Category Archives: politics

Universal Coverage or Maintaining the Status Quo?

Photo credit: cdc.gov

By Marc Seltzer; originally published on March 13, 2010 at care2.com.

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For all the smoke and mirrors, all the outrageous claims, and all the frustration about what is not in the Democrat’s health care reform legislation, the fundamental impact of the proposed reform is very simple.  The Senate bill, soon to be voted on by the House, uses public funds to insure Americans who do not have insurance.  (Making sense of the polling, from the Washington Post)

In providing for universal coverage, it satisfies President Obama’s preeminent campaign goal — one he has not walked away from despite profound economic turmoil and deep political resistance.

It is amazing that the debate over such a simple idea took so long and involved so many distractions.

Republicans do not want to spend public funds to insure the uninsured — plain and simple.  Though they do not say it so clearly, instead, hiding behind claims that the deficit, the recession, and public opinion polls are the reason that the bill is wrong for America.

Smoke and mirrors.  (Krugman dispels some myths)

President Obama seeks to add an entitlement, consistent with contemporary democratic principles of capitalism with a social safety net.  Republicans, consistent with principles of individual effort and individual reward, seek to resist it.

What is more puzzling is why the left is so fractured in its desire for reform.  There has not been a serious proposal for an open-enrollment public option or for single payer public insurance on the table since the beginning.  This is not to say that the United States wont move towards public insurance or public medicine in the long run.  But with only a subsidy and insurance regulation on the table, the left’s threats to undermine President Obama’s universal coverage program because it does not do away with the for profit medical system makes little sense.

What would make sense is to take a longer range view:  To believe that universal coverage is an important step in the direction of providing good care for all; to trust that reforms included in this legislation can be used to regulate for-profit insurance practices to eliminate exclusions and rescissions which kept people who wanted insurance from receiving it; and to recognize that a variety of reasonable cost-containment measures will be used to slow the growth of health care inflation.

I have written often about deficits and debt, reform of fee for service medicine and changing financial incentives in health care.  And I think this legislation is serious medicine for the problems we have in these respects.  And I have spoken with Canadians and Europeans who love their publicly funding health care systems.  And I still think that this legislation is a serious attempt to insure that all Americans can receive adequate health care.  If I were like most supporters of this health care reform, I would say that this legislation is poor, for one reason or another, and then suggest that it was the best we could get under the circumstances.  But this legislation is powerful, historic and designed to solve the problems we face.  So why, complain?

Pass the bill.

(Sign the petition)
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More thoughts on national issues: my podcast ramblings and conversations with Jessica Pieklo.

March 19, 2010 Update:  Paul Krugman sounding more positive, as well, in the New York Times.

Podcast March 11, 2010

Audio Podcast, March 11, 2010 “My show”

Changing filibuster rules at the start of next legislative session?  (Ezra Klein of Washington Post)

President Obama campaigns for health care reform — beginning to sound like his old self again. (C-Span covers St. Louis speech)

Politico “Barney Frank wants financial reform on C-Span

Podcast March 10, 2010

“My show” podcast — March 10, 2010

David Leonhardt’s article on health care finance.

Why don’t we leave the lawyers alone?  Detainee lawyers criticized by Lynn Cheney, while other conservatives come to their aid.  (New York Observer commentary) (New York Times article)  The left criticizes Bush administration lawyers.  This is politics.  The lawyers are doing their job, fulfilling an important role in the system — in both cases.  What do you think?

The Chief Justice wonders, “why we’re there” referring to the State of the Union address and Obama’s criticism of the court.

Podcast March 9, 2010

March 9, 2010 “My Show

Health care reform vote counting.  Tension or media hype? (Wall Street Journal)

Democrats and Republicans differ on universal coverage.  Cost cutting in tax on high value insurance plans gets little credit.

Military tribunals and civilians courts.  Will legislating the answer help or hurt?

Podcast March 6, 2010

March 6, 2010 “My Show”

Iraqi election and the courage of starting a new democracy.

Health care reform and whether “reconciliation” is really just a buz word and political attack with no real historic significance.

Email or call with comments (310) 928 1408 and I will try to discuss in the next show.

Military Tribunal or Civilian Courts for Terrorists?

By Marc Seltzer; originally published on January 6, 2009, at care2.com

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The recent decision to treat the perpetrator of the December 25, 2008, terrorist attack on a commercial airline flight as a criminal defendant, rather than as an enemy combatant, again raises questions about the use of civilian courts for terrorists.

A foreign national enemy soldier in U.S. federal court, will not, in fact, receive all the constitutional rights of U.S. citizens.  Still they will receive more substantial legal protections than likely to be provided in a military tribunal.  Why then provide all the rights and process of U.S. civilian courts, rather than simply relying on military courts and justice?

The answer relates more to the failure of the Bush administration to effectively establish and use military tribunals than to the appropriateness of federal court for terrorists.  The Bush administration created secret prisons and harsh interrogation techniques but no workable process for judging enemy prisoners.  Under the circumstances, Republican criticism of the Obama administration decision to prosecute Abdulmutallab in civilian court is hypocritical.

This case is different in key ways from the case of the five Guantánamo detainees, who will be tried in federal court.  For example, the government will seek the death penalty for the five Guantánamo detainees.  After the damage to the government’s reputation because of treatment of prisoners at Abu Ghraib, and questions about interrogation and legal authority for detention without trial at Guantánamo, the execution of these detainees without a traditional civilian trial would have aroused international outrage and significant domestic criticism.

However, the December 25th attempt to destroy a plane as it descended towards Detroit failed, and no injuries resulted.  Thus, the government will likely seek incarceration, not the death penalty.  Moreover, Defendant Abdulmutallab has not been interrogated using enhanced techniques and his detention will be at the hands of the Obama administration, which has disallowed torture.  Therefore, there is not the same need to demonstrate the legitimacy of the process as there was with the Gauntanamo detainees.

The Bush administration proposed to deal with detainees outside of the civilian legal process, but parts of its plans were rejected by Congress and the courts.   After scandals at Abu Ghraib and questions about the administration’s treatment of prisoners and judgment in reviewing detainee cases without judicial oversight, the Bush administration lost some credibility in its role as authority over detainees.  This also cost the executive branch authority to use what should have been an ordinary process in time of war, the military tribunal.

The Obama administration has asserted that it will use tribunals in some cases.  For example, where evidence against a detainee is not sufficient to achieve a conviction in a civilian court, the administration will still seek to incarcerate people it believes are a threat, using a military tribunal.  Similarly, if a large number of foreign soldiers needed to be tried, it would overwhelm a civilian court, but be easily accommodated in the more flexible rules of a tribunal.

It makes no sense to try every enemy soldier in a civilian court. But the Obama administration will have to pick up where the Bush administration failed.  It will have to demonstrate to Congress and the courts that it can conduct military tribunals with the right mix of prosecutorial judgment and judicial process.

For now, the December 25, bomb attempt left an obvious trail of evidence and only one defendant.  This is an easy case for a federal court to handle.  Moreover, the defendant started providing information to the law enforcement officials immediately upon his arrest.  CIA or military intelligence officials could have been called in, but the defendant cooperated and provided detail immediately, according to the administration.  Under these circumstances, the administration’s decision to prosecute Abdulmutallab in civilian court was sound, although the greater challenge will come as the administration tries to prosecute some of the remaining Guantánamo detainees in military courts.

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January 6th, 2009, UPDATE:  In depth discussions on foreign policy and detentions on C-Span; President Obama discussing security issues.

Questioning Conventional Wisdom — “Jobless Recovery”

By Marc Seltzer; originally published January 6, 2010

Don’t be too sure

. .

“Jobless Recovery”

No adjective characterizes political and media discussions of the recovery from the 2008 recession more than the word “jobless.”

Is it true?  Have the stars aligned to deny us a bright future?  Should we be worried?

LIBERAL EXPRESSIONS OF CONCERN

One way to evaluate what people are saying is to look at their motivation.  In this case, liberals and conservatives are both motivated to characterize the job prospects as worse than they likely are.  Many liberals, such as outspoken Nobel Laureate Economist Paul Krugman, want the government to take action in support of job creation so they focus on the high unemployment rate.  Ten percent is certainly higher than a more ideal 5 or 6 percent that would be a healthy level for the economy, if it were not in either an excessive boom or bust cycle.  But the current high unemployment reflects the depth of the recession, not a “jobless” recovery.

In 2009, the growth rate only turned positive in the third quarter.  Jobs are a lagging indicator and always follow the business turn-around and improvement in growth rate by many months.

Thus, the 2009 recovery is not “jobless” because unemployment has not yet come down.  Every recession involves the loss of jobs and every recovery involves the improvement in business conditions and higher growth rate long before jobs return.

Professor Krugman is worried about a weak recovery and thus wants to see additional stimulus aimed at creating jobs.  He is particularly concerned that the slow return of jobs creates great suffering and harms employment prospects for the long-term unemployed.  His proposals could help alleviate high unemployment and move the economy more quickly towards full employment, but they do not indicate that this is a jobless recovery whereas other recoveries were not.  Rather they reflect the fact that the severity of the recession led to millions of layoffs and that it will take time for millions of workers to be rehired into the labor market.

HOW ABOUT THOSE REPUBLICANS?

On the other side of the isle, the Republicans are constantly saying that the Obama administration actions such as stimulus spending and health care reform are bad for the economy and that we are headed for a jobless recovery.  However, it serves the Republican political goals if the Obama administration can be described as failing to lead an economy out of recession.  Millions of people are unemployed and many who are employed face job insecurity.  The Republicans exploit this to political advantage by claiming that current policies are wrong and pointing to a “jobless” recovery as evidence of failure.  The Republicans will continue to have every incentive to claim that Democratic policies are causing a jobless recovery until the 2010 elections.

But that doesn’t make it so.  Remember that it is far quicker to lay off employees than it is to rehire them.  Layoffs can be done by thousands on a single day, while rehiring takes substantial human resource department efforts, paperwork and staffing in itself.  Unless employees were simply furloughed, a thousand employees laid off in a single afternoon could take months to rehire in ordinary conditions.  For this reason, and because the recession of 2007-2008 involved a spectacular financial crisis with fast and deep layoffs, reaching a peak 750,000 a month in January of 2009, unemployment may only decrease by 750,000 to two million new jobs a year in coming years.  Remember, we lost more than seven million jobs.

Nonetheless, six to eighteen months after the growth rate becomes strong, we should expect to see substantial gains in employment.  It will be correct to say during the recovery that jobs are not created as fast as they were lost, but that is a hardly the standard for a “jobless” recovery.  The real key is the growth rate.  It reached more than 2% in the third quarter of 2008.  Six months from now it should be higher still.   The activity is reflected in increased hours and temp job hires for now, but inevitably job creation will follow.

The real question is whether innovative action in the public and private sector can increase the speed of job creation without distorting the marketplace and creating waste.  Nations such as Germany subsidized jobs during the crisis to limit layoffs.  Many nations, including ours, supported public and private sectors with stimulus spending, preventing layoffs from getting worse than they did.  Now, the question is whether means will be found to efficiently return to higher employment more quickly than in other deep recessions.

May 6, 2010 UPDATE:  Recent jobs data finally confirming predictions:  Denver Post

Combining the House and Senate Health Care Bills

By Marc Seltzer; originally published on December 29, 2009, at care2.com

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While the House and Senate health care reform bills are nearly identical, they differ in a couple of important ways — and this can potentially make the final bill much better than what has so far been contemplated.  Comparisons:  Bloomberg & New York Times.

The just-passed Senate bill partially funds health care insurance for those who cannot afford it by taxing luxurious insurance plans.  (I see it as ending a subsidy, not a tax at all — as I explain here)  This is not only a source of revenue, but crucially the tax will create an incentive for insurance companies to create cost-savings plans, “bending the cost curve,” of the entire system by reducing excess health care services.  Decreasing the unneccessary care lowers demand, cutting prices for insurers and eventually for businesses and individuals.  See Atul Gawande, New Yorker, Dec. 14 — a must-read on costs (and also June 1, New Yorker).

However, the House bill takes a different tack.  It raises taxes on high-income Americans, under the theory that they can afford to pay more without cutting into food, shelter or health care.  At some point, increasing taxes on wealthy Americans does lower their overall investment in new businesses — a drag on the economy — but such taxes are at a relative low point and the proposed tax is not so dramatic as to significantly damage investment potential.

The conventional wisdom is that the Conference Committee, which will meet in the new year to create one final health care bill, will choose between House and Senate options.  On many provisions, the Senate bill will prevail, because it is more cost-conscious, as already noted, and there is less support for the House provisions in the Senate, where the Democrats have no margin of error on the final vote.  Senate legislation has already been CBO (Congressional Budget Office) scored to reduce the deficit at ten- and twenty-year projections.  This does require doctors to take less payment from Medicare patients than they have in the past and requires individuals to buy insurance or pay a fine, which will be unpopular for some people who neither have insurance nor want to pay for it.  On the other hand, projected cost savings of the Senate legislation do not entirely factor in other cost-containment approaches, which are being tested, from malpractice reform to replacing the fee for service model, and which will likely bear fruit over the next decade.

Deficit Reduction and Health Care Cost Containment

The conference committee should take both the Senate tax on high value insurance plans and the House tax on wealth in the final form of the bill.  This would lower the deficit even further.  It might upset a moderate Democrat or two and it might not induce any Republicans to vote for health care reform, so Harry Reid needs to shepherd his flock and ask Olympia Snowe and Susan Collins where they stand on the idea, but it has the distinct advantage of creating universal health care legislation that is strongly positive on deficit reduction and still stepping in the right direction by changing health care incentives.

Currently incentives in the profit-driven system reward over-testing and overuse of resources by those who have, and tolerate underuse by those who have not. The Senate legislation, as it stands, gives the have-nots a chance to participate in the health-care marketplace.  While taxing wealth must be done cautiously so as not to damage investment and new business potential, here the benefit of lowering the deficit in the process of providing the opportunity for basic health care for all Americans is a worthy purpose for a moderate wealth tax.  Control of the deficit will return rewards to many who pay the tax by improving confidence in the economy and raising prospects for investments.  This could be a win-win in the long run, provided that the economy was emerging from the current recession before tax increases were imposed.

The Senate’s health care legislation is a monumental accomplishment in the direction of universal coverage. It also begins to tackle cost issues by taxing luxurious insurance plans and pointing towards other models of care that will lower demand and drive down costs.  We could add substantial deficit reduction to the legislation — an unplanned bonus — by including the House’s moderate tax on wealth in addition to the Senate bill’s revenue measures.

What are your priorities?  If this sounds appealing, please spread the word.

Listen to care2.com blogger Jessica Pieklo and I discuss health care and more on our weekly podcasts.

January 4, 2009 UPDATEHendrik Hertzberg at the New Yorker on support and opposition to the health care bill.  An outspoken liberal, Mr. Hertzberg is in favor of the current legislation.

On the White House blog, a comparison of President Obama’s Transition period positions on health care reform compared with the near final product.

January 11, 2009, UPDATE:  PBS Newshour hosted a good discussion on whether it was better to adopt Senate or House approaches, but there was no mention of taking both.  Why not?

President Obama Achieving the Possible

By Marc Seltzer; originally published on December 20, 2009, at care2.com

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I, for one, would like to see a re-energized Republican party.  I don’t think its good for America when one party has lost its way and we have to rely, at least temporarily, on the leadership of only one political team.

I rather like medical malpractice reform, a piece of the current Republican puzzle.  If Republicans could coalesce around a message of discipline and sacrifice for the common good on post-recession budgets — and maybe cleaning up the terrible problem in states that elect judges without asking them to recuse themselves when they preside over the cases of their campaign donors, they could have the beginning of a party platform.

Instead, I had to read in the NY Times today that the Republican response to President Obama’s efforts to reach reasonable and practical agreements to reduce international pollution and to the President’s leadership on health care — again seeking compromise in order to achieve what is possible — is that the President should only be working on the economy.

As if it weren’t bad enough that the Republicans have opposed serious efforts at health care reform — including opposing the current reform package that takes significant steps at cost control, while providing health care to those priced out of the system.  (The New York Times reported “the $871 billion cost of the bill would be more than offset by the new revenues and cuts in spending, so that it would reduce future federal budget deficits by $132 billion between 2010 and 2019” per the CBO.)

As if denying that environmental pollution could have a global impact, and claiming that serious scientists doing their best to understand and report climate change were balanced by a far smaller number of skeptics, many of whom represent polluting interests, wasn’t holding America back.

Now the Republican message is that the President of the United States should not do more than one thing at a time.  No matter that the nation is at war, that China presents capitalist competition at a whole new level, that environmental damage is not bound by borders and China, India, Brazil and the like are industrializing fast, that regulation of our private financial system needs obvious overhall and that the great gains in productivity and commerce of recent years got absorbed into rising health care costs rather than making our products more competitive on the international market or our workers better paid and businesses more profitable.  The Republicans want the President to address no more than the economy.  And on the economy, they want unregulated markets, without government action.  In other words, laissez faire, and let the chips fall where they may.

This President is tackling real problems in the economy, health care, and national security, and laying the groundwork for longer-term progress on environmental protection, education, and financial regulation.  His administration is developing new partnerships in international cooperation in keeping with changes in the dynamic power and nature of world nations.

Take for example, the health care compromise aiming to garner 60 votes in the Senate.  It will be picked on mercilessly by those who wanted something more or something less.  Some will say it does nothing and others will say it remakes the American economy into a socialist order.  But read the basics of what it achieves and think.  It offers an estimated 30 million people, who were rejected from or priced out of health insurance, the opportunity to obtain coverage.  It subsidizes low income wage earners and it taxes enough of those parts of the health care industry that are subsidized and overused to achieve significant cost-cutting.  It has features which draw the praise of economists like Paul Krugman. See his recent NY Times op-ed “Pass the Bill.”

The fact that Mr. Obama speaks well and that he uses expressions, such as “don’t let the perfect be the enemy of the good,” which turn out to perfectly capture the political dynamic, is a mighty bonus.  The President has clear insight into what realistic progress looks like.  Those who criticize compromise do not, although they may have a point that in the future progress can go beyond what we agree to today.  But we have to start from where we are, and sometimes getting started is the hardest part.  Once we move in the direction of cleaner energy, we can invest our education, creativity, entrepreneurial spirit and regulatory know-how to take us farther than we can now imagine.  Or more dire circumstances may force us to take other measures.  But this is still the beginning.  We are not lacking leadership at the top.  Let’s take advantage of where we are and get started.

To hear my conversation with care2.com blogger Jessica Pieklo on Copenhagen hopes and Health Care votes follow this link and click on the “December 15, 2009 podcast, Copenhagen’s Promise and Health Care Reform Politics.”

The Vice President’s Op-ed is also worth reading:  Joe Biden in the NY Times.

December 21, 2009 UPDATE: NY Times Editorial in favor of the Senate bill.

Sacrificing the Public Option, Expanding Medicare and Universal Coverage

By Marc Seltzer; originally published on December 13, 2009, at care2.com
. . .

How does the latest health-care proposal in the U.S. Senate measure up on Progressive principles?

The Progressive movement has rallied behind single payer and public option reform proposals in the belief that not only is universal coverage a fundamental right, but not-for-profit medicine is a better way to get quality health care at a reasonable price.

Unlike most developed nations, the United States has a sizeable part of its population that goes without health insurance.  President Obama took up the cause of greatly expanding coverage in his presidential campaign. He also spoken firmly of reform in terms of bending the cost-curve, making insurance and medical care more affordable to individuals and to the nation, in light of fast-rising health-industry costs.  However, Mr. Obama stopped short of embracing single payer, leaving in question what type of structural changes would be used to achieve reform goals.

The political reality is that both the House of Representatives and Senate are split among those who want to change the system towards government-run health insurance and those intent on maintaining a mostly private system.  In the House of Representatives, the Democratic majority was able to pass legislation substantially expanding coverage and including a limited public option, a small government-run insurance program for those not insured through their employer.  The vote was fairly close and may have reflected inclusion of a controversial abortion-funding restriction, such that the exact count of Representatives who would support a public option if the anti-abortion funding provision were not part of the final bill is uncertain.

In the Senate, Democrats need sixty votes to close debate and move forward.  They have close to, but not quite, that many, who will accept some form of a public option.  Thus, negotiations have continued to explore what types of limited government insurance programs would be acceptable to at least a few conservative Democrats, independents or moderate Republicans.

This week a Senate group reached a compromise that attempts to replace the public option with a public/private non-profit insurance program like that which is currently offered to Congressional legislators and federal employees.  The compromise proposal did not stop there, however.   It also included a provision to significantly expand Medicare, by lowering the age of participation from 65 to 55.

How should Progressives look on this proposal?

All the proposals under consideration push towards universal coverage.  It is really the structure that makes them different.  The use of a public/private program is not equivalent to the public option, or government-run program.  However, the federal authority sets rates, controls profits, and guides provision of health care.  It is a strong control on profit-driven insurance.

Moreover, expanding Medicare is a major step in the direction of single payer.  The Medicare program is single payer for its participants.  Private insurance does not participate except in supplemental programs.  There are approximately 35 million additional Americans who would be eligible to participate, if the age requirement was lowered — more than 10% of the population.  Those under fifty-five would remain in their current employer-provided plans and a small number would participate in the new public/private plan.

Given that there is not political power to create a nationwide single-payer program, the expansion of Medicare to include 35 million additional participants and the coverage of uninsured by a public/private program is much more than could have been achieved by the limited public option as it was contemplated.  The small public option is replaced by a public/private plan, which covers those currently uninsured.  The vast expansion of Medicare offers many more Americans a single payer model of insurance.  Whether this shifts the political equation in the Senate or House is the big question, and this should become known in coming days.

Care2.com/causes blogger Jessica Pieklo and I discussed the new proposal as soon as we got word.  You can hear our conversation by following this link and clicking the December 11, 2009, podcast, and more information should become available as soon as the Congressional Budget Office provides “scoring” or budget estimates.

December 14, 2009, UPDATE: First responses — Senator Lieberman