Will HCR Reduce Costs? [Updated]

A new report from the Medicare's Office of the Actuary says no. Coverage will expand to 34 million more people - but overall medical spending will increase about 0.9% in the first decade to achieve that goal. A couple of notes:

1. Even if this report turns out to be accurate, I'd argue (as the White House does) that HCR is still a bargain.

2. This is a rather pessimistic analysis (that's not to suggest it's flawed; in fact, pessimism is helpful in these sorts of matters). That's just a way of saying that it's extremely difficult to predict the costs of such a sweeping bill (and besides, it's way beyond my expertise). It should also be noted that this report concerns total medical spending, not the deficit specifically. But on the question of the deficit and costs more generally, I would point you to the arguments and analyses of some leading economists and health care experts* who would disagree with this report's finding. Bottom line: it's a tough question! The consensus seems to be that the bill either lowers costs or - in the new report's more pessimistic prediction - comes really close. For a bill that extends insurance to 32-34 million Americans, that's pretty impressive.

3. The fact that I came across this article on the Huffington Post says something about epistemic closure: namely, that it is largely a right-wing phenomenon with no liberal analogue (at least not right now).

*The Commonwealth Fund study I linked to dates from December 2009; for a more updated look at the bill's costs from David Cutler, a Harvard health care economist and one of the study's authors, see this WSJ editorial. He concludes that the bill will cut costs and gives most of its saving measures "passing" grades (Subscription required.)

UPDATE: Some helpful analysis from Jon Chait here. He points out that the Medicare Actuaries are extremely reluctant to factor behavioral changes into their analyses, meaning that their findings sometimes underestimate savings that are created by changing incentives. (This was one of the reasons that the office overestimated the cost of the Medicare prescription drug bill by 37%.) And this bill is chock full of programs aimed at changing behavior and incentives - at least some of which will produce major savings, just not savings which can easily be predicted.

Keep This in Mind

Next time you hear somebody cite First Things as a home for intelligent Catholic conservatism, just respond with this. Joshua Keating is good-natured enough to poke some fun.

It shouldn't shock me anymore, but somehow it still does: this is the opposition.

Maybe I'm Just Being a Puritan, But...

...I think it's really beneath the dignity of the President and the presidency to hawk a t-shirt, especially this one, to commemorate a legislative achievement.* First of all: this is health care reform, not the Stanley Cup. It doesn't need a t-shirt.

More importantly: the DNC and Organizing for America should know better than to stick the Obama brand on something that refers to a major political achievement as a "BFD." (Frankly, I find a lot of the official Obama marketing and media outreach to be cheesy and distasteful. But whatever.) It's not that I disagree with the shirt - getting health care done was a big effing deal, and I'm glad it happened. But can we show a little more respect for the office than this?**

*Yes, I realize this is technically the work of the DNC and Organizing for America, not the White House. But still.

**Also, if you're going to comment that there are other, more serious offenses that harm the dignity of the presidency (like lying about torture), don't bother: I realize this, and I agree with you. But this one is beneath Obama, and it should have been a no-brainer to whatever bozo was running the shirt design contest.

In Which I Write About Television

Or something. Actually, I'm not going to say much, since (as you may have noticed from the lack of posting) I'm incredibly busy right now. But I wanted to say that I find something a little odd about the pieces I keep reading by people who take 30 Rock personally. Or, to put a finer point on it, by people who seem to be reading way too much into the show. I don't think Tina Fey is out to mock single women in order to feel better about the dullness of her real-life marriage, or that we're actually supposed to think Liz Lemon isn't attractive (that's part of the joke!), or that deep-down the show promotes conservative politics.

The most bizarre example of this trend was Feministing's take on 30 Rock a few months back, in which the writer came so close to getting the joke:

The most frustrating thing about 30 Rock, an otherwise excellent show, are the constant references to the fact that Tina Fey's character Liz Lemon is ugly. The thing is, Tina Fey fits conventional standards of female beauty almost to a T.

That's why it's funny! The entire Liz-Jenna dynamic set up by the show is one big joke: Liz, who is constantly referred to as plain or homely, is naturally beautiful. But Jenna, the heavily made-up blonde TV star who always talks about her good looks, has that faded-beauty look to her: you can tell that she was attractive when she was younger, but her refusal to deal with her age gracefully means she always looks like she's grasping (unsuccessfully) for some of her past glory. Hence her absurd dismissals of Lemon's looks: that she could never be an actress "because of her neck" and so on. It's a joke. Maybe we should just laugh - and refrain from suffocating the show's humor with forced political readings of our favorite episodes. (Unless I'm doing a political reading. Then it's OK.)

Healthcare Is Passed! [UPDATED with link]

And I was the first caller on C-SPAN! (Yes, yes, I know, the real credit goes to President Obama, Speaker Pelosi, and Majority Leader Reid, for their historic leadership, but let me have my blogger's day in the sun! I'll have more thoughtful reactions later when I've calmed down...)

Apparently my performance was loved by some (or at least one!)...

"Im loving this first caller into #CSPANright now, 'I think this will go down as a wonderful day in American Legislative History'"

UPDATE: Link to video here - call starts just before the 35-minute mark.

Getting it Wrong on Reconciliation

Megan McArdle doesn't seem to grasp the details of the current discussions over reconciliation and the healthcare bill, but she sure does enjoy "dismantling current liberal talking points!"

In a post that I'm kind of baffled by, McArdle admits that she doesn't care that much about the legitimacy of using reconciliation to pass healthcare reform, but still, liberals are wrong and they're doing something really crazy with it. Just sayin'.

To that end, she cites a post by Prof. Joyner at Outside the Beltway noting that just over half of the major bills passed by reconciliation had supermajority support. This, Joyner says, shows that historically, reconciliation hasn't been used "as an end-around to avoid a cloture vote," so using it to bypass a filibuster and enact major legislation "is exceedingly rare, having happened at most 7 times since 1980." Joyner concludes, "using reconciliation to avoid a supermajority on health care reform would simply be unprecedented."

In response, McArdle wrote, "The word "unprecedented" doesn't strike me as all that troubling--we're not in court. But to the extent that you care, this use really does seem to be novel." So to sum it up: she doesn't care. But if you care - which, just to remind you, she doesn't - Democrats are totally wrong and are tossing historical precedent out the window. Again: just sayin'.

There's just one problem: both McArdle and Joyner have their facts completely wrong. The Senate already passed healthcare with a supermajority. Does anyone else recall the massively important 60-39 vote to pass healthcare on Christmas Eve? Or the constant reminder that both the Senate and the House have already passed bills, and the only remaining task is to reconcile the two bills? Does Megan McArdle not understand this, or did she simply forget that the bill has already been passed?

No one - no one - is talking about using reconciliation to pass comprehensive healthcare reform. The only use of reconciliation would be to make changes in the Senate bill's taxing and spending provisions in order to reconcile it with the House bill. This really isn't that complicated, but Megan McArdle is apparently not alone among major journalists in failing to understand it. Jon Chait recently banged his head against a wall trying to explain it to Politico's Mike Allen. "In the grand scheme of things," Chait wrote, "the changes in the reconciliation bill will be minor [...] I understand perfectly well how intelligent people who don't follow this debate closely might not catch on to the distinction. But this is what Mike Allen does all day -- and, as I understand it, much of the night and the wee hours of the morning as well. How can anybody still not understand this?"

I wonder the same thing myself - but here's a stab at an answer: lots of people don't want to understand it. Having a clear grasp of the facts makes the bill's (impending?) passage more difficult to criticize.

A New Direction? [Updated]

The story here is still coming together, but it seems that Virginia Governor Bob McDonnell, who I criticized in a recent post about this very issue, may be changing his stance on workplace protections for LGBTQ Virginians:

After a day of legislative maneuvering and protests, Gov. Bob McDonnell issued an unusual executive directive saying workplace discrimination, including bias against gays, is prohibited in Virginia.

McDonnell’s pronouncement doesn’t make the anti-bias statement law, but says it must be obeyed in Virginia because such discrimination would be against the state and U.S. Constitutions.

When taking office, McDonnell stopped short of signing the executive order that previous governors signed - one which would have banned such discrimination. And it's not clear that he's actually calling on the legislature to make the change into law. Additionally, his statement is meeting with some opposition from Attorney General Ken Cuccinelli, who was on his ticket and shares a solid Christian right background. We'll see what happens, but it's a positive sign. Hopefully McDonnell will press forward with this welcome change. I argued that he was and remains a culture warrior, but I'd be happy to be proven wrong.

UPDATE: Marc Ambinder explains the "executive directive" as carrying less force than an executive order, but nonetheless directing the state to treat McDonnell's earlier executive order as if it did protect gay workers. Ambinder notes that the decision seems to have been motivated, at least in part, by fear of appearing like too much of a culture warrior - and he adds that "it does say something that the very conservative Republican governor of Virginia understands that it does not look good to be seen as endorsing discrimination against gays." It's pretty revealing that Republicans are just now realizing this, but there you have it.

The President's Ear

There's a lot of argument right now about who has it. Some of the more liberal members of the party are convinced it's Rahm Emanuel and that he is cynically destroying the Obama presidency by caving on every liberal goal. Steve Clemons has been making this argument in a series of increasingly obnoxious, uncharacteristically fact-free posts that seem to add up to - well, I couldn't really say. His most specific piece of advice is this head-scratcher:

Set up a Team B with diverse political and national security observers like Tom Daschle, John Podesta, Brent Scowcroft, Arianna Huffington, Fareed Zakaria, G. John Ikenberry, Brent Scowcroft, Joseph Nye, Rita Hauser, Susan Eisenhower, Katrina vanden Heuvel, John Harris, James Fallows, Chuck Hagel, Strobe Talbott, James Baker, Zbigniew Brzezinski, and others to give you a no-nonsense picture of what is going on.

What does this even mean? Is there going to be a "Team B" room where respected academics team up with publishers of an internet tabloid to tell Obama that Guantanamo should be closed by now, as if he didn't know that? And besides, nearly all of these people are either writing blogs, regular opinion columns, academic papers, or magazine pieces - or appearing regularly on TV. Is there any reason to think their opinions aren't already known, or that they're not in contact with the White House already? (If you think Tom Daschle's not communicating with the White House right now...) This is exactly the kind of gimmicky nonsense that the White House doesn't need.

Anybody can read my complaints about this presidency right on this site, but one thing you won't see me claim is that this president is indifferent to progressive causes. He might not always go as far as I would like, but I simply cannot see this portrayal of Emanuel as a cynical, unprincipled Machiavellian running the White House into the ground and abandoning all progressive goals as nothing more than a lazy caricature. Ezra Klein seems to agree with me, and he offers some helpful perspective:

In fact, what appears to be happening is that Barack Obama is listening to his policy people. He didn't scale back the health-care reform bill because they convinced him that the different pieces didn't work on their own. He's trying to close Guantanamo because a lot of people who work on this stuff think we should close Guantanamo. That's the thing about electing a smart technocrat as president: He's swayed by smart, technocratic arguments. The political people are being used to help sell and shepherd the policy, and to figure out how much of the policy can pass Congress, but they seem to be losing the major arguments over what that policy should be.

The obvious counterargument here is the stimulus debate, but as Michael Tomasky has noted, the limits on the size of the stimulus appears to have come from the House of Representatives (and then, later in the process, from the Senate). Maybe Rahm and the White House didn't do enough to break through those limits, but they also thought the recession would be a lot milder than it actually was, and so didn't act with quite the urgency that better information might have furnished.

The point about the stimulus is well-taken. And I'd add to the domestic policy part of this argument that Obama has very publicly staked a massive part of his presidency on the success of comprehensive healthcare reform. And he has not backed down from the goal of a comprehensive bill. The period immediately following the Brown election was disheartening, but people who thought the White House would give up or scale back their efforts were wrong. Obviously, a lot depends on what happens in the next few weeks - we'll see if we get the bill (and it's now appearing that we will). When healthcare is done, people will come back to their senses. The process has been wrenching, and liberals faced some agonizing moments when Obama's approach seemed excessively cautious and pragmatic. But I expected caution and pragmatism, and that's what Obama promised in the campaign. And after a long, grueling process, he still hasn't abandoned the healthcare effort. He kept that promise too.

The Tensions of Obama-ism, Pt. II

Can he get worthwhile legislative victories and govern as a uniter? Edward Luce of the Financial Times says no (registration required, link via Brad DeLong):

Forget bipartisanship Obama: shoot for the moon: The problem started even before he was inaugurated. Mr Obama was faced with two conflicting objectives. First, try to revive a rapidly sinking economy by crafting a big fiscal stimulus – one that should be “timely, targeted and temporary” in the words of Lawrence Summers, Mr Obama’s chief economic adviser. Second, try to win over as many Republican votes as possible. In the event, Mr Obama got the worst of both worlds – a poorly designed stimulus that won only three (out of 41) Republican votes in the Senate. The price of those three was high. In order to appeal to the Republicans, a third of the “stimulus” was frittered away in minute tax cuts that most families either saved or used to help reduce their household debts. Designed to stimulate the economy and Republican support, the tax cut achieved neither. Second, its overall size was cut from $1,200bn to about $800bn – considerably lower than most economists believed was necessary to kick-start the economy. In order to win over Susan Collins, a Republican senator from Maine, the Democrats removed $83bn of short-term spending from the bill at the cost of 400,000 jobs....

A year later, little has changed. This week pundits got excited about a $15bn jobs promotion bill that was enacted in the Senate. The excitement was confined to political observers, who noted that the bill passed with the support of 13 opposition votes, including that of Scott Brown, the Republican who took the late Ted Kennedy’s Senate seat in last month’s Massachusetts election. It was celebrated as a victory for bipartisanship. What it did not herald was much of a victory for jobs. Economists confined their observations to the fact that the bill, which offers employers a one-year holiday on the 6.2 per cent payroll tax they pay if they hire someone who has been out of work for more than two months, was unlikely to make a notable dent in unemployment. Businesses are suffering from a lack of demand not supply....

Finally, Mr Obama’s bipartisan instincts arguably contributed to the parlous state of healthcare reform today. The most serious blow to the bill came last summer when Mr Obama allowed a small group of centrist Democratic and Republican senators to negotiate on a compromise. The exercise robbed Mr Obama of three valuable months and ceded the initiative to people who had no prior record of fighting for healthcare reform. It also created the space for the demagogic “townhall” meetings in which the bill was depicted as a Trojan horse for socialism, euthanasia and an all-seeing federal bureaucracy. The net result? No Republican votes....

American presidents with the greatest record of bipartisan legislative achievement, notably Franklin Roosevelt, Lyndon Johnson and Ronald Reagan, got their way by intimidating opponents, not by splitting the difference. As Machiavelli famously observed, it is better for a prince to be feared than loved. For all his intelligence, nobody fears Mr Obama...

One popular theory right now is that as long as the Republicans remain in la-la land, the president may have to choose between sound policy and political comity. But right now he's trying for the latter, and in so doing he's sacrificing the former and getting neither. (Actually, to be fair, I'm not sure I'd go so far as to say he's not getting any sound policy changes - health care, if it passes, will be huge, and the stimulus, for all its flaws, was necessary and successful, even in its watered-down form).

My gripe: I think the choice between good politics and good policy is a false one. Matt Yglesias argued a while back that a larger stimulus would have boosted the economy much more than the one we got, which in turn would have done a lot more to reassure nervous Democrats than limiting its price tag (and, correspondingly, its effectiveness) did. I agree with this analysis. The public wants political reconciliation, but it also wants policies that work. If Obama can get the policy right, than he's solved more than half of his problem - the rest is just a messaging battle, trying to convince people that the Republicans a) have no serious policy ideas and b) have consistently refused to negotiate in good faith. I think that's a political fight Democrats can win, but if they can't marry their political argument with tangible policy victories, they'll be in hot water come November.

Finally, A Party I'd Go To

The Post reports that there's a new movement afoot: coffee parties!

From a pretty funny story today:

Furious at the tempest over the Tea Party -- the scattershot citizen uprising against big government and wild spending -- Annabel Park did what any American does when she feels her voice has been drowned out: She squeezed her anger into a Facebook status update.

let's start a coffee party . . . smoothie party. red bull party. anything but tea. geez. ooh how about cappuccino party? that would really piss 'em off bec it sounds elitist . . . let's get together and drink cappuccino and have real political dialogue with substance and compassion.

Friends replied, and more friends replied. So last month, in her Silver Spring apartment, Park started a fan page called "Join the Coffee Party Movement." Within weeks, her inbox and page wall were swamped by thousands of comments from strangers in diverse locales, such as the oil fields of west Texas and the suburbs of Chicago.

I have been searching for a place of refuge like this for a long while. . . . It is not Us against the Govt. It is democracy vs corporatocracy . . . I just can't believe that the Tea Party speaks for all patriotic Americans.. . . Just sent suggestions to 50 friends . . . I think it's time we start a chapter right here in Tucson . . .

The snowballing response made her the de facto coordinator of Coffee Party USA, with goals far loftier than its oopsy-daisy origin: promote civility and inclusiveness in political discourse, engage the government not as an enemy but as the collective will of the people, push leaders to enact the progressive change for which 52.9 percent of the country voted in 2008.

Finally, there's a national movement to unite two of my favorite things: civil, compassionate, and inclusive political discourse geared towards progressive change...and coffee! Now, all we need is someone to start a Beer Party Movement. That's not as pressing for me personally - after all, being a poli-sci nerd and a college student tends to turn many evenings into beer + political conversation, but for the rest of America, yearning for the hoppy, malty, and substantive experiences that Georgetown students enjoy so frequently...

(By the way, I should take this opportunity to throw in my lot with James Fallows, the Atlantic's national correspondent, who describes himself as an "inveterate coffee-and-beer drinker -- coffee until 3pm, beer thereafter." This is really more of an aspiration for me, since a college student's budget does not permit that much beer - unless you're drinking the cheap stuff, and I've already shown myself to be a beer snob. Someday!)