Friday, October 30, 2009


Americans don't give a flying monkey about bipartisanship, when it comes to getting the public option.
"Which of these would you prefer – (a plan that includes some form of government-sponsored health insurance for people who can’t get affordable private insurance, but is approved without support from Republicans in Congress); or (a plan that is approved with support from Republicans in Congress, but does not include any form of government-sponsored health insurance for people who can’t get affordable private insurance)?"

Fifty one percent said they preferred the public option; 37 percent said they preferred a bill with some support from Republicans in Congress. Six percent said neither and seven percent expressed no opinion."
Good to know that Americans care more about the substance of the bill than they care about holding hands with their evil twins on the other side of the political spectrum. Because, really, bipartisanship doesn't pay your health care premiums when you get fired and the insurance companies denies you coverage because you're pregnant or diabetic.

And as Tapper points out, this might embolden the Democrats to go ahead with the public plan with no Republican support and, maybe, this means we can end the obsession with Olympia Snowe. Unfortunately, I don't think it's that simple: the reason why they might need at least one Republican vote - and Snowe's seems the most likely to come on board - is because there are some Democrats and Independents who might vote to filibuster a bill with a public option in it.

Thursday, October 29, 2009

Ridiculous Conclusions.

And since I'm all about blogging again, why not post my upcoming article in Zahraničná politika? I'm back on Obama, with gloves off.

Ridiculous Conclusions

Sometimes the tactical decisions that Obama makes make one wonder what the man really believes in. And, increasingly, they don't even seem to produce their purported goals.

When the President received criticism for being the first president since 1991 not to receive the Dalai Lama during his most recent visit to Washington in October, the press was promptly educated by his senior adviser Valerie Jerrett that "it is not a signal of any lack of commitment to human rights .. that's a ridiculous conclusion to draw." At the same time, Jerrett admitted it is "a fair point to make" that the decision to postpone the meeting was made out of respect to Chinese sensitivities to Tibet. In other words, it was a tactical move, not a principled move; the appearance of bending over backwards to please the Chinese should not be disconcerting - the President knows what he's doing - trust him.

To be sure, America's dependence on China is hardly a secret. With some $2 trillion in US government bonds, China is the largest holder of the US debt and thus the largest funder of its massive deficits. Amicable relations with China are therefore a clear priority for US foreign policy. And yet, this sort of diplomatic calculus could hardly justify not meeting with the Dalai Lama. For one thing, even George W. Bush received him during his visit in 2007 (and awarded him the Congressional Gold Medal) and other Congressional leaders, including Nancy Pelosi, met with him during his most recent visit in October. Of course, this was enough to make the Chinese dissatisfied: shortly thereafter, China accused the US of interfering with their internal affairs. In the end, Obama's tactical move not only enraged those who think the US should take a principled stand on human rights in China, but it also failed to deliver the goal of pleasing the Chinese government, instead encouraging them to make even more ambitious demands.

To anyone who has been watching Obama's presidency with a little bit of a critical eye, this scenario looks eerily familiar. In fact, we witnessed a similar tactical blunder even before the Obamas moved into the White House, when then president-elect asked Pastor Rick Warren to deliver the invocation at his inauguration ceremony. For the sake of context, this choice was controversial due to Warren's widely publicized support for Proposition 8, an anti-gay marriage ballot measure in California during the November election. The choice of an extremely conservative pastor was widely seen as Obama's attempt to reach out to the conservative base and passionately criticized by his largely progressive supporters. In the end, it did very little to improve national cohesion (as evidenced by the largest partisan gap in Obama's job approval ratings, according to PEW) and at the same time offended his socially progressive supporters.

Fast forwarding to last summer, we saw the same pattern emerge during the health care reform debate. As the debate quickly focused in on the question of the public plan - a government run insurance option - the legislators increasingly looked to the White House for guidance. At this critical juncture, in an apparent attempt to bring some Republican support on board, the President and his advisors, through interviews and press conferences communicated the message that while the President supports the public plan, it is "not the entirety of health-care reform" and "not the essential element". Ironically, this telegraphed flexibility did not make Republicans any more constructive in the reform efforts. In fact, despite the president's soft-pedaling on one of the key components of reform, it seems likely that if reform passes, it will happen with no Republican votes.

Obama's willingness to make sacrifices to achieve greater goals - Dalai Lama vs the Chinese, progressive issues vs national cohesion, public option vs bipartisan support - is theoretically understandable as shrewd political calculus. However, it is then imperative to judge his effectiveness in making these trade-offs and, so far, it seems to be very limited. In fact, it seems that every time the President decides to give something up, he receives very little in return. The impression it creates is one of an almost pathological desire to please his opponents even if this disregards the sensitivities of those that might be hurt in the process.

It is certainly understandable how his predilection for compromise and trade-offs would make Obama appealing to a certain committee in Norway. At home, however, he is testing the patience of his liberal base. It is ironic that one of the common criticisms of George W Bush was his inflexibility. These days, Democrats sometimes wish that Obama would exhibit some of that stubbornness, at least when it comes to defending their interests – the promises he made a year ago.

20 Years.

Yes, it's been almost 20 years since the revolutions in Central and Eastern Europe that effectively ended the Cold War and that being one of my personal favorite topics, I was delighted to find a pretty good article on it in the New York Review of Books. Hiding in the analysis of the article are a couple of really fun anecdotes that are worth quoting:

So what happened in 1989 can only be understood on the basis of a scrupulous, detailed chronological reconstruction of intended and unintended effects, in multiple directions on multiple stages, day by day, and sometimes—as on the evening of November 9 in Berlin—minute by minute. The reporting or misreporting of events, especially by television, is itself a vital part of the causal chain. When a trusted, avuncular presenter on the 10:30 PM West German television news declared that "the gates in the Wall are wide open" they were not yet wide open; but this report helped to make them so, since it increased the flood of East Berliners (who watched and were more inclined to believe West German television) hoping to get through the frontier crossings to the West, and the crowds of West Berliners coming to greet them on the other side.An erroneous report on Radio Free Europe that a student called Martin Šmid had been killed, in the suppression of the November 17, 1989, student demonstration in Prague, helped to swell the protesting crowds in the first days of the Velvet Revolution in Czechoslovakia. (In what seems to me the best, and certainly the most amusing, of the retrospective chronicles, György Dalos tells how the student came home the next evening to be told by a somewhat agitated father that he was reportedly dead.)

With regards to the apparent US apathy towards or understatement of what was going on in CEE:
Nor did Bush set much store by bearded dissidents who looked like something out of Berkeley in the 1960s. Victor Sebestyen, in a book full of sharp snapshots and crisp narrative, has a well-sourced account of the President meeting with the leading Hungarian dissident János Kis in Budapest in July 1989, and subsequently telling aides, "These really aren't the right guys to be running the place." Much better to stick with a preppy reform communist.
The bottom line of the article seems to be that 20 years later, given the significance of the events of that year, someone needs to write a comprehensive history of 1989 from all angles. However, looking at these anecdotes, I think this would make for brilliant material for a 4-hour epic movie 1989 (fine, I'll settle for a 10-part series on PBS). I mean, seriously - a blunder on TV, a screw up on the radio and you have a revolution - that is classic.

Gosh, WTF.

I realized that I totally stopped posting anything on the blog and that's not fun. I guess the temptation to just spit out random crap on Facebook is easier than blogging and I keep telling myself that I will just reserve the blog for longer more thought out stuff .. except that doesn't happen anymore, because all longer more thought out entries never start as longer more thought out entries, instead they almost always happen as a quick reaction to something and then take a life of their own .. except all the quick reactions to crap are now channeled to FB, hence the death of blogging. But that has to end. Now!

Monday, October 19, 2009

Health Reform in America – Why It Should, Could and Probably Won't Happen

A super belated installment of my article in Zahranicna Politika. It was meant to be a "US Health Reform 101" for readers outside the US who may not be familiar with the problem. Of course a few things have changed since the time it was written but the conclusion still rings true, especially when one looks at the Senate Finance Committee bill.

Health Reform in America – Why It Should, Could and Probably Won't Happen

The story of US health reform is a complicated one and a thorough analysis of the topic is beyond the scope and scale of this column. However, it has become increasingly difficult to ignore given the prominence it has risen to in the last few months. Not only has it become the number one domestic issue that the president, lawmakers, lobbyists, news reporters and policy analysts are occupied with, but it is also quickly becoming the gauge for the Obama administration's success and potentially one of the determinants of the mid-term Congressional elections (in November 2010) and the next presidential election (in November 2012). Even more broadly, it has been a fascinating study in the functioning (some would say, malfunctioning) of the US political system and its many quirks. In short, for anyone interested in US politics, there are many reasons to care about health reform.

So what is all the fuss about? Why all the talk about reforming a system which is defined by spectacular innovation and some of the most advanced treatments and therapies? The standard answers to that question typically involve three aspects of the system: access, cost and outcomes. Quite simply, with all its high technology and innovation, the US health system leaves many people uninsured, and despite being the most expensive in the world, it produces worse outcomes. Specifically, while almost a fifth of non-elderly Americans don’t have any health insurance, the cost per capita is roughly twice that of most developed countries, and yet life expectancy is remarkably below average while infant mortality is astonishingly high. Underneath all these characteristics lies the fact that health care in America is an amalgam of disjointed systems of financing and delivery with little coordination of care, no incentives for prevention and wellness and plenty of room for duplication and errors.


If this brief description of the complexity of US health care and its flaws in and of itself doesn’t make it obvious how much of a fool’s errand trying to revamp the system is, consider the fact that during the last reform effort, led by Hillary Clinton, the backlash from all stakeholders was so strong that for the last 15 years most lawmakers treated health care like a bag of toxic waste they wouldn’t touch with a ten foot pole. And yet, given the ambitious nature of Obama’s agenda, it seemed almost natural that he would try to find the Holy Grail.

Interestingly, despite the obvious difficulty of the task and the discouraging historical precedent, as recently as in June, there was a widespread sense of confidence on Capitol Hill that this time around things are different and something will get done. For starters, in the 15 years since the last attempt, healthcare spending has ballooned 160%, while the ranks of the uninsured have swelled from 41 million to 47 million. In fact, according to the CNN exit polls from the presidential election, while the economy was the number one issue for the vast majority of voters, healthcare ranked as number one for as many as did the issues of terrorism and Iraq. Even more specifically, two thirds of voters said they were worried about health care costs (and 60% of them voted in favor of Obama). In addition to having an apparent mandate and greater urgency, the new Democratic administration was also equipped with an expanded Democratic majority in both chambers of Congress - the first time such power alignment occurred since 1993. Perhaps more importantly, unlike in 1993, there seemed to be an agreement among key stakeholders, including the for-profit healthcare industry, about the need for reform. This was a major difference from the Clinton era, when the lobbying and advertising efforts of the health insurers, pharmaceutical manufacturers and doctors killed reform in its infancy. The new administration, trying to prevent Clinton’s mistakes, kept the process as open and collaborative as possible so as not to ignite hostile opposition from any of the key groups, instead making deals with each of them. The premise was that if we can fix the system and expand coverage, all of the participants will benefit and should therefore contribute in their own ways towards making the overhaul affordable. In short, for a very long time it seemed like the stars were aligning for the impossible to occur.

In hindsight, it was only a question of time when the fairy tale would turn into a mean fight. Once the committees in Congress started drafting bills – there are 3 of them in the House of Representatives and 2 in the Senate with jurisdiction over health care – the details got in the way of noble goals. The reality is that while most agree on the need for reform, there are numerous starkly different ideas about both how it should be accomplished and paid for – and each of them has a different set of proponents and enemies. The obvious goal is to find a solution that upsets the smallest number of participants – which isn’t very consistent with the objective of revamping 16% of the US economy. To make matters more complicated, the differences of opinion do not necessarily fall along party lines, rendering the Democratic majorities in Congress largely useless. As an example, a major portion of the debate has been around the possible introduction of a government-run health insurance option that would compete with private health insurers. While progressive democrats perceive this as an essential part of the reform, the conservative block of the party is vehemently against it. Recognizing the complexity of these diverging interests, Obama has been smart in keeping his demands as vague as possible and instead putting out broad parameters for reform – it has to expand coverage, improve quality and save money. This strategic vagueness, however, didn’t prevent the opponents of reform from poking holes in the proposals and the proponents of different solutions from engaging in hostile debates.

And so here we are in August and the whole reform effort appears to be on life support. Why? If reform fails, history books will probably trace its death to the August congressional recess. The recess is a month-long break during which lawmakers typically go back home to meet with their constituents. Early on in the month it became clear that having a bunch of health care proposals sitting around for a month was like leaving a carton of milk on the table for a few days. The news became quickly dominated by reports of contentious town hall meetings in which lawmakers encountered anger and even violence, often fueled by outrage over the supposed attempt to nationalize healthcare and over particular provisions in the health care bills, some of which were completely made up. The famous example was the rumor that Obama’s reform would create government-run “death panels” that would determine which patients are worth living – which turned out to be a gross misrepresentation of actual proposals to include funding for voluntary end-of-life counseling. Another example of populist hysteria was the accusation that the reform will force preferential hiring of homosexual hospital administrators and includes funding for sex change operations, when in fact none of the proposals include any such language. Absurd or not, these protests have a good chance of making lawmakers uneasy about their support for reform especially if they are Democrats in conservative districts or states and thus vulnerable in the next election.

So does this mean that health care reform is dead? Probably not entirely. Obama has made the issue so central to his domestic policy that a complete failure could harm the future prospects of both his party and his own. However, given the lack of legislative will and mounting opposition in the electorate, the most viable alternative is to settle for some smaller incremental changes such as expanding some public programs like Medicaid to cover more poor people and children and pay for it by cutting spending in a few targeted areas. This would be very far from a comprehensive reform of financing and delivery of care, and it will certainly anger the progressive Democratic base. However, faced with the prospect of getting nothing at all, the progressives will likely take whatever “reform” they can get. In the end, it seems quite possible that this will all have been yet another exercise in the realpolitik in the US legislative process and perhaps another lesson for those who believed in Change: it’s slow, painful, full of compromise and ultimately not very satisfying.