Daily Archives: November 2, 2009

The Public Option Shibboleth, or Act 2 of: HealthCare: A Diatribe

blogpost by Ogenec

Dear Readers, between DJ Hero and other pursuits, I have been delinquent in writing this piece. My bad.  And I’m kinda cheating. I’d promised that Part 2 of my diatribe would address the Baucus bill, while Part 3 would address the public option. However, in light of the passage of time and developments under way in Congress, it makes sense to flip that around. Accordingly, I’ll talk about the public option now, and in Part III whatever bill emerges from conference.
So, here we go:

“The Defining Moment”, today’s OpEd by Paul Krugman is a good place to start. GeoT sent it to me today, with the comment that Krugman was talking to me and the rest of the public option holdouts: time to be reasonable, in otherwords. GeoT was just kidding; he knows I’m the epitome of reasonableness 🙂 But his point is well-taken; in many ways, it’s time to put up or shut up. Instead of being negative about the public option, perhaps we should be more constructive and say what we affirmatively are for, rather than against.

I will do that in a bit, but let me clear up a misconception. I rail against a public option not because I’m opposed to the concept, but because I think proponents both overstate and understate its impact. The real issue is health care reform, which the public option in and of itself does not address.

Let me demonstrate what I mean.  Most proponents claim that the public option will (a) provide competition to insurers, which will in turn (b) help to hold health care costs down, all without (c) morphing into a single-payer plan.  I think that’s pure bunk.  As presently envisaged, the public option will not do (a) or (b); it’s not sufficiently robust.  If, however, you do make it sufficiently robust to fix (a) or (b), the public option will lead, ineluctably, to a single-payer system.

Let’s take these one at a time.  First, the notion that the public option will provide competition.   Not under the current plan, it won’t:  The scale of the program is too small.  As presently constituted, the CBO projects that only 6 million people would enroll in the public plan.  How does such a limited plan introduce competition?  How does it break away from the employer-based model?  Answer: it doesn’t.

Well, then, what about holding health care costs down?  That part is a double-fail.  No real competition means no downward pressure on health care costs.  But it’s even worse than that — CBO projects that premiums for the public plan will exceed what folks in private plans are paying:

[A] public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees.

So let’s recap.  The public option now under consideration would not provide sufficient competition to insurers; health care costs would not go down; and premiums for those in the public plan would go up.  What’s not to like?  This kind of a public option would not present the threat identified in (c) above.  It’s so neutered as to foreclose any risk that it is a stalking horse for a single-payer system.

Most progressives agree with this assessment.  And, say they, that’s precisely the problem: we need the “robust” option.  One that is open to everyone ab initio (or shortly after inception), and that pegs reimbursement to Medicare, or Medicare plus 5%.   Here’s the problem with that approach.  It busts the budget, imposes negative externalities on insureds in private plans and the uninsured, all of which ensure a slow death for private insurance.  It busts the budget because as the number of people covered under the public option increases, so does the cost.  A greater expansion takes the bill well over the $900 billion threshold Obama has set.  And even that threshold is suspect, as both the House and Senate versions of the plan rely on Medicare-related savings that are unlikely to be realized.   As proof, just recall the recent debates over the COLA adjustment and staving off the long-planned cuts in Medicare reimbursement rates for doctors.  The likelihood that Congress will display fortitude it heretofore has never possessed to reduce Medicare reimbursements when push comes to shove is virtually nil.

Meanwhile, much has been made of the savings that will accrue to the government (and, hence, the taxpayers) if reimbursement rates are tied to Medicare.  But very few have asked the question, from whom do those savings come?  And the answer is clear: from the same people who unwittingly subsidize Medicare — those in private insurance and the uninsured. That then leads to the next problem — single-payer through the backdoor.   Fred Hiatt explains these inter-related problems quite cogently:

[I]f, as seems likeliest — and as House legislation mandates — the plan uses government power to demand lower prices from hospitals and drug companies, those providers may lower quality or seek to make up the difference from private payers. Private companies would have to raise their rates, so more people would choose the public plan, so private rates would rise further — and we could end up with only the public option and no competition at all. Single-payer national health insurance may be the best outcome, but we should get there after an honest debate, not through the back door.

Robert Samuelson also makes the same point: 

[A] favored public plan would probably doom today’s private insurance. Although some congressional proposals limit enrollment eligibility in the public plan, pressures to liberalize would be overwhelming. Why should only some under-65 Americans enjoy lower premiums? … Private insurance might become a specialty product. …Many would say: Whoopee! Get rid of the sinister insurers. Bring on a single-payer system. But if that’s the agenda, why not debate it directly?

So there’s the nub of the matter.  Either the public option will be so limited as to be neutered and of no significance in providing competition to health insurers.  Or it will be so robust as to kill off private insurance.  The economic equivalent of the Northern snakehead fish, and we get single-payer by default.  But if the latter outcome is what we prefer, let’s have the guts to say so openly and directly.  Let’s not do by indirection what we suspect we can’t accomplish with an honest and frank debate.

Click for details

This is why I’ve been cool to the idea of a public option.   The public option, in and of itself, does not address the real problem – the escalation in the cost of healthcare delivery.  Even if you stripped out the administrative inefficiency of the balkanized health insurance system, you are still left with unsustainable increases in healthcare costs.  And the public option does nothing to address that.  Which is the reason Medicare – touted as the model for the public option – is itself going bankrupt.  To my mind, the underlying issue of increasing costs is far more important.  So the focus on public option rather misses the point: it is the equivalent of addressing the symptom and not the disease.  I want a system that addresses the underlying issues of escalating health-care costs.  I think Wyden-Bennett does; I think the Baucus bill did; and I think Dole-Daschle does as well.  In Part 3, I will expound more fulsomely on this, and analyze the merged bill from this perspective.  I know you can’t wait 🙂

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Filed under Democrats, Economy, Health, Republicans, Uncategorized

Climate Change: Snow cap disappearing from Mount Kilimanjaro

“The snows of Kilimanjaro may soon be gone. The African mountain’s white peak — made famous by writer Ernest Hemingway — is rapidly melting”

WASHINGTON – Some 85 percent of the ice that made up the mountaintop glaciers in 1912 was gone by 2007, researchers led by paleoclimatologist Lonnie Thompson of Ohio State University report in Tuesday’s edition of Proceedings of the National Academy of Sciences.
And more than a quarter of the ice present in 2000 was gone by 2007.

The snows capping Mount Kilimanjaro, Africa's tallest peak, are shrinking rapidly and could vanish altogether in 20 years,


If current conditions continue “the ice fields atop Kilimanjaro will not endure,” the researchers said.

The Kilimanjaro glaciers are both shrinking, as the ice at their edges melts, and thinning, the researchers found.

Similar changes are being reported at Mount Kenya and the Rwenzori Mountains in Africa and at glaciers in South America and the Himalayas.

“The fact that so many glaciers throughout the tropics and subtropics are showing similar responses suggests an underlying common cause,” Thompson said in a statement. “The increase of Earth’s near surface temperatures, coupled with even greater increases in the mid- to upper-tropical troposphere, as documented in recent decades, would at least partially explain” the observations.

Changes in cloudiness and snowfall may also be involved, though they appear less important, according to the study.

One of a growing number of isolated remnants of ice spires that were once full glaciers in the crater of Mount Kilimanjaro in Africa.


On Kilimanjaro, the researchers said, the northern ice field thinned by 6.2 feet (1.9 meters) and the southern ice field by 16.7 feet (5.1 meters) between 2000 and 2007.

Researchers compared the current area covered by the glaciers with maps of the glaciers based on photographs taken in 1912 and 1953 and satellite images from 1976 and 1989.

The research was funded by the U.S. National Science Foundation and National Oceanic and Atmospheric Administration.
Source:

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FACT CHECK: GOP math suspect in stimulus debate

posted by GeoT

WASHINGTON – Beware the math. Some Republican lawmakers critical of President Barack Obama’s stimulus package are using grade-school arithmetic to size up costs and consequences of all that spending. The math is satisfyingly simple but highly misleading.
It goes like this: Divide the stimulus money spent so far by the estimated number of jobs saved or created. That produces a rather frightening figure on how much money taxpayers are spending for each job.
On Friday, the White House released estimates that $160 billion in stimulus spending created or preserved 650,000 direct jobs.
By the critics’ calculations, that’s over $246,000 a job — and a terrible deal for taxpayers. Why spend nearly $250,000 to employ a highway worker or a teacher making a small fraction of that?
The reality is more complex.
First, the naysayers’ calculations ignore the value of the work produced.
Any cost-per-job figure pays not just for the worker, but for material, supplies and that worker’s output — a portion of a road paved, patients treated in a health clinic, goods shipped from a factory floor, railroad tracks laid.
Second, critics are counting the total cost of contracts that will fuel work for months or years and dividing that by the number of jobs produced only to date.
A construction project, for one, may only require a few engineers to get going, with the work force to swell as ground is broken and building accelerates.
Hundreds of such projects have been on the books, in which the full value of the contracts is already counted in the spending totals, but few or no jobs have been reported yet because the work is only getting started.

To flip the equation politically, it’s as if the 10-year cost of George W. Bush’s big tax cuts were compared with the benefits to the economy that only accrued during the first year.

Read More Here:

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Maiden voyage of ‘Twin Towers’ warship USS New York‎

posted by GeoT
(click image below for USS New York home website)

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The Pre-Commissioning Unit (PCU) New York (LPD 21) made her maiden voyage from Louisiana arriving in NYC this morning. The commissioning ceremony for the new warship will be Saturday. The New York has 7.5 tons of World Trade Center steel in the bow.

Read about it here:

USS New York arriving in port this morning:

Watch “OUT OF THE ASHES: USS New York:

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The G.O.P. Stalinist’s Invade Upstate New York by Frank Rich

Op-ed by Frank Rich

Frank Rich

Frank Rich/The New York Times

New York Times/Frank Rich—Barack Obama’s most devilish political move since the 2008 campaign was to appoint a Republican congressman from upstate New York as secretary of the Army. This week’s election to fill that vacant seat has set off nothing less than a riotous and bloody national G.O.P. civil war. No matter what the results in that race on Tuesday, the Republicans are the sure losers. This could be a gift that keeps on giving to the Democrats through 2010, and perhaps beyond.

The governors’ races in New Jersey and Virginia were once billed as the marquee events of Election Day 2009 — a referendum on the Obama presidency and a possible Republican “comeback.” But preposterous as it sounds, the real action migrated to New York’s 23rd, a rural Congressional district abutting Canada. That this pastoral setting could become a G.O.P. killing field, attracting an all-star cast of combatants led by Sarah Palin, Glenn Beck, William Kristol and Newt Gingrich, is a premise out of a Depression-era screwball comedy. But such farces have become the norm for the conservative movement — whether the participants are dressing up in full “tea party” drag or not.

articleInlineThe battle for upstate New York confirms just how swiftly the right has devolved into a wacky, paranoid cult that is as eager to eat its own as it is to destroy Obama. The movement’s undisputed leaders, Palin and Beck, neither of whom have what Palin once called the “actual responsibilities” of public office, would gladly see the Republican Party die on the cross of right-wing ideological purity. Over the short term, at least, their wish could come true.

The New York fracas was ignited by the routine decision of 11 local Republican county chairmen to anoint an assemblywoman, Dede Scozzafava, as their party’s nominee for the vacant seat. The 23rd is in safe Republican territory that hasn’t sent a Democrat to Congress in decades. And Scozzafava is a mainstream conservative by New York standards; one statistical measure found her voting record slightly to the right of her fellow Republicans in the Assembly. But she has occasionally strayed from orthodoxy on social issues (abortion, same-sex marriage) and endorsed the Obama stimulus package. To the right’s Jacobins, that’s cause to send her to the guillotine.

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More @ New York Times

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N.Y. Republican Scozzafava Throws Support to Democratic Candidate–Palin Pick Gets Stiffed

posted by GeoT

“Throughout my career, I have been always been an independent voice for the people I represent. I have stood for our honest principles…
It is in this spirit that I am writing to let you know I am supporting Bill Owens (Democrat) for Congress and urge you to do the same.

FULL STATEMENT:

I want to thank you for your support and friendship. Over the past 24 hours, I have had encouraging words sent to my family and me. Many of you have asked me whom you should support on Tuesday.

Republican Dierdre K. Scozzafava supports Dem Candidate

Since announcing the suspension of my campaign, I have thought long and hard about what is best for the people of this District, and how to answer your questions. This is not a decision that I have made lightly.

You know me, and throughout my career, I have been always been an independent voice for the people I represent. I have stood for our honest principles, and a truthful discussion of the issues, even when it cost me personally and politically. Since beginning my campaign, I have told you that this election is not about me; it’s about the people of this District.

It is in this spirit that I am writing to let you know I am supporting Bill Owens for Congress and urge you to do the same.

It’s not in the cards for me to be your representative, but I strongly believe Bill is the only candidate who can build upon John McHugh’s lasting legacy in the U.S. Congress. John and I worked together on the expansion of Fort Drum and I know how important that base is to the economy of this region. I am confident that Bill will be able to provide the leadership and continuity of support to Drum Country just as John did during his tenure in Congress.

In Bill Owens, I see a sense of duty and integrity that will guide him beyond political partisanship. He will be an independent voice devoted to doing what is right for New York. Bill understands this district and its people, and when he represents us in Congress he will put our interests first.

Please join me in voting for Bill Owens on Tuesday. To address the tough challenges ahead, we must rise above partisanship and politics and work together. There’s too much at stake in this election to do otherwise.

SOURCE:

Related Story:
Taking a few days off
As I leave for a short break, the news that Scozzafava endorsed Democrat Owens in the NY-23 race made my day

Read it here: Joan Walsh@ Salon.com

Future of GOP and moderate Republicans uncertain

(CNN) – Vice President Joe Biden is heading back to New York’s 23rd congressional district to campaign for Democrat Bill Owens
Biden heads to NY-23

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Filed under 2010 Elections, Elections, Independents, Partisan Politics, Republicans, Uncategorized, Washington, DC

Democrats’ Quiet Changes Pile Up

posted by GeoT

WASHINGTON — While President Barack Obama still faces stiff headwinds on a range of major legislation on his agenda, he has been signing into law a slew of smaller initiatives that had gathered dust on the Democratic wish list for years.
Many of the bills had been blocked by Republicans who considered the measures unnecessary expansions of government or too costly. But facing Democratic majorities in Congress, conservatives are picking their battles and in many cases letting the legislation roll through.

Last week, Mr. Obama signed defense-policy legislation that included an unrelated measure widening federal hate-crimes laws to cover sexual orientation and gender identification — 12 years after it was first introduced. The same legislation also tightened the rules of admissible evidence for military commissions, an issue that consumed Congress in debate in 2007 but received almost no attention this go-round.

President Barack Obama signs the Family Smoking Prevention and Tobacco Control Act in the Rose Garden of the Whitehouse

Other new measures signed into law since the administration took office, all of which kicked up controversy in past congresses, make it easier for women to sue for equal pay, set aside land in the West from development, give the government the power to regulate tobacco and raise tobacco taxes to expand health insurance for children. Congress and the White House, in the new defense-policy bill, also killed weapons programs that have survived earlier attempts at termination, among them, the F-22 fighter jet, the VH-71 presidential helicopter and the Army’s Future Combat System.

Rob Nabors, the White House’s deputy budget director, called the series of new laws “a very, very quiet but important victory.”

To conservatives, they are Democratic payback to liberal interests. “The left knows what it wants,” says former Republican House Speaker Newt Gingrich. “It’s been trying to get it for some time, and this is its moment.”

Cont’d Here:

Please see 44-D blogpost: “What exactly HAS President Obama accomplished in the first 10 months?”

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