This Year, We Have Activists

The biggest difference between 1993 and 2009 when it comes to health care is the coordinated message machine - on the left this time - pushing for reform. Under Clinton, the White House horded the policy and nobody could go out and sell it, or at least rebut the attacks from industry. This time, the Health Care for America Now structure allows activists a place both to attack back at industry and keep them occupied, while arguing for a consistent set of principles that must be part of any reform. Today, HCAN did something great, calling on the Justice Department to look at monopolies in the insurance market.

Activists backing President Barack Obama's health care overhaul are asking the Justice Department to open a wide-ranging investigation of what they say is monopoly-like power in the hands of major insurers [...]

"A lack of antitrust enforcement has enabled insurers to acquire dominant positions in almost every metropolitan market," said the letter to the Justice Department, signed by Richard Kirsch, the group's director. "The failure to attack anticompetitive practices has enhanced the dominant positions of these insurers. This must be reversed." [...]

In a report earlier this year, the American Medical Association found that insurance markets in most major metropolitan areas were dominated by two companies, and in many cases only one. In all, 94 percent of the metropolitan areas met the government's definition of "highly concentrated" markets for health insurance.

Separately, a recent report by the congressional Government Accountability Office found that in most states, a single insurer dominates the market for small business health insurance, even though many companies offer coverage. The GAO found that the median, or midpoint, statewide market share of the largest insurer was about 47 percent, although the median number of licensed carriers was 27.

This is all the more important, considering that the health insurance industry's "compromise" solution for reform is to EXPAND THEIR MONOPOLY by mandating that everyone in America buy health insurance from them, without the opportunity for a public plan alternative. With nobody to compete with and essentially a forced market, insurers would have every incentive to consolidate further, the very action which has driven up health care premium costs over the years, as an HCAN report later today will show. While insurers aren't the only cause of rising health care costs - pharmaceuticals, medical device operators, hospitals, there's plenty of blame to go around - this model of activism can be scaled to pressure both the industry and the political class.

Health care reform will rise or fall this year based on the success of these activist efforts, toward both the special interests and the politicians. Frank Luntz (who won't say who paid him for the health care memo) isn't the only game in town anymore.

Lies My Insurance Lobby Told Me

I know I'm heartened by the news that Democrats plan to develop a plan to communicate on health care. Who thought of that, give him or her a cookie! To think, political parties can create a "message" that they can "argue" to the "public." It's really heady stuff.

Senator Evan Bayh, Democrat of Indiana, said many Democrats felt “unease that we did not have a strategy” to answer the criticism coming from Republican members of Congress and Republican consultants like Frank I. Luntz, an expert on the language of politics.

Senate Democrats met for more than an hour at the Capitol with David Axelrod, Mr. Obama’s senior adviser, and Jim Messina, a deputy White House chief of staff.

“Axelrod came to reassure us that they do have a strategy,” Mr. Bayh said.

Wouldn't want to make Evan Bayh nervous that there wasn't a structure in place for him to defy. Oh, and the Luntz talking points are 16 years old, so if you were caught flat-footed by them you're not much of a politician.

Incidentally, the details of the Democratic messaging on this give me a little pause. Max Baucus explained that “You can choose your own doctor, you can choose your own health plan. There’s total choice here. I do not want to say this defensively, but this is not a big government plan.” If you're saying "I do not want to say this defensively," then you're saying it defensively.

The overall message is one of "shared responsibility," which just doesn't sound all that consumer-friendly. Especially when the "sharing" part of the responsibility has already started to collapse.

Hospitals and insurance companies said Thursday that President Obama had substantially overstated their promise earlier this week to reduce the growth of health spending.

Mr. Obama invited health industry leaders to the White House on Monday to trumpet their cost-control commitments. But three days later, confusion swirled in Washington as the companies’ trade associations raced to tamp down angst among members around the country […]

Health care leaders who attended the meeting have a different interpretation. They say they agreed to slow health spending in a more gradual way and did not pledge specific year-by-year cuts.

“There’s been a lot of misunderstanding that has caused a lot of consternation among our members,” said Richard J. Umbdenstock, the president of the American Hospital Association. “I’ve spent the better part of the last three days trying to deal with it.”

These are out and out lies coming from the industry. We have their pledge in writing, calling for a reduction of 1.5 percentage points to the annual growth of health care. Now they're trying to hedge that the 1.5% would be achieved eventually. You knew they would backtrack, I guess I'm surprised it happened within five days, but since $2 trillion dollars in savings equals $2 trillion dollars in their profits, this idea that they would patriotically put the good of the country ahead of their bottom line was always suspect.

So I have another "message" for David Axelrod, Max Baucus and the gang. How about this: "the insurance companies are thieves, they don't deserve the benefit of the doubt, and we need to both enforce their proposed savings and institute a public health care plan to compete with them on price and quality of service."

Has the benefit of being true.

Look To The Data And Frame Accordingly

So here we go with another blogosphere-level talk about framing, this time applied to the health care debate. Frank Luntz has dispatched his memo, and Celinda Lake dispatched hers, and then every winger parrots the Luntz points, and then liberals get all indignant about it, and finally George Lakoff comes in and tells everyone that Democrats are nurturant parents and Republicans monsters.

Where exactly do we get with this exercise? Luntz' talking points date from 1993 and actually much further back than that. We've been having these arguments since Harry Truman proposed national health care in the 1940s. Each side thinks they can outsmart the public into accepting their views, but I really think political insiders make too much of this. In the 40s and 50s, doctors were more plentiful and the greed baked into the current system not as obvious. Now everyone who interfaces with the health care system winds up unhappy about one aspect or another. They hate the insurance companies and like their doctors. You can try and leverage that any way you want, but masking over this essential truism will never fly. That's why I actually think that progressives have been smart to foreground the idea of a public health insurance plan over everything else, even though the cost containment and how to fund the overall plan are far greater obstacles to success. According to Lake's poll, 70% of the public supports a public option, and they are completely resistant to attacks. That's because current insurance options suck, and everybody knows it. They also generally like the President, and will support who he supports, and that (at this point) includes a public plan.

In the end, public opinion actually does strengthen with experience. It's easier to fool people about something abstract, but there's nothing abstract about health care. People understand the devil they know; it cannot possibly be worse than the devil they don't know. You can put rings around the rhetoric and make it look pretty, but in the end, people will support you if you relate to their lives.

Let's Not Oversell Luntz

Yes, I saw the Frank Luntz memo. I thought he was working for Hollywood now because he was "tired of selling reality," but I guess he came out of retirement for one last shot at denying Americans the right to health care. Or maybe not - the memo pretty much includes the same bromides we heard back in 1993 - that Republicans should talk about rationing, and a "government takeover" of health care, with politicians and bureaucrats deciding who gets treatment. There's no real alternative option here, just buzzwords like "waste" and "choice" and "patient-centered" and "more". Really, that's his prescription:

(10) It’s not enough to just say what you’re against. You have to tell them what you’re for. It’s okay (and even necessary) for your campaign to center around why this healthcare plan is bad for America. But if you offer no vision for what’s better for America, you’ll be relegated to insignificance at best and labeled obstructionist at worst. What Americans are looking for in healthcare that your “solution” will provide is, in a word, more: “more access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.”

Just do it!

This assumes that 2009 looks like 1993, and I simply don't believe it. Americans have had 16 more years of shoddy treatment at the hands of insurance companies. 16 more years of denied care, not from the government, but from the current health care system. 16 more years of overpaying for treatments and losing their coverage to a pre-existing condition. Luntz wants Republicans to personalize the crisis, but Democrats can do that all day long.

Also, it's not clear to me that any of this even matters to a great extent. Republicans know that the cudgel of budget reconciliation will force their participation in the discussion or get completely shut out. They can talk about "government takeovers" all day long, but they don't have the numbers to obstruct.

Grassley wants to stick with Baucus for as long as he can but knows that Democratic leaders such as House Speaker Nancy Pelosi (Calif.), Senate Majority Leader Harry Reid (Nev.) and White House Chief of Staff Rahm Emanuel are waiting in the wings, ready to force through a Democratic bill if a consensus fails to emerge.

“Here’s something we Republicans have to consider: We can be bargaining in good faith up to that ... one, last issue — whatever that might be — and regardless of how [well-]intentioned Sen. Baucus is on reaching an agreement with me, Pelosi and Reid could decide to pull the rug out from under them at the midnight hour and not have an agreement,” Grassley said.

Grassley later characterizes reconciliation as having ended bipartisanship, but his very presence in the debate suggests that the opposite is true.

The real icebergs for health care reform have popped up on the Democratic side of the aisle. Arlen Specter and Ben Nelson oppose a public option. The Chair of the Budget Committee killed the White House's proposal on partial funding, with capping charitable deductions for the wealthy. And there will be a host of other pitfalls, with the progressive groups pushing from the bottom demanding real reform. Republicans aren't involved in that debate. It's very hard for them to GET involved in that debate, because they have no interest in it.

When Barack Obama informed congressional Republicans last month that he would support a controversial parliamentary move to protect health-care reform from a filibuster in the Senate, they were furious. That meant the bill could pass with a simple majority of 51 votes, eliminating the need for any GOP support. Where, they demanded, was the bipartisanship the President had promised? So, right there in the Cabinet Room, the President put a proposal on the table, according to two people who were present. Obama said he was willing to curb malpractice awards, a move long sought by Republicans that is certain to bring strong opposition from the trial lawyers who fund the Democratic Party.

Nothing, it turned out. Republicans were unprepared to make any concessions, if they had any to make.

Somebody didn't read the Luntz memo.

Relying On Ignorance

Another example of Republicans relying on the weeklong attention span of the American electorate can be seen in this chart by McClatchy:



Far from being "the way the Senate does business," filibusters of this amount are COMPLETELY WITHOUT PRECEDENT in the last 45 years. Yet the press continues to report this as "The Congress just can't get anything done," without the historic context, and people get perturbed that those politicians in Washington can't get anything done, and so they hate the whole lot of them. This is a deliberate tactic from Republicans because they know it's their only way out of their political hole in 2008. Frank Luntz (via Digby) lays it out (I always like when a GOP operative asks the question "Can the GOP bounce back?" as if he has no vested interest in the outcome):

Still, a Republican victory is not impossible. Not yet. One promising indicator is the fact that Congress is at its lowest approval point in a generation - even lower than in 1994, when Republicans seized the majority in the House after 40 years of Democratic control.

The Democrats blew into Washington in 2006 as a breath of fresh air in response to Republican scandal, Republican budget mismanagement and a Republican war. But in recent weeks, that freshness has turned stale. Despite majorities in both houses, Congress is seen as having failed to set tough ethics standards, failed to stop wasteful spending and failed to fix illegal immigration.

And those failures offer a glimmer of hope for the GOP.

Anger and frustration toward politicians is even greater than it was in 1992, when Ross Perot won nearly 20 percent of the popular vote as a third-party candidate. Americans are fed up with Washington, with the noise and static, with the lack of common sense and with nothing ever getting done. If a Republican candidate empathizes with and embraces the fed-up nation, that's step one.

How much you wanna bet that Luntz came up with this idea to filibuster absolutely everything and obstruct the Congress from doing the nation's business?

You can see this in California too. Republicans in the State Senate is obstructing the passage of the budget, which isn't great but has been agreed to by all other parties. State Senate Republicans claim to have objections to the budget but REFUSE to spell them out. They have no interest in writing a responsible budget plan. They simply want to make government look bad because they think that bodes well for them.

You have the monster Reagan created when he called government the problem rather than the solution; a political party so wedded to their ideology that they would rather shut down the government than allow the other side a "victory," victory being broadly defined as the passage of any legislation affecting the lives of any citizens. This is the ultimate bad actor tunneling its way into the corridors of power. They worship power but detest the business that goes along with it; so they explain to their constituents that he who governs least governs best, and as if to prove it they try really hard not to govern at all, and damn the consequences.

Democrats highlighted this last week with the all-night Iraq debate. They need to keep going. This Custer's Last Stand by filibustering every piece of legislation needs to be exposed for what it is, a cheap political ploy. The Republicans ought to remember that Custer lost his battle.

The New Conservative Normal

It's interesting that the same critique made by the so-called establishment press against bloggers is now being employed by conservatives against liberals, namely that y'all are just too angry:

Particular issues can arouse passions here and there for anyone with any political views. But, for many on the left, indignation is not a sometime thing. It is a way of life.

How often have you seen conservatives or libertarians take to the streets, shouting angry slogans?

This was written by Thomas Sowell, the guy who called for a military coup a couple weeks ago. And just yesterday we learned that abortion clinic bomber Eric Rudolph is taunting his victims and their families from prison. So I don't think there's a monopoly on anger in any political party.

But why I highlight this sorry excuse for a column is because it's clearly becoming a new conservative meme. Two years ago it was that liberals didn't have any ideas. Considering that the Bush Administration is following Democratic advice on issues like talking to Iran and Syria, increasing the size of the military, using the Agreed Framework as a base for negotiations with North Korea, etc., that line won't work anymore. Now it's that liberals are too angry. When Frank Luntz says it (and he did several times on Bill Maher last weekend) you know that's what they're going with. Of course, now they have to argue that liberals are too angry AND wusses who won't protect the country. Leading to a new class of angry wusses.

In fact, they are mistaking anger for passion. Whenever Democrats get passionate about issues and actually excite the public, they tend to win elections. When Republicans get passionate, it's about protecting their little fiefdom, which comes off as... angry:

An angry and bitter Paul Wolfowitz poured abuse and threatened retaliations on senior World Bank staff if his orders for pay rises and promotions for his partner were revealed, according to new details published last night.

Sounding more like a cast member of the Sopranos than an international leader, in testimony by one key witness Mr Wolfowitz declares: "If they fuck with me or Shaha, I have enough on them to fuck them too."

(Incidentally, the World Bank report says Wolfowitz violated rules and he should go.)

"You're just angry" is a fine way to shut down debate and disengage on ideas, but it's not likely to get very far. Especially when those tut-tutting about anger are some of the orneriest sould who've ever walked the earth.