Republican Ideas on Health Care

The main strategy of Republicans is to block any meaningful health care reform. Their overall plans would do little if anything to help the uninsured, increase the ability of insurance companies to avoid consumer protection laws by operating out of the states with the weakest regulations, and would increase out of pocket expenses for most people. However, when Republicans have made suggestions which could be considered as part of an overall health care reform measure many Republican ideas have already been included.

Newt Gingrich and John C. Goodman list several suggestions in an op-ed in The Wall Street Journal. This hardly represents a meaningful health care reform proposal but many of the Republican ideas are already included in the current health care legislation. The Wonk Room goes through many of these suggestions noting how many are now in the bill. I’ll just add comments on a few of the topics.

The Republicans are trying to portray themselves as the defenders of Medicare  after years of trying to destroy the program. The Medicare cuts being proposed are not serious cuts to the program. Most of the cuts would be to Medicare Advantage programs which use the bulk of the subsidies they receive to increase profits for insurance companies and sometimes use a small amount to provide extra benefits to entice customers. In addition, if there is near-universal health care it will not be necessary to fund as much money for Medicare to pay for added expenses due to cost shifting because of the uninsured.

The article is misleading when it says Medicare pays doctors by the task but  doctors “do not get paid to advise patients on how to lower their drug costs.” No, there is not a CPT code for advising patients on lowering drug costs but Medicare does pay for office calls in which such matters can be discussed, and does pay more when more time is spent counseling patients.

They also write that “Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail.” True, but the same is true of most private payers. This is an area which is just starting to be considered. It could either be added to health care reform legislation or could be added in the future.

Gingrich and Goodman advocate meeting the needs of the chronically ill but one of their key recommendations for doing this will not have this result. They write that “Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start.” The problem is that when people with chronic diseases have to pay for more expenses out of money in their own account they tend to avoid many necessary tests and office visits to save money. In the long run this leads to poorer outcomes and higher costs. There is also the danger of these accounts being depleted leaving patients with chronic medical conditions without sufficient coverage.

They also advocate eliminating junk lawsuits. I agree, but Republicans tend to greatly exaggerate the effect of this. Malpractice suits and the resultant defensive medicine do result in wasted money we should attempt to recover but this is a small part of overall health care costs. The health care legislation does provide for state demonstration tests regarding tort reform. I would be happy to see some actual solutions included in the bill. Perhaps if the Republicans took an attitude of compromising to get their ideas included, as opposed to all deciding early on to vote against health care reform, they might have been successful in having more concrete solutions for tort reform included.

Continuing The Fight For Health Care Reform

Most of the talk about health care reform in the blogs since the loss in Massachusetts has been about ways to ram through health care reform despite losing the super-majority in the Senate. While I agree with the importance of passing health care reform, both in terms of public policy and politically, such arguments often overlook what really must be done first–win over the hearts and minds of the voters. We cannot afford to fail to pass health care reform, but nothing good will come out of ramming through unpopular legislation.

Some liberals think that once the health care plan is passed everyone will see that it is nothing like what is being portrayed by the right wing noise machine and will learn to love the new plan. Most key provisions of health care reform will not take effect until after the 2010 and 2012 elections. During this time people will continue to hear scare stories about the doom we will face. These scare stories about health care reform are no more true than the scare stories of planetary doom in 2012 based upon the Mayan calendar, but they will still be believed by far too many people.

Ramming through health care reform before obtaining the support of the voters is also a mistake as it would reinforce one of the right wing’s criticisms of Democrats as being arrogant in their exercise of power. Sure, it is true as Democrats counter that the Republicans have done far worse than this when in power, but voters will respond to what they see today. Acting like Republicans is no way to convince the voters that the Democrats are any better. Fortunately the Democratic leadership decided against actions such as delaying the seating of Scott Brown or quickly holding a vote before he was seated.

There are many obstacles to selling health care reform but the distortions from the right wing noise machine could have been predicted. Polling does prove that most Americans do not really understand what is in the bills and are more willing to support them once they understand. Obama needs to to campaign for his policies as strongly as he campaigned to beat Hillary Clinton and John McCain. He is now showing that he realizes this.

As Americans do support most of the individual aspects of the health care plan I have suggested that different portions be proposed and debated separately. Pushing everything at once provides too many avenues for the right to obfuscate the real issues. A majority would be likely to support eliminating restrictions on pre-existing conditions, eliminating rescission of policies after people become sick, offering the choice of a public option, establishing exchanges to provide a choice of health care plans, eliminating the Medicare donut hole, and even paying a little more in taxes to provide coverage for those who cannot afford it. Even if there are not enough votes in the Senate to pass portions such as the public option, we should have a public debate and a vote. Sooner or later the public will figure out who it is that is blocking the measures they want. Let the Republicans try to run on such a record.

At present Democrats have far too many points to defend at once, allowing the Republican to create their distortions such as claiming the massive bill contains death panels. Democrats  needed to do a better job of explaining that the Medicare Part D cuts being proposed are cuts in subsidies given to the insurance companies by George Bush, and not actual cuts in Medicare. It is astounding that the Democrats could ever wind up in the situation of allowing the Republicans to falsely portray themselves as the defenders of Medicare.

There is  increased hope that a deal might be reached to have the House pass the Senate bill in return for plans to fix the problems with separate legislation. If this was the fantasy world of The West Wing I would prefer to see a series of individual battles and victories for health care reform, but a deal such as what is being discussed is more realistic in this world.

If such a deal cannot be reached, and ideally even if one can, Obama should take advantage of the State of the Union Address to explain what is actually in the health care plan and to also tell the American people that he has heard their concerns and is recommending that Congress make some changes.

One mistake which Obama can still rectify is backing away from his opposition to the individual mandate. The mandate changes how people see individual fixes they might otherwise support, and plays into the talking points of the far right. Many independents voted for Obama because they realized after Katrina that we cannot have a government which ignores the need for government action when necessary. However, while many are willing to support government helping those who need assistance at obtaining health care, they are justifiably nervous about government programs designed to help people whether they ask for the help or not.

People who see this as a more voluntary plan to help either themselves or others would be more willing to support this as opposed to a plan which is mandatory for themselves. There are many other ways around the free rider problem which would not lead to opposition from many on both the left and the right as has occurred as a result of the individual mandate.

There are many other details I would change but this is already far too long for a blog post. I will end by repeating one of my other objections to the course the health care debate has taken even if, in this case, it might not be politically feasible to change course.

The Democrats have fallen into a trap of accepting the Republican dogma that taxes should never be raised, as most forget that even Ronald Reagan did raise taxes. They are forced to find ways to limit the people who pay for the health care reform measures, leading to opposition from certain groups and an overall impression that they are trying to sneak something by the American people. Everyone benefits from health care reform in the long run and far more money can be raised less painfully if there is a broad based tax. If Barack Obama had used his oratory skills from the start to explain to people exactly what they must pay and what they get in return I wonder if Americans would have understood this. Or perhaps I’m returning to the fantasy world of  The West Wing on this argument.

The Public Still Opposes Republicans, And Will Support Health Care Reform If Handled Better

Republicans are feeling very good this week, as would be expected after winning a Senate seat in Massachusetts and possibly being successful with their strategy to do anything to block health care reform regardless of how much they harm the country. They should not get over confident that they can win without several unusual factors which helped them in Massachusetts. Public Policy Polling found that only 19 percent of voters are happy with the direction of the Republican Party:

One lesson that can be taken from the recent GOP successes in Massachusetts, New Jersey, and Virginia is that your party can be a complete mess and still win an election.

Our national poll this week found that only 19% of voters in the country are happy with the direction of the Republican Party, compared to 56% who are unhappy with it. Even among independents, who have voted overwhelmingly for Scott Brown, Chris Christie, and Bob McDonnell 58% say they don’t like the direction the GOP is headed in.

The GOP’s own voters are displeased with where the party’s going- 38% say they are unhappy with the current direction to 35% who support it. In a trend that perhaps provides at least a ray of hope to Democrats the Republicans unhappy with their own party are disproportionately moderates. 54% of them are displeased to 25% content- the question is what Democrats can do to get those folks to actually jump ship.

Disliking the Republicans does not necessarily mean people will vote Democratic. Far too many Democrats saw the repudiation of George Bush and the previous Republican-controlled Congress in 2008 and 2006 as support for a specific agenda as opposed to opposition to the status quo. If voters remain upset about the status quo, many are likely to respond by voting Republican.

I don’t normally pay much attention to anonymous blog comments, but part of the problem can be seen in the first comment at Public Policy Polling’s site:

Tom, I personally think that you’re analysis isn’t correct, but I do think that many ppl I know, from around me, who always voted for Democrats, their whole life, and are promising never ever to put a ballot with a D near it in the ballot box! We’ll vote for the Republican always b/c the Dems went to the extreme left with Obama et al. That’s the problem!

In reality it is the Republicans on the extreme right with Obama taking a centrist course. The Republicans have managed to distort a fairly conservative fix to our health care delivery problems as a radical solution. Democrats deserve part of the blame here. This includes failing to properly prepare for this inevitable attack  as well as some policy mistakes, including Obama backing away from his opposition to the individual mandate.

Democrats  needed to do a better job of explaining that the Medicare Part D cuts were cuts in subsidies given to the insurance companies by George Bush, and not actual cuts in Medicare. It is astounding that the Democrats could ever wind up in the situation of allowing the Republicans to falsely portray themselves as the defenders of Medicare.

The Democrats  might have been better off pushing for pieces of health care reform in smaller chunks which the pubic could understand rather than having to defend themselves on far too many fronts at once. A majority would be likely to support eliminating restrictions on pre-existing conditions, eliminating rescission of policies after people become sick, offering the choice of a public option, and even paying a little more in taxes to provide coverage for those who cannot afford it. The Democrats might have won on each of these as individual battles while they now risk losing the war. It is not too late for the Democrats to take up each of these measures. Public support might lead to their victory, or if the Republicans continue to block everything they will then risk being the party which is shocked in November.

White House Blog Addresses Change In Email Program

As I noted yesterday, the White House has discontinued the email address used to send copies of viral email with misinformation about health care reform less than two weeks after the program began. While those wearing tin foil hats on the far right saw a government conspiracy to track down dissidents, this was really a case of new technology creating concerns which had not previously been considered. The White House blog has discussed the issue, correctly describing the irony of the situation:

An ironic development is that the launch of an online program meant to provide facts about health insurance reform has itself become the target of fear-mongering and online rumors that are the tactics of choice for the defenders of the status quo.

The even greater irony is that those engaging in this fear-mongering are often the same people who supported acts of true surveillance when performed by the Bush administration. Their actions betray the fact that their true concerns are over partisan politics, not civil liberties.

They also discussed how the program is being changed and affirmed their support for privacy:

The Reality Check website exists to inform public debate about health insurance reform – not stifle it.  As the President said, “We are bound to disagree, but let’s disagree over issues that are real.”  To that end, we’ve seen incredible response from website visitors who are using the tools provided on the site to share videos and other content with friends and family.

To better understand what new misinformation is bubbling up online or in other venues, we want your suggestions about topics to address through the Reality Check site.  To consolidate the process, the email address set up last week for this same purpose is now closed and all feedback should be sent through: http://www.whitehouse.gov/realitycheck/contact

The White House takes online privacy very seriously.  As our published privacy policy makes clear, we will not share personal information submitted through the site with anyone. We also ask that you always refrain from submitting others’ information without permission.

Now the right wingers can get back to worrying about Obama’s birth certificate, the NAFTA superhighway,  floride in the water, or whatever else the voices in their heads are warning them about today.

Steven Pinker on The Impact of Bush’s War on Science

AlterNet has posted an interview with Steven Pinker regarding the “war on science” conducted by the Bush administration. Here is an excerpt:

JAS: Quite a few people argue that the Bush administration has been especially misleading and meddlesome in distorting the truth about scientific research, suppressing evidence in favor of a political agenda. Do you think it’s true that the Bush administration is more anti-science than previous administrations, or do some of these problems stretch back even farther?

SP: To some extent they go back further. To be honest, I was skeptical of claims that the Bush administration is worse than previous ones. But I have now been turned around, and I see that the accusations are correct, that there is a Republican war on science, and that it does seem unprecedented. I see that in the areas with which I have firsthand familiarity. For issues like sex education and climate, I have had to take the word of the scientists who have been directly involved.

JAS: What changed your mind?

SP: I’ve been personally involved in three issues, and in each case, intervention from the Bush administration has gone against scientific consensus.

The first involved bioethics, where the President’s Council on Bioethics has been packed with cultural conservatives and opponents of biomedical research, with a concerted effort to exaggerate the downside of biomedical research and to play up the fears.

The second is evolution, where Bush himself called for the so-called “controversy” between intelligent design and evolution to be taught in schools, whereas virtually every intelligent scientist believes that there is no such controversy.

The third involves regulation of language on the airwaves, where my book The Stuff of Thought was cited by the solicitor general in a brief to a U.S. Appeals Court on whether the Federal Communications Commission has the authority to sanction the networks for failing to bleep out fleeting expletives — that is, celebrities such as Cher or Bono or Nicole Richie saying “fucking brilliant” or “they can fuck themselves” during live television broadcasts. And the government cited what I think are bogus considerations about protecting the mental health of children as a rationale for restricting speech on the airwaves. They used my writing to support their case in a way that I felt was deceptive.

JAS: Do you believe that the Bush administration’s actions will have any lasting impact on Americans’ levels of trust in science and scientific institutions?

SP: Yes. For example, the Religious Right and their supporters in the Bush administration argue that scientists are suppressing debate about evolution. Having long ago lost the legal battle to have intelligent design taught in the classrooms, they are now framing the issue as an attempt to “teach the controversy,” therefore putting scientists on the side of appearing to want to suppress controversy.

To the extent that they succeed in framing the debate that way, it would look as if scientists are pushing their own dogma. And that is simply dishonest. Scientists would have no interest in a debate between astronomy and astrology or chemistry and alchemy, simply because you have to draw the line somewhere and impose some barrier to entry of basic scientific credibility before you engage in a debate. But that can be distorted into making it seem as if scientists are as dogmatic as the defenders of religious fundamentalism.

Sarah Palin and Aerial Hunting of Wolves

[youtube=http://www.youtube.com/watch?v=6T85cOGc8L0]

Sarah Palin continues to be criticized for her support of arial hunting, as described in the above video. I’ve previously posted this ad from The Defenders Action Fund. Humane Society Legislative Action Fund, which has never before endorsed a presidential candidate, has endorsed Obama, citing both Obama’s record on protection of animals and Palin’s record which “is so extreme that she has perhaps done more harm to animals than any other current governor in the United States.”

Why McCain Is Losing And the Conservative Era Has Ended

Hugh Hewitt ignores the polls and argues that John McCain will close and win. It is a post worth reading to better understand why not only John McCain but the Republican Party is losing across the board, with similar arguments coming from McCain and Palin. Hewitt’s argument comes down to arguing that electing Obama is too great a risk, not only because of his inexperience but because of what Hewitt sees as far left policies. What the Republicans fail to understand is that they are losing because they have moved too far to the right for the American people, and what they see as far left is far closer to the middle of American opinion.

Obama is winning because he embodies common sense ideas which transcend the left-right divisions and which are in tune with those of the American people. On the economy, Obama offers pragmatism rather than ideological extremism. While Hewitt tries to portray Republicans as the defenders of “growth and capitalism’s essential genius” the reality is that their polices represent a stark break with our capitalist system, attempting to use government to transfer the wealth to a small oligarchy. Their economic principles, like their political principles, represent those of a banana republic, not the United States of American which most Americans remember. Obama, who receives much of his economic advice from the University of Chicago, hardly a bastion of socialism, is our best hope of restoring the economic system which has made American great, not for just a few but for entrepreneurs and all Americans who desire to work hard to get ahead.

Hewitt describes the foreign policy crises we face, but it is Republican policies which have weakened us and have seriously undermined American influence throughout the world. Americans know, as five previous secretaries of state recently stated, that we must talk with our enemies, as well as work with our friends.One of the most important decisions any president must make is over whether to go to war, and John McCain has showed that he lacks to judgment to be trusted on this. John McCain’s greater experience is worthless when his decisions are so flawed.

While Hewitt tries to paint Obama as a radical, his liberal values represent traditional American values. The use of torture is a violation of our values, and John McCain’s halfhearted opposition is not enough. Americans desire to restore the separation of powers which protect us from oppressive government, and do not want someone such as Sarah Palin who desires even more power than Dick Cheney and has a history of attempting to ban books to be a heartbeat away from the presidency.

Americans recognize the importance of the fourth estate and understand the danger of political leaders who repeatedly attack the free press. Claims that those in the media who expose them are biased only works for so long. If the media which fails to repeat their distorted view of the world appears to conservatives to be biased, this is only because, as Stephen Colbert put it, “reality has a well-known liberal bias.” Conservatives regularly ignore reality in their defense of the Iraq war, their Voodoo economics and claims that tax cuts always pay for themselves, their denial of evolution as the basis of modern biology, and in their denial of the scientific consensus on the human role in climate change. Hewitt’s reasons for why McCain will win are similarly a denial of reality.

Hewitt attempts to repeat the tired Republican claims of liberals being hostile to religion, confusing support for separation of church and state which our founding fathers wisely supported for hostility to religion. As Obama has pointed out, traditionally it has often been religious leaders who were the strongest defenders of separation of church and state, recognizing that this is essential to guarantee the right for everyone to worship as they choose. Americans are especially wary of a political party which panders to religious extremists to increase the power of government in their lives. Following the extremism of Republican rule, Obama’s experience in teaching Constitutional law is far more important in restoring the greatness of our nation than John McCain’s years of experience in failed Republican government.

The voters have been fooled by Hewitt’s arguments in the past. The loss of Congress by the Republicans in 2006 and Obama’s strong lead in the polls today show that they are catching on. These same old arguments are no longer fooling them. Smears based upon Wright, Ayers, and Rezko no longer work as voters want to hear about the real issues and are increasingly realizing that Republicans only know how to smear and have no idea how to govern. Besides, the same type of attacks tend to apply far more to Republicans than Democrats. Americans realize that voting for Obama doesn’t represent a “lurch to the left” but a return to normalcy after a period of having government in the hands of extremists.

Humane Society Endorses Obama, Criticizes Palin’s “Retrograde Policies on Animal Welfare and Conservation”

I’ve previously noted how Sarah Palin’s history of mistreatment of animals led to The Defenders Action Fund airing commercials opposing her. Adding Palin to the ticket also led to the Humane Society Legislative Action Fund making its first ever endorsement of a presidential ticket. They note both Obama and Biden’s record of strong support for animal protection legislation. They write that John McCain has supported some animal protection bills but “has  been inattentive or opposed to others.” Then there’s the Palin problem:

While McCain’s positions on animal protection have been lukewarm, his choice of running mate cemented our decision to oppose his ticket. Gov. Sarah Palin’s (R-Alaska) retrograde policies on animal welfare and conservation have led to an all-out war on Alaska’s wolves and other creatures. Her record is so extreme that she has perhaps done more harm to animals than any other current governor in the United States.

Palin engineered a campaign of shooting predators from airplanes and helicopters, in order to artificially boost the populations of moose and caribou for trophy hunters. She offered a $150 bounty for the left foreleg of each dead wolf as an economic incentive for pilots and aerial gunners to kill more of the animals, even though Alaska voters had twice approved a ban on the practice. This year, the issue was up again for a vote of the people, and Palin led the fight against it—in fact, she helped to spend $400,000 of public funds to defeat the initiative.

What’s more, when the Bush Administration announced its decision to list the polar bear as threatened under the Endangered Species Act, Palin filed a lawsuit to reverse that decision. She said it’s the “wrong move” to protect polar bears, even though their habitat is shrinking and ice floes are vanishing due to global warming.

The choice for animals is especially clear now that Palin is in the mix. If Palin is put in a position to succeed McCain, it could mean rolling back decades of progress on animal issues.

It appears the prospect of Sarah Palin ever becoming president is a terrifying thought to a wide variety of people.

Palin Under Attack For Treatment of Animals

[youtube=http://www.youtube.com/watch?v=EQobIUE1zTU]

Sarah Palin is under criticism for what is being described as brutal forms of hunting animals. The Defenders Action Fund has produced the above commercial. Their web site is also critical of John McCain’s environmental record. Pamela Anderson has also criticized Palin, blurting out, “I can’t stand her. She can suck it” while speaking out against abuse of animals.

Pamela Anderson’s criticism of Palin follows Matt Damon’s criticism of McCain’s choice of Palin as being “like a really bad Disney movie.” With her record of cruelty to animals, I cannot help but wonder if this is what these stars are really warning us about:

T. Boone Chickens And The Swift Boat Liars

Last week T. Boone Pickens offered to pay one million dollars to anyone who could disprove even a single claim from the Swift Boat Liars. I wish I had heard that as it sounds like easy money. Of course if you believe Pickens would actually make good on his offer there’s some email with business offers from some Nigerians which I’d like to forward on to you.

On Friday I posted John Kerry’s letter accepting this challenge. Pickens quickly reneged and has issued the following statement:

Dear Senator Kerry:

So glad to hear from you regarding the Swift Boat Veterans for Truth political ad campaign, and an offer I made public at an American Spectator dinner in Washington, D.C. last week. I am intrigued by your letter, and am certainly open to your challenge.

My concern at the Spectator Dinner was, and continues to be, that you and other political figures were and are maligning the Swift Boat Veterans, and I want to prevent this important part of American history from being unfairly portrayed.

In order to disprove the accuracy of the Swift Boat ads, I will ultimately need you to provide the following:

1) The journal you maintained during your service in Vietnam.
2) Your military record, specifically your service records for the years
1971-1978, and copies of all movies and tapes made during your
service.

When you have done so, if you can then prove anything in the ads was materially untrue, I will gladly award $1 million. As you know, I have been a long and proud supporter of the American military and veterans’ causes. I now challenge you to make this commitment: If you cannot prove anything in the Swift Boat ads to be untrue, that you will make a $1 million gift to the charity I am choosing — the Medal of Honor Foundation.

There goes the chances of anyone other than Kerry to even attempt to collect as nobody would have access to the material requested even if there is other evidence disproving the claims of the Swift Boat Liars. Kerry’s military record has previously been posted on line (from the years he was actually in the Navy), but it is quite a change in condition to expect someone to give their personal journal to someone who has clearly demonstrated the motivation to twist whatever information is available. Besides, from their history it is clear that no amount of evidence will get them to admit that they are lying as they have no interest in the truth. It is hardly necessary to let them poke around in Kerry’s personal records to disprove a bunch of obvious lies.

Pickens also changes the wager from disproving any claims made to disproving what was in the ads. While this could still be done, it is strange that all the false claims published in their book are suddenly no longer under consideration.

Moving the goal post has been common for the defenders of the Swift Boat Liars. First they claimed Kerry could end the attacks by releasing his military records. The military records were released and posted on line and that didn’t shut them up. Then they demanded that Kerry sign a Form 180 to have his records released. Kerry did so and journalists reviewing the records verified that these were the same as the records posted on line. Naturally conservatives then said this was not enough, and many even outright lie and say Kerry never released his records. We see this tactic once again from Pickens. They are determined to spread their lies and there is absolutely nothing which they will accept as evidence to disprove their false claims. Even before reviewing the facts surrounding Kerry’s medals, the conduct of Kerry’s accusers in this matter is enough to discredit them.