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The Obama Administration will find a way to blow health care reform yet. Mere Rhetoric notes a report that Obama aides plan to address Tuesday's election defeats by resurrecting Orszagism, the doctrine that health care reform is the way to control the deficit because it will enable the government to "bend the cost curve" down without compromising care. From Josh Gerstein:
White House Press Secretary Robert Gibbs insisted Wednesday that the White House plans no changes whatsoever in its legislative strategy or agenda as a result of this week’s contests. However, a White House aide told ABC that the administration will seek to bolster moderates by returning to an argument that health care reform will curb the deficit—a talking point Obama aides have de-emphasized in recent months in favor of a focus on making the insurance system more secure and predictable. [E.A.]
If I recall, the White House had"de-emphasized" Orszagism because those who heard the argument tended to fall into roughly two camps: 1) Voters who thought it was at best pie-in-the-sky and that the government probably couldn't "bend the curve" over the next two decades--the way it hasn't been able to do with Medicare, for example; and 2) Voters who thought the government could indeed "bend the curve" and were terrified by the prospect, because the argument seemed to be that only if the government controlled virtually the entire health system could it really turn the screws start denying treatments initiate a "very difficult democratic conversation" over which treatments were really cost-effective, including treatments at the end of life. ...
It was only when the Orszagism was in fact de-emphasized (over the summer) that opposition to health care reform stopped its relentless upward rise and actually fell for a brief period. Why go back to the debacle of last Spring? Vague policyspeak about curve-bending has already, unnecessarily, cost health care reform the support of the elderly. Does Obama want to give reform's opponents the ammo to drive opposition above the 60% line? Go ahead. Make Dick Morris' day. ...
P.S.: I should make it clear that I am in camp #1--I don't think Americans will tolerate draconian, or even semi-draconian, denials of service. As a result I don't think the curve (which is driven mainly by advances in medicine that yield expensive treatments) will be bent. That's why I'm for health care reform. But Orszagism is still lousy politics, because lots of voters will fall into Camp #2. ...
For more: See kf's extensive fall Orszagism collection. ... 12:06 A.M.
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Good for the Juice? The prospects for health care reform have been looking up. I've now seen it described by two separate non-complacent pundits as a "fait accompli." The only problem is this. That part's not still going so well! ... P.S.: I was going to write a post saying that Democrats in Congress are likely to ignore the polls (and the survivalist id those polls awaken) simply because they won't want to have to go through this whole tedious process again. Then I thought, have they really hated the process? Legislation like this is a good "juice" bill--it motivates all sorts of lobbyists--for insurers, hospitals, drug companies, unions--give a Congressman lots of money to try to make sure the fine print goes their way. Suddenly even backbenchers are worth millions. Meanwhile only a few Senators and Representatives have, so far, been put on the spot and forced to make difficult votes, no? Unless you are one of those unlucky pols (e.g., Blanche Lincoln) what's not to like?
Someone who knows more about the culture of Congress might be able to better answer that question: Is Congress hating the health care reform slog or happily wallowing in it? ... 12:07 A.M.
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Funding for 300 miles of actual (not "virtual") fence along the Mexican border appears to have been killed in a House-Senate conference, after the Senate voted for it 54-44. So Senators from California, Arizona and Texas get to say they voted for the fence, but it doesn't get built. That's how Kabuki is done! ... [Tks to alert reader M] 12:06 A.M.
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Bending the curve both ways: Obama is planning to require a "Project Labor Agreements" on big federal construction projects, which will force non-union workers "to pay union dues and pension contributions for which they likely will never receive benefits," complains the Washington Times. But if that's what "delivering" for labor comes to mean, we'll have gotten off easy. Really delivering for labor would be applying Davis-Bacon-style government-set "prevailing wage" requirements to, say, all health care workers who are paid with federal money, no? ... [via Going Rogue] 12:05 A.M.
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Congress' ego says the time to finish the health bill is now. Congress' id still says "We don't want to get killed in 2010." When the ego says 'yes,' politicians do dramatic things like cancel the Senate's scheduled Columbus Day recess. When id says 'no,' they slow down anyway. They oppose "arbitrary deadlines." They say things like, "We will vote on this when it is ready.”
It looks like the id is winning. From The Hill:
Senior Obama lieutenants, including Vice President Joe Biden, Chief of Staff Rahm Emanuel and Office of Management and Budget Director Peter Orszag, have all said recently they think Congress can get a bill to the president before the end of the Thanksgiving break.
The comments suggest the White House is trying to light a fire under congressional negotiators, but it doesn’t appear to be working. [E.A.]
The way to change the Congressional id's inclination--to "light a fire"--was for Obama's speech to move the polls dramatically in the direction of public support, especially among likely voters (e.g., seniors). It didn't--at least it didn't enough. ... 12:08 P.M.
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How defensive is Marc Ambinder about the Atlantic's pretentious, journalistically compromising** "First Draft of History" event? Yes, "[t]he company is making money off of this," he admits right off the bat. They are livestreaming it, to their credit, and you can listen to the "vital conversations" at the link above. ... It's going on right now! ... ... P.S.: Right now, Eric Cantor is saying nothing he hasn't said 100 times before and Chuck Todd is treading water. Not vital! I think I have to do some laundry. ... Update: Here are Thursday's breakout headlines! "Blackstone's Pete Peterson worried about the deficit." ...
**--Atlantic is "making money" by staging a conference at which the presence of powerful officials like Larry Summers, David Axelrod, and John McCain, plus businessmen like Citigroup's Vikram Pandit, creates an aura of prestige (and access) sufficient to attract sponsorship from companies like Boeing and Allstate and ExxonMobil. So are they really going to write something that pisses off Summers, Axelrod, McCain or Pandit so much that they don't come to the conference, or don't come to future conferences? At the very least they've engineered an obvious, gratuitous disincentive. ... Never mind pissing off Boeing and Allstate and ExxonMobil. ...
Remember, this conference obviously did not spring up to fill the need for more Washington conferences. It sprang up to fill the need for the Atlantic to finally start making some money. ... 12:29 P.M.
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Fire Up the Id! Now this is exciting: Over at OMB, Peter Orszag will be posting his "daily step count" as part of the OMB Pedometer Challenge! ... Finally they've figured out a way to make health care reform seem fun and appealing , as opposed to, say, a doomed, moralistic Carter-like attempt to get Americans to change their lifestyles in order to cut costs. ... [Thanks to alert reader J.] 1:10 P.M.
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kf in August, E.J. today.
kf Tuesday, Page Six today (Doris Kearns Goodwin style!) ... 2:17 P.M.
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Robert Samuelson scorns the egomaniacal "quest for glory" of Congressional Democrats who are trying to pass health care reform. But of course the quest for glory may be the only reason a worthwhile reform could still pass. It ain't going to pass it because it's popular! (Orszagism has seen to that by scaring seniors.) You'd have to be an especially rigorous believer in the Howell Raines Fallacy** to think that if a policy isn't popular then it can't be a good one. ...P.S.: If I remember correctly, the untouchable contributory plan that we now call Social Security wasn't especially popular when it passed in 1935--after all, it would be years before it took full effect. (The popular part of the New Deal's central legislation was Old Age Assistance, a fast-acting straight cash dole to the elderly, which is why it was placed at the beginning of the bill. It's now part of the SSI program.)
**--The assumption that whatever changes you want are of course demanded by the great and good American people. ... 1:09 A.M.
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Did ACORN chicanery elect Al Franken? That's the import of this tactfully phrased Minneapolis Star Tribune column.** Franken won by 312 votes. ACORN claimed to have registered 48,000 43,000 ew Minnesota voters. If just 1% were ineligible but cast ballots, or had ballots cast for them illegally, and survived the recount process ... that's 480 430 votes, almost certainly overwhelmingly cast for Franken. ... Maybe in pristine Minnesota even ACORN is clean. If so, the state would apparently be an outlier. ...
**--Item originally said "story." It's a column. (I was thrown off by the byline, "Katherine Kersten, Star Tribune.") That makes no difference in Kirsten's argument, though Dave Weigel makes a fuss about it, and then bizarrely says it's a "smear" to even raise the obvious question of whether the voters--you almost want quotes around the word--registered by a highly questionable outfit like ACORN were legit and made a difference in a very close race. The most important question, I would imagine, is whether ACORN handled absentee ballots for anyone in the state. Would we trust an organization, whose registrations featured (in the NYT's words) "fraudulent submissions from low-paid field workers trying to please their supervisors" to distribute, collect, and maybe even mail in absentee ballots for, say, shut-ins at nursing homes? If there were funny business, would a recount necessarily have detected it (assuming the ballots were clearly marked)? ... That's more questions! Sorry! ... P.S.: There are also obvious potential problems with same-day-registration that might not be picked up on a recount. ... P.P.S.: In neighboring, also pristine Wisconsin, ACORN employed as voter registration workers felons "convicted of crimes including cocaine possession and robbery."
Carolyn Castore, state political director for the group, told the AP: “We have a lot of folks with felony records and, frankly, they need jobs.”
Update: Here's an example of funny business with absentee ballots, by a group joined at the hip to ACORN in New York. ... But I'm sure there's nothing to worry about in Minnesota. ...1:14 A.M.
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People I respect (my mother) claim Roman Polanski got a bum deal in 1977. But it's worth remembering that the French--now in the process of being outraged by his arrest--can be absurdly resistant to extradition by the ugly Americans, especially when an artiste is involved. Here's a Steven Levy article on one famous case--the Unicorn Killer, a Philadelphia hippie who seems to have stashed the remains of his ex-girlfriend in a steamer trunk. He fled before trial, winding up in France. When discovered, he successfully resisted extradition (at least initially) after a campaign that played up his having written "written four novels, one a philosophical novel on the Holocaust." He was eventually extradited, tried and convicted. ... P.S.: He also seems to have maybe invented social networking, or at least spam:
In the 1970s he persuaded Bell Telephone to finance a networking scheme in which he sent information to a list of contacts that ranged from author Alvin Toffler (whom [he] introduced to computer conferencing) to corporate Brahmins in Fortune 500 firms.
1:20 A.M.
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Stupidest question on the latest CBS/NYT poll:**
23. Which comes closest to your view? 1. The U.S. needs to fix its health care system now as part of fixing the overall economy. Or 2. Because of the state of the economy, the U.S. cannot afford to fix its health care system right now.
Unless you want to be a heartless Republican (2) you have to buy not only the basic Orszagist argument the health care reform is the key to solving the deficit problem but the broader argument that it's the key to fixing the entire economy? What if you just think it's something we should do and that we can afford to pay for? ... No wonder respondents were so confused by the poll's barrage of nonsensical, tedious, and guilt inducing questions ("are [health care reforms] confusing to you?") that when the big question (#41) about whether they supported Obama's health plans finally arrived, CBS and the Times managed to produce an unprecedentedly huge number who said they "don't know enough"--47%--rendering the poll basically useless. Congratulations! ... The Paranoid View: For the Times, it was less risky to have a useless poll than one that actually measured where health care stands with voters. ....
Update: Several emailers point out that conservative and libertarian plans to "fix" health care also fall into the poll's vast excluded middle--at least if they aren't necessary for fixing the overal economy or don't have to be done now, but are nevertheless considered affordable. And if you don't think health care needs a "fix" at all--well, you're a total unperson as far as question 23 goes.
**--They've asked this question twice before, in July. Doesn't make it any less stupid. ... 2:34 A.M.
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Fish Out of Water Uncomfortable in Own Skin! Beck seems phony here, no?*** Something creepily inauthentic about him. ...
***--Except 2/3 of the way through, when he says he's never heard of kf. ... [Thanks to alert reader H.] 2:40 A.M.
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"Orszag Sees Health Law in Six Weeks" (Bloomberg): OMB Director Peter Orszag didn't really predict a health care law in six weeks--he said "The goal would be, yes, over the next six weeks or so, maybe sooner." We know all about "goals." But the 6-week frame is not an accident, because something happens in 6 weeks: elections. If Democrats lose big gubernatorial races in New Jersey and Virginia, that could produce a new wave of jitters among already skittish Congressional swing Democrats (a possibility Charles Lane pointed to months ago). That's one of the extraneous factors left out of some sophisticated positive assessments of the bill's chances. Better to get it done before the ax might fall. ... Meanwhile, Ezra Klein says we're on the 10 yard line. Sure! But we are playing 43-man Squamish. ... 1:06 A.M.
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The Grants of Others: Lynne Munson's suggested NEA apology is a whole lot better than actual National Endowment for the Arts Chairman Rocco Landesman's actual statement, which is just a tad unapologetic and defensive about the Breitbart.com conference call scoop:
a) These were organizations that depend on the NEA for grants. It's not that they were explicitly asked by NEA and other government officials to support the president's policy agenda. It's that they were asked to vaguely but passionately get with the program by people who seemed to have an uncomfortably flimsy idea of the boundaries between promoting the President's public service plans and making art and community organizing ... and supporting the president's policy agenda. Maybe it's all one big activity--the president's "very aggressive agenda" at the national level, with "service" at the local level meaning being an "agent of change" and learning to "connect with ... progressive groups" (as White House official Buffy Wicks put it on the conference call). Praxis! Cue will.i.am. ...
b) I don't read the what's said on the conference transcript as an explicit call to support Obamacare (though several grantees did just that a few days later). It's a call to support the public service initiative. But what if you are a potential NEA grant applicant and you don't believe there should be a public service initiative? Maybe, like the late Jack Kemp, you think it's a waste of talent. That particular political conviction is apparently officially inconceivable. If you share it, don't expect a fat grant anytime soon. Robert Heinlein interpreters hoping to stage a community theater production of Stranger in A Strange Land: The Musical are advised to look elsewhere.
c) It's obviously not just the fault of the one NEA official who participated in the call and has now been relieved of his assignment, but rather a problem in the culture of the incoming Obamaites--at least the incoming Obamaites who are sufficiently low-level and unwonkish to be assigned to the NEA. Maybe Landesman should order a viewing of The Lives of Others to underscore to them what (in admittedly extreme form) people who worry about politicizing funding for the arts are worried about.
d) Sure, the meeting tarnished the NEA but it also tarnished Obama's public service initiative, which now looks like it's being propped up by subtly coerced participation from government grantees, and steered into being an "agent of change" for "progressive" causes. I await the strongly-worded denunciation from prominent fellow national service supporters like Newsweek's Jon Meacham.
e) Who is this "former NEA Director of Communications" that Landesman keeps referring to? Does he have a name? Is he an un-person? Are they airbrushing him out of group photos? Is his name an unpronounceable symbol, like Prince's? Landesman has only been on the job a few days and he's sounding East German already.
5:07 P.M.
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Is retiring Ohio Republican Senator George Voinovich the real Olympia Snowe--i.e. the GOP vote that will get health care reform through the Senate? His Ohio colleague Sherrod Brown suggests as much today. There's a ready-made Vandenberg-like MSM legacy for Voinovich if he does. ... The notion could also be textbook Dem wishful thinking--see what Voinovich told The Note. ['Wishful' like notion that Specter would switch parties and endorse a "card check" deal--ed Yes, exactly like that.]. ... 3:05 P.M.
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Thursday, September 17, 2009
Looks like the Law of Curated Humor--which holds that whenever the MSM offers up examples of celebrated wit, they will not be funny--extends to Twitter. ... 2:46 A.M.
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I hate to say it,** but doesn't Nancy Pelosi have a point when she worries about a rhetorical "climate" in which violence might take place? A few years ago, I fretted that crazies on the angry left might turn violent. These days, I've heard enough scary stories from conservative friends to justify worrying about the angry right. It only takes one or two people to make a mess, and the way opposition to Obama is phrased will obviously have something to do with how many, if any, nutters come out of the woodwork. Glenn Beck, the recent times I've listened to him, puts his Obama criticism in an apocalyptic framework--as if Obama is staging some sort of coup-- that might seem to justify violence (despite Beck's own disclaimers) if you happened to be a very disenchanted person with weapons lying around.
Righteously denouncing Beck only enhances his appeal, of course--better to deal with "root causes." But Pelosi's hardly crazy to worry. ...
**-- It's way more fun to mock Pelosi. ... 2:40 A.M.
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Orszagism Lives!
"The larger the bill is, the more it's going to save. ..."
-- Democratic Sen. Benjamin Cardin, quoted in WaPo about health care reform in the days before Obama's big speech.
2:38 A.M.
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Expectations: Low! ... Expectations: Exceeded. A moderately effective speech. ...
1) Triangulation: Almost always works! Obama pushed off, most notably, against single payer but also against Dems who demand a public option. Didn't emphasize that the public option is itself a fairly centrist solution--as opposed to systems that would deny the private option. ...
2) Rebranding: Virtually none that I could see, despite a lot of talk among commentators (including Keith Hennessey). No attempt to pretend that this isn't the same bill and being sold as the same bill. ...
3) Orszagism: Still there, but gets an image makeover. In it's new, airbrushed form, we're told that "our health care problem is our deficit problem" (which it is) but not that Obama's reforms are necessarily the solution to the deficit problem (which they aren't, even if they'd work--you could also raise taxes or cut spending elsewhere). The content of those long-term structural reforms is redefined along free-lunch, non-grandiose lines: Obama no longer insists that the bill "reduce health-care inflation" or transform the "health care delivery system." Only "waste and abuse" that does "nothing to improve your care" will be targeted. That's a relief! Only "common sense best practices" will be encouraged by the new cost-cutting panel. All building up to the central iffy policy pitch
[W]e've estimated that most of this plan can be paid for by finding savings within the existing health care system
Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan ..
a) Does anyone really believe this--that is, if you define waste and inefficiency as things that don't actually help improve your health, as opposed to things that might improve your health marginally but aren't worth the cost? b) Specifically, does the average Medicare recipient feel that the system that he enjoys is rife with waste, inefficiency, fraud, and abuse? I suspect not. This seems like the greatest point of vulnerability in the speech. ... Faced with the need to choose between a) alarming centrist budget hawks concerned about deficits driven by rising health costs and b) alarming seniors concerned about the measures that might be taken to control rising health costs, Obama chose to pretend the problem didn't exist (though he did throw budget hawks a crude procedural bone--see #9 below). ...
4) "This-is-the-moment-ism: Why, after posing as a practical moderate, go on and on about the need to avoid timidity and do "what the moment calls for" and "history's test." Obama couldn't let a speech slip by without veering into grandiosity--but this very grandiosity undercuts his attempt to appear like a reassuring centrist who wants to disrupt existing arrangements as little as possible. Makes kicking the can "further down the road" suddenly seem vaguely appealing. Instead of "this is really a big deal like 1935 and 1965," why not say "this really isn't such a big deal"? ... In particular, couldn't Obama somehow make the point that a trillion dollars over 10 years isn't such a big deal. He tried, by comparing it to expensive things the Dems didn't like (the Iraq War, tax cuts). More effective would be comparison to effective things the Dems and the voters do like (i.e.,"that's less than a sixth of the cost of Social Security" or "one fifth as much as Medicare now costs each year"). It's only $100 billion a year, people!
5) Heckling: Effective, I thought, outweighing the disrespect effect. Showed that there was some dissent about Obama's flat assertions about, for example, no coverage for illegal aliens. (The dissent involves whether there is any verification mechanism that will actually stop illegals from getting coverage, whatever the law says.) But then I'm the guy who thought Rick Lazio taught Hillary Clinton a lesson. Brian Williams was clearly upset, but he only has one vote. (I normally ask my mother about issues like this, but she was watching Federer.) ... Assignment: This can't be the first time a President has been heckled. ...
6) Specificity: "This exchange will take effect in four years ..." Confident assertions of specifics suggest that Obama is in control and laying down the law. Needed more of these....
7) Kennedy: This section surprisingly effective, given that everyone knew it was coming. I'd prefer an appeal to social equality as opposed to "large heartedness," but then the Kennedys--or at least Teddy--don't precisely stand for social equality, do they? ...
8) "[T]here is something that could make you better, but I just can't afford it." A good description of the need for health care coverage expansion. But why not broaden it into a general principle--that we don't say, as a society, "there is something that could make you better but we can't afford it." Because then it could be used as an argument against rationing in the future? And that would be a problem because.....
9) Veto threat: The clearest veto pledge Obama made was: "I will not sign a plan that adds one dime to our deficits, either now or in the future." Is Obama really going to veto a plan because if nothing is done it will add to the deficit in 15 years? And if so, why? The other problem with this pledge, which he repeated for effect, is that it tethers Obama to the deficit-estimating methods of the CBO, which in turn leads him to endorse a plan for mandatory "spending cuts if the savings we've promised don't materialize." That won't reassure voters worried about, you know, spending cuts, and it doesn't make any policy sense. If the savings don't materialize, why not raise taxes, or cut the HUD budget, or Social Security? Why do the savings have to come from medical care? But the CBO loves such mandatory fallback cuts, so they're in. ... Keep in mind, these are cuts that go into effect after the administration's plans to pick the low-hanging fruit of "waste" that doesn't impact care have been exhausted. Doesn't that imply that the mandatory spending cuts will come at the expense of care? ... Update: Hennessey seems to think the fallback spending cut plan is an attempt to muscle the CBO into saying"the bills don’t increase the long-term budget deficit" without doing the things that would make the cuts actually automatic. If that's true, I don't quite understand--why set up a big fight with the CBO that you might lose, after you've pledged to veto the bill if you lose it? Seems as if CBO holds all the cards in that one, no? ...
10) How Much Government is Enough? Just as Obama's winding up, he drifts off into locker dorm room musings about whether "the danger of too much government is matched by the perils of too little." Why, in a speech that's already too long? We're not debating philosophy. We're fixing the health care problem. ... Ditto the airy discussion of civility that follow, which seemed like a bone thrown to those who wanted a condemnation, but which only got in the way of an effective "I hear you" pitch. ... 6:49 P..M.
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In an email not intended for publication, alert kausfiles reader J does a better job than kaus at summarizing what's (so far) gone wrong on health care:
Obama does indeed appear to have misjudged the issue. The core of the issue was his statement that providing universal coverage and controlling long term costs were the same issue.[**] This sounded phony, but he then let people think that he really believed that -- and of course he probably did, since why say it at that early stage if he did not believe it? Then he of course could not be specific about how he was going to achieve these immense long term savings, so that justified the suspicion about rationing, death panels, and so on. In other words, to the very large number of people who have adequate insurance now, he did not stress that he was going to improve their situation (by assuring that the could keep coverage if they changed jobs or lost their jobs ), but that he was going to make it worse by casting doubt on whether what they have now could continue. ....
That is just politically extremely unwise -- to say the health care issue is about whether we can keep everything we have or rather have to give a lot of it up so we can have universal coverage. And who gives it up, under this view -- not the rich, but the elderly, the average worker with health care coverage, and so on. The Republicans found this issue, as who would not have, and have been mainlining it, successfully. [E.A.]
Hereby adopted as kf's official what-went-wrong explanation. ... It certainly seems more persuasive than the spotty and CW-burdened Wall Street Journal account. ...
**--In other words, Orszagism.. ... 10:15 P.M.
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Politico conveys the latest White House staff boasts about health care strategy:
Top officials privately concede the past six weeks have taken their toll on Obama's popularity. But the officials also see the new diminished expectations as an opportunity to prove their critics wrong ...
Dickerson: Who knew it was all a brilliant plot to lower expectations? ... 9:45 P.M.
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Anti-anti-anti-Orszagism: David Brooks mounts the conventional defense against anti-Orszagism:
The second liberal response has been to attack the budget director, Peter Orszag. It was a mistake to put cost control at the center of the health reform sales job, many now argue. The president shouldn’t worry about the deficit. Just pass the spending parts.
But fiscal restraint is now the animating issue for moderate Americans. To take the looming $9 trillion in debt and balloon it further would be to enrage a giant part of the electorate.
Brooks is being disingenous, I think. The complaint against Orszag isn't that he's worried about the deficit. You could easily have a substantial health reform effort that was deficit-neutral--that didn't add to the $9 trillion, which is the estimated deficit for 10 years. Where Obama and Orszag went wrong was in ostentatiously blabbering about long-term health cost "game changers" beyond that 10 year period, involving a "very difficult democratic conversation" on whether to put limits on treatments toward the end of life. It's the "game changers" that rightly scare people who worry about moving toward Brit-style rationing or other sorts of restrictions..
This discussion of long-term "game changers" was almost entirely gratuitous, policy-wise. 1) They're unproven. Maybe they'll work--i.e. cut costs without affecting care. Maybe they won't. It's irresponsible to make speculative efforts to control long term health costs, something that hasn't been done in this country, the centerpiece of an attempt to extend care; 2) They're long term! There's plenty of time to institute whatever curve-bending changes in medical practice between now and 2019, as eminently respectable policy person Uwe Reinhardt notes; 3) Cutting health care costs isn't the only responsible way to control the deficit. You could also cut other costs (e.g., Social Security) or raise taxes; 4) It was intellectually misleading to argue that spending a trillion dollars to extend health care coverage (and add demand to the system) was somehow the way to control long term costs, which was the essence of Obama's appeal in his address to Congress. Maybe expanded coverage would give the government more monopsony leverage--a not-unscary prospect in iitself, especially if you are "suspicious of centralized government," as Brooks says we Americans are--but basically the two issues seem separable. If you want to control long term costs and shift to a different treatment model you could start doing that independent of efforts to broaden coverage (which, indeed, Orszag proposes doing). There's no clear policy reason--certainly no reason we've been given--that the two have to be linked.
Brooks has it backwards, then, when he suggests Orszag's critics are saying Obama should have put good policy common sense aside for cheap political reasons. The policy groundwork for insisting on legislating "game-changers" now is weak. The only reason to include them was political--the calculation that even a speculative, possibly Potemkin-like effort to address long term costs would appeal to Blue Dog legislators and independent voters. It's this political calculation that appears to have been the big mistake--the curve-bending, treatment-denying talk has scared seniors so much that popular support for the whole package (including among independents) has sunk to dangerous and possibly fatal levels.
P.S.: I've learned the hard way not to question the judgment of John Harwood, but his Obama's-in-good-shape analysis seems a little ... well ... Ambinderish. ... Same goes for Norman Ornstein, who focuses on the inside game (for Senate votes) and ignores the outside game (for public opinion). Is he ...rearranging reconciliation votes on the Titanic! ... And didn't Ezra Klein tell us a couple of weeks ago that the inside game had failed, and now Obama was going to move the argument "to the country" where he'd "marshal public support"? What happened with that? ...
P.P.S: According to Atlantic, Obama is going to seize on his moment of seeming weakness to ... draw lines in the sand! Auspiciously, none of the lines (as reported by Ambinder) is an insistence on Orszag's long-term rule benders. But the night is young. ... 2:46 P.M.
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The New Republic explores new revenue models, Atlantic -style. ... And they're going to viciously attack Christina Romer after she's helped them charge $250 a seat? ... 2:45 P.M.
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"Hot Blue on Blue Action": Joe Klein vs. Glenn Greenwald: Tom Maguire buries his real lede--Is it possible that Glenn Greenwald is not a member of the secretive Journolist? ... P.S.: On the question of whether "Klein pretends to position himself as an observer rather than a rooter at TIME," I would say the answer is no.. It would be futile to do otherwise at this point, anyway--as Maguire notes. ..."Rooter" is too passive, though. More like "player." ... You got a problem with that? ... 2:44 P.M..
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From OMB director Donald Rumsfeld Peter Orszag's recent blog post explaining the deficit estimate increase:
... the Administration is insistent that health care reform not only be deficit neutral over the next ten years, but also incorporate changes that will help reduce the deficit thereafter.
a) Isn't it pretty clear that these "changes that will help reduce the deficit" after ten years are the very changes that have scared seniors and others out of supporting Obama's health reform? I thought the plan was not to talk about them any more. ... b) Please tell me you're not going to veto a health care reform that is "deficit neutral over the next ten years" just because it doesn't also include those longer term defcit-cutting "game changers." You're not going to veto it--everyone knows this--but mightn't this be a good time to reassure us that you are not insane? ... 12:03 P.M.
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From Resilience to Delusion: Is Christopher Hitchens really offering up the most ancient, cliched rationalization of infidelity in defense of his friends, Elizabeth and John Edwards?
In the unequal battle between life and death (as she understood in her father's case), Eros has its part in warding off Thanatos, and if this really was--as I believe--her husband's first lapse, it might have been partly because of the death-haunted context in which, for all his money and charm, he found himself.
'Thanatos made me do it.' This was also Warren Beatty's rationalization in Shampoo, if I remember right. ... P.S.: I think there is actually a significant possibility that Hitchens really believes Rielle Hunter was John Edwards' "first lapse"--that he's not just trying to be kind to his friends. He should stop being a fool. ... Update: Alert reader E emails--
John Edwards had never strayed before. I guess he'd been waiting 30 years for someone to say the magic words, "You're so hot!" ....
12:26 P.M.
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Test Your Tomato IQ: Lots of delicious U.S.-grown tomatoes in L.A. supermarkets last week. Weren't they supposed to be rotting in the fields due to lack of low-wage illegal immigrant labor? ... 10:22 P.M.
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Do we really need angry outsider Pat Caddell to tell us that Edward Kennedy's absence left a "vacuum of leadership" in the Senate? (He "knew how to get things done" and "worked across aisles"!) How is David Broder supposed to earn a living? ... P.S.: Caddell also says that health care "probably would have been a done deal if [Kennedy] was around," which seems like pretty much 100% BS, unless Kennedy would have cajoled Obama into pursuing a different strategy. ... 10:51 P.M.
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Jonathan Cohn's "defense" of Obama's emphasis on Orszagistic curve-bending--against what he perceives as the looming Blame Orszag CW--isn't really a defense at all. Cohn assumes it was a big mistake, and basically argues "who knew"?
Obama surely has made mistakes, among them focusing so heavily on how reform would reduce the cost of medicine. Had he spent more time reminding voters that reform would provide them with the security they now lack--security from financial ruin and medical catastrophe, the type private insurance too rarely provides--he probably would have been better off.
But I'm not so sure this was obvious a few months ago, when Obama kicked off his campaign for health reform. ... [E.A.]
Oh, yeah? ... Backfill: Dick Morris saw the GOP's opening. ...
P.S.: Cohn even takes as mitigating evidence the proliferation of puffers on Orszag himself:
I seem to remember quite a few writers and television commentators gushing over how Obama and his advisors aggressive approach to the cost problem. Remember, these were the days when Washington feted Budget Director Peter Orszag as a celebrity and turned “bend the curve” into a bumper sticker.
And if Obama had a Budget Director who'd said, "Security First, We'll Bend the Curve Later," the press wouldn't have sucked up to him too? ...
P.P.S.--Orgy of Recrimination, Please! Before we get to the unconvincing contrarian pieces defending (or explaining) Obama's mistake, let's have a decent CW interval in which we bash him for it, OK? Otherwise he might make it again. It's a "teachable moment"! ...
Least poll-tested argument: Cohn combats the idea that it doesn't matter so much if we spend more of our GDP and our budget on health care:
But the money spent on medicine is money not spent elsewhere--it's government dollars that didn't go into schools or public housing;
"Public housing"! Now there's a government expenditure with a good track record. By all means, let's spend less money treating sickness and disease and more money on the beloved public housing program. ... Suggested bumper sticker: "Less Healing, More HUD!" ... I mean, how could these guys be losing the debate? ...
Update--Orszag's Won Time Magazine! Cohn's very civil response. He defends the substance of "curve-bending," not the (disastrous) politics. ... Michael Grunwald, in a Time piece that reads like it was written in May, is still making the Orszagist case. "[R]eform won't be worth selling if it doesn't include real cost restraints ..." he announces. Why? Why does everything have to be done at once--the Comprehensivist Fallacy? We can give security now and try to bend the curve over the long run, as Uwe Reinhardt recommends. ... 2:35 A.M
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What would be the best thing that could happen to Obama? Losing Congress in 2010, argues Red State's Erick Erickson of Red State. It worked for Bill Clinton! Think how popular Obama would be if he was standing up against mean GOP legislators instead of trying (or pretending to be trying) to pass unpleasant bills like cap & trade, immigration legalization and "card check." ... Even better: Pass a health care bill and then lose Congress in 2010. ...
Minor Hmms: 1) As things stand now, Erickson says, "Barack Obama cannot work the center." Hmm. I'm not so sure about that. He could be working the center a lot harder than he has been on education, welfare, the auto bailouts and the CIA, to name four. (And he probably thought he was working the center when he focused his health care pitch on curve-bending cost-control. Goes to show it's not enough to mindlessly triangulate.) ...
2) Erickson speculates that if Obama lost Congress he'd still get immigration reform through, thanks to moderate GOP senators like Grassley and Bennett. Hmm, again. Isn't immigration more likely to remain another one of those Washington Mirage Issues where you can technically count enough votes for legalization, but (because legislators are rightly skittish) the vote somehow magically never takes place? ...
3) Erickson even speculates that Obama, recognizing the utility of a loss in 2010, will "start" to undermine the Blue Dogs in swing districts. Really? "Start"? What would he do to undermine the Blue Dogs that he's not doing already? ... Hmm. 6:21 P.M.
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Barack got your tongue? Yesterday's post by formerly prolific OMBlogger and kf Designated Fall Guy Peter Orszag was his first in three weeks. ... 6:52 P.M.
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Matt Yglesias throws Orszag (or at least Orszagism) ... under the bus!
"I don't know to what extent the Obama Administration was being naive or what, .. 'cause they very much led with this kind of cost-control argument, which I think they thought was going to be appealing to Republicans when, in fact, the fact that the argument is unpopular is even more appealing to Republicans ..." [E.A.]
I thought "Blame Orszag" would be CW by Sept.14. My mistake. I should have said by next Tuesday. ... 3:25 P.M.
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Don't mess with Rabbi Saperstein! ... 3:22 P.M.
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Jon Alter's latest column--calling for health care to be treated as a "civil right"--brings up an underdiscussed question: In a single payer plan, would health care be treated as a constitutional entitlement that couldn't be taken away without "due process" under the Warren Court's so-called "New Property" doctrine? My Con Law knowledge is a few decades out of date--but the doctrine covered welfare benefits, guaranteeing a hearing to individuals before they could be denied. Why not health benefits? ...
Isn't it possible, then, that rules produced by Orszag's cost-cutting IMAC board preferring some treatments over others, or some patients over others, would be hamstrung by constitutional proceduralism? Maybe sick patients who want disfavored Treatment X would sue and demand an individualized hearing before their "right" to that treatment could be denied.
And if the "New Property" operated to constitutionalize treatment rights in a single payer system, would the same doctrine apply to a so-called "public option" plan that competed with private plans in a health insurance "exchange"? If not, maybe a government-run "public option" would have an efficiency advantage over government-run single-payer. It wouldn't have to worry about all those hearings.
In fact, the more I think about the "public option" idea, the more it appeals to me--not because it's the "thin end of a wedge that will move the system" towards single payer, as Clive Crook summarizes it, but because it seems superior, in some respects, to single-payer.
1) Obama sells the "public option" as a way to "keep the private insurers honest." But the converse effect might be more important: the private insurers in the "exchange" would keep the "public" plan honest. Sure, in this marketplace the government plan will probably get the lion's share of customers. It will offer more security, for one thing. But if it starts to provide lousy service, or excludes too many treatments, the private plans might start to lure some of those customers away. Private insurers would provide an escape valve--an "exit"--unavailable in single-payer government monopoly. The obvious analogy is to private "charter" schools competing with public schools.
2) Likewise, if the public insurers managed succumbed to cost-bloat--if all the people who washed the laundry in hospitals became unionized, for example, and politicized government plans blithely passed the giant resulting bill on to their customers (not wanting to anger the SEIU and other good Dem supporters)-- the private sector might underbid the public plan and 'bend the cost curve' down! Again, that's something that probably wouldn't happen in a single payer scheme; and
3) As discussed, "public option" might help avoid having every "we won't pay for this treatment" decision become a constitutional issue in a way a universal, single-payer entitlement couldn't.
I'm not saying all the differences between the two sorts of plans would cut against single payer--some days it seems completely appropriate to handle treatment decisions as a constitutional matter, since lives are at stake. If a single payer plan is, as a result, less able to deny treatments, that could be a feature, not a bug.
I'm just saying the differences between the two forms of "government" plan have been blurred (mainly by the right), that some of those differences may favor the "public option," and that Obama may be missing a bet in failing to defend the "public option" by pushing off against government-run single payer plans of the left rather than by pushing off against the greedy, evil private insurance companies.
Triangulation--something that lets Obama seem a centrist--helps at this point, right? Or are voters worried that he's insufficiently fond of unchecked government dominance? ... 3:18 A.M.
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If 1000 Twittering Rabbis Swear ...: I was wrong, so wrong to entertain even mild doubts about Ben Smith's report that Obama had told a group of rabbis "We are God's partners in matters of life and death." Smith has now followed up with several of the rabbis. They deny the statement was grandiose, calling it either "mainstream" or "inspirational" or "pablum." But they don't dispute that Obama said it. ... Rabbi Josh Yuter says, "My guess is he didn't really mean it in the way it came out." ... Rabbi David Saperstein translates it as "we are God's partners in preserving life and delaying death," which does take the sting out of it! ... Words to inscribe over the door of the death life! panel. ... ..
P.S.: Smith didn't talk to any of the notorious twittering rabbis, who--according to Saperstein--broke an off-the-record stricture.** ...
P.P.S.: Even the Obama-skeptical rabbis Smith interviews seem to bend over backwards to get Obama off the hook on the "partners" quote. Perhaps they were lulled into cooperating by the soothing melody of "Deutschland Uber Alles," which played while Obama's audience was on hold. ... That was one of the rabbinically twittered details that made the whole account seem too good to check. But it was checked, and it's still good! ... [stolen from Sheffner]
**--Saperstein is not a master of brevity. Twitter gains fresh appeal. ...
Update: Rabbi Yuter, whose substantive post-call blog post is here, emails to say, "I did not recall President Obama making the statement. When asked by a Washington Post reporter for confirmation of the quote, I had to defer. I do not deny that he said it but I've trained myself to ignore such statements." ... Of course, last week Press Secretary Gibbs mentioned that there was a transcript of the call and said he'd have to check it. If Obama didn't say what the twitterer said he said, and what even his defenders seem to assume he said, you'd think Gibbs' office would have pointed to the transcript by now, no? ... 11:24 P.M.
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If You've Lost Robert Pear ... : From Maguire:
Old New York Times reporting: "Death panel" rumors "false," the product of a familiar network of anti-reform "pundits and conservative media outlets":
There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.
New New York Times reporting: "[F]ears ... about possible rationing" are "not entirely irrational":
The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing, which could affect access to the most expensive services in the final months of life.
Next thing you know, the NYTers will be grabbing the mike at town halls. ...
P.S.: At least when voters are having notentirelyirrationalfears that Obama would have the state play god by exercising yes/no power over life-ending medical decsions, he didn't go and say something creepily extravagant and provocative like "we are God's partners in matters of life and death." ... Whew! ... Oh.. ... [also via Maguire] ... Update: I'm now having mild, but gnawing, doubts as to the epistemological status of that Obama quote. Politico reports it (twice). It seems to come from the real time twitter feed of a rabbi who was in on the phone call. (The rabbi has since deleted the tweet, giving an odd explanation.) Press Secretary Gibbs was asked about the quote Friday, didn't deny it, but said he'd have to check the transcript.... 5:10 P.M.
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Groopman vs. Gawande? I missed New Yorker contributor Dr. Jerome Groopman reaming President Obama on the magazine's July 23 podcast. Groopman accuses the President of "happy talk" that pretends the problem of long-term cost control will be painless. He also claims the "current" reform propoals will "build a huge bureaucratic superstructure around things that are not gonna save money and probably aren't going to improve quality."
Groopman's critique isn't mine--he thinks "rationing is going to be inevitable" and fees for doctors hospitals and drug companies have to be radically reduced. But his arguments certainly sit uneasily with the implication of the famously influential article by his fellow New Yorker doc, Atul Gawande--which is that, hey, if we only crack down on the wasteful McAllen, Texases of the world we can dramatically cut costs relatively painlessly. ...
P.S.: I obviously agree with Rick Hertzberg, who argues you have to give everyone the "goodies" (of universal coverage) first, and then whatever hard choices are necessary become easier. And I don't quite understand why the choice has to be Euro-style rationing (Groopman's view) if we're willing to make the alternative hard choice of raising taxes (or cutting other spending) to pay for avoiding it. ... 1:20 A.M.
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Gawker says that the National Enquirer has "has been 100 percent right about everything on this story"--a now-common MSM overreaction. I'd say the Enquirer has been more like 95% right--still better than anyone else. Their main blind spot is a refusal to say anything bad about Elizabeth Edwards, presumably for fear of offending their readership who prefer the story line of St. Elizabeth the Resilient Victim. (Enquirer editor David Perel: "She's been hurt. She lashed out. ... [T]here's some places I don't want to go.") Fortunately, HuffPo's Lee Stranahan is still around to chronicle Elizabeth's dissembling. ...
P.S.: Bonus Google gold! ... 1:19 A.M.
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Systemic Change at Dreidl HQ: Marc Ambinder now sticks in a 'to be sure' graf before selling us the optimistic WH spin. Today's good news for Obama? He's "about to go on vacation"! .... 1:03 A.M.
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kf Gets to Yes! I tend to favor a public option--at least it seems worth trying. Meanwhile, private insurance companies think it will put them out of business. But why is this fight not susceptible to a tradtional hack form of compromise: let half the states** try a public option, if they want, the rest stick with the private sector or co-ops? Then liberals are happy and the insurance companies are happy. The issue can be revisited in a few years when we see what happens. ... You're welcome. ... Now we can move on to the more presssing problem--getting Orszag's disturbing treatment-denying "game changers" out of the bill so public support doesn't collapse so completely that passage of anything becomes impossible. ..
**--or states representing half the population. 5:59 P.M.
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Kareem wants to coach the Lakers. ... 4:17 P.M.
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Kf welcomes Howard Fineman to the Blame Orszag Club:
Orszag's fantasy
Every president wants to reconcile frugality and generosity, and there is always an ambitious and clever aide willing to tell him it can be done. In Obama's White House it is Budget Director Peter Orszag, who confidently told Obama that carefully administered universal health coverage would save the government money in the long run. ... [snip]
Obama doesn’t like to make enemies, and he loved the idea — fueled by the likes of Orszag — that he could fight the reform battle on conservative turf: that we need to completely change the system because otherwise we will go bankrupt as a country.
But that was a tactical mistake on two fronts. First, Elmendorf undercut it with three devastating CBO reports.
And even if the proposals did save the government money, Republicans in Congress weren’t going to care!
For two generations, they were on the receiving end of Democratic fear-mongering how the GOP wanted to “throw grandma in the snow.” Now they are relishing the chance to accuse Obama of the same thing.
Prediction: CW by September 14. ... 9:49 P.M.
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Do the folks over at NRO's The Corner realize that The Man Who Shot Liberty Valance is a Marxist movie? Forces of production (sheepherders, farmers) meeting fetters (cattle barons, Lee Marvin). Bourgeois freedoms (Jimmy Stewart) the product not of incremental progress but of a violent revolutionary moment (John Wayne). Etc. ... 10:57 P.M.
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'Little GM, You Used to Be So Big': Harry Shearer has written Fresh New GM!'s theme song. ... It even has a bridge. ... Downloadable Sept. 8, apparently. ... P.S.: TTAC's thorough review of GM's uninspiring future product plans (mainly a flood of ... Buicks) suggests that Shearer has the tone about right. ... P.P.S.: I'm not predicting New GM! will fail. But it's hard to see it succeeding without the immediate labor cost advantage that Ron Bloom and Steve Rattner failed to negotiate for them, or an infusion of outside a---kicking executives that hasn't happened either. ... Plus: Some anti-Lutzism. ... It looks as if the one American plant where UAW workers built Toyotas--the NUMMI joint venture with GM in San Jose, started in 1984--will close. NUMMI's products had a good reputation, but apparently it was only profitable "for a single year." ... 11:47 P.M.
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Ross Douthat wants the GOP to stop defending grandmas against Orszagist curve-bending and
stand for the principle that Medicare can't pay every bill and bless every procedure
As a Democrat, I applaud this long-overdue attempt to return Republicanism to its historic mission. It will be comforting to see Douthat's party reclaim its its traditional image as skinflints attempting to deny the poor and elderly compassionate medical treatments and benefits that might prolong their miserable lives. It's been getting confusing lately! ... Maybe we can trade them Orszag for a pro-life big spender to be named later. ... 11:51 P.M.
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Everything's Under Control! I missed Ezra Klein's latest optimistic spin last week on the health care debate. Klein notes that Obama isn't talking about "bending the cost curve" on the stump, and that Republicans have gained traction, not with arguments about cost and the long-term deficit, but with fears of cost-cutting and rationing. So far, so good.
But Klein says the administration always intended its "curve bending" arguments as a means of building "Washington support" and passing a bill by August ("the plan was to keep this in Washington"). Now that this effort has failed,** "the argument moves to the country" where the administration's pitch will be different, focusing on stories of insurance injustices. "You don't win appealing to the wallet, you win by grabbing the gut."
This reeks of making-the-best-of-a-bad-situationism:
1) Did the administration really think it was going to pass a bill reforming the entire health care system without winning the "outside" battle for public support? If so, someone drew the wrong lesson from the "stimulus" bill. (The stimulus bill was intended to address an acute crisis.)
2) Did the administration think that Obama could run around talking obsessively about his plans to "bend the curve" of health costs (including in a nationally televised press conference), giving interviews to the New York Times about the need for a "very difficult democratic conversation" on restricting end-of-life care and the news would stay in Washington? Note: They've invented the telegraph!
3) Most important, does the adminsitration think it has plenty of time now to move on to win the argument in "the country"--as if this were a stately, well-ordered two-stage fight, a formal legal appeal to a higher court of public opnion? Does anyone really believe this? I doubt even Ezra Klein believes it--though I guess every great spinner believes his own spin. (And Klein, unlike Ambinder, seems like a spinner rather than a spinnee.)
What he breezily glosses over is the possibility--increasingly, the actuality--that they've already lost the public opinion battle for the near future. If they now need public opinion to pass the bill in the fall, they aren't going to pass a bill. It turns out you may only get one chance to roll out a giant legislative initiative. You can't roll it out with a cost-cutting rationale and then switch cunningly and seamlessly to a security-providing rationale without addressing the fears raised by the first set of arguments.
Specifically, a few "gut"-grabbing insurance horror stories aren't going to calm the "rationing" fears of those now covered by Medicare (who don't worry about their insurance, or didn't until Obama came along). The best defense is not always a good offense (cf. Dunkirk). In this case, what's required would seem to be more a dramatic repudiation of the administration's own cost-bending, treatment-discouraging rhetoric.
Obama can't fire himself, but he can fire the curve-bending wonks who convinced him that talking about end-of-life issues was a good way to sell universal care. He can find himself a health-care Petraeus. And he can ditch the closest thing to a "death panel" in the legislation--the IMAC board. The more traumatic and high-profile the intra-administration upheaval, the more space Obama buys to relaunch his plan as a rationing-free coverage extension.
That would be a Plan B. ...
P.S.: Maguire mocks the NYT's effort to bury, under a layer of anti-yahoo sneering, the evidence in its own pages of Obama talking about restricting end-of-life treatments to save money. ...
**--See Lori Montgomery's wildly unconvincing argument that health care reform has to drive down the long-term cost curve (not just be "paid for") in order to pass. Maybe if the vote was taken by the respectable, responsible newspaper editors who order up hothouse pieces like Montgomery's. As Klein notes, the "curve-bending" argument didn't even carry the day inside the Beltway, while provoking active hostility outside. ... 3:49 P.M.
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