Here are some more points about the so-called healthcare "summit".
8. It is not reconciliation that is perverse, it is the filibusteR, which is not part of the constitution or any kind of "law of the land." It is part of Senate
protocol, and is totally undemocratic. Of course, so is the Senate in a very real sense, since every state gets 2 senators regardless of its population.
Combining this with the filibuster means that something like 30% or less of the population can prevent the huge majority from getting its way. In fact,
combining the nature of the Senate and the filibuster with the fact that so few people vote, you can see how senators representing only a tiny fraction of
the population can prevent anything from getting done. Reconciliation really means majority rule: the basis for most of our constitutional democracy.
9. Tom Coburn is a doctor. So? He makes two main points. Number 1: Fee for services -- in other words, paying healthcare providers on the basis of procedures
undertaken instead of results obtained -- encourages overtreatment and de-emphasizes preventive medicine. This is true, and has been addressed by Obama and other Democrats. Number 2: Tort reform will save lots of money. This is dubious as I have stated elsewhere. Coburn claims that 1/3 of healthcare spending is wasted on non-medical expenses. Yes, but it's not frivolous lawsuits. The outrageous waste is on profits for the insurance industry and duplicated and wasteful administrative expenses. Here in Massachusetts most healthcare companies such as Harvard Pilgrim, Tufts and BCBS are not for profit; in other words, the money they make does not go to shareholders and stock speculators. This is rarely the case in other parts of the country (BCBS in Maine, for example, is part of the same for-profit corporation (Anthem, subsidiary of WellPoint) that is trying to raise premiums in CA by up to 39%.) Execs of these companies are getting very high salaries while gouging their premium payers. That doesn't seem to enter Coburn's calculations at all.
10. A beneath contempt point from the beneath contempt party: John Kyl (PTR whip) of Arizona says that Democrats trust Washington to make decisions while Republicans trust American individuals and families. It takes a lot to be completely beneath contempt, but this babble makes it with room to spare.
11. The Dems have had their moments -- good and bad. VP Biden makes the good point that the Republicans want to eliminate annual and lifetime caps on benefits, and forbid denial of benefits for pre-existing conditions, as well as other regulatory steps, yet they don't want the government to interfere in the free market. He points out that this is contradictory. On the other hand, the President, who was generally pretty tough, is a bit unbelievable when he claims "We have tried to take every cost-containment idea that is out there. Every health care proposal that economists say will reduce health care costs we have tried to adopt in the various proposals." Well, there is one that is the grandaddy of them all that was not even put on the floor by the Dems: SINGLE PAYER. This is the one idea that has been proven to work throughout the world, but is the plan that dare not speak its name. Even its pale imitators, the public option and Medicare buy-in have been throttled by industry shills like Lieberman. Shame on you Obama for this lie.
Which brings me to the really surrealistic part of this whole debate. Dozens of countries throughout the world have universal healthcare plans that are successful, much cheaper than ours, and which produce healthier citizens. The bloviating pols are constantly calling our failure of a system the "best in the world," but no commentator seems to have challenged them. JUST LOOK AROUND AT THE OTHER COUNTRIES IF YOU WANT TO SEE WHAT WORKS!!!!!!!
Sunday, February 28, 2010
Saturday, February 27, 2010
Healthcare "summit", part I
OK, I went over the outlines and quotes from the healthcare "summit" on Thursday. It took me a while to catch up because we lost internet and TV connections for quite a while due to damage from the latest storm. Here is some commentary on the issues raised by both sides.
1. A big part of the PTR strategy was to use a full printout -- about 2400 pages -- of the Senate-passed bill as a prop to emphasize their silly point that the bill is somehow ponderous and incomprehensible. This of course plays on the fact that reading and understanding difficult and complicated issues is somehow "elitist". The idea of emphasizing this is just what you'd expect from a party that is beneath contempt. The simplest counter is to point out that a complete working description of of the specs of a complicated but functioning system such as, say, a Boing 747, would likewise take thousands of pages. Should we then assume that such a compendium of specs -- each one necessary to describe functionality and specify safety issues -- should be scoffed at solely because it is long, complete and takes up space? This is so absurd as to be ... well, beneath contempt. To bad Obama couldn't have been prepared enough to point this out. Furthermore, the PTR wants the Feds to go into the business of rooting out "waste, fraud and abuse." Interestingly, the bill does address these issues in many pages; increasing the emphasis would make the document even longer -- not that the PTR has had a long and impressive
history of tackling corporate fraud. How many pages of documentation did they produce on KBR and other contractors in Iraq? The PTR loves big government interference -- see the Patriot Act e.g. -- when it agrees with their ideology. The Reagan-era OBRA, a major rewrite of tax policy among other things, amounted also to thousands of pages; furthermore, the "R" in its title reminds us all of how it was passed: rammed through Congress by reconciliation -- as were the Bush tax cuts that primarily benefitted the wealthy.
2. The PTR, no friend historically of either Social Security or Medicare, has decided to use scare tactics regarding the latter. Yes, the Senate bill would cut -- even eliminate -- the Medicare Advantage plans. But these are exactly the kind of inefficient items that they usually inveigh against. In this case, the Advantage plans are subsidized plans run by insurance companies that provide an extra layer of bureaucracy and spending between the actual government
Medicare and the consumer of healthcare. They are an example of an idea that simply did not work -- see my blog on Advantage plans. Only about 20% of Medicare recipients have such plans and there is no evidence that these plans are more "healthful" than regular Medicare. Furthermore, they cost about 15% more than the regular Medicare plans;
this extra cost is paid as a subsidy by the remaining 80% who don't have Advantage plans.
The PTR is also shedding crocodile tears over Medicare/Medicaid doctors whose payments are always being cut -- then restored -- under various Medicare saving plans. Oddly, tort reform which cuts lawyers incomes is a "big idea" for the PTR. However, tort reform is only a very small part of the possible savings related to healthcare. Of course tort reform within reason is a good idea but not so simple. The Texas version of tort reform is basically to screw consumers by limiting the liability of large corporations to the extent that it is cheaper for them to do unsafe
things and pay small penalties than to make pro-safety changes in their products. (Some time I'll relate the story of our dealings with the Texas-based Dell Computer after their laptop set fire to our house.)
In spite of what conservative "experts" such as Paul Ryan say about the terrible condition of Medicare and Social Security, both systems can be made solvent for at least half a century by changing the "tax" structures that pay for them. That is a long story that real economists such as Paul Krugman have related much more authoritatively than I can.
3. In a related attack on a federal program, Lamar Alexander says of the Senate bill: "It dumps 15 million Americans into a Medicaid program" which is being shunned by more and more doctors. That's rather odd coming from a spokesman for the party that thinks anyone can get good medical care by simply going to an emergency room. Emergency rooms are the most expensive possible ways of obtaining medical care, and the least efficient. There are no vaccinations, prenatal care, or preventative medicine that can generally be obtained via that route, and, of course, as any conservative should know, it is by no means a free lunch. Hospitals simple transfer the cost of unpaid emergency room visits to other payers, including cities and states, who must collect it in taxes or other fees paid by the rest of us. Paul Ryan, a big advocate of eliminating Medicare and Medicaid, frankly states that the rationing of healthcare is a reasonable idea, not much different from the rationing of cable TV for those who can't
afford it. So there you have the PTR's love of the "common man." If you can't afford it tough -- that's life.
4. While I'm mentioning Rep. Paul Ryan, some of his analyses of the Democratic plan are a bit misleading. It is important to understand that the savings are "back-loaded" -- in other words, more is saved in the second decade than in the first -- so looking at the numbers for just the first 10 years doesn't tell the whole story. The PRT is making a big deal about Ryan, who at least had something substantive to say. I am not enough of an expert to evaluate his other claims, but I will let you know how they fare when real economists and experts on the Congressional Budget Office evaluation report in.
5. I agree that the Democratic plan as now constituted will not save a lot of money; it has many other virtues, however, like bringing insurance to about 10 times as many uninsured people as anything the Republicans have come up with, while regulating the rapacious and much-hated insurance industry.
6. The PTR has been trotting out its favorite polls, as if to show that the "American People" support their position. Well, of course, one of the American People's most favored ideas is SINGLE PAYER -- an idea so radical that neither party will mention it. In fact, poll after poll has shown that any sort of "public option" enjoys more popularity than either party. (Polls uniformly show that, in terms of trust, Obama comes out way on top, with the Dems a weak second, and the Republicans a very dismal last.)These polls the PTR didn't mention. In no poll does any idea or party get as much as 60% -- the magical number that Republicans think is what's needed to pass any kind of legislation these days. As for popular "disapproval" of the Senate-passed plan, or what the PTR has managed to label "Obamacare", it is doubtful that most people polled could name a single provision in it, or explain in any coherent way why they did or didn't like it. These polls are simply asking people which talking points or propaganda has been most effective. Certainly outright lies, like the "Death Panels" and "losing your doctor" have been very effective, as outright lies often are. Interestingly enough, when people are asked about individual items from the plan, such as regulating insurance company rates, disallowing cancellations for pre-existing conditions etc., the public, as the President correctly pointed out, is quite supportive. And, finally, the polls may show the plan is unpopular, but nowhere as unpopular as the Republican Party.is
7. I would like to see a poll which asks the question: "Should the government be allowed to take over Social Security?"
Anyway, it's getting late. I'll write more tomorrow, and add some links to this blog.
1. A big part of the PTR strategy was to use a full printout -- about 2400 pages -- of the Senate-passed bill as a prop to emphasize their silly point that the bill is somehow ponderous and incomprehensible. This of course plays on the fact that reading and understanding difficult and complicated issues is somehow "elitist". The idea of emphasizing this is just what you'd expect from a party that is beneath contempt. The simplest counter is to point out that a complete working description of of the specs of a complicated but functioning system such as, say, a Boing 747, would likewise take thousands of pages. Should we then assume that such a compendium of specs -- each one necessary to describe functionality and specify safety issues -- should be scoffed at solely because it is long, complete and takes up space? This is so absurd as to be ... well, beneath contempt. To bad Obama couldn't have been prepared enough to point this out. Furthermore, the PTR wants the Feds to go into the business of rooting out "waste, fraud and abuse." Interestingly, the bill does address these issues in many pages; increasing the emphasis would make the document even longer -- not that the PTR has had a long and impressive
history of tackling corporate fraud. How many pages of documentation did they produce on KBR and other contractors in Iraq? The PTR loves big government interference -- see the Patriot Act e.g. -- when it agrees with their ideology. The Reagan-era OBRA, a major rewrite of tax policy among other things, amounted also to thousands of pages; furthermore, the "R" in its title reminds us all of how it was passed: rammed through Congress by reconciliation -- as were the Bush tax cuts that primarily benefitted the wealthy.
2. The PTR, no friend historically of either Social Security or Medicare, has decided to use scare tactics regarding the latter. Yes, the Senate bill would cut -- even eliminate -- the Medicare Advantage plans. But these are exactly the kind of inefficient items that they usually inveigh against. In this case, the Advantage plans are subsidized plans run by insurance companies that provide an extra layer of bureaucracy and spending between the actual government
Medicare and the consumer of healthcare. They are an example of an idea that simply did not work -- see my blog on Advantage plans. Only about 20% of Medicare recipients have such plans and there is no evidence that these plans are more "healthful" than regular Medicare. Furthermore, they cost about 15% more than the regular Medicare plans;
this extra cost is paid as a subsidy by the remaining 80% who don't have Advantage plans.
The PTR is also shedding crocodile tears over Medicare/Medicaid doctors whose payments are always being cut -- then restored -- under various Medicare saving plans. Oddly, tort reform which cuts lawyers incomes is a "big idea" for the PTR. However, tort reform is only a very small part of the possible savings related to healthcare. Of course tort reform within reason is a good idea but not so simple. The Texas version of tort reform is basically to screw consumers by limiting the liability of large corporations to the extent that it is cheaper for them to do unsafe
things and pay small penalties than to make pro-safety changes in their products. (Some time I'll relate the story of our dealings with the Texas-based Dell Computer after their laptop set fire to our house.)
In spite of what conservative "experts" such as Paul Ryan say about the terrible condition of Medicare and Social Security, both systems can be made solvent for at least half a century by changing the "tax" structures that pay for them. That is a long story that real economists such as Paul Krugman have related much more authoritatively than I can.
3. In a related attack on a federal program, Lamar Alexander says of the Senate bill: "It dumps 15 million Americans into a Medicaid program" which is being shunned by more and more doctors. That's rather odd coming from a spokesman for the party that thinks anyone can get good medical care by simply going to an emergency room. Emergency rooms are the most expensive possible ways of obtaining medical care, and the least efficient. There are no vaccinations, prenatal care, or preventative medicine that can generally be obtained via that route, and, of course, as any conservative should know, it is by no means a free lunch. Hospitals simple transfer the cost of unpaid emergency room visits to other payers, including cities and states, who must collect it in taxes or other fees paid by the rest of us. Paul Ryan, a big advocate of eliminating Medicare and Medicaid, frankly states that the rationing of healthcare is a reasonable idea, not much different from the rationing of cable TV for those who can't
afford it. So there you have the PTR's love of the "common man." If you can't afford it tough -- that's life.
4. While I'm mentioning Rep. Paul Ryan, some of his analyses of the Democratic plan are a bit misleading. It is important to understand that the savings are "back-loaded" -- in other words, more is saved in the second decade than in the first -- so looking at the numbers for just the first 10 years doesn't tell the whole story. The PRT is making a big deal about Ryan, who at least had something substantive to say. I am not enough of an expert to evaluate his other claims, but I will let you know how they fare when real economists and experts on the Congressional Budget Office evaluation report in.
5. I agree that the Democratic plan as now constituted will not save a lot of money; it has many other virtues, however, like bringing insurance to about 10 times as many uninsured people as anything the Republicans have come up with, while regulating the rapacious and much-hated insurance industry.
6. The PTR has been trotting out its favorite polls, as if to show that the "American People" support their position. Well, of course, one of the American People's most favored ideas is SINGLE PAYER -- an idea so radical that neither party will mention it. In fact, poll after poll has shown that any sort of "public option" enjoys more popularity than either party. (Polls uniformly show that, in terms of trust, Obama comes out way on top, with the Dems a weak second, and the Republicans a very dismal last.)These polls the PTR didn't mention. In no poll does any idea or party get as much as 60% -- the magical number that Republicans think is what's needed to pass any kind of legislation these days. As for popular "disapproval" of the Senate-passed plan, or what the PTR has managed to label "Obamacare", it is doubtful that most people polled could name a single provision in it, or explain in any coherent way why they did or didn't like it. These polls are simply asking people which talking points or propaganda has been most effective. Certainly outright lies, like the "Death Panels" and "losing your doctor" have been very effective, as outright lies often are. Interestingly enough, when people are asked about individual items from the plan, such as regulating insurance company rates, disallowing cancellations for pre-existing conditions etc., the public, as the President correctly pointed out, is quite supportive. And, finally, the polls may show the plan is unpopular, but nowhere as unpopular as the Republican Party.is
7. I would like to see a poll which asks the question: "Should the government be allowed to take over Social Security?"
Anyway, it's getting late. I'll write more tomorrow, and add some links to this blog.
Thursday, February 25, 2010
Tune in!
You can catch the healthcare debate at Blair House (recessed for lunch now) on CSPAN (also on the NY Times Blog). It's worth watching to see the President actually debating members of the PTF. I'll have some comments later when it's over.
Monday, February 22, 2010
Majority Rules
Josh Marshall of Talking Points Memo (TPM) makes the very good suggestion that Dems stop using the phrase "reconciliation" and call it majority rules. It's about time that they created terminology that is accurate and favorable to their point of view. He also points out that they missed the opportunity to call the "Stimulus Bill" the Jobs Bill. Maybe it's not too late. They certainly need a snazzy name for healthcare reform as well. Anyone have a good suggestion?
Sunday, February 21, 2010
Tom Friedman on "Global Weirding"
I think that Tom Friedman has been naive about politics (he thought that Bush's war in Iraq was a good thing since it was intended to produce an exemplar of democracy in that part of the world). However, he has a good column today about global warming and the morons who think -- or at least say -- that an Atlantic seabord snowstorm shows it ain't happening. Here's a link.
Public option and/or Medicare expansion
Medicare expansion may not be so much an alternative to the "public option" as a stalking horse for it. It seemed that this idea might actually have been part of the Senate plan were it not for Joe Lieberman and Ben Nelson, while the public option never seemed to have much of a chance in the Senate in spite of its popular appeal. I personally think that the precedent of being able to "buy in" to Medicare before retirement may actually be a more promising step toward a strong public option than the ponderous and highly restrictive Democratic plan that has been going by that name. In spite of dis-information to the contrary, Medicare is a highly popular plan and is quite efficient in delivering healthcare while controlling costs -- certainly much better than for-profit health insurers. Unfortunately, these are issues where the facts seem to fall before the falsehoods of the PTR and its masters in the insurance industry.
It is important to remember that, underneath the obstructionism of the Chamber of Commerce and other pro-business groups, most businesses -- especially manufacturing businesses such as the automakers -- favor strong healthcare reform because it will help make them more competitive if it can remove healthcare premiums from their expenses. All of their foreign competitors, in fact, have strong single-payer or other highly regulated, efficient and successful plans. As we should all know, workers in the other highly-industrialized countries with which we compete are happier, healthier and enjoy longer life-spans and higher standards of living than our own workers. For all the defects of the Democrats, they do want our workers to enjoy these benefits, while the PTR would favor the status quo. That's one of the major reasons the PTR constantly bashes the Canadians and the Europeans (especially the French).
It is important to remember that, underneath the obstructionism of the Chamber of Commerce and other pro-business groups, most businesses -- especially manufacturing businesses such as the automakers -- favor strong healthcare reform because it will help make them more competitive if it can remove healthcare premiums from their expenses. All of their foreign competitors, in fact, have strong single-payer or other highly regulated, efficient and successful plans. As we should all know, workers in the other highly-industrialized countries with which we compete are happier, healthier and enjoy longer life-spans and higher standards of living than our own workers. For all the defects of the Democrats, they do want our workers to enjoy these benefits, while the PTR would favor the status quo. That's one of the major reasons the PTR constantly bashes the Canadians and the Europeans (especially the French).
Saturday, February 20, 2010
There they go again
This from the AP (my italics):
"Yet passing anything but a very modest bill would likely mean using special budget rules that let Democrats override Republicans in the Senate with a simple majority. Using the budget route — called reconciliation — to resolve differences between the House and Senate bills probably would enrage Republicans. "
How will we notice any difference if the PTR is enraged? How can that possibly be an argument for or against any policy, strategy or tactic? If the PTR will give V votes for the Dems healthcare reform, and we multiply by the enragement factor E, then we get the equation (0)(V) = 0. Why does the AP write such claptrap?
Also, what the AP write calls a "simple majority" is what is known in most democracies as, simply, a majority. The filibuster is not a law of nature; it isn't a law of anything -- not even a Senate law. It simply means that someone says that they'll continue talking until shut up by a cloture vote. Why doesn't the AP point out that allowing this to go unchallenged is undemocratic, especially in an intrinsically undemocratic chamber of government (viz.: the Senate).
As more and more newspapers eliminate their own reporting and depend on the AP we will get more and more issues framed by this kind of superficial pop-phraseology. But even staff writers for well-respected newspapers are sometimes guilty: see my related blog on one writer's use of the term "moderates."
"Yet passing anything but a very modest bill would likely mean using special budget rules that let Democrats override Republicans in the Senate with a simple majority. Using the budget route — called reconciliation — to resolve differences between the House and Senate bills probably would enrage Republicans. "
How will we notice any difference if the PTR is enraged? How can that possibly be an argument for or against any policy, strategy or tactic? If the PTR will give V votes for the Dems healthcare reform, and we multiply by the enragement factor E, then we get the equation (0)(V) = 0. Why does the AP write such claptrap?
Also, what the AP write calls a "simple majority" is what is known in most democracies as, simply, a majority. The filibuster is not a law of nature; it isn't a law of anything -- not even a Senate law. It simply means that someone says that they'll continue talking until shut up by a cloture vote. Why doesn't the AP point out that allowing this to go unchallenged is undemocratic, especially in an intrinsically undemocratic chamber of government (viz.: the Senate).
As more and more newspapers eliminate their own reporting and depend on the AP we will get more and more issues framed by this kind of superficial pop-phraseology. But even staff writers for well-respected newspapers are sometimes guilty: see my related blog on one writer's use of the term "moderates."
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