Kevin Drum

The Politics of Opt-Out

| Tue Oct. 27, 2009 3:03 PM EDT

Andrew Sullivan thinks the "opt-out" public option is a piece of political genius.  Imagine, he says, what happens next if it passes:

Well, there has to be a debate in every state in which Republicans, where they hold a majority or the governorship, will presumably decide to deny their own voters the option to get a cheaper health insurance plan. When others in other states can get such a plan, will there not be pressure on the GOP to help their own base? Won't Bill O'Reilly's gaffe — when he said what he believed rather than what Roger Ailes wants him to say — be salient? Won't many people — many Republican voters — actually ask: why can't I have what they're having?

....Imagine Republicans in state legislatures having to argue and posture against an affordable health insurance plan for the folks, as O'Reilly calls them, while evil liberals provide it elsewhere. Now, of course, if the public option is a disaster in some states, this argument could work in the long run. But in the short run? It's political nightmare for the right as it is currently constituted. In fact, I can see a public option becoming the equivalent of Medicare in the public psyche if it works as it should. Try running against Medicare.

I was mulling over the exact same scenario last night and couldn't quite make up my mind about how this would play out.  In the end, though, I think Andrew's argument is pretty compelling.  As Rich Lowry complained over at The Corner, "Does a state get to opt-out of the taxes too?"  That's technically a moot point if the public option is truly self-funding, but in the reality of the political world it's powerful whether it makes sense or not.  It's like Republican governors turning down stimulus money: it sounds good on the stump, but who's going to do it in the real world?  It's crazy if you're paying for it anyway.

So yes, this could be a huge winner.  If it passes, then for the next four years Republican state legislators all over the country will be teaming up with the universally loathed insurance industry to try and deny their citizens access to a program that, to most of them, sounds like a pretty good deal.  I don't know if Harry Reid was deviously thinking exactly that thought when he decided on this, but I'll bet someone was.  It's hard to think of something that could force the GOP to make itself even more unpopular than it already is, but this might be it.

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The High Cost of Technology

| Tue Oct. 27, 2009 2:25 PM EDT

Ezra Klein quotes Kaiser Permanente CEO George Halvorson on the cost of healthcare:

The point is that CT scans in this country cost a multiple of what everyone else pays. It costs a few hundred dollars in Europe and over $15,000 here. You can't find a place in Europe than costs $15,000. You can't find a place here that costs less than $15,000. Anyone who is looking at the cost of care and is not looking at the unit cost of care is missing the point. ... To have a health care debate in this country that isn't aware of the price differential is not an informed debate.

Hmmm.  This doesn't sound quite right.  CT scan prices vary depending on the procedure, but in general they seem to range from around one thousand to a few thousand dollars.  $15,000 seems like a stretch.

Still, CT scans and MRIs do cost a lot more here than overseas — upwards of 5x as much in some cases.  Why is this?  I sort of understand why doctors are paid more here and why prescription drugs cost more.  But a CT machine is a CT machine.  Siemens sells them for the same price in the U.S. as in Europe, don't they?  So what accounts for the fantastic cost difference?  And why don't insurance companies bargain the price down?  This really does seem to be a little more mysterious than high physician salaries and high drug costs.

Valley-ism

| Tue Oct. 27, 2009 1:31 PM EDT

The Washington Post has a big story today about Matthew Hoh, a former Marine who served in Iraq and then joined the Foreign Service earlier this year to work in Afghanistan.  He resigned last month after becoming disillusioned with the war.

First off, here's the basic timeline of Hoh's service:

He arrived in Zabul following two months in a civilian staff job at the military brigade headquarters in Jalalabad, in eastern Afghanistan. It was in Jalalabad that his doubts started to form....By the time Hoh arrived at the U.S. military-run provincial reconstruction team (PRT) in the Zabul capital of Qalat [in July], he said, "I already had a lot of frustration. But I knew at that point, the new administration was . . . going to do things differently. So I thought I'd give it another chance."

I confess that this makes me a little skeptical about the whole story.  Hoh "already had a lot of frustration" after two months?  And he quit two months after that?  Unless Hoh is the fastest learner on the planet, that really doesn't seem like enough time to get very far up the learning curve.

Still, everybody the Post talked to has a ton of respect for the guy, and his critique is pretty simple and specific:

Hoh was assigned to research the response to a question asked by Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, during an April visit. Mullen wanted to know why the U.S. military had been operating for years in the Korengal Valley, an isolated spot near Afghanistan's eastern border with Pakistan where a number of Americans had been killed. Hoh concluded that there was no good reason. The people of Korengal didn't want them; the insurgency appeared to have arrived in strength only after the Americans did, and the battle between the two forces had achieved only a bloody stalemate.

Korengal and other areas, he said, taught him "how localized the insurgency was. I didn't realize that a group in this valley here has no connection with an insurgent group two kilometers away." Hundreds, maybe thousands, of groups across Afghanistan, he decided, had few ideological ties to the Taliban but took its money to fight the foreign intruders and maintain their own local power bases.

"That's really what kind of shook me," he said. "I thought it was more nationalistic. But it's localism. I would call it valley-ism."

Hmmm.  Afghanistan was a tribal region in the 90s too, but the Taliban still managed to take over a pretty big chunk of the country and provide al-Qaeda with an operating base.  Valleyism won't necessarily keep that from happening again.

Still, Hoh's evaluation is pretty orthodox.  I basically think he's right, and apparently so does Richard Holbrooke, who told the Post, "I agreed with much of his analysis."  What's less clear is what he thinks we ought to do about it.  So I'd be interested in hearing more from serious Afghanistan bloggers and analysts: Is Hoh right?  And if so, what's the answer?

The Anti-Denialism Deniers

| Tue Oct. 27, 2009 12:25 PM EDT

In the LA Times today, Jonah Goldberg takes on the global warming movement:

The push in Congress for a huge new carbon tax is a dangerous farce. Yes, it's true that CO2 levels and global temperatures have risen since the Industrial Revolution, and that's something to take seriously. But the political reality is that truly meaningful global restrictions on CO2 emissions in the near future simply will not happen, and pretending otherwise is a waste of time, money and political capital.

....That's the case Steven D. Levitt and Stephen J. Dubner make in their book, "SuperFreakonomics," which is already being torn apart by environmentalists horrified at the notion they might lose their license to Get Things Done as they see fit.

Is the atmosphere getting too hot? Cool it down by reflecting away more sunlight. The ocean's getting too acidic? Give it some antacid.

The technology's not ready. But pursuing it for a couple of decades will cost pennies compared with carbon rationing.

I've read a million anti-warming diatribes in the past few years, but something about this one irritated me more than usual.  I think it was the desperately flip tone.  Goldberg clearly doesn't want to be part of the outright denialist school — they're a wee bit too vulgar, I suppose — but he wants to deny nevertheless.  So he tosses out a few jokes, takes on the weakest possible arguments for addressing climate change (they want to kill your dog!), and then latches on to Levitt and Dubner's new book as a supposedly sober and scientific way of advocating total inaction.  Never mind that Levitt and Dubner themselves, as well as everyone quoted in their book, has stated clearly that CO2 reduction is essential, should be pursued with vigor, and that geoengineering research should be done in addition to, not instead of, greenhouse gas reductions.

And this, whether or not Levitt and Dubner intended it, is the problem with their book.  They may include sentences here and there implying that geoengineering is a last resort, not a first one, but that's very clearly not the lesson most people have taken away from their discussion.  The lesson most people have taken away is the one that Goldberg obviously took: we should throw a few billion dollars into 18-mile sulfate tubes, stop worrying about global warming, and get back to business.  L&D really owed it to their readers not to allow anyone to reasonably leave with that interpretation.

As for Goldberg, he wonders somberly why public belief in global warming has declined lately and decides (natch) that it's the Democrats' fault for actually trying to do something about it.  The fact that his side of the aisle has waged a blistering, no-holds-barred denialism war for the past few years apparently has nothing to do with it.  But he should be more willing to take credit for a job well done.  Conservatives hate international treaties, they hate business regulations of any kind, and they hate Al Gore.  Convincing the public that global warming is just a liberal fraud is sort of a trifecta for them.  Nice work.

Quote of the Day

| Tue Oct. 27, 2009 11:16 AM EDT

From Jon Kingsdale, director of the Massachusetts health insurance exchange, on reining in healthcare spending in America:

If you're going to do health-care cost containment, it's going to have to be stealth. It's going to have to happen before any of the players understand what's happening.

Well, either stealth or main force, anyway.  If the former doesn't work, eventually we'll resort to the latter whether anyone likes it or not.

Nyah Nyah Nyah

| Mon Oct. 26, 2009 9:12 PM EDT

Getting in one last lick before the great Fox War becomes yesterday's news, Mickey Kaus follows up today on his earlier blog post about Fox News' lack of independence:

I argued that I have no faith that Roger Ailes didn't take direction from the Bush White House. The most sophisticated response I've gotten is, in effect, 'Sure he did. But you don't think Rick Kaplan at CNN took direction from the Clinton White House?' I don't know about Kaplan. But Kaplan only ran CNN for three years or so — just passing through. Roger Ailes pretty much is Fox News. The network has never existed without him.

Seriously?  This was the most sophisticated rebuttal he got?  That's pathetic.  Conservatives really need to step up their game.

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A Wee Question

| Mon Oct. 26, 2009 8:19 PM EDT

Can someone please explain to me why a supposedly sophisticated magazine like the Economist continues to insist on the juvenile practice of refusing to byline blog posts?  I know, I know, voice of God blah blah blah.  But seriously.  Isn't it time to grow up and enter the 21st century?  After all, the whole point of the blog format is to highlight personal voices.  I know I'd link to them more often if I knew who I was conversing with.

Stop Digging

| Mon Oct. 26, 2009 6:46 PM EDT

The latest story from those pilots who overshot Minneapolis is that they had their laptops out and got so absorbed in what they were doing that they lost track of time.  Private pilot James Fallows isn't buying it:

The difficulty for the pilots is that the version of the story they're resisting — that they simply fell asleep — is less damning for them than any alternative version. If they fell asleep, that's bad, but they could argue some kind of force majeure. But if their "heated conversation" (previous story) or intense laptop use (current story) kept them from remembering their most elemental responsibility as pilots, that really is beyond the pale. The closest comparison would be, say, to an operating-room crew that got so interested in watching a football game on TV that they sliced open a patient but forgot to take out his appendix. Forgetting where you are going is incredible enough on its own. And not having any back-of-mind nag saying, "Wait a minute, we haven't heard anything on the air-traffic control frequency for a while" also is outside any known experience of the professional flight-crew world.

The laptop story really, really doesn't hold water.  Air traffic controllers tried to reach them repeatedly with no success, and there's just no way that busily reviewing flight schedules could have absorbed them so fully that they didn't even hear their radio.  These guys need to remember the first lesson about what to do when you find yourself in a hole: stop digging.

Opt-Out Noses Ahead of Trigger at the Wire

| Mon Oct. 26, 2009 5:16 PM EDT

Last Friday it looked like the most likely compromise on including a public option in the healthcare bill was Olympia Snowe's "trigger." But either that was just a feint or else everyone changed their minds over the weekend:

The Senate health care legislation will include a government-run insurance plan, but states would be allowed to “opt out” of it, the majority leader, Harry Reid of Nevada, announced Monday afternoon.

....“Under this concept, states will be able to determine whether the public option works well for them and will have the ability to opt out if they so choose. I believe that a public option can achieve the goal of bringing meaningful reform to our broken system.”

Snowe has announced that she won't support this, so that means Republicans are now unanimously opposed to healthcare reform. It can still pass, but only if the Democratic caucus is unanimously willing to allow a floor vote.  Needless to say, this is still up in the air.  Fasten your seatbelts.

15 Years to Go

| Mon Oct. 26, 2009 2:16 PM EDT

Josh Marshall:

It's news to no one that physical, print newspapers are in the throes of a historic decline. But the numbers themselves really take your breath away when you see them. According to the Audit Bureau, daily circulation fell 10.6% year over year in the period between April to September.

Ad revenues are one thing; and they're likely enough to be fatal to newspapers as the dominant mode of news distribution in the country. But that figures in economic trends of various sorts. But readership, while obviously intimately related, is a different sort of metric. I have many thoughts on this. But at the moment I'm not sure what to say other than those numbers take my breath away. A ten percent decline year over year is the rate of a mode of distribution going out of existence.

A few years ago I was on a panel discussion and the moderator asked us all how long newspapers distributed on newsprint would last in the United States.  My guess was 20 years: that is, the last newspaper in the country would shut its doors in 2025.

That's now looking pretty optimistic: a lot of people these days seem to think that 2012 is more like it, and today's news won't do anything to change their minds.  At the same time, there are various ways you can look at that 10% drop, and one of them is simply that the recession has condensed several years of decline into a single year.  A $500 newspaper subscription is a prime candidate to get sliced out of the family budget when times are tough and news can be found everywhere.  So maybe all that's happening is that a cohort of the least dedicated readers are leaving all at once, and when the recession starts to lift newspaper circulations will begin to stabilize a bit.  Or at least decline more slowly.

Maybe.  I'm not sure what I think anymore.  On the one hand, there's a generational attachment to newspapers that just won't go away as fast as people think.  (People routinely underestimate generational attachments.  But the fact is that they only truly go away when generations die out, and that takes a while.)  On the other hand, there really does seem to be a tipping point issue here: as circulations decline, and newspapers respond by cutting back staff, the quality of the product spirals down.  That's a vicious cycle, and there's a point at which the quality deteriorates so fast and so hard that even old newspaper diehards just don't want to bother anymore.  I'm pretty far along the diehard continuum myself, but the deterioration of the LA Times is so obvious these days that even I'm not sure how much longer I really feel like paying for it.  We'll see.

In any case, I guess I'll stick with 2025 for now.  There may be small local papers around for longer than that, but no big city dailies.  New York will be the last to go, but in fifteen years newspapers will be a thing of the past even there.