Kevin Drum

The Great Health Reform Divide

| Wed Jun. 23, 2010 11:32 AM EDT

This week marked the three-month anniversary of the passage of health care reform. On Monday, Obama used the occasion to issue a harsh warning to health insurance executives against exorbitant rate increases. "[W]e’ve got to make sure that this new law is not being used as an excuse to simply drive up costs,” Obama thundered. He also unveiled what the White House calls a new "Patients' Bill of Rights," which highlights some of the new consumer protections and explains how insurers will be force to comply with the law.

Despite Obama's tough rhetoric, the "Patients' Bill of Rights" also makes it clear that the reach of the federal government will only go so far, even when it comes to the kinds of rate hikes the White House has condemned. The New York Times explains:

But for all of Mr. Obama’s browbeating, the new health care law stopped short of giving the administration the power to reject or limit rate increases. Instead, it established the annual reviews, starting next year, and makes available $250 million in grants to states to implement the review process.

States that accept the grants must recommend whether insurers with patterns of excessive pricing should be allowed to market policies through newly created exchanges, which will help individuals and businesses shop for coverage starting in 2014.

As it turns out, the White House had actually proposed giving the federal government the authority to reject unreasonable rate hikes, but the measure never made it into the final bill because of rules governing the reconciliation process. Sen. Dianne Feinstein (D-Calif.) has tried to reintroduce the proposal as a stand-alone bill, but the current political climate makes it difficult to imagine passing it any time soon. So the onus is now on the states to act, and it's quickly becoming clear which states will take the initiative (and federal money) to do so. The White House points out that states like California, New York, and Maine are already taking the opportunity to strengthen their oversight and require more transparency from companies that want to raise rates. And it's no surprise that the states with the most initiative are largely Democratic strongholds that already have a strong history of enforcing consumer protection measures. It's the start of the great divide between red and blue states that will become increasingly apparent as more parts of the law are put into place.

There's still some leeway for the federal government to assert greater authority and oversight over premium hikes, even in red states that are unwilling or reluctant to embrace the health law. The annual review process will require the federal government to work with state regulators to flag and scrutinize "unreasonable" premium increases. Though this will demand a measure of cooperation from state officials, the process could still create a more uniform standard for scrutiny and ramp up oversight in the twenty-odd states that currently don't have a "rate review" authority to examine premium hikes. That said, the administration has yet to finalize the rules defining exactly what an "unreasonable" rate hike is. And the insurance lobby that the White House has so thoroughly villified is doubtlessly doing all it can right now to shape the rules that will govern them.

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Afghanistan's 15 Minutes of Fame?

| Wed Jun. 23, 2010 10:00 AM EDT

Whether or not Obama decides to sack General McChrystal today, the president is unlikely to use the opportunity to change the overall course of his Afghanistan strategy. None of the sniping and lockerroom insults captured in the Rolling Stone piece questioned the tactics or resources that Obama has dedicated to the war. And the counterinsurgency approach that Obama has embraced in the country has basically been what McChrystal has wanted all along. And the administration is unlikely to reconsider its basic plan—an increase of 30,000 new troops until July 2011, when Afghan security forces are supposed to start taking over.

But maybe now really is the time to be asking the tough questions about how Obama’s war is going—and what both civilian and military commanders could be doing better. It certainly hasn’t been smooth sailing over the last few months, as Spencer Ackerman explains:

The past two months in Afghanistan have been brutal. Since returning from a Washington summit with Obama, President Hamid Karzai acrimoniously parted ways with two of his top security officials, men trusted by the U.S. who believe Karzai’s attempts at outreach to the Taliban to bring the war to a close represent capitulation. A United Nations report released this weekend documented a rise in violence in southern Afghanistan ahead of a crucial attempt at pushing the Taliban out of Kandahar, the south’s most populous city.

McChrystal had to slow down his push to provide what he calls a “rising tide” of security for Kandahar in order to secure buy-in from residents, as Karzai pledged his support for the operation at a mostly supportive local shura only last Sunday.What remains unclear from any Kandahar planning is the effect even a successful operation will have on the overall strength of al-Qaeda’s allies in Afghanistan — and al-Qaeda itself, across the border in Pakistan.

Thomas Friedman also has a blistering column today, accusing Obama of failing to answer basic questions about the surge:

If our strategy is to use U.S. forces to clear the Taliban and help the Afghans put in place a decent government so they can hold what is cleared, how can that be done when President Hamid Karzai, our principal ally, openly stole the election and we looked the other way? Secretary of State Hillary Clinton and others in the administration told us not to worry: Karzai would have won anyway; he’s the best we’ve got; she knew how to deal with him and he would come around. Well, I hope that happens. But my gut tells me that when you don’t call things by their real name, you get in trouble. Karzai stole the election, and we said: No problem, we’re going to build good governance on the back of the Kabul mafia.

The McChrystal flap has already ignited more news coverage and punditry about the US strategy in Afghanistan than we’ve seen in many, many months. (“This morning everyone in Washington everyone is a war correspondent,” tweeted Slate’s John Dickerson as the Rolling Stone article was first making the rounds.) I suspect that the attention will be fleeting, given the increasing brevity of the news cycle (remember Elena Kagan?) and lawmakers' own interest in keeping the focus on the economy and domestic issues in a tough election year. But the war effort could certainly benefit from the heightened scrutiny and demand for accountability that we've seen in the last 24 hours. Wishful thinking, perhaps?

Update: All the major news networks are reporting that McChrystal has been relieved of his command and will be replaced by General David Petraeus, who is currently heading up US Central Command.

Hello, Everyone.

| Wed Jun. 23, 2010 9:00 AM EDT

I'll be filling in for Kevin while he's away for a couple of days. Normally, you can find me over on Mother Jones's main news blog, writing about politics, immigration, and the occasional juicy conspiracy theory. Before coming to MoJo, I was at The New Republic, where I spent much time covering health care reform (which may creep onto the blog this week as well). Sadly, I have no cats. But I'm looking forward to the back-and-forth with everyone here.

Housekeeping Announcement

| Wed Jun. 23, 2010 12:49 AM EDT

I'll be out of town for the next few days, returning on Monday. Suzy Khimm will be guest blogging in my absence, and who knows — one or two others might pop in too. You never know. Catblogging, of course, will continue on schedule. And by the way: it would be great if you guys could get this whole McChrystal thing cleared up before I get back. And that oil spill thing too. OK? 

KIPP: A Limited Educational Success Story

| Tue Jun. 22, 2010 8:28 PM EDT

Ryan McNeely reports some good news on the education front:

Mathematica Policy Research just released a preliminary report of their large, multi-year study of the effectiveness of KIPP charter schools on increasing educational attainment. Their finding: “For the vast majority of KIPP schools studied, impacts on students’ state assessment scores in mathematics and reading are positive, statistically significant, and educationally substantial.” Further, “estimated impacts are frequently large enough to substantially reduce race- and income-based achievement gaps within three years of entering KIPP.”

Ryan says that the research design looks solid and the results, though still preliminary, are encouraging. I'd add that it's also encouraging to see these kinds of results in middle schools. Quite often, charter schools show good results in elementary schools but those results end up washing out in later grades. High school is still the acid test, but it's nonetheless good news to see that KIPP is showing steady good results beyond just the primary grades.

But there's always a "but," isn't there? And there are a couple of them here. First, although this study design is solid — it compares kids who got into KIPP schools via lottery with kids who applied but didn't get in — it's still the case that these are kids who applied to KIPP schools. All by itself that means they and their parents are part of the upper fraction who care about education and are willing to put in the work that KIPP demands of families. That's a limited set. Second, there aren't very many KIPP schools, and their structure is a built-in reason for this: KIPP schools demand a lot of their teachers, who work very long hours and are required to be on call at all times. They pay a bit more for this, but only a bit, and this isn't a model that scales well. You can always find a small cadre of dedicated young teachers willing to put up with this, but you're never going to find the hundreds of thousands you'd need to make this work on a large scale.

That's not to say that KIPP is a failure. It's not. It's a success. But it's a limited one, and probably always will be.

The Decline and Fall of Adult Movies

| Tue Jun. 22, 2010 4:04 PM EDT

Ross Douthat on summer popcorn movies:

On the 35th anniversary of the great white blockbuster, John Podhoretz has an essay blaming the unprecedented box-office success of “Jaws” for the rise of the lousy, disposable summer tent-pole movie. In his review of “Toy Story 3,” David Edelstein takes a different tack, arguing that if you want to trace Hollywood’s decline into dreck like “The A-Team” and the umpteen “Shrek” sequels, “the beginning of the end was ‘Star Wars,’ synthetic then as now, clever but never exhilarating, infinitely merchandisable.”

My father was a professor of film history and criticism (among other things), and he felt pretty much the same way. I remember asking him what he thought of Star Wars a few years after it came out, and after he made some negative comment or another I told him I thought it was a terrific film. He didn't really agree, but he did say that his real problem wasn't with Star Wars per se — which, after all, was something of an homage to the Buck Rogers serials of his youth — but with what Star Wars had done to movies. Everyone wanted to make the next Star Wars now, but too often that just meant simpleminded stories and lots of special effects and not much more.

Well, I still think he was wrong about Star Wars, and I think he was probably wrong about its impact too. Douthat again:

You know what? An awful lot of the middlebrow blockbusters of the 1980s were really, really good. If you just look at the 15 years after Spielberg’s great white shark first terrorized bathers and moviegoers, the legacy of “Jaws” and “Stars Wars” includes the Indiana Jones saga, the “Back to the Future” trilogy, “Ghostbusters,” “Top Gun,” “Beverly Hills Cop,” “Alien” and “Aliens,” Tim Burton’s Batman movies, “Die Hard,” “The Hunt for Red October” and “E.T.,” among other entertainments. That’s a pretty impressive roster of popcorn movies.

....It’s only really in the 2000s, in fact, that sequel-itis, the comic-book obsession, and the corrupting influence of special-effects — as well the siphoning of highbrow talent to television networks — created a box-office landscape dominated by movies that (to quote Edelstein’s indictment) “cost hundreds of millions and are not so much made as microengineered.” (Of the 25 highest-grossing movies of the last decade, only “Avatar” and “Finding Nemo” weren’t based on pre-existing properties.) And blaming “Jaws” and “Star Wars” for creativity-killing trends that came to fruition 30 years later seems like an enormous stretch.

I think that's pretty much right.  Star Wars was a different kind of blockbuster than, say, Ben Hur or Gone With the Wind, but blockbusters have always been with us. The difference now isn't really related either to the rise of special effects or the popularity of science-fiction-inspired themes, it's related to the fact that adults barely go to the movies anymore. Blockbusters today are geared almost exclusively to the 18-29 year old demographic, and that demo simply demands a different kind of movie. It's a cohort that's interested in video games, comic books, and plenty of adrenaline, and if that's the audience for your product then those are the kinds of movies you're going to produce. It has nothing to do with the success of Jaws or Star Wars.

There is, of course, always a chicken and egg problem here. Did adults abandon movies because movies got juvenile? Or did movies get juvenile because adults abanonded them? I've never come to a firm conclusion about this myself, but I suspect it's more the latter. As a social experience — for dates, for hanging out with your friends, for getting out of the house — movies are as good as they've ever been. And that's a big part of what kids want out of their pastimes. But adults? They mostly just want to relax with a bit of good entertainment, and they have a whole lot of other options for that these days. Options that, from an adult point of view, are generally superior.

So that leaves kids as the primary audience for movies, and moviemakers have responded by making movies for kids. That's too bad for the dwindling number of us who are over 30 but still like going to movies, but I don't blame George Lucas for that. I blame him for Howard the Duck and the second Star Wars trilogy, but not for Transformers II.

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Is McChrystal's Mess Really Obama's Fault?

| Tue Jun. 22, 2010 1:49 PM EDT

Jackson Diehl makes the case that Gen. Stanley McChrystal isn't to blame for exposing his staff's feuds with President Obama in Rolling Stone this week. Obama is:

If anyone deserves blame for the latest airing of the administration’s internal feuds over Afghanistan, it is President Obama. For months Obama has tolerated deep divisions between his military and civilian aides over how to implement the counterinsurgency strategy he announced last December.

....A scathing memo by [Karl] Eikenberry describing Karzai as an unreliable partner was leaked to the press last fall....Biden, for his part, gave an interview to Newsweek’s Jonathan Alter in which he said that in July of next year “you are going to see a whole lot of [U.S. troops] moving out.” Yet as Secretary of Defense Robert M. Gates tartly pointed out over the weekend, “that absolutely has not been decided.”

This is pretty weak tea. Whoever leaked Eikenberry's memo shouldn't have done it, but that leak happened before Obama decided on his Afghanistan strategy. The memo itself was merely Eikenberry offering his blunt advice in an ongoing debate, which is entirely proper. And Biden, speaking shortly after the final decision on Afghanistan was announced (the exact timing is unclear from Alter's book), was just giving a slightly aggressive take on a strategy that everyone had already agreed to: namely that troop withdrawals would begin in July 2011. He didn't publicly criticize the strategy or McChrystal or anyone else. Gates's "tart" statement came months later and only under prodding from an interviewer.

As Diehl says, we all know perfectly well that there are tensions between McChrystal and some members of the White House staff over our Afghanistan strategy. That's been obvious for over a year, ever since the strategy started being being hashed out. But that's entirely normal, and there's a big, big difference between being on one end of a policy fight (perfectly OK) and later publicly trashing everyone you disagreed with (not OK). And there's an even bigger difference between a civilian doing it (imprudent at best, sleazy at worst) and a general officer doing it (idiotic at best, insubordinate at worst). Even if Obama should be managing staff tensions over Afghanistan better, which is at least a defensible position to take, blaming the Rolling Stone debacle on him just won't fly. This is McChrystal's mess.

Chart of the Day: Obama's Shakedown

| Tue Jun. 22, 2010 1:20 PM EDT

Via Steven Taylor, this chart shows what happened to BP's stock price after President Obama finished his infamous shakedown session with BP last Wednesday. Apparently, after brutally assaulting BP's leadership with threats of Chicago style anti-business thuggery, the market rejoiced, sending BP's stock up more than two points in the space of a few hours.

In any case, as Dave Weigel has pointed out, the escrow account was hardly Obama's idea in the first place:

On Thursday, Rep. Anh "Joseph" Cao told me that he pressed BP on the fund idea a month ago, inspired by the example of Exxon after its 1989 spill off the coast of Alaska. And on Friday I talked with Ray McKinney, another engineer, who is running for Congress in Georgia against Rep. John Barrow (D-Ga.). McKinney stressed that there was no serious disagreement about the escrow issue, and said Democrats were concocting a political debate when all that mattered was making BP pay and investigating the disaster.

Are Democrats concocting a political debate? No. I suppose they're reveling in a political debate that's mostly been handed to them on a silver platter by tone deaf Republicans, but that's a different thing. All Obama did was announce the fund. It was Republicans who made it into yet another media firestorm.

Dr. Jekyll and Mr. Tea Party

| Tue Jun. 22, 2010 12:26 PM EDT

Matthew Continetti has a good piece in the latest issue of the Weekly Standard about the schizophrenic nature of the tea party movement, and it's worth reading. But even as he goes into considerable depth about the tension and turmoil in a movement that (in his description) is torn between a Dr. Jekyll side represented by ur-tea-partier Rick Santelli and a Mr. Hyde side represented by clownish conspiracy theorist Glenn Beck, I don't think he truly gives the muddle this produces the attention it deserves. Take this passage:

First, the Tea Party is unified by the pervasive sense that the country is wildly off course.

....Second, the Tea Party is unified in opposition to the policies that it believes put America in its current predicament. It’s opposed to bailouts, which favor the wealthy and connected. It’s opposed to out-of-control spending at every level of government. It’s opposed to an expansive state that subsidizes bad behavior while accruing more and more power for itself, opposed to a limitless government that nonetheless fails in the basic duties of securing the borders, regulating the financial sector, and keeping America safe.

....But there are also signs that the Tea Party is in the middle of a tumultuous adolescence. Its activists haven’t had much to say, for example, on the topic of the big banks. A recent Washington Post poll showed it losing support....There is the palpable anxiety among sympathizers that if the Tea Party did gain power, it would be unable to shape its diverse sentiments into a programmatic agenda.

Italics mine. Here's the thing: as near as I can tell, tea partiers are not, in fact, especially put out by bailouts to the wealthy. Santelli's founding rant, as Continetti points out, was aimed at homeowners being bailed out of mortgages they couldn't afford. And as Continetti himself admits just a few sentences later, tea partiers don't have much to say about Wall Street banks. That's pretty odd for a movement supposedly opposed to big bailouts. The reality is quite different: if the tea partiers are really upset that Congress hasn't yet reined in the financial sector, they sure have a funny way of showing it. All the evidence I've seen suggests just the opposite: most tea partiers think not that Obama's financial reform proposals are too modest, but that they verge on socialism. They think he wants to take over the banks the same way he took over the car companies.

Ditto for securing the borders — though here the schizophrenia is a little more explicable. Tea partiers do indeed seem to be temperamentally outraged by illegal immigration, but Dick Armey and FreedomWorks, who are big tea party funders, aren't. So that's tamped things down a bit on the immigration front. (Though obviously that could change if immigration becomes a front-and-center legislative issue later this year.)

In other words, the inchoate rage of the tea party movement is, if anything, even worse than Continetti says. Tea partiers are, obviously outraged about Obama, outraged at his "socialism," and outraged at the increasing deficit and the social programs it funds. But there's simply not much evidence that they're really outraged at Wall Street or at the business community in general. Nor are they outraged by two foreign wars and skyrocketing military spending. Nor are they outraged by the obvious possibilities for government overreach that are inherent in things like massive warrantless wiretap programs and a less than robust attitude toward constitutional rights for anyone suspected of terrorism.

No, what they're outraged by is having to pay taxes that fund social services they don't approve of and having to tolerate social change that alarms them. And whether it's Glenn Beck or Rick Santelli or anyone else that's the face of the movement, this is, at its core, the same thing that the middle class right has been outraged about for decades whenever a Democrat is in office. There's really no need to make this more complicated than it is.

(But the piece is still worth reading. Continetti's take is an honest one, and some of his insights are worthwhile and intriguing. I just don't think the big picture is quite as complicated as he makes it out to be.)

Media Coverage of Healthcare Reform

| Tue Jun. 22, 2010 11:16 AM EDT

Pew has done a study (here) that looks at media coverage of healthcare reform, and the good news is that there was a lot of coverage of healthcare reform. Some of it was even substantive. But Igor Volsky isn't impressed:

Health coverage in the far more influential mainstream press did very little to serve the public interest and as the debate progressed, Americans became more, not less, confused about the policy. “A solid majority of Americans consistently said the health care debate was hard to understand — a number that increased from 63% in July 2009 to 69% in December 2009, according to surveys from the Pew Research Center for the People & Press.”

Actually, it's pretty natural that people would become more confused as time goes by no matter how good or bad the coverage was. Hell, I was more confused as time went by. Proposals come and go, amendments are offered and rejected, negotiation sessions drag on, studies are issued, and as the broad outlines take shape small details become ever more important. But there's more to it than that, as another part of the Pew study demonstrates:

To a great extent, the health care debate was a talk show story, getting the most attention from the ideological cable and radio hosts.

....In the talk show sector, the subject was more than twice as big as it was in the media overall, filling 31% of the airtime from June 2009 through March 2010 versus 14% generally. On those shows, no other subject was deemed nearly as newsworthy. The No. 2 talk story in that time frame was the economy, all the way back at 7%.

....A month-by-month breakdown of health care coverage in the talk show sector reveals a major increase during the dog days of summer. In August, when the town hall protests exploded, 60% of all the talk show airtime was devoted to health care. (The second-biggest talk show topic, terrorism, was at 5% that month). In September, health care filled 39% of their airtime, and in October, it was still high at 30%.

This was true of both liberal and conservative talk shows, but of course conservative talks shows generally dwarf their liberal counterparts in audience size. And the study concludes that conservative talkers were far more successful at spreading their memes than the liberals were — though frankly, I'm surprised that liberals were as successful as they were. And I'm very surprised that the "rationing" meme was as muted as it was. I would have figured that for the #1 spot, to be honest.

In any case, my guess is that any issue that's heavy talk show fodder is almost bound to produce poor coverage in the mainstream media. Like it or not, talk shows generate talking points and talking points drive politics. And the mainstream media covers politics. This is just the world we live in.