Marcia Angell, M.D., is one of the nation's most well-respected experts on health care issues. And with good reason. A board-certified pathologist who also trained in internal medicine, she's a former editor of the New England Journal of Medicine and senior lecturer at Harvard Medical School. Her writing credits include The Truth About Drug Companies and an award-winning article at TNR on the same subject. (She co-wrote that with Arnold Relman, a distinguished physician, writer, and intellectual in his own right.)

Angell is a well-known advocate for single-payer health care: If it were up to her, she'd simply expand Medicare to cover everybody. This is not, of course, the kind of health care reform we're going to get this year. Instead, we will--if we are lucky--get something that looks like the bill that passed the House of Representatives on Saturday night.

Angell is not impressed, as she explains today at the Huffington Post:

Is the House bill better than nothing? I don't think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

I'm a longtime single-payer supporter myself. If Angell could get her way, I'd be thrilled. But Angell can't get her way.

“We are turning to socialism and away from God!” Joseph Grab said as he stood amid the thousands who gathered on Capitol Hill today to attend Michele Bachmann’s “House Call” protest against the health care reform bill. Grab, a retired engineer from Hershey, Pennsylvania, was clutching a leather-bound King James in his hand and a green sign that simply said “Pray” in the other. “This bill is going to include murdering babies, it’s going to bankrupt us, and it’s going to make totalitarianism grow,” he said gravely.

Two years ago, I wrote about my long-standing problems with Comcast’s broadband and television service. The intermittent outages, the frequent slowdowns, the unavailable phone support, and the incompetent repair people, to whom Comcast had outsourced its service to customers. So why did I stick with Comcast? Well, the people Verizon sent over couldn’t figure out how to connect the FIOS line from the garage across the house to the cable television and computer. In addition, Comcast not only promised to be good but made me one of those $99 a month offers for phone, internet, and TV that I couldn’t refuse. So I stuck with Comcast.

My wife ordinarily handles our house finances – and last month, she asked me about the Comcast bill. It wasn’t $99 a month. It had gone up to $250 or so. Of course, we had a few extras like the tennis channel, but that was about it. Once the initial offer had expired, our bill had evidently doubled.   I called Comcast for an explanation, and the sales person offered to sell me an entirely new package. I was having none of it. I decided to try Verizon again. I figured that if Comcast’s repair people could figure out how to get from the garage to the TV, Verizon’s people could do it, too.

David Wessel has a column in today’s Wall Street Journal laying out three approaches to solving our Too Big Too Fail (TBTF) problem. The first two amount to different ways of “busting them up,” as Wessel puts it. The third, which the administration and the Fed have endorsed, amounts to forcing banks to hold more capital, scrutinizing their balance sheets more vigorously, and obtaining some sort of “resolution authority.” That last reform would allow the government to liquidate a megabank in an orderly way (like the FDIC does with smaller banks), rather than either bail them out entirely or simply let them implode, a la Lehman Brothers.  

I happen to support every one of the administration’s proposals on this score. But, despite their merits, I’m not convinced they address the consequences of bigness. For that, we probably do have to talk about shrinkage.

To see why, you need to start with what the TBTF problem actually is, which Wessel helpfully explains:

Investors who lend to or trade with these firms, for good reason, believe taxpayers will stand behind the debt of TBTF firms if things go bad. So, these firms can borrow more cheaply than too-small-to-save firms. That taxpayer subsidy -- and that's what it is -- means these institutions can make riskier bets, collecting rewards if they win and sticking taxpayers with the tab if they don't.
 
This is an old problem. But the rescues of Bear Stearns and American International Group and the uproar over the Lehman Brothers bankruptcy have expanded it beyond ordinary big banks. The past year has established a pattern: Executives of TBTF firms may be fired and their shareholders squeezed, but bondholders and trading counterparties will be protected.

The administration proposal that gets at this problem most directly is resolution authority. As I understand it, the key part of the proposal is to require banks to have a so-called "living will"--basically a road map that would guide the government on how to value and unwind all the assets on the bank’s balance sheet.

Washington Post opinion page editor Fred Hiatt frets that health care reform will likely be counterproductive. Hiatt argues that Congress is afraid to do the two most potentially effective reforms, changing the tax treatment of health care and creating an independent panel to control Medicare spending:

The Information Master:
Jean-Baptiste Colbert's Secret State Intelligence System

By Jacob Soll

(University of Michigan Press,
277 pp., $65)

That resonant piece of verbal shorthand, TMI--or Too Much Information--would make a fine epigraph for our age. Anyone with an Internet connection today has access to exponentially greater quantities of writing, images, sound, and video than anyone on earth could have imagined just twenty years ago. Small wonder that we have become obsessed with the idea of "information" as an abstract substance independent of its content--something that we accumulate, measure, and "process," rather than ponder and understand. And small wonder that the management and control of information, whether by its "producers," by governments, or by corporations such as Google, has emerged as an increasingly important political concern, and as a subject of scholarship.

Few issues since the collapse of venerable Lehman Brothers one year ago have caused as much consternation as performance bonuses for bailed-out bankers. Yet, even among sophisticated observers, there is confusion about what really happened. So, with the benefit of a year's perspective, how should we think about banker compensation in the context of bank bailouts?

Here's a hint: The bonus outrage has distracted attention from the more important way that taxpayers underwrote the wealth of profligate bankers, which was to preserve the extensive equity holdings that senior personnel at these institutions had accumulated prior to the debacle of 2008. And this diversion, in turn, has delayed effective action that might inject a bit of moral culture into the money culture of Wall Street.

President Obama’s speech yesterday was disappointing. As a diagnosis of the problems that let us into financial crisis, it was his clearest and best effort so far. He didn’t say it was a rare accident for which no one is to blame; rather he placed the blame squarely on the structure, incentives, and actions of Wall Street.

But then he said: Our regulatory reforms will fix that. This is hard to believe. And even the president seems to have his doubts, because he added a plea that--in the meantime--the financial sector should behave better.

The audience was composed of our financial elite, but the Wall Street Journal reports “not one CEO from a top U.S. bank was in attendance” (p.A4). How’s that for demonstrating respect, gratitude, and a willingness to behave better?

Louis Brandeis, of course, would have seen things differently. The author of Other People’s Money: And How The Bankers Use It, was under no illusions concerning the underlying financial power structures and how they operated. He would have regarded an appeal to the better nature of bankers as somewhere between humorous and sad.

A year ago on September 15, 2008, the financial crisis took a drastic negative turn. The Lehman Brothers investment firm declared bankruptcy, causing a 1,000-point slide in the Dow and triggering a cascade of bank losses that threatened to topple the entire financial system. Click through this slideshow to see scenes from the crash.

Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.

The new Census numbers are out and they show a grim increase in the number of uninsured in 2008 to 46.5 million--figures that are bound to be worse now 12 months into our current recession.

But this number has been under attack for the past year, as conservative columnists, blogs, and other voices repeat the argument that the Census figures are inflated. This inclination of health reform opponents to fight over this has been so great that President Obama didn't even want to engage the argument last week. In his otherwise excellent speech, he said there were “more than 30 million” who cannot get coverage. I interpreted this as a way to simply acknowledge the significant scale of the problem and focus on the solutions, without having people fall into a debate about numbers. Predictably, the health reform opponents have taken this as a victory.

Those who seek to minimize or dismiss the number of uninsured actually misunderstand the very nature of the problem. It’s better not to think of the uninsured as a discrete population, one that can be marginalized, than to think of uninsurance as a condition that can afflict anyone.

Most estimates of the uninsured are for a specific point in time, or over the course of only one year. When just looking at a two-year period, far more people--nearly 1 in 3--find themselves uninsured, as Families USA has calculated using Census data. And for every day they are uncovered--and most of them are uncovered for more than six months--they are likely to not get care and/or face the risk if not the reality of financial ruin. One trip to the emergency room without coverage can mean thousands of dollars of unexpected bills.

For those who say that two years is too long a period to evaluate, please let our Congress know--as they are busy fretting about the ten-year cost of health reform. If we are going to calculate the ten-year cost, we ought to calculate the ten-year benefit, of how many Americans will be prevented from falling into uninsurance, preventing the gaps that are disruptive to both quality care and a family’s financial stability.

President Obama understands this: This weekend, he cited a new Treasury Department report that indicates about half of non-elderly Americans went uninsured for some portion of 1997-2006. With the continuing erosion of coverage without health reform, the number who would benefit by not having such a gap in coverage over the first ten years of health reform is likely well over half the country. That’s not a problem, or a benefit, to minimize.

But let's go back to that conservative critique of the 46.5 million figure, which comes directly from the U.S. Census. Critics make three arguments here: 1) the number includes immigrants; 2) the number includes people who are eligible but not enrolled for public health programs like Medicaid and SCHIP; and 3) the number includes people who make more than a certain income, and supposedly could “afford” coverage. The implication is there’s really no major problem, that people are simply choosing to be uninsured.

This is wildly misleading, on multiple levels:

In his NYT mag piece, Paul Krugman blames macroeconomists for believing the world behaved as well as the math behind their models. His solution? To re-embrace Keynes.

But in a provocative counterpoint on VoxEU, Scott Sumner says looking back to Keynes won't solve the problem. Instead he claims that macroeconomists didn't trust their models enough, and that the latest developments in the field should have helped prevent the crisis.

Sumner's main argument is that the Fed didn't loosen monetary policy before and after Lehman's bankruptcy, as most of us believe, but in fact tightened it--this despite signs the economy was slowing rapidly. But how can that be, especially since Allan Meltzer and the like have been crying about the hyperinflationary risks of easy money?

It boils down to the Fed's ability to pay interest on excess reserves. Although the Fed has created a vast amount of extra cash, banks are happy to just hold on to it because the rate being paid on reserves (that is, the money they park at the Fed) is just as good as or better than what banks could get elsewhere.

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

Have you ever been in an alley fight with three muggers while your sanctimonious non-helping cousin berates your poor fighting skills from a nearby window? Me neither. I feel like I have, though, listening to the shadenfreude coming from some single-payer advocates on the sidelines of the current health reform debate.

This morning’s New York Times provides a prime example, in a short interview with Dr. David Himmelstein of Physicians for a National Health Plan. He and the group he co-founded deserve credit for their long advocacy of a single-payer plan. They deserve less credit for their unhelpful and sometimes inaccurate stance in this critical moment of the fight for both a huge progressive reform and the Obama presidency.

This morning, Himmelstein was asked about the critical problem of medical bankruptcy, a subject to which he has contributed valuable research.

A reporter asked: "Would any of the plans under discussion on Capital Hill reduce the rate of medical bankruptcies?"

Himmelstein responded: "Only the single-payer plan sponsored by Representative John Conyers, Jr. and Senator Bernie Sanders. The others pretty clearly do little or nothing for medical bankruptcy." [italics added].

Before further comment, I should say that I see considerable merit in the single-payer system Himmelstein desires. Certainly from a public health perspective, single-payer would be vastly preferable to our current system. Give me ten more progressive senators, and we’d be having a different conversation right now. In the world we actually live in, we are in a tough fight to pass imperfect, but quite valuable bills that would do a lot of good.

For all their imperfections, the bills now under debate could have a particular impact on one problem: medical bankruptcy. To see why, consider the predicament of a family of four earning $55,000 per year.

One of the more promising signs for health care reform over the past two years has been the apparent support of the business community. Corporate executives and trade groups have repeatedly spoken out about the problems of our health care system. Even more remarkably, they have joined coalitions pledged to finding comprehensive solutions--the sorts of plans that would bring affordable insurance to all Americans while easing the financial burden many companies now face.

A few days after the stress-test results hit Wall Street last week, Fed chairman Ben Bernanke took to a podium in Jekyll Island, Georgia, to share his thoughts on the much-hyped exercise. The chairman went deep into the weeds on how 150 government examiners spent ten weeks scrubbing the balance sheets of the country's largest banks. He pronounced the findings firmly in the mainstream of independent studies, with copious citations to bolster his case. Then, when he was done, Bernanke tried to place the stress tests in a broader context.