On July 17th, Senator Jim DeMint (R – South Carolina) famously said about Obamacare:

“If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”

Senator DeMint is wrong.  Universal Health Care / Coverage will not be the end for Obama in the sense that Waterloo was the end for Napoleon.  Tonight’s speech could go a long way to determining if Obamacare will be his Russian Winter, however.  Failure on this issue… or worse, a tragic success… could weaken this administration leaving them ineffectual and ultimately doomed in the 2012 election.  Tortured analogy aside….

In mid-June 1812, Napoleon crossed the Niemen, beginning his invasion of Russian Poland.  In mid-June of this year, Obama gave his “ticking time bomb” speech to the AMA where he emphasized the need for a public option (while simultaneously ruling out tort reform).  Next Monday is the 197th anniversary of Napoleon’s disastrous capture of Moscow.  By the end of that year, the Grand Armee’ had been expelled from Russian territory.  If history repeats itself on health care, we could see a disastrous success by the Democratic party which leads to a large-scale collapse of public support as early as Christmas.  Napoleon’s Waterloo was still 3 years away and it’s 197th anniversary will be in the height of election season: June of 2012.

There are two fundamental issues with regard to universal health coverage: the practical issues involving costs and quality, and the moral issues involving who should be covered.  For most supporters of universal health care, the moral issues trump the practical.  Further, for many opponents of universal health coverage, moral issues are historically common and powerful motivations for their support (abortion, for example).

I understand and appreciate the moral argument for universal health coverage.  What I struggle with is the asymmetry associated with Congress’ addressing of this particular moral imperative.  Katrina’s devastation created just such a moral imperitive; a humanitarian need that honest, hard-working people from every walk of life rallied around and addressed.  Taking the President at his word, why is this moral imperative different?  Why does the burden, in terms of tax rate, fall disproportionately upon those with greater income?  And by disproportionately, of course, I mean exclusively (at least for now)?

On complicated issues, I often try to reduce things to the simplest analogue I can find.

Consider a small town of 20 people.  Three of these people are elderly, 5 are either infirmed or children and two others who are not providing for themselves something considered critical… say, clean water.  The argument is raised that having clean water is a moral imperative and the town should provide it for everyone.  Everyone agrees that clean water is important for everyone, but when the town begins to discuss who should carry the water to those who cannot (or chose to not) carry the water for themselves, different arguments arise.  In one camp, people feel that those who are the strongest should carry the water.  In the other camp, people feel that its ok to help the elderly, infirmed and children, but if the remaining two people above want water, they can contribute to the effort.  Further, the work should generally be divied up so that everyone who is able, works the same amount even if the amount each person carries differs.

The current health care bills in Congress are from the first camp.  As I said, I am sympathetic to the moral argument, but I can only see it from the second camp.  Everyone works, everyone drinks.

It sounds as though the Public Option is no longer an indispensible piece of the Obama Administration’s health care plan.  If this is true, to many observers of the health care debate, this represents a substantial shift in policy from only a month ago.

“Any plan I sign must include an insurance exchange: a one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans – including a public option to increase competition and keep insurance companies honest – and choose what’s best for your family.” (from July 17)

“The public option, whether we have it or we don’t have it, is not the entirety of healthcare reform,” Obama said at the town hall event in Colorado. “This is just one sliver of it. One aspect of it. And by the way, it’s both the right and the left that have become so fixated on this that they forget everything else.” (from August 15)

Whether or not a “good plan” (however that is defined) requires a public option is not the point here so much as the political fallout from such a change.  Is this Obama’s “read my lips” moment?  Hard to say, but even harder to dismiss.  Is the Obama Administration in real trouble on health care and how did they get to this point?

I believe failure on health care reform would be a serious problem for any administration that made it a priority, though not necessarily insurmountable.  What motivated opposition to his plan may be much more serious – both in 2010 and 2012.  So why did he fail?  In a single word: TRUST.  There are two kinds of trust in American politics: (1) trust that you are trying to do the right thing, motivated by principle, in the best interests of the American people, and (2) trust that regardless of your motivations, you are competent to make the things you promise actually happen.  The American people stopped trusting the Bush Administration on both counts over involvement in Iraq, the handling of aid following Katrina and ultimately the economic collapse of 2008.  Whether or not it was deserved, the Bush Administration lost the trust of the public and this lead directly to the powerful performance of the Democratic party in the 2008 elections.  The conveyed message to the voting public was: “If you don’t trust Bush and his cronies, put someone else in charge.”  The public didn’t and so they did.

With their victories, the Democratic party held the Presidency with a popular, charismatic new leader, the House with a substantial majority, and (after Arlen Specter’s party switch and Al Franken’s seating) a “sort-of” fillibuster-proof hold on the Senate.  There was talk of a permanent Democratic majority powered by a shift in public support (if you like the Democrats) or massive pandering to their political supporters (if you don’t).  There is still a long time between now and the 2010 elections, but the invincibility of the Democratic Party is no longer a foregone conclusion.

During the campaign, Obama established himself as a uniter who would reach across party lines and lead in a bipartisan way.  With the economy as the overwhelming issue, the Obama Administration claimed that by passing its stimulus package, unemployment would be capped at 8% while failure to do so could lead to 9% unemployment.  This danger, the public was told, required fast approval of enormous funds which Congress passed in an essentially party-line vote – losing a small amount of trust in his sincerity about bipartisanship.  When unemployment climbed past 9.5% and the President was forced to admit that it could cross 10% despite the stimulus package, he lost significant trust in his team’s competence.

Distrust in both his motivation and competence were fanned during the government bailouts of Chrysler and GM.  By assuring the public that bailout funds provided the best chance of avoiding bankruptcy, the Administration built expectations from the public that would ultimately prove disappointing.  At the same time accusations were made claiming he wanted (1) government running business to support his alleged socialist view of the world and (2) he intended to use this crisis to make large payoffs to his supporters – in this case the Unions.  Among his detractors, either or both allegations “stuck” when the final deals came down, selling out those with senior claims on the car companies’ debt and granting large shares to both the government and the unions.

Other issues arose, as they always do, but in my opinion played only a confirming role in the distrust equation.  Professor Gates, Justice Sotomayor, the Iranian elections, and even Cap and Trade had comparatively little effect on the public’s view of the administration.

Then came Health Care.  As with the stimulus package, the Administration claimed that this was an emergency of such magnitude that it had to be done immediately regardles of pricetag or opportunity for debate.  Despite claims of long-term savings, those suspicious of the President’s and the Congress’ competence (recalling the now-recanted unemployment claim) had only to look at the Congressional Budget Office’s numbers which seemed to disagree with his rosy projections.  For those now inclined to be suspicious of Obama’s motivations, there was even more fuel for the distrust fire… If this plan were so good, why did Congress insist on exempting themselves?  If this plan were so important, why had so few members of Congress actually read the details before being pressured to vote?  Why does it look like the President is cutting backroom deals with Big Pharma in order to gain their support?  Here, the flubs were substantive… claiming the AARP supported their plan only to be corrected… dramatically over-stating the contribution from the AMA only to be corrected… and prior to the backroom deal above, suggesting that Big Pharma would provide an $80B contribution and allow the government to negotiate down their drug costs only to be corrected.

Unfortunately for the Administration, this distrust – along with some help from those ideologically opposed to this brand of reform – manifested itself in increasingly vocal media events.  The President, members of Congress, and independent commentators fundamentally missed (or ignored) the point of these protests – describing the participants as crazy, Nazis, racists, selfish, greedy, manipulated or simply ignorant – and couched their arguments accordingly, inflaming the opposition even more.

Ultimately, I believe, the issue for the majority of protesters was simple, if not always stated:  “We’ve seen what you’ve done so far… even if we agree that there are some problems with our Health Care System, why should we trust you to fix it?”  Answers that are limited to, “The Republicans don’t have a solution” or “We can’t keep going the way we are going” can never address this concern.  I think this is a question the Obama Administration cannot accept as honest.  When you want the support of someone who doesn’t trust you, the first thing you have to do is understand that they really don’t trust you and then  establish yourself (or at least your process) as open and honest.  To that end, in the interest of saving his health care reform and the Democratic party’s chances in the upcoming elections, I would advise the President and Democratic Congressional leadership to do the following:

1. Simplify the bill, make it public, and require every member of Congress to read it
2. Give the public and independent sources time to discuss its merits and alternatives
3. Remove any and all special interest perks or exceptions from the bill
4. Set objective standards for measuring success and provide a sunset clause should it fail

I don’t know if this would be enough to win back the trust of the opposition, but it would be a start.  The Administration can’t afford to keep going down the path its on.

…are out.

Clearly, the new strategy on the Left is to equate opposition to Obama to racism.  Do you think it is a coincidence that there is suddenly a flurry of opinion pieces on Birthers and racists and how it relates to Obama’s policies?

First, we had the Yglesias piece, which I discussed below.  Then Bill Maher weighed in.  Now, there is this column by Harold Meyerson which hits upon the same irrelevant points–Birthers, racists, etc.  It includes gems like this to explain the sudden lack of support for Obama’s wonderful health care reforms:

When future historians look back at this passage in our nation’s history, I suspect they’ll conclude that this Obama-isn’t-American nuttiness refracted the insecurities and, in some cases, the hatred that a portion of conservative white America felt about having a black president and about the transformation of what many thought of as their white nation into a genuinely multiracial republic. But whatever the reasons, a mobilized minority is making a very plausible play to thwart a demobilized majority.

Right.  It’s the GOP’s fault.  The Democrats can’t even bring a vote on health care to the House floor and it’s the fault of the Senate GOP and their filibuster, which, uh, they are one vote short to implement anyway.  So, when that fails, just say they are all racist nuts who think Obama isn’t an American.  How desperate are they getting? And what is the origin of all this?

Well, the Democratic National Committee for starters.  Here’s part of a recent statement by their communications director:

Republicans and their allied groups – desperate after losing two consecutive elections and every major policy fight on Capitol Hill – are inciting angry mobs of a small number of rabid right wing extremists funded by K Street Lobbyists to disrupt thoughtful discussions about the future of health care in America taking place in Congressional Districts across the country.

However, much like we saw at the McCain-Palin rallies last year where crowds were baited with cries of ’socialist,’ ‘communist,’ and where the birthers movement was born – these mobs of extremists are not interested in having a thoughtful discussion about the issues – but like some Republican leaders have said – they are interested in ‘breaking’ the President and destroying his Presidency.

Well, let’s get back to reality.  The fact is that most Americans–not a noisy minority–are in some sort of opposition to Obama’s plans.  From Gallup:

• Although the majority of Americans believe the U.S. healthcare system has major problems, less than 20% perceive that the U.S. healthcare system is in a state of crisis. This has not shifted significantly in 15 years.
• More Americans now mention healthcare as the nation’s most important problem than was the case a few months ago. It is unlikely that the quality of healthcare deteriorated in four months, but rather that its salience has increased for the average American with the increased focus on the topic from politicians and the news media. This follows the pattern seen in 1993 and 1994; concern about healthcare shot up as the problem was being addressed in Washington, D.C., but dropped thereafter. The current percentage of Americans naming healthcare as the country’s biggest problem is significantly lower than in 1994.
• At this point, almost 7 out of 10 Americans say economic-related issues are the nation’s top problem; 16% say healthcare is the top problem.
• One in 10 Americans say healthcare is the most important financial problem facing their family.

2. Americans are not convinced that healthcare reform will benefit them personally. This is, in part, because most Americans are satisfied with their current medical care and access to healthcare. Seniors in particular are not convinced that healthcare reform will benefit them.

• Most Americans do not see a direct personal benefit for themselves if healthcare legislation is passed.
• Eighty-four percent of Americans are insured and most say they are satisfied with their insurance and healthcare.
• Americans are more likely to be convinced that new healthcare legislation will have a negative effect personally rather than a positive one, although a substantial minority falls in the middle, saying it will have no effect on them either way.
• Most Americans rate the quality of healthcare they receive and their healthcare coverage as excellent or good. These views have been stable in recent years.
• While younger adults (those 18 to 49) are as likely to believe reform could help them as say it could hurt them, older Americans, particularly those 65 years and older, are far less likely to perceive that their medical care or access to healthcare would improve under new healthcare legislation.

3. Americans agree that healthcare costs are a major problem for the country. Americans do not, however, believe that healthcare reform would lessen costs — neither for the system as a whole nor for individuals.

• An overwhelming 79% of Americans say that they are dissatisfied with the total cost of healthcare in this country.
• Forty-five percent say that healthcare costs would increase overall with a new healthcare reform law, compared to 30% who say they would decrease.
• Personally, 34% say their healthcare costs would increase under a new law; 18% say they would be reduced.

4. The push for healthcare reform is occurring in an environment characterized by high levels of concern about fiscal responsibility, government spending, and the growing federal deficit. Americans are being asked to approve major new healthcare expenditures at a time when they are not yet convinced that the last massive outlay of government money — the stimulus — has made an impact.

• Americans are worried about their country’s budget deficit.
• President Obama gets his lowest marks on handling the federal deficit.
• Those who disapprove of Obama’s job performance are most likely to say it is because of the high levels of spending introduced in his administration.
• A Pew Research poll released this week shows that those who are worried about new healthcare legislation are most likely to say it is because it involves too much spending and would increase the deficit.
• Less than a third of Americans perceive that the stimulus plan has made the U.S. economy better, although about half hold out hope that it will eventually.
• Americans, on balance, perceive that the stimulus plan has, thus far, had no effect or made their own financial situation worse (64% and 22%, respectively). Looking ahead, Americans are just as likely to say the stimulus’ long-term effect will make their situation worse as make it better.

5. Americans have relatively little confidence in Congress and thus, by inference, little confidence that Congress can effectively and efficiently reform the country’s massive healthcare system.

• Two-thirds of Americans say members of Congress do not have a good understanding of the issues involved in healthcare reform.
• Just 17% of Americans have a great deal or quite a lot of confidence in Congress, near the bottom of a list of institutions Gallup measures each year.

6. Americans continue to have more confidence in President Obama on healthcare issues than in either the Democrats or Republicans in Congress. Obama’s political capital, however, is waning. This leads to a circularity in which Obama’s hard push for healthcare reform may hurt his approval ratings, and his falling approval ratings may hurt his credibility on healthcare reform. One inevitable byproduct of Obama’s strong push on reform is the politicalization of healthcare. Most Democrats support it, Republicans oppose it, and independents are in the middle.

• President Obama’s job approval rating has fallen from an average of 66% in early May to 56% for the week of July 20-26.
• Given a list of sources for recommendations for healthcare guidance, Americans say they are more confident in Obama than in either Democratic or Republican leaders in Congress — although doctors, researchers, and hospitals are rated higher than Obama.
• Twenty-two percent of Republicans want a new healthcare law passed this year, compared to 63% of Democrats.

7. Americans have mixed or ambivalent views of the role government should have in healthcare. They favor some government involvement, but not a government-run healthcare system.

• Less than half of Americans favor replacing the current system with a government-run healthcare system.
• Americans responding to questions asked by various polling organizations in recent weeks indicate that they do favor a public option plan (run by the government) that would compete with private plans.
• Americans believe that it is the government’s role to help see that all Americans have access to healthcare, although this sentiment was waning as of November 2008.

8. On a case-by-case basis, Americans favor many specific proposals that have been put forth as ways of reforming healthcare.

• Polls from several polling organizations released this week show that Americans favor a public option government plan to compete with employer plans, requiring insurance companies to cover everyone regardless of pre-existing conditions, tax credits to help some people pay for health insurance, and expansion of government plans to cover low-income Americans.
• Americans also appear to agree with a number of different ways of paying for healthcare reform, including taxes on the rich and requiring employers to pay a fee if they don’t provide health insurance.

9. Despite positive views of many specific reform proposals, Americans appear ambivalent at this juncture on the overall merits of passing a broad healthcare plan.

• In mid-July a majority of Americans favored passing a major healthcare reform bill (described without reference to who is supporting it).
• By later in July, several organizations’ surveys show a plurality of Americans opposed to passage of plans variously labeled as Obama’s plan, the plan proposed by President Obama and the Congressional Democrats, healthcare proposals being discussed in Congress, or healthcare reform legislation being considered right now.
• Other recent poll questions, which describe the plan in great detail, continue to show plurality of majority support.
• A plurality, but not a majority, of Americans say that a new healthcare plan would improve the overall level of medical care and improve access to healthcare in the U.S.

10. All in all, while the majority of Americans ultimately favor passage of healthcare reform, many are willing to wait until next year to see it happen.

This is the facts.  The marching orders are there to convince Americans otherwise.  It won’t work.

The way things are going, Obama is on his way to a major defeat on health care.  However, it is not yet a fait accompli.

How can he turn things around?

I think the smartest thing he can do right now is to pivot into a populist position.  He has been spending much of the time talking about cost and deficits and this is not capturing anyone’s imagination right now.

So, if I’m Obama, the FIRST thing I do is make one thing very loud and clear with the following statement:

I am so confident in the effectiveness of this bill, I pledge to you that every member of the government–Congress, the Supreme Court and the Federal Bureaucracy, plus myself and my family–will be covered under this health care plan. 

Obama has been reticent when asked to make this pledge and, of course, Congress has exempted itself from the bill as well.  This exemption will end up being a major issue if it ever comes to a vote and could end up killing the bill all by itself.

However, if Obama gets on the right side of the issue now, he will show he is personally invested in the fight and this will pay dividends politically.  It might piss off Congress, but it could also pressure them into action.  Maybe a little triangulation is needed in this case. 

To me, this is a no-brainer and a great way to get back to his populist roots.  Will he do it?

Turns out the surtax on the rich proposed by the Democrats as a way to fund health care will have the perverse effect of affecting doctors the most.

The top eight highest-paid professions in the U.S. are–you guessed it–in the medical or dental fields.

Medical and dental specialists top the list of the highest paid professions, as they hold numbers one through eight of the 25 highest earning jobs as well as five other rankings on the 2004 list. Anesthesiologists are number one, internists number two and obstetricians and gynecologists number three of the top professional earners in the United States. Oral surgeons take the fourth spot, orthodontists the fifth and prosthodontists the sixth. Psychiatrists are listed as the seventh of the highest paid professions, while surgeons are ranked as the eighth. The average 2004 income for these eight professions is more than $145,600 US dollars (USD).

Mind you, these are average salaries–the average anethesiologist makes $314,000 per year, for instance.  So a healthy portion of the medical field will be affected by the proposed surtax on wealthy individuals.  

This type of punishment will serve as a disincentive for some who would otherwise enter the medical field.  The result will be fewer doctors and, thus, more expensive health care.   

Of course, it could also happen that future generations of doctors will work for the government as civil servants and will not be paid as much as they are now.  In which case, where will the money to fund health care come from?

You know the Left is worried when a liberal like Robert Reich calls on all Democrats to unite to pass health care. 

This bill is dead…

In most tellings of the Robin Hood story, the hero and his Merry Men were attempting to stop runaway taxation upon the public.  Robin Hood “stole” from Prince John and (depending upon the tale) either returned the money to the unfairly taxed or held it for the absent King Richard.  Fundamental to the moral of this fable is the idea that those whom Robin Hood robbed deserved their punishment for their wicked ways – the government was robbed, but not honest merchants, farmers, or craftsmen who happened to be successful.  To accept the application of this aphorism to universal health coverage, we must accept that those who will be taxed higher have unjustly taken from the poor who will benefit.  To see the government as Robin Hood, we would have to see a medical doctor husband and attorney wife as the analogies to Prince John and the Sheriff of Nottingham.

A more honest analogy (and not necessarily a pernicious one) would be to paint the administration as “Slick Willie” Sutton.  Sutton was another notorious thief who was asked by reporters why he robbed banks.  Sutton allegedly replied, “Because that’s where the money is.”  I have no idea how well this level of honesty would play with the public (“We intend to increase taxes on the wealthiest Americans, fair or not, because we really want universal health coverage and we can’t think of another way to pay for it that the majority of the public would accept.”) but I’d love to find out.

It can be intelligently debated whether or not increased taxation on the wealthiest Americans is necessary to pay for universal health coverage or even if it is a desirable thing.  It is, however, dishonest to both the moral and the story to claim that increased taxation on the wealthiest Americans to pay for health care is “just” in the sense of Robin Hood.  In the present case, it seems that the Robin Hood analogy is the precise opposite of the picture the administration wants to paint.  Then again, it’s catchy and easily spun which really is the point of soundbites, afterall.  And it’s almost certainly better than the soon-to-be spun, “Give unto Washington what belongs to Washington.”

I opined a few weeks ago that Obama and the Democrats are headed for a health care disaster on par with 1994 and, amazingly, all the pieces are falling into place.

As in 1994, the GOP has come out with a chart to depict the madness of the pending health care bureaucracy that will be created by the new reform bill.  All we need now is a new ’Harry and Louise’ ad and the circle will be complete.

The only difference is that this time the Dems appear to be willing to bite the bullet and get some kind of bill passed.  The result will be a major disruption of the economy and the daily lives of Americans and it will be very unpopular with a wide swath of the country. 

This could be the ‘Hurricane Katrina’ of the Democratic Party and, unless the GOP can capitalize, might even signal the beginning of the end of the current two-party power structure.

When Obama and Congressional Democrats were passing laws earlier this spring expanding the size of the federal government by 34 percent, there was little or no cry from the mainstream media about the need for moderation or bipartisanship.  You see, the press agrees with the idea of a larger government in general, so Obama’s proposals were roundly cheered.  Moderation and bipartisanship–two bugaboos long held dear by the media during GOP rule–were no longer sacrosanct, not with the Democrats back in power.

David Broder, the epitome of the establishment journalist, was particularly quiet.  But now that it appears that health care reform is in danger of being chopped to pieces, with the Democrats suffering the bulk of the damage, he has once again dredged up the notion that bipartisanship and moderation is a holy covenant to be pursued by all.  His latest column extols a Tom Daschle-Bob Dole alliance to advance some sort of politically palatable health care bill.  Of course, that paragon of GOP moderation, Howard Baker, is involved as well. 

Let’s be real:  The point of all this is to get some kind of health care law passed with the least amount of short-term damage to the Left politically (meaning, the 2010 elections).  What better way to give Obama cover on all the controversial issues produced by health care reform than to call on a couple of crotchety old senators to advance a bipartisan solution?   If enough Republicans go along, then some of the potential anger over the bill can be dissipated among both parties.  Whatever program is actually produced can always be expanded and modified later.  Dole and Daschle will serve to get the policy’s foot in the door.  Hopefully, the GOP does not fall for this.  The true believers on the Left like E. J. Dionne don’t want it anyway.

Now, if only Broder had called on Dole and Baker to take part in the stimulus package, he might have a leg to stand on. 

And perhaps we’d even have some money left over for health care reform…

Stimulus?

Its things like these that erode credibility when it comes time for the American public to be asked to write checks for something like Obamacare.

The President’s four year term offers shelter but all you have to do is watch Congress to see how well the public is handling things.  What we’re seeing is representatives backing down from the grander ambitions of the Obamacare plan especially since the Administration has apparently tried to shelter itself by leaving members of Congress up to the task of writing the legislation (some leadership, eh?).  You can get away with that with 60 percent approval ratings and while the public is still mightily angry with your predecessor, but those in Congress are under the gun with re-election thoughts never far from view.

All the more reason to embrace the tremendous wisdom and foresight of the Forefathers who set about to build a government that would work agonizingly slow and deliberately, with a strong bias towards consensus rather than accelerated change.

Clive Cook has an excellent article up at the Financial Times on the implication of the so-called “public option” of ObamaCare.  The “public option” would be a federally-funded public health insurance carrier (not unlike Medicare) that would “compete” with private health care insurance companies.  In comments Monday, President Obama assured members of the American Medical Association that the public option would not be a “Trojan horse for a single-payer system.”

Clive Cook disagrees:

A significant minority of more conservative Democrats are sceptical.  They worry that a public plan would crowd out private insurers and that the US would end up with a national government-run health plan: in effect, Medicare, the existing programme for the elderly, widened to cover everybody.

*          *          *

A less obvious objection [to the public option for all] is that a healthy private insurance market is worth preserving.  The seething hatred many Democrats – and many other Americans of no fixed ideology – feel for private health insurers ignores the value they bring – and the extra value they could add if their incentives were better designed and their customers had the information they needed to make intelligent choices.

If competition is a good thing, competition among insurance providers is a good thing too.  [A]bolishing it [would] abolish pressures for innovation and other kinds of cost reduction.  In other industries, competition pays for itself in spite of the apparent waste of marketing and other forms of duplicated effort.

*          *          *

Shutting it down is not the purpose of the public plan, say its Democratic supporters: the public plan is just one more choice.  This is disingenuous.  If the public plan had to compete on truly level terms with private plans, how would it be able “to keep them honest”?  If it is going to exert the pressure it is intended to and really make a difference, it will have to flex its political muscle, its ability to attract subsidy and its superior buying power: “accept this lower reimbursement or no Medicare patients for you”.  A public plan cannot be just another competitor: it is anti-competitive, and meant to be.

Government “competition” is never fair, in the sense that government never plays by the same rules applied to private industry.  Government doesn’t need to concern itself with turning a profit, and, indeed, when losses to government-run enterprises mount, the government simply funds the losing enterprise with more tax-payer-supplied dollars.   Cook is absolutely right that government-run enterprise is uniquely anti-competitive by nature.

In April of this year, the Lewin Group (an independent health care consulting firm) issued a report about how implementing the public option, as currently conceived, would affect the 170 million Americans who currently have private health insurance.  It found premiums for the public option would be 30 to 40 percent lower than private insurance plans – savings achieved by imposing price controls on doctors.

The Lewin Group concluded the public option would not only attract 28 million new Americans who currently are not covered by health insurance, but would also cause 120 million Americans to leave (or get booted from) their private insurance in favor of the public option — leaving only 50 million Americans in private insurance. 

When the anti-competitive advantages of this public option are combined with the near-infinite scale of the enterprise, the result would be a government-created Walmart for health care — or Medicare on steroids.  How private industry could fairly compete with such a monster no rational person has explained.

Jason Fodeman weighs in on the fiscal insanity of converting 80% of the American health care system to Medicare:

Since Medicare became law in 1965, real per capita health-care expenditures have increased almost six fold.  Medicare has not stood idly while costs have escalated either.  Medicare has as much blood on its hands as anyone.  Medicare has 36 trillion dollars in unfunded liabilities.  The system is broke. 

*          *          *

Medicare’s inadequacies are no surprise.  It possesses the same deficiencies the public has become accustomed to from all forms of government.  For a reminder, just take a trip to the DMV.

On a final note, it’s imparative that sincere advocates of an improved American health care system stop framing the arguments in terms of the number of millions (currently, 48 million) of Americans who do not have health insurance — either through private carriers or via access to Medicare or Medicaid boondoggles.  Health insurance and access to health care (and, in particular, good health care) are very different things.

What’s most important for Americans moving forward is access to affordable and effective health care — whether its by virtue of employer-subsidized private insurance or some other means of access.  In future posts, we’ll discuss the best way for Americans to reduce the cost of health care, while making access universally available.

Graf lifted from Hot Air concerning the drama and upheaval in Iran and the White House’s strange CNN-like, near-silence on the issue:

Fun fact: Whereas The One was “shocked and outraged” by the murder of George Tiller, the most he can muster here for mass beatings and cold-blooded killings across Iran is that he’s “troubled.” Make of it what you will.

* * * * *

I remember during the lead-up to the election thinking at times that Mr. Obama detested all this world politics stuff.  He treated it just seriously enough during the debates but was far more interested in driving discussion back to domestic issues (like the current health care proposal), very much in line with his organizing roots.

That sentiment is hardly unique among Presidential aspirants, but unlike recent Presidential predecessors it looks like with this first international crisis he’s stubbornly trying to avoid dignifying the situation with a more robust response.  This points to one of his internal tensions, charismatic and drawn to the highest office but ideologically more suited to something more nuts and bolts like congressional work putting together legislation.  Like it or not he signed up for all that comes with the job and ought be more Presidential here.

Hopefully he wakes up from that fantasy of a Presidency unencumbered by a distressed world, and can show a little more interest, agility and skill in what seems like a fairly critical juncture in U.S./Iranian relations and the shaping of the Middle East.

I think a good rule of thumb when it comes to the political tolerance of the American electorate is “if it doesn’t affect my daily life, then I might be okay with it”. 

And so, as far-reaching as some of Obama’s initiatives might look on paper, their practical ramifications have not yet shown up squarely in the face of John Q. Citizen.

There are a few areas, however, that do affect the electorate on a daily basis.  The price of gas is one.  Housing values are another.  The stock market has become more relevant in recent years, as more people are directly involved through their retirement plans.     

When these areas are disrupted and uncertainty arises, politicians pay the price.  Each of these particular areas have been through major shocks in the past 18 months.  The end result was the sound repudiation of the GOP in the 2008 elections.   

So far, the Democrats have been successful at avoiding connection to these particular pressing issues, putting most (if not all) of the blame on Bush.  Meanwhile, Obama’s early policies have mostly to do with vague financial processes and wonky budgetary maneuvers.  We may argue over their wisdom and their future benefits, but the average person probably can’t perceive how they affect his daily life just yet. 

That could change soon as Obama and his party are about to undergo a massive effort to transform something that will affect all Americans immediately:  Health Care.

The last time this was tried, 1994, it resulted in major political upheaval, as HilaryCare went down to defeat and the GOP took over both houses of Congress.

If he’s not careful, Obama could be headed for the same kind of fiasco, at least if early indications hold up.   The American Medical Association has come out against his plans for a public healthcare plan.  Liberal and moderate Democrats are at each other’s throats over the details.  And this is before the various special interests groups rev up their opposition.

The current health care system isn’t very popular, but it’s familiar.  It’s the devil people know.  They may think some changes are in order, but most don’t expect anything drastic.   They want the problem–whatever it is–fixed and then they want to go on with their lives as before.

Of course, it’s a completely unrealistic attitude.  Americans want health care for all and don’t want to have to pay for any of it.  Woe unto any politician who doesn’t reach that goal, especially after promising to fix it.  Like social security, it’s another rail of politics that can electrocute you when you touch it.

And so, Obama is about to get zapped.  If he succeeds in passing a new system into law, those who fear the uncertainty of it all will not be happy when their regular health care routine is disturbed.  If health care reform is defeated, those who expected the moon from the Democrats will be pissed.

In the aftermath of such a debacle, Americans will reach political overload.  It will be too much, too soon.  They will have suffered through more than two years of political back and forth over the same (seemingly unsolvable) issues and will no doubt react strongly at the polls when given a chance, especially if unemployment and the price of energy remain problematic. 

Just as they personally liked Bill Clinton back in 1994, they personally like Barack Obama now.  As with Clinton, they are going to have some patience with him, to allow him to grow into his position.  But the voters aren’t too fond of Nancy Pelosi and Harry Reid.  They might do the political calculus and figure out that, as with Clinton, the best way for Obama to grow is with a GOP-controlled Congress in place to keep his worst instincts at bay.  The last time the federal government exercised some sort of fiscal restraint, the same combination was in play. 

Of course, if that doesn’t work, then both parties will be in trouble in 2012 and unless the GOP can come up with a suitable alternative, I wouldn’t be surprised if truly alternative options emerged.