The Real Barack Obama

Our story so far: Democrats offer up a bipartisan proposal to fund advance care counseling and Republicans turn it into a plan to create death panels.  Democrats agree to fund home nurse care and Republicans tar it as a secular brainwashing program.  Democrats take Republican concerns about cost containment seriously by setting up the Independent Medicare Advisory Council and Republicans start screaming about "rationing."  Democrats give in on a public option and accept a co-op program in its place and Republicans dig in and finally announce that they're just going to oppose everything no matter what Democrats do.

The White House has taken notice:

Given hardening Republican opposition to Congressional health care proposals, Democrats now say they see little chance of the minority’s cooperation in approving any overhaul, and are increasingly focused on drawing support for a final plan from within their own ranks.

....Rahm Emanuel, the White House chief of staff, said the heated opposition was evidence that Republicans had made a political calculation to draw a line against any health care changes, the latest in a string of major administration proposals that Republicans have opposed.

“The Republican leadership,” Mr. Emanuel said, “has made a strategic decision that defeating President Obama’s health care proposal is more important for their political goals than solving the health insurance problems that Americans face every day.”

OK then.  Obviously Emanuel said this with presidential approval, so the question is: did Obama ever expect anything different?  Was his calm, deliberative, bipartisan sales pitch genuine, or did he know it would fail all along?

We've been asking this question ever since the primaries — does he really believe he can sweet talk Republicans into cooperating with him? — and we still don't know the answer.  Obama is a guy who plays his cards very close to his chest.  But the next couple of months should give us a clue.  If he really believed it, then he probably doesn't have much of a Plan B and the next stop for this train is Chaosville.  But if it was mostly an act, then his next step is obvious: he'll make a barnstorming public case that he made a good faith effort to work with Republicans but they were just completely intransigent.  He'll attack them mercilessly and do everything he can to whip public opinion into a lather against the obstinate, obstructionist, reactionary GOP.

If that was his plan all along, it wouldn't be a bad one.  He correctly divined a long time ago that the American public was weary of endless partisan fighting and wanted a break, and he rode that insight to victory.  Regardless of his own beliefs, then, it meant he had to start his presidency by demonstrating a genuine effort to work across the aisle, and he had to keep it up long enough to show he was serious.  Only if it plainly failed would he be able to turn the screws and start fighting on pure partisan lines.

Will it work?  Stay tuned.

Novak, Corn, and Plamegate

At the time, Robert Novak couldn't have know that, despite a half century of covering Washington, one little line would ignite the scandal that would come to dominate his legacy: "Wilson never worked for the CIA, but his wife, Valerie Plame, is an agency operative on weapons of mass destruction." Following the conservative columnist's death yesterday at the age of 78, mentions of his role in outing the CIA operative were ubiquitous in the numerous obits commemorating his life.

Our DC bureau chief, David Corn, played a unique role in the Plamegate saga, too. Then working for the Nation, he was the first to raise the possibility that Bush administration officials, bent on smearing diplomat Joseph Wilson, had broken the law by leaking the identity of Wilson's wife. Let's just say that David's role in breaking this news did not endear to him Novak, with whom he'd enjoyed a friendly enough relationship over the years. Over at Politics Daily, David recalls his interactions with Novak pre- and-post Plamegate:

I learned of the death of Bob Novak from an e-mail sent to me by an NPR reporter looking for a comment. And I felt awkward, for my last public exchange with the conservative columnist and TV pundit who relished his "Prince of Darkness" nickname had been an ugly one. There is, of course, the don't-speak-ill-of-the-dead rule. But what could I say about a fellow who had blasted me on national television as an ideological hack?

There wasn't always bad blood between us. Years earlier, as a substitute host on CNN's "Crossfire," I had come to enjoy wrestling with Novak. When I began that gig, though, he barely paid any attention to me before or after tapings, adopting an attitude that seemed to say, "Show me your stuff, kid." He acted as if I were an irritant, not a sparring partner who deserved to be in the ring with him. But I didn't expect much from Novak. For years, I had thought he used his column and cable appearances to do favors for conservative allies and to sully (sometimes unfairly) liberals. Eventually, he warmed up -- well, as much as he could -- and started pumping me for information on what Democrats and liberals in Washington were thinking. I hardly held any top-secret information in that regard, but we did what most political reporters in D.C. do when forced to spend time together: trade tidbits, gossip and half-stories. And in his 2000 book, "Completing the Revolution" (as in: the "conservative revolution"), he described me as a "bright, young, left-wing journalist." (Given his age, I suppose someone in his early 40s was "young.")

Barney Frank and the Loons

Here's a clip from the Barney Frank Show, soon to be a reality series on MSNBC.  Sean Hannity and Michele Bachman were all over this last night, full of faux dismay and tut tutting about how Frank treated his constituents, but oddly enough, they didn't play this particular clip featuring the woman proudly waving the Obama = Hitler sign.  Strange, isn't it?

Anyway, it's here mainly for entertainment value.  Not everyone can afford to do this, and not everyone has Barney's, um, way with words either.  Still, it shows a refreshing willingness to call a loon a loon instead of just fretting defensively about decorum and manners, and it's also fun to watch.  Fun is good!  And while some people will be offended by it, I'll bet the majority reaction outside the right wing would eventually become supportive if more Dems did this.  People would start laughing at the loons instead of pretending their black helicopter nonsense represents some kind of genuine upwelling of "heartland" grievance.  Give 'em hell, Barney.

Filibuster Wanking

This is, I admit, just total blue sky wanking, but the whole healthcare reconciliation debate raises another question: what if Democrats got rid of the filibuster?

Basically, this is easy to do.  Without going into all the gory details, it depends on having a friendly Senate chair declare the filibuster unconstitutional and then having it sustained by a majority of the Senate.  So all you need is Joe Biden (the chair) and 51 Democrats to support him and the filibuster is history.

This would, obviously, be the end of Barack Obama's post-partisan unity act, and the next step would be for the opposition party to go ballistic and shut down the Senate.  That's what Dems would have done if Republicans had tried this, and it's what Republicans would do if Democrats try it.  At that point, either the Senate chair rams through rule changes that eliminate the various ways individual senators can halt business, or else it becomes a pure public relations battle.  So who would win?

Beats me.  But I don't think it would depend very much on the nature of the bill that touched things off.  It would depend on how the public felt when they learned — really learned — just how the Senate works and how wildly undemocratic it is.  I suspect most people don't really have a clue about this and would basically support a move to make it into a majoritarian institution.

On the other hand, the public is also generally repelled by exercises in pure power mongering, and there's no question that's what this would be.  So it's a tossup.  I wouldn't mind finding out, though.

POSTSCRIPT: Yes, I know this isn't in the cards or anything.  But it's August.  Aside from death panels, things are slow.  Give me a break.

Dr. Dean's Health Care Prescription

Miriam Raftery, editor of the East County Magazine, provided a report earlier this week from an appearance at a San Diego bookstore by Howard Dean. The former Vermont governor, presidential candidate, and DNC chair, who is a physician, is on a book tour promoting Howard Dean’s Prescription for Real Healthcare Refom.

While Dean was ridiculed on the stump in 2004 as an out of control lefty, he has always been a New England moderate, and has never proposed anything faintly resembling socialized medicine. But Dean does believe, as he put it:

"The free market just doesn’t work in medicine. You can’t be an informed consumer. I never saw someone with severe chest pain jump off the table and say, 'Doctor, I’m going to the cheaper guy down the street.'"

Dean also doesn’t favor compromising on a public option, because “the public option is the compromise.” He advocates opening up Medicare so that those under 65 can buy in, while allowing anyone who chooses to keep their private insurance. 

“Americans ought to be able to decide for themselves: Is private health insurance really health insurance? Or is it simply an extension of the things that have been happening on Wall Street over the past five to ten years, in which private corporations find yet new and ingenious ways of taking money from ordinary citizens without giving them the services they’ve paid for?”

Here's another choice bit from Raftery's account, which offers a good precis of Dean's book as well as his talk in San Diego.

Dean noted that public healthcare in Europe was established not by liberals, but was in fact championed by conservative statesman Winston Churchill. "Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion," Churchill once stated. "Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available."

According to reporting yesterday on NPR, the cost of medical fraud in the United States runs anywhere from $60 billion to $600 billion a year--in other words, it might actually exceed the price tag for health care reform. Instead of whining about the expense of reform measures, Republicans and Blue Dog Dems might think about saving us money by cracking down on fraudulent practices, which target both the government and private insurers. 

Obama has recently announced a new DOJ/HHS task force to combat fraud, and some versions of the health care reform bill have a measly $100 million set aside for anti-fraud measures. It seems like far too little and too late--but apparently, it's more than has been done by past administrations, or by the oversight committees, the appropriations and legislative committees whose job it is to ride herd on taxpayer funds. 

Here is a bit from the NPR report:

Medical fraud takes several forms. Most commonly, criminals get a list of patients’ names, then create fictitious doctors. They send bills to Medicare or Medicaid or health insurers for services supposedly rendered to these patients. By the time the payers figure out that the doctors they’re paying are fictitious and no service was ever rendered, the criminals have closed up shop and moved on.

Another popular form of health care fraud is the “rent-a-patient” scheme. Recruiters find people with health insurance willing to get care they don’t need, in exchange for cash or cosmetic surgery. Several years ago, insurers and the FBI said they had cracked a big case. People from 47 states were paid to come to California to receive unneeded care, including colonoscopies and surgery for sweaty palms. The doctors who performed the work reportedly charged insurers a total of $1 billion.

I suppose the libertarian Republicans would say it’s just a small price to pay for our free market system. And of course, if the government started taking a closer look at the crooks who illegally rip off the system, they might also have to deal with the crooks who rip off the system quite legally--the price-gouging insurance and pharmaceutical companies and their ilk.

Cpt. Jason V. Basilides, a 1st Battalion, 4th Infantry Regiment platoon leader from Virginia Beach, Va., speaks to local leaders through interpreter Najeeb Ghafoori during a foot patrol July 27 in Deh Chopan district, Zabul province. (Photo courtesy army.mil.)

Eco-News Roundup: Wednesday, August 19

News from our other blogs and across the WWW on health, environment, energy, and wildlife.

Health Timeline: Universal coverage doesn't just happen. It takes time to work out the kinks.

Minority Opinion: Are there enough Republicans left to filibuster public healthcare?

Four Years Later: Looking back at Katrina, and what hasn't gotten done.

Astroturf Admissions: More letters (fake) against the Markey-Waxman bill turn up.

Island Eaters: Invasive plants have gobbled up dozens of islands. See which ones here. [BBC]

Sticks and Stones: Social rejection can make you hurt, physically. [LiveScience]

Need To Read, August 19, 2009

Some must-reads from around the web:

Oprah's DC-heavy list of powerful women.

Obama's first rendition—part of a crackdown on contractor fraud?

Slow internet connection? Why cities get short-changed in a stimulus program to provide better broadband.

Protesters heckle John Yoo at the first day of lectures at Berkeley's law school.

California may jail more drug offenders—two weeks after it was ordered to reduce its prison population.

David Corn, Mother Jones' DC bureau chief, is on twitter, and so are my colleagues Daniel Schulman, Nick Baumann, and our editors-in-chief, Clara Jeffery and Monika Bauerlein. You can follow me here. (The magazine's main account is @motherjones.)

Fighting the Ghosts

An awful lot of journal articles supposedly written by medical researchers are actually written by pharmaceutical company PR departments.  Someone is finally starting to do something about it:

With a letter last week, a senator who helps oversee public funding for medical research signaled that he was running out of patience with the practice of ghostwriting. Senator Charles E. Grassley, an Iowa Republican who has led a long-running investigation of conflicts of interest in medicine, is starting to put pressure on the National Institutes of Health to crack down on the practice.

....The full scope of the ghostwriting problem is still unclear, but recent revelations suggest that the practice is widespread. Dozens of medical education companies across the country draft scientific papers at the behest of drug makers. And placing such papers in medical journals has become a fundamental marketing practice for most of the large pharmaceutical companies.

“Just three days ago, I got a request to be the author of a ghostwritten article about the effectiveness of a cholesterol-lowering drug,” Dr. James H. Stein, professor of cardiology at the University of Wisconsin School of Medicine, said this month. “This happens all the time.” He declined to attach his name to the paper.

Grassley's a weird dude, and he's been notably unhelpful on the healthcare reform effort.  But at least he's not completely worthless.  Good for him for taking this on.