Shameless self promotion

As of the time of this post's publication, if you type "explain health care reform" on Google, WAG is the number one hit.

The question is, should I view this as cool or terrifying?

On the one hand, kind of neat to know that what I'm writing is actually having an impact.

On the other hand, the first thing many people will read for information on health care reform will be written by "guy on the Internet." An example of how the Internet era is breaking down Experts' mediation between raw facts and the public's consciousness - Google's algorithms don't account for author qualifications.

At least, unlike some sites, this guy on the Internet has critical thinking skills, so even if I'm wrong on some things, you can trust the analysis to be well thought out.

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How to explain the health care reform bill to your family and friends very very simply

Companies agree: "health care reform won't cost us jack"

Conservative commentators have been crowing over AT&T's report that health care reform has caused it to take a $1 billion accounting charge. House Majority Leader John Boehner called it another example of "job killing tax increases."

Actual business leaders disagree.

Noted bastion of socialism CFO.com explains that "Health care hit is minimal":

AT&T, Caterpillar, and Deere are among the companies that are reporting large first-quarter accounting charges because of the repeal of a tax deduction by the new health-care law. But the charges will have little effect on company valuations or cash flow, analysts say.

The Patient Protection and Affordable Care Act strips companies of a 28% tax deduction related to retiree drug benefits. The deduction is actually the tax-free treatment of a government subsidy that companies receive for providing retiree drug benefits equivalent to Medicare Part D, says tax expert Robert Willens, who heads a consultancy in New York. Since the deduction can't be claimed until the benefits are paid out, companies make the adjustment by writing down the deferred tax asset balances related to the subsidy, notes Willens.

Under the new law, the subsidy is no longer tax-free and must be included in a company's taxable-income calculation. The law eliminates the "double dipping" possibilities that were part of the tax code since 2003, says Willens. Under the original Medicare prescription-drug law, companies received deductions for making payments into retiree drug plans, as well as getting tax-free treatment for the subsidies they received for paying into the plans.

Last week AT&T announced it plans to take a $1 billion noncash charge related to the new law in the first quarter. Also announcing first-quarter charges were Caterpillar ($100 million), Deere ($150 million), and AK Steel ($31 million). Steelcase and DTE Energy also said they would be subject to similar accounting charges, although they have not yet specified the amounts.

A study of S&P 500 companies by Credit Suisse shows that the new law will cause companies to reduce their deferred tax assets by an aggregate $4.5 billion, with 45 of the companies possibly seeing a charge that is more than 10% of their consensus first-quarter earnings estimates. However, investors should not "overreact" to the potential earnings hit, cautions Credit Suisse's David Zion, because the charge will have very little effect on company valuations.

Indeed, the "eye-popping" numbers being reported are not a good indication of the costs being incurred in the first quarter, notes study co-author Christopher Cornett. That's because a quirk in the accounting rules requires companies to recognize the present value today of future cash costs going out as far as the drug benefits are offered.

...

The Credit Suisse report also points out that corporate cash flows from operations won't suffer much from the loss of the tax deduction, either. Between 2013 and 2019, it's likely that 20 companies will pay more than $5 million per year, on average, of additional taxes as a result of the new law. However, the tax hit amounts to less than 1% of the trailing five-year average cash flow from operations for each of the companies.

This argument is strikingly similar to ones made by liberal commentators.

It's becoming clear that although the GOP claims to be the party of markets and of business, the party's ideology is increasingly disconnected from what's actually good for business. Today's business leaders have recognized that sensible regulation is a prerequisite for the operation of their companies, and politicians have been slow to catch up. 20 years from now, will the GOP have updated its policy positions to account for the new realities of business, or will a new generation of businesspeople abandon the party that has championed their interests for the past century?

How to explain the health care reform bill to your family and friends very very simply

Health care reform has passed. Now it's time to explain what it does.

Why is this so important? Because the public will like the bill once they find out what's in it. Republicans know it, and polling bears it out. It's therefore our job to get the word out to our family and friends - and in a way that's easy to understand.

So how do you explain a 2,000+ page bill in under two minutes? Easy.

First, ask the family member or friend if they think insurance companies should be able to revoke people's coverage when they get sick, or deny people coverage because they've got a preexisting condition.

They'll say "no." (If they say "yes," well, you're never going to persuade them).

Then you explain the bill like this:

"Well that's good, because that's the first thing the health care bill does, is ban those outrageous insurance company practices. In fact, there are really just five basic things the health care bill does:

"First, it bans insurance companies from revoking your coverage when you get sick, or denying you coverage because of preexisting conditions.

"Second, with those regulations in place, you've gotta make sure that people don't just wait around till they get sick before buying insurance - otherwise, insurance companies would all go out of business since only sick people would buy insurance. So the bill requires all Americans to buy health insurance - that's the 'individual mandate.'

"Third, if everyone has to buy insurance, you've gotta make sure people can actually afford it. So the bill provides subsidies to help low and middle income people afford insurance.

"Fourth, if the government is paying for people's insurance, you've gotta keep the insurance companies honest and force them to compete. And the bill does this by establishing 'exchanges' where you can shop around for insurance policies online. Insurance companies must post prices and customer satisfaction data to help you compare policies. Basically, the exchanges would be like the Target of health insurance. (See here for more info on the exchanges)

"Last, you've of course gotta pay for all this. And the bill does this with fees on medical device makers and other corporations that benefit from the bill, taxes on the most expensive "Cadillac" insurance plans, and reductions in Medicare fraud and waste. And the Congressional Budget Office actually found that this would reduce the deficit by over $100 billion over the next ten years.

"So really, the bill starts by preventing outrageous insurance company practices, and the rest is just necessary to make that first part work. It's a pretty moderate, common sense bill."

Framed this way, it's almost impossible to reject the bill. If you reject any piece of this, it means you're implicitly supporting insurance companies' ability to rescind coverage and deny on the basis of preexisting conditions, or you're supporting a system that will bankrupt the insurance industry and the federal government.

So again, the summary is:

1. Insurance regulation: Bans insurance companies from revoking or denying coverage because you get sick.
2. Individual mandate: Requires everyone to buy health insurance in order to prevent people from waiting till they get sick to buy insurance
3. Subsidies: Provides subsidies to make sure everyone can afford to buy insurance
4. Online exchanges: Establishes online exchanges where you can shop for insurance coverage, in order to promote competition and keep companies honest
5. Paying for the bill: Pays for the subsidies with a combination of spending cuts and taxes on companies that benefit from reform

If you're really pressed for time, you can explain it as The Economist does in three sentences:

Under Barack Obama’s plan, which is bogged down in Congress [just passed], the private-insurance market would expand dramatically—but so would regulation. The proposal would require all Americans to buy cover. To make it affordable, the government would regulate products and prices and offer subsidies for the poor.

For a slightly more detailed explanation, see my post "The simplest explanation of health care reform you will ever read." And if you're really wanting more nitty gritty, go read Ezra Klein's blog.

Questions? Suggestions? Leave them in the comments.

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Republican staffer says public will probably like health care reform once they find out what's in it

I ran into a Republican Hill staffer on my way to work today and asked him about last night’s health care vote. His answer was a little surprising:

I gotta hand it to Obama getting it done. It's somewhat of a political gamble with some of the provisions not kicking in until 2012. Democrats will lose seats in November, but when the bill starts kicking in and people find out what the bill does—if it works—Obama will have put himself in a good situation.

I’m torn. I don’t like the cost of the bill, but I also can't stomach people getting turned away from health insurance. That's just wrong.

Slowly the truth starts to come out. Here's what David Axelrod has to say:

“This only worked well for the Republican Party if it failed to pass,” David Axelrod, one of the president’s closest political advisers, said at the White House as he watched the vote count for the final bill reach 219 in favor. “They wanted to run against a caricature of it rather than the real bill. Now let them tell a child with a pre-existing condition, ‘We don’t think you should be covered.’”

Pot, kettle, black

Conservative pundits are up in arms over 11-year-old Marcelas Owens voicing his support for health care reform. Beck in particular moans, "But what he's being put through now — knowingly by adults — is obscene. The senators are exploiting him and it's absolutely despicable."

Adults putting words in kids' mouths? Does anybody remember this gem of a video from back in November?



A little like the pot calling the kettle black, don't you think?

Health care reform in three sentences

The Economist explains President Obama's health insurance plan in three sentences:

Under Barack Obama’s plan, which is bogged down in Congress, the private-insurance market would expand dramatically—but so would regulation. The proposal would require all Americans to buy cover. To make it affordable, the government would regulate products and prices and offer subsidies for the poor.

The above quote is from a special report in last week's Economist on health insurance around the world, which situates the President's reform proposals in the context of how other countries treat health insurance. It's the shortest explanation of the reform bill I've yet seen (though I think my own is still the best).

The article also contained this bombshell graphic, which shows that the US health care system is hardly free of the hand of government, even relative to other countries:

Seen in this light, and explained so succinctly, the President's plan sounds like the moderate, common sense approach that it is. In contrast with its reporting on US politics, the Economist's international and business reporting is still quite good.

Since the Economist is now behind a pay wall, here's the full context of the quote:

In countries where state-financed health care is not available to all, some governments are worried that too few of their citizens have sufficient cover. They want private insurance to be expanded to cover everyone. The most prominent effort is under way in America, where about 47m people lack health insurance of any kind. Under Barack Obama’s plan, which is bogged down in Congress, the private-insurance market would expand dramatically—but so would regulation. The proposal would require all Americans to buy cover. To make it affordable, the government would regulate products and prices and offer subsidies for the poor.

This effort is similar to reforms undertaken over the past decade in the Netherlands and Switzerland. The Swiss were keen to expand access to all, and to contain costs; the Dutch saw private insurance as a boon both to consumer choice and to innovation in the delivery of health care. To ensure equitable access, both countries forbid private insurers from discriminating against applicants because they are in poor health or at high risk of falling ill. This practice, known as “lemon dropping”, continues in the American market for individual health coverage.

Inevitably, however, some insurers (say, those offering cheap, bare-bones packages) will attract younger, fitter and cheaper customers while others (with a reputation for quality or gold-plated coverage for chronic diseases) will attract the old, the sick and the costly. In the Netherlands, Switzerland and Germany, which copied some earlier Swiss reforms, regulations force companies that make “excess” profits in this way to hand over that money to those who end up with costly patients. Uwe Reinhardt, a health economist at Princeton University, jokes that Germany has the illusion of 200 private health insurers but because of risk adjustment it in fact has just one. The Dutch are now shifting from risk-smoothing after the fact to doing it even before the fiscal year begins.

Such a tightly regulated expansion of private insurance—in effect, turning health insurance into a utility—can expand coverage. European countries that followed this path now enjoy near-universal access. So does the American state of Massachusetts, which has implemented similar reforms. If Congress eventually accepts Mr Obama’s proposals, the rest of America will also see coverage increase markedly.

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State of the Union smackdown, plus Republicans' hilarious plan for health care reform

Like I said earlier, Wednesday was a big day.  First, Apple unveiled its iPad tablet computer (on which I think Congress should model its health care bill).  Hours later, President Obama gave his first State of the Union address.

And it was a good one.

I have to admit, I was worried.  Over the last week, for the first time since his 2004 Convention speech, I had less than total faith in Barack Obama.  It wasn't Scott Brown's election in Massachusetts: as I've explained, there's no logical way to interpret it as a rejection of President Obama or his policies.  Rather, it was the President's own actions.  First, his apparent refusal to push Congressional Democrats to pass health reform immediately seemed morally indefensible and politically baffling.  Second was his out-of-character about face to put a three-year freeze on discretionary spending; what disconcerted me was not so much the policy implications of the spending freeze, but that it seemed so reactive to events - a rare break from his brand of calm steadfastness.

Before this evening, I genuinely feared that the President might say in his State of the Union, "I came to this office to bring change to America, but the American people are telling me I'm moving too fast--and I'm listening."

Thank God that did not happen.  With this speech, Barack is back.  [UPDATED: Mostly back.  A couple people have pointed out that the President did not explicitly endorse cap-and-trade, which is a major concern.  For the moment, I'm relieved by the speech, but no longer quite reassured.  If the President really wants to lead, I'll need to see him sticking his neck out for a cap on carbon, not just the easy rhetoric on green jobs.]  Several points reassured me that he still is the man he said he was, and that there's still Hope to bring change to Washington - and America.  For now, I want to focus on one: health care.

On that issue, which has consumed my thoughts for the past two weeks, I thought the President made it absolutely clear where he stands: pass the damn bill.

After nearly a century of trying, we are closer than ever to bringing more security to the lives of so many Americans. The approach we've taken would protect every American from the worst practices of the insurance industry...

Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office the independent organization that both parties have cited as the official scorekeeper for Congress our approach would bring down the deficit by as much as $1 trillion over the next two decades.

Still, this is a complex issue, and the longer it was debated, the more skeptical people became. I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, this process left most Americans wondering what's in it for them.

But I also know this problem is not going away. By the time I'm finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.

As temperatures cool, I want everyone to take another look at the plan we've proposed. There's a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here's what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.

This is the closest Obama has come to articulating express support for a specific health reform proposal, and he's urging Congress across the goal line.  True, he didn't say, "I want the House to pass the Senate version of the bill, and the Senate to pass House-friendly Amendments A, B, and C."  But it doesn't take a prophet to read the writing on the wall.  Four times the President refers to "the approach we've taken," "our approach," "the plan we've proposed," "this approach."  Those are all past tense, describing an object that already exists: he's expressing that he's in favor of some close version of what's already been written.  The basic elements common to the House and Senate bills - the five pillars of insurance regulation, an individual mandate, subsidies, taxes + spending cuts, and competition, together in a comprehensive package - constitute the plan he wants everyone to calm down and "take another look at."

The President does of course say that he's willing to consider "a better approach" from either party, and he urges Congress to "come together and finish the job."  But in context, surrounded by the language of urgency, those don't seem like exhortations for Democrats to work with Republicans to develop a compromise.  Rather, he's calling the Congressmen's bluff who say there's no rush, who advise that we should put on the brakes until we find a better approach.  He's saying, "I haven't seen anything that makes me think that any of you out there have something better than what we've got.  Prove me wrong, I dare you.  But if you can't do it - and fast - we're not waiting any longer."  Thus when he says, "come together and finish the job," I think he's talking about the House and Senate coming together, not Democrats and Republicans.

Now, one Republican says he does have a "better approach."  In the GOP response, my current state's governor Bob McDonnell asserts:

Republicans in Congress have offered legislation to reform healthcare, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes.

Really?  You mean Republicans haven't just been obstructing the President's agenda for obstructionism's sake, but have had a plan of their own all along?  Where might I find this mysterious document?  Fortunately, Gov. McDonnell told me:

In fact, many of our proposals are available online at solutions.gop.gov

Ah, so that's why no one in the GOP can ever seem to talk about their solutions: they've been hiding on the Internet!  Naturally, I looked up the GOP health care plan to see what Gov. McDonnell was talking about.  Here's the summary of it:

You mean the Republicans put so little effort into their health care plan that they couldn't even change the formatting from the Microsoft defaults?   The three zeros in the "Scorecard" at the bottom of the page are also a nice touch.  The GOP thinks it can give everyone in the US affordable health care with zero tax increases, zero Medicare cuts, and zero job losses - and not even an asterisk next to those zeros to provide the source of the info?  Who's putting their trust in naive hope now?  


And there's more comedy to be had.  Check out the very first plank in the plan:

That's right: the GOP plan for "lowering health care premiums" is to...... pass a "plan [that] will lower health care premiums"!

The non-partisan CBO score already showed that the GOP health plan was a joke, but surely the existence of this document is the best proof I have that the GOP is doomed in the long-term, utterly bereft of ideas.  And in the short-term, I don't think President Obama should wait up for "a better approach."


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iPads and iPols

Wednesday was a big day.  While President Obama was preparing his State of the Union address, Steve Jobs was announcing Apple's new tablet computer: the iPad.  And I have to say, I wasn't exactly blown away.  


As numerous bloggers have pointed out, it seems basically like a giant iPod Touch.  Perhaps more shockingly, Steve Jobs didn't sell me on it either (you can watch his presentation here).  "It's thin," he says.  Ok, so what?  "If you rotate it, the screen rotates too, so it doesn't matter which way you're holding it."  Yeah, the iPhone does that too.  


Beyond its features, I don't understand the niche for it.  What does it do that you can't do with a Kindle or laptop?  The Kindle lets you read books without burning your eyes out.  A laptop is easier to type on.  And if you already have these devices, why buy an iPad?  


Despite these questions, I have little doubt that the iPad will sell.  Apple's loyal early adopters will line up outside Apple stores to buy them.  The media will cover the lines outside the stores, causing more people to think, "this must be a great product," and line up behind the early adopters.  It's a self fulfilling prophecy.

More importantly, while the iPad itself hardly seems revolutionary NOW, I have no doubt that the subtle changes it ushers in today will have major follow-on impacts on business, technology, and the way we live our lives.  Most obviously, the iPad fundamentally changes the way we interact with computer content: from manipulation of physical devices (e.g. keyboard, mouse) to control the content, to manipulation of the content directly.  It seems small now--maybe even inconvenient (I imagine the keyboard is nowhere near as effective as a physical one)--but who knows what innovations will be built on the shift the iPad has initiated?  20 years from now, will computers be Minority Report style interfaces where we whisk icons, graphics, and text through the air with a hand flick?  Based on the difficulties of interfacing with MS Office software, that doesn't seem like such a bad future.


The other important thing to note is that whatever the iPad lacks now, it's only version 1.0.  Apple doesn't presume it can anticipate all the device's flaws and potentialities in advance and bake those into a perfect, final product: it lets the device evolve over time.  Based on flaws it finds in the field and suggestions solicited from users, Apple will no doubt have version 2.0 out in 6 months that fixes flaws and adds new features.  Moreover, Apple understands that creative iPad users will figure out new ways to use the device so much better than Apple can, and therefore farms the job of improving the device out to the users themselves.  If there's a problem, a developer will write an app to fix it.  If a developer spots an unrealized capability the device has enabled, well there'll be an app for that too.


Which makes me think, why can't we take an approach like that to health care?  Why can't Congress work more like the App Store?  The House can pass the current Senate bill that does five basic things, then have the Senate develop "apps" to fix bill 1.0 through the reconciliation process.  Even better, allow health reform's users (e.g. doctors, nurses, patients, scientists, economists) to write "app legislation" to solve problems they spot as they go about their business, and make those "apps" available in a market in which smaller institutions (states, localities, hospitals, companies) can shop for ones that solve their own unmet problems as needed.


Call it the Apple approach to health care reform.  Of course, the second half of that is just a little unconstitutional, but I don't see why the House and Senate can't act as hardware manufacturer and app developer.


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The simplest explanation of health care reform you will ever read

The problem with the health care bill is that nobody knows what’s in it.  Nate Silver at FiveThirtyEight has done an excellent job explaining that while the public opposes the generic entity of “Obama’s health care bill,” a majority actually supports the bill once you explain what it does.  In fact, most people who oppose the bill believe things about it that are demonstrably false.

It’s understandable: health care is an incredibly complex issue—one in which there are few obviously right answers—and the current bill has been tortured by political sausage-making into a 1,000+ page behemoth of convolution.

But when you step back and look at the health care bill, it’s really not as hard to understand as it seems, and it's possible to write a simple explanation of the health care bill.  In fact, the Senate bill does just five main things:

1. Bans insurance companies from denying coverage to people with preexisting conditions, and from rescinding coverage after you get sick
2. Requires all Americans to purchase health insurance
3. Provides subsidies for those unable to afford insurance premiums
4. Establishes "exchanges" for people to compare and purchase insurance policies
5. Pays for all of this with taxes on expensive “Cadillac” insurance plans and companies in the health care industry, and reductions in Medicare spending

As Paul Krugman points out, each of these pillars is crucial to the others’ success.  Take one pillar out of the package, and the whole structure collapses.  Understanding that, here's how to truthfully explain the health care bill to any skeptic on left or right such that its necessity becomes obvious - if you just want the short, bulleted version, scroll down toward the bottom.

We’ll start with the component that everyone agrees on: insurance companies should not be able to deny Americans coverage because of pre-existing conditions, nor take away your coverage once you get sick.  Our current system ensures that the Americans most in need of health care have the hardest time getting it.  This is wrong and immoral.  The bill bans these insurance company practices, so that no American will ever be denied by an insurer because of sickness.  Even Republicans support this provision (or say they do at least).

But this universally popular provision creates a new problem: if insurers have to accept anyone regardless of health, it creates an incentive for healthy people to wait until they get sick to buy insurance.  It’d be like waiting until your house burned down to buy home insurance - no insurance company can stay in business if it's forced to pay benefits to people who haven't paid premiums into the risk pool.  To cover these late-comers, insurers would have to raise premiums on everyone else.  Rising premiums would drive more people out of the system, requiring further premium increases, creating a “death spiral” that would bankrupt the insurance industry and ultimately require a true government takeover of health care.  Hence the individual mandate: if insurance companies have to cover everyone regardless of health status, then you have to require everyone to buy insurance. (Check out Ezra Klein's blog for more on this.)

Not everyone, of course, can afford insurance premiums.  So the health care bill provides subsidies to defray the costs for lower-income Americans.  Perhaps these could be more or less generous, but philosophically, the idea is sound: if you require everyone to buy insurance, you have to help out those who can’t afford to pay for it.

Of course now we’re requiring everyone to buy insurance companies’ product—and paying for those who can’t afford to do so.  If this is not to be just a massive transfer of taxpayer wealth to insurance companies, we have to limit insurers' ability to raise prices.  This can be done through command-and-control policies (e.g. price ceilings), but I prefer market solutions that work by facilitating competition.  It seems like the easiest way to do this would be to create a government-run insurance option to compete with private insurers, but that's off the table, so the current bill does the next best thing: it creates “insurance exchanges” that help Americans to compare and choose private insurance policies.  Again, there are better and worse ways to implement the exchanges, but on principle, it’s a reasonable idea.

Finally, we need to find a way to pay for all this (the subsidies and exchanges).  There are two ways to do it: borrow money and continue to explode the deficit, or pay for it ourselves with taxes and/or spending cuts.  The Senate bill does the latter, and actually reduces the deficit over the next 10 years:

• First, the bill taxes so-called “Cadillac” insurance plans that require very little out-of-pocket expenses.  This makes sense: these Cadillac plans are partially responsible for driving our health care costs so high, because their generous coverage encourages people to over-consume health care with little regard to the cost.  Since we need to raise revenue, it makes sense to do so in a way that has the additional benefit of discouraging irresponsibly extravagant plans.
• Second, the bill taxes various companies in the health care industry, notably medical device manufacturers.  This also makes sense: the bill would help more Americans to afford these companies’ products, so it’s only fair that the companies should pick up part of the tab.
• Third, the bill reduces Medicare spending, mostly by targeting inefficiencies and waste, and by reducing payments to doctors.  I can’t speak to the specifics, but the broad concept of freeing up dollars from Medicare makes sense.  It’s a bloated program that will deplete its trust fund by 2017, so Medicare can’t continue in its current form for much longer, regardless of what Obama's bill does.  In any case, Republicans have long clamored against entitlement spending; to oppose cuts in Medicare spending now reveals the extent of their party’s moral and intellectual bankruptcy.

So there you have it.  The Senate bill isn’t perfect, but it makes a lot of sense.  And the calls to break up the bill and pass only the popular provisions simply won’t work, because taking one provision away will doom the whole system.  Here’s a summary of the argument:

• The Senate health care bill starts by doing what everyone agrees is right, and bans insurance companies from denying or rescinding coverage because of illness. 
• To avoid creating an insurance death spiral where people simply wait until they get sick to buy insurance, it mandates that all Americans buy insurance (just like we do with car insurance). 
• And to help lower-income Americans afford the product they’re now being required to buy, the bill provides them with subsidies.
• To prevent insurance companies from simply raising premiums on its now-captive market, the bill introduces competition in the form of insurance exchanges that allow you to shop around for the best policies.
• Finally, to pay for all this, the Senate bill taxes health care companies and Cadillac insurance plans, and reduces spending on Medicare—reductions which are inevitable in any case given Medicare’s looming insolvency.

If you want to ban insurance companies from discriminating against sick people, all of the other provisions of the bill must follow (in one form or another).  By the same token, if you oppose all forms of the other provisions, it means you support insurance company practices of denying or revoking sick people’s coverage.  Now your Congresspersons just need to get the message—so call them!

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Calvin & Hobbes and Democratic proposals to "scale back" health reform

I get a daily Calvin & Hobbes cartoon emailed to me, and this one couldn't have been more timely.  Calvin's shattered excitement - you might say hope - instantly reminded me of how I feel about Democrats' current proposals to scale back health care reform: in Rep. Anthony "Wiener" Weiner's words, to "take a step back and say, ‘What are the things people really want out of health care, the things that are popular?’ Then we could step back in and try again."

Do only the parts that are most popular?  To win the Presidency on a message of hope, secure 59 seats in the Senate, and pass a good health care bill in both the House AND Senate, only to "take a step back" at the 1-yard line -  that would be like winning 10 cents in the lottery.  In fact, based on the proposals that seem to be taking shape, 10 cents may be overly generous.

Here's what the New York Times is reporting:

Lawmakers, Congressional aides and health policy experts said the package might plausibly include these elements:

• Insurers could not deny coverage to children under the age of 19 on account of pre-existing medical conditions.
• Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.
• The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.
• The federal government would offer grants to states to establish regulated markets known as insurance exchanges, where consumers and small businesses could buy coverage.
• The federal government would offer tax credits to small businesses to help them defray the cost of providing health benefits to workers.
• If a health plan provided care through a network of doctors and hospitals, it could not charge patients more for going outside the network in an emergency. Co-payments for emergency care would have to be the same, regardless of whether a hospital was in the insurer’s network of preferred providers.

The package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care. To help older Americans, it could narrow a gap in Medicare coverage of prescription drugs, sometimes known as a doughnut hole.

That first bullet is especially egregious.  Limit the ban on discriminatory insurance practices only to children?  Kissing babies is for the campaign trail, not governing.  Maybe we can include little American flags for war widows in the health bill as well.  How could that be unpopular?

The proposals listed in the Times are worse than nothing - they're a festering pile of garbage.  If that's all Democrats can muster after getting this far, if they change their votes at the last minute because they suddenly think that health care reform is not popular, it will only confirm the prevailing narrative of the party as spineless and lacking core ideals.  It may even necessitate a new level of losing beyond The Choakley.

The point is, the reason elected officials exist is so that they can do precisely what is NOT popular.  That's why James Madison and the "demi-gods" who created this country established a republic and not a democracy.

The current crop of spineless "leaders" in Congress fall somewhat short of demi-gods.  If they are the best that our brilliant Constitution can produce, well that's like winning 10 cents in the lottery.

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Your guilty conscience may force you to vote Democratic, but deep down inside you secretly long for a cold-hearted Republican to lower taxes, brutalize criminals, and rule you like a king. That's why I did this: to protect you from yourselves.

-Sideshow Bob

Ok, we're all feeling devastated over the possibility that Scott Brown's unthinkable victory has doomed health reform, that Democrats have, once again, clutched defeat from the jaws of victory.  As I wrote yesterday, The Choakley establishes a whole new level of losing.


But get your heads up, it's time to move forward.  All is not lost, and health reform is not dead yet.  


Indeed, liberal bloggers spent the day explaining the myriad possibilities for passing the bill.  By far the simplest solution would be for the House to simply pass the Senate bill as is, and then "patch it up" across the next several weeks by passing separate legislation through budget reconciliation, which cannot be filibustered.  More complicated would be to break up the bill, passing the more controversial portions through reconciliation and then essentially daring Republicans to vote against the popular ones.  Heck, there's even a hint that with Scott Brown already facing tough reelection prospects in 2012, it may be possible to persuade him and Olympia Snowe to agree to a compromise bill and avoid a filibuster.





So passing the bill seems workable, and hardly time to throw in the towel.


But inevitably, there are already calls from the putrid punditry to abandon the whole shebang.  Martha Coakley's defeat, so the conventional wisdom goes, was actually a rejection of President Obama, health care reform, and the national Democrats by angry Massachusetts voters.  Her loss reveals, so these pundits say, that Democrats have shifted too far to the left--too liberal even for Massachusetts--and must therefore reign in their progressive policies to avoid disaster in November.


Frankly, I just don't see the logic.  I don't claim to understand the intricacies of Congressional procedures, but I do know two things: this election was in no way a referendum on the person or policies of President Obama, and abandoning health reform now would be political suicide for Democrats.


Take, for example, The Weekly Standard's Fred Barnes, who maniacally cackles, "Obama's agenda, chiefly health care, took a beating in Massachusetts. In fact, it was the chief cause of Coakley's defeat."  Really?  On what basis?  For this to be true, you would have to believe that Massachusetts voters rejected Coakley because she supports a LESS liberal version of a health care policy already in place in their state--which Coakley's opponent voted FOR when he was in the state senate!  How can Scott Brown have won because of voters' opposition to health reform when he voted for a MORE liberal health bill himself?


Moreover, if voters opted for Brown out of rejection of President Obama, the polls would have been tight for months.  Instead, they show a steady double-digit lead for Coakley, which collapsed over the last two weeks.  Nothing happened over that period which would have made Obama's policies dramatically less popular in Massachusetts.  Simply put, there's just no logical way to spin this as a referendum on Obama's health reform package.


(For further reading, check out Nate Silver's post here, one of the smartest I've read.)


But even assuming that I'm wrong, and that this election actually DOES reveal health reform's deep-seated unpopularity, Democrats should NOT respond by moving to the right and abandoning the Obama agenda.  You can't beat a Republican by becoming more like one.  That's a foundational tenet of marketing: if you don't differentiate, you're dead.


Pretend you're a House Democrat.  The House could pass health reform right now and be done.  It's already passed its own health care bill.  For reform to fail now, it would mean that some House Democrats who had voted for reform would have to switch their votes and vote against the Senate bill--either you're a liberal who doesn't think the bill goes far enough, or a conservative who's spooked by Coakley's defeat.


Ultimately, I don't think House liberals will kill the bill.  The real worry is that "moderates" will abandon the bill to shore up their conservative credentials.


The key point is that if you're one of those wavering moderates, voting against the bill gains you nothing, because you've already voted for a health care bill.  Once you voted for the initial House bill, your die was cast, and nothing you do now can prevent the wave of attack ads for that initial vote.  What does abandoning health care now gain you except the privilege of saying, "I actually voted for health reform before I voted against it"?

More fundamentally, if you vote against health care, and you vote against climate legislation, and you vote against the stimulus, and you vote against financial regulation... what is left that defines you as a Democrat?  If you agree with conservatives on every major issue, why wouldn't a conservative voter just vote for a Republican and get the real thing?


As someone who does sales and marketing research for a living, I can tell you that you won't sell anything by making your product the same as everyone else's, by competing on the same attributes and features as your competitors.  You have to carve out your own space where you stand out.  Similarly, you can't beat a Republican if you have nothing different to offer.


I'll close on this note, by quoting Jonathan Cohn at The New Republic:

For all of the panic in Democratic ranks right now, the reality of the situation is stunningly simple. In the span of twenty-four hours, the House of Representatives--the House in which Democrats command a huge majority, in which liberals actually have some sway, and in which leadership actually has power--could put health care reform on the president's desk for signing.

One lousy vote. One lousy, stinking roll call vote. That's the only hurdle in the way of health care reform.

Are Democrats really willing to give up now?

Give your Congressperson a call and tell them not to give up now: pass the Senate bill and work out the kinks later.

UPDATED: More evidence that opposition to health reform is not what sank Martha Coakley:

•  82% of Obama supporters who voted for Brown support the public option, as do 86% of Obama voters who stayed home. 
  
• 57% of Obama voters who stayed home on Tuesday support the Senate health care bill or think it doesn't go far enough.
• And of Obama voters who cast a ballot for Brown, nearly half (49%) support the Senate bill or think it does not go far enough. Just 11% think it goes too far.  

To be fair, that poll was commissioned by MoveOn.org, but they're some interesting numbers nonetheless.


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Levels of losing: the Choakley

                I'm not here
                This isn't happening
                I'm not here
                I'm not here

                   - Radiohead

The Dead Man Walking.  The “This Can’t Be Happening.”  The Stomach Punch…… The Choakley?

Bill Simmons’ ingenious “Levels of Losing,” which ranks the myriad ways a sports fan can have his heart broken by a crushing loss, captures a universality of emotion with which any fan or political junkie can immediately empathize.  Watching Martha Coakley surrender Ted Kennedy’s seat to a Republican, I couldn’t help but wonder where Coakley’s epic fail would fall in the levels of losing.


After reading through Simmons’ sixteen levels of losing, I’ve narrowed the list down to the top five I think best describe Coakley’s defeat.  In making the list, I’ve kept in mind that Coakley’s loss is so much more than a failed individual contest, but that it represents the possible failure of everything liberals have been working for across the last year—indeed, the last half century—just at the precipice of success.

#5. The Role Reversal

Simmons’ definition: “Any rivalry in which one team dominated another team for an extended period of time, then the perennial loser improbably turned the tables… For the fans of the vanquished team, the most crushing part of the ‘Role Reversal’ isn't the actual defeat as much as the loss of an ongoing edge over the fans from the other team. You lose the jokes, the arrogance and the unwavering confidence that the other team can't beat you. There's almost a karmic shift. You can feel it.”

Why it fits: Well this doesn’t take a genius.  Massachusetts hadn’t elected a Republican to the Senate since 1972—that’s twelve straight elections without a Republican victory.  The seat won by Scott Brown had been held by Ted Kennedy, the arch-liberal of the Senate, for over 40 years.   Massachusetts has a formidable Democratic get-out-the-vote machine, and had voted for Barack Obama by 26 points just 13 months ago.  By all accounts, a Democrat running for Senate in Massachusetts should have been a juggernaut.

#4. The Dead Man Walking

Simmons’ definition: “Applies to any playoff series in which your team remains ‘alive,’ but they just suffered a loss so catastrophic and so harrowing that there's no possible way they can bounce back. ... Especially disheartening because you wave the white flag mentally, but there's a tiny part of you still holding out hope for a miraculous momentum change. ... So you've given up, but you're still getting hurt, if that makes sense.”

Why it fits: This is exactly how I felt in the two to three days before the election.  Every poll showed Coakley losing, and Brown had all the momentum, and yet still I held out hope—even predicting against all rational evidence that Coakley could pull it out.  Heck, even Nate Silver wrote two posts that offered up some sliver of possibility.  But ultimately, as we all knew deep down it must, the miraculous momentum change never came.

#3. The Broken Axle

Simmons’ definition: “When the wheels come flying off in a big game, leading to a complete collapse down the stretch. ... You know when it's happening because (A) the home crowd pushes their team to another level, and (B) the team that's collapsing becomes afflicted with Deer-In-The-Headlitis.”

Why it fits: Whether a new poll showing a surging Scott Brown, a fresh gaffe out of Coakley’s mouth, or a new media story chronicling Coakley’s collapse—and all three feeding each other in a self-fulfilling death spiral—it seemed the wheels kept falling off the Coakley caravan even after there were no wheels left to fall off.  First she scoffed at the basic duties of politicking: “As opposed to standing outside Fenway Park? In the cold? Shaking hands?”  Then she called Curt Schilling “another Yankees fan.”  Two insults to the Red Sox in one campaign?  Stick a fuahk in ‘ah, she’s done.

#2. The “This Can’t Be Happening”

Simmons’ definition: “You're supposed to win, you expect to win, the game is a mere formality. ... Suddenly your team falls behind, your opponents are fired up, the clock is ticking and it dawns on you for the first time, ‘Oh, my God, this can't be happening.’”

Why it fits: Now we’re really starting to dig deep into the dark depths of Democratic despair.  Do I even need to say anything here?

#1. The Stomach Punch

Simmons’ Definition: “Any roller-coaster game that ends with (A) an opponent making a pivotal (sometimes improbable) play or (B) one of your guys failing in the clutch. ... Usually ends with fans filing out after the game in stunned disbelief, if they can even move at all. ... Always haunting, sometimes scarring.”

Why it fits: This is #1 because it not only captures the emotion of the final “this can’t be happening” days of the race, but because it encompasses the entire timeline of the health reform battle—a true political roller coaster ride if there ever was one.  We started with such promise, watching entranced on a frigid but hope-filled January morning as a young new president called us to “set aside childish things… to choose our better history,” the cold clarity of the bitter air crystallizing the hard but noble work that must now be done.  Swept into power on the promise of reforming America’s health care, economy, and climate, the new president had a 365-electoral vote mandate to carry out his agenda.

But as that agenda launched into action, the roller coaster began, and we felt that our better history might still be some time in the making.  The emotion reached a fever pitch in the August town halls, and liberals felt enraged and defensive over lunatic cries of “death panels,” “rationing,” and “government takeover.”  Frustrated progressives begged the President to abandon bipartisanship, and felt vindicated as each successive “moderate” Republican spurned the President’s open hand.

The President, however, stood firm, and delivered a game-changing speech.  By November, the bill had passed the House, and the Senate was even considering a public option—or not, as liberals again turned their rage toward Joe Lieberman for scuttling it.

Still, Joe played ball on the rest of the bill.  Health care reform was alive, and it had gotten further than at any time before.  With the public option gone, and after some stomach-turning horse-trading, we finally had Lieberman, Mary Landrieu, and Ben Nelson on board.  Filibuster after Republican filibuster failed, and on Christmas Eve, the second chamber passed health reform.  Just reconcile the bills and get them on the President’s desk.  The long, hard-fought slog was nearing its end, and universal health care was finally, inevitably, coming to America.  And with the finish line in sight… the wheels came flying off.  This isn’t happening.

...

Truth be told, I don’t think any one of Simmons’ levels of losing, by itself does justice to the disbelieving despair felt in liberal circles right now, because there’s a unique twist: the Ted Kennedy factor.  Here was universal health care’s most passionate advocate, so close to achieving his life’s work, cut down by a tumor just short of seeing his dream become reality.  Here was the man chosen to replace him—by the people Kennedy had served for forty years—unraveling his life’s work in the final mile.  Even the most rabid Republican has to feel some level of sympathy—even moral uncertainty—over Scott Brown’s stomach punch to a dead man’s last wish.

And to top it off, Massachusetts, alone of all states, already has universal health care!

Is there a sports analogy?  A star player who’d led his team through the playoffs, only to meet with a tragic accident and have to watch from the sidelines (or heaven) as his hapless replacement choked away the chance for greatness?  Texas’s Colt McCoy comes to mind: the winningest quarterback in NCAA history, who had to sit out the 2010 BCS national championship game after pinching a nerve five plays into it.  McCoy was replaced by a true freshman, who showed his inexperience by throwing a crucial interception that was returned for a touchdown with less than 20 seconds left in the first half.

But even that analogy only goes so far.  The freshman at least grew up quickly, and gave Texas two second-half touchdowns.  That’s more than can be said of Martha Coakley’s choke-job.

So it looks like we have no choice but to create a whole new level of losing based on recent events: The Choakley.

Definition: When a team’s star player is injured in the final game of his career, either (A) in a championship game in which the player’s team has a big lead, or (B) after a long playoff run but before the championship game, in which that player’s team is heavily favored… and that player’s replacement proceeds to throw away the game through sheer ineptitude.  As the other team chips away, the fans watch the jumbotron in dismay, as the injured star watches helplessly from the sidelines as his work unravels.  It’s not just the loss that gets you, but that the injury’s arrival at the last minute, rather than any skill on the part of the other team, is what led to the defeat—and that the star player will never get another shot.  Double points if the replacement player was a late season trade from a team with which he had previously won a championship.

Where does The Choakley rank in Simmons’ levels of losing?  I’d put it at #2—right behind the 1986 World Series.  But I could be persuaded otherwise.  After all, the 1986 loss has been exorcised, twice, albeit 18 and 21 years later.  Let’s just hope Ted Kennedy’s wish doesn’t have to wait that long. All I can say is, I'm glad I have health insurance.