How to save Health Care Reform from Joe Lieberman

It’s been pretty clear that the Democratic leadership in the Senate are bunch of amoral cowards who are not only afraid to play hardball, but unwilling to at least pretend to play hardball. As the predictable consequence of this weakness, Sen. Reid has let the health care reform debate become an opportunity for “centrist” Democrats to use logically inconsistent assertions about reform (which often go unchallenged) as a pretext to block the Senate from making progress. Joe Lieberman, who Jonathan Chait says “pose[s] the greatest threat to health care reform”, has provided the clearest example of this hypocrisy yet in his incoherent flip-flopping on the public option compromise which would allow Americans to buy into Medicare.

Democrats in the Senate still seem to think there’s some virtue in being polite to their colleagues who would uphold a status quo that kills tens of thousands of Americans every year, but this needs to end. While I doubt the leadership in the “upper house” would ever deign to lower themselves to hurting Joe Lieberman’s feelings in order to save lives, here’s what I would do if I were in charge :

1) Joe Lieberman is persona non grata – From this point forward, it should just be assumed that the Democratic caucus has 59 members. I wouldn’t suggest taking punitive measures against him (yet), lest the leadership come off as spiteful and alienate some of the votes still in play. Rather, Democrats should just ignore Lieberman completely. Stop inviting him to caucus meetings, don’t pay attention to the things he says, and actively engage on-the-fence Senators like Nelson, Collins, and Snowe while making no secret of the fact that the Senate leadership is no longer interested in giving a troll like Lieberman the attention he craves. If asked about Lieberman, Dems should be diplomatic, but treat him as if he were Sen. Graham or McCain. If Joe bashes any aspect of the reform effort, amiably write it off saying something like “Of course Joe would say that. Sen. Lieberman is a good friend, but he’s made it clear over the past few months that his vote isn’t in play.” If Joementum isn’t going to negotiate in good faith, stop negotiating.

2) Put reconciliation back on the table – I understand budget reconciliation is a convoluted process which the Democratic leadership is weary of employing, but they underestimate its value as a threat to moderate Senators who are willing to cut a deal. Harry Reid should split the Senate bill into its budget and non-budget related components (per standard reconciliation procedure), include the House version of the public option, and submit the bills to the CBO for scoring. Even if Reid never intends to move forward on reconciliation, a pending CBO score for a reconciliation-ready robust public option should hang like the sword of Damocles over the heads of every centrist Senator. If you don’t cut a deal, we’ll have a more liberal bill waiting to be passed.

3) The public option is still dead – It’s been obvious since the summer that the public option wouldn’t make it out of the Senate, so the Democratic leadership needs to work overtime to find a good alternative, even if it means taking a hit from the base. Unfortunately, it looks like allowing people to buy into Medicare is a non-starter, but ditching the public option entirely in exchange for ditching annual/lifetime coverage limits, implementing a hard 95% medical loss ratio, ending the monopoly exemption for insurers, and including Ron Wyden’s ideas for opening up the health care exchange (singular, not plural) to every American would accomplish just as much if not more than the already-watered down public options would. The key is to keep focused on the purpose of the bill and not the specifics. If a public option can be traded out for a compromise that will encourage stiff competition and actually control costs, be willing to make a deal.

4) Bring back the “constitutional option” – Once again, like reconciliation, I doubt Harry Reid would ever have the balls to pull something like this off, but it’s still worth employing as a tactic to get moderate Senators talking. The Democratic leadership should start trying to get whip counts together to see if they can scrounge up 51 votes for the nuclear option. Moreover, they need to make a serious effort to put the legitimacy of the filibuster in the spotlight. Every Democrat should be prepared to decry the filibuster as a parliamentary trick that has no constitutional basis and start peppering their speech with go-to phrases like “up or down vote”, “framer’s original intent”, and “simple majority” as a way of drawing attention to the fact that Republicans are using a procedural loophole to subvert small-D democracy. If Democrats can get the message across, they can assure the public there’s no shame in using a loophole to kill another loophole.

As they say, politics ain’t a beanbag, but for too long Democrats in the Senate have chosen the path of least resistance and let the American people be a punching bag in the process. This isn’t a game. Harry Reid and the rest of his cohorts need to put down their copies of “Robert’s Rules of Order” and pick up Machiavelli’s rules for kicking some ass (aka. “The Prince”). They need to stop being congenial and realize that if reform doesn’t happen in the next few weeks, it’s unlikely to happen for another generation or more. The fate of hundreds of thousands of lives rests on their shoulders.

Great Moments For Democracy

Perhaps not entirely by coincidence, the New York Times homepage presented its readers with the following juxtaposition:

Great Moments for Democracy

Moderate Republican Dede Scozzafava committed the unforgivable sin of supporting abortion rights, marriage equality, and the economic stimulus package. She had the endorsement of the RNC, Republican leaders in Congress, and fer chrissake Newt Gingrich; more importantly, she reflected the views of her district’s Republican voters. This was not enough for a coalition of mostly D.C.-based crybabies from throwing huge amounts of money and high-profile endorsements (yes, that means Sarah Palin) at Douglas Hoffman, whose qualifications for office consist of being a millionaire and supporting tax cuts.

It’s a little uncomfortable for me to admit that I pretty much wholeheartedly agree with Newt Gingrich’s comments on the affair:

“I felt very deeply that when you have all 11 county chairman voting for someone, that it wasn’t appropriate for me to come in and render my judgment,” he said. “I think we are going to get into a very difficult environment around the country if suddenly conservative leaders decide they are going to anoint people without regard to local primaries and local choices.”

The whole thing conveniently ignores that States’ rights idea the right like to throw around when it supports their thinking. Meanwhile, RNC Chairman Michael Steele has cheerily flip-flopped (“Doug’s campaign will receive the financial backing of the R.N.C. and get-out-the-vote efforts to defeat Bill Owens on Tuesday.”), demonstrating the kind of courage in one’s convictions he hasn’t become famous for.

So what does this have to do with a corrupt president appointing himself to another term? Mainly just the one very important overarching theme: The Democratic process getting cornholed. In one case we have utterly disconnected party elites hand-picking an unqualified candidate because he passes the litmus tests that qualify him as the type of bonafide right-wing moron that lost the 2006 and 2008 elections for the GOP. In the other case, we’ve got a sham electoral process driving an opposition candidate from the race. In both cases, the voter loses the right to back the candidate of his or her choice. Democracy FAIL.

Itchy Trigger Finger

For the moderates who claim they can only support a public option if it includes a trigger, here’s an idea : We pass a heath care reform bill with a robust public option and heath insurance exchanges that are open to everyone (a la the Wyden plan). The public option is behind a trigger that goes into effect the moment the bill is signed and kicks off if a single American dies of a treatable condition becuase they cannot afford heath care. At the rate Americans have been dying to protect the status quo (approx. 45,000 per year), that means we’ll only have to wait 10 minutes or so for the public option. Problem solved!

Better Dead Than Red

I find the “What about people in the red states?” argument against an opt-out public option wholly unpersuasive. Yes, an opt-out public option could end up preventing millions of people from having access to quality affordable health care, but there’s a simple solution to that problem : Stop Voting For Republicans. If enough people do that, then you don’t have to worry about getting your heath care taken away by a bunch of wingnuts who think Barack Obama is the love child of Hitler and Malcolm X.

The main reason a robust public option is off the table at all is because conservative voices are over-represented in the Senate, yet we’re supposed to care because a bunch of ignorant, regressive, fools in the small states might take away a vital component from the compromise of a compromise of a compromise health care plan that Congress can barely pass? Cry me a frickin’ river.

I’m sick of seeing people suffer because the founders decided to give the representatives of small, states a de facto over anything even mildly progressive. Every major leap forward our nation has taken has been in spite of conservatives, so when I think about all of the progress still waiting to be done, I’d rather just get the best deal we can and let the rest of the country keep living in the dark ages. Better to lead by example and hope they catch up then let the tyranny of the minority keep screwing everyone over.

Articles I’ve Read Lately That I Like

Obama’s High Bar

The problem for the addlebrained Obama-rejectionists is that the president, as far as they are concerned, couldn’t possibly do anything right, and thus is unworthy of any conceivable recognition. If Obama ended world hunger, they’d accuse him of promoting obesity. If he solved global warming, they’d complain it was getting chilly. If he got Mahmoud Abbas and Binyamin Netanyahu to join him around the campfire in a chorus of “Kumbaya,” the rejectionists would claim that his singing was out of tune.

What would actually work? Driving down the cost of health care

What provisions in a “health reform act” would actually drop costs in health care? Let’s leave aside for the moment all the myriad other arguments – some might be seen as too much government intrusion, some would destroy the health plan industry, some would be cripplingly difficult for providers, and so on – and just focus on cost. Given the real structure of health care markets in the United States at this moment, what could be written into federal law and regulation that would actually reduce cost?me of these changes are massive, some would be invisible to those outside the industry, but all could be legislated or regulated, and all would “bend the curve” toward lower costs.
. . .
Limiting medical loss ratios: Many European countries dictate that health plans must return 85% or 90% or 92.5% of the premium paid in as medical services paid out. U.S. health plans, in contrast, compete on (and brag to Wall Street analysts about) how low their medical loss ratio is. Some are as low as 60%.
. . .
Increasing subsidies for digitization, tied to productivity improvements: There are huge inefficiencies in the actual practice of medicine. No one can improve on them until the people running health care can actually track what they are doing, in detail. In something as complex as health care, that means total digitization, like any other business.

Subsidizing automation: Many things in health care would be done much more efficiently by automation, from lab work and pharmaceutical distribution to tracking inventory. Today’s system does little to encourage such automation – instead,it actually supports the inefficiency.

Standardization and checklists: Many parts of health care have established pathways that are clinically proven and widely published in the medical literature, yet followed only at the clinician’s whim. These are not matters for the doctor’s judgment, these are matters like washing your hands between patients, fully draping a patient for a central line placement, getting clear verbal confirmation from everyone in the surgical suite that they agree on who the patient is and what the operation is for. Standard pathways, and simple feedback mechanisms like checklists to make sure they are followed, are still not common practice in health care. If regulations made them mandatory, following them would save billions of dollars in fighting infections and having to re-admit patients to the hospital with problems that could have been prevented.

High Cost of Death Row

Perhaps the most extreme example is California, whose death row costs taxpayers $114 million a year beyond the cost of imprisoning convicts for life. The state has executed 13 people since 1976 for a total of about $250 million per execution. This is a state whose prisons are filled to bursting (unconstitutionally so, the courts say) and whose government has imposed doomsday-level cuts to social services, health care, schools and parks.

Money spent on death rows could be spent on police officers, courts, public defenders, legal service agencies and prison cells. Some lawmakers, heeding law-enforcement officials who have declared capital punishment a low priority, have introduced bills to abolish it.

A Smarter (and Cost-Efficient) Way to Fight Crime

Most crimes in the United States are committed by long-term repeat offenders, a majority of whom are eventually caught. One of every 100 adults in the United States is now behind bars; many are serving lengthy sentences. The crimes they committed clearly did not “pay” in any objective sense of the term.

Why, then, did they commit them? The short answer is that most criminals are not the dispassionate rational actors who populate standard economic models. They are more like impulsive children, blinded by the temptation of immediate reward and largely untroubled by the possibility of delayed or uncertain punishment.

The evidence suggests that when hardened criminals are reasonably sure that they will be caught and punished swiftly, even mild sanctions deter them. But not even the prospect of severe punishment is effective if offenders think they can get away with their crimes.

One way to make apprehension and punishment more likely is to spend substantially more money on law enforcement. In a time of chronic budget shortfalls, however, that won’t happen.

But Mr. Kleiman suggests that smarter enforcement strategies can make existing budgets go further. The important step, he says, is to view enforcement as a dynamic game in which strategically chosen deterrence policies become self-reinforcing. If offense rates fall enough, a tipping point is reached. And once that happens, even modest enforcement resources can hold offenders in check.

The Many Faces of the GOP

The Republican party just redesigned their website to be a red version of Barack Obama’s campaign site. Knowing their primary goal should be to convince the rest of the country they’re not just a bunch of bitter old white dudes, they updated the logo to replace the “O” with a bunch of yearbook photos. Since your time is valuable, I’ll save you the strain of hitting reload a bunch of times. Here’s all of them :

I’ll leave it to others to analyze the demographic breakdown of these images and what it says (if anything) about the type of voters the Republican Party is trying to attract, though I’d be willing to bet if the GOP was really as diverse as the images here suggest, we’d have a much more civil discourse in this country.

Don’t Forget 1996

While conservatives are laughing themselves silly over Chicago’s failed bid to host the 2016 Olympics, deluding themselves into seeing their own rabid hatred of Barack Obama reflected in the eyes of the IOC, let’s take a step back here. Putting aside for the moment that Rio is an excellent choice to host the 2016 games, if I was on the International Olympic Committee, I dunno if I’d be so keen on hosting the Olympics in the America either. I don’t know how much American news the Swiss receive, but if they saw one of the gun-toting mobs of tea baggers holding signs of the President’s face Photoshopped with a Hitler mustache, it probably wouldn’t do much to help them forget that the last time the United States hosted the Summer Olympics, a right-wing domestic terrorist planted a bomb in the middle of the Centennial Olympic Park.

If you take a look at Eric Rudolph’s statement on the Olympic Bombing, it looks like something that could have been written yesterday :

Even though the conception and purpose of the so-called Olympic movement is to promote the values of global socialism, as perfectly expressed in the song Imagine by John Lennon, which was the theme of the 1996 Games even though the purpose of the Olympics is to promote these despicable ideals, the purpose of the attack on July 27 was to confound, anger and embarrass the Washington government in the eyes of the world for its abominable sanctioning of abortion on demand.

I’m not saying this is why the IOC didn’t chose Chicago, but if I had to chose a venue for the Olympics, the recent explosion in right-wing lunacy would certainly make me think twice about whether or not it’s safe for the United States to host another Olympic Games.

You’re either for making money or against it.

Y’know that hilarious Protect Insurance Companies video that every other person was posting on Facebook yesterday? Well, prepare yourself to take back those chuckles because Jim Geraghty at the National Review (with an approving link from Andrew Sullivan) has an epic takedown of the fake-PSA :

Because $10 a Head To Watch ‘Land of the Lost’ Wasn’t Greed

The greed of health insurance company executives is the topic of satire in this video from Will Ferrell, who is by some accounts the highest paid star in Hollywood; Forbes said this year he was merely the 20th highest paid actor in Hollywood.

Get it? If you’ve made a lot of money pumping out absurdist comedies, then you’re a hypocrite for even suggesting that letting insurance companies profit off the deaths of their customers is a bad thing. This kind of argument is simplistic and ridiculous. It’s like saying “Michael Pollan doesn’t want people to eat junk food, but he eats three meals every single day.”

I Have A Nightmare

We really live in a golden age for race-baiting. Back in the day, there was a spectrum of racism of sorts. You knew something racist fell somewhere between Al Jolson in blackface, zip-a-de-doo-dah racism and the move your wallet to your front pocket because you see a black guy walking down the street racism. It was a simpler time.

In the last two years, however, Republicans have been so angry they’ve had to invent new ways to be racist. No longer can we judge racist sentiment simply by its degree of offensiveness. Now there are multiple varieties of racism which have become almost like an ingredient the cupboard of conservative hate speech that’s used to flavor every utterance the way a great Italian chef might finish off a dish with a drizzle of their finest extra virgin olive oil.

You’ve got the birther crowd with their “Faked the moon landing” racism. The Fox News saying Michelle is Barack’s “Baby Mamma” which is more of an “Oh my god, you’ve never really met a black person before have you?” racism. The “Fiscal conservative” / Tea Party “Complain about high taxes while comparing the President to a monkey” racism. The Matt Drudge “Ominously link to a story that incidentally involves people of different races as if to imply there’s racial backlash against caucasians” racism. And the religious extremist “Don’t blame me if the Bible says Obama is the anti-Christ” racism.

Then there’s Rush Limbaugh and Glenn Beck, who are like the Thomas Edison and Nicola Tesla of racist bullshit. These guys aren’t just content to be the “Telling a racist joke, but it’s cool because everyone knows I’m not racist” guys. Oh no. They’re innovators. They went out there, saw that America elected a black guy, and said “The old ways being a racist asshole aren’t good enough”.  In the process they’ve erected multimedia empires, doing for the “Aggrieved white guy cries reverse-discrimination” racism what Henry Ford did for auto manufacturing (or, not to change the subject, anti-semitism).

Now if the right wing’s artisans of racial hatred could only devote this uniquely American spirit of ingenuity into endeavors that don’t…well…threaten to destroy the social and political fabric of our nation, then we might get somewhere.

Conservative Politics Disguised As Religion

I’ve always had a soft spot in my heart for the Presidential Prayer Team. After all, they were the ones who gave us my favorite bit of post-9/11 kitsch :

On a lark, I decided to check in on the organization whose self-described mission was to “pray for our national leaders in accordance with biblical principles, regardless of political persuasion“, but it seems like the election of Barack Obama has dampened the enthusiasm quite a bit. Here’s what the PPT site looked like back in 2006 :

And here’s what the Presidential Prayer Team site looks like today :

Funny how a “non-partisan organization” would go out of its way to avoid using the current President’s name or photo. It’s almost as if members of the Presidential Prayer Team are less likely to pray for President Obama than President Bush. I wonder why that is?

Bonus detail : Notice the site no longer references a Bible quote in the masthead. Is 1 Timothy 2:1-2 not as popular now as it was when Republicans ran the country?

I urge, then, first of all, that requests, prayers, intercession and thanksgiving be made for everyone— for kings and all those in authority, that we may live peaceful and quiet lives in all godliness and holiness.

Weakest Excuse Ever

Roy Edroso’s round-up of wingnut reaction to Joe “You lie!” Wilson contains this hilarious gem (via Tom Tomorrow) :

Riehl World View rushed to interview the Congressman, and though they only repeated one word of his responses (“appalling,” regarding the President’s assertion), they characterized him as open-minded (“he went into the speech hoping Obama would genuinely reach out both to the people and across the aisle to address their concerns”), sensitive to the needs of his constituents (“Wilson also stressed his concern for the existing high unemployment in South Carolina”), and a man of even temperament, at least on most occasions (“Other than the single, short impromptu blurt, Wilson said he was in complete control of himself at all times”).

True. Wilson was “in complete control of himself”, except when he wasn’t. And if you really think about it, with the exception of a few interviews, Sarah Palin has spent the majority of her life NOT sounding like a complete dumbass. Like when she’s sleeping or eating or waiting for others to stop talking.

Why Domestic Violence is a Pre-Existing Condition

Add this to the long list of reasons why I will never, ever, ever vote Republican :

It turns out that in eight states, plus the District of Columbia, getting beaten up by your spouse is a pre-existing condition.

Under the cold logic of the insurance industry, it makes perfect sense: If you are in a marriage with someone who has beaten you in the past, you’re more likely to get beaten again than the average person and are therefore more expensive to insure.

In human terms, it’s a second punishment for a victim of domestic violence.

In 2006, Democrats tried to end the practice. An amendment introduced by Sen. Patty Murray (D-Wash.), now a member of leadership, split the Health Education Labor & Pensions Committee 10-10. The tie meant that the measure failed.

All ten no votes were Republicans, including Sen. Mike Enzi (R-Wyoming), a member of the “Gang of Six” on the Finance Committee who are hashing out a bipartisan bill.

It’s a shame that the only chance of getting a “bipartisan” bill is to work with the party that voted en masse to defend insurance companies against battered wives.

Never Forget

I remember those days immediately following 9/11, when we were overcome by a patriotic spirit uniting every American, regardless of party, in the belief that universal healthcare is a socialist plot to kill your grandma.

Like I Needed Another Reason To Hate Glenn Beck…

I guess it makes sense that somebody who would evoke the revolutionary mantra of taxation without representation would be ignorant and self-righteous enough to co-opt everything they can get their hands on. Here’s the logo to Glenn Beck’s “9/12 Project

Needless to say, conservatives’ Photoshop skills are about as good as their historical analysis in this case. The original (which I love) :

Of course the great flaw that undercuts most of the Revolutionary rubbish that Beck and his teabaggin’ allies casually name-drop is that the Founding Fathers were fighting a monarchy which is, for those who prefer a democracy, tyrannical. For modern conservatives, who waited mere weeks after losing a fair election to carelessly accuse Obama et. al. of a burgeoning despotism, wrapping themselves in the accomplishments of the revolutionary movement don’t make them look like the second coming of Thomas Paine, it makes them look like a bunch of friggin’ babies.

It’s hard to be bipartisan when only one party cares

I’ve got a lot of conservative friends and family who sincerely believe that we’re in serious need of health care reform and that it’s unconscionable for the richest country in the world to let people die because they’re too poor to go to the doctor. Though I may vocally disagree with their positions, I won’t second-guess their stated motives for opposing the current plan. Indeed, I could see why a Republican would oppose Democratic health care efforts in the hopes that a more conservative plan emerges at some point in the future.

But here’s the deal : Republican politicians don’t care about heath care reform. They may talk a good game, but look at the past four decades. Ronald Reagan swept into office in 1980 and re-invigorated conservatism. He never tried to achieve universal health care. In 1994, Republicans took back the Congress promising reform in their “Contract with America”. They also never tried to ensure every American had access to quality affordable health care. In 2000, George W. Bush “won” the election and presided over six years in which Republicans had de facto control of the legislative and executive branches. Once again, solving our health care crisis wasn’t part of the agenda.

Seeing a pattern here?

Honestly, I’d rather the health care debate be about reforming a Republican health care bill that has already passed, but the last Republican President to even attempt to insure every American was Richard Nixon. No other Republican President or Congress has made a serious effort to ensure access to health care is a right afforded to everyone regardless of income.

I wish this wasn’t the case. I wish both sides could at least agree that there’s a problem requiring a solution, but the lack of interest among Republicans in Congress has made consensus impossible. At this point, conservatives should stop holding their breath hoping for something better to come along. Republicans have drawn a line in the sand between the various flavors of Democratic health care reform and no bill at all. If that is unacceptable to you, then should probably ask why the GOP hasn’t even bothered trying to protect the uninsured.