Kevin Drum

Ad Wars

| Tue Aug. 4, 2009 12:29 PM EDT

Dan Neil, whose day job consists of winning Pulitzer prizes for driving around test tracks in Porsches and Lamborghinis, also writes an advertising column for the LA Times.  And he says that in the healthcare war, liberals are getting their asses kicked:

There's some hope on the horizon, though, in the ad from Americans United for Change....To a kicky bass riff and the occasional cash register ring, the female narrator asks, "Why do the insurance companies and the Republicans want to kill President Obama's health insurance reform?" Note the yoking of insurance companies to Republicans. Note also that it's Obama's health insurance reform. Evil insurance.

The ad then lights into Cigna Corp. CEO Ed Hanway, who is retiring with a $73-million golden parachute. The GOP's prescription for the healthcare crisis? "Be as rich as Ed and you'll be happy too."

Of course it's disingenuous. Executive compensation at insurance companies is at best peripheral to escalating healthcare costs. For all we know, Hanway may be one of the good guys. The important thing is that the ad hominem ad is pointed, shrewd and manipulative.

Well, watch the ad and decide for yourself.  If you ask me, it's still got too light a touch.  And unlike Ezra, I can't say that I feel especially sorry for Karen Ignani, head lobbyist for the health insurance industry.  She's got a job to do, and she's doing it.  But the reality is that I don't think the insurance industry has actually conceded all that much during this round in the healthcare wars.  They were afraid of getting steamrolled, so they did what they had to do to survive.  Nothing more, nothing less.

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Happy Birthday!

| Tue Aug. 4, 2009 11:46 AM EDT

Happy birthday, Mr. President!  Or is it?  If we don't really know where he was born, do we really know when he was born either?

Who's the Boss?

| Tue Aug. 4, 2009 1:29 AM EDT

David Corn thinks Barack Obama needs to get angrier.  That's probably not going to happen.  But will he settle for Timothy Geithner?

Treasury Secretary Timothy Geithner blasted top U.S. financial regulators in an expletive-laced critique last Friday as frustration grows over the Obama administration's faltering plan to overhaul U.S. financial regulation, according to people familiar with the meeting.

....Friday's roughly hourlong meeting was described as unusual, not only because of Mr. Geithner's repeated use of obscenities, but because of the aggressive posture he took with officials from federal agencies generally considered independent of the White House. Mr. Geithner reminded attendees that the administration and Congress set policy, not the regulatory agencies.

Apparently Geithner is pissed off at all the Fed, SEC, and FDIC folks who keep badmouthing his regulatory reforms to Congress.  "Administration officials say they aren't worried about the overhaul's prospects," the Journal reports, and I imagine they do say that.  But I'll bet they don't believe it.

Democrats Want to Kill Your Grandma!

| Tue Aug. 4, 2009 12:46 AM EDT

As you may be aware if you pay attention to other precincts of the blogosphere, Betsy McCaughey was on Fred Thompson’s radio show a couple of weeks ago warning listeners about a hidden outrage in the House healthcare bill:

McCaughey said "Congress would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."  She said those sessions would help the elderly learn how to "decline nutrition, how to decline being hydrated, how to go in to hospice care ... all to do what's in society's best interest or in your family's best interest and cut your life short."

This is so ridiculously untrue that you almost have to admire the sheer brass of the thing, but in any case it's lit up a firestorm in right-wing circles.  Mickey Kaus has some advice:

Tip for Dems: If you don't want people to think that subsidized, voluntary end-of-of-life counseling sessions are the camel's nose of an attempt to cut costs by limiting end of life care, then don't put them in a bill the overarching, stated purpose of which is to cut health care costs! ... I mean, did that provision have to be in the bill? If it really was just an added "benefit" for patients that had nothing to do with cutting costs (which I don't believe for a minute), did it even belong in the bill? Isn't there some group of Congressional Democrats — let's call them "the leadership" — whose job it is to prevent their co-partisans from inserting into major legislation relatively minor provisions that will have the effect of sinking the whole package?

I get Mickey's point, but I wonder if he's asking the impossible.  As near as I can tell, movement conservatives are geniuses at plucking obscure provisions out of bills and twisting them with an abandon that would make Huey Long blush.  Maybe it's a dark art, but it's still an art — and conservatives are its Rembrandt.

Now, maybe Dems should have figured this out anyway and ditched the relevant wording before the bill got out of committee.  After all, if you're playing in the big leagues, you have to hit big league pitching.  Still, think about this: we're talking about someone who saw a routine provision about advance care directives and somehow realized she could turn it into "Democrats want to kill your grandma!"  And it worked!  What sane person could have seen that coming?  What's more, even if some bright Democratic staffer had seen it and presciently sent it to the deep freeze, does anyone doubt that someone who could sniff out such murderous possibilities in a funding provision for advance care planning would have any trouble finding something else to take its place?  You'd have to gut the entire bill before you could be sure it was sufficiently sanitized against satanic skills like that.

No, the only answer is to assume that this kind of chain email fodder is always going to crop up and be ready to fight back against it.  Which, so far, doesn't really seem to be happening.  That's the real problem.

Mobile MoJo

| Mon Aug. 3, 2009 6:13 PM EDT

As it happens, I myself own a dumb phone.  A very dumb phone.  But it's sufficient for my needs because, basically, I never use it anyway.

However, if you have a smart phone, you can now do something even smarter with it: read Mother Jones online.  You can read the magazine.  You can read our online web articles.  You can read my blog.  You can read our other blogs.  You can read everything.

Now, since I don't have a smart phone myself, I can't honestly tell you how well this works.  But give it a try and let me know.  It's time for me to replace my old phone anyway, so maybe this will be enough to get me to replace it with something smarter.  More details here.

Fighting Back

| Mon Aug. 3, 2009 5:50 PM EDT

The latest schtick from right wing activists is an organized effort to disrupt town hall presentations from members of Congress who are in their home districts during the August recess.  According to Robert MacGuffie, who runs the website rightprinciples.com:

Tea partiers should "pack the hall... spread out" to make their numbers seem more significant, and to "rock-the-boat early in the Rep's presentation...to yell out and challenge the Rep's statements early.... to rattle him, get him off his prepared script and agenda...stand up and shout and sit right back down."

Lovely.  But Mark Kleiman has the same idea as me:

If I were a Member of Congress threatened by this nonsense, I wouldn't stop holding town meetings; I'd start out each meeting by welcoming my constituents and warning them that there's an organized group in the hall planning to disrupt the proceedings. Never pass up an opportunity to portray your opponents as extremists, especially when they are.

I might be careful about doing this in states with concealed carry laws, but otherwise it sounds like a pretty good idea.

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Getting to Yes

| Mon Aug. 3, 2009 5:20 PM EDT

I missed this a couple of days ago, but Robert Pear and David Herszenhorn write in the New York Times that for all the turbulence surrounding healthcare reform right now, there's actually a surprising amount of bipartisan consensus about certain parts of it:

Lawmakers of both parties agree on the need to rein in private insurance companies by banning underwriting practices that have prevented millions of Americans from obtaining affordable insurance. Insurers would, for example, have to accept all applicants and could not charge higher premiums because of a person’s medical history or current illness. All insurers would have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans would be required to have insurance.

....Lawmakers also agree on the need to provide federal subsidies to help make insurance affordable for people with modest incomes. For poor people, Medicaid eligibility would be expanded.

The chaos on Capitol Hill, combined with bitter disagreements over how to pay for the legislation and the role of a public plan, has obscured the areas of potential consensus.  “There is wide agreement on the two elements of the legislation that the public cares about most: insurance market reforms and the expansion of coverage, with subsidies,” said Drew E. Altman, the president of the Kaiser Family Foundation, which focuses on health policy.

In other words: community rating plus subsidies for low-income families.  That's nice to hear.  I'd like a lot more than that, of course, but if we manage to pass a bill that contains reasonably strong forms of both these things, it will be a huge step forward.

(Via Jonathan Zasloff.)

Negative Interest Rates

| Mon Aug. 3, 2009 3:24 PM EDT

Tyler Cowen writes today about the monetary views of Scott Sumner:

The Fed has already taken some unconventional monetary measures to stimulate the economy, but they haven’t been entirely effective. Professor Sumner says the central bank needs to take a different approach: it should make a credible commitment to spurring and maintaining a higher level of inflation, promising to use newly created money to buy many kinds of financial assets if necessary. And it should even pay negative interest on bank reserves, as the Swedish central bank has started to do. In essence, negative interest rates are a penalty placed on banks that sit on their money instead of lending it.

Much to the chagrin of Professor Sumner, the Fed has been practicing the opposite policy recently, by paying positive interest on bank reserves — essentially, inducing banks to hoard money.

Of all the things the Fed has done to fight the recent financial meltdown, this is the one I've never quite understood: paying interest on bank reserves.  As a general policy it might be a good idea (Steve Randy Waldman wrote a decent primer about it here), but as Sumner points out, in the middle of a financial crisis it gives banks an incentive to hoard money at the Fed instead of loaning it out.  That's the opposite of what we want.

On the other hand, minimum bank reserves are still mandatory in the U.S., so I guess I also don't understand the point of negative interest.  Banks are required to keep those reserves at the Fed, so they couldn't withdraw them even if they wanted to.  Essentially, a negative interest rate would just be a tax on banks.

So, as usual, I'm confused.  This doesn't really seem to make sense either way.

MoJo Mix: 3 August 2009

| Mon Aug. 3, 2009 2:02 PM EDT

I can't decide whether the ongoing Birther resurgance is a) the usual wingnuts doing their usual wingnut thing, or b) a brilliant GOP tactical ploy to divert attention from health care reform. You? While you mull it over, 3 more questions for your Monday mix:

1) Will health care reform actually happen?

2) Carbon footprint, sure. But what's your water footprint?

3) Why is HBO's 40-year-old co-creator of Hung claiming there are no talented and attractive actresses over 35?

Laura McClure hosts podcasts, writes the MoJo Mix, and is the new media editor at Mother Jones. Read her investigative feature on lifehacking gurus in the latest issue of Mother Jones.

Health Insurance Hell

| Mon Aug. 3, 2009 1:34 PM EDT

The big fault line in the healthcare debate right now is over the "public option" — a proposal that people should have the option of getting healthcare coverage from either a private insurance carrier or from a government program.  Conservatives are worried that this would put too much pressure on private insurers, but Michael Hiltzik asks the obvious question: who cares?

The firms take billions of dollars out of the U.S. healthcare wallet as profits, while imposing enormous administrative costs on doctors, hospitals, employers and patients. They've introduced complexity into the system at every level. Your doctor has to fight them to get approval for the treatment he or she thinks is best for you. Your hospital has to fight them for approval for every day you're laid up. Then they have to fight them to get their bills paid, and you do too.

....Why do we tolerate this? The industry loves to promote surveys indicating that most Americans are "satisfied" with their current health insurance — 37% are "very satisfied" and 17% "extremely satisfied," according to one such study.

Yet these figures are misleading. Most people are satisfied with their current insurance because most people never have a complex encounter with the health insurance bureaucracy. Medical care generally follows the so-called 80-20 statistical pattern — 20% of patients consume 80% of care. If your typical encounter is an annual checkup or treatment of the kids' sniffles, or even a serious but routine condition such as a heart attack, your experience is probably satisfactory.

But it's on the margins where the challenges exist. Anyone whose condition is even slightly out of the ordinary knows the sinking feeling of entering health insurance hell — pre-authorizations, denials, appeals, and days, weeks, even months wasted waiting for resolution.

Sounds great to me!  Why would anyone want to change this system?

Health insurance is a weird industry.  Healthcare itself is provided by doctors, nurses, hospitals, pharmaceutical companies, hospices, and device makers.  Insurance companies do none of this.  They don't do research, they don't perform surgeries, they don't change bedpans, and they don't make diagnoses.  They're just middlemen.  All they do is pay the bills after marking them up 30%.  They don't do anything at all to make healthcare better or more efficient.

But for some reason we're supposed to care about whether they continue to exist or not.  Why?  I care about the quality of my doctors, my nurses, the hospital I go to, and the drugs I take.  I don't really care who takes on the administrative task of paying the bills — except that I wish they were handled a lot more efficiently and with a lot less hassle than private insurers typically do.  Frankly, a world without private healthcare insurers sounds pretty good to me.

And as long as we're reading the LA Times, they've got a nice piece by Michael Rachlis, a doctor in Toronto, about the Canadian healthcare system.  Guess what?  It's pretty good!  It's not the system I'd choose — in particular, I think public funding should provide a basic level of healthcare but patients should always have the right to pay more for better care if they want to — but it works as well or better than ours for a fraction of the cost.  Read the whole thing for more.