Kevin Drum - January 2011

The GOP's Healthcare Non-Plan

| Mon Jan. 24, 2011 11:34 AM PST

The Republican mantra on healthcare reform is "Repeal and Replace." But replace it with what? Ross Douthat has some ideas, one of which is this:

Republicans should work to deregulate the new health care exchanges, so that high-deductible, catastrophic coverage can be purchased as easily as comprehensive plans.

But as Jon Cohn points out, PPACA already supports high-deductible plans:

Look closely at the standards for coverage in the insurance exchanges: The minimal, or bronze, insurance option allows out-of-pocket spending of up to $12,500 for a family of four. The actuarial value is 60 percent, which means, very roughly, that the plan only covers about 60 percent of the average person's medical bills. Those are some pretty high deductibles!

Ross's second idea is to limit subsidies for low-income workers, which, needless to say, guts the entire point of the bill. His third is to tweak the individual mandate in ways that, as Jon Chait says, are probably sensible. Unfortunately:

There's little reason to believe either that these objections represent the right's real problem with the Affordable Care Act or that they're willing to consider any tweak to improve the law.

The conservative base has simply been whipped into such a frenzy on this issue that it's impossible to imagine Republicans making any change that isn't designed to lead to full repeal. There's a reason why conservative magazines and writers keep repeating the slogan "Repeal" endlessly. It's more a point of honor than policy. The Affordable Care Act has become, in the right wing mind, a monstrosity, a completely illegitimate assault on American freedom, and an emotional wound that conservative elites work very hard to ensure never heals.

Of course, it's very helpful for conservative elites like Matthews and Douthat treat the right's objections to the individual mandate (a policy tool Republicans either supported or had little objection to up until 2009) at face value. Eventually conservatives will make their peace with health scare reform, and either put their policy imprint on it or not. But in the meantime the overwhelming conservative impetus is to sabotage the law by any available means. A reform to the law that satisfies objections to the individual mandate, but that does not satisfy the urge to repeal the bill, will be seen by most Republicans as untouchable.

Is there any serious argument that Jon is wrong about this? Republicans have never taken universal healthcare seriously, after all. In fact, as near as I can tell, they're philosophically opposed to the whole idea, regardless of how it's implemented. Wonky healthcare proposals from various corners of conservativedom should mostly be thought of not as serious plans, but as useful window dressing that allows conservatives to claim on Sunday chat shows that they do too have constructive ideas about healthcare. But the plain fact is that none of these comprehensive proposals could get the support of even a quarter of the Republican congressional caucus. Maybe not even that much. Republicans have had plenty of time to think about this, and if they seriously thought that a Douthat-esque plan was a good idea they would have proposed it long ago. They didn't, and they're not going to this time around either.

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Filibuster Reform is Dead

| Mon Jan. 24, 2011 10:45 AM PST

Over the weekend a reader asked me whatever happened to Democratic plans to reform the filibuster at the beginning of this year's Senate session. It's still in progress, I said, but I hadn't heard anything specific. However, that was because I didn't read the paper on Saturday. Paul Kane reports:

To the dismay of a younger crop of Democrats and some outside liberal activists, there is no chance that rules surrounding the filibuster will be challenged, senior aides on both sides of the aisle say, because party leaders want to protect the right of the Senate's minority party to sometimes force a supermajority of 60 votes to approve legislation.

Instead, rank-and-file lawmakers will receive pitches from Sens. Charles E. Schumer (D-N.Y.) and Lamar Alexander (R-Tenn.), who have been negotiating more limited changes, such as with "secret holds" that allow an anonymous senator to slow legislation. In addition, some modifications could be made to the way confirmations are handled for agency nominees who do not have direct roles in policymaking.

Unsurprisingly, no one wants to seriously muck around with the filibuster. Republicans are opposed because they're the minority party and Democrats are unenthusiastic because someday they might be the minority party:

While liberal groups such as MoveOn.org and some unions such as the Communications Workers of America are supporting the Udall effort, the liberal coalition is far from united on the issue. Some large members of the AFL-CIO have been noticeably silent, while some abortion rights groups have publicly declared their opposition to changing filibuster rules. That, some Democratic aides said, is because in the 1990s and in the early days of the George W. Bush White House - when Republicans controlled both ends of the Capitol - these groups relied on their Senate Democratic allies and the 60-vote threshold to protect key rights such as Davis-Bacon wages for federal works projects and the Roe v. Wade abortion decision.

So there you have it. We'll get some minor changes at best, but nothing serious.

Please Don't Be Offended

| Mon Jan. 24, 2011 10:15 AM PST

I might be the last person to notice this, but I still sort of wonder what it says about us. I was over at Dave Weigel's place a few minutes ago, and he linked to a Twitter post by Jim Geraghty, who I don't happen to follow. When I clicked the link, it included the following message:

This Tweet is from someone you're not following. The media they're mentioning could be anything, even something you might find offensive.

It could be anything! We can't have that, can we? Best to hide it from sensitive eyes.

This is, obviously, no big deal, and you can change your default setting pretty easily to see everything automatically. Still, it seems a little dismaying that we're so delicate these days that even when we actively click on a link, we apparently need to be protected from the mere possibility of getting a fleeting glimpse of something we might find offensive. Buck up, America!

And while we're on the subject of why not a single Republican has announced a presidential candidacy yet — yep, that's the subject — isn't the answer obvious? It's because they all know Barack Obama is as good as a shoo-in in 2012. Unless something cataclysmic happens, the only reason for any Republican to run is either as a vanity candidate or to get practice for 2016.

Liberals and Economic Growth

| Mon Jan. 24, 2011 9:19 AM PST

Mike Konczal and Matt Yglesias scoff at the notion that the economy will suffer unless the president constantly massages the egos of sensitive businessmen, a sentiment I share profoundly. Matt goes on to note that, in any case, regardless of what the business class thinks, economic growth is usually better under Democrats than Republicans:

The fact of the matter is that businessmen like conservative politicians....Economic growth was better in the 1990s than in the 2000s, but businessmen liked George W Bush better than Bill Clinton. Growth was better under FDR than under Eisenhower, but businessmen liked Ike. And that’s fine, businessmen are free to like or dislike whomever they want. But their subjective view of politicians doesn’t cause or hamper economic growth.

....I really do think progressives need to try harder to claim the mantle of growth for ourselves. Conservatives like to talk about the importance of economic growth, but they’re not only bad at delivering it in practice, they’re remarkably hostile to the idea of boosting growth....

I agree that liberals ought to do a better job of persuading the electorate that liberal policies are friendly toward economic growth, but it's worth a pause to say that even if we do this successfully it won't affect the business community's view of us at all. Despite what they say, business executives don't care much about economic growth. They should, but they don't. What they care about is low taxes, light regulations, firm anti-union policies, robust corporate profits, and a sense that the bureaucracy of the government is sympathetic to their needs. Liberals are just never going to give them that other than narrowly and briefly (as with financial deregulation, for example, which was great for the Democratic Party but turned out to be not so great for the economy).

As for the broader electorate, they don't care much about generic economic growth either. They care about their own paychecks. This means that if Democrats want to win them over, they need to support policies that support economic growth and channel that growth largely toward the working and middle classes. Those are separate challenges, but without them both an agenda dedicated to economic growth won't really do us much good.

A Visit To Quantico

| Sun Jan. 23, 2011 3:06 PM PST

Earlier today Jane Hamsher and David House visited the Quantico Marine Corps Base to visit accused WikiLeaks leaker Bradley Manning and deliver a petition protesting the conditions of his confinement. David House is on Quantico's visitation list, and both he and Jane have been there before. Before today's visit, Jane called the base to let them know she was coming. Apparently that was a mistake. Here are excerpts from her live Twitter feed of the visit:

At Quantico w @DavidMHouse to deliver 42,000 sigs 4 Bradley Maning to brig. Holding us at gate, never happened before

Demanding my social security number before they'll let me on Quantico base, but won't say why. Never happened before.

Quantico guards say I'll be arrested if I go to McDonalds while @davidmhouse visits Manning. "That privilege has been withdrawn."

Now been here at Quantico gate for 30 min. Will not let us leave base, holding us.

Gunny Foster Military Police #1715 writing me ticket for not hving latest insurance card. Sorry to 42,000 people who signed Manning petition

Can't leave base, can't go 2 brig, can't get my driver's license, Gunt Foster threatening 2 arrest us. Haven't done a thing.

The guards absolutely knew we were coming @auerfeld & told to harass us. "This was what I was told to do" said Gunny Foster.

We've been coming 2 Quantico 4 months @chrisvcb, @DavidMHouse has official permission 2 visit Bradley Manning,

Gunny Foster towing my car bc they won't accept my electronic proof of insurance, demanding paper.

Forcing @DavidMHouse 2 go 2 court. Wouldn't give ticket, gave him a summons 2 appear in court.

Military police searching & impounding my car. Won't let @DavidMHouse on 2 see Bradley Manning, won't say why.

It's 28 degrees, forcing us 2 stand outside.

Still holding us, my car on tow truck but Quantico guards still won't let us leave.

For whatever reason, Quantico Marine brass don't want Manning 2 have visitor now. Isolation & enforcement of solitary confinement complete.

Marines now say House can't walk to see [Manning] but can go off base, get a cab & come back on. But visitation over at 3pm.

Tow truck driver says we also have to pay 4 time he had 2 wait for Quantico marines 2 release us: $300.

Quantico Marine brass showed up PERSONALLY 2 make sure @DavidMHouse never got 2 see Manning. Next visiting period: next week.

Quantico top brass made sure we were held until visiting hours were over & impossible 4 @DavidMHouse 2 see Manning. Message clear.

They have let me on Quantico base every time @dtfrannyb, & I went where they told me to & complied w all requests. Never been a problem

A "statement of events" written afterward is here. This doesn't appear to be a shining moment for either our government or our military forces.

Organizing the Middle Class

| Sun Jan. 23, 2011 1:04 PM PST

Matt Yglesias has a complaint:

I think labor-friendly writers sometimes don’t do the best possible job of distinguishing between unions qua social and political institutions and collective bargaining as a labor market institution. Something like EFCA is the only way to revive collective bargaining as a major force in private sector labor markets. But I don’t think it’s correct to see EFCA → union density as the only conceivable form of politically influential mass membership organization. 

Actually, I'm pretty sure that most labor-friendly writers are keenly aware of this distinction. But put that aside. It's obviously true that organized labor isn't the only conceivable form of politically influential mass membership organization. The question is whether it's the only conceivable form of politically influential mass membership organization dedicated to the economic concerns of the middle class. Right now I'd say it is for the simple reason that no one seems able to conceive of an alternative. But I sure wish someone would.

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The View From My Picture Frame

| Sun Jan. 23, 2011 11:52 AM PST

Andrew Sullivan has great success getting people to figure out the location of random photos taken around the world, so I'm going to try it too. Except this is a photo of a painting. It's signed by someone named J. Gaston, and pretty obviously seems to be a Paris street scene. But is it? And which street? We're giving this to my sister-in-law in a couple of weeks, and I thought it would be nice if I could tell her what it's a painting of. Anyone know?

UPDATE: It's the Porte Saint Martin on St. Martin Boulevard in Paris. Thanks to Rjerrard and Skeptc for the ID. Pictures here and here.

The Problem With Damage Caps

| Sun Jan. 23, 2011 11:19 AM PST

Few things demonstrate the deliberate bad faith of conservative arguments for tort reform more than their support of damage caps in medical malpractice suits. Their claim is that caps reduce "frivolous lawsuits," but of course they do nothing of the sort. Almost by definition, frivolous lawsuits are those filed for small dollar claims in hopes that insurance companies will figure it's cheaper to settle than to fight. Big dollar lawsuits that exceed damage caps are the exclusive domain of serious injury — the precise opposite of frivolous.

The LA Times has a good piece today about the problem with medmal caps in California, which were set at $250,000 for non-economic damages in 1975 and haven't been changed since. This means that in 1975 dollars, today's caps are set at about $60,000. The problem is that this number is so low that lawyers are reluctant to take anything but the most slam dunk cases. And in the case of Olivia Cull, who died due to an "incident" at Mattel Children's Hospital UCLA two years ago, that turned into an insurmountable obstacle because a lawsuit was the only way for her parents to find out what really happened:

Distraught, the Culls sought answers from their daughter's doctors....When they demanded answers from hospital officials, the Culls said, they were told to review the records and, if they found a problem, to contact a lawyer.....As they sifted through records, they wondered how others in similar situations made sense of it all. "It's confusing," Joy Cull said...To get more information, the Culls decided to sue the hospital. But like others, they had trouble finding a lawyer willing to take the case. Given the state cap on damages, they said, many lawyers did not consider their case worth pursuing.

....In July 2009, weeks after first seeking counsel, the Culls filed a wrongful death lawsuit after lawyer Jin Lew at Los Angeles-based Michels & Watkins agreed to take the case pro bono....The lawyers found that Olivia's medical records were incomplete, the Culls said, and filed more requests until the hospital supplied hundreds of additional pages.

In addition to the lawsuit, the Culls filed a complaint with Los Angeles County health officials that triggered an investigation by the state Department of Public Health. In February, state investigators reported that a postdoctoral fellow who treated Olivia removed her catheters without a doctor's supervision. Investigators also found that a second fellow who treated Olivia had not been cleared to treat patients.

Imagine that. The records were incomplete until a lawyer forced the hospital to cough up the whole file. A pro bono lawyer, because a case with maximum damages of $250,000 simply isn't worth the number of hours it takes to pursue it.

Medical malpractice cases are complex and expensive. Hospitals won't voluntarily admit to mistakes, and they won't voluntarily make their full records available unless they're forced to. They'll especially not do this if they know perfectly well that damage caps make it vanishingly unlikely that they'll have to deal with anyone but distraught family members who have no idea how to work the system.

A $250,000 cap is plenty high for storefront lawyers filing frivolous lawsuits. The only things it prevents are real lawsuits over serious malpractice, like the one in the Culls' case. In the end, they got their $250,000 settlement, which they're using to fund scholarships in their daughter's memory, and the hospital agreed to change its procedures. But it almost didn't happen thanks to California's antiquated damage cap law.

POSTSCRIPT: And just to address the obvious questions: No, there's been no explosion in medical malpractice suits over the past 20 years. Nor has there been an explosion in payouts. Nor are medical malpractice suits a major component of rising healthcare costs. Medmal reform is a good idea, but mainly to make it fairer. A reformed system that actually worked properly would cut down on frivolous lawsuits but would probably increase the number of legitimate complaints that never see the light of day under current rules. More here.

Chart of the Day: Financial Assets

| Sat Jan. 22, 2011 10:22 PM PST

The Wall Street Journal reports:

Over the two years ending September 2010, Americans withdrew a net $311 billion — or about 1.4% of their disposable income — from their savings and investment accounts, according to the Federal Reserve. That’s a sharp divergence from the previous 57 years, during which they never made a net quarterly withdrawal. Rather, they added an average of 12% of disposable income to their holdings of financial assets — including bank accounts, money-market funds, stocks, bonds and other investments — each year.

There were no net withdrawals during the 2001 recession. Nor the 1991 recession or the 1981 recession. Nor during the oil shock recessions of the 70s. Not during any recessions until now. It's just another way in which the the 2008-09 recession has been the most damaging to household finances since World War II.

Housekeeping Note

| Sat Jan. 22, 2011 7:56 PM PST

Just to clear up a couple of things from the previous post:

  • No, I don't think private sector unions are going to make a comeback. I'm not delusional.
  • No, I don't think the middle class wage stagnation of the past few decades is due solely to the demise of unions. I do, however, think that economists underrate this because they focus too much of their attention on the pure effect of unions on wages and too little on the broader influence of (a) unions on politics, (b) politics on economic and financial institutions, and (c) economic and financial institutions on the distribution of wages (and everything else, for that matter).

That is all.