Democrats: Are You Ready for ... Victory?
Why Andrew Sullivan is not someone you'd want to follow into battle, Part XVIII: Andrew Sullivan declares , upon contemplating a possible Coakley loss:
Democrats can stop hoping at this point.
I can see no alternative scenario but a huge - staggeringly huge - victory for the FNC/RNC machine tomorrow. ... [snip]
What comes next will be a real test for Obama. I suspect serious health insurance reform is over for yet another generation.
Even if Coakley wins - and my guess is she'll lose by a double digit margin - the bill is dead. The most Obama can hope for is a minimalist alternative that simply mandates that insurance companies accept people with pre-existing conditions and are barred from ejecting patients when they feel like it. That's all he can get now - and even that will be a stretch. [E.A.]
Later, Sullivan writes , about health care reform:
It's over. Rahm Emmanuel did such a great job, didn't he?
Excitable! ... Q: How do we know this is the real Andrew Sullivan, and not one of his ghostbloggers ?** A: The ghost would have been more level-headed.. ...
It's not over, of course. There's a good chance of passing the Senate bill through the House, which would be a perfectly legitimate course of action. Nate Silver, for one, has a useful analysis free of theatrical overreactions .. ... Does Dennis Kucinich, in the crunch, really want to be the one who blocked coverage for the uninsured? ... P.S.: Jon Chait calls on Sullivan to keep his head . Never a good bet. ... But once he loses it he recovers quickly ! Peer pressure works. ...
**-- Sullivan's new name for them, apparently, is "under-bloggers." Flattering! ... 12:31 P.M.
Stop me before I curate again: Slate Overboss in Pre-Election Shock Tweet: Even the liberal Obamaphile Jacob Weisberg wouldn't vote for Coakley ( because of her role in the Amirault case ). .... Neg for Meg: Who is the mystery "celebrity" that conservative radio host John Phillips hears will jump into the California governor's race in about a week? Phillips doesn't specify that it's a Republican.... Lawrence O'Donnell thinks Senate GOP leader McConnell has been secretly trying to make sure Obama's health care reform passes . ... 2:53 P.M.
Kf hears that if Coakley loses on Tuesday, the White House strategy will in fact be to try to pass the already passed Senate bill, word for word, through the House. Sudden Victory! **... Sorry about all the lost Kabuki! ... And Mr. Trumka, you'll have to get labor unions out from under the Senate's "Cadillac tax" later. ... P.S.: You didn't actually believe Speaker Pelosi when she dismissed this prospect, did you? ... P.P.S.: Always trust content from kausfiles . ...
Update : Keith Hennessy raises the question : Would it really be less controversial for the House to pass the already-passed Senate bill intact, as opposed to quickly ramming through a new House/Senate compromise before Brown is seated? A: Yes. One strategy requires blocking the result of the Mass. election. The "sudden victory" strategy does not. You could seat Brown promptly, and if the House passed the Senate bill it would still be Game Over. ... Of course, that assumes that spooked House lawmakers can be persuaded to pass the Senate bill (something Megan McArdle doubts ).. ... [ via 538 ]
**-- formerly known as " Pong. "... 1:29 P.M.
Blame Orszag First, Part VIII: A friend emails:
I think Mass. is validation of your take on Obama's stupid framing of insurance reform. He has given people absolutely nothing to feel bad about if the bill is stopped. "WHAT? THEY TOOK AWAY MY COST CONTAINMENT?"
Coakley and all the Dems are bearing the burden of that stupidity. It's not that people don't want insurance reform. It's that they don't want what they have been hearing about it -- from Obama no less than the Republicans.
Obama has let the respectable press nudge him into talking about vague or downright ominous-sounding Orszagist cost-controlling schemes at virtually every opportunity. Here he is being all-too-easily driven off-message on NPR recently :
SIEGEL: Mr. President, some people have faulted this whole process for not focusing enough on how medicine is practiced in the U.S. and our appetite for lots of tests and the like . I want to ask about a recent, coincidental event, which would be the new guidelines on mammography. They suggested that we've been testing too much and it would be better to get tested less. There was an outcry. ...
OBAMA: Well, I think what it says, No. 1, is that we still have a tendency to think that more medicine is often - is automatically better medicine. And that's just not the case . Inside this reform bill that I'm pushing is a provision that has a panel of experts - doctors, medical experts - who are going to look at all these practices to start changing how we think about medicine.
SIEGEL: Will politicians defer to their judgments - to their scientific judgments?
OBAMA: Well, one of my goals is to make sure that doctors and scientists are giving the best information possible to other doctors who are seeing patients. Look, if you talk to most health care economists right now, they will tell you that every good idea out there, when it comes to improving quality of care and reducing costs of care, are embedded in this bill. It's not going to happen overnight because we're going to have to change both how doctors think about health care and how patients think about health care .
And there are going to be millions of small decisions all across the country and interactions between doctors and patients that, over time, change the trajectory of our health care system. The important point is that we're getting started in this process. And I'm actually very confident that the average person is going to say to themselves, if, right now, I'm taking and paying for five tests and my doctor tells me that I only need one, that person's going to want to take one - save some money and save some time. But they need some validation . They need somebody who's giving them the better information. And we have set up a system where, year after year, best practices are going to get disseminated across the country. [E.A.]
a) Obama says,"[W]e're going to have to change both how doctors think about health care and how patients think about health care." And here I just wanted to get covered! I'm not sure I want to change how I think about health care. ... I thought the genius of the President's health care strategy was that it told people who were happy about their current insurance not to worry. Now he's telling them that under his bill they will need to alter the whole way they look at not only insurance but medicine itself-- that they, and the doctors they like, have it all wrong. Bad voters! Thinking that "more" is better! That's so American. Get your heads re-programmed. b) As Peggy Noonan notes rather forcefully, Obama's making an inside,elite appeal here--to moderate swing members of Congress and respectable Ron Brownstein types:
He negotiates each day with Congress, not with the people. But the people hate Congress! Has he not noticed?
c) "I'm taking and paying for five tests and my doctor tells me that I only need one." Do you have any confidence that Obama knows what he's talking about here? I don't. I think he's read some New Yorker articles. ...
These don't seem like mistakes a pol like FDR or LBJ would make. The program we know as Social Security, for example, was not all that popular when it was enacted in 1935 (for one thing, it took years to get up to speed). But FDR and the Dems realized this--which is why they hid our current contributory pension scheme behind a straight, cash-dispensing program of Old Age Assistance for the elderly poor--a means-tested plan that was wildly popular because it promised to start sending out checks immediately. (It's still with us, having morphed into SSI, which sends checks to, among others, impoverished seniors.) .... 11:26 P.M.
The Deal: Join a Union, Get a Tax Break?
Is Health Care Reform Now a Vehicle to Promote Unionization? It's one thing to delay until 2018 the tax on "Cadillac" health plans for existing union-negotiated plans, to let the parties rejigger the balance between wages and benefits. That's a standard "grandfather" clause, letting people whose existing arrangements are disrupted keep them going for a while (though why it should apply only to union pay packages is a good question).
But it's another thing to extend this union loophole to collective bargaining agreements that haven't been negotiated ye t, or to not-yet unionized firms that organize and then tap into existing collectively bargaining benefit arrangements. That would in effect give workers a tax bonus if they should organize between now and 2018. The government might as well mail a "first time union member" check of $3,000 to every American who successfully unionizes his workplace. As IBD notes, that would be a pretty good substitute for the stalled "card check" legislation , which would try to spur organizing by letting unions avoid a secret ballot (and call in federal arbitrators to set wages).
So which is it? Does the loophole extend only to existing union members or does it apply to future
union members--to grandfathers not yet born?
I haven't been able to figure out the answer to this question from descriptions
, and suspect it is one of those important issues that turns on the fine details of statutory language (e.g. what the meaning of "is" is). The "Cadillac" tax doesn't kick in for
non-union members until 2013. Does the bill give unions until then
to sign up new members--who would then be "grandfathered" until 2018 at least?**
If someone knows the answer, feel free to contact me. ( Mickey_Kaus@msn.com ). I hope the business lobbyists' who declared war on "card check" are on high alert. ....You wouldn't think Obama could afford to rile up more opposition to his plan at this point. ...
**--That's certainly what Lori Montgomery's WaPo summary suggests, perhaps inadvertently:
Health plans negotiated on behalf of state and local workers, or as part of collective-bargaining agreements, would be exempt for five years after the 2013 effective date, giving labor leaders time to negotiate new contracts,
How Health Care Reform Could Crash
Poll watcher Sean Trende (if that really is his name) thinks Massachusetts GOP challenger Scott Brown may have peaked too soon . Hmm. Doesn't necessarily look like it. .... Mark Blumenthal has some guidance for reading and reconciling all the Mass. polls--it's not just that lower turnout (and tighter voting screens on polls) tend to favor Brown. Everybody knows that! It's also a robo vs. human contest, especially when it comes to independents.
Perhaps it is harder for them to tell a live interviewer they are ready to vote Republican. Perhaps the more anonymous nature of the automated methodology better simulates the act of voting which will ultimately force a decision.
Plus the Incumbent Rule is on the line, yet again. ...
P.S.--Shock Waves Rippling: Trende makes a good point about the possible effect of a Brown win on health care:
[P]eople are predicting that if Brown wins either (1) the Democrats will pass the Senate bill or (2) the Democrats will get the revised bill through the Senate before Brown is seated.
I guess this is possible, but you have to think that a few more Democrats in R-leaning districts or states will be spooked enough by this to resist voting for the bill . Does Evan Bayh really think his seat is THAT safe? If Scott Brown can win in Massachusetts, John Hostettler can sure as heck win in Indiana. [E.A.]
I suppose, if the Congressional id is screaming for a way not to pass health care , the most obvious way that's left would seem to be this: a Senator bails (Nelson, most obviously) or if Coakley is defeated they just can't pass the bill before Brown takes her place. (Darn!) So the bill can't go back to the Senate--any House-Senate compromise is doomed by the lack of a 60th vote. The only hope becomes getting the House to pass the already-approved Senate bill word-for-word (the Sudden Victory strategy). But just enough House liberals declare they can't stomach the Senate bill--on the grounds that the uncompromised Cadillac tax is unacceptable, perhaps, or the subsidies are too low, or that a public option is essential. Presto, a train wreck. Everyone gets to go home and claim they were fighting the good fight. ... P.P.S.: Jay Cost runs down the names of the House swing votes , although he's paying more attention to the moderates who might bail on a compromise, not the liberals who might balk at the Senate bill. ... 2:21 A.M.
How to Blow It All in One Twitter
Haiti Donations: If, like me, you still don't trust the Red Cross ( sorry, boss! ) former Mystery Pollster Mark Blumenthal and others recommend Partners in Health . You can donate here . [ via Atlantic Politics Channel ] 8:20 P.M.
Amy Wilentz-- a good twitterer to follow re: Haiti ... 2:10 A.M..
Today's worry: That Obama will get unions to swallow the "Cadillac tax" on costly health care plans in part by somehow promising to pass a version of labor's "card check" bill before the big Dem majorities vanish in November. ... The mechanics of such a deal seem complicated: Unless the unions are bigger suckers than I think they are, the White House would presumably have to get all the swing Senate votes on "card check" (e.g., Blanche Lincoln) to promise not to filibuster , even though that meant going on record for another controversial leftish agenda item and angering their business constitutents. Extracting such a promise would almost certainly require specifying what sort of "card check" bill we're talking about (e.g. Retain secret ballot for organizing elections but with a shorter election timetable? What about mandatory arbitration?). And that would in turn add a whole new galaxy of issues to the already touchy health care negotiations. Still, I hope the business opponents of "card check" are alert to the threat. Murphy ? . ... 2:19 A.M.
Twitter has dramatically lowered the barriers that once prevented respected figures from publishing what Malcolm Gladwell calls " Disqualifying Statements ". Here are three tweets that do the job for me:
The amazing thing abt "The Hangover"? You can watch it again, know ev. thing that's coming, know how it ends, and still laugh 2x as hard. David Carr
Don't try "Tangled Up in Blue" as your first Rock Band effort. Dylan should have never gone electric. Greg Mitchell
Some idiot set firecrackers off on a jet and were spsd to be afraid of that? Al-Q is a joke Spencer Ackerman
Maybe the second one is ironic in a way I'm not getting. ... P.S.: More nominations accepted. ( Mickey_Kaus@msn.com ). Remember, everybody has at least one Disqualifying Statement in them. ... 2:10 A.M.
Why Peter Orszag is No Gary Hart
We're All Claire Milonas Now: Byron York places the blame for ObamaCare's unpopularity squarely on Orszagism-- specifically the claim that "you can insure millions of currently uninsured people and save money in the process." People don't believe it. Opponents of the bill don't believe it and half the supporters of the bill secretly don't believe it. (They think they are " stuffing the beast." or " feeding the beauty "). ... [ via Instapundit ] 1:24 P.M..
Hasen v. Kaus: We will find out soon enough, in the Citizens United case, whether Prof. Hasen was right (in thinking the Court will strike down most of the restrictions on corporate financing of campaign ads) or I was right (in thinking the Court would grope for at least a temporary halfway house/centrist position). Let me say that upon rereading I have somewhat less than rock solid confidence in my prediction--though it seems like the preferable outcome. ... 10:33 P.M.
Sudden Victory Suddenly Acceptable: Insiders scoffed when it was suggested that the House should simply pass the Senate bill, word for word, thereby avoiding the need for a second, risky Senate vote . Why, House liberals would never stand for it! They needed changes, if only to show they'd fought! The House must be allowed to work its will in conference! Now, with the prospect that a Republican might win Kennedy's Senate seat--denying Dems their 60th vote-- they're not scoffing anymore . ... Jon Chait is on board with this "Pong" strategy**, which maybe should be officially renamed Sudden Victory (to distinguish it from the standard "ping pong" approach of sending a modified bill back to the Senate). Chait also notes that many of the changes the House would want can be handled later through the "reconciliation" process, which only takes 50 votes (i.e. Pong Plus ). ... kf in December , TNR in January. ...
**-- Update: Shrum too . ... 2:34 P.M.
Truth About Cars hasn't completely lost its bite. It's Detroit Auto Show coverage trashes a) GM CEO Ed Whitacre's strategic dissembling about how the government will "make a lot of money" on its bailout, b) Chrysler's iffy forecasts and absurd new "lifestyle" trim levels (e.g. "Express, Hero, Heat, Crew and Uptown," plus "Detonator" and "Shock"), c) Honda's seeming inability to wring impressive mileage numbers from its hybrids, d) VW's new commitment to blandness , and e) Transpo Secretary Ray LaHood's general public cluelessness . .... P.S.: But they're wrong, so wrong about the looks of the Honda CR-Z 2-seat hybrid . The production version with its pug schnoz is much cuter than the excessively lean-mean concept car. ... 1:20 P.M.
kf is Stumped: Here are two seeming contradictions I haven't quite figured out how to resolve:
1. I admired the "military reform" movement championed by Col. John Boyd, Gary Hart, and James Fallows, which attempted to do more with less money by altering the culture that underlay defense spending. But I'm deeply skeptical of the "delivery reform" movement championed by Peter Orszag and Atul Gawande, which attempts to do more with less money by altering the culture that underlies health care spending. Why would a neoliberal find one proposition compelling but not the other? ...
Possible answers: 1) Military reform promoted a new doctrine for how to achieve the goal of beating the enemy--maneuver warfare (as opposed to attrition warfare). Health care reform proposes no equivalent new strategy, only a different means of pursuing the old strategies. Its military equivalent would be procurement reform, not strategic reform; 2) Maneuver warfare ultimately proved successful at winning wars but not so successful at cutting costs. A lot of the fancy high-tech weapons the military reformers derided turned out to work, especially in a fast-changing "maneuver" context. Now we have to pay for them; 3) All our military has to do is to be able to defeat our enemies. Once we have superiority, there's no reason to pursue ever-more-expensive weaponry. But the purpose of the health care system is to keep people alive--its enemy is, in effect, death, which will never be defeated. We can always do better, and there will always be legitmate reason to pursue ever-more-expensive treatments (which is why all of Gawande's hodge-podge trial-and-error efficiencies , however desirable, won't necessarily compensate for the rising cost of more complex, yet effective, procedures) ...
2. I'm skeptical of the ability of "sunshine" procedural reforms--open meeting requirements, or televised conference committeees, etc.--to actually show voters what is going on. More likely they just drive the real negotiations into an un-televised pre-meeting. But I admit that when you attend an actual debate in Congress, you do learn things. (Examples: During the 1996 welfare reform debate, when Bob Dole accidentally allowed an amendment that essentially restored the welfare entitlement after being assured on the floor by Sen. Chafee that it was non-controversial. Or during the immigration debate of 2007, when Harry Reid tellingly congratulated Sen. Byron Dorgan for pushing the dealbreaking amendment that effectively scuttled the bill.)
Possible explanations: 1) When the outcome is in doubt, Senators have to come to the floor of the Senate to do battle, and because they are adversaries they try to surprise each other in public. It's not all Kabuki. But in most conference committees--like the one the Dems are skipping on health care--the outcome isn't really in doubt. There are just deals to be cut. 2) Floor votes and debates are the only time Senators and Representative are all gathered in one place. Naturally they try to get in a lot of actual business. ....
None of these answers is completely satisfying. Suggestions welcomed. ... 11:18 P.M.
I went to my local Mexican diner and offered to give them a bundled payment to cure my hunger, but they insisted I pay for every dish I ordered under the archaic "fee for taco" model. ... 11:17 P.M.
Honey, Will You Be My Game-Changer?
Maybe the unexcerpted book has more detail. On the other hand, I wouldn't expect Edwards' staffers to tell on themselves, would you? I'd expect them to emphasize that, see, they really had this secret doomsday strategy to save their party should Edwards come close to winning! And sure enough ....
A second failure of the excerpt, at least, is to answer the question "Just how wacky is Elizabeth?" and to get to the heart of her actual personality. True, she's depicted as a snob in heavy denial who flies into inappropriate rages. But is that all? If she's wacky enough , remember, Edwards' decision to take up with another woman may be more explicable, if not excusable. ...
We Remember Jim Johnson!
Rug or punk? You make the call! ... 3:18 P.M.
New research by Edward Pinto, a former chief credit officer for Fannie Mae and a housing expert, has found that from the time Fannie and Freddie began buying risky loans as early as 1993, they routinely misrepresented the mortgages they were acquiring , reporting them as prime when they had characteristics that made them clearly subprime or Alt-A. [ Emphasis added ]
"[A]s early as 1993." Hmm. Doesn't that put this alleged routine misrepresentation well before Designated Fall Guy Franklin Raines' tenure as head of Fannie Mae--and back into the watch of Getting-Away-With-It-Because-I'm-Well-Connected-and- Spread-It-Around Mondale campaign manager and initial Obama veep-vetter Jim Johnson ? I think it does! (Johnson was CEO of Fannie Mae from 1991-1998 .) ... P.S.: 'Misrepresented the mortgages ...." Isn't misrepresenation some kind of, I dunno ... fraud or ... crime ? Even if it was done in an arrogant, misguided attempt to extend the American dream of home ownership down the income scale (which maybe had a side effect of justifyiing the high pay of Fannie Mae executives)? ... Just asking! ... [ via Instapundit ] 3:10 P.M.
If that's what Brit Hume thinks why shouldn't he say it? This is my in-depth analysis of Hume/Woods controversy. Carl Cannon has more context . ... 4:23 P.M.
Did Tom Brokaw read this NYT article before going on Meet the Press and claiming it shows the folly of "what happens at UCLA, where they extend life no matter what the cost?" The article actually badly damages the righteous, self-referencing Dartmouth/Orszag/Leonhardt Cult of Curve-Bending , which holds, a la Brokaw, that high-cost hospitals spend more on Medicare without producing results. a) Did you know that the Dartmouth analysis--contrasting the amount spent by U.C.L.A. in the last six months of life with the smaller amount spent by Mayo in Rochester- -doesn't count the money spent on patients who live ?
It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.
That distinction tends to get lost in the Dartmouth end-of-life analysis , which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive. [E.A.]
And here I thought having patients survive was kind of the whole point. ... b) The NYT 's Abelson gives a cheering example of an instance where U.C.L.A.'s expensive "Hail Mary" worked. ... And Tom Brokaw wouldn't want a doctor who'd throw the Hail Mary? Is there a more benign use of society's resources than throwing medical Hail Mary's? More videogames, maybe? c) Abelson presents several sources of evidence that variations in spending aren't as great as the Dartmouth cult would have it; d) Most important, spending more appears to not necessarily be as wasteful as Orszag and Obama would have us think it is, at least according to one study (commissioned by the expensive California hospitals themselve):
To focus their analysis, the researchers chose to look only at a single category of patients: elderly people with heart failure. The dead would be counted, as Dartmouth does, but so would the living.
What they found seemed to contradict the Dartmouth thesis. The hospital that spent the most on heart failure patients had one-third fewer deaths after six months of an initial hospital stay.
One-third is a huge number, no? ... Yes, the high-cost hospitals paid for the study. But if we're going to start taking things like that into account ...
I'd say Brokaw's comments prove Jack Shafer's point: The biggest corrupting force isn't money, it's consensus--what respectable people believe. These days, they believe the Dartmouth dogma. ... 5:23 P.M.
All the hopes and dreams of the Democratic Party are bound up in the person of one woman: Janet Napolitano! . She must be protected at all costs. ... 2:20 P.M.
The NYT is Peter Orszag's Love Child
C-SPAN BFD: Complaints about the Dems failure to televise or otherwise open up the House/Senate health care negotiations seem near-completely hollow (as were Obama's promises during the campaign). Real legislative deals are always most efficiently cut behind closed doors, where the principals can be candid and concession-minded without fear of embarrassment, and where they can't grandstand. ... That's life. It's not like we don't know what the issues are , or that we won't find out how they've been resolved ....If the Dems let C-SPAN cover the negotiations they'd just have to find another room nearby in which to hold the real negotiations first. ...
In essence, understandably desperate Republicans (aided in this case by MSM reporters looking for a bit of cheap, non-ideological adversarialism ) have now adopted, for tactical reasons, one of the most immature goo-goo liberal fantasies: the idea that "open meetings" on high-profile issues produce actual legislative transparency (as opposed to another layer of fake transparency). Next they'll be complaining the negotiators don't exhibit enough race and gender diversity. ...
Who’d have imagined it? But then, who in the UAW of the 1970s and 80s imagined that GM would one day be bankrupt? Like so many of the internal problems that brought GM down, labor issues were largely a product of GM’s sheer size and dominance in the market. The same arrogance that led GM to squander its technological edge and commitment to quality led GM’s UAW workforce to believe that the gravy train would always be there, and that the primary goal was to get a bigger cut of the pie. That sense of certainty that GM would always be a dominant player in the industry has died hard, but with bankruptcy the lesson seems to have been learned. [E.A.]
This seems like a convenient liberal fallback fantasy: First line of defense --the UAW didn't help bankrupt GM. Second line of defense-- OK, sure, the UAW helped bankrupt GM. But these "labor issues were largely a product" of the attitudes engendered by "GM's sheer size and dominance in the market," not by, say, New Deal-style unionism itself. But wasn't the impending end of GM's dominance clear a couple of decades ago? Why couldn't the spirit of cooperation have effectively taken hold a few months, or even years, before bankruptcy and the resulting bailout? ... Alternative view: GM's labor issues were, and are, largely a product of the labor laws that structure labor relations in America's unionized industries . In other words, the Wagner Act. It will always be less efficient to produce cars in a regime of adversarial negotation and legalistic grievance-filing and rulemaking, especially in an industry where (like virtually all industries these days) you have to be constantly making lots of little changes. If GM somehow survives, and the "gravy train" returns, the Wagner Act will still be there to make sure it goes away again. ... 11:10 P..M.
One day I'll read a persuasive article describing how we can "bend the curve" on health care costs without reducing care. Hasn't happened yet! The latest addition to this massive Archive of the Unconvincing is the NYT's David Leonhardt's piece on what he forthrightly calls "rationing" of medical capacity in Richmond, Virginia . Basically, Virginia limits the number of hosptial beds. South Dakota doesn't. The idea seems to be that without the limits, medical entrepreneurs build more capacity, and then doctors order patients to use that capacity, running up costs without improving care. This would seem to require doctors to order up treatments they should know are flat out not effective--not just cost -ineffective-but that's the argument. So how does the Richmond vs. Dakota comparison come out?
1. In Richmond the number of beds per 1000 residents fell from 4.8 in 1996 to "about three." You would now expect Leonhardt to unleash a string of stats showing that medical care in Richmond has gotten better despite these limits. You would be wrong. Care in Richmond is "better than in most American metroplitan areas," says Leonhardt. OK, but what was it like before? Maybe it was better than nearly every metro area before. Richmond hospitals do a "better-than-average job of treating heart attacks," Leonhardt says. OK, but were they much-better-than-average before? Anyway, that's just heart attacks. ... Oh, and a patient named Janet Binns--actually, a patient's daughter--feels there is "nothing cheap about the care." Well, all right then! ....
But wait a minute:, Leonhardt later notes that "[S]ome of Richmond's hospitals do poorly on Medicare's metrics." But that's "kind of the point," he assures us, because it just proves that Medicare in Richmond is just like the rest of the country. Huh? I thought the point was that Richmond's cuts hadn't reduced the excellent quality of care, not that they'd lowered it to the national average. ... And why doesn't he tell us more about those underperforming "metrics"?
2. South Dakota, meanwhile, lifted its regulatory caps on hospital beds. As a result, a health care company named Bon Secours went on "an expansion binge. ...Suddenly, southeastern South Dakota had vastly more medical capacity than just a few years earlier." You would expect Leonhardt to now demonstrate that all this expensive new medical capacity didn't translate into healthier South Dakotans. You would be wrong. He just drops the subject. For all we know, the Bon Secours spending binge revolutionized prarie health care the way LBJ's rural electrification program revolutionized life in the Texas hill country.
3. Some "doctors and hospitals" told Leonhardt that Virginia regulators had become "lax" in their rationing of hospitals beds recently. You would expect Leonhardt to then demonstrate that this rumored relaxation had in fact happened--with the number of hospital beds per thousand rising, perhaps. You would be wrong . Yet Leonhardt uses the rumored, unsubstantiated laxity to explain why Richmond's "spending growth had ... accelerated" recently. Yikes.The curve is coming unbent! Instead of 39th cheapest in the country, Richmond is now only 69th. But wait--a dozen paragraphs earlier Leonhardt had tried to convince us that rationing worked in Richmond by brandishing the "39th" figure. If that was merely an ephemeral success, why didn't he tell us at the time? Alternative explanation : Rationing works for a while. Then it stops working and costs start rising because it starts to impinge on care (which prompts regulators to become "lax" and allow new facilities).
4. Richmond is one city in Virginia. What's happened in the rest of the state?
5. Some 37 states have a program like Virginia's requiring hopsitals to get permission to add beds, etc. What's happened in those other states?
6. Indeed, if so many states have this program, then isn't it part of the status quo? In other words, it's not "our future." It's our present. Whatever savings the regulations may produce, they are part of the profligate spending curve that Obama confidently tells us he'll bend further .
7. Leonhardt's articles in general would be more convincing if he didn't seem a puppet of the
Orszagist agitprop bureau"Dartmouth researchers" he constantly cites. It's almost as if they're ...I don't know ... feeding him the stats he says he needs. Too bad they didn't feed him some better ones.
kf Prepares for the Pivot!
Willie Brown, Meet Willie Voegeli: From "Willie's World," a column written by former California Assembly Speaker Willie Brown :
Bailout II Watch, Accountability Edition: Back in October, Big Money 's Matthew DeBord saw hope for General Motors, and trouble for Toyota ("the competition"), in the year end sales trends:
At the moment, signs are actually good for the Big Three. All are seeing their U.S. market share increase, while Toyota and Honda are seeing theirs trend down. ...
For GM in particular, this is an important trend. In 2008, it saw a market-share spike at the end of the year (currently, its market share is about 20 percent). [E.A.]
DeBord didn't back down when challenged ("a trend is a trend")--even citing, as evidence of this "trend," the prediction from Edmunds.com that GM's share would "rise to just over 22 percent in October, comparable with its share from a year ago." Truth About Cars and kf scoffed. The results are now in. So who was right?
By my calculations, GM's market share in October was 21%, a point under the Edmunds' prediction. (A point is a big deal in the auto market.) It then fell back to a little over 20%. Over the three months since DeBord's trend-sighting--the last three months of 2009--GM's share has
held steady at about 20.45%. Mighty blunt spike (though a small improvement over the previous lousy quarter).
Meanwhile, Toyota's share didn't trend "down," despite a legitimately damaging can't-turn-off-the-engine scandal . Toyota got 18.1% of the last three month's sales, also a small improvement over the previous quarter (17.5%).
I would say DeBord, grasping at phantom trends, was close to 70% wrong. Your mileage may vary.
P.S.: Grim spikeless long term GM charts available here and here . According to a GM director, the corporation's recovery plans are based on maintaining at least a 19 percent share . So far, that minimal goal has been achieved. (With enough incentives .... ) But there's no promising year-end consumer shift in GM's favor. And Toyota is not in trouble. ... 9:54 P.M.
Proof that, given freedom from heavy-handed regulation and the right human capital infrastructure, the profit-driven hipsters of Silicon Valley can create new bureaucracies just as inane as the government's in a matter of months. ... 9:47 P.M.
The Dems' Rookie Mistake: Achieving Their Goal
You have to wonder whether Congressional Dems, facing the 2010 midterms, realize they've in effect made the rookie Washington lobbyists' mistake of getting their big bill passed in one year when they could have taken two or three. After February, if all goes according to expectations, they'll more or less have done a lot of the job they were elected to do.** After that, who needs them? ***
Look at the way various groups can be expected to react to the health care victory:
A-- Will old people be happy? No, they're kind of pissed off.
B-- Will young people be happy? Well, they're getting targeted by the mandate to buy insurance and milked by community rating to make the system solvent. So maybe not.
C-- Will opponents of the bill like it? Obviously not. They will turn out.
D-- Will supporters of the bill like it? Two subgroups here: i) Those who wanted more (like a public option or single payer) are disappointed and maybe angry and demoralized. But at least they have a good reason to show up at the polls (to elect liberals who will help them achieve what they want). ii) Those who didn't necesarily want more-- who are happy with the Pelosi/Reid product-- have far less incentive to show up . For them, the deed is done. Unless, that is, Dems can somehow bait the Republicans into making repeal of Reid/Pelosi a hard-core pledge. ****...
I still expect the Democrats will hold the House and Senate , simply because (in part thanks to the Feiler Faster principle ) the entire health care issue will seem like less of a big deal by November. But when you think about it in this category-by-category way, the outlook is kind of grim for the Dems, no? ....
P.S.--BREAKING! Wait, a nice, constructive debate over amnesty for illegal immigrants will save them. ....
**--There is the pattern: Once Democrats have established key, long-demanded institutions--Social Security, Unemployment Compensation, Medicare--voters are then quite happy to elect Republicans--Eisenhower, Nixon, Reagan--to run the resulting, larger government. They're especially happy to do it once it's clear the Republicans won't tamper with the basic structure. (A semi-exception is AFDC-welfare, where voters never demanded, and in fact hated, the basic structure--giving no-strings cash to single parents who could work.)
***--If they'd gone the Medicare buy-in route, by way of contrast, the Dems could have lowered the entry age by two years or so every session--all the while pledging to lower it another two years or ten years if they were returned to power. Cover and cover, expand and expand, elect and elect. ...
****--I suppose that, in the welfare reform debate of 1996, pro-reformers should have worried that Newt Gingrich's Republicans would wake up and realize that once they'd ended the AFDC entitlement, they'd have lost their main argument against the "failed liberal welfare state"--and the main reason for voters to reelect them . Luckily the Gingrichian combination of principle and hubris was sufficient to preclude this realization. ... Also welfare reform was a) way more popular than the Dems' current health care reform (in other words, group D above was something like 70% of the electorate) and b) completed much closer to the election--thereby maximizing any tendency of "D (ii)" voters to sentimentally and somewhat irrationally reward those who'd achieved it after the fact. ... Also c) it wasn't immediately clear that the Dems wouldn't unreform welfare if they got their Congressional majorities back. (They still might, of course. But the threat at least appears to have receded.) ... 10:10 P.M.