Time for a Blogging Sabbatical

As you've undoubtedly noticed if you've been coming to this site regularly, my posts have been getting fewer and farther between.  Though I can always point to the demands of my real job as an excuse (it is a pretty demanding job, after all), the reality is that I haven't been any busier than normal lately.  For whatever reason, though, I've been having more trouble finding the time to write here, and when I do sit down to write a post, much of the time I abandon it halfway through, usually because I'm not convinced it contributes anything useful or original to the discourse.  

So I've made a decision.  I'm taking a sabbatical from blogging.  It's something I need to do. I'm not sure how long it will be.  Maybe a few months.  Maybe longer.  We'll see.  During that time I may post something once in a while, if I feel particularly motivated.  In the meantime, I'll continue to post my thoughts on Twitter, so feel free to follow me there.  If I post something here, I'll give you a heads up over there so you don't have to keep coming to the site.  
For the record, I've very much enjoyed blogging here and I appreciate all of you who have read my posts over the years and especially those of you who have taken the time to comment or email me.  I promise that I'll return to writing eventually.  I hope you'll come back then.

Cheers.

Why the GOP has no health care plan

The Hill reports that there is currently a debate within the GOP caucus as to whether they should offer an alternative health care reform bill.

Some House Republicans are growing frustrated that their leaders have not yet introduced a health care reform alternative.

For months, the message from House GOP leaders on a healthcare bill has been similar to ads for yet-to-be-released movies: Coming soon.

According to several GOP lawmakers, the leadership is split over how to proceed in terms of unveiling an alternative to the final Democratic bill that Speaker Nancy Pelosi (D-Calif.) intends to unveil as soon as this week.

Rep. Tom Price (Ga.), chairman of the conservative Republican Study Committee (RSC), revealed the schism within his party late last week.

“There’s a difference of opinion over what ought to be the strategy from a political standpoint on this issue. I happen to believe we ought to have a bill. There are others who believe, as strongly, that the principles that would be outlined and would be adhered to in the Republican bill are what need to be discussed because everybody can embrace those principles,” Price said last week.

The problem the GOP faces is a very simple one: it is impossible to translate their "principles" into a functional plan. This is why they never lifted a finger to address the issue of health care reform during the entire time they controlled the White House and Congress. Indeed, the one health care related bill they passed (the Medicare prescription drug bill) was a massive new--and completely unfunded--government entitlement, something that would seemingly violate any possible list of GOP principles in profound ways.

In the current debate, if you ask a GOP politician what he/she would do to reform health care, you're likely to hear a lot of buzzwords, things like "portability" and "competition across state lines." This all sounds well and good. Competition is generally a good thing and most of us would prefer it if our health insurance wasn't tied to our employment. But when you try to reduce these ideas to policy, the result is a disaster.

There are two fundamental problems we face with our health care system. The first is the fact that tens of millions of people in this country are either uninsured or under-insured. The second is the fact that health care costs are rising rapidly. Any proposal to reform our health care system must address these problems.

The one idea that Republicans have offered to address these problems is relatively easy to understand. They want to allow private health insurers to sell policies across state lines. Thus, as long as an insurer complies with the regulations of its home state, it could sell insurance outside of the state. This would increase the amount of competition and thereby reduce premiums. The problem with this idea, of course, is that it would create an instant "race to the bottom." The insurance industry would lobby the states to relax their regulations and then would all set up shop in the state that was most willing to comply with their demands. The result would de facto deregulation of the industry. But, from the GOP perspective, this is a feature, not a bug. Without laws mandating what they have to cover, insurance companies would gravitate toward high-deductible, low-benefit policies that could be offered for reduced premiums. Businesses would start offering these kind of policies to their employees in order to cut costs and many individuals would choose such policies in order to save money on premiums. While this might reduce average premium prices (at least in the short term) and allow some people who currently can't afford insurance on the individual market to purchase it, the result would be a system in which just about everyone is under-insured.

But this is exactly what conservatives want. They believe (or at least claim to believe) that the reason health care costs are out of control is because people don't have enough personal stake in health care spending. The believe that if people have to pay a greater percentage of costs out-of-pocket, they will have an incentive not to "purchase" unnecessary care.

As anyone who has studied health care policy for more than ten seconds knows, however, treating health care like grocery shopping is a recipe for disaster. First, when it comes to health care, "consumers" simply don't have the expertise to be intelligent "shoppers." We're not doctors. We generally don't know what diagnostic test or procedure we need or when we need it. We don't know which doctor or hospital is the best "deal." We don't know which drug offers the most "bang for our buck." Most of us never will, either. That's why we have doctors. Moreover, when you make people pay for routine and preventative medical care out-of-pocket (as high deductible policies do), the inevitable result is that people don't get enough routine and preventative care. That results not only in worse health outcomes, but it drives up costs. It is much easier and cheaper to treat conditions if they are detected early.

On some level, I'm pretty sure that most Republican politicians know all of this. They know that their "principles" don't translate well into actual policies. They know that if they were to produce an actual bill, nearly every health care policy expert in the country would immediately point out its myriad flaws. And on some level they also know that the only way to effectively deal with the problem of the uninsured or to control costs is through greater (not lesser) government involvement in the health care system. Indeed, one of the final quotes in the article is very revealing on this score:

One House Republican who spoke on the condition of anonymity said, “The fact is, [GOP leaders] are very concerned with doing anything that the base would interpret as ‘Democrat-lite’ or ‘socialized-lite’ … which is forcing a little of paralysis.”

That paralysis is a consequence of the fact that, absent greater government involvement, there really is no way to deal with the uninsured or to reduce systemic costs. If the GOP were to produce a bill and submit it to CBO-like analysis, the results would undoubtedly show that it does almost nothing to address either problem. Indeed, it could very well be shown to make both problems worse. That's why there is no GOP health care plan.

The Politics of the Opt-Out

The rumor at the moment (which may well be disproved shortly) is that the health care bill Harry Reid will send to the Senate floor will include a national public insurance plan that individual states may choose to "opt out" of. I've previously written that I think the "opt-out" is by far the best of the various watered-down public option compromises that have been suggested. In fact, there are scenarios where I think the "opt-out" might actually be better than the full-fledged public option. But I want to expand upon that thinking a little bit, because it requires quite a bit of speculation.

Let's assume, for the moment, that the Senate bill includes an public option with an opt-out provision and that this version of the public option is the one that survives the House-Senate conference process and is eventually signed into law by the president. What happens then?

Well, assuming it's a true opt-out provision, the national plan will initially be available in every state. Undoubtedly there will be calls from conservatives (particularly Republican politicians who are considering presidential runs in 2012) for states to opt-out of the public plan. Minnesota Governor Tim Pawlenty has already stated that he will lead such a campaign in Minnesota. As we saw with the stimulus bill, however, there is often a stark difference in both priorities and opinions between state-level Republicans and Republicans with aspirations for national office. It is one thing to posture for the national media; it is quite another to actually take steps to deprive citizens in your state from being eligible for a federal benefit. It would not surprise me at all if, when push comes to shove, many state-level Republican (even in very red states) balk at the idea of opting out of the national plan.

On the other hand, unlike the stimulus battle, it's not just ideologues who will have an interest in opting out. Insurance companies will not want the competition of a public plan and may well try to lobby hard at the state level to get states to opt-out. Republicans running for Congress in 2010 may also seize upon the opt-out as a campaign theme. They would have little to lose in the short term by demonizing the health care bill, especially when much of it will take time to go into effect.

These efforts will, of course, be counterbalanced by Democrats who, having voted for the plan, will be very invested in defending it. And, on the merits, the Democrats will have a winning argument. Their opponents will be trying to deny their citizens an option that their friends and family in other states will have. Moreover, I suspect that much of the business community will at least tacitly support the Democrats on this one. Having another insurance option can only help businesses who are struggling mightily with the costs of rising premiums.

The bottom line is that it is very difficult to predict exactly how this debate will play out in the short term and how many states will ultimately choose to opt-out. If I had to guess, I'd guess that no more than a handful would opt-out, but I could easily wrong. One thing I'm fairly certain of, however, is that a large number of states will not opt-out, including many of the most populous states, like California and New York. Therefore, whatever happens, there will be a national public plan of significant size.

Many people have suggested that this would create a perfect laboratory to test whether the public option does in fact work to control costs. I'm not so sure that's true. My guess is that, even if the public plan works to control costs, we won't see a significant disparity in premiums between opt-out states and public plan states. The reason for that is that private insurers will feel pressure to be competitive with the public plan even in states where the public plan is unavailable. After all, states can always opt back in, and if it becomes obvious that people in opt-out states are paying much more for insurance, politicians and businesses in those states will clamor to opt back in. Thus, the only real test of the public option will be whether it slows the rise of premiums nationally, and it will take time to make that assessment.

Indeed, it's possible (likely even) that Republicans will point to the lack of any significant premium disparity between opt-out states and public option states as evidence that the public option doesn't work (even if it is working on a national level to control prices). Fortunately, while this might score rhetoric points, it is very unlikely to lead any additional states to opt-out. Once the national public plan is up and running, state legislatures will be loathe to opt-out of it because such a move would necessarily deprive many of their citizens of their existing health insurance (which could be disastrous politically). Thus, it's a smart bet that the universe of opt-out states will only get smaller as the years go on, not bigger.

On a purely political level, this issue could pay dividends for Democrats for years to come. Democrats running for office in public option states would have a reliable, winning issue in every election ("the Republicans want to take away your health insurance"). And in opt-out states, Democrats would also have a strong message ("I will give you the same options that everyone else in the country has already"). That's an issue that could breath new life into the Democratic party in red states.

So to summarize, I think that a public option with a state opt-out will likely accomplish nearly everything a national public option would. And while the politics of the issue may be a wash in the short term, in the long term they overwhelmingly favor the Democrats. Indeed, from a purely political perspective, the opt-out may well prove to be far superior to the full-fledged public option, and without sacrificing much, if anything, on a policy level.

The Party of One Idea

Now that they are no longer controlling the reins of government, conservatives and Republicans are suddenly very concerned about the size of the federal budget deficit and the national debt.  They never miss an opportunity to suggest that President Obama is primarily (if not exclusively) responsible for the size of both the deficit and the debt.  And careless members of the mainstream media have shown a remarkable willingness to accept this premise. But as Steve Benen patiently explains (yet again), this is nonsense:

Specifically, 40% of the fiscal deterioration we're seeing -- the single largest contributing factor -- can be attributed to Bush policies. Another 12% comes from Bush's financial rescues, while 20% are the result of the economic crisis. What's President Obama's share? Just 16% of the total, most of which is the result of new spending that was necessary to prevent a depression. Indeed, blaming Obama is backwards: "[P]roperly accounted for, the deficit actually goes down when you compare Obama's budget proposals to current policy, not up."

And finally, let's also not forget that it only makes sense to run large deficits given the circumstances. We're dealing with an economic collapse and two wars, following eight years in which we were led by "the most fiscally irresponsible president in the history of the republic."

Bush inherited the largest budget surplus in American history and turned it into the largest deficit in American history. Obama, in contrast, found a fiscal fiasco waiting on his desk on his first day on the job. Before anyone blasts the president for the mess, perhaps they ought to grab a mop.

Steve's right about all this, of course, but since most members of the media seem incapable of processing any argument involving numbers, I wonder if there isn't another way to make this same point.

Let's try this. Suppose that somehow, magically, the GOP found itself once again in control of Congress and the White House. Republicans could set the agenda and pursue whatever policies they saw fit. What would they do to bring the deficit under control?

Well, let's tick through the options. One idea that some Republicans have suggested (safe from their position in the minority) is to cancel the rest of the stimulus bill. The near universal consensus among economists, however, is that stimulus spending in the coming year will be crucial. Moreover, the states, including most red ones, are very much counting on this money. I find it hard to believe that the GOP--even with a larger majority--could garner anywhere near enough votes to cancel the stimulus bill. Moreover, doing so would only improve the deficit numbers for one year (after that, the stimulus spending is done). Even if it didn't harm the economy, it would do nothing whatsoever to improve the long term deficit numbers.

So what else? We can be pretty sure that there would be no tax increases. No Republican member of Congress has voted for a tax increase since the 80s and virtually all of them have taken oaths not to do so under any circumstances.

So what about spending cuts? Well, the largest source of potential spending cuts is in the defense budget, but the GOP has always been fiercely opposed to any cuts in defense spending, and it's hard to see that changing any time soon. Most of them also want to increase spending in Afghanistan, restart boondoggle missile defense projects, and waste money on fighter planes that don't work.

So that leaves us with entitlement spending. Would the GOP make major cuts to Medicare? It's possible, but they are currently opposing efforts to rein in wasteful Medicare spending and promising to protect seniors from any cuts whatsoever. It seems highly unlikely that the GOP would make any real effort to reduce spending on Medicare.

So what about Social Security? Well, for starters, Social Security is a much smaller program than Medicare, so even drastic cuts would not make much of a dent in the overall spending picture. Moreover, the last time the GOP tried to "reform" Social Security (by converting it into 401k-style individual accounts), their plan involved massive up front transition costs that were to be paid for by borrowing. In other words, if they passed Bush-style Social Security reform, it would massively inflate both the deficit and the debt, both in the short term and long term.

So what does that leave us with? Not much. Honestly, I have no idea what the GOP would do. As near as I can tell, they don't currently have a single idea, realistic or otherwise, for reducing the deficit in the long term. My guess is that if they suddenly found themselves back in power, they'd fumble around for a while and then, having thought of nothing else to do, try to pass some sort of tax cut. It wouldn't make any sense and it would make the budget situation worse, but they just don't have any other policy ideas. They are the Party of One Idea. And it doesn't matter that their one idea is the primary reason we are in such a bad budget situation in the first place.

This sounds like parody, but it's not. If journalists actually pressed Republicans to explain how they would reduce the deficit, I bet that the most common answer would be to cut taxes. Let's get them on the record. 

Rush Was Not and Cannot Be Libeled

The lengths to which supposedly "serious" conservatives are willing to go to defend Rush Limbaugh are staggering. The National Review this morning has an entire editorial fluffing Limbaugh and attacking his critics. It ends with this gem:

Rush is a rich and powerful man and quite able to take care of himself, but the dishonest attacks on him are the template for equally dishonest attacks on private citizens in less exalted positions, from Tea Party organizers to town-hall critics. If Rush can be ruthlessly libeled by the Democrats and the media, so can they.

Actually, the template for such attacks is what Rush has been doing for a living every day for the last few decades, but I'll get back to that. There is so much insanity and projection embedded in this single paragraph that it's worth unpacking it a little bit first.

First, as a legal matter, Rush was not libeled, at least by the media. For something to be slander or libel (especially when it involves a public figure), you have to know that what you are saying or writing is false. What happened here was that someone circulated an email that purported to be the "Top Ten Racist Rush Limbaugh Quotes." Contrary to what the National Review and Rush's knee-jerk defenders claim, these quotes are not all fabricated. Most of them, in fact, are well-documented (his quote about Donovan McNabb, etc.). Several of them, however, are unverifiable. They come from secondary sources (books and magazine articles about Rush) and supposedly date back to very early in Limbaugh's career. It's not as if there are transcripts of everything Rush has said on air since the 70s, so who knows whether they're true.

Armed with the list of quotes, some people in the media (mainly bloggers) repeated these quotes without verifying them. That's no doubt sloppy reporting and whoever repeated those quotes--at least the ones that cannot be proven to be genuine--should issue a retraction. But it's not libel. No one said anything knowingly false. Indeed, the reason people were so willing to believe that all of these quotes were real was that many of them were, in fact, real. Limbaugh has said a number of very racist things over the years (many which didn't even make the Top Ten). Moreover, as far as I can tell, the most widely repeated quotes from the list (in the particular the McNabb quote) were the real ones, not the ones Rush claims were made up.

But let's go one step further. Suppose I were to repeat, right now, one of the quotes Rush claims was fabricated--let's use the slavery quote as an example--and attribute it to him. Would that be libel? The answer is almost certainly no. After all, I don't know that it's false. It comes from a book--101 People Who Are Really Screwing Up America--and I have no particular reason to trust Limbaugh more than the author of that book. And there's no independent way of verifying the truth; there's no comprehensive repository of all of Limbaugh's statements.

I, of course, wouldn't do that because I have higher standards, but guess who doesn't. That's right, Rush Limbaugh. Limbaugh has made a career out of exactly this sort of character assassination. When he isn't making stuff up himself, he is credulously repeating stuff made up by other people. Any right wing nutjob who writes a book gets invited onto to Limbaugh's show to pollute the airwaves with their outlandish claims, and Rush will then repeat it.

Was Vince Foster murdered in an apartment owned by Hillary Clinton? According to Rush he was. Was Michael J. Fox faking his Parkinson's disease symptoms? According to Rush he was.
Is Justice Sotomayor a "bigot" and "racist" comparable to David Duke? According to Rush she is. Indeed, just in the past week, Limbaugh repeated several times a false and rather despicable character attack against Obama Department of Education official Kevin Jennings. And these are just examples I came up with in 2 minutes of Googling. There are similar examples to be found in nearly every broadcast Limbaugh has ever done.

Limbaugh is a slander-merchant. That's what he does for a living. The notion that someone like him could ever be unfairly treated by the media is inherently ludicrous. To portray Rush as a victim of such tactics--as opposed to the world's biggest practitioner of them--is insulting to everyone's intelligence and a sign of the complete intellectual decay of magazines like the National Review.

Health Care and Legislative Strategy

For whatever reason, the Democratic Party is a risk-averse bunch. Right now, Senate Democratic leaders are discussing how to merge the various versions of the health care bill that have passed out of committee. Based on news reports (and having watched how Democrats operate for years now), my guess is that the discussion is largely centered around gaming out what kind of a bill can garner enough votes on the floor to survive cloture and pass. Driving this discussion will be the assumption that it would somehow be politically disastrous to miscalculate and advance to the floor a bill that doesn't have enough votes. As a result, the bill that finally emerges will likely be one that falls well short of what many of us would like to see.

This calculation might make some sense if there was some sort of rule preventing the Senate from considering more than one health care bill per term. But of course there's no such rule. The Democrats control the legislative agenda and can always scale back the bill and vote again. Indeed, they could keep doing this until something passed.

So why be so cautious on the first round? I strongly suspect that if the Democrats put a strong bill on the floor, one that included a robust public option, and then aggressively pushed all of their members to vote for at least cloture, at the end of the day, no one would join the Republicans in filibustering the bill and it would pass. Just call their bluff. They'll fold.

And if I'm wrong about that, well at least those of us who want a strong public option (a group that includes nearly all Democratic voters who are following the debate closely) will know exactly who to blame, i.e., the Democrat Senator(s) who joined with the Republicans to filibuster the most important piece of Democratic legislation in the last forty years. That would itself be very clarifying.

I understand that this would create a flurry of headlines declaring that Obama and the Democrats have suffered a legislative defeat, but those headlines would be short-lived, and wouldn't necessary hurt the Democrats (obstructing health care legislation has its own political downside). But more importantly, the Democrats could easily regroup, water-down the bill however much is necessary and pass it. Some kind of bill will surely pass. And it least then we'd know it is the best we could do under the circumstances.

I know that I'm being naive for even suggesting this, because it's just not how Democrats operate, but it is the way a less neurotic and cowardly political party would operate, so I thought I'd at least throw it out there.

The "Opt-Out" Compromise May Actually Be Better Than a Pure Public Option

There's been a lot of discussion in the last 24 hours about a potential public option compromise. The proposal is to have a national public insurance option but to allow individual states to opt-out if they don't want to be a part of it.

Among those who have been fighting the hardest for the inclusion of a public option (and doing a fantastic job, I should add), this proposal has been greeted with a lot of skepticism and even outright scorn.

With all due respect, though, I think these folks may be reflexively dismissing something that could turn out to be as good or better than a full public option.

First, as a purely political matter, this proposal is much more likely to pass than a pure public option. And if you assume that some sort of compromise will be necessary to get sufficient support in the Senate, this is definitely the compromise to make, because it gives up very little. Like Nate Silver, I suspect the vast majority of states would not opt-out. It's one thing for national Republican politicians to preen and posture about death panels and socialized medicine. But at the end the day, states--even very Republican ones--tend not to opt-out of federal programs that provide benefits to their citizens. How many red states have opted out of Medicaid? Or the stimulus bill? The GOP and the insurance companies may be good at scaring people about hypothetical reforms, but it's much harder to convince people that they shouldn't have access to something that their friends and family in the next state over do. State politicians would also be wary of putting businesses in their state at a competitive disadvantage. Any lobbying from the insurance industry in favor of opting out would be counterbalanced by lobbying from businesses who want to have more options for insuring their employees and more competition to keep premiums under control. Ultimately, I doubt all that many state-level Republicans would be clamoring to opt-out of the public option.

So under one very plausible scenario, no states would choose to opt-out (at least for very long) and we'd come away with a robust national public option that's available to everyone.

But suppose a number of the red states do opt out. Would that really be so bad? I don't think so, and here's why. First, it's not as if the citizens in those states would be completely deprived of the benefits of the bill. They would still be protected from denial of coverage for pre-existing conditions. They would still be eligible for the subsidies in the bill for purchasing insurance. And because the majority of states would choose not to opt-out, the citizens of opt-out states would still indirectly benefit from the competitive pressure provided by the national public option. Insurers in public option states would obviously have to offer rates competitive with the public plan or they would lose business. But insurers in opt-out states would also have to offer rates competitive with the public plan because if they didn't, every Democratic politician in the state (not to mention local and national journalists) would highlight the disparity in premiums, and, before long, political pressure would force state politicians to opt back in.

Either way, the public plan will serve its purpose. It will help to control costs.

But there's another benefit to the opt-out proposal that I've yet to hear anyone mention, and it's this: an opt-out public option would--by its very nature--be demonstrably bipartisan. Even if every single Republican member of Congress voted against it (which would not surprise me at all), a number of states with either Republican governors or Republican-controlled legislators would undoubtedly choose not to opt out. The Obama administration and Congressional Democrats would therefore be able to point to these refusals to opt-out as evidence of the bipartisan nature of the bill and the ultra-partisanship of the national GOP. It's pretty hard to paint something as some sort of crazy liberal socialist death plan when GOP politicians all over the country are choosing not to opt out of it. This state-level bipartisanship would, to at least some extent, mute GOP criticism of the bill and make campaigning against it a little more difficult. It would also, I suspect, provide a winning political argument to state Democratic politicians for years to come ("they want to take away your public option; I won't let 'em do that")

I understand the reticence of those who have fought hard for a robust public option to accept anything that is offered as a "compromise" proposal. But I think it would behoove everyone to step back and really consider how this sort of a proposal would likely play out. It may be that, at the end of the day, this is actually a better proposal.