tales of copper city

Why Washington loves the filibuster

Jonathan Chait of the The New Republic has an excellent piece on why official Washington is reluctant to give up the filibuster.  Meanwhile the nation lies in gridlock.  An impressive electoral victory by President Obama is dribbling away, which, of course, is why the Republicans love the filibuster.

And Obama refuses to retaliate with recess appointments over the Senatorial "holds" on his appointments.  

Barack Obama seems harder to understand the more we get to know him.  He lets the Republicans have their way with him.  

Years of magical thinking about health care reform

Olympia Snowe, the Republican Senator from Maine recently said, "The public option would give the government too much power over the health care system." 

For decades now, and for many in Washington in both political parties, this is the mantra that has been used to halt health care reform, despite the mountain of evidence from the other democracies that controlling health care spending will occur only if we give government much more power over the health care system.

Reform is good when government gives the insurance industry more money for more insurance. The industry can, in turn, continue to escalate the costs for health insurance as it sees fit.

This is called "painless progress."  It is seemingly "win-win," at least in the short run. It is a major temptation for modern Democrats. 

Think about the bail-outs of the financial industry.  We have shelled out billions to investment firms, banks and insurance groups without demanding that these industries be placed under stricter government regulation. 

Painless progress.

Chilling out

Matt Miller's column, "Take a Chill Pill," in The Daily Beast has it about right.  The critics (and that includes yours truly, quite often) need to stop wringing their hands and start acknowledging that we will likely get a health care reform bill this year, probably later than we want but almost certainly this year. Nate Silver of FiveThirtyEight also agrees and gives detailed reasons why.

As Miller, a senior fellow with the Center for American Progress points out, the critical move will come when the Senate finally reports a bill and then it goes to conference between the House and the Senate.  That's when the White House and President Obama will step up with a full court press, marshaling supporters that have been at work for over a year, and hitting the hustings to galvanize public opinion.

Sarah Palin's "death panel" and Rush Limbaugh's, "Obama's a Nazi," and the hubbub at the town hall meetings are the rantings of a core within the Republican Party that's totally out of control and totally out of the picture, and they know it.  And a lot of Democrats in Congress know they can't possibly let this group shout our futures down.

Good news about health care reform?

Paul Krugman notes the good news out of the White House about health care reform.  He's still worried that the industry groups will use the good will they created with this move to block a public plan in health care reform.

That was my reaction to the news also. 

But there's another possibility.  The public plan could be pegged to the progress in lowering health care costs generally set out in the industry agreements, creating a kind of all payer scenario.

Instead of the public plan along with Medicare bargaining independently to lower rates, the progress in rates payments could be what the public plan offers, eliminating what private insurance terms "unfair competition." 

This could put pressure on blue dog Democrats to go along with a modified public plan.  Of course they will try to argue that with this agreement, which is totally unenforceable, we should take a "wait and see" stance.

Blue Dogs and Republicans will do anything to block genuine progress in harnessing private power for the public good.

It's not the way I would go but I don't have any idea about how difficult this all is. 

When LBJ created Medicare, it would have been so, so, simpler to move the whole nation to a public plan instead of plunging further into the war in Vietnam.

Oh well...we'll see.

Social policy: or everything is connected to everything else

I'm sure that most observers of the stimulus debate are aware of the shifting justification for public spending and public investment. 

Instead of basing these investments and stimulus spending on "health" or "education" or "jobs", the explanation is that it is all connected together. 

Eight years of tax cuts for the wealthy, an attack on Social Security, a major disaster of a prescription drug program for the elderly (with the cynical proviso that government cannot bargain for lower prices with the pharmaceutical industry), were based on core "market fundamentalism." 

The market is always right to Republican fundamentalists, and whenever you must wonder into entitlement land (as with Bush's Medicare drug program) you make sure that the resulting program expands the role of the private sector in the Medicare program.

Getting the privatization nose under the Medicare tent has been a long-time goal for Republicans. 

Health care reform and the divided American democracy

Will we succeed this time in health care reform?  Who can say?

As the current brouhaha with Governor of Illinois reveals, in American politics, anything can happen.

The list reasons we must have reform is tiresomely long: as a percentage of gross domestic product, we spend way to much for health care when compared to other Western democracies. Yet 47 million Americans still don’t have health care insurance.

And until we provide insurance to all Americans we can’t do much very serious about controlling health care. I fwe limit the annual growth of spending for doctors and hospitals they will be far less likely to treat those without insurance.   

We are shamefully behind crucial health status measures like infant mortality, longevity, and the like.  We waste billions of dollars each year on paperwork and on health care procedures that remain unproven.

And so on.

A prayer for health care

Claudia Ricci, a professor of English and Journalism at SUNY/Albany, and a dear friend, has published a piece of mine, "A Prayer for Health Care," in her blog: My Story Lives.

The blog has a wonderful design.  I hope you will check it out.

Claudia is a novelist and the author of the beautiful novel, Dreaming Maples. 

Her husband Richard Kirsch, is head of Citizen Action in New York and is playing an increasingly prominent role in the national movement to finally get comprehensive health care reform.

Gore and health care reform

Here's another reason why Gore would be very, very strong.  His identification with global warming will make it difficult for the press to trap him in endless policy wonkery about the other huge issue facing us, health care reform.

He is on record as favoring a "single payer" system, and the press will hunt him down on that and try to take him down by pinning him to Canada, or to some other system.

He could respond by saying that he will fight for health care for all and that we will have to find our own way of getting health care to all in a way that will be affordable.

If I were running in that circumstance I would then say something like the following, which is a true story, taken from my experience on working on universal health care during my New York years:

"People everywhere always ask me, when the subject of universal health care comes up: 'Why can't we just provide Medicare to everyone?'"

"Why not?" Gore could say.

Political amnesia and negotiating Medicare drug prices

If you want to see how it's going to go with the Democrats' plans to change the drug plan for Medicare, the one that has been touted as insanely expensive, wasteful, and a give-away to the drug companies, read this in the Washington Post.  And as Kevin Drum notes, roughly the same story appears in the Wall
Street Journal and the LA Times.

Drum suggests that the big conundrum at the center of the story is that we don't know how to negotiate drug prices with the pharmaceutical industry and that fixing prices is a bad thing. Drum suggests that the answer is to have the  government  demand that the industry offer the government its best price, the lowest price that it offers say, Germany or Canada. This is referred to as the "most favorable price" policy, and Wal-Mart uses it all the time to get the lowest prices possible.

Maybe that's a good idea but all of these stories represent some very bad reporting, reporters engaging in horse-race reporting or political handicapping in ways that result in an issue winding up in a very different place than it should had the media attended to the broader set of issues that belong to this issue. It is the broader context that the Democrats are fighting for, the context that the public needs to hear.

Health care spending: the democracy connection

Nowadays, anytime I stumble upon an aritcle on health care spending or the health care crisis in a major newspaper or magazine, I almost know it will be seriously wrong.  As usual, Paul Krugman's articles  on health care reform in the New York Times and the New York Review of Books are the exception.

Yesterday, I noticed a column in the New York Times by David Leonhardt, "The Choice: A Longer Life or More Stuff,' here. Leonhardt’s thesis is that all that health care spending  is saving lives, a point that the perennial hand-wringing about rising health care costs misses. For the first time, medicine is helping improve the health of whole communities and extending life expectancy with important new drugs that control cholesterol, high blood pressure and the like, with new technology like portable defibrillators, and with amazing new surgical procedures like those for patients with coronary artery disease.

As evidence, Leonhardt notes that life expectancy for a baby born in 1950 was 68 and that babies born today can expect to live to 78. Thus, his big point: let’s lighten up about health care spending; you get what you pay for and these days you get a lot.   

Leonhardt is probably right that medicine is making  some inroads on life expectancy; Medicare seems to have extended life expectancy for people over 65. Still, he’s just giving medicine  way too much credit that belongs elsewhere. 

Surely that 10-year increase in life expectancy since 1950 is mostly due to societal sea changes like the sharp decline in smoking from public health campaigns, causing a big drop in heart disease and lung cancer, or to safer highways, less poverty, less discrimination, and cleaner air. For all that, and for Medicare and Medicaid, we can thank resurgent democracy during the Great Society era and the coming to the fore of public health agencies and activisim.

But the other problem with his argument is that the life-saving benefits of today's medicine are being purchased by other nations for far less money and are being spread around far more equally.