Breaking Down Baucus' Useless Bill

Not entirely fair in the headline here, Baucus' proposal released today does do some good things, including subsidizing individuals at up to 300% of the poverty level to purchase insurance out of regulated health insurance exchanges.  The trouble is that in a failed effort to be "bipartison," the bill failed on the kind of cost control measures that American health care desperately needs.  It contains no public option, and institutes fees on the most expensive insurance plans, a set of fees that will be shifted to consumers.  Instead of a public option, Baucus opted for coops.

The Baucus bill instead would create of a series of private health insurance cooperatives, which Baucus and other centrist Democrats say could offer the same protections as a new government plan.

This kind of language dominates media reports on the topic and has dominated the conversation on coops ever since the idea surfaced, but the question I've always asked is "how are we going to create these things?"  The answer in the Baucus proposal, it turns out, is that we're not.  Baucus sets aside money for loans and grants for the creation of coops by anyone who wishes to, but does not actually create anything.  I don't know if anyone has actually done any studies as to why there are few health care coops, it could be start up costs, in which case the Baucus proposal would effectively lead to their creation, or it could just be that they aren't viable in the insurance market, in which case we're just throwing away money to create some things that won't be able to last past the public investment to starting them anyway.  I think the coop idea is rediculous anyway, but its not obvious that the Baucus proposal even leads to the existence of more coops.  Why the media has put so much emphasis on the Finance Committee is beyond me, it lead to a crap proposal that isn't going to get any Republican votes anyway.  I'm frankly not convinced that the finance committee will even pass this, and I would be just fine if they didn't.

Side note-The New York Times has a pretty good feature on the Baucus proposal.  To summarize, nobody likes it, liberals hate it because it doesn't have a public option, and conservatives hate it because they claim its "too much government."  A great idea we've had here, put pressure on Baucus to create a "bipartison bill," and then be surprised when everybody hates what he proposes.  Its time everyone recognize that no Republican will support any health care reform that reaches beyond ending recessions and pre-existing conditions.

A "weak public option" may be a myth

There's a recent post over at Blue Oregon about whether or not a "weak public option" is better than none and whether its worth fighting for.  The post has lead to a lot of feedback, currently 68 comments.  The thing is that I'm not convinced this is even a debate worth having.  I've made my belief that a strong public option is necessary pretty clear, but lets go back and look at what a strong public option (as opposed to a weak one) actually entails.  University of California Public Policy Professor, Jacob Hacker examined three crucial provisions (sorry, this file seems to have disappeared from the internet) that he argued make the difference between a good public plan and a not so good public plan.  Those three provisions were:

(1) a "Medicare tie-in" that allows the public plan to develop a broad national provider network with competitive payment rates quickly, (2) the creation of a national excahnge that can give a wide range of firms, as well as uninsured Americans, access to both the public plan and regulated private insurance options, and (3) providing the public plan with enough authority to reduce medical inflation through drug-price bargaining and innovations in the financing and delivery of care.

According to Hacker all three of the bills contain some elements of a "strong public option," but all have some problems.  For example the House Energy and Commerce Committee bill fails to set its imbursement rates to Medicare allowing providers to negotiate independently with the public plan under threat of opting out if they don't pay more than Medicare does, this would obviously drive up costs.

There are two things on my mind considering the question of whether a weak public option is better than no public option at all.

To begin with, health care reform does not stop with this fight, it will inevitably be tinkered with in the future.  With that in mind however, it will be extremely unlikely for a program passed now to be abandoned, once we create programs we really don't like to get rid of them.  So a weak public plan could someday become a strong public option.  I think the far greater risk comes from no public option at all where the American taxpayers end up footing the bill for subsidies that benefit insurance companies without any competitive pressure to bring costs down, I'm sure insurance companies would just love to have 50 million new customers financed by the Federal Government.  A weak public option on the other hand still has some bargaining and cost control power, just not as much as it should have.

Secondly, I don't think there's a lot to be gained by weakening a public plan.  I have a hard time imagining that the strength of a public plan as opposed to its very existence, is a deal breaker for many (or any) Democrats in Congress.  I'm sure various members have preferences on these matters, but I doubt that anyone whose vote is necessary will withhold their vote because the public plan is too strong, more likely they oppose the public option, period.  I don't know how those whip counts would look, but the scenario under which a public option is acceptable to members whose votes are needed, but a strong one is unacceptable just doesn't seem plausible to me.

The far more dangerous possibility is that a trigger will be inserted into the bill, this is merely a means of destroying the public option, the trigger will never get sprung, though I have little doubt that the conditions that allow it to be put into place will arise.  On the question of whether or not to accept a "weak public option," however, I think the answer is clearly that a strong public option should be fought for, but it can be strengthened in the future and if it must be weakened in order to pass, then that should be supported.  The worst possible outcome is no public option at all, and that's what we should be fighting to avoid.

Why would we want banking innovation?

When I first heard about the recovery of major banks' profits I was encouraged, we made a big public investment to prevent a complete crash and they had apparently used that to recover and return to some sense of normalcy.  In that sense the bailing out of financial institutions seemed to work, and should be applauded.  The trouble is that the way in which they've recovered is disturbing, effectively returning to the same way they did business before that caused the economic crisis.

Goldman Sachs, JPMorgan Chase and others - which have received tens of billions of dollars in federal aid - are once more betting big on bonds, commodities and exotic financial products, trading that nearly stopped during the financial crisis.

That Wall Street is making money again in essentially the same ways that thrust the banking system into chaos last fall is reason for concern on several levels, financial analysts and government officials say.

There have been no significant changes to the federal rules governing their behavior. Proposals that have been made to better monitor the financial system and to police the products banks sell to consumers have been held up by lobbyists, legislators and turf-protecting regulators

This has been my concern since the crisis began.  One thing I thought Obama would do that would be an important change would be to re-regulate banking institutions to prevent the kind of gambling that they engaged in that got us where they are.  Obama does have a proposal for re-regulation of banks, so the problem isn't being completely ignored. The thing is that I don't feel like Obama's heart is really in this one, and while I'm in no position to comment on what will be an effective banking regulation, I highly suspect that anything Obama proposes and anything Congress can get behind, doesn't really address the problem.  What I find bizarre here is the talking point in response to arguments for more regulation, that we don't want to "prevent innovation by over regulating."  This is a variation off a traditional free-market talking point that in some contexts has some validity, the thing is that it really doesn't here.  What I've never heard anyone mention in response to someone who says this however is why we would even want our banks innovating.  Personally I want my bank, in an ideal perfect world (that doesn't exist) to protect my money and use it to lend out to people who will be able to pay it back.  I do not want my bank to be innovative, I want it to do the normal stuff and not engage in complex investment schemes like credit default swaps.  Now Apple Computers on the other hand I do want to innovate, I want them to try to make the next step and advance technology, that's good for the world, complex methods of shuffling money around and trading as though they have value things that really don't have any on the other hand, is not productive or helpful to the world in any way.  Why have I never heard anybody bring this up, is innovation in the case of a bank, actually a good thing that we should be protective of when considering new regulations?

The lack of any changes in the regulation of financial institutions yet has allowed them to return huge profits again, but by doing the same things they were doing before, by being innovative, and in the profits screwing up real people's lives.  Sorry, but lets please not show deference to the innovation argument as we consider new regulations on the banking industry, and please lets get on this before they crash our economy by innovating again.

Promising Words from Wyden

I find this extremely encouraging.  While I've worried about Wyden's position in the health care debate, specifically whether he would support a public option, I find the tone of support he takes here to be a big relief, though he doesn't actually talk about the public option, the fact that he talks in optimistic terms (both from a policy perspective and in terms of momentum in Congress) about the principles outlined in Obama's speech that are enshrined in the bills that have been passed out of committee so far, and offers criticism of particular parts without bringing up the public option, I consider a major relief.  I would still like to see him make a stronger statement in support of the public option, but after this I'm a lot less worried about where Wyden will come down in all this.  Wyden did however have some concerns that should be explored.

Wyden says, "the area that i would like to be bolder in is in this area of creating a market through choice and competition."

Wyden believes the proposal wouldn't allow nearly as many people as it should to choose to enter so-called health insurance exchanges, if they're unhappy with the insurance their employers provide.
"Only people who are unemployed and uninsured and work at very small businesses would be allowed choice and competition in the exchanges," Wyden noted "Anybody who works at a mid-size business who doesn't like what they have, a government bureaucrat steps in and says you don't have choices.

As long as we're on this topic, I'm highly skeptical of the "choice and competition" talking point that Obama and Democrats have picked up on.  Many employers offer multiple plans to their employees, and employees then choose the plan they wish to buy into.  Employers who do this are effectively creating on a very small scale something we can call an "insurance exchange," as has been proposed in every bill on a much larger scale.  Personally I have never met someone who, when given such a choice has any clue what they're choosing.  People will get a choice, and businesses purchasing plans off the exchange will have a choice, but there's no reason to believe that they will make an economically rational one given the way insurance plans are presented.  In High School my mom once changed plans at Washington State University because one of them offered better coverage for the asthma medication Advair, which our original insurance plan didn't want to cover, but was doing an incredible job of controlling my asthma.  That was an awfully narrow consideration, that if you're able to do an in depth cost benefit analysis of the two plans, might not actually be worth it.  However, since health care plans are unreadable for most people, consumers will make choices like the one my mom made rather than really figuring out which plan offers the better deal holistically.  I think we need reform badly enough that I'm willing to get behind a strong health insurance exchange, but I'm pretty skeptical that it can actually work, even educated and informed consumers are going to be unable to distinguish between plans and will choose based on pretty narrow criteria.  Wyden's other concern was related to the tax on health care companies that forms a central part of the Baucus cop out plan, and was endorsed by Obama the other night.

But Wyden was perhaps most critical of the financing scheme--enshrined in the Baucus plan, and endorsed by Obama--to raise the funds needed to pay for the bill by taxing high-end private insurance plans. That measure sells politically--who doesn't like the idea of taxing insurance companies?--but the incidence of the tax is likely to befall insurance consumers, including middle class Americans who Obama vowed not to increase taxes on.
"This financing system is not my first choice," Wyden said. "We're going to be working in the finance committee to address the concerns you describe."

Everything I've read on the topic of this type of a financing scheme agrees that the costs will just be passed on to consumers.  Given the realities of American health care that's just not a productive outcome.  I think Wyden is spot on here, and hopefully we can come up with a better way to finance this.

I was really relieved at the tone that Wyden seems to take here, he's not playing games with whether he'll support something like what Obama laid out the other night, but he is engaging seriously with the policy and looking for ways to work towards a better bill.  As far as the two points I highlighted here, I think Wyden is wrong on the first, but so is Obama, absent a single payer approach however, it makes a lot of sense.  And on the second he's spot on.  Hopefully Wyden can help improve the Senate bill (whichever one becomes the Senate bill) and cast his vote for universal health care.  Now he better not make me regret this post by working against a public option.

A Thought on Hate Crimes

NPR's Talk of the Nation did a segment today with Judy Shepard, Matthew Shepard's mother, she has a book out entitled The Meaning of Matthew in which she seems to talk about how Matthew Shepard's life and death transformed the gay rights movement as well as her personal struggle with that horrible incident.  I haven't read the book so if that's not accurate forgive me.

At one point during the show, Judy Shepard discussed her support for hate crimes legislation, and she framed hate crimes as being the use of brutality in order to control a group of people through fear.  So a cross burning is not aimed at the person whose lawn it is burned on so much as being an expression of lynching to strike fear in the hearts of the targeted community.  Cross burnings and lynchings are ways to control the African American community rather than a means of attacking that particular person (though of course they are at the same time attacking that person).  This seems right to me, and got me thinking, if the point of hate crimes laws is to add an extra legal sanction against that brutal means of expressing control over a marginalized community, why not prosecute such acts as terrorism cases?  The Patriot Act defines terrorism as the following:

(5) the term `domestic terrorism' means activities that--

`(A) involve acts dangerous to human life that are a violation of the criminal laws of the United States or of any State;

`(B) appear to be intended--

`(i) to intimidate or coerce a civilian population;

`(ii) to influence the policy of a government by intimidation or coercion; or

`(iii) to affect the conduct of a government by mass destruction, assassination, or kidnapping; and

This is a small piece of the Patriot Act that I consider useful, because terrorism is precisely that, it is a means to intimidate and coerce populations or governments to behave in a certain way under threat of violence.  Sounds a lot like Judy Shepard's description of a hate crime.  If nothing else can come from the horrible events of September 11th 2001, and the absurd policies that followed it, it should be that we as a society will not tolerate violence as a means of social control or coercion.  Rather than prosecuting these types of acts as "hate crimes" they should be prosecuted as acts of domestic terrorism.  I am supportive of hate crimes legislation and agree with the goal, but prosecuting these types of actions as terrorism rather than hate crimes seems to add a lot more levity to the situation and seems more socially justifiable to people who misconstrue hate crimes legislation as a form of "thought control."

Thoughts on Lyndon Johnson and Medicare and Medicaid

I was listening to NPR yesterday when on whatever show I was listening to they started talking about the past attempts by President's to reform health care.  What got me thinking in this conversation was when they brought up how Lyndon Johnson decided to be incremental and fight to establish Medicare and Medicaid.  Assuming the absence of universal coverage, few Americans, and no good lefty will deny the positive impact of Medicare and Medicaid on the American health care landscape.  Imagining America without those two programs is a sorry picture even considering the long term budgetary problems that Medicaid faces, including in Oregon with its innovative Oregon Health Plan.  That budgetary challenge is a function of rising health care costs in general and is a primary reason that health care reform is necessary, but I digress, imagining America without those two programs is a sorry picture of deep poverty and very high rates of uninsured.

The question, however, is whether that situation would be so intolerable as to provide the extra momentum for Johnson, Nixon, Carter, or Clinton to pass universal health care.  My sense is that Johnson pushed through an agenda that helped a lot of people, but at the cost of a long term fix to America's health care crisis.  He created a sense of complacency, and shockingly in the recent debate, selfishness.

The biggest barrier to momentum on health care reform during the current debate (other than institutional barriers in the Senate) has been the hostility of elderly Americans who, however incorrectly, think that Democrats are trying to kill them, or cut their medicare.  The Survey USA poll cited at the top of this paragraph finds Americans over the age of 65 to be the only group in which a plurality opposed the Obama outline plan.  Now, lets pretend that Medicare didn't exist, and elderly Americans are struggling to get health care coverage.  Not only do elderly Americans without health insurance become strong supporters of universal health care, but it also builds support for the program amongst younger Americans who are tired of watching their grandparents suffer.

The moral of the story is this, while Johnson eased a lot of suffering and passed two very good programs by fighting for Medicare and Medicaid, he simultaneously took the wind out of the sails for universal health care, and made the moral case for health care reform more dubious by allowing opponents to frame the uninsured in negative terms to a greater extent than they otherwise would be able to.  Half measures do not work, they are unable to bring the costs down, and improve the position of opponents of reform in future battles.  Johnson was able to pass both Medicare and Medicaid by big margins, had he decided to fight that battle I can't imagine with most elderly Americans lacking health insurance, plus those who gained coverage through medicaid, plus everyone that was left out by the Great Society Health Care reforms all pressuring the Senate and House, that we would not have managed to pass some version of universal health care, quite possibly in a better form than Obama's proposal.  I recognize that the House and Senate are not necessarily a reflection of public opinion, but the 120 million Americans (do not put too much stock in this number, I just added the uninsured, plus 1/2 of the elderly, plus medicaid enrollment, I actually suspect that due to the economics of the matter the number would be higher, either way it wasn't a particularly scientific approach that got me there) who would be uninsured today if Medicare and Medicaid didn't exist would not be such a ho-hum affair, and it would be a lot harder for opponents to stand in opposition.  The moment to do this was 1965 and Johnson blew his chance and made it a lot harder to pass universal health care.  At the same time, he made a lot of people's lives better and reshaped America rather than fighting a battle that he wasn't sure if he could win.

Obama's speech before Congress next week

At TMP Cafe today, Robert Reich has a piece on what Obama should say too Congress next week.  All evidence seems to indicate that this is not even close to what Obama will in fact say, that said, I was more intrigued by this comment by wyt to Reich's post than I was by what Reich said.

You don't need compassion to sell health care and the public option. You need to pitch to self-interest and build up hatred and distrust of the insurance companies. The far right can't understand a world without evil in it. Obama fairly enough sees all in shades of gray. But it's time to speak to the nuts in way that looks true through their polarized glasses - which primarily polarize not along left-right but along good-evil.

Obama needs to highlight the true evil in the current system, and launch a crusade against it. The hard left - which also like a polarized view - will rejoice. And the hard right, which includes many who have life experiences that make it easy to hate the insurance firms, will join in.

Without portraying the insurers as evil (which in large part they are), there's no "bipartisan" way to promote the alternative, which is a public option.

I think wyt hits the issue right on its head, with one caveat.  Compassion can be expressed by stirring up hatred of insurance companies, the message ought to fundamentally be, "look at these greedy insurance companies and their insane profits, look how they exploit the health of ordinary Americans all in the name of making money."  By so doing Obama would appeal to self interest by appealing to most people's frustrations with private insurance as it now conducts its business as well as the self interest of 75 million Americans who are uninsured and underinsured.  He could appeal to compassion by emphasizing our responsibilities to others and demonstrating how the behavior of insurance companies undermines our moral commitments to one another.  The commenter is dead on, the approach from the start here should have been to build up hatred of insurance companies, demonize the crap out of them.  That kind of a moral tirade, wyt calls it a "crusade," that works too, is effectively what Brown University Political Scientist James Morone argues in Hellfire Nation is the fundamental principle of American politics dating all the way back to John Winthrop's "City on the Hill" speech.  Roosevelt was a master of this, as Morone writes:

At the heart of Roosevelt's moral talk lay his utopian picture of shared community.  Roosevelt constantly pounded the selfish individual.  He closed his first, hard-fought reelection campaign by wearily telling supporters, "I should like to have it said of my first administration that the forces of selfishness... met their match."  Instead, he extolled mutual responsibility.  During his second term, he urged the cleargy to "return to the religion as exemplified in the Sermon on the Mount"- the ultimate statement of what we owe one another, culminating in the Bible's most lyrical call to alms."

Eventually, Roosevelt's little sermons took a predictable form, almost a formula.  First invoke religion; in the next breath, turn to social conditions.  Faith sets up economics.  "we have always known that heedless self interest was bad morals," Roosevelt said in his second inaugural address.  "We know now that it is bad economics."  Again, cheering his own first term: "The greatest change... has been the change in the moral climate of America."  With this change came "our rediscovered ability to improve our economic order."

I had a chance to meet Morone in class a few years ago after reading his book, and he started off talking to our class about the Clinton health care reform effort in 1994.  He walked into class and asked us, "why did health care reform die in 1993?"  I raised my hand and said, "you guys got hammered by a very well organized and well financed insurance lobby that was ready to scare the crap out of the public to kill reform."  Professor Morone looked at me for a moment and said, "I've asked that question to a lot of people including those who were involved in that battle in the Clinton Administration and that's about the most clear and coherent answer I've heard."  Morone then continued to talk about how the debate was framed almost entirely by the right's ability to frame the issue around the morality of the uninsured with no clear moral response coming from the left.  Clinton needed to engage in moral warfare against the insurance industry in order to pass reform, otherwise the moral argument about the lazy poor was bound to win the debate, as it did.

Clinton made the problem worse by delivering speeches about how, "the age of big government is over," and caving in to the Republicans on welfare reform (a year after the failure of health care reform admittedly), this all propagated the moral line that poor people are poor because of their own lack of morality, and therefore there's no public need to help them.  While it is certainly not 1993 and the social dynamics are very different than they were then, the right has succeeded in framing health care along the same lines they did in 1993.  Spread lies to scare the crap out of people and convince them that reform will hurt them, then convince the public of the lack of morality of those who lack insurance, this removes the uninsured from the debate, and makes it about self interest along lines that have nothing to do with the actual proposal.  Once the debate is set on these terms 45 million who lack health insurance and 25 million who are under-insured get taken out of the debate.

I recognize that Obama wanted to kill the "private insurance is more efficient than government" meme by setting this conversation in terms of market efficiency and the public cost of health care.  The cost of focusing on that was an unnecessary ceding of the moral ground.  Obama has become the demon because in the minds of many Americans he's trying to kill grandma and steal my money, when there was an easy and obvious demon in this debate, supporters of health care reform just ignored the demon.  The health insurance industry is the perfect demon, and Obama should (but again, I'm sure won't) recognize that in his speech before Congress next week.  Rather than running towards compromise Obama should rediscover his inner Roosevelt and reclaim the moral ground in this debate that is so easily attainable for those of us who want universal health care.  As I laid out yesterday, abandoning the public option is just about the worst idea imaginable, we have reached a critical point at which one of two paths must be followed, all out war for health care reform, or capitulation to a minority that has no interest in compromise or supporting any reform package.  The former is the far superior path, but I fear the decision has already been made.

health care reform and the budgetary death trap

The talk the of the day seems to be that Obama's prepared to jettison the public option.  This is an enormous mistake, to begin with, Survey USA recently found 77% of the public supporting the public option.  Even for Senators like Landrieu, whose electoral fears are understandable, the public option is not going to be electorally dangerous, support for any bill with or without a public option might be since public opposition to health care is overwhelmingly based on misconceptions about the proposals.  This is evidently driven by whip counts rather than the nature of the public debate, since no real conversation about the public option has even begun for the most part.

The deal is that I have a hard time believing either of two things, that any health care bill that achieves universal coverage has 60 votes in the Senate, and that the public option does not have 51.  Therefore, either way we're at the point of either magically and suddenly re-framing the way cloture votes are perceived (infinitely unlikely), or we get a new Senator from Massachusetts and convince all the Dems to vote to end debate regardless of their position on the legislation itself (still unlikely but a little more plausible than the first), or budget reconciliation.  In all of those scenarios we should actually only need 51 votes for the public option, which again, I have a hard time believing doesn't exist.

This is just flatly bad policy, the public option is the only force under the proposed bills that has any ability to significantly lower health care costs, by creating a strong, nonprofit competitor to insurance companies that can deliver health insurance with very low administrative costs.  Without that public option we do get improvement, but we get a budgetary mess (ironic given that the conservative Democrats opposing the public option claim to be so concerned about the budget deficit).  What we end up with without a public option is some network of subsidies and mandates within a government regulated private insurance exchange, this brings us to near universal coverage, which is good, and there is some reason to believe that it might lower costs marginally, while Hawaii's employer mandate has some major problems, it has managed to hold costs under the national average.  So its not out of the realm of possibilities that the growth in health care costs might be kept down just by dramatically reducing the number of uninsured, but there's no mechanism to force the insurance market to lower premiums and to keep administrative costs (and profits) down.


Jacob Hacker has a very good article on this in which he compares Medicare Advantage to the traditional government run medicare program, and finds that traditional medicare has far lower administrative costs.

the Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage. This is a near perfect “apples to apples” comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population.

Hacker's example is even in a competitive market in which the Medicare Advantage private plans have to compete with traditional Medicare, and traditional Medicare delivers much lower administrative costs.  Some studies have challenged the assertion that Medicare is far more efficient than private insurance by deducting taxes from private insurance's non-delivery (normally referred to as administrative) costs.  There's a point to be made here regarding taxes, I'll grant that one, but to give them profits misses the entire point.  How we concluded as a society that my health should be an item that other people can profit on is beyond me.  Profits are a big part of the problem, and I'm more than happy to allow them to take a hit by trying to compete with a nonprofit government provided option, that hit is a part of where savings to the public will occur.  Without that hit, and without the public option being able to take steps to lower its costs (negotiating drug prices, pegging rates to medicare...) the public is going to take a major budgetary hit somewhere down the road.  One of the reasons we're talking about this is that health care costs will force Medicare and Medicaid spending to double over the next 30 years.  We need some force in the market to force costs down significantly, and subsidizing private insurers to cover people at 400% of the poverty level will only increase Federal health care expenditures unless something forces costs down.

Reform is good, period, having nearly 50 million Americans uninsured is unacceptable, but reform that fails to really address rising costs is just begging for trouble, its a huge mistake for Obama to abandon the public option, hopefully these rumors will not turn out to be true.  Furthermore, if he announces this in front of the AFL-CIO as is rumored, he's going to get destroyed, as well he should, its a terrible idea.

I think I'm going to puke

In a recent ad, Michael Steele continues the Republican Party's scare the living crap out of seniors strategy.  As Washington Monthly points out, this on top of suggesting last week that Social Security should be privatized.

just last week, Steele said -- within a 24-hour timeframe -- that Medicare is a) a great government program that Democrats are trying to undermine and the GOP is trying to protect; and b) a terrible program that doesn't work and should probably be privatized. And this only came after Steele ran one of the all-time dumbest op-eds to ever run on health care policy.

I obviously have a different opinion of Steele than most progressives do, for me, I think he's scary because he is extremely TV savvy and comes across on TV as both reasonable and friendly.  This is a dangerous trait for someone who has absolutely no grasp of public policy.  I don't know what Steele's favorability numbers are like, but it seems to me like if they're not high its probably because of a lack of exposure, because he is very good at these scripted appearances in commercials, and I think progressives ignore that at their peril.

For anyone with a firm grasp of the health care debate, as is usually the case, Steele's ad is a piece of crap, its dishonest and as a result wholly unconvincing.  The trouble is that low information voters just get his folksy demeanor and are likely to accept the talking points.  This debate has been totally mishandled on the left side, and as a result we've got an uninformed population of seniors who think Obama's trying to kill them.  We should have been talking about Republican hostility to medicare and Social Security on day one of this debate, at this point in terms of public perceptions I fear the only way out is to have an epic battle between millennials and their grandparents.  Maybe we need to invoke the Sarah Silverman strategy over health care, it is absolutely insane that the primary group of people who get government health insurance (and like it) have been scared so thoroughly that they're the one's standing in the way of getting something for the rest of us.  This concludes my semi-pointless rant, I really had to get that out of my system, if I keep going this post may never end.

a budget neutral economic stimulus for Oregon

I've been meaning to write this post for a couple of days now since the State of Oregon Economist Tom Potiowsky issued his report on the state of the Oregon economy on Thursday indicating that recovery may be particularly slow in Oregon.  Collins, Snowe, Specter, and Nelson put States in a real bind by negotiating a lot of the aid to States out of the stimulus bill back in February.  This put States in the position of having to cut spending or increase taxes in order to balance their books, creating what Krugman termed, "the problem of the 50 Herbert Hoovers."  The road to full recovery is likely to be slow to begin with, and if Oregon lags behind the rest of the nation, it could be an awfully tough road back.  It seems that while a second stimulus would be very useful from the federal level, a State-level stimulus package in Oregon would be particularly useful, but there's no way it can happen given Oregon's budgetary situation.  That's why I was taken with an idea I originally bumped into in the the Washington Monthly about a month ago of taxing College Endowments as an economic stimulus (I for the life of me can't seem to find this post).  The point being that because College Endowments have become a status symbol, they're holding on to them instead of spending them.  Last time I checked the endowment was supposed to be sort of a "rainy day fund," and if now is not a rainy day I don't know what is.  In defense of Universities, there has been a sizable dropoff in the size of endowments recently due to the fact that donors are tightening their belts.  A policy that could force Universities to spend their endowments rather than holding on to them would be very beneficial to those communities.  As a result, college endowments being currently tax free nonprofits, I propose setting a temporary tax on college endowments in the State of Oregon to force them to put some of that money into the economy, there are a number of beneficial uses that this money could be put towards.

Students-Have been hit with an enormous tuition increase this year, if Universities dedicated some of their endowment to not increasing tuition then students would both not be forced to drop out due to affordability, which is a long term positive and increases the likelihood that Universities will be able to rebuild their endowments in the future, as well as allowing those students who do stay in college to engage in more discretionary spending locally, this helps local businesses.

Infrastructure-Invest in new buildings and/or more maintenance on campus, this allows plumbers, carpenters, drywallers... to stay in business, keeping unemployment down and leading to more local spending.

General Operations-Kill all spending freezes and layoffs, keeps people employed and allows departments to operate as they did two years ago, once again (are we noticing a theme here?) this means more spending in the local economy by not forcing academic departments to do things like not using any more paper, and keeping people employed.

The circumstances surrounding the money reserved in college endowments is a tricky issue, and some of that money can't be spent.  Without a thorough study of the status of endowments in Oregon I can't speculate on how much they can actually start spending in the near future, but any policy that forces them to spend more seems to me like it would be a good idea.  The following are the total amount of the endowments for Oregon Colleges and Universities, so we can imagine what 1/2 or 1/4 of that put into the local economy would do for Portland, Corvallis, Eugene, or Salem.  And the best part is, its not only budget neutral, but budget enhancing, as the State gets a chunk of whatever doesn't get spent.

University of Oregon-$498 million
Oregon State University-$476 million
Willamette University-$283 million
Lewis and Clark College-$231 million
University of Portland-$95 million
Linfield College-$71 million
Portland State University-$47 million
Southern Oregon University-$20 million
Western Oregon University-$10 million
Eastern Oregon University-$3 million
*list not based on who has the biggest endowments, but who I thought about

That's a lot of money out there that could be boosting the economy and is instead sitting in a bank account somewhere, there are very good ways it could be spent to help students, faculty, and the university itself.  Any policy that gets them to spend a chunk of that is a net good, tax them for this year (and this year only) and see what they decide to use rather than give back to the State, and what they do give back to the State helps prevent cuts to education, infrastructure, or the Oregon Health Plan.

Robert Reich's incrementalist parable

Robert Reich has a good piece on the need to fight the desire to be incrementalists on health care reform.  This is great parable that I thought was worth repeating in as many places as possible.

Years ago, as the story goes, Britain's Parliament faced a difficult choice. On the European continent drivers use the right lanes, while the English remained on the left. But tunnels and fast ferries were bringing cars and drivers back and forth ever more frequently. Liberals in Parliament thought it time to change lanes. Conservatives resisted; after all, Brits had been driving on the left since William the Conquerer's charriot. Parliament's compromise was to move from the left to right lanes -- but incrementally, on a voluntary basis. Truckers first.

My attitude has long been that in terms of health care policy, incrementalism is public policy's version of Zeno's Paradox.  If we forever resist universal coverage in favor of measures to insure part of the uninsured population, we never reach the point at which everyone has access to quality health insurance.  In environmental policy by contrast there's no particular desired end point, so we can always hope to achieve better environmental outcomes, and can pursue those by increments, a small positive step here, a small positive step there and we always make progress.  In health care on the other hand all progress towards universal coverage that falls short leaves some other group still lacking in coverage, and as we cover progressively more people in reforms, those left out become ever more vulnerable to moralistic claims about the lazy poor that the United States is so prone to.

RIP Senator Kennedy

Senator Edward M. Kennedy died today after his long battle with brain cancer. It is a sad day for all Americans as Senator Kennedy was a great figure in the United States Senate. While he was initially dismissed as a pick of nepotism he proved to be one of the most influential figures in the history of the United States Senate. He was a true liberal lion and cared for the poor and working class in this country very deeply. He was responsible for leading the fight against Judge Robert Bork for Bork’s confirmation to the Supreme Court and was responsible for much landmark legislation. This included:
Immigration and Nationality Act of 1965
National Cancer Act of 1971
Federal Election Campaign Act Amendments of 1974
COBRA Act of 1985
Comprehensive Anti-Apartheid Act of 1986
Americans with Disabilities Act of 1990
Ryan White AIDS Care Act of 1991
Health Insurance Portability and Accountability Act of 1996
Mental Health Parity Act of 1996
State Children’s Health Insurance Program of 1997
No Child Left Behind of 2002
Edward M. Kennedy Serve America Act of 2009
Senator Kennedy served his country well and will be greatly missed.

There's got to be an ad in this somewhere

The conservative strategy in opposing health care reform is clearly to scare the living crap out of the elderly.  The irony in all this being that it is Republicans who are the longstanding enemies of Medicare and social security.  As recently as the past election the Republican Nominee for President advocated cuts in Medicare to slash the federal budget deficit.  So it is really strange to see the Republicans turning seniors into their base as they oppose a centrist plan to reform health care.  So why hasn't Moveon or someone run an ad based on this quote:

"The reality of it is, this single-payer program known as Medicare is a very good example of what we should not have happen with all of our health care," said Steele. "The reality of it is, how many times have we been at the trough of bankruptcy and no money for the Medicare program, where Congress is running around like chickens with their head cut off, trying to figure out how to fix a program that they've already mismanaged? So now you want to do that, Congressman, on a larger scale? You want to include all of us. You're talking about taking our senior population, and expanding it to all of the population? Government cannot run a health care system. they've already shown that. Trust the private markets to do it the right way."

or this one.

We've had Medicare since 1965, and Medicare has never done anything to make people more healthy. If there's any opportunity for more healthy activity, it's going to be, again, a private, competitive...

There's got to be a way to counter the fear mongering, seems to me that while the Republicans are pretending that the Democrats are trying to kill Medicare we should be reminding them who passed and still supports Medicare and who opposed and still hates it.  Where are the moveon ads on this?

Wyden's game on the Public Option

Most accounts I've seen have Oregon Senior Senator Ron Wyden playing coy on the public option, suggesting that he might or might not support it.  I've had a difficult time figuring out what exactly Wyden's position is on the matter, but he did seem to take a small step towards, "standing in the way [of the public option]," as he said he wouldn't when he signed a letter along with major health care reform roadblocks such as Ben Nelson, Mary Landrieu, Susan Collins, and Olympia Snowe urging a delay in the reform effort.  That letter allowed for the push to slow to a halt leading into the August recesses, that allowed the anti-reform brigades time to organize and present their fake populist outcry against health care reform.

I'm not sure what Wyden's position is precisely here, beyond that he understandably likes his own bill.  When it was first drafted a couple of years ago Wyden's bill was an excellent roadmap for what passable health care reform might look like given the slim Democratic majority of 2006, with of all people Robert Bennett of Utah as its cosponsor.  The thing that's odd about this whole thing, however, is that Wyden won the argument before it began, his Healthy Americans Act was the first coherent presentation that I'm aware of, of the "health care exchange" model that forms the basis of the Senate HELP Committee bill, the House Education and Labor Committee bill, and the Obama outline plan.  There are only two major differences that I'm aware of:

1) to Wyden's credit, his bill seems to advance insurance portability a little bit more effectively than the health care exchanges presented in the House and;
2) Wyden's bill contains no public option

Clearly the second is the more contentious issue, oddly given that a public option advances the goal of health care portability more effectively than anything else in the insurance exchanges that are presented in the bills that have been passed out of committee.  This is very strange, given that its the first difference that Wyden's bill is more effective on, there may also be some very specific cost-containment measures in Wyden's bill that don't exist in other bills, but many of those could easily be added in by amendment.  That the public option has become the point of contention with Wyden is very strange, since a well organized public option that assumes Medicare providers will participate in the public plan, ties reimbursement rates to Medicare rates, and allows for drug price bargaining by Medicare and the Public Option would provide tremendous downward pressure on private health care costs.

Back when he introduced it, Wyden's plan was a good outline for bipartison, effective health care reform that promoted universal coverage.  Since that time however, it has become obvious that the goal of the Republican Party on many issues is to block the Democratic majority from any accomplishments, this was apparent from the stimulus debate and from Republican repositioning on the once bipartison Employee Free Choice Act, as well as to block any health care reform.  This is part of why the debate has had nothing to do with the actual proposals, with half the debate being about Canada and Britain (solutions that are not being proposed by anyone with power) and the other half being about blatant lies and distortions.  While Wyden's proposal could pick up Republican support in 2007 I seriously doubt that it could today.  Nonetheless I'm not opposed to having a vote on Wyden's plan, but his waffling on a public option is just plain bizzarre, as Jacob Hacker (linked in previous paragraph) argues compellingly, Wyden's plan too would benefit from a public option.  Its time for Wyden to stop playing whatever game he's playing here and get on board with the public option, its hard enough to pass health care reform over the objections of conservative Republicans, they don't need help from progressive Democrats.

Cwech Blug is Back!

From June 2005 up to January 2007 I tried to regularly post here, and while there were lull months when something got in my way I was able over that period on most months to post 20 or so times.  After the 2006 election I faded, with class it became difficult to keep posting consistently, and my brain was too fried to come up with interesting things to post.  Even after graduating and getting through the 2008 election cycle I couldn't bring myself to bring the Cwech Blug back online. What I realized during that time was that the Cwech Blug was an important outlet for me to continue to keep my writing sharp and to maintain an outlet for my thoughts. As the health care debate has heated up this August I finally concluded that in spite of being on the verge of starting graduate school (which will undoubtedly put more pressure on me from class than I had as an undergrad), I needed to bring this blog back.  This time I resolved to protect myself from creative lulls and class pressures by adding two good friends with good minds for politics to help me out, with three of us posting it should be a lot easier to consistently keep material coming and to avoid the pressure of having to constantly be posting something just for the sake of posting. This should keep the material here more interesting and fresh, while bringing some different perspectives to the table and allow for consistency of posts.

I hope that I can regain readers and find new ones from the last run at this blog, and keep interesting material coming.