The jagged little pill that is health care coverage
Rush Limbaugh believes that there is no health care crisis in America. And he's not alone. With the right wing's relentless onslaught against any attempt to reform health care in America just getting started, the need for honest reporting on the issue is greater than ever. (David Goodfriend's honest comments on CNBC were refreshing, but unfortunately, they represent the exception, not the rule.)
This week, the Congressional Budget Office released a partial analysis of the Senate health committee's draft health care reform bill. And immediately, Glenn Beck, Sean Hannity, David Brooks, USA Today, The New York Times, and ABC's Jake Tapper all misinterpreted its findings, claiming that the legislation would cost a trillion dollars while still leaving nearly 40 million Americans uninsured. When House Majority Leader John Boehner advanced similar fallacies on The Situation Room, he wasn't challenged by Wolf Blitzer.
CBO Director Douglas W. Elmendorf actually explained his agency's findings in a letter to Sen. Ted Kennedy. He wrote that those considering the analysis should know that "[t]he draft legislation released by the HELP [Health, Education, Labor and Pensions] Committee ... indicates that certain features may be added at a later date." Furthermore, the draft legislation evaluated didn't include "a 'public health insurance option' and requirements for 'shared responsibility' by employers. Depending on their details, such provisions could ... have substantial effects on our analysis." In other words, withhold final judgment, because that's what we are doing. But that's not what was done in the press. At least Robert Reich was paying attention.
The other piece of health care news making the rounds this week involved President Obama's speech to the American Medical Association. A bit of background: While the AMA is a powerful lobbying force for the medical industry, it claims only 29 percent of America's doctors as members. Despite this, NBC's Savannah Guthrie and CNN's Kitty Pilgrim both claimed that it represents "the nation's doctors."
It should also be noted that the press often ignores the group's sponsorship by the pharmaceutical industry.
While usually opposing changes to the status quo (the AMA opposed the creation of Medicare in the 1960s, for example), the organization has signaled a willingness to consider a public health insurance option. But in two separate articles this week, Sheryl Gay Stolberg, Robert Pear, and Jackie Calmes of The New York Times continued to report that the group is resolutely against such an idea, repeating an omission from the previous week. The aforementioned errors -- overstating the degree to which the AMA speaks for doctors and ignoring its corporate sponsorship -- were also in effect.
Following the pattern, The Washington Post's Ceci Connolly described the AMA as being "the nation's largest physician group" without noting that there are 800,000 doctors in America or that the AMA gets at least 20 percent of its budget from drug companies.
With everything Frank Luntz is doing to undermine health care reform in America, the last thing the public needs is more misinformation on the issue.
Other major stories this week:
Media just can't get it right on Obama, economic polling (MOE +/- 0%)
Five months into his tenure, Obama and his administration remain broadly popular. But in an attempt to generate drama, multiple news organizations interpreted new polling data this week on the economy in the most negative light possible.
ABC's The Note -- yet another liberal product of the "All Barack Channel" -- cited a New York Times/CBS News poll noting that 57 percent of the public had a favorable view of the Democratic Party, as opposed to only 28 percent who thought well of the Republicans. The Note's Rick Klein spun that unambiguous outcome thusly: "The new polls have little good news for Republicans -- unless you count worrisome news for the president as good news for his opponents." Most administrations wouldn't consider support from nearly six in 10 Americans as "worrisome news," but Klein apparently does.
Klein summarized his analysis by writing, "Either something or somebody gets dragged down when a popular president pushes unpopular policies." It was a sentiment echoed by The New York Times, which managed to misrepresent its own survey. The Times article on the poll said, "A majority of people said his [Obama's] policies have had either no effect yet on improving the economy or had made it worse." But omitted from the story were several important numbers; among them, the 57 percent of the public that approved of Obama's handling of the economy and the 32 percent who felt that his policies had improved the country's economic condition -- more than twice the number of those who thought they had hurt it. Forty-eight percent of respondents believed that so far, no effect had been felt. The Times grouped that number with the 15 percent who thought Obama's policies had hurt the economy in order to produce the supposed "majority."
Over at Congressional Quarterly, an article on the same poll (and an NBC News/Wall Street Journal poll) headlined "Honeymoon Over: It's on Obama's Watch Now" commented that while Obama had once enjoyed "a grace period when the public saw the nation's problems as ones he inherited," there was now "public concern ... over the size of the deficit."
It isn't wrong to note that people are concerned about budget deficits. But the article ignored yet another key finding from the NBC/Journal poll: that 6 percent of the public currently blames Obama for the budget situation, while 46 percent blame President Bush. That might not be something worth reporting for Sean Hannity, but it should be for a CQ journalist.
Speaking of deficits, conservative commentators have, of course, used much ink and airtime to attack Obama on that and other economic issues. Media coverage has, by and large, given them free rein to do so, in the process helping to promote the idea that neither the public nor responsible economic commentators will tolerate increased deficits. This was the narrative advanced by the Journal, NBC's Nightly News, the CBS Evening News, and the Times this week.
While a majority of the public does want the administration focused on deficit reduction (52 percent in the Times/CBS poll, 58 percent in the NBC/Journal poll), the reports, being so eager to portray the tide of opinion as turning against Obama, failed to note that prominent economists have disagreed with the idea that reducing the deficit should be the administration's most important priority at the current time, Nobel Prize winner Paul Krugman and Moody's chief economist Mark Zandi among them.
Hey, Fox News. Jealous much?
So, what happened when ABC News announced plans to broadcast a June 24 prime-time special called "Questions for the President: Prescription for America," a town hall meeting on health care reform with Obama, from the White House? Fox News and media conservatives went absolutely nuts.
That's right: To say that Fox News hosts and guests have been critical of ABC News would be putting it mildly. One host, for example, agreed with a Republican National Committee complaint that ABC's special "will become a glorified infomercial" for the Obama administration. But in expressing concerns about the ABC News broadcast, those on Fox News did not make any attempt to distinguish -- or even mention -- the extraordinary access Fox News had to Bush, Vice President Dick Cheney and other high-ranking administration during the Bush years -- using those opportunities to lob softball questions and provide an uncritical platform for administration talking points -- from the ABC event.
In a flashback of sorts, Media Matters for America noted that just last year, Fox News was boasting about its "unprecedented" access to the Bush White House. Who could forget their moving "George W. Bush: Fighting to the Finish" tribute?
Some Fox News hosts and guests have also suggested a "conflict of interest," pointing to the fact that former ABC News correspondent Linda Douglass is now communications director of the Department of Health and Human Services' Office of Health Reform. Again, Fox News' concern over the ABC News special is noteworthy given Fox's history. In 2006, Tony Snow, then a Fox News anchor and radio host, left Fox to serve as Bush's White House press secretary.
One highlight of Fox's weeklong whine-fest was how hosts and guests attempted to explain away their own network's rightward tilt. On Special Report, Charles Krauthammer actually acknowledged that Fox News is the "voice of opposition in the media," while Fox & Friends co-host Steve Doocy laid it on rather thick, saying that "here at Fox we still do journalism" and that "when you watch the other channels ... you don't hear a lot of the criticism."
Perhaps Eric Boehlert, a senior fellow here at Media Matters, said it best appearing on Fox News when he said: "I think conservatives are confusing being in the minority with being victims of liberal bias."
Walpin: They'll turn this into a scandal or die trying
Since Gerald Walpin was fired from his position as inspector general at the Corporation for National and Community Service last week, conservatives and Fox News hosts have claimed that he was removed for investigating an Obama ally. The White House has since provided a list of reasons for Walpin's termination, including but not limited to the corporation board's concerns over Walpin's behavior and conduct, as well as a complaint filed by acting U.S. attorney for the Eastern District of California Lawrence G. Brown regarding Walpin's actions during his investigation into the misuse of AmeriCorps grants given to a nonprofit organization in Sacramento, California.
Fox & Friends aired on-screen text this week asserting as fact the claim -- disputed by the Obama administration -- that Walpin was "fired for protecting taxpayers." Other graphics that aired throughout the report asked whether Walpin was "dismissed for doing his job" and if there was a "cover-up at AmeriCorps."
As has become standard operating procedure, Fox's Glenn Beck took things to the absurd, stating that Walpin was dismissed because he "wouldn't sit in the last row of seats; he wouldn't get up from the counter." Get it? Walpin's firing equals the struggle for civil rights.
Walpin attempted to mount a defense this week by taking to the conservative airwaves with appearances on Glenn Beck and Fox & Friends as well as Laura Ingraham's radio program. In each of his appearances, hosts failed to note or ask Walpin about Brown's allegations. Specifically, that Walpin and his staff "did not include" or "disclose" relevant information regarding the case involving the misuse of AmeriCorps to Brown's office; that Walpin repeatedly discussed the case in the press after being advised "under no circumstance was he to communicate with the media about a matter under investigation"; and that Walpin's "actions were hindering our investigation and handling of this matter."
SOURCE: MediaMatters
Saturday, June 20, 2009
Friday, June 19, 2009
BOB HERBERT A Threat We Can’t Ignore
NY TIMES
Even with the murders that have already occurred, Americans are not paying enough attention to the frightening connection between the right-wing hate-mongers who continue to slither among us and the gun crazies who believe a well-aimed bullet is the ticket to all their dreams.
I hope I’m wrong, but I can’t help feeling as if the murder at the United States Holocaust Memorial Museum in Washington and the assassination of the abortion doctor in Wichita, Kan., and the slaying of three police officers in Pittsburgh — all of them right-wing, hate-driven attacks — were just the beginning and that worse is to come.
As if the wackos weren’t dangerous enough to begin with, the fuel to further inflame them is available in the over-the-top rhetoric of the National Rifle Association, which has relentlessly pounded the bogus theme that Barack Obama is planning to take away people’s guns. The group’s anti-Obama Web site is called gunbanobama.com.
While the N.R.A. is not advocating violence, it shouldn’t take more than a glance at the newspapers to understand why this is a message that the country could do without. James von Brunn, the man accused of using a rifle to shoot a guard to death at the Holocaust museum last week, was described by relatives, associates and the police as a virulent racist and anti-Semite.
Investigators said they found a note that had been signed by von Brunn in the car that he double-parked outside the museum. The note said, “You want my weapons — this is how you’ll get them.”
Richard Poplawski, who, according to authorities, used a high-powered rifle to kill three Pittsburgh police officers in April, reportedly believed that Zionists were running the world and that, yes, Obama was planning to crack down on gun ownership. A friend said of Poplawski, he “feared the Obama gun ban that’s on the way.”
There is no Obama gun ban on the way. Gun control advocates are, frankly, disappointed in the president’s unwillingness to move ahead on even the mildest of gun control measures.
What’s important to grasp here is that this madness has nothing to do with hunting, which the politicians always claim to be defending, and everything to do with the use of firearms to resist policies and lawful government actions that some gun owners don’t like.
In a speech in February to the Conservative Political Action Conference, the executive vice president of the N.R.A., Wayne LaPierre, said: “Our founding fathers understood that the guys with the guns make the rules.”
A new book by Dennis Henigan, a vice president at the Brady Center to Prevent Gun Violence, goes into detail on this point. In “Lethal Logic: Exploding the Myths That Paralyze American Gun Policy,” Mr. Henigan refers to a Harvard Law Journal article written by an N.R.A. lawyer titled, “The Second Amendment Ain’t About Hunting.” In the article, the lawyer makes it clear that for the N.R.A., the right to bear arms is “directed at maintaining an armed citizenry. ... to protect against the tyranny of our own government.”
There was a wave of right-wing craziness along those lines during the Clinton administration. Four federal agents were killed and 16 others wounded in 1993 during an attempt to serve a search warrant at the Branch Davidian compound near Waco, Tex., where a stockpile of illegal machine guns had been amassed. The subsequent siege ended disastrously with a raging fire in which scores of people were killed.
In the aftermath of Waco, the N.R.A. did its typically hysterical, fear-mongering thing. In a fund-raising letter in the spring of 1995, LaPierre wrote: “Jack-booted government thugs [have] more power to take away our Constitutional rights, break in our doors, seize our guns, destroy our property, and even injure or kill us. ...”
Whatever the N.R.A. may intend by its rhetoric, there is always the danger that those inclined toward violence will incorporate it into their twisted worldview, and will find in the rhetoric a justification for murder. On the second anniversary of the Branch Davidian fire, less than a week after LaPierre’s inflammatory fund-raising letter went out, Timothy McVeigh blew up the Alfred P. Murrah Federal Building in Oklahoma City.
You cannot blame the N.R.A. for McVeigh’s actions. But you can sure blame it for ignoring the tragic lessons of history and continuing to spray gasoline into an environment that we have seen explode time and again.
The Southern Poverty Law Center has reported a resurgence of right-wing hate groups in the U.S. since Mr. Obama was elected president. Gun craziness of all kinds, including the passage of local laws making it easier to own and conceal weapons, is on the rise. Hate-filled Web sites are calling attention to the fact that the U.S. has a black president and that his chief of staff is Jewish.
It might be wise to pay closer attention than we’ve been paying. The first step should be to bring additional gun control back into the policy mix.
Even with the murders that have already occurred, Americans are not paying enough attention to the frightening connection between the right-wing hate-mongers who continue to slither among us and the gun crazies who believe a well-aimed bullet is the ticket to all their dreams.
I hope I’m wrong, but I can’t help feeling as if the murder at the United States Holocaust Memorial Museum in Washington and the assassination of the abortion doctor in Wichita, Kan., and the slaying of three police officers in Pittsburgh — all of them right-wing, hate-driven attacks — were just the beginning and that worse is to come.
As if the wackos weren’t dangerous enough to begin with, the fuel to further inflame them is available in the over-the-top rhetoric of the National Rifle Association, which has relentlessly pounded the bogus theme that Barack Obama is planning to take away people’s guns. The group’s anti-Obama Web site is called gunbanobama.com.
While the N.R.A. is not advocating violence, it shouldn’t take more than a glance at the newspapers to understand why this is a message that the country could do without. James von Brunn, the man accused of using a rifle to shoot a guard to death at the Holocaust museum last week, was described by relatives, associates and the police as a virulent racist and anti-Semite.
Investigators said they found a note that had been signed by von Brunn in the car that he double-parked outside the museum. The note said, “You want my weapons — this is how you’ll get them.”
Richard Poplawski, who, according to authorities, used a high-powered rifle to kill three Pittsburgh police officers in April, reportedly believed that Zionists were running the world and that, yes, Obama was planning to crack down on gun ownership. A friend said of Poplawski, he “feared the Obama gun ban that’s on the way.”
There is no Obama gun ban on the way. Gun control advocates are, frankly, disappointed in the president’s unwillingness to move ahead on even the mildest of gun control measures.
What’s important to grasp here is that this madness has nothing to do with hunting, which the politicians always claim to be defending, and everything to do with the use of firearms to resist policies and lawful government actions that some gun owners don’t like.
In a speech in February to the Conservative Political Action Conference, the executive vice president of the N.R.A., Wayne LaPierre, said: “Our founding fathers understood that the guys with the guns make the rules.”
A new book by Dennis Henigan, a vice president at the Brady Center to Prevent Gun Violence, goes into detail on this point. In “Lethal Logic: Exploding the Myths That Paralyze American Gun Policy,” Mr. Henigan refers to a Harvard Law Journal article written by an N.R.A. lawyer titled, “The Second Amendment Ain’t About Hunting.” In the article, the lawyer makes it clear that for the N.R.A., the right to bear arms is “directed at maintaining an armed citizenry. ... to protect against the tyranny of our own government.”
There was a wave of right-wing craziness along those lines during the Clinton administration. Four federal agents were killed and 16 others wounded in 1993 during an attempt to serve a search warrant at the Branch Davidian compound near Waco, Tex., where a stockpile of illegal machine guns had been amassed. The subsequent siege ended disastrously with a raging fire in which scores of people were killed.
In the aftermath of Waco, the N.R.A. did its typically hysterical, fear-mongering thing. In a fund-raising letter in the spring of 1995, LaPierre wrote: “Jack-booted government thugs [have] more power to take away our Constitutional rights, break in our doors, seize our guns, destroy our property, and even injure or kill us. ...”
Whatever the N.R.A. may intend by its rhetoric, there is always the danger that those inclined toward violence will incorporate it into their twisted worldview, and will find in the rhetoric a justification for murder. On the second anniversary of the Branch Davidian fire, less than a week after LaPierre’s inflammatory fund-raising letter went out, Timothy McVeigh blew up the Alfred P. Murrah Federal Building in Oklahoma City.
You cannot blame the N.R.A. for McVeigh’s actions. But you can sure blame it for ignoring the tragic lessons of history and continuing to spray gasoline into an environment that we have seen explode time and again.
The Southern Poverty Law Center has reported a resurgence of right-wing hate groups in the U.S. since Mr. Obama was elected president. Gun craziness of all kinds, including the passage of local laws making it easier to own and conceal weapons, is on the rise. Hate-filled Web sites are calling attention to the fact that the U.S. has a black president and that his chief of staff is Jewish.
It might be wise to pay closer attention than we’ve been paying. The first step should be to bring additional gun control back into the policy mix.
On Health Care, Obama Tries to Seize the Moment
NY Times - By KEVIN SACK
In their heart of hearts, few in the Obama administration would have predicted late last year that they would be this well positioned by June to achieve a major victory on health care. As the economy faltered, and attention focused on Wall Street and Detroit, it seemed unthinkable that Congress would be ready to devote the summer of 2009 to the costly proposition of providing health coverage for all, a goal that has eluded presidents since Theodore Roosevelt.
But five months after the inauguration, health care dominates the domestic agenda on both ends of Pennsylvania Avenue. Any package that emerges will preserve the country’s private insurance system, at least for now. It could nonetheless bring sweeping changes, requiring that everyone be insured, creating a government health plan to compete with commercial carriers and perhaps taxing employer-provided health benefits.
One Senate committee began the formal drafting of its overhaul plan in a contentious session this week, while a second — the influential Finance Committee — delayed the release of its proposal until after the Fourth of July because of emerging concerns about its cost. In the House, hearings on a draft proposal are scheduled for next week. Both chambers are striving to vote on bills before the August recess so that a conference committee can negotiate a compromise and send it to President Obama by October.
Mr. Obama now rarely lets a day pass without pushing the case for broad-based change. His cool-headed analysis is increasingly sprinkled with impassioned rhetoric. “If we do not fix our health care system,” he told the American Medical Association on Monday, “America may go the way of G.M.”
That politics and economics have converged to spark such momentum “is remarkable,” said Peter R. Orszag, the White House budget director. “You have industry groups that are cognizant of the need to make changes, members of Congress who have been preparing for this moment and a president quite committed to doing it. It is a rare alignment of forces.”
And yet, students of history in the White House and Congress realize they are only now entering the riskiest phase, when real details begin to generate real opposition. To date, a fragile coalition of stakeholders has been kept at the table by presidential leadership and fiscal realpolitik. But it may not take much for the guiding principle of “shared responsibility” to fracture into shards of self-interest.
On Monday, the American Hospital Association expressed deep disappointment in Mr. Obama’s weekend proposal to help pay for expanded coverage by cutting Medicare payments to hospitals. The next day, the United States Chamber of Commerce announced it would oppose a bill that included any one of three central elements: a new government insurance option, a requirement that businesses provide health coverage to workers or pay a fine, and the creation of a federal board to set insurance benefits. By midweek, the release of higher-than-expected cost estimates by the Congressional Budget Office had emboldened Republicans to step up their criticism, and forced the Senate Finance Committee back to the drawing board.
Kathleen Sebelius, the secretary of health and human services, said the administration was prepared for the undulations of the legislative process. “There will be a lot of times when it appears that everything is falling apart,” Ms. Sebelius said. “Anytime specific legislative language is crafted, there’s something to hate about it.”
But Ms. Sebelius said she had been impressed by the dedication of Congressional leaders, and by Mr. Obama’s “absolute focus on the fact that this is a moment — we’re not going to lose this moment.”
The moment arises from a confluence of factors: Democratic control of the White House and Congress; the exasperation of big business and consumers with uncontrollable health costs; heightened economic insecurity during the recession; the Massachusetts model for achieving near universal coverage; Mr. Obama’s determination that health care is central to economic recovery; the presence of health care enthusiasts at the helm of key Congressional committees; and even Senator Edward M. Kennedy’s battle against brain cancer.
Mr. Obama, among others, has observed that if a deal is not concluded this year, when his popularity is high and lawmakers are not running for re-election, it is not likely to happen at all.
What separates this year’s initiative from past health care expansions is that it would try to address the system’s shortcomings in cost, access and quality all at once. It would do so with intricately interlocking components intended to make health care affordable, end discriminatory insurance practices and redirect treatment toward prevention.
Whether any individual piece will produce its intended savings or improvements is impossible to tell; when judging how they might work in concert, the uncertainty is compounded.
Seeking broad popular support, the president and Congressional leaders have played between the 40-yard lines of the health policy spectrum. Those who favor a single-payer, government-run insurance system have been marginalized, along with those who would unleash the system to the free market.
Mr. Obama and the Democrats began by using the stimulus package to direct new money toward the computerization of health records and research on the effectiveness of medical procedures. In the legislation now being considered, there is broad Democratic consensus on mandating that almost all Americans have coverage, expanding eligibility for Medicaid, subsidizing insurance for the working poor, establishing an insurance marketing exchange and requiring insurers to cover those with pre-existing conditions.
But there are profound disagreements on other proposals, including the Medicare cuts, tax increases to pay for the subsidies, and the public-plan option, which insurers regard as a threat to their existence. The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, has been searching for a compromise that might attract Republican support.
Although the Democrats may be able to pass bills without Republican votes, bipartisanship is important to Mr. Obama because it would set the tone for the rest of his term. The essential tension of the coming few weeks will revolve around whether the Democrats can maintain momentum while working to satisfy Republican concerns. Mr. Obama is leaving the details to Congress while pronouncing that he is “open to” particular compromises, like substituting member-owned insurance cooperatives for the public plan.
At a comparable stage of the Clinton health care push of 1993, “it seemed that health care reform was unstoppable,” former Senator Tom Daschle has written. The Clinton administration’s subsequent tactical failures have become the antimatter of Mr. Obama’s strategy, persuading him to move quickly, stay out of the weeds and share ownership with Congress.
In addressing the doctors this week, Mr. Obama argued that whatever the cost of revamping the system, “the cost of inaction is greater.” But he also made clear that he understood the most enduring lesson from past efforts.
“As clear as it is that our system badly needs reform,” he said, “reform is not inevitable.”
In their heart of hearts, few in the Obama administration would have predicted late last year that they would be this well positioned by June to achieve a major victory on health care. As the economy faltered, and attention focused on Wall Street and Detroit, it seemed unthinkable that Congress would be ready to devote the summer of 2009 to the costly proposition of providing health coverage for all, a goal that has eluded presidents since Theodore Roosevelt.
But five months after the inauguration, health care dominates the domestic agenda on both ends of Pennsylvania Avenue. Any package that emerges will preserve the country’s private insurance system, at least for now. It could nonetheless bring sweeping changes, requiring that everyone be insured, creating a government health plan to compete with commercial carriers and perhaps taxing employer-provided health benefits.
One Senate committee began the formal drafting of its overhaul plan in a contentious session this week, while a second — the influential Finance Committee — delayed the release of its proposal until after the Fourth of July because of emerging concerns about its cost. In the House, hearings on a draft proposal are scheduled for next week. Both chambers are striving to vote on bills before the August recess so that a conference committee can negotiate a compromise and send it to President Obama by October.
Mr. Obama now rarely lets a day pass without pushing the case for broad-based change. His cool-headed analysis is increasingly sprinkled with impassioned rhetoric. “If we do not fix our health care system,” he told the American Medical Association on Monday, “America may go the way of G.M.”
That politics and economics have converged to spark such momentum “is remarkable,” said Peter R. Orszag, the White House budget director. “You have industry groups that are cognizant of the need to make changes, members of Congress who have been preparing for this moment and a president quite committed to doing it. It is a rare alignment of forces.”
And yet, students of history in the White House and Congress realize they are only now entering the riskiest phase, when real details begin to generate real opposition. To date, a fragile coalition of stakeholders has been kept at the table by presidential leadership and fiscal realpolitik. But it may not take much for the guiding principle of “shared responsibility” to fracture into shards of self-interest.
On Monday, the American Hospital Association expressed deep disappointment in Mr. Obama’s weekend proposal to help pay for expanded coverage by cutting Medicare payments to hospitals. The next day, the United States Chamber of Commerce announced it would oppose a bill that included any one of three central elements: a new government insurance option, a requirement that businesses provide health coverage to workers or pay a fine, and the creation of a federal board to set insurance benefits. By midweek, the release of higher-than-expected cost estimates by the Congressional Budget Office had emboldened Republicans to step up their criticism, and forced the Senate Finance Committee back to the drawing board.
Kathleen Sebelius, the secretary of health and human services, said the administration was prepared for the undulations of the legislative process. “There will be a lot of times when it appears that everything is falling apart,” Ms. Sebelius said. “Anytime specific legislative language is crafted, there’s something to hate about it.”
But Ms. Sebelius said she had been impressed by the dedication of Congressional leaders, and by Mr. Obama’s “absolute focus on the fact that this is a moment — we’re not going to lose this moment.”
The moment arises from a confluence of factors: Democratic control of the White House and Congress; the exasperation of big business and consumers with uncontrollable health costs; heightened economic insecurity during the recession; the Massachusetts model for achieving near universal coverage; Mr. Obama’s determination that health care is central to economic recovery; the presence of health care enthusiasts at the helm of key Congressional committees; and even Senator Edward M. Kennedy’s battle against brain cancer.
Mr. Obama, among others, has observed that if a deal is not concluded this year, when his popularity is high and lawmakers are not running for re-election, it is not likely to happen at all.
What separates this year’s initiative from past health care expansions is that it would try to address the system’s shortcomings in cost, access and quality all at once. It would do so with intricately interlocking components intended to make health care affordable, end discriminatory insurance practices and redirect treatment toward prevention.
Whether any individual piece will produce its intended savings or improvements is impossible to tell; when judging how they might work in concert, the uncertainty is compounded.
Seeking broad popular support, the president and Congressional leaders have played between the 40-yard lines of the health policy spectrum. Those who favor a single-payer, government-run insurance system have been marginalized, along with those who would unleash the system to the free market.
Mr. Obama and the Democrats began by using the stimulus package to direct new money toward the computerization of health records and research on the effectiveness of medical procedures. In the legislation now being considered, there is broad Democratic consensus on mandating that almost all Americans have coverage, expanding eligibility for Medicaid, subsidizing insurance for the working poor, establishing an insurance marketing exchange and requiring insurers to cover those with pre-existing conditions.
But there are profound disagreements on other proposals, including the Medicare cuts, tax increases to pay for the subsidies, and the public-plan option, which insurers regard as a threat to their existence. The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, has been searching for a compromise that might attract Republican support.
Although the Democrats may be able to pass bills without Republican votes, bipartisanship is important to Mr. Obama because it would set the tone for the rest of his term. The essential tension of the coming few weeks will revolve around whether the Democrats can maintain momentum while working to satisfy Republican concerns. Mr. Obama is leaving the details to Congress while pronouncing that he is “open to” particular compromises, like substituting member-owned insurance cooperatives for the public plan.
At a comparable stage of the Clinton health care push of 1993, “it seemed that health care reform was unstoppable,” former Senator Tom Daschle has written. The Clinton administration’s subsequent tactical failures have become the antimatter of Mr. Obama’s strategy, persuading him to move quickly, stay out of the weeds and share ownership with Congress.
In addressing the doctors this week, Mr. Obama argued that whatever the cost of revamping the system, “the cost of inaction is greater.” But he also made clear that he understood the most enduring lesson from past efforts.
“As clear as it is that our system badly needs reform,” he said, “reform is not inevitable.”
Out of the Shadows Paul Krugman
NY Times:
Would the Obama administration’s plan for financial reform do what has to be done? Yes and no.
Yes, the plan would plug some big holes in regulation. But as described, it wouldn’t end the skewed incentives that made the current crisis inevitable.
Let’s start with the good news.
Our current system of financial regulation dates back to a time when everything that functioned as a bank looked like a bank. As long as you regulated big marble buildings with rows of tellers, you pretty much had things nailed down.
But today you don’t have to look like a bank to be a bank. As Tim Geithner, the Treasury secretary, put it in a widely cited speech last summer, banking is anything that involves financing “long-term risky and relatively illiquid assets” with “very short-term liabilities.” Cases in point: Bear Stearns and Lehman, both of which financed large investments in risky securities primarily with short-term borrowing.
And as Mr. Geithner pointed out, by 2007 more than half of America’s banking, in this sense, was being handled by a “parallel financial system” — others call it “shadow banking” — of largely unregulated institutions. These non-bank banks, he ruefully noted, were “vulnerable to a classic type of run, but without the protections such as deposit insurance that the banking system has in place to reduce such risks.”
When Lehman fell, we learned just how vulnerable shadow banking was: a global run on the system brought the world economy to its knees.
One thing financial reform must do, then, is bring non-bank banking out of the shadows.
The Obama plan does this by giving the Federal Reserve the power to regulate any large financial institution it deems “systemically important” — that is, able to create havoc if it fails — whether or not that institution is a traditional bank. Such institutions would be required to hold relatively large amounts of capital to cover possible losses, relatively large amounts of cash to cover possible demands from creditors, and so on.
And the government would have the authority to seize such institutions if they appear insolvent — the kind of power that the Federal Deposit Insurance Corporation already has with regard to traditional banks, but that has been lacking with regard to institutions like Lehman or A.I.G.
Good stuff. But what about the broader problem of financial excess?
President Obama’s speech outlining the financial plan described the underlying problem very well. Wall Street developed a “culture of irresponsibility,” the president said. Lenders didn’t hold on to their loans, but instead sold them off to be repackaged into securities, which in turn were sold to investors who didn’t understand what they were buying. “Meanwhile,” he said, “executive compensation — unmoored from long-term performance or even reality — rewarded recklessness rather than responsibility.”
Unfortunately, the plan as released doesn’t live up to the diagnosis.
True, the proposed new Consumer Financial Protection Agency would help control abusive lending. And the proposal that lenders be required to hold on to 5 percent of their loans, rather than selling everything off to be repackaged, would provide some incentive to lend responsibly.
But 5 percent isn’t enough to deter much risky lending, given the huge rewards to financial executives who book short-term profits. So what should be done about those rewards?
Tellingly, the administration’s executive summary of its proposals highlights “compensation practices” as a key cause of the crisis, but then fails to say anything about addressing those practices. The long-form version says more, but what it says — “Federal regulators should issue standards and guidelines to better align executive compensation practices of financial firms with long-term shareholder value” — is a description of what should happen, rather than a plan to make it happen.
Furthermore, the plan says very little of substance about reforming the rating agencies, whose willingness to give a seal of approval to dubious securities played an important role in creating the mess we’re in.
In short, Mr. Obama has a clear vision of what went wrong, but aside from regulating shadow banking — no small thing, to be sure — his plan basically punts on the question of how to keep it from happening all over again, pushing the hard decisions off to future regulators.
I’m aware of the political realities: getting financial reform through Congress won’t be easy. And even as it stands the Obama plan would be a lot better than nothing.
But to live up to its own analysis, the Obama administration needs to come down harder on the rating agencies and, even more important, get much more specific about reforming the way bankers are paid.
Would the Obama administration’s plan for financial reform do what has to be done? Yes and no.
Yes, the plan would plug some big holes in regulation. But as described, it wouldn’t end the skewed incentives that made the current crisis inevitable.
Let’s start with the good news.
Our current system of financial regulation dates back to a time when everything that functioned as a bank looked like a bank. As long as you regulated big marble buildings with rows of tellers, you pretty much had things nailed down.
But today you don’t have to look like a bank to be a bank. As Tim Geithner, the Treasury secretary, put it in a widely cited speech last summer, banking is anything that involves financing “long-term risky and relatively illiquid assets” with “very short-term liabilities.” Cases in point: Bear Stearns and Lehman, both of which financed large investments in risky securities primarily with short-term borrowing.
And as Mr. Geithner pointed out, by 2007 more than half of America’s banking, in this sense, was being handled by a “parallel financial system” — others call it “shadow banking” — of largely unregulated institutions. These non-bank banks, he ruefully noted, were “vulnerable to a classic type of run, but without the protections such as deposit insurance that the banking system has in place to reduce such risks.”
When Lehman fell, we learned just how vulnerable shadow banking was: a global run on the system brought the world economy to its knees.
One thing financial reform must do, then, is bring non-bank banking out of the shadows.
The Obama plan does this by giving the Federal Reserve the power to regulate any large financial institution it deems “systemically important” — that is, able to create havoc if it fails — whether or not that institution is a traditional bank. Such institutions would be required to hold relatively large amounts of capital to cover possible losses, relatively large amounts of cash to cover possible demands from creditors, and so on.
And the government would have the authority to seize such institutions if they appear insolvent — the kind of power that the Federal Deposit Insurance Corporation already has with regard to traditional banks, but that has been lacking with regard to institutions like Lehman or A.I.G.
Good stuff. But what about the broader problem of financial excess?
President Obama’s speech outlining the financial plan described the underlying problem very well. Wall Street developed a “culture of irresponsibility,” the president said. Lenders didn’t hold on to their loans, but instead sold them off to be repackaged into securities, which in turn were sold to investors who didn’t understand what they were buying. “Meanwhile,” he said, “executive compensation — unmoored from long-term performance or even reality — rewarded recklessness rather than responsibility.”
Unfortunately, the plan as released doesn’t live up to the diagnosis.
True, the proposed new Consumer Financial Protection Agency would help control abusive lending. And the proposal that lenders be required to hold on to 5 percent of their loans, rather than selling everything off to be repackaged, would provide some incentive to lend responsibly.
But 5 percent isn’t enough to deter much risky lending, given the huge rewards to financial executives who book short-term profits. So what should be done about those rewards?
Tellingly, the administration’s executive summary of its proposals highlights “compensation practices” as a key cause of the crisis, but then fails to say anything about addressing those practices. The long-form version says more, but what it says — “Federal regulators should issue standards and guidelines to better align executive compensation practices of financial firms with long-term shareholder value” — is a description of what should happen, rather than a plan to make it happen.
Furthermore, the plan says very little of substance about reforming the rating agencies, whose willingness to give a seal of approval to dubious securities played an important role in creating the mess we’re in.
In short, Mr. Obama has a clear vision of what went wrong, but aside from regulating shadow banking — no small thing, to be sure — his plan basically punts on the question of how to keep it from happening all over again, pushing the hard decisions off to future regulators.
I’m aware of the political realities: getting financial reform through Congress won’t be easy. And even as it stands the Obama plan would be a lot better than nothing.
But to live up to its own analysis, the Obama administration needs to come down harder on the rating agencies and, even more important, get much more specific about reforming the way bankers are paid.
Thursday, June 18, 2009
'Cash-for-Clunkers' Bill Passes
'Cash-for-Clunkers' Bill Passes in Bid To Revive Car Sales
Trade-In Plan Set for Obama's Signature
The Senate approved a $1 billion program yesterday to give vouchers to consumers who trade in their gas-guzzling clunkers for more fuel-efficient models -- a move that dealers hope will revive slumping auto sales.
Congressional leaders attached the legislation to a $106 billion spending bill to fund troops in Iraq and Afghanistan. The spending bill passed by a 91 to 5 vote but not before some Republican lawmakers unsuccessfully sought to strip the measure from the bill.
"Let's not add a billion dollars of unnecessary debt," said Sen. Judd Gregg (R-N.H.) during the Senate floor debate.
Dealers, unions, trade groups and automakers have been lobbying for months for the legislation in hopes that it would stop the streak of dismal U.S. auto sales.
"The simple fact is that we need to get Americans into car showrooms, and this is the bill that will do it," Rep. Candice S. Miller (R-Mich.), a co-sponsor of the legislation, said in a statement.
The auto sales program, which offers vouchers of up to $4,5000, now moves to the White House for the president's signature. President Obama has repeatedly encouraged Congress to pass a so-called cash-for-clunkers bill.
Consumers would be able to start using the vouchers as soon as the National Highway Traffic Safety Administration finalizes the rules -- a process that must conclude within 30 days of the president's approval.
Under the program, trade-in vehicles, 1984 models or newer, must have average fuel economy of no more than 18 miles per gallon. And the new car or truck must get better gas mileage than the one that was scrapped.
The payoff grows depending on the difference in the fuel efficiencies of the old and new cars. For instance, a new car getting at least 4 more miles per gallon than the old car will be eligible for a $3,500 voucher. A new car getting at least 10 more miles per gallon would get a $4,500 voucher.
To guarantee vehicles are actually roadworthy -- and not just sitting on cinder blocks -- trade-ins must be registered and insured to the same owner for at least a year.
Speaking on the Senate floor, Sen. Carl M. Levin (D-Mich.) said the program "will provide a much-needed boost to the automobile industry."
The legislation's funding would last through the end of the fiscal year, Nov. 1. But some lawmakers are already pushing to expand the program.
Several other countries, such as China and Italy, have offered similar trade-in vouchers. And lawmakers point to the success of Germany's program as indication that vouchers can turn dismal auto sales around.
At the end of the program's first month, sales in Germany were up 21 percent from a year before. During the same period, U.S. sales slumped 41 percent.
Dealers applauded the Senate's action yesterday, and some got additional good news. GM said it had decided to keep 60 of the more than 1,000 dealers with whom it had sought to terminate agreements. The reversals were made after the automaker corrected financial information that was used to evaluate which stores to keep.
The company, which is operating under bankruptcy protection, declined to name the individual dealers.
Trade-In Plan Set for Obama's Signature
The Senate approved a $1 billion program yesterday to give vouchers to consumers who trade in their gas-guzzling clunkers for more fuel-efficient models -- a move that dealers hope will revive slumping auto sales.
Congressional leaders attached the legislation to a $106 billion spending bill to fund troops in Iraq and Afghanistan. The spending bill passed by a 91 to 5 vote but not before some Republican lawmakers unsuccessfully sought to strip the measure from the bill.
"Let's not add a billion dollars of unnecessary debt," said Sen. Judd Gregg (R-N.H.) during the Senate floor debate.
Dealers, unions, trade groups and automakers have been lobbying for months for the legislation in hopes that it would stop the streak of dismal U.S. auto sales.
"The simple fact is that we need to get Americans into car showrooms, and this is the bill that will do it," Rep. Candice S. Miller (R-Mich.), a co-sponsor of the legislation, said in a statement.
The auto sales program, which offers vouchers of up to $4,5000, now moves to the White House for the president's signature. President Obama has repeatedly encouraged Congress to pass a so-called cash-for-clunkers bill.
Consumers would be able to start using the vouchers as soon as the National Highway Traffic Safety Administration finalizes the rules -- a process that must conclude within 30 days of the president's approval.
Under the program, trade-in vehicles, 1984 models or newer, must have average fuel economy of no more than 18 miles per gallon. And the new car or truck must get better gas mileage than the one that was scrapped.
The payoff grows depending on the difference in the fuel efficiencies of the old and new cars. For instance, a new car getting at least 4 more miles per gallon than the old car will be eligible for a $3,500 voucher. A new car getting at least 10 more miles per gallon would get a $4,500 voucher.
To guarantee vehicles are actually roadworthy -- and not just sitting on cinder blocks -- trade-ins must be registered and insured to the same owner for at least a year.
Speaking on the Senate floor, Sen. Carl M. Levin (D-Mich.) said the program "will provide a much-needed boost to the automobile industry."
The legislation's funding would last through the end of the fiscal year, Nov. 1. But some lawmakers are already pushing to expand the program.
Several other countries, such as China and Italy, have offered similar trade-in vouchers. And lawmakers point to the success of Germany's program as indication that vouchers can turn dismal auto sales around.
At the end of the program's first month, sales in Germany were up 21 percent from a year before. During the same period, U.S. sales slumped 41 percent.
Dealers applauded the Senate's action yesterday, and some got additional good news. GM said it had decided to keep 60 of the more than 1,000 dealers with whom it had sought to terminate agreements. The reversals were made after the automaker corrected financial information that was used to evaluate which stores to keep.
The company, which is operating under bankruptcy protection, declined to name the individual dealers.
Judge to review Cheney interview in CIA leak case
NEDRA PICKLER Associated Press
A federal judge said Thursday that he wants to look at notes from the FBI's interview with former Vice President Dick Cheney during the investigation into who leaked the identity of a CIA operative.
U.S. District Judge Emmet Sullivan's decision to review the documents followed arguments by Obama administration lawyers that sounded much like the reasons the Bush administration provided for keeping Cheney's interview from the public.
Justice Department lawyers told the judge that future presidents and vice presidents may not cooperate with criminal investigations if they know what they say could become available to their political opponents and late-night comics who would ridicule them.
"If we become a fact-finder for political enemies, they aren't going to cooperate," Justice Department attorney Jeffrey Smith said during a 90-minute hearing. "I don't want a future vice president to say, `I'm not going to cooperate with you because I don't want to be fodder for 'The Daily Show.'"
Sullivan said the Justice Department must give him more precise reasons for keeping the information confidential than they had in previous court filings.
Cheney agreed to talk to FBI agents in June 2004 as they were investigating the leak of former CIA operative Valerie Plame's identity to reporters the year before. Her name was revealed after her husband, former Ambassador Joseph Wilson, criticized the Bush administration's prewar intelligence on Iraq.
The leak touched off a lengthy inquiry that led to Cheney's former top aide, I. Lewis "Scooter" Libby, being convicted on charges of obstruction of justice and lying to investigators. During his trial, jurors found that Libby lied to the FBI and a grand jury about his conversations with reporters. Bush commuted Libby's sentence, and he never served prison time.
Libby was the only person charged in the case. No one was charged with leaking Wilson's name.
In July 2008, the liberal watchdog group Citizens for Responsibility and Ethics in Washington submitted a Freedom of Information Act request to the Justice Department seeking records related to Cheney's interview in the investigation. The Justice Department declined to turn over the records, and CREW filed a lawsuit in August.
The Justice Department reported in court filings that it found three documents totaling 67 pages that related to the watchdog group's FOIA request, but said the documents were exempt since they were part of a law enforcement matter and their release could interfere with future cases. They also said the interview contained classified material and that presidential communications were shielded to allow candor with the president and his advisers.
CREW argued that the public has a right to know the role that Cheney played in the leak and why he was not prosecuted.
Libby told the FBI in 2003 that it was possible that Cheney ordered him to reveal Plame's identity to reporters. The prosecutor in that case, Special Counsel Patrick Fitzgerald, said in his closing remarks at Libby's trial that there was a "cloud" over Cheney's role in the case.
Fitzgerald told members of Congress who also sought the information that Cheney set no conditions about the use of his interview with investigators.
A Cheney spokeswoman declined to comment on the case.
A federal judge said Thursday that he wants to look at notes from the FBI's interview with former Vice President Dick Cheney during the investigation into who leaked the identity of a CIA operative.
U.S. District Judge Emmet Sullivan's decision to review the documents followed arguments by Obama administration lawyers that sounded much like the reasons the Bush administration provided for keeping Cheney's interview from the public.
Justice Department lawyers told the judge that future presidents and vice presidents may not cooperate with criminal investigations if they know what they say could become available to their political opponents and late-night comics who would ridicule them.
"If we become a fact-finder for political enemies, they aren't going to cooperate," Justice Department attorney Jeffrey Smith said during a 90-minute hearing. "I don't want a future vice president to say, `I'm not going to cooperate with you because I don't want to be fodder for 'The Daily Show.'"
Sullivan said the Justice Department must give him more precise reasons for keeping the information confidential than they had in previous court filings.
Cheney agreed to talk to FBI agents in June 2004 as they were investigating the leak of former CIA operative Valerie Plame's identity to reporters the year before. Her name was revealed after her husband, former Ambassador Joseph Wilson, criticized the Bush administration's prewar intelligence on Iraq.
The leak touched off a lengthy inquiry that led to Cheney's former top aide, I. Lewis "Scooter" Libby, being convicted on charges of obstruction of justice and lying to investigators. During his trial, jurors found that Libby lied to the FBI and a grand jury about his conversations with reporters. Bush commuted Libby's sentence, and he never served prison time.
Libby was the only person charged in the case. No one was charged with leaking Wilson's name.
In July 2008, the liberal watchdog group Citizens for Responsibility and Ethics in Washington submitted a Freedom of Information Act request to the Justice Department seeking records related to Cheney's interview in the investigation. The Justice Department declined to turn over the records, and CREW filed a lawsuit in August.
The Justice Department reported in court filings that it found three documents totaling 67 pages that related to the watchdog group's FOIA request, but said the documents were exempt since they were part of a law enforcement matter and their release could interfere with future cases. They also said the interview contained classified material and that presidential communications were shielded to allow candor with the president and his advisers.
CREW argued that the public has a right to know the role that Cheney played in the leak and why he was not prosecuted.
Libby told the FBI in 2003 that it was possible that Cheney ordered him to reveal Plame's identity to reporters. The prosecutor in that case, Special Counsel Patrick Fitzgerald, said in his closing remarks at Libby's trial that there was a "cloud" over Cheney's role in the case.
Fitzgerald told members of Congress who also sought the information that Cheney set no conditions about the use of his interview with investigators.
A Cheney spokeswoman declined to comment on the case.
Report on Bush Policy May Come In 'Weeks' FINALLY!
Probe Is Focused On Interrogation Program's Approval
By Carrie Johnson Washington Post
A Justice Department report focusing on possible ethics violations by Bush administration lawyers who approved waterboarding of terrorism suspects is still "a matter of weeks" from release, Attorney General Eric H. Holder Jr. told lawmakers yesterday.
At a Senate Judiciary Committee hearing, Holder said that officials in the department's Office of Professional Responsibility (OPR), which investigates allegations of attorney misconduct, are reworking the 200-page draft report and incorporating comments from lawyers who have been the focus of the investigation.
The conclusions of the five-year-long probe are hotly anticipated because they could shed new light on the interplay between the Bush White House, the Justice Department and the CIA in formulating an interrogation policy that critics assert included torture.
Key Senate Democrats and left-leaning interest groups yesterday exhorted Holder to pick up the pace. Sens. Richard J. Durbin (D-Ill.) and Sheldon Whitehouse (D-R.I.) pointed out that the former government lawyers whose conduct is at issue had submitted their arguments six weeks ago.
"The American people have a right to know how the U.S. Justice Department came to issue legal opinions approving acts of cruelty that shocked the world, damaged U.S. moral authority and harmed efforts to combat terrorism effectively," Human Rights First and more than a half-dozen other activist groups wrote. "We urge you to release the OPR report now and send a clear message that transparency in government and adherence to the law are core American values as well as key assets to U.S. national security."
But the attorney general, apparently trying to lower expectations, cautioned lawmakers that the acting chief of the OPR, Mary Patrice Brown, was carefully examining the materials and that they eventually would require extensive declassification, adding even more time to the release date.
"One of the things that I think we want to do is to declassify as much of this report as we can so that when people read it, either in this body or the general public, they'll have a full feeling for what it is our lawyers in the Office of Professional Responsibility dealt with and what is the basis for the conclusions that they reach," Holder said.
Obama administration officials generally have advocated looking forward to new initiatives, rather than spending attention and scarce resources finding fault with their predecessors. The White House agenda already is packed with reforms to health care and foreign policy and other initiatives, so delaying a conversation about alleged torture that could inflame Republicans and polarize voters may be a desirable political move, analysts said.
A draft version of the report earlier this year recommended disciplinary referrals to state bar associations for two of the former department lawyers, John C. Yoo and Jay S. Bybee, but their supporters say the men acted in good faith based on their view of the anti-torture statutes. The conduct of another lawyer, Steven G. Bradbury, is also under review.
Independent experts disagree about the likelihood that the bar associations will bring cases against the men, and the statute of limitations in Pennsylvania, where Yoo is licensed, has expired.
Criminal charges against the lawyers are unlikely, legal experts say, so the ethics report is one of few avenues to legal reckoning for officials who blessed or developed the Bush interrogation policies. Last week a federal judge in California allowed a former detainee to go ahead with a lawsuit alleging that Yoo violated his constitutional rights.
By Carrie Johnson Washington Post
A Justice Department report focusing on possible ethics violations by Bush administration lawyers who approved waterboarding of terrorism suspects is still "a matter of weeks" from release, Attorney General Eric H. Holder Jr. told lawmakers yesterday.
At a Senate Judiciary Committee hearing, Holder said that officials in the department's Office of Professional Responsibility (OPR), which investigates allegations of attorney misconduct, are reworking the 200-page draft report and incorporating comments from lawyers who have been the focus of the investigation.
The conclusions of the five-year-long probe are hotly anticipated because they could shed new light on the interplay between the Bush White House, the Justice Department and the CIA in formulating an interrogation policy that critics assert included torture.
Key Senate Democrats and left-leaning interest groups yesterday exhorted Holder to pick up the pace. Sens. Richard J. Durbin (D-Ill.) and Sheldon Whitehouse (D-R.I.) pointed out that the former government lawyers whose conduct is at issue had submitted their arguments six weeks ago.
"The American people have a right to know how the U.S. Justice Department came to issue legal opinions approving acts of cruelty that shocked the world, damaged U.S. moral authority and harmed efforts to combat terrorism effectively," Human Rights First and more than a half-dozen other activist groups wrote. "We urge you to release the OPR report now and send a clear message that transparency in government and adherence to the law are core American values as well as key assets to U.S. national security."
But the attorney general, apparently trying to lower expectations, cautioned lawmakers that the acting chief of the OPR, Mary Patrice Brown, was carefully examining the materials and that they eventually would require extensive declassification, adding even more time to the release date.
"One of the things that I think we want to do is to declassify as much of this report as we can so that when people read it, either in this body or the general public, they'll have a full feeling for what it is our lawyers in the Office of Professional Responsibility dealt with and what is the basis for the conclusions that they reach," Holder said.
Obama administration officials generally have advocated looking forward to new initiatives, rather than spending attention and scarce resources finding fault with their predecessors. The White House agenda already is packed with reforms to health care and foreign policy and other initiatives, so delaying a conversation about alleged torture that could inflame Republicans and polarize voters may be a desirable political move, analysts said.
A draft version of the report earlier this year recommended disciplinary referrals to state bar associations for two of the former department lawyers, John C. Yoo and Jay S. Bybee, but their supporters say the men acted in good faith based on their view of the anti-torture statutes. The conduct of another lawyer, Steven G. Bradbury, is also under review.
Independent experts disagree about the likelihood that the bar associations will bring cases against the men, and the statute of limitations in Pennsylvania, where Yoo is licensed, has expired.
Criminal charges against the lawyers are unlikely, legal experts say, so the ethics report is one of few avenues to legal reckoning for officials who blessed or developed the Bush interrogation policies. Last week a federal judge in California allowed a former detainee to go ahead with a lawsuit alleging that Yoo violated his constitutional rights.
Wednesday, June 17, 2009
Nevada senator apologizes for affair with former staffer
MORE GOP Family VALUES!!
John Ensign, a rising GOP star and possible presidential candidate, says he won't resign.
Reporting from Las Vegas — Nevada Sen. John Ensign, an emerging Republican leader who has been mentioned as a possible 2012 presidential candidate, apologized Tuesday for an extramarital affair with a former staff member but indicated that he had no plans to resign.
"It's absolutely the worst thing I have ever done in my life," he said at a televised news conference. "If there was ever anything that I could take back in my life, this would be it."
A grim-faced Ensign, 51, did not identify the woman he was involved with from December 2007 to August 2008, although he described her and her husband as close friends who had worked for him.
"That closeness put me into situations during a very difficult time in my marriage, which led to my inappropriate behavior," he said. "We caused deep pain to both families, and for that I am sorry."
He and his wife, Darlene, sought counseling, he said, and their marriage is "stronger than ever." She was not at the news conference but issued a statement supporting him. They have three children.
It was unclear why Ensign made the disclosure so abruptly. He skipped a Senate vote related to tourism, his state's lifeblood, and flew to Las Vegas for the hastily arranged news conference.
The silver-haired, telegenic conservative has been a rising star in the Republican Party. He is a regular on the cable news circuit, often criticizing President Obama's economic stimulus package. Ensign recently visited Iowa, where he chatted up locals, ate ice cream and fueled speculation that he was gearing up for a presidential bid.
He headed the GOP's Senate campaign panel in 2008, when the party lost at least eight seats. Now he chairs the Republican Policy Committee, a Senate leadership position.
Political experts speculated that Ensign's admission would do him little harm here. "He's the leading voice in Nevada and in the country for fiscal restraint," said Robert Uithoven, a Republican consultant based in the state.
But the revelations could derail his national ambitions, at least in the short term, by turning off values voters in the South and the Corn Belt, experts said.
"It's hard enough for someone in Nevada to run on the national stage because Nevada has such a libertarian streak that others don't understand," said Joseph M. Valenzano III, who teaches political communication at the University of Nevada, Las Vegas. "He didn't need this."
The senator also could be vulnerable to charges of hypocrisy. He belongs to Promise Keepers, a Christian group whose members pledge, among other things, to abide by biblical principles to build strong marriages.
As a candidate for the Senate, Ensign demanded that President Clinton resign after having an affair with a White House intern. He also voted to impeach Clinton.
Years later, Ensign strongly suggested that Sen. Larry Craig resign in the wake of his arrest in a 2007 airport bathroom sex sting in Minneapolis. The Idaho Republican pleaded guilty to a misdemeanor.
Ensign is a social conservative who opposes abortion and backs gun rights, but he won office by touting small-government principles, said Eric Herzik, who chairs the University of Nevada, Reno, political science department.
A veterinarian, Ensign spent four years in the House and was elected to the Senate in 2000. Two years earlier, he had lost a contentious race by a few hundred votes to Sen. Harry Reid, now the Senate majority leader.
The pair has a well-known nonaggression pact: They refuse to criticize each other in public.
"I don't know the details. I talked with him today," Reid told reporters, according to CQPolitics.com. "Of course, he's my friend. This is a private family matter. I just hope that Darlene and he work things out."
Ensign, among Nevada's most popular politicians, has vowed to help the state party rebuild after the devastating 2008 election.
The GOP has been hobbled by an unpopular governor, Jim Gibbons, whose estranged wife has accused him of having affairs with at least two women.
John Ensign, a rising GOP star and possible presidential candidate, says he won't resign.
Reporting from Las Vegas — Nevada Sen. John Ensign, an emerging Republican leader who has been mentioned as a possible 2012 presidential candidate, apologized Tuesday for an extramarital affair with a former staff member but indicated that he had no plans to resign.
"It's absolutely the worst thing I have ever done in my life," he said at a televised news conference. "If there was ever anything that I could take back in my life, this would be it."
A grim-faced Ensign, 51, did not identify the woman he was involved with from December 2007 to August 2008, although he described her and her husband as close friends who had worked for him.
"That closeness put me into situations during a very difficult time in my marriage, which led to my inappropriate behavior," he said. "We caused deep pain to both families, and for that I am sorry."
He and his wife, Darlene, sought counseling, he said, and their marriage is "stronger than ever." She was not at the news conference but issued a statement supporting him. They have three children.
It was unclear why Ensign made the disclosure so abruptly. He skipped a Senate vote related to tourism, his state's lifeblood, and flew to Las Vegas for the hastily arranged news conference.
The silver-haired, telegenic conservative has been a rising star in the Republican Party. He is a regular on the cable news circuit, often criticizing President Obama's economic stimulus package. Ensign recently visited Iowa, where he chatted up locals, ate ice cream and fueled speculation that he was gearing up for a presidential bid.
He headed the GOP's Senate campaign panel in 2008, when the party lost at least eight seats. Now he chairs the Republican Policy Committee, a Senate leadership position.
Political experts speculated that Ensign's admission would do him little harm here. "He's the leading voice in Nevada and in the country for fiscal restraint," said Robert Uithoven, a Republican consultant based in the state.
But the revelations could derail his national ambitions, at least in the short term, by turning off values voters in the South and the Corn Belt, experts said.
"It's hard enough for someone in Nevada to run on the national stage because Nevada has such a libertarian streak that others don't understand," said Joseph M. Valenzano III, who teaches political communication at the University of Nevada, Las Vegas. "He didn't need this."
The senator also could be vulnerable to charges of hypocrisy. He belongs to Promise Keepers, a Christian group whose members pledge, among other things, to abide by biblical principles to build strong marriages.
As a candidate for the Senate, Ensign demanded that President Clinton resign after having an affair with a White House intern. He also voted to impeach Clinton.
Years later, Ensign strongly suggested that Sen. Larry Craig resign in the wake of his arrest in a 2007 airport bathroom sex sting in Minneapolis. The Idaho Republican pleaded guilty to a misdemeanor.
Ensign is a social conservative who opposes abortion and backs gun rights, but he won office by touting small-government principles, said Eric Herzik, who chairs the University of Nevada, Reno, political science department.
A veterinarian, Ensign spent four years in the House and was elected to the Senate in 2000. Two years earlier, he had lost a contentious race by a few hundred votes to Sen. Harry Reid, now the Senate majority leader.
The pair has a well-known nonaggression pact: They refuse to criticize each other in public.
"I don't know the details. I talked with him today," Reid told reporters, according to CQPolitics.com. "Of course, he's my friend. This is a private family matter. I just hope that Darlene and he work things out."
Ensign, among Nevada's most popular politicians, has vowed to help the state party rebuild after the devastating 2008 election.
The GOP has been hobbled by an unpopular governor, Jim Gibbons, whose estranged wife has accused him of having affairs with at least two women.
Gun Rulings Open Way to Supreme Court Review
NY TIMES By JOHN SCHWARTZ
A year ago, the United States Supreme Court issued a landmark decision establishing the constitutional right of Americans to own guns. But the justices did not explain what the practical effect of that ruling would be on city and state gun laws.
Could a city still ban handguns? The justices said the District of Columbia could not, but only because it is a special federal district. The question of the constitutionality of existing city and state gun laws was left unanswered.
That left a large vacuum for the lower courts to fill. Supporters of gun rights filed a flurry of lawsuits to strike down local gun restrictions, and now federal appeals courts have begun weighing in on this divisive issue, using very different reasoning.
One court this month upheld Chicago’s ban on automatic weapons and concealed handguns, while in April a California court disagreed on the constitutional issue.
The differing opinions mean that the whole issue of city and state gun laws will probably head back to the Supreme Court for clarification, leading many legal experts to predict a further expansion of gun rights.
The new cases are fallout from last year’s Supreme Court case, District of Columbia v. Heller, which struck down parts of Washington’s gun control ordinance, the strictest in the country, and stated for the first time that the Second Amendment gives individuals a right to keep and bear arms for personal use. But the court declined to say whether the Second Amendment in general applies to state and local governments.
In January, the United States Court of Appeals for the Second Circuit, in New York, in a ruling joined by Judge Sonia Sotomayor, declined to apply the Second Amendment to a New York law that banned the martial arts device known as chukka sticks. The ban was allowed to stay in place.
Then in April, a three-judge panel of the Ninth Circuit, in San Francisco, ruled that the Second Amendment did apply to the states, even though it allowed a California county to ban guns on government property like state fairgrounds. That case, Nordyke v. King, is being considered for a rehearing by the full Ninth Circuit.
Those two conflicting cases set the stage for two other cases that were heard as one in the Seventh Circuit in Chicago, testing that city’s handgun ban. On June 2, a three-judge panel of the court, led by Chief Judge Frank H. Easterbrook, a well-known conservative, ruled that there was no basis for the court to apply the Second Amendment to the states. Such a decision, Judge Easterbrook wrote, should be made only by the Supreme Court, not at the appellate level.
The right of states to make their own decisions on such matters, Judge Easterbrook wrote, “is an older and more deeply rooted tradition than is a right to carry any particular kind of weapon.”
The lawyers for the plaintiffs, including the National Rifle Association, have asked the Supreme Court to take up the Chicago cases.
A split among the federal appeals circuits, especially on constitutional issues, invites Supreme Court action, said Adam Winkler, a law professor at the University of California, Los Angeles.
“Californians, Hawaiians and Oregonians have a Second Amendment right to bear arms, but New Yorkers, Illinoisans, and Wisconsinites don’t,” Professor Winkler said. “The Supreme Court will want to correct this sooner rather than later.”
The process of applying amendments of the Bill of Rights to the states, known as incorporation, began after the Civil War but had its heyday in the activist Supreme Court of the Earl Warren era. Much of the Bill of Rights, including the First Amendment’s freedom of speech and some rights of criminal defendants, have been applied to the states, but other elements have not, including the Seventh Amendment right to a civil jury trial and the Second Amendment.
Incorporation fell out of favor after the 1960s, but a new generation of largely liberal scholars of law and history have brought it back into the intellectual mainstream, said Akhil Reed Amar, a law professor at Yale University, who supports the process.
“The precedents are now supportive of incorporation of nearly every provision of the Bill of Rights,” Professor Amar said. “Now what’s odd is that the Second Amendment doesn’t apply to the states.”
Sanford Levinson, a law professor at the University of Texas, said he would be surprised if the Supreme Court accepted these gun cases, because some of the conservative justices on the court had scoffed at incorporation arguments in the past and might not want to set a precedent.
Professor Amar, however, argued that the justices would not only take up the case but would also ultimately vote for incorporation of the Second Amendment.
Even if the Second Amendment becomes the controlling law of every state and town, constitutional scholars say it is still unlikely that gun laws would be overturned wholesale. The Supreme Court’s Heller decision last year, notes Nelson Lund, a law professor at George Mason University, “clearly indicates that governments will still have wide latitude to regulate firearms.”
Even the Ninth Circuit in California, while applying the Second Amendment to the states, still upheld the gun ordinance that gave rise to the lawsuit.
Eugene Volokh, a law professor at the University of California, Los Angeles, said the view of the Ninth Circuit reflected what polls have said was, by and large, the view of the American people.
“There is a right to bear arms,” Professor Volokh said, “but it’s not absolute.”
A year ago, the United States Supreme Court issued a landmark decision establishing the constitutional right of Americans to own guns. But the justices did not explain what the practical effect of that ruling would be on city and state gun laws.
Could a city still ban handguns? The justices said the District of Columbia could not, but only because it is a special federal district. The question of the constitutionality of existing city and state gun laws was left unanswered.
That left a large vacuum for the lower courts to fill. Supporters of gun rights filed a flurry of lawsuits to strike down local gun restrictions, and now federal appeals courts have begun weighing in on this divisive issue, using very different reasoning.
One court this month upheld Chicago’s ban on automatic weapons and concealed handguns, while in April a California court disagreed on the constitutional issue.
The differing opinions mean that the whole issue of city and state gun laws will probably head back to the Supreme Court for clarification, leading many legal experts to predict a further expansion of gun rights.
The new cases are fallout from last year’s Supreme Court case, District of Columbia v. Heller, which struck down parts of Washington’s gun control ordinance, the strictest in the country, and stated for the first time that the Second Amendment gives individuals a right to keep and bear arms for personal use. But the court declined to say whether the Second Amendment in general applies to state and local governments.
In January, the United States Court of Appeals for the Second Circuit, in New York, in a ruling joined by Judge Sonia Sotomayor, declined to apply the Second Amendment to a New York law that banned the martial arts device known as chukka sticks. The ban was allowed to stay in place.
Then in April, a three-judge panel of the Ninth Circuit, in San Francisco, ruled that the Second Amendment did apply to the states, even though it allowed a California county to ban guns on government property like state fairgrounds. That case, Nordyke v. King, is being considered for a rehearing by the full Ninth Circuit.
Those two conflicting cases set the stage for two other cases that were heard as one in the Seventh Circuit in Chicago, testing that city’s handgun ban. On June 2, a three-judge panel of the court, led by Chief Judge Frank H. Easterbrook, a well-known conservative, ruled that there was no basis for the court to apply the Second Amendment to the states. Such a decision, Judge Easterbrook wrote, should be made only by the Supreme Court, not at the appellate level.
The right of states to make their own decisions on such matters, Judge Easterbrook wrote, “is an older and more deeply rooted tradition than is a right to carry any particular kind of weapon.”
The lawyers for the plaintiffs, including the National Rifle Association, have asked the Supreme Court to take up the Chicago cases.
A split among the federal appeals circuits, especially on constitutional issues, invites Supreme Court action, said Adam Winkler, a law professor at the University of California, Los Angeles.
“Californians, Hawaiians and Oregonians have a Second Amendment right to bear arms, but New Yorkers, Illinoisans, and Wisconsinites don’t,” Professor Winkler said. “The Supreme Court will want to correct this sooner rather than later.”
The process of applying amendments of the Bill of Rights to the states, known as incorporation, began after the Civil War but had its heyday in the activist Supreme Court of the Earl Warren era. Much of the Bill of Rights, including the First Amendment’s freedom of speech and some rights of criminal defendants, have been applied to the states, but other elements have not, including the Seventh Amendment right to a civil jury trial and the Second Amendment.
Incorporation fell out of favor after the 1960s, but a new generation of largely liberal scholars of law and history have brought it back into the intellectual mainstream, said Akhil Reed Amar, a law professor at Yale University, who supports the process.
“The precedents are now supportive of incorporation of nearly every provision of the Bill of Rights,” Professor Amar said. “Now what’s odd is that the Second Amendment doesn’t apply to the states.”
Sanford Levinson, a law professor at the University of Texas, said he would be surprised if the Supreme Court accepted these gun cases, because some of the conservative justices on the court had scoffed at incorporation arguments in the past and might not want to set a precedent.
Professor Amar, however, argued that the justices would not only take up the case but would also ultimately vote for incorporation of the Second Amendment.
Even if the Second Amendment becomes the controlling law of every state and town, constitutional scholars say it is still unlikely that gun laws would be overturned wholesale. The Supreme Court’s Heller decision last year, notes Nelson Lund, a law professor at George Mason University, “clearly indicates that governments will still have wide latitude to regulate firearms.”
Even the Ninth Circuit in California, while applying the Second Amendment to the states, still upheld the gun ordinance that gave rise to the lawsuit.
Eugene Volokh, a law professor at the University of California, Los Angeles, said the view of the Ninth Circuit reflected what polls have said was, by and large, the view of the American people.
“There is a right to bear arms,” Professor Volokh said, “but it’s not absolute.”
Health Care Rationing Rhetoric Overlooks Reality
By DAVID LEONHARDT NY Times
Rationing.
More to the point: Rationing!
As in: Wait, are you talking about rationing medical care? Access to medical care is a fundamental right. And rationing sounds like something out of the Soviet Union. Or at least Canada.
The r-word has become a rejoinder to anyone who says that this country must reduce its runaway health spending, especially anyone who favors cutting back on treatments that don’t have scientific evidence behind them. You can expect to hear a lot more about rationing as health care becomes the dominant issue in Washington this summer.
Today, I want to try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords that tries to hide the fact that societies must make choices.
In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources. Even in the United States, the richest society in human history, we are constantly rationing. We ration spots in good public high schools. We ration lakefront homes. We ration the best cuts of steak and wild-caught salmon.
Health care, I realize, seems as if it should be different. But it isn’t. Already, we cannot afford every form of medical care that we might like. So we ration.
We spend billions of dollars on operations, tests and drugs that haven’t been proved to make people healthier. Yet we have not spent the money to install computerized medical records — and we suffer more medical errors than many other countries.
We underpay primary care doctors, relative to specialists, and they keep us stewing in waiting rooms while they try to see as many patients as possible. We don’t reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don’t pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal.
“Just because there isn’t some government agency specifically telling you which treatments you can have based on cost-effectiveness,” as Dr. Mark McClellan, head of Medicare in the Bush administration, says, “that doesn’t mean you aren’t getting some treatments.”
Milton Friedman’s beloved line is a good way to frame the issue: There is no such thing as a free lunch. The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.
On Wednesday, a bipartisan panel led by four former Senate majority leaders — Howard Baker, Tom Daschle, Bob Dole and George Mitchell — will release a solid proposal for health care reform. Among other things, it would call on the federal government to do more research on which treatments actually work. An “independent health care council” would also be established, charged with helping the government avoid unnecessary health costs. The Obama administration supports a similar approach.
And connecting the dots is easy enough. Armed with better information, Medicare could pay more for effective treatments — and no longer pay quite so much for health care that doesn’t make people healthier.
Mr. Baker, Mr. Daschle, Mr. Dole and Mr. Mitchell: I accuse you of rationing.
•
There are three main ways that the health care system already imposes rationing on us. The first is the most counterintuitive, because it doesn’t involve denying medical care. It involves denying just about everything else.
The rapid rise in medical costs has put many employers in a tough spot. They have had to pay much higher insurance premiums, which have increased their labor costs. To make up for these increases, many have given meager pay raises.
This tradeoff is often explicit during contract negotiations between a company and a labor union. For nonunionized workers, the tradeoff tends to be invisible. It happens behind closed doors in the human resources department. But it still happens.
Research by Katherine Baicker and Amitabh Chandra of Harvard has found that, on average, a 10 percent increase in health premiums leads to a 2.3 percent decline in inflation-adjusted pay. Victor Fuchs, a Stanford economist, and Ezekiel Emanuel, an oncologist now in the Obama administration, published an article in The Journal of the American Medical Association last year that nicely captured the tradeoff. When health costs have grown fastest over the last two decades, they wrote, wages have grown slowest, and vice versa.
So when middle-class families complain about being stretched thin, they’re really complaining about rationing. Our expensive, inefficient health care system is eating up money that could otherwise pay for a mortgage, a car, a vacation or college tuition.
The second kind of rationing involves the uninsured. The high cost of care means that some employers can’t afford to offer health insurance and still pay a competitive wage. Those high costs mean that individuals can’t buy insurance on their own.
The uninsured still receive some health care, obviously. But they get less care, and worse care, than they need. The Institute of Medicine has estimated that 18,000 people died in 2000 because they lacked insurance. By 2006, the number had risen to 22,000, according to the Urban Institute.
The final form of rationing is the one I described near the beginning of this column: the failure to provide certain types of care, even to people with health insurance. Doctors are generally not paid to do the blocking and tackling of medicine: collaboration, probing conversations with patients, small steps that avoid medical errors. Many doctors still do such things, out of professional pride. But the full medical system doesn’t do nearly enough.
That’s rationing — and it has real consequences.
In Australia, 81 percent of primary care doctors have set up a way for their patients to get after-hours care, according to the Commonwealth Fund. In the United States, only 40 percent have. Over all, the survival rates for many diseases in this country are no better than they are in countries that spend far less on health care. People here are less likely to have long-term survival after colorectal cancer, childhood leukemia or a kidney transplant than they are in Canada — that bastion of rationing.
None of this means that reducing health costs will be easy. The comparative-effectiveness research favored by the former Senate majority leaders and the White House has inspired opposition from some doctors, members of Congress and patient groups. Certainly, the critics are right to demand that the research be done carefully. It should examine different forms of a disease and, ideally, various subpopulations who have the disease. Just as important, scientists — not political appointees or Congress — should be in charge of the research.
But flat-out opposition to comparative effectiveness is, in the end, opposition to making good choices. And all the noise about rationing is not really a courageous stand against less medical care. It’s a utopian stand against better medical care.
E-mail: Leonhardt@nytimes.com
Rationing.
More to the point: Rationing!
As in: Wait, are you talking about rationing medical care? Access to medical care is a fundamental right. And rationing sounds like something out of the Soviet Union. Or at least Canada.
The r-word has become a rejoinder to anyone who says that this country must reduce its runaway health spending, especially anyone who favors cutting back on treatments that don’t have scientific evidence behind them. You can expect to hear a lot more about rationing as health care becomes the dominant issue in Washington this summer.
Today, I want to try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords that tries to hide the fact that societies must make choices.
In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources. Even in the United States, the richest society in human history, we are constantly rationing. We ration spots in good public high schools. We ration lakefront homes. We ration the best cuts of steak and wild-caught salmon.
Health care, I realize, seems as if it should be different. But it isn’t. Already, we cannot afford every form of medical care that we might like. So we ration.
We spend billions of dollars on operations, tests and drugs that haven’t been proved to make people healthier. Yet we have not spent the money to install computerized medical records — and we suffer more medical errors than many other countries.
We underpay primary care doctors, relative to specialists, and they keep us stewing in waiting rooms while they try to see as many patients as possible. We don’t reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don’t pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal.
“Just because there isn’t some government agency specifically telling you which treatments you can have based on cost-effectiveness,” as Dr. Mark McClellan, head of Medicare in the Bush administration, says, “that doesn’t mean you aren’t getting some treatments.”
Milton Friedman’s beloved line is a good way to frame the issue: There is no such thing as a free lunch. The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.
On Wednesday, a bipartisan panel led by four former Senate majority leaders — Howard Baker, Tom Daschle, Bob Dole and George Mitchell — will release a solid proposal for health care reform. Among other things, it would call on the federal government to do more research on which treatments actually work. An “independent health care council” would also be established, charged with helping the government avoid unnecessary health costs. The Obama administration supports a similar approach.
And connecting the dots is easy enough. Armed with better information, Medicare could pay more for effective treatments — and no longer pay quite so much for health care that doesn’t make people healthier.
Mr. Baker, Mr. Daschle, Mr. Dole and Mr. Mitchell: I accuse you of rationing.
•
There are three main ways that the health care system already imposes rationing on us. The first is the most counterintuitive, because it doesn’t involve denying medical care. It involves denying just about everything else.
The rapid rise in medical costs has put many employers in a tough spot. They have had to pay much higher insurance premiums, which have increased their labor costs. To make up for these increases, many have given meager pay raises.
This tradeoff is often explicit during contract negotiations between a company and a labor union. For nonunionized workers, the tradeoff tends to be invisible. It happens behind closed doors in the human resources department. But it still happens.
Research by Katherine Baicker and Amitabh Chandra of Harvard has found that, on average, a 10 percent increase in health premiums leads to a 2.3 percent decline in inflation-adjusted pay. Victor Fuchs, a Stanford economist, and Ezekiel Emanuel, an oncologist now in the Obama administration, published an article in The Journal of the American Medical Association last year that nicely captured the tradeoff. When health costs have grown fastest over the last two decades, they wrote, wages have grown slowest, and vice versa.
So when middle-class families complain about being stretched thin, they’re really complaining about rationing. Our expensive, inefficient health care system is eating up money that could otherwise pay for a mortgage, a car, a vacation or college tuition.
The second kind of rationing involves the uninsured. The high cost of care means that some employers can’t afford to offer health insurance and still pay a competitive wage. Those high costs mean that individuals can’t buy insurance on their own.
The uninsured still receive some health care, obviously. But they get less care, and worse care, than they need. The Institute of Medicine has estimated that 18,000 people died in 2000 because they lacked insurance. By 2006, the number had risen to 22,000, according to the Urban Institute.
The final form of rationing is the one I described near the beginning of this column: the failure to provide certain types of care, even to people with health insurance. Doctors are generally not paid to do the blocking and tackling of medicine: collaboration, probing conversations with patients, small steps that avoid medical errors. Many doctors still do such things, out of professional pride. But the full medical system doesn’t do nearly enough.
That’s rationing — and it has real consequences.
In Australia, 81 percent of primary care doctors have set up a way for their patients to get after-hours care, according to the Commonwealth Fund. In the United States, only 40 percent have. Over all, the survival rates for many diseases in this country are no better than they are in countries that spend far less on health care. People here are less likely to have long-term survival after colorectal cancer, childhood leukemia or a kidney transplant than they are in Canada — that bastion of rationing.
None of this means that reducing health costs will be easy. The comparative-effectiveness research favored by the former Senate majority leaders and the White House has inspired opposition from some doctors, members of Congress and patient groups. Certainly, the critics are right to demand that the research be done carefully. It should examine different forms of a disease and, ideally, various subpopulations who have the disease. Just as important, scientists — not political appointees or Congress — should be in charge of the research.
But flat-out opposition to comparative effectiveness is, in the end, opposition to making good choices. And all the noise about rationing is not really a courageous stand against less medical care. It’s a utopian stand against better medical care.
E-mail: Leonhardt@nytimes.com
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