Rebuilding The Republican Party

Jon Henke suggests transparency as an issue Republicans can use in attempts to rebuild the party:

Transparency is an area of genuine opportunity for progress right now, because (1) the majority party promised they would do it, and (2) the minority party has a political incentive to hold the majority to their promise.

However, as easy and obvious a policy as transparency seems, there are also two problems with it: (1) the majority now has a political disincentive to be transparent, and (2) the minority problem has no credibility to insist upon it.

Demanding more transparency is something I would expect the minority party to push for. It remains to be seen how well the Democrats will do at providing transparency as opposed to falling into the majority’s natural tendency to oppose it. Being a supporter of the checks and balances provided in a strong two party system I would like to see the Republicans make transparency an issue and keep the Democrats honest.

Unfortunately, as Henke even admits, the Republicans have no credibility on this issue. It was the Republicans who increased government secrecy when in office, and it was the Republicans who worked to weaken the checks and balances of our political system.

The problem faced by anyone who wants to rebuild the Republican Party is that they first must disassociate themselves from virtually everything the Republicans have done in recent years. I suspect that in most countries a party which has both taken such unpopular positions and has had as horrible a track record at governing as the GOP would find itself become a tiny minority party while another party would emerge to become the major opposition party (and possibly governing party in the future).

In the United States the current two party system is so firmly entrenched that we might face a prolonged period in which the Democrats govern and the Republicans are a weak party but no other opposition parties can develop meaningful strength.

While this is the most likely scenario, it is risky to make long term predictions in politics. We saw both with the political handling of 9/11 and with Katrina that unforeseen events can rapidly change the political landscape. While we have not had a major change in the major political parties for well over a century the changing politics of the internet might allow a new opposition party to win should the Democrats fail and voters be too smart to return to the Republicans.

There is even the outside chance that the Republicans might even be able to embrace a new set of issues which allows them to win, but that will be difficult unless current Republicans are replaced by new members who do not share the extremist views currently dominating the party.

Conservative Scare Tactics On Medical Information Technology

On any given day I generally only get around to posting on a  portion of the items I consider writing about. One topic I had hoped  to write about yesterday was the conservative scare stories about the medical information provisions of the stimulus bill which originated in an op-ed by Betsy McCaughey. I never completed this as I’m probably not capable of discussing a topic such as health information technology without it turning into a long post and I had a evening meeting to get to. In addition there was a tremendous amount of false information included in the stories being spread by the right which warranted response. (Instead I wrote about the conservative scare stories about Cass Sunstein as this was something I could write about much more quickly and still make the meeting.)

In order to note that the conservative scare stories regarding medical information technology are nonsense, and to avoid falling too far today by writing about this topic in depth this afternoon, I’ll refer readers to some good posts on this topic.

The Progress Report summarized the provisions and the misinformation being spread by conservatives:

Late last month, the House passed an economic recovery package containing $20 billion for health information technology, which would require the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically. The version of the recovery package passed by the Senate yesterday contains slightly less funding for health information technology (“health IT”). But as Congress moves to reconcile the two stimulus packages, conservatives have begun attacking the health IT provisions, falsely claiming that they would lead to the government “telling the doctors what they can’t and cannot treat, and on whom they can and cannot treat.” The conservative misinformation campaign began on Monday with a Bloomberg “commentary” by Hudson Institute fellow Betsy McCaughey, which claimed that the legislation will have the government “monitor treatments” in order to “‘guide’ your doctor’s decisions.” McCaughey’s imaginative misreading was quickly trumpeted by Rush Limbaugh and the Drudge Report, eventually ending up on Fox News, where McCaughey’s opinion column was described as “a report.” In one of the many Fox segments focused on the column, hosts Megyn Kelly and Bill Hemmer blindsided Sens. Arlen Specter (R-PA) and Jon Tester (D-MT) with McCaughey’s false interpretation, causing them to promise that they would “get this provision clarified.” On his radio show yesterday, Limbaugh credited himself for injecting the false story into the stimulus debate, saying that he “detailed it and now it’s all over mainstream media.”

McCAUGHEY GETS THE FACTS WRONG: In her commentary, McCaughey writes, “One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.” But the fact is, this isn’t a new bureaucracy. The National Coordinator of Health Information Technology already exists. Established by President Bush in 2004, the office “provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation” of “health information technology.” Far from empowering the Office to “monitor doctors” or requiring private physicians to abide by treatment protocols, the new language tasks the National Coordinator with “providing appropriate information” so that doctors can make better informed decisions. As Media Matters noted, the language in the House bill, on which McCaughey based her column, does not establish authority to “monitor treatments” or restrict what “your doctor is doing” with regard to patient care. Instead, it addresses establishing an electronic records system so that doctors can have complete, accurate information about their patients. The Wonk Room’s Igor Volsky pointed out that “this provision is intended to move the country towards adopting money-saving health technology (like electronic medical records), reduce costly duplicate services and medical errors, and create jobs.”

HEALTH I.T. BELONGS IN RECOVERY PACKAGE: Projected to create over 200,000 jobs, the funding for health information technology in the recovery package is both an important stimulus and a down-payment on broader health care reform. Speaking in Ft. Myers, FL, yesterday, President Obama said that investment in health IT was “an example of using a crisis and converting it into an opportunity.” We are going to computerize our health care system, institute health IT,” said Obama. “That creates jobs right now for people to convert from a paper system to a computer system, but it also pays a long-term dividend by making the health care system more efficient.” Currently, fewer than 25 percent of hospitals, and fewer than 20 percent of doctor’s offices, employ health information technology systems. Researchers have found that implementing health IT would result in a mean annual savings of $40 billion over a 15-year period by improving health outcomes through care management, increasing efficiency, and reducing medical errors. Investing in health would also help primary care physicians — who often bear the burnt of tech implementation without seeing immediate benefits — afford the infrastructure for expansion. The Congressional Budget Office has estimated that one-third of $2 trillion spent annually on health care in America may be unnecessary due to inefficiencies in the system such as excessive paperwork. Investments in infrastructure like health IT will help improve the quality of America’s health care.

The problem with conservative misinformation is that the right wing noise machine spreads the misinformation to other sources. Steve Benen reviewed the flow of this misinformation. He shows how the false claims in an op-ed were quickly picked up by Matt Drudge, Rush Limbaugh, Fox, and the editorial page of The Wall Street Journal.

I previously noted that The American College of Physicians backs the Health IT provisions in the stimulus bill. The ACP would hardly back a bill which would allow Washington to tell physicians what we can and cannot do as McCaughey claimed.

While many physician organizations support funding for medical information technoligy, there remains questions as to how the money should be spent.  A group of fifty experts in electronic health records, most of whom are physicians, have sent this letter (pdf) to the White House and Congressional offices urging funding of programs to help small physician organizations to implement electronic medical records systems.

Yesterday Michelle Cottle looked at some of the other complexities which must be worked out.