Would Republicans Filibuster a $626 Billion Defense Bill?

What? you may ask.

For a fleeting moment, something in us hopes.

Why would Senate Republicans try to block the Defense appropriations bill?

Might it be because of the strain of such a large appropriation on the federal budget?

$626 Billion in one...single...year...is far more money than the contemplated health care reform spending of about $900 Billion over ten years (starting slowly in 2010 with new subsidies for state high-risk health insurance pools).

Any conservative could reasonably consider defense spending efficiency, yes?

How about during a time when the U.S. faces no enemy or rival in the world capable of credibly challenging our navy, air force, or land forces? How about considering we spend far more on defense as a portion of our total economy than any other developed nation?

If we spent 1/2 as much, we would could still overwhelm any current or likely foe.

The answer unfortunately is a Washington game, from the Republican party, which seems enamored of Washington games lately:

If the filibuster on the $626 billion defense bill had succeeded, Democrats would have had to scramble to find a way to fund the military operations, because a stopgap funding measure for the Pentagon will expire at midnight Friday. Such an effort to come up with another stopgap defense bill might have disrupted the very tight timeline on health care.

Imagine...just for a moment...a more sane world.

A world in which the Republican party filibustered the Defense appropriations bill because it is a massive, budget-destroying $626 BILLION DOLLARS!

Oh....we can only hope we'll have genuine conservatives in the Republican party again someday...

It seems most of the Senators in Washington calling themselves "Republicans" have little or no regard at all for the actual federal deficit, in spite of much repetitive rhetoric.

They want to have it both ways.

They want to talk restraint on Washington spending.

But they been spending America into crisis for years, with budget-busting defense appropriation after appropriation, where even canceling a single out-of-date jet fighter (F-22) that the Pentagon did not want, took a determined effort from the administration so that it was considered a significant victory....

We are in sad, sad shape.

What would put us into better shape?

Sizing defense spending down to proportion to the actual threats we face, instead of being ready to instantly fight a major war (what is "major" you may ask -- "major" is a situation where there is an actual hostile opponent that is fielding organized armies of hundreds of thousands of well-armed and trained troops supplemented by powerful naval and/or air forces that is seriously preparing to fight us; the last such major situation ended in the 1990s as the Warsaw Pact dissolved. The Iraq of 2003 was at most a medium-sized war).

We are ready to fight massive enemies not because there are any massive enemies anywhere in the world.

There are not.

We spend this much because it is profitable for military contractors and attracts votes in the current set of Senators and Representatives that represent these for-profit military contractors.

President Eisenhower, who was also Supreme Allied Commander during World War II, warned us about this -- the "military-industrial complex" -- but somehow his party, the Republican party, seems to have little regard for this wise and experienced conservative leader of the 1950s.

We need to bring troops home from around the world, reduce new weapons purchases, and focus more on intelligence and research, so as to increase our real basis of security.


(For perspective, it might help readers to know I was an avid supporter of Reagan (from 1975) and his massive defense spending, though I was not old enough to vote in a presidential election until 1984. I favored Reagan's military buildup, until Gorbachev began to clearly signal major change in 1986-1988. By 1988 it was clear that ideas and technology and information were changing the world, not military strength.)

Republicans and Lieberman Trying to Keep Their Familiar Place

Every opponent of good health reform ideas are in the end only trying to secure a place for themselves and make a living and have a decent life, personally.

When Joe Lieberman (Senator of Connecticut) basically kills or puts off into the future one of the best reform ideas to date -- the Medicare buy-in for ages 55-64, which would lower overall national (public and private) health care spending, strengthen Medicare, and reduce federal deficits -- well, he's only trying to keep the life he knows.

Joe feels important, at the center of things. He loves it.

That's the life he wants.

In Connecticut are big insurers, such as health insurers like Aetna (in Hartford.)

Aetna itself is part of Senator Lieberman's constituents.

Joe wants to protect Aetna, and help it thrive.

Aetna represents a part of Connecticut jobs. Jobs in Hartford.

Joe wants to be important, and wants to preserve and strengthen Aetna's profitability.

...

Republicans....want to have a place.

If Health Care Reform is tremendously successful -- such as would follow from the recently proposed ideas of the Medicare buy-in for ages 55-64, from regulating the Medical Loss Ratio (percentage of health insurance premium income health insurers must pay out for actual health care) up to 90%....

Well, such pieces of reform would accelerate the benefits of health care reform and make good results clearer, sooner.

And having a social program designed largely by the Democrats thrive and benefit Americans in a more obvious and rapid fashion would make the Republican party seem less useful.

Less useful, less needed.

Who needs Republicans if Senators like Ron Wyden already offer the best market-based ideas?

Republicans don't want to lose more elections and become a smaller party.

They want to be important.

They want to regain that heady power they loved.

Power, importance, control.

Reform opponents are pushed to ignore the best interests of America as a whole by three strong motivations.

1. Because they want to be important and have power.
2. Because they want to have a place and make a living.
3. Because they believe in the evolving narrative, the invention, the fiction of a certain Russian emigre who renamed herself Rand. It's a powerful, self-serving world view in which only select individuals are important and produce the good things in the world, and everyone else is second class -- a lower class of people that should look up to their superiors. (More is coming about this very important fact in a later post.)

But of these motivations, the second -- just a need to have a place, to make a living -- is the one that counts, that increases the number of opponents of reform from a scattered few to an important minority that are unable to see all the sides of important issues.

How to Lower the Immediate Cost of Reform, and...Republicans "trapped in a cul-de-sac of their own making"

(Note: this is not the coming-topic post I mentioned a couple of days back, but this is a post on exactly where Congress should go right now.)
-----------------------------------------------------------

Republicans have driven themselves into a cul de sac. They agree on the basics of insurance reform, and they should.

Consider the people they represent (Bloomberg poll):

Americans overwhelmingly approve of President Barack Obama’s goals for remaking the U.S. health- care system even as they express skepticism he can achieve them, according to a Bloomberg News poll.
More than 8 out of 10 people support covering the uninsured, curbing costs, creating an insurance-purchasing exchange, and preventing insurers from dropping coverage or refusing to accept people with preexisting medical conditions. Majorities say employers should have to offer insurance and individuals should be required to have coverage.

NPR offers a good summary of the political situation in health care reform.

In brief, if you prevent insurance companies from excluding preexisting conditions without also creating a requirement for individuals to have health insurance (a mandate), then you have an overwhelming problem: people could simply wait until they get sick and then buy insurance, only when their claims would be high. This, in turn, would cause the premiums to rise sharply, which in turn would cause those who are not sick to drop coverage and wait until they get sick, etc.

Therefore it is necessary to require everyone to buy insurance -- a mandate. Because otherwise health insurance doesn't work.

Unlike life insurance or home insurance or auto insurance, an illness (medical loss) doesn't always happen in seconds or minutes, and the expenses are not all incurred within a day. They continue.

There's no way around the conclusion that an individual mandate is a necessity if you outlaw the exclusion of preexisting conditions.

The whole purpose of health care is to treat the sick, not to keep insurers profits higher or avoid costs by refusing the sick.

And health care costs require insurance -- very few can afford to pay for good health care for non-routine illness or accidents out of pocket.

Very few could afford, say, $50,000 or $140,000 out of pocket.

Thus health insurance is a reasonable idea, a good idea, but...it cannot work for sick people without laws. For instance, at an absolute minimum, laws about enforcement of contract -- that the insurer cannot drop coverage on whatever pretext when a person has an expensive condition.

Once we outlaw excluding preexisting conditions -- in other words we require insurers pay to care for sick people -- then individual mandates become necessary.

But the cost of comprehensive health insurance today with reasonable deductibles (that a household could actually pay off in a year) is higher than lower income households are able to pay.

Thus the individual mandate requires subsidies to allow lower-income households to be able to afford to purchase the required insurance.

As Republicans generally are opposed to higher taxes and/or deficit spending, they end up in a trap -- a political cul-de-sac of their own making.

...

I and others have proposed specific ideas to make health insurance less expensive, both in terms of holding down long term health care inflation (read this,) and in terms of immediate cost by carefully outlining what is a reasonable "basic" required health insurance policy that would be mandated for young, currently healthy people as their minimum required insurance.

These proposals are not partisan in any fashion. It does not make sense to think that a 25-year old should be required by law to have a health insurance policy that costs $6,000 or $7,000/year regardless of their own preferences.

Most 25-yr-olds would prefer a policy that provides for routine checkups and some basic coverage -- their minimum requirement could be a policy that would provide inexpensive clinic care for occasional need such as infections, and of course coverage for the unlikely expensive condition such as cancer or an accident.

Such coverage for a 25-yr-old need not cost $7,000/yr, nor should a 25-yr-old be required by law to help subsidize in a large way the average health care costs of a 50-yr old. Proposals to allow significant variations in policy cost by age are entirely appropriate. Older people have on average more earning power, and higher health care expenses.

The mandated minimum "basic" policy should truly be basic. It should be no-frills health care.

Anyone could choose, as in other marketplaces, whether to go economy-class or to go first-class -- whether to get their routine and occasional care in a low-cost clinic or in an upscale doctor's office, according to the policy they choose.

If such no-frills policies were available, most lower-income households would choose such a basic policy, which would neither be especially generous nor would it contain tricky loopholes or caps meant to fool the policy holder or avoid paying for reasonable care. Such basic policies would be considerably less expensive.

That lower cost would in turn reduce the need for and total cost of subsidies a great deal.

The most common failure we see in the thinking in Congress, year in and year out, is an appreciation of scale and cost that corresponds to the actual means of the average American household. Congress should not mandate expensive health insurance. It should mandate very basic health insurance that is sound and reliable.

What is an example of "basic" insurance? In the past, some instances of less expensive care got a bad reputation. Consider the old-style, unpopular HMOs (Health Maintenance Organizations), or "managed care", which were carefully structured to reduce expenses and costs. HMOs were popular initially due to lower cost, but became less popular since they offered less choice and stories spread of long waits and denied care, creating an impression of not enough quality. But, some HMOs provided and provide health outcomes of quality as good as that of more expensive plans.

But a better version of managed care is offered by isolated providers here and there -- coordinated or cooperative or "integrated" care. This managed care actually offers superior quality at lower costs.

Consider Mayo Clinic for instance. Mayo is one of the best providers in the world, and...Mayo costs less than most of its competitors. Superior systems like cooperative care spread slowly since the structure of health care payment does not reward their cost-effective quality. When a health care provider heals someone faster with less proceedures, they get less compensation under most of American health care delivery structures. (See link below for a better way to pay for care. )

There are yet more ways to cut costs while maintaining quality in a basic plan. A plan could specifically require doctors follow "best practices," make extensive use of nurse practitioners in clinics, and other cost saving features. When value (quality/price) itself becomes a goal, organizations are able to respond and create new innovations and efficiencies. They only need a reimbursement structure that encourages quality, value, and effectiveness.

Death Panels -- Considering and Answering Palin's Real Fears

Sarah Palin just expounded further on her fears about "death panels." Let me first show her letter (below), then I will recommend a specific way to respond to the main fear Palin pinpoints.

-----------------------------------------------------------
Senator Reverend Ruben Diaz Chair, New York Senate Aging Committee Legislative Office Building Room 307 Albany, NY 12247
September 8, 2009

RE: H.R. 3200: America's Affordable Health Choices Act of 2009 and Its Impact on Senior Citizens

Dear Senator Diaz,

Thank you for asking me to participate in the New York State Senate Aging Committee's hearing regarding H.R. 3200, "America's Affordable Health Choices Act of 2009." You and I share a commitment to ensuring that our health care system is not "reformed" at the expense of America's senior citizens.

I have been vocal in my opposition to Section 1233 of H.R.3200, entitled "Advance Care Planning Consultation."[1] Proponents of the bill have described this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. That is misleading. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often "if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program."[2] During those consultations, practitioners are to explain "the continuum of end-of-life services and supports available, including palliative care and hospice," and the government benefits available to pay for such services.[3]

To understand this provision fully, it must be read in context. These consultations are authorized whenever a Medicare recipient's health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is "to reduce the growth in health care spending."[4] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As one commentator has noted, Section 1233 "addresses compassionate goals in disconcerting proximity to fiscal ones.... If it's all about obviating suffering, emotional or physical, what's it doing in a measure to 'bend the curve' on health-care costs?"[5]

As you stated in your letter to Congressman Henry Waxman of California:
Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen ... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign.[6]

It is unclear whether section 1233 or a provision like it will remain part of any final health care bill. Regardless of its fate, the larger issue of rationed health care remains.
A great deal of attention was given to my use of the phrase "death panel" in discussing such rationing.[7] Despite repeated attempts by many in the media to dismiss this phrase as a "myth", its accuracy has been vindicated. In the face of a nationwide public outcry, the Senate Finance Committee agreed to "drop end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly."[8] Jim Towey, the former head of the White House Office of Faith-Based Initiatives, then called attention to what's already occurring at the Department of Veteran's Affairs, where "government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care."[9] Even Washington Post columnist Eugene Robinson, a strong supporter of President Obama, agreed that "if the government says it has to control health care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending."[10] And of course President Obama has not backed away from his support for the creation of an unelected, largely unaccountable Independent Medicare Advisory Council to help control Medicare costs; he had previously suggested that such a group should guide decisions regarding "that huge driver of cost . . . the chronically ill and those toward the end of their lives...."[11]

The fact is that any group of government bureaucrats that makes decisions affecting life or death is essentially a "death panel." The work of Dr. Ezekiel Emanuel, President Obama's health policy advisor and the brother of his chief of staff, is particularly disturbing on this score. Dr. Emanuel has written extensively on the topic of rationed health care, describing a "Complete Lives System" for allotting medical care based on "a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated."[12]

He also has written that some medical services should not be guaranteed to those "who are irreversibly prevented from being or becoming participating citizens.... An obvious example is not guaranteeing health services to patients with dementia."[13]

Such ideas are shocking, but they could ultimately be used by government bureaucrats to help determine the treatment of our loved ones. We must ensure that human dignity remains at the center of any proposed health care reform. Real health care reform would also follow free market principles, including the encouragement of health savings accounts; would remove the barriers to purchasing health insurance across state lines; and would include tort reform so as to potentially save billions each year in wasteful spending connected to the filing of frivolous lawsuits. H.R. 3200 is not the reform we are looking for.

Thank you for calling attention to this important matter. I look forward to working with you again to ensure that we keep the dignity of our senior citizens foremost in any health care discussion.

Sincerely,

Governor Sarah Palin

-----------------------------------------------------------


I just had a further insight on exactly what Palin and many people actually do fear when they speak of "death panels."

A real, actual fear.

First, let me point out I myself will likely take advantage eventually of any possible consultations about what kinds of treatment and care I could receive in old age in varied situations, so as to lay out under what conditions I would like what kind of care, and under what conditions I would not want certain kinds of treatments.

But part of the reason such a consultation with my doctor will someday be valuable to me personally is that I do not have an overwhelming fear of death. Instead, I am more afraid of having a lingering, uncomfortable hospital intervention where the outcome of dying is clearly inevitable.

Like Senator Kennedy recently, I'd rather be sailing, sitting at home, eating ice cream, and spending quality time with friends and family as the end approaches.

Sure I have some ordinary fear of dying, but not a strong, active fear that takes over and dominates when I think on dying. My life experiences have moved me past that.

So I actually see that kind of consultation as a positive -- it will give me more control of my own going, in my own way, according to what I like and value....

But...if I did have a strong, powerful fear of death -- which is a very commonplace human condition -- I'd have an entirely different feeling about such a consultation.

I'd dread and fear even the consultation, and it would discomfort me greatly to contemplate even the consultation.

I'd feel that even the suggestion of such a consultation was ominous and threatening.

Then I'd likely feel that it would be wrong, horrible, to subject people to such a consultation if they were not ready for it.

So I'd want such consultations to be entirely voluntary.

Just like they were written in the proposed legislation -- voluntary.

But there's more to this....

I think I can vaguely appreciate Palin's own feeling that some people would feel pressured even by talking with their own doctor -- as if just the options where they could opt for less heroic care would create a kind of social pressure to choose other than what they would really want.

Now...to feel that way myself -- pressured -- I'd have to feel less autonomous, less able to form my own opinions and know what I think and feel independently of others.

But there are people who feel swayed and pressured by others' opinions quite easily I understand.

So I'm guessing at how they would feel....

They might feel pressured enough just by a suggestion alone to actually ignore their own preferences, in a instance where a doctor communicates incompetently or oddly enough to not phrase options in a neutral way.

Therefore, it would make sense for any such consultation initiation to also be voluntary -- only initiated by the patient themselves, and not by suggestion of their doctor. This would avoid some instances where an individual that has little sense of self-determination could end up choosing wrongly for themselves.

Though I expect this was indeed the original intent behind the proposal -- that such consultations be genuinely 100% voluntary in *every* sense -- it could be made explicitly clear in any such proposal that only a patient could initiate even the option of having such a consultation.

There could be no phone call or letter from any provider or insurer to ask whether the patient wanted such a consultation.

Therefore, by that standard, no entity other than the patient, or their family or friends or social groups, or articles they read, could suggest having such a consultation.

Each person wanting such a consultation would have to come upon even the information about the availability of such a consultation as an Medicare or insurance benefit from independent sources other than their insurer or health care provider.

This would adequately address the fear I believe. To address Palin's fears adequately requires that the option for such a consultation never be mentioned to a patient by their doctor or insurer unless the patient brings up that they want such a consultation.

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.

...