Sunday, August 16, 2009

Who Won the Election??

Remind me, who won the election last November? Obama and the Democrats crushed the Other Party in to little bits. Remember? So why are the Dems running away with their tails between the legs on health care?

No public option? Are you kidding me?


  1. Doug:

    Well, if there's no public option, President Obama has largely himself to blame (and I say this as an Obama supporter and voter who still thinks he's doing a good job).

    I think Obama and his administration made a fundamental misjudgement in pushing their health-care proposal -- they focused to an unusual degree on the high cost of health care (an admittedly important issue, but also a really difficult one to sort out and afix a public policy solution to), and not on issues that I'd argue resonate more deeply with the public, such as:

    -- Portability of health-care benefits;
    -- Retaining some form of insurance if you lose your job (not a minor issue, with unemployment running @ 10 percent in many areas of the country);
    -- Ending the lousy practice of insurance deniability based on pre-exisiting conditions and/or age;
    -- Making everybody carry some form of insurance, not unlike car insurance, to deepen and broaden the insurance pool;
    -- Doing something about long-term health care, particularly nursing home care, for the elderly confronted with significant health-care issues.

    Instead, at nearly every turn (including his town hall meeting in Wisconsin), Obama has:
    -- criticized the health-care and insurance industry mainly on a cost basis, not on coverage failures;
    -- argued (with contrary evidence widely available, such as the CBO estimates) that all kinds of cost savings are available in health care;
    -- Never really presented Congress with a plan of what is acceptable and what's not, which is a formula for getting this thing nit-picked to death, which is what's happening. Can you honestly sum up in three or four sentences what Obama wants out of "health care reform?"

    I think his inexperience as a legislator -- some who knows how bills are pieced together, how and when to compromise, and when to not -- are showing through.

  2. Heather here:

    I am terribly disappointed. "Change we can believe in" seems to have become “Oh, the conservatives won’t like this? Well, by golly, we’ll change it.”

    True reform requires bold, committed leadership, not compromise and backing down at every turn. This administration did not allow the single-payer option to be considered, so they started from a point that was center, not left. Now it appears they are wavering on the "commitment" to a public option. If they go down this road, we will not have substantial change. We will not put power back in the people's hands. We will not be changing the status quo.

    Please write President Obama at and ask him to be resolute in giving the people the public option they need and deserve.

    I’ll share one of my many problems with the current health “care” system (I have so many, I could fill this blog): my monthly health insurance premiums are now only $15 less than my mortgage payments, and that’s with a $2,500 deductible.

  3. Heather:

    Do you think there are votes in Congress to pass a single-payer plan? Obama can't run the country by fiat.

  4. I think Heather's point is that Obama is following the sad sack tradition of Democrats by caving in without really much of a public fight.

    Re: comment #1 on the failing (-ed?) strategy of focusing on costs and not coverage, I agree completely.

    I hasten to add that the crazy talk and scare tactics from opponents is another big factor. It's frustrating that the Obama people who knew how to counter this stuff during the campaign seem to have gotten amnesia.

    And some of the blame falls on 'the public' too many of whom are simply too lazy or disinterested and will swallow lies. "The government is taking over your health care!"

    How many people don't realize that Medicare and Medicaid *are* government health insurance. And that the VA *is* government health care. In other words, we already have something like 30% of health care dollars spent for government-run programs.

    President Obama, Fight, damn it!

  5. Heather here:

    No, I don't think there are votes for a single-payer plan. My point in mentioning single-payer is that if you start from a point of compromise, meeting in the "middle" gets you closer to the other side, not to your own.

    By not allowing the single-payer option to be part of the discussion, reform was destined to produce less change to the system than if it were included.

    Whether there are votes in Congress for something or not, I believe it is important to work for what you truly want, not just take what you can get from the beginning.

    For one, accepting only what you can get right now assumes a static playing field, that people cannot be swayed. But people can be and are. And circumstances change to move them one way or another.

    As much as I hate the backroom dealing of politics (I am, alas, in many ways a Pollyanna at heart), it would seem that if the Obama administration were using some Lyndon Johnson-type skills on the opponents of health care reform in Congress -- cajoling, coercing, and mollifying them -- it could be an effective strategy. Granted, I don't know that this hasn't been going on. A backroom deal is a backroom deal. But it doesn't appear to be happening.

    We are so important, though, to this process. If the public support isn't visible, if we don't call, write, email, and visit our members of Congress, if we don't march in rallys and attend listening sessions, if we don't stand up to be counted on election day and every other day, then we will be drowned out by the shouting of the uninformed and misinformed who are willing to do those things. What we do really matters.

    Let me add another "fun" fact about Heather's health insurance: I've lived in Wisconsin for twelve years, but because of pre-existing conditions, my health insurance company is the same one I've had all my adult life, Blue Cross and Blue Shield of Illinois. I'm stuck.

  6. Nice point regarding Medicare and Medicaid. I'll have to mention that to my ultra-conservative inlaws who are about to go on Medicare.

  7. Heather:

    That's all fine and good, but I don't believe Obama ever campaigned for a single-payer health-care system. Nor did, I'm willing to bet, many of the Dem. House and Senate members who won seats previously held by Republicans that gave the Dems the majority of both houses. It's one thing for the likes of Tammy Baldwin to support a single-payer system; she has absolutely no risk in doing so, politically, given the voting tendencies of her district. But it's quite another for newly elected Democratic senators and House members in, say, North Carolina, or New Hampshire, or Alaska, to campaign for, or even hint at, support for a single-payer system.

    One other point -- why is it that the "other side" is always the one that's mis-informed and lacking information? I know plenty of Republicans who thought Obama supporters were "mis-informed" and "uninformed" during the 2008 election.

    My point is -- I don't voters are dumb.I think voters often have passionate views about things that affect them directly, whether it be health care, jobs, or education. It's a big country, and we shouldn't be surprised that big issues like health care create divided opinion.

  8. I agree with the point above regarding compromises. It is unfortunate that a pretty middle of the road proposal (government option vs single payer) is beaten up instead of fine tuned.
    We let the extreams of both sides drive debate, and people tend to see compormises as everyone looses instead of everyone wins. We need a new Henry Clay.

  9. Heather here:

    “That's all fine and good, but I don't believe Obama ever campaigned for a single-payer health-care system.”

    He didn’t campaign for single-payer. I didn’t say he did. And I didn’t say a Blue Dog or any other kind of Democrat has to support it, either.

    I said that the single-payer faction should have been allowed to be at the table, just as all the other stakeholders and interest groups were. In creating a vision of what our health care system should be, excluding the single-payer option from the discussion was a wrong move. Would you create a plan for improving race-relations in the United States and leave out the smallest ethnic group because they have no power and wouldn't gain any ground for themselves? No. I don’t think you would. Just because single-payer doesn’t have wide support or a powerful group behind it doesn’t mean it doesn’t have something to offer, doesn’t mean it should be left without a voice.

    I think it is important to educate our leaders and for our leaders to educate us. To strictly stick to a party line, as you suggest is necessary, doesn’t encourage examination, discussion, participation, elucidation, or any other brain-expanding “-ation” that could foster innovation and the creative thinking needed for this problem. (Have you heard all the reframing, and talking points being said over and over?)

    How rare it is to have a leader say that they want to consider all sides and then actually do it. Wouldn’t we have a better society if more of them did so, rather than just rule things out from the get-go for political expediency?

    And I did not say that “the "other side" is always the one that's mis-informed and lacking information.” I said that if we don’t make ourselves heard in multiple ways, “then we will be drowned out by the shouting of the uninformed and misinformed who are willing to do those things.” That means what it says, the uninformed and misinformed, not the informed, are shouting and disrupting the listening sessions on health care. By definition, the informed wouldn’t be saying the incorrect things the uninformed and misinformed are.

    You are translating my words into something else.

    On your point that you don’t think voters are dumb: Some voters are as stupid as they come; some are brilliant. There is a wide range of intellect in our populace.

    But I do believe there are extreme right-wing media resources, much greater in both number and power than any opposing left-wing ones, that foment hate, redefine reality, and stream propaganda. Do I think Rush Limbaugh and Bill O’Reilly have had an impact on the public? (Do I even have to answer that question?) And do I think one impact has been to “dumb down” Americans. Boy, howdy!

    I grew up in Oklahoma. Believe me, I know the “other side.” I used to be the “other side.”

  10. Heather:

    The one presidential candidate who campaigned for a single-payer system -- Dennis Kucinich -- got nowhere. I don't think that's an accident. He's not "at the table" advocating for a single-payer health care system because the Democrats didn't want him to be president. The candidate who didn't campaign for single payer did end up president. Single-payer did have a voice at the table, when the Democrats were deciding who they wanted to be their candidate. That view was rejected by the voters. That's how politics in our republic works. (A guess on my part, but I assume you're happy with Sotomayer's ascension to the Supreme Court; I know I am. She's the kind of justice I assumed Obama would appoint to the bench.)

    If Americans have been dumbed down by the likes of Rush and Fox, how did a majority of those who voted in 2008 elect Obama?

  11. I've got to weigh in, sorry for being late to the conversation. I agree the focus has not been where it should be- i.e. the elimination forever of pre-existing conditions and individual underwriting and pooling risk to reduce indibvidual premium costs liek Heather's.

    Obama has focused too much on cost but even when he talks about cost he doesn't do it right. There's been too much emphasis on the "blue pill" versus the "red pill" which comes across as rationing and government control. There is an alternative to this whole "comparative effectiveness" program that again sounds like government direction of treatment.

    Instead the focus should be on eliminating the 30% of waste that everyone agrees exists in healthcare. Go to to learn how it should be done. This site was started by the former CEO of ThedaCare in Appleton. They instituted a LEAN process much like what's done in manufacturing to assess every activity and ask "Is this necessary?" If it doesn't improve the health of the patient or get at some vital information, the task is eliminated. They saved $22 million in one year. If instituted broadly think of what we could do in expanding coverage and reducing cost. By the way ThedaCare improved their already stellar health outcomes by doing this. ThedaCare is routinely designated as one of the top health plans in the nation on quality measures. This is the cost issue-- and Congress doesn't get it.

    In addition we need malpractice reform because docs all too often order extra tests to CYA which is a waste issue also.

  12. Thanks, Mike.

    By the way folks you should hustle over to Mike's new blog at:

    Mike knows his stuff and is a good guy, fellow Mononan, and former alder colleague.

    On the tort reform thing, I have to add that maybe doctors need an education in the actual risks they face and not just the scare stories. Plus, doctors just hate lawyers anyway! (Hmm, just remembered there a few docs that read this blog. No offense to them is intended.)

  13. Doug/Mike:

    I've always been skeptical of the "there's lots of waste in the system" arguments applied to almost anything. Lots of smart people work in government these days, and a fair number of smart people are elected and surround themselves with bright, capable people. Why haven't they done anything about it before?

    In health care, I think it has to do with two things, primarily -- a) lots of expensive medical treatment gets spent on elderly citizens nearing the end of their lives; and b) patients/consumers have little basis (abetted by the health-care providers) in truly knowing whether the treatment recommended by their doctor is in their best long-term interest, or -- importantly for this debate -- whether it fits into any rationale cost-benefit analysis. The doctor says, "you need this thing" (be it an expensive regimen of pills, a surgical procedure, or even hospitalization), and we as consumers -- generalizing here -- tend to go along with this advice. Doctors and the health-care industry know this, of course, and although I've rarely encountered doctors who order up treatment to make a buck, it certainly provides little incentive to hold down costs or treatment.

    Problem B seems to be something that you can get at re. the kind of stuff Mike highlights with ThedaCare. But, a cautionary note might be this influential article from the New Yorker:

    which suggests certain doctors may be open to this approach, and others may not. It doesn't surprise me that the kind of cost-savings highlighted in the article occur in places like Minnesota and Wisconsin -- with a long political culture of things like co-ops and progressive politics -- and not in places like Texas.

    Problem A is a much stickier widget. I give points to Obama and his team for at least raising the issue of end-of-life medical rationing, the elephant in the room of this debate, even at the cost of political support. I just think he bit off a bit more than the political system was willing to swallow.

  14. Heather here:

    Anonymous, this will be my last post in response to you. I think I have been precise and clear in my choice of words, but you seem to be misunderstanding what I am writing (or perhaps purposely acting obtuse?).

    Plus, if I am going to debate someone, I'd like to know who they are. (I don't know how you stand this "anonymous" business, Doug!) Come out, come out, wherever you are!

    Being "at the table" means being included in the health care summit held March 5. Period. I'm not talking about the election.

    And the part of America that is being dumbed down is the part that is listening and watching the extreme right-wing media resources. Most Americans don't listen and watch the extreme right-wing media resources. Therefore, there were sufficient numbers of non-dumbed down people able to make an informed decision.

  15. Doug, et al-
    Glad to add to the discussion. I know the "there's tons of waste in the system" seems obvious but please check out the link- its run by John Toussaint, an M.D. and former CEO of ThedaCare, he knows his stuff and is trying to help other providers reduce waste and therefore save reform. He also contributed an op ed in the Wall Street Journal which will appear in a few days on this subject. You can read it now at the link- go to the blog page.

    - Mike