reform (noun): 1) amendment of what is defective, vicious, corrupt, or
depraved, 2) a removal or correction of an abuse, a wrong, or errors
Physicians for a National Health Program
December 22, 2009
To the Members of the U.S. Senate:
It is with great sadness that we urge you to vote against the health care
reform legislation now before you. As physicians, we are acutely aware of
the unnecessary suffering that our nation?s broken health care financing
system inflicts on our patients. We make no common cause with the
Republicans? obstructionist tactics or alarmist rhetoric. However, we have
concluded that the Senate bill?s passage would bring more harm than good.
We are fully cognizant of the salutary provisions included in the
legislation, notably an expansion of Medicaid coverage, increased funds for
community clinics and regulations to curtail some of private insurers? most
egregious practices. Yet these are outweighed by its central provisions ?
particularly the individual mandate ? that would reinforce private insurers?
stranglehold on care. Those who dislike their current employer-sponsored
coverage would be forced to keep it. Those without insurance would be forced
to pay private insurers? inflated premiums, often for coverage so skimpy
that serious illness would bankrupt them. And the $476 billion in new public
funds for premium subsidies would all go to insurance firms, buttressing
their financial and political power, and rendering future reform all the
Some paint the Senate bill as a flawed first step to reform that will be
improved over time, citing historical examples such as Social Security. But
where Social Security established the nidus of a public institution that
grew over time, the Senate bill proscribes any such new public institution.
Instead, it channels vast new resources ? including funds diverted from
Medicare ? into the very private insurers who caused today?s health care
crisis. Social Security?s first step was not a mandate that payroll taxes
which fund pensions be turned over to Goldman Sachs!
While the fortification of private insurers is the most malignant aspect of
the bill, several other provisions threaten harm to vulnerable patients,
* The bill?s anti-abortion provisions would restrict reproductive choice,
compromising the health of women and adolescent girls.
* The new 40 percent tax on high-cost health plans ? deceptively labeled a
?Cadillac tax? ? would hit many middle-income families. The costs of group
insurance are driven largely by regional health costs and the demography of
the covered group. Hence, the tax targets workers in firms that employ more
women (whose costs of care are higher than men?s), and older and sicker
employees, particularly those in high-cost regions such as Maine and New
* The bill would drain $43 billion from Medicare payments to safety-net
hospitals, threatening the care of the 23 million who will remain uninsured
even if the bill works as planned. These threatened hospitals are also a key
resource for emergency care, mental health care and other services that are
unprofitable for hospitals under current payment regimes. In many
communities, severely ill patients will be left with no place to go ? a
human rights abuse.
* The bill would leave hundreds of millions of Americans with inadequate
insurance ? an ?actuarial value? as low as 60 percent of actual health
costs. Predictably, as health costs continue to grow, more families will
face co-payments and deductibles so high that they preclude adequate access
to care. Such coverage is more akin to a hospital gown than to a warm winter
Congress? capitulation to insurers ? along with concessions to the
pharmaceutical industry ? fatally undermines the economic viability of
reform. The bill would inflate the already crushing burden of
insurance-related paperwork that currently siphons $400 billion from care
annually. According to CMS? own projections, the bill will cause U.S. health
costs to increase even more rapidly than presently, and budget neutrality is
to be achieved by draining funds from Medicare and an accounting trick ?
front-loading the new revenues while delaying most new coverage until 2014.
As homeowners seduced into balloon mortgages have learned, pushing costs off
to the future is neither prudent nor sustainable.
We ask that you defeat the bill currently under debate, and immediately move
to consider the single-payer approach ? an expanded and improved
Medicare-for-All program ? which prioritizes the advancement of our nation?s
health over the enhancement of private, profit-seeking interests.
Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program
Posted: December 21, 2009 07:15 PM
With Monday morning's 1 a.m. 60-40 vote, the Senate's health care bill took another step towards passage, prompting a fresh round of public celebrations. "I think it's very exciting," HHS Secretary Kathleen Sebelius told HuffPost. "It's a big day."
Even many of those with serious reservations about the bill were slipping on their party hats. "Make no mistake about it," said SEIU president Andy Stern, "for working Americans, this vote signals progress."
And Paul Krugman, while calling the legislation "a seriously flawed bill we'll spend years if not decades fixing," applauded it as "an awesome achievement."
This typifies the current thinking of the "Don't let the perfect be the enemy of the good" crowd. Unfortunately, there are three faulty premises at work in this line of reasoning. First, that those who oppose the bill do so because it's not perfect (as opposed to because it's a hot health care mess). Second, that the bill is, well, good (as opposed to a total victory for Pharma and the insurance industry -- witness the spectacular spike in health care stocks following Monday's vote).
Third is the premise that this is as good a bill as we can get right now, and we can always go back and improve it later.
It doesn't work that way. We heard the same kinds of sentiments about No Child Left Behind when it passed in 2001. Backers on both sides of the aisle had problems with it, but both sides celebrated it as a major step forward -- and promised to make it better in the future.
"The agreement we reached reflects the best thinking of both sides," said Sen. Joe Lieberman.
"This was a reform bill. We can't have reform without resources, and that will be the next step," said Sen. Tom Daschle.
"This is a good bill... And there are going to be many additional steps that will be necessary along the way, but all of us are committed to following in those steps," said Sen. Ted Kennedy, the primary Democratic co-sponsor of the bill.
But despite the widespread commitment to taking the "many additional steps" needed, the steps were never taken, the resources were never allocated, the bill was never improved, and, indeed, is now generally regarded as a disaster (or, as Bill Clinton put it last year, "a train wreck").
In an ominous sign of things to come, Vicki Reggie Kennedy, Sen. Kennedy's widow, made many of the same arguments that were used in support of No Child Left Behind in her Washington Post op-ed promoting passage of the current health care bill.
It's a moving piece of writing -- and nobody doubts her late husband's heartfelt dedication to health care reform. But nobody doubted his dedication to education reform, either.
If the miserable Senate health care bill becomes the law of the land, it's only going to encourage the preservation of a hideously broken system. Just how broken the system is is summed up in the fate of Byron Dorgan's drug re-importation amendment.
This is an idea that Obama co-sponsored when he was in the Senate and unequivocally championed on the campaign trail: "We'll allow the safe re-importation of low-cost drugs from countries like Canada."
But when Dorgan introduced an amendment that would do just that, the White House, sticking to the deal it made with the pharmaceutical industry, lobbied against it -- and the commissioner of the supposedly non-political FDA just happened to release a letter citing "significant safety concerns" about all those dangerous drugs from Canada. Big Pharma's many congressional lackeys trumpeted the letter and the amendment was killed.
But that didn't stop David Axelrod from insisting in an interview with John King this weekend that "the president supports safe re-importation of drugs into this country. There's no reason why Americans should pay a premium for the pharmaceuticals that people in other countries pay less for."
No reason other than our broken system surrendering to the special interests.
From start to finish, the insurance and drug industries -- and their army of lobbyists -- had control over the process that resulted in a bill that is reform in name only. The postmortems of how they pulled it off have already begun. On Sunday, the Chicago Tribune published an exhaustive front-page analysis by Northwestern University's Medill News Service and the Center for Responsive Politics of how it was done. The main culprit: "a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation."
The study found that 13 former congressmen and 166 Congressional staffers were actively engaged in lobbying their former colleagues on the bill. The companies they were working for -- some 338 of them -- spent $635 million on lobbying. It was money extremely well spent -- delivering a bill that, by forcing people to buy a shoddy product in a market with no real competition, enshrines into law the public subsidy of private profit.
As we approach the end of Obama's first year in office, this public subsidizing of private profit is becoming something of a habit. It is, after all, exactly what the White House did with the banks. Just as he did with insurance companies, Obama talked tough to the bankers in public but, when push came to shove, he ended up shoving public money onto their privately-held balance sheets.
This is not just bad policy, it's bad politics.
Sharp-eyed opponents are already seizing on the opportunity to rebrand Obama and the Democrats as the party beholden to special interests.
Sunday night, just before the post-midnight vote was taken, John McCain took to the Senate floor and, hearkening back to his days as a crusader for campaign finance reform, lambasted Obama and the Democrats' "negotiations with the special interests," adding: "We should have set up a tent out in front and put Persian rugs in front of it. That's the way that this has been conducted. So the special interests were taken care of, then we had to take care of special senators."
This kind of populist rhetoric resonates with voters across the board, including independents. If Democrats cede this turf by celebrating a bill that is a victory for special interests and special senators, look for a lot more of this kind of rhetoric in the run-up to 2010.
President Bush brought us preemptive war. President Obama's specialty seems to be preemptive compromise. He gave the farm away to Pharma, and then had to keep on giving when Lieberman, Nelson, and the other industry-backed Senators came calling.
There are many reasons for hoping the current Senate bill doesn't become law. But the biggest reason of all is the desperate need for a DC pattern interrupt. The desperate need to draw a line in the sand against the continued domination of our democracy -- and the continued undermining of the public interest -- by special interests.
By Naomi Klein, posted on EnviroNation, December 21, 2009
Contrary to countless reports, the debacle in Copenhagen was not everyone's fault. It did not happen because human beings are incapable of agreeing, or are inherently self-destructive. Nor was it all was China's fault, or the fault of the hapless UN.
There's plenty of blame to go around, but there was one country that possessed unique power to change the game. It didn't use it. If Barack Obama had come to Copenhagen with a transformative and inspiring commitment to getting the U.S. economy off fossil fuels, all the other major emitters would have stepped up. The EU, Japan, China and India had all indicated that they were willing to increase their levels of commitment, but only if the U.S. took the lead. Instead of leading, Obama arrived with embarrassingly low targets and the heavy emitters of the world took their cue from him.
(The "deal" that was ultimately rammed through was nothing more than a grubby pact between the world's biggest emitters: I'll pretend that you are doing something about climate change if you pretend that I am too. Deal? Deal.)
I understand all the arguments about not promising what he can't deliver, about the dysfunction of the U.S. Senate, about the art of the possible. But spare me the lecture about how little power poor Obama has. No President since FDR has been handed as many opportunities to transform the U.S. into something that doesn't threaten the stability of life on this planet. He has refused to use each and every one of them. Let's look at the big three.
Blown Opportunity Number 1: The Stimulus Package
When Obama came to office he had a free hand and a blank check to design a spending package to stimulate the economy. He could have used that power to fashion what many were calling a "Green New Deal"—to build the best public transit systems and smart grids in the world. Instead, he experimented disastrously with reaching across the aisle to Republicans, low-balling the size of the stimulus and blowing much of it on tax cuts. Sure, he spent some money on weatherization, but public transit was inexplicably short changed while highways that perpetuate car culture won big.
Blown Opportunity Number 2: The Auto Bailouts
Speaking of the car culture, when Obama took office he also found himself in charge of two of the big three automakers, and all of the emissions for which they are responsible. A visionary leader committed to the fight against climate chaos would obviously have used that power to dramatically reengineer the failing industry so that its factories could build the infrastructure of the green economy the world desperately needs. Instead Obama saw his role as uninspiring down-sizer in chief, leaving the fundamentals of the industry unchanged.
Blown Opportunity Number 3: The Bank Bailouts
Obama, it's worth remembering, also came to office with the big banks on their knees -- it took real effort not to nationalize them. Once again, if Obama had dared to use the power that was handed to him by history, he could have mandated the banks to provide the loans for factories to be retrofitted and new green infrastructure to be built. Instead he declared that the government shouldn't tell the failed banks how to run their businesses. Green businesses report that it's harder than ever to get a loan.
Imagine if these three huge economic engines—the banks, the auto companies, the stimulus bill—had been harnessed to a common green vision. If that had happened, demand for a complementary energy bill would have been part of a coherent transformative agenda.
Whether the bill had passed or not, by the time Copenhagen had rolled around, the U.S. would already have been well on its way to dramatically cutting emissions, poised to inspire, rather than disappoint, the rest of the world.
There are very few U.S. Presidents who have squandered as many once-in-a-generation opportunities as Barack Obama. More than anyone else, the Copenhagen failure belongs to him.
Watch Naomi and Bill McKibben react to President Obama's Copenhagen speeches. Naomi says that Obama "could have come to the table with inspiring emissions cuts and we would be in a very, very different mood today. He didn't do it. It's time to stop making excuses for him and get mad."
As the president's job performance numbers and ratings on his handling of virtually every domestic issue have fallen below 50 percent, the Democratic base has become demoralized, and Independents have gone from his source of strength to his Achilles Heel, it's time to reflect on why. The conventional wisdom from the White House is those "pesky leftists" -- those bloggers and Vermont Governors and Senators who keep wanting real health reform, real financial reform, immigration reform not preceded by a year or two of raids that leave children without parents, and all the other changes we were supposed to believe in.
Somehow the president has managed to turn a base of new and progressive voters he himself energized like no one else could in 2008 into the likely stay-at-home voters of 2010, souring an entire generation of young people to the political process. It isn't hard for them to see that the winners seem to be the same no matter who the voters select (Wall Street, big oil, big Pharma, the insurance industry). In fact, the president's leadership style, combined with the Democratic Congress's penchant for making its sausage in public and producing new and usually more tasteless recipes every day, has had a very high toll far from the left: smack in the center of the political spectrum.
What's costing the president and courting danger for Democrats in 2010 isn't a question of left or right, because the president has accomplished the remarkable feat of both demoralizing the base and completely turning off voters in the center. If this were an ideological issue, that would not be the case. He would be holding either the middle or the left, not losing both.
What's costing the president are three things: a laissez faire style of leadership that appears weak and removed to everyday Americans, a failure to articulate and defend any coherent ideological position on virtually anything, and a widespread perception that he cares more about special interests like bank, credit card, oil and coal, and health and pharmaceutical companies than he does about the people they are shafting.
The problem is not that his record is being distorted. It's that all three have more than a grain of truth. And I say this not as one of those pesky "leftists." I say this as someone who has spent much of the last three years studying what moves voters in the middle, the Undecideds who will hear whichever side speaks to them with moral clarity.
Leadership, Obama Style
Consider the president's leadership style, which has now become clear: deliver a moving speech, move on, and when push comes to shove, leave it to others to decide what to do if there's a conflict, because if there's a conflict, he doesn't want to be anywhere near it.
Health care is a paradigm case. When the president went to speak to the Democrats last week on Capitol Hill, he exhorted them to pass the bill. According to reports, though, he didn't mention the two issues in the way of doing that, the efforts of Senators like Ben Nelson to use this as an opportunity to turn back the clock on abortion by 25 years, and the efforts of conservative and industry-owned Democrats to eliminate any competition for the insurance companies that pay their campaign bills. He simply ignored both controversies and exhorted.
Leadership means heading into the eye of the storm and bringing the vessel of state home safely, not going as far inland as you can because it's uncomfortable on the high seas. This president has a particular aversion to battling back gusting winds from his starboard side (the right, for the nautically challenged) and tends to give in to them. He just can't tolerate conflict, and the result is that he refuses to lead.
We have seen the same pattern of pretty speeches followed by empty exhortations on issue after issue. The president has, on more than one occasion, gone to Wall Street or called in its titans (who have often just ignored him and failed to show up) to exhort them to be nice to the people they're foreclosing at record rates, yet he has done virtually nothing for those people. His key program for preventing foreclosures is helping 4 percent of those "lucky" enough to get into it, not the 75 percent he promised, and many of the others are having their homes auctioned out from right under them because of some provisions in the fine print. One in four homeowners is under water and one in six is in danger of foreclosure. Why we're giving money to banks instead of two-year loans -- using the model of student loans -- to homeowners to pay their mortgages (on which they don't have to pay interest or principal for two years, while requiring their banks to renegotiate their interest rates in return for saving the banks from "toxic assets") is something the average person doesn't understand. And frankly, I don't understand it, either. I thought I voted Democratic in the last election.
Same with the credit card companies. Great speech about the fine print. Then the rates tripled.
The president has exhorted the banks, who are getting zero-interest money, to give more of it to small businesses. But they have no incentives to do that. There are too many high-yield, reasonably low risk investments to make with zero-interest federal loans. I wouldn't mind a few billion to play around with right now myself, and I can't say I'd start with some guy who wants to start his own heating and air company, or an existing small business owner who is hanging on by his fingernails in tough economic times. I'd put my money in something like emerging markets, or maybe Canada. (Have you noticed how well Canadian equities are doing lately?) Or perhaps Chinese wind turbines. (Oh, we're investing there already with stimulus funds.)
The time for exhortation is over. FDR didn't exhort robber barons to stem the redistribution of wealth from working Americans to the upper 1 percent, and neither did his fifth cousin Teddy. Both men told the most powerful men in the United States that they weren't going to rip off the American people any more, and they backed up their words with actions. Teddy Roosevelt was clear that capital gains taxes should be high relative to income taxes because we should reward work, not "gambling in stocks." This President just doesn't have the stomach to make anyone do anything they don't want to do (except women to have unwanted babies because they can't afford an abortion or live in a red state and don't have an employer who offers insurance), and his advisors are enabling his most troubling character flaw, his conflict-avoidance.
Like most Americans I talk to, when I see the president on television, I now change the channel the same way I did with Bush. With Bush, I couldn't stand his speeches because I knew he meant what he said. I knew he was going to follow through with one ignorant, dangerous, or misguided policy after another. With Obama, I can't stand them because I realize he doesn't mean what he says -- or if he does, he just doesn't have the fire in his belly to follow through. He can't seem to muster the passion to fight for any of what he believes in, whatever that is. He'd make a great queen -- his ceremonial addresses are magnificent -- but he prefers to fly Air Force One at 60,000 feet and "stay above the fray."
It's the job of the president to be in the fray. It's his job to lead us out of it, not to run from it. It's his job to make the tough decisions and draw lines in the sand. But Obama really doesn't seem to want to get involved in the contentious decisions. They're so, you know, contentious. He wants us all to get along. Better to leave the fights to the Democrats in Congress since they're so good at them. He's like an amateur boxer who got a coupon for a half day of training with Angelo Dundee after being inspired by the tapes of Mohammed Ali. He got "float like a butterfly" in the morning but never made it to "sting like a bee."
Do you think Americans ought to have one choice of health insurance plans the insurance companies don't control, or don't you? I don't want to hear that it would sort of, kind of, maybe be your preference, all other things being equal. Do you think we ought to use health care as a Trojan Horse for right-wing abortion policies? Say something, for God's sake.
He doesn't need a chief of staff. He needs someone to shake him until he feels something strongly enough not just to talk about it but to act. He's increasingly appearing to the public, and particularly to swing voters, like Dukakis without the administrative skill. And although he is likely to squeak by with a personal victory in 2012 if the economy improves by then, he may well do so with a Republican Congress. But then I suppose he'll get the bipartisanship he always wanted.
No Vision, No Message
The second problem relates to the first. The president just doesn't want to enunciate a progressive vision of where this country should be heading in the 21st century, particularly a progressive vision of government and its relation to business. He doesn't want to ruffle what he believes to be the feathers of the American people, to offer them a coherent, emotionally resonant, values-driven message -- starting with an alternative to Ronald Reagan's message that government is the problem and not the solution -- and to see if they might actually follow him.
He doesn't want to talk about social issues, even though they predictably have gotten in the way of health care reform and will do the same on one issue after another. Abortion? You don't advance a progressive position by giving a center-right speech at Notre Dame that emphasizes cutting back on the number of abortions without mentioning that sex education and birth control might be useful means to that end, mumbling something about a conscience clause that suggests that pharmacists don't have to fill birth control prescriptions if it offends their sensibilities, and allowing states to use health care reform to set back the rights of women and couples to decide when to start their families based on somebody else's faith. If you believe that freedom includes the freedom to decide when you will or won't have a child, say it, say it with moral conviction, and follow it up with action. Perhaps something as simple as this: "I won't sign a health bill into law that forces women and couples to have a child they did not intend and are not ready to parent because of the dictates of someone else's faith or conscience." You know what? A message of that sort wins by 25 points nationally, and you can speak it in Southern and win with evangelical Christians in the deep south if you speak to them honestly in the language of faith. That shouldn't be hard for a president who is a religious Christian.
Gays? Virtually all Americans are for repealing don't ask/don't tell (except for conservatives who haven't yet come to terms with their own homosexuality -- but don't tell them that, or at least don't ask). This one's a no-brainer. Tell Congress you want a bill on your desk by January 1, and announce that you have serious questions about the constitutionality of the current policy and won't enforce it until your Justice Department has had time to study it. Don't keep firing gay Arabic interpreters. But that would require not just giving the pretty speech on how we're all equal in the eyes of God and we should all be equal in the eyes of the law (a phrase he might want to try sometime). It would require actually doing something that might anger a small percentage of the population on the right, and that's just too hard for this president to do. It's one thing to acknowledge and respect the positions of people who hold different points of view. It's another to capitulate to them.
Immigration? Joe Wilson yells, "You lie." So instead of acting like a man and going after Wilson on the spot (the man just attacked him in front of the entire nation in a joint session of Congress), he accepts his apology the next day, and a day later rewards Wilson for his incivility and bigotry by tightening the rules so that illegal immigrants can't even buy insurance themselves on the health care exchange the Democrats are creating sometime between 2013 and 2025 (depending on how many seats they lose in the meantime, and hence how long, if ever, it takes for the exchange to get set up).
Good policy? No. Not only is it inhumane -- can you imagine being really sick or in terrible pain but being too afraid even to go to a clinic because you might be deported? -- but it's a public health hazard for sick people not to get care and spread their illnesses, a drain on American taxpayers as illegal immigrants who finally have no choice but to find their way, when they're incredibly ill, to emergency rooms or public clinics, and a despicable policy toward their children, many of whom are American citizens, but who in either case shouldn't have to be sick, in pain, and without preventive care as their bodies and minds are developing, no matter where their parents come from.
Is it good politics? No. During the election I tested messages on just this issue, and a strong progressive message beat the most convincing anti-immigrant message we could throw at it by 10 points. Two weeks ago, I tested messages on just this issue as it applied to health care, and that margin had doubled.
If you just talk sensibly with Americans, they are sensible people. But ask them one-dimensional polling questions like, "Do you think illegal immigrants should get health care?" and you'll entirely miss the art of the possible.
Jobs? Watch for a $25 billion plan that makes good political theatre and that every economist I know says will move the unemployment rate from 10.0 percent to 9.95 percent. Not enough to save 30 seats in November. And not enough to save a generation of families from financial ruin and lower education, higher unemployment, and poorer health for the rest of their -- and their children's -- lives.
The problem with the president's strategic team is that they don't understand the difference between compromising on policy and compromising on core values. When it comes to policies, listen all you want to the Stones: "You can't always get what you want" (although it would be nice if the administration tried sometime). But on issues of principle -- like allowing regressive abortion amendments to be tacked onto a health care reform bill -- get some stones. Make your case to the American people, make it evocatively, and draw the line in the sand. That's how you earn people's respect. That's the only thing that will bring Independents back.
And that's where the problem of message comes in. This White House has no coherent message on anything. The message on health care reform changed even more frequently than the interest rates on credit cards last Spring, and turned a 70-30 winning issue into its current 30-50 status with the public. Last week on the Sunday news shows, I remember watching in disbelief as Larry Summers smugly told the 15 million Americans out of work that the recession was definitively over and that all economists agree. Then Christina Romer, another of the President's chief economic advisors, announced on the next show that the recession is definitely not over.
That's simply inexcusable. The least two members of the economic team can do before they fan out on the Sunday morning shows is to agree on whether we're in a recession, how it relates to joblessness, and how to talk about it sensitively without seeming out of touch. That's the job of the White House messaging team, which has been AWOL since at least the start of the health care battle last Spring.
It's the same problem we've seen with messaging the deficit. Are deficits good -- we're supposed to deficit spend our way out of a severe recession, right? -- or bad -- they're a drag on the economy and stealing from the next generation. So which are they? How about telling the American people, at the very least, when they're good and when they're bad, not flipping back and forth in the same sentence between deficit spending and deficit reduction.
To be honest, I don't know what the president believes on anything, and I'm not alone among American voters. He introduced his recent job summit by saying that even in these times, the role of government should be limited. Really? That was a nicely nuanced reinforcement of the ideology of limited, ineffective government promulgated by Ronald Reagan and George W. Bush. Unfortunately, it runs against all the available data and everything Democrats have stood for since FDR.
Abortion? Who knows. Gays? I suspect intellectually he believes in equal rights but deep down he thinks they're icky. Something is sure holding him back from doing the obvious. Immigrants? He probably has an opinion, but he's not going to waste political capital on them; he sold them out in 15 seconds on health care. Foreclosures? Nice speeches, and I'm sure it really concerns him when he hears the stories of families firsthand. But not enough to divert the cash from the lenders to the borrowers. And the problem is, the average American knows it. Job creation? Would be nice, and I presume he believes that people who want to work ought to be able to work. But when 700,000 people were losing their jobs a month in his first few months of office and over millions have lost their jobs on his watch (a process, of course, initiated by his predecessor, whose name, to my knowledge, he has not uttered since entering office), three letters should have come to mind: W - P - A. President Roosevelt had no legs to stand on, but he sure had spine.
The Politics of the Lowest Common Denominator
And capping off all of these aspects of the president's leadership style is his preference for the lowest common denominator. That means you don't really have to fight, you don't have to take anybody on, you don't take any risks. You just find what the public is so upset about that even the Republicans would stipulate to it if forced to (e.g., that excluding people from health care because they have "pre-existing conditions" is something we can't continue to tolerate) and build it into whatever plan the special interests can hammer out around it.
Unfortunately, what Democrats just can't seem to understand is that the politics of the lowest common denominator is always a losing politics. It sends a meta-message that you're weak -- nothing more, nothing less -- and that's the cross the Democrats have had to bear since they "lost China" 60 years ago. And in fact, it is weak.
Want health care reform? Let Congress work it out, and whatever comes out, call it a victory. It's telling that when the Senate triumphantly announced that it had the 60 votes for cloture on Friday, insurance stocks hit a 52-year peak.
Energy? Okay, if you don't really want to mess with the oil and coal industries, let the caps slip higher and higher and industry will cut pollution around the edges. It won't really solve the problem, but it's the golden mean between the right thing to do and the wrong thing to do, which is the essence of Obampromise. It also hamstrings you in Copenhagen, but oh well, they could use a little global warming there this time of year anyway. Have you noticed it's cold as hell over there?
Financial regulation? The president's all for the good stuff: regulating derivatives and other fancy financial products no one but the people making bundles off of them who crashed the economy (and now run it) understand. Tell bankers the days of wine and roses are over. But if we have to have half-reform so Goldman Sachs is willing to keep sending its best and brightest through the revolving door at Treasury, that's okay; the Dow is up. So jobs are bleak and the average American is enraged that Wall Street had a bumper year -- with record bonuses -- as they're losing their homes. But you know the old adage about a half a loaf.
That's in fact what the health care debate is over. We shouldn't have had to settle for half a loaf. If the president had simply placed appropriate blame on the health insurance industry for its pre-existing conditions, it's cutting off care for breast cancer victims in the middle of treatment, and its doubling our premiums and co-pays during the Bush years, he would have harnessed populist anger and pushed this bill through six months ago, and it would have looked like the change we were told to believe in. But if you cut backroom deals with every special interest who is part of the problem and offer the American people no coherent message while the other side is messaging straight out of the messaging memo written by Frank Luntz ("government takeover," "a bureaucrat between you and your doctor"), you can expect half a loaf. And the other half will be paid for by middle class taxpayers, as in the Senate bill, which includes provisions like taxing good middle class tax plans like PPOs, which will disappear as soon as insurance companies and big businesses have the excuse of the missing tax break. Remind me, when we've just had the largest transfer of wealth to the upper 1 percent of the country from working and middle class Americans in a century, why it would be such a terrible thing instead, as in the House bill, to ask people who make over a million dollars a year to pony up for the health care of their (and their friends') housekeepers, instead of taking away health care plans union workers traded for salary increases?
The president's biggest success has been on the international stage: He's not George W. Bush, and he's eloquent to boot. He's done a great deal with that eloquence to speak to Muslims around the world and to make clear to others in the international community that America is back -- mostly. But that international community is just starting to learn that his eloquence doesn't always have much behind it.
Am I being too hard on the president? He's certainly done many good things. But it would be hard to name a single thing President Obama has done domestically that any other Democrat wouldn't have done if he or she were president following George W. Bush (e.g., signing the children's health insurance bill that Congress is about to gut to pay for worse care for kids under the health insurance exchange, if it ever happens), and there's a lot he hasn't done that every other Democrat who ran for president would have done.
Obama, like so many Democrats in Congress, has fallen prey to the conventional Democratic strategic wisdom: that the way to win the center is to tack to the center.
But it doesn't work that way.
You want to win the center? Emanate strength. Emanate conviction. Lead like you know where you're going (and hopefully know what you're talking about).
People in the center will follow if you speak to their values, address their ambivalence (because by definition, on a wide range of issues, they're torn between the right and left), and act on what you believe. FDR did it. LBJ did it. Reagan did it. Even George W. Bush did it, although I wish he hadn't.
But you have to believe something.
I don't honestly know what this president believes. But I believe if he doesn't figure it out soon, start enunciating it, and start fighting for it, he's not only going to give American families hungry for security a series of half-loaves where they could have had full ones, but he's going to set back the Democratic Party and the progressive movement by decades, because the average American is coming to believe that what they're seeing right now is "liberalism," and they don't like what they see. I don't, either.
What's they're seeing is weakness, waffling, and wandering through the wilderness without an ideological compass. That's a recipe for going nowhere fast -- but getting there by November.
Drew Westen, Ph.D., is Professor of Psychology and Psychiatry at Emory University, founder of Westen Strategies, and author of The Political Brain: The Role of Emotion in Deciding the Fate of the Nation.
Eternal Cluelessness of the Versailles Dem Mind
by: Paul Rosenberg
Sat Dec 19, 2009 at 18:00
This diary has two sources. First is a HuffPo story story flagged by glenjo in a quick hit:, and the second was John Emerson's diary earlier today, "Stupid Voters, Part Two". John's diary is both fundamental, and flat-out brilliant. If you haven't read it already, do so immediately, before returning to read the rest of this diary, which only focuses on magnifying a part of his analysis through the lens of the recent story that glenjo picked up on.
John distinguishes between 3 different groups who Dems frequently tag with the "stupid voter" meme:
There are three groups of voters who Democrats routinely accuse of being stupid: hard-core Republicans, "low information voters", and non-voters....
The hard-core crazified Republicans are not, in general, stupid, and it's totally wrong to think of them as trailer trash. A high proportion of them, perhaps the majority, are well-educated and prosperous....
The next two groups of supposedly-stupid voters, low-information voters and non-voters, are purely and simply the product of Democratic failures. Low-information voters decide how to vote based on ambient information (i.e., free media and local scuttlebutt), and the free media are predominantly right wing. Non-voters, the second group, either are unaware of politics entirely and unconvinced that the Democrats have anything to offer them, or else they are prevented from voting by concrete problems such as lack of transportation or lack of time. In any case, both these classes of voters or potential voters are people who the Democrats, one way or another, have failed to reach.
John goes on to note that the Dems do worst at getting out the vote among those who support them most:
By contrast, Obama's best demographic was the 14% of the population with no HS degree, but this demographic is the one least likely to vote, making up only 4% of the actual voters.
and he talks the various reasons why this is so--the routine failure of Dems to message and outreach to their natural base, after which he writes:
When smart, well-paid, experienced people fail in stupid ways, it's always a good idea to ask whether their actual and their professed goals are different. There are many reasons to think that this is what is happening in the present case. The Democratic Party is a business like any other, and just as newspapers get their money from advertisers, and not from readers, the Democratic Party gets its money from donors rather than from voters.
Bringing new voters from the lower orders into the party would almost certainly require policy proposals which would negatively impact the big-money people, and even if the Democratic Party started winning elections that way, the boodle coming in would be reduced, and boodle is what pays the mercenary pros at the party headquarters.
Now, it's bad enough that this has been the dominant pattern since at least the early Reagan era. But it's absolutely horrendous that it should still be the case, when the public has been justifiably horrified by what the GOP has wrought, and the stars have beeen perfectly aligned to initiate a new ~40 year party system dominated by the Democrats.
And yet we have the Huffpo story, to which I now turn:
Paul Rosenberg :: Eternal Cluelessness of the Versailles Dem Mind
Rep. Capuano Tells Fellow Dems: 'You're Screwed'
When House Democrats gathered on Friday for their end-of-the week caucus meeting in the basement of the Capitol, caucus chairman John Larson (D-Conn.) told the group he wanted them to hear first from Rep. Michael Capuano, who'd just returned from a primary campaign for the Senate seat in Massachusetts vacated by the death of Ted Kennedy.
Larson asked Capuano, who finished in second place, to share the wisdom he learned on the campaign trail.
Capuano took to the microphone, looked out at his colleagues and condensed what he'd learned into two words. "You're screwed," he told his friends in the House, according to one attendee. The room's silence was broken only by soft, nervous laughter.
Capuano confirmed the gist of the message -- "I'm not sure of the exact wording," he told HuffPost, chuckling -- and said that he doubted his wisdom was anything they didn't already know."I think I was just confirming stuff they already knew," he said. "I focused on two things: the war in Afghanistan and jobs."
Everywhere Capuano went in his state, he said, he was bombarded with demands that the government do more to create jobs. He was also greeted by deep skepticism about Obama's escalation of the eight-year-old war in Afghanistan.
Capuano said he told the caucus that opponents of the war need to be given a chance to vote against funding for it on the House floor.
"If we do anything [on the war], we need to have a separate vote on it. People who can vote for it, can vote for it. But those of us who want to vote against it, [should] be given that opportunity, too," he said. "But I focused mostly on jobs. People are tired of the promises of jobs. They need them now."
Now, that first part of the story is disheartening enough. My superwonk analysis of it:
Is there anyone outside of Versailles that doesn't already know this?
But the conclusion:
Majority Leader Steny Hoyer (D-Md.), in an interview with two reporters in his office late last week, argued that Democrats were better prepared to withstand a Republican wave than they were in 1994, because they see this one coming.
"Unlike '94, nobody's having anything sneak up on them. Nobody in this House believes this next election is a slam dunk, which means they're out raising money, they're out in their districts -- working hard, communicating on jobs and getting the economy moving," he said. "And all of that, in my opinion, augurs well for a Democratic Party."
As I wrote in response to the quick hit:
So, even when they know, the do nothing. They're just like Republicans used to be, before they all started taking their crazy pills.
It's so nice to know that the Dems are communicating on jobs and getting the economy moving.
In November, it will be the voters' turn to do the same.
Of course, John's analysis turns the tables, here. It's not the Versailles Dems who are stupid. So what if they're passing up the chance to dominate politics for the next 40 years or so? If they do that, they're going to get a lot less money from the fat cats, and that would be really bad.
Of course, I don't think it's as simple as that, as I wrote in a comment to John's diary. Responding specifically to this passage:
Bringing new voters from the lower orders into the party would almost certainly require policy proposals which would negatively impact the big-money people, and even if the Democratic Party started winning elections that way, the boodle coming in would be reduced, and boodle is what pays the mercenary pros at the party headquarters.
I think there's something else important going on that helps stabilize this situation beyond the boodle, and that's plain old social structure. The big donors and the top party operatives are part of the same social set--or at least they socialize enough with one another for business reasons that act in ways that mimic those of people from a common social set. They have internalized norms and expectations that tend to control interactions among a homogeneous social group. And part of this is that they all tend to think alike, even the ones who think that they differ deeply over this or that issue.
One direct result of this, is that they will openly scoff at your description above. Money unites them so profoundly that it is like water uniting all the fish in the ocean. Of course they can't see it. They all agree that it's absurd. You're the one who's all wet.
And the "stupid voter" meme, IMHO, is a sort of trickle-down phenomena that derives
This is the very essence of Versailles, at least on the Democratic side. Its why even Democrats would defend Scooter Libby, and decry the idea of investigating the Bush Administration for absolutely anything. It's why Versailles Dems can only be regarded as our implacable ideological enemies. They would rather lose without us than win with us--even for the rest of their lives--and it's all because they are friends and/or clubmates with the people who are destroying America, and share their same fundamental outlook on the world, just as virtually everyone in the original Versailles did, just as they were all virtually clueless about the terrible fate towards which they were hurtling.
In his post, John followed the passage above about boodle with the following:
In large part this explains the constant refrain from the Democratic leadership: we'd like to do the right thing, but political realities make it impossible. The truth is that the Democratic leaders are very happy with the political realities and don't want to change them. If it were "politically possible" to pass single-payer, for example, the Democratic Party would lose incredible amounts of money from key donors in the medical biz. Single-payer might make the voters ecstatically happy, but these happy voters are not at all likely to replace the money the party lost.
If you look at the present healthcare debate, it's all been about process: the filibuster, and the conservadems, and the committee chairmen, and the Congressional procedures, and various delaying tactics like holds and demands for readings, and so on. This kind of last-minute crisis manoeuvring is what the pros thrive on. It puts them in control since they're the only ones who really understand it, and they especially love it because it allows them (ever-so-politely) to flip off the Democratic voters who expected better. The Democratic Party is going to make a lot of money from the failure of healthcare reform.
With a stronger Democratic Party and stronger campaigning, lawmaking would go much differently. It would be much harder for the Democratic leaders to play their donors off against their voters, much harder to engineer short-term crises (like the present Lieberman crisis) in order to bully people into accepting second best, and the Democratic leadership would no longer be able to tell the voters "We're sorry, but what you want is not politically possible".
In these crisis discussions, nobody ever talks about the long term, and when the crisis is over, no one talks about the long term then either. A year ago, where was the Democratic effort to get the word out about healthcare reform? Why do the low-information voters only hear disinformation? Why did so many of the people who most desperately need health insurance not vote? Why do so many nominally-Democratic Congressmen have Republican attitudes toward healthcare reform? Why do Democrats tolerate the crippling House and Senate rules, which they could change with a majority vote? The list could go on, but the answer is that everyone who counts (i.e., not me or you) likes things pretty much the way they are. The present reality facilitates the expert wheeling-and-dealing and extortion of boodle that the party pros are best at, and the candidates and the parties can fatten up. The officeholders and pros are doing very well for themselves, and if you don't like it, that's your problem.
Note that what John says above about the role of crisis is perfectly compatible with Naomi Klein's exegesis in The Shock Doctrine. There is no difference that makes a difference between Freidmanite conservatives and Rubinite neoliberals. They are essentially one and the same ideological party, with two cosmetically different faces.
In short, this is, at bottom, a grand battle between plutocracy and democracy. And as we just saw at Copenhagen, the plutocrats are perfectly willing to wreck the planet, rather than cede any meaningful power to a reality-based democratic majority of humanity--or even of the wealthy nations, whose average citizens are far more willing to sacrifice their meagers holdings than the top 1% are.
The plutocrats think they will be able to escape catastrophe in their gated communities, perhaps with the last remaining polar bears on Earth as their pets, ala Michael Jackson. That's what the denizens of the original Versailles thought, too.
This is not a threat. It's a reminder.
A reminder of why, for all their cleverness in fooling us, the Versailles Dems truly are clueless after all.
I posted this on John's first diary, but it is worth repeating. (4.00 / 2)
These are the CNN stats from the 2008 election:
white, col grad: McCain won by 4 points.
white, no col: McCain won by 18 points.
non-white, col grad: Obama won by 53 points.
non-white, no col: Obama won by 67 points.
Now, I know John is now talking about those with no HS degree, but what is startling here is that education seems to have the opposite effect on whites and non-whites. Educated whites tended to vote Dem more than uneducated whites, while educated non-whites tended to vote Repub more than uneducated non-whites. John's refusal to take race into account undercuts many of his points.
The uneducated were Obama's best group, as long as the uneducated were not white. Uneducated whites were in fact Obama's WORST group. I don't know why this should be surprising. Look at the New York Civil War riots, and the pushing of Chinese exclusion laws in the West. For most of this country's history, race relations and class relations are intertwined. The idea that there's a great mass of untapped, uneducated, white energy for Dems to take advantage of is a pipe-dream. As for the uneducated non-whites, the Dems already have them.
This does not mean, however, that we should not push for policies that help the disadvantaged, even if they are Palin supporters.
How health lobbyists influenced reform bill
Former staffers of lawmakers from Harry Reid to Mitch McConnell push clients' agenda
By Andrew Zajac
December 20, 2009
David Nexon had a big problem. An early version of national health care legislation contained a $40 billion tax aimed squarely at members of the medical device trade association he represents.
Nexon, a former adviser to the late Massachusetts Sen. Ted Kennedy, went to work. He marshaled 14 people like himself -- lobbyists who were once congressional aides, many of them from staffs of congressional leaders or committees that had a hand in crafting the health care overhaul.
When Senate Democrats unveiled their bill in mid-November, Nexon's handiwork was evident. The tax on device-makers was still large -- $20 billion -- but only half what it might have been without the efforts of Nexon and his fellow lobbyists.
Nexon's team is an illustration of how deeply the health care industry has embedded itself on Capitol Hill, using former aides of lawmakers and ex-lawmakers themselves.
An analysis of public documents by Northwestern University's Medill News Service in partnership with the Tribune Newspapers Washington Bureau and the Center for Responsive Politics found a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation.
At least 166 former aides from the nine congressional leadership offices and five committees involved in shaping health overhaul legislation -- along with at least 13 former lawmakers -- registered to represent at least 338 health care clients since the beginning of last year, according to the analysis.
Their health care clients spent $635 million on lobbying over the past two years, the study shows.
The total of insider lobbyists jumps to 278 when non-health-care firms that reported lobbying on health issues are added in, the analysis found.
Part of the lobbying pressure on current members of Congress and staffers comes from the powerful lure of post-congressional job possibilities.
"There's always a worry they may be thinking about their future employment opportunities when dealing with these issues, particularly with health care, because the stakes are so high and the breadth of the issues -- pharmacies, hospitals, doctors," said Emory University political scientist Alan Abramowitz.
Lobbyists' earnings can dwarf congressional salaries, which currently top out at $174,000 annually for lawmakers and $156,000 for aides, though committee staff members can earn slightly more.
In the health care showdown, insider lobbying influence has magnified the clout of corporate interests and helped steer the debate away from a public insurance option, despite many polls indicating majority support from Americans, according to Rutgers University political scientist Ross Baker.
"It imposes a kind of conservative bias on the discussion," said Baker, himself a former Senate staffer.
The lineup of insiders working for clients with health care interests includes at least 14 former aides to House Majority Leader Steny Hoyer and at least 13 former aides to Montana Democratic Sen. Max Baucus, the chairman of the Finance Committee and a key overseer of the health care overhaul.
Nexon, who is now senior executive vice president of the Advanced Medical Technology Association, is among at least a half-dozen former Kennedy aides lobbying on health care.
Nexon acknowledged the value of congressional connections, "but in the end, it's not who I know, it's what I know."
It makes sense to hire former staffers for the health care showdown because they tend to be "more generalists, dealing with a broad range of issues," something that is in demand for legislation that sprawls across at least a half-dozen federal agencies and encompasses issues ranging from tax policy to hospital reimbursement rates, according to Nexon. But specific issues also get specialized help. Earlier this year, the Christian Science Church hired a former Kennedy staffer, Carolyn Osolinik, and three of her colleagues at the Mayer Brown law firm, all veterans of Capitol Hill. The firm has been paid at least $110,000 so far to push a provision requiring insurers to consider covering Christian Science prayer treatments.
Phil Davis, a senior official of the church, said the church wanted access to decision makers. "The noise level goes sky high. It's hard to get in to talk to people," he said.
The largest insider lobbying cadre belongs to the Pharmaceutical Research and Manufacturers of America, or PhRMA, which employs at least 26 former congressional members and staffers, according to Medill/CRP research.
Two other drug interests, biotech firm Amgen Inc. and the Biotechnology Industry Organization trade group, with at least 24 and 16 insiders respectively, ranked second and fourth among reported hiring over the past two years of lawmakers' former staffers and members of committees considered in the analysis.
"The numbers shouldn't surprise anyone," said Ken Johnson, a PhRMA senior vice president. "Former staffers have a unique understanding of how the legislative process works. And when you are trying to advocate on behalf of smart public policies, you want smart people on your team."
But Bob Edgar, president of Common Cause, a nonpartisan, nonprofit watchdog group, had a harsher assessment, blaming "a toxic cocktail of insiders and money" for short-circuiting a government-run plan that would have competed with private insurers.
"We'll get a bill. And the president will sign it. But it'll be less than the country deserves," said Edgar, a former six-term member of the House.
Health care lobbyists increase their effectiveness by strategically targeting their campaign contributions or the donations of the interests they represent, Edgar said.
Health industry contributions to congressional candidates have more than doubled so far this decade, rising to $127 million in the 2008 election cycle from $56 million in the 2000 election, with disproportionate sums going to the party in power and to members of committees that oversee health care, according to the Center for Responsive Politics.
But lobbyist and former Kennedy staffer Andrew Rosenberg said political conditions, not big money or the predispositions of lobbyists sidelined a public option.
"You could see this coming from a long way off. The Democratic Party is now the big tent party. They have to get to 60 votes. That is the reality," Rosenberg said. "It was going to have to be something that appeals to moderates" opposed to expanding government-run health insurance.
Robert ReichFormer Secretary of Labor, Professor at Berkeley
"Don't make the perfect the enemy of the better," says the President and congressional insiders when confronted with the sorry spectacle of a health-care bill whose scope and ambition continue to shrink, and whose long-term costs to typical Americans continue to grow. They're right, of course. But by the same logic, neither the White House nor congressional Democrats will be able to celebrate the emerging legislation as a "major overhaul" or "fundamental reform." At best, it's likely to be a small overhaul containing incremental reforms.
Real reform has moved from a Medicare-like public option open to all, to a public option open to 6 million without employer coverage (still in the House bill), to a public option open only to those same people in states that opt for it, or about 4 million (the original Harry Reid version of the Senate bill), to no public option but expanded Medicare (the Senate compromise) to no expanded Medicare at all (the deal with Joe "I love all the attention" Lieberman).
In other words, the private insurers are winning and the public is losing.
Pharmaceutical companies are winning as well. Yesterday, proposals to allow US pharmacies and wholesalers to import prescription drugs from Europe and Canada were defeated in the Senate. No matter that American consumers pay up to 55% more for their prescription drugs than Canadians, or that the measure would have saved the government at least $19.4 billion over ten years (according to the Congressional Budget Office). Big Pharma's argument that the safety of such drugs couldn't be assured was belied by the defeat of another proposed amendment that would have allowed drug imports only if their safety and economic benefits were certified by the Secretary of Health and Human Service.
Doctors and hospitals are also winning. More and more of the putative "savings" from health care reform ("savings" should really be understood as projected costs that are under the wildly-escalating costs projected without such savings) rely on constraints on future Medicare spending. But the details of such constraints keep vanishing, while ever more of the messy work of coming up with them is assigned to a so-called Medical Advisory Board that will supposedly recommend them later on. What no one wants to admit is that Congress never actually implements promised Medicare savings. When crunch time comes, it caves in to the AMA and the AARP. In a few years time, when boomers swell the ranks of seniors, and the political power of the AMA and AARP together rival that of Wall Street, the cave-ins will be boggling.
Meanwhile, opponents of abortion are winning, too. Ben Nelson (a Nebraska Democrat who enjoys being the spoiler even as much as Joe Lieberman) is holding out for even more restrictions.
The political reality right now is that Harry Reid will do anything to get sixty votes -- which means Lieberman, Nelson, and even Olympia Snowe are able to use extortion on behalf of Big Insurance, Big Pharma, the AMA, and abortion foes. The President, meanwhile, remains eerily above the fray. Having closed deals months ago with Big Insurance, Big Pharma, and the AMA -- in order to get their support in exchange for guaranteeing them big profits -- his only apparent interest is keeping the deals going while helping Reid corral sixty votes for just about anything. (The deals have caused some awkwardness for the White House. Drug importation would have cost Big Pharma far more than the $80 billion price tag it agreed to, forcing the White House to oppose importation even though the President had publicly supported it during his presidential campaign last year, and even though John McCain supported yesterday's amendment.)
Is the effort worth still worth it? Yes, but just. Private insurers will have to take anyone, regardless of preconditions. And some 30 million people who don't now have health insurance will get it. But because Big Insurance, Big Pharma, and the AMA will come out way ahead, the legislation will cost taxpayers and premium-payers far more than it would otherwise. Cost controls are inadequate; in fact, they barely exist. If Wall Street's top brass are "fat cats," as the President described them last weekend, the top brass of Big Insurance, Big Pharma, and the AMA are even fatter. While they don't earn as much, they're squeezing the public for even more.
We are slouching toward health-care reform that's better than nothing but far worse than we had imagined it would be. Even those of us who have seen legislative sausage-making up close, even those of us who never make the perfect the enemy of the better, are concerned. That two or three senators are able to extort as much as they have is appalling. Why hasn't Reid forced much of the bill into reconciliation, requiring only 51 votes? Why has the President been so cowed? In all likelihood, the White House and the Dems eventually will get a bill they can call "reform," but they will not be able to say with straight faces that the reform is a significant improvement over the terrible system we already have.
By Steffie Woolhandler and David Himmelstein
New York Times, Room for Debate blog, Dec. 11, 2009
Milk and lemon both taste good in tea. But mix them together and it's a curdled mess. Similarly, the latest Senate health reform compromise combines two appetizing elements - a Medicare expansion and tighter insurance regulations - to create a noxious brew.
Both the House and Senate versions of reform would turn over hundreds of billions of tax dollars to the same private insurers who've proven incapable of controlling costs or giving American families the coverage they need. And these bills would make failure to buy insurers' defective products a federal offense. Together these measures greatly augment insurers' financial and, hence, political muscle.
The only concessions wrung out of the insurers for this windfall are modest new regulations on the policies they sell to individuals: insurers will have to accept every applicant; they won't be allowed charge the sick higher premiums; and they'll be able to charge older people only two to three times more than the young.
Most of these regulations won't change things for people who get their coverage through an employer, but they're helpful for the many of the roughly 7 percent of the population who buy their own private insurance.
For insurers, the regulations make the near-elderly who don't get employer-sponsored coverage into pariahs. On average, they cost insurers far more than twice as much as the near-teens, but they can't be charged premiums to match their costs.
Now the Senate plans to take some of these high-cost patients off private insurers' books, and make them Medicare's problem. Consequently, the costs of this Medicare buy-in will be high - both for patients and for the taxpayers who will subsidize the near-poor starting in 2014.
Meanwhile, younger, healthier and hence more profitable patients will be forced into private insurance. There's no public option for them, nor for anyone offered employer-sponsored coverage. If you have private insurance and you like it, you can keep it; if you have private insurance and you don't like it, you still have to keep it.
But even though it's bad health policy, this new compromise is brilliant politics. For insurers, it offers a hidden subsidy. Meanwhile, it gives the appearance of responding to the vocal and growing legion of single payer supporters who want Medicare for All.In the end, the Senate compromise, like its House counterpart, will do little to salvage the sinking U.S. health system. Costs will continue to skyrocket, putting coverage more and more out of reach for middle class Americans, and driving the costs of taxpayer-funded subsidies through the roof.
In contrast, a single payer system could save nearly $400 billion annually on health insurers' overhead and the paperwork they inflict on doctors and hospitals - savings that would make universal coverage affordable. Medicare for All won't grow from the Senate compromise, but from its ashes.
Steffie Woolhandler is a professor of medicine and David Himmelstein is an associate professor of medicine, both at Harvard Medical School. They are co-founders of Physicians for a National Health Program (www.pnhp.org).
If the fight over health care reform has proven anything, it's just how broken our system has become -- from the crippling influence of money on our politics to the way the modern misuse of the filibuster has taken away the power of the duly elected majority and handed it to a handful of bought-and-paid-for senators (yes, I'm talking about you Joe Lieberman).
This disturbing and destructive state of affairs has created a country that is, in the words of Tom Friedman, "only able to produce 'suboptimal' responses to its biggest problems."
And that's where we find ourselves on health care as we head towards the legislative end game. The big optimal solutions have all been gutted -- and we are left to pick through the patchwork of suboptimal ones.
What makes this exercise harder is that the details seem to change form more frequently than the characters in Twilight. At the moment, and while we are waiting for the latest CBO score, "the whole town," as Mike Allen puts it, "is talking about a proposal that few have seen, and none understand."
One by one, Congressional leaders who said they would not support a bill without a public option have come to the conclusion that, on second (or third or fourth) thought, they actually will. Leaving aside what this does to the already tattered trust the public has in their representatives, is a progressively watered-down public option preferable to a Medicare expansion combined with a national non-profit insurance plan similar to the one offered to federal employees, regulated by the Office of Personnel Management?
Bernie Sanders, one of the leading advocates of the public option, is now arguing that these proposals combined "may be stronger than the very weak public options that both the House and the Senate have already passed."
Jacob Hacker, the godfather of the original public option concept, also approves of the proposed expansion of Medicare, calling it an "enormous positive development."
Of course, expanding Medicare by allowing those 55 to 64 to buy into the program won't be subsidized for the first three years and therefore may end up being prohibitively expensive, especially if it ends up being an expansion of Medicare not tied to Medicare rates.
Amidst the tea leaf reading and jockeying for political position (at least among Democrats; Republicans are united in their commitment to kill reform) it's important not to lose track of the things that absolutely have to be included in any health care bill for it to deliver reform in more than name only.
It has to expand access to include as many of the 46 million uninsured Americans as possible. Both the House version and the current incarnation of the Senate bill go a long way to meeting this goal.
It has to create competition and reduce costs. In the end, it doesn't matter if this is accomplished by creating a government-run non-profit insurance provider (the so-called "public option") or by adopting a national privately run system that is heavily regulated by the federal government, and allowing those 55 to 64 the "option" of buying into the Medicare program. It's not the label we give these that matters, it's the end result: competition and cost reduction. The current bill mandates that most Americans get insurance coverage, creating 30 million new customers for the insurance industry. These new customers have to have options -- especially less expensive options -- or this will be a massive windfall for insurance companies.
The best way to provide more choices for consumers is through the latest incarnation of Sen. Ron Wyden's Free Choice Act, which he is offering as an amendment to the health care bill. The provision would give employees the ability to choose their own insurance plans within the insurance exchange -- instead of having to accept the plan chosen by their employer, as is the case in the bill Harry Reid brought to the floor of the Senate.
To qualify as real reform, the bill also needs to give Congress the ability to negotiate with the drug companies over Medicare prescription drug prices. The White House cut a deal with PhRMA taking away this ability to negotiate. That agreement is still part of the Senate bill but not part of the House bill -- and should not survive the conference process.
And, knowing how quickly things can get slipped into bills, or carved out of bills, in the dark of night, we have to ensure that the positive elements of the current bill don't suddenly vanish -- especially the provisions that keep insurance companies from denying people coverage on the basis of pre-existing conditions or dropping customers when they actually become sick.
If the final bill contains all these elements, it will be a suboptimal solution worth supporting.
Then we can move on to the business of fixing our broken system, so we can get back to being a country able to produce optimal responses to our biggest problems.
Posted: December 10, 2009 07:42 PM
Former Secretary of Labor, Professor at Berkeley
Posted: December 11, 2009 12:05 PM
The public option is dead, killed by a handful of senators from small states who are mostly bought off by Big Insurance and Big Pharma or intimidated by these industries' deep pockets and power to run political ads against them. Some might say it's no great loss at this point because the Senate bill Harry Reid came up with contained a public option available only to 4 million people, which would have been far too small to exert any competitive pressure on private insurers anyway.
To provide political cover to senators who want to tell their constituents that the intent behind a robust public option lives on, the emerging Senate bill makes Medicare available to younger folk (age 55), and lets people who aren't covered by their employers buy in to a system that's similar to the plan that federal employees now have, where the federal government's Office of Personnel Management selects from among private insurers.
But we still end up with a system that's based on private insurers that have no incentive whatsoever to control their costs or the costs of pharmaceutical companies and medical providers. If you think the federal employee benefit plan is an answer to this, think again. Its premiums increased nearly 9 percent this year. And if you think an expanded Medicare is the answer, you're smoking medical marijuana. The Senate bill allows an independent commission to hold back Medicare costs only if Medicare spending is rising faster than total health spending. So if health spending is soaring because private insurers have no incentive to control it, we're all out of luck. Medicare explodes as well.
A system based on private insurers won't control costs because private insurers barely compete against each other. According to data from the American Medical Association, only a handful of insurers dominate most states. In 9 states, 2 insurance companies control 85 percent or more of the market. In Arkansas, home to Senator Blanche Lincoln, who doesn't dare cross Big Insurance, the Blue Cross plan controls almost 70 percent of the market; most of the rest is United Healthcare. These data, by the way, are from 2005 and 2006. Since then, private insurers have been consolidating like mad across the country. At this rate by 2014, when the new health bill kicks in and 30 million more Americans buy health insurance, Big Insurance will be really Big.
In light of all this, you'd think the insurance industry would be subject to the antitrust laws, so the Justice Department and the Federal Trade Commission could prevent it from combining into one or two national behemoths that suck every health dollar out of our pockets (as well as the pockets of companies paying part of the cost of their employees' health insurance). But no. Remarkably, the Senate bill still keeps Big Insurance safe from competition by preserving its privileged exemption from the antitrust laws.
From the start, opponents of the public option have wanted to portray it as big government preying upon the market, and private insurers as the embodiment of the market. But it's just the reverse. Private insurers are exempt from competition. As a result, they are becoming ever more powerful. And it's not just their economic power that's worrying. It's also their political power, as we've learned over the last ten months. Economic and political power is a potent combination. Without some mechanism forcing private insurers to compete, we're going to end up with a national health care system that's controlled by a handful of very large corporations accountable neither to American voters nor to the market.
WASHINGTON — Private security guards from Blackwater Worldwide participated in some of the C.I.A.’s most sensitive activities — clandestine raids with agency officers against people suspected of being insurgents in Iraq and Afghanistan and the transporting of detainees, according to former company employees and intelligence officials.
The raids against suspects occurred on an almost nightly basis during the height of the Iraqi insurgency between 2004 and 2006, with Blackwater personnel playing central roles in what company insiders called “snatch and grab” operations, the former employees and current and former intelligence officers said.
Several former Blackwater guards said that their involvement in the operations became so routine that the lines supposedly dividing the Central Intelligence Agency, the military and Blackwater became blurred. Instead of simply providing security for C.I.A. officers, they say, Blackwater personnel at times became partners in missions to capture or kill militants in Iraq and Afghanistan, a practice that raises questions about the use of guns for hire on the battlefield.
Separately, former Blackwater employees said they helped provide security on some C.I.A. flights transporting detainees in the years after the 2001 terror attacks in the United States.
The secret missions illuminate a far deeper relationship between the spy agency and the private security company than government officials have previously acknowledged. Blackwater’s partnership with the C.I.A. has been enormously profitable for the North Carolina-based company, and became even closer after several top agency officials joined Blackwater. “It became a very brotherly relationship,” said one former top C.I.A. officer. “There was a feeling that Blackwater eventually became an extension of the agency.”
George Little, a C.I.A. spokesman, would not comment on Blackwater’s ties to the agency. But he said the C.I.A. employs contractors to “enhance the skills of our own work force, just as American law permits.”
“Contractors give you flexibility in shaping and managing your talent mix — especially in the short term — but the accountability’s still yours,” he said.
Mark Corallo, a spokesman for Blackwater, said Thursday that the firm was never under contract to participate in clandestine raids with the C.I.A. or with Special Operations personnel in Iraq, Afghanistan or anywhere else.
Blackwater’s role in the secret operations raises concerns about the extent to which private security firms, hired for defensive guard duty, have joined in offensive military and intelligence operations.
Representative Rush D. Holt, a New Jersey Democrat who is chairman of the House Select Intelligence Oversight Panel, said in an interview that “the use of contractors in intelligence and paramilitary operations is a scandal waiting to be examined.” While he declined to comment on specific operations, Mr. Holt said that the use of contractors in such operations “got way out of hand. It’s been very troubling to a lot of people.”
Blackwater, now known as Xe Services, has come under intense criticism for what Iraqis have described as reckless conduct by its security guards, and the company lost its lucrative State Department contract to provide diplomatic security for the United States Embassy in Baghdad earlier this year after a 2007 shooting that left 17 Iraqi civilians dead.
Blackwater’s ties to the C.I.A. have emerged in recent months, beginning with disclosures in The New York Times that the agency had hired the company as part of a program to assassinate leaders of Al Qaeda and to assist in the C.I.A.’s Predator unmanned vehicle program in Afghanistan and Pakistan. Leon E. Panetta, the C.I.A. director, recently initiated an internal review examining all Blackwater contracts with the agency to ensure that the company was performing no missions that were “operational in nature,” according to one government official.
Five former Blackwater employees and four current and former American intelligence officials interviewed for this article would speak only on condition of anonymity because Blackwater’s activities for the agency were secret and former employees feared repercussions from the company. The Blackwater employees said they participated in the raids or had direct knowledge of them.
Along with the former officials, they provided few details about the targets of the raids in Iraq and Afghanistan, although they said that many of the Iraq raids were directed against members of Al Qaeda in Mesopotamia. The former intelligence officials said that Blackwater’s work with the C.I.A. in Iraq and Afghanistan grew out of its early contracts with the spy agency to provide security for the C.I.A. stations in both countries.
In the spring of 2002, Erik Prince, the founder of Blackwater, offered to help the spy agency guard its makeshift Afghan station in the Ariana Hotel in Kabul. Not long after Mr. Prince signed the security contract with Alvin “Buzzy” Krongard, then the C.I.A.’s third-ranking official, dozens of Blackwater personnel — many of them former Navy Seals and Army Delta Force operatives — were sent to provide perimeter security for the C.I.A. station.
But company’s role soon changed dramatically as Blackwater operatives began accompanying C.I.A. case officers on missions, according to former employees and intelligence officials.
A former senior C.I.A. official said that Blackwater’s role expanded in 2005 as the Iraqi insurgency intensified. Fearful of the death or capture of one of its officers, the C.I.A. banned C.I.A. officers from leaving the Green Zone in Baghdad without security escorts, the official said.
That gave Blackwater greater influence over C.I.A. clandestine operations, since company personnel helped decide the safest way to conduct the missions.
The former American intelligence officials say that Blackwater guards were only supposed to provide perimeter security during raids, leaving it up to C.I.A. officers and Special Operations military personnel to capture or kill suspected insurgents or other targets.
“They were supposed to be the outer layer of the onion, out on the perimeter,” said one former Blackwater official of the security guards. Instead, “they were the drivers and the gunslingers,” said one former intelligence official.
But in the chaos of the operations, the roles of Blackwater, C.I.A., and military personnel sometimes merged. Former C.I.A. officials said that Blackwater guards often appeared eager to get directly involved in the operations. Experts said that the C.I.A.’s use of contractors in clandestine operations falls into a legal gray area because of the vagueness of language laying out what tasks only government employees may perform.
P.W. Singer, an expert in contracting at the Brookings Institution, said that the types of jobs that have been outsourced in recent years make a mockery of regulations about “inherently governmental” functions.
“We keep finding functions that have been outsourced that common sense, let along U.S. government policy, would argue should not have been handed over to a private company,” he said. “And yet we do it again, and again, and again.”
According to one former Blackwater manager, the company’s involvement with the C.I.A. raids was “widely known” by Blackwater executives. “It was virtually continuous, and hundreds of guys were involved, rotating in and out,” over a period of several years, the former Blackwater manager said.
One former Blackwater guard recalled a meeting in Baghdad in 2004 in which Erik Prince addressed a group of Blackwater guards working with the C.I.A. At the meeting in an air hangar used by Blackwater, the guard said, Mr. Prince encouraged the Blackwater personnel “to do whatever it takes” to help the C.I.A. with the intensifying insurgency, the former guard recalled.
But it is not clear whether top C.I.A. officials in Washington knew or approved of the involvement by Blackwater officials in raids or whether only lower-level officials in Baghdad were aware of what happened on the ground.
The new details of Blackwater’s involvement in Iraq come at a time when the House Intelligence Committee is investigating the firm’s role in the C.I.A.’s assassination program, and a federal grand jury in North Carolina is investigating a wide range of allegations of illegal activity by Blackwater and its personnel, including gun running to Iraq. Several former Blackwater personnel said that Blackwater guards involved in the CIA raids used weapons, including sawed-off M-4 automatic weapons with silencers, that were not approved for use by private contractors. In separate interviews, former Blackwater security personnel also said that they were handpicked by senior Blackwater officials on several occasions to participate on secret flights transporting detainees around war zones. The former Blackwater personnel said that during the flights, teams of about 10 Blackwater personnel provided security over the detainees. “A group of individuals were selected who could manage detainees without the use of lethal force,” said one former Blackwater guard who participated in one of the flights.
Intelligence officials deny that the agency has ever used Blackwater to fly high-value detainees in and out of secret C.I.A. prisons that were shut down earlier this year. Mr. Corallo, the Blackwater spokesman, said that company personnel were never involved in C.I.A. “rendition flights,” which transferred terrorism suspects to other countries for interrogation.
The New York Times
December 4, 2009
Questioning a $30,000-a-Month Cancer Drug
By Andrew Pollack
A newly approved chemotherapy drug will cost about $30,000 a month, a sign
that the prices of cancer medicines are continuing to rise despite growing
concern about health care costs.
Critics, including many oncologists, say that patients and the health system
cannot afford to pay huge prices for drugs that, on average, provide only a
few extra months of life at best.
And Folotyn (made by Allos Therapeutics) has not even been shown to prolong
lives ? only to shrink tumors. The drug was approved by the Food and Drug
Administration in late September as a treatment for peripheral T-cell
lymphoma, a rare and usually aggressive blood cancer that strikes an
estimated 5,600 Americans each year.
(James V. Caruso, the chief commercial officer for Allos) said the price of
Folotyn was not out of line with that of other drugs for rare cancers.
Patients, moreover, are likely to use the drug for only a couple of months
because the tumor worsens so quickly, he said.
In a note to clients in October, Joshua Schimmer, an analyst at Leerink
Swann, estimated that a typical treatment would last 3.5 months and cost
$126,000, or about $36,000 a month.
Allos Therapeutics, Inc.
Prescribing Information for Folotyn (pralatrexate injection)
Issued: September 2009
Indications and Usage:
Folotyn is indicated for the treatment of patients with relapsed or
refractory peripheral T-cell lymphoma (PTCL). This indication is based on
overall response rate. Clinical benefit such as improvement in progression
free survival or overall survival has not been demonstrated.
Adverse reactions (list includes only those events occurring in 10 percent
or more of patients treated):
Liver function test abnormal
Pain in extremity
Upper respiratory tract infection
Percent of patients experiencing any adverse event: 100 percent
Forty-four percent of patients (n = 49) experienced a serious adverse event
while on study or within 30 days after their last dose of Folotyn.
The Library of Congress, THOMAS
Patient Protection and Affordable Care Act (Amendment in Senate)
Title VII - Improving access to innovative medical therapies
Sec. 7002, (a), (2), (k)
(7) Exclusivity for reference product
(A) Effective date of biosimilar application approval - Approval of an
application under this subsection may not be made effective by the Secretary
until the date that is 12 years after the date on which the reference
product was first licensed under subsection (a).
Comment: Fotolyn is a new miracle drug brought to us by our highly revered
pharmaceutical industry. This new drug has no demonstrated clinical benefit,
though all patients have adverse reactions, almost half of them serious -
In an astonishing moment of candor, James Caruso, chief commercial officer
for Allos, provided reassurance that the very high monthly cost of Fotolyn
would not be protracted since the tumor worsens so quickly.
What makes this drug a miracle only the investment community can understand.
Desperate patients will spend an average of $126,000 for this worthless
drug. On Wall Street that's a miracle, but within the health policy
community, that's a tragedy.
You can be assured that, in crafting health care reform, Congress has
responded to the very high prices of newer patented therapeutic agents, but
in a perverse way. Recognizing the great potential of genetically-engineered
biologics, Congress has included in the legislation an unprecedented 12 year
exclusivity, protecting the firms from competition of biosimilar products.
Maybe the biotech firms will be able to parley this into seven-figure
treatment programs for the desperately ill. The soak-the-sick policies may
not work for patients, but they certainly work well for Wall Street. And
doesn't that seem to be where Congress's loyalties lie these days?
-------------- next part --------------
An HTML attachment was scrubbed...
This is the blog of a journeying person. My paths meander through autumn's season. I am learning to soar. There is a craftsman's cottage with a gated picket fence waiting for me. My heart sees it, but not yet my eyes. Hugs From The Heart.
Raise Your Children Not to Kill Another Mother's Child