Why do conservatives and Republicans blame Obama for out-of-control spending?

At some point, I'll have more to say in answer to that question.  For now, though, this chart illustrates why I ask it in the first place:

Cato ("Individual Liberty, Free Markets & Peace") Institute's Daniel Mitchell explains:

...the 2009 fiscal year began on October 1, 2008, and the vast majority of the spending for that year was the result of Bush Administration policies. Yes, Obama did add to the waste with the so-called stimulus, the omnibus appropriation, the CHIP bill, and the cash-for-clunkers nonsense, but as the chart illustrates, these boondoggles only amounted to just a tiny percentage of the FY2009 total — about $140 billion out of a $3.5 trillion budget.

 So, why aren't we seeing pictures of George W. Bush in Hitler-stache at these "Tea Party" rallies?

In which Mike Pence lies about the Democratic reform proposal's effect on families' premiums

Marc Ambinder hi-lites an obvious case of partisan cherry-picking from our very own Representative:

Here's the latest health care reform claim, by Rep. Mike Pence:


"The CBO has confirmed what every American already knows, the Democrats' plan for a government takeover of health care will dramatically raise health care costs on working families. This latest CBO study reveals that the health care bill before the U.S. Senate will raise individual insurance premiums by up to 13 percent. That means every family that refuses the government's one-size-fits-all plan, will be forced to spend an additional $2,100 a year to keep their current health care.

Pence doesn't say, but here's where he gets the figure:

Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.

Fairly clear, right?  Only if you're suddenly blinded.

The very next sentence in the CBO report is: "Those figures indicate what enrollees would pay, on average, not accounting for the new federal subsidies. The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT."'

For those receiving subsidies -- the people who Pence's statement is targeting because they're the most vulnerable -- the CBO says that "...the amount that subsidized enrollees would pay for nongroup coverage would be roughly 56 percent to 59 percent lower, on average, than the nongroup premiums charged under current law."

Just to re-hash: Pence claimed that the CBO said that the Democratic plan would raise premiums by 13 percent.  In the real world, the CBO said that the Democratic plan would reduce premium costs by somewhere between 50 and 60 percent.  

Opposing liberal policies for legitimate reasons is one thing; lying outright about said policies is another.  Is this the best we can do?

Mike Pence is very concerned about rising health insurance costs...so what has he done about it?

I had the opportunity two weeks ago to attend a panel discussion on health insurance reform.  Representative Mike Pence was one of the panelists.  His opening comments intrigued me, as they included a number of interesting assertions.

First, Pence said unequivocally that the current system was flawed and not working for consumers.  Second, he said that he believed rising health insurance costs constitute a "crisis" and offered an impossible-to-substantiate claim that in 2005 he had urged President Bush to take on health insurance rather than Social Security.  Finally, Pence claimed that this was an issue he had been working very hard on ever since he was elected 9 years ago. 

All of that was news to me.  I went home from the panel and began researching Pence's legislative history on health insurance reform.  I found that he had voted to cap medical malpractice damages (2003-2004 session) and had twice introduced bills that would create small business associations that could purchase insurance across state lines (2003-2004 session, and 2005-2006 session).  Neither of the small business association bills even made it out of committee, and at both times you had a Republican-controlled Congress (which means that not even the Republicans think these were good bills).  Of course, this may be because there are significant problems with this type of "plan" for making health insurance more affordable. 

I e-mailed Mr. Pence's office to ask what else he had done to address this crisis and why he thought his own party had failed to do anything meaningful to solve the problem of skyrocketing health care and insurance costs when they were in power.  That was about three weeks ago.  I am yet to hear back from them, even though they promise a response in "ten business days."  I'll let you know when we're finally able to get in touch.

P.S.  For those of you who are curious about what your legislator(s) do while they are in Congress, this website can be very helpful.

A military surge provides space for - but no guarantee - of political reconciliation

From the NYT:

As the Obama administration prepares to unveil a new set of “benchmarks” to measure political progress in Afghanistan — and to prod President Hamid Karzai to improve governance there as he anticipates more troops from America — Iraq’s experience can serve as a cautionary tale.

Much of what has stalled the election law stems from the failure to achieve the same sort of benchmarks, which Congress imposed when President Bush ordered a “surge” of American forces here in 2007 to stanch an incipient civil war.

Adopting legislation to knit the country together; reforming the Constitution; strengthening independent security forces; reconciling Iraq’s Shiites, Sunnis and Kurds — all were benchmarks, and all remain partly or wholly unmet, despite the security gains that were supposed to create the space for political progress and thus peace.

Local post: Muncie Action Plan meetings

If you're in Muncie and want to be involved in the process, here are the meeting place and times for the Muncie Action Plan community meetings:

December 1st – Ball Memorial Hospital Auditorium, 2401 W. University Avenue – 5:30 PM to 7:30PM
December 2nd – Southside High School Cafeteria, 1601 E. 26th Street – 5:30 PM to 7:30 PM
December 2nd – Muncie Area Career Center President's Room , 2500 N. Elgin Street – 5:30 PM to 7:30 PM
December 3rd – Forest Park Senior Center, 2517 W. 8th Street – 1:00 PM to 3:00 PM
December 3rd – Northside Middle School Cafeteria, 2400 W. Bethel Avenue – 5:30 PM to 7:30 PM

Here's the website.

A thought for the holidays

I know a number of individuals and families who already do this sort of thing. It's a good idea:

...this holiday season we will spend excessive amounts of money on trivial and momentary entertainment. Instead, we could make contributions to local organizations that make long-term investments in our communities.

Want to do something important? Cut your spending on gifts for the family and give a generous check to your local adult literacy program. Write a check to a conservation group, like the Sycamore Land Trust. Donate to your local public library or school foundation. These groups will keep your money working for years to benefit many, not for just several hours to benefit a few.

Brule's Rules

Worth your while:



h/t: John C.

Evan Bayh: You have to pay for everything, except wars, which are awesome.

Glenn Greenwald, who is occasionally prone to hyperbole, lays into Senator Evan Bayh (D-IN) over Bayh's proclamation that he is a deficit hawk, even though he thinks wars should be started without any thought to funding them:

Bayh wants to send other people into every proposed war he can find and keep them there forever ever without ever bearing any of the costs himself -- not in military service for him or his family nor even in higher taxes to pay for his glorious wars. Sacrifice is for everyone other than Evan Bayh and his friends. He runs around praising himself as a "deficit hawk" while recklessly supporting wars and indefinite occupations that the country can't afford and which drive us further into debt. He feigns concern over the "deficit" only when it comes time to deny ordinary Americans benefits which he and his family already possess in abundance.

Much of this comes from Bayh's appearance on Fox News Sunday, which included this exchange with host Chris Wallace:

WALLACE: Senator Bayh, you brought up the question of cost, and the administration has put the cost -- and this is kind of astonishing to, I think, a lot of people -- $1 million per soldier per year, so if you sent 30,000 soldiers, that would be a $30 billion price tag.

Now, some top Democrats are talking about the idea -- the new idea of a war tax to pay for the escalation in Afghanistan. Good idea?

BAYH: No, I don't think it's a good idea, not at this point, Chris. First of all, you need to provide for the nation's security regardless of your financial situation, and there's no bigger deficit hawk in Congress than I am.

I think we need to start coming to grips with this. We're going to have a big vote coming up on the debt ceiling. I don't think we should vote to raise the debt ceiling until we have a strategy in place to get our deficits down.

So we've got to take the fiscal situation seriously, but, number one, national security comes first.

Number two, we've got to look at cutting spending in other parts of the budget before we even talk about raising taxes.

If these wars were not wars of choice (and, in fact, all wars involve some degree of choice about how resources are allocated and utilized), it would be easier to argue that the cost is not something we can worry about at the moment; but seeing as Iraq turned out to be the textbook case of a war of choice and Afghanistan has increasingly looked like one, it's hard to argue that we simply must fight these fights without any concern over the cost in blood and treasure.

On Football Power Rankings

As a follow-up to C's football-related post, here is a quick complaint about sports journalism:

Every week I kill time by reading NFL "Power Rankings" on various sports websites. I'm sure you are all familiar with what these are.

For the last few weeks, the Colts have squeaked through with wins while the Vikings look dominant. The Colts are 10-0, the Vikings 9-1. Every power ranking I have looked at has the Colts #2 and the Vikings lower.

My complaint is this: the accompanying comment for the Colts is always something like, "That was a subpar performance; they have a lot of problems to fix or else they won't be undefeated much longer."

The accompanying comment for the Vikings is something like, "These guys are unstoppable. Another outstanding all-around performance. Nobody's playing better right now."

THE VIKINGS SHOULD BE RANKED ABOVE THE COLTS IN THESE POWER RANKINGS, IF THAT'S HOW THEY FEEL. THAT IS WHY THEY ARE POWER RANKINGS AND NOT STANDINGS. EVERY SPORTS JOURNALIST SORTS THE TEAMS BY RECORD FIRST FOR 90+% OF THEIR POWER RANKINGS. THIS IS NOT HOW THEY SHOULD WORK. I WOULD LOOK AT THE STANDINGS IF I WANTED TO KNOW WHICH TEAMS HAD GOOD RECORDS.

That's all.

Dallas Clark is a really good football player

Re: Taxing health insurance benefits to pay for reform

In comments, B wonders whether or not President Obama will end up supporting a tax on health insurance as part of the Senate health care bill, primarily because Obama lambasted McCain's health care plan during the campaign for including pretty much the same tax.  As I've said before, there are significant differences in the overall packages and what they'll do for working- and middle-class families and, as they say, therein lies the rub.  From October of 2008, Harvard University's Jeff Liebman on the effect of McCain's plan to tax health insurance:

Here's how the McCain plan works. Every family receives a refundable tax credit of $5000 that can be used only to purchase health insurance. Individuals receive $2500. McCain's advisers say the cost of this tax credit is $3.6 trillion dollars over ten years. They also say that their plan is revenue neutral because they introduce a new tax on employer-based health insurance that the Joint Committee on Taxation scores as raising $3.6 trillion over 10 years.

Currently, employee compensation in the form of employer-provided health insurance is exempt from both the personal income tax and FICA payroll taxes. Most employee payments for employer-based health insurance are also tax preferred. McCain's plan would eliminate these and other health-related tax expenditures.

The fact that the plan is revenue neutral means that the tax savings for families receiving tax cuts are exactly balanced by the tax increases for families whose taxes go up. But because the tax cuts are front loaded, after just a few years most American families will see their tax bills go up under the McCain plan.

What does this mean for a typical family? In 2009 the average premium for a family health insurance policy will cost about $13,600. With McCain's new tax on employer-provided health benefits, families in the 25 percent federal income tax bracket (which starts at taxable income of $65,100) will pay additional income tax of $3400, additional payroll tax of $1040, and will have their earnings cut by $1040 as their employers pass on the increase in the employer portion of the FICA tax. So the total tax on health insurance will be $5480, $480 more than the value of the new health insurance tax credit.

Because the McCain tax credit would be indexed only to inflation while the cost of health insurance has been rising at around 7 percent a year, the net tax increase will rise rapidly over time. By 2012 this typical family would receive a tax credit from the McCain plan of about $5337. But with premiums rising in that year to over $16,600, the new McCain health insurance tax would reach $6699 - for a net tax increase of $1362. By 2016, the tax credit would be $5823, while the new tax would be $8782 - a net tax increase of almost $3000.

Families in lower tax brackets will initially receive a tax cut from the McCain plan, but after a few years, they too will pay higher taxes. And millions of families with better than average health insurance plans or living in states with higher than average health care costs will see their taxes go up under the McCain plan by substantially more than is illustrated in the example above. In effect, the McCain plan punishes families with good health care by raising their taxes the most.

Lady GaGa and Christopher Walken do "Poker Face"

h/t: The Daily Dish.

KSM in NYC: What do you think?

Khalid Sheik Mohammed, known as one of (if not the) chief planner of the 9/11 attacks, will be tried in federal court in New York City. The right is incensed. William Kristol published an e-mail from a sister of one of the victims:

Today Attorney General Eric Holder will announce that Khalid Sheikh Mohammed and several of his fellow 9/11 co-conspirators will be brought to New York City and tried in federal court. No doubt the Attorney General will invoke the phrase, "Swift and certain justice." This is a sham. There will be nothing swift and nothing certain about it.

The trial will be a travesty. The prosecutors at the Southern and Eastern Districts fought over these career-making cases like vultures at a kill. But who will be the vulture? In open court, it will be Khalid Shiek Mohammed who will hold forth, mocking his victims, exulting in the suffering of their families, ridiculing the judge, his lawyers and the American justice system, and worst of all, rallying his jihadi brothers to kill more Americans as the men and women of the US military risk their lives in the mountains of Afghanistan and the sands of Iraq. All, just blocks from where 20,000 body parts were dug out of the rubble of the Twin Towers.

Remember KSM's famous opening line when he was grabbed in Rawalpindi? "I'll talk to you guys after I get to New York and see my lawyer." Thanks to the Obama admnistration, it looks like he’ll get his wish. And he’ll do his best—with the help of this top-drawer lawyers and much of the media—to make the real defendants at the trial the CIA interrogators—and the American government.

How will this help achieve what our president claims he wants to achieve--"restoring respect for America"? Is that what he really wants?

I am of the opinion that this particular court setting is most appropriate.  After all, New York was far and away the community most affected by these attacks.  Also, I'm not particularly worried about what KSM will reveal about the CIA interrogators that has not already come out (we know pretty much all there is to know about how he and others were treated during their detainment).  And of course the interrogations did not concern the investigation into whether, in fact, KSM helped with 9/11, but with ongoing security concerns regarding future terrorist attacks.  I doubt that the prosecutors will rely very heavily - if at all - on evidence obtained during KSM's detention, primarily because they won't have to. 

Anyways, I gotta run.  Particularly for any lawyers out there, what do you think of all this?

Cost-control: House vs. Senate

The House bill has been taking some criticism lately because it expands coverage without doing very much to cut costs. Ezra Klein explains the ways in which the Senate Finance Committee's bill compensates for that weakness:

The Senate Finance Committee's bill, which will be quite close to the merged Senate bill, allows you to tell three credible stories on cost control that the House bill simply doesn't.

The first comes from the excise tax on high-cost health insurance plans. The idea here is simple enough: you're taxing any growth in health-care premiums that's faster than the rate of growth in GDP plus one percentage point, which is going to make people a lot less accepting of premium increases and unchecked growth. This is, in the simplest sense of the term, a cost control. In theory, it controls costs by taxing one of the drivers of cost growth into submission. It is, by far, the policy economists are most united on, and the one that works in the most straightforward and blunt way.

The second comes from the newly formed Medicare Commission, which is a lot stronger than people realize. The idea isn't simply that a panel of experts gets to dream up interesting reforms to try out in Medicare. It's that they are charged with making sure that Medicare hits certain growth targets, and their package of reforms has to achieve that goal. Those reforms are then sent to Congress, where Senate debate is limited to 30 hours, and amendments must be both budget neutral and "germane." This report, in other words, is exempt from the filibuster. So far as anything is ever easy to pass, this is easy to pass. If Congress cannot manage action even within this streamlined process, then it simply cannot cut health-care costs at all, and our federal government will go bankrupt.

The third is the delivery-system reforms. The House bill has these too, though they're a bit weaker. They key alchemy, however, is the interplay of the delivery-system reforms and the MedPAC commission. The Senate builds in a lot of pathways by which an idea that starts in Medicare through the commission and proves successful can be brought to pilot and then brought to scale across the health-care system. Medicare serves as the laboratory, but other institutions created in the bill serve as the factory.

All three of those stories make sense, and any of them, on their own, would represent the most significant effort at cost control in a generation, if not ever.

The 100 Greatest Quotes from the Wire

For all you fans out there (NSFW - cursing, violence, etc.):

Local post: Teacher licensing and school funding in Indiana

Indiana State Superintendent of Schools Tony Bennett recently proposed a series of changes to the ways in which teachers are educated (briefly: more subject mastery, less pedagogy) and how licenses will be granted in the state (again, briefly: make it easier to transition into teaching from another career).  Many teachers, ed. school folks, teachers-in-training do not like the reforms.  The manner in which this all unfolded was not very surprising.

The proposed changes are not as bad as many say they are, but they are also not a solution to the problems with Indiana's - and the country's - public education system.  They may attract some people from the professional world with expertise in particular areas into the teaching profession, but this kind of thing is already happening.  Nonetheless, these changes may be necessary in order to compensate for the looming teacher shortage that will come as more and more boomer-teachers retire.  It might weaken the ed. schools, which may or may not be one of the governor's goals.  It might affect teachers' unions, though there is no reason to believe that this new kind of teacher will have any less incentive to join than one who is traditionally-trained.  It won't attract a huge swath of talented and motivated people to the profession who otherwise wouldn't teach - only money would do that.  As things stand, most teachers in Indiana - even if they are the best-educated, most successful, and most experienced teachers in their districts - will not make half of what the average superintendent makes in a year. 

Following the jump, three videos that make up a segment from WFIU on the current funding formula used by the state DOE and on  Bennett's proposed changes:

'B' 2012 Watch

As I began my health care analysis to be posted Sunday, I realized that I should start a new tradition: the 'B' 2012 Watch. I will periodically post opinions of prospective candidates for the 2012 election. Given the radical shift in my views between 2004 and 2008, I figured it might be funny to look back on this when 2012 is actually upon us. Although I am a registered independent, I intend to vote in the Republican primary...

Top 5 Preferred Candidates for GOP Nomination

1. Greg Ballard Condi Rice
2. John Thune
3. David Petraeus
4. Mitt Romney
5. Mitch Daniels
   

Distribution of Likelihood of Vote (out of 1)
[Prob. candidate runs * Prob. candidate is preferred|Candidate runs]

1. Romney (.6)
2. Thune (.1)
3. Pawlenty (.1)
4. Jindal (.1)
5. Palin, Daniels, Petraeus, Cantor, Rice (.02)

 Likelihood of Final Vote:

1. GOP (.8)
2. Democrat (.2) 
   

Approval of Obama (1-10/Binary): 3/Nay

Addiction, Drugs, and Guns

For those of you interested in addiction issues, prohibition, or guns, here's an intriguing (and old) bloggingheads discussion. This Kleiman guy knows his stuff.

The Brookings Institution responds to Rahm

I earlier linked to this statement from Rahm Emanuel, which was basically taken as a defensive reaction to the concerns of liberal policy wonks who don't "get it":

“Let’s be honest, the goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.”

William Galston, a Brookings senior fellow, responds:

Dear Rahm,

It may surprise you to learn that many of us here at Brookings like politics as much as you do, and some of us even know something about it. But we don’t understand it exactly the way you do.

Yes, politics is the art of the possible. But leadership is the art of expanding the possible. Leadership without politics is futile. But politics without leadership is blind.

If you define “success” as a bill—any bill—you (and by implication, the man you serve) are telling your former colleagues in Congress that they are free to do whatever suits their short-term political convenience. This all but guarantees that their work product will duck the hard issues. In the case of health care, it means that they won’t embrace real, guaranteed, and substantial long-term cost reductions throughout the entire system, private as well as public, without which universal coverage will quickly become unsustainable.

It’s time for the White House to step in and speak out. That means publicly specifying the essential elements of meaningful health care cost containment. And it means insisting that they are included both in the Senate bill and in the conference report. I think you know what they are. If not, call Peter Orszag.

Sincerely,

William A. Galston, Senior Fellow

The infamous den of useless utopian thinking known as the Brookings Institution

David Leonhardt on what should change in the House health care proposal

Over at the NYT, David Leonhardt has an interesting column on what could - and should - change in the health insurance reform bill. A few of his ideas:

THE EASY STUFF Each year, about 100,000 people die from preventable infections they contract in a hospital. When 108 hospitals in Michigan instituted a simple process to prevent some of these infections, it nearly eliminated them.

If Medicare reduced payments for the treatment of such infections, it would give hospitals a huge financial incentive to prevent them. The Senate bill takes a small step in this direction by cutting payments to hospitals with high infection rates by 1 percent. The House bill merely requires hospitals to report their rates publicly. There are also other basic patient safety areas in which the bills can do much better.

WHAT WORKS? Earlier this year, I used prostate cancer as an example of how our fee-for-service medical system leads to higher costs and worse outcomes. There are a handful of possible treatments for early-stage prostate cancer, and the fastest-growing are the most expensive. But no one knows which ones work best.

Modern medicine is full of such uncertainty. Again, the federal government could make a big difference here by giving Medicare a moderate amount of money for research, which would pay for itself many times over. The stimulus bill began paying for such research, but the health reform bills fail to pick up where the stimulus leaves off.

A FED FOR HEALTH Twice a year, an outside advisory board sends Congress a list of suggestions for Medicare payment rates, based on the available evidence. Congress generally ignores them, in deference to the various industry groups that oppose any cuts to their payments.

We already have a wonderful model for how to avoid such interference. It’s called the Federal Reserve. The Fed is charged with setting interest rates based on economic conditions, not politics. The Senate bill would create such a commission for Medicare. Unfortunately, it initially applies to doctors and home health care providers but not hospitals, thanks to a deal between the hospitals and the White House. It expands to include everyone in 2019. The House bill has no such commission.

Whether one ends up in the final bill will be a good test of Mr. Obama’s endgame leadership.

The GOP Alternative

A week and a half ago, House Republicans finally unveiled their proposal for reforming the health insurance industry. According to the GOP website, there are four basic principles at the heart of their proposal:

* Number one: let families and businesses buy health insurance across state lines.
* Number two: allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.
* Number three: give states the tools to create their own innovative reforms that lower health care costs.
* Number four: end junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it's good medicine, but because they are afraid of being sued.

I'm no expert, so I'm interested to hear what people know about these proposals - good and bad.  Here's my understanding of some of the potential drawbacks at play here.

Number(s) one and two (portability): The problem is that different states have different regulatory systems for insurers, some much more lax than others.  Let's say that Montana has the weakest laws for insurance companies.  In a national system, insurance companies would have an incentive to locate and sell their insurance packages out of Montana.  In so doing, they would evade the stricter consumer protections that many state legislatures have enacted for their citizens, and over time, consumers would have fewer and fewer protections as more and more insurers work out of Montana.  Thus, a Hoosier purchasing insurance might have more choices to pick from, but at a significant cost to her rights as a policy holder.  More expensive plans would likely have more protections, but those would not be available to most middle-, working-, and lower-class consumers.

Number three (state innovation): This sounds great, but from my reading of the commentary - and also from Mike Pence's statements at last night's health care panel, this seems to simply be a plan to enlarge and give additional funding to state high-risk pools.  These pools tend to have higher premiums, less generous benefits, and they also (usually) adjust premiums based on age.  

Number four (tort reform): Most states have already done this by placing caps on damages that can be recovered for medical malpractice.  It has not brought down the cost of care or the cost of insurance.  This discussion at the NYT health care blog was interesting.

Again, these are my very basic understandings of some of the potential problems with the GOP alternative.  I welcome corrections and clarifications on this stuff.

Lifestyle choices and health care costs

I agree with B's concern about government getting too involved in our private lives, especially regarding what we eat and drink, and I think we should be careful to draw intelligent notches in that slope.  That said, I think the lifestyle and cost comparison presented is too unrealistic to be helpful in thinking about this (I understand B. was using hyperbole on purpose here).  The problem, really, is that most of the obese and otherwise unhealthy people in this country don't die at 40; rather, the many wonderful medicines, surgeries, and treatments that we have available to us are able to keep people like this alive, many well into their 60s, 70s, and 80s.  This places an enormous burden on our health care system, and especially on Medicare.  Perhaps the solution should focus less on punishing individuals and more on incentivizing institutions - rewarding doctors and hospitals, maybe even employers for better health outcomes (target weights/BMIs, etc.). 

My Dear Friend C.

Kudos to my friend C. for his recent post on health care. A few comments:

none of the reform efforts have done anything to address how the personal choices people make - in their diet, exercise, and lifestyle habits - affect the cost of health care and health insurance.

This is extremely difficult ground for the government to tread on, and I fear that most "solutions" to this problem would represent far too great an intrusion of government into our private lives. Tax on soda and candy is one thing...but it's not too hard to imagine where the slippery slope leads.

Moreover, let's look at two people:

Person A sits around watching TV all day. He eats Domino's Dots and drinks giant screwdrivers. He stays out drinking til 3 a.m., even when he has work the next day. He weighs roughly 400 pounds. He drops dead of a heart attack at age 40 while playing tennis for the first time in 17 years.

Person B is the picture of health. He lives to be 90. Along the way he has various health problems associated with growing older, but thanks to modern modical innovations is able to beat them. He passes away peacefully with his wife by his side.

While Person A will live an uncomfortable life, his medical costs will be nothing compared to Person B's chemotherapy or whatever. We are living longer thanks to medical innovation, but many of these treatments are extremely expensive.

The point is that "rising health care costs" are not solely linked to unhealthy behaviors like being fat and not exercising. I believe this has to be taken into consideration when crafting policy to correct unhealthy lifestyles - if dictating lifestyle choices is an acceptable role of government in the first place.

First and foremost, there will be tangible benefits to a reformed system that will outweigh the corresponding costs

I would interject here that the Democratic cost estimates will almost surely be lower than the actual costs. The CBO and others have commented on how many of their assumptions do not hold up to political reality.

I wouldn't call it a "right," but I would say that it is in our national interest to pursue such a goal.  B and his conservative allies might disagree, or say that it is pie-in-the-sky idealism to believe that our nation is even capable of achieving anything near universal, quality coverage.

Conservatives have offered a number of ideas for how to expand coverage (e.g. portability of coverage). I think conservatives are more inclined to say that if the costs associated with expanding care are too high, universal coverage becomes neither attainable (due to limited resources) nor desirable.

---

In sum, I believe C. and I have the following disagreements on the House health care bill:

1. Since expanding coverage is C.'s primary interest, he is willing to accept a flawed bill in order to get momentum in the direction of universal health care. I value expanding coverage, but not as much as C.
   
2. Since I disagree with quite a few provisions of the House bill, I fear the same momentum C. craves for fear of a "runaway freight train" of government control/intervention and a ruinously expensive new entitlement.
3. C. appears ready to accept the Stupak amendment, whereas if I were a pro-choice liberal, I would not find the House bill worth the cost in terms of reproductive rights.

I'm sure there are quite a few more, but the soda machine broke and I have to type a sign. I welcome further discussion on this issue.

B.

Flawed reform vs. No reform (Block Quotes Edition)

To start, Rahm Emanuel stated quite clearly why, whenever one sets out to change a system, the reforms will not be perfect:

“Let’s be honest, the goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.”

He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”

The bill we get is not going to be perfect.  In fact, it will be far from perfect.  The key issue, it seems, is whether doing something imperfectly is preferable to doing nothing.  On this point, the essential question is, Will the situation worsen, improve, or stay the same if flawed reforms are enacted?

Harvard Medical School's Marcia Angell has argued that the bill is not better than nothing, emphasizing that health care costs will continue to rise and insurance coverage will not improve for many Americans:

It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

John Cohn, writing at for The New Republic,  takes issue with Angell and other liberals and progressives who are dissatisfied with the present reforms, arguing that, in fact, a number of good things will come from this bill:

Veterans Day

To all those who have served, thank you.

Response to L

A quick challenge to my dear friend L's recent post:

I will admit that there are flaws, as every single piece of legislation passed in American history has had. I think Democrats understand this point: “Our plan is not perfect, but it is a good start toward providing affordable health care to all Americans,” said Representative Peter A. DeFazio of Oregon in the NYT article.

What do you believe are the biggest flaws of this legislation? Everyone agrees there are flaws, but the solutions would pull the legislation in different directions. I am curious to hear exactly what L and C consider the biggest flaws of the House bill to be. 

Consider the recent "Stupak amendment." This would go a long way towards denying coverage for abortions to those who need it most. Is the flawed bill worth such a drastic step back on reproductive rights?

I am suspicious that Democrats want to pass a bill simply to say they have "passed health care reform." Much like I am suspicious Republicans want the bill to fail because it would be a blow to the President.

For the longer Obama waited, the more criticism he would endure from those who elected him partially (primarily, for many) to deliver on this promise.

I strongly disagree that health care was a primary reason Obama was elected. I googled a CNN exit poll, and only 9% listed health care as the most important issue. The economy was at 62%.

Even if we accept that the economy and health care are inextricably linked, the House bill does not address the overlapping parts. As far as I know, it does not even purport to lower costs (bills with a public option at least claim to do so) or create new jobs. It simply creates a new entitlement by taxing the rich.

Looking for debate in all the wrong places

Ezra Klein makes a point that is often forgotten:

The reality is that the debate that led to this bill did not really take place across congressional committees and floor speeches. It took place in think tanks and campaigns. In policy forums and among experts. The basic shape of the House's bill is virtually identical to the bills we saw during the campaign, and they were all expressions of the ideas being developed and refined in think tanks and policy shops and advocacy groups ever since Clinton's effort failed.

When people complain about Congress "rushing" health insurance reform, or refusing to "debate" it in substantive ways, they fail to acknowledge that there are many academics, economists, policy wonks, and government staffers who have spent huge chunks of their lives working on - and debating - this issue.  The problems have been indentified.  Solutions have been modeled.  This bill will bring significant changes to the health insurance system in this country.  It will affect who wins and who loses. But a grand, mysterious, and wild experiment it is not.

Health Care Reform Bill Passes House

America is now one very big, very important step closer to realizing its greatness.

This New York Times article does a nice job exploring the jubilation of the Democrats and the absolute terror of the Republicans, who are understandably frightened that rich people will have to shoulder some higher taxes so that poor people -- although health care costs are daunting for the middle-class as well -- can get medical coverage in the world's richest nation.

Of course, objections to the legislation are much more numerous than this, and generally cloaked in more nuance: it's bad for the economy; it will destroy America's medical ingenuity; our quality of care will diminish; and it's just too damn expensive.

My closest Republican friend, an able and witty contributor to this blog, has warned that this "bill is a disaster" and opined that there are "better ways to do" health care reform. He is convinced that the "particulars" of the bill will prove very harmful to and costly for America. I think he's wrong.

I will admit that there are flaws, as every single piece of legislation passed in American history has had. I think Democrats understand this point: “Our plan is not perfect, but it is a good start toward providing affordable health care to all Americans,” said Representative Peter A. DeFazio of Oregon in the NYT article.

But my good friend surely understands that political capital is not inexhaustible and certainly not interminable. Those who call for delaying passage of this bill and demand more and more changes often seem to be less interested in creating a more perfect piece of legislation than in stopping its passage altogether. For the longer Obama waited, the more criticism he would endure from those who elected him partially (primarily, for many) to deliver on this promise. He has been chided unfairly for months about his inability to follow through on campaign promises, and the more unpopular his performance in office becomes, the more probable it is for a few allies here and there to cast their lot elsewhere.

Waiting one more month to vote on this could have been a disaster to Democratic efforts. It passed the House just barely, and the opposite may have been true one month later. Further changes to the bill would have likely accomplished the following:

1. Upset its current supporters.
2. Somewhat assuaged its opponents, though probably not enough to convince them to vote otherwise.
3. The changes would have been so substantial as to render the bill a hollow piece of legislation that does not bring the needed reform. The winner: no one.

Oh, and one last thing: Kudos to Representative Anh “Joseph” Cao of Louisiana, the lone Republican to vote in favor of the legislation.

Now, onto the Senate...

Lieberman Discussion continued

My dear friend C. recently wrote:

2) If Lieberman is just a half-smart legislator, he will realize that the opportunity to pass major health insurance reform comes along rarely.  So, "coming back to the public option 3-4 years from now," will be difficult if not impossible.  If he helps the Republicans filibuster the bill, who knows when the next opportunity to do something about this issue will present itself.

I tend to disagree - not about the public option, but about the "opportunity to do something about" major health insurance reform. I think a qualification is needed: this may be the last opportunity for Democrats to pass a bill that needs not include the Republicans in any way. Republicans are more than willing to work towards a better health care/insurance system. For now the Democrats are not interested in working with them, but bipartisan reform will always be an option in the future.

A little perspective...

h/t: Susan G.

Explaining liberal "apoplexy" over Lieberman

A couple of days ago Joe Lieberman said that he would join a filibuster to oppose any bill containing a public option. As any reasonable observer might expect, liberals were upset by this development, as Lieberman's "bold stand" could scuttle the entire effort at health-insurance reform. Lieberman, though an independent, caucuses with the Democrats and has generally been reliable as the Democrats' 60th vote in the Senate on domestic matters, which is important because 60 votes are required to break a filibuster. By putting his vote in play on this issue, Lieberman is basically holding the bill hostage to his own personal desires and concerns.

Some have championed Lieberman's independence on this as a sign of his personal fortitude and integrity, a commitment to principles of some kind - even though these principles are unstated and unknown. Lieberman said yesterday that he doesn't think that the a "government-run health insurance plan that puts the taxpayer on the line" is not something he can support "at this point in our nation's history."  Does he have a problem with any government insurance plan?  Just with plans that "put the taxpayer on the line"?  On the line - through subsidies of any kind, higher taxes, or premiums?  If his concern is not with those issues, is it just not the right "time in our nation's history?"  One is only left to wonder.

Liberals are fired up about this for several key reasons:

1) Lieberman has frequently stated his support for large-scale health insurance reform.

2) If Lieberman is just a half-smart legislator, he will realize that the opportunity to pass major health insurance reform comes along rarely.  So, "coming back to the public option 3-4 years from now," will be difficult if not impossible.  If he helps the Republicans filibuster the bill, who knows when the next opportunity to do something about this issue will present itself.

3) Lieberman is just wrong about a lot of the elements of the public option.

4) Lieberman used to oppose the filibuster, in principle.

5) Lieberman, like some other public officials, seems to be doing the bidding of the private insurance industry.

6) Even though he lost the Democratic primary in 2006, Lieberman caucuses with the Democratic party and was allowed to keep his chairmanship of the Homeland Security committee.  Some expected Lieberman to repay graciousness with graciousness, and the filibuster threat is not very gracious.

If you prefer video, the following segment from Rachel Maddow hits on a lot of these points.

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