Wednesday, November 11, 2009

Health Care Wednesday: Shhhhhhhhhhhh edition!

Kurtz (TPM): Thought Experiment

TPM Reader JF:

What would happen if a few female members of the House put in (or merely proposed) an amendment to the health care bill which stated that men would be barred BY LAW from purchasing health insurance which covered Viagra, all hair-growth medications or procedures or transplants, etc.?
JedL (DK): Senate aide: Dems hush-hush on Carper's 'triggered co-ops' to avoid progressive pushback

This was a revealing final paragraph of Congress Daily's article about Tom Carper's plan to replace the public option with what amounts to state-level triggered co-ops (emphasis added):

The Democratic aide said staffers have tried to keep Carper's alternative quiet due to concerns that publicity could draw attacks from liberal activists, which could complicate efforts to line up support from the full Democratic caucus.

Given that Carper's plan -- which would create a series of state-level non-profit insurance carriers in states without competition -- is actually worse than co-ops (because they'd only be created in the case of a trigger), it's not surprising that Democrats would fear the reaction from liberals. No shock there.

But what is interesting is that they are afraid that pushback from progressives could scuttle Carper's plan to kill the public option. Even though they may be stupid enough to think that they can pull the wool over our eyes, they at least realize they need to keep us happy.

What's mystifying is that they would thinks a strategy of "shh, don't tell the progressives" is an effective way of accomplishing that.

Dave Weigel tweeted this morning, "Oh, 'Morning Joe' cast, do you seriously think Obama didn't sell HCR as 'cost control' from the beginning? Were you in a coma?"

The cast of the MSNBC morning show aren't the only ones confused. Sen. Mark Warner (D-Va.) told the far-right Washington Times, "I wish the president would have started the debate by explaining to the American people that our current health care system is not financially sustainable, for even another decade. Driving down health care costs should have been the focus of the debate."

It was apparently quite a widespread coma.

Marc Ambinder valiantly tries to explain that this is "unreality."

The FIRST argument that the White House turned to about health care was about the cost of doing nothing. (It was Tom Daschle's formulation, actually, that Obama adopted during the campaign and the transition and the early part of this year.)

From December 22: ""Some may ask how at this moment of economic challenge we can afford to invest in reforming our health-care system. And I ask a different question. I ask how can we afford not to."

Progressive activists didn't like the obsessive focus on cost. And they believe that the president hemmed himself in by imposing a seemingly arbitrary $900 billion cap on costs over ten years.

The argument THEY wanted him to make--the liberal argument, if you will -- is a moral argument. People are getting sick and dying because they can't afford health care in a country of plenty. But Obama subordinated that argument to focus on cost.

This isn't a subjective question. Mark Warner and the "Morning Joe" cast may think the White House didn't emphasize the cost argument, but their collective memories aren't quite as reliable as transcripts.

In his first weekly address devoted exclusively to talking about health care, President Obama referenced the word "cost" 10 times, including the unambiguous line: "[T]he soaring costs of health care make our current course unsustainable." A week later, he delivered another weekly address, focused on nothing but health care costs: "The President has long noted that skyrocketing health care costs will be disastrous in terms of our long term national debt unless we pass real reform."

He went on to emphasize this argument in interviews, speeches, addresses, and statements. It was hard to miss.

This was a fundamental part of the pitch from the very beginning. Obama talked about costs on the campaign trail, as president-elect, and throughout the process. Maybe that was the right strategy, maybe not. But for relevant political players to pretend this reality never happened is absurd.


A couple of weeks ago, Sen. Joe Lieberman (I-Conn.) made it sound as if any kind of competition for private health insurers was completely unacceptable -- even if competition is "triggered" years from now, based on key benchmarks.

But that couldn't be, could it? Even some Republicans can tolerate a weak "trigger" compromise. Could the former Democrat really be offended that much by the idea of added choice and competition for consumers? Apparently so.

In a scrum with reporters just now, Sen. Joe Lieberman (I-CT) was asked how strong his commitment to filibustering any health care reform public option really is. Asked if he saw any "wiggle room" on his pledge -- say, a trigger for example -- Lieberman said he "felt like standing firm on this one."

"I don't feel like wiggling," he said.

In other words, no flexibility, no competition, no compromise.

This puts the Connecticut senator to the right of Olympia Snowe, who would accept a public option kicking in down the road, giving insurers at least some incentive to meet certain benchmarks.

It also muddles the Senate picture. If Lieberman isn't just posturing -- and really, who knows? -- there aren't 60 votes for a public option, there aren't 60 votes for a public option with an opt-out compromise, and there aren't even 60 votes for a public option "trigger" compromise. As far as Lieberman is concerned, the only health care reform bill that can pass is one that shields private insurance companies from competition entirely.

One can imagine a scenario in which the Senate bill has a trigger, prompting Snowe to vote with Democrats, and Lieberman to vote with Republicans.

For what it's worth, Lieberman met with Senate Majority Leader Harry Reid (D-Nev.) yesterday. Reid said he's "confident" that the two will be able to "work something out."

What that agreement might look like is anybody's guess.


The Washington Post's Ruth Marcus explained in her new column that she's "not a huge fan" of the House health care bill -- she didn't say why, exactly -- but the columnist ended up cheering for the legislation anyway. Apparently, Marcus heard an "appalling amount of misinformation being peddled" by Republicans, and grew disgusted.

I don't mean the usual hyperbole about "a children-bankrupting, health-care-rationing, freedom-crushing, $1 trillion government takeover of our health-care system," as Texas Republican Jeb Hensarling put it. Or the tired canards about taxpayer-funded abortion or insurance subsidies for illegal immigrants. Or the extraneous claims about alleged Democratic excesses....

I mean the flood of sheer factual misstatements about the health-care bill.

Marcus proceeds to document all kinds of lies from a variety of GOP lawmakers. There were obvious falsehoods about Medicare, taxes, Comparative Effectiveness Research, jobs, and the public option. It was as dishonest a display as one will ever see from one party in one day.

You have to wonder: Are the Republican arguments against the bill so weak that they have to resort to these misrepresentations and distortions?

Good question. When you take an intellectually unserious caucus, add dashes of panic and paranoia, and throw in a healthy dose of ignorance, you end up with a group of people who can't help but lie -- they have nothing else of value to say.

Marcus' column was especially impressive for resisting the urge most of the media establishment gives into: trying to pretend "both sides" are equally bad. It's lazy but common, and Marcus, to her credit, called it like she saw it. There was no need to put a pox on both houses, when only one had earned it.

House Republicans spent the entire debate shamelessly lying. Here's wishing other media figures were as willing as Marcus to say so.

digby: An Immoderate Proposal

I have a moral objection to paying for any kind of erectile dysfunction medicine in the new health reform bill and I think men who want to use it should just pay for it out of pocket. After all, I won't ever need such a pill. And anyway, it's no biggie. Just because most of them can get it under their insurance today doesn't mean they shouldn't have it stripped from their coverage in the future because of my moral objections. (I don't think there's even been a Supreme Court ruling making wood a constitutional right. I might be wrong about that.)

Many of the men who are prescribed this medication are on Medicare, so I think it should be stripped out of that coverage as well. And unlike the payments for abortion, which actually lower overall medical costs (pregnancy obviously costs much, much more) banning tax dollars from covering any kind of Viagra would result in a substantial savings:

The price of Pfizer’s Viagra has doubledsince it was launched, according to a list of wholesale acquisition costs paid by pharmacies, obtained by BNET. In May 1999, a 100-count bottle of the blue diamonds cost $700. Today, that same bottle costs $1,457.61, a 108 percent increase, according to the list:

(Click to enlarge.)

The blog of online pharmacy AccessRx notes that Pfizer has also been extracting more frequent price rises in addition to higher price rises:

… we’re not sure if you’ve been tracking price increases recently, but Pfizer began to raise the cost of Viagra twice a year instead of once a year in 2007. Including the last six price increases since Jan. 1, 2007, the price of Viagra has gone up 45.5%.

The WAC list indicates that while Pfizer was initially content to take price increases of 3 percent per year, in 2003 it doubled that increase. In January 2009, Pfizer bumped it up to 11 percent. Then in August it took another 5 percent.

It’s an astonishing example of pricing power, given that Viagra is in direct competition with Eli Lilly’s Cialis and Bayer’s Levitra. The heat from Cialis is particularly severe: Cialis sales in the U.S. were up 16 percent to $149.4 million in Q2; Pfizer’s Viagra was up only 4 percent at $207 million.

I don't want my tax dollars touching even one milimeter of that overly engorged expense.

I realize that many people disagree with my moral objections to men getting erections which God clearly doesn't want them to get, but my principles on this are more important to me than theirs are to them. So too bad. If you want a boner, pay for it yourself.

And I think those noxious advertisements for the drugs should be banned as well, if only for aesthetic reasons. Having to watch my baby boomer fellows wail "Viva Viagra" is offensive to anyone who has any taste in music.

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