Posts filed under 'Healthcare'

Some see benefit in insurance bill

One group is definmitely in favor of the Reid-Lieberman-Nelson-Obama insurance company protection bill:

The rise in stock prices has been particularly striking in the period since Sen. Joe Lieberman (I-Conn.) said on October 27 that he would filibuster a Senate health care reform bill if it included a public option – a threat that caused Senate leaders to cave without much of a fight.

Here’s a quick breakdown of major health insurance company stock performance from Oct. 27 to Friday’s market close:

  • Coventry Health Care, Inc. is up 31.6 percent;
  • CIGNA Corp. is up 29.1 percent;
  • Aetna Inc. is up 27.1 percent;
  • WellPoint, Inc. is up 26.6 percent;
  • UnitedHealth Group Inc. is up 20.5 percent;
  • And Humana Inc. is up 13.6 percent.

By comparsion, the Dow Jones Industrial Average is only up 2.3 percent during that time; the NASDAQ Composite is up a (relatively) paltry 1.4 percent.

December 21st, 2009

Westen: Obama – Pretty Speeches, Compromised Values, and the Quest for the Lowest Common Denominator

Psychologist, and political consultant Drew Westen is getting pretty fed up with the President:

Leadership, Obama Style, and the Looming Losses in 2010:
Wess

By Drew Westen

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 stopped 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 turn 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 Elizabeth Roemer, 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 some 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.

December 21st, 2009

Public option inventor says pass healthcare bill

Jacob Hacker, the inventor of the “public option,” still supports the healthcare bill without it:

Why I Still Believe in This Bill

By Jacob S. Hacker

Now that the core demand of progressives has been removed from the Senate health care bill–namely, the public health insurance option–should progressives continue to support the effort?

For me, the question is particularly difficult. I have been the thinker most associated with the public option, which I’ve long argued is essential to ensuring accountability from private insurers and long-term cost control. I was devastated when it was killed at the hands of Senator Joe Lieberman, not least because of what it said about our democracy — that a policy consistently supported by a strong majority of Americans could be brought down by a recalcitrant Senate minority.

It would therefore be tempting for me to side with Howard Dean and other progressive critics who say that health care reform should now be killed.

It would be tempting, but it would be wrong.

Since the first campaign for publicly guaranteed health insurance in the early twentieth century, opportunities for serious health reform have come only rarely and fleetingly. If this opportunity passes, it will be very long before the chance arrives again. Many Americans will be gravely hurt by the delay. The most progressive president of my generation–the generation that came of age in the anti-government shadow of Ronald Reagan–will be handed a crippling loss. The party he leads will be branded as unable to govern.

The public option was always a means to an end: real competition for insurers, an alternative for consumers to existing private plans that does not deny needed care or shift risks onto the vulnerable, the ability to provide affordable coverage over time. I thought it was the best means within our political grasp. It lay just beyond that grasp. Yet its demise–in this round–does not diminish the immediate necessity of those larger aims. And even without the public option, the bill that Congress passes and the President signs could move us substantially toward those goals.

As weak as it is in numerous areas, the Senate bill contains three vital reforms.  First, it creates a new framework, the “exchange,” through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted.  Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans.

These are signal achievements, and they all would have been politically unthinkable just a few years ago.

To be sure, the bill also contains a requirement on individuals to have coverage, which has become the main target of criticism from the left. Without the public option, this mandate amounts to forcing people to buy private insurance without creating an affordable public alternative with which insurers must compete.

But the correct response to this critique is to make the requirement less necessary by providing greater assistance with the cost of premiums and by facilitating enrollment in the exchange–in other words, by making coverage more attractive and easier to obtain.

The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage. The most important way to do this is to move away from the Senate bill’s state exchanges and toward a national exchange such as that contained in the House bill. The federal government needs to be directly involved in implementing and enforcing strong national regulations of insurers and creating the new exchange. Otherwise, the effort for reform might fail at the hands of hostile governors.

The federal government is the only entity big enough and powerful enough to ensure a highly consolidated private insurance industry follows the law.  It can and must demand transparency and obedience to the new rules. Insurers must open their books, and subject their rates, administrative costs, and profits to federal review. These new rules must apply to all plans, not just those within the exchange. And states should have authority not only to enforce these rules, but to innovate beyond them as well.

These are not politically unrealistic goals. Most are already embodied in the House bill. In bridging the differences between the two bills, Democratic leaders and the President must insist on a final bill that delivers on these fundamentals.

If it does not deliver–if the new options offered through the exchange do not attract broad enrollment, if insurers continue to undermine health security with impunity–then the worst fears of progressives will come true. Coverage will be too expensive because only those with the highest health costs will sign up. Fewer Americans will obtain insurance than expected. Small employers won’t want to take advantage of their ability to buy insurance through the exchange. And Americans will become increasingly disillusioned with the promise of reform.

Progressives have good reason to be angry. Yet we should harness our anger to fix the bill–now and every year from now. The current bills in Congress do too little to help Americans immediately; their main actions are delayed for years. If and when legislation passes, progressives should demand immediate concrete actions to make the promise of a reform a reality more quickly and more effectively.

So a bill must pass. Yet it must be a better bill that passes. And  it must be understood by the President, the Congress and every American as only a step–an important but ultimately incomplete step–toward the vital goal that the campaign for the public option embodied: good affordable health care for every American.

***********

Jacob S. Hacker is the Stanley B. Resor Professor of Political Science at Yale University. An expert on the politics of U.S. health and social policy, he is author, coauthor, or editor of numerous books and articles, both scholarly and popular, including The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream (2006; paperback, January 2008) and Health At Risk: America’s Ailing Health System and How to Heal It (2008).

1 comment December 20th, 2009

Greenwald: The corporate-government merger dominates Democratic “mainstream”

In a new article, Glenn Greenwald provides perhaps the best summary what underlies the divide among “progressives” on healthcare reform and so many other issues, the increasing (one might say, near total) corporate-government merger that dominates all aspects of American society and culture:

The underlying divisions in the healthcare debate

By Glenn Greenwald

Ed Kilgore has a very perceptive analysis in The New Republic about the underlying (and largely unexamined) ideological and strategic differences among progressives that are at least partially driving the rift over the health care bill.  He argues — correctly — that the current debate “displays a couple of pretty important potential fault lines within the American center-left” that have manifested in other disputes as well.  That was the principal point of this much-maligned Daily Kos post observing that many (but not all) of the progressive bloggers most vehemently demanding passage of the health care bill also supported the Iraq War.  As the author of that post (Jake McIntyre) explicitly said, his intent wasn’t to suggest that those individuals shouldn’t be listened to because of their Iraq position six years ago (that would be an invalid and unfair claim), but simply that — as Kilgore says – there are underlying and significant differences in strategic and ideological outlook driving the health care debate that have been present for some time but are typically ignored.

Shared contempt for the Bush administration (at least once Bush and the Iraq War became discredited) largely obscured these differences when Bush was in office.  The desire to undermine the Bush GOP and dislodge that movement from power subsumed all other objectives and united people with vastly different political outlooks and agendas.  There is still a shared revulsion towards the Palin/Limbaugh Right, but that faction is too marginalized and impotent to serve the same function.  With the unifying force of Bush/Cheney gone, the divisions Kilgore describes are now vibrant and increasingly potent.  In addition to health care and Iraq, roughly the same progressive fault lines are seen over the bank bailout, escalation in Afghanistan, Obama’s economic team, tolerance for Obama’s embrace of Bush/Cheney civil liberties polices, and even the reaction to Matt Taibbi’s recent Rolling Stone article on Obama’s subservience to Wall Street.

There are many reasons for the progressive division on the health care bill.  There are differences over the narrow question of health care policy, with some believing the bill does more harm than good just on that ground alone.  Some of it has to do with broader questions of political power:  if progressives always announce that they are willing to accept whatever miniscule benefits are tossed at them (on the ground that it’s better than nothing) and unfailingly support Democratic initiatives (on the ground that the GOP is worse), then they will (and should) always be ignored when it comes time to negotiate; nobody takes seriously the demands of those who announce they’ll go along with whatever the final outcome is.  But the most significant underlying division identified by Kilgore is the divergent views over the rapidly growing corporatism that defines our political system.

Kilgore doesn’t call it “corporatism” — the virtually complete dominance of government by large corporations, even a merger between the two — but that’s what he’s talking about.  He puts it in slightly more palatable terms:

To put it simply, and perhaps over-simply, on a variety of fronts (most notably financial restructuring and health care reform, but arguably on climate change as well), the Obama administration has chosen the strategy of deploying regulated and subsidized private sector entities to achieve progressive policy results. This approach was a hallmark of the so-called Clintonian, “New Democrat” movement, and the broader international movement sometimes referred to as “the Third Way,” which often defended the use of private means for public ends.

As I’ve written for quite some time, I’ve honestly never understood how anyone could think that Obama was going to bring about some sort of “new” political approach or governing method when, as Kilgore notes, what he practices — politically and substantively — is the Third Way, DLC, triangulating corporatism of the Clinton era, just re-packaged with some sleeker and more updated marketing.  At its core, it seeks to use government power not to regulate, but to benefit and even merge with, large corporate interests, both for political power (those corporate interests, in return, then fund the Party and its campaigns) and for policy ends.  It’s devoted to empowering large corporations, letting them always get what they want from government, and extracting, at best, some very modest concessions in return.  This is the same point Taibbi made about the Democratic Party in the context of economic policy:

The significance of all of these appointments isn’t that the Wall Street types are now in a position to provide direct favors to their former employers. It’s that, with one or two exceptions, they collectively offer a microcosm of what the Democratic Party has come to stand for in the 21st century. Virtually all of the Rubinites brought in to manage the economy under Obama share the same fundamental political philosophy carefully articulated for years by the Hamilton Project: Expand the safety net to protect the poor, but let Wall Street do whatever it wants.

One finds this in far more than just economic policy, and it’s about more than just letting corporations do what they want.  It’s about affirmatively harnessing government power in order to benefit and strengthen those corporate interests and even merging government and the private sector.  In the intelligence and surveillance realms, for instance, the line between government agencies and private corporations barely exists.  Military policy is carried out almost as much by private contractors as by our state’s armed forces.  Corporate executives and lobbyists can shuffle between the public and private sectors so seamlessly because the divisions have been so eroded.  Our laws are written not by elected representatives but, literally, by the largest and richest corporations.  At the level of the most concentrated power, large corporate interests and government actions are basically inseparable.

The health care bill is one of the most flagrant advancements of this corporatism yet, as it bizarrely forces millions of people to buy extremely inadequate products from the private health insurance industry — regardless of whether they want it or, worse, whether they can afford it (even with some subsidies).   In other words, it uses the power of government, the force of law, to give the greatest gift imaginable to this industry — tens of millions of coerced customers, many of whom will be truly burdened by having to turn their money over to these corporations — and is thus a truly extreme advancement of this corporatist model.  It’s undeniably true that the bill will also do some genuine good, as it will help many people who can’t get coverage now to get it (though it will also severely burden many people with compelled, uncontrolled premiums and will potentially weaken coverage for millions as well).  If one judges the bill purely from the narrow perspective of coverage, a rational and reasonable (though by no means conclusive) case can be made in its favor.  But if one finds this creeping corporatism to be a truly disturbing and nefarious trend, then the bill will seem far less benign.

As I’ve noted before, this growing opposition to corporatism — to the virtually absolute domination of our political process by large corporations — is one of the many issues that transcend the trite left/right drama endlessly used as a distraction.  The anger among both the left and right towards the bank bailout, and towards lobbyist influence in general, illustrates that.  Kilgore says that anger among the left and right over corporatism is irreconcilable, and this is the point I think he has mostly wrong:

To put it more bluntly, on a widening range of issues, Obama’s critics to the right say he’s engineering a government takeover of the private sector, while his critics to the left accuse him of promoting a corporate takeover of the public sector. They can’t both be right, of course, and these critics would take the country in completely different directions if given a chance.  But the tactical convergence is there if they choose to pursue it.

This supposedly irreconcilable difference Kilgore identifies is more semantics than substance.  It’s certainly true that health care opponents on the left want more a expansive plan while opponents on the right want the opposite.  But the objections over the mandate are largely identical — it’s a coerced gift to the private health insurance industry that underwrites the Democratic Party.  The same was true over opposition to the bailout, objections to lobbying influence over Washington, and most of all, the growing anger that Washington serves the interests of financial elites at the expense of the working class.

Whether you call it “a government takeover of the private sector” or a “private sector takeover of government,” it’s the same thing:  a merger of government power and corporate interests which benefits both of the merged entities (the party in power and the corporations) at everyone else’s expense.  Growing anger over that is rooted far more in an insider/outsider dichotomy over who controls Washington than it is in the standard conservative/liberal ideological splits from the 1990s.  It’s true that the people who are angry enough to attend tea parties are being exploited and misled by GOP operatives and right-wing polemicists, but many of their grievances about how Washington is ignoring their interests are valid, and the Democratic Party has no answers for them because it’s dependent upon and supportive of that corporatist model.  That’s why they turn to Glenn Beck and Rush Limbaugh; what could a Democratic Party dependent upon corporate funding and subservient to its interests possibly have to say to populist anger?

Even if one grants the arguments made by proponents of the health care bill about increased coverage, what the bill does is reinforces and bolsters a radically corrupt and flawed insurance model and an even more corrupt and destructive model of “governing.”  It is a major step forward for the corporatist model, even a new innovation in propping it up.  How one weighs those benefits and costs — both in the health care debate and with regard to many of Obama’s other policies — depends largely upon how devoted one is to undermining and weakening this corporatist framework (as opposed to exploiting it for political gain and some policy aims).  That’s one of the primary underlying divisions Kilgore identifies, and he’s right to call for greater examination and debate over the role it is playing.

December 19th, 2009

AFL-CIO statement on real healthcare reform

The AFL-CIO has issued a statement on healthcare reform:

Contact: Amaya Tune/Eddie Vale 202-637-5279

Statement by AFL-CIO President Richard Trumka
On Health Care Bill
December 17, 2009

The labor movement has been fighting for health care for nearly 100 years and we are not about to stop fighting now, when it really matters.

But for this health care bill to be worthy of the support of working men and women, substantial changes must be made.  The AFL-CIO intends to fight on behalf of all working families to make those changes and win health care reform that is deserving of the name.

The absolute refusal of Republicans in the Senate to support health care reform and the hijacking of the bill by defenders of the insurance industry have brought us a Senate bill that is inadequate:  It is too kind to the insurance industry.

Genuine health care reform must bring down health costs, hold insurance companies accountable, assure that Americans can get the health care they need and be financed fairly.

  • That’s why we are championing a public health insurance option:  It is the way to break the stranglehold of the insurance industry over consumers that has led to double digit premium increases virtually every year.
  • Employers must pay their fair share.
  • And the benefits of hard-working Americans cannot be taxed to pay for health care reform—that’s no way to rein in insurance companies and it’s the wrong way to pay for health care reform.

Those are the changes for which we will be fighting in the coming days.

The Senate bill does some good things:  It will provide health insurance to 30 million more Americans and provide subsidies to low income individuals and families.  Benefits will have to meet minimum standards and insurance companies will no longer be able to deny coverage based on pre-existing conditions or impose lifetime or unreasonable annual limits.  The bill also includes some relief for plans with early retirees as well as delivery system reforms that may lead to lower costs over the long haul.  And Senate leaders have made a commitment to close the Medicare prescription drugs donut hole which is so costly to seniors.

But because it bends toward the insurance industry, the Senate bill will not check costs in the short term, and its financing asks working people and the country to pay the price, even as benefits are cut.

The House bill is the model for genuine health care reform.  Working people cannot accept anything less than real reform.

December 18th, 2009

Paul Starr and Paul Krugman support healthcare bill

Meanwhile healthcare expert Paul Starr and economist Paul Krugman argue that even this eviscerated healthcare bill is worth supporting. Here is Krugman:

Illusions and bitterness

By Paul Krugman

There’s enormous disappointment among progressives about the emerging health care bill — and rightly so. That said, even as it stands it would take a big step toward greater security for Americans and greater social justice; it would also save many lives over the decade ahead. That’s why progressive health policy wonks — the people who have campaigned for health reform for years — are almost all in favor of voting for the thing.

The argument about the evil of the individual mandate is,as Jon Cohn says, all wrong. It was wrong during the primaries, when Obama unfortunately used it to demagogue his rivals — helping set the stage for problems now. And it’s still wrong.

And the truth is that health care reform was probably doomed to be deeply imperfect. As Ezra Klein pointed out a few weeks ago, we’re basically in a hostage situation: progressives really, really want to cover the uninsured, while centrists whose votes are needed can take it or leave it. So the centrists have a lot of power — which in the case of Joe Lieberman means the power to double-cross and indulge his pettiness.

Now, in a hostage situation there are times when you have to just say no — when giving in, by encouraging future hostage-takers, would be worse than letting the hostages perish. So the question has to be, is this one of those times? I don’t think so, given the history: as Kevin Drum points out, health reform has come back weaker after each defeat. I’d also point out that highly imperfect insurance reforms, like Social Security and Medicare in their initial incarnations, have gotten more comprehensive over time. This suggests that the priority is to get something passed.

But what’s happening, I think, goes beyond health care; what we’re seeing is disillusionment with Obama among some of the people who were his most enthusiastic supporters. A lot of people seem shocked to find that he’s not the transformative figure of their imaginations. Can I say I told you so? If you paid attention to what he said, not how he said it, it was obvious from the beginning — and I’m talking about 2007 — that he was going to be much less aggressive about change than one could have hoped. And this has done a lot of damage: I believe he could have taken a tougher line on economic policy and the banks, and was tearing my hair out over his caution early this year. I also believe that if he had been tougher on those issues, he’d be better able to weather disappointment over his health care compromises.

So there’s a lot of bitterness out there. But please, keep your priorities straight.

By all means denounce Obama for his failed bipartisan gestures. By all means criticize the administration. But don’t take it out on the tens of millions of Americans who will have health insurance if this bill passes, but will be out of luck — and, in some cases, dead — if it doesn’t.

December 17th, 2009

AFL-CIO opposes current Senate bill

The conflict over the Senate healthcare cave-in intensified today as the AFL_CIO said it would not support the current version of the bill and the SEIU leader Andy Stern criticized President Obama by name. And Senator Byron Dorgan accused the White House of using the FDA to kill his provision allowing drug re-importaion from Canada to reduce cost:

Over at Open Left, David Sirota points us to this Wall Street Journal interview with Senator Byron Dorgan about the White House role in killing the drug importation bill:

Last week, [Dorgan] said he heard rumors that the FDA was going to send a letter objecting to drug importation on safety grounds, which he has said is a bogus reason. He said he called FDA Commissioner Margaret Hamburg, who said she knew nothing about such a letter.

He said his timeline shows that a letter, signed by Hamburg questioning the safety of drug imports, was sent 24 hours later to a few senators who opposed importation. That piece of paper became a rallying cry for other senators who voted down Dorgan’s amendment.

“I think the letter was prompted, probably drafted somewhere else,” like “the White House” Dorgan said.

The context for this is that the White House cut a secret deal with the drug industry to get its support for the health care bill.

Sirota explains the importance of this development about the FDA:

So Hamburg, who is supposed to be concerned only with science, first says she has no idea what Dorgan is talking about. Then, suddenly, 24 hours later, she’s signed onto a headline-grabbing letter saying Dorgan’s bill would threaten American consumers. Something smells here – something smells really bad.

Hamburg is an Obama appointee, so the FDA isn’t fully removed from politics. However, its declarations about safety are supposed to be science-based – not political. And by this Wall Street Journal account, Dorgan is asserting that, in fact, its declaration that imports are unsafe – a dishonest declaration that provides zero empirical scientific evidence – may have been written by political staffers in the White House.

If this is true, it’s a genuine scandal. It’s one thing for the White House to oppose a measure, make arguments against a measure on any grounds it wants. But if the White House political staff played ventriloquist for a science/safety declaration from the FDA, that’s a huge problem.

Sam Stein reports from Huffington Post on the unions’ attitude:

Nation’s Largest Union: Change Health Care Bill Or Else

By Sam Stein

The nation’s largest union group said Thursday that it will not support the Democratic health-care bill unless “substantial changes” are made to the current Senate version.

AFL-CIO President Richard Trumka said in a statement to reporters that without a public option for insurance coverage or an employer mandate – and with a tax on high-end insurance plans that some union members get – the health care legislation supported by Senate Democrats falls far short of meeting his group’s standards.

“[For] this health care bill to be worthy of the support of working men and women, substantial changes must be made,” said Trumka. “The AFL-CIO intends to fight on behalf of all working families to make those changes and win health care reform that is deserving of the name.”

The remarks are a strong indication that the coalition of pro-health-care-reform groups has begun to fray. Earlier in the day, Service Employees International Union President Andy Stern penned a letter to his fellow union members in which he called out President Barack Obama for abandoning his own principles of reform.

“President Obama must remember his own words from the campaign. His call of ‘Yes We Can’ was not just to us, not just to the millions of people who voted for him, but to himself. We all stood shoulder to shoulder with the President during his hard fought campaign. And, we will continue to stand with him but he must fight for the reform we all know is possible,” Stern wrote.

“Our challenge to you, to the President, to the Senate and to the House of Representatives is to fight,” Stern continued. “Now, more than ever, all of us must stand up, remember what health insurance reform is all about, and fight like hell to deliver real and meaningful reform to the American people.”

Stern, like Trumka, called for Democrats to make changes to the legislation as the process moves forward. And his rebuke of Obama – a staunch personal ally – was a telling sign of the growing frustration within the labor movement.

Both labor leaders were particularly incensed over the concessions made by the Senate’s Democratic leadership to Sen. Joseph Lieberman (I-Conn.), the 60th member of their caucus. “The public option is declared impossible. Americans cannot purchase Medicare at an earlier age. The health insurance reform effort we have needed for a century is at risk,” Stern wrote.

Officials at both unions met late into the night on Wednesday in emergency sessions to discuss the Senate bill. Aides say the conversations were lengthy and, at times, emotional. The labor community, while privately angry with the White House and Democrats in Congress, still needs the support of these lawmakers on other legislative priorities. Meanwhile, having poured millions into advertisement and man-hours in order to get health care passed, they have watched in horror as the principles they worked for were abandoned in a matter of days.

Officials are also aware of how much would be lost by simply scrapping the bill altogether. Stern noted that under the Senate’s bill 30 million additional people would be covered, pre-existing conditions would no longer be an excuse to deny coverage, and people who get sick would no longer lose their insurance. Trumka, likewise, pointed to “good things” in the Senate bill, including the fact that “insurance companies will no longer be able to deny coverage based on pre-existing conditions or impose lifetime or unreasonable annual limits.”

December 17th, 2009

Howard Dean: Stop fake reform

Howard Dean explains his opposition to the Senate healthcare bill in a Washington Post op-ed:

Health-care bill wouldn’t bring real reform

By Howard Dean

If I were a senator, I would not vote for the current health-care bill. Any measure that expands private insurers’ monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform. Real reform would insert competition into insurance markets, force insurers to cut unnecessary administrative expenses and spend health-care dollars caring for people. Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these.

Real health-care reform is supposed to eliminate discrimination based on preexisting conditions. But the legislation allows insurance companies to charge older Americans up to three times as much as younger Americans, pricing them out of coverage. The bill was supposed to give Americans choices about what kind of system they wanted to enroll in. Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries — in the range of $20 million a year — and on return on equity for the company’s shareholders. Few Americans will see any benefit until 2014, by which time premiums are likely to have doubled. In short, the winners in this bill are insurance companies; the American taxpayer is about to be fleeced with a bailout in a situation that dwarfs even what happened at AIG.

From the very beginning of this debate, progressives have argued that a public option or a Medicare buy-in would restore competition and hold the private health insurance industry accountable. Progressives understood that a public plan would give Americans real choices about what kind of system they wanted to be in and how they wanted to spend their money. Yet Washington has decided, once again, that the American people cannot be trusted to choose for themselves. Your money goes to insurers, whether or not you want it to.

To be clear, I’m not giving up on health-care reform. The legislation does have some good points, such as expanding Medicaid and permanently increasing the federal government’s contribution to it. It invests critical dollars in public health, wellness and prevention programs; extends the life of the Medicare trust fund; and allows young Americans to stay on their parents’ health-care plans until they turn 27. Small businesses struggling with rising health-care costs will receive a tax credit, and primary-care physicians will see increases in their Medicare and Medicaid reimbursement rates.

Improvements can still be made in the Senate, and I hope that Senate Democrats will work on this bill as it moves to conference. If lawmakers are interested in ensuring that government affordability credits are spent on health-care benefits rather than insurers’ salaries, they need to require state-based exchanges, which act as prudent purchasers and select only the most efficient insurers. Sen. John Kerry (D-Mass.) offered this amendment during the Finance Committee markup, and Democrats should include it in the final legislation. A stripped-down version of the current bill that included these provisions would be worth passing.

In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.

I have worked for health-care reform all my political life. In my home state of Vermont, we have accomplished universal health care for children younger than 18 and real insurance reform — which not only bans discrimination against preexisting conditions but also prevents insurers from charging outrageous sums for policies as a way of keeping out high-risk people. I know health reform when I see it, and there isn’t much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.

***********

The writer is a former chairman of the Democratic National Committee and was governor of Vermont from 1991 to 2002.

December 16th, 2009

Congressional Dems blame healthcare disaster on Obama

A little late, Democrats in the House are lashing out at Obama and the White House for their undermining of healthcare reform, Rachel Weiner reports in the Huffington Post.

“The president keeps listening to Rahm Emanuel,” said Rep. John Conyers (D-Mich.). “No public option, no extending Medicare to 55, no nothing, an excise tax, God!” he exclaimed about the Senate health care bill to Roll Call. “The insurance lobby is taking over.” Rep. Dave Obey (D-Wis.), told Politico of Senate delays, “It’s ridiculous, and the Obama administration is sitting on the sidelines. That’s nonsense.”*

Russ Feingold is one who realizes that the Congress was outmaneuvered by Obama and the White House, who wanted an insurance industry friendly bill from the beginning:

Sen. Russ Feingold (D-Wisc.) similarly suggested that blaming Lieberman was ignoring the real culprit — Obama.

“This bill appears to be legislation that the president wanted in the first place, so I don’t think focusing it on Lieberman really hits the truth,” said Feingold. “I think they could have been higher. I certainly think a stronger bill would have been better in every respect.”

Markos, at Daily Kos suggests that propgressives ought to strip out the mandate to buy insurance from private companies that are free to charge whatever they want, or the bill should be killed:

My take is that it’s unconscionable to force people to buy a product from a private insurer that enjoys sanctioned monopoly status. It’d be like forcing everyone to attend baseball games, but instead of watching the Yankees, they were forced to watch the Kansas City Royals. Or Washington Nationals. It would effectively be a tax — and a huge one — paid directly to a private industry.

Without any mechanisms to control costs, this is yet another bailout for yet another reviled industry. Subsidies? Insurance companies are free to raise their rates to absorb that cash. More money for subsidies? More rate increases, as well as more national debt. Don’t expect Lieberman and his ilk to care. They’re in it for their industry pals….

The insurance industry began 2009 fearing genuine reform that would force them to become responsible corporate citizens, and they are exiting it on the cusp of a dramatic government-sanctioned windfall. It pays to be an industry that’s too big to fail.

Strip out the mandate, and the rest of the bill is palatable. It’s not reform, but it’s progress in the right direction.

Meanwhile, Obama evidently thinks he can make everyone forget this disaster with a few faux populist noises about the bankers he handed the country over to.

December 16th, 2009

Will labor oppose healthcare cave-in?

Sam Stein at Huffington Post brings word that the AFL-CIO and SEIU are both in emergency meetings to decide whether to oppose the Senate healthcare cave-in or just not to fight for it. As a top labor official emailed Stein:

“What is really frustrating folks here is that it’s impossible to make and implement plans to pressure senators when the White House and Reid keep undermining the efforts no one from the outside can put any credible pressure on Senators because they know the White House will back that Senator up whatever they do. If the White House is going to cave to a Senator who spent the entire election campaigning with McCain and calling Obama a traitor how are we supposed to have any leverage over anyone?

“If Lieberman — who has done so many horrible things directly to Obama — can get away with this on Obama’s signature issue it makes it infinitely harder for us to pressure senators, on issues in the future, because there is no fear of retribution or coercion from the White House. They only pressure progressives, not anyone in the middle.”

December 16th, 2009

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