Enemies of Reform
"I Think Your Mom Probably Did": The Best of the Weekend
Published September 27, 2009 @ 10:46PM PT
Every weekend, I share my three favorite videos or stories that helped enhance my own understanding of the health care debate. In Washington, the focus is almost entirely on the machinations of the Senate Finance Committee, the House’s preparations for a full floor debate, and the looming question of what package can or will survive in the Senate. But with such a focus on the politics, there’s not quite enough on the policy. Luckily, the first two articles helped me fill in the gaps.
1.) Kaiser Health News, “Canadian Doctor: Dutch Health Care System Could Work In U.S.”
Dr. Robert Ouellet, until recently the president of the Canadian Medical Association, was also recently on a fact-finding mission to several European countries to assist the Canadian government in finding ways to improve their own universal health care system. This interview really has it all – musings on where the American health care system needs to go, comparisons to the Netherlands and several other countries, and myth-busting about the much-maligned Canadian system.
As mentioned before, those looking to blacken the name of Canadian medicine need to spend more time talking to Canadian doctors.
Q: In the United States, we’ve heard a lot of negative things said about the Canadian health care system. How do you respond?
A: First, people are not dying on the streets in Canada. I think there is a lot of exaggeration in what we have seen in the ads in the United States about the Canadian system. We have a problem of access and we want to fix that, that's for sure. We're not denying patients care because they don't have money. We have good quality. Many doctors, I am one of them, went to the United States for training. So it's not fair to say our system is so bad. That's not true.
Q: Would the United States be well-advised to adopt some of the Canadian ways of doing health care?
A: I think so. The most important thing for us is to keep our system universal. If it is one value that you want to import, that's fine. But it doesn't mean you need to import all [of our system] because it won't work in the States. And it's the same for us. You have good things in your system. But we don't want to have your system here in Canada. This is why we went to some European countries, to look at something different. And the first value we were looking for is universal access.
Read the whole interview at Kaiser Health News.
2.) The New York Times, “Medicare Scare-Mongering”
If we’re having a health care debate, then it must be time for someone somewhere to be darkly warning that Medicare is about to face massive debilitating cuts! If I was a senior citizen, I'd be ticked that my presumed gullibility had become such a political target. As this New York Times editorial illustrates, the reality is that a major goal of health care reform is to strengthen the Medicare program to increase its solvency and quality.
What the Republicans aren’t saying -- and what the Democrats clearly aren’t saying enough -- is that in important ways, coverage for a vast majority of Medicare recipients, those in traditional Medicare, should actually improve under health care reform.
The House legislation, the only bills in near-final form, would reduce and ultimately eliminate a gap -- the so-called doughnut hole -- in Medicare drug coverage that currently forces more than three million beneficiaries to pay for drugs entirely out of their own pockets once they hit specified spending levels. That would also benefit many other beneficiaries who pay high premiums for coverage in the gap that they never end up using.
The House bills would also waive deductibles and co-insurance for preventive care that can head off serious illness, expand eligibility for programs that assist low-income beneficiaries and provide incentives for doctors and hospitals to coordinate care, improve quality, and lower costs. All that should benefit many if not most Medicare beneficiaries. And delivery system reforms should benefit the private plans as well.
Read the full editorial at New York Times.com
3.) Stabenow Replies To Kyl: You Don't Need Maternity Benefits, 'But Your Mother Did'
My favorite video from the Senate Finance Committee mark-up (with a big h/t to Igor Volsky over at Think Progress). Once again, a conservative member of Congress is making the case that legislatures should not create minimum standards for coverage (a la, a mandate). I don’t buy that argument, but if you’re going to make it, I’d avoid citing a class of medical care that half of the population had an excellent chance of needing at some point in their lives.
Plus, it’s basically a video of a United States Senator making a “Your Mama” joke. What’s not to love?
When It Comes to Laws, Understanding Is Better than Reading
Published September 27, 2009 @ 06:23PM PT
“Read the bill” was a common refrain at congressional town halls throughout August. I agreed with the general principle -- members of Congress should understand what they’re voting on before they vote on it. Regular folks should also be paying attention to the political process, if for no other reason than to learn whether their representative is putting their interest first. But reading the text is no guarantee that you’ll understand what you’re reading, as many frustrated American citizens also learned this summer. Reading the bill isn’t a good in and of itself. It's only a good if it yields understanding.
In fact, there are three distinct areas where the focus on "scripta sola" -- only the text of the bill -- actually harms our understanding of what’s going on in health reform.
1.) What the hell are they talking about, anyway?
I’ve lost count of the number of people who’ve said or written to me that “this is the worse legalese that I’ve ever read.” I’m always tempted to ask, “How many bills have you read before, exactly?” Legalese might not exactly be like reading another language, but it’s at least like reading Chaucer or Shakespeare -- if you’re used to reading or hearing it, it’s not that difficult. But as many a seventh grader has learned, getting to the “used to the language” stage can be a true pain.
That’s why we’ve seen so many viral emails spreading misinformation – it’s almost too easy to make your standard bill language sound vaguely menacing. Context clues are not much help when you don’t know the context in the first place.
2.) The text of the bill is only one part of the debate
The "read the bill" flare-up erupted this week into the debate that took up entirely too much of the first day of mark-up in the Senate Finance Committee. Traditionally, no matter if the chair is a Republican or a Democrat, he submits a “Chairman’s mark” for a bill. This presents the full content of the bill in plain English (or as close as they can get), and helpfully also highlights how these provisions are or are not different than current law. The amendments are similarly presented in plain English, argued in plain English, and adapted. After the process is over, the bill is translated into legal language. If there are any discrepancies, the plain English version prevails.
The Baucus Health Care Plan: Here Be Accounting Tricks
Published September 17, 2009 @ 05:10PM PT
The long-awaited and much-derided Sen. Max Baucus Chairman’s Mark intended to serve as the foundation for the Senate Finance Committee bill has, shall we say, a very limited audience. For once, I agree with Sen. Mitch McConnell when he writes, “The only thing bipartisan is the opposition.” But even if the proposal that took months to hammer out has zero Republican votes and progressive Democrats openly frustrated, there is one constituent who is quite impressed -- the Congressional Budget Office, which gave the Baucus bill inarguably the most impressive score of any health care proposal for cost reduction. But the reasons why Baucus’ plan appeals to the CBO are the very same reasons it is being vilified everywhere else... and why it's unlikely to become more popular the more people study it.
For starters, it’s not a surprise that the CBO looked upon the bill so favorably. After all, CBO Director Doug Elmendorf was photographed being in the room while “the gang of six” bipartisan negotiators were hammering out a deal. (In fact, there are more pictures of Elmendorf with the gang of six than there were pictures of gang of six participant Sen. Jeff Bingaman!) It’s also certainly the case that CBO’s rules for giving good scores on health care reform should be easy to predict by now. After all, HR 3200 yielded a very good score, as did the Wyden-Bennett plan. HR 3200, however, is also a textbook example on how to get, essentially, rogered by the CBO’s strict rules process. The House had fixed the Medicare Sustainable Growth Rate in its Paygo bill, netting a surplus of $265 billion. House leaders presumed that, since it was health care-related, that surplus should apply to HR 3200. The CBO did not agree, and when it proclaimed that HR 3200 would yield a $249 deficit, opponents of the bill had a new talking point –- even though the House health care reform effort creates a $16 billion surplus!
The point was clear to the gang of six: play by the CBO’s rules if you want your proposal to live. However, my Spidey-sense began to tingle yesterday when Sen. Kent Conrad requested CBO also score the Baucus bill in a 20 year-window. It’s an unusual move. But much like a lawyer only asks a question in front of a jury that s/he knows the answer to, Conrad knew what was coming. A $774 billion price tag over 10 years (even better than what Baucus himself reported), and a $49 billion surplus within the first 10 years. In short, the Baucus bill not only wouldn’t add to the deficit, it would reduce it. Extended out to a 20-year window, and the health bill would save hundreds of billions of dollars for the federal government.
Unfortunately, how it achieves those jaw-dropping savings is likely to be a ticking political time bomb.
The Baucus Health Care Plan: Who Will Vote for THIS?
Published September 16, 2009 @ 03:58PM PT
You’ve heard endlessly about how you need 60 votes to pass anything in the Senate. (It’s the number of votes required to end a filibuster.) You’ve even heard the number 60 used to justify why the Senate Finance Committee is jettisoning something as popular as the public option from their bill. As Sen. Kent Conrad said again and again on TV, there are “not 60 votes in the U.S. Senate” to pass a public option. But given the reaction to Sen. Max Baucus’ bill, crafted in secret with a bipartisan “gang of six” including Mr. Conrad, the magic number is not 60. It’s 12.
That’s the number of votes it would take to vote this mess of a proposal out of the Senate Finance Committee. And it’s not at all clear that it will get those 12 votes.
In a post later tonight, I’ll go over my reactions to the policy, although I’m going to have a hard time besting Shadowfax’s summary, “As for the bill itself: it pretty much sucks.” Or even Ezra Klein’s reaction to the “free rider” provision: “This isn't just the worst policy in the bill. It's one of the worst policy ideas I've ever seen.” We were expecting this bill to be substantially weaker that what we’ve seen from the House, the Senate HELP Committee, or President Obama’s less detailed blueprint. But we were expecting them to be weaker for a political end –- to get the 60 votes needed for passage, and entice bipartisan support.
Yeah. That’s not going to happen.
The gang of six was originally a gang of seven, with more Republicans than Democrats. But then Orrin Hatch dropped out. The end result of the gang of six's months of negotiations -- months where their deliberations stalled reform and helped its popularity sink in the polls -- is that very few of the members now support the compromise they helped create. Mike Enzi and Chuck Grassley are openly airing their disunity after spending most of August bashing health care reform. Look for them to bring hundreds of amendments to the table. Olympia Snowe, the best hope of a Republican vote, said she won’t immediately support the compromise she had one of the biggest hands in crafting. And Republican leadership, in the form of Sen. Mitch McConnell, calls it “yet another thousand-page, trillion-dollar government program”... even though the actual Chairman’s Mark is a mere 223 pages and the CBO says it will only cost $774 billion. (I understand. Math is hard.)
The co-op meant to replace the public option as a compromise to Republicans and the insurance industry hasn’t solved the politics of the situation either. Republicans have been deriding it as government-run health care all the same. AHIP warms over the same language they used for the public option, calling it, “a new untested government-created co-op that could disrupt the quality coverage on which millions of Americans rely today.”
But the best part is Democrats and progressives are not amused either. Sen. Jay Rockefeller -- excluded from the secret negotiations despite being the #2 ranking Democrat on the committee, as well as chair of the Subcommittee on Health -- says there is “no way” he can vote for it. Sen. Ron Wyden, also on the committee, seems to also have big problems with how the bill defines “affordable health care”: “I don't know very many working-class families who you can look in the eyes and say: 'Do you have that kind of money in your checking account?' -- because they don't.” Sen. John Kerry has expressed milder reservations, but it’s not a home run for him. We haven’t even heard from Sen. Charles Schumer yet, who’s been an outspoken supporter of the public option and against the co-op. Ditto Sen. Robert Menendez.
Normally you would count on progressive organizations to push reluctant senators to back health care reform. But that’s a huge question mark for the Baucus plan. The AFL-CIO, AFSCME, and MoveOn have all unleashed highly critical statements. Health Care for America Now called the bill a failure and “a gift to the insurance industry.” So count them out.
If there are zero or one Republican votes, then the bill can’t even be voted out of committee without holding onto 11 or 12 of the 13 Democrats. Ironically, the huge concessions to get to 60 votes may kill any chance Baucus has of getting to 12.
(Photo credit: The Senate Finance Committee home page).
The View of American Health Care from Canada and China
Published September 16, 2009 @ 07:28AM PT
If it’s time to debate reforming an American health care system that leaves too many behind, bankrupts individuals, businesses and bust government budgets, and doesn’t yield results commensurate with what we’re paying for it, then that must also mean it’s time to beat the crap out of other countries' health care systems! All politics is the same, I suppose. When you’re running behind, distract by going negative on your rivals. But what’s good for the goose is good for the gander. Other countries are talking about our health care system as well -- and not in a good way.
For example, China is not at all amused at our big spending on health care. As gets frequently mentioned, China has purchased a significant portion of the American national debt. That debt outlook has been looking worse for years, increasingly because of the three-times-the-rate-of-inflation march of our health care costs. But as the current efforts to begin to rein in costs has hit a bumpy patch, the country holding a large share of our debt is moving from concerned to alarmed. So much so that Chinese officials grilled White House Office of Management and Budget Director Peter Orszag on a recent visit to the White House. The topic: health care costs and how our efforts at reform are looking.
With nearly half of their $2 trillion in foreign currency reserves invested in U.S. bonds alone, the Chinese are understandably concerned about our creditworthiness. And this concern has brought them ineluctably to the issue of health care. "At some point, if you refuse to contain health care costs, you'll go bankrupt," says Andy Xie, a prominent Shanghai-based economist, formerly of Morgan Stanley. "It's widely known among [Chinese] policymakers."
Not encouraging words from a country that gets colloquially referred to as “America’s banker.”
Meanwhile, Canadian political scientist Jonathan Malloy penned a witty editorial entitled, “The Health-Care Debate, Up North.” Have Canadians’ psyches been damaged by the tough talk in advertisements from know-nothings like Rick Scott of Conservatives for Patients Rights? Not at all, suggests Malloy. In fact, it seems to have boosted national confidence: “Every Republican fulmination against Canadian health care gets big play in the Canadian media, because it reinforces our sense of difference with the States. (When Democrats criticize our system, we're hurt but keep quiet.)” While conservatives in the U.S. are blasting Canadian health care -- despite the fact that the proposal on the table bears scant resemblance to Canadian health care -- conservative Canadians are joining progressives to blast American health care.
The slogan “An admitting nurse doesn't check your credit card -- she checks your pulse” might not be as catchy as “Don’t put senior citizens to death,” but there are two sides to every story.
(Photo credit: http://www.flickr.com/photos/jeffsand/ / CC BY 2.0)
The Public Option: Popular Everywhere But the U.S. Senate
Published September 14, 2009 @ 10:34PM PT
Many sound notes of exasperation that the public option continues to be the focal point of the health care fight, both on the right and the left. But at this point, their exasperation is itself becoming exasperating. At its core, we’re talking about a policy point that, despite eight months of pummeling, remains popular except in the halls of the United States Senate and the corridors of the headquarters of the insurance companies. It is the latest incarnation of the people vs. the powerful -– and I’d say folks have a right to be angry that the people seem to be losing.
Two bits of news today reinforce the unmistakable trends of continues popularity and support. Washington Post-ABC News released their latest poll, finding support for health care reform in general is split right down the middle. But giving people the choice of private insurance or the ability to voluntarily buy into a high-quality, government-administered public health insurance plan, similar to Medicare, scores better at 55%. But that’s the tip of the iceberg! When actually described correctly as being an option available only to those who don’t already have insurance, support jumps to 76%. It’s like the August of our discontent never happened.
One of the canards about the public option is that physicians won’t support it because they’ll refuse its presumably lower negotiated payment rates. But today’s New England Journal of Medicine should put the lie to that once and for all. A survey by email and phone of 2,130 physicians (well above the 800-1,000 sampling of most polls) finds tremendous support among doctors for the public option -– 63% of doctors support health reform that incorporates a choice between public and private coverage, whereas only 27% prefer reform where private insurance is the only option. Even surgeons, slightly more conservative and skeptical of reform by nature, come in at 59%.
Oh, and tomorrow the AFL-CIO is set to endorse a public option formally, after their incoming president has warned darkly about primary challenges for Democrats who vote against it.
Now I should note that popularity does not always correlate to the right policy, particularly on something as complex as health care. But let’s review. All three major Democratic nominees for president endorsed a public option two years ago. This year, so did the leadership in the House and the Senate, as did all but one committee chair with jurisdiction over health care. The last committee chair released a blueprint with a public option months ago, before changing his mind. 100 members of the House are threatening to vote against a health care bill that doesn’t contain it. The Senate Majority Leader is for it, as are the number two (Durbin) and the number three (Schumer) Democrats in the Senate. A still-popular President of the United States devotes a significant portion of his health care stump speech to it. Progressives are for it. Labor is for it. Doctors are for it. The American people are for it.
What’s on the other side? Entrenched Republican resistance that has already said jettisoning the public option isn’t enough for them to vote for the bill. And an insurance industry that’s dishing to Business Week about their ability to influence centrist senators like Baucus and Conrad and Blue Dog congressman like Ross.
It’s one thing to year in and year out lost to the lobbyists and special interests whose money and influence control the levers of power. It’s quite another to have our noses rubbed in it.
(Photo credit: The White House, via Sen. Max Baucus' web site.)
Blame Joe Wilson, Not the Immigrants
Published September 11, 2009 @ 10:31PM PT
Too many people wanted to know what I thought about Rep. Joe Wilson for my taste. The answer is I didn’t think anything much of him before President Obama’s address on Wednesday, and think even less of him now. Aside from heckling the sitting President of the United States during a nationally televised address, he hadn’t done anything of substance. His one contribution to the health care debate –- proclaiming the president was lying when he said illegal immigrants would benefit from health care reform –- was all anger and no accuracy. Despite the national fascination, he was utterly irrelevant to health care reform.
Until today, of course, when first the centrist Democrats of the “gang of six” and then the White House capitulated to the concerns of the heckler. Apparently we reward you in the United States Congress for being an ass clown. (Some would joke it’s probably a requirement.)
Wilson’s continued assertion that he was set against health care reform because it would benefit those here illegally was false in a way that defies logic. The House bill expressly reserves the tax credits for low- and middle-income people to afford insurance premiums in the Exchange to “an individual who is lawfully present in a State in the United States” (Sec. 242 (a) (1). Sec. 246 takes it a step further and proclaims, “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” This is as open-and-shut as it gets, and even nonpartisan sites like FactCheck.org, prompted by Wilson’s outburst to check again, concluded, “They receive no government funds for this and cost the taxpayers nothing.” This was a net political win. The opposition to health care reform embodied in Wilson looked both unreasonable and wrong.
So why, then, did both Sens. Kent Conrad and Max Baucus publicly re-open the issue as though Wilson had made a legitimate claim? Baucus’ framework document already said, “No illegal immigrants will benefit from the health care tax credits.” That’s pretty damn clear. But when confronted with an unsubstantiated, inappropriate, angry outburst from an idiot, Conrad began a-thinking: “We really thought we’d resolved this question of people who are here illegally, but as we reflected on the President’s speech last night we wanted to go back and drill down again.” In their totally improvised new regulation, when you apply for a tax credit, you’ll need proof of citizenship... because apparently using your previous year’s tax return as proof that you qualify for a tax credit isn’t enough paperwork or proof that you’re a tax-paying resident. If it’s just to really double-dog guarantee that no undocumented worker gets an affordability tax credit, it’s redundant and needlessly bureaucratic. If it’s a move to prevent that immigrants aren’t paying for health insurance even with their own money, it’s a libertarian’s nightmare. As Ezra Klein writes, “there's a reason Best Buy doesn't have a citizenship requirement and Safeway doesn't ask for papers. It's cumbersome and inefficient and, at the end of the day, we want people to spend money on things anyway.”
Conrad later clarified to say he only meant there’d be a citizenship requirement for the tax credit –- so he’s merely being redundant. But honestly, combined with the hugely problematic and needlessly weak ideas negotiated into Baucus’ framework document, it makes me wonder who Baucus and Conrad won’t roll over for. What's next -- specific legislative language that forbids an assassination squad going after Sarah Palin's baby?
But then, it got worse. Baucus and Conrad, I understand. But this leaves me speechless:
A White House spokesman, Reid Cherlin, said that the president’s proposals would bar illegal immigrants from purchasing private insurance through the new government marketplace, known as an exchange, and that verification of immigration status would be required for anyone seeking to purchase coverage.
Yes, that would be the White House overreacting worse than conservative Democrats. And you know what? Joe Wilson is still wrong! He will continue railing against funding the health care for undocumented workers even despite these redundant and potentially oppressive changes. His argument had zero basis in fact -- you can’t have less than a zero basis in fact. This nets no new vote for reform. And it makes the health care bill that Joe Wilson wasn’t going to vote for anyway a little worse for all of us -- including those of us who were born here, were naturalized, or are here through work visas, who now must verify our own papers before buying health insurance.
I guess you can get pretty far in life just being an ass clown.
(Photo credit: http://www.flickr.com/photos/notionscapital/ / CC BY 2.0)
For more on health care reform as it relates to immigration reform, please see these previous posts:
