Palin 2012

This is self-explanatory:

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All Eyes On Reconciliation

If health care reform is going to pass successfully through Congress, it's looking more and more like that's going to involve the reconciliation process. A bunch of folks are making that argument right now, ranging from Henry Aaron of Brookings to Jon Cohn of The New Republic. The reason why is rather simple: Senate democrats don't need 60 votes to pass reconciliation, because in reconciliation there is no filibuster.

As you would expect, the right-wing media (think FOX News) has already started churning out the propaganda on this one. As Ezra Klein notes, they're calling it the "nuclear option." Not surprisingly, they've missed the mark with this one, too, and are hoping their viewers are too ignorant to catch them at it. This is because the nuclear option refers to a point-of-order process in the Senate that allows a filibuster to be ended not through the 60 votes of cloture, but by recognizing the unconstitutional nature of the filibuster. In fact, it used to be called the constitutional option, but that sounded way too legitimate and noninflammatory to remain in use. I will stress the following point in bold face: The nuclear option does not and never has referred to any part of the budget reconciliation process.

What's the most ironic--or infuriating--is that Republicans are expressing such outrage that Democrats would pursue such an unorthodox route to pass health care reform, which the CBO shows would reduce the deficit, when Republicans themselves used reconciliation to push through the two largest (and deficit increasing) tax cuts our nation has ever seen. Why the irony? Because Senate rules stress that legislation passed via reconciliation must reduce the deficit. During the Bush administration, those rules were simply ignored. In fact, in the history of the reconciliation process, it's the only time that's happened.

As an excellent overview report from the Center on Budget and Policy Priorities makes clear, there is a strong precedent for using reconciliation to pass health reform. In fact, reconciliation brought us the State Children's Health Insurance Program, Medicare Advantage, and COBRA. Republicans had a hand in each of those in one way or another. What there was no precedent for was Republicans' use of reconciliation to cut taxes for the wealthy and jack up the deficit. But they seem to have forgotten about that.

What is clear, is that no matter what route the Democrats take in an attempt to move forward, they will be met with continued obstructionism from the right. Reconciliation can certainly work, but it will not necessarily be a smooth or painless process. In fact, if you want to catch a glimpse of the ugly political fight that might be ahead, you should read this from Jeff Davis. Don't say I didn't warn you.

Why the Right Hates Democracy

In the United States, our democracy works through a representative process. That is, we elect individuals to represent us in the legislature and we hold them accountable by making them run for re-election. Of course, the cynics need no further introduction to begin asserting "All politicians care about is getting re-elected!" I'm not sure that that statement is wholly accurate, but I'm also quite certain that it contains a great deal of truth. Still, that's not the point. The point is that our elected representatives are to be held accountable for representing us.

To be held accountable, however, requires two conditions to be met: the representative must have the responsibility to act in our best interests--or as we wish them to--and perhaps more importantly, they must have the authority to act. In the title of this post, I assert that the republicans hate democracy, which is perhaps hyperbolic, but the basis for the accusation is that absent a 60-seat super-majority in the Senate, the minority party can be as obstructionist as it wants to be, and this republican minority has been just that.

Now, if it were the case that the democratic majority was elected as a fluke, and its agenda did not reflect the will of the people, then the republicans would be embracing democracy by taking a stand against the majority. On health care reform, however, polls show that this is not the case. What's more, republicans have framed this whole affair such that the responsibility of governing falls squarely on the democrats, while republican obstructionism has not provided democrats with the authority necessary to uphold that responsibility. It's as if the democrats have been tasked to eat soup with chopsticks, but first had their hands tied behind their backs by the republicans.

It's highly unfair, to be sure, but that's politics. So what can the dems do? Well, sunshine is the best disinfectant. It's important to bring the message to the American people that you can either ask the majority party to govern and give them the authority to do so, or you must acknowledge that their inability to push legislation through Congress is not a failure on their part as much as it as a resounding success of your "just say no" politics. Of course, no party will readily admit to such self-incrimination. Therefore, it's the democrats who must make it abundantly clear that the lack of bipartisanship--in fact, the lack of Constitutional government process (I checked and the filibuster's not in there)--are rendering the legislative branch of government useless.

As a recent (Jan. 2010) Pew poll shows, it's a tall order. As politically active and as fervently opinionated as Americans can be, most have no idea of how our government works or has been working. More than two-thirds of those polled were unaware that no republicans voted for health care reform. Three-quarters had no idea how many votes are required in the Senate to end a filibuster. In fact, more of those polled knew who Stephen Colbert was than knew who Harry Reid was. (Stephen: If you're reading this, I know who both of you are, and I would love to come on the show and bask in the warmth of your awesomeness.)

My point is simply this: Democrats have been assigned the responsibility to govern and Republicans have denied them the authority needed to do so. That's a flaw in the design of our government (the filibuster) working to ensure that the voices of the people aren't heard--let alone acted upon, and that's why the right hates democracy.

Health Wonk Review

The latest edition of the Health Wonk Review is up on Joe Paduda's Managed Care Matters blog. I made it--briefly--into this edition, too. So, I have selfish reasons for suggesting that you read it. And stay tuned, because in March, I'll be taking my first turn hosting HWR, which I'm really looking forward to.

Fourth and Goal: More Health Policy Football

The media would have you and I to believe that health reform has failed once again. Those on the right are already rushing the field declaring victory before the clock has finished winding down. The thing is, the game's not over. As I wrote back in September, President Obama faced third-and-long on the eve of his address to the nation on health reform. Feel free to disagree, but I think--given the level of complete and utter tea-baggery that dominated the news throughout all of August--that he was able to get the first down. Health reform got back on track. Things were moving. Heck, the House passed a bill, and then the Senate followed suit. It looked like a Democratic "touchdown" was a near certainty.

But the Republican opposition is strong--if only because it remains so obstinate--and when Scott Brown picked up the seat in Massachusetts, the game-winning drive seemed to stall right in the red zone. If you ask me, I think it's fourth and goal. That means that there's no more room for progressing to another political "first down." Congress and the President are down to their last chance: Either they finish the drill and punch one through--enacting health reform--or they leave defeated after having possessed nearly unfathomable momentum.

As in football, there are options: run it, pass it, QB sneak, you get the idea. The only thing that really matters is that the offense gets on the same page, because the defense has proven itself a unified opposition. Of course, there's the possibility that even the most well-designed play will fall short of paydirt. But if that happens, at least the party can leave with its head held high. The other option, taking a knee and letting time expire, shouldn't be in the playbook at all.

If you want a good lesson in the history of health reform, and of two starkly different reactions to Republican obstructionism, this piece by Brown University's Jim Morone is a must-read. It all comes down to a simple choice: fight like hell or go home.

Reform Is A House: People Just Don't Understand

It's becoming more and more obvious that most people--even the very politically active--are poorly informed. Now, before you go on the offensive, attacking me by saying "Oh, so you know what's best for everybody and if they disagree with you they must be poorly informed?" let me stop you. Yes, I got into this line of work because I wanted to further our understanding of how the system does and does not work, so that I could play a part in improving it, so that I could in my own way, help people. Of course that assumes that people want to be helped. The way things are playing out, however, it seems more and more like people don't want to be helped and would prefer to be left alone. I am totally okay with that--pushing my agenda on others is not something I've ever enjoyed--as long as the people are making an informed decision.

Now, again, before you go hurling accusations and "know-it-all, out-of-touch, liberal elite" labels my way, here's the key point: People are not poorly informed because they disagree with me. They are poorly informed as evidenced by the fact that they disagree with themselves. As shown in the most recent Kaiser Family Foundation Health Tracking Poll, Americans strongly support the provisions of health care reform at the same time that many of those same people oppose reform as a whole. It's like a prospective home buyer being shown one thing at a time and saying "I love the bedrooms, the living room is great, the kitchen is state-of-the-art, the bathrooms are spacious, even the yard is well-landscaped." Then, when they're asked if they're interested in buying, they respond "I hate this house." The only way that can make sense is if a person sees only the house and fails to understand that all the components they loved actually come with it. In this analogy, such a scenario seems outlandish, but given the complexities of the legislative process--and even of the text of the legislation itself--it's not surprising that people are uninformed about what provisions health care reform legislation actually contains.

Starting from the point of that complexity, opponents of reform have done everything in their power not to clarify, but rather to obstruct, the facts. Talking heads have generated almost more misinformation than I really thought possible. And a lot of people believed them, which isn't hard to understand, because if you don't have access to--or don't understand--the actual information, you have no basis for comparison that would permit you to recognize misinformation for what it is. All you see is the house from the street. If you had the time, and requisite background to get into the house and look around, you'd see that it's a great place to live. Since you don't, you stand outside looking on while someone who really doesn't want you to buy the house doesn't tell you what it's actually like inside, but fills your head with ideas of a dilapidated shack--a deteriorating interior.

As much as I wish we wouldn't, Americans hold opinions for some pretty stupid reasons. We vote for candidates who are good looking over candidates who are more plain in appearance. We vote for candidates who we think are "like us" or who "make us feel good" even though neither of those things is especially relevant to governing. We like to watch reality TV and make snap judgments about people, places, and things, which we ultimately know very, very little about. We all like to think of ourselves as above average--despite the blatant mathematical impossibility of that ever being true. And we love to surround ourselves with people whose ideas support our own--whether they are valid or not. It's a simple way to operate, sure, but it's not very informed.

As the Kaiser Poll results show, people are presently uninformed about the specific provisions of health care reform and this is having a big impact on their support for reform as a whole. Once people know what reform would do, they tend to support it in droves. Thus, the biggest obstacle to enacting health reform in our time may not be--as we are taught--the political chokepoints in Congress or the powerful influence of health care lobbying dollars, but rather an unenlightened populace, with notions so misguided that the very things they are opposing aren't even on the table from the beginning.

Government Spending on Health Care in the United States

Many opponents of health care reform say things like "We need to reform our health care system, but we don't need government-controlled socialized medicine coming between patients and their doctors." When I hear people say things like that, it's an immediate indication to me that they aren't informed about our health care system--they don't know how it's structured, financed, or delivered. With that in mind, today's post aims to educate everyone on a simple fact. When you're done reading this, you'll know exactly what proportion of health care spending in the United States is publicly financed.

First, we have to take a look at the various categories of health care spending and the levels of that spending (in billions of dollars) in 2007.

• Medicare ($418)
• Medicaid (including State share) ($340)
• Other Public Health Programs ($189)
• Federal, State, and Local Employee Coverage ($134)
• TOTAL PUBLIC SPENDING: $1081
• All Private Health Spending ($1018)
• TOTAL U.S. HEALTH CARE EXPENDITURES: $2099

Note that this doesn't take into account other government funding like that for the National Institutes of Health, the Centers for Disease Control and Prevention, or the Federal Drug Administration, although some of the work done by these agencies could be considered health care. As a result, these estimates will err on the conservative side.

Still, some 52% of U.S. health care is publicly financed ($1081/$2099). But what if we take into account the federal government's subsidy of employer-based health insurance? That adds a non-trivial $250 billion a year. That raises public spending to $1331 and total spending to $2349. The effective proportion of U.S. health care that is publicly financed then rises to 57%. Folks, that's starting to close in on two-thirds.

So, when people talk of government involvement in health care as a thing to be avoided, I wonder if they know how involved the government already is. My hunch is they have no clue, because it seems like the idea is to keep the private system we have and avoid a public system at all costs. The thing is, our delivery system is overwhelmingly private, while our financing system is much more publicly financed than most people know. Perhaps if opponents of reform were aware of this, they'd be much more concerned about seeing effective health reform enacted rather than fighting it at all costs.