David Leonhardt offers another good piece: Real Choice: It's Off Limits in Health Bills
Klepper and Kibbe: Health Care Reform's Deeper Problems
My own: The Real Issue in the "Nationalizing Our Health Care" Rhetoric
And a pleasantly informative and interesting Fresh Air podcast: T.R. Reid: Looking Overseas For 'Healing of America'
------------------------
Update 9-10:
Please Don't Call It Health Reform
August 21, 2009
The Real Issue in the "Nationalizing Our Health Care" Rhetoric, or The "Government Takeover"
Millions of Americans fear health care reform would lead to "nationalization" (or "Government takeover" or "socialized care") of health care in America.
I've read or heard "nationalize" used this way dozens of times now in the last month -- enough to know that it is a widespread idea. Just lately, this same idea is being expressed often with additional phrases that have the same meaning.
A significant part of the opposition to health care reform -- the major part -- springs from fear of a Government takeover of health care, which would seemingly lead to rationing of health care and all the other familiar ills of a big, impersonal Governmental bureaucracy.
Arbitrary power. The idea of "pulling the plug" on Grandma is only a representation of this more general fear of impersonal, arbitrary power.
...
"Nationalize" has a meaning which is clear to most people -- a government takeover -- government owns and thus fully controls the business or industry, such as a nationalized railroad or even an entire nationalized sector of the economy.
So a nationalized Health Care System in the true, genuine meaning of the word would be when most hospitals were taken over and owned by the government, along with most clinics, so that many or most doctors would work for the government directly or through a thinly separated veil. Most health care workers would be government employees -- their paychecks would be directly from the government.
This would be nationalization, in the true sense of the word.
...
Now, in contrast, the proposed House bill HR 3200 leaves private, free-market hospitals private and free-market.
Private or self-employed doctors remain privately- or self-employed under HR 3200.
Instead of nationalization, the private health insurers and a public health insurer would compete to gain policy-holders and would pay doctors and hospitals according to negotiated pay scales, just as now. Some low-income individuals and families would receive help paying their premiums, regardless of whether they choose a private or public insurer.
Did you get that last part? Those choosing private insurers would get the same subsidy those choosing the public insurer get.
Level playing field. From the beginning.
The conservative Heritage Foundation points out "Individuals will not be permitted to use their subsidies to purchase coverage that does not meet the definition of 'essential health benefits.'"
But...who would want to purchase insurance without essential benefits??
People purchase such policies only because they are fooled by the insurers.
There is indeed private insurance available right now without essential benefits -- that is why medical bills piling up on people who actually had/have insurance is the leading cause of bankruptcy!
Those bankrupt families and individuals had insurance without essential benefits.
...
So those on the other side of the debate, who do not worry about "nationalization" can reasonably ask:
Where's the Beef?
Where is the nationalization??
...
It is then tempting to conclude that this fear is simply the result of intentional fear-mongering.
Calculated lies.
I concluded this myself after hearing of Palin's "Death Panel" idea.
That was indeed a lie.
There never was anything remotely similar to death panels, or panels to choose who gets what care, in the legislation. There is a public panel to help form the standards of minimum acceptable benefits insurers can offer -- the opposite of a death panel. This is more a life panel, which helps prevent insurers from tricking policy holders with loopholes. Of course this isn't the panel Palin meant.
There is a panel to oversee comparative effectiveness research -- research to find out what treatments work the best. Again, more of a life panel, since finding out what works best will improve all of our odds of getting the best possible treatment. Of course, this isn't the panel Palin meant. I'm not sure if I can find the panel Palin meant.
Instead, the last panel of note is the patient-friendly panel the administration has proposed, IMAC, a panel of experts (including doctors) given the task to think up ways to improve among other things Medicare quality, access to care, and reimbursement rates and to consider broader reform ideas such as increasing effectiveness. IMAC is to make proposals, which the President and Congress can reject or accept each year.
IMAC should help to improve Medicare effectiveness. Effectiveness, for instance, would mean at times paying $200 to repair something now so that it won't break down in a year or so and cost $2000 instead.
"Effectiveness" does not mean refusing to pay $2000 when necessary.
It means smart choices such as planning ahead and choosing better treatments, often reducing costs while maintaining or increasing quality.
The effect would be to improve health by encouraging more effective treatments (such as by higher payments). Savings result since more effective treatments save time and expense, and reduce patients' suffering.
That would be like quality auto-repair.
In other words...just ordinary common sense.
There're the panels.
Where's the beef?
...
So the "Where's the nationalization?" question is quite reasonable.
...
But...there is an indirect way in which one can fear that there would be a sort-of "nationalization" of health care, in a sense, in a way that is somewhat related to the word nationalization.
The entire issue boils down to this single question -- and only this one single question -- whether the government would take over all health care reimbursement over time and then decide what is paid for in a top-down way, so that most doctors and hospitals would then only be able to do what government would decide to pay them to do.
In a word, control.
Notice the crucial distinction here. This isn't even about whether there will be a Single Payer system. No, it's more exact.
It's about whether the decisions will end up, in the long run, being made in a top-down way.
Single Payer, or the very different Public Option (which is a competing public health insurer), either one, could be top-down, or not, depending on how it is set-up.
A strong, popular public insurance provider itself could try to operate in a top-down manner, but if it did...many people would choose to go elsewhere for their insurance!
Indeed, there is a severe problem right now with private insurers making top-down decisions!
That's why people are so sensitive about it!
...
So there is only one real issue here in relation to a Public Option or HR 3200.
Will doctors and patients have most of the control in deciding what care/treatments to have?
That's it, nothing else.
That's the fear that dwarfs the others, in real opposition and fear of heath care reform.
Cost is also a central issue -- one this blog has focused on in multiple posts (see Reader Favorites in the right-hand column) -- but the fear and larger anger is about losing control and such possible imagined outcomes as severe rationing.
...
That issue of choice (control) is one this blog has addressed and 100% satisfied in a major post on how to structure reimbursement for health care.
Here's how to correctly set up reimbursement to doctors and hospitals (click here).
...
Let me suggest to President Obama that he needs to be still more plain-spoken. For now, he needs to leave behind lengthy, technical paragraphs.
In a short, brief statement, Obama needs to communicate on this real issue.
Without any other competing issue or information or topics during the statement.
This one question by itself.
I recommend 150 words or less.
Here's a suggestion:
Some political figures and commentators have made-up some distortions and outright fabrications in the last couple of months to try to torpedo our much needed health care reform. One of these fabrications is using the word "nationalization" to refer to health care reform when in fact hospitals and doctors would remain completely in the private free market just as they are right now.
I am proposing to Congress today that we clarify our reform legislation to explicitly leave all the choice and control of health care in the hands of doctors and patients, and that we do this by changing payment to be primarily for the outcomes of treatments. We will begin to pay for outcomes over time, instead of just for the sheer number of tests and procedures regardless of effect. It won't be the number of tests you order, it will be the number of patients you help that determines your pay. In this way the actual choice of what treatment is used by a doctor or hospital will be entirely up to that doctor or hospital and the patient, and never up to any government bureaucrat. Paying for care in this way will increase innovation and unleash the real power of the free market to improve our health care.
I've read or heard "nationalize" used this way dozens of times now in the last month -- enough to know that it is a widespread idea. Just lately, this same idea is being expressed often with additional phrases that have the same meaning.
A significant part of the opposition to health care reform -- the major part -- springs from fear of a Government takeover of health care, which would seemingly lead to rationing of health care and all the other familiar ills of a big, impersonal Governmental bureaucracy.
Arbitrary power. The idea of "pulling the plug" on Grandma is only a representation of this more general fear of impersonal, arbitrary power.
...
"Nationalize" has a meaning which is clear to most people -- a government takeover -- government owns and thus fully controls the business or industry, such as a nationalized railroad or even an entire nationalized sector of the economy.
So a nationalized Health Care System in the true, genuine meaning of the word would be when most hospitals were taken over and owned by the government, along with most clinics, so that many or most doctors would work for the government directly or through a thinly separated veil. Most health care workers would be government employees -- their paychecks would be directly from the government.
This would be nationalization, in the true sense of the word.
...
Now, in contrast, the proposed House bill HR 3200 leaves private, free-market hospitals private and free-market.
Private or self-employed doctors remain privately- or self-employed under HR 3200.
Instead of nationalization, the private health insurers and a public health insurer would compete to gain policy-holders and would pay doctors and hospitals according to negotiated pay scales, just as now. Some low-income individuals and families would receive help paying their premiums, regardless of whether they choose a private or public insurer.
Did you get that last part? Those choosing private insurers would get the same subsidy those choosing the public insurer get.
Level playing field. From the beginning.
The conservative Heritage Foundation points out "Individuals will not be permitted to use their subsidies to purchase coverage that does not meet the definition of 'essential health benefits.'"
But...who would want to purchase insurance without essential benefits??
People purchase such policies only because they are fooled by the insurers.
There is indeed private insurance available right now without essential benefits -- that is why medical bills piling up on people who actually had/have insurance is the leading cause of bankruptcy!
Those bankrupt families and individuals had insurance without essential benefits.
...
So those on the other side of the debate, who do not worry about "nationalization" can reasonably ask:
Where's the Beef?
Where is the nationalization??
...
It is then tempting to conclude that this fear is simply the result of intentional fear-mongering.
Calculated lies.
I concluded this myself after hearing of Palin's "Death Panel" idea.
That was indeed a lie.
There never was anything remotely similar to death panels, or panels to choose who gets what care, in the legislation. There is a public panel to help form the standards of minimum acceptable benefits insurers can offer -- the opposite of a death panel. This is more a life panel, which helps prevent insurers from tricking policy holders with loopholes. Of course this isn't the panel Palin meant.
There is a panel to oversee comparative effectiveness research -- research to find out what treatments work the best. Again, more of a life panel, since finding out what works best will improve all of our odds of getting the best possible treatment. Of course, this isn't the panel Palin meant. I'm not sure if I can find the panel Palin meant.
Instead, the last panel of note is the patient-friendly panel the administration has proposed, IMAC, a panel of experts (including doctors) given the task to think up ways to improve among other things Medicare quality, access to care, and reimbursement rates and to consider broader reform ideas such as increasing effectiveness. IMAC is to make proposals, which the President and Congress can reject or accept each year.
IMAC should help to improve Medicare effectiveness. Effectiveness, for instance, would mean at times paying $200 to repair something now so that it won't break down in a year or so and cost $2000 instead.
"Effectiveness" does not mean refusing to pay $2000 when necessary.
It means smart choices such as planning ahead and choosing better treatments, often reducing costs while maintaining or increasing quality.
The effect would be to improve health by encouraging more effective treatments (such as by higher payments). Savings result since more effective treatments save time and expense, and reduce patients' suffering.
That would be like quality auto-repair.
In other words...just ordinary common sense.
There're the panels.
Where's the beef?
...
So the "Where's the nationalization?" question is quite reasonable.
...
But...there is an indirect way in which one can fear that there would be a sort-of "nationalization" of health care, in a sense, in a way that is somewhat related to the word nationalization.
The entire issue boils down to this single question -- and only this one single question -- whether the government would take over all health care reimbursement over time and then decide what is paid for in a top-down way, so that most doctors and hospitals would then only be able to do what government would decide to pay them to do.
In a word, control.
Notice the crucial distinction here. This isn't even about whether there will be a Single Payer system. No, it's more exact.
It's about whether the decisions will end up, in the long run, being made in a top-down way.
Single Payer, or the very different Public Option (which is a competing public health insurer), either one, could be top-down, or not, depending on how it is set-up.
A strong, popular public insurance provider itself could try to operate in a top-down manner, but if it did...many people would choose to go elsewhere for their insurance!
Indeed, there is a severe problem right now with private insurers making top-down decisions!
That's why people are so sensitive about it!
...
So there is only one real issue here in relation to a Public Option or HR 3200.
Will doctors and patients have most of the control in deciding what care/treatments to have?
That's it, nothing else.
That's the fear that dwarfs the others, in real opposition and fear of heath care reform.
Cost is also a central issue -- one this blog has focused on in multiple posts (see Reader Favorites in the right-hand column) -- but the fear and larger anger is about losing control and such possible imagined outcomes as severe rationing.
...
That issue of choice (control) is one this blog has addressed and 100% satisfied in a major post on how to structure reimbursement for health care.
Here's how to correctly set up reimbursement to doctors and hospitals (click here).
...
Let me suggest to President Obama that he needs to be still more plain-spoken. For now, he needs to leave behind lengthy, technical paragraphs.
In a short, brief statement, Obama needs to communicate on this real issue.
Without any other competing issue or information or topics during the statement.
This one question by itself.
I recommend 150 words or less.
Here's a suggestion:
Some political figures and commentators have made-up some distortions and outright fabrications in the last couple of months to try to torpedo our much needed health care reform. One of these fabrications is using the word "nationalization" to refer to health care reform when in fact hospitals and doctors would remain completely in the private free market just as they are right now.
I am proposing to Congress today that we clarify our reform legislation to explicitly leave all the choice and control of health care in the hands of doctors and patients, and that we do this by changing payment to be primarily for the outcomes of treatments. We will begin to pay for outcomes over time, instead of just for the sheer number of tests and procedures regardless of effect. It won't be the number of tests you order, it will be the number of patients you help that determines your pay. In this way the actual choice of what treatment is used by a doctor or hospital will be entirely up to that doctor or hospital and the patient, and never up to any government bureaucrat. Paying for care in this way will increase innovation and unleash the real power of the free market to improve our health care.
August 20, 2009
Obama Health Care Meeting
Archived link here (click on "Organizing for America").
Obama is doing a good job in clarifying the confusing health care debate situtation.
We'll have to wait to see if news media reports accurately what he says (in accurate context, so that the actual meaning is presented). At times we know media has misreported or misdirected some of what has happened, focusing on uninteresting issues that most people care less about than the real issues, such as countering health care inflation, which is indeed an issue people widely care about.
Obama is doing a good job in clarifying the confusing health care debate situtation.
We'll have to wait to see if news media reports accurately what he says (in accurate context, so that the actual meaning is presented). At times we know media has misreported or misdirected some of what has happened, focusing on uninteresting issues that most people care less about than the real issues, such as countering health care inflation, which is indeed an issue people widely care about.
August 17, 2009
Nice Overview of Practical Health Care Reform
Here are the Consumers Union proposals for Health Care Reform. Consumer's Union is the same organization we all know as Consumer Reports (the magazine that's been around for decades).
They offer reform proposals that are strikingly similar to what we've heard as the broad proposals in Congress that are less controversial. But they also offer some additional proposals we'd like to see embodied in legislation which readers of this blog will recognize.
The Consumers Union proposals would constitute good Health Care Reform, and could be implemented using details on exactly how to structure incentives such as given here on this blog.
Link here.
They offer reform proposals that are strikingly similar to what we've heard as the broad proposals in Congress that are less controversial. But they also offer some additional proposals we'd like to see embodied in legislation which readers of this blog will recognize.
The Consumers Union proposals would constitute good Health Care Reform, and could be implemented using details on exactly how to structure incentives such as given here on this blog.
Link here.
August 15, 2009
Blogging Obama Health Care Town Hall -- Colorado
C-Span archive of Colorado 8-15 Obama Town Hall on Health Care Reform.
I will offer an overview and some choice highlights.
My quotes are quick typing, rough paraphrases often (even parts in quotes at times):
---------------------------------------------------------------------------------
This has been "It was an economy of bubbles and busts...in which, the average worker...their wages and incomes had flat lined for a decade...."
"We can't go back to that kind of economy."
"If we want this country to succeed in the 21rst century we have to lay a new foundation for lasting prosperity...and health insurance reform is a key pillar of this new foundation....This economy won't work...until companies aren't slashing payrolls...to pay for health insurance..."
Pay raises have disappeared into health care premiums.
"It's only natural this debate is going to be an emotional one."
"you can have 20 great town hall meetings, and if there is one where someone loses their temper, that's the one you see on TV"
Obama offers more specific examples of outrageous health insurance failure...
Obama reviews health insurance reform. Does a good job, clear, brief, well-explained. Actually interesting, and you want to listen, even if you know about it. (about 11-12 minutes in and on)
Nice, he emphasizes that "if you think this has nothing to do with you, think again" That's right. Everyone, including those with good on-the-job insurance are vulnerable now. Good work on Obama's part. He's going from good to great on this.
"I know there's some skepticism -- 'How are you going to save money in the health care system?' "
You're doing it right here in Grand Junction....(already. Grand Junction has an innovative setup that is effective in increasing quality and value)
"These struggles have always boiled down to a contest between hope and fear. It was true when Social Security was born...."
"For you to keep what you've got [in health care]...is going to require change.....premiums would continue to skyrocket, going up three times faster than wages..."
Obama begins taking questions:
...
...
Encouragingly, Obama is addressing the most important ultimate Health Care question -- Cost Inflation over long time periods.
Even better, he talked about examples of cooperative care like Mayo, Grand Junction, etc.
Obama seems better prepared in that he is talking from the big-picture now, including getting right to the real points of contention -- such as whether Government should be involved in anything, should be involved in health care at all, such as Medicare, etc.
Preventative Care! Yes! The plug was short and sounded good. I'll post it tomorrow some time.
Making Hospital statistics available to allow people to compare hospital effectiveness. "Comparison shop"
... Very Rough Paraphrases in quotes:
"There is no Magic Bullet" We can't all get "all the health care we want, for free"
---
Obama does a nice job of laying to rest the "death panels" rumor/lies and the implied "plot" to "sneak euthanasia" into reform --- he accurately labels these arguments against reform: these arguments "feel dishonest"
Obama handles this well I think, because he addresses the misrepresentations without attacking any individual doing so. He only references that some republicans supported similar provisions (to pay for consultations about end-of-life care) in the past. He's not going after an individual though.
This is the high road, and it's good for the nation for the president to take the high road.
---
We are only trying to be sure that the choices being made in the private marketplace (insurers) "aren't discriminating against people because they are sick"
That hospitals are incentivized for better success (less readmissions).
...
"We're going to have to overcome wrong information" (overcome intentional misrepresentations)
To eliminate the preexisting condition problem we have to also require all people to be covered (so that you can't just wait until you get sick to get insurance).
...
Obama is going for the Big Issue (for the nation, and in the underlying politics)...
The Budget deficit, and where exactly it comes from.
Good stuff.
We cannot solve the deficit unless we control the growth in the largest parts of spending -- Medicare, Medicaid, Defense spending...
...
Thankfully, Obama ended right there, on the most important point. Without further distraction.
The most important point is always the best end point.
---
Let me say we are very lucky to have this person as President.
Fixing so much severe mismanagement of our Nation over such a long period of years -- it isn't easy.
I will offer an overview and some choice highlights.
My quotes are quick typing, rough paraphrases often (even parts in quotes at times):
---------------------------------------------------------------------------------
This has been "It was an economy of bubbles and busts...in which, the average worker...their wages and incomes had flat lined for a decade...."
"We can't go back to that kind of economy."
"If we want this country to succeed in the 21rst century we have to lay a new foundation for lasting prosperity...and health insurance reform is a key pillar of this new foundation....This economy won't work...until companies aren't slashing payrolls...to pay for health insurance..."
Pay raises have disappeared into health care premiums.
"It's only natural this debate is going to be an emotional one."
"you can have 20 great town hall meetings, and if there is one where someone loses their temper, that's the one you see on TV"
Obama offers more specific examples of outrageous health insurance failure...
Obama reviews health insurance reform. Does a good job, clear, brief, well-explained. Actually interesting, and you want to listen, even if you know about it. (about 11-12 minutes in and on)
Nice, he emphasizes that "if you think this has nothing to do with you, think again" That's right. Everyone, including those with good on-the-job insurance are vulnerable now. Good work on Obama's part. He's going from good to great on this.
"I know there's some skepticism -- 'How are you going to save money in the health care system?' "
You're doing it right here in Grand Junction....(already. Grand Junction has an innovative setup that is effective in increasing quality and value)
"These struggles have always boiled down to a contest between hope and fear. It was true when Social Security was born...."
"For you to keep what you've got [in health care]...is going to require change.....premiums would continue to skyrocket, going up three times faster than wages..."
Obama begins taking questions:
...
...
Encouragingly, Obama is addressing the most important ultimate Health Care question -- Cost Inflation over long time periods.
Even better, he talked about examples of cooperative care like Mayo, Grand Junction, etc.
Obama seems better prepared in that he is talking from the big-picture now, including getting right to the real points of contention -- such as whether Government should be involved in anything, should be involved in health care at all, such as Medicare, etc.
Preventative Care! Yes! The plug was short and sounded good. I'll post it tomorrow some time.
Making Hospital statistics available to allow people to compare hospital effectiveness. "Comparison shop"
... Very Rough Paraphrases in quotes:
"There is no Magic Bullet" We can't all get "all the health care we want, for free"
---
Obama does a nice job of laying to rest the "death panels" rumor/lies and the implied "plot" to "sneak euthanasia" into reform --- he accurately labels these arguments against reform: these arguments "feel dishonest"
Obama handles this well I think, because he addresses the misrepresentations without attacking any individual doing so. He only references that some republicans supported similar provisions (to pay for consultations about end-of-life care) in the past. He's not going after an individual though.
This is the high road, and it's good for the nation for the president to take the high road.
---
We are only trying to be sure that the choices being made in the private marketplace (insurers) "aren't discriminating against people because they are sick"
That hospitals are incentivized for better success (less readmissions).
...
"We're going to have to overcome wrong information" (overcome intentional misrepresentations)
To eliminate the preexisting condition problem we have to also require all people to be covered (so that you can't just wait until you get sick to get insurance).
...
Obama is going for the Big Issue (for the nation, and in the underlying politics)...
The Budget deficit, and where exactly it comes from.
Good stuff.
We cannot solve the deficit unless we control the growth in the largest parts of spending -- Medicare, Medicaid, Defense spending...
...
Thankfully, Obama ended right there, on the most important point. Without further distraction.
The most important point is always the best end point.
---
Let me say we are very lucky to have this person as President.
Fixing so much severe mismanagement of our Nation over such a long period of years -- it isn't easy.
Senator Arlen Specter Actually Gets Through and Makes Contact
Like most people, I've seen news clips of town halls, including a bit where it appears someone has approached Senator Arlen Specter and is basically yelling at him.
But then I actually watched the video of the Lebanon, Pennsylvania town hall of the 11th, and more than just 10 or 20 minutes.
What I saw was an entirely different outcome than the news clips suggest.
The news pieces left me with the impression the meetings are basically overwhelming anger dominating and leaving little room for any detail in discussion. It appears the angry groups have gotten their people in the door first, and few are present that haven't been egged on by circulating emails to the effect of stand-up-for-America-before-it-is-destroyed, before they euthanize relatives, impose socialism, etc., ad nauseam.
But the real outcome of Specter's town hall of the 11th is far more interesting and complex than such news reports suggest.
...
First, let me point out the idea that America is being destroyed by big Government is an old, old idea. In the mid 70s, when my father would sometimes drive me to school (6 miles), we would hear "Eddie" on the radio at 7:45 or 8:00 each morning. The rant of Mad Eddie was a dead ringer for a compressed Rush Limbaugh rant 20 years later. It would make sense that people like Limbaugh were formed by people like Mad Eddie -- "I'm mad too, Eddie" was his tag line. I hardly need to lay out what Eddie said. It sounded like a more practiced version of what these people in Specter's town halls were saying much of the time.
The process of people getting to this mindset is simple enough. You have a situation where many blue collar jobs have been destroyed by change and by "free trade" which is actually subsidized imports that take jobs, leaving stagnantly lower-wage jobs to pay for ever-escalating mortgage and health costs over the decades. The resulting middle-class squeeze is very real. So the experience of people that listen to these anger-based radio programs is that there is plenty to be angry about -- American life has become very difficult and precarious. The idealized America of their dreams has been assaulted, and feels like it is being destroyed. It's no joke.
The radio talk shows then try to focus that anger on some identifiable target, with simple repetitive ideas that can be learned like mantras. The talk shows live and die by whether they can keep their audiences interested, piqued.
It's no accident that this connects to "taxes." It's about being able to survive, financially.
There is more detail I could add on this psychology and resulting mindset, but this post is about the surprising town hall of Arlen Specter on August 11th.
...
If you watch the meeting, you see Specter is the one that moves up to the person talking to him. You see that Specter is quite able to handle difficult situations. You see that Specter handles some of the most difficult questions easily.
The first eye-opening surprise to me was at 15 minutes in the video, where Specter is asked about health care reform forcing everyone to help pay for abortions -- "kill her unborn baby" -- he doesn't simply go to the easy response that federal money does not support abortions or that he doesn't favor abortions, etc.
Instead, Specter does the difficult -- he explains you can be in a plan that doesn't pay for abortions, or a plan that does, by your own choice! He moves right on, question done. At this point, I'm realizing Specter is rather brave.
The audience is clearly and overwhelmingly a very reactionary talk-radio sort of group. But Specter doesn't ease around anything, or use qualifiers.
Immediately next, he's asked about Single Payer -- "Are you for a Single Payer system? Will you vote for a bill that would make a Single-Payer system either through the bill or in the future."
It's clearly a point-blank ideological challenge question.
Specter: "I'm prepared to keep Single-Payer on the table as a matter of consideration and flexibility.... I know the public opinion polls are high in support of Single-Payer. I know that." [Loud boos and heckling]
So, at this point the audience is starting to get it -- Specter isn't really afraid. They are not intimidating him. The shout-down didn't work. The challenge question didn't work. The "kill-the-baby" didn't work.
They haven't cowed Specter.
The questions then change tack, a lot of different strategies. Specter answers well and reasonably.
For instance after 20 minutes: "...What are you going to do to restore this country back to what our founders created, according to the Constitution"? (big applause)
After 54 minutes we get the assertion that the reform will "write off" a 74-yr-old with cancer because they will no longer be a working tax-payer -- euthanasia.
Specter doesn't use kid gloves in response. Specter: "Well, you're just not right. Nobody who's 74 is going to be written off because they have cancer. That's a vicious, malicious, untrue rumor! Who's got the next number?!"
The amazing thing in all of this -- Specter, by this time, is actually communicating with what were strongly closed minds.
Closed minds got a direct face to face experience that opened them a little.
Even though it appears the minds remain closed, I know better. Will these individuals support this health care reform? Of course not. Many of this talk-radio mindset have heard probably 4, 5, or more assertions against reform they've believed. If they now doubt 1 or 2, that still leaves at least 2 or 3 they believe.
But a more important kind of opening happened. They got a chance to actually hear a face-to-face response by someone they have to admit they have at least a little in common with clearly say that a talk-radio lie they've heard is "untrue."
That gives these individuals a chance to make their own worldview more complex and a few, a few, will go further, and read more widely or think new thoughts.
The first step in changing Fear and it's fellow travelers of Anger and Rumor is to actually think a new thought. I have no doubt Specter will put a few people into thought.
That's quite an accomplishment.
They actually have to face the fact that Specter thinks differently but...is here, and is real, and has a lot in common with themselves. Don't believe me? Listen after 103 minutes.
In fact, anyone will find a good perspective by listening to everything after 103 minutes.
Listen to the whole part with the man in the white T-shirt from 108 minutes on -- "I'm laid off....electric rates will necessarily skyrocket {a cap-and-trade distortion, rates skyrocketed already}...we have no more money...I can't even put food on the table....We have no money." Exactly. Even the people that are working feel agreement.
"The people in this room want their country back."
Yes, they want to be able to live, work and manage to put food on the table.
.
But then I actually watched the video of the Lebanon, Pennsylvania town hall of the 11th, and more than just 10 or 20 minutes.
What I saw was an entirely different outcome than the news clips suggest.
The news pieces left me with the impression the meetings are basically overwhelming anger dominating and leaving little room for any detail in discussion. It appears the angry groups have gotten their people in the door first, and few are present that haven't been egged on by circulating emails to the effect of stand-up-for-America-before-it-is-destroyed, before they euthanize relatives, impose socialism, etc., ad nauseam.
But the real outcome of Specter's town hall of the 11th is far more interesting and complex than such news reports suggest.
...
First, let me point out the idea that America is being destroyed by big Government is an old, old idea. In the mid 70s, when my father would sometimes drive me to school (6 miles), we would hear "Eddie" on the radio at 7:45 or 8:00 each morning. The rant of Mad Eddie was a dead ringer for a compressed Rush Limbaugh rant 20 years later. It would make sense that people like Limbaugh were formed by people like Mad Eddie -- "I'm mad too, Eddie" was his tag line. I hardly need to lay out what Eddie said. It sounded like a more practiced version of what these people in Specter's town halls were saying much of the time.
The process of people getting to this mindset is simple enough. You have a situation where many blue collar jobs have been destroyed by change and by "free trade" which is actually subsidized imports that take jobs, leaving stagnantly lower-wage jobs to pay for ever-escalating mortgage and health costs over the decades. The resulting middle-class squeeze is very real. So the experience of people that listen to these anger-based radio programs is that there is plenty to be angry about -- American life has become very difficult and precarious. The idealized America of their dreams has been assaulted, and feels like it is being destroyed. It's no joke.
The radio talk shows then try to focus that anger on some identifiable target, with simple repetitive ideas that can be learned like mantras. The talk shows live and die by whether they can keep their audiences interested, piqued.
It's no accident that this connects to "taxes." It's about being able to survive, financially.
There is more detail I could add on this psychology and resulting mindset, but this post is about the surprising town hall of Arlen Specter on August 11th.
...
If you watch the meeting, you see Specter is the one that moves up to the person talking to him. You see that Specter is quite able to handle difficult situations. You see that Specter handles some of the most difficult questions easily.
The first eye-opening surprise to me was at 15 minutes in the video, where Specter is asked about health care reform forcing everyone to help pay for abortions -- "kill her unborn baby" -- he doesn't simply go to the easy response that federal money does not support abortions or that he doesn't favor abortions, etc.
Instead, Specter does the difficult -- he explains you can be in a plan that doesn't pay for abortions, or a plan that does, by your own choice! He moves right on, question done. At this point, I'm realizing Specter is rather brave.
The audience is clearly and overwhelmingly a very reactionary talk-radio sort of group. But Specter doesn't ease around anything, or use qualifiers.
Immediately next, he's asked about Single Payer -- "Are you for a Single Payer system? Will you vote for a bill that would make a Single-Payer system either through the bill or in the future."
It's clearly a point-blank ideological challenge question.
Specter: "I'm prepared to keep Single-Payer on the table as a matter of consideration and flexibility.... I know the public opinion polls are high in support of Single-Payer. I know that." [Loud boos and heckling]
So, at this point the audience is starting to get it -- Specter isn't really afraid. They are not intimidating him. The shout-down didn't work. The challenge question didn't work. The "kill-the-baby" didn't work.
They haven't cowed Specter.
The questions then change tack, a lot of different strategies. Specter answers well and reasonably.
For instance after 20 minutes: "...What are you going to do to restore this country back to what our founders created, according to the Constitution"? (big applause)
After 54 minutes we get the assertion that the reform will "write off" a 74-yr-old with cancer because they will no longer be a working tax-payer -- euthanasia.
Specter doesn't use kid gloves in response. Specter: "Well, you're just not right. Nobody who's 74 is going to be written off because they have cancer. That's a vicious, malicious, untrue rumor! Who's got the next number?!"
The amazing thing in all of this -- Specter, by this time, is actually communicating with what were strongly closed minds.
Closed minds got a direct face to face experience that opened them a little.
Even though it appears the minds remain closed, I know better. Will these individuals support this health care reform? Of course not. Many of this talk-radio mindset have heard probably 4, 5, or more assertions against reform they've believed. If they now doubt 1 or 2, that still leaves at least 2 or 3 they believe.
But a more important kind of opening happened. They got a chance to actually hear a face-to-face response by someone they have to admit they have at least a little in common with clearly say that a talk-radio lie they've heard is "untrue."
That gives these individuals a chance to make their own worldview more complex and a few, a few, will go further, and read more widely or think new thoughts.
The first step in changing Fear and it's fellow travelers of Anger and Rumor is to actually think a new thought. I have no doubt Specter will put a few people into thought.
That's quite an accomplishment.
They actually have to face the fact that Specter thinks differently but...is here, and is real, and has a lot in common with themselves. Don't believe me? Listen after 103 minutes.
In fact, anyone will find a good perspective by listening to everything after 103 minutes.
Listen to the whole part with the man in the white T-shirt from 108 minutes on -- "I'm laid off....electric rates will necessarily skyrocket {a cap-and-trade distortion, rates skyrocketed already}...we have no more money...I can't even put food on the table....We have no money." Exactly. Even the people that are working feel agreement.
"The people in this room want their country back."
Yes, they want to be able to live, work and manage to put food on the table.
.
August 14, 2009
Live Blogging Obama Health Care Town Hall
Archived video via C-Span. (C-Span is looking more nuetral today in their headline titles)
Here is my rough, very paraphrased, partial transcript (not perfect) and a couple of comments.
2:11 Central Time: Obama points out that people with health insurance are not really secure -- they can be dropped.
2:18: Companies slashing payroll to pay for health insurance.
2:19: People across the nation gathering and having difficult discussions about Health Care in a civil way -- that reflects America.
2:21: Reform will stop the practice of insurers dropping sick policy holders on pretext of application mistakes. One (limited) study found "20,000" dropped this way. The woman dropped during breast cancer for not including acne on her original application for insurance.
2:22: Insurers to be prohibited from denying coverage for preexisting conditions, and also not allowed to place caps (limits) on annual or lifetime costs. Limits also on out-of-pocket expenses.
Finally, insurers to be required to cover preventive routine checkups -- mammograms, etc.
2:24: I don't want gov. bureaucrats meddling in your healthcare, but I also don't want insurance company bureaucrats meddling in your healthcare (applause).
2:26: Everytime we are in sight of healthcare reform, special interests try to "scare the heck" out of people. "...what is truly scary...is if we do nothing." 14,000 lose coverage everyday. The deficit would continue to grow. In about 8 years Medicare goes into the red, and consider we already are limited by deficits right now.
"Change is never easy. It never starts in Washington. It starts with you."
Questions:
2:30 Can you pick and choose from foreign health care systems that work and use those ideas here?
A: Americans spend $5,000-$6,000 more per year than people in any other nation. You don't notice it when your employer pays most of your premium, but we have smaller pay increases as a result. ... Countries like Netherlands -- private in all respects except Government is the insurer... What we've said is, let's find a uniquely American system, because a majority gets health insurance on the job. Changing everything is too disruptive. ... We would give someone like you (the woman asking the question) a tax credit to help you buy insurance.... We would set up an exchange (to buy insurance). We would reform insurance practices.
Obama has laid out much of his view of reform in a nutshell here.
2:35 Medicare changes?
A: ...What we've proposed is not to change benefits nor to rationcare.... What we've proposed is to eliminate some of the practices that are not making people healthy. Such as Medicare subsidies to insurers [that don't subsidize care, but are instead only extra profits for the insurers at tax payer expense.]
If you take your car in to be fixed and it breaks a week later what if the mechanic said ok, let's just start over [and charge you again.] That wouldn't make sense. We want to give hospitals incentives to change this practice [similar to the auto repair example -- give hospitals incentives (money) to reduce re-admissions].
Highlights only now, paraphrased --
"We don't have a heath care system. We have a disease care system."
Emphasizes preventive care, such as preventing diabetes from leading to an expensive foot amputation.
Q:How can you pay for all of this?
A: 2/3 from efficiencies, eliminating waste. Other 1/3:....taxes...Obama's proposal: limit high-income tax deductions to the same rate as middle-income tax deduction rates: 28%.
"We've got to get over the idea that we can have something for nothing."
The previous medicare drug-cost (prescription) reform: they (Bush and Congress) did not pay for the costs in the legislation... That's part of our deficit now.
...
Here's what the Public Option actually is: Just like a big insurer, but not-for-profit. What opponents argue is you can't have a level playing field -- it would drive private insurers out of the market. That is a legitimate concern,...if the public option is being subsidized.
Q: Will a Public Option be effectively subsidized because it underpays, like Medicare, so that private insurers paying higher rates to doctors effectively subsidize Medicare?
A: Let's change the way we pay for care -- results instead of procedures. But...yes, if doctors only collect 80 cents on the dollar (from Medicare) then yes, private policies make up the difference. Also...free Emergency Room care is paid for by all of us paying taxes and insurance premiums. We are *already* paying for this subsidized care, but don't know it.
[Obama seems to be implying that since Medicare pays for a lot of waste (ineffective, redundant hospital procedures) in addition to effective care, and that this difference, the waste, is the source of the answer to how Medicare *is not* subsidized. That is, the total payments from medicare include the extra payments for useless care that does nothing, and thus balances against the underpayment vs. private insurers. I think that's what he meant.]
Obama asks for skeptical questions.
Q: Insurance agent (broker) in individual market asks why the switch to "insurance reform" and vilifying insurers?
A: I believe private insurers do have a place in the health care system. I want to see practices that are very tough on people, that those practices change. Some of these changes are very hard to achieve unless everyone is covered (mandated). This stops cherry picking. Insurers are willing to accept this because the added new customers will help balance the costs of more complete insurance (better practices). The only way to change practices that hurt people is if everyone is covered.
Here is my rough, very paraphrased, partial transcript (not perfect) and a couple of comments.
2:11 Central Time: Obama points out that people with health insurance are not really secure -- they can be dropped.
2:18: Companies slashing payroll to pay for health insurance.
2:19: People across the nation gathering and having difficult discussions about Health Care in a civil way -- that reflects America.
2:21: Reform will stop the practice of insurers dropping sick policy holders on pretext of application mistakes. One (limited) study found "20,000" dropped this way. The woman dropped during breast cancer for not including acne on her original application for insurance.
2:22: Insurers to be prohibited from denying coverage for preexisting conditions, and also not allowed to place caps (limits) on annual or lifetime costs. Limits also on out-of-pocket expenses.
Finally, insurers to be required to cover preventive routine checkups -- mammograms, etc.
2:24: I don't want gov. bureaucrats meddling in your healthcare, but I also don't want insurance company bureaucrats meddling in your healthcare (applause).
2:26: Everytime we are in sight of healthcare reform, special interests try to "scare the heck" out of people. "...what is truly scary...is if we do nothing." 14,000 lose coverage everyday. The deficit would continue to grow. In about 8 years Medicare goes into the red, and consider we already are limited by deficits right now.
"Change is never easy. It never starts in Washington. It starts with you."
Questions:
2:30 Can you pick and choose from foreign health care systems that work and use those ideas here?
A: Americans spend $5,000-$6,000 more per year than people in any other nation. You don't notice it when your employer pays most of your premium, but we have smaller pay increases as a result. ... Countries like Netherlands -- private in all respects except Government is the insurer... What we've said is, let's find a uniquely American system, because a majority gets health insurance on the job. Changing everything is too disruptive. ... We would give someone like you (the woman asking the question) a tax credit to help you buy insurance.... We would set up an exchange (to buy insurance). We would reform insurance practices.
Obama has laid out much of his view of reform in a nutshell here.
2:35 Medicare changes?
A: ...What we've proposed is not to change benefits nor to rationcare.... What we've proposed is to eliminate some of the practices that are not making people healthy. Such as Medicare subsidies to insurers [that don't subsidize care, but are instead only extra profits for the insurers at tax payer expense.]
If you take your car in to be fixed and it breaks a week later what if the mechanic said ok, let's just start over [and charge you again.] That wouldn't make sense. We want to give hospitals incentives to change this practice [similar to the auto repair example -- give hospitals incentives (money) to reduce re-admissions].
Highlights only now, paraphrased --
"We don't have a heath care system. We have a disease care system."
Emphasizes preventive care, such as preventing diabetes from leading to an expensive foot amputation.
Q:How can you pay for all of this?
A: 2/3 from efficiencies, eliminating waste. Other 1/3:....taxes...Obama's proposal: limit high-income tax deductions to the same rate as middle-income tax deduction rates: 28%.
"We've got to get over the idea that we can have something for nothing."
The previous medicare drug-cost (prescription) reform: they (Bush and Congress) did not pay for the costs in the legislation... That's part of our deficit now.
...
Here's what the Public Option actually is: Just like a big insurer, but not-for-profit. What opponents argue is you can't have a level playing field -- it would drive private insurers out of the market. That is a legitimate concern,...if the public option is being subsidized.
Q: Will a Public Option be effectively subsidized because it underpays, like Medicare, so that private insurers paying higher rates to doctors effectively subsidize Medicare?
A: Let's change the way we pay for care -- results instead of procedures. But...yes, if doctors only collect 80 cents on the dollar (from Medicare) then yes, private policies make up the difference. Also...free Emergency Room care is paid for by all of us paying taxes and insurance premiums. We are *already* paying for this subsidized care, but don't know it.
[Obama seems to be implying that since Medicare pays for a lot of waste (ineffective, redundant hospital procedures) in addition to effective care, and that this difference, the waste, is the source of the answer to how Medicare *is not* subsidized. That is, the total payments from medicare include the extra payments for useless care that does nothing, and thus balances against the underpayment vs. private insurers. I think that's what he meant.]
Obama asks for skeptical questions.
Q: Insurance agent (broker) in individual market asks why the switch to "insurance reform" and vilifying insurers?
A: I believe private insurers do have a place in the health care system. I want to see practices that are very tough on people, that those practices change. Some of these changes are very hard to achieve unless everyone is covered (mandated). This stops cherry picking. Insurers are willing to accept this because the added new customers will help balance the costs of more complete insurance (better practices). The only way to change practices that hurt people is if everyone is covered.
August 12, 2009
You *Think* You Have Insurance, But...Do You?
Does everyone know that their own insurance, seemingly so good, is in fact just exactly like walking on a frozen pond that has plenty of thin ice? You usually won't fall into the icy water on most steps (years), and might be lucky for a very long time, but...
Such as having a policy canceled during breast cancer because you didn't report acne.
If you think you're safe because you have group-coverage from your employer, think again.
Because...what if you aren't with that employer in a year or two? For any reason.
You can have your individual-market insurance canceled for unrelated, innocent mistakes in your application, which are almost or entirely impossible to avoid -- provide every detail of every kind of every health care visit and test result and medication for the last 10 years. Wait...there's more...
You won't be told you must report even things you don't know about, such as when your doctor didn't mention them to you.
These hidden practices give insurers huge advantages -- they can then find excuses to cancel policies if someone is desperately ill and the medical costs are large, and thus increase profits.
Most medical claims costs go to care for high-cost patients. So canceling just some of those patients greatly increases profits.
Therefore the insurer doesn't even verify the application information at the beginning, since that would lose the advantage of being able to cancel on this pretext later!
This is the "free" market situation right now.
Further, anyone, you, me, all of us -- except high profile people like legislators and reporters in the media which insurers are afraid to cancel -- can end up desperately ill and then have a canceled policy in the individual market quite quickly. Here's how: all that's needed is a major illness or accident that removes you from work long enough to lose your job, or even just a simple layoff for economic reasons. Next, if you can't pay the huge expense of cobra ($500-$1800/month, but still hard to pay even with the new 65% subsidy Obama signed into law)...or 18 months pass and cobra expires.... Then...you are in the individual market, but...whoops, you have a preexisting condition.
Time to sell everything you have, pay what you can, and then go bankrupt. But if you can't pay any more then....what happens when you need more treatment?
Finally, most people will not have an opportunity to learn first-hand about this danger ahead of time, since only a small minority become seriously ill or badly injured. So few of us actually personally know someone who has gone bankrupt this way. Years ago, this did not happen.
Most people pay their premiums, without serious illness, and everything seems fine. Routine visits are satisfying and paid for and there is no way to realize the safety net has broken ropes in it.
Most people aren't even aware their employers have recently changed their policies to shift part of the costs onto workers, of necessity, as costs skyrocket at 5%-10%/year.
Has your deductible just gone up a lot? Doubled? Tripled? Do you know?
What can be done about this?
Here is a solution already agreed on across the political spectrum. Here is an even better solution we will need in the long run. Here are reforms to control the health care cost-inflation that is slamming everyone now.
“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals' policies if any condition was not disclosed when the policy was obtained, "even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.” -- Daily Dose Blog (8/11)
Such as having a policy canceled during breast cancer because you didn't report acne.
If you think you're safe because you have group-coverage from your employer, think again.
Because...what if you aren't with that employer in a year or two? For any reason.
You can have your individual-market insurance canceled for unrelated, innocent mistakes in your application, which are almost or entirely impossible to avoid -- provide every detail of every kind of every health care visit and test result and medication for the last 10 years. Wait...there's more...
You won't be told you must report even things you don't know about, such as when your doctor didn't mention them to you.
These hidden practices give insurers huge advantages -- they can then find excuses to cancel policies if someone is desperately ill and the medical costs are large, and thus increase profits.
Most medical claims costs go to care for high-cost patients. So canceling just some of those patients greatly increases profits.
Therefore the insurer doesn't even verify the application information at the beginning, since that would lose the advantage of being able to cancel on this pretext later!
This is the "free" market situation right now.
Further, anyone, you, me, all of us -- except high profile people like legislators and reporters in the media which insurers are afraid to cancel -- can end up desperately ill and then have a canceled policy in the individual market quite quickly. Here's how: all that's needed is a major illness or accident that removes you from work long enough to lose your job, or even just a simple layoff for economic reasons. Next, if you can't pay the huge expense of cobra ($500-$1800/month, but still hard to pay even with the new 65% subsidy Obama signed into law)...or 18 months pass and cobra expires.... Then...you are in the individual market, but...whoops, you have a preexisting condition.
Time to sell everything you have, pay what you can, and then go bankrupt. But if you can't pay any more then....what happens when you need more treatment?
Finally, most people will not have an opportunity to learn first-hand about this danger ahead of time, since only a small minority become seriously ill or badly injured. So few of us actually personally know someone who has gone bankrupt this way. Years ago, this did not happen.
Most people pay their premiums, without serious illness, and everything seems fine. Routine visits are satisfying and paid for and there is no way to realize the safety net has broken ropes in it.
Most people aren't even aware their employers have recently changed their policies to shift part of the costs onto workers, of necessity, as costs skyrocket at 5%-10%/year.
Has your deductible just gone up a lot? Doubled? Tripled? Do you know?
What can be done about this?
Here is a solution already agreed on across the political spectrum. Here is an even better solution we will need in the long run. Here are reforms to control the health care cost-inflation that is slamming everyone now.
August 11, 2009
Obama's Health Care Town Hall Live
C-Span replay of Obama's Health Care Town Hall 8-11.
One must "dismiss" the editorial labeling of C-Span: Pres. Obama Dismisses Opponents of Health Care Reform which, in fairness, is just the opposite of what Obama has done. He has dismissed some misrepresentations, by addressing them. He hasn't dismissed people or opponents.
C-Span also mislabels a NYTimes article it links as: NYTimes: Pres. Obama Calls Protests "Outlandish"
Whereas in fact the actual headline at NYTimes is: Healthcare Critics Make Outlandish Claims: Obama
If I can find a non-biased source that offers the entire event, I will use it.
One must "dismiss" the editorial labeling of C-Span: Pres. Obama Dismisses Opponents of Health Care Reform which, in fairness, is just the opposite of what Obama has done. He has dismissed some misrepresentations, by addressing them. He hasn't dismissed people or opponents.
C-Span also mislabels a NYTimes article it links as: NYTimes: Pres. Obama Calls Protests "Outlandish"
Whereas in fact the actual headline at NYTimes is: Healthcare Critics Make Outlandish Claims: Obama
If I can find a non-biased source that offers the entire event, I will use it.
Something Longer and Deeper is Afoot
Something rather larger than mere politics is beginning to play out lately.
...
Let's take a glance at the politics, as a backdrop.
First, let me say this blog has been intentionally non-partisan, as partisan approaches are self-defeating and prevent clear thinking. But even this kind of discipline is only a logical necessity, and not about the greater questions in life, which are on another level altogether.
So let's look at the world of illusion for a moment, so that we can gain hints from the unusual eddy in the water.
When a political movement begins spreading a desperately dramatic misrepresentation that goes so overboard as does the "euthanizing the elderly" meme, well...this is unusual, and...self-defeating, even on the political level, in time.
This is the inevitable consequence of making up such dramatic rumors (aka lies). The chickens will come home to roost, someday.
This political game could be at great cost to the Republican Party, unless they violently distance themselves. Once wider credibility is lost, recovering it may not be possible.
...
But that's only politics. Which is only an eddy on a river in some sense.
...
A larger game is afoot.
One much deeper and more meaningful than "political" calculations of who's up and who's down, and "Waterloos" and such.
Obama hasn't yet laid into Palin et al.
He hasn't taken them to the woodshed the way he could, if he chose, which would be so easy.
Instead of connecting these deceptions to his opponents, Obama mildly undoes the rumors themselves.
Consider the temper of his response.
This kind of restraint seems so unusual in a President, to me. Not just unusual lately, or for a decade or two. Has a President acted like this before?
Obama is acting with such character that it is frankly unforeseen. For lack of a better word, this kind of character is...Christian, in many ways. Since when did a President actually act like a Christian? I mean an actual Christian, if I can even communicate with the word. Not at all like what we are accustomed to seeing. Something rare. Now-a-days we use a word like Saint, but this has connotations I don't seek here. Have we even had a truly Christian President? Not for decades, I'm sure. Carter may have been to some extent, but couldn't really communicate. Christian is normally pretty much unattainable in the world of power. And it's still no sure thing. But even where we are at is amazing.
Those hoping to score political points against Obama don't even realize the playing field they are on.
They have no idea what is even going on.
They are sheep in the woods.
A larger contest is being played out here. We are seeing something like a contest for the soul of the nation.
...
Polls will not tell us much.
The psychological/soulful outcome of these times will take years to unfold and become fully visible.
I don't expect Obama to be perfect. He's human, so he's bound to make mistakes. Still, I'm taken aback at the way he is operating.
Expect the media and most columnists to be clueless. They simply have no idea how things like this work.
Even the mainstream media of three decades ago probably wouldn't understand I think.
We mostly have children in a sandbox now, though some sit on the side and do mental flights of calculation.
Watching Obama, I am reminded that there is a Soul of our nation. A Soul in America.
A soul is usually steady, but a soul can move, change.
America can remain the same for decades, longer, and it can change in character in a flash of days and months, only a brief moment in time.
We won't know for a while, with the mind, what the outcome of this is.
...
Let's take a glance at the politics, as a backdrop.
First, let me say this blog has been intentionally non-partisan, as partisan approaches are self-defeating and prevent clear thinking. But even this kind of discipline is only a logical necessity, and not about the greater questions in life, which are on another level altogether.
So let's look at the world of illusion for a moment, so that we can gain hints from the unusual eddy in the water.
When a political movement begins spreading a desperately dramatic misrepresentation that goes so overboard as does the "euthanizing the elderly" meme, well...this is unusual, and...self-defeating, even on the political level, in time.
Conservative critics say the legislation could limit end-of-life care and even encourage euthanasia. Moreover, some assert, it would require people to draw up plans saying how they want to die.
These concerns appear to be unfounded. AARP, the lobby for older Americans, says, “The rumors out there are flat-out lies.” -- NYtimes
This is the inevitable consequence of making up such dramatic rumors (aka lies). The chickens will come home to roost, someday.
This political game could be at great cost to the Republican Party, unless they violently distance themselves. Once wider credibility is lost, recovering it may not be possible.
...
But that's only politics. Which is only an eddy on a river in some sense.
...
A larger game is afoot.
One much deeper and more meaningful than "political" calculations of who's up and who's down, and "Waterloos" and such.
Obama hasn't yet laid into Palin et al.
He hasn't taken them to the woodshed the way he could, if he chose, which would be so easy.
Instead of connecting these deceptions to his opponents, Obama mildly undoes the rumors themselves.
Consider the temper of his response.
Opponents contend revised health care will result in a government-run system where people are denied care. But Obama says as specifics of a bill emerge in the fall, the arguments will become more reasoned.
This kind of restraint seems so unusual in a President, to me. Not just unusual lately, or for a decade or two. Has a President acted like this before?
Obama is acting with such character that it is frankly unforeseen. For lack of a better word, this kind of character is...Christian, in many ways. Since when did a President actually act like a Christian? I mean an actual Christian, if I can even communicate with the word. Not at all like what we are accustomed to seeing. Something rare. Now-a-days we use a word like Saint, but this has connotations I don't seek here. Have we even had a truly Christian President? Not for decades, I'm sure. Carter may have been to some extent, but couldn't really communicate. Christian is normally pretty much unattainable in the world of power. And it's still no sure thing. But even where we are at is amazing.
Those hoping to score political points against Obama don't even realize the playing field they are on.
They have no idea what is even going on.
They are sheep in the woods.
A larger contest is being played out here. We are seeing something like a contest for the soul of the nation.
...
Polls will not tell us much.
The psychological/soulful outcome of these times will take years to unfold and become fully visible.
I don't expect Obama to be perfect. He's human, so he's bound to make mistakes. Still, I'm taken aback at the way he is operating.
Expect the media and most columnists to be clueless. They simply have no idea how things like this work.
Even the mainstream media of three decades ago probably wouldn't understand I think.
We mostly have children in a sandbox now, though some sit on the side and do mental flights of calculation.
Watching Obama, I am reminded that there is a Soul of our nation. A Soul in America.
A soul is usually steady, but a soul can move, change.
America can remain the same for decades, longer, and it can change in character in a flash of days and months, only a brief moment in time.
We won't know for a while, with the mind, what the outcome of this is.
August 10, 2009
Expanding Preventive Care Could Add to Costs or Cut Costs, CBO Says
Letter Cites Health Benefits and Says Savings Would Require Emphasizing Cost-Saving Care -- Finding the Dream Blog (link to detailed analysis here).
The nutshell version --
some preventive care cuts overall long-term health care cost dramatically,
some preventive care cuts long-term costs moderately,
some adds to long term costs but still improves health on average,
some actually reduces health on average,
and finally, some less efficient types of preventive screening and less-efficacious procedures can add to cost due to overuse when not well-indicated, suggesting they be used in more narrow ways.
The nutshell version --
some preventive care cuts overall long-term health care cost dramatically,
some preventive care cuts long-term costs moderately,
some adds to long term costs but still improves health on average,
some actually reduces health on average,
and finally, some less efficient types of preventive screening and less-efficacious procedures can add to cost due to overuse when not well-indicated, suggesting they be used in more narrow ways.
(Update) The Curious Case of the Misleading CBO Letter
So, the CBO responded to questions from the House Energy and Commerce Committee about the CBO's evaluation of the cost-saving effects, or lack thereof, of preventive medical care and wellness services, with a lengthy, somewhat involved letter that began thusly:
Ok, if you're still with us, by this time I think most people would think reasonably that they have gotten the drift of this letter. Looking a bit further along, evidently the CBO is just going to lay out more and more about why preventive care will cost more than it saves, more or less.
Or perhaps, at least having waded this far into the dense, 7-page letter, one might reasonably conclude one could skim a bit and skip to near the end for any more summary stuff. At the end, the letter discouragingly bogs the reader down into budget scorekeeping arcana. Skimming backwards, one then could examine the end of the section on Preventive Medical Care:
Somehow, this doesn't appear to suggest Preventive Care must cost more than it saves, even by the narrow measure of medical costs only, does it?
The only question is whether the sentences of the CBO letter, each one accurate in itself, should have been arranged differently.
I think so.
Let me suggest a summary statement that accurately conveys the substance available from the CBO regarding Preventive Medical Care.
Let's just reword the CBO summary statement to reflect the information and references the CBO itself offers in the letter:
There, that's better now, don't you think?
At least it conveys the content the CBO found.
If I were an news editor, I'd then require a more accurate headline also:
Expanding Preventive Care Could Add to Costs or Cut Costs, CBO Says
Letter Cites Health Benefits and Says Savings Require Emphasizing Cost-Saving Care -- Finding the Dream Blog
-------------------------------------------
Update 8-26
The NYTimes has a new op-ed piece on the inability of the CBO to estimate medical savings from reforms.
August 7, 2009
Honorable Nathan Deal
Ranking Member
Subcommittee on Health
Committee on Energy and Commerce
U.S. House of Representatives
Washington, DC 20515
Dear Congressman:
This letter responds to the question you asked at a July 16, 2009, committee markup concerning the Congressional Budget Office’s (CBO’s) analysis of the budgetary effects of proposals to expand governmental support for preventive medical care and wellness services. Specifically, you asked whether the agency’s scoring methods reflect potential reductions in federal costs from improvements in health that might result from expanded support for those activities.1
Preventive Medical Care
Preventive medical care includes services such as cancer screening, cholesterol management, and vaccines. In making its estimates of the budgetary effects of expanded governmental support for preventive care, CBO takes into account any estimated savings that would result from greater use of such care as well as the estimated costs of that additional care. Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.
That result may seem counterintuitive. For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending—for that individual. But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. Even when the unit cost of a particular preventive service is low, costs can accumulate quickly when a large number of patients are treated preventively. Judging the overall effect on medical spending requires analysts to calculate not just the savings from the relatively few individuals who would avoid more expensive treatment later, but also the costs for the many who would make greater use of preventive care.2 As a result, preventive care can have the largest benefits relative to costs when it is targeted at people who are most likely to suffer from a particular medical problem; however, such targeting can be difficult because preventive services are generally provided to patients who have the potential to contract a given disease but have not yet shown symptoms of having it....
Ok, if you're still with us, by this time I think most people would think reasonably that they have gotten the drift of this letter. Looking a bit further along, evidently the CBO is just going to lay out more and more about why preventive care will cost more than it saves, more or less.
Or perhaps, at least having waded this far into the dense, 7-page letter, one might reasonably conclude one could skim a bit and skip to near the end for any more summary stuff. At the end, the letter discouragingly bogs the reader down into budget scorekeeping arcana. Skimming backwards, one then could examine the end of the section on Preventive Medical Care:
In sum, expanded governmental support for preventive medical care would probably improve people’s health but would not generally reduce total spending on health care. However, government funding for some specific types of preventive care might lower total spending.
From this, how could anyone fault headlines such as these below which flowed from this letter?
Expanding Preventive Care May Add to Costs, CBO Says
Letter Cites Health Benefits but Few Savings -- Washington Post
Congressional Budget Expert Says Preventive Care Will Raise -- Not Cut -- Costs -- ABCNews
The only problem is....the headlines are pretty much asserting the opposite of what you should conclude if you work painfully through the CBO letter in full, carefully, and read the most significant of its source references, carefully.
!
Reading the entire CBO letter, plowing through it's carefully precise prose, one finally happens upon an accurate, summary-type statement near the top of the 3rd page which should have been an emphasized part of the general summary statement for the entire Preventive Medical Care section:
Treatments for existing medical conditions range from those that save money to those that cost money in much the same way that preventive services do: About 20 percent save money, and about 60 percent have costs that many consider reasonable relative to their benefits, according to the study cited above. Thus, not only preventive services but medical services more generally could be evaluated in order to encourage high-value services of both types and discourage low-value ones.hmmmm...
Somehow, this doesn't appear to suggest Preventive Care must cost more than it saves, even by the narrow measure of medical costs only, does it?
The only question is whether the sentences of the CBO letter, each one accurate in itself, should have been arranged differently.
I think so.
Let me suggest a summary statement that accurately conveys the substance available from the CBO regarding Preventive Medical Care.
Let's just reword the CBO summary statement to reflect the information and references the CBO itself offers in the letter:
In sum, expanded governmental support for preventive medical care would improve people’s health but would not generally reduce total spending on health care itself unless targeted specifically at the cost-saving and most cost-effective preventive care only, as determined by research such as in the references in this letter. In this way, government funding for some specific types of preventive care could clearly lower total health care spending.
There, that's better now, don't you think?
At least it conveys the content the CBO found.
If I were an news editor, I'd then require a more accurate headline also:
Expanding Preventive Care Could Add to Costs or Cut Costs, CBO Says
Letter Cites Health Benefits and Says Savings Require Emphasizing Cost-Saving Care -- Finding the Dream Blog
-------------------------------------------
Update 8-26
The NYTimes has a new op-ed piece on the inability of the CBO to estimate medical savings from reforms.
August 7, 2009
Dr. Arnold Relman: Broad Principles of Health Care Reform
Dr. Arnold Relman, familiar to some readers of this blog from this post, writes to the NYTimes about how to reform Health Care:
Careful readers of this blog will expect my view on Relman's ideas: I agree with each of Dr. Relman points.
This leaves only the question of how to "encourage physicians to practice in private, not-for-profit multispecialty groups, where they would work for salaries rather than fee-for-service."
The best way to encourage organizations like this -- such as the Mayo Clinic for instance -- is to reimburse for outcomes-over-time, as laid out here on this blog with details such as how to create ongoing outcome criteria tables, how to handle partial successes, how to change the incentives in selecting and paying for drugs, and how to set outcome reimbursement rates via bidding. Paying for outcomes-over-time would reward the practices of these cooperative-care organizations.
Under a pay-for-outcome system, when a cooperative-care provider treats a patient more efficiently, such as by multispecialty pinpointing of the best treatment regimen, they would receive the same pay as a less efficient provider that takes longer and does more to achieve the same outcome. The same pay for the same outcome is only fair. This is widely referred to as "quality-" or "value-based" care.
To the Editor:
David Leonhardt (“Health Care and the T-Word,” Economic Scene, July 29) is quite correct in identifying the growth in health care spending at a rate far greater than the growth in the United States economy as the critical health care problem. He is also correct in noting the waste and unnecessary expense in our health system. But he is quite mistaken in believing that tax reform will eliminate the perverse incentives in the system and deliver the kind of system we need.
The “root of the problem,” to use his language, lies in the way doctors are organized and the way they practice and are paid. Doctors are, and should be, the most important factor in determining how clinical resources are used in the diagnosis and treatment of illness and injury. Neither insurers nor government administrators can make the medical care decisions in a given case. Only doctors and their patients can do that.
The solution to our problem is to cap total national expenditures through an earmarked, graduated health care tax, provide universal coverage on a prepaid basis and encourage physicians to practice in private, not-for-profit multispecialty groups, where they would work for salaries rather than fee-for-service.
That kind of reform will not be easy to achieve, but it should be the ultimate goal of our legislative efforts, because it would be the best — maybe the only — way to make the medical care system work efficiently for the benefit of patients, at a cost we can afford. Tinkering with taxes on private insurance isn’t going to do the job.
Arnold S. Relman
Boston, July 29, 2009
The writer is professor emeritus of medicine and of social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine.
Careful readers of this blog will expect my view on Relman's ideas: I agree with each of Dr. Relman points.
This leaves only the question of how to "encourage physicians to practice in private, not-for-profit multispecialty groups, where they would work for salaries rather than fee-for-service."
The best way to encourage organizations like this -- such as the Mayo Clinic for instance -- is to reimburse for outcomes-over-time, as laid out here on this blog with details such as how to create ongoing outcome criteria tables, how to handle partial successes, how to change the incentives in selecting and paying for drugs, and how to set outcome reimbursement rates via bidding. Paying for outcomes-over-time would reward the practices of these cooperative-care organizations.
Under a pay-for-outcome system, when a cooperative-care provider treats a patient more efficiently, such as by multispecialty pinpointing of the best treatment regimen, they would receive the same pay as a less efficient provider that takes longer and does more to achieve the same outcome. The same pay for the same outcome is only fair. This is widely referred to as "quality-" or "value-based" care.
August 6, 2009
Massachusetts to "Kill-Off" Fee-For-Service -- Here's the Next Step
While the Health Care Reform debate spreads and confuses and drags on, we are going to simultaneously see actual cost-control reform enacted and carried out right in front of us.
It's like a play where a group of doctors on the stage argue loudly about how to treat dozens of patients struck by a slow and deadly disease (Inflation Plague), but then in the foreground some in the audience notice a nurse and a doctor arrive and calmly begin treating one of the patients.
We are going to witness right now how Universal Coverage in a state which must balance its budget entails forced real change.
The Federal Government doesn't have to balance its budget quickly. Massachusetts must.
So, facing exploding costs and a real time deadline, we get to see what-can-be-done when-you-really-have-to-do-it (audio and excerpt below).
Now, the part of this Global Payment system that stands out in the report is how they hope to manage incentives!
The irony here is that a Global Payment system will lead to increasing costs later, the opposite of its intent. Here's why:
Since the Global Payment -- a recurring monthly or annual payment to providers for patients (presumably by age) -- is fixed, it is independent of condition. Therefore a patient with an expensive-to-treat condition is likely to be ignored or given palliative care unless likely to live long enough to eventually pay off the cost via the recurring fixed payment, and also only if they remain with that provider. Therefore the incentive to the provider is not to treat this condition, unless the recurring payment is high enough and the patient is guaranteed to remain with that provider long enough afterwards.
This quandary would then result in political pressure to increase state support for payments in order to try to induce providers to treat these more expensive conditions for sicker patients.
So, the necessary determination of minimum Global payment-by-age amounts would become a political decision! Even if off-loaded to a board, it will be politicized.
Yet Kane mentions (excerpt above) that a means for quality measuring (electronic records) is in place. In other words, much of the necessary initial structure needed to pay for quality/value instead of just capitation (Global payment), is in place!
Once you being to measure outcomes, then you can structure incentives for outcomes.
It is far less political and less destined-for-trouble to pay for successful outcomes measured over time intervals -- so that the last few increments of pay for a fully-successful treatment happen only if the patient lives long enough or remains cured long enough to meet the longer success-over-time criteria, which for many conditions would have the last increments at a year or longer. There is pay for shorter periods of success, but more pay for longer periods of success.
Compare this to trying to choose levels of global payments by age, which due to state subsidy could become one of the hottest political decisions each year. (Update: the WSJ has a detailed look at France's excellent system, which is shifting away from Global Payments in one area: "Ironically, France is actually in the midst of shifting to a fee-for-service system for its state-run hospitals. The hope is that it will be easier for the government to track if the money is being spent efficiently, compared with the old system of simply giving hospitals an annual lump-sum payment.")
The two systems, Global payments vs. Pay-for-Outcomes-Over-Time, have some similarity, yes, but a profound difference also. Pay-for-Outcomes-Over-Time doesn't try to decide politically or at a board exactly what the pay levels should be. Instead a normal bidding process (see "Update 7-10, 7-17 -- Setting Prices" here) sets up pay levels for outcomes over time in an ongoing, democratic way involving doctors and automatically comparing costs.
The fact that part of the quality measuring apparatus is in place makes the necessary next pieces of reform quite easy -- paying for outcomes based on current condition, along with incentives specifically for health maintenance. These will solve the critical problem of having the right incentives in place to care for very sick patients -- if it's reasonably possible to improve the patient's condition, then the pay-for-outcome system will result in trying to do so, without any regulatory oversight needed!
Regulatory oversight will fail all too often, by nature. Just as the FDA fails to protect citizens until after many deaths accumulate, regulatory oversight is slow and can't see everything until after it is obvious in hindsight. A structure to pay-for-outcome would work better.
It's like a play where a group of doctors on the stage argue loudly about how to treat dozens of patients struck by a slow and deadly disease (Inflation Plague), but then in the foreground some in the audience notice a nurse and a doctor arrive and calmly begin treating one of the patients.
We are going to witness right now how Universal Coverage in a state which must balance its budget entails forced real change.
The Federal Government doesn't have to balance its budget quickly. Massachusetts must.
So, facing exploding costs and a real time deadline, we get to see what-can-be-done when-you-really-have-to-do-it (audio and excerpt below).
Now, the part of this Global Payment system that stands out in the report is how they hope to manage incentives!
But some worry "global payment" sounds suspiciously like the managed care "capitated" HMO plans of the 1990s. Those plans were also based on paying health care providers a fixed amount per patient.
That experiment failed, because it gave doctors and hospitals an incentive to hold back on care.
To avoid a repeat of that experience, advocates of global payment say health providers will have to be watched closely.
"You need someone monitoring this," says Nancy Kane of the Harvard School of Public Health. "You can't just walk away because you've set the limit."
Kane is a health care finance expert who also served on the recent Massachusetts Payment Reform Commission.
She says there are ways these days to prevent stinting on care.
"There's a lot of quality measuring that can go on now that didn't used to be available," she says. "We now have electronic medical records. It's easier to monitor what's going on. So I think the whole reporting system and the intention to maintain a monitoring infrastructure is all critical to avoiding the bad days of managed care."
The irony here is that a Global Payment system will lead to increasing costs later, the opposite of its intent. Here's why:
Since the Global Payment -- a recurring monthly or annual payment to providers for patients (presumably by age) -- is fixed, it is independent of condition. Therefore a patient with an expensive-to-treat condition is likely to be ignored or given palliative care unless likely to live long enough to eventually pay off the cost via the recurring fixed payment, and also only if they remain with that provider. Therefore the incentive to the provider is not to treat this condition, unless the recurring payment is high enough and the patient is guaranteed to remain with that provider long enough afterwards.
This quandary would then result in political pressure to increase state support for payments in order to try to induce providers to treat these more expensive conditions for sicker patients.
So, the necessary determination of minimum Global payment-by-age amounts would become a political decision! Even if off-loaded to a board, it will be politicized.
Yet Kane mentions (excerpt above) that a means for quality measuring (electronic records) is in place. In other words, much of the necessary initial structure needed to pay for quality/value instead of just capitation (Global payment), is in place!
Once you being to measure outcomes, then you can structure incentives for outcomes.
It is far less political and less destined-for-trouble to pay for successful outcomes measured over time intervals -- so that the last few increments of pay for a fully-successful treatment happen only if the patient lives long enough or remains cured long enough to meet the longer success-over-time criteria, which for many conditions would have the last increments at a year or longer. There is pay for shorter periods of success, but more pay for longer periods of success.
Compare this to trying to choose levels of global payments by age, which due to state subsidy could become one of the hottest political decisions each year. (Update: the WSJ has a detailed look at France's excellent system, which is shifting away from Global Payments in one area: "Ironically, France is actually in the midst of shifting to a fee-for-service system for its state-run hospitals. The hope is that it will be easier for the government to track if the money is being spent efficiently, compared with the old system of simply giving hospitals an annual lump-sum payment.")
The two systems, Global payments vs. Pay-for-Outcomes-Over-Time, have some similarity, yes, but a profound difference also. Pay-for-Outcomes-Over-Time doesn't try to decide politically or at a board exactly what the pay levels should be. Instead a normal bidding process (see "Update 7-10, 7-17 -- Setting Prices" here) sets up pay levels for outcomes over time in an ongoing, democratic way involving doctors and automatically comparing costs.
The fact that part of the quality measuring apparatus is in place makes the necessary next pieces of reform quite easy -- paying for outcomes based on current condition, along with incentives specifically for health maintenance. These will solve the critical problem of having the right incentives in place to care for very sick patients -- if it's reasonably possible to improve the patient's condition, then the pay-for-outcome system will result in trying to do so, without any regulatory oversight needed!
Regulatory oversight will fail all too often, by nature. Just as the FDA fails to protect citizens until after many deaths accumulate, regulatory oversight is slow and can't see everything until after it is obvious in hindsight. A structure to pay-for-outcome would work better.
August 4, 2009
Some Republicans Begin to Destroy the G.O.P.
In the House, Representative Mike Pence of Indiana, chairman of the Republican Conference, distributed a packet to colleagues on Friday urging them to argue that the Democrats’ plan would include “more than $800 billion in new tax hikes” and “harmful cuts” to Medicare that would “result in millions of seniors losing their health coverage.” -- NYTimes
Ever since the Democratic Party began adopting many of the best Republican ideas in the 1990s, the G.O.P. has increasingly become a victim of its own political strategies.
Any political party has its problem members, but the Republican Party is really starting to look self-destructive.
There is only a brief time -- perhaps months, perhaps a year -- during which increasingly fanciful misrepresentations will work. But using progressively more dramatic falsehoods has consequences.
There is a cost for lying, which increases over time.
First, the open breach of morals begins a process of decay, both within and without. As the group morals decline, a few of those with more integrity leave or lose due to the party's direction and national rhetoric. More and more of the voters leave. The remaining members and followers begin to believe their own rhetorical lies, even as the intentional misrepresentations and smears grow more disconnected from any realism.
Consider how in spite of the fact that a local newspaper in Hawaii reported Barack Obama's birth in 1961, it was nevertheless possible for significant numbers of the people to believe the fantasy that Obama wasn't born there.
This demonstrates a process of gradually divorcing the mind from reality -- a decay of integrity and perception, together.
The decay of integrity (truthfulness) causes the decay of perception.
It appears too much of the Republican party has advanced some distance along this terrible process.
Like many, in my youth I liked some Republicans -- I was excited about Reagan in 1975 after hearing him speak, long before I was old enough to vote (I was still too young when Reagan won in 1980, but was happy to vote for him in 1984...before the senseless further ramp in "defense" spending). I voted for Republicans many times because they offered better candidates. Many Democrats did not signal an appreciation of enterprise at that time. It's fair to say I've been a "swing" voter -- voting for the winning Presidential candidate each time (though I skipped 2000) until 2004 when the better candiate was "swift-boated." But now that Democrats seem to respect enterprise, and in view of the rhetoric from Republicans, I'd expect a Democrat to be the better candidate more often.
Here in Texas we have the half-crazed Rick Perry, for instance, who was willing to indirectly hint at the idea of seceding from the union. "There's a lot of different scenarios," Perry said. "We've got a great union. There's absolutely no reason to dissolve it. But if Washington continues to thumb their nose at the American people, you know, who knows what might come out of that. But Texas is a very unique place, and we're a pretty independent lot to boot."
And this is far from the worst. While there are worse, Perry is more amusing I think (read this and then consider this quote from Sam Houston himself: “All new states are invested, more or less, by a class of noisy, second-rate men who are always in favor of rash and extreme measures, but Texas was absolutely overrun by such men.” ...heh heh heh...)
The G.O.P. may have already doomed itself through this process of believing its own lies. It might not be possible to recover.
The G.O.P. would need a visionary of very high integrity, who does not stretch the truth, ever, to have a chance to heal its self-inflicted wounds.
They would need someone of Barack Obama's caliber.
Consider the most damning part of this change: take the Barack Obama of today and move him back to 1972 or so, and he would be a quite excellent Republican. He is reasonably "conservative" in several ways that matter greatly, just as he is also has certain "liberal" elements -- the best (reminds me of Reagan in this way). In fact, Obama transcends party in my opinion. But back then, he would be quite electable as a Republican in most parts of the country.
Now, far too many in the Republican party consider Obama the enemy. Just this process alone -- the search for and dependence on having some enemy -- is self-destructive.
This is because too many in the party have lost their way, lost their roots -- they have been taken over by a process of distortions and misrepresentations so long in the making that many party members are now as lost in fantasies as the worst cults.
That's how far this party has fallen.
...
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