health care

I really like and respect Marc Ambinder, but he is just wildly off base here:

But Democrats are beginning to notice that opponents of health care reform have discredited themselves. They ramped up much too quickly. When smaller, conservative groups Astroturfed, they inevitably brought to the meetings the type of Republican activist who was itching for a fight and who would use the format to vent frustrations at President Obama himself. There were plenty of activists who really wanted to know about health care, and some who were probably misinformed -- scared out of their chairs -- to some degree, but the loudest voices tended to be the craziest, the most extreme, the least sensible, and the most easy to mock.

The American people remain anxious and confused about health care reform. That is an underlying reality that Republican activists are so eager to exploit. But doing so required a certain restraint -- and a willingness to traffic in at least approximate truths -- and an ability to make distinctions within their own ranks about which tactics were valid and which tactics were venomous. It also required a sophistication about the media. ...

Remember, the target audience for Republicans is Blue Dog Democrats in Congress. They won't panic unless they perceive organic anxiety.  The White House's goal was to prevent the Blue Dogs from panicking. The swing constituents in these congressional districts aren't angry Republicans, and the Blue Dogs know this.  They're political independents for whom the sanctity of the process is important. These are the type of voters who like President Obama because he appears willing to bring people together even though they don't agree with their policies.

As usual, in a pattern that the left patented during the Bush administration, the organized right lost control of its message. ...

That last sentence is really the nub of the problem with this post, since the organized left kind of had the last laugh at Bush's expense in 2008.

I know what it's like to work in a political operation controlled by the White House. And I can attest to the fact that the Obama people are following the Bush playbook to a T: first, pivot to the scraggly disorganization and off-messageness of the opposition.

This is what "Rush is the leader of the Republican Party" was all about. It was what the strange recycling the birther stuff months after it first surfaced was all about. And it's embodied in the ethos of Marc's post, in which any failure to act within the received boundaries of political discourse is automatically a liability for Republicans and a plus for the Obama White House.

For the Bush Administration in mocking the anti-war movement, and Obama deligitimizing the "mob," what both White Houses missed is that the general public has different sets of expectations for political leaders and opposition movements. Oppositions are supposed to be loud, vocal, off-message, inchoate. The President of the United States is supposed to have his stuff together.

Take as an object lesson the Bush Administration's treatment of the anti-war movement. Early on, they were, in words Marc used, "easy to mock." The conservative media had a field day roasting Susan Sontag, then Michael Moore, then Cindy Sheehan, then John "stuck in Iraq" Kerry. And, at times, this genuinely rallied the base.

However, the left ultimately won the political argument about the war (even if they lost the policy argument) -- despite the ineptitude of their leading voices -- because the ever-increasing chorus of opposition eventually ignited a media backlash against the war. When Bush was at 70%+, his prosecution of the war was first branded "divisive" because something like 500,000 anti-war activists were marching on CNN. And it was a short hop from branding the war "divisive" to branding it a disaster.

Much the same is now happening with health care. The public option is, at the very minimum, now perceived as divisive. As controversial. As anything but the sweetness and light upon which Obama uniquely depended on to govern.

In the long run, the side that most insistently believes in its own arguments usually wins. This neatly sums up the outcome of the 2008 election, and the current state of the health care debate. I don't think every swing voter would categorically embrace everything that's happened at the town hall meetings (on either side), but the fervor of one side over the other sends important signals to unaffiliated voters that the doubts outweigh the reassurances on Obamacare, and to armchair quarterbacks everywhere, that the President is on the defensive and dogged by opposition.

More than that, it sends signals to swing Congressmen. It's not uncommon for members of Congress to freak out when one, maybe two people, pose uncomfortable questions in town hall meetings. Because members tend to self-perceive a bubble around them, they place high value on anecdotal feedback.

Now, scale this up to the scenes from town hall meetings. What are people who are programmed to overreact to negative feedback from a handful of questioners supposed to do when confronted with hundreds? React the opposite way? Implausible. Even if they believe the bogus astroturf argument, is it not reasonable to believe a seedling of doubt has been sown even in the most partisan Democratic members, that Obamacare is a political dog that's stirred up a hornet's nest. 

More likely than not when September rolls around, the Blue Dogs are going to have a clear message for the White House: "Make this go away."

This new health reform video produced by Colorado's Independence Institute (disclosure: my employer) is a great example of combining original research with short, viewer-friendly animation to convey a clear message about the dangers of greater government intervention in our health care.

It tells the story of Oregon's experience with Medicaid rationing, specifically how organized special interest groups were able to use their lobbying power to give higher priority to providing coverage for more politically correct treatments (eg, substance-abuse, birth control, weight loss) while treatments for others got lower priority or no coverage at all.

This video is a sequel to a similar animated piece on Obama Care that highlighted the dangers of health insurance mandates, using the Massachusetts story and a bus hitting

We need to keep framing the story with honest arguments based in real-world policy examples that are easily accessible to everyday voters. Yes, I'm biased, but this is excellent work from a state-level think tank -- I'd like to see more emulating this strategy.

A lot is being made of the town hall meetings held by Senators and Congressmen regarding health care, and the anger being expressed by many of the crowds. What the far left fails to realize is that they are causing much of this anger, not as much through their proposals, but by manner they treat people with differing opinions. This started during the presidential campaign when the left and a complicit media summed up McCain supporters as 'down-scale', angry, uneducated, hicks. The campaign is long over, personally I've been called worse, and would be completely willing to let this go if it weren't for the fact that it is a tactic that is being put into use again against citizens who challenge the administration's health care plans. Now the left is again trumpetting any opposition as being 'mob-like.' An email sent from the Democratic Party calls out the "Anti-reform Mobs", and tell the reader how scared these angry mobs are...

People are scared because they are being fed frightening lies. These crowds are being riled up by anti-reform lies being spread by industry front groups that invent smears to tarnish the President’s plan and scare voters. But as the President has repeatedly said, health insurance reform will create more health care choices for the American people, not reduce them. If you like your insurance or your doctor, you can keep them, and there is no “government takeover” in any part of any plan supported by the President or Congress.

First, this is insulting. People who don't want government run health care, or this version of health reform are being characterized (like during the campaign) as simple-minded, reactionary, idiots. Second, the proof that these people are intellectually challenged is that "the President has repeatedly said," that this is a good thing. So anyone who questions the President is clearly dim-witted (or forgot to drink their Kool-Aid). The great thing about this country isn't the political parties, it's the political debate. Talking down about those that disagree with you is nothing new in politics, but its being taken to a new level by either the administation or the administration/party operatives. People are angry, some are over-the-top inappropriately angry, but most are rightfully angry that they are not being heard and are being belittled for being thoughtful concerned citizens that are demanding a debate. Finally, the Senators and represenentatives that are continuing to do town halls knowing that they may face a hostile reaction deserve kudos. I may not agree with their policy, but I appreciate their backbone, and that they are doing their job and listening to their constituents. Cause for Anger

Reports out of Florida indicate that Democrats have decided to do something about the emerging threat of those pesky voters talking back to their betters. You see, the way it works is the politicians talk AT the people, and the people shut up and listen. These angry people are doing it wrong.

In light of new video I have acquired, It's understandable that Democrats would want to stock up on Union security to put a stop to all that protesting.  Witness the mob!

UPDATE

Well, this is fascinating. The Tampa Bay Online story that I linked above has been radically changed.   It initially said this...

Reed said she set up the town hall with the help of Service Employees International Union, a large, politically active union that represents nursing home workers, among others. "I represent a number of people who ask questions about what's going on with health care, so I thought it would be good to put on a meeting and have the congresswoman come in and give an update," said Reed.

Asked earlier today about possible disruption at the event, Kim Diehl of SEIU said, "We're prepared. We have strategies to deal with it if it should come up."

That has been deleted and replaced with something far more SEIU/Democrat friendly:

The meeting was organized by Reed plus the Service Employees International Union, other unions and Organizing for America, a liberal group that grew out of the Obama presidential campaign.

Some opponents accused the organizers of trying to stack the crowd by allowing early admission to those on their side. Reed denied that, saying those admitted early were organizers setting up the room.

In any case, opponents appeared to outnumber proponents both inside and outside.

After doors to the meeting room closed, some of those outside crowded around the windows of the meeting room, where they held up signs and chanted.

In the last week or so, similar disruptive protests have erupted at town hall meetings in several states.

Democrats, including White House spokesman Robert Gibbs, have said the disruptions were organized attacks aimed at Democrats by conservative, anti-health care reform interest groups. Several protestors at Thursday's meeting in Tampa angrily rejected that contention.

Castor's staff said Reed planned the meeting and invited Castor before the controversy became so heated. Reed said she set up the meeting because, "I represent a number of people who ask questions about what's going on with health care, so I thought it would be good to put on a meeting and have the congresswoman come in and give an update."

Reed said she was shocked by the number of people who turned out and some of their reactions. "When you get to the point of possible violence, you've gone over the edge," she said.

In a news conference prior to the town hall, Castor had said, "I do expect some rabble-rousing." She said the protesters who have been appearing at town hall forums on health care "would have been protesting Medicare … they would never have accepted Social Security."

Tampa police spokeswoman Andrea Davis said the department was told a couple hundred people would show up and sent a squad of 10-15 officers, two marked cars, two supervisors and some undercover officers. As the crowd grew, more were brought in mainly for traffic control, she said, but they also broke up some scuffles. She said no arrests were made.

So they eliminated the part about the SEIU being a "large, politically active union".  They also eliminated the SEIU representative saying "We have strategies to deal with" the protesters.

In their place, they just inserted Democratic talking points. Terrific.

See also:

• Red State

• Carol with a report from the event (with pictures)

• Nadia Naffe, who says police reports were file by people saying they were injured by SEIU people, as well as this: "The last thing I was before I exited the event were two women running over to a cop sitting in his vehicle, screaming, “Don’t you see that man over there has a gun?” The cop looked up and calmly replied, “Ma’am in this country people have the right to bear arms”."

• The one picture of somebody actually being hit at the Tampa meeting.  The person delivering the hit is identified as Karen Miracle.  I'm guessing she's the Karen Miracle who is Treasurer of the E. Hillsborough Democratic Club.  Her husband, Garry (also pictured), is the Political Director.

• Another apparent Democrat arrested.

[Note: Sorry, the title should read "2009 VS 2005", but I can't change it without breaking links]

Paul Krugman:

A number of people in the news analysis business seem to be equating the role of liberal activists in making trouble for Republicans back in 2005, during the debate over Social Security privatization, with that of conservative activists in making trouble for Democrats over health care reform. [...] Seriously, I’ve been searching through news reports on the Social Security town halls, and I can’t find any examples of the kind of behavior we’re seeing now. Yes, there were noisy demonstrations — but they were outside the events. That was even true during the first month or two, when Republicans actually tried having open town halls. Congressmen were very upset by the reception they received, but not, at least according to any of the report I can find, because opponents were disruptive — crowds booed lines they didn’t like, but that was about it. [...]

So please, no false equivalences. The campaign against Social Security privatization was energetic and no doubt rude, but did not involve intimidation and disruption.

Reality:

• NW Progressive Institute, March 2005: "a boisterous crowd which frequently interrupted the discussion with shouts and hard nosed questions. ... Democrats in the audience who were interrupting the panel.... the crowd erupted in anger... Democrats in the audience started shouting him down again."

 

• Savannah Morning News, March 2005: "By now, Jack Kingston is used to shouted questions, interruptions and boos. Republican congressmen expect such responses these days when they meet with constituents about President Bush's proposal to overhaul Social Security."

 

• USA Today, March 2005: "Shaken by raucous protests at open "town hall"-style meetings last month ... Santorum was among dozens of members of Congress who ran gantlets of demonstrators and shouted over hecklers at Social Security events last month. Many who showed up to protest were alerted by e-mails and bused in by anti-Bush organizations such as MoveOn.org and USAction, a liberal advocacy group. They came with prepared questions and instructions on how to confront lawmakers."

Democrats argue that a Public Option won't crowd out private health insurance. It will just give them "healthy" competition. I'm skeptical, in large part because the government can and will simply legislate away the normal aspects of competition (the need to balance the books, to make cost/benefit calculations, and to negotiate on price/quality, rather than on "...or else we'll regulate you into submission").  Policies designed to keep down health care spending will not survive against politicians up for reelection.

The people responsible for Trillion dollar deficits are unlikely to usher in an era of health care spending restraint.

Other Democrats have just come right out and acknowledged that a public option would eventually crowd out private health insurance.

A public insurance plan able to use Medicare's bargaining power to secure deep discounts for its customers and ensure the maximum possible network would be cheaper and more efficient than private insurers. Over time, this increased efficiency would make the plan more attractive because it could offer more coverage for less money. As consumers recognized this fact, they would increasingly migrate towards the plan, and the public insurer would become, if not a de facto single payer system, something close to it. The public insurer, in this scenario, is a game changer. [...] Insurers, predictably, howled that a public insurer with access to Medicare's market power would put them out of business. (Generally speaking, liberals agreed with that.)

Still other Democrats have pointed to the education system as an example of universal coverage with private alternatives.  On Twitter, Pandagon's Jesse Taylor argued that a Public Option wouldn't affect private insurance...

What healthcare choice can you exercise right now that a.) would be gone under a public option and b.) couldn't be taken away currently?

Politicians who make this argument should be confronted with this question: What school choice can you exercise right now that would be gone if we had vouchers and school choice for everybody?

Democrats refuse to level the playing field between the public and private options in education.  They will do the same thing in health care. 

I know the Left likes to ridicule anyone who mentions Ayn Rand or Atlas Shrugged. They especially like it when conservatives or Republicans say something about "Going Galt".

It seems to me that one reason for this is a (deliberate?) misunderstanding of what we -- or at least, I -- mean when we say that.

By "Going Galt", it seems to me, we (mostly) mean that someone will not take that next step, make that investment of time, effort, thought, or money, to make their mark in the world and make a difference.

Like Rand's great philosopher Hugh Akston who became a short order cook in a roadside diner, rather than using abilities to their utmost, someone who "goes Galt" might simply choose to do something else, rather than take the extreme Galt/Wyatt/Mulligan option of completely removing themselves from the reach of the looters and the moochers.

In that light, I think Obamacare is going to cause us more problems than many have been imagining. . . .

I have heard from a surgeon whom I trust and respect (though I don't know his source for this information) that much more than half of all surgeons are 55 or older.

Given the basic premise that people do things based on the incentives involved, and given the further premise that Obamacare (or, if it fails, the next incarnation of it) will reduce the financial and professional incentives to become a doctor, my friend believes strongly that we will be in for medical rationing simply because we will not be able to find enough doctors, regardless of what happens due to gov't bureaucratic manipulations.

My friend spent 14 years -- FOURTEEN YEARS -- after college training to become a doctor, then surgeon, then getting his specialty skills.

What makes people think that we will be able to find "volunteers" to go through such a rigorous and lengthy program, all the while incurring massive amounts of debt for the cost of their schooling and training, just so that they can be asked to work 36-hour shifts* for whatever salary a bureaucrat determines they are worth?

My friend loves his work. He does it for the satisfaction he gets from it.  (Now.) But when asked if he would have gone through everything he went through solely for the satisfaction of the job, he says no.  The potential to make a good living for himself and his family was definitely part of the attraction to the career choice in the first place.

There are other jobs he could have loved and been accomplished in performing, while paying well.  Plus they would have afforded him much more time to spend with his family as his children grew up, rather than having to spend significant portions of not just days but nights as well away from home and on call.

The point I want to leave you with is that we can expect to lose men such as him from the medical profession if we insist on making them gov't cogs rather than free actors, capable of making what they can in a market which rewards them for their dedication, efforts, sacrifices, and skills.

Beware what you wish for, Obamacare supporters.  You might just get it . . . and then the supply of producers whose efforts you have appropriated will dry up, relieving you of the burden of looting them.

---------------

* Yes, I know the 24+ hour shifts don't last forever.  And that they are concentrated in the early years of training, but does that really make anyone think that people will jump at the chance to perform such arduous tasks for the pittance the DC paper pushers are willing to fork out?  Really?

HEALTH CARE - SO EASY A CAVE MAN CAN DO IT

1 - Restrict punitive damages in malpractice suits to $750,000.2 - Enact a federal coding standard... require all medical insurance companies to use the same system. If the industry won't standardize itself, this is an appropriate role for the federal government.3 - Repeal all laws that restrict which companies can operate in certain states.4 - Prohibit employers (including government) from providing health insurance for employees. Instead, require them to provide a cash amount consistent to what they are currently paying for the policy today.

This allows all insurance companies to operate anywhere, with no protected territories.This eliminates unnecessary overhead due to proprietary legacy billing systems.This eliminates the motive for trial lawyers to jack claims to get rich. Trial lawyers can't sue someone for 85 bazillion dollars for having a sponge sewn up inside them. Consequently, malpractice insurance is cheaper.Employers no longer have the overhead associated with administering a health care benefit.Each person/family can now go out and buy their own policy.

5 - Abolish Medicaid and Medicare.6 - Establish a reasonable income limit (use current Medicaid eligibility guidelines + 20%) and give the poor a voucher to go buy their own policy.

Cost to enact? The government will need a small bureaucracy to administer the voucher program. This would best be handled at the state or county level and should be funded federally with some of the money that we no longer spend on Medicaid or Medicare.

Benefits: Former state dependents (Medicaid recipients), now become empowered consumers. They probably can't add more cash to the amount of their voucher to buy an upscale policy. Many of them will become ruthless price hawks, trying to get the most coverage for that money.

A basic flaw our current system is that my health insurance does not work for me. They work for my employer. If they don't give me the service I want, I have no recourse. Under the plan I listed above, every insurance company will be responsible to every customer. They will be forced to compete in a market that they had previously not. If Single Mom has Allstate health insurance, and Geico offers free dental, don't you think she'll switch? If Busy Businessman is getting hassled trying to get his claims paid by Nationwide, don't you think he'll find a hassle free company? It's self policing.

Stigma - Do you know how hard it is to find a dentist that takes Medicaid? Some folks are also embarrassed having to tell someone that they are on government assistance. This plan removes that stigma. No health care provider will know how you paid for your insurance.

Some government oversight is in place because insurance companies will have to justify rate increases (affects the cost of vouchers) to Congress.

If you forward an inaccurate email or write an inaccurate blog post, the White House wants to see it.

There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care.  These rumors often travel just below the surface via chain emails or through casual conversation.  Since we can’t keep track of all of them here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov.

What, exactly, does the White House plan to do with this information? 

UPDATE: The White House responds...

"There is a lot of misinformation about health insurance reform circulating on the Internet and elsewhere,'' she explains. "Some of it is intentionally misleading.

"We want to be sure people have the facts about health insurance reform that will lower costs, protect consumers from insurance regulations that deny them coverage and assure quality and affordable health care for all Americans,'' she adds. "We are not compiling lists or sources of information. We may post fact checks from time to time to be sure Americans know the truth about health insurance reform.''

I believe that is the case. This was simply an inartful way of asking people to help them figure out which new claims they need to be addressing.  The White House should respond to inaccurate arguments.  But I hope they will do so in a transparent way.  Instead of responding to private emails, they should be linking and responding to claims made publicly online.  Better yet, they should be participating in a dialogue - responding to the better criticisms made by important critics in the internet media and blogosphere. That would be transparent and valuable.

Let’s put aside our right-leaning suggestion box for a moment and put the challenge straight to the left as follows… (Warning: intellectual honesty check.) Will your bill:

1. Control Costs? If you have any third-party payer system, you’ll have a situation in which people overconsume. Because they have no incentive to be bargain shoppers, they won’t shop for bargains. Costs will continue to go up. Subsidized healthcare ensures people will continue consume more of what they don’t have to pay for directly. That’s the major driver of costs in healthcare. How will you deal with this problem—which is the main problem (not “administrative costs”?)

2. Avoid Using Price Controls? Bureaucrats determining prices will, as it always has, mean gross distortions (that whole supply and demandt thing). In the absence of real prices, resources don’t get allocated properly, because prices are a way to deal with dispersed, complex information. This is the problem we saw in the Soviet Union and it’s a major problem for the Canadian system. Will your system use price controls?

3. Avoid a Special Interest Bonanza? Any subsidized, government-provided reform will mean healthcare becomes a Freddie and Fannie phenomenon. Private companies that serve the government insurer will become special interests. They will game the system and rape it, as they have in so many other spheres of our life when colluding with government. Their prices will go up (unless controlled) and their profits will remain private. Losses will get covered up by continued subsidies and cost-shifting through higher taxes. This may also mask the cost-spiral (for a while). Eventually, heavy rationing will ensue or taxes will go through the roof. Is this bill healthcare corporatism?

4. Avoid Rationing Healthcare (Limiting “Access”)? If the government really wants to control costs, it will have to ration care. The problem is, we need a system in which individuals ration their own care, not bureaucrats with little or no connection to the individual. I ration my own healthcare (by shopping with my HSA dollars) and I prefer to keep it that way, despite the protestations of leftish types who believe they can make better decisions about my healthcare than I. Rationing means quality goes down and access gets limited.

5. Avoid More Deficit Spending? President Obama seems to be betting on energy taxes (cap and trade) to pay for what would amount to massive increases in government spending on healthcare. If the cap and trade bill doesn’t pass, will the government be able to pay for healthcare reform by simply cost-shifting to the wealthy? Or will taxes go up for everyone and big time rationing happen? The American people are at their end with the record deficits. Are you willing to push the envelope?

If your healthcare bill can’t pass this simple 5 question test, it’s not a good bill.