Editore"s Note
Tilting at Windmills

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January 25, 2007
By: Kevin Drum

HALFWAY MEASURES....I don't want to jump all over Barack Obama before he has a chance to present his ideas in a serious way, but can I just say that I found his healthcare speech today distinctly underwhelming? He starts out with his trademark high-flown rhetoric ("Plans that tinker and halfway measures now belong to yesterday") but then we get to this:

If we brought our entire health care system online, something everyone from Ted Kennedy to Newt Gingrich believes we should do, we'd already be saving over $600 million a year on health care costs. The federal government should be leading the way here.

....Another, more controversial area we need to look at is how much of our health care spending is going toward the record-breaking profits earned by the drug and health care industry.

....We also have to ask if the employer-based system of health care itself is still the best for providing insurance to all Americans. We have to ask what we can do to provide more Americans with preventative care, which would mean fewer doctor's visits and less cost down the road. We should make sure that every single child who's eligible is signed up for the children's health insurance program, and the federal government should make sure that our states have the money to make that happen. And we have to start looking at some of the interesting ideas on comprehensive reform that are coming out of states like Maine and Illinois and California, to see what we can replicate on a national scale and what will move us toward that goal of universal coverage for all.

Like I said, I'll wait for more. But this sure sounds like tinkering and halfway measures to me. After declaring in no uncertain terms that "affordable, universal health care for every single American must not be a question of whether, it must be a question of how," we get a few lines about better use of technology, some tsk-tsking about insurance industry profits, and a bit of musing about whether employer-based healthcare is still the best idea out there. That's....not very bold. After all, the link between employment and healthcare has been the fundamental issue underlying the universal healthcare debate for the past century, and I'd expect Obama to have a few thoughts about it by now.

We'll see. Maybe he's just setting the stage. Maybe in a little while he'll give a major speech in which he really does endorse universal healthcare rather than fiddling around the edges of the debate. We'll see.

UPDATE: Just to be clear: I'm not looking for a 300-page white paper. But I'd like to know that Obama is committed to genuine universal healthcare, not just a bunch of band-aids on our current system. This speech simply doesn't give me the warm fuzzies on that front.

I know that endorsing a serious universal healthcare plan is politically difficult, and maybe Obama is just working up to it slowly. That's fine. But high-profile candidates have a special obligation here. Dennis Kucinich can yell "Medicare for All" until he turns blue, and nobody's going to listen. That's not fair, but it's reality. High-profile candidates like Obama, Clinton, and Edwards can change that. If they commit to a genuinely bold healthcare initiative, it becomes a legitimate topic overnight. Until they do, though, it stays on the fringe.

Kevin Drum 1:04 PM Permalink | Trackbacks | Comments (77)

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Comments

We need a hero.

And I think that when he shows up, it will be obvious.

Posted by: katiebird on January 25, 2007 at 1:30 PM | PERMALINK

Obama recognizes that America already has the best health care system in the world, so "tinkering" as Kevin calls it, is exactly what the doctor ordered! Even so his propopsals jeopardize the free market principles that give our health care system its strength.

Posted by: Al on January 25, 2007 at 1:33 PM | PERMALINK

This is exactly my concern with Obama. All talk and no real substance is a fear for me. I'd like him to take a tough stance on something other than himself. I applaud his coming down hard on Fox News, but it concerns me that his rhetoric seems to outweigh his accomplishments.

Posted by: Doubting Thomas on January 25, 2007 at 1:34 PM | PERMALINK

No.

Not very bold at all.

Wait and see how much funding he gets from the Medical Insurance and Big Pharma lobbies. A little later in this campaign cycle, we'll see where he really stands. Right now, we're at the "that's a nice business you got there, it'd be a real SHAME if something were to, you know, happen to it." stage.

Posted by: Extradite Rumsfeld on January 25, 2007 at 1:38 PM | PERMALINK

The US spent 1.9 trillion dollars on healthcare in 2005. So 0.6 billion / 1900 billion = 0.0003, or 0.03%. Healthcare costs go up by that amount every couple days at current growth rates.

So, assuming that estimate is correct we can get back to the good old days of tuesday by implementing this plan.

And isn't the federal government already pioneering this at the VA?

Posted by: jefff on January 25, 2007 at 1:40 PM | PERMALINK

If our system is the "best health care system in the world" then the world is in serious trouble. No system that spends as much as our system does, and provides so little service can be called either efficient, or moral.

Al would rather see 46 million Americans do without health care at all than have one pharmaceutical company do with one dollar less of profits.

If health care is to continue to be a commodity, like beer and soap, then I propose that all other services become commodities as well. For instance, police protection.

Before the police are allowed to stop a burglar from robbing Al's house, they should force Al to present proof that he can afford to pay their services. And if he dare say "but I pay through my taxes" they should respond "what are you, a communist?"

Posted by: Dicksknee on January 25, 2007 at 1:42 PM | PERMALINK

I'm agnostic on Obama (hate the hype) but this speech warmed me up a few degrees.

Lookit, he flat out calls for universal health care coverage. C'mon. He's setting the table for a serious debate. And his timetable of end-of-next-president's-term is the right one. Not going to happen in the next two years.

Why such negativity? He's saying we have to do it, it has to be universal, we can model on what's working in other nations and several US states, we have to *do it* not talk about it, the time for action is now.

What do you want? Jesus Christ on a ray of sunshine? Get your wonky heads out of your wonky ... stop me.

I like the speech. It pushes things forward.

Posted by: Piehole on January 25, 2007 at 1:43 PM | PERMALINK

its time to talk issues and detail again.

Obama and Hillary and the rest need to release their plans to the public in detail via the Internet. TV will not be able to kill the plan and the blogsphere will get into the minutia to make it really excellent legislation. Open to the public and it will sale through and everyone will be happy.

The Internet makes the beltway a whole lot bigger. Let the dem candidates embrace that reality.

Posted by: patience on January 25, 2007 at 1:48 PM | PERMALINK

And maybe John McCain really wants to get out of Iraq, really is pro-choice and pro-gay marriage, really is a great big giant liberal, but he's just saying these things he doesn't really mean or believe so that the right-wingers will vote for him, and then, someday, when he's president, all our liberal dreams will come true! If Obama isn't walking the walk, maybe it's because he isn't walking the walk.

Posted by: bobbo on January 25, 2007 at 1:49 PM | PERMALINK

It is a problem with Senator Obama, high language and little details. Probably whey he gives off he feeling of a very good Motivational Speaker.

Posted by: JM on January 25, 2007 at 1:52 PM | PERMALINK

And please, since this is clearly going to become more of an issue (as though it could be less of one), let us be careful to distinguish between universal care and universal coverage (or financing).

Talking about universal care opens the door -- not entirely wrongly imo -- to discussions of the drawbacks of, e.g., the UK's NHS, and in any case it would be a much larger undertaking (not worth it, again imo).

Universal coverage, on the other hand, is practical both politically and administratively, and imo is a very good idea. Also, the only serious opponents to it are those who make money off the current coverage system -- principally inscos -- and they shouldn't be too tough to demonize as Enemies Of America's Families And Children.

Posted by: bleh on January 25, 2007 at 1:53 PM | PERMALINK

Obama wrote about some health care ideas in his new book

With these principles in mind, let me offer just one example of what a serious health-care reform plan might look like. We could start by having a nonpartisan group like the National Academy of Science’s Institute of Medicine (IOM) determine what a basic, high-quality health-care plan should look like and how much it should cost. In designing this model plan, the IOM would examine which existing health-care programs deliver the best care in the most cost-effective manner. In particular, the model plan would emphasize coverage of primary care, prevention, catastrophic care, and the management of chronic conditions like asthma and diabetes. Overall, 20 percent of all patients account for 80 percent of the care, and if we can prevent diseases from occurring or manage their effects through simple interventions like making sure patients control their diets or take their medicines regularly, we can dramatically improve patient outcomes and save the system a great deal of money.

Next, we would allow anyone to purchase this model health-care plan either through an existing insurance pool like the one set up for federal employees, or through a series of new pools set up in every state. Private insurers like Blue Cross Blue Shield and Aetna would compete to provide coverage to participants in these pools, but whatever plan they offered would have to meet the criteria for high quality and cost controls set forth by IOM.

To further drive down costs, we would require that insurers and providers who participate in Medicare, Medicaid, or the new health plans have electronic claims, electronic records, and up-to-date patient error reporting systems—all of which would dramatically cut down on administrative costs, and the number of medical errors and adverse events (which in turn would reduce costly medical malpractice lawsuits). This simple step alone could cut overall health-care costs by up to 10 percent, with some experts pointing to even greater savings.

With the money we save through increased preventive care and lower administrative and malpractice costs, we would provide a subsidy to low-income families who wanted to purchase the model plan through their state pool, and immediately mandate coverage for all uninsured children. If necessary, we could also help pay for these subsidies by restructuring the tax break that employers use to provide health care to their employees: They would continue to get a tax break for the plans typically offered to workers, but we could examine a tax break for fancy, gold-plated executive health-care plans that fail to provide any additional health benefits.

The point of this exercise is not to suggest that there’s an easy formula for fixing our health-care system—there isn’t. Many details would have to be addressed before we moved forward on a plan like the one outlined above; in particular, we would have to make sure that the creation of a new state pool does not cause employers to drop the health-care plans that they are already providing their employees. And, there may be other more cost-effective and elegant ways to improve the health-care system.

The point is that if we commit ourselves to making sure everybody has decent health care, there are ways to accomplish it without breaking the federal treasury or resorting to rationing.

Posted by: Jeff on January 25, 2007 at 1:53 PM | PERMALINK

Anytime someone says that we need to bring the entire health care system online, I realize that they are dangerously ignorant. I spend my days working on this, and it is both extremely difficult to do, and extremely time consuming.

It ain't gonna happen anytime soon.

Universal health care is needed, and we need, today, to reject the failed, idiotic, for-profit Repukeliscum model. We've tried it, it doesn't work.

Posted by: POed Lib on January 25, 2007 at 1:55 PM | PERMALINK

I've got a question for the wonks out there: It's always taken as an unquestioned premise that giving people more access to preventive care upfront reduces overall costs. That sounds like it ought to be right, but is there any hard data to back that up? And by that I mean studies that actually control for things like, the people who have preventive care are usually wealthier and therefore likely to live under healthier conditions, etc. It sounds good, but I wonder whether it's not a little bit like the perennial bullshit proposals to balance the budget by "cutting waste" rather than making difficult choices.

Posted by: Glenn on January 25, 2007 at 1:59 PM | PERMALINK

I think this is just the way Obama operates. He states a goal clearly and forcefully, but he stays fairly agnostic on the way to get there. Now, for those of us who have already made up our minds on the issue and want our own favorite plan enacted, this can get a bit frustrating. But there's a lot to be said for forging a consensus on ends before moving on to what works and what doesn't.

Posted by: Ben on January 25, 2007 at 2:00 PM | PERMALINK

And we have to start looking at some of the interesting ideas on comprehensive reform that are coming out of states like Maine and Illinois and California,

I think you can advocate a bold plan, or you can advocate a plan that can pass Congress and be signed by the president. I think you need to pursue a "thin end of the wedge" strategy, and pass a small improvement now and work toward another small improvement in the future.

Posted by: calibantwo on January 25, 2007 at 2:10 PM | PERMALINK

Hmm, Glenn's request may be a bit of a tall order.

Certainly preventive care is cheaper than treatment for a specific condition, but that's just "a stitch in time saves nine."

Testing that proposition rigorously, though, would raise significant ethical barriers. It probably would not be possible ethically to deny preventive care to a control group in order to compare them to a test group that is provided with such care.

It might be possible simply to provide preventive care to a group of people who are demographically similar to a segment of the population known to not receive such care, and then later compare the health records of the former group to those of some sample of the latter segment, although of course that would require obtaining access to those records after the fact.

Very expensive in any case...

Posted by: bleh on January 25, 2007 at 2:15 PM | PERMALINK

I concur with Ben and some other commenters - he's clearly stressing the idea, but what good is yet another 50 page wonkish health care proposal? If Ezra Klein endorses it, does anyone in Washington care? He's just setting himself up for getting some serious shit done in Washington.

I hope. But you gotta have faith.

Posted by: Steve W, on January 25, 2007 at 2:16 PM | PERMALINK

Ben's correct.

I'm getting really sick of this "Obama has no substance" meme that the Lefties are hyping more than even the wingnuts.

Obama says in a speech that he is in favor of universal health care, but because he didn't outline a comprehensive plan, you think he has no substance? Geezus! Read his books, go to his website, if you want more details! But stop complaining that because in this or that speech he doesn't hit every bullet point that you expect that he is unserious or lacking in details. In other words, do some f-ing homework.

In fact, I think Obama better end every one of his speeches with "for more details, see www.obama2008.com", to keep the circular firing squad from forming to shiv yet another Dem.

Posted by: Disputo on January 25, 2007 at 2:16 PM | PERMALINK

Obama is not a hollow man, he is filled with ambition. Unfortunately, ambition is his only reason for seeking the Democratic nomination for president.

Posted by: Brojo on January 25, 2007 at 2:17 PM | PERMALINK

Obama is not a hollow man, he is filled with ambition. Unfortunately, ambition is his only reason for seeking the Democratic nomination for president.

Yet another mind reader who eschews research. Nice.

Posted by: Disputo on January 25, 2007 at 2:21 PM | PERMALINK

Where's the beef?

Posted by: Hillary Clinton on January 25, 2007 at 2:21 PM | PERMALINK

"...his propopsals jeopardize the free market principles that give our health care system its strength."
Posted by: Al on January 25, 2007 at 1:33 PM | PERMALINK


The health care system is in fact so strong it's strong-arming Americans into bankruptcy.

What I want to know is where did the invisible hand of free enterprise competition go? Why isn't there sufficient competition to keep prices down where America as a nation can afford the kind of healthcare system we need and want?

Find that one flaw in the system and let the government regulate it or challenge companies in court for price fixing or whatever it takes to fix that one flaw, then things might improve.

As a Dem I have grave doubts that making the healthcare financing system part of government is in any way wise.

I want the free enterprise system to work. Why doesn't it and what has to be done to fix it before it bankrupts us all?

Posted by: MarkH on January 25, 2007 at 2:22 PM | PERMALINK

Where's the beef?

Posted by: Hillary on January 25, 2007 at 2:23 PM | PERMALINK

What Obama brings to the table is who he is, which, I admit is a lot, but that isn't what we need at this juncture.

We need people with a lot of critical detail in the inner wonk-world, and people serious about exterminating the basis of Republican power permanently.

Posted by: cld on January 25, 2007 at 2:26 PM | PERMALINK

Obama's right. There still are questions as to how we should do universal healthcare. Possibly we should require people to own healthcare, as they are doing in Massachusetts. Possibly we should have a universal voucher system. Possibly we should provide tax credits to start up insurers, raise competition, and bring prices down. Possibly, but this is not likely, socialized medicine will work.

There must be policy analysis. There must be process. We must experiment with different ways to do universal healthcare at a state level. Eventually, the evidence will present itself undeniably, and the best solution would emerge.

This is policy analysis, and its the last thing ideologues would want to do. Ideologues on the Right will demand a pure market healthcare system, and ideologues on the Left will demand socialized healthcare. Ideologues on both sides refuse to listen to evidence or opposing views, and will likely religiously follow their ideas to the end.

That's not what America needs. What America needs is experimentation combined with a determination to reach its ultimate goal. The "what", universal healthcare has been figured out. The "how" part is what we must experiment to discover. No matter how unsatisfying this may sound to the hard core socialized medicine advocates and hardcore libertarians, Obama was right on all accounts.

Posted by: brian on January 25, 2007 at 2:26 PM | PERMALINK

....Another, more controversial area we need to look at is how much of our health care spending is going toward the record-breaking profits earned by the drug and health care industry.

Hmm... I love Barry-O, but I'm wondering if the guy has seen a report from a major drug company in the past five years. I mean, sure, these guys were pushing IRRs of 17-20% in the 80s and 90s, but the past so many years has been a much more universally accepted 5-7%, which, in business speak, is solid but by no means the gouge of the 80s and 90s.

I'd like to see some real talk about FDA reform to reduce the need for drug companies to earn SO MUCH money from their drugs in SUCH LITTLE TIME. Drug companies and health care consumers could live much more comfortably together if profitting for these guys wasn't such a sprint. Aggressive marketing these guys use now adays is a sign (not a cause) that all the incentives are lined up in the wrong places.

Posted by: Garrett on January 25, 2007 at 2:29 PM | PERMALINK

One thing IS for sure:

Whether they are or not, Democrats seem to be convinced they're in a very strong position. Strong enough to defeat "Harry and Louise" in 2008. HillaryCare was defeated when Clinton was already in office. AFTER the election. Now - they're going to campaign on the issue. This is almost certain to get the Big Pharma, and Insurance companies to roll out the big guns, to either buy them off, or buy off some R candidate to defeat them.

So the Dems who are touting universal care are either one of two things:
1. They're shaking down Big Pharma and Insurance for campaign contributions.
OR
2. They're really serious about Universal Care (I remain skeptical until someone takes a really strong position that they can't redact either - let's see that Sword hanging over their throne!) - and they believe they can win while supporting this issue.

Since Universal Health Care is not all that popular a position with the public; (and if it is, that could easily change with a well-funded advertising blitz), then I must conclude that the Dems are really confident about 2008. And that this confidence comes from other issues.

Which means - either they're planning something stunning on Iraq. Or, they *know* that the other Culture of Corruption shoe will soon drop. Or, maybe they're just clueless about how easily UHC can be destroyed by a slime campaign. They've been clueless before.

Posted by: Extradite Rumsfeld on January 25, 2007 at 2:35 PM | PERMALINK

Obama's wife has worked for the University of Chicago Hospital for several years as a 'community relations' administrator. They met at Harvard Law, this is starting to sound familiar...Can you say 'michellecare'?

Posted by: Buzz on January 25, 2007 at 2:37 PM | PERMALINK

Al: Even so his propopsals jeopardize the free market principles that give our health care system its strength.

I think you are misstating his ideas. What Kevin quoted is mostly just an awareness of issues that need to be addressed.

But what free market principles are you talking about? State government erect, at doctors' and nurses' request, strong barriers to entry into the health professions; then state and federal government subsidize the training of doctors and nurses. Federal and state governments subsidize the scientific research that results in medical progress.

Since the U.S. has tax-funded police working in parallel with private security agencies, and tax-funded schools working in parallel with private schools, a tax-funded judiciary operating in parallel with the private sector ("Judge Judy", etc), tax-funded transportation (river levees, dams, locks; air traffic control; roads) operating in parallal with non-tax-supported railroads and roads, tax-funded scientific research operating in parallel with privately funded research, and a tax-funded military protecting our free market oil imports, THEN what principles oppose our having a tax-funded universal health care system operating in parallel with whatever "free" market is there?

The only issues are pragmatic: since health care resources are limited, how will a "universal" system allocate them? What is the appropriate balance of "efficiency" and "doctor-patient autonomy"? Why have a system in which people who do no useful work (heirs, heiresses, professional athletes) have inexhaustible medical care but 45million hard-working ambitious poor people have practically none?

I claimed yesterday that Canada, Germany, and Switzerland are moving toward a system more like the US, but I did not mean to claim that the US system is perfect. I made the classic "conservative" arguments: make small, well thought-out adjustments, based on what we know works and avoid starry-eyed revolutionary changes; and think about the real costs.

There isn't enough money to pay for, nor enough health care professionals to provide, all the health care that everybody would feel entitled to if everybody felt entitled to get what all the rich people get. And we do not want a system that removes all individual autonomy: if we try, rich people will merely fly to foreign countries for their health care.

We are going to get a multi-tiered system, so we should think about what the lower tier does not cover, if it is the universal and tax-funded tier.

Posted by: calibantwo on January 25, 2007 at 2:38 PM | PERMALINK

I'm confused. Huffingtonpost has a headline saying he called for universal health care in 6 years. That doesn't sound incremental.

Posted by: catherineD on January 25, 2007 at 2:48 PM | PERMALINK

The problems don't seem all that difficult to solve from a theoretical perspective. First, you want to mitigate for adverse selection that would otherwise cause people to eschew insurance. Well, it seems like a tax credit equal to some portion of premium payments would fix this. Second, you want poor people to be able to afford normal expenses not covered by insurance. Another tax credit that decreases with income for out-of-pocket expenses would fix this. Third, you don't want insurers denying coverage to sick people. You could fix this by identifying specific parameters (like age, sex, etc.) that could be used in establishing premiums, outlaw use of other parameters, and require insurers to take all comers. You could also set up a risk pool to avoid any situation where one carrier ends up with a disproportionate share of really sick people.

This would probably mean that the government ends up paying for a decent fraction of health treatment and insurance, but individuals pay for the rest.

Posted by: henry evans on January 25, 2007 at 2:49 PM | PERMALINK

cld: What Obama brings to the table is who he is, which, I admit is a lot, but that isn't what we need at this juncture. We need people with a lot of critical detail in the inner wonk-world

No, the president needs to have a basic knowledge of issues, but it is his staff and congressional staffs that have to have the detailed knowledge to work out the details among themselves after a lot of talk and negotiation. More knowledge by the president doesn't hurt, but it isn't necessary as long as he/she is interested and knows that somebody has to know about the details.

Posted by: anandine on January 25, 2007 at 2:50 PM | PERMALINK

Obama says in a speech that he is in favor of universal health care, but because he didn't outline a comprehensive plan, you think he has no substance?
Posted by: Disputo on January 25, 2007 at 2:16 PM | PERMALINK

Honestly - I can live without details in the speeches. And I do trust Obama more than I trust Hillary on this following point:

I just want some assurance that he will seriously pursue UHC, and that he will not back down as soon as Big Pharma and Insurace open their wallets.

Because if you thought that the War on Terror was the fight of the century, you have not seen anything compared to what Big Pharma and Insurace are going to do to fight this.

I want to know that not only can these Dems NOT be bought, I want to know that they can't be intimidated.

Posted by: Extradite Rumsfeld on January 25, 2007 at 2:51 PM | PERMALINK
I don't want to jump all over Barack Obama before he has a chance to present his ideas in a serious way

Is there some kind of reason people can't present their ideas in a serious way before or when announcing their candidacy for the Presidency? Its hardly as if such announcements are generally made on the spur of the moment without advance consideration. Wouldn't "...before he gets around to..." be more accurate than "...before he has a chance to..."?

Posted by: cmdicely on January 25, 2007 at 2:54 PM | PERMALINK

I can't say this surprises me all that much. Sorry to get all Z Magazine about it, but I think THIS is pretty scathing, at least in terms of what progressives should expect from Barack.

Posted by: peter on January 25, 2007 at 2:55 PM | PERMALINK

Anytime someone says that we need to bring the entire health care system online, I realize that they are dangerously ignorant. I spend my days working on this, and it is both extremely difficult to do, and extremely time consuming.

Is it intrinsically more difficult than online banking (ATMs, and all that) or web-based commerce?


Up till now it has been actively opposed due to privacy worries, and there has been no dedicated effort to implement a system. I appreciate that medical records are more complex than billing invoices; but on the other hand people send quite complex documents electronically hundreds of thousands of times per day (journal articles, home purchase agreements, contracts, technical illustrations).

Posted by: calibantwo on January 25, 2007 at 2:59 PM | PERMALINK

As every working stiff knows, employer based "healthcare" is as bad or worse than no healthcare at all. Between deductions taken from your check for healthcare taxes, co-payments and deductibles etc. at the doctors office you end up paying as much or more than if you just paid cash. This sort of "healthcare insurance" is nothing more than window dressing to make the employer look good and it's a joke.

If we have a TRILLION dollars to throw way at an assinine war why don't we have enough to provide real health insurance for every American?

Posted by: Hah! on January 25, 2007 at 3:03 PM | PERMALINK

Good job Disputo, you are a champ. I think a downside of the netroots/blogosphere is that too many lazy weenie-nerds have access to a keyboard and contaminate bandwidth with their complaints that their specific, and sometimes obsessive, needs are not being addressed – right here, right now and in the way they want.

I remember being a leader of student government at OSU. My office was next door to the office of the OSU Student’s Socialist Party (it was the 1970s). They would spend the entire day loudly arguing about the most arcane and pointless issues, so much so that I don’t think that they ever got anything else done.

“We can’t trust Obama. He’s so hollow….waa, waa, waa”

My god!

Posted by: Keith G on January 25, 2007 at 3:09 PM | PERMALINK

I'm confused. Huffingtonpost has a headline saying he called for universal health care in 6 years. That doesn't sound incremental.

No confusion about it. This is what Obama said:

"I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country."

And this is what Kevin calls "fiddling around the edges of the debate."

Really, folks. Some research, please. Stop propagating wingnut memes.

Posted by: Disputo on January 25, 2007 at 3:10 PM | PERMALINK

Razzle Dazzle, baby, Razzle Dazzle! As Sharpton would probably ask, "where's the beef?"

The same critique here could be applied to EVERYTHING Obama says.

Posted by: gq on January 25, 2007 at 3:15 PM | PERMALINK

"brian" wrote: Ideologues on the Right will demand a pure market healthcare system

Well, sure: Bush's proposals are something very much like that, reducing health care consumption by making it too expensive for most people.

and ideologues on the Left will demand socialized healthcare.

Which "ideologues on the Left" are on record as demanding that? Or was that yet another dishonest straw man from a right-winger? Well, never mind, then...

Posted by: Gregory on January 25, 2007 at 3:16 PM | PERMALINK

Kevin Drum..just one question...why does Obama need to make BOLD statements? Is this a criteria you have for all presidential candidates or just Barack. I am unable to discern what your issue is here.

This speech was all together very impressive. Obama set out a clear objective, to establish that he has the political resolve to push for universal health care. To tell, the public that no matter what prior objections they may have heard in the past or how much corporate money opposed the idea, that it is simply a matter of having the political will to achieve it.

Now, if this is what you want, it is definitely a compelling message to hear. It works because it tells you that we as citizens have the power to make this a political reality.

Obama goes on to say that he cannot do this solely on his own. He needs a Congress with a majority to pass the bills. We do not have a supermajority in Congress right now to pass any bill GWBush vetos. That is the political reality. Obama seeks to galvanize the base to not just elect a President but to also go to the ballot box and vote in congress people and Senators who also have the politic will to fight for universal health care. That is leadership.

All this whinning about policy details is totally unwarranted and invalid. This speech was not to some think tank and even if it was LONG on details the American public would only listen to sound bites of those details.

So stop with this 'no substance' and 'rhetoric'...nothing but right wing meme's is what they are.

Hillary definitely lacks the political resolve to stand up against Big Pharma and Insurance companies to make universal health coverage a reality. She can't sell policy ideas because she gets bogged down in the details and everyone's eyes glaze over.

Obama is blazing a new trail, and he has the integrity, discernment and resolve to bring this country out of the nightmare we have endured under GWBush.

We need bold leadership and that is what he brings us. Leadership which understands consensus is what wins in politics, not bold plans and wonky details...but bold leadership...to stand up and know what is right and lead the public when the majority are clamoring for what is wrong out of fear. It takes courage to provide bold leadership and not the 'smallness of politics' that GWBush engages in and Hillary triangulates about.

Obama is leadership personified, it is seldom seen in politicians with long records in Congress or the Senate. In other words, what is good about an 'experienced' politician?

Posted by: glissade on January 25, 2007 at 3:16 PM | PERMALINK

"its time to talk issues and detail again."

No, it's not. It's almost two years until the election--time to lay the groundwork by talking about principles, not details.

"As every working stiff knows, employer based "healthcare" is as bad or worse than no healthcare at all."

No, it's not. Something is almost always better than nothing.

Posted by: rea on January 25, 2007 at 3:17 PM | PERMALINK

peter, I read this:

ZNet | U.S.

Obama's Audacious Deference
Liberal-Left Myopia and Obama’s Audacious Deference to Power

by Paul Street; January 24, 2007


OK, so I only read half of it. Maybe Marxist-Leninist pretenders like Noam Chomsky won't like Obama, but for progressives who would like to make a positive impact in this generation, Obama has a lot to offer.

That article is for people who seriously consider that blowing up the NY Stock Exchange might enhance human progress even more than blowing down the World Trade Center towers.

Posted by: calibantwo on January 25, 2007 at 3:17 PM | PERMALINK

It is time to start pushing for specific answers.

Single Payer is the answer, everything else is a smokescreen.

Posted by: jharp on January 25, 2007 at 3:18 PM | PERMALINK

anandine, More knowledge by the president doesn't hurt, but it isn't necessary as long as he/she is interested and knows that somebody has to know about the details.


Well, that's what they said about Young George, isn't it?

Posted by: cld on January 25, 2007 at 3:18 PM | PERMALINK

Meanwhile:

Ford posts worst loss in its history: $12.7 billion

http://www.freep.com/apps/pbcs.dll/article?AID=/20070125/BUSINESS01/70125006/0/BUSINESS

Great economy you've got there Mr. "President".

Posted by: Ha! on January 25, 2007 at 3:22 PM | PERMALINK

Mandated insurance is just another blank check to the insurance executives. Watch how high their profits and salaries go as the rest of us are forced to spend money we don't have to get coverage we can't use.

Get the insurance industry out of health care, and you'll see some affordability (finally) in health care. Cover everyone under Medicare. Get rid of the donut hole. Put Medicare premiums at the correct point to pay for it. Use government assistance to pay Medicare premiums (thus replacing Medicaid).

One and only one bureaucracy is bound to save money. (You don't think health insurance companies are bureaucracies, too? You've never tried to get payment from one.)

American's cling to the "market" like a security blanket. It is not the answer to an area like health that should not ethically result in profit.

Posted by: Cal Gal on January 25, 2007 at 3:23 PM | PERMALINK

Well, that's what they said about Young George, isn't it?

Oh good lord, don't start comparing a playboy alcoholic with a self-made civil rights atty and law prof.

Posted by: Disputo on January 25, 2007 at 3:25 PM | PERMALINK

Wellpoint's (Anthem) numbers this morning. $800,000,000 profit in the fourth quarter and $3,100,000,000 (that's $3.1 billion) for the year. Does anyone think that is not obscene when so many have no insurance?

Posted by: jharp on January 25, 2007 at 3:30 PM | PERMALINK

I think Kevin Drum is mistaken about this. It is far more important for the 08 campaign (that is, the Dem primaries followed by the victory of the Dem nominee) to establish the principle that universal coverage must happen, than to endorse the details of any particular plan. The impression the campaign needs to leave in the public mind is exactly the one Sen. Obama very effectively gets across here -- that universal coverage is no longer a matter of whether, but of how.

There is, to be sure, in addition to this, an important policy debate to be had here as well, and some of that debate will and should happen in the primaries. But I would much rather it were conducted as a pragmatic debate, on the basis of an unambiguous, party-wide commitment, to be endorsed ultimately by the general electorate, that universal coverage must be the outcome.

Controversy and therefore compromise over the details of any plan (even "single payer") are inevitable. The key is to set the national agenda up in such a way, that no amount of controversy over or compromise on the details can undermine the general public commitment to achieving universal coverage (as in fact happened in the early 90's).

Posted by: Amileoj on January 25, 2007 at 3:32 PM | PERMALINK

Disputo,

Well, that is what they said about Young George, isn't it?

Democratic standards are just that much higher. While in outline Obama is the kind of person Republicans like to hear themselves admiring, in practice he simply insults them if he knows what he's talking about.

Is he vague to a purpose? I can easily imagine it. But the problems before us now really are complex and require complex understanding, as with the Middle East, broad brush solutions to anything will never work, we need to let the air out one little valve at a time.

Posted by: cld on January 25, 2007 at 3:43 PM | PERMALINK

Amileoj:
How does make a difference. If you think that putting choices on the internet and extending KidCare proposals and state experiments with personal mandates and tax write-offs are the methods, then you are pursuing a universal coverage solution that will not lead to true universal coverage.

What happens when somebody picks a coverage that doesn't handle the illness they will get in six months?
What happens when somebody can't get any tax benefit because they pay a negligible amount in taxes?
What happens to people with prior conditions that insurance companies want to avoid?

If done the wrong way, universal insurance won't make things any better. Also, it will be difficult to pass a good universal insurance bill soon after passing a bad universal insurance bill.

There is not much excuse for a candidate to still be making up his mind at this point. The basic facts surrounding our healthcare problems have not changed significantly in recent times. (Life spans have increased significantly since the 1950s. Costs have gone up significantly, but not in any surprising way.)

Posted by: reino on January 25, 2007 at 3:47 PM | PERMALINK

Set up a national system, picking the best ideas from Canada, France, U.K., etc.

Roll it out as "Medicare for All." Tax it like Medicare.

If people want private care, let them pay their insurance premiums as "tax deductible."

It would be tough, but with the right people in place to research and implement a good program, it could be done in five years or less.

I've worked in the U.K., and know several people from Canada, and I can say this: Whenever you see an American posting comments saying things like "socialized medicine has been proven not to work," you can be assured that he or she does NOT know what they are talking about.

The current system is set up to make money FIRST! Health care may come in 2nd Place, but even that is a stretch...

Medicare for All.

Posted by: Ranger Jay on January 25, 2007 at 3:50 PM | PERMALINK
And this is what Kevin calls "fiddling around the edges of the debate."

Until and unless there is an articulated vision of the shape and form of a universal healthcare system, yes, that's exactly what it is.

Posted by: cmdicely on January 25, 2007 at 3:51 PM | PERMALINK

In the Old Bush administration I don't think I agreed with one thing James Baker ever did, but at least he was good at it. In the present Bush we have a remarkable object lesson in an administration that I simply disagree with and one that I disagree with and isn't any good at it. And they're psychopathically conceited and think they're geniuses.

Somebody said, of Republican demands that Democrats come up with their own plan for Iraq (an easy, obvious, broadbrush kind of solution), 'They drop the egg and they're demanding we should have a plan for how to put it back together?'

In the next ten years there will be a lot of little eggshells that have to be stuck back together and I think the next president will have to be someone who knows a lot about how they fit.

Posted by: cld on January 25, 2007 at 3:58 PM | PERMALINK

Just to be clear: I'm not looking for a 300-page white paper. But I'd like to know that Obama is committed to genuine universal healthcare, not just a bunch of band-aids on our current system.

What gives, Kevin, did you not make it to the end of Obama's speech?

Now is the time to push those boundaries once more. We have come so far in the debate on health care in this country, but now we must finally answer the call first issued by Truman, advanced by Johnson, and fought for by so many leaders and Americans throughout the last century. The time has come for universal health care in America.

Obama called for universal health care, in so many words, in a major public speech. He didn't call for some "solving America's health care crisis" or similar mush; his call for universal health care was, frankly, unambiguous.

I'm agnostic about Obama, but no one can claim that he has the long history of mendacity and incompetence that Bush does. It's one thing to dismiss Bush's claims out of hand; experience makes this stance the only logical option. But your tepid reception, in light of the speech's plain text, is mystifying.

Posted by: Gregory on January 25, 2007 at 4:10 PM | PERMALINK

Until and unless there is an articulated vision of the shape and form of a universal healthcare system, yes, that's exactly what it is.

Obama just jumped in with both feet into the middle of the debate by saying that he is "absolutely determined" to have UHC in the US within 6 years, and yet you agree with Kevin that he is "fiddling around the edges of the debate" just because he hasn't provided you with the details you deem sufficient? (He has articulated a vision of its shape and form, if you'd only care to look, but I assume that you require a 500 page position paper or somesuch.)

I'm reminded of your past insistence that the Dems would lose in Nov unless Pelosi ran on impeachment. Why do you always insist that Dems build huge targets around themselves instead of slowly building public support?

Posted by: Disputo on January 25, 2007 at 4:15 PM | PERMALINK

calibantwo:

I can appreciate where you’re coming from, hence my apprehension in linking to the review at all, but I do think you’re creating a straw man of your own by marginalizing the “radical” left as mere reactionaries advocating “blowing up the NY Stock Exchange” in order to “enhance human progress”. Hyperbole notwithstanding, there’s a lot in the Street piece to be concerned about, it seems to me, including such Obama positions as when he decries South American populists for their attempts to “resist America’s efforts to expand its hegemony” and for trying to “follow their own path to development.” Methinks that’s just how neoliberals in the Kennedy administration got us into Vietnam. Plus, isn’t expanding America’s hegemony one of our current administration’s favorite pastimes?

Speaking of Vietnam, Obama’s screed on the costs of that war (especially in the context of the current one), worth repeating, I think---“The disastrous consequences of that conflict – for our credibility and prestige abroad, for our armed forces (which would take a generation to recover), and most of all for those who fought – have been amply documented.”----COMPLETELY ignores, as Street points out, the costs of that war on without question its most ravaged victim, the Vietnamese civilians (2 million dead? Conservatively?).

There’s a lot more. This doesn’t strike me as splitting hairs. A lot of this speaks to Obama’s fundamental understanding both of American history and of social and political reality. I don’t want to blow anything up, but I think there are specific salient details of this man’s worldview and political platform that progressives will and should be quite concerned about. And I think they ought to at least be part of the discussion.

Posted by: peter on January 25, 2007 at 4:19 PM | PERMALINK
Obama just jumped in with both feet into the middle of the debate by saying that he is "absolutely determined" to have UHC in the US within 6 years, and yet you agree with Kevin that he is "fiddling around the edges of the debate" just because he hasn't provided you with the details you deem sufficient?

Without more details, "universal healthcare" is meaningless rhetoric, correct.

I'm reminded of your past insistence that the Dems would lose in Nov unless Pelosi ran on impeachment.

I'm a bit confused about how you can be reminded of something that never happened.

Why do you always insist that Dems build huge targets around themselves instead of slowly building public support?

Public support for the broad idea of universal healthcare has consistently polled over 50% for something like a decade. The time now is to build support for a more specific vision of universal healthcare, before the Republican attempts to define its form in a way which frustrates the substantive point succeeds in defining the contours of the debate.

Posted by: cmdicely on January 25, 2007 at 4:26 PM | PERMALINK

The problem isn't that Obama didn't give any details. The problem is that the details he gave are not impressive.

As far as Kucinich--it's perfectly fair for people not to pay attention. He isn't trying to actually become President, so he shouldn't be treated ike people who are trying to actually become President.

Posted by: reino on January 25, 2007 at 4:36 PM | PERMALINK

peter: including such Obama positions as when he decries South American populists for their attempts to “resist America’s efforts to expand its hegemony” and for trying to “follow their own path to development.”

The South American populists would serve their citizens better if they worked to achive admission to the WTO, as India and China have, instead of resisting American hegemony and following their own path to development. Chavez in Venezuela and Morales in Bolivia have turned their countries in the direction of expanding poverty, not alleviating it. The progressive goal ought to be to expand human liberty, not merely to stifle the rich. The goal ought to be to prevent concentrations of wealth from producing transgenerational aristocracies and political power, not to confiscate the wealth or to prevent the accumulation of wealth. Entrepreneurs at all levels ought to be respected, therefore, even those that create large corporations, up to the point where they use their wealth to hinder the advancement of others.

To me, taxing inherited wealth to provide medical care to the poor has this liberty-enhancing progressive effect. government controls on prices, and hostilities to profits do not, in my opinion, have any progressive liberty-enhancing effects.

Posted by: calibantwo on January 25, 2007 at 5:01 PM | PERMALINK

Without more details, "universal healthcare" is meaningless rhetoric, correct.

Um, dude, he gave more details; your blinders are just too thick to see it.

I'm a bit confused about how you can be reminded of something that never happened.

Right. You merely insisted that Pelosi hurt would Dems in Nov by taking impeachment off the table when in fact it was never an issue, just as I predicted.

In any case, your prognostication abilities seem to be more affected by your personal desires than an objective analysis of the facts.

Posted by: Disputo on January 25, 2007 at 5:21 PM | PERMALINK

Btw, I've had it for one day with the circular firing squad that is developing once again in this forum.

Posted by: Disputo on January 25, 2007 at 5:23 PM | PERMALINK

calibantwo:

Ugh. I disagree with 75-80% of that. Now you are making me just as nervous as Obama. :) I don’t want to go round and round about it, suffice to say ideological disparities like these are disconcerting, politically if not academically. I hope they don’t keep a Democrat out of the Whitehouse this time around.

Posted by: peter on January 25, 2007 at 5:27 PM | PERMALINK

So Kevin
Any thoughts on Hilary's health care plan? Edwards plan? McCains plan? Richardsons' plan? Other candidates who are exploring a run health care plan? Or just Obama's plan?

Posted by: JerseyMissouri on January 25, 2007 at 5:39 PM | PERMALINK

Right. You merely insisted that Pelosi hurt would Dems in Nov by taking impeachment off the table when in fact it was never an issue, just as I predicted.

Um, no, if you read the thread you linked I said the manner in which she referred to impeachment (the reflexive taking it off the table followed by walking it back) had guaranteed that accountability for the executive for past wrongdoing wouldn't be a positive issue, and that that was, compared to simply leaving the gate open and pivoting to accountability while dismissing impeachment talk as premature, counterproductive. The only thing objectively demonstrated by the facts is the point we agree on: that she destroyed impeachment/accountability for past wrongdoing as an issue.

What we disagreed on, who that would have been a useful issue for had it been a feature of the election, is not demonstrated by the results of the campaign in which it was neutralized (I would say by Pelosi's foolish initial response, which she ineffectively tried to walk back, to the Republicans efforts to neutralize the issue: you would, of course, characterize it differently.)

In any case, your prognostication abilities seem to be more affected by your personal desires than an objective analysis of the facts.

I would say the evidence demonstrates that rather more clearly about your recollection of the past than it does for my "prognostication abilities".

Posted by: cmdicely on January 25, 2007 at 6:02 PM | PERMALINK
The South American populists would serve their citizens better if they worked to achive admission to the WTO, as India and China have, instead of resisting American hegemony and following their own path to development.

Which South American populists are you referring to?

Those in Venezuela (WTO member since 1995)? Bolivia (WTO member since 1995)? Ecuador (WTO member since 1996)? Brazil (WTO member since 1995)? Argentina (WTO member since 1995)?

Please, which South American populists would do better by acheiving admission to the WTO?

Posted by: cmdicely on January 25, 2007 at 6:09 PM | PERMALINK

And, on Kevin's "update":

Dennis Kucinich can yell "Medicare for All" until he turns blue, and nobody's going to listen. That's not fair, but it's reality.

Hey, you know, if its not fair, you could make it less reality by, you know, drawing attention to the position and making substantive posts about it rather than leaving it for throw away one-line comments in posts about Obama.

Posted by: cmdicely on January 25, 2007 at 6:24 PM | PERMALINK

For a factually accurate, even-handed, and entertaining perspective on Obama, see

SHOULD BARACK OBAMA BE PRESIDENT (Nimble Books, October 2006) available at

http://www.amazon.com/exec/obidos/ASIN/0978813804/webadvertising-20 or

http://www.nimblebooks.com/wordpress/should-barack-obama-be-president/

Posted by: Fred Zimmerman on January 25, 2007 at 6:33 PM | PERMALINK

cmdicely: Please, which South American populists would do better by acheiving admission to the WTO?

It could have been worded better. Chavez and Morales are working in the opposite direction to the WTO. Bush did this with the temporary steel import tariffs (I guess "import tariffs" is redundant), but they were temporary. Morales cancelling all the energy contracts with Brazil, and Chavez expropriating the energy and telecommunications industries are intended to be permanent and are a larger scale besides.

Nice of you not to call me an ignorant liar plain and simple.


peter: I disagree with 75-80% of that.

not this line, I hope:

calibantwo: The progressive goal ought to be to expand human liberty, not merely to stifle the rich.

not this line, I hope:

calibantwo: The goal ought to be to prevent concentrations of wealth from producing transgenerational aristocracies and political power, not to confiscate the wealth or to prevent the accumulation of wealth.

"Ill gotten gain" may be the root of all evil, but even Jesus Christ did not oppose the accumulation of wealth; he opposed keeping it once it had been accumulated. Lenin, Mao, Idi Amin, Robert Mugabe, and now Chavez and Morales have shown that you can destroy wealth without alleviating poverty in the least.

Posted by: calibantwo on January 25, 2007 at 10:10 PM | PERMALINK

"Obama recognizes that America already has the best health care system in the world..."

Just as you, Al, recognize that the moon is made of moldy camembert. It must be wonderful living in a country so perfct it can never be improved. I wonder why, then, you are such an bitter, twisted fuck?

Posted by: Kenji on January 25, 2007 at 11:11 PM | PERMALINK

If bringing the US health care system online saves $600 million a year, it's barely worth getting excited about.

If I've done the numbers right, Medicare alone costs around $337 billion annually.

In that context, $600 million, immense as it sounds on first hearing it, is almost the very definition of minor tinkering.

The big battles are administration costs, overinflated specialists' salaries (artificially inflated by the deliberate undersupply of doctors by the AMA), and drug costs (inflated by the unethical marketing tactics of the drug companies, and, arguably, by overly restrictive intellectual property laws).

Posted by: Robert Merkel on January 25, 2007 at 11:42 PM | PERMALINK

>>If I've done the numbers right, Medicare alone costs around $337 billion annually.

Indeed.

'The U.S. could eventually pay a big economic price for all these jobs. Ballooning government spending on health care is a major reason why Washington is running an enormous budget deficit, since federal outlays for health care totaled more than $600 billion in 2005, or roughly one quarter of the whole federal budget.'
'What's Really Propping Up The Economy ' - Business Week
http://www.businessweek.com/magazine/content/06_39/b4002001.htm?chan=top+news_
top+news+index_businessweek+exclusives

And this doesn't count the tax expenditures side of the ledger. That's the free pass for employer health insurance which is deductible to the company but not taxable to the recipients. That's the single largest one on the books, dwarfing the $80B/yr mortgage interest deduction.

That same Business Week article continues:

'Moreover, as the high cost of health care lowers the competitiveness of U.S. corporations, it may accelerate the outflow of jobs in a self-reinforcing cycle. In fact, one explanation for the huge U.S. trade deficit is that the country is borrowing from overseas to fund creation of health-care jobs.

There's another enormous long-term problem: If current trends continue, 30% to 40% of all new jobs created over the next 25 years will be in health care. That sort of lopsided job creation is not the blueprint for a well-functioning economy.

Almost invisibly, health care has become the main American job program for the 21st century, replacing, at least for the moment, all the other industries that are vanishing from the landscape. With more than $2 trillion in spending -- half public, half private -- health care is propping up local job markets in the Northeast, Midwest, and South, the regions hit hardest by globalization and the collapse of manufacturing.

Still, using health-care spending to create the vast majority of new jobs, while beneficial in the short run, is not desirable over the long run. A well-balanced economy needs to provide a wide variety of jobs, not just positions for doctors, nurses, and medical technicians.

The biggest worry is that demand for health care will absorb too much of the workforce and squeeze out other types of jobs. If medical spending rises to 25% of gross domestic product by 2030, as many economists expect, health care's share of jobs could grow to 15% or 16% of the labor market from today's 12%, based on historical patterns.

Such a shift in employment would require health care to be the single biggest creator of jobs in the economy for the foreseeable future. And while the U.S. could in theory afford to spend 25% of GDP on health care, it's hard to imagine a world in which our children have to choose between working for the local hospital or the local health insurer.'

Just as you can't demand low rates to borrow and high rates to save; you can't look to curtail the health care-industrial cost spiral while at the same time looking to it as the primary source of job growth.

Posted by: MsNThrope on January 26, 2007 at 9:28 AM | PERMALINK
Just as you can't demand low rates to borrow and high rates to save;

Unless you are a bank, in which case that's pretty much your entire business model.

Posted by: cmdicely on January 26, 2007 at 1:52 PM | PERMALINK

Just as you can't demand low rates to borrow and high rates to save;

Unless you are a bank, in which case that's pretty much your entire business model.
Posted by: cmdicely

Much of that business model rests upon the fact that banks create 'money supply' out of thin air (the multiple expansion of deposits). I aced Econ 301 (Money and Banking) back in the day.

I understand the 'spread' whereby banks pay their depositors as little as possible on deposits and charge as much as possible lending (and re-lending) out those deposits.

Which brings us full circle back to my original assertion.

Posted by: MsNThrope on January 27, 2007 at 8:56 AM | PERMALINK




 

 

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