Max Baucus Talks Health Care Reform; Followed by Paul Begala, Karen Tumulty, and Norm Ornstein

by: Matt Singer

Fri Mar 27, 2009 at 11:09:18 AM MST

There were some positive notes -- he spoke highly of a public health insurance option and didn't take using the reconciliation option off the table; he said he wants it to be bipartisan, but not at the expense of a good bill, etc. For more of a roundup, check out my tweets on it either on Twitter or Facebook (where you can comment).

At the heart of the conversation, as always of late (it seems), was the public health insurance option. Unsurprisingly, private insurance companies REALLY, REALLY hate it. So do Republicans. But here's what I don't get. Virtually all of the cost control measures being discussed -- from monopsony negotiating power to comparative effectiveness and moving away from fee-for-service -- rely on a public health insurance option, either directly or indirectly through modeling good insurance behavior (and imposing it on a wildly uncompetitive insurance industry).

So if we take the public health insurance option off the table, the question becomes -- how do we control costs without it? In theory, we can do one of three things:

1. Hope insurance companies adopt better cost control practices on their own.
2. Impose fierce regulations so that private insurance basically becomes a publicly-controlled, privately-profitable industry, but where meaningful competition DOES NOT EXIST.
3. Throw people to the wolves.

Compared to a straight-forward public option, these all strike me as asinine choices. Number two strikes me as the most likely compromise point, but I can't see why either liberals or conservatives would rather end up here than with a public health insurance option (although I can see why private insurance companies would).

Note: this is the justification for even having a relatively toothless public health insurance option -- one prohibited from negotiating and required to operate without public subsidies. Such an operation could still apply market pressure by embracing the moves away from fee-for-service and deploying comparative effectiveness research.

Am I missing something?

Update -- As with the panel at CAPAF, I still don't know if anyone has a realistic answer to this other than extremely fierce regulation of insurance companies. Again, insurance companies are probably OK with that alternative. Guaranteed revenue streams make up for harsh regulations. But both quality and cost will suffer for it because of the elimination of market incentives. We'll instead be hoping that government gets it right.

To put it another way, this solution -- government deciding exactly how insurance will work with private companies getting the profits -- has all the worst aspects of central planning and capitalism run amok.

Helena IR urgues veto of horse slaughter bill

by: Jay Stevens

Thu Mar 26, 2009 at 13:21:03 PM MST

After acknowledging that there is a need for a horse-slaughtering facility, the editorial explains why it opposes HB 418:

However, Butcher's bill is far off base, and raises significant questions.

Since when can a legislative act limit the legal authority of a court?

Or, for that matter, how can the Legislature limit a citizen's right to challenge a government action by any legal means possible?

This bill would set a poor precedent for an industry that has already shown disregard for environmental regulations elsewhere.

Gov. Schweitzer should veto HB418, and demand a revised measure that addresses the need but does not trample on the rights of others, not to mention the authority of judges - all of whom were elected just like legislators.

It would have been nice if the backlash against HB 418 had happened earlier -- like when the bill hit its first House committee, not after it was passed by both bodies of the legislature. Still, that's fair; this thing kind of snuck under a lot of people's radar until it was passed out of the House. And the proponents' arguments sound quite reasonable -- it's only when you actually read the bill that you understand what it's proposing: a free judicial and regulatory pass for an industry that has a spotty health and safety record.

Congratulations, legislators. You've given Montana a turd sandwich. Let's see if Schweitzer serves it up on a paper plate for us to eat.

Beacon Rushes to Conclusions About Rushing to Conclusions

by: Matt Singer

Thu Mar 26, 2009 at 10:32:03 AM MST

The AIG bonus mess has more or less settled the argument over whether the $800-billion stimulus plan was rushed. It's safe to say it was.

It appears that Congress, by overlooking or ignoring the insertion and ramifications of a provision that protects AIG, a company bailed out with billions of taxpayer money, should have slowed down the process.

How much should Congress have slowed down? Economists, people who study, you know, stimulus, were calling for extraordinarily quick action. Congress took that. Days delayed on this stuff can have huge impacts on when outcomes play out.

I don't think the Jobs Bill was perfect. I'm not sure anyone does. But time was of the essence.

Update -- In comments, Dave Budge asks for evidence that economists actually think the proper way to respond to these kinds of circumstances is to move quickly. Here's Simon Johnson, former Chief Economist of the IMF, writing in The Atlantic:

In a financial panic, the government must respond with both speed and overwhelming force. The root problem is uncertainty-in our case, uncertainty about whether the major banks have sufficient assets to cover their liabilities. Half measures combined with wishful thinking and a wait-and-see attitude cannot overcome this uncertainty. And the longer the response takes, the longer the uncertainty will stymie the flow of credit, sap consumer confidence, and cripple the economy-ultimately making the problem much harder to solve.

How to counter "scientific-sounding spin"?

by: Jay Stevens

Wed Mar 25, 2009 at 07:47:13 AM MST

Can we ever know, on any contentious or politicized topic, how to recognize the real conclusions of science and how to distinguish them from scientific-sounding spin or misinformation?

Congress will soon consider global-warming legislation, and the debate comes as contradictory claims about climate science abound. Partisans of this issue often wield vastly different facts and sometimes seem to even live in different realities.
In this context, finding common ground will be very difficult.

Mooney's solution?

Perhaps the only hope involves taking a stand for a breed of journalism and commentary that is not permitted to simply say anything; that is constrained by standards of evidence, rigor and reproducibility that are similar to the canons of modern science itself.

Yeah, and the newspaper publishing the new, more rigorous commentaries will be delivered by a fleet of flying pigs.

Seriously, if we want to take action on climate change, we can't wait around for utopian journalistic ethics to kick in. Right now, the very existence of climate change has warped into a political issue and calls for a political solution. But what? A massive grassroots campaign to educate voters and pressure lawmakers to respond to the science?

Local action? Of course, local action doesn't help when the neighboring town installs a coal-burning electricity plant while you're spending municipal dollars weatherizing city buildings, does it? At some point, we need federally-enforced standards for carbon dioxide pollution.

What have you got? Do you know of any other grassroots orgs tackling this problem? Possible solutions to the current political morass?

Stewart v CNBC

by: Jay Stevens

Fri Mar 13, 2009 at 05:42:12 AM MST

Not only does Stewart makes look Cramer look like a lying, groveling d*uche, but he pretty much, in just a few minutes, peels back the facade of news coverage. It's a game. The media starts know it's a game. They know what's going on, but they package the news for consumption, and a product that's very different from reality is what's shown.

You can speculate why. Media figures are herd animals; they're shy about stepping out alone into unchartered territory. They deliver content they think their audience wants. They don't think their audience is sophisticated enough to understand the subtleties of issues. Whatever.

But as Stewart pointed out, media coverage has consequences.  

The brain teaser of the day

by: Jay Stevens

Fri Feb 27, 2009 at 07:05:25 AM MST

Trust me: I link!

by: Jay Stevens

Wed Feb 18, 2009 at 09:06:22 AM MST

But why do we trust columnists? Bloggers -- at least the good ones -- link to the information or data that support their arguments. Objectively that makes blogs more trustworthy than print columns. (Yet, still, I wouldn't trust a blogger further than I could throw her.) What guarantee do we have that a syndecated columnist doesn't invent facts to support predetermined political bias?

Like Steve Benen noted, a correction for Will's column has yet to appear.

Beware the echo chamber!

by: Jay Stevens

Mon Feb 16, 2009 at 19:13:35 PM MST

Sunday Frank Rich wrote a much more erudite column on this topic than I could muster. In short, Rich noted that the cable tv and talk radio doom-and-gloom talk about Obama, Congressional Democrats, and the stimulus plan and the subsequent suberserviance to the punditocracy to that message was the result of the DC-insider "echo chamber." But here, on the other side of a passed bill, and a quick look at some polls, show that -- by golly! -- people liked the stimulus bill, Democrats, and Obama! And...well...generally despise Congressional Republcians.

Rich:

Overdosing on [DC insider] culture can be fatal. Because Republicans are isolated in that parallel universe and believe all the noise in its echo chamber, they are now as out of touch with reality as the "inevitable" Clinton campaign was before it got clobbered in Iowa. The G.O.P. doesn't recognize that it emerged from the stimulus battle even worse off than when it started. That obliviousness gives the president the opening to win more ambitious policy victories than last week's. Having checked the box on attempted bipartisanship, Obama can now move in for the kill.

Kos' Research 2000 poll shows that Congressional Dems gained three points during the stimulus debates, and Congressional Republicans dropped ten points to a 39-percent approval rating. And lest you think Research 2000 is biased, Gallup showed the Republican Congress critturs with a 31-percent approval rating.

So...why would, say, Dennis Rehberg shout from the rooftops his opposition to the stimulus package? Sure, there are some legitimate concerns with the bill...but then Rehberg's opposition seemed purely political. Or did the constituent calls lend him courage? Is Montana against the stimulus package by a 10-to-1 margin, or are the calls from the Representative's base, the folks whose stance on the stimulus was already created by the Rush Limbaughs and Dave Bergs of the world?

What's a politico to do? Do you believe the calls...or the polls?

There they go again...

by: Jay Stevens

Mon Feb 16, 2009 at 15:13:56 PM MST

A number of folks quickly and thoroughly dismantled Will's claim about the 1970s scientific community and global cooling. (Not to mention his claim about arctic ice levels in 1979 -- and that rebuttal came from his supposed source.) In short, Will -- besides cherry-picking, misinterpreting, and inventing data -- based his column today on a dumbed-down, out-of-context re-telling by Newsweek of a 1970s scientific study about long-term climate forecasts.

In short, Will is writing a piece that misinforms the public about science based on a news report that misinformed the public about science.

And hasn't that been one of the inanities of this "debate," how the media has almost crimanally fumbled the topic? Unable -- either from lack of ability or lack of funds -- to research the issue and discern good from bad argument, the media has generally placed the scientific community's consensus on the issue against a handful of denier groups in an attempt to "balance" the "debate." Worse still, many of the data and groups that claim global warming are financed by industries that stand to benefit financially if global warming is thought to be a hoax -- and we also know that, for some energy corporations, exploiting the media to spread doubt about global warming was a condoned strategy.

ED Kain:

Essentially, global warming has become just another talking point in a long and growing list of talking points that the conservative movement uses to keep apostates out of their fold (shrinking that big tent) and to berate liberals with, rather than viewing warming as both a real cause for worry, and as an opportunity to demonstrate honest governance. Apparently obstructionism and denial are better tactics.

...Conservatives should be reading these pieces and paying heed to the vast consensus on global warming. Even if there areome holes in the larger argument, that's still no excuse to ignore what very well may be the global crisis of the coming century. Conservatives ought to be conserving things, and the environment should be at the top of the list-even above rugged individulaism and the "right" to low taxes.

That's the thing, we're stuck debating whether global warming even exists. And that's exactly how conservatives -- weirdly beholden to the short-term interest of a small segment of the big business community -- wants it. And the media, always attuned to the insider echo chamber, presents this as a viable alternative...

Good Column

by: Matt Singer

Sun Feb 15, 2009 at 09:51:01 AM MST

"Feigned outrage"

by: Jay Stevens

Fri Feb 13, 2009 at 15:57:23 PM MST

I don't know what's worse, the weird official reaction to the bong...or Phelps' craven willingness to apologize to any- and everybody for something that's...well...not all that bad. It was bad enough that he caused the networks to shove hours of swimming coverage down our throats, now there's this. And just as he won his medals with little panache and charisma, he mangled Bong-gate, showed the world that he's gutless.

After all, this was the perfect time for a statement against the "war on drugs," how millions, billions, have been squandered investigating, convicting, and jailing non-violent drug offenders, with no discernable outcome outside of bloating police budgets and increasing the aggression of police raids. He could have admitted to smoking pot, and played the rebel. We would have loved it! It's time!

Instead...

Phelps woes only increase. The world's social climbers and ambitious bureaucrats and headline-hungry ad agencies recognize fear when they see it. Despite Phelps' apologies, Kellogg pulled the plug on the swimmer. And the Richland County, South Carolina, Sherriff's department is on a mission to bag themselves a celebrity: eight have already been arrested, and a dozen officers have been assigned to crack the case.

David Sirota:

America is a place where you can destroy millions of lives as a Wall Street executive and still get invited for photo-ops at the White House; a land where the everyman icon -

Joe Sixpack - is named for his love of shotgunning two quarts of beer at holiday gatherings; a "shining city on a hill" where presidential candidates' previous abuse of alcohol and cocaine is portrayed as positive proof of grittiness and character. And yet, somehow, Phelps is the evildoer of the hour because he went to a party and took a hit off someone's bong.

As with most explosions of fake outrage, the Phelps affair asks us to feign anger at something we know is commonplace. A nation of tabloid readers is apoplectic that Brad and Jen divorced, even though one out of every two American marriages ends the same way. A country fetishizing "family values" goes ballistic over the immorality of Paris Hilton's sex tape ... and then keeps spending billions on pornography. And now we're expected to be indignant about a 23-year-old kid smoking weed, even though studies show that roughly half of us have done the same thing; most of us think pot should be legal in some form; and many of us regularly devour far more toxic substances than marijuana (nicotine, alcohol, reality TV, etc.).

So, in the interest of a little taboo candor, I'm just going to throw editorial caution to the wind and write what lots of us thought - but were afraid to say - when we heard about Phelps. Ready? Here goes: America's drug policy is idiotic.

Doctors can hand out morphine to anyone for anything beyond a headache, but they can't prescribe marijuana to terminal cancer patients. Madison Avenue encourages a population plagued by heart disease to choke down as many artery-clogging Big Macs and Dunkin' Donuts as it can, but it's illegal to consume cannabis, "a weed that has been known to kill approximately no one," as even the archconservative Colorado Springs Gazette admitted in its editorial slamming Phelps. Indeed, it would be perfectly acceptable - even artistically admirable in some quarters - if I told you that I drank myself into a blind stupor while writing this column, but it would be considered "outrageous" if I told you I was instead smoking a joint (FYI - I wasn't doing either).

That said, what's even more inane than our irrational reefer madness is our addiction to the same high that every pothead craves: the high of escapism. Nerves fried from orange terror warnings, Drudge Report sirens and disaster capitalism's roller-coaster economics, our narcotic of choice is fake outrage - and it packs a punch. It gets us to turn on the television, tune in to the latest manufactured drama, and drop out of the real battle for the republic's future.

Bingo. Only I would throw Phelps in there, who's so willing to along with the feigned outrage. And I'd add that no doubt most Americans are left scratching their heads over the latest witch-hunt - which makes Phelps' reluctance to stand up for himself and against this weird media mania all the more frustrating.

New Montana Blog

by: Matt Singer

Tue Feb 03, 2009 at 22:50:44 PM MST

How I Would Push for Single-Payer

by: Matt Singer

Mon Feb 02, 2009 at 15:20:15 PM MST

It's not clear what sort of money will buttress their campaign, but there will certainly be some. And whether or not the Conference is competitive on the air wars, they'll muster an impressive grassroots force (anyone who attends health reform panels or events knows that single payer supporters are much better organized and vocally present than supporters of alternative options). The question is where they'll be aimed.

My sense of the single payer movement, having watched and interacted with them for some time, is that they think, not necessarily wrongly, that their enemies are on the left. Their targets tend not to be those blocking reform, but those promoting the wrong type of reform. See their attacks on the reform initiative in California, or on the Health Care for America Now coalition (which promotes something close to the Edwards/Clinton/Obama plan). It's a sincere disagreement, and there's a compelling strategy to the approach: Single payer can't become the consensus choice for the country if it doesn't first become the consensus on the left.

If I was a single-payer advocate, I would make a much more ambitious gambit. One of the biggest fights in the health care arena is over whether to maintain employer responsibility for health insurance. HCAN and other progressives outside single-payer world say yes, mostly for political reasons, but also for some ease of transition reasons (and ease of transition is a big deal, see Atul Gawande's latest New Yorker article for the reasoning).

But a lot of employers don't want to be in the health insurance business any more. Fair enough, single-payer advocates could say, get on board with single-payer and you've got a bill that can get real support in a Democratic Congress and where significant business backing could actually move Republican votes.

Now this is a difficult strategy. Winning major business backing for single-payer won't be easy (not cause it's bad for business, but because of ideology), but it won't be much harder than getting HCAN and folks like me to back off our advocacy of a public/private hybrid system. And whereas business would respond to a coalition of the liberals supporting single-payer by doubling down on opposition, the moderates of the world would at least be intrigued by a labor-business coalition bringing single-payer to the table.

In other words, if you're throwing the hail mary pass, at least throw it in the correct direction.

Full of sound and fury

by: Jay Stevens

Mon Feb 02, 2009 at 09:10:46 AM MST

Lee Enterprises (NYSE: LEE) got a necessary reprieve last week when it received waivers on extending its latest debt payment, but it is not out of the woods by any stretch. And while no one was expecting that profits would even hold steady, preliminary Q1 figures show a staggering loss, as earnings from continuing operations plunged 69 percent to $6.8 million ($0.15 per share) from $22.1 million ($0.48 per share) a year ago.

Revenue dropped 13 percent, advertising 15 percent, and classified advertising 29.7 percent.

January 26:

The Missoulian announced Tuesday that it has laid off four employees and two others were told their jobs will end Feb. 13 as part of a work force reduction.

February 1:

The Missoulian is not closing its doors or unplugging its press. We are still the strongest news source in western Montana, with the largest staff of trained and experienced reporters, and we intend to remain so. Our print circulation remains steady - we reach more than 61,000 readers each day and more than 93,000 on Sundays - and then there's our online readership. Did you know that, according to online audience analyzer Quantcast, the Missoulian is ranked in the top 10,000 Web sites in the U.S. for its reach? Last time we looked, we ranked 8,705th and had a larger online reach than any other local media in western Montana. In fact, our print edition has a larger reach than any other local media in western Montana as well....

The plain truth is, no other entity does what newspapers do, and we believe the service newspapers provide is critical to our very way of life, not to mention our First Amendment rights. The Missoulian's news staff is experienced and deeply dedicated to making sure your local newspaper is filled with critical, investigative coverage of the important issues of our day. Only the Missoulian offers the sort of detailed, comprehensive news and feature stories that our readers need to be informed, active participants in our community. We at the newspaper are committed to being your eyes and ears in the community, and holding our elected and appointed officials accountable to us, the taxpayers and voters. That's what we do and that will not change - whatever the future brings, and no matter how we adapt to it.

We recognize that times are changing, as they always do. And we embrace the challenge of the changing times. It brings with it toughness of character but also innovation and creativity. We have lots to do, lots to say, and the privilege of the platform to carry it out.

Pogie, February 1:

I don't think the Missoulian is dying, though someone might want to hold up a mirror in front of its parent company, just in case. Wasting valuable editorial space on self-promoting hokum while the nation is facing a recession, the Legislature is in session, and Montana soldiers are fighting and dying in two wars could explain why the prognosis isn't terribly promising, though.

Let's face it: for years, large corporate-run newspapers have been making fat profits. Enormous profits. In the first part of this decade, newspapers made almost 30 percent in profit. That's why Lee Enterprises took on enormous debt in its bid to swallow up local newspapers across the country. Declining profits -- to, say, only just under 20 percent -- is leading Lee Enterprises to cut staff. In short, the moves this company and other media companies are making to address their current woes is only going to hurt their product, and, in the long run, hurt the industry.

And that's the problem with corporate-owned media, isn't it? Profit drives content, not an understanding that newspapers and media in general play a vital role in our communities.

So, yeah, sure I'll poke holes in the Missoulian's recent editorial -- which had the distinct whiff of panic -- but my thoughts right now go out to the staff at the paper, who believe in newspaper work, believe in the product they're selling, and whose work is phenominal, and yet they suffer for the profit-driven, short-sighted, corporate-board created business strategy of their parent company.

Voting is a right

by: Jay Stevens

Thu Jan 15, 2009 at 23:45:43 PM MST

On the face of it, that's an excellent question. By doing a little investigation, we can see who registers on Election Day, and why. Like Jhwygirl, who did a little research and discovered many folks use same-day registration because their previous efforts to register went awry through no fault of their own - lost registration cards, etc. In fact, testimony given before the House State Administration Committee reinforced jhwygirl's findings:

Carroll College student Kevin Olp said he showed up to vote in Helena on Election Day and learned he wasn't registered to vote here. He is from Billings, spent part of last year on a U.S. Senate internship in Washington and attended college in Helena.

He said he went to the Lewis and Clark County election office and registered on Election Day.

"I saw people of all different ages," he said. "I think it's a misrepresentation that it's just a bunch of students that want till the last minute."

A little understanding of why people use same-day registration would go a long way to preserving it, and making our system more open and more participatory.

Right?

Right?

Well, the Helena IR chose a novel approach to answer the question. They stated their prejudiced opinion as fact:

What is usually unsaid regarding voter turnout efforts, of course, is that people who take little interest in politics and often don't even think about voting until right before Election Day are a lot less likely to cast their votes on the basis of any particular party's ideology. If they were political animals, burning with political convictions, no amount of inconvenience would keep them from registering to vote.

Instead, people making these late-coming registrations are more likely to simply vote in line with their own personal interests. If that means expanding government services rather than decreasing the size of government, Democrats should benefit from these new voters. So it probably isn't very surprising that HB88 was sponsored by a Republican.

Where to start with this? It seems pretty clear from work done by voting rights advocates that same-day registrants can't be stereotyped as brainless, disinterested voters. And the notion that these people vote only to have the state lavish public works and services down on them is...weird. H*ll, it's right out of the Republican "welfare queen" rhetorical playbook of the 80s and 90s. Suffice to say, there's absolutely no evidence that all, most, or any Election Day registrants vote because of welfare checks.

If the editorialist had any familiarity with the vaunted Republican GOTV playbook they'd know why state Republicans keep trying to kill same-day registration. Having a large and disinterested electorate combined with arbitrary barriers to voting is part of the plan. It's much easier to take over, say, a local school board if your well-organized (and extremist) base is turning out in an election where everyone else stays home. And if you want to know why Republicans are so hostile to same-day registration and, to some degree, vote-by-mail and early voting, it's because the recent resurgence in Democratic GOTV voting uses those tools of election inclusion as part of their organizational plans.

But that's utterly beside the point, which party same-day registrants prefer. In the end, it comes down to this: voting is a right, not a privilege, and any law that disenfranchises voters through arbitrary registration requirements should be reviled for being contrary our democratic principles. Maybe Republicans shouldn't be b*tching about how hard it is to enact same-day registration - although no county elections official testified that the burden imposed by the law was too onerous - but should be concerned with how they can appeal to more voters.

Our rights shouldn't be subverted because the government finds it too hard to ensure them. No one promised us that maintaining our rights would be easy.

The News of Business and the Business of News

by: Matt Singer

Sun Jan 11, 2009 at 16:01:11 PM MST

Missoula Area Chamber of Commerce President and Chief Executive Officer Kim Latrielle said she doesn't want to see the city scale back plans for retail businesses. Rather, she said she wants Missoula to bring a new main attraction to town so the local economy can support all the retail it has planned.

"I believe with my whole heart that we need to figure out a way to get more people to Missoula, to bring new money to Missoula," Latrielle said.

The Chamber represents businesses all over Missoula. Latrielle said retailers report that when football season ends, so does their season to earn good income. An exposition center could fill the gap and is on the table as part of the strategic planning efforts at the fairgrounds.

Beyond that, for the Chamber of Commerce's initial response to concerns that a surplus of retail space may be getting developed being to say it is just fine strikes me as irresponsible. Unnecessary development is the underlying phenomenon behind bubbles. Empty retail storefronts won't be very attractive.

Anyways -- I always wanted to mention some interesting phenomena happening in the media world.

The Seattle Post-Intelligencer may be on its way out. There is similar news out of Denver, where Rocky Mountain News is likely to shutter its doors. But the big story on the media front I've seen lately is Michael Hirschorn's "End Times" anticipating the potential fall, this year, of The New York Times.

It is no groundbreaking statement to say that the Internet has impacted journalism in ways that the businesses have yet to figure out (they're facing much the same situation as record labels without as many advantages from intellectual property law).

One of my roommates anticipates subscribing to the Missoulian soon. Like many of us, he enjoys reading the paper in the morning, especially on Sundays. But after he mentioned his plans to subscribe, we ended up in a conversation about the utterly unnecessary (for us) portions of the newspaper. We don't pick up a Montana newspaper for national or international coverage that we read the day before on the Internet.

I'm not sure where news coverage is going. I know that as Hirschorn says, 1) if the current business models fail we will find new ones because the need for news is too great and 2) citizen journalists simply will not (and can not) replace some kind of professional journalism.  

Insurance and Pharmaceuticals

by: Matt Singer

Sun Jan 11, 2009 at 13:02:21 PM MST

That the pharmaceutical companies are supporting health care for all should be of no surprise. They sell health care. While PhRMA executives no doubt hold a philosophical opposition to poor people having health care (ed. note: I realize this is gratuitous sniping), their bottom-line won't necessarily take a hit from big-time health care reform.

It is also worth noting that pharmaceutical companies also lack a ton of reason to be super-concerned about single-payer health insurance. Insurance companies would be put out of business by single-payer. Depending on the details of the plan, pharmaceutical companies would just be selling their drugs.

The bigger question is what is the drug industry fighting over and what have they indicated a willingness to accept so far? This is the more interesting stuff and it basically falls into two categories:

• Marketing to Doctors. Drug companies market heavily to doctors through paid trips to conferences, etc. There's also the simpler stuff like free pens. So far, the drug companies are willing to stop giving cheap plastic crap to doctors, but have been unwilling to roll back the more lavish (and distorting) forms of marketing to doctors.
• Marketing to Consumers. This one is huge -- the pharmaceutical sector spends a lot of money convincing consumers to ask their doctors about new medicines, helping induce demand. This both results in unnecessary treatment and also possibly threatens health as new drugs have less research available and greater unknowns.

Those are two major reforms that make sense regardless of where insurance reform heads in the next year. But in insurance reform, there are actions that can be undertaken. According to The Washington Post, some pharmaceutical companies may even be game to consider these routes, which would include doing a better job of evaluating drug effectiveness so that public insurance options have a better sense of what to cover and doctors get better guidance on what to prescribe (because they hopefully aren't attending as many fancy pants trips provided by drug companies).

Update -- Curmudgeon points out in comments that we also want to give Medicare the power to negotiate prescription drug prices. That's a fantastic point. It was stupid of me to overlook it.

Honest Questions

by: Matt Singer

Wed Jan 07, 2009 at 13:33:03 PM MST

In almost none of these cases do I see a ton of real inquiry into what a single payer plan actually looks like. Medicare for All? Cool. Let's figure out what Medicare looks like when it covers pediatrics and women of child-bearing age. Let's figure out what it looks like when its core population is young people who do stupid things like take drugs and ski. Let's figure out its financing mechanisms. Let's figure out what the cost controls look like. Let's figure out the transition mechanisms.

Single payer, as I've written before, isn't a system. It's a genus of systems, maybe a class, order, or phylum. Any system within that broad category is going to have a whole ton of particular features. It is generally those features that will provide for the eventual success or failure of the system.

I deeply appreciate that people hate insurance companies. I'm not super gung-ho myself. But a bumper sticker solution isn't going to work to solve our health care woes. We need a truly deeper understanding. And if single payer advocates aren't being pressed with those questions and aren't coming up with solutions, they're being treated with kid gloves. Paternalism isn't much good for any of us.

So how do we finance it? How do we transition it? Who administers it? And how do we control costs under it?

Update -- Matthew Koehler smartly points out in comments that Americans' eating habits are far more burdensome for the health care system than skiing or pot smoking. True, true. I wasn't meaning to imply otherwise (although I understand that could have been inferred).

Going along with the honchos

by: Jay Stevens

Thu Dec 25, 2008 at 19:09:24 PM MST

The honchos in the profession (Paul Krugman excepted) said everything was fine. Agreeing with the honchos will never get you in trouble. You will never lose your job or even miss a promotion because you made the same mistake as all the leading lights in the profession.

On the other hand, if you go against the honchos and end up being wrong, well you should be prepared to be sent to oblivion. You are obviously a raving lunatic who has no business being taken seriously as an economist. Even when you end being right against the honchos you can't count on any great reward, since the honchos so control the profession and the media that "nobody could have seen" will be repeated at least frequently as the fact that some people did see.

Anyhow, what would an economist expect to happen in a situation in which option one carries no risks and reasonable expected rewards and option two carries enormous risks and only moderately higher expected rewards? In short, the incentives in the economics profession, just as in finance, strongly encourage a lack of original thinking.

Come to think of it, that's a great explanation for the failure of the media during the Bush administration, too. DC insider opinion dominated the thinking of the major press outlets on Iraq, the Plame affair, torture, and the prosecutor purge, to name just a few scandals in which journalists fell far behind the facts.

Those same honchos decide whether the country's ready for progressive political change, say. It's safe to say that the traditional media gatekeepers have been bypassed when it comes to writing opinions or arguing policy; but those same gatekeepers still seem to have ownership over the brakes when it comes to executing actual policy.  One of our challenges as progressive activists is to find a way to circumvent those reluctant opinion makers.

Unfortunately we could be battling human nature, not just established institutions.

Discuss.

Covering the Covering of the Uninsured

by: Matt Singer

Mon Dec 08, 2008 at 23:30:15 PM MST

The book includes a healthy section on the media's coverage of the health care fight from 1993/1994. In Fallows' description, the press covered the issue primarily from a horse race perspective, as a measure of the President's political strength, rather than on the merits of the plan. Inaccurate coverage was repeated and fears stoked through a drip-drip of articles focusing on the negative ends of trade-offs.

At one point, he describes a study by an academic focused on press coverage of the plan:

Jamieson's analysis of published survey data indicated that, despite a year's worth of news coverage, the public remained confused on basic factual issues about the contents of the Clinton plan and the alternative proposals. Jamieson and her colleague Joseph N. Cappella ran an experiment to test how informative press coverage had been. Subjects in their experimental group read fifteen news articles about the health-reform process. Subjects in the control group read one article about health reform--and fourteen articles on another topic. The groups were then tested to see not which plan they preferred but how well they understood what various plans would do. The group that had read fifteen health articles did not do better on this test than the group that had read only one.

If you, like me, weren't much involved in the health care debate of the early-mid '90s, I think it may almost be surprising to read news clips from the era that make the political need for reform seem almost stronger than the case made today in the press:

An article in Time magazine shortly after the president's speech said, "Politicans almost unanimously agree that public sentiment so strongly favors some kind of health-care reform that many Congress members dare not run for reelection in 1994 without having voted to enact any." "The reviews are in and the box office is terrific," the political analyst William Schneider wrote just after the plan was present. "President Clinton's health-care reform plan is a hit. . . . The more people read and hear about the plan, the more they seem to like it." But as Congress prepared to consider what to do with the plan, the scandal-and-spectacle switch was thrown again by the press.

Over the coming weeks and months, there will be a lot of news stories of varying degrees of accuracy and relevance when it comes to reporting on the various health care proposals being considered by Congress.

During our health care event this evening, we had a fairly good conversation about the details of reform, which are unfortunately complex. We discussed Baucus's framework and both the Wyden bill and HR 676, John Conyers' single payer proposal.

Mike Dennison this morning described that "single payer" is not a plan, but rather a class of plans (hell, a class of frameworks) that could be implemented in a lot of ways (including some very terrible plans, if you wanted to imagine them). It is not necessarily, as a result, the "simple solution" that his headline-writers claimed earlier this year. In fact, when it comes to health care, it is unlikely that there will be a "simple solution." (Similarly, a "simple solution" on energy is unlikely -- these are big complex systems with a lot of moving parts.)

What is likely is that we'll have a bill -- possibly a few different bills -- put forward by a host of folks that will have meaningful differences on a number of fronts. My hope is through Left in the West, I can do some small part to help deepen understanding of the differences between these bills. I'm also optimistic that with Dennison's knowledge on these issues (even if he and I don't seem to see eye-to-eye) that Lee will provide informative coverage of the debates.

Maybe, 2008 won't have to be like 1994. And, maybe, this won't be the closing paragraph on our story, as it was on Fallows' recounting of that last fight:

Sooner or later, the American public would have to accept some arrangement for balancing its interest in advanced technology, individual choice, and manageable cost. For the previous two years, the political and journalistic systems had devoted tremendous attention to this issue. And at the end of the process there was no sign that the public was closer to understanding the problems it faced or the choices it would have to make than if the whole exercise had never occurred.