Howard Dean's Prescription for Real Healthcare Reform

Howard Dean's Prescription for Real Healthcare Reform—Now an iPhone App

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Advice

If I were an elected Democratic official holding a town hall on health care reform, this is the preamble I'd adopt.

So glad to have all you folks here. It shows what an important issue we are talking about today. Now because we are here to share views, I'd appreciate that everyone get a chance to say their piece without interruption.

That includes me. Please give me a chance to answer your questions without interruption.

Before we start, it will help me to know where you folks are coming from.

Who here currently has some form of health insurance? Please raise your hands.

Of those, who is covered under a plan provided by your employer?

And who covers themselves, pays for insurance out of pocket?

Next, who here gets their health care from the government, under Medicare, Medicaid, or the Veterans Administration?

Finally, is there anyone here eligible for Medicare or VA coverage who has opted for private insurance instead? Please raise your hands.

Roids

So the names of the hundred MLB players who tested positive will come out in ones and twos, in declining order of fame and salary level.

There was a time when I was of the "their bodies, let them do what they want" school of thought.

That view evolved. I gradually realized that if steroids are bad for people, that permitting them would have two bad implications. The first is we, sports fans, would be taking advantage of people willing to damage themselves for fame and fortune. The second is that we, sports fans, would be collaborating in a policy regime that would exclude more talented or hardworking athletes because they refused to juice. The Mark Caminitis would drive out the Frank Robinsons.

Well, that's an exaggeration. What would really happen is the replacement level players who got into the majors would all be juicing. And, if it IS bad for you, then the League would be setting up a system where their most marginal players were risking their health to try to earn enough service time for a pension.

The nice thing about evolution is it never stops. Seeing the ubiquity of juice in the baseball (seriously, is there anybody left who would surprise you, after Petite?), I've come to doubt the "if" part of the syllogism above. And if it is true that taking steroids under a doctor's supervision isn't dangerous (as Manny apparently was doing in LA), then what's the problem?

Players are permitted to use any number of performance enhancing methods. In the drug realm, they are allowed to use caffeine and nicotine (the latter proven to enhance concentration), even though the delivery mechanisms for nicotine are mostly life shortening. Amphetamines were rife throughout the majors (there is a story of a pair of coffee urns, labeled "Coaches" and "Players"), use that didn't stop after Jim Bouton went public with this in Ball Four

They are allowed to have cortisone shots, not just for injuries, but for normal wear and tear on the joints that afflict older players. And, of course, cortisone IS a steroid. It is just not an anabolic steroid.

Players are also allowed to have performance enhancing surgery. One of the complaints about the impact of steroids on baseball is that their use allows older players, especially sluggers, to extend their careers by reversing the effect of aging that reduces muscle mass. Bonds hitting 72 home runs at the age of 37, as Hank Aaron remarked recently, is unnatural. But the same is true of Tommy John, whose "injury" was wear and tear on his left arm. How is replacing a worn out tendon any different from using a drug that allows a player to use weightlifting sessions to retain muscle mass as he ages?

The performance-enhancing surgery that really gets my goat is Lasix. Ted Williams had extraordinary eyesight. In spring training events, he would put pine tar on the bat barrel, and then call out the number of seams (None, 1 0r 2) the bat had hit. Now a player like Derek Jeter (on everybody's never juiced list) can get surgery to duplicate Williams's genetic inheritance.

What is really going here is that the career home run numbers of the players using steroids is wreaking hell with all of the standard Hall of Fame threshholds. It's also raising doubts about win totals of players like Roger Clemens, who would have been a lock for the Hall after he left Toronto. But a key element in evaluating players for the Hall is their career numbers. Jim Rice's rapid fall off hurt him badly in HoF ballotting. Likewise, a compiler like Mussina is helped by the focus on career threshholds.

But one is stuck with the world one is in. If steroids aren't dangerous, when properly used in a doctor supervised weight training program, why not legalize their use? That is certainly better than reading stories of high school kids ordering drugs over the internet from fly by night companies in Mexico because scouts have told them they have to get bigger.

Passage

In today's NYT David Leonhardt writes the following:

Members of Congress have come up with one idea after another to pay for covering the uninsured. But they still haven’t put together legislation that could pass.

This is simply false. The House HAS passed legisation that covers the uninsured, and provided funding for doing so.

There is also no doubt that there are at least 51 votes in the Senate for the House bill. A filibuster can be beaten if Reid wants to beat it. Between using strong arm tactics within his caucus, and shutting down business on all other matters while taking cloture vote after cloture vote, he will eventually get the bill to the floor. He will also be able to pick off Republicans who really can't go into a 2010 race being seen as opposed to providing up to a fifth of their constituents with health care services they do not currently have. And, of course, there is the reconciliation process that can be used to circumvent the automatic filibuster Reid has created.

It's not just Leonhardt. Scott Lemiux discusses an Ezra Klein post about what compromises are necessary to get passage.

So let's be clear. A good bill, with a public option, would easily pass in both houses. The insurance lobby, through the Senate Finance Committee doing everything it can to gut the Senate bill, and to slow the process down because the lobbyists are well aware that a good bill would pass easily. Slowing down the process allows the lobbyist's disinformation machine more time to operate, more time to confuse voters with false, even crazy ("the government will kill old people!") information.

The media is doing us, once again, a tremendous disservice by treating what can only be called lies as legitimate points of debate. The opponents of a good bill don't care about costs, even though they say so, because a bill with a strong public option that removes current insurance industry subsidies is cheaper than either the status quo or a "reform" plan that adds more subsidies to the insurance industry. All the malarkey that is intended to make old people afraid is totally ridiculous; they will be completely unaffected because they are already on a government health plan that was supposed to lead the country down the path to socialism. The US has the worst health care system in the OECD, but the media parrots, unchallenged nonsensical claims about the US having the best health care in the world and about how awful health care is in Canada. And d0n't get me started on why it is that wars don't have to be paid for, but health care does.

Media support for dishonest GOP spokespeople and Democrat Senators fronting for the insurance companies won't do the trick if a good bill, like the House bill, reaches the floor of the Senate. It will pass. There is no reason for Reid to take elements of a bad Finance committee bill into the Senate bill. He has the votes he needs.

And, in the end,we will get a reasonably good bill.

Really.

Prisoner's Dilemma NOT

John is right that Matt is wrong. The point of the prisoners' dilemma is that it is not a dilemma. It is a trap.

But John is wrong when he says the upshot of the political situation on health care reform is:

If congresspeople think that regardless of the success of the healthcare bill, they will be better off having voted against it, then they will.

Given a good health care bill with a strong public option, they can:

• Vote for it, and be better off with their constituents, but worse off with their donors/future employers.

• Vote against it, and be better off with their donors/future employers, but worse off with their constituents.

This is independent of whether or not the bill passes.

Hence their focus is entirely on preventing a good bill with a strong public option from getting to the floor for a vote. They can vote for a bad bill their donors support, and claim to be for reform when they run for re-election.

If Pelosi or Reid are seriously committed to effective health care reform, they will make sure a good bill with a strong public option is what hits the floors. There will be enough Blue Dogs, and Class '10 Senators not willing to risk their seats to kowtow to the lobbies. They'll do all they can to gut the bill behind the scenes. But if presented with a good bill, the majority will vote for it.

Gabba Gabba Hey

So it looks like Palin quit in order to get in front of an indictment for some serious corruption.

This is incredibly good news. Because you know what she is going to do.

She is going to go around the country raising money for her legal fund, pitching her book. And what will her theme be?

That she is the target of a vast media and establishment conspiracy, because they want to silence the only authentic voice on the national political scene. It is already obvious the media is out to get her. But now the establishment Republicans are joining in. They talk a good game, but in the end they are up there in Washington, living lives regular folks will never know, and making fools of regular folks.

Unlike those Washington Republicans, she actually walks the walk. Her daughters DO practice abstinence. When one of them gets pregnant, she proudly becomes an unwed teenage mother. She doesn't pretend she thinks the Universe is 6,000 years old. She believes it. She speaks in tongues. She doesn't really bother keeping the heathen foreigners straight, because America is good enough for her, and should be good enough for any real American.

She's the real deal. She's one of us, one of the knuckle dragging Know-Nothings. And that is why the media and political elites are out to get her.

The Republican establishment has to be terrified. They've run this scam out ever since Nixon, that they are the party of Real Americans, proudly ignorant (dittoheads!) racist jingoists who have a tenuous grasp of reality. Sarah Palin can make the case that she, not Haley Barbour, not, errrr, player to be named later, is just a big phony.

Town Hall

Apparently Helen Thomas and Chip Reid had a cow in today's presser with Robert Gibbs. Washington Times reporter Christina Bellantoni tweeted:

Helen Thomas to Gibbs re: town hall format argument: "I'm amazed at you people who call for openness and transparency"

This is in reference to today's Presidential town hall on health care. Leave aside the pearl clutching demand that only the WHPC should be permitted to ask the President questions. Part of what is going on here is that the WHPC, and their colleagues, are using a narrative frame that is completely out of step with both public opinion and, as Obama said in his last press conference, simple logic.

The basic narrative frame the media has adopted is that any policy needs to preserve the existing collection of medical care financing organizations--insurance companies, HMOs--because, well, just because. Here's a collection of NY Times articles, of which this one is representative. (Krugman sneaks one in that search with a solid counter-argument.

There is this Olympia Snowe interview with the AP, where she says (no joke) that she is opposed to the public option because it would lower the cost of financing health care:

"If you establish a public option at the forefront that goes head-to-head and competes with the private health insurance market ... the public option will have significant price advantages," she said.

The media completely accepts that one of the policy objectives in health care reform is the preservation of insurance companies that have created a system where Americans get the worst health care in the OECD, both in terms of covereage and of effectiveness, at the highest cost in the OECD. So they (as in the ABC "town hall") continually focus their questions on the impact on the health finance business, rather than on the health care provided to American citizens.

In other words, they are asking the wrong questions, questions that reflect what the President has pointed out, is a completely illogical position:

"Just conceptually, the notion that all these insurance companies who say they're giving consumers the best possible deal, if they can't compete against a public plan as one option, with consumers making the decision what's the best deal, that defies logic," Obama said.

So if the President is going to actually discuss the real policy issues involved with health care reform, he has to take his questions from the public, and not the press.

Small Business

One of the things about being a small business person is that you really do want to offer health care to your employees. The public option would help small business development enormously.

Executive testmony

Wendell Potter, former health industry executive, explains how the industry cheats customers.

15 years ago, when reform was last on the table, 95% of the money collected in premiums went to pay for health care. Now it is less than 80%. The term for this value is the "medical-loss ratio." As Ezra says, this is a telling construction. It means they regard paying medical reimbursements is a cost.

George Lakoff made a similar point in an interview I had with him. In most businesses, the more your customers demand, the better off you are. This is true for people who make good things, like high butterfat ice cream, and people who provide services to correct bad things, like autobody shops. In the case of a health insurance company, the incentive is reversed. Providing services reduces your profits. And that is why we are where we are today.

Humor

Or, actually, reality.

Ezra's 101

On this one, Ezra Klein explains how a public plan works in a bloggershead discussion.

Lies Refuted

Here Howard Dean knocks down all the Frank Luntz talking points that Norah O'Donnell recites to him.

No Coverage

This is not a video, but a National Public Radio Fresh Air podcast. Karen Tumulty discusses her brother's case of losing his individual catastrophic insurance coverage when he became very ill.

KT (as she calls herself in Swampland comments) is reprising her TIME cover story on her brother's difficulties.

Public Option

This one, from HCAN, is a simple advocacy ad. But it summarizes the case very nicely.

Recission

I am going to start collecting videos documenting all that is wrong with the current health care system, and and/or advocating a public option.

This one features insurance company executives saying they indeed retroactively rescind converage when a customer turns out to have a serious and expensively treated medical problem. That is, they collect premiums from their customers until they get really sick, then they comb through their medical records to find a reason to remove their coverage.

Tapper

So Jake Tapper of ABC tweets the following:

does POTUS think it's safe to put detainees in US prisons?

 

Throwing hands in the air I tweet back:

@jaketapper You mean as opposed to safely jailing serial killers and domestic terrorists? What is wrong with you people?

I get a direct message saying that I am being "tiresome." Of course, he doesn't follow me, so I cannot DM back.

So I'll put the reply here.

Jake-- the point is that this is such an  incredibly stupid question that I find it disturbing that you and other members of the Beltway media take it in the least bit seriously.  The people who are raising the question are lying about their concern, and engaging in fearmongering.  They know perfectly well that the US military can transport individual prisoners to secure facilities,  where people can be kept locked up. The US is very good at imprisonment.

Rather than asking whether Obama thinks it is "safe" to put detainees from Guantanamo in supermax prison facilities, what you should be doing is asking elected Republican officials what the heck they are talking about. Every single Senator's state has a max security prison.  Ask them about the rate of jail breaks from those facilities.  Ask them if their prisons are so poorly administered that they cannot hold a prisoner.

Fecklessly following whatever idiotic talking point that comes out of Republican mouths is destroying your, and your colleagues, credibility, Jake.

I suppose it is tiresome to hear that.  But it's no less true.

Prevention is Underrated

April 9, 2009 16:38

DKos's public health expert DemFromCT has a link to a Nature editorial that starts out:

Complacency, not overreaction, is the greatest danger posed by the flu pandemic. That's a message scientists would do well to help get across.

As I've read in earlier posts by DemFromCT, the key to preventing a large number of deaths from a virulent swine flu virus is to get the reinfection rate down below 1 per infected person. Then it snuffs itself. The trouble is that this is nearly impossible to do if too many people are infected. So you need to act very early in the process of the flu's spread. Judging by the number of joke threads running through twitterstreams, this is not widely understood. The public health professionals appear to be overreacting to a small number of cases.

So if the CDC and the WHO are successful in limiting the spread of the disease, they will be seen not as successful managers but as nervous nelliew. And it will be harder, next time, to implement effective measures precisely because they were so effective.

This reminded me of the Y2K computer scare. In fact, a lot of work was done, a lot of money was spent, and the crisis was averted. But the very success of the effort led to many people concluding that there really hadn't been an incipient crisis after all.

Moreover, not only did the Y2K software repairs prevent a collapse of corporate computer systems, it also forced the creation of systems of off site backups and disaster recovery. This, in turn, was partly responsible for the speed with which Wall Street was able to restart their systems following 9/11.

Robust systems that prevent disaster are hard to justify to bean-counters, and taxpayers. But that is the right way to design a system.

Convention

May 8, 2009 09:19

Adam Liptak writes a largely contentless piece about Souter and his possble replacements.

But I noticed two utterly conventional and very irksome elements. The first is that he off-handedly describes Souter as "liberal."  This is simply not an accurate characterization.  It's true that Souter respects precedent and is not particularly activist  in his rulings. It is simply bizarre  that a justice who treats stare decisis as an important principle be labeled "liberal," especially in such an off-hand fashion. 

This isn't a bad thing for progressives looking for a real liberal to be appointed to the court. But it is an illustration of just how far to the right the Overton Window has shifted.   That upholding a 1973 ruling that has been the law of the land for more than a generation, and is widely accepted by rank and file Americans makes a Justice into a "liberal" flies in the face of the dictionary definitions of liberal and conservative.

The second irksome element is this:

Justice Antonin Scalia’s views about the importance of adhering to the text and original meaning of the Constitution and statutes, for instance, has come to dominate conservative judicial thinking.

While it's true that Republicans constantly repeat this claim,  it is a canard, just as is their deriding "activist judges."  It is hard to find an example of flouting the Founders intent more striking than Bush v Gore, nor an example of more aggressive activism.  Another example of Scalia's wing's activist disrespect for the constitution and the legislature was the Lilly Ledbetter opinion.

This article is an excellent illustration of Walter Pincus' analysis of the decline of journalism, posted yesterday in the Columbia Journalism Review:

Today, mainstream print and electronic media want to be neutral, presenting both or all sides as if they were refereeing a game in which only the players—the government and its opponents—can participate. They have increasingly become common carriers, transmitters of other people’s ideas and thoughts, irrespective of import, relevance, and at times even accuracy.

Conservatives have excellled at their PR approach, of falsely characterizing themselves and the opposition, setting the conventional frames for the lazy media to follow. 

Just Shoot Me

John Ensign is a Senator. He is one of the United States' most important, most powerful politicians. We are in a deep economic crisis. And this is what he says, publicly on Twitter, about his view of how best to conduct fiscal policy:

The tax code is too complex. That's why I'm for throwing out the whole tax code.

Sure, it's too complex.  But this isn't a policy position.  It's not even a bumper sticker slogan. It's just nonsense.

And then he includes a link, and, what does it say?

http://www.johnensign.org/issues/tax-reform

Well, no, he doesn't want to throw out the "tax code."  No, he doesn't want to simplify it. He wants to subsidize, through the tax code, some stuff, and penalize some stuff.  He wants to further complicate the tax code with special treatment for some activities.

These people are completely incoherent. And they sit in the Senate, setting tax policy.

Oh, and he appreciated my retweet and comment.

@aweaton6388 @5M1L3 @jhilborn @jhilborn @ClaytonCalhoon @BattleBornPAC Thanks for the re-tweets and comments.

My comment? "Laughing, pointing."  (Transposition typo on "laughing" corrected here.)

The F Word

Josh Marshall links to a fairly detailed description of how AIGFP managed what can only be called a fraudulent scheme to cook its own books and those of its counterparties.  

While some reinsurers are large, well-capitalized entities that generally avoid these pitfalls, AIG was already a troubled company when it began to write more and more of these risk-shifting transactions more than a decade ago. It is easy to promise the moon when people think that they can deliver, but because AIG and their clients saw how easy it was to fool regulators and investors, the practice grew and most regulators did absolutely nothing to curtail the practice.

It was easy for AIG to become addicted to the use of side letters. The firm, which had already encountered serious financial problems in 2000-2001, reportedly saw the side letters as a way to mint free money and thereby help the insurer to look stronger than it really was. AIG not only helped banks and other companies distort and obfuscate their financial condition, but AIG was supplementing its income by writing more and more of these reinsurance deals and mitigating their perceived exposure via side letters.

A key figure in AIG’s reinsurance schemes, according to several observers, was Joseph Cassano, head of AIG-FP. Whereas the traditional use of side letters was in reinsurance transactions between insurers, in the case of both CELL and PNC neither was an insurer! And in both cases, AIG used sham deals to make two non-insurers, including a regulated bank holding company, look better by manipulating their financial statements. Falsifying the financial statements of a bank or bank holding company is a felony.

Moreover, the folks at AIG knew the jig was up. The AIGFP division showed a large loss in the third quarter of 2007.  Hence, in December of 2007, they decided that they had only one more shot at milking the scam before everything fell apart.    All you have to do to see this is read the "retention bonus" "contract." (pdf)

  

(a) Covered Persons Who Are Not Members of the Senior Management Team.

Subject to Sections 3.01(c) and 3.01(d), for the 2008 Compensation Year and the 2009 Compensation Year, each Covered Person (other than members of the Senior Management Team) shall be awarded a Guaranteed Retention Award for each of those Compensation Years equal to one hundred percent (100%) of such Covered Person’s 2007 Total Economic Award.

(b) Covered Persons Who Are Members of the Senior Management Team.

Subject to Sections 3.01(c) and 3.01(d), for the 2008 Compensation Year and the 2009 Compensation Year, each Covered Person who is a member of the Senior Management Team shall be awarded a Guaranteed Retention Award for each of those Compensation Years equal to seventy-five percent (75%) of such Covered Person’s 2007 Total Economic Award.

In other words, the bonus pool under previous, "profitable" years was not going to be replicated in 2008 or 2009. So the firm agreed, with itself, to pay big bonuses anyway to the people who were responsible for these enormous losses, the destruction of the company and its counterparties.

In the first article, the side letters make it clear that neither party expected AIG to ever pay off these CDS instruments--that they were intended to fraudulently overstate the assets on the counterparty's balance sheet.

It is getting increasingly difficult to understand why the operative federal agency in these affairs is the Treasury and not the DOJ.

Dope

Blogging in spurts.

We'll start with this. More to follow. 

A number of people were irked by President Obama smirking and chuckling over the potheads on line.  It was irksome; there was no atempt to defend a policy position that is clearly wrong. There was just some throwaway ridicule and a knowing statement to the audience that implicitly said "You know this is NOT happening."  And the audience chuckled along.

While I agree with that irked reaction, as far as it goes, it misses a point  In responding to a very popular question in this way, Obama was conceding the policy point without engaging it.  He was saying, and the audience was agreeing with him,  that smoking marijuana isn't a big deal. It's funny, kinda like Vinny in the Bronx in his underwear making fun of Brian Williams, but it 's not really important.  Obama would not have cracked this little joke about grand theft auto, or rape or tax evasion, or pretty much any crime that people do time for.  But a lot of people are doing time for this funny little indulgence.  Not a large fraction of the lawbreaking dope smokers, but a large fraction, internationally speaking, of the general population is in jail because they did something that the elites in that room have also done, and find kinda, well, cute, in their position in the stratosphere.

After all, Obama himself has indulged in the wacky weed. I expect that most of his audience has done so as well. As have I. And, I suspect, you,  reading this.  

Opposing legalization is indefensible.  Nobody even tries anymore to defend the position.   It's not just that they find it funny that people point this out. It's that they know it, and don't even try to defend their opposition.

ZOMG PORK!!

Yesterday, Jake Tapper tweeted this:

WH sez nation/govt need tighten belts BUT POTUS signing the omnibus spending bill (with earmarks) disconnect? 

I replied:

Disconnect? No. You're repeating the same behavior--identifying a tiny issue that may or may not be a gotcha and inflating it.

He answered:

9 billion tiny? tell Dem Sens Bayh and Feingold, who say POTUS should veto bill. r they "playing gotcha and inflating it"?

I replied: 

Yeah. 9B is tiny. And I've yet to hear of a bridge to nowhere. Good science stuff mostly.The F22. Now THAT'S an earmark.

This demonstrates the limitations imposed by 140 characters.

There are too many things to expand on here to do well, but I will take a crack at them.

First, on the simple substance of this, the 9 billion dollars of "earmarks" are indeed trivial within the scope of federal spending that should include, if necessary, paying people to dig holes and then paying other people to fill them up again. In this climate, even a bridge to nowhere is worth considering.  If there is only 9 billion dollars of money "wasted" on projects that don't make sense, that's small potatoes compared to the size of the problem and the size of the solution.

But, as far as I can tell, the "earmarks" that have been identified so far all seem to be pretty good expenditures of government money. Volcano monitoring is a public good, like sea walls and levees.  Honeybees are a critical part of our agricultural ecosystem. Helping former gang members reenter civil society is clearly a good thing.  I haven't, as I tweeted, read about any of these earmarks that would line up with the bridge to nowhere, a clear waste of public funds.

In context, making a fuss over this makes even less sense. The Federal budget under the Bush administration and Republican legislatures wasted hundreds of billions of dollars, literally shrink-wrapping billions of dollars onto shipping pallets and dropping them off in Iraq.  An enormous number of federal jobs have been outsourced to private sector contractors at much higher costs than civil service staff, and to the detriment of institutional memory.  Insurance companies are being paid to administer Medicare that can be done with current Federal staff with minimal additional marginal cost.  We pitch hundreds of billions of dollars a year on cost overruns on military procurement of equipment that has no discernable mission and often doesn't even work properly.  (See America's Defense Meltdown, no longer available as a pdf.) 9 billion dollars spent on small local projects that, as far as I can tell actually are of public benefit, is not in same city, never mind the same ballpark as the torrent of money that has come out of the Treasury for Republican cronies.

Blaming Obama for this makes even less sense. He's not inserting the earmarks. Congress is, with six of the top ten inserters being Republicans. So it doesn't even make sense to blame Democrats.

What is most irksome about this is that it is not merely stenography of, at best, misleading and stunningly hypocritical Republican talking points. It's giving those talking points a megaphone, while focusing on trivial Russert-like gotchas that will make no appreciable difference in how and when the US gets out of the chasm that the Republican party has thrown the country in.  It's frittering around the edges, trying to gin up a scandal where none exists.