Kevin Drum

John McCain and California's Caps

| Fri Feb. 26, 2010 12:38 PM EST

During the healthcare summit yesterday, John McCain hailed California and Texas for implementing damage caps in medical malpractice suits. But then he stumbled a bit and decided he actually wanted to talk only about Texas, not California. He nervously made a lame joke about California stealing Arizona's water to cover this up, but at the time I tweeted: "McCain doesn't want to talk about California's damage caps. Why? Because it hasn't kept premiums down."

And it hasn't. We passed a law called MICRA in 1975 that limited noneconomic damages in malpractice cases to $250,000. Adjusted for inflation, that cap is now about the equivalent of $60,000. Nonetheless, its impact on malpractice premiums has been negligible. The chart below comes from the Foundation for Taxpayer and Consumer Rights, which definitely has a dog in the fight since it was founded by insurance industry scourge Harvey Rosenfield, who championed Proposition 103, an initiative that implemented state approval of insurance rates. It was passed in 1988.

Still, the results are pretty clear. After 1975, malpractice premiums continued to zoom upward, rising at an even higher rate than in other states. But after 1988 (that's the green line for easy reference), California premiums leveled off while rates in the rest of the country continued to rise. The reason for this is pretty simple: large damage awards are actually pretty rare and don't make up a huge proportion of total malpractice payouts. Capping them changes the picture, but it doesn't change it that much. But it does substantially cut into trial lawyer income.

Which, of course, is the whole point. If you want to annoy trial lawyers, you should cap damages. If you really want to reform malpractice law, however, look elsewhere.

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Healthcare Summit: The Takeaway

| Fri Feb. 26, 2010 12:04 PM EST

Here's the lead story in the print edition of the LA Times this morning:

Democrats' next option: Go it alone

Facing unbending Republican opposition to a healthcare overhaul, President Obama confronted a stark reality Thursday as his televised summit ended: If he and his Democratic allies in Congress want to reshape the nation's healthcare system, they will have to do it by themselves.

I'm not sure how the summit is playing on TV, but this is, I think, about the best possible spin for Obama. If, over the next few days, the takeaway from the summit is that Republicans are just dead set against doing anything — whether due to principle or just political bloodymindedness, it doesn't matter — that helps his cause with both the public and his own caucus.

Healthcare Summit Wrapup III

| Fri Feb. 26, 2010 1:02 AM EST

A sampling of bigfoot liberal pundit reaction to the summit. Steven Pearlstein:

The most important thing Republicans think is that if there are Americans who can't afford the insurance policies that private insurers are willing to offer, then that's their problem — there's nothing the government or the rest of us should do about it....That was their clear message Thursday. It was their message during all those years when their party controlled Congress and the White House and they did nothing and said nothing about the plight of the uninsured. And it is clear that they would continue to do nothing if, by some miracle, Democrats were to drop their plan or embark on a more modest approach. For Republicans, the uninsured remain invisible Americans, out of sight and out of mind.

E.J. Dionne:

The Republicans simply don’t want to pass comprehensive health-care reform. That is the main lesson of today’s health-care summit.

Paul Krugman:

So what did we learn from the summit? What I took away was the arrogance that the success of things like the death-panel smear has obviously engendered in Republican politicians. At this point they obviously believe that they can blandly make utterly misleading assertions, saying things that can be easily refuted, and pay no price. And they may well be right.

Can't disagree with any of that! Still, my take is that the summit was basically a draw, but with a slight edge to the Republicans. They didn't have to win, after all. They just had to seem non-insane, and for the most part they did. What's more, Obama missed a chance to provide a punchy, 60-second sales pitch for the Democratic plan. A recent Kaiser poll that's been making the rounds shows that Americans don't like the Democratic plan but they do like the features of the plan. They just don't know they're there. So Obama should have outlined those features in quick, soundbite format. He missed a bet by not doing that.

What Happened to John Yoo's Emails?

| Thu Feb. 25, 2010 8:00 PM EST

Hmmm. "Most of" John Yoo's emails from his stint writing torture memos for the Justice Department were deleted before he left. You know, it takes a pretty deliberate effort to delete emails and make them nonrecoverable. CREW wants an investigation.

Healthcare Summit Wrapup II

| Thu Feb. 25, 2010 5:35 PM EST

A quick followup on my previous healthcare summit posts.

First, Obama's big closing issues were covering 30 the million uninsured and doing something about preexisting conditions. Those are smart choices because (a) they're popular issues with the public and (b) they're poison for Republicans. Their plans simply don't (and can't) cover a substantial number of the uninsured because you can't do this in a private system without federal subsidies, and that requires tax increases. Likewise, solving the preexisting condition problem within a private system leads you inevitably to a mandate and subsidies, which requires a tax increase. They're stuck.

Second, his basic message was a promise to consider some changes to his current position and a challenge to Republicans to do the same instead of merely insisting on starting over from scratch. "If we saw movement, significant movement, not mere gestures, we wouldn't have to start over," he said. In other words: cut the talking points and get serious about addressing real problems.

Will it work? It depends on what you think "work" means. There's no chance of Republicans making any concessions, of course, but Obama's stated willingness to consider their ideas might help win over public opinion and stiffen some Democratic spines. But that largely depends, I think, on how the press ends up playing this. Stay tuned.

Healthcare Summit Wrapup

| Thu Feb. 25, 2010 5:00 PM EST

So what will be the basic Obama/Gibbs media takeaway from the healthcare summit? I figure there are three main possibilities:

  1. "I'm disappointed that Republicans just fell back on the same old talking points instead of having a serious discussion."
  2. "Our differences turned out to be pretty fundamental after all: we want to tackle real problems and Republicans just want to tinker around the edges. But I'm convinced the American people prefer something to nothing."
  3. "I'm grateful that Republicans had some good ideas, but they fell far short of addressing our real problems."

If I were president, I'd choose #1. Luckily, I'm not, and I figure Obama will pretty much choose #3. The initial reaction of the press, however, appears to be "Jesus, what a waste of time."

Which it pretty much was.1 As an aside, this is why I wasn't very excited about the idea of holding regular versions of the "question time" that Obama held with congressional Republicans last month. They got taken by surprise then, but there was never any chance that would happen a second time. And it didn't. They were armed with every talking point in the book this time, and some of those talking points resonate pretty well. What you saw today is about what any future question time would look like.

1Just to be clear, I mean a waste of time substantively. In terms of its impact on the politics and public opinion of healthcare reform, we'll have to wait and see.

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Financial Link Dump

| Thu Feb. 25, 2010 3:44 PM EST

Looking for something to do instead of watching more healthcare bloviating? Mike Konczal has a bunch of good posts up:

Go read. It's all good stuff.

Obama's Hole Card: Preexisting Conditions

| Thu Feb. 25, 2010 1:45 PM EST

Here's my idiosyncratic halftime take on the White House's goal at today's healthcare summit. The one topic that Democrats keep hammering on over and over is the problem of insurance companies refusing to cover people with preexisting conditions. "This is an area where we can come together," Obama says. Republicans, in contrast, have been relentlessly trying to talk about everything but this. They've barely acknowledged the preexisting conditions problem at all.

For Obama, this is the ballgame. My guess is that he wants to maneuver Republicans into either (a) admitting that they're unwilling to regulate this, which would be highly unpopular, or (b) admitting, however grudgingly, that the practice needs to be banned. Because if they admit it has to be banned he can make the following argument:

  • If insurance companies are forced to take on all comers, then people can game the system by buying insurance only when they get sick. This would obviously decimate the private insurance industry.
  • So you have to require everyone to buy insurance at all times. It's the only way to have a broad pool that keeps costs down (another frequent Obama talking point.)
  • But obviously you can't force poor people to buy insurance they flatly can't afford. So if you mandate coverage, then you have to subsidize low-income families that can't afford insurance, and you have to provide incentives for small businesses so that they can cover their employees.
  • And if you do that, you have to have a funding source. Preferably one that also helps rein in premium costs. Like, oh, an excise tax.

This seems to be the direction he's trying to push things. The question is (a) can he force Republicans to address this? and (b) can he then make the rest of the argument in plain enough terms that it makes sense to everyone?

This is, basically, a debating trick, and Republicans obviously want to avoid getting sucked into it. This is why they try to mumble a bit about high-risk pools and then quickly move on. But the preexisting conditions problem is one of the few issues that almost universally resonates as unfair with the public, and Obama's job is to get everyone to understand what it takes to fix it. If he does, he'll come out of today's summit in better shape than he went in.

Has Pakistan Finally Turned Against the Taliban?

| Thu Feb. 25, 2010 1:15 PM EST

Following up on yesterday's post about the capture of Taliban leaders in Pakistan, the New York Times fills in some details about increased cooperation between Pakistan's ISI and the CIA:

Interviews in recent days show how they are working together on tactical operations, and how far the C.I.A. has extended its extraordinary secret war beyond the mountainous tribal belt and deep into Pakistan’s sprawling cities.

Beyond the capture of Mullah Abdul Ghani Baradar, C.I.A. operatives working with the ISI have carried out dozens of raids throughout Pakistan over the past year, working from bases in the cities of Quetta, Peshawar and elsewhere, according to Pakistani security officials. The raids often come after electronic intercepts by American spy satellites, or tips from Pakistani informants — and the spies from the two countries then sometimes drive in the same car to pick up their quarry.

....And yet for two spy agencies with a long history of mistrust, the accommodation extends only so far....Even as the ISI breaks up a number of Taliban cells, officials in Islamabad, Washington and Kabul hint that the ISI’s goal seems to be to weaken the Taliban just enough to bring them to the negotiating table, but leaving them strong enough to represent Pakistani interests in a future Afghan government.

This contrasts sharply with the American goal of battering the Taliban and strengthening Kabul’s central government and security forces, even if American officials also recognize that political reconciliation with elements of the Taliban is likely to be part of any ultimate settlement.

Italics mine. However, Spencer Ackerman suggests that far from being as sharp as the Times suggests, "the strategic differences here may be ones of degree." This seems like the better guess. Both sides now agree that the Taliban needs to be seriously beaten up, and at most, the argument is over just how much to beat them up in order to get them to sue for peace. Not only is that not a huge difference, but it's one that both sides will legitimately find difficult to calibrate anyway. If that's really the extent of their disagreement — admittedly a big if — there's a real glimmer of progress here.

The Healthcare Summit So Far

| Thu Feb. 25, 2010 11:33 AM EST

Quick comment on today's healthcare summit: John Boehner and Mitch McConnell are smart enough to know their own limitations and choose others to speak for the Republican side. And they've mostly chosen speakers who are good at this stuff and know how to talk in ways that make sense.

The Democrats, who should be in better shape because they have a single leader, are insisting on letting every leader speak: Nancy Pelosi, Harry Reid, Steny Hoyer, and Max Baucus so far. These folks are not great speakers. Why are they so lame that they insist on speaking anyway? For once in their preening lives, why don't they just fade into the background and let President Obama orchestrate their side? Obama may yet come out on top in today's session, but the behavior of the Democratic congressional leadership so far constitutes political malpractice.