The future of American democracy

I’m married to a pessimist.  He’s been reading Gibbon’s The Decline and Fall of the Roman Empire and is convinced we are now well into the decline.  While I’m not quite so pessimistic, I admit I have my own moments of despair.  Sometimes it feels as though we have no control over the future.  Almost certainly, the Republican party has already caved in.  But events like the recent election in Alabama and the  generic polling that consistently shows a preference for electing Democrats to Congress this year give me a ray of hope.  If Virginia can almost completely flip the state legislature, why can’t we do the same for Congress?

I can think of at least three roadblocks:  Money (think the Koch’s), voter suppression (gerrymandered districts and new voter rules), and, last but not least, the age of the Democratic leadership.

A lot has been written about the first two roadblocks on my list but not so much about the third.  I love the members of the Vermont delegation but, let’s face it, the youngest is Representative Peter Welch who is exactly my age – 70.  I’m pretty sure that I am will vote for his reelection – and for Bernie’s – but there are a number of younger folks who will be ready to take their places next time around.  For right now, we need their seniority.

Moving from Vermont to national politics we have Nancy Pelosi (77) and Chuck Schumer (67).  If the Democrats retake the House, and even if they don’t, it is time for Nancy to retire gracefully.  She has served us well as both majority and minority leader, but it is time for the next generation.

Howard Dean, another Vermont politician I supported for President, is one of the few of my generation speaking out about this.  In a recent NPR interview with Rachel Martin, Dean said

The most important age group for us is people under 35. They elected Barack Obama in 2008. But now it’s time to let them take over. And they’re going to have to take over on their own terms. We have tons of talent in our party. We do not need to rely on my generation anymore. And these kids think differently. They’re more respectful of each other. They’re willing to listen to each other’s ideas and work things out. They’re entrepreneurial. They’re more conservative than we are economically than the left wing of the Democratic Party. They’re mostly libertarian.

I just think this is the future of America. They are diverse. They value immigration. They value different kinds of people. They believe that gay rights is the civil rights issue of their time. They care deeply about the environment. We need a real change in this country and the only way to do it is for us to get out.

Dean goes on to say that the party has to change because the world is changing and is no longer so dependent on institutions.  There are all sorts of interesting people running for Congress this year filed as Democrats.  I believe I read that most of the House seats in red districts have a Democratic challenger.  At this point, I think the most important role the Democratic Party as an institution can play is to help raise money as the elections will be won by grassroots workers who will not necessarily be Democrats.

So what about 2020.  The word here is that Bernie is gearing up for another run.  Yes, I know that Bernie’s base was young people in 2016, but by 2020 he and they will be four years older.  And even though there is likely nothing there, the Jane Sanders financial stuff is going to haunt any campaign.

My pessimistic husband sees no one who can run, but remember in 2007 no one thought that Barak Obama known only to Democratic activists for his speech at the 2004 Convention, could run, much less win. So let’s look at some new faces:  Seth Moulton (age 40, ex-Marine Congressman from Massachusetts); Cory Booker (Senator from New Jersey, age 49); Kamala Harris (Senator from California, age 55); Kirsten Gillibrand (Senator from New York, age 55); Amy Klobuchar (Senator from Minnesota, age 58); and Chris Murphy (Senator from Connecticut, age 45).  Look them up.  And I’m sure that there are some Mayors out there who would be interesting candidates.

I still think our democracy can be saved, but we each have to play the proper role and for Democrats of my generation, that means following Howard Dean’s example and moving ourselves to a supporting role.

 

Dr. Bones Explains Health Care

This past Sunday, the back page of the Boston Globe “Ideas” section was a great cartoon by Dan Wasserman.

And I’m still disappointed about the public option, but I’m not quite ready join Howard Dean and dismiss the entire bill.  [An update:  soon after I first published this Howard was on the Rachel Maddow show saying he is now not going to oppose the bill due to some additional changes that had been made.]

For more from Wasserman use the blogroll link for Out of Line.

Moving closer to Health Care Reform

Everyone on the Sunday talk shows yesterday optined that the health care reform effort was moving closer to passage. 

“We’re entering the final stage, and everyone is maneuvering to get the best possible deal,” said Drew E. Altman, president of the nonpartisan Kaiser Family Foundation. “The odds of passing legislation are steadily moving up.”

The final bill will not be perfect, but I believe it will contain a public option of some kind.  The other big questions are financing  and affordability.  The reason I think the bill will have a public option is because a friend my husband  was talking to the other morning supports one.  He is not a political activist, tends to be conservative, and is a veteran.  He talked about the rise in premiums he had experienced and the fact that vets have now come to understand that they won’t lose their coverage under VA – or have to pay for it – but that others will gain  the kind of health care they have.  He thinks this is a good thing.  And the opinion polls show others are moving his way.

I think there will be an opt out provision for the states, but, unlike the stimulus funding, the governors will not be able to “refuse” to implement the reforms at all.  I think it will end up will a 3 to 5 year trial period after which a state could opt out or a similar period during which the insurance companies in a state would have to lower premiums or they would have to become part of the government provided health care.

There are a lot of details to negotiate.  Like how to pay for reform.  We will have to see if the President has, in the end, provided the weapon to defeat the bill .  Is his 900 Billion cap going to mean a bad bill or no bill?

Howard Dean has a great feature on his health care reform webpage.  The vote tracker allow one to sort for public option supporters.  Dean, like President Obama, is not supporting a particular bill, but iw helping to keep an eye on the votes in support of the public option.  His latest count is 218 house votes and 51 in the Senate.  We need to work on those undecideds in the House, but it appears that if all Democratic caucus members vote against the filibuster, the Senate can then pass a bill with a public option.  Go to his list and filter for undecided Democrats and if your Congressperson or Senator is on the list, give them a call.

Even John McCain now thinks Congress will pass a bill with some kind of public option.

“I think the Democrats have the votes, and in the House, Blue Dogs bark but never bite,” Mr. McCain said on CBS’s “Face the Nation,” using the nickname for conservative Democrats . “So I don’t think they have a problem over in the House side. In the Senate I think the Democrats are very aware that they don’t want a repeat of the Clinton failure in 1994. So I think it’s very likely they will get something through. But it’s not clear to me what it is.”

The Democrats need to forget the Republicans and get the votes in the party.  Even Senator Ben Nelson appears to be moving toward support of some type of public option.

The remaining big pitfall is abortion and whether the bill has a provision to pay for the procedure under the public option.  Right now, I have to say that will be a compromise point and reproductive choice will remain a choice only for those that can afford a choice.

Facts for the Health Care Debate

Anyone who reads this blog regularly already knows that I am in favor of reform all the way to single payer.  However, with single payer not an option, I have been sending email and writing everyone , including President Obama, that we need to keep the public option.  I don’t believe anything will really change without it.  But the debate has really degeneated.  Things are being presented as “fact” that are not true, but once said take on a life of their own.

This week Newsweek presented a two-page spread by Sharon Begley titled “The Five Biggest Lies in the Health Care Debate”.  But I think there are actually 6.  The quotes are from Begley; the comments are mine.

1) There will be electric funds transfers out of your bank account that you will not control.

 Take the claim in one chain e-mail that the government will have electronic access to everyone’s bank account, implying that the Feds will rob you blind. The 1,017-page bill passed by the House Ways and Means Committee does call for electronic fund transfers—but from insurers to doctors and other providers. There is zero provision to include patients in any such system.

2) You’ll have no choice in what health benefits you receive.

In fact, the House bill sets up a health-care exchange—essentially a list of private insurers and one government plan—where people who do not have health insurance through their employer or some other source (including small businesses) can shop for a plan, much as seniors shop for a drug plan under Medicare part D. The government will indeed require that participating plans not refuse people with preexisting conditions and offer at least minimum coverage, just as it does now with employer-provided insurance plans and part D. The requirements will be floors, not ceilings, however, in that the feds will have no say in how generous private insurance can be.

3) Older patients and the very sick will not get treatment.  This is related to the Stephen Hawking myth.  The one that he would be dead now if he were getting benefits under the British health care system.  Only he is under the British National Health and as of this morning is alive and still doing his work.

The House bill does not use the word “ration.” Nor does it call for cost-effectiveness research, much less implementation—the idea that “it isn’t cost-effective to give a 90-year-old a hip replacement.”The general claim that care will be rationed under health-care reform is less a lie and more of a non-disprovable projection (as is Howard Dean’s assertion that health-care reform will not lead to rationing, ever). What we can say is that there is de facto rationing under the current system, by both Medicare and private insurance. No plan covers everything, but coverage decisions “are now made in opaque ways by insurance companies,” says Dr. Donald Berwick of the Institute for Healthcare Improvement.

What I don’t understand is why wouldn’t we want to know what is most effective so we can all be treated in the best, most cost effective and beneficial way.

4) Illegal Immigrants will get free health care.  I think they already do when they go to emergency rooms and our insurance premiums reflect that cost.

Will they be eligible for subsidies to buy health insurance? The House bill says that “individuals who are not lawfully present in the United States” will not be allowed to receive subsidies.

Can we say that none of the estimated 11.9 million illegal immigrants will ever wangle insurance subsidies through identity fraud, pretending to be a citizen? You can’t prove a negative, but experts say that Medicare—the closest thing to the proposals in the House bill—has no such problem.

5) There will be death panels making decisions about who gets treatment.   Related to #)3, this has been debunked all over but still lives particularly in the minds of Betsey McCaughy and Sarah Palin.

This lie springs from a provision in the House bill to have Medicare cover optional counseling on end-of-life care for any senior who requests it. This means that any patient, terminally ill or not, can request a special consultation with his or her physician about ventilators, feeding tubes, and other measures. Thus the House bill expands Medicare coverage, but without forcing anyone into end-of-life counseling.

I’ve had a lot of older relatives who have had end of life discussions with their doctors to decide on the level of treatment desired.  Everyone found them comforting and helpful to have decisions made.

6)  The government will set doctor’s wages.  I believe that one way to control costs is to put doctor’s on salary rather than fee for service which often ends up in many extra tests as the doctor and his or her practice tries to pay for equipment and up the billing.  However the proposed bills do not do this.

This, too, seems to have originated on the Flecksoflife blog on July 19. But while page 127 of the House bill says that physicians who choose to accept patients in the public insurance plan would receive 5 percent more than Medicare pays for a given service, doctors can refuse to accept such patients, and, even if they participate in a public plan, they are not salaried employees of it any more than your doctor today is an employee of, say, Aetna. “Nobody is saying we want the doctors working for the government; that’s completely false,” says Amitabh Chandra, professor of public policy at Harvard’s Kennedy School of Government.

I close with the picture Newsweek chose to accompany this story.

Town Hall Face:   An unsightly condition caused by unsanitary health-care politics

The Health Care Debate – mid-August

Everyone is talking about health care.  Sarah Palin thinks one of the House bills would lead a death panel.  Stephen Hawking defends the British system from attack by Americans.  Howard Dean thinks Palin is making things up.  And Christopher Hayes mocks us all proving that the Left has a sense of humor.

Sarah has retired as Governor of Alaska but she’s still posting on her facebook page.  CNN quotes her

In her post, the former Republican vice presidential candidate said President Obama’s health care plan would create a “death panel” that would weigh whether her parents or son Trig were “worthy of health care.”

This phrase, “Death Panel”, is now resonanting all around the country.  President Obama addressed it at his town hall meeting in New Hampshire.  Howard Dean tried to refute it

Former Democratic National Committee Chairman Howard Dean told CNN Sunday that former Alaska Gov. Sarah Palin had deliberately made up charges that the Obama administration’s health care bill would lead to euthanasia.“About euthanasia, they’re just totally erroneous. She just made that up,” he said. “Just like the ‘Bridge to Nowhere’ that she supposedly didn’t support.

“There’s nothing like euthanasia in the bill. I practiced medicine for a long time, and of course you have to have end of life discussions — the patients want that. There’s nothing… euthanasia’s not in this bill.”

In the past few years, I have been party to several end of life discussions most directly with my parents and more indirectly with my in-laws.  All have been conducted with the patient, family, and doctors.  Don’t we want our insurance, including Medicare, to pay the doctor for his or her time and encourage those discussions?

And now the British are weighing in also.  Yesterday, Stephen Hawking received his Presidential Medal of Freedom and jumped in with a response to the Investor’s Business Daily – which in it’s zeal appears to have forgotten that Mr. Hawking is British and under National Health.  The best summary is in the New York Times ,

The physicist Stephen Hawking is defending Britain’s National Health Service after an editorial in Investor’s Business Daily said Mr. Hawking “wouldn’t have a chance in the U.K.,” where the health service would have deemed his life “essentially worthless.”

The publication’s mistake, which came in an editorial titled “How House Bill Runs Over Grandma,” has since been corrected. But on a larger level, the snafu also shows how quickly rationing, particularly at the end of life, has become a focus of the health care reform debate.

Mr. Hawking — who received the Presidential Medal of Freedom at the White House on Wednesday — responded to the editorial this week, telling The Guardian newspaper, “I wouldn’t be here today if it were not for the N.H.S. I have received a large amount of high-quality treatment without which I would not have survived.”

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At this point, I fear for any type of health care reform.  New polls seem to show that older Americans oppose reform. The medical industry is threatening to pull support if legislation call for anything more that the co-op model.  Chris Matthews interviewed a man carrying a gun outside of the President’s New Hampshire town hall meeting.   I wonder if when they get back to Washington, there will be anyone left, Democratic or Republican, who wants to vote for health care reform.  Maybe they would prefer to just left the system explode or maybe implode.  Or we can be like Chris Hayes and try to laugh at the situation.

Here are parts of Hayes’  “Your Questions About Health Care Reform Answered”

Ok, so there’s been a lot of misinformation about proposals to reform the health insurance industry and provide (near) universal coverage. Understandable! It’s complicated stuff. Herewith, I’ll try to answer some questions

1) Is it true that all of the bills currently proposed would end the practice of “rescission,” whereby health insurance providers refuse to treat customers who’ve paid their premiums simply because they’ve become ill?

No! That’s a common misunderstanding. Actually, all of the bills would ban incisions, that is, they would legally bar surgeons from performing surgery until a panel of twelve gay illegal immigrant government bureaucrats unanimously signed off on the procedure.

2) Is it true that health care reform would ban insurers from refusing to insure people because of pre-existing conditions?

Wrong again. To get rid of health inequality, the bills actually mandate that every American be given a pre-existing condition. A National Illness Commission, with academics appointed from Harvard, Reed College and Berkeley, will evaluate each citizen, and based on their demographic profile, choose their malady. Each disease or syndrome is scored on a scale of 1 to 10, with 10 being the most severe. White christian men will receive pre-existing conditions of 8 or higher. Black people, “wise latinas,” and ACORN members will be exempted.

5) Will the current bills plug the “donut hole” in the Medicare prescription drug benefit so seniors don’t have to pay exorbitant out of pocket expenses for their medication?

Absolutely not. The legislation will ban donuts.

If you don’t laugh, you’ll have to cry.

So what’s up with the Democrats and Health Care

Will the Blue Dogs kill Heath Care reform or can Nancy Pelosi, Ted Kennedy, and the President prevail?

Here is a blog entry by Christopher Hayes from July 28 titled “What the Hell Is Max Baucus thinking!?!”

The following comes from a reader and frequent correspondent. This is not someone with particularly progressive politics. In fact, he only very recently has come to identify as a Democrat. No radical lefty, he.

 I don’t get the democrats on this one. Even if Charles Grassley and Olympia Snowe vote for this deal, the Republicans will still run against it as the Obama/Pelosi plan. Why not stick to your guns, treat the problem from a parliamentary perspective, and put through a plan that you actually think is optimal. The current attempt won’t protect their downside at all and may limit the upside. Very frustrating.

 More than frustrating. Enraging.

That’s it, the entire entry.  A lot of us are asking the same question.

Then there is my health care guy, Howard Dean.

Howard Dean guest hosted Countdown with Keith Olbermann at an opportune time last night, following reports that the Senate Finance Committee–helmed by Montana Democrat Max Baucus–is preparing to exclude a public option from its long-awaited healthcare bill.

“What if the Senate Finance Committee has already done the Republicans’ dirty work for them?” Dean asked rhetorically at the beginning of show.

Dean has just authored a book on healthcare reform–detailing why America needs a public option–and knows quite a bit about the subject from his years as a doctor and governor of Vermont. He called Baucus’s reported bill the “so-called compromise.”

Dean asked Chris Van Hollen, chairman of the Democratic Congressional Campaign Committee, why Baucus would “give away something something so fundamental to healthcare reform as a public option?”

“We‘ve got to have a public option in the plan that we send to the president‘s desk,” Van Hollen responded. “We‘re all still hoping that the Senate Finance Committee bill will have a public option.”

Dean noted that 72 percent of Americans, according to a New York Times poll, support a public option. “Is what Americans want already dead in the Senate?” Dean asked.

“No,” Van Hollen answered. “I certainly hope not. It‘s certainly not dead with respect to the bill that we‘ll send to the president‘s desk.” But it isn’t clear what kind of leverage House Democrats have with the likes of Baucus, nor do we know yet whether they’ll be able to keep their own Blue Dog conservatives in line.

“Voters were promised change they can believe in,” Dean told Van Hollen. “Are you concerned about what may happen to our party in 2010 or 2012 if we don‘t get any change at all?”

I’m not quite sure why the Blue Dogs and the Republicans are so afraid of the public option.  Health care for veterans which works pretty well is public as is Medicare.  So back to Chris Hayes and his post from today.

This has got me thinking: Republicans opposed Medicare when it was created. They hate socialized medicine, government-run health care and the public option now. So why don’t they put their money with their mouths are and propose scrapping Medicare? Any bills like this been introduced? If not, why not? I seriously think every single conservative and Republican caught railing against government run healthcare needs to be asked if they support disbanding Medicare.

Obama’s Press Conference at 60+ days and other Presidential Matters

How’s he doing?  I thought the press conference last night showed a more subdued President Obama.   David Biespiel said on Politico’s Arena

Overall: Professor in chief. I saw the news conference on CNN from my hotel room. Will cable TV present every Obama news conference as if it’s the last night of Yalta? I disagree with the interpretation that these night time press conferences should be for dramatic events only. Meeting with the press monthly on prime time is good for democracy–whether the climate is dramatic or not. 

I tend to agree with him.  I don’t think the President is at his best with press conferences – he seems to do better with town hall meetings – but they are informative.  Maybe he should think about a prime time town hall meeting.

Thomas Mann from Brookings said on Politico’s Arena

What struck me about last night’s press conference was how the President managed both to maintain his signature leadership style — cool, intelligent, knowledgeable, and reasonable — and to forcefully advocate his position that his economic recovery program and his budget are inextricably linked. He also signaled clearly, especially in his closing remarks, that he fully understands the obstacles he faces and that some of his priorities will take years to accomplish. It appears he will continue to aim high with an ambitious agenda in spite of the clamor of critics for cutting back on his objectives. In a world in which an exclusive focus on short-term gains has dominated behavior in government and in the private sector, Obama is planning an eight-year program of governance that aspires to grapple seriously with long-term challenges.

Which leads me to talk about the Republican opposition.  Several Republicans posted on the Arena their disappointment that there was no real opposition agenda.  I believe that the President has also pointed out that there is no alternative budget so there can be a real discussion.

Eugene Robinson wrote in today’s Washington Post

Some listeners thought they heard flexibility or even retreat on the president’s ambitious agenda of health care, energy and education. I heard the opposite — a single-minded focus on these three initiatives, which Obama maintains are vital if the economy is to be put on sound footing. His strategy is to let Congress work out the details, but he was clear that he expects all of the Big Three to be reflected in the budget. One thing we’ll learn about him, the president said, is that he’s persistent. I’m going to take him at his word.

If you recall, Barack Obama stuck to a consistant message throughout his campaign.  He never let himself get sidetracked to drawn into debates he didn’t want to have.  I think last night showed he is still the same person, that what we saw during the campaign is what we got as a President.

One negative note to my evaluation of his first 60 days.  I am still worried about some of his appointments, particularly in the economic area.  As I have said before I am very very skeptical about Larry Summers in particular.  Christopher Hayes gave this piece of advice back in January and I think it is still relevant.

But as the Obama administration continues to fill thousands of government positions, they’d do well to heed the words of a wise man who once said that “tallying up your years in Washington is no substitute for judgment.” That was President Obama, whose primary campaign was largely predicated on the principle that having gotten something crucial, like the Iraq War, right when other people got it wrong was of such overwhelming importance that voters should elevate someone who’d been a state senator just a few years earlier to the highest office in the land over a competitor with years in Washington under her belt.

The voters agreed, and I continue to think they got it right. Maybe the president should go back and read some of his old speeches the next time there’s an opening in his administration.

And not to beat a maybe dead horse:  where is a job for Howard Dean?