Archive for the ‘Health’ Category

Frum Fired

So the thing I don’t get about David Frum getting canned is that there’s an unequivocal sense in which the health care strategy of the GOP failed. And matter what flavor of the hour predictions Chris Matthews was making it always looked they’d pass something through. Even after Scott Brown, they had a bill through the Senate and a huge majority to work with in the House.

The viability of pretty any political strategy depends on an assessment of if you’ll or lose. Since they had 60 votes, or 59 and a passed bill it’s just clear why the GOP thought they would defeat the bill. There were never any unconditional no votes on the Senate side, just conditional yes votes. Maybe they didn’t they could win, but thought their opposition would lead the broader public drop their support for Obama. It hasn’t happened.

You get a similar calculus on financial reform, climate change or immigration. If it’s going to become law then maybe you don’t want to be on the losing side or you’ll take a tough vote to break the tie, but the same politicians being asked to be the 52nd vote for something that’s going down might not be so interested. Just thinking for myself I’d lose my seat for climate legislation, but not to make environmentalists feel better because they lost by a smaller amount.

So you can’t do strategy without having the discussion Frum wants to have, but apparently it’s beyond the pale for the modern GOP to even try to talk openly.



Zero-sum Fun

I would have thought that if a poll resulted in contradictory results, like the NBC-Wall Street poll on health care which says that voting for or against the health care reform will both make voters less likely to vote for their Congress person you might question the validity of poll results. But not if you’re Chuck Todd to whom such a finding indicates “polarization” of the issue.


Health Reform Legislative Strategy

So why do you need a decoder ring (and where can I get one) to read the Washington Post’s analysis of Obama’s legislative strategy on health care reform:

Increasingly, the White House appears to favor having the House pass a version of the measure that cleared the Senate with 60 votes in December. The Senate would then pass changes to the bill to satisfy some demands of House Democrats. That Senate vote would take place under a parliamentary procedure known as reconciliation, which requires 51 votes rather than 60.

It remains unclear whether Democrats have enough votes within their ranks for this strategy to work. At the same time, it is only “one option” the president is considering, a senior White House official said Sunday

Do they appear in favor of the House, then Senate Rec strategy or is it the only option they’re pushing? It’s like one paragraph was written with an on the record quote and the other on background for two different stories and then put together.


Shaddeg and the Public Option

Mike Stark interviewing retiring GOP Rep. John Shadegg

SHADDEG: Well, you could better defend a public option than you could defend compelling me to buy a product from the people that have created the problem. America’s health insurance industry has wanted this bill and the individual mandate from the get go. That’s their idea. Their idea is “look, our product is so lousy, that lots of people don’t buy it. So we need the government to force people to buy our product. And stunningly, that’s what the Congress appears to be going along with. Why would they do that?

P.S. There really is no “this bill” for health insurance companies to have always wanted and it’s misleading to say so. Some versions of the bill help them much more then others. Even now that the Senate has passed a version of health care reform the final product could change in ways that really change how happy the health insurance industry is with the bill.

Common Sense about Health Care

Let’s state some facts:

The US is the only industrialized country that doesn’t provide universal health care.

According to the WHO World Health Report for 2000 the US health care system is ranked 37th which is the lowest of all the western countries (except for New Zealand)

In the US, we spend twice as much on health care per person in comparison with other OECD countries.

From these facts, we can see that there is a correlation between providing universal health care and overall health care system performance. One could even argue that it’s the reason why other industrialized countries have a better health care system because of the ability of the government to compete with private insurers and because of the lowered administrative costs. But let’s not get into too much of the details here, let’s just talk about some common sense.

Does anyone think being ranked 37th is a good thing? Probably not.
Does anyone think paying twice as much for health care is a good thing? Probably not.

Ok good, so we’ve come this far. Now how do opponents of universal health care propose that we improve our system? Instead of crying out “socialism” as your criticism of single payer, why don’t you give an example of a country that has the system that you desire? Where does the World Health Organization rank that country?

My suggestion is to look at what country has the best health care system (France), analyze why their system is so good and adopt similar policies. In other words, we should learn from the best. Who disagrees with learning from the best? Of course you can present your own criteria to show that some other system is better, but then my question would be, “What data would you be using?” I’m using the data from the World Health Organization and you?

So for those of you who oppose the idea of learning from France, give some other model that we should follow and then explain why it’s better, instead of crying out “socialism” which is just empty rhetoric.


Enough About The System

I was recently listening to the October 18th This American Life on health insurance and it hit on quite a few poorly thought out, but nonetheless widely held ideas.

In one section they go over the conflict between insurance companies trying to keep prices down vs. drug companies trying to promote their most profitable drugs. The basic dynamics were presented accurately: drug companies want expensive drugs covered that aren’t always necessary while health insurance companies fight against unnecessarily costly drugs they also do so in a manner that sometimes causes people to not get the drugs they need. And then we’re told it’s “the system” and they’re just following incentives.

All well and good until you think about that fact both political parties have been tweaking “the system” fairly regularly and doing so with significant input from insurance and drug companies. Neither industry is overly interested in proposing any sort of compromise on this particular issue, so people get hurt.

We’re treated to lots of talk about how health insurance are driven by systematic factors though out the whole show. Insurance companies are made up of good people, systematically forced to do bad things. The whole train of thought holds up only as long as you ignore their own input to their own situation. Health insurance lobbyists have torpedoed reform efforts for years and done so in a ethically horrendous and dishonest manner. If the good people of the health insurance companies wanted to avoid rescission or denying coverage based on preexisting conditions you’d have no way of knowing it because they’ve spent decades pushing against the reforms that would make them unnecessary.

You hear the system excuse for denying coverage, drugs and procedures all the time. And once they find a new loophole to exploit you’ll hear it again to defend that practice. We need more discussion of the manipulation of the system instead of more excuses about how we’re all pawns.


Behind the Current Progressive Split on HCR

As you just may possibly have noticed, there is a lively, heated debate going on among the progressive grassroots/netroots about whether or not to support a watered-down health reform package. I have friends in both camps (as does Carrots and Sticks), and actually am split on the question myself, so I cannot say either viewpoint is wrong. As an organization, Carrots and Sticks has to date chosen not to formally engage on health care reform, not because we do not care about the issue, but rather because it had already been so oversaturated with activists and interest groups that we would have been joining too late in the game to make any appreciable difference. So I don’t think it’s prudent to take one side over the other, but there are a ton of important lessons that we can learn from the public option saga, and I’d like to start laying those out here.

To me, the fundamental reason for the divide comes down to politics vs. policy. After all, the progressive movement came together in a rare show of force and fought for a public option as a unified bloc. Now that it seems the public option is dead in this HCR bill (it could feasibly come back later as a stand-alone measure), we must decide how to react. There is first the question of whether a bill similar to that about to pass the Senate is better than nothing, aka the status quo. Given the political dynamics at play, I must assume “nothing” means “nothing for the next decade or more”. With that in mind, I think the bill as currently laid out is unquestionably a step in the right direction. Sure, it’s far from perfect (the mandate, excise tax and implementation dates being the big issues), but the Medicaid expansion, regulatory insurance reforms and creation of the exchange are huge pluses that far outweigh the drawbacks.

Yet on the other hand, progressives just went all-in on an issue and came up empty. A major reason this happened was the White House’s (ahem Rahm ahem) arrogant dismissiveness towards liberal concerns. Rahm thinks we can always be depended upon for campaign support when push comes to shove, so our viewpoints can safely be ignored. At the same time, the Beltway punditocracy fully expects the left flank to cave on its demands after the deals are cut. And frankly, they have no reason to believe otherwise, given the trends of recent history. So this is a crucial moment for the legitimacy of the progressive movement. Those of us who consider ourselves representatives of the movement should be very wary of seeming too much like the pushovers Rahm makes us out to be.

As we see, there are two equally valid lines of reasoning, borne from very similar though not identical priorities, leading to diametrically opposing viewpoints. Notwithstanding the value of healthy deliberation and internal dissent, the conflicting messages coming from the left do not serve us well as a political force, and will never help advance the policies we all want to see enacted. Going forward, the key lesson to be learned is how to best limit the possibility for this sort of situation from happening again. Hindsight is always 20/20, of course, but there are  a handful of important points to note. Keep in mind, these are open (NOT rhetorical) discussion topics:

  • Was victory (passage of a worthwhile public option) ever possible? I’m not sure the answer is as unequivocally “yes” as we had hoped, especially once Obama decided to make nice with PhRMA.
  • A lack of fierce, mobilized and deep-pocketed opposition would definitely help our cause, although that cannot always be possible (example: banking reform). Obviously, we want to maximize our chances of winning while remaining true to core progressive principles. Thus, how strongly should limiting opposition factor in when we choose our mobilizing issues in the future?
  • Did it make sense to put all of our eggs in the public option basket? It very well might have made perfect strategic sense, but we still need to address that question.
  • Did the strategy of whipping the progressive caucus to draw a line in the sand make sense, in retrospect? Could it have been done more effectively? How else could we have injected our demands into the debate?

Take these questions as food for thought. I don’t pretend to have the definitive answers, nor do I wish to attempt to unilaterally discover them here and now. We’ll no doubt revisit them later.

I’ll finish with a poignant quote from Pandagon’s Amanda Marcotte:

The netroots has only been around for like 6 or 7 years, and only really been a player for 4.  Taking over a party takes longer than that, and that’s all there is to it.  I think there’s a tendency to fight for scorched earth tactics designed to get a lot of results in a very short period of time, and a defeatism when that doesn’t work.  I’ll admit that impetus baffles me, because a lot of us are into politics because we love the game, and so we should have the disposition for a long term fight.  And by “long term”, I mean taking a truly radical stance, which is that political means alone will not get us where we need to go, but that we have to change society itself.


Health Care Reform Infighting

The health care reform debate is clearly getting a little heated. The kill the bill crowd and the swallow the pill and pass the bill crowd just aren’t coming to resolution on what the Democrats should do. Here is Matthew Ygelsias getting annoyed at personal attacks on his pro-bill position:

The cute meme of the day seems to be that the health care reform debate is breaking down along the same lines as the Iraq debate. Which is to say that since, for example, Matt Yglesias was wrong about Iraq he’s also wrong about health care and we should listen to Howard Dean.

He concludes

It’s true that views about the Iraq War line up with views about health care only if you exclude (a) all politicians, (b) all conservatives, and (c) the most prominent liberal pundit in the country. But that’s a mighty arbitrary way of looking at the universe.

Nonetheless, there are substantial similarities between the Iraq War and Health Care votes despite their unrelated subjects. Democrats are being to told to support the bill because it’s important to the party, rather then strictly on the merits of the bill. Both bills were presented as the only path forward, at times misleadingly. And strongest the corollary is that opposing the compromise bill is attacked as simplistic, while supporting the bill makes you a sell out.

The merits of the related arguments are substantially different in each case, but the debate is pretty similar. The case that voting down health care will hurt the Democratic party is much stronger then it was with the Iraq war. Democrats look terribly disorganized and ineffective and failing to pass a bill at this point would be harmful to their electorally chances. But that point runs both ways, passing the bill without a public option is also a serious problem for electoral success.

And there are alternative paths. They can start over and if they failed they would start over and they’d probably use budget reconciliation and need only 50 votes in the Senate. There are lots of problems with that path, but it’s a real option just like sanctions and containment were real options for Iraq.

Carrots and Sticks has come in contact with people on both sides of the push for this bill. They’re both smart and knowledge. Both sides need each other and at the same time need to challenge their respective legitimacy. The question is how do you keep the process constructive? It’s not easy, watch Al Franken on the Senate floor sometime, but that needs to be the goal.