Proudly Presenting Yourself As A Tool - Not Quite The Way To Win

In the past week, several progressive advocacy groups have come out against Tennessee Governor Phil Bredesen for Secretary of Health and Human Services, including MoveOn.org just today.

How can you tell who's a real health care champion? We need someone who's going to support visionary progressive health care reform; someone with a track record of standing up to the insurance and pharmaceutical giants at the heart of our health care crisis; someone who is 100 percent committed to giving every single American the choice of a public health insurance plan so we're not at the mercy of the private insurance companies (just as Obama promised).

Obama is reportedly considering several governors and a few senators. Many of these folks would be great, but at least one would be a bad choice for health care reform: Tennessee Governor Phil Bredesen made his fortune acquiring and running HMOs. As governor, he gutted Tennessee's public health insurance program, causing more than 320,000 people to lose their health insurance. And Bredesen let the private insurance industry pay for his multi-million dollar redecoration of the governor's mansion.

You would think that, faced with this opposition, Bredesen would defend his record, show his independence from special interests and his commitment to reform. Even if it was only rhetorical, this would be the standard move. Yeah, you would think:

“Anybody who’s got some real scars and experience is going to have their detractors,” the governor said Monday in an interview with The Wall Street Journal. “People at the White House are smart enough to be able to assess that.” And he took a swipe at his opponents, saying that “advocacy groups don’t matter nearly as much as the pharmaceutical groups, the hospitals, the doctors’ groups. There’s a lot of very powerful interest groups that will play in this thing.”

The charitable reading of that is that Bredesen thinks the important groups to do combat with are those special interests, but that would be completely at odds with his history:

This quote by Bredesen — dismissing advocacy groups and embracing industry interests — is typical of his tenure in office. In 2005, Bredesen’s wife, Andrea Conte, embarked on a $9.4 million renovation of the governor’s mansion. The largest donor to the project? BlueCross BlueShield of Tennessee, which gave $150,000.

While in making cuts to TennCare, Bredesen largely “cast aside” the “cost saving ideas of advocates” that would have increase health care coverage while also addressing the state’s budget crisis. But as TNR’s Jonathan Cohn notes, advocates will be necessary in pushing health care reform through Congress; a lack of coordinated support amongst liberal allies was part of the reason that President Clinton’s health care plan failed to conservative attacks.

Ezra Klein thinks that the advocacy groups are working too hard opposing Bredesen when they could be coalescing around one of the other candidates. But recent history with the Obama Administration shows that advocacy groups have been much more successful helping to disqualify than to qualify - see John Brennan. What's more, most of the other names mentioned (Rosa DeLauro, Kathleen Sebelius, John Podesta) don't have much to distinguish them from one another. Howard Dean IS attracting grassroots support, and I personally would like to see Judy Feder of Georgetown University because I think she knows her shit more than anyone. But this is not a weakness of the advocacy groups, it's a strength. If they knock out Bredesen, they know HHS will be in relatively good hands.

Bredesen? End Of Health Care Reform As We Know It

Getting back into the talk about who will run HHS, the name Phil Bredesen has come up, which makes me stumble around as if I've been punched in the face.

As governor, Bredesen presided over some drastic cuts to TennCare, Tennessee's once innovative effort to reform Medicaid. I wrote about these in my book, Sick:

...it was a Democratic governor who would succeed in enacting the most sweeping cuts: Phil Bredesen of Tennessee. Bredesen knew a thing or two about health care: before getting into politics, he had made his fortune by founding a company called HealthAmerica—one of the fi rst commercial HMOs to cash in on managed care during the late 1980s. This experience, plus his confi dence in his own intellectual abilities (he had a physics degree from Harvard), convinced him that he could wring new efficiencies from Tennessee’s Medicaid system, just as his HMO had generated financial savings—and hefty profits—in the private market.

A lot of what Bredesen proposed to do—such as reducing fraud by providers and recipients, and improving the use of information technology—made sense. But when those quick fixes didn’t bring the TennCare budget under control, he unveiled a more straightforward plan: he would simply slash the program. More than 100,000 people who had qualified for TennCare because they were “medically needy” would lose their coverage altogether. Those allowed to remain in the program would have to make do with more limited benefi ts. The biggest change would be in the coverage of prescription drugs. “The sad reality is that we can’t afford TennCare in its current form,” Bredesen said. “It pains me to set this process in motion, but I won’t let TennCare bankrupt our state. This is the option of last resort.”

While Bredesen undoubtedly faced tough circumstances, he didn't exactly distinguish himself by coming up with creative solutions--or fighting for people who, after all, were among Tennessee's most vulnerable citizens. As liberal advocates protested planned cuts, he fought bitterly with them, threatening even more draconian measures if they wouldn't buy into his programme.

That's not the only reason Bredesen worries me, though. Another concern is characterological. He is typical of the top figures in the health industry I've met over the years: Self-made entrepreneurs a bit too convinced of their own brilliance, completely unaware that the strategies for making private insurers profitable don't help--and often hurt--the sicker, poorer people whom insurance should ideally protect. Their biggest fans are often people who know a ton about health care at the macro level, but haven't spent much time observing it on the ground--where reality is often messier than the statistics suggest.

Ezra Klein has more. I mean, Democrats are already telling America to forget about single payer (hopefully team single payer will have something to say about that), but under Bredesen, you'd basically have to forget about even decent incremental reform.

One bit of good news on that incremental front: the House passed SCHIP today for a second time, and as this bill is in line with the Senate version, it will in all likelihood be signed into law tonight. This is actually pretty good incremental reform, not the kind you'd get with Phil frackin' Bredesen.

...wait, I found somebody worse than Bredesen for HHS. Jim Cooper. The guy that killed the 1994 reform. Think "bigger giveaway to special interests".

The time has come to put away childish things...

Nashville, Tennessee voted down a bid to make English the city's official language. Now local government must continue to use alternative languages in official documents. These "English first" laws are cruel and unnecessary and have little effect on forcing immigrants to learn English - they usually do anyway, at least in the next generation. Glad to see a city in solidly Republican Tennessee rejecting it. Immigrant-bashing not only threatens to make the GOP a permanent minority nationally, it's not even successful in their strongholds.

Dirty Little Secret

It turns out that those giant ponds of coal ash, toxic sludge created by coal-fired power plants, which can pour into local reservoirs and contaminate drinking water, are unmonitored and unregulated.

The coal ash pond that ruptured and sent a billion gallons of toxic sludge across 300 acres of East Tennessee last month was only one of more than 1,300 similar dumps across the United States — most of them unregulated and unmonitored — that contain billions more gallons of fly ash and other byproducts of burning coal.

Like the one in Tennessee, most of these dumps, which reach up to 1,500 acres, contain heavy metals like arsenic, lead, mercury and selenium, which are considered by the Environmental Protection Agency to be a threat to water supplies and human health. Yet they are not subject to any federal regulation, which experts say could have prevented the spill, and there is little monitoring of their effects on the surrounding environment.

This is a function of effective regulation of smokestacks and air pollution - the coal companies are just moving the pollution to a hidden corner away from regulator's prying eyes.

The amount of coal ash has ballooned in part because of increased demand for electricity, but more because air pollution controls have improved. Contaminants and waste products that once spewed through the coal plants’ smokestacks are increasingly captured in the form of solid waste, held in huge piles in 46 states, near cities like Pittsburgh, St. Louis and Tampa, Fla., and on the shores of Lake Erie, Lake Michigan and the Mississippi River.

Numerous studies have shown that the ash can leach toxic substances that can cause cancer, birth defects and other health problems in humans, and can decimate fish, bird and frog populations in and around ash dumps, causing developmental problems like tadpoles born without teeth, or fish with severe spinal deformities.

“Your household garbage is managed much more consistently” than coal combustion waste, said Dr. Thomas A. Burke, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, who testified on the health effects of coal ash before a Congressional subcommittee last year. “It’s such a large volume of waste, and it’s so essential to the country’s energy supply; it’s basically been a loophole in the country’s waste management strategy.”

The loophole is actually allowing coal-fired power plants to continue to exist. The incident in Tennessee is among the worst-case scenarios, but with more power generation from coal, it's inevitable. And over half of Americans live within 30 miles of one of these kinds of power plants.

Enough. We need to shut down coal plants in the name of public health. The massive PR machine that the coal industry bakrolled to the tune of $45 million last year is pernicious and threatens the safety of the nation. There is no clean coal. Only sick people.

Dirty Coal Creates More Suffering

That horrible coal ash spill in Tennessee is proving to be even bigger than expected.

Officials at the authority initially said that about 1.7 million cubic yards of wet coal ash had spilled when the earthen retaining wall of an ash pond at the Kingston Fossil Plant, about 40 miles west of Knoxville, gave way on Monday. But on Thursday they released the results of an aerial survey that showed the actual amount was 5.4 million cubic yards, or enough to flood more than 3,000 acres one foot deep.

The amount now said to have been spilled is larger than the amount the authority initially said was in the pond, 2.6 million cubic yards.

A test of river water near the spill showed elevated levels of lead and thallium, which can cause birth defects and nervous and reproductive system disorders, said John Moulton, a spokesman for the T.V.A., which owns the electrical generating plant, one of the authority’s largest.

Some would call it "larger" than the amount originally thought to be in the pond, others would say "twice as much." And now it's in the drinking water.

Coal ash (or fly ash) is really nasty stuff, with multiple carcinogens and heavy metals and even radioactive elements like uranium and thorium contained in it, all of which can create a public health hazard. In addition, it's generated when coal is burned, and no matter what is done with the carbon, the residue remains and must be put into landfills or captured and stored at the plant. Power plants generated 71.1 million tons of fly ash in 2005. Incredibly, some of it is recycled and used in things like footpaths, leading to contamination. But I don't think we've ever seen levels like this released, and certainly not into a reservoir. Scientific American has more.

Regardless of whether we have developed "clean coal" technology to mitigate the effects of carbon, the problem of fly ash would persist. Which is why it is so stupid for prominent politicians, including the President-elect to speak laudably of the promise of clean coal. I just saw an ad this week featuring Barack Obama put together by the coal industry, using campaign footage of him in coal country:

"Clean coal technology is something that can make America energy independent!...We put a man on the moon in 10 years. You can't tell me we can't figure out a way to burn coal that we mine right here in the United States of America and make it work!"

There's campaign rhetoric that is relatively harmless and there's this validation of a dirty industry that has very real effects. Big Coal spent $45 million dollars this year to promote their product, which is currently to blame for one of the biggest environmental disasters in American history. Coal is not clean, nor will it ever be. Anyone who says otherwise is part of the problem.

My Foreign Investor, Right Or Wrong

As Digby noted yesterday, the auto industry recovery package looked to be on life support. Looks like Mitch McConnell pulled the plug:

The Kentucky Republican, with a large auto presence in his state, had been seen as a potential ally for the industry, and he provided crucial support for the Treasury Department's financial markets rescue fund this fall. But he has since endured a punishing reelection fight. And faced with strong resistance in his caucus, he said that the bill "isn't nearly tough enough" and that he could not ask taxpayers to "subsidize failure." [...]

While not entirely surprising, the Republican opposition stands in contrast to what have been significant concessions by Democrats to try to move the bill forward.

"Much of this bill is dictated by the president. It is a stunning vote of no confidence," [Rep. Barney Frank (D-Mass.)] said of the Republican opposition.

I think the first mistake was making a "deal" with the loathed President Bush and expecting that to hold.

But let's be clear what's going on here. A bunch of Southern-state Republicans (including, amazingly, Diaper Dandy David Vitter), from right-to-work states, want to push GM and Chrysler into bankruptcy to bolster the foreign auto presence in their home states. Kentucky has a Ford factory but they also have a Toyota plant in Georgetown, so McConnell's on board.

Last week, Jane Hamsher explained the conflict of interest for Bob Corker in Tennessee:

He hasn't mentioned the subsidies his own state of Tennessee has given to foreign automakers, making it harder for the Big 2 1/2 to compete:

Tennessee offered its richest incentive package — and perhaps the most government assistance and tax breaks ever for an American automobile plant — to lure Volkswagen to Chattanooga.

But the state’s chief business recruiter said Wednesday that the benefits from VW’s $1 billion assembly plant far will exceed what could top $500 million in government assistance and tax breaks for the project.

“The Volkswagen investment in this community is going to have a tremendous economic gain for the entire region,” said Matt Kisber, Tennessee’s commissioner for economic and community development. “I’m confident we’re going to have a very reasonable incentive package when you look at the initial costs of what is being offered compared with a much bigger long-term return.”

Yes, that's the logic -- these incentives will bring more money to the region than they cost. But it doesn't always work out that way. As David Cay Johnston noted in Free Lunch, these kinds of subsidies frequently wind up costing communities much more than they ever make back:

Johnson writes: "The tribute Cabela's demanded from Hamburg [Pennsylvania] amounted to roughly $8,000 for each man, woman, and child in town." Johnson points out that between 2004 and 2006, Cabela's earned $223.4 million. During those years, it collected at least $293.7 million in subsidies, more than its reported profits. Meanwhile a family business selling fishing and hunting gear was driven out of business in Hamburg.

Funny nobody is mentioning this.

The GOP does a lot of chest-thumping about "Country First" and patriotism. It's fun to watch them destroy American manufacturing so they can keep Japanese and German corporate executives happy. OK, maybe not so fun.