Kevin Drum

Republicans Still Holding Up Virtually All Obama Appointments

| Wed Jul. 30, 2014 1:52 AM EDT

Jonathan Bernstein notes today that although filibuster reform has technically given Democrats the ability to confirm any executive branch appointment, in practice Republicans can still tie up the Senate by insisting on lengthy parliamentary delays for every nominee. And that's what they're doing:

Senate Republicans continue to impose an across-the-board virtual hold on every executive branch nomination....Republican foot-dragging has created a backlog of more than 100 nominees, almost none of whom are controversial, and some of whom have been waiting since January for Senate floor action.

....I understand that Republicans are upset about the Democrats' filibuster reform. It has robbed them of leverage over nominations — even if it's entirely their own fault for having abused that leverage. But Republicans aren’t harming Senate majority leader Harry Reid by blocking nominations. They’re harming the functioning of the U.S. government. (Perhaps it might be nice to have ambassadors appointed in a few important nations?) And they are needlessly, cruelly, messing with people’s lives. On top of all that, they’re eliminating the leverage of individual Senators. As Ted Cruz (maybe) just learned, there’s no point putting an individual hold on a nomination that is already being held up by the entire Republican caucus.

And why? For the sake, as far as I can tell, of a tantrum.

Pretty much. But this is what they've been doing all along. The point of filibustering everything and everyone has never been just to prevent a few objectionable candidates from being confirmed. It's been to tie up Senate floor time and disrupt even the routine functioning of a federal government that's under Democratic control. Even with filibuster reform they can still do that, so why should they stop now? A broken government is nothing but good news for Republicans.

Bernstein says in another post today that he's tired of hearing about political polarization. It's not really anything new, after all. That's true enough, and this is a good example. It's not a case of polarization, it's just a straightforward case of assholery. There's no principle or ideology behind this, they're merely causing dysfunction for the sake of causing dysfunction. Welcome to the modern GOP.

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My Ten-Dollar Offer to the Halbig Truthers

| Tue Jul. 29, 2014 8:31 PM EDT

There's no question that the statutory text of Obamacare contains a mistake. In one of its sections, it authorizes federal subsidies only for taxpayers who enroll through a state-based exchange, not for those who enroll through the federal exchange. But was it really a mistake? Brian Beutler comments:

Right-wing activists have spent the last several months fabricating a rival narrativea ludicrous theory of intent, in which leading Democrats meant to condition the subsidies, but decided to keep the inducement a secret from reporters, back bench members, governors, budget analysts, and health care reform advocates. This kind of deceptive argumentation is perhaps to be expected from activists. What's become incredibly frustrating to me about the Halbig brouhaha in the last few days is watching the conservative health care writers who were in the same trenches watching the same debate unfoldattempting, from a very skeptical vantage point, to explain the bill correctlysuddenly turn around and vouchsafe the Halbig Truthers.

That suggests something to me. As far as I know, not a single reporter who covered the Obamacare battle believes that Congress intended to restrict subsidies to state exchanges. As Beutler says, "To the extent that the question wasn’t probed widely, if at all, it's because that would've been almost like asking whether the subsidies were intended to be denominated in Rubles." Sarah Kliff agrees: "It was never a question, during the five years I've spent writing about Obamacare, whether this would be case." Nobody in Congress questioned the universality of subsidies. Nobody in the executive branch questioned it. No governors questioned it. None of the bureaucrats tasked with building the exchanges questioned it. And nobody in the press questioned it.

And that brings me to my suggestion: Is it really true that no one in the press questioned it? For the moment, let's forget about liberals. Hell, everyone knows we're in the bag for Obamacare, and by now we've probably scrubbed all our old posts of damning evidence. Ditto for the mainstream media. They're just shills for Obama anyway. But how about conservatives? They covered the Obamacare battle pretty obsessively too. Here's my guess: every single article written by conservatives between January 2009 and March 2010 (a) assumed that subsidies were universal and (b) never so much as mentioned the possibility that they weren't. In other words, they all believed in universal subsidies too because there was never any reason in their reporting to believe otherwise. Not one single reason.

But maybe I'm wrong! So here's my offer: I will send a crisp, new ten-dollar bill to anyone who can point out a conservative who so much as suspected that subsidies were limited to state exchanges prior to March 2010. Surely that's incentive enough? Let's start digging up evidence, people.

The Forgotten Murder Trial of the NRA's Top Lawyer

| Tue Jul. 29, 2014 4:48 PM EDT

Robert J. Dowlut is the NRA's top lawyer, a "human encyclopedia" on the subject of state gun laws and the man responsible for much of the gun lobby's success in a series of court cases that have steadily eroded restrictions on gun ownership in the United States. "He is a really reliable and exhaustive source for legal input on the issue," says one admirer.

But 50 years ago, according to a pile of court documents MoJo's Dave Gilson uncovered for "The NRA's Murder Mystery," a teenage Dowlut had a rather different relationship with guns:

Shortly before dark on the evening of April 17, 1963, Robert J. Dowlut went looking for a gun inside the city cemetery in South Bend, Indiana. Making his way through the headstones, he stopped in front of the abandoned Studebaker family mausoleum. He knelt by the front right corner of the blocky gray monument and lifted a stone from the damp ground. Then, as one of the two police detectives accompanying him later testified, the 17-year-old "used his hands and did some digging." He unearthed a revolver and ammunition. As Dowlut would later tell a judge, the detectives then took the gun, "jammed it in my hand," and photographed him. "They were real happy."

Two days earlier, a woman named Anna Marie Yocum had been murdered in her South Bend home. An autopsy determined she had been shot three times, once through the chest and twice in the back, likely at close range as she'd either fled or fallen down the stairs from her apartment. Two .45-caliber bullets had pierced her heart.

....The following morning, Dowlut was charged with first-degree murder. A year and a half later, a jury found him guilty of second-degree murder. Before the judge handed down a life sentence, he asked the defendant if there was any reason why he shouldn't be put away. Dowlut replied, "I am not guilty." A day later, the Indiana State Prison in Michigan City registered Dowlut, now 19, as prisoner number 33848.

Less than six years later, Robert Dowlut would be a free man—his murder conviction thrown out by the Indiana Supreme Court because of a flawed police investigation. The court ordered a new trial, but one never took place. Dowlut would return to the Army and go on to earn college and law degrees. Then he would embark on a career that put him at the epicenter of the movement to transform America's gun laws.

Click the link to read the whole story.

Guns and Doctors: A Follow-Up

| Tue Jul. 29, 2014 3:05 PM EDT

Aaron Carroll responds to my skeptical take on doctors asking patients about their gun ownership:

I think you ask legitimate questions, but these are consensus things that pediatricians ask about. You’re thinking like an adult, and not as a parent.

I don’t know if internists ask adults about guns. I doubt they do. But pediatricians do ask parents. They also ask if parents have talked about street safety. They ask if they keep chemicals out of reach of their children. They ask if they’ve checked the temperature of the hot water heater. They ask about water safety, bathtubs, and talk about drowning. Fire safety. Bike safety. Car safety (including airbags). I could go on and on and on.

This is what pediatricians do. You may be too far removed from that to remember, but it is! Read Bright Futures. It’s hundreds of pages long.

In my post, I was mostly thinking about adult doctors, not pediatricians, though I suppose both were on my mind. In any case, this is an obvious distinction, and I thought it was worth passing along.

Quote of the Day: "The Press Loves to Cover Her Hard"

| Tue Jul. 29, 2014 2:49 PM EDT

Dave Weigel notes that the media is still obsessed with Hillary Clinton's comment about being "dead broke" when she and Bill left the White House:

They've got to be sick of this by now. Maggie Haberman had it nailed three weeks ago: Hillary Clinton was "still raw over the partisan wars that hindered her husband’s legacy and left the couple with millions of dollars in legal debt." Her answer, as she told Ramos, was accurate, and it's baffling to her that this became a "gaffe." As she continued her tour, HarperCollins was printing up copies of Clinton, Inc., a tell-all by the Weekly Standard's Daniel Halper. On Page 18, Halper recalls that in 2001 "the Clintons were broke, owing a fortune in legal fees from the many investigations into their personal lives," and that they had to be loaned $1.3 by Terry McAuliffe. Until just a month ago, that was how even conservatives remembered the Clintons' departure from the White House.

What's the deal with this? Sure, Hillary could have responded to questions about her wealth a little better. She's not the natural politician Bill is. But really, there's not much else here. So why does it continue to be news a full month later? Uber-insider Mark Halperin explains:

She has a lot of positive attributes that are currently just being overwhelmed by all this negative coverage. And it’s going to keep going. The momentum—there’s, there’s— The press loves to cover her hard.

This comes courtesy of Bob Somerby, who's been following this ever since the initial flood-the-zone coverage of Hillary's "gaffe" in the Washington Post. Somerby tells the rest of the story:

Multimillionaire TV stars asked if voters would support a person as wealthy as Clinton. In response to Clinton’s answers, some of the nation’s most famous pundits launched their famous “gaffe culture.”

The Washington Post even launched a front-page jihad concerning the size of Clinton’s speaking fees. In the New York Times, Maureen Dowd assailed Clinton for her “rapacious” behavior and her “wanton acquisitiveness,” which she was said to be passing along to her daughter.

....Halperin made a starting suggestion—he suggested the press corps’ coverage of a major candidate could determine the outcome of our next White House campaign.

Plainly, that’s what happened in Campaign 2000, when a twenty-month war against Candidate Gore let George Bush reach the White House. In the main, that war was conducted by the mainstream press corps, not by the RNC.

The press corps’ poisonous war against Gore let Bush reach the White House. But it’s a basic law of the guild: Major journalists never suggest that the behavior of their own guild could have such startling effects.

The media's preoccupation with the Clintons' wealth won't last forever. Even for the Washington press corps, it's too transparently silly to pretend that it's somehow surprising that a presidential candidate is wealthy. But Somerby and Halperin are right: it's a sign of things to come. The press has never liked Hillary, and she's never liked them, and that's that. If she decides to run for president, this is going to be one of her biggest problems—or maybe her biggest, period. She's just never going to catch a break.

Should Doctors Ask You About Your Guns?

| Tue Jul. 29, 2014 12:47 PM EDT

In Florida, it's illegal for a physician to ask you if you own a gun. Pediatrician Aaron Carroll thinks this is ridiculous:

When pediatricians ask you about using car seats, they’re trying to prevent injuries. When they ask you about how your baby sleeps, they’re trying to prevent injuries. When they ask you about using bike helmets, they’re trying to prevent injuries. And when they ask you about guns, they’re trying to prevent injuries, too.

....When I ask patients and parents whether they own guns, if they tell me they do, I immediately follow up with questions about how they are stored. I want to make sure they’re kept apart from ammunition. I want to make sure they’re in a locked box, preferably in a place out of reach of children. Doing so minimizes the risks to children. That’s my goal.

When we, as physicians, ask you if you drink or smoke, it’s not so that we can judge you. It’s so we can discuss health risks with you. When we ask you about domestic violence, it’s not to act like police detectives. It’s so that we can help you make better choices for your health. When we ask you about what you eat or whether you exercise, it’s so we can help you live better and longer. We’re doctors; it’s our job.

I don't often disagree with Carroll, but I think I might here. Not about Florida's law: that really is ridiculous. The state may have an interest in making sure doctors don't give demonstrably bad advice, but it certainly doesn't have a legitimate interest in preventing them from asking simple, fact-oriented question. This represents prior restraint on non-commercial speech, and as such it's beyond the pale.

That said, should physicians ask about gun ownership? I'm not so sure. Carroll says he only wants to discuss "health risks," and that's appropriate. Doctors have expertise in the area of human health: that is, the biology and physiology of the human body. But that's not the same thing as the safety of the human body.

Not only do doctors have no special professional expertise in this area, but it's simply too wide open. Does your car have air bags? Do you ever jaywalk? Have you checked your electrical outlets lately? Is your house built to withstand an earthquake? Do you know how to work safely on your roof? Do you make sure to watch your kids in the pool? Are you planning any trips to eastern Ukraine?

I could go on forever in this vein. These are things unrelated to human physiology. If you define them all as health risks, you're simply defining every aspect of life as a health risk, and therefore your doctor's concern. That goes too far, and I don't blame people for sometimes reacting badly to it. There are certainly gray areas here, but generally speaking, if I want advice about my health, I'll see a doctor. If I want advice about gun safety, I'll talk to a gun pro. I think it might be best to leave it this way.

FULL DISCLOSURE: My view is almost certainly colored by the fact that I'm all but phobic about doctors. I hate visiting them, I hate talking to them, and I hate the fact that they never seem to really, truly respond to what I tell them. I would be very annoyed if a doctor suddenly veered off and started quizzing me about general safety issues.

I'm keenly aware that this is an obvious overreaction on my part, and I do my best to restrain it when I'm actually talking to a doctor. Nonetheless, it's there.

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Color Me Skeptical About a Guaranteed Income for All

Tue Jul. 29, 2014 11:50 AM EDT

Should we have a guaranteed minimum income in the United States? Something nice and simple that would replace nearly our entire current alphabet soup of means-tested welfare programs?1 Dylan Matthews posts about this frequently, and others chime in occasionally as well. It even has some support among conservatives.

I am not so sure, myself. Keith Humphreys makes a couple of good points here, but I want to step back a bit. At a bare minimum, I need answers to four questions:

  1. How big would it be?
  2. Is it a family benefit or a personal benefit?
  3. Is it for adults only, or would children also qualify for a benefit?
  4. How would it phase out with income?

There are many more details to work out, all of them important, but I don't think you can even begin to talk about this without answers to these four basic questions.

I'm skeptical about the whole thing because I don't think you can make the details work out. Nor do I think that it's politically feasible either now or in the future.2 What's more, I'm always skeptical of ideas like this that haven't been adopted by any other country, even the ones with far more liberal welfare states than ours. I figure there must be a reason for this.

But I'm happy to be proven wrong. Just give me a policy skeleton to work with. What exactly are we talking about here?

1Proponents usually (but not always) make exceptions for education and health care, which are too variable and too expensive to be handled by a simple minimum income.

2Perhaps it's feasible in our far-distant robot future. Maybe even necessary. For now, though, let's stick to the medium-term future.

America Should Get Out of the Peacekeeping Business in Israel

| Tue Jul. 29, 2014 10:58 AM EDT

From the Washington Post:

Anyone who has made even a passing glance at the Israeli media in the past few days will have noticed the incredible chorus of criticism being directed at John Kerry right now. The secretary of state has been lambasted by all sides for his apparent failure in attempts to negotiate a cease-fire between Israel and Hamas.

[Examples follow]

And it's not just Israelis. Elsewhere in the Post, David Ignatius takes Kerry to task too:

Secretary of State John Kerry has made a significant mistake in how he’s pursuing a Gaza cease-fire — and it’s not surprising that he has upset both the Israelis and some moderate Palestinians.

Kerry’s error has been to....

I think we should stop right there. Kerry has made only one mistake, and that was trying to negotiate a ceasefire in the first place. He didn't fail because of any personal shortcomings; he failed because there were no terms under which either side would ever have agreed to a ceasefire. The fighting will stop when both sides decide to stop, and not a minute before. It's long past time for everyone to acknowledge this.

The United States has been trying to broker peace in the Middle East for the past 20 years. Maybe longer, depending on how you count. But 20 years at least, and every attempt has failed. Various Americans have tried, all with different approaches, and the result has been the same every time: not just failure, but a steady and inexorable deterioration of the situation. It's no longer credible to pretend that maybe a different person with a different approach and different sympathies might have made a difference in any particular situation. Blaming Kerry for this latest failure is just delusional.

Quite famously, we all "know" what a deal between Israel and the Palestinians needs to look like. It's obvious. Everyone says so. The only wee obstacle is that neither side is willing to accept this obvious deal. They just aren't. The problem isn't agreeing on a line on a map, or a particular circumlocution in a particular document. The problem is much simpler than that, so simple that sophisticated people are embarrassed to say it outright: Two groups of people want the same piece of land. Both of them feel they have a right to it. Both of them are, for the time being, willing to fight for it. Neither is inclined to give up anything for a peace that neither side believes in.

That's it. That's all there is. All the myriad details don't matter. Someday that may change, and when it does the United States may have a constructive role to play in brokering a peace deal. But that day is nowhere in the near future. For now, it's time for America to get out of the peacekeeping business. Our presence there does no good, and might very well be doing active harm. This doesn't mean withdrawing from the region, it just means getting out of the shuttle diplomacy business. Neither side is ready for it, and probably won't be for years. Let's end the charade.

Take Two: Just How Good Are Generic Meds Anyway?

| Tue Jul. 29, 2014 1:04 AM EDT

A few days ago I wrote a post about generic painkillers and the fact that doctors themselves—who should know better—often don't use them. "If physicians aren't really sold on generics in their own personal lives," I asked, "does this mean they're not really sold on them in their professional lives too?"

Well, perhaps I got it backwards. A friend sent me a link to a Forbes article from last year about the FDA retracting its approval of a generic version of Wellbutrin:

The episode is bringing momentum to a movement that has been quietly building among many doctors and medical societies that are increasingly willing to ask a question that borders on heresy: Are generics really identical to the branded products they are meant to replicate? To a surprising degree, they say, the answer is no.

If you’re a layperson, this is the way you probably think of generics: They’re the exact same products in different packaging; generics companies can sell such medications for a fraction of the cost of the originals because they don’t have to spend huge sums on drug development and marketing....But generic drugs diverge from the originals far more than most of us believe.

....The FDA’s rules effectively acknowledge that. The agency’s definition of bioequivalence is surprisingly broad: A generic’s maximum concentration of active ingredient in the blood must not fall more than 20% below or 25% above that of the brand name. This means a potential range of 45%, by that measure, among generics labeled as being the same.

In other words, physicians are becoming increasingly concerned about the reliability of prescription generics, so maybe they're a little bit skeptical about over-the-counter generics too.

Now, I doubt that anyone seriously thinks this applies to aspirin or ibuprofen. There's nothing proprietary about the formulas for these medications, and everyone knows how to make them just as well as the big guys. Still, I suppose it's possible that a generalized uncertainty about generic prescription meds could translate into a bit of uncertainty about OTC meds too. And that little bit might be enough to make lots of doctors shrug their shoulders and plunk down an extra dollar or two for a name brand.

I'm just guessing here, of course. Mostly I just thought it was an interesting article and wanted to pass it along.

Medicare Actuaries Are Big Fans of Obamacare's Cost Reduction Programs

| Mon Jul. 28, 2014 8:42 PM EDT

As long as we're perusing the 2014 Medicare Trustees Report, here's another interesting chart. It shows just how much the Medicare actuaries expect to save thanks to all the cost-reduction measures included in Obamacare. It's a pretty speculative forecast, of course, but their estimate is that Obamacare will reduce federal spending a lot. By 2080, the savings add up to about 1.5 percent of GDP, which in today's dollars amounts to $250 billion per year.

Now, don't take this too seriously on a pure policy basis. Projections that are extended 70 years out are pretty worthless. Trend lines don't stay the same that long, and government policies change every decade anyway. Nor does this mean that Obamacare is a free lunch. It still has a high net cost since it's insuring a whole lot of people who never had insurance before.

Still, this shows that the Medicare actuaries take the efficiency measures in Obamacare pretty seriously. If we stick to them, they really are likely to cut the growth rate of Medicare spending. And remember: Medicare costs get reflected in overall health care costs too. If Republicans ever win their jihad against Obamacare, we lose not just the Medicare savings, but a lot of savings in private health care too. That's a lot to give up.