ABOUT THOSE OVERPAYMENTS! David Leonhardt broke our hearts, describing big Medicare fraud: // link // print // previous // next //
FRIDAY, DECEMBER 18, 2009
We want our $800 back: On balance, as non-experts, we would tend to agree with Paul Krugmans judgment about the developing health reform plan. (Headline: Pass the Bill. Click here. As non-experts, we tend to do what Krugman says.) That said, we would add several planks to Krugmans message to progressives, with which his column opens.
But first, a note about what happened in the Senate on Tuesday night.
Last month, progressive economist Dean Baker provided some info about the looting which characterizes our health care spending. Trust usfew voters have any real knowledge of what follows, in large part thanks to the near-total absence of real progressives in our national discourse:
According to Baker, those patent monopolies, all by themselves, add $800 to our per-person spending. Each year.
(In the second comment to Bakers post, comedian Jeff Caldwell relates that $800 to our massive overall over-spending, as compared with the spending of a nation like France. If Baker has accounted for $800, what accounts for the rest of our $3700 in annual over-spending? So the comedian asks.)
In short, Americans are getting massively looted through their prescription drug prices. But so what? On Tuesday evening, the Senate decided not to take action on this remarkable problem. On Wednesday evening, Ed Schultz did an excellent job examining this vote on The Ed Show. But so what? That same morning, the New York Times had devoted exactly one sentence to this remarkable action:
That single sentence, deep in a long report, represents the New York Times only coverage (to date) of this remarkable vote. In the Washington Post, readers were allowed to understand a bit more of their world:
Americans get massively looted on prescription drug prices. Dorgan offered a chance to address this problem. But 30 Democrats voted his amendment down, joining only 17 members of the other tribe.
Thirty Dems opposed the Dorgan amendment; only 27 supported it. The Times devoted exactly one sentence to this remarkable matter.
Why is it hard to pass progressive reform? In large part, because of matters like this. The vast bulk of voters have no idea of the ways they get looted in their health spending. Typically, successful efforts at social reform are driven along by righteous anger. Its hard to get the voters angry when big news orgs like the New York Times so defiantly avoid informing them about the ways they get abused.
But then, the New York Times has refused, all year, to examine the looting in our health system. But so too with the Washington Post. In a nation whose press corps functions this way, the typical voter will lack the first clue about the real world.
You cant do reform in this manner.
That said, it isnt just the mainstream press which makes so little effort to tell voters about this looting. On that very same Wednesday evening, Rachel Maddow clowned her way through what may have the strangest hour weve ever seen on a cable news channel. (Dick Armey pronounced my last name as Maddox! Porn sites look really funny with the GOPs URL-shortener!) But then, where in the liberal/progressive world has anyone ever made a real effort to inform the public about the ways they get looted in their health spending? Your liberal journals certainly havent. Mainstream liberal columnists havent. Has Bernie Sanders ever done it? We thought Sanders ended up looking slightly silly this week with his lengthy amendmentand he may be the most progressive member of the Senate.
Tell us: Who has ever told the public about the various ways they get looted through their health care? What progressive has ever done this in the dogged, systematic way which may eventually get results? Sanders has a salary; a staff; a platform; a budget. Has he ever done this? When? In what way? How loud? In fact, your country has virtually no progressive politics because its power structure includes so few active progressives.
Remember when Ross Perot had all those charts? When has our side produced any charts about the size of our health care looting?
Ed Schultz screamed and yelled about Tuesdays vote; we say good for him! But what did most of us progressives do? We spent the week wailing about Joe Lieberman, treating ourselves to a good cleansing cry. For the most part, this was a silly, inane, futile acta perfect example of the childish culture of American pseudo-progressives.
This brings us back to Krugmans courteous message to progressives. In todays column, Krugman urges a yes vote on the Senate bill, and he gives some actual reasons. But first, he offers this:
On balance, we agree with Krugmans views on the bill, although we do so as frustrated non-experts. But wed offer a different message to progressives. Just get over your goddamned selves, our own helpful message would start.
Wed advise progressives to stop wasting time on caterwauling about Lieberman. After all, forty other senators stand behind him, supporting the very same filibuster, including relatively non-crazy people with names like Collins, Snowe, Voinovich, Lugar, Hutchison, Alexander. (Have you ever heard anyone criticize, challenge or question Lugar for his stance on these matters? Why not?) These people were elected with Republican votes, just the way Vile Lieberman was. And guess what, progressives? People elected with Republican votes may not be inclined to vote your way! They represent voters who dont (yet) see the world the way you do.
The traditional remedy for such situations has always been this: Go work in the vineyards. Reformers go out and spread the word; within our system, reformers help voters develop frameworks of understanding which will produce loud demand for reform. This week, we pseudo-progressives have shrieked and wailed about the perfidious Liebermans conductembellishing a bit as we go. But when have we ever done the hard serious work required for better outcomes?
Below, we continue our series on David Leonhardts recent piece about scary/scare stories, the kinds of scare stories which tend to drive American politics. Those scare stories tend to work because they trade on fifty years of pseudo-conservative messagingmessaging the other side has worked quite hard to establish. (Big government never did anything right! European health care is a disaster!)
During that period, our side has tended to frolic and play. (We completely sat out the 1990s, the era which sent George Bush to the White House.) Can we talk? Were ugly and stupid and nobody likes us. On balance, were silly, self-impressed, frivolous people. We dont deserve to win.
If it werent for all those people who die young from lack of insurance, we wouldnt deserve to win. That said, our heroes have completely stopped discussing those people this week. Their plights have disappeared from our screeds. Were much too progressive for that!
(In this piece in the Washington Post, Howard Dean quite literally doesnt mention the subsidies which would let many such people get insured. Some are mothers of teen-aged girls, mothers who might otherwise die; see THE DAILY HOWLER, 9/17/09. We like Howard Dean a lot. But why on earth is that missing?)
Krugman is being polite todaypolite to the pseudo-progressive who likes to watch the Idiot Maddow laugh at the funny tea-baggers. The baggers have thoroughly kicked our keisters this yearand Maddow is still frowning darkly and rolling her eyes at their dumb stupid dumb ways.
She slips her cool million into her pocket. Were so dumband so well entertainedthat we admire these born-loser instincts!
We can burn Joe in effigy, Krugman allows, at the start of a serious column. And we can boo-hoo for ourselves as we do. Of course, we could spend our time in a different way. Why has no one heard about Dean Bakers post? We could spend our time looking into a mirror, asking our loser selves that.
PART 3ABOUT THOSE OVERPAYMENTS: Sometimes, the analysts give up and cry. Thats what happened when they read Ruth Marcus column on Wednesday.
Marcus seems like a good, decent person. But this made the analysts cry:
To the analysts, that more hopeful reading was hopeless. The baseline of our health care spending shows that we currently spend two to three times as much, per person, as other developed nations. Anyone with an ounce of sense would understand an obvious fact: That baseline is built on large doses of looting. But at the Post, Marcus finds her spirits soar when she imagines a world in which our overall health care spending rises at only 6.9 percent!
6.9 is less than 7.2. But we couldnt blame the analysts when they started to sob.
Unfortunately, we had a slightly similar reaction to parts of David Leonhardts worthwhile Economic Scene piece in last weeks New York Times.
Like you, we arent health care experts; we fight our way through the personality blather, looking for the occasional piece which sheds a bit of light on the merits of proposed health reform. And Leonhardt, warning about scare stories, said he thinks theres a lot of good stuff in the Senate bill. He started by stating an obvious fact about our current health system:
Most voters simply dont know thatthough wed agree its abundantly clear. But Leonhardt, warning about scare stories, said theres actually a lot of good cost-cutting stuff in the existing health bills. And he said hes been seeing good signs from the Congress:
Is real cost-cutting built into these bills? We progressives prefer to spend our time wailing about the demon Lieberman and complainingat least several months too latethat the public option is gone.
Leonhardt said the Congress is (to quote his headline) Finding the Nerve To Cut Costs. Wed love to think thats true, in constructive ways, because our current health care system is plainly built around large gobs of corporate looting. But sometimes, it can be discouraging to puzzle out the way these bills work. Leonhardt tries much harder than mosthas done so throughout the year. But this is how he explained the Senates attempt to address perhaps the single clearest example of overpayment in the Medicare program:
Maddening! According to Leonhardt, fraud is rife at these home health agenciescorporate entities which would thus be looting the public through the publics Medicare system. And yet, what triumph does Leonhardt report? Rather than hunt down the fraud and punish the fraudsters, the Senate bill would simply cut overall payments to these agencies! Apparently, the fraud will persist! The fraudsters will simply have to find ways to cut back on overall costs.
Leonhardt tries much harder than most. To us, he has seemed to do much more serious work than most other major scribes this year. We were a bit frustrated by this passage, in which he adopts an odd sort of logic. But we were most struck by his columns framework, in which he directly addresses a key problem in our politics.
Congress will face scare stories, he said. In our politics, those scare stories tend to worktend to do lots of harm. But why are those scare stories so darn effective? Weve pondered that question a lot this year. Well ponder again in Part 4.
Coming Mondaypart 4: Why do those scare stories work?