The financial underpinnings of the Medicare and Social Security programs have eroded substantially as a result of the nation's recession, according to a government forecast issued today.
The report, by the trustees who monitor the fiscal health of the twin pillars of the government's assistance to older Americans, shows that Medicare remains the more urgent problem, with its trust fund predicted to run out of money in 2017, two years earlier than projected a year ago. The report also says that the Social Security system will become insolvent by 2037, four years sooner than the estimate given last year.
The trustees' report is the official, yearly appraisal of the fiscal health -- or fragility -- of the two massive entitlement programs. And over the years, the forecasts have been intertwined with political debates over how to try to ensure that the nation's retirement system can withstand the aging of the giant Baby Boom generation and -- more recently -- the country's economic downturn.
In March, the Congressional Budget Office gave its own forecast of the deteriorating finances of the Social Security system, saying that a longstanding surplus in the program's trust fund would diminish by next year, more quickly and dramatically than predicted in the past.
Today's news is more somber than that during the milder recession earlier this decade, when the economy made little dent in the trust funds that support monthly Social Security checks and the hospital part of Medicare health care benefits.
Today's report reflects the fact that fewer workers have been paying into both systems, as the country has lost 5.7 million jobs since recession began in December 2007.
President Obama has consistently said that finding ways to rein in Medicare's expenditures is essential to revamping the nation's health care system--and stabilizing the nation's economy overall. And at what the White House called a "fiscal responsibility summit" convened in February, the president's top economic advisers reiterated that the administration is committed to placing Social Security on more solid financial footing. However, they have provided few details of how or when they plan to pursue that goal, even as key Democrats and Republicans in Congress have said in recent days that they would like to begin consider substantial changes to the retirement program this fall.
Tuesday, May 12, 2009
A Moderate Plan for Health Care
One of the most contentious issues in the Congressional debate over health care reform is over whether to create a new public plan to compete with private insurers. Senator Charles Schumer of New York is making strenuous efforts to forge a compromise that ought to appeal to political moderates who are not reflexively opposed to a government-run program or beholden to private insurers concerned about profit margins.
Any competition between a new public plan and private plans would be waged on a regulated field of battle within a new health insurance exchange. Most reform proposals envisage the exchange as a place where individuals unable to obtain coverage at work and ineligible for existing public programs like Medicaid could buy policies that would be available to everyone without regard to pre-existing medical problems. Low-income people would get subsidies to help buy a private or public plan.
Opponents of a new public plan have raised the specter that it might have unfair advantages that would enable it to draw customers from private insurers and ultimately drive them out of business, leaving virtually all Americans enrolled in a full-fledged single-payer system, like Medicare. That prospect could be mitigated by appropriate ground rules.
The insurance industry is so desperate to avoid competition that it has already pledged numerous reforms and called for tighter regulation of the private market to expand coverage and control costs. But even with tighter regulation, Congress should include a public plan option to give consumers broader choice, provide a refuge for people who don’t trust private insurers to have their best interest at heart and serve as a yardstick for judging the performance of private plans.
Private plans have done a poor job at restraining premium increases; they mostly pass rising medical costs on to the subscriber. A good dose of competition from a public plan with potentially lower administrative costs and no need to generate profits might be the right competitive medicine to improve their performance.
Senator Schumer, a Democratic member of the crucial Senate Finance Committee who was assigned to study the issue, has come up with some reasonable principles to ensure that any competition between a public plan and private plans would be a fair fight. In general, he suggests that a public plan should have to comply with the same rules and standards as private plans.
The public plan could not be supported by tax revenues or government appropriations but by premiums and co-payments. It would have to maintain reserves, like private insurers, and provide the same minimum benefits as all other insurers in the exchange. It could not compel doctors who want to participate in Medicare to also participate in the new public plan. And it would be run by different officials from those who run the insurance exchange to lessen the likelihood that federal officials would give unfair advantages to their program.
One can argue over details, but Mr. Schumer is on the right track. It should be possible to design a system in which public and private plans could compete without destroying the private coverage that most Americans have and for the most part want to keep. The question is whether Republicans in Congress are willing to try.
Any competition between a new public plan and private plans would be waged on a regulated field of battle within a new health insurance exchange. Most reform proposals envisage the exchange as a place where individuals unable to obtain coverage at work and ineligible for existing public programs like Medicaid could buy policies that would be available to everyone without regard to pre-existing medical problems. Low-income people would get subsidies to help buy a private or public plan.
Opponents of a new public plan have raised the specter that it might have unfair advantages that would enable it to draw customers from private insurers and ultimately drive them out of business, leaving virtually all Americans enrolled in a full-fledged single-payer system, like Medicare. That prospect could be mitigated by appropriate ground rules.
The insurance industry is so desperate to avoid competition that it has already pledged numerous reforms and called for tighter regulation of the private market to expand coverage and control costs. But even with tighter regulation, Congress should include a public plan option to give consumers broader choice, provide a refuge for people who don’t trust private insurers to have their best interest at heart and serve as a yardstick for judging the performance of private plans.
Private plans have done a poor job at restraining premium increases; they mostly pass rising medical costs on to the subscriber. A good dose of competition from a public plan with potentially lower administrative costs and no need to generate profits might be the right competitive medicine to improve their performance.
Senator Schumer, a Democratic member of the crucial Senate Finance Committee who was assigned to study the issue, has come up with some reasonable principles to ensure that any competition between a public plan and private plans would be a fair fight. In general, he suggests that a public plan should have to comply with the same rules and standards as private plans.
The public plan could not be supported by tax revenues or government appropriations but by premiums and co-payments. It would have to maintain reserves, like private insurers, and provide the same minimum benefits as all other insurers in the exchange. It could not compel doctors who want to participate in Medicare to also participate in the new public plan. And it would be run by different officials from those who run the insurance exchange to lessen the likelihood that federal officials would give unfair advantages to their program.
One can argue over details, but Mr. Schumer is on the right track. It should be possible to design a system in which public and private plans could compete without destroying the private coverage that most Americans have and for the most part want to keep. The question is whether Republicans in Congress are willing to try.
‘What Color Is That Baby?’ BOB HERBERT
I remember as a young deputy city editor at The Daily News attending my first “sked meeting,” a large gathering of editors held every afternoon to consider which stories would go into the next morning’s paper and how they would be played.
I was sitting at the far end of a conference table from the editor who was conducting the meeting. The News had very seldom had a black person at those gatherings. Mine was the only black face in the room.
One of the stories being pitched was about a baby that had been killed on Long Island. The editor running the meeting was completely relaxed. He was sprawled in his chair and was holding a handful of papers. His legs were crossed.
“What color is that baby?” he asked.
A tremendous silence fell over the room. Everyone understood what he meant. If the baby was white, the chances were much better that the story was worth big play. It might be something to get excited about.
Annoyed at not getting a response, the editor repeated himself. Then his eyes caught mine staring down from the other end of the table.
The Daily News has changed radically since those days, and my career flourished there. But that old story came to mind last week as I followed the lavish newspaper and television coverage given to the murder of a 21-year-old Wesleyan University student, allegedly by a man who had attended a summer course with her at N.Y.U. a couple of years ago.
There is no doubt that this was a tragic and compelling and, thus, newsworthy story. And I’ve long argued that we haven’t paid enough attention to the staggering number of murders committed in this country — well over 150,000 every 10 years or so.
But the press is still very color conscious in the way it goes about covering murder. Editors may not be asking, “What color is that victim?” But, on some level, they’re still thinking it.
Which is why we’ve heard so little about an awful story out of Chicago. Some three dozen public school students have been murdered since the school year began, most of them shot to death. These children and teenagers have been killed in a wide variety of settings and situations — while riding a city bus, playing in parks, sitting in the back seats of cars, in gang disputes, in robberies, in the crossfire of sidewalk shootouts.
It’s an immense and continuing tragedy. But these were nearly all African-American or Latino kids, so the coverage has been scant.
In contrast, the news media gave the public enormous amounts of information about the Wesleyan student, Johanna Justin-Jinich, and — in another big story — about Julissa Brisman, the masseuse who had advertised on Craigslist and was killed in a Boston hotel room last month.
It’s a searing double-standard that tells us volumes about the ways in which we view one another, and whose lives are considered to have value in this society and whose are not. Another disturbing aspect of the coverage is the extreme prurient interest that drives it. The press goes wild over stories about murderous attacks on women who are young, attractive and white.
A closer look at how and why the news media covers some of these stories is overdue. I’d like to see more coverage, not less, of murderous violence in the U.S. But I’d like that coverage to be much broader, more meaningful and less sensationalized.
It’s important to give readers and viewers some insight into the real lives of murder victims like Ms. Justin-Jinich, a talented student whose promise was extinguished in an act of madness, because it helps us to understand the absolute horror of murder and why we need to do much more to stop it.
But why overlook the humanity of so many others because of their ethnic background or economic circumstances? Surely the slaughter of dozens of Chicago schoolchildren is worthy of wide national coverage. CNN has covered the story, but there has been precious little coverage elsewhere.
The killings during this school year are an acceleration of the slaughter of previous years. Back in 2007, I got a letter from a woman named Rita Sallie, whose 13-year-old daughter, Schanna Gayden, was shot to death in a Chicago playground by a thug who was aiming at someone else.
“I cannot accept the fact that she is gone,” Ms. Sallie wrote, “or the way that she was taken from me and those who love her. I wish you could have known her.”
I spoke to Ms. Sallie by phone the other night. We talked about the latest round of killings, and about Schanna. “Oh gosh, that kid was funny,” she said. “She was so. ...”
Her voice trailed off and several moments passed before she could stop herself from weeping.
I was sitting at the far end of a conference table from the editor who was conducting the meeting. The News had very seldom had a black person at those gatherings. Mine was the only black face in the room.
One of the stories being pitched was about a baby that had been killed on Long Island. The editor running the meeting was completely relaxed. He was sprawled in his chair and was holding a handful of papers. His legs were crossed.
“What color is that baby?” he asked.
A tremendous silence fell over the room. Everyone understood what he meant. If the baby was white, the chances were much better that the story was worth big play. It might be something to get excited about.
Annoyed at not getting a response, the editor repeated himself. Then his eyes caught mine staring down from the other end of the table.
The Daily News has changed radically since those days, and my career flourished there. But that old story came to mind last week as I followed the lavish newspaper and television coverage given to the murder of a 21-year-old Wesleyan University student, allegedly by a man who had attended a summer course with her at N.Y.U. a couple of years ago.
There is no doubt that this was a tragic and compelling and, thus, newsworthy story. And I’ve long argued that we haven’t paid enough attention to the staggering number of murders committed in this country — well over 150,000 every 10 years or so.
But the press is still very color conscious in the way it goes about covering murder. Editors may not be asking, “What color is that victim?” But, on some level, they’re still thinking it.
Which is why we’ve heard so little about an awful story out of Chicago. Some three dozen public school students have been murdered since the school year began, most of them shot to death. These children and teenagers have been killed in a wide variety of settings and situations — while riding a city bus, playing in parks, sitting in the back seats of cars, in gang disputes, in robberies, in the crossfire of sidewalk shootouts.
It’s an immense and continuing tragedy. But these were nearly all African-American or Latino kids, so the coverage has been scant.
In contrast, the news media gave the public enormous amounts of information about the Wesleyan student, Johanna Justin-Jinich, and — in another big story — about Julissa Brisman, the masseuse who had advertised on Craigslist and was killed in a Boston hotel room last month.
It’s a searing double-standard that tells us volumes about the ways in which we view one another, and whose lives are considered to have value in this society and whose are not. Another disturbing aspect of the coverage is the extreme prurient interest that drives it. The press goes wild over stories about murderous attacks on women who are young, attractive and white.
A closer look at how and why the news media covers some of these stories is overdue. I’d like to see more coverage, not less, of murderous violence in the U.S. But I’d like that coverage to be much broader, more meaningful and less sensationalized.
It’s important to give readers and viewers some insight into the real lives of murder victims like Ms. Justin-Jinich, a talented student whose promise was extinguished in an act of madness, because it helps us to understand the absolute horror of murder and why we need to do much more to stop it.
But why overlook the humanity of so many others because of their ethnic background or economic circumstances? Surely the slaughter of dozens of Chicago schoolchildren is worthy of wide national coverage. CNN has covered the story, but there has been precious little coverage elsewhere.
The killings during this school year are an acceleration of the slaughter of previous years. Back in 2007, I got a letter from a woman named Rita Sallie, whose 13-year-old daughter, Schanna Gayden, was shot to death in a Chicago playground by a thug who was aiming at someone else.
“I cannot accept the fact that she is gone,” Ms. Sallie wrote, “or the way that she was taken from me and those who love her. I wish you could have known her.”
I spoke to Ms. Sallie by phone the other night. We talked about the latest round of killings, and about Schanna. “Oh gosh, that kid was funny,” she said. “She was so. ...”
Her voice trailed off and several moments passed before she could stop herself from weeping.
Thank You GEORGE W BUSH!
ON JUDGEMENT DAY. How do you think GOD will treat GWB? hk
U.S. Soldier in Iraq Kills 5 Comrades at Stress Clinic
By Ernesto Londoño Washington Post
BAGHDAD, May 11 -- An American soldier opened fire on comrades Monday afternoon inside a combat stress clinic at a large U.S. military base in Baghdad, killing five and wounding three in an attack that prompted officials to promise to try to ease the strain on troops deployed to war zones.
The gunman was taken into custody shortly after the 2 p.m. shooting at Camp Liberty, part of a sprawling military installation near Baghdad International Airport, U.S. military spokesman Lt. Col. Brian Tribus said.
The military did not identify the gunman or shed light on what his motive might have been. Tribus said the gunman's name will be disclosed when and if charges are filed.
Defense Secretary Robert M. Gates and President Obama vowed to conduct a thorough investigation.
"I would like to express my horror and deep regret for today's shooting incident," Gates said at a briefing at the Pentagon. "Such a tragic loss of life at the hands of our own forces is a cause for great and urgent concern."
Gates said the Pentagon needs to redouble its efforts to relieve the stress caused by repeated deployments in war zones with limited time at home in between.
The shooting, among the deadliest attacks on American troops in Iraq in recent months, comes as U.S. commanders are grappling with the rising rate at which service members are committing suicide. Military leaders have attributed the increase to the stress of multiple deployments to Iraq and Afghanistan.
Monday's attack was the deadliest incident involving a soldier opening fire on comrades since the 2003 invasion of Iraq.
The rampage shook up soldiers at Victory Base Compound, which includes Camp Liberty, in large part because most feel relatively safe at the heavily guarded base.
"A lot of soldiers are wondering why," said a senior military official in Baghdad, who spoke on the condition of anonymity. "We will be asking as leaders: What could we have done? How could we have protected the soldiers?"
White House press secretary Robert Gibbs said that Obama was "saddened" and "shocked" by the shootings and that the president's "heart goes out" to the families of those killed.
Obama will press Gates in a meeting Monday afternoon to investigate the shootings to "ensure we fully understand what happened," Gibbs said.
Most military facilities in Iraq have combat stress clinics. Small outposts have officers trained to counsel soldiers experiencing depression, anxiety and other symptoms of combat stress. The military in recent years has launched campaigns to ease the stigma often associated with counseling.
Soldiers may walk into the clinics without making an appointment and are sometimes escorted by a friend or supervisor.
Soldiers are generally required to carry their weapons on military bases, which in the past have been targeted by extremists. They are supposed to make sure the weapons are not loaded when they enter buildings such as dining facilities, stores and office buildings.
At least 140 soldiers committed suicide in 2008, according to the Army, a considerable increase compared with the 115 cases reported the previous year and the 102 documented in 2006. The number is the highest since the military started tracking suicide data in 1980. The Marine Corps, Navy and Air Force also reported an uptick in suicides last year.
The number of soldiers who committed suicide during the first few months of this year is on pace to surpass last year's figure.
The Army's vice chief of staff, Gen. Peter W. Chiarelli, told lawmakers in April that at least 48 soldiers had committed suicide this year. "These current figures are unacceptable," he said.
Also on Monday, the military said an American soldier was killed by a roadside bomb in southern Iraq. The attack occurred at 2 p.m. Sunday in Basra province. U.S. soldiers recently deployed additional troops to the province to replace British soldiers, who formally ended their mission there last month.
U.S. Soldier in Iraq Kills 5 Comrades at Stress Clinic
By Ernesto Londoño Washington Post
BAGHDAD, May 11 -- An American soldier opened fire on comrades Monday afternoon inside a combat stress clinic at a large U.S. military base in Baghdad, killing five and wounding three in an attack that prompted officials to promise to try to ease the strain on troops deployed to war zones.
The gunman was taken into custody shortly after the 2 p.m. shooting at Camp Liberty, part of a sprawling military installation near Baghdad International Airport, U.S. military spokesman Lt. Col. Brian Tribus said.
The military did not identify the gunman or shed light on what his motive might have been. Tribus said the gunman's name will be disclosed when and if charges are filed.
Defense Secretary Robert M. Gates and President Obama vowed to conduct a thorough investigation.
"I would like to express my horror and deep regret for today's shooting incident," Gates said at a briefing at the Pentagon. "Such a tragic loss of life at the hands of our own forces is a cause for great and urgent concern."
Gates said the Pentagon needs to redouble its efforts to relieve the stress caused by repeated deployments in war zones with limited time at home in between.
The shooting, among the deadliest attacks on American troops in Iraq in recent months, comes as U.S. commanders are grappling with the rising rate at which service members are committing suicide. Military leaders have attributed the increase to the stress of multiple deployments to Iraq and Afghanistan.
Monday's attack was the deadliest incident involving a soldier opening fire on comrades since the 2003 invasion of Iraq.
The rampage shook up soldiers at Victory Base Compound, which includes Camp Liberty, in large part because most feel relatively safe at the heavily guarded base.
"A lot of soldiers are wondering why," said a senior military official in Baghdad, who spoke on the condition of anonymity. "We will be asking as leaders: What could we have done? How could we have protected the soldiers?"
White House press secretary Robert Gibbs said that Obama was "saddened" and "shocked" by the shootings and that the president's "heart goes out" to the families of those killed.
Obama will press Gates in a meeting Monday afternoon to investigate the shootings to "ensure we fully understand what happened," Gibbs said.
Most military facilities in Iraq have combat stress clinics. Small outposts have officers trained to counsel soldiers experiencing depression, anxiety and other symptoms of combat stress. The military in recent years has launched campaigns to ease the stigma often associated with counseling.
Soldiers may walk into the clinics without making an appointment and are sometimes escorted by a friend or supervisor.
Soldiers are generally required to carry their weapons on military bases, which in the past have been targeted by extremists. They are supposed to make sure the weapons are not loaded when they enter buildings such as dining facilities, stores and office buildings.
At least 140 soldiers committed suicide in 2008, according to the Army, a considerable increase compared with the 115 cases reported the previous year and the 102 documented in 2006. The number is the highest since the military started tracking suicide data in 1980. The Marine Corps, Navy and Air Force also reported an uptick in suicides last year.
The number of soldiers who committed suicide during the first few months of this year is on pace to surpass last year's figure.
The Army's vice chief of staff, Gen. Peter W. Chiarelli, told lawmakers in April that at least 48 soldiers had committed suicide this year. "These current figures are unacceptable," he said.
Also on Monday, the military said an American soldier was killed by a roadside bomb in southern Iraq. The attack occurred at 2 p.m. Sunday in Basra province. U.S. soldiers recently deployed additional troops to the province to replace British soldiers, who formally ended their mission there last month.
LIMBAUGH is stupid and his LISTENERS ever more!!
The Reticence in Broadcasting Network
By Dana Milbank Washington Post
Rush Limbaugh was halfway through his second hour of broadcasting excellence yesterday when he paused for a moment of self-pity.
"Look at me," the radio host instructed his millions of listeners. "On Tuesday, before Obama is inaugurated, I'm invited to the White House for a birthday lunch by the president, and I'm toasted. Twelve weeks later, I am public enemy number one."
Mega-dittos, Rush. But it's hard to imagine he's too broken up about it.
On Sunday, former vice president Dick Cheney leapt to Limbaugh's defense on CBS's "Face the Nation," agreeing with the broadcaster that former secretary of state Colin Powell should leave the Republican Party. Asked to take sides between Powell's and Limbaugh's versions of Republicanism, Cheney said: "I'd go with Rush Limbaugh."
The night before, comedian Wanda Sykes, speaking before President Obama and thousands of others at the White House Correspondents Association dinner, said of Limbaugh's expressed wish that Obama fail: "I hope his kidneys fail -- how about that?" She further speculated that "maybe Rush Limbaugh was the 20th hijacker, but he was just so strung out on OxyContin, he missed his flight."
Obama press secretary Robert Gibbs, who has already given Limbaugh priceless publicity by using the White House podium to brand him the leader of the Republican Party, tried to calm the situation by distancing Obama from Sykes.
"I think there are a lot of topics that are better left for serious reflection rather than comedy," Gibbs said. "I think there's no doubt that 9/11 is part of that." It had an unfortunate echo of Bush press secretary Ari Fleischer's denunciation of comedian Bill Maher after the attacks of Sept. 11, 2001: Americans need to "watch what they say."
At noon yesterday, Limbaugh went on the air with his usual bombast: "I'm Rush Limbaugh, America's truth detector, America's real anchorman, the doctor of democracy, all combined as one harmless, lovable little fuzzball."
He ignored the Sykes controversy -- though he seemed to refer to it at the end of his show when he interrupted himself with what appeared to be a conversation with a producer: "How can they be running a response when I didn't respond? . . . Well, there isn't going to be a response."
This means one of two highly unlikely things had to be true: Limbaugh really was the 20th hijacker, or he was taking the high road.
As he assumes ever-greater command over the American conservative movement, the high road has not been a common route for Limbaugh. On his show yesterday, he compared Cheney favorably with Bill Clinton: "He is not hot for interns." He discussed House Speaker Nancy Pelosi's looks: "She wears Armani clothes -- fashionable. Botox shots -- fashionable." He hurled epithets: "Compliant sycophantic slavish drive by media." He made caricatures of Democrats' positions: "There's just a genuine dislike for this country . . . certainly by a lot of Democrats." And he continued his personal assault on the president's character: "Barack Obama has yet to show in any way how he will control the cost of anything, including his ego."
Though the recent attacks went unmentioned, El Rushbo exulted in his notoriety. He read a quote by H.L. Mencken: "The men the American people admire most extravagantly are the most daring liars; the men they detest most violently are those who try to tell them the truth."
Limbaugh certainly attracts his share of violent detestation. A request for readers' Limbaugh jokes on The Post's Web site yesterday produced a bumper crop of one-liners, not one of which the editors saw fit to print in this column.
Among callers to his show yesterday, the opinions of Limbaugh were more on the side of extravagant admiration: "There are no words to adequately describe our appreciation for your program and your individual accomplishments as a patriot."
The host had a similar sentiment: "I normally don't pat myself on the back, but today global warming is an issue that has the concern of 30 percent of the American people, and years ago it was over 50 percent," he said.
"That's because somebody spoke up day in and day out and said, 'This is a hoax, this is BS.' That somebody was me."
An on-air promo for the show modestly called Limbaugh "the man who runs America." Limbaugh himself, whose talent is "on loan from God," said he was broadcasting with "half my brains tied behind my back just to make it fair."
Even in this compromised state, he was able to get off good shots at stimulus spending ("It was about stimulating the Democrat Party and stimulating Barack Obama"), the administration's economic policy ("Everybody's going to be poorer . . . they want stagnant zero-sum economics") and his political opponents ("The feminazis ought to be interested in this"). A love of dictators, he argued, is "why Obama has a high approval rating."
Limbaugh played some excerpts of Cheney's appearance on "Face the Nation," where the former vice president praised the radio host and disparaged Powell. "The biggest mistake Republicans can make is to follow Colin Powell's advice . . . to move to the center," Limbaugh told his listeners yesterday. Cheney, by contrast, "knows that there's no such thing as a centrist . . . there's no such thing as a moderate."
Maybe that's because Limbaugh hijacked them?
By Dana Milbank Washington Post
Rush Limbaugh was halfway through his second hour of broadcasting excellence yesterday when he paused for a moment of self-pity.
"Look at me," the radio host instructed his millions of listeners. "On Tuesday, before Obama is inaugurated, I'm invited to the White House for a birthday lunch by the president, and I'm toasted. Twelve weeks later, I am public enemy number one."
Mega-dittos, Rush. But it's hard to imagine he's too broken up about it.
On Sunday, former vice president Dick Cheney leapt to Limbaugh's defense on CBS's "Face the Nation," agreeing with the broadcaster that former secretary of state Colin Powell should leave the Republican Party. Asked to take sides between Powell's and Limbaugh's versions of Republicanism, Cheney said: "I'd go with Rush Limbaugh."
The night before, comedian Wanda Sykes, speaking before President Obama and thousands of others at the White House Correspondents Association dinner, said of Limbaugh's expressed wish that Obama fail: "I hope his kidneys fail -- how about that?" She further speculated that "maybe Rush Limbaugh was the 20th hijacker, but he was just so strung out on OxyContin, he missed his flight."
Obama press secretary Robert Gibbs, who has already given Limbaugh priceless publicity by using the White House podium to brand him the leader of the Republican Party, tried to calm the situation by distancing Obama from Sykes.
"I think there are a lot of topics that are better left for serious reflection rather than comedy," Gibbs said. "I think there's no doubt that 9/11 is part of that." It had an unfortunate echo of Bush press secretary Ari Fleischer's denunciation of comedian Bill Maher after the attacks of Sept. 11, 2001: Americans need to "watch what they say."
At noon yesterday, Limbaugh went on the air with his usual bombast: "I'm Rush Limbaugh, America's truth detector, America's real anchorman, the doctor of democracy, all combined as one harmless, lovable little fuzzball."
He ignored the Sykes controversy -- though he seemed to refer to it at the end of his show when he interrupted himself with what appeared to be a conversation with a producer: "How can they be running a response when I didn't respond? . . . Well, there isn't going to be a response."
This means one of two highly unlikely things had to be true: Limbaugh really was the 20th hijacker, or he was taking the high road.
As he assumes ever-greater command over the American conservative movement, the high road has not been a common route for Limbaugh. On his show yesterday, he compared Cheney favorably with Bill Clinton: "He is not hot for interns." He discussed House Speaker Nancy Pelosi's looks: "She wears Armani clothes -- fashionable. Botox shots -- fashionable." He hurled epithets: "Compliant sycophantic slavish drive by media." He made caricatures of Democrats' positions: "There's just a genuine dislike for this country . . . certainly by a lot of Democrats." And he continued his personal assault on the president's character: "Barack Obama has yet to show in any way how he will control the cost of anything, including his ego."
Though the recent attacks went unmentioned, El Rushbo exulted in his notoriety. He read a quote by H.L. Mencken: "The men the American people admire most extravagantly are the most daring liars; the men they detest most violently are those who try to tell them the truth."
Limbaugh certainly attracts his share of violent detestation. A request for readers' Limbaugh jokes on The Post's Web site yesterday produced a bumper crop of one-liners, not one of which the editors saw fit to print in this column.
Among callers to his show yesterday, the opinions of Limbaugh were more on the side of extravagant admiration: "There are no words to adequately describe our appreciation for your program and your individual accomplishments as a patriot."
The host had a similar sentiment: "I normally don't pat myself on the back, but today global warming is an issue that has the concern of 30 percent of the American people, and years ago it was over 50 percent," he said.
"That's because somebody spoke up day in and day out and said, 'This is a hoax, this is BS.' That somebody was me."
An on-air promo for the show modestly called Limbaugh "the man who runs America." Limbaugh himself, whose talent is "on loan from God," said he was broadcasting with "half my brains tied behind my back just to make it fair."
Even in this compromised state, he was able to get off good shots at stimulus spending ("It was about stimulating the Democrat Party and stimulating Barack Obama"), the administration's economic policy ("Everybody's going to be poorer . . . they want stagnant zero-sum economics") and his political opponents ("The feminazis ought to be interested in this"). A love of dictators, he argued, is "why Obama has a high approval rating."
Limbaugh played some excerpts of Cheney's appearance on "Face the Nation," where the former vice president praised the radio host and disparaged Powell. "The biggest mistake Republicans can make is to follow Colin Powell's advice . . . to move to the center," Limbaugh told his listeners yesterday. Cheney, by contrast, "knows that there's no such thing as a centrist . . . there's no such thing as a moderate."
Maybe that's because Limbaugh hijacked them?
The Old Faithful of Nonsense By Eugene Robinson
Can't we send Dick Cheney back to Wyoming? Shouldn't we chip in and buy him a home where the buffalo roam and there's always room for one more crazy old coot down at the general store?
For the final act of his too-long public career, Cheney seems to have decided to become an Old Faithful of self-serving nonsense. His latest in a series of eruptions came Sunday on "Face the Nation," when he continued to press his revisionist case for torture -- and, for good measure, counseled his beloved Republican Party to marginalize itself even further from public opinion and common sense.
"It's good to go back on the show," Cheney told host Bob Schieffer at the beginning of the interview. "It's nice to know that you're still loved and are invited out in public sometimes."
I don't know about the love, but I do know why Cheney gets asked to appear on talk shows so regularly. Unrestrained by protocol or objective reality, he's pretty much guaranteed to say outrageous things. He requires no prompting or coaxing. As far as he's concerned, issues have just one side -- his -- and anyone who disagrees must secretly wish to deliver our nation to al-Qaeda.
So when Schieffer asked if Cheney "literally" meant to say that the Obama administration has "made this country more vulnerable" to terrorist attacks by repealing Bush-era policies on torture and detention, the former vice president didn't pause for a nanosecond. "That's my belief," Cheney said, "based upon the fact, Bob, that we put in place those policies after 9/11. . . . It was a time of great concern, and we put in place some very good policies, and they worked, for eight years."
Cheney added that "to the extent that those policies were responsible for saving lives, that the administration is now trying to cancel those policies or end them, terminate them, then I think it's fair to argue -- and I do argue -- that that means in the future we're not going to have the same safeguards we've had for the last eight years."
This is the crux of Cheney's "argument," and I put the word in quotation marks because it isn't really a valid argument at all. After the Sept. 11, 2001, terrorist attacks, the Bush administration approved programs and methods that previously would have been considered illegal or unacceptable: arbitrary and indefinite detention of terrorism suspects, waterboarding and other abusive interrogation methods, secret CIA prisons, unprecedented electronic surveillance. Since 2001, there have been no new attacks on what the Bush administration creepily called the "homeland." Therefore, everything that was done in the name of preventing new attacks was justified.
The fallacy lies in the fact that it is impossible for Cheney to prove that anti-terrorism methods within the bounds of U.S. law and tradition would have failed to prevent new attacks. Nor, for that matter, can Cheney demonstrate that torture and other abuses were particularly effective.
Other high-ranking officials from the previous administration, including George W. Bush himself, have had the manners and good sense to follow long-established custom and refrain from attacking the new president and his policies. Cheney, however, is not only accusing President Obama of knowingly putting American lives at risk -- an outrageous charge -- but is also diving headlong into partisan politics.
Schieffer asked him about Rush Limbaugh's assertion that the Republican Party would be better off if Colin Powell left and became a Democrat. One would think that Cheney would have at least a measure of respect for a longtime colleague with whom he had served in two administrations. But one would be wrong.
"Well, if I had to choose in terms of being a Republican, I'd go with Rush Limbaugh, I think," Cheney said. "I think my take on it was Colin had already left the party. I didn't know he was still a Republican."
Let's see: Given a choice between a former chairman of the Joint Chiefs of Staff and secretary of state who has given to his nation a lifetime of exemplary public service or an entertainer who brags about how much money he makes from bombast and bluster, Cheney would go with the gasbag. This is advice that's supposed to help the Republican Party?
I really think Cheney would be happier if he were home on the range. I'm sure the deer and the antelope would enjoy listening to what he has to say.
For the final act of his too-long public career, Cheney seems to have decided to become an Old Faithful of self-serving nonsense. His latest in a series of eruptions came Sunday on "Face the Nation," when he continued to press his revisionist case for torture -- and, for good measure, counseled his beloved Republican Party to marginalize itself even further from public opinion and common sense.
"It's good to go back on the show," Cheney told host Bob Schieffer at the beginning of the interview. "It's nice to know that you're still loved and are invited out in public sometimes."
I don't know about the love, but I do know why Cheney gets asked to appear on talk shows so regularly. Unrestrained by protocol or objective reality, he's pretty much guaranteed to say outrageous things. He requires no prompting or coaxing. As far as he's concerned, issues have just one side -- his -- and anyone who disagrees must secretly wish to deliver our nation to al-Qaeda.
So when Schieffer asked if Cheney "literally" meant to say that the Obama administration has "made this country more vulnerable" to terrorist attacks by repealing Bush-era policies on torture and detention, the former vice president didn't pause for a nanosecond. "That's my belief," Cheney said, "based upon the fact, Bob, that we put in place those policies after 9/11. . . . It was a time of great concern, and we put in place some very good policies, and they worked, for eight years."
Cheney added that "to the extent that those policies were responsible for saving lives, that the administration is now trying to cancel those policies or end them, terminate them, then I think it's fair to argue -- and I do argue -- that that means in the future we're not going to have the same safeguards we've had for the last eight years."
This is the crux of Cheney's "argument," and I put the word in quotation marks because it isn't really a valid argument at all. After the Sept. 11, 2001, terrorist attacks, the Bush administration approved programs and methods that previously would have been considered illegal or unacceptable: arbitrary and indefinite detention of terrorism suspects, waterboarding and other abusive interrogation methods, secret CIA prisons, unprecedented electronic surveillance. Since 2001, there have been no new attacks on what the Bush administration creepily called the "homeland." Therefore, everything that was done in the name of preventing new attacks was justified.
The fallacy lies in the fact that it is impossible for Cheney to prove that anti-terrorism methods within the bounds of U.S. law and tradition would have failed to prevent new attacks. Nor, for that matter, can Cheney demonstrate that torture and other abuses were particularly effective.
Other high-ranking officials from the previous administration, including George W. Bush himself, have had the manners and good sense to follow long-established custom and refrain from attacking the new president and his policies. Cheney, however, is not only accusing President Obama of knowingly putting American lives at risk -- an outrageous charge -- but is also diving headlong into partisan politics.
Schieffer asked him about Rush Limbaugh's assertion that the Republican Party would be better off if Colin Powell left and became a Democrat. One would think that Cheney would have at least a measure of respect for a longtime colleague with whom he had served in two administrations. But one would be wrong.
"Well, if I had to choose in terms of being a Republican, I'd go with Rush Limbaugh, I think," Cheney said. "I think my take on it was Colin had already left the party. I didn't know he was still a Republican."
Let's see: Given a choice between a former chairman of the Joint Chiefs of Staff and secretary of state who has given to his nation a lifetime of exemplary public service or an entertainer who brags about how much money he makes from bombast and bluster, Cheney would go with the gasbag. This is advice that's supposed to help the Republican Party?
I really think Cheney would be happier if he were home on the range. I'm sure the deer and the antelope would enjoy listening to what he has to say.
Harry, Louise and Barack By PAUL KRUGMAN
Is this the end for Harry and Louise?
Harry and Louise were the fictional couple who appeared in advertisements run by the insurance industry in 1993, fretting about what would happen if “government bureaucrats” started making health care decisions. The ads helped kill the Clinton health care plan, and have stood, ever since, as a symbol of the ability of powerful special interests to block health care reform.
But on Saturday, excited administration officials called me to say that this time the medical-industrial complex (their term, not mine) is offering to be helpful.
Six major industry players — including America’s Health Insurance Plans (AHIP), a descendant of the lobbying group that spawned Harry and Louise — have sent a letter to President Obama sketching out a plan to control health care costs. What’s more, the letter implicitly endorses much of what administration officials have been saying about health economics.
Are there reasons to be suspicious about this gift? You bet — and I’ll get to that in a bit. But first things first: on the face of it, this is tremendously good news.
The signatories of the letter say that they’re developing proposals to help the administration achieve its goal of shaving 1.5 percentage points off the growth rate of health care spending. That may not sound like much, but it’s actually huge: achieving that goal would save $2 trillion over the next decade.
How are costs to be contained? There are few details, but the industry has clearly been reading Peter Orszag, the budget director.
In his previous job, as the director of the Congressional Budget Office, Mr. Orszag argued that America spends far too much on some types of health care with little or no medical benefit, even as it spends too little on other types of care, like prevention and treatment of chronic conditions. Putting these together, he concluded that “substantial opportunities exist to reduce costs without harming health over all.”
Sure enough, the health industry letter talks of “reducing over-use and under-use of health care by aligning quality and efficiency incentives.” It also picks up a related favorite Orszag theme, calling for “adherence to evidence-based best practices and therapies.” All in all, it’s just what the doctor, er, budget director ordered.
Before we start celebrating, however, we have to ask the obvious question. Is this gift a Trojan horse? After all, several of the organizations that sent that letter have in the past been major villains when it comes to health care policy.
I’ve already mentioned AHIP. There’s also the Pharmaceutical Research and Manufacturers of America (PhRMA), the lobbying group that helped push through the Medicare Modernization Act of 2003 — a bill that both prevented Medicare from bargaining over drug prices and locked in huge overpayments to private insurers. Indeed, one of the new letter’s signatories is former Representative Billy Tauzin, who shepherded that bill through Congress then immediately left public office to become PhRMA’s lavishly paid president.
The point is that there’s every reason to be cynical about these players’ motives. Remember that what the rest of us call health care costs, they call income.
What’s presumably going on here is that key interest groups have realized that health care reform is going to happen no matter what they do, and that aligning themselves with the Party of No will just deny them a seat at the table. (Republicans, after all, still denounce research into which medical procedures are effective and which are not as a dastardly plot to deprive Americans of their freedom to choose.)
I would strongly urge the Obama administration to hang tough in the bargaining ahead. In particular, AHIP will surely try to use the good will created by its stance on cost control to kill an important part of health reform: giving Americans the choice of buying into a public insurance plan as an alternative to private insurers. The administration should not give in on this point.
But let me not be too negative. The fact that the medical-industrial complex is trying to shape health care reform rather than block it is a tremendously good omen. It looks as if America may finally get what every other advanced country already has: a system that guarantees essential health care to all its citizens.
And serious cost control would change everything, not just for health care, but for America’s fiscal future. As Mr. Orszag has emphasized, rising health care costs are the main reason long-run budget projections look so grim. Slow the rate at which those costs rise, and the future will look far brighter.
I still won’t count my health care chickens until they’re hatched. But this is some of the best policy news I’ve heard in a long time.
Harry and Louise were the fictional couple who appeared in advertisements run by the insurance industry in 1993, fretting about what would happen if “government bureaucrats” started making health care decisions. The ads helped kill the Clinton health care plan, and have stood, ever since, as a symbol of the ability of powerful special interests to block health care reform.
But on Saturday, excited administration officials called me to say that this time the medical-industrial complex (their term, not mine) is offering to be helpful.
Six major industry players — including America’s Health Insurance Plans (AHIP), a descendant of the lobbying group that spawned Harry and Louise — have sent a letter to President Obama sketching out a plan to control health care costs. What’s more, the letter implicitly endorses much of what administration officials have been saying about health economics.
Are there reasons to be suspicious about this gift? You bet — and I’ll get to that in a bit. But first things first: on the face of it, this is tremendously good news.
The signatories of the letter say that they’re developing proposals to help the administration achieve its goal of shaving 1.5 percentage points off the growth rate of health care spending. That may not sound like much, but it’s actually huge: achieving that goal would save $2 trillion over the next decade.
How are costs to be contained? There are few details, but the industry has clearly been reading Peter Orszag, the budget director.
In his previous job, as the director of the Congressional Budget Office, Mr. Orszag argued that America spends far too much on some types of health care with little or no medical benefit, even as it spends too little on other types of care, like prevention and treatment of chronic conditions. Putting these together, he concluded that “substantial opportunities exist to reduce costs without harming health over all.”
Sure enough, the health industry letter talks of “reducing over-use and under-use of health care by aligning quality and efficiency incentives.” It also picks up a related favorite Orszag theme, calling for “adherence to evidence-based best practices and therapies.” All in all, it’s just what the doctor, er, budget director ordered.
Before we start celebrating, however, we have to ask the obvious question. Is this gift a Trojan horse? After all, several of the organizations that sent that letter have in the past been major villains when it comes to health care policy.
I’ve already mentioned AHIP. There’s also the Pharmaceutical Research and Manufacturers of America (PhRMA), the lobbying group that helped push through the Medicare Modernization Act of 2003 — a bill that both prevented Medicare from bargaining over drug prices and locked in huge overpayments to private insurers. Indeed, one of the new letter’s signatories is former Representative Billy Tauzin, who shepherded that bill through Congress then immediately left public office to become PhRMA’s lavishly paid president.
The point is that there’s every reason to be cynical about these players’ motives. Remember that what the rest of us call health care costs, they call income.
What’s presumably going on here is that key interest groups have realized that health care reform is going to happen no matter what they do, and that aligning themselves with the Party of No will just deny them a seat at the table. (Republicans, after all, still denounce research into which medical procedures are effective and which are not as a dastardly plot to deprive Americans of their freedom to choose.)
I would strongly urge the Obama administration to hang tough in the bargaining ahead. In particular, AHIP will surely try to use the good will created by its stance on cost control to kill an important part of health reform: giving Americans the choice of buying into a public insurance plan as an alternative to private insurers. The administration should not give in on this point.
But let me not be too negative. The fact that the medical-industrial complex is trying to shape health care reform rather than block it is a tremendously good omen. It looks as if America may finally get what every other advanced country already has: a system that guarantees essential health care to all its citizens.
And serious cost control would change everything, not just for health care, but for America’s fiscal future. As Mr. Orszag has emphasized, rising health care costs are the main reason long-run budget projections look so grim. Slow the rate at which those costs rise, and the future will look far brighter.
I still won’t count my health care chickens until they’re hatched. But this is some of the best policy news I’ve heard in a long time.
Sunday, May 10, 2009
TOBACCO UNDER FDA CONTROL!
Chances Bright for Legislation Seeking FDA Regulation of Tobacco
Lyndsey Layton/Washington Post
After 15 years of debate, tens of millions spent on lobbying and a roller-coaster legislative history, public health advocates say they believe Congress is finally ready to regulate tobacco -- and their opponents privately agree.
This week, a Senate committee will take up its version of a bill that passed the House by a comfortable margin last month. Supporters say they have more than the 60 votes needed to make the legislation filibuster-proof when it reaches the Senate floor sometime after Memorial Day.
The sponsors, Rep. Henry A. Waxman (D-Calif.) and Sen. Edward M. Kennedy (D-Mass.), with help from party leaders, have pushed the legislation onto a fast track. And President Obama, himself a smoker who has struggled to quit, has said he intends to sign the bill -- a reversal from President George W. Bush, who sought to kill it.
The legislation would give the Food and Drug Administration broad powers over the manufacturing and marketing of tobacco, a product used by 20 percent of Americans yet largely unregulated.
The very idea of tobacco regulation strikes some as nonsensical: Take a product that, if used as directed, will kill a third of those who use it and place it under the control of an agency charged with protecting public health. But advocates say FDA oversight is the best hope for reducing the 400,000 deaths each year from tobacco use.
"If this happens, and if the FDA uses its powers, it will be an enormous public health achievement," said Matthew L. Meyers, president of the Campaign for Tobacco-Free Kids, who has been pushing the legislation for 15 years.
For the first time, the $89 billion tobacco industry would have to disclose the ingredients in its products. Under the measure, the FDA could ban the most harmful of the estimated 6,000 chemicals used in cigarettes, cigars and other tobacco products. And it could reduce the amount of nicotine, perhaps to a point where tobacco is no longer addictive and smokers who want to quit can break free more easily. The bill stops short of allowing the FDA to ban tobacco or reduce the amount of nicotine to zero.
The legislation would require tobacco companies to expand the size of warning labels from 30 percent to 50 percent of the package. The Senate bill mandates that graphic images of the health effects of tobacco consumption be included.
Advertising and promotion would be restricted. Tobacco manufacturers would be unable to use the terms "light," "mild" and "low" unless they can scientifically prove that the product so labeled is less harmful than standard tobacco. The bill would also create a tobacco center within the FDA funded by fees from the industry that are estimated to reach more than $500 million annually by 2013, according to the Congressional Budget Office.
The FDA first tried to regulate tobacco in the 1990s, but the industry battled it to the Supreme Court, which ruled 5 to 4 in 2000 that the agency had exceeded its statutory authority. It called on Congress to amend the law.
But during that legal battle, the political climate surrounding the issue shifted rapidly enough that by the time the Supreme Court rendered its decision, a curious thing had happened: Philip Morris, the maker of Marlboro and the largest tobacco company in the country, said it would accept some government oversight.
At the time, Philip Morris executives were charting a strategy to improve the company's image and regain the social acceptance it had lost in the 1990s as congressional hearings, court cases and suits by state attorneys general unearthed evidence that tobacco companies lied to the public about the addictive nature of nicotine. In late 2001, Philip Morris changed its name to the Altria Group; executives said they wanted to craft a new image untainted by cigarettes. They also embraced federal oversight as a way to convince the public that Altria was socially responsible, according to internal company documents.
William Phelps, a spokesman for Altria, said the company thinks FDA approval will help Altria market new products that are less dangerous to the health. Altria recently acquired U.S. Smokeless Tobacco; is testing "snus," a new line of "spit-free" smokeless tobacco products; and recently opened a $350 million research facility in Richmond to develop products that pose lower health risks.
Sen. Mike Enzi of Wyoming, the top Republican on the committee that will discuss the bill, said he wants to see some kind of legislation on tobacco but is opposed to the Kennedy measure. "It makes me leery when a tobacco company is backing this," he said. "Nothing changes in it without Philip Morris's approval."
Some public health professionals are also skeptical.
"I'm a little suspicious of anything that Philip Morris supports," said Richard Hurt, a doctor who directs the nicotine-dependence program at the Mayo Clinic. "I haven't known Philip Morris to do anything in the interest of public health."
Altria's competitors also oppose the bill. They say Altria is backing it because restrictions on marketing tend to freeze market shares, which would lock Philip Morris into the top spot.
Sen. Richard Burr (R-N.C.), whose state is home to R.J. Reynolds Tobacco and Lorillard Tobacco, has threatened to filibuster the Kennedy bill. He and Sen. Kay Hagan (D-N.C.) have proposed an alternative bill that would promote "reduced risk" tobacco products instead of restricting cigarettes.
David J. Adelman, a tobacco analyst for Morgan Stanley, said FDA regulation was not likely to hurt the industry's overall profits, unless the agency demands so many changes in tobacco products that consumers no longer want to smoke them. He said the bill could squeeze out small companies because they are less able to afford the process involved to get a new product approved for the market.
Lobbying activity surrounding the bill is intense. In the first quarter of 2009, Altria spent $4.29 million to make its case regarding this bill and a couple of other pieces of tobacco legislation, according to federal lobbying records. Its chief rival, Reynolds American, owner of R.J. Reynolds, spent $1.59 million in that period. Lorillard, the third-largest tobacco maker, paid lobbyists $850,000 in the first three months, records show. The Campaign for Tobacco-Free Kids, meanwhile, spent $157,000 during that period.
"I think a lot of people want to get something on the books to begin the process of regulation," said Hurt of the Mayo Clinic. "The tobacco companies are still wildly successful. They still have 43 million smokers, and they're not going to give them up easily. Only time will tell whether this is a mistake or the beginning of reducing the tobacco toll in this country."
Lyndsey Layton/Washington Post
After 15 years of debate, tens of millions spent on lobbying and a roller-coaster legislative history, public health advocates say they believe Congress is finally ready to regulate tobacco -- and their opponents privately agree.
This week, a Senate committee will take up its version of a bill that passed the House by a comfortable margin last month. Supporters say they have more than the 60 votes needed to make the legislation filibuster-proof when it reaches the Senate floor sometime after Memorial Day.
The sponsors, Rep. Henry A. Waxman (D-Calif.) and Sen. Edward M. Kennedy (D-Mass.), with help from party leaders, have pushed the legislation onto a fast track. And President Obama, himself a smoker who has struggled to quit, has said he intends to sign the bill -- a reversal from President George W. Bush, who sought to kill it.
The legislation would give the Food and Drug Administration broad powers over the manufacturing and marketing of tobacco, a product used by 20 percent of Americans yet largely unregulated.
The very idea of tobacco regulation strikes some as nonsensical: Take a product that, if used as directed, will kill a third of those who use it and place it under the control of an agency charged with protecting public health. But advocates say FDA oversight is the best hope for reducing the 400,000 deaths each year from tobacco use.
"If this happens, and if the FDA uses its powers, it will be an enormous public health achievement," said Matthew L. Meyers, president of the Campaign for Tobacco-Free Kids, who has been pushing the legislation for 15 years.
For the first time, the $89 billion tobacco industry would have to disclose the ingredients in its products. Under the measure, the FDA could ban the most harmful of the estimated 6,000 chemicals used in cigarettes, cigars and other tobacco products. And it could reduce the amount of nicotine, perhaps to a point where tobacco is no longer addictive and smokers who want to quit can break free more easily. The bill stops short of allowing the FDA to ban tobacco or reduce the amount of nicotine to zero.
The legislation would require tobacco companies to expand the size of warning labels from 30 percent to 50 percent of the package. The Senate bill mandates that graphic images of the health effects of tobacco consumption be included.
Advertising and promotion would be restricted. Tobacco manufacturers would be unable to use the terms "light," "mild" and "low" unless they can scientifically prove that the product so labeled is less harmful than standard tobacco. The bill would also create a tobacco center within the FDA funded by fees from the industry that are estimated to reach more than $500 million annually by 2013, according to the Congressional Budget Office.
The FDA first tried to regulate tobacco in the 1990s, but the industry battled it to the Supreme Court, which ruled 5 to 4 in 2000 that the agency had exceeded its statutory authority. It called on Congress to amend the law.
But during that legal battle, the political climate surrounding the issue shifted rapidly enough that by the time the Supreme Court rendered its decision, a curious thing had happened: Philip Morris, the maker of Marlboro and the largest tobacco company in the country, said it would accept some government oversight.
At the time, Philip Morris executives were charting a strategy to improve the company's image and regain the social acceptance it had lost in the 1990s as congressional hearings, court cases and suits by state attorneys general unearthed evidence that tobacco companies lied to the public about the addictive nature of nicotine. In late 2001, Philip Morris changed its name to the Altria Group; executives said they wanted to craft a new image untainted by cigarettes. They also embraced federal oversight as a way to convince the public that Altria was socially responsible, according to internal company documents.
William Phelps, a spokesman for Altria, said the company thinks FDA approval will help Altria market new products that are less dangerous to the health. Altria recently acquired U.S. Smokeless Tobacco; is testing "snus," a new line of "spit-free" smokeless tobacco products; and recently opened a $350 million research facility in Richmond to develop products that pose lower health risks.
Sen. Mike Enzi of Wyoming, the top Republican on the committee that will discuss the bill, said he wants to see some kind of legislation on tobacco but is opposed to the Kennedy measure. "It makes me leery when a tobacco company is backing this," he said. "Nothing changes in it without Philip Morris's approval."
Some public health professionals are also skeptical.
"I'm a little suspicious of anything that Philip Morris supports," said Richard Hurt, a doctor who directs the nicotine-dependence program at the Mayo Clinic. "I haven't known Philip Morris to do anything in the interest of public health."
Altria's competitors also oppose the bill. They say Altria is backing it because restrictions on marketing tend to freeze market shares, which would lock Philip Morris into the top spot.
Sen. Richard Burr (R-N.C.), whose state is home to R.J. Reynolds Tobacco and Lorillard Tobacco, has threatened to filibuster the Kennedy bill. He and Sen. Kay Hagan (D-N.C.) have proposed an alternative bill that would promote "reduced risk" tobacco products instead of restricting cigarettes.
David J. Adelman, a tobacco analyst for Morgan Stanley, said FDA regulation was not likely to hurt the industry's overall profits, unless the agency demands so many changes in tobacco products that consumers no longer want to smoke them. He said the bill could squeeze out small companies because they are less able to afford the process involved to get a new product approved for the market.
Lobbying activity surrounding the bill is intense. In the first quarter of 2009, Altria spent $4.29 million to make its case regarding this bill and a couple of other pieces of tobacco legislation, according to federal lobbying records. Its chief rival, Reynolds American, owner of R.J. Reynolds, spent $1.59 million in that period. Lorillard, the third-largest tobacco maker, paid lobbyists $850,000 in the first three months, records show. The Campaign for Tobacco-Free Kids, meanwhile, spent $157,000 during that period.
"I think a lot of people want to get something on the books to begin the process of regulation," said Hurt of the Mayo Clinic. "The tobacco companies are still wildly successful. They still have 43 million smokers, and they're not going to give them up easily. Only time will tell whether this is a mistake or the beginning of reducing the tobacco toll in this country."
The American Press on Suicide Watch
By FRANK RICH
IF you wanted to pick the moment when the American news business went on suicide watch, it was almost exactly three years ago. That’s when Stephen Colbert, appearing at the annual White House Correspondents’ Association dinner, delivered a monologue accusing his hosts of being stenographers who had, in essence, let the Bush White House get away with murder (or at least the war in Iraq). To prove the point, the partying journalists in the Washington Hilton ballroom could be seen (courtesy of C-Span) fawning over government potentates — in some cases the very “sources” who had fed all those fictional sightings of Saddam Hussein’s W.M.D.
Colbert’s routine did not kill. The Washington Post reported that it “fell flat.” The Times initially did not even mention it. But to the Beltway’s bafflement, Colbert’s riff went viral overnight, ultimately to have a marathon run as the most popular video on iTunes. The cultural disconnect between the journalism establishment and the public it aspires to serve could not have been more vividly dramatized.
The bad news about the news business has accelerated ever since. Newspaper circulations and revenues are in free fall. Legendary brands from The Los Angeles Times to The Philadelphia Inquirer are teetering. The New York Times Company threatened to close The Boston Globe if its employees didn’t make substantial sacrifices in salaries and benefits. Other papers have died. The reporting ranks on network and local news alike are shriveling. You know it’s bad when the Senate is moved, as it was last week, to weigh in with hearings on “The Future of Journalism.”
Not all is bleak on the Titanic, however. The White House correspondents’ bacchanal was on tap for this weekend. And this time no one could accuse the revelers of failing to get down with the Colbert-iTunes-Facebook young folk: hip big-time journalists now stroke their fans with 140-character messages on Twitter. Or did. No sooner did boldface Washington media personalities ostentatiously embrace Twitter than Nielsen reported that more than 60 percent of Twitter users abandon it after a single month.
The causes of journalism’s downfall — some self-inflicted, some beyond anyone’s control (a worldwide economic meltdown) — are well known. To time-travel back to the dawn of the technological strand of the disaster, search YouTube for “1981 primitive Internet report on KRON.” What you’ll find is a 28-year-old local television news piece from San Francisco about a “far-fetched,” pre-Web experiment by the city’s two papers, The Chronicle and The Examiner, to distribute their wares to readers with home computers via primitive phone modems. Though there were at most 3,000 people in the Bay Area with PCs then, some 500 mailed in coupons for the service to The Chronicle alone. But, as the anchorwoman assures us at the end, with a two-hour download time (at $5 an hour), “the new telepaper won’t be much competition for the 20-cent street edition.”
The rest is irreversible history. This far-fetched newspaper experiment soon faded, even in San Francisco, the gateway to Silicon Valley. Today The Examiner, once the flagship of William Randolph Hearst’s grand journalistic empire, exists in name only, as a flimsy giveaway. The Chronicle is under threat of closure.
But this self-destructive retreat from innovation is hardly novel in the history of American communications. In the last transformative tech revolution before the Internet — television’s emergence in the late 1940s — the pattern was remarkably similar. The entertainment industry referred to TV as “the monster,” and by 1951, the editor of the industry’s trade paper, Variety, was fearful that the monster would “eventually swallow up practically all of show business.” Movies had killed vaudeville a generation earlier. This new household appliance threatened to strangle radio, movies, the Broadway theater, nightclubs and the circus. And newspapers too: “NBC’s New ‘Today’ Attacked by Papers as Competition” screamed a front-page Variety headline in 1952.
The vulnerable establishments in all these fields went nuts. Most movie studios pushed back against the future by refusing to sell their old movies to television or allow their stars to appear on it. Few seized the opportunity to produce programs for the new medium. Instead, some moguls tried to compete by exhibiting sports events by closed-circuit in networks of movie houses. In 1952-53, Cinerama, 3-D and Cinemascope were all heavily promoted to try to retain movie audiences. None of these desperate rear-guard actions could slow the video revolution. Movie newsreels, movie palaces, radio comedy and drama, and afternoon newspapers, among other staples of the American cultural diet, were all doomed.
And yet in 2009, Hollywood movie studios, radio and the Broadway theater, though smaller and much changed, are not dead. They learned to adapt and to collaborate with the monster.
In the Internet era, many sectors of American media have been re-enacting their at first complacent and finally panicked behavior of 60 years ago. Few in the entertainment business saw the digital cancer spreading through their old business models until well after file-sharing, via Napster, had started decimating the music industry. It’s not only journalism that is now struggling to plot a path to survival. But, with all due respect to show business, it’s only journalism that’s essential to a functioning democracy. And it’s not just because — as we keep being tediously reminded — Thomas Jefferson said so.
Yes, journalists have made tons of mistakes and always will. But without their enterprise, to take a few representative recent examples, we would not have known about the wretched conditions for our veterans at Walter Reed, the government’s warrantless wiretapping, the scams at Enron or steroids in baseball.
Such news gathering is not to be confused with opinion writing or bloviating — including that practiced here. Opinions can be stimulating and, for the audiences at Fox News and MSNBC, cathartic. We can spend hours surfing the posts of bloggers we like or despise, some of them gems, even as we might be moved to write our own blogs about local restaurants or the government documents we obsessively study online.
But opinions, however insightful or provocative and whether expressed online or in print or in prime time, are cheap. Reporting the news can be expensive. Some of it — monitoring the local school board, say — can and is being done by voluntary “citizen journalists” with time on their hands, integrity and a Web site. But we can’t have serious opinions about America’s role in combating the Taliban in Pakistan unless brave and knowledgeable correspondents (with security to protect them) tell us in real time what is actually going on there. We can’t know what is happening behind closed doors at corrupt, hard-to-penetrate institutions in Washington or Wall Street unless teams of reporters armed with the appropriate technical expertise and assiduously developed contacts are digging night and day. Those reporters have to eat and pay rent, whether they work for print, a TV network, a Web operation or some new bottom-up news organism we can’t yet imagine.
It’s immaterial whether we find the fruits of their labors on paper, a laptop screen, a BlackBerry, a Kindle or podcast. But someone — and certainly not the government, with all its conflicted interests — must pay for this content and make every effort to police its fairness and accuracy. If we lose the last major news-gathering operations still standing, there will be no news on Google News unless Google shells out to replace them. It won’t.
One of the freshest commentators on Internet culture, Clay Shirky, has written, correctly, that nobody really knows what form journalism will take in the evolving post-newspaper era. Looking back to the unpredictable social and cultural upheavals brought about by Gutenberg’s invention of movable type, he writes, “We’re collectively living through 1500, when it’s easier to see what’s broken than what will replace it.” So who will do the heavy journalistic lifting? “Whatever works.” Every experiment must be tried, professional and amateur, whether by institutions like The Times or “some 19-year-old kid few of us have heard of.”
What can’t be reinvented is the wheel of commerce. Just because information wants to be free on the Internet doesn’t mean it can always be free. Web advertising will never be profitable enough to support ambitious news gathering. If a public that thinks nothing of spending money on texting or pornography doesn’t foot the bill for such reportage, it won’t happen.
That’s why the debate among journalists about possible forms of payment (subscriptions, NPR-style donations, iTunes-style micropayments, foundation grants) is inside baseball. So is the acrimonious sniping between old media and new. The real question is for the public, not journalists: Does it want to pony up for news, whatever the media that prevail?
It’s all a matter of priorities. Not long ago, we laughed at the idea of pay TV. Free television was considered an inalienable American right (as long as it was paid for by advertisers). Then cable and satellite became the national standard.
By all means let’s mock the old mainstream media as they preen and party on in a Washington ballroom. Let’s deplore the tabloid journalism that, like the cockroach, will always be with us. But if a comprehensive array of real news is to be part of the picture as well, the time will soon arrive for us to put up or shut up. Whatever shape journalism ultimately takes in America, make no mistake that in the end we will get what we pay for.
IF you wanted to pick the moment when the American news business went on suicide watch, it was almost exactly three years ago. That’s when Stephen Colbert, appearing at the annual White House Correspondents’ Association dinner, delivered a monologue accusing his hosts of being stenographers who had, in essence, let the Bush White House get away with murder (or at least the war in Iraq). To prove the point, the partying journalists in the Washington Hilton ballroom could be seen (courtesy of C-Span) fawning over government potentates — in some cases the very “sources” who had fed all those fictional sightings of Saddam Hussein’s W.M.D.
Colbert’s routine did not kill. The Washington Post reported that it “fell flat.” The Times initially did not even mention it. But to the Beltway’s bafflement, Colbert’s riff went viral overnight, ultimately to have a marathon run as the most popular video on iTunes. The cultural disconnect between the journalism establishment and the public it aspires to serve could not have been more vividly dramatized.
The bad news about the news business has accelerated ever since. Newspaper circulations and revenues are in free fall. Legendary brands from The Los Angeles Times to The Philadelphia Inquirer are teetering. The New York Times Company threatened to close The Boston Globe if its employees didn’t make substantial sacrifices in salaries and benefits. Other papers have died. The reporting ranks on network and local news alike are shriveling. You know it’s bad when the Senate is moved, as it was last week, to weigh in with hearings on “The Future of Journalism.”
Not all is bleak on the Titanic, however. The White House correspondents’ bacchanal was on tap for this weekend. And this time no one could accuse the revelers of failing to get down with the Colbert-iTunes-Facebook young folk: hip big-time journalists now stroke their fans with 140-character messages on Twitter. Or did. No sooner did boldface Washington media personalities ostentatiously embrace Twitter than Nielsen reported that more than 60 percent of Twitter users abandon it after a single month.
The causes of journalism’s downfall — some self-inflicted, some beyond anyone’s control (a worldwide economic meltdown) — are well known. To time-travel back to the dawn of the technological strand of the disaster, search YouTube for “1981 primitive Internet report on KRON.” What you’ll find is a 28-year-old local television news piece from San Francisco about a “far-fetched,” pre-Web experiment by the city’s two papers, The Chronicle and The Examiner, to distribute their wares to readers with home computers via primitive phone modems. Though there were at most 3,000 people in the Bay Area with PCs then, some 500 mailed in coupons for the service to The Chronicle alone. But, as the anchorwoman assures us at the end, with a two-hour download time (at $5 an hour), “the new telepaper won’t be much competition for the 20-cent street edition.”
The rest is irreversible history. This far-fetched newspaper experiment soon faded, even in San Francisco, the gateway to Silicon Valley. Today The Examiner, once the flagship of William Randolph Hearst’s grand journalistic empire, exists in name only, as a flimsy giveaway. The Chronicle is under threat of closure.
But this self-destructive retreat from innovation is hardly novel in the history of American communications. In the last transformative tech revolution before the Internet — television’s emergence in the late 1940s — the pattern was remarkably similar. The entertainment industry referred to TV as “the monster,” and by 1951, the editor of the industry’s trade paper, Variety, was fearful that the monster would “eventually swallow up practically all of show business.” Movies had killed vaudeville a generation earlier. This new household appliance threatened to strangle radio, movies, the Broadway theater, nightclubs and the circus. And newspapers too: “NBC’s New ‘Today’ Attacked by Papers as Competition” screamed a front-page Variety headline in 1952.
The vulnerable establishments in all these fields went nuts. Most movie studios pushed back against the future by refusing to sell their old movies to television or allow their stars to appear on it. Few seized the opportunity to produce programs for the new medium. Instead, some moguls tried to compete by exhibiting sports events by closed-circuit in networks of movie houses. In 1952-53, Cinerama, 3-D and Cinemascope were all heavily promoted to try to retain movie audiences. None of these desperate rear-guard actions could slow the video revolution. Movie newsreels, movie palaces, radio comedy and drama, and afternoon newspapers, among other staples of the American cultural diet, were all doomed.
And yet in 2009, Hollywood movie studios, radio and the Broadway theater, though smaller and much changed, are not dead. They learned to adapt and to collaborate with the monster.
In the Internet era, many sectors of American media have been re-enacting their at first complacent and finally panicked behavior of 60 years ago. Few in the entertainment business saw the digital cancer spreading through their old business models until well after file-sharing, via Napster, had started decimating the music industry. It’s not only journalism that is now struggling to plot a path to survival. But, with all due respect to show business, it’s only journalism that’s essential to a functioning democracy. And it’s not just because — as we keep being tediously reminded — Thomas Jefferson said so.
Yes, journalists have made tons of mistakes and always will. But without their enterprise, to take a few representative recent examples, we would not have known about the wretched conditions for our veterans at Walter Reed, the government’s warrantless wiretapping, the scams at Enron or steroids in baseball.
Such news gathering is not to be confused with opinion writing or bloviating — including that practiced here. Opinions can be stimulating and, for the audiences at Fox News and MSNBC, cathartic. We can spend hours surfing the posts of bloggers we like or despise, some of them gems, even as we might be moved to write our own blogs about local restaurants or the government documents we obsessively study online.
But opinions, however insightful or provocative and whether expressed online or in print or in prime time, are cheap. Reporting the news can be expensive. Some of it — monitoring the local school board, say — can and is being done by voluntary “citizen journalists” with time on their hands, integrity and a Web site. But we can’t have serious opinions about America’s role in combating the Taliban in Pakistan unless brave and knowledgeable correspondents (with security to protect them) tell us in real time what is actually going on there. We can’t know what is happening behind closed doors at corrupt, hard-to-penetrate institutions in Washington or Wall Street unless teams of reporters armed with the appropriate technical expertise and assiduously developed contacts are digging night and day. Those reporters have to eat and pay rent, whether they work for print, a TV network, a Web operation or some new bottom-up news organism we can’t yet imagine.
It’s immaterial whether we find the fruits of their labors on paper, a laptop screen, a BlackBerry, a Kindle or podcast. But someone — and certainly not the government, with all its conflicted interests — must pay for this content and make every effort to police its fairness and accuracy. If we lose the last major news-gathering operations still standing, there will be no news on Google News unless Google shells out to replace them. It won’t.
One of the freshest commentators on Internet culture, Clay Shirky, has written, correctly, that nobody really knows what form journalism will take in the evolving post-newspaper era. Looking back to the unpredictable social and cultural upheavals brought about by Gutenberg’s invention of movable type, he writes, “We’re collectively living through 1500, when it’s easier to see what’s broken than what will replace it.” So who will do the heavy journalistic lifting? “Whatever works.” Every experiment must be tried, professional and amateur, whether by institutions like The Times or “some 19-year-old kid few of us have heard of.”
What can’t be reinvented is the wheel of commerce. Just because information wants to be free on the Internet doesn’t mean it can always be free. Web advertising will never be profitable enough to support ambitious news gathering. If a public that thinks nothing of spending money on texting or pornography doesn’t foot the bill for such reportage, it won’t happen.
That’s why the debate among journalists about possible forms of payment (subscriptions, NPR-style donations, iTunes-style micropayments, foundation grants) is inside baseball. So is the acrimonious sniping between old media and new. The real question is for the public, not journalists: Does it want to pony up for news, whatever the media that prevail?
It’s all a matter of priorities. Not long ago, we laughed at the idea of pay TV. Free television was considered an inalienable American right (as long as it was paid for by advertisers). Then cable and satellite became the national standard.
By all means let’s mock the old mainstream media as they preen and party on in a Washington ballroom. Let’s deplore the tabloid journalism that, like the cockroach, will always be with us. But if a comprehensive array of real news is to be part of the picture as well, the time will soon arrive for us to put up or shut up. Whatever shape journalism ultimately takes in America, make no mistake that in the end we will get what we pay for.
Saturday, May 09, 2009
HEALTH CARE UPDATE
Competing demands on health overhaul from groups
Associated Press
Patients and doctors. Small businesses and multinationals. Retirees, workers and insurance companies.
Some have more money and clout. All have something in common when it comes to overhauling health care: a huge stake in the outcome.
Their competing demands will help determine what happens as Congress writes legislation to reshape the nation's $2.5 trillion health care system to bring down costs and cover 50 million uninsured people. If the whole undertaking starts to fall apart, look to opposition from one or more of these groups as the reason why.
All say their goal is for everyone to have access to quality and affordable care. Beyond that, consensus breaks down.
A look at 10 groups with the most influence, or most at stake, in the health debate, and what they want and are trying to avoid:
___
Workers:
Some 60 percent of people under age 65 get health care through an employer. But employers don't have to offer health insurance, and as the economy frays, some are dropping it. Labor unions want to require employers to help pay for coverage for their employees.
Unions also believe the path to affordable care runs through a new public insurance plan that would compete with private plans. Middle-class workers, for the first time, would have the option of government insurance. Proponents of this approach, already embraced by President Barack Obama and many Democrats, believe it would drive down costs for all.
___
People with health conditions:
A common complaint about insurers is that they won't cover people with existing health conditions or that they charge them too much. Patients' advocacy groups want to require insurers to cover all comers, not just the healthy, and limit what they can charge the sick. They contend that would spread risk and costs throughout the population.
___
Older people:
Among the top goals for AARP is ensuring health coverage for people age 50-64 (at 65 they can get Medicare). That could be done by allowing middle-aged people to buy into Medicare. AARP also is eager for Congress to fix the coverage gap in the Medicare drug benefit that patients fall into once their prescription expenses exceed about $2,700.
___
Uninsured people:
The estimated 50 million uninsured people in the U.S. don't have lobbyists, but various advocacy groups aim to speak on their behalf. The liberal group Health Care for America Now says any health overhaul should mean coverage for everyone by including a public plan, basing out-of-pocket costs on ability to pay and providing a standard benefit with preventive care and treatment for serious and chronic diseases.
___
Insurance companies:
For private insurers, the bogeyman is competition from the government. They contend a public plan would drive them out of business. To stave that off, the industry is offering to curb its practice of charging higher premiums to people with a history of medical problems, as long as Congress requires all Americans to get insurance.
___
Small businesses:
Opposition from small business helped kill a health care overhaul during the Clinton years. Their top goal remains the same: to avoid any kind of requirement for employers to provide health care. The National Federation of Independent Business says that is unacceptable and favors subsidies to help people buy insurance. Small businesses want to make the same tax breaks for health insurance available to all, not just those who get coverage through an employer.
___
Big businesses:
Even though most big businesses offer health care to their employees, they strongly oppose an employer mandate, fearing the government would start dictating what kind of policies they could offer. Businesses want to avoid taxes on the health insurance benefits.
___
Hospitals:
Hospitals worry that a new government insurance plan would reduce the fees they can collect. They support requirements for individuals and employers to purchase insurance so "everyone plays a role in making sure that there's coverage," says Tom Nickels, a senior vice president at the American Hospital Association.
___
Doctors: Doctors have similar concerns as hospitals about a public plan. They also want to prevent insurers from raising rates on patients with health problems. They would cap or eliminate tax breaks for employer-provided benefits, using the revenue to subsidize care for low-income people. Doctors want curbs on medical malpractice awards so they don't face the threat of huge jury awards. They contend that leads to "defensive medicine" — performing unnecessary procedures to avoid getting sued.
___
Drug companies:
The drug lobby opposes a government insurance plan and has joined the advocacy group Families USA in proposing to cover more of the uninsured by expanding Medicaid, the federal-state insurance program for the poor. Pharmaceutical companies support federal subsidies to help middle-class people unable to afford insurance. Drug companies oppose efforts to squeeze bigger discounts from them under Medicaid.
"We don't want bureaucrats making the decisions about what medicines can be used by the patients of our country and that's the end result of a pure public plan," says Billy Tauzin, head of the Pharmaceutical Research and Manufacturers of America.
___
On the Net:
Pharmaceutical Research and Manufacturers of America: http://www.phrma.org/
American Hospital Association: http://www.aha.org/
National Federation of Independent Business: http://www.nfib.com/
AFL-CIO: http://www.aflcio.org/
AARP: http://www.aarp.org/
America's Health Insurance Plans: http://www.ahip.org
American Medical Association: http://www.ama-assn.org/
Families USA: http://www.familiesusa.org/
Health Care for America Now: http://www.healthcareforamericanow.org/
Associated Press
Patients and doctors. Small businesses and multinationals. Retirees, workers and insurance companies.
Some have more money and clout. All have something in common when it comes to overhauling health care: a huge stake in the outcome.
Their competing demands will help determine what happens as Congress writes legislation to reshape the nation's $2.5 trillion health care system to bring down costs and cover 50 million uninsured people. If the whole undertaking starts to fall apart, look to opposition from one or more of these groups as the reason why.
All say their goal is for everyone to have access to quality and affordable care. Beyond that, consensus breaks down.
A look at 10 groups with the most influence, or most at stake, in the health debate, and what they want and are trying to avoid:
___
Workers:
Some 60 percent of people under age 65 get health care through an employer. But employers don't have to offer health insurance, and as the economy frays, some are dropping it. Labor unions want to require employers to help pay for coverage for their employees.
Unions also believe the path to affordable care runs through a new public insurance plan that would compete with private plans. Middle-class workers, for the first time, would have the option of government insurance. Proponents of this approach, already embraced by President Barack Obama and many Democrats, believe it would drive down costs for all.
___
People with health conditions:
A common complaint about insurers is that they won't cover people with existing health conditions or that they charge them too much. Patients' advocacy groups want to require insurers to cover all comers, not just the healthy, and limit what they can charge the sick. They contend that would spread risk and costs throughout the population.
___
Older people:
Among the top goals for AARP is ensuring health coverage for people age 50-64 (at 65 they can get Medicare). That could be done by allowing middle-aged people to buy into Medicare. AARP also is eager for Congress to fix the coverage gap in the Medicare drug benefit that patients fall into once their prescription expenses exceed about $2,700.
___
Uninsured people:
The estimated 50 million uninsured people in the U.S. don't have lobbyists, but various advocacy groups aim to speak on their behalf. The liberal group Health Care for America Now says any health overhaul should mean coverage for everyone by including a public plan, basing out-of-pocket costs on ability to pay and providing a standard benefit with preventive care and treatment for serious and chronic diseases.
___
Insurance companies:
For private insurers, the bogeyman is competition from the government. They contend a public plan would drive them out of business. To stave that off, the industry is offering to curb its practice of charging higher premiums to people with a history of medical problems, as long as Congress requires all Americans to get insurance.
___
Small businesses:
Opposition from small business helped kill a health care overhaul during the Clinton years. Their top goal remains the same: to avoid any kind of requirement for employers to provide health care. The National Federation of Independent Business says that is unacceptable and favors subsidies to help people buy insurance. Small businesses want to make the same tax breaks for health insurance available to all, not just those who get coverage through an employer.
___
Big businesses:
Even though most big businesses offer health care to their employees, they strongly oppose an employer mandate, fearing the government would start dictating what kind of policies they could offer. Businesses want to avoid taxes on the health insurance benefits.
___
Hospitals:
Hospitals worry that a new government insurance plan would reduce the fees they can collect. They support requirements for individuals and employers to purchase insurance so "everyone plays a role in making sure that there's coverage," says Tom Nickels, a senior vice president at the American Hospital Association.
___
Doctors: Doctors have similar concerns as hospitals about a public plan. They also want to prevent insurers from raising rates on patients with health problems. They would cap or eliminate tax breaks for employer-provided benefits, using the revenue to subsidize care for low-income people. Doctors want curbs on medical malpractice awards so they don't face the threat of huge jury awards. They contend that leads to "defensive medicine" — performing unnecessary procedures to avoid getting sued.
___
Drug companies:
The drug lobby opposes a government insurance plan and has joined the advocacy group Families USA in proposing to cover more of the uninsured by expanding Medicaid, the federal-state insurance program for the poor. Pharmaceutical companies support federal subsidies to help middle-class people unable to afford insurance. Drug companies oppose efforts to squeeze bigger discounts from them under Medicaid.
"We don't want bureaucrats making the decisions about what medicines can be used by the patients of our country and that's the end result of a pure public plan," says Billy Tauzin, head of the Pharmaceutical Research and Manufacturers of America.
___
On the Net:
Pharmaceutical Research and Manufacturers of America: http://www.phrma.org/
American Hospital Association: http://www.aha.org/
National Federation of Independent Business: http://www.nfib.com/
AFL-CIO: http://www.aflcio.org/
AARP: http://www.aarp.org/
America's Health Insurance Plans: http://www.ahip.org
American Medical Association: http://www.ama-assn.org/
Families USA: http://www.familiesusa.org/
Health Care for America Now: http://www.healthcareforamericanow.org/
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