Healthcare Maneuvering

The latest trial balloon from the Democratic leadership is that they might split healthcare reform into two bills.  The first would have all the controversial provisions and would go through the reconciliation process, where it needs only 50 votes.  The second would go through the normal process and therefore need 60 votes, but since it includes the stuff that's widely popular it would pass anyway.  But Ezra Klein is puzzled: if you piss off Republicans by using reconciliation for Bill #1, what are the odds you can then sweet talk them into supporting Bill #2?

The one potential answer is that reconciliation isn't about bypassing the GOP at all. It's about bypassing a handful of centrist Democrats. Angry Republicans won't support a consensus-oriented second bill after being cut out of the important work of the first. But Democrats like Kent Conrad might, as reconciliation won't specifically have hurt them, even as its real point was to take the process out of their hands and put it back in the hand of the Democratic Senate Leadership.

It's hard to say if this chatter is really serious, but if it is the point is probably to protect centrist Democrats.  They can vote against Bill #1 and for Bill #2, and then go home and tell their constituents that they voted against a gummint takeover of healthcare (public option, strong subsidies) but in favor of sticking it to the evil insurance industry.

At least, that's the usual thinking behind this kind of thing.  Harry Reid probably isn't under the delusion that he can get more then one or two Republican votes no matter what, but he does care about protecting the flanks of his own caucus.  This is one way to do it.

As I have written previously, the most likely upshot of the health care debate is for Congress to adopt some version of health care "exchanges" based on the FEHBP, the Federal Employees Health Benefits program. Some people are calling the FEHBP a "public option," but that's not what it is. In fact, it doesn't even contain a public option. The whole reason it might be acceptable to conservatives is that it keeps the private insurance system intact. As described by Physicians for a National Health Program, FEHBP "is actually a mix of private health insurance plans that carry the same problems of private plans generally: administrative waste, restrictions on health care providers, inequities and inadequate cost controls."

In fact, the FEHBP was proposed back in the 1980s as an alternative to Teddy Kennedy’s universal health insurance campaign. That proposal, as Stephanie Mencimer wrote here last week, came from none other than the Heritage Foundation. So its credentials are spotless, or ought to be spotless in the eyes of mainstream and rightwing Republicans. Not even Dick Armey’s gang of patriots, agitating at town hall meetings, could call Heritage a socialist institution.

The FEHBP does require private insurance plans to meet certain standards, which could represent some small improvement over the present system, provided it survives as part of the final health reform plan. But the best plans offered under FEHBP aren't cheap, requiring steep contributions from the employee--so it also preserves the present system of unequal care depending on income.

You can get a glimpse of the best-case scenario that might result from a reform based on the FEHBP, in this exchange between Washington Post business writer Steven Pearlstein and a government employee living in Maryland who belongs to the Federal Health Plan:

Federal employee: I have a choice among many possible insurance plans. I have chosen one of the more expensive ones (I pay a little over 30% of the premiums) and have been very pleased thus far with the range of doctors that I can access and especially the speed with which my claims are processed. I recently called to ask if a procedure had been pre-approved and was informed within just a few seconds that my plan did not require pre-approval for that procedure. It is clear that the computers at the other end are online and the people answering questions are well-trained. Last year a scheduler at a testing center nearly cried with relief when she heard what my insurance plan was.

I presume that I get this excellent service in part because if I had a bad experience, I could switch to another provider during the open plan period. Unlike a person working for a private employer with a choice of perhaps two or three plans both from the same provider, who would have to appeal to the deaf ears of the employer's HR department, my choice is meaningful. I might have to wait out 13 months in a plan I didn't like, but that is it. No worries about pre-existing conditions, or qualifying for coverage or anything.

So, could this model actually work for the uninsured pool of people? Could the government demand that the insurance companies offer the same plans available to federal employees to the pool of uninsured or not let them participate in the program? Could it just be negotiated that way since the potential pool is so large and the premiums will be subsidized for some? Could non-profit cooperatives have the clout to get this?

Or do I only get service this good because the Senators and the Representatives are in the same plan that I am (or at least their staff are) and the insurance companies treat us better so they don't make the powerful people who share our plans angry?

Steven Pearlstein: The Federal Health Plan provides the model for the so-called exchanges that are at the center of the Democrats' health reform proposal. Everyone who buys insurance through the exchange would basically have the kind of choices you do, and be able to move around from plan to plan in a way creates an ongoing competition among the plans, not only on the issue of price but quality of service and depth of network, etc. That is the kind of competition that will improve the whole system and, to a degree, help to bring down cost growth.

Pay to Play: For the cost of medical fraud, we could pay for healthcare reform.

Dean 3G: Guess who's got his own healthcare reform Rx? Howard Dean.

If You Can't Beat 'Em, Eat 'Em: New findings show antioxidants can fuel breast cancer. [National Geographic]

Next!: The public option may be breathing its last.

Small Screen: The McSteamy's sex tape, hydrated by Fiji Water.

Wolf Woes: State of Idaho will allow a cull of 25% of its wolf population. [MongaBay]

 

Afghan National Police officers, Afghan National Army soldiers and U.S. Army 1st Battalion, 4th Infantry Regiment Soldiers patrol on foot July 27 to speak with village leaders in Deh Chopan district, Zabul province. (Photo courtesy army.mil.)

Things you may have missed from around the web yesterday:

The most outrageous lies told about foreign health care.

McCain's voting record: not so maverick-y anymore.

Max Baucus does not like those people with "YouTubes" at health care town halls.

Did Mozart die of strep throat?

Novak, Corn, and Plamegate.

Are seniors really defecting from AARP to a conservative alternative?

Charlie Crist is a rare example of a green GOP governor—but for how long

Religious conservatives experience a conversion to Harry Potter fandom.

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.)

Edmund Andrews writes in the New York Times about Ben Bernanke:

As central bankers and economists from around the world gather on Thursday for the Fed’s annual retreat in Jackson Hole, Wyo., most are likely to welcome Mr. Bernanke as a conquering hero....Fellow economists [...] are heaping praise on Mr. Bernanke for his bold actions and steady hand in pulling the economy out of its worst crisis since the 1930s. Tossing out the Fed’s standard playbook, Mr. Bernanke orchestrated a long list of colossal rescue programs: Wall Street bailouts, shotgun weddings, emergency loan programs, vast amounts of newly printed money and the lowest interest rates in American history.

I really don't have it in for Bernanke or anything (honest!), but this level of adulation puzzles me.  Yes, the blizzard of term facilities and liquidity programs he engineered during 2007 and 2008 was impressive, but is everyone really so sure that no other Fed chairman would have acted similarly?  And beyond that, there's pretty broad agreement that Bernanke (a) badly mishandled the runup to the crisis, (b) inherited and then perpetuated weak regulation of consumer loan products, something that aggravated the housing bubble, and (c) was complicit in allowing Lehman Brothers to collapse.  These are all serious black marks, especially the Lehman fiasco, which is widely believed to have been the trigger for the most acute phase of the crisis during the fall of last year.

Reappointing Bernanke would hardly be a disaster.  But his judgment has been questionable on several fronts, his dedication to better consumer regulation is doubtful, and we'd all be better off if we stopped pretending that Wall Street has to be endlessly coddled by reappointing whatever Fed chairman they've gotten used to over the past few years.  Hero worship of the Fed is a vice that's worth stamping out, and now's a good time to start.  Let's give someone else a chance.

The families of Shane Bauer, Josh Fattal, and Sarah Shourd, the three Americans detained in Iran after accidentally crossing the border while hiking in Kurdistan, are breaking their silence: After more than two weeks of keeping a low profile, they've launched a www.freethehikers.orgwebsite and are doing media interviews to push for consular access to their loved ones. (Catch them on Good Morning America and NBC this morning between 7 and 8 am EDT—we'll post video later on, if available). The Iranian government has confirmed that Bauer (whose Mother Jones investigation on corruption in Iraq was just published), Shourd, and Fattal are being held in Tehran, but has refused to grant Swiss diplomats, who handle US affairs in Iran, the right to visit them. The families' full statement is after the jump; there's also a Facebook group supporting the hikers and a Twitter hashtag (#ssj).

Quote of the Day

From Michael Scherer, after pointing out that Sarah Palin's latest Facebook post is wrong:

Maybe Palin will post a follow up on Facebook clarifying.

Um, sure.  That would certainly be in character, wouldn't it?

If you thought billions of pounds of indestructible plastic circling the gyres of the ocean was depressing, sorry to say it gets a lot worse. Scientists are now reporting that " indestructible" plastics decompose with surprising speed and release toxic substances into the water.

The findings were reported today at the 238th National Meeting of the American Chemical Society. Lead researcher Katsuhiko Saido of Nihon University, Japan, and his team found that plastic in the ocean decomposes with exposure to rain, sun, weather, and ocean—giving rise to yet another source of global contamination that will continue far into the future. Their key findings:

  • Polystyrene begins to decompose within one year, releasing components that are detectable in the parts-per-million range. 
  • Plastics themselves usually don't break down in living animal bodies after being eaten. But the substances released from decomposing plastic are absorbed and could have adverse effects. BPA and PS oligomer can disrupt the functioning of hormones in animals and can seriously affect reproductive systems.
  • The researchers simulated the breakdown of plastic products at low temperatures found in the oceans. Degrading plastic this way created three new compounds not found in nature:  styrene monomer (SM), styrene dimer (SD) and styrene trimer (ST). SM is a known carcinogen and SD and ST are suspected carcinogens.
  • BPA ands PS oligomer are not found naturally either and therefore must have been created through the decomposition of the plastic.

Seems to me we need to reconsider what goes into the ocean with the same urgency we're almost beginning to exhibit towards the atmosphere.

 

The fact that tomorrow's presidential election in Afghanistan will be mired in corruption, fraud, and backroom dealing is all but certain, writes The Nation's Ann Jones, author of Kabul In Winter and an incisive voice on all things Afghan. The more pressing question, she says, is this: Will the U.S., in the name of demonstrating Afghanistan's "progress" toward democracy, validate the election and deem it "credible"?

If it does (and it very likely might), tomorrow will be a sad day for democracy. According to Jones, here are just a few of the reaosns why progress will be the last thing this election represents: 

Stacking the Deck: All the members of the so-called Independent Election Commission were appointed by President Karzai, and they've never disguised their allegiance to him. So the initial vetting process for candidates eliminated some promising challengers and spared old cronies, including the war criminals the process was meant to screen out.

Backroom Deals: One after another, potential and declared candidates have bowed out to back Karzai. Word leaks out about which ministries they've been promised. Karzai buys the support of local leaders running for provincial offices, using (illegally) all the perks of office, from airplanes to free airtime on national TV, to help his friends and himself. One of his deals brought him Hazara support in exchange for the notorious Shia Personal Status Law, enforcing a wife's sexual servitude in violation of the Afghan Constitution.

Voter Fraud: In May in Ghazni, $200 would buy 200 blank registration cards, but lots of people, including minors, already had plenty. Men were able to get a bunch by handing in a list of women for whom they will vote by proxy. Since no central registry exists, verification is impossible. A recent report places the number of voter registration cards distributed (not including fakes) at 17 million, almost twice the estimated number of eligible voters in the country.

Juan Cole points out that 33 polling stations in Ghazni province won't be open tomorrow because of poor security, and that the Taliban are confiscating voting cards house by house. And, of course, there are those letters and warnings from the Taliban. The ones that say they'll attack and even kill anyone who votes.

Election gaming might even extend to the Americans. Reports have emerged in the run-up to the election that the U.S. envoy to Afghanistan and Pakistan, Richard Holbrooke, might be brokering a backroom deal to install Ashraf Ghani, the more Westernized presidential candidate who's currently running in third, as an executive in the Karzai administration if Ghani agrees to drop out and back Karzai in the election. Time has likely run out for that deal, however.