Tag: Healthcare

GOPLand in Bad Decline

An excellent Boston Globe op-ed describes the current, historically bad state of the Grand Old Party, held hostage as it is by the most extreme elements of its fringe membership. I’ve even put it in graph form:

Pretty easy to gather that, compared to everybody else, Democrat and “Independent” alike, self-described Republicans hold very different views on the issues of the day. And it’s not as though, were these folks asked about immigration or abortion, they’d suddenly step back into some region of the non-lunatic spectrum. GOP identifiers largely believe (to the tune of 58%) that the President of the United States is a secret Muslim born in Kenya, after all. And that he’s furthermore planning to usher in a Socialist Empire of some sort. People are certainly entitled to their insane views; the problem is, as the article notes:

In America, we don’t really have splinter parties. When one of our parties goes crazy, it doesn’t slide to the margins.

Yep. It’s not as though this is some tiny, ad-hoc group’s take on some arcane local zoning issue we’re talking about here. This is a national party competing for the Presidency. We either need more choices, or need the GOP to sort itself out, and fast.

But, far from dusting itself off and letting some cooler heads prevail, the modern GOP just pushes the crazy meter even further along. Here’s the man that delivered the response to Obama’s joint-session address on the subject of the President’s citizenship:

STARK: What do you personally believe, I mean – do you think there’s a question [surrounding Obama’s citizenship] here?

BOUSTANY: I think there are questions, we’ll have to see.

Alright, they must have chosen Boustany because of some sort of unique ability or achievement in the healthcare and its administration in LA. Or not:

…ranked Louisiana dead last in 2008 among the 50 states for the overall health of its people, hugely because of its high percentages of people without health insurance, preventable hospitalization, infant mortality, cancer deaths, cardiovascular deaths, and overall premature deaths. The Trust for America’s Health had similar findings in its 2008 rankings. The infant mortality rate in Louisiana, according to the United Health Foundation report, is more than triple that of Slovenia and the Czech Republic.

And yet, apparently, this is the best the GOP had sitting on the bench, waiting to make an important speech to an audience who’d just watched Obama make his case.

Worth noting the ending of the afore-linked op-ed:

Maybe Democrats should be happy that Republicans have been reduced to a lunatic fringe. But the lunatics still have their seat at the table, and someday they may be sitting at its head again. What then?

2010, the GOP, and Play or Pay

Greg Sargent pulls out some interesting figures from a recent WaPo poll:

* That Dems hold an overwhelming 20-point lead on which party is most trusted on major issues, with Obama preferred over Republicans by 12 points on health care.

* That a majority, 53%, agrees that “government reform of the nation’s health care system is necessary to control costs and expand coverage,” underscoring yet again that the public wants government action.

* That a plurality now believes reform won’t prevent people from keeping their own health care, suggesting the public may be it reform as less and less threatening.

* That a big majority, or 62%, believe Republicans have not made a good faith effort to cooperate with Dems on health care.

That last one seems the most damning. Everyone talks about 2010 being full of doom for the Democratic party. To be sure, historic majorities like the current Democratic position don’t last. By definition, any “historic” majority is going to include seats that, for one reason or another, are more likely to be held by the non-historic-majority party more often than not.

But, and it’s a big but: to go back to the “predictable” seat holder party-wise, you still have to give those “predictable” voters a reason to prefer you. And the GOP isn’t doing it so far. Even worse: people are noticing. Naturally, we need to see some of these toss-up districts broken out to be sure, but I suspect this polling data is more or less on the nose.

The bad news for Democrats in this poll is this:

a big majority wants Dems to craft a bill that will win GOP support

Since we know a priori that no proposal will win GOP support (party leaders have done everything but put that in writing on granite tablets), there would appear to be a rather hazardous, built-in capacity for outrage. That is: voters, never ones to pay a lot of attention, will see that some healthcare reforms passed, not realize that nothing rolls out until 2012 or later (circa 2010: “I ain’t seen nuthim from it ‘tall!”), see (and be told repeatedly) that not one member of the GOP voted for it in the House and that (at most) one or two GOPers voted for it in the Senate, and will assume that all the “problems” with the bill are well and truly the fault of the Democrats. And, here’s the rub: they’ll assume it’s all because they wouldn’t work with the GOP, not because the GOP refused to work in good faith with the Democrats. The ever feckless Reid et al. will try to point out that no GOP proposal or counter-offer (beyond Go Die in the Streets) ever appeared. But the media cares not for nuance, and you need to be setting up the short, two or three word rhyming drumbeat right now, every day, every hour, and every minute about GOP intransigence such that, when the time comes (and it will come), you can merely call back to your groundwork, which will seem familiar, and will almost automatically become the basis for the discussion. No Democrat should even be approaching a microphone without uttering something like “The GOP needs to Play, or Pay.”

Of course, that will not happen. And, we all know that, even if the Democrats managed to gain seats in 2010, it will be portrayed as “good for Republicans.” Everything always is.

Cost Benefit Analysis (Result: Go Die in the Streets)

Total spending on health care, per person, 2007:

United States: $7290
United Kingdom: $2992
Italy: $2686
Spain: $2671

We must be getting the best outcomes, right? Think of all our technology!?! Think again:

As of the 2006 data (the most recent I can find), we ranked 27th in infant mortality, just behind the Slovak Republic, with Mexico nipping at our heels. Life expectancy at 65 for females (compared among the relatively wealthy nations) ranks 14th, males 18th. We perform similarly poorly in almost all metrics you look at, perennially trailing countries that spend 4 or 5 times less per person than we do; hell, we trail countries that people would otherwise routinely mock as sadly “backward” or “economically stunted.” Dread France beats us on costs and outcomes. Repeatedly. (This data and much more available here. Use it. Please.) So, just to summarize in the simplest, clearest terms possible:

we pay 2.4 times more per person on healthcare than our next nearest competitor and get substantially worse outcomes than countries spending even less than that.

But, by all means, GOP: don’t mess with such a powerhouse of efficiency. Well, beyond your proposed “solutions” of blowing up the existing employer-based system and putting everybody out on the streets to fend for themselves.

Today’s GOP can effectively be summed up by the phrase “Go Die in the Streets.” Seriously, it applies to every position they have. Clearly, they’re working backwards from it to form whatever passes for policy in their lairs.

Just to review, I give you the 2010 GOP Platform:

Social Security: Go Die in the (Wall) Streets

Welfare: Go Die in the Streets

Immigration: Go Die in the Streets (preferably of your home country, but we’re not picky)

Healthcare: Go Die in the Streets

Military Spending: Go into the Streets so you can Die

Firearms/Gun Control: Go Die in the Streets

Abortion: Go Die in the (back) Streets

Prove me wrong, children. Prove me wrong.

GOP: Officially Defunct

There is no serious dialogue between the Democrats and the GOP. How can you possibly form any governing coalition between groups when one half of those groups refuses to accept empirical reality?

This is a post about Joe Wilson, but not about him specifically. But let’s start there. He’s the one who lied when he called out “You Lie!” in reference to coverage of illegal aliens. Facts are troublesome things to the modern GOP; one need not read any further than the name of the appropriate subsection to see what’s what, but Politifact goes one further:

…health reform leaves in place the status quo on illegal immigration, and certainly does not provide any new benefits particularly for illegal immigrants

If this outburst were limited only to the sad fucktard that is Joe Wilson, that’d be one thing. But Dana Milbank lays out the entire sad situation:

Wilson was only the most flagrant. There was booing from House Republicans when the president caricatured a conservative argument by saying they would “leave individuals to buy health insurance on their own.” They hissed when he protested their “scare tactics.” They grumbled as they do in Britain’s House of Commons when Obama spoke of the “blizzard of charges and countercharges.”

When he asserted that “nothing in this plan will require you or your employer to change the coverage or the doctor you have,” there was scoffing and outright laughter on the GOP side. Rep. Jeb Hensarling (Tex.) shook his head in disbelief. Several Republicans shouted “What plan?” and Rep. Louis Gohmert (Tex.) waved at Obama a handwritten poster he made on a letter-size piece of paper: “WHAT PLAN?” Gohmert then took that down and replaced it with another handmade poster that said “WHAT BILL?”

The essential outcome of all this is something the media seems to forget on a daily basis: There is no GOP anymore as a functional political party interested in governance. Full stop. All policy debate, healthcare or otherwise is being conducted by Democrats: liberal and conservative. They then have to pass said policy through a perfectly mysterious 60-vote supra-majority in the Senate that the media can never see fit to explain either. Just why is it that the Senate cannot move on 51-vote majorities? Why is that anti-democratic policy in place and ruling our worlds? Easier to repeat whatever it is Drudge is peddling, I suppose. But consulting the MSM, you will never, ever find out what’s behind those mysterious 60-vote requirements. But, rest assured, there is no dialogue, because there is no (functional) GOP. It seems more and more likely that the ultimate outcome of the current situation is a new third party that, over time, first relegates the GOP into a regional, state-level party, and then into Whig-town.

And but Obama is exactly right, though probably a few decades late, in issuing this warning:

[When] we can no longer even engage in a civil conversation with each other over the things that truly matter, we don’t merely lose our capacity to solve big challenges. We lose something essential about ourselves.

One might add that we also lose the ability to govern the country at all.

You’d hope that the powers-that-be in the GOP (or the public at large) will see this sequence as a tipping point, and Joe Wilson will become the Joe McCarthy of his era (though, in his case, managing to be his own Joe Welch). Based on the various FOXnews reactions last night, I seriously doubt it. Things will only get much, much worse as Joe Wilson is held out as some sort of conquering hero and sets about creating a whole crew cast in the vapid image of Sarah Palin.

Whoa there, Trigger

Why are the Republicans so afraid of the Power of the Market? Here’s (extremely conservative) Democrat Ben Nelson saying why he’d support a so-called “trigger” option that would, at some hypothetical point in the future, activate a public plan built into some version of the forthcoming insurance reform (emphasis added):

“If, somehow, the private market doesn’t respond the way that it’s supposed to [to other aspects of health care reform], then it would trigger a public option or a government-run option,” Nebraska Sen. Ben Nelson said Sunday on CNN’s State of the Union, “but only as a failsafe, backstop to the process. And when I say trigger … I don’t mean a hair trigger. I mean a true trigger – one that would only apply if there isn’t the kind of competition in the business that we believe there would be.”

Naturally, the Republicans are against even this idea (emphasis in original):

Former House Speaker Newt Gingrich said Republicans aren’t likely to be receptive to public option “trigger,” which would kick into effect only if private insurers fail to meet benchmarks.

“I don’t think so,” Gingrich said on Fox News Sunday.

[–]

Gov. Pawlenty says “all it does is delay the inevitable… if Republicans embrace the trigger, all  they’re going to do is shoot themselves in the foot.”

I see. I see. What we have here is the old accidental truth seepage. If you’re in front of cameras, lying, for long enough…eventually and by accident some truth will get out of you. The GOP leadership in charge of messaging knows damned well that the mythical “market” of insurance won’t work at all. Healthcare is not and has never been a traditional market. It’s the nature of it. Thus, they know, KNOW that a trigger option, no matter how non-hair-trigger it might be will, in fact, be triggered. In one fell swoop such a trigger would show both the inability of the markets to solve every problem on this Earth, and (b) implying a role for government in, you know, anything not abortion or gun-ownership related.

Fuck the general welfare and well-being of The Republic. This would undermine the fundamental, guiding principles of the GOP: government isn’t part of the problem, government is the problem. And, just like with S-CHIP, such things cannot be allowed, no matter what the human cost.

Yep

“My fellow Americans, we say that healthcare is a right of all citizens. The other party says that it is a privilege for those who can afford it. If you agree with them that healthcare is a privilege, not a right, then vote for them. We would like to persuade you to join us, but if we can’t, then we are going to defeat you.

"Decades ago our opponents tried to block Social Security and Medicare, using the same bogus arguments that they are using today against healthcare reform. They said Social Security and Medicare would bankrupt the country. They were wrong. Once we fix the cost inflation of our broken medical sector, with some minor tweaks Social Security and Medicare can be made solvent forever.

"Decades ago, our opponents said that Social Security and Medicare would turn the United States into a fascist or communist police state. They were wrong then and they are wrong now. And not only are they wrong, they are hypocritical. Many of our opponents who claim absurdly that universal healthcare will bring tyranny to the U.S. have defended some of the greatest assaults on civil liberties and the rule of law in American history during the previous administration.

"They can draw a Hitler mustache on me. They can draw a mustache on the Mona Lisa, for all I care. They are wrong and we are going to defeat them.

"We won the elections and we are the majority. We would like to build the biggest consensus possible, but progress is more important than consensus. Our job is to help the American people, not split the difference between right and wrong by giving a veto to the party that the American people have rejected.

"In this fight, as in earlier struggles, powerful interests are opposed to the needs of the people. In the 19th century, we the people defeated the Southern slave owners, freed the slaves and saved the nation. In the 20th century, while fighting alongside many other nations to save the world from militarism and totalitarianism, we the people here at home tamed the corporations for a generation and fought segregation based on race, gender and, more recently, sexual orientation.

"Today the campaign for affordable healthcare as a right, not a privilege, is opposed by powerful interests in the medical and insurance industries. They seek to deceive and confuse you. And they seek to bribe or intimidate your elected representatives into serving their will rather than the needs of the public.

"They may win this battle. They may win the next. But we will never stop fighting for the needs of the many against the greed of the few. For more than 200 years, from the time we threw off the tyranny of the British empire and established our republic, we have worked to realize the spirit of ‘76 on this continent and in the world beyond. The enemies of progress have money on their side. We have history on ours.”

–Michael Lind

Yglesias is Right

Matt Yglesias again comes down on the right side of the argument. The nut of his take:

there is one crucially important difference [between Democrats and Republicans when holding the majority power]. Democrats hand out committee chairmanships by a blind seniority rule. Republicans do not. Chairman need to rotate out of their positions after fixed terms, which then gives the caucus as a whole input over who takes over next. Consequently, the Senate leadership has some meaningful leverage over Republican Senators—even Senators from liberal states. If they’re really determined to make Snowe (and Collins) vote “no,” they have tools at their disposal to make that happen. By contrast, the Democratic leadership heads into tough fights basically disarmed with no real tools of discipline and leverage at their disposal

Yep. True discipline will only occur when some of these senior Senators face losing their beloved power-levers. You vote “No” on cloture over a keynote issue like healthcare, you should lose all seniority. Period. Furthermore, the Democrats could make serious hay by simply offering moderate Republicans like Snowe and Collins certain perks they’d never, ever get by simply party-lining it along with the rest of the GOP. Better committee, Chair of something, bigger office, whatever the hell it takes to procedurally sweeten the pot: do it. That’s how to begin, begin rebuilding anything resembling the much sought after bipartisanship that high-Broderism so values.

Let’s review: healthcare reform is and always has been a debate between liberal and conservative Democrats. To the extent that any GOP votes can be found in the Senate, those individuals should be rewarded by receiving treatment that any conservative Democrat with equal seniority might enjoy. But you can basically forget the GOP as honest negotiators or compromise partners in this debate. Not going to happen. Thus: absolute requirement that every Democrat vote for cloture. Or else.

El Dorado

As the Obama administration merrily dispatches with that part of healthcare that the public broadly (and, the WH would add: inexplicably) favors, the Public Option, they still stand pat on the part that will really get the folks screaming: the individual mandate. Marc Ambinder chanels the latest (and inevetiably a self-loathing Clinton administration alum) “anonymous source” from inside the Obama administration who chooses to leak this sort of self-damning pablum:

The president continues to operate under the belief that liberals will warm to the bill when presented with a goodybag that includes includes an individual mandate, community rating, guaranteed issue, and a minimum required package. There’s no chance, really, that a bill WON’T feature these reforms. Quietly, to secure and keep Democrats on board, the White House is going to bargain, providing inducements, like more money for favored projects, etc., in order to secure individual votes.

Let’s get Rahm in order on something right now: Without a robust public option there can be no individual mandate. Without strict cost controls and the much-longed-after downward bend to the cost curve, all you’re left with is today’s overpriced, low-choice coverage which, under new laws anybody can get…and they’d have to. That’s sort of why the insurance lobbies favor a plan with no public option and/but an individual mandate; especially if their buddy Max Baucus manages to use the legislation to increase their profit margins to 35%. Oh, and we’d be ditching the employer mandate as well. So there’d be impetus for employers to ditch the matching coverage schemes of today to cut their costs in favor of kicking you out on your own…where you’d be required by law to pay ever more since you’d have no access to the sort of pooled coverage groups and bargaining power that might actually, you know, contain costs. This is really sounding like a wonderful plan they’ve got going.

You can ditch the public option, but with it has, HAS to go: the individual mandate. You then rely on slow growth of acceptance (the campaigning Obama said as much: people will buy healthcare if they can afford it. They want to buy in, but often can’t in the current setup that’s too heavily weighted towards certain “good” jobs with plans attached or the occasional large coverage pools.) It would be a bad outcome, and would extend the period of suffering for all of us; but it’s not nearly as bad as losing the public option and the employer mandate and yet inexplicably keeping the individual mandate along with none of the potential consumer choice and provider competition-oriented benefits. Now you’re forced to buy insurance that too few folks can afford anyway.

Instead, we’re being told to quit being smelly hippies and get on board with the wonderful program of force-fed shit sandwiches, and could we please all agree it’s the best of all possible worlds? Uh, no. We can’t. Lead, follow, or get the fuck out of the way.