The Trillion Dollar Question

In my (bungled) attempt to look at drug company advertising, I noted that the House Ways and Means Committee looked at, then discarded, the option of cutting out their deduction for advertising as a business expense to help pay for reform. One commenter rightly observed that this is a function of having to scrape for cash anywhere it can be found to pay for a policy that must remain deficit-neutral within a 10-year budget window, despite numerous up-front costs, and a completely artificial ceiling placed on how much can be spent in those ten years.

For a while now, the conversation about health care has been all about costs--in particular, the cost to the federal government. Somewhere along the line, somebody decided that health reform shouldn't involve the government sending out more than $1 trillion over ten years, even if we can provide that much money through some combination of higher taxes and savings in the medical care system.

There is no magic reason why $1 trillion should be the theshold. My colleague Jonathan Chait recently suggested that it's all because of way our bodies look. If we all had twelve fingers and toes rather than ten, he said, the magic number would be $1.2 trillion. I guess that would mean it's god's fault.

My own theory is that conservatives and centrists complaining about the price of reform don't think guaranteeing affordable coverage is really so important. I include among them a certain Democrat from North Dakota who runs the Budget Committee and keeps talking about what we can't afford to do. To be clear, Senator Kent Conrad is not god, although I wonder sometimes if he thinks he should be.

The problem is that capping the cost of the bill at $1 trillion over ten years (and by the way, in that time America will spend something around $24 trillion annually on health care) has led to fiscal scolds cutting the kinds of things out of the plan that would increase access, like lowering the subsidies that would make insurance affordable to everyone, or shrinking the benefits package so individuals would have worse coverage and higher out-of-pocket costs.

"We are very concerned that [lawmakers] have that fixed and arbitrary total dollar amount and this is it," said Stephen Finan, senior director of policy for the American Cancer Society Cancer Action Network. "Either it's not going to be enough to pay for adequate insurance or we just dumb down the level of benefits. We are concerned we could wind up with a package that is neither adequate nor affordable coverage."

Lead fiscal scold Kent Conrad gets quoted in this article too, telling us that we all "have got to be realistic about what is possible" and "We can’t do everything we’d like to do and pay for it and bend the cost curve the right way."

First off, this is actually untrue. A viable public option which didn't firewall out those with employer coverage and has a provider network and rates similar to Medicare could bend that cost curve. As could giving Americans more choices in their coverage by breaking regional monopolies through an insurance exchange. The same with expanding access and eliminating the hidden fee of paying for costly ER visits for the uninsured. And empowering an independent board to make changes to Medicare rates and structures while partially insulated from the political process. And a host of other ideas where more reform, of the kind that people like Kent Conrad don't want, can lower costs.

But this amounts to playing on the other side of the field. Americans trust Democrats on health care issues, for the most part, because they have traditionally emphasized more access to care and treatment. That's not to say that the cost issue is meaningless - it's actually in many cases complementary to the cause of access - but it's a matter of emphasis. And the moral case for health care reform has been almost entirely extinguished.

This year, however, it's not just been the opponents of the policy who have relied on the "mellifluous language of the standard economic theory of markets." It's been the advocates of reform. Ask yourself what the administration's one-line goal is on health-care reform. Is it "equal treatment for everybody?" Is it "if every American is guaranteed a lawyer, why not a doctor?" Is it even "guaranteed health care for everyone?"

No. It's "bend the curve." And the problem with "bending the curve" is that it's a broadly testable proposition. This is, in part, why the Congressional Budget Office's skeptical assessments pose such a threat to health-care reform. If the White House's primary objective was health care for every American, or guaranteed care that you could keep even if you lost your job, or choice of insurance plans for every American, you could spend a bit more on health care and say you were achieving your goal. But if you say that the point of health-care reform is to save money, and then the outfit charged with estimating such things says it won't, that strikes at the heart of the project.

Now, we're getting some better news from the CBO in the last 24 hours, as they have announced that the House bill will increase the number of people receiving employer coverage, and that a public insurance option can exist in tandem with private insurance. But the way the health care fight has played out, it has privileged these messages from the CBO. And to the media, they only matter when they matter anyway.

Somewhere along the line, Democrats in Congress and an Obama Administration obsessed with not following in the footsteps of the Clinton health care failure have forgotten to make the simple case that they support quality, affordable health care for every man, woman and child in the country. They've made a case about costs, but not a case about imperatives. There are plenty of economic arguments to make, but the moral arguments - about insurance companies denying coverage to those with a pre-existing condition, or dropping customers for the flimsiest of reasons when they ask to use their health insurance - but those have been pushed into the background. Health care is one of the more profound moral issues in public policy, and right at the moment that we're nearing a major shift in policies, we're talking cost curves and independent advisory boards. It's all important, of course, but consigning tens of millions of Americans to the horrors of no medical coverage adds a certain oomph.

If this moral case were made, a true argument about the human consequences of delay, maybe that $1 trillion dollar number inches upward. And maybe some deficits are floated within the 10-year budget window. But we turned this debate into one primarily about costs. This played right into the hands of the fiscal scolds.

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.

They're Reframing Torture

Greg Sargent is right - the media has managed to find a "he said, she said" entryway into the torture debate by focusing on the irrelevant data point of whether or not torture works. It doesn't - ask Bush's FBI Director - but turning this into a debate humanizes the tactic, turning it into some option that's open to reasonable disagreement instead of a universally rejected, illegal action. We don't have a debate over whether stealing from rich investors through a Ponzi scheme "worked." It's illegal and that's the end of the story. Here's Sargent:

This is precisely what Cheney and other Bushies want the debate to be about: Whether torture has stopped terror attacks, as opposed to whether it’s moral, or detrimental to America’s global image, or a boon to Al Qaeda recruitment, or whether the architects of the policy broke the law and should be prosecuted.

The Bushies want this question — “did torture stave off terror attacks and save lives?” — hovering in the air. There’s plenty of evidence that torture hasn’t worked at all and has done more harm than good. Even some former Bush administration officials have conceded it hasn’t done anything to stop terror attacks.

But it’s easy for the Cheney camp to muddy the waters and turn this into a matter of debate by citing unspecified classified info that supposedly supports the claim that it has saved lives — info that we’ll never see. Having the debate focused this way also lays the groundwork for the Cheney camp to say “I told you so” in the event of another terror attack.

And not only do sadists like Bill O'Reilly enable this misdirected debate, but useful idiots like Andrea Mitchell.

The law never asks if what the lawbreakers have done "worked." The law follows the law to its conclusion. A debate about the efficacy of torturing human beings debases everyone who participates in it. It mainstreams these vile actions. Eric Holder has this exactly right.

Attorney General Eric Holder said Wednesday that he would "follow the law" as he weighed potential prosecutions of Bush administration officials who authorized controversial harsh interrogation techniques [...]

"We are going to follow the evidence, follow the law and take that where it leads. No one is above the law," Holder said at an Earth Day event.

...I can't believe I'm saying this, but what Shepard Smith said.

On FoxNews.com's online show The Strategy Room, Smith took his opposition to a whole other level. "We are America!" he shouted, slamming his hand on the table. "I don't give a rat's ass if it helps. We are AMERICA! We do not fucking torture!!"

...I should add that the NYT also ran a powerful op-ed today from Ali Soufan, an FBI special agent who interrogated Abu Zubaydah before the CIA decided to take the gloves off, who avers that "there was no actionable intelligence gained from using enhanced interrogation techniques on Abu Zubaydah that wasn’t, or couldn’t have been, gained from regular tactics." I still say it's a false debate.

Giving Away The Tax Argument

During the Presidential race the Obama campaign kept putting out "tax calculators" and emphasizing their tax cut plans for 95% of Americans. Now the DCCC, the Democratic campaign arm in the House, is specifically targeting House Republicans for opposing the stimulus package, foregrounding that they voted against "the largest tax cut in American history". Here's a sample robocall they are putting into these districts:

Hello, I’m calling on behalf of House Democrats with an important message about the economy.

Did you know Congressman Thad McCotter voted against President Obama’s economic recovery plan, endorsed by the U.S. Chamber of Commerce? McCotter’s empty rhetoric can’t hide that he voted to raise the AMT tax on 22 million middle class Americans and against the largest tax cut in history.

Call McCotter at 734-632-0314 to ask why he voted to raise taxes on middle class families.

Check out www.recoveryforamerica.org to learn more.

Paid for by the Democratic Congressional Campaign Committee, 202-741-1350, not authorized by any candidate or candidate’s committee.

It's great that they're engaging in some off-cycle organizing and campaigning. But the message is stupid, short-sighted and reinforcing to conservative frames. First of all, 65% of the stimulus consisted of spending and investment, much of which is wildly popular, and also the only way it will work, through fiscal spending filling in the gaps for decreased private investment and consumer spending and creating more jobs and more demand. Tax cuts aren't only a minor part of the bill, they have less stimulative value. If this works, it won't be because of tax cuts, it will be in spite of them. And, as Brian Beutler notes:

We'll all be better off if as many Americans as possible swap out their tax cut mania for a sense that government can, in fact, meliorate the country's biggest problems. I, personally, would like to keep the number of people who think tax cuts saved the economy to a minimum. The fewer the better--both for progressives and progressivism.

The government's eventually going to have to raise taxes to pay for all this, after all. Democrats will almost certainly be the ones to do this and there's no reason they should be sabotaging public support for those increases years in advance.

The media already highlights the tax side of the equation over spending, dramatically portraying tax increases while relegating spending cuts to paragraph 27. It feeds the tax revolt and distorts the debate. And it's completely irresponsible. And the DCCC is simply enabling this.

Taxes are the price we pay for a functioning society, and America is worth paying for. Joe Biden tried to run with this message once during the campaign and got his head cut off, so now Democrats are turning back. They are trying to take tax cuts "off the table" with rhetoric that accepts the right's frame. When both parties are running on who will cut your taxes the most, it cheapens the value of federal investment in providing for the future, and the ability for government to prove its value as a guarantor of those most basic rights of life, liberty and the pursuit of happiness, as well as promoting the general welfare.

If we're embarking on a new effort to convince the public that government can work, you don't start by bragging about starving it of resources. You can't win a fight with Republicans about cutting taxes. It's a race to the bottom and the losers are the least of society.

How Democracy Ought To Work

So Barack Obama put out a recovery plan. A lot of politicians and economists took issue with various parts of it. Paul Krugman thought that the urgency of Obama's language didn't match the relative weakness of the plan. Senators like Kent Conrad and John Kerry and Tom Harkin couldn't abide by the corporate tax cuts and the "trickle-down" nature of what should be a jobs program. Obama said he would listen to anyone who thought they had a better idea on the plan, and sure enough, by Saturday morning, he had agreed to some changes on the tax side.

Democratic congressional officials said that Obama aides came under pressure in closed-door talks to jettison or significantly alter a proposed tax credit for creating jobs.

Further, Democrats sought inclusion of relief for upper middle-class families hit by the alternative minimum tax. The so-called AMT was originally designed to make sure the very wealthy did not escape taxes, but it now hits many more people because of inflation, despite measures by Congress every year to prevent it from reaching tens of millions of middle-income families.

Congressional officials said aides to the president-elect had agreed to increase the $10 billion originally ticketed for energy tax breaks, although the final total remained unclear. Two officials said at least $20 billion would be reserved, but others indicated it could go higher [...]

But congressional Democrats are making it clear they want to put their own stamp on the revival plan, despite the inevitable delays. Some Obama ideas, like a $3,000 job creation tax credit, might get scrapped.

My understanding is that the job creation tax credit would just be too easily gamed. And I'm a little annoyed that the AMT fix is getting shoved in there and not along with a repeal of the Bush tax cuts for the wealthy. At some point you have to add revenue.

But here's the point. The leader of the party, and the nation, proposes a solution to a big and challenging problem. It's criticized. That leader, instead of arrogantly and angrily denouncing the critics and blustering forward, LISTENS and adapts.

We have no experience with this over the last several years, but it's nice, huh? It's called "leadership."

Of course, some things never change: the leader is still using polling to shape the language on the stimulus (sorry, the RECOVERY). But taking a page out of Frank Luntz' book for liberal purposes isn't going to really sadden me.

Yearly Kos: Friday Sessions

The panels and discussions on this day could be spread out to an entire week. You kick yourself for missing certain things that are all happening at the same time. But here's a snapshot of what I saw today so far:

• Wes Clark was on fire in the morning keynote. He implored the President to stop hiding behind David Petraeus, screaming "This is YOUR war!" He put his emphasis on engaging our so-called "enemies" instead of isolating them, saying that the problem is the failure of leadership in the region, which leads us to spending $100 billion dollars a year in Iraq when bridges are falling down in Minneapolis.

• The panel on "Evolution & Integration In The Blogosphere" was illuminating. Instead of just being a self-regarding session about how to break out and become a big-time blogga, yo, it was a productive session about expanding reach through state and local blogging, as well as reaching out to other blogospheres (mommy bloggers, food bloggers, even gossip bloggers) that aren't necessarily political but have ideas that the progressive movement can plug into. In addition, there was good discussion on increasing access to broadband (which would open up poor and rural areas) and increasing diversity in the progressive blogosphere, as well as innovating technology.

• I saw Rick Perlstein speak on framing the debate. He essentially read a review of his that he wrote about an FDR book, which had a lot of good stuff in it, but wasn't a panel discussion so much as a book reading. Key quote: "There are more people who have bosses than who ARE bosses."

• The "Future Leaders" panel featured 7 Democratic candidates who lost by a hair in severely red areas in 2006, and who are all running again: Charlie Brown, Darcy Burner, Larry Grant, Eric Massa, Scott Kleeb, Dan Seals, and Gary Trauner. Massa in particular has been generating a lot of buzz on the convention floor, but I thought all of them were excellent. I spoke briefly with Gary Trauner (WY-AL) and was very impressed by his passion and his belief in progressive values, particularly on tax fairness.

• The lunchtime keynote was Andy Stern of the SEIU in conversation with Harold Meyerson. I've seen Stern speak a couple times before and have read his book, so much of it was familiar. But he's really a must for working people to listen to. He's whip-smart and he understands the revolutionary economic changes that have unsettled working people. Look him up, buy the book.

• The "Blogs vs. MSM" was certainly the panel of the day. Mike Allen of the Politico and Jay Carney of Time were matched up with Jill of Feministing and the great Glenn Greenwald. Allen and Carney were going out of their way to blow smoke up Greenwald's ass ("What Henry Waxman is to Congress, Glenn Greenwald is to the blogosphere"), and Greenwald would sit there stone-faced, and then launch into a relentless attack on the facts of how the traditional media conducts the discourse of the country. In other words, he ignored the niceties and focused on the facts, which is what all of the journalists being assailed by him should do as well. He mentioned that 70% of Americans in 2003 still believed Saddam Hussein was personally involved in 9/11, and how recently 44% of Americans could identify John Edwards as the guy who got a $400 haircut, and the reasons involved with those perceptions. He mentioned how in 2006, after the NSA wiretapping scandal was advanced, the media would not declare that the situation was a violation of the law, but they would discuss the issue in political terms, discussing how this would be "a good issue" for Republicans. What we need are journalists who are referees, willing to confront those who they report, willing to be adversarial and skeptical. Bloggers do NOT want the media destroyed, or to become partisan. We just want them to do their job better.

My issue was one of resources. The media is being forced to do more with less, and because they are general assignment reporters and generally not experts on subjects, they cover for this by opening up that well-worn rolodex. And by and large, that rolodex reflects a range of opinion from The New Republic to Free Republic. They laud the blogosphere for its expertise (expertise that Jay Carney said he "didn't know" about), but never use that expertise in their articles, preferring to have bloggers gnash their teeth on the sidelines. Why aren't the bloggers part of the expert rolodex if they are so good on particular issues.

I do give Allen and Carney credit for coming into the lion's den, but Greenwald definitely got the better of them. The guy's a master.

• I saw my friends hekebolos and thereisnospoon in discussion with George Lakoff about the "Overton Window," the idea of setting up fully progressive positions to move the debate to the left. Lakoff began by dismissing the entire idea, which made for a really interesting discussion. Personally, I think the best way to think about these ideas is to not think about them at all. I think Democrats worry too much about HOW they should act instead of just acting. It's the Hamlet complex.

• Right now I'm in an Israel/Palestine and Middle East policy discussion featuring Juan Cole of Informed Comment and a writer for Bill Maher. "Intellectual mountaintop air so high I had to keep swallowing to keep my ears popping," to quote one of my favorite writers, Peter DeVries.

The Baby Party

I touched on the Sheryl Crow-Karl Rove incident at the painfully unfunny White House Correspondents Association dinner, where Crow and Laurie David tried to engage Rove on the subject of global warming and Rove snapped "Don't touch me." Rove's take on the matter was that “She came over to insult me and she succeeded.”

Top Democrats will never do this, but it seems to me that this would be the perfect opportunity to give the Republicans a taste of their own medicine. Republicans live to feminize Democrats; see the fake Edwards haircut controversy for an example. Now we have the GOP's top strategist running away from two women, shrieking "Don't touch me!" like Margaret Dumont in an old Marx Brothers movie, and snootily harrumphing that he was o-ffended by the whole thing.

What a little baby!

And the GOP's culture of babyhood is certainly well-documented; we have a President who makes a living out of throwing temper tantrums, we have a Congress that whines and cries at every opportunity.

If the Republicans are always trying to frame the Democrats as the Mommy Party, why aren't we similarly always framing them as the Baby Party?

The recent filibusters in the Congress should be construed "baby-like obstructionism." The entire conservative worldview can be boiled down to the behavior of a 4 year-old at the mall stamping her feet and yelling "I don't WANT to help people! I don't WANT to pay taxes! I wanna go home!" They always whine and cry about "personal attacks" from the other side of the aisle and the "politics of personal destruction." And the issue that occasioned the Rove-Crow controversy is global warming, which the Republicans have used the logic of two year-olds to deny, looking outside their window and seeing snow and thinking "See, there's no global warming," which is no different than infants who think that toys disappear when they're out of their sight.

These are the characteristics of children, and I don't think the American people want a Party full of mewling little babies running the most powerful nation on Earth. After all, they've seen the effects of that for six years.

This goes along with the need for Democrats to fight back, and that's not always simply with a litany of facts. Kevin Drum found a great example of this, some advice on how Edwards could defuse the haircut non-controversy and attack Republicans in the same breath.

Imagine if Edwards said something on these lines:

Yeah, I'm rich; I get $400 haircuts. I started out poor, and today I own a big fancy house; I drive my favorite car, and I don't have to look in the price column of the menu when I eat out. You media elitists and right wingers can't keep all the good things in life just for yourselves. I don't intend to give any of it up; I just want everybody to have the same chance at getting rich I did. And I want anybody who works hard to have some of the good things in life whether they get rich or not. That's the American way; everybody gets to dance, and there are lots of prizes besides first.

Now that is not exactly what I believe, but from his public statements, I'd say that it is exactly what Edwards believes. It is a pretty mainstream take.

It demolishes the "Democrats are sissies" trope that is the main point of all this, by fighting back with tough fighting words. It even includes an appropriate country music reference for that dog whistle politics.

Furthermore, Edwards could go on to say "Why do Republicans hate it so much when poor people rise up and do well? They seem to do everything they can to keep the poor entrenched in their own station while their rich fatcat friends continue to benefit enormously from the policies of inequality. If anyone beats the odds and actually rises their station in life, Republicans attack them for being too rich like them. Why can't they stand it when the poor get rich?"

That's a class warfare attack I could really get behind. It portrays the GOP as hiding behind castle walls and shooting crossbow darts at anyone who tries to make their way inside. Time after time, the Baby Party tries to pull up the drawbridge on every American but themselves and their rich friends. When Edwards accomplishes the amazing feat of actually scaling those castle walls, they whine and cry and bluster about it like the babies that they are.

I really think this can fly. Mockery is a dynamic element in American politics, and so is slotting stories into a familiar narrative. The GOP is The Baby Party. Learn it. Live it. Know it.

UPDATE: Well, that was handled about the opposite of how I suggested:

"It’s a ridiculous amount of money for a haircut. I’m actually embarrassed by it. This guy had to come to where I was to get a haircut. I knew it’d be expensive. I didn’t know it would be that expensive. Hopefully, I’ll have enough sense not to do that again."

I really don't know what to say about that. He had NOTHING to apologize about. That's either some bad advice by consultants or a knee-jerk defensive posture. I'm very disappointed.