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The "man in charge of the [Chevy] Volt’s battery development and integration" is bailing out of General Motors "in the middle of [the Volt's] frenzied gestation." TTAC thinks it's a perverse side-effect of government intervention--with all the new federal electric car money sloshing around, and pay caps looming, it's more lucrative to be an independent "consultant." ... 5:35 P.M.
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Ben Sheffner says Gawker is "running a very risky business." Why? No libel insurance. ... 12:30 P.M.
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Bob Wright thinks the Web is the new God, in a particular sense. .... 1:37 A.M.
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Charles Lane argues that unions are now a "significant" impediment to "sensible health care reform" because of their tooth-and-nail fight against taxing "Cadillac" health plans. ... Even if you think (as I do) that the unions have a point when they argue they gave up wage increases in order to get lavish health benefits, isn't the answer to give them five years (or until their next contract negotiation) to rebalance the mix to what it would be in a world in which employer health benefits didn't go untaxed? ... If the problem for powerful unions is they no longer have quite the clout they used to have to extract wage increases in exchange for giving up "luxury" health benefits ... well, that's their problem. ...
P.S.: Lane also criticizes unions who support single payer but want to preserve their right to bargain for "supplemental" coverage.
Probably the only thing less likely to pass Congress than single-payer is single-payer with a layer of extra benefits for unions only.
Hmm. Why shouldn't unions, or anyone, be free to bargain for supplemental benefits**--at least for more treatments or services--on top of what's available in a single payer plan (as long as those benefits are taxed)? Lane seems to imply that the idea of single payer is that the government plan would have near-monopoly status--you take what it offers, and that's it. No adding on to the system for, say, cancer drugs the government's decided not to pay for.** If that's Lane's version of single-payer, I know a woman named Betsy who'd like to talk to him. ... 1:50 A.M.
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Whatever you think of the Polanski case, this is a good hed:
Free Roman Polanski! Demand Harvey Weinstein and Woody Allen
1:51 A.M.
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Getting to Know the Public Option As It Disappears: Steven Pearlstein argues that the "public option" isn't necessarily a good way to keep down health costs. He notes that, unlike Medicare, "public" insurers would have to bear the costs of collecting premiums, managing care and marketing. Administrative expenses would inevitably be significantly higher than Medicare's 2-3 percent. Plus, the "public" plans wouldn't necessarily have much market leverage in areas where a single dominant hospital, for example, just has to be in your network.
But Pearlstein is assuming that the purpose of the "public option" is to control costs! What if, as Jacob Hacker and Rhul Rajkumar note, it is also designed to serve as a "crucial backup for those ill served by private plans"? Security, not cost. (Pearlstein asserts that a public option wouldn't be "the long-awaited safety net for the uninsured," but never backs it up with an explanation.)
And why do I get the disquieting sense that if the Obama administration had needed a strong defense of the "public option," Pearlstein could have written it the other way?
P.S.: Hacker and Rajkumar produced a generous and highly useful set of answers to my questions about the "public option" that they've championed. My initial reactions:
1) H & R note that when it comes to "community rating"--requiring insurers to charge the same rate to sick and ill people--there will likely be a "cat and mouse game" as insurers try to avoid the rules. But when it comes to preventing private insurers from gaming the system by attracting only healthy patients (even if they charge everyone the same rate) H& R rely on the effectiveness of regulation. (I don't see how competition from "public" plans will help out regulators in the latter case . Will a public option discipline private insurers that engage in "cherrypicking"? The availability of a public option seems what is likely to allow private firms to get away with cherrypicking--the victims denied insurance can always get it from the public plan. That also seems likely to decrease the incentive for regulators to prosecute.)
2) Won't sick people flock to the secure public option? H &R say such "adverse selection" will be "modest,"--and that "extreme adverse selection that really jacks up the cost of the public plan" is "unlikely." But nobody knows, right? And H & R's fallback solution to this problem--"risk adjustment," requiring those who enroll healthy customers to pay money to those with less healthy customers--seems like a solution that proves too much, as lawyers likely say. If "risk adjustment" reallly works, won't it solve all problems of private insurer cherrypicking--indeed, virtually all the problems of health insurance? Yet obviously H & R think there will be continuing cherrypicking, if only on a "cat and mouse" level.
3) Why will the public plan "create a strong competitor that pushes plans to focus on controlling costs and improving value"? As Pearlstein notes, the public plan will have to do most of the things private plans now do--in fact, they will probably farm the administration out to private contractors. To the extent the public option cuts costs by aggressively managing care, doesn't that defeat the purpose of having it as a Medicare-like backup that doesn't aggressively manage care? Won't the public plan be more vulnerable than private plans to anti-managed-care lobbying by voters? So the pro-public argument on costs basically amounts to an antitrust argument: competition in some markets is weak, and this will add another competitor. .
4) The public option is a strange hybrid of Medicare and faux-competitor, apparently. It could emphasize security or cost-cutting depending on who is running it. It seems worth a shot. But I'd feel better about the whole private/public combo if some of my conservative friends would explain to me just what it is that private insurers do that makes them worth preserving. The central problem, sketched by David Cutler in his book Your Money or Your Life, is that the free market does not reward insurers who provide excellent care. The market punishes insurers who provide excellent care, because the people who will be most attracted by excellent care are sick people, the very people who will drive insurers into bankruptcy. If private firms want to make a profit, at least in the indivudal market, the surest way to do it is to think up innovative ways to screw buyers--deny care to those likely to need it, write complicated clauses into policies that allow the insurer to weasel out of paying, etc.. Everyone agrees private insurers do these things. What do they do that's so great that makes up for it? [Keep out unions?--ed Good point! But Medicare eliminates the private insurance middlemen and doesn't seem, yet, to have forced unionization upon hospitals, etc. Of course Dennis Rivera and the Democrats aren't done with their work yet.]
On H & R's final point, I'm still not convinced that if there is no public plan, and the health insurance market becomes a hell of "unraveling choices, runaway costs, and rampant health insecurity" that there will be no political will to intervene later (because we've missed our "once in a generation chance"). Why isn't health care politics more like the environmental politics--you make some changes one year, and then if you win an election you make some more changes next year? (For a contrary argument, see my colleague Timothy Noah, who thinks the insurance lobby will be more powerful than ever after a reform mandating that everyone buy their product.)
P.P.S.: Reader D.C. submitted his own thorough set of answers to my public plan questions. Here is his explanation of why he thinks a public plan would attract enough healthy people to avoid a vicious circle in which it attracted the sickest people and had to raise premiums, further deterring the healthy:
[T]here are many ways for the public option to attract healthy workers, including:
-- peace of mind that you won't lose your job, your insurance, or your sanity when you get sick
-- a much larger pool of doctors to choose from (you get to choose your doctor, as opposed to most HMO's) [True?-MK]
-- portability if you move to a different state
-- ease of customer service (yes, it's the government, but compare the status quo)
-- fewer shenanigans trying to deny coverage based on technicalities
-- better preventative coverage [why?--MK]
-- coordination with state and local health providers
Seems logical enough, though I can't vouch for D.C.'s credentials. Offering security might not unequivocally raise costs, because security attracts the healthy as well as the sick. Still, if that were the predominant effect, wouldn't private insurers be offering a lot more security than they do know?
At bottom, there clearly still seems to be an uneasy, ongoing tension between a public plan's cost-cutting purpose and it's security-for-those-who-get-sick purpose. Hard to see how it can do 100% of both at the same time. And I still don't think H & R know which of those two forces will win out.
Not that this is a fatal objection--one reason to try would be to find out. Unlike Pearlstein, I wouldn't be troubled if "security" won decisively at the expense of "cost-cutting." ... 8:42 P.M.
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Bob Wright on Colbert Report, discussing Evolution of God. "I don't believe in any of these three religions." Colbert (as Colbert) is not receptive. ... 10:35 P.M.
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Jeff Toobin, wrong again? 11:03 P.M.
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Thinking Through The Pubic Option: John Edwards is "tired of all the lies"! ... [via Gawker] 11:39 P.M.
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My friend Bob Wright posts a persuasive "partial list" of the "false and misleading things" he argues a recent New Republic book review said about The Evolution of God.
If [reviewer Jerry] Coyne wants to write a devastating review of my book-and there can be little doubt that he wants to-he's going to have to start over.
The disputes are grouped into six substantive issues. My guess is that #4 and #5 are the hottest areas of contention. ... My own non-devastating attempt to grill Wright on his view of Islam comes toward the end of this interview. ... 9:54 P.M.
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So You Have A Death Panel in That Basket! Tom Maguire digs further into that April Bloomberg story--and the David Leonhardt NYT interview behind it--and discovers that Obama came a lot closer to talking about "death panels" back in April than I'd thought. Here's the key passage [emphasis added by Maguire]. It comes as Obama is talking about the hip replacement his grandmother got a few weeks before her death:
THE PRESIDENT: ... I don't know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn't have a hip replacement and she had to lie there in misery in the waning days of her life - that would be pretty upsetting.
LEONHARDT: And it's going to be hard for people who don't have the option of paying for it.
THE PRESIDENT: So that's where I think you just get into some very difficult moral issues. But that's also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
LEONHARDT: So how do you - how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now.
Yikes. ... I'm sure the "not determinative" part was very important to Obama. Still! He's talking about a panel of independent experts making end-of-life recommendations in order to save costs that have an effect at an individual level. And he thought it would be in the bill that emerges. ... It's also pretty clear that something like the "IMAC" panel is what he has in mind. Whether or not the IMAC would actually do this--Harold Pollack says end-of-life issues are well down the curve-bender's list, for example--Obama thought it would do it. . .
And if health care advisor Ezekiel Emanuel believes there's actually not that much money to be saved on end-of-life care, he hadn't gotten the message to the President back in April. ...
P.S.: Hmm. If, say, Peter Orszag led Obama down the fatal path of talking about end-of-life-savings, and if Ezekiel Emanuel thinks Orszag is wrong about this, then who is Ezekiel's own brother going to recommend throwing overboard when if health care reform stalls? Just speculating! ...
Update: Timothy Noah argues that you really need all three parts of Uwe Reinhardt's "three-legged stool" to make insurance reform work. 1) Insurance companies accept all comers; 2) Individual mandate to buy insurance; 3) Subsidies so poor people can fulfill that mandate. Fine. Let's do those three things! They pointedly do not include Peter Orszag's long-term game-changers, or Obama's "very difficult democratic conversation" about end of life care. Even Reinhardt, who supports the long-term Orszag agenda, doesn't think it's something we can do in this round of reform--that's "a much longer-run effort that may take an entire decade or more." Why didn't someone tell that to Obama (who actually pledged to veto a bill that didn't do the long-term curve-bending that Reinhardt says can't be done)? 'Sir, we can achieve universal coverage.' 'No, let's have a very difficult democratic conversation first." ... P.S.: Orszag's politically disastrous "game changers" are also the piece of Obama's reforms mysteriously left off Ezra Klein's list of health care areas of agreement and disagreement. ... 9:52 P.M.
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A second talented editor leaves the L.A. Times Entertainment section in as many weeks. Kate Aurthur, who's going to the Daily Beast, was--according to kf's well-informed source--
the one top editor with any sense of innovative spirit, creativity or awareness of the internet left in the Calendar section.
Do Times employees not find Entertainment chieftain Sallie Hofmeister's leadership inspiring? ... P.S.: I used to enjoy mocking the LAT, but it's so doomed there's no point anymore. If there were a death panel for newspapers, it would issue a DNR order. ... 9:48 P.M.
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David Brooks may spend until the end of his days being asked which Republican senator he's referring to in his recent MSNBC confession:
I sat next to a Republican senator once at dinner and he had his hand on my inner thigh the whole time. I was like, ehh, get me out of here....
He'll be asked at every dinner party he attends for the forseeable future. He'll be asked by his dentist, when he's in the chair. He'll be asked by his editors. I urge Brooks to seek the counsel of Bob Woodward, who managed to keep an even more sought-after name secret for decades. But there is a smaller universe of suspects with this one. It might be hopeless.
P.S.: I know I have my favorite. ... As a TPM reader notes, it would have to be someone Brooks really didn't want to piss off. ... 1:49 A.M.
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A couple of weeks ago I interviewed Bob Wright about his Evolution of God for KCRW, my local NPR supplier. They're running it today--Tuesday--at 2:30 West Coast time. Says here it's "live stream/on demand/podcast." Voices were raised. They wanted contentious. ... Update: Less contentious than I remembered! Better to bill it as "thoughtful." That's the ticket. Thoughtful. ... I also think some of the things Bob says toward the end about the tolerant history of Islam might provoke some blowback from the right. ... 1:48 A.M.
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Jeffrey Toobin said something that's not true? I'm shocked shocked ... [via Olson] ... Update: Olson cites more evidence against Toobin's crowd-pleasing oversimplification. ... 1:47 A.M.
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Mr. LUTZ: [W]here we really messed it up and took our eye off the ball in terms of product was in '70s, '80s and early '90s. And I think we've - in the last five or six years - we've had a radical transformation in the way we approach the product and our goals for products and look at the awards we've gotten. We got car of the year.
SIEGEL: But when you take your eye off the ball for more than 20 years...
Mr. LUTZ: Yeah, well, that was bad. ...
Update: It's also pathetic that Lutz cites the Motor Trend Car of the Year contest. If you follow cars, you know that this is not a respected award. It has a reputation for ...well, see TTAC's cynical flow chart. Over the years it has been won by some mediocre cars (1995 Chrysler Cirrus?), some awful cars (1971 Chevy Vega,1983 Renault Alliance), some loser cars (2002 Ford Thunderbird) and lots of cars Bob Lutz wouldn't be caught dead in (1997 Chevrolet Malibu) including more than ten from what Lutz labels as GM's lost decades. ... [Thanks to Reader D] 1:45 A.M.
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My friend Robert Wright, who applies a Marxist/materialist view of religion in his new book, thinks Palestinians, and the Muslim world generally, will behave better when they no longer feel "humiliated and dispossessed" and "not in control of their own destiny." Presumably he'd say the same thing about Israeli Jews who believe "God wants the people of Israel to populate all of the promised land." ... I share his basic viewpoint--but it has a big Marxist/Condescension problem, not unlike Obama's famous "cling" problem with guns and God in Pennsylvania. 'That's a nice little religious faith you have there. But I know that your beliefs will change if your circumstances change.' At some point the people you are dealing with sense that you think you know better than they do (which you probably do and definitely think you do). ... When I last wrote about this problem, I didn't have a very satisfying solution, though it looks better to me now than it did then. .... One response I didn't discuss is to hang a lantern on the problem and drily condescend to God too: "The Abrahamic God has shown the capacity for great moral growth," writes Wright. See you next week at the usual time, God. ... Not sure that helps! ... 1:53 A.M.
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