Monday, December 21, 2009

Going to Press with the Media We Have

I find it fascinating that the Post has two of the sharpest policy (Ezra Klein) and political (Greg Sargent) analysts around writing highly regarded blogs, and yet have a stable of mostly unaccountable fools and tools writing Op-Eds on their premium location.
DougJ: The arrogance meme

Kaplan “economics columnist” Robert Samuelson has a bizarre, content-free, anti-Obama screed today. I’m not going to link, but here’s a sample:

Barack Obama’s quest for historic health-care legislation has turned into a parody of leadership. We usually associate presidential leadership with the pursuit of goals that, though initially unpopular, serve America’s long-term interests. Obama has reversed this. He’s championing increasingly unpopular legislation that threatens the country’s long-term interests. “This isn’t about me,” he likes to say, “I have great health insurance.” But of course, it is about him: about the legacy he covets as the president who achieved “universal” health insurance. He’ll be disappointed.


What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.

There is very little substantive criticism of the plan and a lot of citations of poll numbers.

I’ve had a hard time figuring out where the media’s arrogance meme comes from. I don’t think Obama strikes many voters as arrogant, whatever their problems with him might be. I tend to think it comes from the obvious contempt he has for media elites.

There’s something rich about such a self-absorbed group accusing of Obama (or anyone else) of thinking it’s all about him.

from the comments:


Thanks for not linking.

It is just amazing how bad the daily Kaplan’s columnist are.

I’ve had a hard time figuring out where the media’s arrogance meme comes from.

They get it from the Republicans who use it as code for “uppity”. It really is that simple.

Krugman: What has health care reform ever done for us?

Reading Tim Fernholz’s takedown of Robert Samuelson’s latest, it struck me that this is pretty much what we’ve been hearing over the last few days from all the people who have made careers by righteously demanding entitlement reform, but are running away now that the real thing has made an appearance. Health care reform does nothing, they cry — except for covering 30 million people, ending overpayment on Medicare advantage, making the first real attempt to use medical evidence to guide health care spending, starting up a wide range of pilot projects on cost control while empowering an expert panel to put the results of those projects into effect, providing financial incentives to limit excess coverage, and so on.

But aside from that, you see, it doesn’t do anything.

And my thoughts turn, as they so often do, to Monty Python:

All right… all right… but apart from better sanitation and medicine and education and irrigation and public health and roads and a freshwater system and baths and public order… what have the Romans done for us?

Fernholz: "To Be Sure" About Health-Care Reform, Don't Read Robert Samuelson.

Robert Samuelson is the archetypal Washington columnist, who's managed to write about federal politics for years without learning a thing about it. He's also got the cliches down, one of which is the "to be sure" paragraph, where editors ask writers to stick the strongest counter to their own argument; it usually comes at the end of a piece. The Post's editors had Samuelson stick his "to be sure" in the fourth paragraph, and it's a doozy. Here's what we're talking about:

Barack Obama's quest for historic health-care legislation has turned into a parody of leadership. .... of course, it is about him.

... To be sure, [health care reform] would provide insurance to 30 million or more Americans by 2019. People would enjoy more security. But even these gains must be qualified. Some of the newly insured will get healthier, but how many and by how much is unclear.

So, according to Samuel, this whole year-long legislative effort is entirely about Obama's ego ... except for the 30 million people who will get health insurance because of the effort. It's a "to be sure" so big that it blows Samuelson's whole argument out of the water.

Except that there is no argument there. Samuelson argues that the bill will fail to cover more people and cost much more than expected based on his own back-of-the-envelope calculations about immigration, a report from the Lewin Group, which is funded entirely by the private insurance industry, and a 2007 CBO report that discusses total federal spending, not health care. He totally ignores all of the current studies by the CBO and other independent analysts that say the bill will cut the deficit -- a notoriously stingy CBO's latest estimate says the bill will save $132 billion over the first decade, and a corrected estimates of the long-term costs say the bill will cut the deficit by "between one-quarter percent and one-half percent of GDP" over the second decade while cutting the growth rates of Medicare and Medicaid costs in half. These facts don't make it into Samuelson's column.

The biggest joke is that Samuelson once again fails to understand the political dynamics that led to this bill's creation; in fact, it is the same mistake he made in the summer with the stimulus. (Remember what I said about not learning?) He totally elides Congress from his analysis -- this is "Obama's plan" despite the fact that he didn't write it, Congress did, and that various members of Congress (none mentioned in this column) put in things that Obama didn't like, and took out things he did. Obama will have to own these reforms, and he played a role in their creation, but to assign him total responsibility here is just willful blindness to the basic facts of how the U.S. government works.

Here's a bet. No one will be able to shred this post by Post blogger Ezra Klein as effortlessly as any sentient being instantly shredded Samuelson's piece.
Ezra Klein: Jane Hamsher's 10 reasons to kill the bill

I've gotten a lot of requests to respond to Jane Hamsher's list of 10 reasons to kill the Senate bill. At this point, I'm not sure there's much in the way of productive dialogue to be had here. Some of the list is purposefully misleading and is clearly aimed more at helping activists kill the bill than actually informing anyone about what is in the bill. Some of it points out things that really should be changed in the bill but aren't central to the legislation itself, and are simply being leveraged to help activists kill the bill. But maybe there's some utility to putting the document in context.

1) Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.

"You," huh? For the 85 percent of the country already covered by health-care insurance, it doesn't force "you" to do anything at all. People on Medicare are not going to be paying money to private insurance. People with employer-based care will not see their situation change.

For the nearly 50 million Americans caught in the ranks of the uninsured, here's the deal: The bill expands Medicaid, a public program, to cover about 20 million of, uh, "you." Private insurance gets nothing. If you make more than 133 percent of the poverty line, but less than 400 percent, there's a huge system of new subsidies to help you afford private coverage. There are also new regulations on insurers forcing them to spend between 80 percent and 85 percent of every premium dollar on medical care, barring them from rejecting you or charging you higher premiums due to preexisting conditions, ensuring they can't place any annual caps on insurance benefits, and more.

But here's the catch: So long as insurance won't cost more than 8 percent of your monthly income, you have to buy into the system. You can't wait until you get sick or get hurt and and then buy insurance, shifting the costs onto everyone else. The cost of having a universal, or near-universal, system is that people have to participate. The promise is that, for the first time, participation will be possible.

2) If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.

Again, who's "you?" If you don't have employer-based coverage, Medicare, Medicaid, or anything else, and premiums won't cost more than 8 percent of your monthly income, and you refuse to purchase insurance, at that point, you will be assessed a penalty of up to 2 percent of your annual income. In return for that, you get guaranteed treatment at hospitals and an insurance system that allows you to purchase full coverage the moment you decide you actually need it. In the current system, if you don't buy insurance, and then find you need it, you'll likely never be able to buy insurance again. There's a very good case to be made, in fact, that paying the 2 percent penalty is the best deal in the bill.

3) Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.

How many is "many?" For a look at how various families will fare with reform and without reform, see this table, and this article. But if you don't want to click the links, this graph, which shows the financial risk that medical costs pose to families with different incomes with and without reform, tells the story:

Rec Reform - Dollars.jpg

The vast, overwhelming majority of families will be better off under this bill. The families in the greatest danger get the most help. They will have insurance that they can use, and if they need it, subsidies to help them afford it. Compared with the status quo, in which about 50 million people have no insurance and tens of millions more have insurance they can't afford to use, this is a massive improvement. As Jonathan Cohn writes, "This is a hugely progressive program to bolster economic security, the likes of which we haven't enacted in this country for a long, long time."

4) Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.

The Senate bill is better than the House bill on this score, but it's still a problem. That said, the restriction here is not on the right to choose, but on whether primary insurance covers abortion. In the House bill, the exchanges can't offer primary insurance that covers abortion. In the Senate bill, individual states can choose to bar abortion from their exchanges, but it is not the default.

5) Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.

"You" probably don't have these plans, which are tilted towards the rich, not the middle class. Your plan probably doesn't cost more than $23,000 a year. And if it does, the only part that gets taxed is the part in excess of $23,000 a year. The average family health-care plan costs about $13,500 -- almost a full $10,000 less than the plans this policy taxes. If we don't manage to slow the growth in health-care costs, this policy will, over time, hit plans that are less generous. But economists consider the excise tax, which functions as a tax on insurers who let premiums grow too quickly, one of the most effective cost-control mechanisms in the bill.

There's an equity aspect here, too: The problem with the excise tax is that it doesn't go far enough. All plans would be fully taxable. This policy begins to chip at the edges of one of the most regressive elements of our system: Health benefits, which are mostly given to better-off workers, are protected from taxes, while income isn't. A worker at Wal-Mart with no health benefits sees his entire paycheck taxed. A worker at Goldman Sachs with a $40,000 health-care plan is getting $40,000 of his paycheck tax-free. It's wildly regressive.

6) Many of the taxes to pay for the bill start now, but most Americans won't see any benefits -- like an end to discrimination against those with preexisting conditions -- until 2014 when the program begins.

It's not even clear what Hamsher is referring to here (the accompanying link is broken). The main tax in the bill is the excise tax, which starts in 2013, not "now." And the bill isn't funded primarily by taxes. It's funded primarily by changes to Medicare. It would be useful if Hamsher explained what tax changes people are going to notice in, say, 2011. My understanding is that the answer to that is, essentially, "none at all." The word "many" is obscuring a lot more than it's illuminating here, making it seem as if the majority of the bill's funding mechanisms trigger immediately. They do not.

7) Allows insurance companies to charge people who are older 300% more than others.

The status quo is that insurers can charge people as much as they want, and they can refuse some people altogether. Hamsher doesn't present it this way, but the bill is a huge improvement on this front.

8) Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.

This is correct. The bill gives pharmaceutical companies a 12-year exclusivity period, and then changes get 12 years atop that. It's one of the worst elements of the bill, and should be changed.

9) No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.

This isn't really part of the bill, so much as it's a failure to pass a change that people have been trying to pass for a decade now. People should keep trying. But saying you'll torpedo trillions in subsidies and protections for the poor if you don't also get drug re-importation is a bit like saying you'll refuse to pay the sale price for this TV if Best Buy doesn't also let you use a coupon.

10) The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year -- meaning in 10 years, your family's insurance premium will be $10,000 more annually than it is right now.

It's not even clear what this is supposed to mean. According to the Congressional Budget Office, this bill reduces the average cost of premiums by a little bit for most people, and a ton for the people the bill directly affects. According to the Center for Medicare and Medicaid Services, the bill cuts spending in the long term. According to everybody, it decreases the deficit. The bill has at least five major cost controls that won't exist in its absence. Hamsher, earlier in this list, came out in opposition to two of them. And the bill does all this while covering more than 30 million people, ending the ability of insurers to discriminate based on preexisting conditions, creating a new and more competitive insurance market, taking the first steps away from fee-for-service medicine, and much more.

And that's the problem with Hamsher's list more broadly. The points about the bill's provisions are, in most cases, misleading. But much more problematic is that Hamsher's list implies that the bill is failing relative to a world in which we don't kill the bill. But in that world, there's still no drug re-importation. Still 50 million uninsured. Still rampant cost growth. In the world where we pass the bill, most everything gets somewhat better, if not good enough. More people have insurance. The insurance industry ditches its worst practices. Fewer families go medically bankrupt. More people catch diseases early, when they can be cured, rather than late, when they become fatal. People who would otherwise have died live. The medical system begins the process of updating itself for the 21st Century, and responding to the cost pressures it's placing on the rest of the country.

Compare that to the world in which we kill the bill, a world in which everything just continues to get worse, and politicians are scared away from the issue for decades.

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