the costume he was going for. He has let himself fall into an almost uniquely unpleasant position: If a bill fails, he will shoulder most of the blame. Four other committees have passed their health-care reform bills. Only his Finance Committee has lagged. But if he passes some sort of compromise bill, it is still likely to disappoint many Democrats, as his slow schedule and emphasis on retaining Grassley's and Enzi's support will probably be seen as the reason the final product was weak. At this point, the best Baucus can hope for is to avoid being seen as the villain. It is hard to imagine him being cast as the hero.

The blame for that goes entirely to the bizarre process that he has constructed. If he had sent a bill into the Finance Committee and its progress had slowed amid objections from Blanche Lincoln and Tom Carper, at least the impediments would have been obvious and the targets for reformist ire clear. Instead, Baucus created an ad hoc committee composed of Kent Conrad, Jeff Bingaman, Mike Enzi, Chuck Grassley, Olympia Snowe, and Orrin Hatch (who later dropped out). They have conducted their work behind closed doors, and done so slowly. There is little information flowing in or out of their negotiations, and there was never a clear explanation of why this group was chosen in the first place.

The end result is that health-care reform isn't struggling through the Finance Committee. It's struggling through the Max Baucus Committee. He built the process and selected the participants and made the decisions. And he did so without ever explaining why this process was necessary, why the larger committee had to be excluded, why Finance couldn't stick to the schedule of Energy and Commerce or Ways and Means or HELP. As such, Baucus bears uncommon responsibility for the product. If his process fails, then he will have failed. For a man whose career has been defined by an aversion to risk, Baucus is running the most dangerous and unexpected legislative play in recent memory. He has put himself at the center of health-care reform. At one point, that seemed likely to assure him the credit. Right now, it seems certain to leave him the blame.

Yglesias: Just Because Things Should Be Totally Different Doesn’t Make Incremental Reform a Bad Idea

This Atlantic article on our badly broken health care system by David Goldhill is very good. It makes the case, correctly, that the entire health care system should be totally different from how it is. I agree with a lot of it. But I think Goldhill is deploying his insights to the pretty insidious purpose of arguing against the kind of health reforms that now exist in the congress. The simple fact of the matter is that defeating the current reform effort is not going to lead to the emergence of some alternative, radically different health care reform. Defeat of the current legislative effort will demoralize proponents of health reform, teach politicians that any talk of modifying Medicare is politically toxic, and basically result in another 10-15 years of the status quo followed by some kind of budget crisis.

Passing the kind of ideas that are currently on the table would still leave us with a system with a lot of problems. But it would ameliorate several of those problems, and solve a few. It would also, I think, teach politicians the lesson that it’s possible to change the health care system. And that might lead to more and better reforms down the road.

SGW (Smooth Like Remy) finds a Clarification

Turns our rumors of the demise of the public option have been (greatly) exaggerated.

An administration official said tonight that Health and Human Services Secretary Kathleen Sebelius "misspoke" when she told CNN this morning that a government run health insurance option "is not an essential part" of reform. This official asked not to be identified in exchange for providing clarity about the intentions of the President. The official said that the White House did not intend to change its messaging and that Sebelius simply meant to echo the president, who has acknowledged that the public option is a tough sell in the Senate and is, at the same time, a must-pass for House Democrats, and is not, in the president's view, the most important element of the reform package.

A second official, Linda Douglass, director of health reform communications for the administration, said that President Obama believed that a public option was the best way to reduce costs and promote competition among insurance companies, that he had not backed away from that belief, and that he still wanted to see a public option in the final bill.

"Nothing has changed.," she said. "The President has always said that what is essential that health insurance reform lower costs, ensure that there are affordable options for all Americans and increase choice and competition in the health insurance market. He believes that the public option is the best way to achieve these goals."


A third White House official, via e-mail, said that Sebelius didn't misspeak. "The media misplayed it," the third official said.

Misplayed indeed.

This is the kind of thing you can bet will happen until health care reform gets passed. The GOP and the drive by media will announce certain platforms dead just to see if the WhiteHouse will let the meme linger out there and rile up liberals and progressives. I am really happy that the Obama administration jumped all over this right away. I am really interested to see if the end of life provisions make it into the final bill too for that matter.

For now we just have to wait and see. And pray.

Yglesias: Rep Jay Inslee Slams Undemocratic Filibuster

I find it extremely frustrating how reluctant progressive legislators are to condemn procedural practices in congress that make progressive change difficult. So good on Rep Jay Inslee (D-WA) for speaking out:

The filibuster is so undemocratic it just defies defense. Particularly, as you said, it used to be this once-in-a-generation regional conflict issue that’s meant to protect the regions that has now prevented majority rule in this country. It’s a huge, insidious problem. I have to tell you in my conversations with senators, including in our party, I’ve gotten nowhere on this issue. When they get into that fine institution, they kind of like the idea one person can stop the entire country dead on its heels to keep a post office open in Schmuckbucket or wherever. I have to tell you, I’m very frustrated by it.

I particularly like Inslee’s point about the blinkered perspective of his senate colleagues. It doesn’t surprise me that most Senate Democrats prefer to put their own parochial interests ahead of the interests of the country, the world, and the progressive movement. But I’d like to think that at least a handful of people might be interested in doing the right thing and becoming catalysts for future pressure and change.

Andy Borowitz: (http://www.borowitzreport.com/ )

August 17, 2009

In Move to Appease Critics, Obama Promises to Extend Health Care Coverage to Morons

Appeal to Key Demographic

Facing opposition to his health care reform proposals, President Barack Obama has decided to reach out to a key demographic: morons.

Starting this week, Mr. Obama will host a series of town halls to roll out new features of his health care plan which will extend health care coverage to "all idiotic Americans," in the words of one White House source.

"We clearly underestimated the role that doofuses and dimwits were going to play in this debate," the source said. "We want to send them the message that this plan will give them coverage - but we need to come up with a one-syllable word for ‘coverage.'"

But critics of the President's new plan worry that extending coverage to every American who is a few bricks shy of a load could triple the size of the nation's deficit.

"The sheer number of lamebrains in the U.S. is much greater than the Administration estimates," says Davis Logsdon, who studies the demography of idiots at the University of Minnesota. "Just look at Glenn Beck's ratings."