Kevin Drum

How to Win

| Fri Aug. 21, 2009 1:03 PM EDT

Does Barack Obama really believe that calm bipartisanship is a successful political strategy in modern Washington DC?  Well, it got him elected, didn't it?  Matt Yglesias takes it from there:

My worry would be that it strikes me as very plausible that a political strategist could overlearn the lessons of his own success. The fact of the matter is that Obama’s margin of victory was more-or-less exactly what you would expect based on fundamentals-driven models of presidential elections. We know that the strategy Obama employed “worked” (he won, after all) but there’s no clear evidence that it was particularly brilliant. But you can easily imagine Obama and David Axelrod and other key players becoming overconvinced by their own success.

Nobody ever, ever, ever believes this.  There's always a narrative behind presidential victories, and there always will be, despite the fact that 90% of them are dead wrong.  Obama ran an excellent primary campaign and a perfectly decent general election campaign, but the latter boiled down to one word: "Change."  That's what most elections boil down to: "Time for a change" vs. "Experience counts."  They both work fine in alternate cycles, but neither is especially brilliant or especially new.  Pericles pioneered them both in his long career, and that was 25 centuries ago.

The post-partisan schtick might yet work.  But even though it was effective during last year's campaign, it's not really what won him the presidency.  A little bit of ruthlessness vs. Hillary Clinton got him through June, and repeating a nice, simple message over and over and over kept him on top throughout the fall.  That's a combination he might want to remember.

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"Yes, But"

| Fri Aug. 21, 2009 12:40 PM EDT

Charles Krauthammer writes today that he'd like to hold a reasoned discussion about end-of-life counseling.  "We might start by asking Sarah Palin to leave the room," he says.

That's "close to reasonable," says Joe Klein.  But no, it isn't.

Krauthammer is part of the swelling "Yes, but" crowd, and for my money these guys are infinitely worse than the flat-out nutters themselves.  I mean, at least nutters have the excuse of being nutters, right?  They can be dismissed or mocked or yelled at or whatever.  But everyone outside the nutter base understands that they're crazy.

Then there's the "Yes, but" contingent.  Sober.  Serious.  Looking at all sides of the issue.  Stroking their chins.  Coming to conclusions.

And what are those conclusions?  Well, golly, the nutters might be nuts, but they have a point!  Allowing Medicare to reimburse doctors for advance care counseling might be the first tiny step toward turning them into junior Dr. Mengeles after all.  Krauthammer bases this conclusion primarily on his belief that living wills are pretty much useless:

So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we've nudged you ever so slightly toward letting go.

It's not an outrage. It's surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health-care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it's intended to gently point the patient in a certain direction, toward the corner of the sickroom where stands a ghostly figure, scythe in hand, offering release.

Subtle pressure indeed.  The only thing that's subtle here is Krauthammer's faux evenhandedness.  Up until two minutes ago, politicians and pundits across the political spectrum universally believed that advance care counseling was an entirely sane and uncontroversial practice, one that any compassionate society would encourage.  Those same politicians and pundits knew perfectly well that it was never about guiding patients in any particular direction and has never been motivated by cost savings in any way.  They knew that other countries reimburse for advance care planning — just like any other use of a doctor's time — and it hasn't led to any pressure, subtle or otherwise, to pull the plug on grandma.

They knew this.  Until two minutes ago.  But now they're pretending — subtly, temperately — that maybe it isn't true after all.  And they're doing this not because they've changed their minds, but because they want to kill healthcare reform for political reasons and they don't care whether innocent bystanders get hurt in the process.  Their "Yes, but" campaign might ensure that patients forevermore mistrust doctors who talk about advance care directives, but they also know that sober, serious, subtle op-eds endorsing this point of view are more likely to derail healthcare reform among the chattering classes than Sarah Palin's Facebook maunderings.  It is intellectual venality of the first order.

Too Much Compassion

| Fri Aug. 21, 2009 11:49 AM EDT

I tend to be pretty squishy and bleeding heart over things like compassionate release for prisoners with terminal diseases.  Usually, though, they're 70 years old and have served 40 years in prison or something.  Releasing a mass murderer after eight years is another thing entirely.  Compassion ought to have its limits, and the Scottish government seems to have lost its mind in the case of Lockerbie bomber Abdel Basset Ali al-Megrahi.  The Libyans aren't exactly helping matters either.  What a mess.

Healthcare Ripoffs

| Fri Aug. 21, 2009 11:10 AM EDT

Miller-McCune glosses some recent research about the exorbitant rates the uninsured are forced to pay for medical care:

For example, one doctor billed $4,500 for an office visit when Medicare would have paid just $134. Another doctor billed $14,400 for removal of a gallbladder when Medicare would have paid $656. And a hip replacement cost $40,000 when Medicare would have paid $1,558.

....[Jeffrey] Rice said people should know they have a choice even when their insurance company is paying the bill. "Everyone knows you don't buy a car without knowing what the Blue Book value is. Well the same should be true in health care," he said.

....Previous research published in 2007 in the journal Health Affairs showed the "uninsured and other 'self-pay' patients for hospital services were often charged 2.5 times what most health insurers actually paid and more than three times the hospital's Medicare-allowable costs." The study by Gerard Anderson also found the "gaps between rates charged to self-pay patients and those charged to other payers are much wider than they were in the mid-1980s."

"Blue Book," of course, is a little harder to figure out for triple bypass surgery than it is for a 2003 Honda Civic.

In any case, this practice demonstrates both the pros and cons of going to the mattresses over inclusion of a public option in a healthcare reform bill.  On the one hand, the really important thing is to get the uninsured insured.  With anyone.  They'll get better care and their bill will be way lower, regardless of whether they have a public or private insurer.  On the other hand, private insurance is expensive, and in most of the plans on offer middle income families (above a cutoff of about $50,000) won't get any government subsidies to purchase it.  A public plan would (a) almost certainly be cheaper and (b) put price pressure on private plans to be cheaper too.  Result: more people are insured and fewer people are paying outrageous bills for common procedures.

Chart of the Day

| Thu Aug. 20, 2009 10:24 PM EDT

I haven't had a chart of the day here for weeks.  What the hell is going on around this place?

Well, here's today's: day trips to Canada are down.  Way down.  It's not clear why, either.  The accompanying story blames it mostly on new passport rules, along with "other factors, including the recession and the higher Canadian dollar."  But that doesn't really hold water.  The downward spike from May to June might be due to new passport rules, but the chart makes clear that travel has been steadily decreasing ever since it recovered from 9/11 in early 2002.  Obviously passport rules have nothing to do with this 7-year trend, and neither does the recession or the strength of the Canadian dollar.

So what is it?  Take your guesses in comments.

UPDATE: Actually, maybe the exchange rate explains it after all.

What Gay Marriage Means

| Thu Aug. 20, 2009 4:05 PM EDT

When Steve Chapman asked same-sex marriage opponent Maggie Gallagher to offer a few "simple, concrete predictions" about what would happen if SSM were legalized, she "politely declined."  However, now that Chapman has gotten the ball rolling, she's taken to The Corner to offer a few "preliminary predictions about the short-term effects of SSM":

  1. In gay-marriage states, a large minority people committed to traditional notions of marriage will feel afraid to speak up for their views, lest they be punished in some way.
  2. Public schools will teach about gay marriage.
  3. Parents in public schools who object to gay marriage being taught to their children will be told with increasing public firmness that they don't belong in public schools and their views will not be accomodated in any way. 
  4. Religous institutions will face new legal threats (especially soft litigation threats) that will cause some to close, or modify their missions, to avoid clashing with the government's official views of marriage (which will include the view that opponents are akin to racists for failing to see same-sex couples as married).
  5. Support for the idea "the ideal for a child is a married mother and father" will decline.

Of these, #4 strikes me as almost certainly mistaken.  Interracial marriage bans were struck down more than 40 years ago, but so far as I know, churches are still legally free to marry whomever they wish without interference from the government.  I expect the same will be true as same-sex marriage bans are overturned.

Gallagher's other objections are more plausible, but what's striking about them is how self-referential they are.  The balance of her list all boils down to about the same thing: if social attitudes become more tolerant toward SSM, then.....social attitudes will become more tolerant toward SSM.  Which is hard to argue with.  I don't think anyone will be "punished" for opposing SSM, but it's almost certainly true that as SSM becomes more widely accepted, people who remain unreconciled will feel somewhat socially marginalized — something that happens anytime there's social change of any sort.

Widespread acceptance of gay marriage, then, will result in widespread acceptance of gay marriage.  Aside from that, though, Gallagher doesn't really predict any concrete harm to society.  So what's the problem?

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Bullet Point of the Day

| Thu Aug. 20, 2009 1:37 PM EDT

From a press release announcing some of the dirty laundry that former DHS secretary Tom Ridge will air in his upcoming memoir:

• How Ridge effectively thwarted a plan to raise the national security alert just before the 2004 Election.

Paul Bedard of US News adds that this was "something he saw as politically motivated and worth resigning over."  Juicy!  The book will be released September 1st.

Nihilists and Hypocrites

| Thu Aug. 20, 2009 1:16 PM EDT

Joe Klein says the Republican Party has been taken over by "nihilists and hypocrites":

An argument can be made that this is nothing new....There was McCarthyism in the 1950s, the John Birch Society in the 1960s. But there was a difference in those times: the crazies were a faction — often a powerful faction — of the Republican Party, but they didn't run it. The neofascist Father Coughlin had a huge radio audience in the 1930s, but he didn't have the power to control and silence the elected leaders of the party that Limbaugh — who, if not the party's leader, is certainly the most powerful Republican extant — does now. Until recently, the Republican Party contained a strong moderate wing. It was a Republican, the lawyer Joseph Welch, who delivered the coup de grâce to Senator McCarthy when he said, "Have you no sense of decency, sir, at long last?" Where is the Republican who would dare say that to Rush Limbaugh, who has compared the President of the United States to Adolf Hitler?

Yep.  Both parties have their extreme wings, but the GOP's is not only way deeper into crazy land ("death panels" for them vs a public option for the most liberal Dems), but it's virtually all they have left.  Michele Bachman is pretty much the modal Republican now, not just a fringe nutball.  Conversely, Dennis Kucinich, who's far to the left but perfectly sane and coherent, barely gets the time of day from the mainstream core of the Democratic Party.

I don't actually mind if most or all Republicans vote against healthcare reform.  They're Republicans!  They're opposed to expanded government programs and private sector regulation and new entitlements.  But the death panels and the home nursing inanity and the "healthcare racism" and the town hall screeching and all the rest are the mark of a party that's gone completely off the rails.  They're doomed until they figure out a way to extricate themselves from the Beck/Limbaugh/Fox News axis of hysteria.

Fixing the World

| Thu Aug. 20, 2009 12:29 PM EDT

Bloomberg reports on the upcoming central banker pow-wow:

Federal Reserve Chairman Ben S. Bernanke and fellow central bankers gathering in Jackson Hole, Wyoming, are showing scant signs of reprising the coordinated stance they took fighting the worst financial crisis since the Great Depression as they deal with its aftermath.

....Bernanke, 55, and other policy makers, who meet on Aug. 20-22, are already staking out differing positions as they gain traction in their battle against a crisis that has cost financial companies worldwide about $1.6 trillion in writedowns and losses.....“What you would hope to happen is much better coordination internationally,” [Mohamed] El-Erian said. “What’s likely to happen, however, is that national interests are going to dominate.”

Well, so much for Ben Bernanke being greeted as a conquering hero.  Either that or else conquering hero-hood just isn't what it used to be.

Credible Threats

| Thu Aug. 20, 2009 12:11 PM EDT

Via ActBlue, Blue America has raised nearly $200,000 for members of Congress who have pledged to vote against any bill that doesn't contain a public option.  Pretty impressive.  If push comes to shove, and the choice is no bill vs. a bill without a public option, I sort of hope these guys all break their word and vote for it anyway.  (Or at least enough of them, anyway.)  But my preferences aside, this is a pretty good way of solving a big problem for the public option supporters: how do you make a threat to vote No credible when everyone knows liberals are champing at the bit to pass healthcare reform?  Well, this is one way.  It's a lot harder to make a U-turn and vote Yes after taking a very public stand against it and then accepting a bunch of activist money based on giving your word to stand firm.1

1Which isn't to say they won't do it anyway.  These are politicians, after all, and thus capable of just about anything.  But it's definitely harder.

UPDATE: Ezra Klein says my email explanation of the point I was making was much clearer than my actual post.  So here it is:

The Blue America money helps make the promise to vote against any bill without a public option more credible.  Right now, no one believes it.  Everybody thinks that, in the end, liberals will cave and vote for it regardless.  But with this money in place, which is going to people on condition that they vote against any bill without a public option, it makes it genuinely hard for them to turn around and vote Yes after all.  It helps turn a meaningless threat into a credible one.

CORRECTION: This money was raised by Blue America.  ActBlue is just the conduit.  The text has been corrected to reflect this.