Tuesday, October 6, 2009

Health Care

Kevin Drum's Quote of the Day 
From Gail Wilensky, a conservative healthcare economist:
It's very frustrating to see somebody who makes outrageous statements that bear no relationship to reality receive so much attention.
She's talking about serial healthcare fantasist Betsy "Death Panel" McCaughey.  The quote is from Michelle Cottle's profile of McCaughey in the current New Republic.  Worth a read.

It's an extremely small group, but Time's Karen Tumulty notes the GOP contingent that likes what Democrats are up to on health care reform.
Okay, maybe it's not enough to call a groundswell. But after former Majority Leader Bill Frist told me last Friday that he would end up voting for the bill were he still in Congress (with some caveats about the shortcomings of the legislative language as it now stands), we've heard from some other GOP voices in support of the basic contours of Barack Obama's health care reform effort: Bush Administration HHS Secretary Tommy Thompson, New York City Mayor Michael Bloomberg (who ran as a Republican, but who is now an independent)* and Mark McClellan, who ran both the Food and Drug Administration and the Medicare and Medicaid programs under George W. Bush.
Others are noticing, too. Mike Allen's widely-read "Playbook" feature in Politico included a headline this morning that read, "Tommy Thompson, Frist, Bloomberg give momentum to health care.... Non-Dem Support Builds For Health Reform."
And as long as we're counting GOP heads here, it's probably worth noting that former Republican Senate Majority Leaders Howard Baker and Bob Dole have also "endorsed the sorts of reforms President Obama and his allies are pushing."
Now, as a practical matter, these endorsements probably don't mean much. It's a very modest number of people. Moreover, Frist, Thompson, Bloomberg, McClellan, Baker, and Dole have varying degrees of influence in Republican circles, but not one of them will have a vote when reform comes to the floors of Congress.
But I like the larger framing of this anyway. For one thing, the public, for frustrating reasons I can't fully understand, seems to want a bill with "bipartisan" backing. When high-profile Republicans express tacit support for Democratic efforts, it can help with public perceptions.
For another, it positions congressional Republicans as outside the mainstream. If several notable GOP officials are stepping up to endorse reform efforts, and Republicans on the Hill resist, it makes the lawmakers seem petty and overly partisan.
It reminds me a bit of the presidential campaign when a wide variety of Republicans -- including Ronald Reagan's national security advisor, solicitor general, and White House chief of staff -- endorsed Obama. It undermined GOP arguments that the Democrat was some kind of dangerous radical -- if he were a liberal extremist, why were so many prominent Republicans supporting him?
The same is true here. If health care reform is such a radical idea, why are relatively high profile non-Democrats endorsing the effort?
Update: As I was hitting "publish," an email arrived in my inbox: "Schwarzenegger Endorses Obama Health Care Effort." The list, in other words, is growing.
Throughout the debate on health care reform, the right has been pretty consistent about public-private competition: they don't think it's fair.The argument is unpersuasive, but it's at least coherent. As conservatives see it, if private insurers had to compete against a public plan, the companies wouldn't stand a chance -- a public plan wouldn't have to worry about profit margins, stock prices, or exorbitant salaries for executives, which means it could provide the same service at a lower price. On a level playing field, the argument goes, the private insurance industry simply couldn't compete.
In a Fox News interview yesterday, Rep. Michele Bachmann (R-Minn.) made the exact opposite argument.
"[A]s far as liberals go, they want the government literally to control every aspect of our lives. We saw that with student loans. They put in a quotes [sic] public option for student loans, government couldn't take the competition because the private sector was outperforming by far, so they shut out any private student loans. Today all student loans have to be public or government run.
"They'll do the same thing in health care, government can't compete with private industry -- they're not as innovative, they're not as quick on their feet, they're not as cheap, they're not as high quality." [emphasis added]
On student loans, Bachmann simply doesn't know what she's talking about. But on health care, Bachmann's point is the polar opposite of what conservatives have insisted for months.
In this sense, I see this as a terrific opportunity. As Bachmann sees it, a public plan would invariably fail. By her reasoning, it's inevitable -- if Americans are given a choice, they'd reject Medicare-like public coverage and go with the innovative, affordable, high-quality insurance offered by private companies.
So, here's what I propose: let's give it a shot and see who wins. If Bachmann believes what she said, she can shut liberals up very easily -- give American consumers a choice. If she's right, and "government can't compete with private industry," Americans will choose private coverage. If I'm right, Americans will prefer a public plan. If she's right, the public option would be rejected and wither away. If I'm right, we'd have a vibrant marketplace in which competition lowers costs for everyone.
Reform advocates would welcome that bet. If conservatives believe the private sector is necessarily superior to the public sector, they should gladly take the wager and prove their point.
Let's give Americans the choice and see. Whaddya say, conservatives? Afraid of a little competition?
Doctor recommended reform   Oct. 5: Keith Olbermann is joined by Dr. Paul Hochfeld, an emergency medical physician from Corvallis, Oregon affiliated with the group "Mad as Hell Doctors" to explain why doctors support President Obama's health reform goal.

Jon Chait has a good item this morning noting the ways in which conservatives attack health care reform for incoherent and contradictory reasons, but manage to feel good about themselves anyway.
Of particular interest was a reference to a recent column from the Weekly Standard's Fred Barnes, who said reform plans are at odds with "the laws of addition and subtraction."
Give President Obama credit for persistence. And stubbornness. And lack of imagination. He declared again last week that his health care plan "will slow the growth of health care costs for our families and our businesses and our government." And this historic achievement will be accompanied by a dazzling array of new medical benefits that everyone will receive -- guaranteed by law.... Does he think we're stupid?
Chait tried to explain the policy to Barnes.
I don't mean to go all intellectual elite here, but the concept of expanded coverage and slower cost growth does not, in fact, violate the laws of addition and subtraction. Every other advanced country provides universal coverage, with equivalent or often better performance, at dramatically less cost. Earlier this year, a respected study by the Brookings Institution outlined proposals to expand coverage while reducing cost growth. One of the co-authors of that study, Mark McClellan, who served in the Bush administration, has praised a draft of a Senate Finance Committee bill for fulfilling the report's goals.
Does President Obama think Barnes is "stupid"? I doubt it. Should he think Barnes is stupid? Well, let's just say the Weekly Standard editor's intellect shines through nicely in his columns.
 Perhaps Fred Barnes is hoping his nonsense will sharpen his intellect?
 Benedict Carey (NYT): How Nonsense Sharpens the Intellect
In addition to assorted bad breaks and pleasant surprises, opportunities and insults, life serves up the occasional pink unicorn. The three-dollar bill; the nun with a beard; the sentence, to borrow from the Lewis Carroll poem, that gyres and gimbles in the wabe.
An experience, in short, that violates all logic and expectation. The philosopher Soren Kierkegaard wrote that such anomalies produced a profound “sensation of the absurd,” and he wasn’t the only one who took them seriously. Freud, in an essay called “The Uncanny,” traced the sensation to a fear of death, of castration or of “something that ought to have remained hidden but has come to light.”
At best, the feeling is disorienting. At worst, it’s creepy.
Now a study suggests that, paradoxically, this same sensation may prime the brain to sense patterns it would otherwise miss — in mathematical equations, in language, in the world at large.
“We’re so motivated to get rid of that feeling that we look for meaning and coherence elsewhere,” said Travis Proulx, a postdoctoral researcher at the University of California, Santa Barbara, and lead author of the paper appearing in the journal Psychological Science. “We channel the feeling into some other project, and it appears to improve some kinds of learning.”
Researchers have long known that people cling to their personal biases more tightly when feeling threatened. After thinking about their own inevitable death, they become more patriotic, more religious and less tolerant of outsiders, studies find. When insulted, they profess more loyalty to friends — and when told they’ve done poorly on a trivia test, they even identify more strongly with their school’s winning teams.
In a series of new papers, Dr. Proulx and Steven J. Heine, a professor of psychology at the University of British Columbia, argue that these findings are variations on the same process: maintaining meaning, or coherence. The brain evolved to predict, and it does so by identifying patterns.
When those patterns break down — as when a hiker stumbles across an easy chair sitting deep in the woods, as if dropped from the sky — the brain gropes for something, anything that makes sense. It may retreat to a familiar ritual, like checking equipment. But it may also turn its attention outward, the researchers argue, and notice, say, a pattern in animal tracks that was previously hidden. The urge to find a coherent pattern makes it more likely that the brain will find one.
“There’s more research to be done on the theory,” said Michael Inzlicht, an assistant professor of psychology at the University of Toronto, because it may be that nervousness, not a search for meaning, leads to heightened vigilance. But he added that the new theory was “plausible, and it certainly affirms my own meaning system; I think they’re onto something.”
In the most recent paper, published last month, Dr. Proulx and Dr. Heine described having 20 college students read an absurd short story based on “The Country Doctor,” by Franz Kafka. The doctor of the title has to make a house call on a boy with a terrible toothache. He makes the journey and finds that the boy has no teeth at all. The horses who have pulled his carriage begin to act up; the boy’s family becomes annoyed; then the doctor discovers the boy has teeth after all. And so on. The story is urgent, vivid and nonsensical — Kafkaesque.
After the story, the students studied a series of 45 strings of 6 to 9 letters, like “X, M, X, R, T, V.” They later took a test on the letter strings, choosing those they thought they had seen before from a list of 60 such strings. In fact the letters were related, in a very subtle way, with some more likely to appear before or after others.
The test is a standard measure of what researchers call implicit learning: knowledge gained without awareness. The students had no idea what patterns their brain was sensing or how well they were performing.
But perform they did. They chose about 30 percent more of the letter strings, and were almost twice as accurate in their choices, than a comparison group of 20 students who had read a different short story, a coherent one.
“The fact that the group who read the absurd story identified more letter strings suggests that they were more motivated to look for patterns than the others,” Dr. Heine said. “And the fact that they were more accurate means, we think, that they’re forming new patterns they wouldn’t be able to form otherwise.”
Brain-imaging studies of people evaluating anomalies, or working out unsettling dilemmas, show that activity in an area called the anterior cingulate cortex spikes significantly. The more activation is recorded, the greater the motivation or ability to seek and correct errors in the real world, a recent study suggests. “The idea that we may be able to increase that motivation,” said Dr. Inzlicht, a co-author, “is very much worth investigating.”
Researchers familiar with the new work say it would be premature to incorporate film shorts by David Lynch, say, or compositions by John Cage into school curriculums. For one thing, no one knows whether exposure to the absurd can help people with explicit learning, like memorizing French. For another, studies have found that people in the grip of the uncanny tend to see patterns where none exist — becoming more prone to conspiracy theories, for example. The urge for order satisfies itself, it seems, regardless of the quality of the evidence.
Still, the new research supports what many experimental artists, habitual travelers and other novel seekers have always insisted: at least some of the time, disorientation begets creative thinking.
From the outset, Obama administration officials thought it best to let Congress do the heavy lifting in shaping health care reform proposals. It was, after all, one of the supposed lessons of early 1990s -- the process is less likely to work if the White House drafts the bill and tells lawmakers to pass it.
And for the most part, things have gone largely according to plan. Any day now, the Senate Finance Committee will pass a reform bill, at which point legislation will head to the Senate floor for the first time. When it does, the White House's role will grow from that of an active outsider to "the central player."
Senior White House officials are scheduled to be in the room throughout negotiations to merge competing Senate health care bills from the Finance and Health, Education, Labor and Pensions committees, with the expectation that they will make key decisions to mediate disagreements. In advance of the floor action to follow, Obama and top administration officials have been lobbying Senate Democrats to secure support for a final package.
"The White House presence in the merger will be huge, and it has to be," a senior Democratic Senate aide said Monday. "President Obama will have to weigh in on the most difficult issues."
Barring delays, Senate Majority Leader Harry Reid (D-Nev.) will host talks in his office later this week with Finance Chairman Max Baucus (D-Mont.) and HELP Chairman Chris Dodd (D-Conn.), along with several White House officials, including Rahm Emanuel, Nancy Ann DeParle, and Peter Orszag.
Note, no one seems to mind that the president's team is getting more hands-on in its involvement. Indeed, lawmakers seem inclined to cede control and follow the White House's lead.
With the public option still polling well, no Dems want to be blamed for its demise, and Senate Dems -- mindful that they'll take it on the chin if it's not included -- are handing some responsibility to the White House to signal the way forward.... Senate Dems are in effect saying to Obama: "Tell us what to do. It's your call."
Under the circumstances, this works nicely for everyone on both sides of Pennsylvania Avenue.
Slajda (TPM): Fox News's Shep Smith: 'Every Vote Against The Public Option Is A Vote For The Insurance Companies' 
In a segment just now with Sen. John Barrasso (R-WY), Fox News's Shepard Smith gave a stunning argument in favor of the public option.
"Over the last 10 years health care costs in American have skyrocketed. Regular folks cannot afford it, so they tax the system by not getting preventive medicine," Smith said. "And we all end up paying for it. As the costs have gone up, the insurance industry's profits, on average, have gone up 350 percent. And it's the insurance companies which have paid and which have contributed to senators and congressmen on both sides of the aisle to the point where now we can't get what all concerned on Capitol Hill all seem to [believe] and more than 60 percent of Americans say they support, a public option."
He refuted Barrasso's argument that the public option is a government option.
"Every vote against the public option is a vote for the insurance companies," Smith said.

The likelihood of a bill without a strong public option "has been an enormous win for the insurance industry," Smith said. "But I wonder what happens to the American people when we come out with legislation which requires everyone to have insurance ... but does not give a public option. Therefore, millions more people will have to buy insurance from the very corporations that are overcharging us. ... It seems like we, the people, are the ones getting the shaft here."
"How do we keep costs down without a public option?" he asked.
Smith is known as Fox's least conservative voice, and someone who marches to his own beat. So of all the channel's personalities, he's the most likely to make this argument. And one could argue that he was just playing devil's advocate. But in the next segment he interviewed a former aide to Sen. John Kerry (D-MA) on the same topic. While he took the other side -- that a public option would put the private insurers out of business -- he did so with less passion and spent much less time than he did with Barrasso.
All in all, it's still a stunning clip.

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