Wednesday, September 18, 2013

Flip the script, Mr. President

Denouncing the latest Republican round of budget negotiation-by-hostage-taking, Obama said this to the Business Roundtable today:
just flip the script for a second and imagine a situation in which a Democratic Speaker said to a Republican President, I’m not going to increase the debt ceiling unless you increase corporate taxes by 20 percent.  And if you don't do it, we’ll default on the debt and cause a worldwide financial crisis.  Even though that Democratic Speaker didn't have the votes to force through that particular piece of legislation, they would simply say, we will blow the whole thing up unless you do what I want.  That can't be a recipe for government.
I think it's time that Obama did flip the script. Not in this round, and not by holding the debt ceiling hostage. But by using the leverage his office does afford him.

Since 2011, the extremist wing of the Republican party has consistently set the terms of our budget battles. That's because the the GOP House, enabled by the Hastert Rule and the extremists' ability to dictate to leadership, has wielded an effective veto over any prospective budget compromise. As funding and debt deadlines loom they loudly proclaim their intention to exercise that veto, even at risk of national catastrophe, and no one doubts their willingness.

But the President also has a veto.  It's time -- past time -- for him to prepare the ground on which he might use it to shape the terms of negotiation.

Tuesday, September 17, 2013

J Street can reason. The Anti-Defamation League merely emotes

Whatever the merits of Ian Lustick's argument in last Sunday's Times that the two-state solution for Israel and Palestine is all but dead and that it's time to start imagining long-term alternatives, letters in response from two Zionist organizations, the Anti-Defamation League and J Street, form an instructive contrast.  The letter from the ADL's Kenneth Jacobson is an emotional diatribe.  The justice and need for a Jewish state is assumed rather than demonstrated. Lustick has violated a taboo merely by raising the prospect of a single state in which Jews are neither a majority nor a ruling class:

Monday, September 16, 2013

But Greg Sargent, "handling and manipulation of process and theatrics" matter

Greg Sargent has quite rightly called out a bevy of reporters who have slammed Obama for the process by which he arrived at his Syria policy (and other policies) "without taking a stand on the substance of the policy debates underlying them. It's true that criticizing presidential process can be a dodge, shielding the writer from grappling with the policy merits of, say, a missile strike on Syria. But Sargent overstates the case, I think, by suggesting that process can be cleanly separated from policy.  Holding up Dylan Byers as Exhibit A, Sargent criticizes a
genre of criticism of Obama..largely focused on the President’s handling and manipulation of process and theatrics, and the consequences that allegedly has had for the president and the country. Into this category fall the arguments, mentioned by Byers above, that Obama’s changes of course during the Syria crisis have been “confusing and contradictory,” that this has made him “appear weak on the international stage,” and that he has failed to muscle a progressive agenda through Congress.

Saturday, September 14, 2013

So, Congress, how 'bout that AUMF?

Remember the alternative AUMF proposed by Senators Manchin and Heitkampf?
The Manchin-Heitkamp resolution* calls for two primary things. First, it gives the administration 45 days to secure from Syrian President Bashar al-Assad a commitment to join those nations who have signed and agreed to the Chemical Weapons Convention. If Assad fails to comply, then the Senate gives full authorization to the president to use whatever means possible to respond to the regime's apparent August 21 use of chemical weapons.
So now, thanks to the U.S.-Russian agreement on a Framework for the Elimination of Syrian Chemical Weapons, Assad  has already acceded to the Chemical Weapons Convention. And he will be required to provide an inventory of Syria's CW arsenal within seven days of ratification by the Organization for the Prohibition of Chemical Weapons of a draft decision to be provided by the U.S. and Russia "within a few days." Once that inventory is provided, the Chemical Weapons Convention forbids moving any weapons, "except to a chemical weapons destruction facility" (Article IV, paragraph 4). Inspections are to begin in November, and the framework, as the FT puts it, "is structured around a series of deadlines which will allow the world to judge whether it is being adhered to or not." The framework also stipulates enforcement under Chapter 7 of the U.N. Charter, which authorizes the Security Council to use both non-military and military means.

What the agreement (already famously) does not do is effectively pre-authorize military action in the event that Syria violates the agreement.  Whether this kind of agreement could be so structured, I don't know, but the Russians have made it clear that they will block any future call for a Security Council resolution authorizing force.

Friday, September 13, 2013

America's "inward turn" is moderate and proportionate

It's hard to deny, as Roger Cohen charges, that Obama and his surrogates have whipsawed the world with mixed signals in the wake of the Syrian government's chemical weapons attack on August 21. But Cohen overstates the case and its consequences when claiming that Obama's "dithering"
marked a moment when America signaled an inward turn that leaves the world anchorless.

The president has reflected the mood in America. Almost two-thirds of people surveyed think the United States should not take a leading role in trying to solve foreign conflicts, according to a recent New York Times/CBS news poll. Principle backed by credible force made the United States the anchor of global security since 1945 and set hundreds of millions of people free. Obama has deferred to a growing isolationism. His wavering has looked like acquiescence to a global power shift.
The Times/CBS poll result cited raised my eyebrows too. Specifically, 62% said that the U.S. should not "take the leading role among all other countries in the world in trying to solves international conflicts," while just 34% said that the U.S. should do so. Perhaps even more striking, when asked,  "should the United States try to change a dictatorship to a democracy where it can, OR should the United States stay out of other countries' affairs?" 15% said "try to change," while 72% said "stay out."

So U.S. "isolationism" is "growing." But growing from what?  The Times/CBS pollsters have been asking the first question since September 2002, when the Bush administration was selling its prospective war in Iraq and was pretty fresh off an apparent quick victory in Afghanistan. You could say that the U.S. was at the peak of post-9/11 triumphalism.  At that point, 45% said that the U.S. should "take the leading role," while 49% said it should not.  A drop from 45% to 34% is significant, no doubt. But it strikes me as quite moderate in light of the decade of disastrous war that followed.

Wednesday, September 11, 2013

Beyond disputin', an element of truth

The author of the words below might ask Americans, as the malign plutocrat banker Potter asked George Bailey in It's a Wonderful Life after sketching out his life and prospects, "Do I paint too grim a picture? Or do I exaggerate?"
It is alarming that military intervention in internal conflicts in foreign countries has become commonplace for the United States. Is it in America’s long-term interest? I doubt it. Millions around the world increasingly see America not as a model of democracy but as relying solely on brute force, cobbling coalitions together under the slogan “you’re either with us or against us.” 

But force has proved ineffective and pointless. Afghanistan is reeling, and no one can say what will happen after international forces withdraw. Libya is divided into tribes and clans. In Iraq the civil war continues, with dozens killed each day. In the United States, many draw an analogy between Iraq and Syria, and ask why their government would want to repeat recent mistakes.
That's Vladimir Putin in the New York Times. Yes, he does paint too grim a picture, and exaggerate. The Libya intervention was authorized by the Security Council, e.g., by Russia under Medvedev   And Obama's proposed strike on Syria has little in common with Bush's invasion of Iraq. But the broad question -- have American military interventions post-9/11 done more good than harm? --is hard to answer in the affirmative.

 Again, below, does Putin paint too grim a picture?

Tuesday, September 10, 2013

Why did Putin do it?

Like almost anyone watching, I would be delighted if a U.S. strike against Syria could be averted by an agreement to place Syrian chemical weapons under international control.

At the same time: A world in which Vladimir Putin defuses a crisis by proposing and following through on an executable plan to reduce violence is not the world I thought we live in.  I can't help but at least half-expect yesterday's hope to go up in a puff of smoke, perhaps as Assad simply denies that his regime has any chemical weapons (Syrian buy-in thus far has been voiced by foreign minister Walid al-Moualem). Yet events are rushing forward. France has proposed a Security Council resolution calling on Syria to empower the Organization for the Prohibition of Chemical Weapons to destroy its chemical weapons and require Syria to join the OPCW, the implementing authority for the Chemical Weapons Convention. It's hard to see Russia blocking some kind of Security Council resolution to execute its proposal, if not France's current draft per se, and China too has indicated support. So even if action to secure Syrian CW does not materialize quickly, the Russian proposal seems to be on course at least to break the Security Council logjam and hence defuse the impetus for near-unilateral U.S. action. 

Why did Putin do it? The authorization for military action against Syria that the administration has sought seemed headed for near-certain defeat.  Almost two thirds of Americans are opposed to a strike.  Regarding international conflict, Americans don't want the country to lead, whether from in front or behind. According to the latest New York Times/CBS poll, released today, 62 percent say the U.S. should not take the lead among all other countries in the world in trying to resolve international conflicts, and 61 percent oppose air strikes against Syria. Those numbers are trending the wrong way for the administration.  So why would Putin move to avert a military strike that pretty clearly was not going to happen, at least not until further atrocities hit the headlines? Four possibilities come to mind:

Thursday, September 05, 2013

Syrian site-setting in the Senate

Just what -- or who -- are the likely targets of a strike in Syria? This exchange in the Senate Foreign Services Committee hearing transcript made me pick my head up:
SEN. DURBIN: General Dempsey, we saw these photographs earlier -- these heartbreaking photographs. Page three of The Washington Post this morning, an ad by a group supporting the president's effort has a photograph that's riveted in my mind, as a father and grandfather, of the children on the floor in shrouds, victims of this chemical agent gas attack.

What the administration is asking us for is military authority to launch additional attacks. What have you been charged with in terms of the issue of collateral damage from those attacks as it would affect innocent people and civilians in the nation of Syria?

Wednesday, September 04, 2013

Does Obama really need to choose whether he's a liberal or realist in Syria?

Dan Dresner thinks so.  In his view, a leak to the effect that Obama does not want the contemplated punitive strike to topple the Assad regime (in keeping with his slow-walked support of "moderate" rebel groups) clashes with intimations that Obama aims ultimately to push Assad out, as well as with his stated desire to uphold the international norm against chemical weapons.  Dresner's conclusion:
There are a lot of areas of foreign policy where different paradigms can offer the same policy recommendation, and there are a lot of foreign policy issue areas where presidents can just claim "pragmatism" and not worry about which international relations theory is guiding their actions.  I'm increasingly of the view, however, that Syria is one of those areas where Obama is gonna actually have to make a decision about what matters more -- his realist desire to not get too deeply involved, or his liberal desire to punish the violation of a norm.  If he doesn't decide, if he tries to half-ass his way through this muddle, I fear he'll arrive at a policy that would actually be worse than either a straightforward realist or a straight liberal approach. 
Busy work day ahead, so I will keep this short and maybe flesh out later, but I see a balancing act rather than a contradiction.

Tuesday, September 03, 2013

Did Nancy Pelosi (and Kerry) read Max Fisher?

Kind of looks like it:
Ms. Pelosi said..that she was hopeful the American people “will be persuaded of” military action. 

“President Obama did not write the red line,” she said. “History wrote the red line decades ago.”
[UPDATE: guess that's the party line: Kerry echoed it in his testimony this afternoon:
Now, some have tried to suggest that the debate we're having today is about President Obama's red line. I could not more forcefully state that is just plain and simply wrong. This debate is about the world's red line. It's about humanity's red line. And it's a red line that anyone with a conscience ought to draw. ][9/5: Obama said the same in Sweden.]

Compare Fisher:
The U.S. decision to move toward possible strikes appears, rightly or wrongly, wisely or unwisely, to be all about reinforcing international norms. It’s not about us; it’s not about “because Obama said so.” It’s about “because international norms say so.”

Monday, September 02, 2013

Worth reading on Syria

As a Labor Day labor, I thought it might be useful to share some of the strongest analyses I've read about Syria, some of which are at odds with each other. The choices below address three interrelated questions: what should any U.S. response to the Assad regime's chemical weapons attack seek to achieve? How, if at all, does U.S. (and Obama's) "credibility" factor into the equation? And how, if at all, should we engage with adversaries other than Syria with a stake in the conflict?

1. How narrow a mission?

The Washington Post's Max Fisher argues that the "red line" is not about Obama, it's about a hundred year-old international norm. A strike narrowly focused on upholding the international taboo against chemical weapons use makes sense:

Saturday, August 31, 2013

What's the rush?

So James Fallows asked the president. Why strike Syria  isolated from almost all sources of potential support, domestic as well as foreign? Why not make the case with more deliberation and build more support, foreign and domestic? Surprise! Obama, who boasted of doing just that in Libya, now appears to be on the same page.

At the risk of pointing out the obvious: his statement this afternoon announcing that he would seek Congressional authorization for a strike was pitched to an international audience as well. He's seeking more than Congressional support. My italics:
Here’s my question for every member of Congress and every member of the global community: What message will we send if a dictator can gas hundreds of children to death in plain sight and pay no price?

What’s the purpose of the international system that we’ve built if a prohibition on the use of chemical weapons that has been agreed to by the governments of 98 percent of the world’s people and approved overwhelmingly by the Congress of the United States is not enforced?

Friday, August 30, 2013

The WSJ spotlights an apparent anomaly in ACA subsidies

Once again, the WSJ combines factual accuracy with a negative emphasis in its reporting about the Affordable Care Act.

Today's front-pager, by Christopher Weaver and Louise Radnofsky, spotlights an anomaly: When the subsidies offered by the federal government are taken into account, older adults will pay less for insurance on the ACA exchanges than young adults of the same income if they opt for the cheapest, bronze-level plans. That raises the specter of adverse selection and is therefore worrying insurers, who have to offer insurance to older adults relatively cheaply (but not as cheaply as Weaver and Radnofsky imply). Here's the lede:

Thursday, August 29, 2013

Diplomatic fantasy hour

Cooling down from a run, I caught myself at the tail end of a little diplomatic fantasy: the Obama administration furnishes strong proof that the Assad regime carried out the chemical weapons attack -- and wins a Russian agreement to cut off the arms flow for long enough to equal the estimated damage of a contemplated U.S. missile strike. Or an Iranian agreement.

I know, I know....

UPDATE, 9/1/13:
  1. IAEA or P5? RT : Head of AEOI Salehi says next round of - P5+1 talks scheduled for 27Sept
  2. Should mesh interestingly w/ possible strike on Syria. Deal? You cut off arms to Syria for 3 months; we won't bomb.

    18m  there are an awful lot of moving parts, some potentially pushing US & Iran to an understanding, incl. on Syria CW

    9m
    ...steady stream of messages from Iran suggesting tacitly may accept US assessment re: Syria CW :
Update 9/3: Barbara Slavin reports on signs that the U.S. may be opening the door to Iranian inclusion in Syrian peace talks.

Update 9/9: Today we learn that I didn't let my imagination go far enough:
Asked at a news conference in London if there were steps the Syrian president, Bashar al-Assad, could take to avoid an American-led attack, Mr. Kerry said, “Sure, he could turn over every single bit of his chemical weapons to the international community in the next week — turn it over, all of it, without delay and allow the full and total accounting.” He immediately dismissed the possibility that Mr. Assad would or could comply, saying, “But he isn’t about to do it, and it can’t be done.”

However, in Moscow, Russia’s foreign minister, Sergey V. Lavrov, who was meeting with Syria’s foreign minister, Walid al-Moallem, said in response that Russia would join any effort to put Syria’s stockpile of chemical weapons under international control and ultimately destroy them. 

Mr. Lavrov appeared at a previously unscheduled briefing only hours after Mr. Kerry made his statement in London, taking Mr. Kerry’s comments as a way to suggest a possible compromise. 

“We don’t know whether Syria will agree with this, but if the establishment of international control over chemical weapons in the country will prevent attacks, then we will immediately begin work with Damascus,” Mr. Lavrov said at the Foreign Ministry. “And we call on the Syrian leadership to not only agree to setting the chemical weapons storage sites under international control, but also to their subsequent destruction.” 

Mr. Moallem said later in a statement that his government welcomed the Russian proposal, Russia’s Interfax News Agency reported, in what appeared to be the first acknowledgment by the Syrian government that it even possessed chemical weapons. The Syrian government has historically neither confirmed nor denied possessing such weapons.
This has that too-good-to-be-true feeling, like the prospect in 2009 that Iran would send its highly enriched nuclear fuel to Russia or Turkey for safekeeping. But for a diplomatic moment I'll indulge sweet hope.

In which Nicholas Kristof hurls a Hail Mary toward Assad

Unlike several New York Times columnists, Nicholas Kristof usually gets his facts straight.  And in his advocacy over decades for victims of war and rapine, he's developed a signature line of argument: Okay, it may be imprudent/ineffective for the U.S. to intervene militarily. But we can do x, y and z -- a carefully calibrated and coordinated range of diplomatic, economic and sub-military measures -- to pressure a brutal dictator or warlord to stop or reduce the killing. Such has been Kristof's m.o. in columns urging action in Darfur, South Sudan, and I think, a range of other conflict zones.

His advocacy today for a strike on Syria seems uncharacteristically sloppy, a mesh of unargued or thinly argued assumptions: When slaughter in civil war escalates, it's the U.S.'s responsibility to step in. Arming Syrian rebels earlier might have built a more viable or cohesive or moderate opposition and reduced the slaughter.  A punitive strike now may not only deter further chemical weapons deployment but also cause moderate rebels to spring out of Syrian soil like Spartoi.

Wednesday, August 28, 2013

Obama's national narrative is a bit less triumphal these days

It's hard to wax lyrical about Obama waxing lyrical when he seems on the point of launching an attack on another country with no clear end and to advance no clear U.S. interest. 

But I did think that his speech at the Lincoln Memorial on the 50th anniversary of the March on Washington was a good one, better than the Twitter chatter on my feed would lead you to believe. It was familiar: the always perfecting/never perfected frame, offsetting progress made with challenges yet unmet -- but this time with an edge, an emphasis on the lack of economic progress, for the middle class generally and African Americans specifically, over the last fifty years.

I was moved by his account of the ordinary people who drove major social change, though I've heard it before. And I found his account of the political forces militating against opportunity and shared prosperity satisfyingly meaty:

Tuesday, August 27, 2013

Great news! The debt ceiling deadline's been moved up

I have on a couple of recent occasions expressed anxiety (1, 2) that Democrats would be walking into a trap if they let Republicans pass a two-month continuing resolution that would effectively conflate the battle over a 2014 budget with the imperative to raise the debt ceiling.  The working assumption behind the two-month CR, as I've understood it, is that the government could get by without a debt ceiling hike until the end of November.

I was therefore glad to read this morning that the Treasury, whether by design or necessity, is quick-pitching the envisioned end-of-November double showdown.  The debt ceiling must be dealt with earlier, Treasury Secretary Jack Lew declared in a letter to congressional leaders:

Sunday, August 25, 2013

Democrats should shut down the government

Not really. But they should let Republicans shut down the government rather than agreeing to a two-month continuing resolution that will bring on debt ceiling apocalypse.

When word was that Boehner would postpone a budget showdown until the debt ceiling is reached in November and try to force a defunding of Obamacare then, I suspected that he and his party would shift gears and seek to extract more attainable budget concessions. That has now happened, as Chait summarizes:
The Republican leadership is perfectly aware that a debt default could have explosive implications and that the Obama administration is not willing to negotiate over it. It’s already formulating a line of retreat to back out of this threat. As Politico reports, they want to tie together negotiations over the debt ceiling with negotiations over budget sequestration. Then they can extract concessions from Obama on the budget and sell them to their base as a ransom for lifting the debt ceiling, rather than admit they just gave in on the debt ceiling.
"Gave in" is a relative term. Extracting further budget cuts beyond sequestration would be a major GOP victory by my lights, if not by the GOP base's. And they may get it. As Chait warns here and has warned before, a debt default (stemming from failure to raise the debt ceiling) is a " vastly more dangerous threat" than a government shutdown. Yet Chait, like Greg Sargent and Brian Beutler, seems to have more faith than I do about what Obama will not yield to if faced with a debt default:

Saturday, August 24, 2013

My day in court, cont.

I was on a jury in a criminal trial  this past week. We heard testimony on Tuesday and Wednesday and deliberated Thursday and Friday.  We ended up a hung jury, stuck at 10-2.  I felt that the process worked as it should and everyone comported themselves well -- but at the end, tempers frayed, several people in the majority expressed shame about not being able to come to a verdict, and I seemed to be the only one who felt good about the process and glad to have been there.

In a post I wrote last week during jury selection, I called jury duty the civilized face of a brutal criminal justice system. Ditto the court proceeding as a whole. Leave aside biased law enforcement, Draconian sentencing guidelines and brutal prison conditions -- not to mention environments of concentrated poverty and lack of opportunity -- and justice may happen in the court room, viewed alone. (Except for several strains of cancer the patient is healthy.) Propriety was observed by all parties, defense counsel was competent, the judge kept good control of the proceedings, the jury clearly understood its charge and duties, no one seemed in the grip of any bias or animus, and deliberation for the most part stayed on point and orderly.

Essex County in New Jersey spans Newark, a very poor city; Millburn, a true outpost of Richistan, USA; some very poor inner ring suburbs, and suburbs with varying mixes of rich, poor and middle.  The voir dire reflected that mix, minus the extremes. Perhaps it was a cross section of the American middle class as it's devolved.

Tuesday, August 20, 2013

Friday, August 16, 2013

Paul Krugman's moment of truthiness

I suffered cognitive dissonance this morning when I read this from Krugman:
We also all know that the reality [of how democracy in America functions] falls far short of the ideal. Voters are often misinformed, and politicians aren’t reliably truthful. Still, we like to imagine that voters generally get it right in the end, and that politicians are eventually held accountable for what they do. 

But is even this modified, more realistic vision of democracy in action still relevant? Or has our political system been so degraded by misinformation and disinformation that it can no longer function? 
He goes on to fulminate about Exhibit A: Americans do not know that the deficit has been dropping throughout the Obama years, as they did not know that the deficit was falling through Clinton's first term.

Why am I disconcerted by Krugman's consternation? Of course I share his frustration at the "outright falsehoods" that Republican leaders routinely mouth about the deficit. I agree, as he laments in this column, that our political discourse is shot through with truthiness.

But unlike Krugman (apparently), I recall what Krugman wrote..yesterday. Reacting to a recent morsel of egregious economic misinformation in a Robert Samuelson column, he opined:

Thursday, August 15, 2013

Listen to Boehner, Dems. When he announces a negotiating strategy, he executes

Republicans' latest reported strategy in the looming budget wars is to pass continuing resolutions that will fund the government at sequestration levels through November, when the next debt ceiling deadline looms -- then once again hold the country's faith and credit hostage to extremist demands like defunding Obamacare. Democrats should not take this strategy lightly. Methinks the account below, via The Week, gets the dynamics of this year's prior battles exactly backwards:
The Republican leadership has been increasingly under pressure to appease the right wing of the party. Publicly insisting that ObamaCare funding will be fought further down the road would soothe the demand for that fight in the first place, while kicking the can down the road, perhaps indefinitely.

As the Washington Post's Greg Sargent points out, this is exactly what happened with the last debt ceiling fight. In January, Boehner said the upcoming sequester debate, not debt ceiling fight, gave the GOP its best position to push for major budget cuts. Yet the sequester came and went without the GOP winning those deep concessions.
Come again? The sequester is "major budget cuts." As of now, those cuts are locked in for ten years, a seemingly immovable deadweight on Obama's long-term domestic agenda. Republicans may be ambivalent about their effects, actual and political, and ultimately unable to sustain their will to enact the cuts.  But they did not cave -- they decided to embrace the cuts, and they followed through, and the overall ten-year deficit reduction scorecard remains stuck at a 4-to-1 spending-cuts-to-tax-increases ratio.  In March it was Obama and the Democrats who caved, balking at forcing a government shutdown to shut off sequestration.

Wednesday, August 14, 2013

My day in court

I was on jury duty today. They treat jurors right in Newark. The free coffee is good, the wireless is good, the chairs don't kill you. There's even a small landscaped area outside the front doors, where I spent a pleasant hour during lunch, bending my laptop into the shade. The orientation video was effective (and followed by a short video pitch for volunteers to serve as Court Appointed Special Advocates for foster children that made me cry a little). The master of ceremonies for jurors was jovial and funny ("the intercoms reach everywhere, including the bathroom. So -- Jurors! If you're in the bathroom, and you hear your name called, cut it short"). The judge during voir dire was respectful, friendly, almost courtly to the jurors. All this was as it should be.

And yet, after reading a rash of articles recently about the depravities of criminal justice in the U.S. -- the mass incarceration, the inane mandatory minimum sentencing, the grotesque overuse of solitary confinement, the ubiquity of rape, the law-shaping clout of the private prison industry, the mass deportations, the faux forensic "science" deployed by prosecutors -- I couldn't help but reflect that I was being shown the civil public face of brutal penal system.

Tuesday, August 13, 2013

Boehner's not retreating, he's doubling down

Robert Costa has a funny little narrative today in which John Boehner and Eric Cantor, moderate old hands who know how Washington works, talk the GOP's young Turks off the ledge of a government shutdown when this year's funding runs out at the end of September.  We don't have the votes, we'll be blamed, etc. etc.  But then there's this kicker, which gave me hot flashbacks:
Members were also buzzing about the leadership’s emerging strategy for the autumn talks. Sources tell me the House GOP will probably avoid using a shutdown as leverage and instead use the debt limit and sequester fights as areas for potential legislative trades. Negotiations over increasing the debt limit have frequently been used to wring concessions out of the administration, so there may be movement in that direction: Delay Obamacare in exchange for an increased debt limit. As members huddled and talked through scenarios, leadership aides reminded them that since the House GOP retreat in Williamsburg, Va., earlier this year, the plan has been to end the year with a debt-limit chess game, and not a messy continuing-resolution impasse (my emphasis).
What this flashed me back to was not debt ceiling summer 2011, but early this year, when Boehner made rather a big show of not forcing a debt ceiling showdown, instead suggesting that his caucus would take its stand at the end of March, when the sequester kicked in. Progressive observers reacted with some incredulity that Boehner would let the sequestration cuts, which include massive defense cuts, happen. At the time, McConnell and Boehner's victory at the fiscal cliff  (Obama forced to settle for just half of his reduced December revenue demand, sequester set to spring in two months) was being viewed as a defeat. But it was Obama and the Democrats who folded when it came time to fund the government for the remainder of this fiscal year, quietly acceding to full uncut sequestration.

Monday, August 12, 2013

Detroit's destruction began in its heyday

Thomas J. Sugrue's The Origins of the Urban Crisis: Race and Inequality in Postwar Detroit (1997) is a great book -- and in some ways a simple one.  It provides extensive, fine-grained documentation of two or three (depending on how you count) relentless forces that destroyed Detroit.

The first was the hemorrhaging of manufacturing jobs that was in full flow by the early fifties, and could only have been stemmed by national industrial policies unthinkable in the United States: a rollback of Taft-Hartley's enablement of state right-to-work laws; a German-style role for labor in corporate management; legal restrictions on companies' right to lay off workers or move manufacturing operations as they saw fit.

The second was the vicious, rooted, legally codified and government-sanctioned racism that kept African Americans at the bottom of the labor totem pole, consigning them to the hardiest, dirtiest, poorest-paying and least secure factory jobs and excluding them skilled crafts, retail service and a host of other occupations.

Obama's drinking gourd ain't no Holy Grail


(reposted from 8/10/13)
Was I too dark a prophet when I said
To those who went upon the Holy Quest,
That most of them would follow wandering fires,
Lost in the quagmire? -- lost to me and gone,
And left me gazing at a barren board.
-- King Arthur to his knights, in Tennyson's Idylls of the King, The Holy Grail
Now, I think the really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their holy grail, their number-one priority. The one unifying principle in the Republican Party at the moment is making sure that 30 million people don't have health care and, presumably, repealing all those benefits I just mentioned -- kids staying on their parents' plan; seniors getting discounts on their prescription drugs; I guess a return to lifetime limits on insurance; people with preexisting conditions continuing to be blocked from being able to get health insurance.

-- President Obama, press conference, 8/9/13

Obama has more than once tagged his Republican opposition with a fundamentalist mindset on economic issues. In his mind, they do indeed follow wandering fires -- mirages of a "holy quest." He has used the metaphor before to denote their worship of false economic gods.

Sunday, August 11, 2013

Snowden, patriot; Obama, in denial

This is just to say, for the record, that I think Obama was shamefully disingenuous or self-deluded in declaring in his press conference yesterday that Edward Snowden is not a patriot and suggesting that he himself would have triggered the kind of inquiry into current surveillance practices that Snowden has unleashed if not pushed by Snowden's disclosures.

This, in particular, is a logical elision:
So the fact is, is that Mr. Snowden has been charged with three felonies. If, in fact, he believes that what he did was right, then, like every American citizen, he can come here, appear before the court with a lawyer and make his case

Saturday, August 10, 2013

Obama's drinking gourd ain't no holy grail


Was I too dark a prophet when I said
To those who went upon the Holy Quest,
That most of them would follow wandering fires,
Lost in the quagmire? -- lost to me and gone,
And left me gazing at a barren board

-- King Arthur to his knights, in Tennyson's Idylls of the King, The Holy Grail
Now, I think the really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their holy grail, their number-one priority. The one unifying principle in the Republican Party at the moment is making sure that 30 million people don't have health care and, presumably, repealing all those benefits I just mentioned -- kids staying on their parents' plan; seniors getting discounts on their prescription drugs; I guess a return to lifetime limits on insurance; people with preexisting conditions continuing to be blocked from being able to get health insurance.

-- President Obama, press conference, 8/9/13

Obama has more than once tagged his Republican opposition with a fundamentalist mindset on economic issues. In his mind, they do indeed follow wandering fires -- mirages of a "holy quest." He has used the metaphor before to denote their worship of false economic gods.

Friday, August 09, 2013

For state GOP officials, a manual for undermining Obamacare

In 2011, the National Association of Insurance Commissioners (NAIC) produced a report cataloging risks of adverse selection in the ACA state insurance exchanges and provisions in the ACA designed to avoid or mitigate those risks. (Adverse selection occurs in plans that chiefly attract less health and more expensive customers, e.g. when younger, healthier customers have other options more attractive to them, including remaining uninsured.)

One key ACA measure to mitigate adverse selection is as follows. Those who offer insurance on the exchanges must treat all their customers in that state as one risk pool and must offer silver and gold plans -- the middle options in a spectrum that runs from bronze to platinum. If "young invincibles" choose bronze plans, their choices won't affect pricing in more expensive plans, which may be more attractive to older and sicker customers.

A continued risk is posed, however, by the ongoing existence of an individual market outside the exchanges, where insurers may still sell cheap high-deductible plans that appeal to healthy young people, albeit subject to many if not all of the same rules governing plans offered in the exchanges. In yesterday's New York Times, Eduardo Porter outlined that risk:

Wednesday, August 07, 2013

Are "burn your Obamacare card" proponents incurring potential liability?

Progressives have been first dumbfounded, and then enraged, by the right-wing campaign to convince the uninsured not to purchase health insurance on the exchanges established by the Affordable Care Act.. The young, healthy uninsured whom the exchanges need to sign up in order to thrive are being urged to "burn your Obamacare draft card," as the Koch-funded Freedomworks puts it.  Here's Kevin Drum's reaction:
Nice. I wonder if FreedomWorks plans to help out the first person who takes them up on this and then contracts leukemia? I'm guessing probably not.

What's next? A campaign to get people to skip wearing seat belts? To skip using baby seats in cars? To skip vaccinations for their kids? It's times like this that words fail those of us with a few remaining vestiges of human decency.
There may be legal ramifications to Drum's question.  Might those who gratuitously offer a kind of malign financial advice to the general public -- in particular, to a disproportionately young and poor segment of the public -- incur liability?

Tuesday, August 06, 2013

Read that NYT exposé of price gouging in joint replacements? Here's an antidote

For those angered by the recent New York Times exposé of price-gouging in joint replacement devices and operations in the U.S. (total hip replacement tabs topping out at $112k, vs. $13k in Belgium), a CalPERS health insurance initiative offers a partial antidote. Melanie Evans explains in Modern Healthcare:
Joint replacement prices at the most costly California hospitals plunged by one-third after the state required its workers and retirees to pay out of pocket all costs above a “reference price” of $30,000 for orthopedic surgery, a new study said.

The average cost of joint replacement among high-priced hospitals dropped to $28,465 after the California Public Employees' Retirement System made the change in 2011, wrote University of California researchers James Robinson and Timothy Brown in the journal Health Affairs. That's down from $43,308 the prior year.
Using patient incentives to control costs is usually branded as "conservative" in the U.S. And indeed, "consumer-driven healthcare" is just a misleading euphemism unless crucial elements -- price transparency and genuine choice -- are part of the mix. In this case, they are:

Monday, August 05, 2013

Reminder: chained-CPI means new revenue

Chuck Todd, attempting to flesh out  some talk show chatter from Eric Cantor about budget compromise (GOP-style, i..e., with no new revenue), floats a GOP trial balloon:
Left unsaid by Cantor is what entitlement reform has to look like. There’s been some chatter in GOP circles that it’s about simply taking the president’s offer on chained CPI.  The argument by some Republicans on this strategy is that Republicans would be able to claim victory on stopping the sequester and getting an opening to begin entitlement reform without capitulating to the president’s demand that chained CPI (which would change Social Security benefits among other things) come with some new tax increases. But would the president be open to this? Chained CPI in exchange for turning off sequester? Seems reasonable now… but who knows.

Sunday, August 04, 2013

The happiest wrong I could ever be

I am on vacation from from vacation so to speak, in the Catskills in the rain, inspired by the legislative news and willing to brave this horrific Samsung phone keyboard to get a brief thought down [couldn't do it - finishing the half-baked thought at home, 8/4]. What if the narrative I've invested myself in all year is wrong? That is, that Obama blew his point of maximum leverage at the fiscal cliff and locked us into the sequester, gravely hindering his long-term agenda? Could it be that Republicans will this year choke over sequestration and wriggle out by one means or another?

Tuesday, July 30, 2013

Obama girds for nuclear budget war, cont.

So Obama has repackaged and linked two old proposals -- revenue-neutral corporate tax reform and a package of jobs stimulus measures. The tax reform would be revenue neutral over the long term, cutting rates and reducing loopholes, but would yield a one-shot revenue boost as the loopholes are closed, paying for teh short-term jobs measures.

This mini "grand bargain" is part of Obama's announced series of economic speeches and proposals.  The purpose, as I see it, is twofold. First, to shift the national agenda in the upcoming budget battles from deficit reduction to jobs (short-term stimulus and long-term investments). Second, to present Republicans with a series of manifestly reasonable programs and compromises to reject. That way, when they shut down the government or threaten national default because Obama won't agree to obscenely large spending cuts, he can say, "I offered to compromise six ways to Friday, but my opponents won't agree to anything but more spending cuts and more tax cuts." 

Long-suffering Lincoln

[Updated, with illustration!]
Vandalism at Lincoln Memorial recalls a precursor in Buffalo some 15-plus years ago:



                                                                        On a statue in Delaware Park,
                                                                        almost as old as Noah's ark,
                                                                        some disrespectful, disreputable fellow
                                                                        sprayed Abraham Lincoln's hair bright yellow.

                                                                        It's despicable. It's deplorable.
                                                                        Sunny-side up
                                                                        he looks adorable.

Monday, July 29, 2013

In which "strategic advisor" Howard Dean attacks IPAB

Why would Howard Dean -- physician, former governor, former meteoric presidential candidate and current "strategic advisor" to healthcare clients at a lobbying firm, stick a knife in IPAB, the Independent Payment Advisory Board created by the Affordable Care Act to rein in the federal government's Medicare spending?

In a Wall Street Journal op-ed published this morning, Dean first pays lip service to core aspects of the ACA before launching into a perfunctory, mail-it-in attack on  IPAB:

Sunday, July 28, 2013

By reframing national agenda, Obama hopes to "force a different result" in budget negotiations

When Obama came his speech urging a national refocus on jobs and the foundations of long-term economic growth last Wednesday, the first in a series on the economy, I suggested that he was positioning himself to win a budget showdown should the Republicans shut down the government or seriously threaten a debt ceiling default if he does not agree to radical new spending cuts or the defunding of Obamacare. He is trying preemptively to reframe the argument, to convince the public that jobs and investments that foster long-term economic growth should be the national priority -- not spending cuts,.

In a long interview with the Times' Jackie Calmes and Michael Shear, conducted while he was at Knox College in Galesburg, IL to deliver that speech, Obama continued his bid to shift the agenda:
NYT: [House Republicans] are still embracing sequestration and who are still willing to use the debt limit to go to the mat. 

MR. OBAMA: Well, this is what they say. On the other hand, we also have a number of very thoughtful and sensible Republicans over in the Senate who have said that we should not play brinksmanship, that we should come up with a long-term plan. I met with a couple of House Republicans over the last several weeks who would like to see that happen. They’re not the loudest voices in the room at the moment. 

And part of what I’d like to see over the next several weeks is, if we’re having a conversation that’s framed as how are we growing the economy, how are we strengthening the middle class, how are we putting people back to work, how are we making college more affordable, how are we bringing manufacturing back -- the answer to those questions I think force a different result than if we are constantly asking ourselves how can we cut the deficit more, faster, sooner.

Friday, July 26, 2013

My fantasy flashes in the news, flickers, fades

I have fantasized from time to time that Obama would pull a Jan Brewer and refuse to sign any appropriations bills that don't shut off the sequester. Or the (earlier) Chris Christie variant: that he will sit back, crack open a beer, and wait for Congress to send him a budget he can sign.

Therefore, this peek at alleged White House deliberations by the Washington Post's Zachary Goldfarb and Paul Kane set my heart a bit aflutter:
White House officials also are discussing a potential strategy to try to stop the sequestration cuts from continuing, the lawmakers and Democrats said. Under this scenario, the president might refuse to sign a new funding measure that did not roll back the sequester.
But reality came back quick:
No decision has been made.
And this sounds more like Obama:

Thursday, July 25, 2013

Is Obama preparing for nuclear budgetary war?


It's a foundation built upon five pillars that will grow our economy and make this new century another American century: new rules for Wall Street that will reward drive and innovation; new investments in education that will make our workforce more skilled and competitive; new investments in renewable energy and technology that will create new jobs and industries; new investments in health care that will cut costs for families and businesses; and new savings in our federal budget that will bring down the debt for future generations. That is the new foundation we must build. That must be our future – and my Administration's policies are designed to achieve that future.
That's Obama laying out his broader economic vision -- in April 2009. Three of the five pillars match the five cornerstones he laid down in yesterday/s speech on long term economic growth -- or rather two and a half, as his "jobs" cornerstone yesterday centered in large part on renewable energy.

As many pointed out, there were no new proposals in Obama's speech yesterday, and not much detail -- it was a framework, with details to be supplied in an upcoming series of speeches. And that's okay. As the political storms of autumn approach, dullness is good. Repetition is good. Reminder of what Obama is about -- how he thinks, how he carries himself, what he wants -- is useful, even if it doesn't excite anyone now. It's an impression scheduled for timed release.

Wednesday, July 24, 2013

Could a "doc fix" have a bigger impact on U.S. healthcare than the ACA?

Two interrelated features of the U.S. healthcare system are probably the primary causes for the uniquely high cost of healthcare in the U.S.: weak government control over pricing, and the fee-for-service payment model.

These interrelated weaknesses are exacerbated, as a weekend Washington Post exposé showed, in that Medicare pretty much lets doctors determine the rates at which they paid, by leaving it to the AMA to produce estimates of how long each procedure takes. Surprise! The doctors' chief trade group massively pads the estimated times required for most procedures. 

Even if procedure prices were based on accurate time estimates, free-for-service incentivizes providers to perform a high volume of the most expensive procedures. Nonetheless, countries in which the government imposes monopsony price control -- i.e., every other wealthy country in the world -- generally manage to deliver universal healthcare at two thirds to half the cost per capita of healthcare in the U.S.  Government control over pricing, as Ezra Klein recently forced healthcare free market evangelist Avik Roy to admit, is the sine qua non of effective heathcare cost control.  And we in the U.S. don't have it, as a study published in Health Affairs ("It's the Prices, Stupid...", Gerard F. Anderson et al., 2003) explains:

Monday, July 22, 2013

Why is McCain suddenly John So-New-New?

I have no insight into the latest cut-back in the double reverse that is John McCain's long career. I just want naming rights.

Update: Dana Milbank interviewed McCain 4.0.  The reborn maverick's explanations for his serial transformations make no sense, but as long as this is the final somersault, Democrats won't complain.

Sunday, July 21, 2013

Party of Spite

There is no word for this but sick:
"ObamaCare is bad for America," Boehner told CBS's "Face the Nation." "We're going to do everything we can to make sure it never happens." 

Republicans have already acted to deny Medicaid to millions of uninsured Americans. It's their stated goal to wreck the ACA's insurance exchanges and so prevent millions more uninsured -- a projected 15-17 million over time -- from buying affordable health insurance. They jawed for years about "repeal and replace" but have offered no replacement.  They profess to believe it "good for America" to leave tens of millions uninsured and prone, as they now are, to bankruptcy, lack of regular healthcare, and haphazard, incomplete, unsustained care if they get seriously ill.

Sugarcoat it as they will, the GOP has devolved to nothing other than the Party of Spite.  The party is unworthy of sharing the governance of a village, let alone a nation of 300 million.

Friday, July 19, 2013

"Trayvon Martin could have been me"

ICYMI, America, you elected a black president. Twice. Obama reminded us forcefully of that rather miraculous fact today, while addressing the impact and meaning of the Trayvon Martin affair.

It is always expensive for Obama to affirm his identity as an African American, and so his representation of African American experience and perspective on the Zimmerman trial today to Americans at large came couched in qualifiers. The jury has spoken, but.  Young African American men are more likely to involved in violence, but. Criminal law is mostly a matter for state and local government but. Stand your ground law was not used by the defense but. Politician-initiated conversations about race end up being stilted and politicized, but.

It was straight talk wrapped in apophasis -- "saying by not saying," or saying what I say I shouldn't say: That African Americans still encounter reflexive prejudice in their daily lives, that American justice is still far from colorblind, that we are still collectively failing African American inner city youth.

Thursday, July 18, 2013

Why I'm glad that Democrats didn't change the Senate rules

Almost since Obama took office, almost every writer on politics whom I enjoy reading most, driven mad by GOP obstruction in the Senate, has urged filibuster reform.  Let Harry Reid's latest complaint stand in for a long statistical litany of GOP obstruction: he has had to deal with over 400 Republican filibusters, compared to Lyndon Johnson's one. 

Without doubt, Senate rules could use some rational tweaking. But I have argued since 2009 that the problem is not so much with the Senate rules as with the GOP destruction of governing norms. Instead of a loyal opposition we have had a nihilist one, unwilling to let the majority govern (with a rational level of resistance and negotiation to shape laws more to the minority's liking) and abide the electoral consequences of the laws they pass, unwilling to let the executive branch be staffed so it can perform its constitutional functions, unwilling to allow the lengthy enactment process to work for laws already passed and signed.

The problem is not so much the rules as the GOP; such nihilist opposition is dangerous, and bespeaks graver danger should the extremist party gain control of the presidency and both houses of Congress. Against that very real possibility the filibuster stands as a bulwark: I would rather let the GOP inhibit the Democrats' ability to pass legislation and fill vacancies than enable the GOP to wreak legislative havoc unrestrained if it has not moderated before the next time it gains power.

Wednesday, July 17, 2013

Nonsense question of the day: "Does Obama have a second-term strategy?"

Sometimes it's hard not to suspect that Politico reporters don't believe their own bullshit when they spin out narratives about who's up, who's down, how A perceives B, what C's prospects are, etc.

Today's nonsense question, posed by Glenn Thrush, is Does President Obama have a second-term strategy? Of course the implied answer is no. But the argument is self-cancelling from the get-go.

The implicit premise is that because Obama said during the campaign that his victory might break the GOP's fever of no-compromise opposition, and that fever has not in fact broken, the president is at loose ends. But that premise must be hedged, because of an inconvenient truth that Thrush acknowledges at the outset: Obam never expected that his reelection would end partisan gridlock:

Tuesday, July 16, 2013

The WSJ on the ACA, cont.

Early this month, I looked at a couple of Wall Street Journal stories that emphasized the negative in the Affordable Care Act rollout and wondered whether the WSJ healthcare coverage wasn't Foxifying a bit. One emphasized the premium hike for a relatively small subset of people subject to the individual mandate (and without employer-provided insurance), and one aggregated and exaggerated a series of "blows" to the law, most of which were old news.

Healthcare reporter Louise Radnofsky was on both bylines. She's a good reporter. Her coverage over time has been balanced.*

But as the rollout of the ACA exchanges looms, I wonder whether WSJ news editing is tilting the emphasis on ACA coverage generally [ [UPDATE: I have spoken to someone at the Journal, whose word I trust, who assures me that editors area not imposing a political agenda on reporters. I regret speculating about motive without information.].

Today, Project Millennial blogger Mike Miesen flags another questionable WSJ framing of ACA news that had also registered with me this morning:

Monday, July 15, 2013

A Pooh guide to blogging

While I usually avoid talking or even thinking entirely consciously about this, it often strikes me (usually when I don't find anything to blog about) how strange it is that for five-plus years I've managed, FWIW, to come up with a post idea about six days out of seven.  More often than not, this just happens while I'm reading something (something doesn't add up, or reminds me of something else that doesn't seem entirely arbitrary), but sometimes it's a matter of mood, or caffeine: it feels like something is about to catch.

When it's the latter, my repetitive mind -- not so much a lizard brain as a perpetual child brain -- usually throws up a line from Winnie-the-Pooh "he felt singy." Here is that jewel in its setting (House at Pooh Corner, Ch. 6):
One day, when Pooh was walking towards this bridge, he was trying to make up a piece of poetry about fir-cones, because there they were, lying about on each side of him, and he felt singy.

Sunday, July 14, 2013

Poem for a hot summer Sunday

In high Buddleia season:


                                                                  Butterflies (a truth to utter)
                                                                  don't look much like flying butter.
                                                                  Why do we say "butterfly"?
                                                                  Babies can't say "flutter by."

Saturday, July 13, 2013

"Government-run healthcare," Singapore style

In his long rhetorical war against the Affordable Care Act, Avik Roy likes to hold up Singapore's healthcare system as a shining counter-example. He quite rightly points out that Singapore spends far less on healthcare than the U.S. (4% of GDP vs. 18% for the U.S.), and with better outcomes. How do they do it? Roy -- while acknowledging one aspect of the government's heavy hand --  credits free-market magic:
The key to the Singapore system is mandatory health savings accounts: again, something that libertarians and many conservatives wouldn't like. Matt Miller of the Center for American Progress describes Singapore as "further to the left and further to the right" than the American system--something that could also be said of Switzerland.

Thursday, July 11, 2013

Pulping the bully approach to presidential politics, VI

Ezra Klein is replaying that whole paradox of power thing: When Obama comes out for a policy, the GOP will demonize it -- so if Obama wants to get anything done with a GOP House, how can he jump off his shadow?  This time, Klein brings Jon Favreau to bear, affirming the White House's not-at-all-surprising hyper-awareness of this conundrum:
Jonathan Favreau, who in February stepped down as Obama’s chief speechwriter, said that dealing with the Republican Party’s reflexive opposition is a pervasive reality in the White House. “People take a very realistic approach to it,” he said. “They’re not frustrated or upset. It’s more, ‘This is just the way things are and this is how we’ll deal with it.’ The strategy always comes to ‘What gives us the best chance to get something passed?’”

Since you're here, read this

I don't usually post excerpts without comment, but...I feel like Jon Favreau has told basically the whole story of U.S. politics of the last five years with his piece, The GOP is Terrified Obamacare Could be a Success. It lays bare the bad faith, the all-in commitment to misinformation, the callousness and cruelty of today's GOP.  It makes my heart sing, so I'm going to carry my bucket of water to the ocean of Favreau's readership and say: read it:
But here’s my question: if Republicans are so confident Obamacare will end badly, why not just shut up about it? It’s not like they have the votes to repeal the law—a math problem they still haven’t solved after 37 different tries. Their appeal to the Supreme Court ended in defeat at the hands of a conservative chief justice. And now the bulk of the plan will begin to take effect in just a few months.
At this point, why not sit back and wait for this crazy experiment to self-destruct? Why not let President Obama and the Democrats reckon with the millions of angry Americans who will undoubtedly hate their new insurance or their new insurance protections?
Because Republicans are terrified that Obamacare could actually work.

Tuesday, July 09, 2013

Mistrust among the poor

I am reading Doing the Best I Can: Fatherhood in the Inner City by Kathryn Edin and Timothy J. Nelson, a compulsively readable in-depth account of how poor inner city men view and attempt to fulfill their responsibilities as fathers. The authors lived in Camden, NJ, one of the country's poorest cities, and spoke in depth to some 110 unmarried fathers in Camden and poor black and white neighborhoods of Philadelphia.

The title aptly captures the core idea: the men have shining ideals of fatherhood and marriage but hold themselves to much lower standards in keeping with their earning power and lack of strong ties to their children's mothers. Most beget children as the result of brief and haphazard relationships with women and are much more invested in their relationships with the children than with the children's mothers. Repeatedly, these mostly none-too-trustworthy men express a lack of trust in women.  And one expression of that lack of trust reminded me of a different all-too-common suspicion. Below, a father of three speaks:

Monday, July 08, 2013

Who'll stop the hospital billing machine when you're "covered"?

My family gets its health insurance through my wife's employer, a multi-hospital system. Until this year, we have had in-network coverage only. Last fall, somewhat to my surprise, the hospital-insurer agreed to cover in full an operation out-of-network on grounds that no one in-network was qualified to do it. This was a wake-up call for me, and I insisted that this year we pay more for a plan that provides limited out-of-network coverage.While out-of-network coverage has substantial deductibles and limited co-pays, out-of-pocket expenses are capped at about $11,000 per individual. That strikes me as worthwhile catastrophic insurance if one of us gets seriously ill and needs to tap a top specialist outside the network. But our experience with the covered out-of-network operation we already had raises a question in mind about that out-of-pocket maximum -- for myself and for insured patients in general, particularly those buying on the new healthcare exchanges.

Here's the rub: while our insurer informed us that the operation would be covered in full, they were slow to pay some bills and paid some only in part. We then became targets of "balance billing" -- practices affiliated with the hospital where the operation occurred as well as the hospital itself dunning us for unpaid balances, often under threat of siccing a collections agency on us.

Saturday, July 06, 2013

An "introvert" in the White House

Richard Neustadt, author of Presidential Power and Modern Presidents, seems to have been rather a Kennedy worshipper, judging from a chapter on Kennedy written for a later edition of his signature work.  All the more reason that this minor caveat to a portrait of near presidential perfection caught my eye:
.., he was not a "mixer" socially, not, anyway, with most members of Congress and their wives. His manners were impeccable, his charm impelling, but he kept his social life distinct from his official life and congressmen were rarely in his social circle. To know how Congress works but to disdain its joys is an acquired taste for most ex-congressmen downtown, produced by hard experience. Kennedy, however, brought it with him. Many of the difficulties he was to encounter in his day-to-day congressional relations stemmed from that disdain (p. 174, 1990 edition).

Friday, July 05, 2013

How does Roger Cohen know what Egyptians want?

With all due respect to Roger Cohen's long experience as a reporter, how does he know what the Egyptian revolution has been "about"?

He addresses the question with apparent confidence:
The uprising that ended decades of dictatorship and led to Egypt’s first free and fair presidential election last year was about the right to that vote. But at a deeper level it was about personal empowerment, a demand to join the modern world, and live in an open society under the rule of law rather than the rule of despotic whim.

In a Muslim nation, where close to 25 percent of Arabs live, it also demanded of political Islam that it reject religious authoritarianism, respect differences and uphold citizenship based on equal rights for all.
Cohen's sources? Heba Morayef, head of Human Rights Watch in Cairo, and Mohamed ElBaradei, the world famous "liberal modernizer" (Cohen's phrase) who signed onto the generals' coup. That's it -- the sum total of his cited sources for telling us what 80-plus million Egyptians want.

OK, Krugman: How will hypocrisy help us?

Paul Krugman, Jeremiah of galloping income inequality in the United States, today manages a rather half-hearted tribute to the nation's long-term fidelity to its founding ideals. Half-hearted, because seeing those ideals subverted by encroaching oligarchy, he takes rueful solace only in our national hypocrisy:
Of course, our democratic ideal has always been accompanied by enormous hypocrisy, starting with the many founding fathers who espoused the rights of man, then went back to enjoying the fruits of slave labor. Today’s America is a place where everyone claims to support equality of opportunity, yet we are, objectively, the most class-ridden nation in the Western world — the country where children of the wealthy are most likely to inherit their parents’ status. It’s also a place where everyone celebrates the right to vote, yet many politicians work hard to disenfranchise the poor and nonwhite. 

But that very hypocrisy is, in a way, a good sign. The wealthy may defend their privileges, but given the temper of America, they have to pretend that they’re doing no such thing. The block-the-vote people know what they’re doing, but they also know that they mustn’t say it in so many words. In effect, both groups know that the nation will view them as un-American unless they pay at least lip service to democratic ideals — and in that fact lies the hope of redemption. 

So, yes, we are still, in a deep sense, the nation that declared independence and, more important, declared that all men have rights. Let’s all raise our hot dogs in salute.
Left unspoken here is how hypocrisy helps. It's said that hypocrisy is the tribute that vice pays to virtue -- bad conscience with a cover. The question is, how productive will our ethical unease prove? Now that our income distribution (and opportunity distribution) has reverted to roughly where it was before the Great Depression and the New Deal, will this retrogression prove, to borrow a bit of econ-speak, 'secular or cyclical'?  That is, will we readjust, as Obama in '08 argued we must, from a 30-year Reaganite right turn turbo-charging pressure on wages powered by automation and globalization? Will we find means to train our youth to create and fill "good-paying jobs of the future"? Or was the relatively weak American version of the welfare state merely a one-time strategic retreat by elites that have more recently tightened a now unshakable proprietary grip on the means to prosperity?

Thursday, July 04, 2013

The "I want the best" quality measure in healthcare

On The Incidental Economist, Bill Gardner rather wearily brushes off claims, based on personal experience, that the U.S. has "the best healthcare in the world." He outsources to Aaron Carroll the marshaling of evidence that "on most important measures, the US has poorer quality of care than comparable countries" and concentrates on a prior question: what do we mean by quality of care? He then offers a breakdown of quality measures which, for policy purposes, may be comprehensive, but which I think misses a dimension that may be in the minds of many who claim "best" status for the U.S. Here are Gardner's "dimensions of health quality*":
  • The hotel experience. Some hospitals are nicer places to stay than others. This may seem trivial in the context of life and death, but any hospital manager will tell you that ‘hotel quality’ matters to patients.
  • The relationship experience. Did the health care providers treat you with respect? Were they considerate of your religious beliefs? The well-educated readers of this blog may have difficulty imagining that they would not be well-treated by health care providers. But disrespect may be a primary consideration if you are poor, speak a language other than English, live outside the mainstream culture, or are mentally ill.
  • The rightness of treatments. By the ‘right’ treatment, I mean the one that was most likely to benefit you.
  • Safety. Were you harmed through error or neglect while you were in care?
In response, I posted this comment:

Tuesday, July 02, 2013

For Egypt, a warning from Aesop

Not to pretend to any expertise about Egypt, but as soon as I read about the military's ultimatum to Morsi, this fable of Aesop's came to mind:
There was once a Horse who used to graze in a meadow which he had all to himself. But one day a Stag came into the meadow, and said he had as good a right to feed there as the Horse, and moreover chose all the best places for himself. The Horse, wishing to be revenged upon his unwelcome visitor, went to a man and asked if he would help him to turn out the Stag. "Yes," said the man, "I will by all means; but I can only do so if you let me put a bridle in your mouth and mount on your back." The Horse agreed to this, and the two together very soon turned the Stag out of the pasture: but when that was done, the Horse found to his dismay that in the man he had got a master for good.
Until Mubarak's deposing, Egypt had been under military rule since 1952.  Do Egyptians really want to toss out their first elected leader, in power for just a year, and take the bit again?

In which Ezra Klein makes Avik Roy acknowledge why U.S. healthcare costs are so high

Avik Roy and Ezra Klein had a long --very long -- conversation about Roy's beefs with the Affordable Care Act. They covered "rate shock,"  minimum coverage standards, and Roy's dreams of a more fundamental system overhaul that would push everyone onto healthcare exchanges by privatizing Medicaid and Medicare and ending the employer tax deduction for health care benefit provision. 

Roy has been a relentless critic of the ACA. Having read some of his writings about it but by no means all, I was surprised to learn, as Klein probed his reaction to feature after feature, that he "do[esn't] have* a problem with standardizing benefits" and that "guaranteed issue [no refusals or cost bumps for preexisting conditions]is fine." His objections really boiled down to three: 1) he objects strenuously to "community rating," i.e., the ACA's limiting of the price differential between the youngest and oldest age cohorts to 3-to-1, as opposed to the roughly 6-to-1 ratio that Roy says the market would dictate.  2) He would like the exchanges to offer plans that cover even less than the lowest cost plans in the current design -- plans covering, say, 40% of a member's average yearly costs rather than the 60% that the exchange's lowest-run "bronze" plans are designed to cover. 3) As mentioned above, he would like more radical reform -- health exchanges for everyone.

As Klein eventually made Roy implicitly acknowledge, though, none of his favored solutions get at the root of the United States' disproportionate healthcare inflation.

Monday, July 01, 2013

WSJ leans into the "rate shock" narrative for Obamacare

[Updated 7/13, per "Blows to Obama's Health-Care Law Pile Up"...]

The WSJ's Louise Radnofsky is an experienced healthcare reporter, and her front-page story today about pending "rate shock" for healthy singles when the ACA takes effect is factually accurate. Since the focus is on the risk that the healthy uninsured will stay out of the ACA's healthcare exchanges, it's arguably fair to focus on the subset -- a minority of those who don't get insurance from an employer or the government -- whose premiums may go up. But nonetheless I find the emphasis and framing misleading in some particulars (e.g., the online home page teaser, "Insurance Rates Could Soar Under New Law"). .

The lede goes for maximum shock effect, setting reader perceptions before multiple caveats qualify the picture: