Robert Reich has come up with an extraordinary article spelling out how progressives can fight back against the fearmongers and demagogues, and pass the president's plan for health care reform. His analysis of what's behind the big push back against Obama's plan (when instead we little folk should be delirious with joy that our betters are looking out for us) is extraordinary because he's nailed a crucial point: There's no plan.
Why are these meetings brimming with so much anger? Because Republican Astroturfers have joined the same old right-wing broadcast demagogues that have been spewing hate and fear for years, to create a tempest.
But why are they getting away with it? Why aren't progressives—indeed, why aren't ordinary citizens—taking the meetings back?
Mainly because there's still no healthcare plan.
Exactly. There's no plan. And because there's no plan, anyone opposing health care reform is spewing hate and fear. You have to admit, Reich's argument is a thing of beauty. People's worst fears about health care reform are misguided because whatever they object to is not in the plan. Couldn't be. There's no plan.
Which is not to say there is no misinformation. President Obama stood in front of a town hall style meeting in Portsmouth, New Hampshire this week. He urged the tight little group of hand picked supporters who were allowed in, to engage in a rational discussion of real issues.
Where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed. (Applause.) Because the way politics works sometimes is that people who want to keep things the way they are will try to scare the heck out of folks and they'll create boogeymen out there that just aren't real. (Applause.)
Ah, the voice of sweet reason. We simply can't afford to worry about imaginary bogeymen. Especially when there are those real ones out there. Obama names one: Surgeons.
Nothing against surgeons. I want surgeons -- I don't want to be getting a bunch of letters from surgeons now. I'm not dissing surgeons here. (Laughter.)
All I'm saying is let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.)
But wait a minute. There's something fishy about this. It turns Obama was spewing disinformation. Linda Douglass call your office. There's fearmongering and demagoguery going on.
As it happens, a New Hampshire surgeon, who blogs at Joust The Facts has real facts to share.
Let's start with the reimbursement for foot amputations, which is never "immediate." Since the President was in New Hampshire, we'll use the New Hampshire rates that, for example, I might get paid as an orthopaedic surgeon.
The code for amputation through the mid-tarsal joint, or midfoot, is CPT 28800 Reimbursement? $526.75. The code for amputation through the forefoot, or trans-metatarsal, is CPT 28805, paid at $694.14. A ray amputation of one gangrenous toe, including the metatarsal, is CPT 28810, paid at $406.12. So reimbursement for a variety of foot amputations for serious diabetic infections, which can be life-threatening if left treated inadequately, range from roughly $400-$700. I only wish it was $40,000. Maybe he's thinking of the amount his trial lawyer friends might make from suing the surgeon.
Next, let's recall that that $400-$700 is not just for the surgery. No, that reimbursement is under a 90 day global. "What's that," you ask? Well, the 90 day global means that the reimbursement covers not only the surgery, but also the follow-up care, to be certain that healing occurs, for the next three months. No additional office reimbursement is paid for post-op care during that time, and most patients in this situation would require at least three visits to the office during that post-op period. (Emphasis in the original).
My point in bringing up this discrepancy is not to call the president a liar, but to ask, why go blindly along on health care reform when so often the president's arguments are not correct? Why, when nearly every Obama claim is questionable or false, from the number of Americans who are uninsured, to scare stories about people currently being denied care, to his imagined cost savings. What is the point? And why are progressives so hot for a single payer system, when single payer systems have been shown time and again to result in reduced quality of care and government directed rationing?
It so happens, Bill Clinton delivered the answer at a convention for progressive bloggers in Pittsburgh.
PITTSBURGH - Former President Bill Clinton told an audience of liberal online activists Thursday evening that the nation has “entered a new era of progressive politics” that could last for decades if Democrats can pass ambitious measures such as health care reform and climate change.
In a nearly hour-long keynote address to the fourth annual Netroots Nation convention in Pittsburgh, a gathering of roughly 1,500 progressive bloggers and activists, Clinton said the nation—and public opinion—has dramatically changed in the 16 years since he took office. But he noted that President Barack Obama and the Democratic-controlled Congress needed the support of the online community to achieve their agenda.
“We have entered a new era of progressive politics which, if we do it right, can last 30 or 40 years,” Clinton said. “America has rapidly moved to another place on a lot of these issues.”
“The president needs your help,” he said, “and the cause needs your help.”
Clinton warned against the dangers of failing to compromise on some elements of health care reform, calling for agreement on a plan that includes a handful of elements that have widespread public support and perhaps conceding on those that have little support among voters.
“I want us to be mindful we may need to take less than a full loaf,” he said. “We can’t be in the peanut gallery. We have to be actors. We can’t ask the President to go it alone. We can’t ask Congress to go it alone."
Clinton had a similar message on climate change legislation.
“The President stuck his neck out here and the Congress stuck its neck out,” he said, “but we have to have a bill.” (My emphasis).
According to Clinton, as a consequences of failing to pass a bill, any bill, progressives will miss out on their golden opportunity for 30 or 40 years of political control in Washington. Actually, I think he's conservative in his estimates. If progressives can successfully crush the "fearmongers and demagogues" who've been showing up to ask tough questions at these town hall meetings, they might just remain in power indefinitely. Here's how I used to think the stategy worked. Said I:
But let's be realistic. The objective of Obama and the Democrats is not health care reform. The objective is an enduring progressive congressional majority that they hope to achieve by forcing Americans into a dependence upon progressive government for life supporting medicines and medical care.
I've revised that thinking. While I have no doubt that health care is the vehicle not the objective, it's not the average American that progressives hope to control through their arcane legislative boondoggles. It's the special interest money they're after.
A memo obtained by the Huffington Post confirms that the White House and the pharmaceutical lobby secretly agreed to precisely the sort of wide-ranging deal that both parties have been denying over the past week.
The memo, which according to a knowledgeable health care lobbyist was prepared by a person directly involved in the negotiations, lists exactly what the White House gave up, and what it got in return.
It says the White House agreed to oppose any congressional efforts to use the government's leverage to bargain for lower drug prices or import drugs from Canada -- and also agreed not to pursue Medicare rebates or shift some drugs from Medicare Part B to Medicare Part D, which would cost Big Pharma billions in reduced reimbursements.
In exchange, the Pharmaceutical Researchers and Manufacturers Association (PhRMA) agreed to cut $80 billion in projected costs to taxpayers and senior citizens over ten years. Or, as the memo says: "Commitment of up to $80 billion, but not more than $80 billion."
Don't get me wrong. I'm not here to beat up on the drug companies. But in order to get in on this debate you have to be a player and that means you have to have some serious money. First, you have to get into the back room, then maybe you can make a deal. What gets you in?
Indeed, throughout the past six months, Obama and his top aides have routinely consulted with some of the titans of the private health care, insurance and pharmaceutical industries.
Jeff Kindler, the chairman and CEO of the pharmaceutical giant Pfizer, whose employees donated $124,053 to Obama's presidential campaign, has met with the president three times to talk health care. Karen Ignani, the president and CEO of America's Health Insurance Plans whose employees contributed only $2,251 to the Obama campaign, has visited the White House four times. Tauzin, whose association contributed a scant $3,555 to the Obama campaign, has visited the president four times. And Stephen Hemsley, CEO of the UnitedHealth Group, a managed care and insurance company that contributed nearly $30,000 to the Obama campaign and $50,000 to his inauguration committee, has visited the White House twice.
Lobbyists and industry groups are under big pressure to get in with their campaign contributions and buy a seat at the table or face the possibility that progressive plans will put them on the short end of the stick or maybe even out of business. Not only will they pony up the election campaign funds, they'll bankroll TV commercials in favor of the program.
WASHINGTON — Pressed by industry lobbyists, White House officials on Wednesday assured drug makers that the administration stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion.
Drug industry lobbyists reacted with alarm this week to a House health care overhaul measure that would allow the government to negotiate drug prices and demand additional rebates from drug manufacturers.
In response, the industry successfully demanded that the White House explicitly acknowledge for the first time that it had committed to protect drug makers from bearing further costs in the overhaul. The Obama administration had never spelled out the details of the agreement.
“We were assured: ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal,’ ” Billy Tauzin, the former Republican House member from Louisiana who now leads the pharmaceutical trade group, said Wednesday.
[...]
But failing to publicly confirm Mr. Tauzin’s descriptions of the deal risked alienating a powerful industry ally currently helping to bankroll millions in television commercials in favor of Mr. Obama’s reforms.
Robert Reich insists that the details of the health care plan must be spelled out if there's to be any hope of passing a bill. But there's a reality, evident to both Bill Clinton and Barack Obama. The millions going into TV commercials in favor of the plan will overpower the other messages. Who needs details? Neither Clinton nor Obama care in the least what gets passed, as long as it gives progressive politicians control over special interests and their money. Health care reform and climate change legislation are designed for maximum political control, which means there is one thing we can know with a certainty. Whatever comes out of this health care reform exercise, the least likely is a better health care system.
Update: Linda Douglass, the communications director for the White House’s Health Reform Office, confirms it. A plan for the drug companies to spend $150 million on TV commercials pushing the Obama plan is part of the deal between the drug companies and the White House. There are a couple of ways we can look at it. The drug companies are bribing the White House. The White House is extorting money from the drug companies. It's all quite legal, though, but not what I would call good government.
Good analysis, Tom, as politics in America is really getting out of hand. The supposed "noble intentions" of progressive reform are rapidly giving away to what appears to be power-hungry politicians looking to get everyone on the dole, thus more votes.
Posted by: Nixon | August 16, 2009 at 04:09 AM
Thanks, LT. Power hungry politicians have been masquerading as compassionate champions of the downtrodden for decades, and their game plan hasn't changed much over the years. They've always looked to get everyone on the dole, but what's new is the focus on special interest money and the use of the bully pulpit to get it. Or maybe I just never noticed it, but I don't know of any other time when companies or lobbyists were coerced into ponying up public relations funding for legislation they would not normally favor. With this deal it appears the drug companies have agreed to spend $150 million promoting Obama's plan in the hope of avoiding a complete government takeover.
Posted by: Tom Bowler | August 16, 2009 at 08:02 AM
Hello Tom,
I personally believe that the health care system in this country is broken. But the proposed cure is even worse. What we have in the health care debate is Demand Side Economics (which is what made us sick in the first place) struggling against….nothing, (bombast and criticism). The Conservatives, if they had any intelligence, would be urging Supply Side Solutions (De-regulation of the insurance industry, new insurance products, transparency of the medical process, and repealing HIPA) but there are no Market People left among the Conservatives. As my father used to say, “The only solution for high prices is high prices.” I say, “The only solution to high prices is the open market.”
Posted by: Fred | August 16, 2009 at 08:52 AM
Isn't it fascinating, Fred, how the discussions of controlling the cost of health care never approach the topic of health care itself. They're always about insurance. I don't agree that the health care system in this country is broken, but it is constrained.
Thirty-five years ago hospital nursing schools were shut down across the country in favor of college programs. The purpose was to elevate the status and compensation of registered nurses by making nursing a degreed profession. Result? Shortage of nurses. That's just one constraint.
Broken or not I agree with your antidote, the market. Whether it is deregulation or reregulation, consumers have to control the health care spending, and that can be accomplished with health savings accounts. Insurance should be reserved for the catastropic events.
And then there's the topic of tort reform...
Posted by: Tom Bowler | August 16, 2009 at 11:17 AM