Yesterday, I appeared on GRITtv with Laura Flanders where Yale political scientist Jacob Hacker, best known as the architect of the public option, Luke Mitchell, senior editor at Harper’s magazine, and I discussed what’s left of health reform legislation, our best hopes, and our deepest concerns, going forward. (Click on the link, and scroll down to “Who Let Joe Lieberman Kill the Public Option?”)
During the course of the program, Flanders entertained her audience with clips of Senator Joe Lieberman saying very different things at different times when responding to the same issue. These included shots of Lieberman contradicting himself on the question as to whether one senator should take it upon himself to block major legislation. It’s worth watching the video of the show if only to see and hear Lieberman; he’s just as sanctimonious when he says X as when he takes the opposite position. The clips make Lieberman’s hypocrisy clear. He will say whatever will advance Joe Lieberman’s career.
In regard to Lieberman’s motives, yesterday’s New York Times carried an Op-ed by Ross Douthat that I found disturbing. It suggests that progressives shouldn’t lash out at Lieberman because after all, he represents a point of view that he shares with “plenty of highly-intelligent Obamacare opponents [who] are convinced that greater government intervention in the health care system will cost many more lives in the long run than it saves in the short run.”
Here the conservative argument is that government involvement in health care that attempts to rein in costs will stifle private sector innovation that would save lives down the road. In other words, if we don’t let drug-makers continue to enjoy 16 percent profit margins, and we don’t encourage physicians to continue to run tests that patients don’t really need, we’ll miss out on all sorts of miraculous medical discoveries. To flesh out the thesis, Douthat links to an Atlantic Online piece by Megan McArdle.
Both Douthat and McArdle ignore the fact that we’re already awash in medical “innovation”. At this point, we have thousands of drugs, devices and treatments that pad someone’s income stream, but, for the patient, bring neither comfort nor cure. We don’t need another $1 million drug that might prolong the process of dying by three to five weeks. We don’t need another artificial knee that is no better than the man-made knees that we already have, but costs $500 more because someone has come up with a slick way of marketing it. We don’t need ever more sophisticated (and expensive) diagnostic testing equipment that can discern the fine traces of diseases that will never develop.
I object to Douthat’s Op-ed in part because I don’t think that all points of view deserve equal respect in some Great Supermarket of Ideas. Some ideas come with evidence and a good argument; others are merely flimsy attempts to justify the profiteering and waste in our health care system.
But I was even more offended by the notion that Joe Lieberman is a thoughtful legislator who represents a set of conservative ideas. Lieberman is not an ideologue; he is a chameleon, an opportunist who represents Joe Lieberman. That one man is able to put self-interest ahead of the interests of the nation is tragic.
On this point, Jacob Hacker observed that current Senate rules regarding filibusters threaten “a robust democracy.” The majority may want to pass progressive legislation, but a handful of senators—even one senator—can block progress.
Mitchell, Hacker and I all agreed that, when you evaluate the newest incarnation of reform legislation, the open question is whether private sector insurers, who will be overseen by the Office of Personnel Management, will be well-regulated. We were not optimistic. As Mitchell puts it in the December issue of Harper’s: “The health-care industry has captured the regulatory process, and it has used that capture to eliminate any real competition, whether from the government . . . or from new and more efficient competitors in the private sector who might have the audacity to offer a better product at a better price.”
If this is correct, then health care premiums will continue to levitate. And in the next couple of years, Hacker and I agreed, legislators will have to go back to the table. We are heading for a wall: even if we lack political will, economic necessity will force the issue.
Gotcha covered at Newshoggers.
http://www.newshoggers.com/blog/2009/12/who-let-joe-lieberman-kill-the-public-option.html
Any reaction to the Robert Parry analysis of Lieberman’s motives? (link via a GRITtv comment)
http://www.consortiumnews.com/2009/121509.html
He sees a political dynamic having little or nothing to do with health care reform. I never connected the Hartford-Insurance and Joe-from-Connecticut dots, but that may have been part of the calculus of kissing up to the industry from the jump. And the Israel theme is Realpolitik at its most disagreeable.
The left abandoned Lieberman in 2006, so why on earth would you think he would support liberal ideas. He stood by his vote and the left punished him for it. He never played intellectually dishonest games like Clinton stating that the vote was not to go to war, and because of that they brought in Ned Lamont. I really don’t get the vitriol. He’s not a Democrat. He’s not your guy. For god’s sake posters on Ezra Klein’s blog were wishing cancer on him and his wife and fantasizing about shooting him in the head. Sick, Disgusting and deserving of a visit from homeland security.
I agree with you I think we have plenty of technology. The thing we don’t have is the manpower. Massachusetts has found that out and I don’t believe the fairy tale thinking that the instant we give people insurance cards that we will “save” lives. I will see 80 patients tomorrow and its a 4 month wait to see me. By our office estimates that’s going to go down to 3 months on Jan 1 when I stop seeing new Medicare patients, but that’s not a good thing.
“The majority may want to pass progressive legislation, but a handful of senators—even one senator—can block progress.”
It wouldn’t happen if they didn’t want it to happen. They are remarkably unified and firmly resolved in their positions when it comes to protecting their campaign contributors and the industries in which they will continue to have careers post-Senate.
There are very few who want to “pass progressive legislation,” and they have already pulled their amendments out.
On the bright side: when we hit that wall the next time, will the battle be a little bit easier b/c of all the work reformers have done this time around?j
If those wanting reform would simply abstain rather than vote no, wouldn’t that be best?
I mean I saw Howard Dean on Morning Joe this morning making sense and being pretty reasonable. Basically he said if reform has been hijacked, then it isnt reform so don’t vote for it.
Pretty simple and accurate description of the way forward in my thinking.
Hootsbuddy– the notion that this is all about protecting Israel seems a little round-about .
But I do think it is all about maximixing JL’s power in Congress and his power vis-a-vis the White House.
Jegna–
You are right– Lieberman has never been a liberal Democrat, unless it seemed to his advantage to position himself with liberal Democrats (running with Gore. He wanted to be in the White House. This seemed a way in.)
Many years ago, back in Connecticut, I watched him stand on the sidelines while a reform candidate challenged the Democratic machine that ran CT.
Lieberman didn’t want to endorse either canddiate –until he felt confident that he knew who would win.
His decision wasn’t based on principles–liberal, moderate or conservative. It was based on doing what was best for Joe.
That said, I totally agree that wishing that he develop cancer, or fantasizing murder is sick (and childish).
And yes, giving people an insurance card and encoruaging them to get primary care when there are not enough primary care docs is a recipe for chaos–and much anger.
This is one reason why we cannot possibly roll out reform until 2013.
In the meantime, Medicare is proposing hiking primary care fees by 4% next year. Not huge, but if you do that twice in the next three years, times –plus the 5% to 10% hike that is supposed to kick in in 2013, plus the bonuses for doing various things that are built into the legilsation. . . .Compounded, you are beginning to look at incomes increasing by 20% even 25%.
If med students can see that coming in the relatively near future, they will be more inclined to pick primary care.
And the substantial increases in fudning for loan foregiveness and scholarships for med students who choose primary care that are now built into the legislatoin could make a real difference, especially in attracting low-incocme students who are a) more likely to pick primary care and b) likely to want to go back to places where they grew up, whether inner cities or rural areas.
But we’re still going to be facing a huge shortage of primary care docs in 2013. I think this means: a) paying docs to “see” patients via e-mail and phone which can be more efficient b) making better use of nurse-practioners (Medicare plans to boost their fees next year, and the legislation boost payment for nursing school teachers) and c)bonuses to primary care docs who join large multi-specialty practices, accountable care organizations, integrated systems–places where a back office worries about hiring a clerical staff, negotiating with insurers, whether enough money is coming in to keep the lights on , etc.
If primary care docs could spend all of their time practicing medicine, this would be a much better use of their talent and training.
I realize that some docs just prefer the small practice model and being their own bosses. But in cities, the economics of small practices just aren’t working.
ACarroll– You are right, there are relatively few real progressives in this Congress.
But there is also a problem with the way the Senate is structured.
A simple majority (51 votes) is not enough to pass progressive legislation. You need 60 votes.
And it’s rare that 60% of the Senate is “left.”
60% of Americans are not on the left. Most people would say they’re independent or moderate.
The 60 vote rule to break a filibuster makes it hard for the Senate to get anything done.
In this case, looking back, I don’t think that Rahm or the president or anyone could have gotten the 60 votes together.
I had hopes that, behind closed doors, they could twist arms.
But between Snowe being honestly principled (though I would say wrong) and others stubbornly committed to opposing abortion or government internvention in healthcare, plus show-boats (like Lieberman) seeing an opportunity to gain personal power . . .I don’t think that either bribes or threats could have brought the 60 votes.
And if they had tried to go to reconciliation there is an excellent chance that they would have lost large chunks of the bill—like the subsidies that make it possible for low-income people to buy the insurance.
Finally, this legislation is good for the low-income and lower-middle class people who will qualify for nearly full subsidies. Today, they really can’t afford insurance untless they ahave a generous employer with deep pockets.
And the legislation is good for people suffering from pre-existing conditions who, today, are shut out in the cold. Insurers will still try to avoid them, but they can’t refuse to cover them. Finally, assuming the cap on out-of-pocket spending sticks, this should mean the end of medical bankruptcies.
There are major steps forward.
But– I would’t call it health care reform.
I’d call it “expanding coverage.” –that was one of the three goals of reform.
The other goals were to “lift quality” (that may happen if Medicare uses financial sticks and carrots to make it happen–but I don’t think we can count on private insurers to do it) and “containing costs.”
If the Independent Medicare Advisory Commission is given the power it needs, and is protected from Congress, as the White House and Jay Rockefeller have suggested, it can cut Medicare spending.
That would be a good beginning.
But we’re going to need more legislation.
e-Robin. Yes.
In particular, some members of the public now have a better understanding of the problem. They are beginning to realize that more care is not better care; that unncessary tests can be dangerous, that higher quality and lower costs can go hand in hand.
And by providing subsidies for low-income and lower-middle-class people we have basically made the statement that we have a responsiblity to insure that everyone has insurance . . .Now we have to make sure that insurance means access to good care. (I worry about those high-deductible plans with high co-pays.)
But having voted for the subsidies, there is no turning back. We have made it clear that we are no longer willing to ration care by ability to pay.
Ed– I think we want this legislation to eventually pass– after negotiating to get as much as possible into the final bill, including some aspects of the House bill.
The reason: a gerat many people will still benefit.
I think it’s an exaggeration to say that tens of thousands of lives will be saved.
Many uninsured people die prematurely not becuase they lack health insurance, but because they are poor. If you’re poor, and smoke, and grew up in an unhealhty environment there is a limit to high much healthcare will help them.
So it’s impossible to say how many of the uninsured would survive long if they had insurance.
But, certainly, many people who qualify for subsidies will be better off than they are now.
Finally, if this bill fails to pass, that probably means that the Democrats lose big-time in 2010, and Obama is defeated in 2012.
The Republican who replaces him is not likely to revive health care reform.
So we would be looking at another 7-11 years with no reform. By then our broken system will be on the verge of collapse.
And at that point, we might not be able to afford what it would take to mend it. By then, the spiralling cost of healthcare will have taken an enormous toll on the economy.
I think Dean is basically encouraging liberal senators to keep negotiating, keep fighting for some of the details that matter. I’m not sure he really means it when he says “don’t vote for it.”
If he does, then he is recommendign cutting off one’s nose to spite one’s face. . .
Never a good idea.
Agree Jenga, those who criticize Lieberman are those who disagree with his view. These same folks are much more forgiving of hyperpartisanship and flip-flopping when it is perpetrated by their own guys. Let’s keep it fair.
“Both Douthat and McArdle ignore the fact that we’re already awash in medical “innovation”. At this point, we have thousands of drugs, devices and treatments that pad someone’s income stream, but, for the patient, bring neither comfort nor cure. We don’t need another $1 million drug that might prolong the process of dying by three to five weeks. We don’t need another artificial knee that is no better than the man-made knees that we already have, but costs $500 more because someone has come up with a slick way of marketing it. We don’t need ever more sophisticated (and expensive) diagnostic testing equipment that can discern the fine traces of diseases that will never develop.”
So true!!! How can we get people to understand this? The innovation we need is in programming to help people quit smoking, eat better, and exercise more, not new medications for conditions that only barely qualify as diseases. We need to learn better how to support people with mental illness through community programs, not to develop yet another me-too SSRI or anti-psychotic. If we spent the portion of the money we currently give to pharmaceutical companies and device makers to advertise their products to us on such innovative programming, we might actually see our health care costs *dropping* instead of soaring.
Sharon M.D. & Michael
Sharon M.D.–
Thanks much for your comment.
You write:
“How can we get people to understand this? The innovation we need is in programming to help people quit smoking, eat better, and exercise more, not new medications for conditions that only barely qualify as diseases. We need to learn better how to support people with mental illness through community programs, not to develop yet another me-too SSRI or anti-psychotic.”
The answer is that it will take time to spread the word–to educate the pubic, and change the way we educate doctors.
But I do think that we have reached a tipping point in terms of a great many doctors, nuress and other health care professionals understanding what you are talking about.
They may not be in the majority, but they are among the younger doctors, the women doctors, the nurses who are beginning to figure out how & why our healhcare system is broken.
And a leading edge of hospital administrators understand what this is all about.
The fact that Dr. Atul Gawnde’s June 1 New Yorker aricle got so much attention is telling. Five years ago, it would have just been another article in the New Yorker that very few people read.
The New Yorker audience hasn’t expanded much since then. But Gawande’s piece about over-treatment struck a never, and came at a time when a geat many people were ready to hear what he had to say.
Michael– Please see my response to Jegna.
Unlike Lieberman, lberals like Senator Jay Rockefeller have not “flip-flopped.”
They have remained commited to their principles– providng care for low-income Americans, making sure that people with pre-existing conditions will get care.
The current compromise legislation still offers this care for many Americans.
Shocking – a Senator from Connecticut, with its large concentration of Insurance Companies, would vote the way many of his constituents and campaign contributors would want him to.
Next you will tell me that politicians from Michigan, with its large concentration of auto manufacturers and auto workers would vote for a federal bailout of the auto industry.
Or that Senators from farm states would vote to continue large farm subsidies. Or Senators from oil producing states would vote in favor of oil companies.
I can’t understand how this could be. Perhaps I need a young female doctor (“…the younger doctors, the women doctors,.. who are beginning to figure out how & why…”) to explain it to me.
Legacy–
In September Lieberman proposed a Medicare buy-in.
In December he opposed it.
Suggestion: look at the clips of Lieberman contradicting himself, espeically toward the end of the Flanders show, and you’ll know what people are talking about.
Maggie,
I have no love of Joe Lieberman and I know that he contradicted himself. I am also sure that he is not the first, nor will he be the last.
The problem is not so much with a particular individual as with a system that lets one swing vote dictate so much of what is going to happen.
On the other hand, with respect to this particular issue – allowing 55 to 65 year olds to buy in to Medicare – I think his current “heart felt” opinion is probably correct.
Medicare does not have a sustainable future – at current rates of increase it will go bankrupt in the not too distant future. Before we add more obligations to Medicare, we need to figure out how to make Medicare sustainable. Our situation is analogous to someone who can’t afford their mortgage adding an addition to their house.
Re “Liebercare”- THE US IS NO LONGER A DEMOCRACY.The extreme partisan 60 vote requirement of every piece of legislation and the abuse of the filibuster tactic in the US Senate indicates that our democracy is broken.
This could have dire consequences for our nation whose very foundation is built on the fundamental concept of democracy.
We are in very deep trouble beyond just health care reform at this point.
Believe it!
Dr. Rick Lippin
Southampton,Pa
Maggie,
Leiberman contradicted himself SHOCKER! He’s a politician. Our glorious leader promised 8 times that he would broadcast the negotiations on CSPAN. Now nobody knows what is in the bill except Harry Reid. Does that make Obama a dishonest SOB? I think more likely it showed his naivety. But some could lob the same charges that Leiberman is getting, at Obama on that issue. More than likely though, it shows that everyone is prone to contradict themseleves. A recent case in point, you chastised me last month for looking in other people’s pockets and yet you made a feature length film about looking in other people’s pockets. If you have enough material on the web, video and interviews, everyone will eventually show hypocrisy. Tim Russert made a living on such things.
To dovetail in on Legacy’s point on one swing vote, I think that goes more to strategy and the reconciliation threat. Everyone realized that it was nothing but a hollow threat. Even those fully opposed to the bill would welcome reconciliation. They know it isn’t credible to reform something as big as Healthcare by something with such narrow parameters and the swing senators (now Ben Nelson) are fully taking advantage of that. Changing tax brackets is easy, refoming 1/6 of the economy by such means is impossible, which makes the insurrection on the left shocking. I think it is fascinating that more bloggers don’t think like you, Ezra Klein or Nate Silver and want to pass something, rather than blow up the entire process. I guess that’s your fight. Get out the popcorn.
Legacy–
As you know from my post, I too thought the Medicare buy-in was a bad idea at this stage.
It would have been too expensive becuase, as you say, Medicare is too wasteful.
After we reform Medicare, re-align financial incentives to pay for quality, cut fees in areas where we are over-paying, etc., a Medicare buy-in might be a good option. But
not now.
The fact that Lieberman contradicted himself on healthcare is the least of it. People who know him well (and I know a few of them) have long said that he is a slimey self-righteous hypocrite and opportunist.
I cannot think of a Democrat who is as widely disliked within Democratic circles–and this was true back when he became Gore’s running mate. (Gore is a very intelligent man, but got very bad advice from “political strategists.”
I lived in Ct. for many years . . .the people who put up the money to run Ned Lamont in a primary against Lieberman are good people, and they had very good reason to want him out. They spent a fortune because they saw Lieberman as a truly bad actor.
Rick–
I agree–filibusters have been abused, and the Senate system badly needs repair.
Jenga–
The phrase “looking into someone’s pocket” refers to an individual being jealous of how much someone else earns.
I’m hardly envious of those who profiteer within our health care system.
If I had wanted to, I could have embarked on a much more lucative career a long time ago, in the financial world. Money just isn’t my prime interest.