A Message From Barack Obama


Many have wondered how the internet will be used now that Barack Obama has been elected, after having used the internet during his campaign. It looks like weekly radio addresses from the president are now so old fashioned. Above is the first weekly YouTube address from the president-elect.

Repackaging Bad Ideas in Health Care

I fail to see why Ezra Klein is so excited about a proposal by Bobby Jindal to move Medicaid recipients in Louisiana into managed care plans. This is not anything new or innovative, and it is not a positive step towards health care reform. Many states have already adopted similar plans for Medicaid and it has hardly been a solution to the health care crisis.

This is primarily a way to change how the health care is paid for those already covered by the state’s Medicaid plan. There is some benefit in including more low-income individuals, but it is hardly a good model for health care reform for the entire population. The goal should be for more people to have real coverage, not to throw more people into the inadequate Medicaid systems. There is a tremendous difference between Medicare for All and Medicaid for More.

I do not share Ezra’s fondness for either the British model for universal health care or for capitated medical care. This HMO model was tried (and to some degree still exists) for employer-paid health care and was a dismal failure. (Incidentally, not that the person behind it necessarily means a particular plan is bad, but it was Richard Nixon who first began pushing this idea when he was president).

While there are undoubtedly problems with fee for service health care, the alternative turned out to be far worse, leading to the desire of most consumers to avoid HMO’s which are run in this manner. Capitated systems, in which doctors receive a fixed amount of money per patient (often with adjustments for factors such as age and health status), risk having doctors forced to provide inadequate care in order to get by on what is paid. Doctors are given financial incentive to see patients as little as possible, do as few tests as they can get away with, and treat as little as possible.

Jindal’s plan would include financial incentives if physicians met certain performance criteria. Such plans have not worked out very well so far. Frequently the burden of reporting data to receive financial incentives has been greater than the value of the incentives offered. It comes down to whether it is worth paying employees to submit more paperwork for a small amount of additional money.

While electronic medical records might change this in the future, at present the ability to monitor and reward based upon performance is quite primitive. Those who come out ahead in such systems are not those who really provide quality care but those who can best game the system by having computerized systems in place to report the data being monitored. This leads to problems such as the Veterans Administration, which has spent a lot of money on computerization, but often fails to spend the money to adhere to current standards of medical care. This leads to them looking good on paper, and unfortunately fooling some liberal publications based upon their ability to report data, despite the deficiencies in the care they provide.

Charlie Cook On The Republican Party’s Loss of Upscale Voters

I’ve had many posts over the last several years about the extremism of the Republicans causing them to lose the support of affluent voters, educated voters, suburbanites, and independents? When the election results showed that I was correct on this, I had another string of posts on this topic. I won’t write yet another post on this topic right now. Instead I’ll just quote from today’s edition of The Cook Report in which Charlie Cook says the same thing:

Republicans have lost an enormous amount of support among upscale voters, basically just breaking even among those with household incomes above $50,000 a year, a traditional GOP stronghold. Similarly, McCain’s losing to Obama among college graduates and voters who have attended some college underscores how much the GOP franchise is in trouble. My hunch is that the Republican Party’s focus on social, cultural, and religious issues — most notably, fights over embryonic-stem-cell research and Terri Schiavo — cost its candidates dearly among upscale voters.

The question now is whether Republicans will quickly learn from their mistakes — retooling and rebranding their party soon, putting themselves in a position to capitalize on the missteps of the Obama administration and the rest of the Democratic Party — or will languish, reduced to waiting for the Democrats to collapse and for GOP candidates to win simply because they aren’t Democrats.

Those who write off the 2008 election by saying that Republican candidates weren’t conservative enough are in denial. They are political ostriches, refusing to acknowledge that the country and the electorate are changing and that old recipes don’t work any more.

Obama’s message and agenda were a far cry from those of the Democratic Party of a generation or two ago, but the Republican Party’s message and agenda haven’t changed much other than becoming even more fixated on cultural issues and tax cuts. A top Republican pollster remarked privately to me after the election that he couldn’t think of a single new idea generated on the Republican side during the 2008 campaign.

Hillary Clinton as Secretary of State

I first heard Hillary Clinton’s name mentioned as a possible Secretary of State when watching George Stephanopoulos on This Week last Sunday. This had me wondering if it was a case of either Stephanopoulos having inside information regarding Clinton, or if perhaps he was helping the Clintons launch a trial baloon. The story has taken off and become a major matter of speculation by the end of the week. While we do know that Obama and Clinton have talked about this, we do not really know if it is a serious offer.

It is possible that Obama is only talking with Clinton to avoid the appearance of ignoring her as when he did not vet her for the vice presidency. Obama might be considering Clinton as part of the Team of Rivals approach to government. There have been many comparisons between the Obama vs. McCain race and the Santos vs. Vinick campaign on final season of The West Wing. The show ended with Matt Santos offering the position of Secretary of State to Arnold Vinick. For Obama to offer this to Clinton would be an analogous example of bringing in a rival, but would be far more likely than for Obama to offer the position to John McCain.

This could also be a shrewd decision on Obama’s part to reduce the mischief that Clinton could cause. As Marc Ambinder suggested:

The CW in Washington is that Obama wants Clinton in his cabinet more than Clinton wants to be in the cabinet, the theory being that the moment she steps into the administration, she loses her power base, she loses her Senate seat forever, and she loses her voice on domestic policy. She concedes her political identity.  Actually, on policy: uncuriously silent in all this is Sen. Joe Biden, who has strong foreign policy ideas of his own and a bigger platform to share them with Obama.  Would Clinton become a glorified PR tool for Obama if she accepted the job? A Powell, rather than a Rice?

Andrew Sullivan considers this an inspired idea:

Obama has to offer something to Clinton. She’s his main threat now and rightly regards part of his victory her doing. The primaries helped him. Left to fester in the Senate, Clinton will plot against the president if he doesn’t actively seek her support and engagement and “spread the political wealth” of his mandate.

If Barack Obama receives a call at 3:00 a.m., will Hillary Clinton be one of the people called to the White House at 3:15? For the sake of the country I would prefer that Obama receive advice from a Secretary of State such as John Kerry, although he could also be consulted as the possible next Chairman of the Senate Foreign Relations Committee.

Hillary Clinton has something in common with George Bush–both have been wrong on virtually every major decision they have every made in public life. I might welcome her becoming Secretary of State if this meant totally shutting her out of domestic policy, especially health care, but only if she did not really have a voice in foreign policy. From her position on the Iraq War to her opposition to the ban on cluster bombs, her judgement on foreign policy has been as flawed as her judgement on domestic policy. If this keeps Clinton under control it might be worthwhile, but is it really safe politically to have both Hillary and Bill running around the world?