Succession Politics and Health Care Reform

In Nick's post about Ted Kennedy's torch passing to Obama, he wrote that the late senator's seat would be empty for nearly six months while a special election is organized "unless Massachusetts Dems change the law." Reports out of the state capital suggest that may happen when the Massachusetts legislature returns to session.

Up until 2004, the state did not require special elections to fill mid-term Senate vacancies. John Kerry's campaign for the presidency prompted Massachusetts Democrats, who feared that then-Governor Mitt Romney would appoint a Republican if Sen. Kerry prevailed, to require elections be held no sooner than 145 and no later than 160 days after a Senate seat is vacated. As Nick noted, one missing vote from the reliably Democratic state of Massachusetts could effectively endanger the passage of health care reform in the filibuster-fearing Senate.

On July 2nd, aware of this impediment to his succession at such a critical time, Kennedy wrote Massachusetts state lawmakers asking them to replace him quickly on his death. The New York Times observed that, "Though he did not cite any issues specifically, his note was viewed as an acknowledgment that his absence would leave uncertain… the essence and fate of health care reform, his most cherished legislative goal."

It is increasingly looking like Massachusetts' lawmakers may honor the late senator's dying plea. Yesterday, the Boston Globe reported that state Senate President Therese Murray, "who had privately expressed quite vehement opposition" to Kennedy's request, may have changed her mind. Today, Governor Deval Patrick announced his support for Kennedy's plan, citing "the momentous change legislation that is pending in the Congress today."

No one will know for certain how the state legislature will address the succession issue until they return from recess after Labor Day, but this is certainly one ray of light for advocates of health care reform on an otherwise dark day.

The Placebo Effect

In Wired, Steve Silberman writes about the well-known placebo effect: sometimes a sugar pill all by itself can help cure a disease or reduce its symptoms.  That's why it's not enough for drugs in clinical trials to work.  They have to work better than a placebo.

The placebo effect is mysterious enough on its own.  But there's more.  It turns out that placebos work better in some countries than other others.  It also turns out that ratings by trial observers vary significantly from one testing site to another.  But what's most mysterious is that the placebo effect actually seems to be getting stronger over time. Not only are new drugs having a harder and harder time beating out placebos, but older drugs that have been retested are having problems too:

In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.

....But why would the placebo effect seem to be getting stronger worldwide? Part of the answer may be found in the drug industry's own success in marketing its products.  Potential trial volunteers in the US have been deluged with ads for prescription medications since 1997, when the FDA amended its policy on direct-to-consumer advertising. The secret of running an effective campaign, Saatchi & Saatchi's Jim Joseph told a trade journal last year, is associating a particular brand-name medication with other aspects of life that promote peace of mind: "Is it time with your children? Is it a good book curled up on the couch? Is it your favorite television show? Is it a little purple pill that helps you get rid of acid reflux?" By evoking such uplifting associations, researchers say, the ads set up the kind of expectations that induce a formidable placebo response.

Unfortunately, that's about it.  The mystery of the increased response to placebos remains a mystery.  No one really knows why it's happening.  But it's all pretty fascinating anyway, and the whole piece is well worth a read.

Grassley's Problem

Chuck Grassly is in no danger of not being reelected.  So why is he being so bad-tempered about healthcare reform?  Ezra Klein says it's because he's under tremendous pressure from his fellow Republicans, who have the power to punish him if he supports a Democratic healthcare bill:

This is the final year that Grassley is eligible to serve as ranking member — the most powerful minority member, and, if Republicans retake the Senate, the chairman — of the Senate Finance Committee. His hope is to move over as ranking member of the Judiciary Committee, or failing that, the Budget Committee. But for that, he needs the support of his fellow Republicans. And if he undercuts them on health-care reform, they will yank that support. It's much the same play they ran against Arlen Specter a couple of years back, threatening to deny him his chairmanship of — again — the Judiciary Committee. It worked then, and there's no reason to think it won't work now.

This kind of discipline is normal in a parliamentary system where everyone on both sides is expected to support the party line.  But that discipline is the flip side of a system in which the majority party has the power to turn its campaign platform into law using only its own votes.

You really can't have one without the other.  If you have an intensely whip-based system, in which the opposition party is expected to oppose unanimously, then the majority party has to have to power to govern using only its own majority.  Conversely, if you have a system in which legislation only passes if party members cross lines, then discipline necessarily needs to be weak.

Not to be tedious about this, but this is yet another example of how Congress has become schizophrenic in the age of the routine filibuster.  We either need a system in which the majority rules, or we need a system in which party members cross lines to form temporary alliances.  Right now we have neither.

UPDATE: Via email from reader Thomas F.:

AAAARRRRGGGG!!!!

Grassley does not want health care reform. Grassley does not want health care reform. Grassley does not want health care reform.

As a result, he does not have a problem. He will string this along in the service of his very very very conservative ideology and in service of the Republican party. But he will not support or vote for it in the end, and he will participate in the Gang of Six only as a way to slow legislative progress as a tool to derail the whole thing.

This might go a wee bit too far, but point taken.  I was using Ezra's post as an excuse to blather about the filibuster, but I probably shouldn't have let his implicit Grassley appraisal stand without comment.

Kennedy Funeral: "Wellstone Memorial on Steroids"?

There's been a lot of speculation that the death of Teddy Kennedy will somehow make passing health care reform easier by pulling at Republican senators' heartstrings. This is wishful thinking, and it's not going to happen.

The crucial example in this case is the death of progressive giant Paul Wellstone just before the 2002 election. Wellstone's memorial service was a sort of rally, a tribute to the life he led and the causes he so passionately supported. It was liberal and political. It was, presumably, as he would have wanted. But Republicans slammed the memorial, criticizing its "politicization." (One of the speakers who "politicized" the event was Wellstone's son, Mark.)

Conservatives are already starting to warn that Kennedy's funeral will be a "Wellstone memorial on steroids," as Instapundit wrote. Al Franken, who now holds Wellstone's senate seat, wrote a chapter in his book Lies and the Lying Liars Who Tell Them about the memorial. In a piece about similar dynamics surrounding Coretta Scott King's funeral in 2006, Franken explained:

The chapter was mainly about how cynically Republicans used the memorial politically as they complained that the Democrats had used it politically. And how the mainstream media, many of whom had neither attended the memorial nor seen it on TV, bought into the Republican spin.

Mainly, there was a lot of lying. Rush Limbaugh claimed that the audience was "planted," when, in fact, Twin Cities' radio and TV had to tell people to stay away because Williams Arena was jammed to capacity three hours before the Memorial was scheduled to begin. Thousands were crowded into an overflow gym to watch on a screen and thousands watched outside on a cold, late October night.

A pained Limbaugh asked his audience the day after the memorial: "Where was the grief? Where were the tears? Where was the memorial service? There wasn't any of this!"

This was a lie. I was there. Along with everyone else, I cried, I laughed, I cheered. It was, to my mind, a beautiful four-hour memorial.

[...]

It was the Republicans that tried to cheapen Paul Wellstone's life by dishonoring his death. It was the right-wing media, not the friends and family who spoke at the memorial or the people who came to it, that seized an opportunity to use a tragedy for political gain.

Now Ted Kennedy isn't even buried and you can see the same narrative reemerging. I wrote below that Kennedy's funeral will be an important moment in the history of the Democratic party and the nation. It's true. Democrats, especially the president, are going to face a choice on that day. Will they confine their eulogies and their speeches to talking about Teddy's life? Or will they talk about what Teddy lived for: Democratic politics, liberal policies, and making people's lives better. If it's the latter, they better be ready. Because if President Obama goes out and says the obvious: that the best way to honor Ted Kennedy's life is to complete his quest for health care reform, you'll hear the inevitable holier-than-thou criticism from the right: "How dare you politicize something like this!" 

When it's politically convenient, the Norm Colemans and Rush Limbaughs of the world like to pretend they are the protectors of the legacies of the Ted Kennedys and Paul Wellstones and Coretta Scott Kings of the world. But Norm Coleman was no Paul Wellstone, and the people who will be telling you to "be respectful" and ignore Ted Kennedy's most closely-held beliefs and values are sure as heck no Ted Kennedys. Don't believe it for a minute. 

The Unsung (And Singing) Ted Kennedy

Back in March, Sen. Ted Kennedy’s family and friends organized a private 77th birthday gala for him, appropriately held at the Kennedy Center in DC. It was a star-studded affair. Bill Cosby was master of ceremonies, and all of Kennedy's favorite Irish tenors and Broadway crooners showed up to serenade him. (Apparently, Kennedy was such a huge fan of show tunes and Irish music that his wife gave him singing lessons a few years back so he could better belt out Wild Irish Rose, a video of which was presented during the event.) President Obama made a surprise appearance as the grand finale.

I was there as part of the community gospel choir doing some back up numbers and performing the big rousing patriotic tribute to Kennedy at the end. The man who organized the choir and composed the tribute to Kennedy was the incredibly talented young African-American minister Rev. Nolan Williams, the music minister of the Metropolitan Baptist Church in DC. Kennedy and his wife Vicki had befriended Williams a few years ago after Kennedy asked Williams to accompany him on his regular visits to Walter Reed Army Medical Center to help bolster the spirits of the wounded troops.

Williams told us during one choir practice that he and Kennedy had been making these visits for several years, which was one reason Kennedy’s family had tapped Williams to choreograph the big gospel production at Kennedy's birthday party. What I found touching about the story was that Williams said Kennedy's visits to Walter Reed were never publicized. The country's most famous senator regularly went to the run-down military hospital without the cameras to show his support for the people who had fought in a war he never supported. It was an authentic expression of patriotism and seemed to say a lot about who Kennedy was and why he will be so so sorely missed in American political life.

Durable Goods

This is a little bit confusing.  Durable goods orders were up in July, but it turns out it was mostly because Boeing had a good month:

As encouraging as the report appeared at first glance, it also suggested businesses were still cutting back. Orders for non-defense capital goods excluding aircraft, a barometer of business investment, fell 0.3 percent in July after rising 3.6 percent in June. New orders for computers and related products fell 2.8 percent after rising 0.5 percent in June.

The report today is likely to bolster the view, shared by a growing number of economists, that the recession is winding down or has already ended. It was further proof the manufacturing sector has begun to stabilize as businesses start to restock. Businesses had been slashing inventories for months as they tried to catch up with falling demand.

Aside from commercial jets, orders for durable goods fell 0.3% after rising in June, which "suggested businesses were still cutting back."  But three sentences later this bolsters the view that the recession is winding down.  What am I missing?

Where Do We Go From Here?

Conceding the race for the Democratic presidential nomination in 1980, Edward Kennedy told the delegates at the Democratic National Convention:

We cannot have a fair prosperity in isolation from a fair society. So I will continue to stand for a national health insurance. We must—we must not surrender—we must not surrender to the relentless medical inflation that can bankrupt almost anyone and that may soon break the budgets of government at every level. Let us insist on real controls over what doctors and hospitals can charge, and let us resolve that the state of a family's health shall never depend on the size of a family's wealth.

The president, the vice-president, the members of Congress have a medical plan that meets their needs in full, and whenever senators and representatives catch a little cold, the Capitol physician will see them immediately, treat them promptly, fill a prescription on the spot. We do not get a bill even if we ask for it, and when do you think was the last time a member of Congress asked for a bill from the federal government? And I say again, as I have before, if health insurance is good enough for the president, the vice-president, the Congress of the United States, then it's good enough for you and every family in America.

Nearly 30 years later, that dream—of health insurance for every American—is still unfulfilled, and now Kennedy won't be around to lend his considerable political heft to the continuing debate. His seat in the senate will be empty for six months before Massachusetts can hold a special election to fill it. (Unless Massachusetts Dems change the law.) The Democrats will have 59 votes (if the ailing Robert Byrd is healthy enough) in the Senate, and the Republicans will be able to filibuster anything and everything they want. When the seat's finally filled, it'll be well into 2010, an election year. No one expects sweeping health care reform to be passed in an election year.

Even without Kennedy, the Democrats are at a high-water mark in their political power. For sixty years, the party has tried and failed to bring health care to all Americans. Everyone, inside and outside the party, thinks this year may be health care reform's best chance yet. If Senate Republicans stand firm and filibuster, Democrats' only option to pass health care will be the budget reconciliation process—a parliamentary maneuver that would allow them to pass a bill with a simple majority. Will the Democrats muster the courage to move forward through reconciliation, even in the face of what are sure to be fierce protests from their GOP colleagues?

During the election campaign last year, Teddy and most of the rest of the Kennedy clan made a big show of passing the family torch to Barack Obama. "This November, the torch will be passed again to a new generation of Americans, so with Barack Obama, for you and for me, our country will be committed to his cause. The work begins anew, the hope rises again and the dream lives on," Kennedy told the delegates at the Democratic National Convention.

Can Obama bear the burden? His style is not Kennedy's—he's more careful, more moderate, less emotional. Obama can sure give a speech, but it's not a Ted Kennedy speech. Obama talks about common sense and working together and bipartisanship. Teddy spoke about doing the right thing. As the Boston Globe's Charlie Pierce wrote in 2003, Kennedy's best speeches were eulogies—his greatest from the pulpit of St. Patrick's Cathedral in New York, over Bobby's coffin, "in a voice like that of someone choking on blood":

My brother need not be idealized, or enlarged in death beyond what he was in life; to be remembered simply as a good and decent man, who saw wrong and tried to right it, saw suffering and tried to heal it, saw war and tried to stop it.

Those of us who loved him and who take him to his rest today, pray that what he was to us and what he wished for others will some day come to pass for all the world.

As he said many times, in many parts of this nation, to those he touched and who sought to touch him: "Some men see things as they are and say why. I dream things that never were and say why not."

Teddy Kennedy's funeral will be a huge moment in the history of the Democratic party and the nation. What will his chosen torchbearer say about him? And how will he carry forward Kennedy's legacy?

Ted Kennedy Links

Edward Kennedy died today.

Joe Biden: "I was talking to Vicki this morning, and she said, 'he was ready to go, Joe.' But we were not ready to let him go."

Ted Kennedy and the Future of Liberalism

Ted Kennedy, who died late yesterday, was much, much more than the Liberal Lion of the Senate. He was all we had left. Even in sickness, he was the anchor for decent health care reform. He was the one man in Congress who could pull quarreling politicians into a united effort. (John McCain and Orrin Hatch were Kennedy best friends.)

We are left with weak, squabbling, visionless Democratic puppets and a President whose domestic reform policies are adrift—sliding towards the horizon with each passing day. The lost battle for Afghanistan. Seriously. The British. Then the Soviets. Now us. The phony victory on Wall Street, one bubble replacing another; health care in the hands of right wing screwballs at the town meetings. The very idea that Obama, amidst the rightwing anger of the town meetings, and with health care reform in flux, is vacationing on a huge estate at Martha Vineyard with the wealthiest of the wealthy, is smack out of the George Bush playbook.

So, without Kennedy, even as a shadow in the background, who will it be for health care reform? Max Baucus, pawn of the health care industry? Christopher Dodd, bag man for Wall Street? Lieberman, turncoat? Harry Reid?

To be sure there are decent senators—Dorgan,Conrad, Rockefeller, Levin, Harkin, Leahy. None of them with the knowledge, experience, and political acumen of Kennedy, though.

The flag will be at half mast across the country today. Not on Wall Street, where as the sun goes over the yardarm, you’ll be hearing the popping of corks.

This post first appeared on James Ridgeway's blog, Unsilent Generation.

The Importance of Sleep Deprivation

Yesterday, Andrew Sullivan highlighted this passage from the 2007 OLC opinion on interrogation techniques (PDF):Andrew writes that the "interrogators seem to have had an affinity for sleep deprivation." Indeed. That's probably because sleep deprivation was utterly central to America's torture program. It doesn't sound too bad when you just say it, right? Sleep deprivation? Everyone's pulled an all-nighter once or twice. A third of Americans don't get enough sleep. It's especially easy to play down sleep deprivation when you're someone like Joe "they do it in fraternities" Scarborough. The reality of course, is totally different: fraternities don't keep you awake for up to 11 days, standing, in shackles, in solitary confinement, in diapers, on reduced, liquid rations. They don't kill you, either: 

In conjunction with other pressures... irregular sleep could have serious consequences. "In December 2002, two detainees were killed" while incarcerated at a facility in Bagram, Afghanistan," according to the Senate report. "Investigators concluded that the use of stress positions and sleep deprivation combined with other mistreatment at the hands of Bagram personnel, caused or were direct contributing factors in the two homicides."

You can learn a lot more about the CIA's use of sleep deprivation from this Spencer Ackerman article and this Wired piece. This quote (linked by Sullivan back in 2006) from former Israeli prime minister Menachem Begin, who faced sleep deprivation in the Gulag, also hits home:

[A person subjected to sleep deprivation feels] wearied to death, his legs are unsteady, and he has one sole desire to sleep, to sleep just a little, not to get up, to lie, to rest, to forget ... Anyone who has experienced the desire knows that not even hunger or thirst are comparable it with it.

If starving prisoners is unacceptable, how can depriving them of sleep somehow be okay?