AMA Warns Of Risks Of Gutting Health Care Reform

With Republicans appearing to make abolishing Obamacare a top priority (following their failure to gut ethics oversight of Congress), the American Medical Association has weighed in with this letter (emphasis mine) stressing the importance of making coverage more affordable, providing greater choice, and increasing the number insured:

Dear Majority Leader McConnell, Leader Schumer, Speaker Ryan and Leader Pelosi:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing regarding our ongoing commitment to reform of the health care system and potential legislative actions during the first months of the 115th Congress.

The AMA has long advocated for health insurance coverage for all Americans, as well as pluralism, freedom of choice, freedom of practice, and universal access for patients. These policy positions are guided by the actions of the AMA House of Delegates, composed of representatives of more than 190 state and national specialty medical associations, and they form the basis for AMA consideration of reforms to our health care system.

Health system reform is an ongoing quest for improvement. The AMA supported passage of the Affordable Care Act (ACA) because it was a significant improvement on the status quo at that time. We continue to embrace the primary goal of that law—to make high quality, affordable health care coverage accessible to all Americans. We also recognize that the ACA is imperfect and there a number of issues that need to be addressed. As such, we welcome proposals, consistent with the policies of our House of Delegates, to make coverage more affordable, provide greater choice, and increase the number of those insured.

In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained.

Consistent with this core principle, we believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.

We stand ready to work with you to continue the process of improving our health care system and ensuring that all Americans have access to high quality, affordable health care coverage.

Sincerely,
James L. Madara, MD

Medical groups and physicians have been conflicted regarding expected health care policy under Donald Trump. There was some early support for Tom Price to head Health and Human Services in the hope that he will work to reduce the regulatory burden, but many doctors have come out in opposition to him out of concern for reductions in coverage for many Americans.

While health care policy could likely a major impact of the all-Republican government, it received very little attention during the presidential campaign. This is partially due to the media’s preference to cover the horse race and scandal, Donald Trump making more noise on matters such as the Wall, and an extraordinarily poor campaign by Hillary Clinton which concentrated on stressing Trump’s negatives and avoiding issues. Democrats are now starting to speak out on health care. Chuck Schumer is trying to turn Trump’s slogan against him, warning that Republicans will “Make America Sick Again.” Hopefully they can provide a resistance beyond coming up with a slogan.

Democrats were successful in blocking George Bush when he attempted to partially privatize Social Security in his second term, and similarly have a chance of receiving public support in opposing Republican attempts to reduce health care coverage, including cuts in Medicare and Medicaid. Republicans are also getting jittery about health care legislation. They could safely please their constituents by voting to abolish Obamacare when Barack Obama was in office and they knew he would veto their efforts if it made it past a filibuster. Many now realize they will be held accountable for what happens, including if people lose coverage, and insurance costs continue to rise rapidly. The Committee For A Responsible Federal Budget, typically conservative on government  spending,  has outline the costs of repealing Obamacare, giving further reasons for Republicans to be cautious.

Donald Trump remains a huge wild care, having both promised to abolish Obamacare and to provide a plan to cover all Americans. So far he has given no meaningful specifics, talking primarily about health savings accounts and allowing insurance companies to sell insurance over state lines. Neither is a real plan. One point to Trump’s credit is that, while his major appointees have been from a very narrow group (primarily wealthy conservatives), he has spoken to a wider range of people. Zeke Emanuel, the architect of the Affordable Care Act, came out of a meeting with Trump expressing optimism, as reported by NPR. He believes Trump might seek to have a bipartisan bill after Republicans have complained about how Obamacare was passed by only Democrats. He also pointed out that some conservatives are pushing for “repeal and replace” as opposed to the currently discussed tactic of “repeal and delay” and discussed how legislation might be handled after an initial resolution (even if along party lines) to abolish the ACA utilizing budget reconciliation:

And so that you really do need to repeal and replace, and you need to do it in one bill. Otherwise, you’re really going to disrupt the individual insurance market in a very bad way, and you’ll be responsible for millions of people losing their coverage but also health insurance premiums going up. And I think that is not a scenario that a lot of Republicans really want…

So one possibility is that they pass a resolution saying that they will then come back and pass a bill that will repeal parts of the Affordable Care Act and at the same time have a replacement for those parts of the Affordable Care Act…

The resolution can be party lines, but the bill would then have to construct both the repeal part but simultaneously the replacement part. And I think if you do it that way, you could begin to negotiate with Democrats. If you just have a repeal and we’ll be back in three years and tell you how we’re going to fix it, then the Democrats are simply going to walk away. Chuck Schumer has made that clear.

And they should walk away because then it’s all – it’s the old pottery barn principle that Colin Powell made famous, which is, you break it; you have to fix it, and you take responsibility. And the Democrats will not want their fingerprints anywhere near the breaking of Obamacare and the disruption of the insurance industry in the United States…

The question is, what is the shape of that bill? Is it just a repeal bill, or is it a repeal with replacement? And that negotiation about that bill could take several months. My own estimate is if both sides come with good faith, they could probably hammer this out in about six months. It’s not a small item. I mean health care reform is big.

The question is, what are the gives and takes? I do think – again, one of the reasons I’m optimistic is that when you look at conservative and liberal health policy experts, there’s about 70 or 80 percent overlap between the two groups about the shape of the future and what you would need. And I think that’s, again, why I’m optimistic – because there aren’t that many ways of doing health care reform. They’re really limited.

Of course counting on the sanity of Republicans is a very risky bet.

Bernie Sanders Wishes He Had The Opportunity To Run Against Trump (And So Do I)

sanders-conan

The nomination of Hillary Clinton by the Democratic Party in 2016 was among the worst blunders in the history of politics. She was the about the most status-quo candidate possible in an election where voters wanted change, representing everything which is most reprehensible in our political system. She was shown to have engaged in serious corruption in a year in which voters wanted reform, but many partisan Democrats continue to ignore the well-established evidence against her. It was clear Clinton would have difficulties with young voters, independent voters, many Obama voters, Sanders voters, swing state voters,  and voters in rust belt states. (Yes, there is considerable overlap in these groups, and it should have especially been obvious that many of those who voted for Obama in 2008 or Sanders in 2016 were doing so because they did not want Hillary Clinton to become president).

Beyond Clinton’s corruption and being wrong on virtually every major decision in her career, Clinton is terrible at running political campaigns. She is totally out of touch with the voters, and her political instincts are awful. She could not beat Obama in 2008, and could not have won the nomination in 2016 if the party insiders hadn’t cleared the field for her, in a system already rigged to favor a centrist over insurgent candidate, and then further intervened to support her when there was an unexpected challenge. The failure of the Democratic Party to pay attention to the desires of the voters resulted in the election of Donald Trump.

Bernie Sanders had double digit leads over Trump while Trump and Clinton were close in head to head polling. If Bernie Sanders was the nominee, Democrats, not Republicans, would have won the voters who wanted change. Sanders could get the young, independent, swing state, and rust belt voters to turn out for him in far larger margins than Clinton could. Sanders would have addressed issues of concern to voters while Clinton ran a dreadful campaign which never gave voters a reason to vote for her  beyond gender and the feeling that it was her turn. Sanders would have spoken to the press to get out his message, while Hillary Clinton avoided them as much as possible. With Sanders, there would have been no scandals, and no problems raised by being investigated by the FBI. Only partisan Democrats could think that she was exonerated after being exposed for conducting unethical and reckless behavior, and lying about it to the American people, because she was not indicted.

Bernie Sanders appeared on Conan (video above) and, while too modest to say he would win, showed that he regretted he did not have the opportunity:

Sen. Bernie Sanders of Vermont on Tuesday said he wished he had the chance to run against Donald Trump.

In an interview on “Conan,” Sanders said that while he was unsure whether he would’ve defeated Trump, early hypothetical head-to-head matchups showed him far ahead.

“What the polling showed that early on was all the polls nationally and statewide, I was beating him by much larger margins, much more than Secretary Clinton, but you know, then you go through a three-month campaign,” Sanders told host Conan O’Brien.

“All I can tell you Conan: I wish to God I’d had the opportunity. I would’ve loved to have run against him,” he added.

During his appearance Tuesday night, Sanders also ruminated on the nature of Trump’s election victory. He suggested that Trump used rhetoric to inflame racial and ethnic tensions but successfully branded himself as an outsider who could relate to many voters’ frustration with established industries.

“What Trump managed to do was convince people that he was the antiestablishment candidate at the time when people really are not happy with the economic establishment, the political establishment, and the media establishment,” Sanders said. “I think, sadly, much of what he said will not be true — he will not keep his word.”

He added: “Not everyone who voted for Trump is a racist or a sexist or a homophobe. There are a lot of people who are hurting very badly. They saw him as a glimmer of hope. That’s why they voted for him.”

Today’s attempt in the House to replace the establishment candidate also failed, but the challenge did show signs of growing discontent over the failures of the Democratic Party under the leadership of Nancy Pelosi:

Pelosi easily beat Rep. Tim Ryan (D-Ohio), a seven-term lawmaker who launched an upstart bid to lead House Democrats two weeks ago in response to the party’s disappointing November election results and concerns that Democrats have become out of touch with working-class voters in key swing states such as Pennsylvania, Michigan and Ohio.

But Pelosi’s margin of victory, 134 votes to 63 for Ryan, signaled a large degree of discontent with her leadership after 14 years atop the caucus and, more broadly, with the Democratic policy agenda that many lawmakers say has grown stale. While she cleared her self-declared margin of victory, a two-thirds majority, many Democrats were stunned that almost a third of the caucus was willing to vote for a backbench lawmaker with no major policy or political experience.

Many were left wondering whether a more seasoned Democrat could have actually toppled Pelosi, with several privately suggesting these next two years would have to be Pelosi’s last as leader. Ryan’s 63 votes marked the largest bloc of opposition Pelosi has faced since winning a deputy leadership position 15 years ago that set her on a course to become the first female House speaker.

Being “out of touch with working-class voters” is only part of the problem. Democrats are also out of touch with liberal voters, including many younger potential voters, on foreign policy, mass surveillance, civil liberties, and social/cultural issues. A Republican-lite party has little constituency beyond those content with voting for the lesser evil.

Republican Extremism And The Weakness Of Republican Leadership

The victory of David Brat over Eric Cantor was momentarily a cause for celebration, but the long term results might not be so favorable. Norm Ornstein warns that this will lead to further radicalization of the Republican Party:

First, it is clear that this moves the Republican Party even further to the right, in approach, attitude and rhetoric. Even if the overwhelming majority of incumbents, including establishment ones, have won renomination, even if broader Republican public opinion is more establishment conservative than Tea Party radical, all it takes is an example or two of the opposite to get all politicians jumping at their shadows and muttering to themselves, “That could happen to me.”

…American political parties always face a tension between their establishment and ideological wings. On the Republican side, going back more than a hundred years to the Teddy Roosevelt era, that was a struggle between moderate progressives and conservatives.

Now it is different. There are no moderates or progressives in today’s GOP; the fight is between hard-line conservatives who believe in smaller government and radical nihilists who want to blow up the whole thing, who have as much disdain for Republican traditional conservatives as they do for liberals.

In our 2012 book, “It’s Even Worse Than It Looks,” Tom Mann and I described the Republican Party as an “insurgent outlier.” That is even more true today. The energy and driving force in the party, in its House membership, media dominance, caucus and primary electorates and financial backers, is not its conservative wing but its radical side.

Ornstein is probably right that this will pull the Republicans even further to the right, but how far right can they go before even safe Republican districts are at risk? Will Republicans in these districts support any lunatic with an R after his name, or is there a limit? At the moment it appears that Brat should win, but the narrative would certainly change if the victory by such an extremists were to cause the Republicans to lose a safe Republican district.

Yesterday I noted Brat’s views on slashing spending on Medicare, Social Security, and education.  His plan to replace Obmamacare is just as absurd: “We need to also scrap employer-based health insurance, and give those incentives to individuals to carry their own portable health insurance. If we did that, the issue of pre-existing conditions largely goes away.” This makes absolutely no sense as the individual market has been dominated by insurance plans which have been the most abusive at denying coverage to the sick.

Brat’s campaign manager, Zachery Werrell, scrubbed his Facebook page after the victory but Yahoo News took screen shots while the page was still available:

From comparing George Zimmerman’s shooting of unarmed black teenager Trayvon Martin to abortion to calling for the abolition of the Food and Drug Administration and encouraging the adoption of the silver monetary standard, Zachary Werrell – one of just two paid staffers for the upstart campaign of Randolph-Macon College economics professor David Brat – sought in 2012 and 2013 to build a public profile as a socially conservative libertarian voice…

“Can someone who was outraged that George Zimmerman was found not guilty of ‘SOMETHING ANYTHING’ and who is simultaneously pro-choice explain the logical dissonance there? Ie. Why its not ok to kill someone who is banging your head into concrete but its ok to kill someone for simply existing who, through your conscious actions, you brought into the world?” Werrell had written in an Oct. 24, 2013, posting.

The month before, the campaign manager for the likely next congressman for Virginia’s 7th District – since no Democrat has represented that district since 1971 – questioned whether existing state lines were defensible. “Should sections of States be allowed to secede from a State if they feel they are un/underrepresented in the State Government?” Werrell asked. “I say yes. I derive that opinion from our first foundational document – the Declaration of Independence. What say you?”

On Oct. 25, 2013, he called for an end to the regulation of prescription drugs, citing a story from the Ludwig von Mises Institute. “Abolish the FDA!” he wrote.

On Oct. 29 of that year, it was a piece by Fred Reed from Lew Rockwell’s website on the wussification of boys that set him off. “There is a war on boys!” Werrell wrote. “Rough housing, playing soldier, etc, are all punished or medicated away. And we wonder why there is gender inequality in the classroom and in college/attendance/graduation rates.”

The Reed piece called for the end of women teachers in coed or boys’ schools. “It is time to get women out of the schooling of boys,” wrote Fred Reed. “It is way past time. Women in our feminized classrooms are consigning generations of our sons to years of misery and diminished futures.” The piece further argued that “women should not be allowed within fifty feet of a school where boys are taught” and that “Women are totalitarian. Men are happy to let boys be boys and girls be girls. Women want all children to be girls.”

Brat is far more likely than Cantor to make a major gaffe. It will be interesting to see his take on the views of his campaign manager.

If we can fantasize about a Democratic upset in this Congressional district, we might also fantasize about another upset in the general election. Peter Beinart looked at the weakness of the Republican leadership:

Cantor’s boss, John Boehner is, according to Nancy Pelosi, “the weakest speaker in history.” Less than 50 percent of Republicans approve of his performance. Over the last two years, he has repeatedly retreated in the face of opposition from rank-and-file conservatives who treat him with barely disguised disdain. Until the defeat of Cantor, his most likely heir apparent, it was widely assumed that he would soon either step—or be pushed—aside soon.

In the Senate, Minority Leader Mitch McConnell only avoided Cantor’s fate by attaching himself to his Kentucky colleague Rand Paul, whose upstart Senate candidacy McConnell had opposed. Like Boehner, McConnell is treated with striking disrespect in his own caucus.

David Frum wonders whether the Republican leadership will ever fight back:

At some point, Republican leaders must recognize that they have a fight on their hands whether they like it or not. If they refuse to join that fight, they will be devoured anyway. If they surrender, they condemn the whole conservative project in America to the destructive leadership of fanatics (and the cynics who make their living by duping fanatics).

I never thought there was much of a chance of Grimes to beat Mitch McConnell despite being close in the polls but today Political Wire reported that “A new Magellan Strategies (R) poll in Kentucky finds Allison Lundergran Grimes (D) leading Sen. Mitch McConnell (R) by three points in the U.S. Senate race, 49% to 46%.” Perhaps a major reason that Cantor was defeated is general bipartisan disgust with the Republican leadership, and if so this just might extend to knocking out McConnell.

The 2014 White House Correspondents’ Dinner–Full Video And Best Lines

Above is the video of Barack Obama at the White House Correspondents’ Dinner. Full transcript is here and excerpts follow:

I admit it — last year was rough.  Sheesh.  At one point things got so bad, the 47 percent called Mitt Romney to apologize.

Of course, we rolled out healthcare.gov.  That could have gone better.  In 2008 my slogan was, “Yes We Can.”  In 2013 my slogan was, “Control-Alt-Delete.”  On the plus side, they did turn the launch of healthcare.gov into one of the year’s biggest movies.  (Slide of “Frozen”)

But rather than dwell on the past, I would like to pivot to this dinner.  Let’s welcome our headliner this evening, Joel McHale.  On “Community,” Joel plays a preening, self-obsessed narcissist.  So this dinner must be a real change of pace for you.

I want to thank the White House Correspondents Association for hosting us here tonight.  I am happy to be here, even though I am a little jet-lagged from my trip to Malaysia.  The lengths we have to go to get CNN coverage these days.  I think they’re still searching for their table.

MSNBC is here.  They’re a little overwhelmed.  They’ve never seen an audience this big before.

Just last month, a wonderful story — an American won the Boston Marathon for first time in 30 years. Which was inspiring and only fair, since a Kenyan has been president for the last six.

We have some other athletes here tonight, including Olympic snowboarding gold medalist Jamie Anderson is here.  We’re proud of her.  Incredibly talented young lady.  Michelle and I watched the Olympics — we cannot believe what these folks do — death-defying feats — haven’t seen somebody pull a “180” that fast since Rand Paul disinvited that Nevada rancher from this dinner. As a general rule, things don’t like end well if the sentence starts, “Let me tell you something I know about the negro.”  You don’t really need to hear the rest of it. Just a tip for you — don’t start your sentence that way.

And speaking of conservative heroes, the Koch brothers bought a table here tonight.  But as usual, they used a shadowy right-wing organization as a front.  Hello, Fox News.

Let’s face it, Fox, you’ll miss me when I’m gone. It will be harder to convince the American people that Hillary was born in Kenya.

Of course, now that it’s 2014, Washington is obsessed on the midterms.  Folks are saying that with my sagging poll numbers, my fellow Democrats don’t really want me campaigning with them.  And I don’t think that’s true — although I did notice the other day that Sasha needed a speaker at career day, and she invited Bill Clinton.a, Bill Clinton, Bill O’Reilly, Captain America, Chris Christie, Community, Donald Trump, Facebook, Fox, George Bush, Health Care Reform, Hillary Clinton, House of Cards, Jeb Bush,

And I’m feeling sorry — believe it or not — for the Speaker of the House, as well.  These days, the House Republicans actually give John Boehner a harder time than they give me, which means orange really is the new black.

Look, I know, Washington seems more dysfunctional than ever.  Gridlock has gotten so bad in this town you have to wonder:  What did we do to piss off Chris Christie so bad?

One issue, for example, we haven’t been able to agree on is unemployment insurance.  Republicans continue to refuse to extend it.  And you know what, I am beginning to think they’ve got a point.  If you want to get paid while not working, you should have to run for Congress just like everybody else.

Of course, there is one thing that keeps Republicans busy.  They have tried more than 50 times to repeal Obamacare.  Despite that, 8 million people signed up for health care in the first open enrollment. Which does lead one to ask, how well does Obamacare have to work before you don’t want to repeal it?  What if everybody’s cholesterol drops to 120?  What if your yearly checkup came with tickets to a Clippers game? Not the old, Donald Sterling Clippers — the new Oprah Clippers.  Would that be good enough?  What if they gave Mitch McConnell a pulse?  What is it going to take?

Joel McHale, star of Community and The Soup, did an excellent job. #sixtimesashostandamovie. He has followed a long line of top comedians who have roasted politicians and the media and previous events. The all time best speakers was Stephen Colbert who roasted George Bush in 2006. The full transcript of his speech can be found here.

Following are some of Joel McHale’s best jokes, with video above and full transcript here.

Good evening, Mr. President — or as Paul Ryan refers to you, yet another inner-city minority relying on the federal government to feed and house your family.

I’m a big fan of President Obama. I think he’s one of the all- time great presidents — definitely in the top 50. Please explain that to Jessica Simpson. You’re right. That was low.

All right, how about the president’s performance tonight, everyone?  It is — it’s amazing that you can still bring it with fresh, hilarious material. And my favorite bit of yours was when you said you’d close the detention facility at Guantanamo Bay. That was a classic. That was hilarious, hilarious. Still going.

All right, look, I know it’s been a long night, but I promise that tonight will be both amusing and over quickly, just like Chris Christie’s presidential bid.

It’s a genuine thrill to be here in Washington, D.C., the city that started the whole crack-smoking-mayor craze.

The vice president isn’t here tonight, not for security reasons. He just thought this event was being held at the Dulles Airport Applebee’s. Yes, right now Joe is elbow-deep in jalapeno poppers and talking to a construction cone he thinks is John Boehner. Also true.

Hillary Clinton has a lot going for her as a candidate. She has experience. She’s a natural leader. And, as our first female president, we could pay her 30 percent less. That’s the savings this country could use.

Hillary’s daughter Chelsea is pregnant, which means in nine months we will officially have a sequel to “Bad Grandpa.” It also raises the question, when the baby is born, do you give Bill Clinton a cigar?

Jeb Bush says he’s thinking about running. Wow, another Bush might be in the White House. Is it already time for our every-10- years surprise party for Iraq? Yes.

As it stands right now, the Republican presidential nominee will either be Jeb Bush, Rand Paul, or a bag of flour with Ronald Reagan’s face drawn on it.  A bag of flour. All right.

People are asking, will Donald Trump run again? And the answer is, does that thing on his head crap in the woods?  I actually don’t know. I don’t know.I don’t know if that thing on his head has a digestive system.

Governor, do you want bridge jokes or size jokes? Because I’ve got a bunch of both. I could go half and half. I know you like a combo platter.  Now, I get that. I’m sorry for that joke, Governor Christie. I didn’t know I was going to tell it, but I take full responsibility for it. Whoever wrote it will be fired. But the buck stops here. So I will be a man and own up to it, just as soon as I get to the bottom of how it happened, because I was unaware it happened until just now.

I’m appointing a blue-ribbon commission of me to investigate the joke I just told. And if I find any wrongdoing on my part, I assure you I will be dealt with. I just looked into it. It turns out I’m not responsible for it. Justice has been served. He’s going to kill me.

Mr. President, you’re no stranger to criticism. Ted Nugent called you a subhuman mongrel. And it’s comments like that which really make me question whether we can take the guy who wrote “Wang Dang Sweet Poontang” seriously anymore.

Your approval rating has slipped. And even worse, you only got two stars on Yelp.

Mitch McConnell said his number one priority was to get the president out of office. So, Mitch, congrats on being just two years away from realizing your goal. You did it — kind of.

But thanks to “Obamacare,” or, as the president refers to it, “Mecare,” millions of newly insured young Americans can visit a doctor’s office and see what a print magazine actually looks like. That’s awesome.

Now over 8 million people have signed up for “Obamacare,” which sounds impressive until you realize Ashley Tisdale has 12 million Twitter followers. So that’s pretty good.

Sir, I do think you’re making a big mistake with Putin. You have to show a guy like that that you’re just as crazy as he is. He invades Crimea. You invade Cancun.  Russia takes back the Ukraine. America takes back Texas. Something to think about.

The director of national intelligence, James Clapper, is here. Finally I can put a face to the mysterious voice clearing its throat on the other end of the phone.  It was weird.

And CNN is desperately searching for something they’ve been missing for months — their dignity.  Totally. That was just that table. At this point, CNN is like the Radio Shack in a sad strip mall. You don’t know how it’s stayed in business this long. You don’t know anyone that shops there. And they just fired Piers Morgan.

Fox News is the highest-rated network in cable news.  Yeah. I can’t believe your table  — that far.  And it’s all thanks to their key demographic, the corpses of old people who tuned in to Fox News and haven’t yet been discovered.

Former “Inside Edition” host Bill O’Reilly is not here. He did host that. Bill’s got another book coming out soon, so he’s making his ghost writers work around the clock. Bill O’Reilly, Megyn Kelly and Sean Hannity are the Mount Rushmore of keeping old people angry.

This event brings together both Washington and Hollywood. The relationship between Washington and Hollywood has been a long and fruitful one. You give us tax credits for film and television production, and in return, we bring much-needed jobs to hard-working American cities like Vancouver, Toronto, and Vancouver again.

Hollywood helps America by projecting a heroic image to the rest of the world. We just released another movie about Captain America, or, as he’s known in China, Captain Who Owes Us $1.1 Trillion.

There’s a lot of celebrities here tonight. They’re the ones that don’t look like ghouls. Look around. The cast of “Veep” is here. That’s a series about what would happen if a Seinfeld star actually landed on another good show. I like “The New Adventures of Old Christine,” I swear.

I’m not going to spoil the shocking twist on “House of Cards,” but just know that it was so surprising that Nancy Pelosi’s face almost changed expression. Did you like that one, Nancy? I can’t tell.

Biz Stone, the founder of Twitter, is here. So if any of you congressmen want to cut out the middleman, just show him your penis. Not now! Are you nuts?

And here’s why America is the best country in the world. A guy like me can stand before the president, the press and Patrick Duffy — and tell jokes without severe repercussions. And instead of being shipped off to a gulag, I’m going to the Vanity Fair after-party. That’s right. This is America, where everyone can be a Pussy Riot.

Weiner Campaign Goes Flaccid

I can see forgiving a politician for some sexual misconduct and reelecting the politician. If New York voters want to make Eliot Spitzer their next Controller, this might be a fair deal–getting an overly-qualified individual in return for forgiving past indiscretions. It is harder to see electing Anthony Weiner, especially to a higher office than he previously held, after finding that he continued sexting with at least three women since leaving Congress. It might be argued that this has nothing to do with the duties of mayor, but it is a sign of stupidity, and who wants a stupid mayor? New York voters appear to be thinking along similar lines. Initially he led in the polls, undoubtedly helped by name recognition (and perhaps recognition of other things). With the revelations of his on-going stupidity, his lead has evaporated in the polls. The latest Marist poll has him narrowly holding on to second place, nine points behind Christine Quinn in the Democratic primary.

Nancy Pelosi has described Weiner’s behavior as reprehensible: “It is so disrespectful of women, and what’s really stunning about it is they don’t even realize, they don’t have a clue. If they’re clueless, get a clue. If they need therapy, do it in private,” she said.

Avoiding Depression Over The Debt Ceiling Deal

Yes, the news is pretty bad, but we all expected that once we started negotiating with terrorists the outcome would not be the greatest. I’m avoiding depression by remembering that things really could have turned out far worse. In other words, the Republicans could have won even more if they were  prepared to negotiate seriously before the last minute as opposed to having their own hostage situation with the Tea Party people.

There’s no point in writing about all the negatives. Many people have already done that. I figure it is worth linking to a couple of the stories which do find some positives in this. For example, Jay Newton-Small has five things for liberals to like:

The 2012 budget: At one point in the negotiations, the 2012 budget was to be slashed by $36 billion. The final number of cuts: just $7 billion. And just to ensure we don’t have another bruising government shutdown fight over cuts in September, the deal deems and passes the 2012 budget. Yes, that’s right, the old Gephardt Rule or Slaughter Solution, is back. What’s deem and pass? It’s a legislative trick that essentially means that Congress will consider the budget passed without ever actually having to vote on it.

The trigger: This is counterintuitive, but the trigger is actually pretty good for Democrats. For all that MoveOn thinks that it would force benefit cuts to Medicare, Medicaid and Social Security, it actually wouldn’t trigger benefit cuts to any entitlements. The only cuts it would force would be a 2% or more haircut for Medicare providers. And House Minority Leader Nancy Pelosi, along with most Democrats, has never opposed provider cuts. Not only that, most progressives actually want the Pentagon cuts. So if the committee deadlocks and the trigger is pulled, Democrats won’t be miserable.

The commission: Again, for all the liberal carping about a “Super Congress,” the commission of 12 members — three from each party in each chamber — set up to find the second phase of $1.5 trillion in cuts by Thanksgiving is actually rigged to force some revenue increases. Yes, the Bush tax cuts are off the table. But there are plenty of loopholes, subsidies and other corporate welfare programs that are on the table. And with such a strong trigger, it’s hard to imagine at least one Republican not voting to kill corporate jet subsidies over slashing $500 billion from the defense budget – even if the revenues aren’t offset. The question is: who are Republicans more afraid of, Grover Norquist or the joint chiefs? Democrats’ money is on the joint chiefs.

The immediate cuts: It may seem like a lot, but the $917 billion in the first phase of cuts were carefully negotiated by Vice President Joe Biden and his group. They include $350 billion in Pentagon cuts – a win for liberals. They don’t touch entitlement benefits, another win. And they set top line numbers for the next decade of budgets that aren’t draconian. It still cuts where liberals might prefer to spend, but most of the savings are backloaded to avoid extreme austerity in next few years of fragile economic recovery.  Just $7 billion would be cut in 2012, and only $3 billion in 2013. And of that combined $10 billion, half would come from the Pentagon. On top of that, the discretionary spending caps on budgets in future Congresses are subject to revision by those bodies.

The debt ceiling: Raising the debt ceiling through 2013 will not be contingent on the second round of cuts. There will merely be a vote of disapproval. This avoids another messy fight in January and another round of painful forced cuts.

Nate Silver has more on the good parts in the fine print of the deal.

I have my doubts as to whether the commission will accomplish anything worthwhile.  GOP leaders will choose members hey are sure will not go for any tax hikes and want to limit spending cuts to areas  where we would least want to see cuts. This means we will probably to to the trigger. Cutting defense spending wouldn’t be all bad. As a physician, I am not thrilled by the trigger of a 2% cut in Medicare, but I still need to check out the details. Worst case scenario is an across the board cut in the fee schedule for all Medicare services.  In the past, percentage increases or decreases in Medicare have been a total for the program, with some services changing by more or less than the overall percentage. As long as they have some leeway legally, I bet that they would prefer to cut more than 2 percent in some areas in order to avoid a cut in primary care services (sparing me from the cuts). I’m also not going to worry about a possible 2 percent cut when cuts of more than ten times this are scheduled under  the sustainable growth formula. If Congress can overrule the sustainable growth formula every year, they can also intervene to alter the effects of the triggers.

President Obama’s Press Conference On The Debt Ceiling Talks

President Obama’s press conference on the breakdown of the debt ceiling talks (video above). Summary of the news conference here. Nancy Pelosi has offered another compromise.

Opposition Growing To Medicare Payment Board

At one time we had two competing versions of the health care reform law passed by each house of Congress. The bill from the House of Representatives was much better than the bill from the Senate but, due to the mechanics of getting a bill passed by budget reconciliation after the Democrats lost their 60th Senate seat, we got stuck with the Senate bill instead. One of its faults was the manner in which the Independent Payment Advisory Board in the Senate bill goes too far in being structured towards cutting costs, as opposed to balancing quality and cost, without input from our elected representatives.

There are many tough decisions to be made with regards to Medicare. Cutting costs must be considered, but with an aging population and costly but worthwhile advances in medical technology, we must balance cutting costs with what we want out of the health care system.  At times the best decision might be to maintain current levels of spending, or perhaps even to spend more as opposed to cutting costs. A board designed primarily to cut costs will not necessarily make the decisions we desire.

It might make sense to obtain recommendations from a board which is independent of politics and then have Congress consider them. I’ve found that many of the liberal bloggers who support the IPAB are under the misconception that the recommendations would be subjected to an up or down vote. This is not the case, which is why a growing number of members of Congress, along with health care organizations, support repeal of the IPAB as currently structured in the Affordable Care Act.

Since my previous post on this subject, Politico now reports that National Committee to Preserve Social Security and Medicare, a prominent supporter of the Affordable Care Act, has joined in the opposition to the IPAB.

“IPAB turns Medicare into a scapegoat,” said Max Richtman, executive vice president and acting CEO of the National Committee to Preserve Social Security and Medicare. “Medicare will be forced to make reductions without addressing the rest of the health care costs.”

The group also is concerned that it would be hard for Congress to overturn any decisions by the board; it would have to come up with an equal amount of savings to stop the board’s decisions.

It’s a concern echoed by lawmakers, who are most likely to face the political fallout for the board’s actions.

“Abdicating this responsibility, whether to insurance companies or an unelected commission, would undermine our ability to represent the needs of the seniors and disabled in our communities,” Rep. Allyson Schwartz (D-Pa.), a prominent supporter of most of the reform law, wrote in a letter to colleagues in April.

Currently seven Congressional Democrats have joined in sponsoring a bill to eliminate the IPAB, with other Democrats indicating they would vote for the bill if it makes it to the floor of the House. It will be more difficult for repeal to pass in the Senate:

Gathering support among Democrats will be easier in the House than in the Senate, where the idea began. The House health care bill didn’t include the IPAB, and several dozen members expressed their opposition to the board to then-Speaker Nancy Pelosi.

The National Committee says it is talking with lawmakers about its concerns about the IPAB.

“We’ll be meeting with members, trying to persuade them that they need to be responsible, and the responsible thing to do is to scrap that and take on Medicare costs through the regular committee process,” Richtman said.

Health care provider groups have made IPAB repeal a top priority, too. If they can’t repeal the whole provision, they want to eliminate a deal made last year to keep hospitals out of the program until 2018.

“We’re going to raise holy hell if IPAB happens without the hospitals,” a health lobbyist said.

It is also likely that many Democrats and liberal groups will oppose Republican-led efforts to repeal the IPAB, seeing this as part of the overall efforts of Republicans to repeal health care reform.

If the Republicans really do oppose this out of principle, this is an example where their strategy failed in outright opposing any form of health care reform. If Republicans had participated in the process, they could have received compromises, including less power for the IPAB, malpractice reform, and keeping the 1099 requirements (which have been successfully repealed) out of the final law.

Weiner: More A Case Of Stupidity Than A Major Scandal (So Far)

Anthony Weiner has admitted to sending the picture of his (covered) weiner over Twitter, and of similar behavior with other women he communicated with on line. As scandals go, Weiner’s is fairly small. As Steve Benen wrote:

On the Political Sex Scandal Richter Scale, I’m still not altogether sure why this even registers at all. Given what we know, Weiner shared adult content with women he met online. They were adults and the interactions were consensual. He didn’t commit adultery (Ensign), he didn’t hire prostitutes (Vitter, Spitzer), he didn’t solicit anyone in an airport bathroom (Craig), he didn’t pretend to be someone else in order to try to pick up women (Lee), he didn’t abandon his office for a rendezvous with his lover (Sanford), he didn’t leave his first two wives after they got sick (Gingrich), he didn’t have a child with his housekeeper (Schwarzenegger), there’s no sex tape (Edwards), and no interns were involved (Clinton). He’s not even a hypocrite — Weiner has never championed conservative “family values,” condemning others for their “moral failings.”

This assumes that there isn’t anything more to this. Nancy Pelosi has called for an ethics investigation of Weiner. Assuming that there are no minors and there are not more explicit pictures, my guess is that this is not a career ending scandal, but at very least will be a career stalling one. As can be seen in Steve’s list, the less severe sex scandals do not necessarily end careers, but I doubt he will be elected to a more competitive spot in New York anytime soon. (Elliot Spitzer might even beat him–time does seem to make these scandals less important to voters).

While Weiner’s transgressions appear to be relatively minor (at least so far), they were rather stupid. It is amazing how often we see similar patterns in politicians. Was whatever pleasure Weiner received from sexting with young women really worth all of this?  I would ask whether this will dissuade future politicians (which can be from either party) from doing anything so foolish, but the answer, based upon the past history of sex scandals in Washington, is clearly no.

Evidence Appears To Exonerate Anthony Weiner

The available  evidence continues to support Anthony  Weiner’s contention that the controversial weiner picture on Twitter was sent by someone else. It wound up taking  bloggers to determine what happened with social media sites. Cannonfire demonstrated that this technically wasn’t a case of someone needing to hack Weiner’s Twitter account as it was possible to fake the sending of the twitter picture due to a “feature” of yfrog. In order to get the photo  site to send out a photo as a tweet it appears that it is only necessary to find someones yfrog email address:

Believe it or not, when an outsider sends a pic to someone else’s Yfrog account in this fashion, the action creates a message in the “twitterstream.” The message seems to originate with the Twitter account holder — but it doesn’t. It comes from somewhere else — from someone mailing a picture to the account holder.

This is a serious security flaw in the design of Yfrog and Twitter. It allows a malicious outsider to “spoof” a tweet that seems to come from someone else.

In addition, the post looked at problems in the url, arguing  that  “The anomaly in the header indicates that the image was not sent by Weiner. It had to have been sent by someone else.”

Next step was to track down the culprit. It appears that the picture was posted by a conservative who posts under the name Dan Wolfe who first claimed to find the picture. It turns out that the picture supposedly found by Wolfe has irregularities which cast doubt upon Wolfe himself.  “The date stamp on this image is May 30, not May 27. The EXIF data is strange in other ways”   Not surprisingly, Dan Wolfe has been acting pretty strange today:

Explaining his hesitation to speak on the telephone, Wolfe wrote that his ex-wife (working in conjunction with a former girlfriend of his) had twice secretly recorded him and that the resulting tapes had “gotten me in a lot of legal trouble.” As a result, he contended that if his ex-wife’s attorney “got a hold of a call recorded with me on it they’d have a field day with that. I want to try to avoid.”

While not addressing who would make such a recording, how it would surface, or why it would do harm to him, Wolfe concluded, “I am screwed. If all this comes out along with everything I’m dealing with here–I don’t know what to do.”

Update (June 6, 211): Key word in the title is “appears.” Anthony Weiner admits to sending picture. Nancy Pelosi has called for an ethics investigation of Weiner.