In the health care debate, there is no escape from Betsy McCaughey. In 1994, the tenacious policy wonk wrote an inaccurate TNR piece that killed Hillarycare; today she's the originator of the "death panels." But there's much, much more.
When President Obama arrives in Tokyo on Friday, he will confront a country that seeks to be an ally of the United States. For Japan has never been an American ally. It was first a rival, then an enemy, and finally, after it lost the war it foolishly started with the U.S., it became a protectorate, not an ally.
The distinction matters. An alliance is an institution negotiated between two sovereign governments in which each agrees to a series of reciprocal obligations that have the force of law. A protectorate arrangement, by contrast, sees the protectorate retaining a degree of control of its internal affairs, but surrendering authority to manage external relations--most crucially, in the area of military decision-making. In return for the protectorate's ceding of this key aspect of sovereignty, the dominant partner in the arrangement agrees to provide for the defense of the protectorate.
Polls show that Americans are confused about what health care reform means. And, if you listen to members of Congress on television, you get the impression that some of them aren’t certain, either. But figuring out what health care reform entails isn’t hard. All you have to do is look at Massachusetts.
Health Care Reform: Will It Work? Part 1
A day after blasting Martha Coakley, the frontrunner for Ted Kennedy's Senate seat, for saying she would have voted against the health care bill because of the abortion amendment, Mike Capuano, who voted for the bill, now says he did so only "to keep the health care debate alive"--and that he'll vote against a final bill that includes the abortion funding provision. The interesting question here, I suppose, is how would Kennedy have voted?
I got an email from an old friend, Joel Parker, who is an international vice president of the Transportation Communications Union, and one of the smartest people I know. It's a response to my article on anti-Statism in America that has been on the site today. I am reproducing it for its criticisms rather than its compliments, which bear not only on what I wrote but also on our continuing discussion of the health care bill.
Why Americans Hate to Love the Government, by John B.
Alan Wolfe is a TNR contributing editor and director of the Boisi Center for Religion and American Public Life at Boston College.
Just before the House of Representatives voted on the Stupak Amendment, designed to stop any public funding of insurance plans that cover abortion, the U. S. Conference on Catholic Bishops (USCCB) weighed in with its endorsement. According to The Hill, their action gave the amendment a “boost,” helping its eventual passage.
To the frustration of many a cabinet secretary, the Obama administration is a little behind on its appointments. At this point—with only five weeks to go before the Senate breaks for recess—a little over half of the 514 positions that need filling have been filled. Some jobs are really important: The nominee for the Office of Legal Counsel has been held up for months. Obama’s choice for a USAID director came down just today. U.S. attorney nominations have slowed to a crawl.
Other jobs? Not as important.
Take, for example, the eight-person Broadcasting Board of Governors, which oversees the five media entities—Voice of America foremost among them—tasked with broadcasting American culture and journalism around the globe. In theory, the board is supposed to serve as a “firewall” between the broadcasters’ mission of journalistic objectivity and the political whims of legislators, who would often rather see taxpayer dollars go towards burnishing America’s image abroad. By statute, the president and minority party nominate four governors each to keep a bipartisan mix. But right now, the BBG is only half full. The four currently serving members were all appointed in 2002, and have overstayed their terms by three years—if anyone left, the board would no longer have a quorum to conduct business. Journalistic wise man Walter Isaacson is rumored to be the administration’s choice for the vacant post of chairman, and it’s hard to imagine him being held up for any substantive reason. It’s also hard to imagine the administration nominating him between now and when Congress leaves town in December.
The sad saga of the BBG began almost as soon as it was created in its current form, when the U.S. Information Administration was dissolved in 1999. As this magazine documented in 2005, Bush partisan Kenneth Tomlinson turned the board into an ideological battleground—purging people whom he saw as insufficiently conservative—that hamstrung the broadcasters’ operations and drove morale into the toilet. After Tomlinson was ousted, the well-respected editor James Glassman restored the board to some order, before he was tapped as Undersecretary for Public Diplomacy in the dying days of the Bush administration.
Critics have complained that a drug industry got a sweetheart deal when it struck a bargain with the White House and Senate Finance Committee over health care reform.
There’s new reason to think those critics were right.
It comes from an October forecast by IMS Health, a respected global research and consulting firm. The report, which IMS distributed to clients and which a source provided, projects that the drug industry will see average annual growth of 3.5 percent between 2008 and 2013.
Back in March, IMS had projected no growth at all during that same five-year stretch. In fact, it projected the drug business would actually contract slightly--with negative annual growth of 0.01 percent.
What changed? A major factor, according to IMS, was the emerging details of health care reform.
One of the most contentious aspects of this weekend's House health care debate was whether federally subsidized insurance plans should be allowed to offer abortion services. An 11th-hour deal to secure passage of the bill handed a victory to anti-abortion lawmakers, with the House including an amendment by Democratic congressman Bart Stupak in the final draft.
Very interesting development on the "too big to fail" front today: The Journal reports that Colorado Rep. Ed Perlmutter is planning an amendment to the systemic risk bill currently before the House Financial Services committee. The amendment would partly revive certain New Deal-era restrictions on banks:
I hope readers take the time to read David Leonhardt’s terrific Sunday New York Times Magazine piece on Intermountain Healthcare. It is a great introduction to the changes that organized medicine must adopt to deliver team- and evidence-based care. (I wish we used the term evidence informed treatment, which brings fewer connotations of cookie-cutter care.)
This transition requires changes in the way doctors and hospitals are paid. It also requires changing medical professional culture to embrace a team approach. Many doctors have been socialized to believe in a model in which what matters most resides in the head of individual physicians. Jerome Groopman’s otherwise wonderful How Doctors Think expresses this mindset right in its title. Groopman provides a beautiful account of how doctors effectively diagnose conditions and how their heuristics can go astray. As Darshak Sanghavi notes in Slate, Groopman provides less guidance regarding how we could create systems that make patients less vulnerable to the mistakes or inattention of fallible human beings. (It’s too bad Groopman declined to be interviewed for Leonhardt’s piece, which has a nice little section on these issues.)
The change in medical culture will be tough, not least because there is so much to admire in the traditional medical model. Unfortunately, there is just too much evidence that it frequently produces bad care. More clinical intelligence and compassion reside in a well-deployed team of people than can reside with any single person, no matter how committed and well-trained that person might be.
Betsy McCaughey published a recent Wall Street Journal op-ed, in which she quoted 16 doctors she convened for an anti-reform discussion panel. If one reads the transcript, one finds the expected bias and exaggeration. One also finds more interesting genuine push-back against CER and team models of care. Here, for example, is heart specialist Mark Fields:
This past Saturday the Washington Post ran a detailed assessment of the stimulus funding related to energy-efficiency grants.
I had a friend visiting me this weekend who had fervently backed Barack Obama for President (against the “devil-woman” Hillary), but who now thinks Obama has betrayed his followers – most recently by agreeing to disastrous compromises in the health insurance bill. We argued the point on Sunday morning, while reading reports of the passage of the House bill.
Jason Zengerle argues that if one calls Scott Roeder’s killing of abortion doctor George Tillman a terrorist act, then one has to call Nidal Hassan, who perpetrated the Fort Hood massacre, a terrorist because his actions were “motivated, in part, by religious and political views.” I don’t think I agree with Jason – at least given the evidence to date about Nidal Hassan’s motives.
Here's some more evidence against the declining lending standards theory of the crisis -- and support for the claim that it was the design itself, or existence, of subprime mortgages that played a seminal role in our housing woes.
One of the most revealing moments in Saturday's debate over health care reform was when Rep. Anthony Weiner of New York took the floor. Weiner is a rising star in the Democratic Party, having quickly established himself as an unusually engaging speaker. But, in this case, it was Weiner's effective use of a prop that stood apart.
The prop was the handbook for the Federal Employees Health Benefits Plan, or FEHBP--which is, very roughly speaking, a model for how a reformed health care system might work. Once a year, millions of federal workers, including members of Congress, pick one of the many private insurance options available through FEHBP. They can pick plans without worrying that an insurer will deny coverage or charge them more for a pre-existing condition. And, for the most part, they can carry coverage with the peace of mind that it will be there when they need it.
Weiner had brought the handbook in order to make a point. Opponents of health care reform have spent a lot of time complaining about the complexity of health care legislation, in many cases waving around the huge piles of paper it takes to print the full bills. It's a misleading argument: The bills are long in part because the government uses large type and wide margins to print them. And after the experience of the Bush administration, when the president and his allies frequently made policy without thinking through all of the implications, one could plausibly argue that legislative complexity is actually the product of due diligence. This is one-sixth of the economy we're talking about, after all.
But Weiner's broader argument was that legislation matters less than the reality it creates. "There's been a lot of talk about how big the bill is," he said. "Here's what it's all about. This is what members of Congress get."
He's absolutely right.
WASHINGTON--Here's a story you may have missed because it flies in the face of the dreary conventional wisdom: When advocates of public programs take on the right-wing anti-government crowd directly, the government-haters lose.
At the American Prospect and Feministing, Ann Friedman reminds us that the significance of the Stupak amendment goes way beyond the funding of abortion services for people who happen to buy coverage through the new insurance exchanges:
On some level, I don't care about the nitty-gritty details of this amendment. This isn't just about how the money is allocated or what workarounds exist. This has me so incredibly infuriated because it further segregates abortion as something different, off the menu of regular health care. It is a huge backward step in the battle to convey -- not just politically, but to women in their everyday lives -- that reproductive health care is normal and necessary, and must be there if (or, more accurately, when) you need it.
This also sets apart women's rights from the Democratic/progressive/whatever agenda. As something expendable. But fundamental rights for women are not peripheral. They are core. And not just because of so-called "progressive" values. In a political sense, too: Seeing as how the Democratic party relies on women voters to win elections, you would think they would have come around to this no-brainer by now.
It's pretty cramped underneath this bus, what with 50 percent of Americans down here.
At the Daily Beast, Dana Goldstein asks the question many abortion rights advocates are asking: Did the administration do everything it could?
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.
Massachusetts?
