Wednesday, July 22, 2009 - Posts
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Wednesday, July 22, 2009
Obama Presser: Instant reaction rant:
"In addition to making sure that this plan doesn't add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run. ... [snip]
I won't sign a bill that doesn't reduce health-care inflation so that families as well as government are saving money. I'm not going to sign a bill that I don't think will work.
And my measure of whether things work or not are listening to the American people, but also listening to health-care experts who have shown that in some communities health care is cheaper and delivers a better result. [E.A.]
He's still in the thrall of Orszagism! Here we're dramatically changing insurance (no more "preexisting conditions") and insuring the uninsured and creating a health care exchange and promoting a public option and generally telling everyone they can stop worrying about whether they will have coverage. It's all going to be deficit neutral over a ten year period. Why do we have to also dramatically change the "health care delivery system" at the same time (in order to save even more money after ten years)? Doesn't that undermine the reassuring message that if you like your health coverage, nothing will change? Sure. Nothing will change except the entire health care delivery system! Which is going to be redesigned! By experts! Maybe get rid of fee for service--Obama hinted at change along those line. All seemingly on the basis of a single article in the New Yorker that isn't nearly as convincing as it's made out to be. (I would like to see Dems apply Orszag's logic--that all Medicare expenses can obviously, without sacrifice be cut to the level of the cheapest provider--to the school system.) ...
I know I'd like universal health coverage. That's been debated ad nauseam. What hasn't been debated--what have been blessed mainly by pronouncements from on high couched in euphemisms and deception--are Orszag's "delivery system" changes. I'm worried that they will result in denial of treatments that may be useful at saving and prolonging lives. Obama's refusal at his press conference to declare that all covered treatments would still be covered is an example of what people worry about. And Obama knows--or even scarier, maybe he doesn't--that the difficult decisions don't involve cheap blue pills that are as good as red pills, but treatments that are the "best" but also the "most expensive"--including cancer drugs like Herceptin and Sutent. ...
P.S.: Obama got more mired in explaining (or, rather, santizing) curve-bending and therefore became less effective during the question period. Why was a press conference--as opposed to a speech--the best way to rally support? ....
P.P.S.: On tax increases, Obama said
I don't want that final one-third of the cost of health care to be completely shouldered on the backs of middle-class families who are already struggling in a difficult economy. And so if I see a proposal that is primarily funded through taxing middle-class families, I'm going to be opposed to that ... [E.A.]
In standard Washspeak, this means Obama is open to a health reform that taxes middle class families as long as it isn't "primarily" or "completely" funded by taxes on middle class families. But 49% funded by taxes on middle class families? ... However you interpret these sentences, it's hard to see how Obama hasn't given a flashing green light to non-trivial tax increases on middle class families. ... 6:10 P.M.
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Henry Louis Gates Jr. tells his daughter in The Daily Beast about his arrest for disorderly conduct:
If I had been white this incident never would have happened. He would have asked at the door, “Excuse me, are you okay? Because there are two black men around here try’na rob you [laughter] and I think he also violated the rules by not giving his name and badge number, and I think he would have given that to one of my white colleagues or one of my white neighbors. [E.A.]
Hmm. In my experience, cops never give out their badge and number, regardless of what the "rules" say and regardless of how white I am. I tried it in the '60s and '70s at anti-war demonstrations, it didn't work. Last year, when Manchester, New Hampshire police pulled me over during the Dem primary because they thought I was a pimp, one of the women in my car repeatedly asked one of the cops for his name. He was very friendly but totally ignored the request. Nobody wants to get sued. (Of course, she was probably asking him because she wanted to interview him, not sue him, but he didn't know that.) I'm in talks with PBS about a documentary. I've also learned it never pays to talk back at cops.
P.S.: Here's the key passage of Gates' account in The Root, after a Cambridge cop asks him to step out onto his porch and Gates refuses:
My lawyers later told me that that was a good move and had I walked out onto the porch he could have arrested me for breaking and entering. He said ‘I’m here to investigate a 911 call for breaking and entering into this house.’ And I said ‘That’s ridiculous because this happens to be my house. And I’m a Harvard professor.’ He says ‘Can you prove that you’re a Harvard professor?’ I said yes, I turned and closed the front door to the kitchen where I’d left my wallet, and I got out my Harvard ID and my Massachusetts driver’s license which includes my address and I handed them to him. And he’s sitting there looking at them.
Now it’s clear that he had a narrative in his head: A black man was inside someone’s house, probably a white person’s house, and this black man had broken and entered, and this black man was me.
So he’s looking at my ID, he asked me another question, which I refused to answer. And I said I want your name and your badge number because I want to file a complaint because of the way he had treated me at the front door. He didn’t say, ‘Excuse me, sir, is there a disturbance here, is this your house?’—he demanded that I step out on the porch, and I don’t think he would have done that if I was a white person.
But at that point, I realized that I was in danger. And so I said to him that I want your name, and I want your badge number and I said it repeatedly. [E.A.]
a) Isn't it pretty clear that Gates had a narrative in his head too? b) What was the question he refused to answer? c) Just reading this passage--Gates' own words--it seems to me he pops into litigious mode a little quickly. He says he wanted to file a complaint "because of the way he treated me at the front door." How had he mistreated him at the front door? He asked him 'Would you step outside onto the porch?' (where, as Gates notes, the cop would have more rights). When Gates refuses and instead gives the cop an ID, the cop looks at the ID. And at that point Gates has already determined he's been treated unfairly. He's already refusing to answer questions and planning to file a complaint. Again, from his own words it looks like he rushes a bit to the conclusion that a white man in a similar situation would have been treated differently. Is that really true? I'm not saying that Gates wasn't stereotyped in a deeply annoying and disturbing way. Just saying the stereotypes can run both ways. ... 2:02 P.M.
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The estimable Jonathan Cohn is remarkably unconvincing in arguing that long term health care cost-curve-bending is politically essential, right now, for the Democratic Party--as opposed to essential for some Blue Dog Dems who want to posture as non-big-spenders. If Congress passes a bill that basically produced universal, secure coverage and was deficit neutral over 10 years, are Dems really going to be punished at the polls because it doesn't also reduce the rise in medical expenses that's expected in years 11-30?
It seems particularly unlikely that, as Cohn argues, long term curve-bending is essential for its political appeal to moderate income voters:
If Democrats don't make the difficult decisions on raising revenue and controlling costs, then the reform they pass won't do much to help middle class Americans.
a) Huh? Isn't the reform offering health security to middle class? Cohn should read Drum. b) Cohn suggests that lower subsidies will hurt the near-poor, who are middle class. But that's an argument for higher short term subsidies, which would have to be paid for by short term cuts or revenues. Long term curve bending doesn't affect those subsidies, at least not for a long time; c) In the long run, I suppose, Cohn's argument would be that the expected rise in medical costs will make health care less affordable to those in the middle, taking a bigger bite of their paychecks. True enough. Against this, though, you have to balance understandable middle class fears that Orszag's untested cost-bending solutions, involving empowering bureacrats to deny reimbursement for treatments on grounds that--well, who knows what the grounds will end up being--would bend the curve by undermining the very health security reform promises. That seems, at best, a wash.
I mean, do you really think the middle class Americans will oppose (or not care about) a historic, 10-year-deficit-neutral universal care bill that doesn't bend the curve, but suddenly burn up the Capitol Hill phone lines to demand that the package be passed when they learn that it contains an "Independent Medicare Advisory Commission"? That's red meat out in the suburbs!**
I share the Obamist consensus that failure to pass a health bill would be politically disastrous for Dems, including the very moderates in swing districts who are currently making demands. Democrats need a victory. But a historic coverage-securing bill that isn't a "curve bender" would be more than victory enough. ... And if Republican candidates then really started making a fuss about the perils of rising costs in 2024--as opposed to making a fuss about, say, government-mandated cost-control rationing near the end of life--the stage would be set for the Orszagists to push their curve-bending plans. (Or is it because Cohn et al know this won't happen that they're desperately trying to portray curve-bending as politically essential this year?) ...
**--Isn't it more likely that empowering this cost-cutting commission will open up the reform to a Dick Morris-style they're-destroying-Medicare attack? ... 4:11 A.M.
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