Comparing the private and public sector on health

Ok, I’m sure no-one needs to have the absurdities of the anti-reform rhetoric to be pointed out any more times. (At least, no-one likely to be reading this.) How can a government programme be both so ruthlessly efficient that it will drive insurers into bankruptcy and yet at the same time utterly bloated and inefficient because the government can’t run anything properly?

Instead, let’s ask the question: how does health care coverage in the private and public sector really compare when we try and put simple ideological questions to one side...?

By definition, the private sector exists to make a profit. In certain contexts, usually in competitive marketplaces with low customer switching costs, profits require efficient delivery and therefore tend to encourage great quality and service. But not all contexts are competitive, and health insurance coverage isn’t one of them. The insecurities attached to coverage and its link to employment mean that the cost of switching is extremely high.

(Amongst other things, this leads me to conclude that if a meaty public option becomes watered down in the final bill, an appropriate executive branch response would be to brush off the old Sherman/Clayton book and start applying a bit of anti-trust law to these huge companies. If they want to present a fiction of themselves as lean, green, private-sector business machines, hold them to it. It also makes me think that elements in the bill that loosen the link between employment and coverage may turn out to be extremely important, even though all the attention at the moment is on the public option.)

As everyone knows, there’s two ways of increasing your profits: reducing your costs or increasing revenues.

When it comes to private health coverage the second element trumps the first. This is for the simple reason that death comes to us all sooner or later, but most of us would like to live forever. However much we spend on treatments that keep us alive, we’re still left wanting more. It’s not like you buy a chocolate bar, eat it, and aren’t hungry any more. Until someone invents an immortality pill, there’ll always be more drugs and treatments to spend our money on.

The nature of the market and product determines the business strategy. Selling cigarettes? Killing your client base? Focus on new customer acquisition. Selling health care? Keeping your clients alive longer? Get new products to market that offer a way to keep your customers going so that they can be around to buy more drugs from you in the future.

This is why the private sector has managed to be so amazingly innovative when it comes to developing new health techniques. But it also means that senior executives in hospitals and drug companies who concern themselves with strategy are going to tend to focus on new treatments rather than efficiency savings.

At the end of the day, the resources that can potentially be spent on health coverage are only limited by our ability to pay for them. Our demand for health is essentially infinite. This is what is driving the relentless growth in private sector costs. It’s only partly about the 30 percent that ends up as profit. We’ll always be in the market for new and ingenious ways to keep ourselves alive – and by extension ill much more of the time!

When the private sector does think about cost savings, moreover, it seems to prefer excluding applicants through rescission rather than delivering efficiency savings in health care services. It’s a simple fact that it’s much easier and more reliable method to sit with a pen and strike out badly filled-in coverage forms than it is to march up and down buildings devising innovative new ways to manage business processes.

Public spending, though, is not driven by the same imperatives. People always go on about how the private sector world is focused on the dollars, but in this case it's government that has a bottom line, absent in the private sector. The question of coverage will always be filtered through the question of “what can we afford to deliver?” rather than “What new things can we sell?” Even when this is not explicitly highlighted in the debate (for political reasons, usually), it forms a background presence as a tax-cutting or deficit-reducing movement.

While the private sector will tend to try to limit payouts, then, the public sector by contrast will try and restrict treatments. Insurance companies will tempt you in with a new wonder drug, then try and devise ingenious ways of kicking you out for not filling a form out correctly; the government will say that the new super-drug is too expensive and so can’t be deployed. Result: the private sector is heartless; the public sector rations.

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The Onion: study finds young people remain apathetic about office politics

Something for a Friday:


Study Finds Young People Remain Apathetic About Office Politics

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RIP

Visit msnbc.com for Breaking News, World News, and News about the Economy

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Alex has too much time on his hands and gets carried away with charts

Ok, so, the conclusion from the last post was that we should be very worried about what the deficit and debt are going to do to the Obama reform agenda. Health care, the environment, job creation, investment in education will all be affected by the need to control the terrible situation the US has got itself into.

That said, the one thing that the debt should not do is convince Americans to support the Republican party, which is why I find the budget-terror rhetoric coming from the town hall Republican base rather ironic.

Despite their consistent harping on about the virtues of small government, the Republican record on controlling budgets since World War Two has been appalling, though as you'll see from the following chart Eisenhower and Nixon - essentially traditional Republicans - had a much stronger record than the New Right leaders, Reagan and Bush. Since 1980, every Republican term of office has seen a growth in the national debt as a percentage of the size of the economy. (The chart is of the average annual change in national debt as a percentage of GDP; so, the lower the percentage the better.)


Part of the reason for this is that the Democrats also have a stronger record on job creation. Why? Job creation helps increase trade and hence the total size of the economy, thus reducing debt proportionately. This chart shows the average annual change in the number of jobs during each administration. As you'll see, the red team's record - even under the old style Republican administrations - doesn't compare.



So, argue that the United States needs to acquire economic prudence as it pushes on with its reform ambitions, and that uncosted measures cannot be acceptable. Fine. I agree. Just don't claim in the same breath that the Republicans should have any right to talk about the economy.

(Source data: Wikipedia)

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Some mid-season review budget facts; or, perhaps you don’t yet realize how much you’re in the stink

The OMB has just issued its mid-season report on the budget, based on more gloomy predictions about unemployment and growth. Here’s some highlights.

• The national debt is expected to grow by $11 trillion over the next decade. This means that the national debt accrued between 2008 and 2019 is expected to be greater than the entire national debt acquired between 1776 and 2008
  
• The OMB expects the deficit in 2019 to still be twice what it was in 2008
• Interest payments on debts over the next ten years will alone be bigger than the money spent on Medicaid and TARP
• To pay back just the debt that is expected to be acquired between 2008 and 2019 (i.e. to get back to the level of debt the US had in 2008), tax receipts will have to rise by roughly 30 percent.
• And the real kicker: these assumptions already include expected savings from health care reform, tax reform, and a tax hike for high earners, an estimated $15bn annually in revenues from 2012 onwards for climate change technologies, and nearly $300 billion total from closing loopholes and other measures.

Enjoy your dinner tonight!

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The quagmire of torture

While we’ve all been distracted by the administration’s bumbling back and forth over health insurance reform, the Obama team has been walking a second tightrope, this time on torture.

Yesterday, Eric Holder announced that the DoJ would begin preliminary investigations into whether certain CIA agents in bad faith exceeded the limits of the rules over “enhanced interrogation” set down by the government. In one sense, of course, any prosecution is welcome if its holds criminals accountable for their actions. But as Glenn Greenwald points out, pursuing justice along these lines runs the risk of reprising Abu Ghraib, where a small number of sadistic individuals were (rightly) hung out to dry but no high-level individuals were held accountable for creating the permissive environment in which abuse was cultivated.

Even ignoring the ethical questions involved – something, it has to be said, the Obama administration has been willing to do so far – the decision is highly risky in terms of executive branch politics. It has the potential to create a sour conflict between the DoJ and the CIA over policies that originated in the White House.

The IG report released yesterday explicitly admits that, “The EITs [enhanced interrogation techniques] used by the Agency under the CTC Program are inconsistent with the public policy positions that the United States has taken regarding human rights.” That is, the whole programme was in violation of US law, not just those few individuals who happened to step beyond the EITs' remit. Back in 2001-2003, agents raised their fears with superiors that “a human rights group might pursue them” for following orders, and that “the Agency would not stand behind them if this occurred.” I'm sure that many operatives will read the DoJ announcement of yesterday and conclude that this is exactly what's about to happen.

He may actually be in the right. But Holder is going to have a very tough time reassuring the CIA that the prosecution of egregious violators of the EITs is not simply a question of scapegoating the Agency for White House offenses (legitimated by DoJ interpretations). Hardly a good idea at the best of times, inter-departmental warfare is deeply worrying in the midst of a counter-terrorist conflict that requires unprecedentedly close cooperation between domestic and foreign branches of the administration.

Moreover, this middle route fails to satisfy those who want the people who were ultimately responsible to be prosecuted. But it will still antagonise those who think that all things are legitimate if they keep America safe, thus undermining the key reason for not pursuing prosecutions in the first place.

Mr. President, we were told that you wanted to “move on”, that you’d decided not to prosecute senior officials in the old administration for their crimes because you didn’t want to disrupt your domestic agenda. Well, I’m not sure if you’ve noticed, but that domestic agenda is looking pretty disrupted already... so perhaps we might now consider returning to the questions of who actually was behind this stain on America's conscience, and prosecuting them instead?

Update: Yes, well, exactly.

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Incentives and bonuses

We're bracing ourselves for a renewal of the debate over bankers' bonuses over the next week or so. The banks we've all bailed out are seeking to justify new pay offers on the same old basis of the need to attract the best. Putting aside the fairly obvious point that "the best" is hardly an appropriate term for a cohort of businesspeople who managed to plunge the world into the severest depression since the 1930s, it might be worth also revisiting the assumption that incentives necessarily produce the best results. So, from the rather wonderful TED.com, may I present for discussion and reflection Dan Pink on the social scientific study of motivation:

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Argentina shows the US how it's done

Tens of millions of Argentineans are excluded, at a particularly tough time of the year for many of them. A sector in the grip of ongoing financial difficulties has been plunged into crisis by the global recession. Major organizations have been unable to deliver basic services, several seemingly on the verge of bankruptcy, and the public has been desperate, taking to the streets in protest. The private sector has failed to live up to its much vaunted promises to provide cheap, affordable coverage for all. But, aware that such matters are a right and not a commodity, President Cristina Kirchner has stepped into the fray to announce a national, government-sponsored plan which will fill the doughnut hole and ensure that from now on all Argentineans, irrespective of wealth or background, will be offered universal access.

That’s right: whilst the United States is wasting its time in divisive battles over healthcare, the government of Argentina has decisively moved on to more fundamental questions, proving once again that leadership in the Americas in the twenty-first century will come from the other end of the continent. As the BBC reports, El Presidente Cristina will be providing more than $155m to the Argentine Football Association to provide free, universal coverage of the domestic league’s matches on the terrestrial television channel. A massive funding shortfall from the private sector TV rights package had left the major clubs in dire financial straits and indefinitely delayed the starting of the football season. Now the games will be able to continue. Argentineans are ecstatic.

"Today is a historic day for football, for the AFA, for Argentines and for the possibility of living in a more just and democratic society," Ms Fernandez said. Thank goodness at least one country in the Americas has the cojones to make the truly important decisions when it comes to a crisis!

(For more info, see Argentine Football Association)

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The Two Obamas

One of them is, in Jon Stewart’s words, the finest orator of his generation. The other one, in Jon Stewart’s words, is getting kicked in the rear over health care.

The first Obama is the one most of us think about when the president’s name is mentioned. He’s the man that delivered the speeches that have so far defined his rapid rise to power and will probably define this generation: the anti-war speech from Chicago in October 2002, the 2004 Democratic party keynote, the March 2008 speech on race, the election night victory speech, and this year’s June address to the Muslim world in Cairo. Each showed exceptional delicacy for a modern politician, a degree of dialectical reasoning, an ability to combine serious and honestly held ideas with politically advantageous messages. Without these speeches, Obama would not be president. Neither would he be worthy of the history books.

The second Obama has lived in the shadow of the first, only occasionally making himself known. It’s easy to ignore the midget in the corner, but like it or not he’s there, making life trickier for the first one. The second Obama is the individual who declared he would negotiate with Iran and North Korea without preconditions, who told attendees at a Democratic fundraiser that bitter working class people “cling to guns or religion or antipathy” because of their declining job prospects. He’s the person who told Leno that his bowling was suitable only for the Special Olympics, that the Boston police were “stupid” for arresting Henry Louis Gates, that problems experienced by the Post Office showed why a healthcare public option was a good thing.

Viewed with a sympathetic eye, none of these statements is necessarily all that bad, but all were politically naive. Each produced a backlash that a more experienced politician would have anticipated, and each forced Obama’s team into careful back-tracking after the fact, distracting attention from his core goals and central messages. Don’t forget the healthcare backlash really got going after Gates-gate. Whether right or wrong, none of these remarks were either necessary or useful.

Clearly, both of the Obamas are a product of the same personal characteristics. They are expressions of a man who prizes free thinking and subtlety, who has commendably refused to talk down to the public, and who believes that he should honestly state his views rather than couch his messages behind blandly inoffensive political boilerplate. But whilst the moments of soaring oratory have been based on tightly scripted and well thought out remarks in which the president’s impressive intellectual flexibility has been parsed and checked by political machinery that considers the many ways a statement can be read or misread, Obama’s faux-pas have generally been when the president has been, shall we say, a little too relaxed in his off-the-cuff remarks. They’ve occurred when he’s forgotten that he’s talking to an interviewer or an audience with digital recording equipment in every pocket: in short, when he’s taken his eye off the ball.

Of course, it doesn’t really matter if the president makes the occasional gaffe now and then. Bush managed to take the country to two wars without constructing a single functional sentence. With basically 100 percent coverage of presidential life, it’s more or less impossible not to offer up a snafu to the slavering maw of the news media every now and again.

But are these occasional slips a sign of broader political inexperience? Perhaps they’re indications that Obama works better on defence than offence? Arguably Obama’s two major pre-presidential speeches were the most important politically: the first a gutsy call against a dumb war, a kind of wilful self-immolation that turned out to be a political asset thanks to the terrible failure of post-war reconstruction; the second a tactical response to attacks over Jeremiah Wright. Both represented Obama the underdog. By contrast, his speeches in Europe and Egypt, designed to drive politics in a new direction, were well-received, even masterly, but have yet to produce concrete results. Obama returned from Europe with no additional commitments to send troops to Afghanistan, and Middle Eastern diplomacy remains as fragmented as it ever was.

Most importantly, when Obama attempted to set the agenda on health care during his pre-recess press conference, he faltered. He gave an impression of being adept at policy but weak on the core messages, which the White House team has only slowly managed to rectify at the town halls. Hence the confusion about what’s going on in the White House. Some on the left of the Democratic party are ready to burn their party membership cards, believing that the president has sold out the public option to the Blue Dogs. Others, like Howard Dean, think the public option will be slipped into the final bill during reconciliation.

It’s perfectly feasible that the attempt to keep the debate open is a way of forcing the Republicans to take an intransigent position. This would prepare the way for a Democrat-only bill in the autumn. It’s possible, in short, that this is a clever political game. But as yet no-one seems exactly sure what the president is trying to achieve. Is the White House leading this debate, or is the debate leading it? In Balz and Johnson’s book on the 2008 election, The Battle for America, Obama admits that his early speeches after he declared his candidacy had fallen flat. “I’m actually always sort of a slow starter,” Obama told them. Let’s hope it doesn’t take too much longer for the president to get up to speed on healthcare.

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Don't hold your breath for any Birther poetry nights

Earlier today, thumbing through some old photocopies taken from archives at the University of Georgia, I came across a bunch of letters addressed to Senator Richard Russell, leading light in the conservative coalition that after 1937 effectively halted the New Deal in its tracks. The letters are from the late 1940s and mostly pertain to the battle over the Fair Employment Practices Commission (FEPC).

Brief background: the FEPC had been created in 1941, and during the war – largely thanks to the efforts of A. Philip Randolph and other black activist leaders – had become quite a beefy enterprise. It challenged discriminatory employment practices against African Americans on military bases and required all industries that supplied the government not to discriminate against blacks. Since the war industries were (a) one of the largest sections of the economy; and (b) major potential employers for African Americans who had moved north in the interwar period and tended to be the first fired during the depression, the FEPC amounts to one of most significant challenges to segregation prior to the civil rights era.

Needless to say, Southern white supremacists hated it. When, after the war, Truman tried to extend the life of the commission (it was originally set up by FDR on the basis of wartime executive orders and Truman wanted it to be perpetuated through congressional legislation), Richard Russell and others successfully filibustered the effort. Instead of inaugurating the civil rights era, the late 1940s saw the beginning of the Age of McCarthy.

Anyway, these letters. The first – virtually incoherent, breathless and anonymous – was written entirely in capital letters and had no logical basis to its punctuation; a stream of consciousness piece that Ginsberg would have envied. As far as I can tell, it balances its invective between two groups: Jews – or, as the writer put it, “Nazi-Americanized Bologna gobbling Heinies” – and Democrats, or rather “shiteheel, rawmeal Democrats.” Ha ha. You see what he's done there. With the underlining. Ha.

The second was produced by a wonderfully named man, Harry C. Dwiggins. Dwiggins, in the circle of radical rightists, had the eminent distinction of not only being able to construct a sentence but also owning a typewriter. In his careful, close-set, and no doubt furiously constructed text, he declared the FEPC was a “unconstitutional, unamerican, Communistic, socialistic, Civil Rights Program … first in part, introduced into Soviet Russia by One Joe Stalin of World Wide Communistic Fame, in the form of the damnable (F.E.P.C.) during the year of 1920.” One Joe Stalin of World Wide Communistic Fame! His capitals. Fantastic!

To chuckles (to himself), a third correspondent declared the FEPC should be renamed the “Negro Priority Preferential Employment Committee,” since it was obviously designed to the detriment of the Southern system of white supremacy.

My conclusion from this can only be optimistic. None of today's claims being aired at the town halls have anything approaching the inventiveness of this kind of mid-century abuse. Clearly over time the radical right has lost its sense of lyricism.

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Silence, you pointy-eared academic!

Our friends at the town halls have, as usual, been bloviating on their perennial enthusiasm: claiming the mandate of the Founding Fathers. And surely they're right to do so. During his presidency, Jefferson focused on repealing tyrannical taxes and curtailing the bloated, overweening federal bureaucracy of the time. With arguably his closest ally, James Madison, he helped form the original Republican party to fight the ‘big government’ machinations of Alexander Hamilton, and the two were central in the push to create the Bill of Rights. What better inspiration could you imagine?

Now, Jefferson did sanction the Louisiana Purchase, which in relative terms probably counts as one of the bigger examples of federal activism, certainly a lot bigger than a bit of health insurance reform, but let's put this to one side for a minute, shall we?

What we want is a return to the policies of Jefferson and the Founding Fathers! Cut back the federal bureaucracy! Stop big government! If memory serves, big government consisted of about a couple of hundred people in 1800, obviously horrendously oversized. So we will be wanting to sack basically everyone who works in Washington, right? Oh, and like most of the Founders Jefferson and Madison were active and persistent enemies of standing armies, so we’ll be firing every single soldier, sailor and member of the air force as well and eliminating pretty much the entire defence budget? I’m assuming also that the people advocating a return to exactly what Jefferson wanted will also already be ready to convert to deism: anti-Calvinist, anti-Trinitarian, rejecting the view that Jesus was the Messiah? Oh, and Jefferson and Madison didn’t like paper currency much, either, so it’s gold only from now on. Burn those dollar bills.

Of course not! That’s just stupid and missing the point, you pointy-eared dumbass academic! Today’s activists are following in the spirit of Jefferson, in a kind of “what would Jesus do?” kind of way. Don’t you understand? We don’t need any of this literal nonsense, even if we do maintain our constitutional beliefs are “strict constructions” of the original intent of the Founders. We're talking about applying their principles to the present day. If Jefferson were alive today, he would basically be a 1980s Reaganite. He wouldn’t mind Medicare and Medicaid, and he wouldn't mind tripling the deficit by passing enormous tax cuts for the wealthy, but he’d certainly oppose any further extension of government funding of medical assistance. That would be utter tyranny!

So what about these principles? What about the principles found in the Federalist Papers, for instance? How about Federalist 10 ... where Madison argues that “instability, injustice, and confusion introduced into the public councils, have, in truth, been the mortal diseases under which popular governments have everywhere perished.” Oh.

Federalist 10 was Madison’s attack on faction, which he defined as “a number of citizens, whether amounting to a majority or a minority of the whole, who are united and actuated by some common impulse of passion, or of interest, adversed to the rights of other citizens, or to the permanent and aggregate interests of the community.” Sound familiar? “As long as the reason of man continues fallible, and he is at liberty to exercise it,” Madison argued, “different opinions will be formed.” Indeed, “So strong is this propensity of mankind to fall into mutual animosities, that where no substantial occasion presents itself, the most frivolous and fanciful distinctions have been sufficient to kindle their unfriendly passions and excite their most violent conflicts.” Death panel, anyone?

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Where's the sensible right gone?

Ok, my instincts have been that people should worry a bit less about the misinformation being spread around and focus a little more on the genuine fears and concerns that are being expressed by the protestors at the town hall meetings: over questions of cost, public versus private, and so on. I have had comments on this site from eminently sensible people with reasonable objections to the bills. They and others like them deserve to be heard.

But it's just getting harder and harder to keep on the middle ground when the radical right in America is so determined to circulate nonsense about what's being proposed and, perhaps more importantly, the moderate right has done so little to object to this kind of behaviour ...

Exhibit A: Sarah Palin, Newt Gingrich and others create a national news story about the idea of "death panels" where American seniors will go to be euthanized by evil government bureaucrats. This untruth contributes substantially to growing opposition to the reform bill. As a result, congressmen abandon a perfectly reasonable part of the health care plan to do with optional end of life counselling and tacitly give credit to the original idea that there was a death panel in the proposals.

Meanwhile, we discover that the Republican 2003 Medicare prescription drug bill included elements of the end of life counselling that is now apparently evil. And that, during her brief stint as Alaska governor, Sarah Palin was a sponsor of a “Healthcare Decisions Day” which encouraged people to plan for end of life issues (here and here).

Exhibit B: 

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Glenn Beck's Operation
www.thedailyshow.com
Daily Show Full Episodes Political Humor Spinal Tap Performance

These tactics didn't work in the election last year for two reasons: first, McCain was ambivalent about deploying them; second, there was the mother of all economic crises. Now McCain's off the team and a substantial section of Americans have revealed themselves to have about a six second historical memory. So all guns are blazing on the right.

I continue to think that we can get a reasonable bill out of this rather messy but perhaps salutary experience of populism in action. I continue to believe that Obama should keep to the high ground and continue to engage a broad grouping of congresspeople. I hope that a lot of this is being exaggerated by the fact it's August silly season and we'll be able to move on to more productive things once the negotiating starts again in September. But seriously, my right-wing Republican friends, you're making it very hard to sustain the argument that people should take your views seriously.

If Republicans are serious that Democrats should, in turn, be serious about their concerns, then they have a responsibility to stop circulating untruths, to focus on making their case in the manner one would expect from representatives of the party of Lincoln, and - perhaps most importantly - to disavow the irresponsible behaviour that radical right-wing politicians are engaging in.

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At last! Someone in the media raises the standard of debate

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Screw you, America!*

*not really!

One of the interesting things about observing the current health care rumpus from the other side of the pond is that you get to see what Brits really think about the NHS. It's a curiosity that is by no means unique to Britons, I think, that we reserve the right to complain till we're blue in the face about things we consider "ours," but get very huffy if people from other countries try and do the same.

So whilst you'll find that your average pub conversation about our single-payer system of socialized medicine, or NHS as we'd know it, would emphasize such things as waiting lists, underpaid doctors and hospital-acquired infections, as soon as the GOP starts trying to use these points to make their case against Obama's reform effort, the snark begins.

As Karla Adam in The Washington Post reports, reactions to entirely false claims such as that Ted Kennedy wouldn't get treated in Britain for his brain tumour tend to be pretty short and sweet, not to mention unrepeatable on my demure blog.

It's difficult to prioritize these particular inaccuracies when (a) the anti-reform movement is putting out so many other false claims about the proposed Obama reform, and (b) the Obama reform isn't about single-payer anyway. Still, it's worth pointing out that it's completely untrue that the British system imposes limits on people who are considered "too costly" or "not productive assets for society." We don't have death panels! As the head of the National Institute for Clinical Excellence says in the WaPo, "We don't put a limit on the amount the NHS can spend on an individual patient." It's true that decisions are made nationally about rolling out certain drug treatments on a cost-benefit basis, but this is no different to decisions made by any health care system.

Update: Read all about the #welovethenhs campaign on Twitter.

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Think Glenn Beck's bad? Think again...

From BBC News:

Police have accused a TV presenter in Brazil of being involved in organised drug trafficking and ordering killings to get rid of rivals and boost ratings...

The authorities believe that Mr Souza commissioned at least five murders in order to get rid of drug trafficking rivals and to boost his programme ratings.

They say he wanted to prove his claims that the region he represented in the state of Amazonas was plagued with crime.

A local police chief told the Associated Press that the order to execute always came from the presenter and his son, and that TV crews were alerted to get to the scene of the crime first.

Hmm. Killings to boost ratings...

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Latest trends in party identification

The stats below seem to confirm what would be the logical expectation about Republican extremism in the past month or so. Despite the worrying headlines and panicky reports of fascism on the march, hard-line recidivism from unapologetic and aggressive protesters has been basically counter-productive. Its main effect seems to have been to reduce support for the GOP in general. Whilst the ugly scenes may have turned some people off politics altogether, there's no doubt that the drop off in Democrat support has been smaller than that of the Republicans.

Basically good news for Democrats, and good news for healthcare reform, as it'll encourage the Blue Dogs to hunker down in the party.




That said, at the end of the day the United States since mid-July has been a country where a majority of citizens don't identify with either party. How does that make you feel?

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Wisdom of the ancients: Herodotus on healthcare

Having been rather taken with Herodotus' endorsement of hirsute women as a national security early warning system, I'm coming round to the idea that The Histories may offer many more lessons for us to apply in these troubled times. After all, since we seem to be in a completely reality-free public conversation about health care reform at the moment, applying principles from 2,500 years ago to today's problems probably makes as much sense as the rest of the nonsense circulating in the certain realms of the blogosphere.

So I was delighted to discover Herodotus' description of the following Babylonian custom, which he describes as one of "the wisest of their institutions":

"They have no physicians, but when a man is ill, they lay him in the public square, and the passers-by come up to him, and if they have ever had his disease themselves or have known any one who has suffered from it, they give him advice, recommending him to do whatever they found good in their own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is."

How's that for a public option? I'm sure it'd reduce spiralling costs.

Moreover, in a passage that could have been taken right out of the Sarah Palin playbook, Herodotus explains (though in his case not without sympathy) the workings of what can only be described as a Massagetae "death panel":

"Human life does not come to its natural close with these people; but when a man grows very old, all his kinsfolk collect together and offer him up in sacrifice; offering at the same time some cattle also. After the sacrifice they boil the flesh and feast on it; and those who thus end their days are reckoned the happiest. If a man dies of disease they do not eat him, but bury him in the ground, bewailing his ill-fortune that he did not come to be sacrificed."

Ya know *winks*, I betcha those darn Democrats have already got something like this up their socialized sleeves...

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Why all or nothing usually means nothing

Jonathan Cohn, editor at The New Republic, hits the nail on the head about all the no-compromise, anti-Emanuel talk coming out of the Kos-wing of American politics:

“If the possibility of lesser reform doesn't motivate liberals, then maybe something else will: the possibility of no reform. Twice in the last few decades, once during the Nixon era and then again during the Clinton years, liberals largely shunned compromise efforts at universal coverage because they didn't live up to progressive ideals. But holding out didn't lead to better legislation. It led to twenty years of trying to rebuild the momentum for reform, followed by a debate over proposals that are, if anything, less sweeping than their predecessors.”

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National security strategy 550 BC

Doing some weekend reading, and came across the following passage in Herodotus. On how one particular tribe was able temporarily to resist the incursions of Persian invaders:

Above Halicarnassus, and further from the coast, were the Pedasians. With this people, when any evil is about to befall either themselves or their neighbours, the priestess of Athena grows an ample beard. Three times has this marvel happened. They alone, of all the dwellers in Caria, resisted Harpagus for a while, and gave him much trouble, maintaining themselves in a certain mountain called Lida, which they had fortified; but in course of time they also were forced to submit.

A cheaper option than national missile defense, perhaps?

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Incredible

Rick Scott of Conservatives for Patients' Rights. Watch the clip and tell me this: are those the eyeballs of a man you can trust?



(h/t: Buck Naked Politics)

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And if one side can do it...

In re previous post about wildly throwing around allegations of fascism, cue evidence from Andrew Sullivan on the lovely demeanour of town hall protesters here.

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Could fascism happen here? Dropping the f-bomb.

It had to happen sooner or later. What with Gates, birthers, tea parties, and the rest, fever pitch has been reached and exceeded. The left accuses the right of racism, fanaticism, mob action; the right accuses the left of socialism, atheism and euthanasia. It was inevitable that, sooner or later, someone would bring out the big guns and drop the f-bomb.

And it was Sara Robinson of the Campaign for America’s Future on FireDogLake, who describes herself as one of a “small handful of us who'd made ourselves experts on right-wing culture and politics.” (Sara holds an MS in “Future Studies,” I understand. Interestingly, on her profile she quotes William Blake, “the voice of honest indignation is the voice of God.” I can only presume this means the Tea Party activists are not honest?)

We are, apparently, witnessing the emergence of a fascist America. (h/t: Brilliant at Breakfast; and The Frustrated Teacher) It’s easy, she tells us, to discount current events as political theatre, but “all the noise and bluster actually obscures the danger”:

“These people are as serious as a lynch mob, and have already taken the first steps toward becoming one. And they're going to walk taller and louder and prouder now that their bumbling efforts at civil disobedience are being committed with the full sanction and support of the country's most powerful people, who are cynically using them in a last-ditch effort to save their own places of profit and prestige.

“We've arrived. We are now parked on the exact spot where our best experts tell us full-blown fascism is born. Every day that the conservatives in Congress, the right-wing talking heads, and their noisy minions are allowed to hold up our ability to govern the country is another day we're slowly creeping across the final line beyond which, history tells us, no country has ever been able to return.”

Now, Robinson’s the futurologist and I’m only a simple-minded historian, so I’m undoubtedly not qualified to weigh in on this. But since I happen to be in the process of writing a book partly to do with right-wing extremism in American history, since I am literally right now writing a chapter in this book called “American Fascism” – about how liberals in the 1930s artificially inflated the threat posed by fascism in America in a manner that eerily presaged the arguments of right-wingers in the McCarthy era about the supposed communist menace – I feel it’s almost impossible not to add my two cents.

At least two important points need to be kept in mind before when evaluating Robinson’s argument.

First, ask yourself why it is that people who call themselves “progressives” seem to be so eager to believe that things are always getting worse? I’m reminded of a paper I attended about five years ago about extremist political violence, in which the author spoke about different reasons for the rise of extremist violence in American life in the 1990s (militias, Oklahoma, etc.) and neglected to mention the fact that earlier in the century anti-Semites and white supremacists didn’t need to take out their AK-47s as they had people in Congress explicitly voicing their views and the National Guards doing the marching up and down for them. That is, that the extremist violence was a product of political marginalisation, not the growth of extremism.

So, a bit of perspective, perhaps? Today we are witnessing a movement of grassroots Republican activists funded by rich anti-healthcare PACs who are furiously disrupting Democratic town hall meetings and shouting down elected officials in what I, as a stuck up Brit, confess to consider an extremely uncivilized manner. How does this compare with, say, the destruction of the left after 1968: which included the more or less cold-blooded executions of Black Panthers, the COINTELPRO programme run by the FBI to discredit the civil rights movement and destroy the New Left, the shootings of four students at Kent State University, and the attacks by hundreds of construction workers on anti-war protesters on Wall Street? Or how about the backlash against desegregation of schools following the 1954 Brown decision, in which thousands of Americans gathered at schools and universities to fight integration, when Arkansas Governor Orval Faubus called out the National Guard to exclude nine black students from taking their place at Little Rock Central High, or the beatings and murders of civil rights activists during the 1961 freedom rides? The worst thing you can conclude is that things have always been this bad; a more realistic assessment is that things in the past were a hell of a lot worse.

What about the 1930s, about which I’m writing, when workers were systematically denied basic union rights, when employers operated massive surveillance programmes spying on their own workers, and heavies were paid to beat union organizers to within an inch of their lives, when Henry Ford distributed anti-Semitic propaganda on his plants and auto lots and was awarded a medal of honour by Hitler, when Angelo Herndon was given a twenty year prison sentence for distributing communist leaflets, when nearly all black Americans had no right to vote? Or the 1920s, when the Ku Klux Klan was more than five million strong, in the North and South, and spewed a vile combination of white supremacist, anti-Catholic and anti-Semitic propaganda? Or the turn of the century, when lynchings were common across much of the country? Or the nineteenth century when there was slavery? Aren’t every one of these situations substantially more undemocratic, more dominated by “a system of political authority and social order intended to reinforce the unity, energy, and purity of communities in which liberal democracy stands accused of producing division and decline” (Paxton/Robinson's working definition of fascism), than the world we have before us today?

It’s true that violence and reactionary politics were and remain a vital part of American history. But progress happens too. A real danger of this kind of anticipatory approach to a creeping fascism is that we end up legitimizing the view that democratic progress is impossible. If people can't be reasoned with, they can only be repressed.

Indeed, my second point relates to the more general issue of how democracy dies in a country, the issue that Robinson uses Paxton to address. We have plenty of examples of how authoritarian, and in some cases fairly undeniably fascistic, movements have emerged in the Americas in the twentieth century. (Certainly they suggest that the death of democracy in the United States is not impossible.) Each case is unique, but a fairly consistent pattern is that both sides involve themselves in the erosion of the democratic debate before authoritarians ultimately seize control of the state apparatus in the name of social order.

You can find examples in Chile, Argentina, and many other countries that the collapse of democratic politics was fuelled by a complex political process whereby the threat of fascism was invoked to promote anti-democratic activism on the left, usually in guerrilla form, and then the army subsequently seized control and started murdering people when it felt that civil authorities were failing to repress these groups with sufficient vigour. In absolutely no way am I seeking to place responsibility for these dictatorships on anyone but the dictators. They are the ones who ended democracy. And in certain situations democratic progress truly does become impossible and alternative means are necessary. But let’s not play our part in hurrying along the process by looking eagerly around for fascists, shall we?

In this sense, bandying around accusations that the Republicans are, in Robinson’s words, “blatantly racist, sexist, repressed, exclusionary, and permanently addicted to the politics of fear and rage”, adds fuel to a fire that already is laced with lighter fluid.

There is clearly a segment of the American population that is happy to engage in political violence. It’s undeniable. Moreover, the structure of the American party system, the financial operations underpinning each party, and the media culture in America all tend to encourage politically radical views in ways that are not conducive to a healthily functioning democratic system. But there is also plenty of evidence to suggest that most Americans are substantially less radical than their parties – hence the continuing enthusiasm shown during the past thirty years for divided government (a widely-held grassroots belief with virtually no public, institutional supporters).

I wouldn’t presume to speak for the future; anything can happen, even the rise of a fascist movement in America. You don’t need more than a powerful, well-placed minority to destroy a democracy. But the idea that we are on an unstoppable path to fascism is a terribly one-sided reading of America's troubled history. Painfully, slowly, and not without setbacks, for two centuries American life has continued to be perfected. I suppose, rather unexcitingly, it has got better in some ways and worse in others. But we should not undermine our belief in humanity’s ability to organize its society on civilized grounds. Please. Let’s not give up so easily.

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Election 2009

Make no mistake (to use a favourite phrase of the President’s), we’re in for a major battle this August. The stakes with healthcare are high, almost as high as last year’s election in terms of the impact a setback could have on the Obama presidency's domestic agenda. The Republican camp is resurgent, it’s on message, and it’s united in its spoiler tactics, seemingly with the upper hand as its rank and file turn up to disrupt town halls and the Greek chorus in the House and on cable news media conjure up ridiculous fears of government bureaucrats ordering you to kill your granny. The New York Times is running sympathetic pieces about Karen Ignagni, talking about how in the face of Democratic aggression the poor, long-suffering insurance industry “risks being thrust in the same role it played 15 years ago when it helped derail reform.” The economy has moved out of ICU, and instead of praising the administration people are complaining that jobs haven’t started appearing yet. The healthcare lobbyists are piling money into the debate, making the Blue Dog Democrats some of the biggest money-raisers of all this past quarter. And, for once, Obama’s much touted press conference and speech didn’t quite hit the right notes, as he mastered the details but not the big picture.

The odds still favour a healthcare bill by the end of the year, much stronger than they ever were for Hillarycare. But they’re by no means certain, especially if the Republicans make all the running in August. It’s not clear whether the bill will emerge with any Republican votes at all, or whether it will be produced by Democrats alone, and one should never underestimate the political importance of even two or three Republicans breaking ranks. Such factors could have a major impact on critical issues like how progressive the underlying payment framework for the new spending is, and whether a public option is capable of seriously raising questions for the private insurers’ oligopoly. This, in short, is a big deal.

To win the forthcoming public battle royale, then, the Democrats need to fight as if it was the election all over again. That means getting out the activists who campaigned for Obama last year and getting them to turn up at public meetings, to write to their congressmen, to give money to reform PACs, place ads, and generally express their desire for change. And it means using the power of Obama’s popularity to keep the Democrats united. There was a tremendous wellspring of opposition to the regressive politics of the previous administration shown in the Obama election, and I don’t believe it’s gone away. However, too many reform-minded people seem to have sat back since the election and concluded that it’s Washington’s turn now, or are instead focused on griping about how backward and racist the Republican party is from the sidelines.

If you have the time, I thoroughly recommend this fairly short piece by author R. W. Johnson in the most recent London Review of Books, ‘Author Loses Leg in Lagoon.’ As well as being a fascinating read, it tangentially says something about the very real fears that people have who currently hold health insurance (albeit in South Africa in this instance, not America). Democrat message-makers must recognize that, as a critical issue relating to points in your and your family’s lives, when you’re most vulnerable, many people are quite naturally conservative when it comes to health care. Better the devil you know, right? Rather than impugning that fear of change and focusing on the politically-minded enemy, reformers should respect and seek to reassure it.

There’s encouraging signs that the Obama administration is sorting out its message now on this, and that Obama’s natural tendencies will push him in this direction. Nevertheless, the Democrats should focus on ramming home a small number of key points that are currently emerging as the major emphases in the debate:

1. As Obama has always said, this bill will do nothing to your existing coverage. If you like what you have, you keep it.
2. The consumer protections that have already been agreed with the insurance industry are intended to provide greater security for holders of health care and might offer the potential to control rising drug costs.
3. They’re also going to guarantee that insurers can’t refuse to cover you because you’ve got a pre-existing condition.
4. Unlike the Bush era prescription drug program, this bill will be paid for. What’s more, it may help to control the cost of insurance for small businesses are struggling in the current economic crisis.

In short, the bill is designed to be safe, secure and cheap. If Obama can really drive home these points then he’ll go a long way toward reassuring conservatives of good will that this bill is not going to be the end of the world, leaving the hardliners who will oppose anything that’s proposed by Obama or a Democrat isolated.

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The Birther conspiracy conspiracy (part two)...

(First part here)

Look, if you all tell me either (a) that you have doubts about Obama's birth; or (b) everyone you're meeting on the street is a Birther, I'll shut up and change my mind. But I'm just not convinced that this is so important as everyone seems to be saying it is. Media Matters tells us that this movement is a creation of the conservative media. Rachel Maddow says, “This isn’t just one of the kooky things propounded by the violent far right fringe and at anti-government protests and on far right wing talk radio. The Birthers have actually made it as far as introducing legislation in the United States’ Congress.”



Compare, if you will, to Lev Grossman in TIME magazine, September 3, 2006, on people who doubt that Al Qaeda was behind the 9/11 attacks: "A Scripps-Howard poll of 1,010 adults last month found that 36% of Americans consider it "very likely" or "somewhat likely" that government officials either allowed the attacks to be carried out or carried out the attacks themselves. Thirty-six percent adds up to a lot of people. This is not a fringe phenomenon. It is a mainstream political reality."

Look, I’m sure there’s a few rich PACs and millionaires out there who are happy to pass their money on to G. Gordon Liddy to stir up some race-baiting trouble. But who amongst the elite in the GOP has actually stood up for these people publicly? There are ten Republicans in the House who called for a measure requiring birth certificates to be shown for future candidates for office. Even this is a fudge of a fudge: the sponsors aren’t even prepared to come out and say that they actually doubt Obama’s place of birth because they know it’s all rubbish. Only three of the ten even refused to vote for the recent Hawaiian resolution which explicitly stated that the island was Obama’s place of birth, designed by liberals to force a statement on the matter from Republicans (see here and here).

Meanwhile, even the usual toe-the-line right-wing crazies have been coming out against this. Even Ann Coulter has said the claims are false, for heck’s sake! Bill O’Reilly called the allegations “bogus ... no question about it.” And in discussion with Bernard Goldberg (whose only option was to conclude that the whole affair is a White House conspiracy to make the GOP look bad), he and Goldberg even argued that CNN and Lou Dobbs were only covering the topic for ratings. Dobbs, O’Reilly says, is a “renegade”!

True, Rush Limbaugh and Lou Dobbs have been keeping this going in irresponsible fashion. But even Dobbs has been unable to sustain his allegations, has rapidly become a public embarrassment, and is now just touting this line that there’s a problem with “transparency” rather than the actual issue the fuss is supposed to be about. Rather disingenuously, Dobbs has said, “I said, even though I believe the President is a citizen of the United States, I don’t understand why he shouldn’t produce a birth certificate.” So even the most radical public figures on this issue won’t actually stand up and defend it as an issue.

Moreover, I can’t prove it beyond reasonable doubt, but however much Wonkette wants to laugh about it, my gut says Eric Cantor’s kind of right to say that liberals as well as right-wing nutbags are keeping this in the public eye.

Let’s just look at what’s been going on with the Internet. The general consensus is that WorldNetDaily is the major Birther hotspot online. The WND petition on the matter has 443,000 signatures on it. Even if we accept them as all legitimate (which is, frankly, pretty unlikely for an online petition), this adds up to about a tenth of a percent of the population. I remember at some point hearing someone say that for every person who goes on a protest march there’s ten people at home who feel the same way. This, it seems, is a radically optimistic ratio to use for a website petition, but even if we do use it that would add up to just over 1 percent of the population who are really animated about this. I think that counts as fringe in my book.

This is only indicative, of course. I also had a look on Alexa to see how well WND is doing:

It had a spike just after the election, and another one just after all this stuff came out in the past week. But it hasn’t been growing traffic in any kind of way that would suggest a serious, growing membership base. (No wonder they rely on DailyKos polling.) In fact, get this: it turns out that “Michael Savage” is a far more common keyword search to get someone to WND than “Obama Birth Certificate.” Is it the Dobbs thing that’s got the hits in the past week? The crazy woman YouTube video? The August recess giving journalists nothing better to do? Healthcare? Who knows why this has suddenly hit the headlines, but there's no evidence yet that this is about to become politically significant.

Look at this, too. The following chart shows the search trend on Google for the keyword phrase “Obama birth certificate.” (The small red line is a search for “Birther”):

Again, you can see a few clear peaks: election, Xmas, inauguration, and the recent fuss. But we’re hardly talking about massive ongoing growth in interest, are we? Anyone who’s spent any time looking at these stats for their own sites will tell you that this is not a graph of rising interest. After each media-led peak, the thing sinks back to its former level.

To get a sense of perspective, take a look at this chart:

The blue line represents keyword searches for “obama birth certificate” again. The red line is “Miley Cyrus.”

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Shock news: polls reveal that most Republicans probably believe Obama is actually president

Sometimes too much digital self-righteousness can be bad for your faith in new media. The picture of the world you get from the blogosphere can sometimes resemble a roomful of hysterical teenagers screeching at each other about how cruel their parents are. Take this kerfuffle over the Birthers. An unpleasant, unconvincing theory that Obama might not be American, largely - albeit not exclusively - held by a certain type of basically old, Southern, white racist, has been presented as a powerful and threatening movement taking over the Republican party and about to condemn the United States to a new age of darkness and suffering.

The reality is:

1. According to the main DailyKos poll on the matter, substantially more Republicans think Barack Obama is a citizen than think he isn’t.
2. Despite being the Birther heartland, according to first reports of the PPP poll about to be released (see here and here) more Virginians think Obama is a citizen than that he isn’t.

The danger is that if liberals go around blaming Obama’s falling numbers on loony theories circulating amongst Republicans, they run the risk of failing to respond effectively to the really significant opposition Obama faces over healthcare and the economy during the August recess.

The Cassandra argument in its purest form is that the Birther movement represents a significant and threatening portion of the population. The Republican party, where they live, has been taken over by racist loonies who are so obsessed with defeating Obama that they’ll abandon any pretence of constitutionality and consider such things as secession and overthrowing the president just because he’s black. If we’re not careful they’re going to turn up with their guns and start shooting at us in our nice coastal towns. Some even think Obama is the Antichrist.

Given this view, it was hardly surprising that there was great interest in last week’s DailyKos poll in which 58% of Republicans were outed as Birthers. On YouTube, Crooksandliars fired up the 58% figure with DailyKos editor Markos Moulitsas. Moulitsas said, “Now, we expected Republicans obviously to have a sizeable fringe component that really believed that Obama was not born in this country but we did not expect over half of Republicans to really fall out for that Birther thing.”

All seems pretty clear-cut, doesn’t it? The Republican party is in the hands of wingnuts. Liberals are the saviours of America.

Except then I went to the WorldNetDaily website, which is pretty much the Ground Zero of the Birther conspiracy theory. I found that the site was happily citing the DailyKos findings itself. Now, call me a cynic, but when left and right are in agreement, I tend to get a little suspicious about reality...

Now, I’m no pollster and I don’t know how reliable either the poll or the polling agency was. Let’s give them the benefit of the doubt. But accuracy doesn’t matter so much if you read the questions the way you want to.
As said above, the figures have almost universally been reported as showing that 58% of Republicans are Birthers. If you take the 60 million people who voted for McCain, that would seem to suggest that nearly 35 million Americans, along with another 35 million who voted for other candidates or not at all. “The numbers are really clear,” Moulitsas says, “Republicans actually believe this nonsense.”

But are the numbers really so clear? Actually only 28% of Republican respondents explicitly answered “no” to the question about whether they thought Obama was an American citizen. More of them said they didn’t know, and many liberals – as Moulitsas did – have just lumped these together with the Birthers anyway. Now, just to be clear, I’m not saying 28% is a good thing. Nor that it’s good that people aren’t sure. Nor that some of the people who said "not sure" aren't unsure in a Lou Dobbs kind of way. But it’s a lot less worrying than 58%. In fact, substantially more Republicans said that “yes” Obama was a citizen than said “no” he wasn’t. Moreover (this is where my maths gets risky, so apologies if this is hogwash), if, for the sake of argument, you add 114 Independents to the Republican tally (so that the Dem-Rep ratio matches the 52.8% to 45.6% represented in the election last year), you’ll find that the ratio is more like 24% would say “no” Obama was not an American, whilst 49% say “yes.” So, roughly a quarter of Republican voters will pick up anything to attack Obama with, but more than twice as many have bigger fish to fry.

Proposed DailyKos alternative headline?: “Poll shows GOP is in the hands of conservatives who believe Obama is legitimate president.”


Similar could be said for figures about the South (even despite Weigel’s argument that 70 percent of Southern whites doubt Obama’s birth). I'm not going to deny here that there's plenty of racists in the South. Even more important, though, is the pretty much unmentioned fact that by far the largest section of “no’s” are found among the over 60s. That is, people who grew up in a segregated America. Only 4% of 18-29s across the whole country have any doubts about Obama's birth.

Another suggested alternative news headline for DailyKos: “After fifty years of civil rights progress, racism slowly dying out in America.” Just wait for those hits, boys!

I think, knowing no better, we should put the “don’t knows” down as Doubters, not Birthers. There’s evidence already in the legal challenges raised that suggests people are confused about the meanings of “birth certificate” versus “certificate of live birth”, and about “natural born citizen” versus “naturalised citizen” versus “citizen.” Plenty of people are just a bit dumb and confused without planning to take anyone hostage about it. Moreover, Push Polling has shown in the past that pollsters could even be putting the doubt into the respondents’ heads, rather than getting some deep-seated feeling out of them. So, no, Moulitsas, I don’t the numbers really are so clear.

Remember also that in this context (after the past eight years), the rump are the only ones who’ll be publicly owning up to Republican party membership when a stranger phones them up. The party is seriously detested at the moment. It turns out that in this poll more people called themselves Independents (601) than they did Republicans (527). Ralph Nader must be delighted!

I don’t think it’s a major leap of logic to assume that those people who’d respond “Hell, yeah, I’m proud to be a Republican” to a guy on a telephone are also disproportionately more likely to be the ones to say, “Hell, no, bubba, that black man ain’t no kinda ‘Merican... now where’s mah Bud and shotguhn?” As one commenter on Paul Krugman’s blog put it, “If you call people at home and start asking them silly questions like “do you believe the world is flat”, how many of those with IQ over 110 will bother talking to you? And how many dimwits will stay on the line and enjoy blabbering about the UFO’s that landed in their aunt’s garden last week?”

Of the 2,400 people the pollsters called, 11% (or 264 people) said they believed Obama wasn’t a citizen. And even 11% is worrying, right? That’s potentially 30 million people, isn’t it? 30 million people who really should be worrying about other things. And it is disproportionately centred on the Republican Party. Well, yes, yes, yes, and yes. And again, I’m not trying to excuse anyone of this 30 million who might be trying to veil racist garbage behind a mask of constitutionalism. But what is this “movement” anyway? Responding to a poll doesn’t mean you’ll go out and do anything about it.

My gut feeling is that you should define a movement as having a minimal requirement of people actually moving. And if you did, you’d be looking at a fraction of that 11% really counting as Birthers, even amongst the out and out “no’s.”

More on this later...

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The speech Obama should have made at the health care press conference

Details, but this time with a human face:

“Let me be specific. We will stop insurance companies from denying you coverage because of your medical history. I've told this story before -- I will never forget watching my own mother, as she fought cancer in her final days, worrying about whether her insurer would claim her illness was a preexisting condition so they could wiggle out of paying for her coverage. How many of you have worried about the same thing? A lot of people have gone through this. Many of you have been denied insurance or heard of someone who was denied insurance because they got -- had a preexisting condition. That will no longer be allowed with reform. We won't allow that. We won't allow that.

“With reform, insurance companies will have to abide by a yearly cap on how much you can be charged for your out-of-pocket expenses. No one in America should go broke because of an illness.

“We will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies, eye and foot exams for diabetics, so we can avoid chronic illnesses that cost not only lives, but money.”

“I will not sign a health care bill that is not deficit neutral, that is not paid for. I will not sign a bill that does not have all the reforms that we need to lower health care inflation over the long term. We will not sign a bill that isn’t right for the American people, and I’m for the public option. So I just want everybody to know, Congress will have time to read the bill. They will have time to debate the bill. They will have all of August to review the various legislative proposals. When we come back in September, I will be available to answer any question that members of Congress ask. If they want to come over to the White House and go over line by line what’s going on, I will be happy to do that. We are not trying to hide the ball here. We’re trying to get this done. But the American people can’t wait any longer. They want action this year. I want action this year. And with your help we’re going to make it happen...”

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Unemployment and growth

New York Times (h/t: FDL) reports that the long-term unemployment rate as a percentage of the total workforce has now risen higher than at any point since the Great Depression. Those people who've been out of work for more than fifteen months has exceeded 5%. Meanwhile, perhaps as many as a million and a half Americans are about to reach their limits on government unemployment benefits (as long term unemployed for more than 79 weeks), and the government (at least according to Christina Romer) is working to find a way to extend them. Let's hope they succeed before all those congressmen skip off to their islands in the sun...

The NYT charts make worrying reading, even to a layperson like me. Of the eleven recessions since World War Two, six have seen long term unemployment rates continue to rise for a substantial period of time after the recession itself technically ended, indeed more than a year following the early 1990s crash and two years after the dot-com crash due to the slow rate of exiting the recession. (At risk of overlinking, see Krugman's discussion of how you need a growth rate of 2% or more before unemployment starts to fall.) So, if we accept the IMF predictions that the recession is coming to a close and that the US will begin to grow again in 2010, though at a rate still less than 1%, it could easily be another year or more before the unemployment rate starts coming down significantly, and perhaps even longer depending on how effective the government is at job creation and whether the initiative for government spending gets crunched against a powerful tea party movement later this year. This will create real issues for the Obama administration to face: how far can the already enlarged unemployment insurance program be stretched; how far will congress permit more spending on job creation programs; and how long will the long term unemployed be prepared to wait for Obama to deliver?

I know at least two of my regular blog buddies have been feeling the pinch first hand (PapaM, David), and it's heartbreaking to read about this stuff hitting real, hard-working people. The last few months have seen a stabilisation in the banking sector, a moderate improvement on lending, early signs that the housing crash might have halted, and a major stimulus package passed. If done right, healthcare might even take some weight off the small business sector and make it easier to create new jobs. We're doing mostly the right things and just about heading in the right direction now. But it's still going to be a painful slog for those people in the workforce bearing the brunt of this, though...

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You foreigners just don't know what freedom is

I had my attention drawn to a particular line from an e-mail GLH received from Townhall.com relating to Granny-Death-Gate (TM):

"If the Government takes over health care, bureaucrats will decide who lives and dies in America. In the name of 'creating efficiencies,' they will delay – or deny - treatment to critically ill patients because it costs too much.
"We will have a NATION of Terri Schiavo’s, with a faceless Federal Bureaucracy pulling the plug instead of a Court.!
"Sound crazy? It happens every day in Great Britain."

Then, thanks to Infidel, I was pointed to a video made by some liberal bloggers in Canada (hat tip) taking issue with conservative ads running about how miserable Canadians supposedly were with their health care system:



Both of these reminded me of a time a couple of years back when I was in a part of rural Texas where there was zero public transport. A very kind woman was giving me a lift in her 4x4 down what would otherwise have been a very dusty, very hot road into town from the place I was researching at. I was talking about how handy it was to have buses to get around in if you didn't have a car, to which the women responded, "Sure. I can see that. But we Americans love our freedom, you see."

What does this "outside America" place look like in wingnut world? Nations where we have shackles placed round our ankles so we're not able to let you folks living in the free world hear about how our freedoms have robbed from us by the National Health Service? Where interviewers have guns pointed at us behind our backs so that we pretend to be pleased that we can be sick without worrying about being kicked out of hospital on top? Or is it that we just don't really love our freedom as much as you guys, which is why we've all ended up so committed to the idea of a comprehensive health care system?

Here's my guess what the typical British view of the NHS is. We think it's kind of creaky. There are tremendous problems with waiting lists. Doctors and nurses are often massively overworked. There are lots of inefficiencies. And we wouldn't swap it for the American system for all the tea in China.

Maybe it's because we love our freedom, too.

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Meanwhile...

As we get overheated about beers at the White House, whether Obama is a (half-)self-hating biracial man, whether he's really Kenyan, whether Sarah Palin has lost the hots for Todd, if the government has a secret plan for killing grannies ... a hundred Iranian dissidents have been put on trial for trying to bring free elections to their country (h/t: NYT).

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