Kevin Drum - September 2013

We Hit the Debt Ceiling Months Ago. Nobody Cared.

| Mon Sep. 30, 2013 11:59 PM EDT

Here's another quick reminder for everyone: It's not true that we'll hit the debt ceiling on October 18. We've already hit it. This happened first on December 31 of last year, and then, after a few months of legislative maneuvering, again on May 19. The Treasury Department has been taking extraordinary measures—withholding payments to pension funds, taking money from the Exchange Stabilization Fund, etc.—to keep the government running ever since.

I only mention this to illustrate how far things have degenerated. Nobody even cares about actually breaching the debt ceiling anymore. We did that months ago, and it was just a date on the calendar. It's only when the Treasury has exhausted its ability to rob Peter to pay Paul, with all the attendant chaos this produces, that we've "really" hit the debt ceiling. Welcome to the new normal, courtesy of the Republican Party.

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Shiny Object Watch: The Vitter Amendment

| Mon Sep. 30, 2013 7:00 PM EDT

Erick Erickson, who is pretty clearly the voice of the Tea Party at this point, is unhappy with his fellow Republicans and he's letting everyone know it via Twitter:

At this point, the House should just go on and pass a clean CR. They've already embarrassed themselves and done requisite head pats.

Seriously House GOP, if you're going to fully fund Obamacare, go on and stop the shiny object dangling and just embrace it.

GOP should either find for defund or just embrace the suck.

And which shiny object is Erickson objecting to here? That's hard to say since Republicans could furnish a disco hall with all the shiny objects they've been dangling in front of their base lately, but most likely he's talking about the stupidest shiny object of them all: the Vitter Amendment.

In fact, the Vitter Amendment is so stupid that it's actually a little hard to explain. As you know, the whole point of Obamacare is that it's for people who don't get health insurance via their employer. Back in 2009, however, when Republicans were offering up a slew of amendments to try to embarrass Democrats, Chuck Grassley offered an amendment that would require members of Congress and their staffs to buy insurance via the exchanges.

This made no sense since staffers already had a health insurance plan, just like all other federal employees. But Republicans somehow decided that if Grassley's amendment didn't pass, it would mean Democrats weren't willing to use their own program. So Democrats sighed and went ahead and voted for it.

But wait. The federal government paid for staffers' health insurance. Under Obamacare, they'd have to pay for it themselves. That's a raw deal. So the federal government decided to take the money that had previously gone to health insurance and give it to staffers to offset the cost of insurance on the exchanges. Fair enough.

But now Republicans are up in arms again. Allegedly, this is because they've somehow decided that it's unfair for staffers to get this money, so they want to take it away via the Vitter Amendment. After all, other people on Obamacare don't get money from their employer to offset the cost of insurance.

Which is true. But that's because other employers aren't allowed to dump their employees onto Obamacare. Only Congress does that.

This is all mind-bogglingly stupid. Congressional staffers should never have been put on Obamacare in the first place. It only happened thanks to a craven political ploy from Republicans. Now they want to double down on their cravenness by taking away a chunk of their staffers' compensation under the moronic pretense that they're getting "special treatment." They aren't, of course. In fact, they got screwed by Grassley, and now they're going to get doubly screwed by Vitter.

What's more, this ploy is so craven and moronic that even Erick Erickson recognizes it for what it is. Go figure that. If this is the best Republicans can come up with, even Erickson thinks they should just give up and pass a clean CR. That's how bad things have gotten.

POSTSCRIPT: Of course, passing a clean CR isn't what Erickson wants. He wants the House to fight Fight FIGHT! Refuse to pass anything except a bill that fully repeals Obamacare, and if the government shuts down, then the government shuts down.

But if they're not going to do that, the Vitter Amendment is just about the worst way imaginable to save face. Republicans think they're being clever because they can complain about Congress giving itself "special privileges," and they know that Fox News will dutifully repeat this no matter how dumb it is. But all they're doing is screwing their own staff members because they know they can't fight back. It's truly odious behavior.

How Proton Beams Are a Metaphor for Our Broken Health Care System

| Mon Sep. 30, 2013 3:59 PM EDT

Via Austin Frakt, here's a lovely little chart from a Brookings report that helps explain why health care costs in the United States are so stubbornly hard to control. It shows the growth in proton beam facilities, which Kaiser Health News describes as an "arms race" between hospitals. These facilities are the size of a football field and cost hundreds of millions of dollars to construct.

Which might be OK if PRT were truly an advance in treating cancer. Unfortunately, there's not much evidence that it is, even though it costs far more than old-school IMRT radiotherapy. Here's the conclusion from a recent study of prostate cancer cases:

Although PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment.

In other words, the supposed advantage of PRT—that it targets cancers more precisely and has fewer toxic side effects—doesn't seem to be true. It might be better in certain very specialized cases, but not for garden variety prostate cancer.

And yet, new facilities are being constructed at a breakneck pace. Why? Because if they build them, patients will come. "They're simply done to generate profits," says health care advisor Ezekiel Emanuel. Roger that.

Here's Why the Public Blames Republicans for an Imminent Government Shutdown

| Mon Sep. 30, 2013 1:23 PM EDT

Just another quick reminder, because sometimes this stuff gets lost in the fog.

Q: Why do we need a 6-week Continuing Resolution to keep the government running?

A: Because Congress hasn't passed a budget for the new year, which begins October 1st.

Q: And why is that?

A: There's no mystery. Both the House and Senate passed budget resolutions months ago, but Paul Ryan and the rest of the GOP have refused to open talks with the Senate to negotiate a final budget number.

Q: Why is that?

A: They've been crystal clear about this. They wanted more leverage for their demands, and they figured the only way to get it was to threaten a government shutdown. Here's the Washington Post last May:

Republicans face a listless summer, with little appetite for compromise but no leverage to shape an agreement. Without that leverage, House Budget Committee Chairman Paul Ryan (R-Wis.) said Tuesday, there is no point in opening formal budget negotiations between the House and the Senate.

....“The debt limit is the backstop,” Ryan said before taking the stage at a debt summit organized by the Peter G. Peterson Foundation in Washington. “I’d like to go through regular order and get something done sooner rather than later. But we need to get a down payment on the debt. We need entitlement reform. We’re very serious about tax reform because we think that’s critical to economic growth and job creation. Those are the things we want to talk about.”

This is why the public is likely to blame Republicans for a government shutdown: because Republicans have been very clear all along that they were deliberately stringing out the budget process so they could use a shutdown as leverage for their demands. At the time Ryan made the statement above, it looked like we were going to hit the debt ceiling before we hit the end of the budget year, so that was the "backstop." Now it's turned out that the end of the budget year will come first, so that's become the backstop instead. Either way, though, Republicans have been quite open for months about their desire to delay negotiations until they had a government shutdown of some kind to use as a threat. Now they have it, and they're using it.

So that's that. They're the ones who said they wanted a shutdown as leverage. They can't really pretend otherwise at this point.

It's also worth noting, just for the sake of nostalgia, Ryan's claim that he was doing this because he really, really wanted to talk about entitlement reform and tax reform. That was always laughable—nobody thinks you can negotiate stuff like that in a couple of weeks with a gun to your head—and we haven't heard much about it since. Still, it's worth preserving for the memory vaults.

The Obamacare Fight Starts Tomorrow

| Mon Sep. 30, 2013 12:34 PM EDT

Harold Pollack is tired of wasting his time arguing with yet another disingenuous Avik Roy column predicting doom for Obamacare. In a few days people are going to start finding out what premiums will be like on the exchanges, and he figures they're mostly going to have positive experiences. But that doesn't mean everything will be smooth sailing:

Thousands of employers will blame “ObamaCare” for whatever unpopular moves they impose their workers. It’s the obvious play. In many cases, this blame will be mostly or entirely misplaced. Other times, the blame will be justified, reflecting glitches or unintended consequences of the new law. Either way, many workers will believe what their employers tell them. Millions of workers with relatively modest incomes will see their lives getting a little worse when they were hoping that health reform would make their lives a little better. Other people—I suspect many more—will see their lives getting a little or a lot better. Some of the most deserving people will seek benefits and medical care–only to discover that no help is forthcoming because their states rejected Medicaid expansion. Republicans had better hope that this is a disorganized and politically marginal group.

We've been seeing this all along. For the past year or so, Obamacare has been the perfect foil for every corporation in America that's done something unpopular with its benefits package. In the past, they were forced to vaguely blame their handiwork on "rising prices" and leave it at that, but now they have something better. Cutting back on benefits? Obamacare! Raising copays? Obamacare! Reducing hours? Obamacare! Whatever it is, all they have to do is say that it's a response to Obamacare. CEOs and HR directors across the country are pleased as punch that for at least a little while, they can plausibly deflect criticism for things they were probably planning to do anyway. It's been a godsend.

But deceptive or not, Pollack is right that it's a real phenomenon and that workers will often believe what their bosses tell them. There's not a lot liberals can do about this when it comes to smallish companies—other than relentlessly highlighting the truth and pointing to positive experiences around the country—but in the case of large corporations I hope liberals are able to make it clear that it's a bad PR decision to badmouth Obamacare. The Fortune 5000 folks don't have to be Obamacare boosters, but we should expect them to at least remain neutral. If they're on the side of the tea partiers, they should know that there's a PR price to be paid.

One day left. It starts tomorrow, folks.

I Think Republicans Are Confused About the Word "Compromise"

| Mon Sep. 30, 2013 11:19 AM EDT

Budget ping pong continues today, with the Senate expected to simply ignore the latest House bill and send back a clean Continuing Resolution that funds the government. The Washington Post reports that Republicans continue to object:

House Republicans are weighing several options for what to do when the Senate rejects their latest bill, senior GOP aides said Sunday. The possibilities include: Trying again to repeal the medical-device tax....Attacking a different part of the health-care law, such as a special board created to keep Medicare costs low....Proposing to eliminate health-insurance subsidies for lawmakers and their staff members.

Republicans repeatedly refer to these options as compromises, just like their past offers. "On Sunday," reports the Post, "Republicans tended to argue that they were trying to compromise with Obama and the Democrats to avoid a shutdown while pursuing conservative principles."

So I need to ask again: what exactly do they think is the compromise here? Obviously they're trying to get something they want, but what exactly are Democrats getting in return? I don't get it. If my neighbor threatens to steal my car, and then comes back and says he'll settle for just stealing my TV set, what kind of compromise is that? What am I getting out of the deal?

And just as a reminder, keep in mind that all of this compromising is for a CR that lasts only six weeks. Six weeks! Then we get to play this game all over again with fresh new demands compromises.

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No, Both Sides Don't Do It

| Mon Sep. 30, 2013 10:56 AM EDT

In today's news, a Republican apologist gathers evidence that Democrats have "repeatedly" used debt ceiling hostage taking in past fights with Republican presidents. He fails abjectly. Dave Weigel tells the story.

Friday Cat Blogging - 27 September 2013

| Fri Sep. 27, 2013 3:00 PM EDT

Today you get two Dominos in one. For reasons that escape us, she decided a few weeks ago that her new favorite thing was drinking water out of the tap. So whenever I brush my teeth, she hops up on the counter and demands that I turn on the water. I figure she'll get bored of it eventually. Note the untouched water bowl on the floor, which she passed directly by on her way to the sink. If I pick it up and put it on the counter, she'll drink out of it. But not if it's on the floor.

(When I'm around, anyway. When I'm not around, she's perfectly happy to drink out of it. Kinda makes you think there's some ulterior motive at work here, doesn't it?)

A Quick One-Sentence Reminder of What This Is All About

| Fri Sep. 27, 2013 1:51 PM EDT

The Republican Party is bending its entire will, staking its very soul, fighting to its last breath, in service of a crusade to....

Make sure that the working poor don't have access to affordable health care. I just thought I'd mention that in plain language, since it seems to get lost in the fog fairly often. But that's it. That's what's happening. They have been driven mad by the thought that rich people will see their taxes go up slightly in order to help non-rich people get decent access to medical care.

That's a pretty stirring animating principle, no?

Mid-Cap Executives Are Only a Little Worried About a Debt Default

| Fri Sep. 27, 2013 11:57 AM EDT

I'm not quite sure how seriously to take a poll by the National Center for the Middle Market, which focuses on companies with between $10 million and $1 billion in annual revenues, but I suppose it's as good as any. Today, Jim Tankersley highlights an NCMM poll about the debt ceiling, which NCMM headlines, "Few believe a government default is a real possibility in the near future."

But that's not quite how I read it. The chart on the right suggests that 38 percent of the executives who responded think a default is likely. 38 percent! That's a fair amount, and it's likely to increase as we get closer to October 17. Unfortunately, it's not clear exactly what this means. Does "defaulting on debt obligations" mean defaulting on treasury bonds? Does it mean holding up Social Security checks? Or does it mean not paying a few bills in a timely manner? These are very different things. Defaulting on treasurys would be catastrophic, and if that's what these guys think might happen, they're certainly a lot calmer about it than I would be.

Still, it's true that 63 percent think this is all a big snooze, and that Congress will come to its senses after everyone has blown off a little steam. Unfortunately, this is why business leaders aren't doing much to push for a solution, and it's possible that the very fact of their listless attitude might be increasing the odds that they'll be wrong.

So what will it take to end the debt ceiling crisis? Here's a guess: a stock market crash. If we really and truly breach the debt limit without a resolution, markets will probably go crazy. In fact, they might go especially crazy because they seem so sure that it won't happen. But that's the one thing that always seems to get everyone's attention. You can have failing banks, massive ranks of the unemployed, and auto giants going bankrupt—and Congress will twiddle its thumbs. But let the Dow fall a thousand points or three, and suddenly they spring into action. There are lots of ways this could end, but I wouldn't be surprised if that turns out to be the winner.