Kevin Drum

Healthcare's Penultimate Hurdle

| Thu Dec. 24, 2009 11:31 AM EST

Ezra Klein calls it "winning ugly," but a win's a win: early this morning the Senate voted 60-39 to pass its healthcare reform plan, only the second time in American history that a healthcare bill of this magnitude has even reached the Senate floor. Next stop: a House-Senate conference committee after the winter recess and then one final vote for all the marbles, probably in late January.

So why do I not feel more elated? Part of the reason is that in the modern era of the institutional filibuster, 60 votes is a paper-thin margin and there's still a chance that someone could come back from recess bloodied and beaten up and looking for a pretext to change their vote. The conference report might give them an excuse, and that would mean healthcare reform dies again.

But I think that's unlikely. The bigger reason, of course, is that healthcare has splintered the liberal movement so badly. There's a far-left wing so obsessed with the demise of the public option that it's working overtime to team up with reactionaries to destroy the bill and — maybe — Obama's presidency along with it. The more moderate left supports the bill, but hardly enthusiastically. For us, it's a "starter house," or "the best we could get." That's not exactly a rallying cry. And independents are just confused and exhausted by months of political sniping, intra-left bickering, and the relentless flood of Beck/Palin/Drudge demagoguery.

So it doesn't feel much like a victory yet. But it should. I'm 51 years old and this bill is, without question, the biggest progressive advance in my adult life. You have to go back to the great environmental acts of the early 70s to get close, and to the civil rights/Medicare era to beat it. That's four decades, the last three of which have constituted an almost unbroken record of conservative ascendency. And now that ascendancy is just days away from being — finally, decisively — broken. Warts and all, we're on the cusp of passing a bill that provides all of this:

  • Insurers have to take all comers.  They can't turn you down for a preexisting condition or cut you off after you get sick.
  • Community rating.  Within a few broad classes, everyone gets charged the same amount for insurance.
  • Individual mandate.  (Remember how we all argued that this was a progressive feature back when John Edwards and Hillary Clinton were championing it during the primaries?)
  • A significant expansion of Medicaid.
  • Subsidies for low and middle income workers that keeps premium costs under 10% of income.
  • Limits on ER charges to low-income uninsured emergency patients.
  • Caps on out-of-pocket expenses.
  • A broad range of cost-containment measures.
  • A dedicated revenue stream to support all this.

A trillion dollars in benefit for low and middle income workers. 95% of Americans insured. Medical bankruptcies on the verge of disappearing. And for the first time ever, an acknowledgement that decent healthcare ought to be universal in the United States. This is historic. This is a cause for celebration, not recriminations. As recently as 2005, I wasn't sure I'd ever see this day, and now, a mere three years later, it's here. I can still hardly believe it.

UPDATE: Some good thoughts in a similar vein here from Jon Chait.

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Polishing the Pig

| Wed Dec. 23, 2009 7:21 PM EST

Matt Yglesias comments on Barack Obama's obviously false assertion that he never campaigned on the public option:

I think Obama could fairly say something like “for some activists, the public option may have been the centerpiece of health reform but it’s never been that for me and it wasn’t the heart of what I proposed during the campaign.” But he definitely did campaign saying he’d create one. I’m also really not sure why Obama would try to make consistency with campaign rhetoric a hallmark of his drive. He definitely campaigned against Hillary Clinton’s proposed individual mandate to buy health insurance and also attacked elements of John McCain’s health plan in terms that could easily be seen as inconsistent with the insurance excise tax concept.

Here's what I don't get. As near as I can tell, presidents pretty much never say things like this. They never concede a mixed bag on anything they're associated with. The Iraq war was always going swimmingly. Welfare reform was an unqualified boon. Reagan never raised taxes. Etc. Likewise, Obama seems unwilling to admit that the healthcare reform that finally got spit out of Congress is anything other than exactly what he wanted all along.

I suppose the conventional wisdom is that whatever you end up with is something you have to sell to the American public, and the only way to sell anything successfully is to relentlessly claim it's the greatest thing since Abraham Lincoln invented bifocals. So I guess my question is whether this is really true. Would it hurt Obama (or any president) to admit to a few modest reservations or problems while vigorously defending an overall initiative? Or is the conventional wisdom right, and the best offense is a good offense? Opinions?

Keeping Class Actions Honest

| Wed Dec. 23, 2009 6:24 PM EST

I don't generally support the conservative crusade against class action lawsuits, but there's not much question that some can be pretty abusive while others are little more than fee generators with no real benefit for consumers. In particular, I really hate class actions that generate nothing for consumers but minuscule coupons that are basically just free marketing gimmicks for the companies that ripped them off in the first place. On this score, Todd Zywicki praises Ted Frank's Center for Class Action Fairness:

This is an issue that I worked on extensively while I was at the FTC, so I have some familiarity with how outrageous some of these settlements are and how important work like Ted’s is in protecting consumers.  In particular, what I became aware of is how many of these lawsuits are essentially settled in a collusive bargain between class counsel and the defendant.  Usually the defendant pays a couple million dollars to the lawyers and gives coupons or some similar redress to the members of the class.  In one case a judge noted that the coupons — which allowed class members to get discounts on future purchases — essentially amounted to a request for a court-ordered promotional scheme.  An example (in a case well after I left the Commission) was the FTC’s intervention in the Netflix settlement.

The danger here for a liberal, of course, is that there's no telling how much of the CCAF's work is genuinely dedicated to preventing consumer ripoffs and how much — either now or later — shades into a more general assault on the civil tort system. I'm in favor of the former, not so much the latter. Worth keeping an eye on, though, if Frank really does stick to consumer protection.  CCAF's website is here.

Strange Bedfellows Indeed

| Wed Dec. 23, 2009 5:52 PM EST

Apparently Jane Hamsher has decided that a healthcare bill that provides a trillion dollars worth of benefit to low and middle income workers is so odious that mere opposition isn't enough. Nor is opposition that increasingly employs the worst kind of right-wing talking points. No, it's so odious that it deserves a scorched earth campaign against the Obama White House in partnership with Grover Norquist.  Hard to know what to say about this. What's next? A joint Twitter campaign with Sarah Palin? A letter writing campaign cosponsored by Richard Viguerie? A joint lawsuit with Orly Taitz? Jeebus.

Physics Gifts

| Wed Dec. 23, 2009 2:13 PM EST

Are you interested in cool quantum mechanical type physics stuff but don't really understand it? Do you know someone else who fits that bill? Do you like dogs? Are you looking for a last-minute Christmas gift? If you answered yes to any or all of these questions, why not take a flyer on Chad Orzel's new book, How to Teach Physics to Your Dog?

You probably suspect that I haven't actually read it myself and I'm only saying this because Chad's a good guy and I like his blog.  Well, you'd be right. But I'll bet it's a fun book, and I don't have any other last-minute gift ideas for you. The book website is here, complete with a PDF of Chapter One and a bunch of videos. Have fun.

POSTSCRIPT: Alternatively, how about a gift subscription to Mother Jones? Our publisher probably likes that idea better. But you can always do both!

Quote of the Day: The Demon Pot

| Wed Dec. 23, 2009 1:57 PM EST

From Mary Grabar, "conservative professor of English, commentator, fiction writer, and poet," on why alcohol is OK but marijuana isn't even though it tends to have a milder effect:

That’s exactly what the left wants: a nation of young zombies — indifferent, unengaged, and uncaring. They provide amenable subjects to indoctrination. Alcohol may fuel fights, but marijuana, as its advocates like to point out, makes the user mellow. The toker wants to make love, not war.

I guess she's nailed us, hasn't she? Back to the drawing board, boys and girls. Via Mona.

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Gift Cards

| Wed Dec. 23, 2009 12:53 PM EST

Barry Ritholtz doesn't like gift cards:

Nothing says “I am both thoughtless and inconveniencing” like a gift card. They let the recipient know that you couldn’t be bothered actually picking out a present, so here is a cash equivalent — only so much less convenient than the crisp paper kind of cash. And, you can only spend it in one place.

Now much do gift cards suck? Each year, $5 billion in gift cards go unclaimed, forgotten about or lost. That’s how much people value them — they throw away $5 effen billion dollars worth every year!

My heart is with Barry.  But my brain says different: I'll bet $5 billion is peanuts compared to the value of actual physical Christmas gifts that are essentially thrown away every year.  How many sweaters/books/vases/novelties/etc. have you gotten over the years that basically got tossed in a drawer never to see the light of day again?

Barry goes on to provide a couple of further pieces of advice, one sound and one not. First, the sound one: "If you must get a gift card, then get them a Gift card they will actually use. Maybe they have a favorite clothing store or gadget shop....If your daughter is a Starbucks junkie, then at least you know the gift will be used — and appreciated." I have friends and relatives who love gift cards.  And you know, if that's what they want, then why not get them a gift card? It's their gift, after all. But yes: make sure it's to someplace they like to shop at, someplace where they'd enjoy having some "free" money to go on a little binge. It's fun!

And then the unsound advice: "Even better still: Get them a prepaid credit card. All the major credit card firms (Amex, Visa, Master Card) let you buy prepaid CC as a gift card. These can be used anywhere credit cards are accepted. Its practically cash, and far more flexible than a Abercrombie or a Sears gift card." This is bad advice — for now. The Fed has proposed new rules regulating expiration dates and limiting "maintenance" and "dormancy" fees on gift cards, but they haven't gone into effect yet.  Bank gift cards tend to be riddled with these things.  They're even worse than retail gift cards. AmEx is an exception, but for now I'd avoid Visa and Mastercard gift cards.

I'd add one more thing: some people have a hard time thinking of presents to suggest to their friends and relatives. This makes it hard to shop for them, and they feel guilty about this. So they suggest a gift card instead: it's something they can use, and it relieves the pressure of desperately trying to dream up a Christmas list even though they don't have a lot of good ideas on tap. If you know someone like that, give 'em a break. Get them a gift card and stop bugging them. Life will be happier all around.

Bailouts and Justice

| Wed Dec. 23, 2009 12:14 PM EST

Daniel Gross interviews Treasury Secretary Tim Geithner, who complains that raging populism has made his job harder:

So you don't think the bailouts were too friendly to Wall Street?
The idea that the strategy was unfair and has principally benefited a small number of institutions in New York is a mischaracterization of the design and result of the strategy. I thought people would have understood this after the failure of Lehman Brothers. But when you do too little and you leave the system with real fear that everything is going to fall apart, like any financial crisis, it hurts the poorest most. A just and fair strategy, even if it is politically hardest to explain and justify, is to use well-designed but massive force to stabilize the system.

You know, Geithner really didn't have to go that far.  It's one thing to defend the bailout as an ugly but necessary response to a crisis, but it's quite another to call it a "just and fair strategy."  Basically, the banking system held a gun to our collective heads and forced us to transfer a huge amount of wealth to them, and has spent the entire time since then working feverishly to make sure they pay no price for this and are in no way prevented from ever doing it again. Maybe we didn't have a choice, but there was nothing just about it. I wish Geithner could at least acknowledge that much.

Celebrities and Illness

| Wed Dec. 23, 2009 11:13 AM EST

Via Dave Munger, an article today in USA Today about celebrity idiocy on the medical front:

Doctors and public health groups say they struggle over the best way to respond to celebrity claims.

At Every Child By Two, an immunization campaign co-founded by former first lady Rosalynn Carter, board members were initially inclined to ignore celebrities who question vaccine safety, says executive director Amy Pisani. Now, the group spends 80% of its time explaining why vaccines are still critical.

"We were poised to start working in Africa," Pisani says. "But we were forced to pull back just to re-educate people here in the United States."

I practically go into spasms these days whenever Jenny McCarthy shows up on TV. The damage she's done to millions of kids is almost incalculable. However, as the article says, celebrities can also have quite positive effects when they go public with illnesses that are underacknowledged for one reason or another. So it's not all bad.

Housekeeping Note

| Wed Dec. 23, 2009 1:23 AM EST

I now have 999 Twitter followers.  If you're quick, you can be the 1,000th. Hurry! @kdrum.

(See? I'm taking this new media stuff seriously.  Honest.  Another 700 followers and I'll be ahead of Mickey Kaus.  You don't want me to be behind Mickey, do you?)

UPDATE: Congrats to @eugenephotoblog (Eugene from Atlanta), lucky #1,000! But keep 'em coming. I'm still trying to catch up with Mickey.