Deal Of The Century

So Max Baucus will reveal his long-awaited wet kiss of a bill tomorrow, with subsequent votes in committee in the coming week. We've already seen an outline of it, so we know that it would still cripple people financially who have the temerity to get sick, it would criminalize people who do not buy inadequate private coverage from the insurance industry, it would incentivize employers to offer crappy coverage and discriminate in hiring against people who have no coverage from a family member, and it would not include a public insurance option to compete with private plans. It won't even include a trigger, because the original trigger backer, Olympia Snowe, has decreed that it's a dead letter. Those weak state-based co-ops designed to allow nonprofits like Blue Cross, some of which control 90% of the insurance market, to access billions in government seed money, will be as close as we get in the Finance Committee to a public option. Seemingly, the only reason for the death of the trigger is that Susan Collins said they might lead to a (horrors!) public option, and Snowe probably wants her along as cover for a final bill.

You can pretty much tell what a steaming pile of garbage the Baucus bill would be by the fact that the drugmakers are going all in to support it.

The drug industry’s trade group plans to roll out a series of television advertisements in coming weeks specifically to support Senator Max Baucus’s health care overhaul proposal, according to an industry official involved in the planning.

The move would be a follow-up to the deal that drug makers struck in June with Mr. Baucus and the White House. Under that pact, the industry agreed to various givebacks and discounts meant to reduce the nation’s pharmaceutical spending by $80 billion over 10 years.

Shortly after striking that agreement, the trade group — the Pharmaceutical Research and Manufacturers of America, or PhRMA — also set aside $150 million for advertising to support health care legislation.

President Obama has cited the deal with the group as signifying a new era of cooperation. But some critics say the advertising fund could be wielded against alternative approaches to health care legislation. Some House Democrats, including Henry A. Waxman of California, are seeking drug industry givebacks not covered in the deal with Mr. Baucus and the White House.

You rarely see bribes like this spelled out so succinctly and directly. $150 million is certainly more money than has been spent on health care advertising to date. And it's all going toward the Baucus plan, based on a quid pro quo agreement. Other committee chairs like Henry Waxman want to find more savings that what Big Pharma agreed to by letting the government to bargain for lower drug prices, like many other industrialized nations. But Baucus dutifully abided by the deal, and so his plan will get the ad backing. Matt Taibbi further explains.

The $150 million it committed to support Obama’s bill is now being rolled out in pro-reform ads, which are being aired mostly in the districts of freshman congressmen. The ads are cheesy, half-hearted tripe blandly supporting the weak-as-fuck remnants of Obama’s health care plan, an example being this “Eight Ways Health Reform Matters To You” ad that salutes the end of coverage denials for those with pre-existing conditions.

Now we’re also seeing pressure from a group of freshmen and Blue Dogs, who have composed a letter to a quartet of House Committee chairs requesting that the Waxman language be removed from the health care bill and replaced with the PhRMA language, which happens to be the language the White House is pushing and which will appear in the Baucus bill in the Senate. The pro-PhRMA language retains the preposterous government subsidy to the pharmaceutical industry in the form of laws banning Medicare from negotiating market rates. It is completely useless and of no possible social benefit to anyone except pharmaceutical companies, but this group still managed to get 60 people to sign this bill.

What does this letter say? Does it argue that the PhRMA language is better for America than the Waxman language? Does it say it will cost taxpayers less and provide cheaper drugs to more people? Hilariously, no. What it says is that this PhRMA language, while worse than the Waxman language, is not quite so bad as you think (it doesn’t save as much as the Waxman language, but it still has a 50 percent price reduction, which isn’t terrible!). Moreover, the letter says, substituting this language will help the bill get passed! Here’s the actual language, addressed primarily to Waxman:

“Your efforts to remove this onerous burden on Medicare beneficiaries… are to be greatly commended. However the commitment by President Obama and the AARP to support legislation that would provide a 50 percent reduction is a dramatic step forward in helping fill the doughnut hole. Equally important, it moves us toward our goal of health care legislation.”

In other words, your attempt to put in a real reform is cool and all, but PhRMA has us by the balls, so help us out.

At the same time, the drug industry is employing scumbag from way back Tony Coelho, who may be single-handedly responsible for Democratic silence in the face of the decimation of American manufacturing in the 1970s and 1980s, to attack comparative effectiveness research, another part of the Obama plan. I guess there's nothing two-way about that loyalty.

While we were going back and forth on a public option, this backroom deal to fund future Democratic campaigns (I don't believe for a second that the $150 million will be spent now, but on protecting conservative Democratic incumbents who protected drug industry profits next year) in exchange for backing off a huge subsidy to giant corporations was put into motion. Baucus' delay actually may have crimped this and forced Big Pharma to start spending now. With industry out in front, however, a bill will probably pass.

Just don't read it so closely.

Cost Control Is A Political Problem

Doug Elmendorf, who runs the Congressional Budget Office, testified today that the health care bills under suggestion in Congress would increase public health care spending and continue to threaten the long-term budget outlook.

Under questioning by members of the Senate Budget Committee, CBO director Douglas Elmendorf said bills crafted by House leaders and the Senate health committee do not propose "the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."

"On the contrary," Elmendorf said, "the legislation significantly expands the federal responsibility for health-care costs."

Though President Obama and Democratic leaders have said repeatedly that reining in the skyrocketing growth in spending on government health programs such as Medicaid and Medicare is their top priority, the reform measures put forth so far would not fulfill their pledge to "bend the cost curve" downward, Elmendorf said. Instead, he said, "The curve is being raised."

To which I respond, of course. This is the fundamental problem with health care reform that I've mentioned earlier. Nobody wants to do the trade-offs. There are plenty of cost-control options on the table. One would be capping or eliminating the employer deduction on health benefits, which Elmendorf cites as "a federal "subsidy" that encourages spending on ever more expensive health packages." Another would be putting public health reimbursement rates into the hands of MedPAC and away from the parochial concerns of Congress members, which leads to overpaying for providers in many cases (though lots of Medicaid and Medicare reimbursement rates are low). There are comparative effectiveness reviews that would sweep away ineffective treatments that are too expensive relative to their benefit. There are proposals to change the long-term pay structure of Medicare for providers, away from fee-for-service and toward primary care emphasis and bundled payments. There's the option to make insurers pay the negative externality of denying care by slapping an operating fee on them. And there's a public option that can use Medicare bargaining rates, which would lower costs by 20-30% per individual.

But the unions don't want to break up the inefficient employer-based system and put their gold-plated insurance policies at risk. Congresscritters don't want to lose the power to set Medicare reimbursement rates for their localities. Device makers and their allies want to ensure that their devices aren't rendered useless through research and study. Doctors and hospitals and insurers all want to preserve their profits. And nobody is intellectually honest enough to call for cost controls and a public option that would legitmately drive costs down. Harry Reid's rejoinder is instructive:

Senate Majority Leader Harry M. Reid (Nev.) dismissed Elmendorf's push for the benefits tax. "What he should do is maybe run for Congress," Reid said.

The truth is that we have too shitty a political system right now to get real reform. We might get it incrementally, and can build on it. But the CBO isn't saying anything people don't know. It's just that politicians are afraid to lead.

A Thousand Or So Words Of Despair On Health Care Reform

I may have dismissed the difficulties in paying for health care and the time frame a little prematurely. To be sure, it's a problem. Not the nature of the revenue ideas themselves - a surtax on the wealthy may work, although I'd prefer to go back to President Obama's idea to lower the charitable deduction, and Matt Yglesias explains why:

When possible, it’s better to raise money by broadening the tax base—curbing loopholes, deductions, and exemptions—than by simply raising the rates. The reason is that higher rates on a narrow base do a lot to encourage people to shift income into loopholes, which both undermines your revenue-raising efforts and also distorts the economy. Both the employer tax exclusion proposals and the itemized deductions proposal fit that good model.

The problem is that we're pretty far down the road on the various bills and we're still trying to figure out how to pay for it, which suggests to me that Congress doesn't want to make any hard choices on it. They have a bunch of ideas, but no real strategy. And they've taken the employer deduction off the table because unions don't want to give back what they already have, which makes sense for them but not necessarily the country.

One related point I'd make on this is that there is, in progressive circles, a tendency to confuse the interests of labor unions and the interests of progressivism. The two things often overlap. But they are not, in fact, the same. And that's okay. But this is very much one of those cases. The employer tax exclusion is regressive. It gives employers more power over workers. It reduces choices, fractures the system and increases health-care costs (which in turn decreases wages). Unions are protecting what they have, and that's their right. But protecting the employer-based health-care system, particularly at the expense of a regulated and integrated alternative, is not a terrifically progressive thing to do.

And without changing the incentives in health care and reversing the dynamic of doctors ordering more, insurance companies trying to pay for less and employers still paying the bulk of the costs in an inefficient way, we're not reforming health care. We're just expanding coverage and heading toward the same fiscal iceberg. Which is important in its own way, but not a full solution.

And meanwhile, as the timing of the bill slips, conservatives get emboldened and start running ads in the districts of key Senators. Blue Dogs and Conservadems get cold feet and start looking for ways to deep-six the bill. The problem in that case is that the answer to the Blue Dogs' entreaties would be more reform, which they don't want either.

The emerging bill "lacks a number of elements essential to preserving what works and fixing what is broken," 40 members of the Blue Dog Coalition of moderate to conservative Democrats wrote in a letter to party leaders. To win their support, they said, any legislation would need to be much more aggressive in reining in the growth of health care.

A public option and capping the employer deduction would go a long way for that, but they're against that, too.

Meanwhile, the White House is making all these deals with stakeholders that may have strings attached that would preserve their revenue streams and fail to rein in health care costs. Take a look at this, for example:

The Wall Street Journal reports: "Industry representatives met at the White House Tuesday with officials to consider specifics of a cost-saving agreement the industry reached last month with health-care negotiators and to discuss other concerns that the pharmaceutical industry has with the larger health-care overhaul being considered by Congress. As a presidential candidate, President Barack Obama endorsed re-importation, an idea the industry opposes. White House officials have told the industry if the larger health care bill passes, the cost savings will be so great that reimportation will be unnecessary, according to Billy Tauzin, president of the Pharmaceutical Research and Manufacturers of America." Some of the pharmaceutical companies represented at the Tuesday meeting included Merck & Co., Pfizer Inc., Amgen Inc., Abbott Laboratories and AstraZeneca.

The Wall Street Journal notes: "Sen. Bernie Sanders, an independent from Vermont, said he disagrees with any move to drop the reimportation idea. He has pushed to import drugs from Canada, where they are cheaper because of price controls" (Mundy, 7/7).

Are we going to side-deal ourselves to death here? Will we assure medical equipment makers that we will not ensure comparative effectiveness research that would align costs with results instead of the mish-mash we have today? Will we deal with hospitals but leave the full picture of how they rein in costs unanswered? Who will decide the limits to the system, and the tough choices around end-of-life care, now managed by insurers?

The major problem we are running into with health care is that the political class is so obsessed with allowing everyone to keep what they have, and not putting enough emphasis on the system's unsustainable course, that they risk wringing all the benefit for real people out of the bill, and at that point, it can tip over and die.

This isn't terribly surprising: it's not obvious what health-care reform will do for the average American. I could give you a long answer about delivery system reforms and so forth because it's my job to know these things. But it would have to be a long answer. The basic structure of health-care reform has been specifically built to avoid changing people's existing arrangements. The hope was that Americans would be convinced that their health-care coverage wouldn't change for the worse. But that's also made it hard to explain why it will get better.

One of the president's health-care reform principles is that everyone must be able to keep what he or she currently has. But that means we're not really going to change, or improve, what they have. And that means they're not getting much in the way that's new. Higher taxes aren't buying them obvious benefits. Instead, they seem to be paying the health-care bills of poorer Americans.

If support for the overall effort were more robust, the polling on the tax exclusion would matter less. People are willing to pay for things they want to buy. But though they might abstractly favor health-care reform, it doesn't seem directly related to their lives.

This is the problem of liberalism since the Great Society - people don't feel like they're getting anything for their payments to government, because Democrats have stopped pushing for anything tangible for everyone. A reform constructed to expand coverage for the poor without something tangible for everyone - like a public option to bring down premium costs and not wed people to their job for the health benefits - just will not pass. It has no shot. Because the public needs convincing that they have something at stake in this reform.

Holding Back The Tide

The White House has done a pretty good job of rolling out these deals with the health care industry. They made the main announcement of $2 trillion in savings months ago, and that got a large news hit. Then they've been dribbling out each element of the industry and their pledges to lower costs. We haven't reached $2 trillion - in fact, we haven't come close - but every time they do it, the White House gets another news hit. It's pretty brilliant.

The latest is an agreement with the hospital industry to give back $155 billion in profits over a decade, on the heels of an $80 billion dollar agreement with the drugmakers to help fill the dreaded donut hole for prescription drugs for seniors. Because of the way in which Max Baucus (who is brokering most of these deals) and the White House have done it, assenting to changes in how they are paid, this money can be used to help pay for reform, unlike the $2 trillion, which was outside the purview of the CBO. But they seem to be bargaining, like the drug industry, for the best deal they can get, instead of designing the policy and forcing the various industries to accept it.

Still, you have to wonder: Could these industries be giving up more? The drug deal, at least, doesn't look all that great--except, perhaps, to the drug industry. My reading of the agreement--and, to be clear, there's still a lot of ambiguity here--is that the drug industry has agreed to kick in some of its own money to help fill in the "donut hole" in the Medicare drug benefit.

That's very nice and will, I think, make it easier for seniors to afford their drugs. But it also seems that, as part of the deal, seniors have to buy more drugs from name-brand manufacturers rather than generics. It's entirely possible that the name-brand drug industry--that is, the companies represented by PhRMA--could actually come out ahead [...]

The expected hospital agreement seems may be more signfiicant--and, for liberals, more encouraging. Although it's impossible to know without seeing the details, $155 billion is a decent chunk of change. That could represent a serious sacrifice on the part of the hospitals.

On the other hand, it's not clear whether, perhaps, this is an example of some hospitals effectivelly cutting a deal that hurts others. Insofar as the savings come from reduced payments for charity care--payments that now flow through Medicaid--is this a case in which suburban and speciality hospitals actually do just fine but charity hospitals take a hit?

Perhaps the most important question to answer is what these industry groups are getting in return. Changing payments to the health industry isn't simply about generating savings that can finance expansions of insurance coverage. It's also about changing the behaviors of these industries--and, in so doing, creating a health care system that offers better quality care for less money.

To accomplish that, reform should ideally include measures like strengthening the hand of the Medicare Payment Advisory Commission (MedPAC), developing more data on comparative effectiveness (CE), or building a strong public insurance plan. But hospitals don't like the idea of a stronger MedPAC, drug makers are pretty hostile to good CE, and insurers (among others) hate the idea of a public plan. When the industries cut these deals, are they prying promises from Baucus--or the White House--not to push too hard on these levers?

The effect has been to set a ceiling for what the drugmakers and the hospital industry and the other stakeholders will accept, brokered through the most conservative and industry-friendly committee in Congress, Max Baucus' Senate Finance Committee. Any committee that seeks more savings from industry immediately gets attacked, even though they never made such an agreement.

Having struck a bargain with Senate Finance Committee Chairman Max Baucus (D-Mont.), the industry is aggressively targeting individual House Democrats, warning of repercussions in the 2010 elections if they go along with a tougher set of savings advocated by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.).

PhRMA, the powerful Pharmaceutical Research and Manufacturers Association lobby, is openly playing one chairman against the other. Billions of dollars are at stake; a politically sensitive population, the elderly, is caught in the middle. With House Democrats expected to finalize their bill this week, President Barack Obama could face pressure to come off the sidelines and spell out better where he stands.

What Baucus agreed to specifically in his June 20 bargain is still in some dispute. But PhRMA is bluntly telling House moderates that the senator will oppose the rebates demanded by Waxman and that the smart move is to kill that provision outright and save themselves political pain in 2010.

Then there's the effort in the Senate Finance Committee to deny women legal medical services inside any insurers operating inside the Health Insurance Exchange:

The Senate Finance Committee has been writing a health care reform bill and struggling to create legislation that will have bipartisan support. Chairman Max Baucus considered several compromises to win Republican support, so they can claim it is bipartisan legislation. One of these potential compromises comes in the form of an abortion exclusion, which would prevent abortion services from being covered by some or all insurance plans in the Health Insurance Exchange. We fear that members of the Senate Finance Committee are considering such a compromise.

Remember, most of the groups inside the insurance exchange are private companies. I thought conservatives didn't want to put a government bureaucrat between the patient and the doctor. I guess when it comes to reproductive choice, that's OK.

The Senate HELP Committee's favorable budget score raised hopes that a workable solution was on the way, which was affordable and used a public health insurance plan to increase that affordability. But there's a whole maze of committees and votes to maneuver through. And the Senate Finance Committee is really building a dam to hold back the tide of a legitimate overhaul. Must be all of that industry money.

...see also the tactic of arbitrarily lowering the cost of the bill for no real reason other than $1 trillion is a nice round number.

Bipartisanship For The Sake Of Looking Bipartisan

Democrats are acting like bipartisanship matters in the health care debate, and then the Republicans have a day where they reveal a "plan" with no details, no sense of who would be covered by it and no cost estimates. It's literally a useless four-page outline.

Rep. Roy Blunt (R-Mo.), who heads a GOP health task force, said that when the details are drafted in the coming weeks, they would present a plan that “costs far less than the Democrats’ [plan] and provides better results for the American people.”

But Republicans who stayed at the press conference to answer questions — the leaders made statements but didn’t stay — could not answer whether their plan would include a tax increase to pay for such costly items as refundable tax credits for low- and middle-income workers to help pay for insurance.

These are the same people advocating the complete scrappage of the employer tax deduction, who want to criticize Democrats for raising taxes to pay for health care. These are the same people who introduced a bill to deny comparative effectiveness research in Medicare and Medicaid, in the name of fiscal conservatism:

1. Politicians who rail against wasteful government spending are taking action to prevent the government from reining in … wasteful spending.

2. Politicians who warn that the burden of entitlements is killing the federal budget are stepping in to block … the single most painless route to reducing the growth of entitlements.

3. They’re doing it in the name of avoiding “rationing of health care” … but they’re specifically addressing taxpayer-funded care. If you want to go out and buy a medically useless treatment, Medicare won’t stop you.

4. These same politicians are, of course, opposed to efforts to expand coverage. In other words, it’s evil for government to “ration care” by only paying for things that work; it is, however, perfectly OK, indeed virtuous, to ration care by refusing to pay for any care at all.

By the way, the "rationing" talking point is rank nonsense, but you probably knew that, based on who was promoting it.

Hell, these people have even tried to assert that health care reform shouldn't be passed because it promotes walking.

So given all of this, like E.J. Dionne I can't imagine why you would want to engage these people in any meaningful way, when they have time and again proven themselves not to be partners but unilateral adversaries.

Where did we get the idea that the only good health-care bill is a bipartisan bill? Is bipartisanship more important than whether a proposal is practical and effective? And if bipartisanship is a legitimate goal, isn't each party equally responsible for achieving it?

Most Democrats believe that fixing the system will require increased government intervention to guarantee universal coverage and to contain costs. Most Republicans oppose an expansion of government's role and believe an even more market-oriented system would pave the way to health-care nirvana.

Trying to achieve full bipartisanship by squaring those two views is a recipe for incoherence [...]

It's one thing to compromise to pick up votes, which, one hopes, is what Baucus is doing. It's another to compromise in exchange for nothing at all. The first is bipartisanship with a purpose. The second is the bipartisanship of fools.

And so we get idiotic half-measures like Kent Conrad's "throw a dart at a board" health co-ops idea, which simply does not make any reasonable sense as a substitute for the public plan unless the goal is to maintain the status quo for the sake of not angering Republicans who won't vote for the bill anyway. Health co-ops are fine at the margins, but simply could not possibly be scaled up to provide what a public plan could, which is the impetus for insurers to compete on price and quality. This is just a replay of the Bush years:

But is Conrad right about the politics? A reform proposal that doesn’t have a public plan is bound to cost more (or do less), since a public plan can save money--and save money in ways that the Congressional Budget Office will score. Get rid of the plan, and reform’s overall price tag goes up, making it harder to pass. And if reform without a public plan were to pass, it would simply not work as well, or perhaps at all. It would be more likely to run into problems because budget expenditures turn out to be higher, or implementation problems when private insurance doesn’t live up to its promises. That could sink reform before it even gets underway. In other words, maybe there’s a political risk to including a public plan. But there’s also a big political--and policy--risk to excluding it.

Strategically, Conrad’s approach is more like capitulation than compromise. Reconciliation or no reconciliation, the right political path for achieving reform doesn’t run through a minefield of endless preemptive concessions. When President Bush successfully enacted tax cuts in 2001 (through the reconciliation process, it should be noted), the question was simple: tax cuts, yea or nay? Many Democrats eventually signed on, not because they liked what Bush was peddling, but because they didn’t want to be against tax cuts. And tax cuts mostly for the rich weren’t all that popular. By contrast, there’s little question about the popularity of bold action on health care.

Memo to Congressional Dems: You. Cannot. Reason. With. Radical. Republicans. Who. Want. You. To. Fail. So stop trying, already, or else we'll have to conclude that you want no part of progress either.

Anti-Effectiveness Conservatives

Here we go again with conservatives trying to deep-six comparative effectiveness research in medical treatments, throwing up all kinds of horror stories about "Federal Health Boards" that would dictate to people what they can and cannot receive from their doctor. First of all, if we had to pay for the time and effort to manage 300 million individual health care treatment outcomes, we would need more money than exists in the entire world. Second of all, it's completely bogus, as Ezra Klein explains wearily.

The apparent fear here is that the evidence from comparative effectiveness will be, well, used to make treatment decisions. But that can't be quite right. We use evidence all the time. Your insurer won't pay for a leg amputation when your symptom is a headache. Medicare doesn't cover a wheelchair if you're diagnosed with acute constipation. No one whines about that.

The fear, rather, is that the existence of more evidence will somehow qualitative change the way government uses evidence. The government will decree, in other words, that their testing shows back surgery ineffective, and back surgery is now illegal. Put slightly differently:

Step 1: Comparative effectiveness review.
Step 2: ????
Step 3: Authoritarian medical system

It's sort of what would happen if you applied The Road to Serfdom to the comparative effectiveness debate.

The industry's fear is quite different: This is the profit objection. Right now, most research on, say, drug effectiveness is funded by the pharmaceutical industry. That presents obvious advantages for them and problems for us. The concern here is that if they cease controlling the flow of evidence, then new studies will show that certain treatments don't work. For instance: Claritin goes off patent. Generic versions emerge. They're very cheap. Claritin's manufacturer changes the chemical composition slightly and comes up with Clarinex. They apply for a new patent. They sell it at a heavy mark-up. But it probably doesn't work much better. If there's credible evidence out there showing that it doesn't work much better, that's the end of that business strategy.

Business interests are using the ideological objection to scare people into advocating against comparative effectiveness research, so they can maintain their profit motive. I would imagine that the drug industry could care less if we were in a single payer health care system, as long as they got their drug monopolies and increased their profits. They only use the ideological objection to their own ends.

The New Landscape

In 1994 when Betsy McCaughey wrote her piece in The New Republic full of lies abut the Clinton health care reform bill, the DC establishment accepted it uncritically because, well, she was in The New Republic, and nobody liked these Clinton outsiders anyway, and there was virtually no countervailing opinion independent of the White House that offered any refutation of her claims. The Village was the one and true arbiter of her story, and their acceptance of it colored the entire health care debate from that point forward.

Fast forward to 2009, and another fallacious McCaughey claim based on a clear misreading of legislative language makes the rounds of conservative media. Her claim that health information technology and comparative effectiveness research would cause rationing and give big gubmint a veto over your medical care is ridiculous. Only this time, a mainstream reporter actually chronicled how that conservative media puke funnel reinforces itself and creates opinion where there are only lies. And then a cable news show thoroughly debunks the lie in a long segment. And a series of blog posts reveal that McCaughey is on the board of directors of a medical device company and therefore has a conflict of interest over stopping comparative effectiveness studies, or that she received stock options from that company days before writing her flase op-ed in Bloomberg, or that the think tank she works at is funded by drug companies. As Ezra Klein says, this is a very new age:

Will Olbermann's segment on McCaughey end her relevance? Probably not. But it -- along with the blog posts, and inevitable columns -- will be part of what any CNN producer sees if he wants to run a segment on McCaughey the next morning. It will be part of what an NPR editor reads when she's researching a show. None of this progressive infrastructure existed in 1994. She published her smear job in an influential journal of putatively liberal opinion that was being edited by a self-professed conservative and it quickly become the conventional wisdom. This time, such arguments will not go unchallenged. That doesn't mean they will disappear. McCaughey's arguments are already taking root in the fertile swamp of talk radio. But it will be much harder for such bits of disingenuous nonsense to cement themselves in the center. And by the same token, it will be much easier for liberals to make, and disseminate, their own arguments.

I don't know if that's entirely true - there's nothing the Village likes more than to be willingly blind, and they'll probably opt for a "teach the controversy" approach - but that's better than the 1994 landscape.

Sometimes I definitely feel like I'm spitting into the wind out in the lonely blogosphere, and yet letting smears go unchallenged and letting progressive ideas get sandbagged is no longer an option. There is a progressive infrastructure now that can at least get a piece of the spotlight through relentless effort. It ought to actually be funded (greetings, liberal angels!), but even today it does have an impact.