Wed, 08/19/2009 - 2:40pm — mass
Obama buries the public option, worries about brand image.
Via Marc Ambinder:
White House advisers and Democratic strategists concede that President Obama's poll numbers are at post-inauguration lows, and that the public has grown queasy about the health care debate. But they insist that the discontent has its roots in disenchantment over Washington's ways...
A White House official conceded today that Obama would have to weather anger from liberals for a while.
More worrisome, officials said, was the growing belief that Obama's brand is being tarnished....They believe that Obama's favorability rating declines, largely from independents (and within that group, women), can be reversed if he reminds these voters of the bipartisan instincts in his bones.
Privately, White House aides have communicated to the House leadership that the onus on changing minds about the public plan is on Congress, not on the president.
The president continues to operate under the belief that liberals will warm to the bill when presented with a goodybag that includes includes an individual mandate, community rating, guaranteed issue, and a minimum required package. There's no chance, really, that a bill WON'T feature these reforms. Quietly, to secure and keep Democrats on board, the White House is going to bargain, providing inducements, like more money for favored projects, etc., in order to secure individual votes.
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So, Obama, with the bully pulpit,
refuses to lead. Surprise. Surprise. Surprise.
"Someone needs to point out that elephants produce infinitely more shit than donkeys." Brad Mays
Where are the barf bags?
This, the Mike Lux rationalization of why things are falling apart: Anonymous WH staffers.
Bit I see a president who doestnot want Po bear to responsibility for his own actions and lack of leadership.
The Lux piece is downright weird: I'm for the Obama plan; Are Anonymous White House Staffers?
It's all conniving, selfish staffers, undercutting the noble leader.
Someone sucking up to Max Baucus? Like Obama?
Well, denial
is the first stage.
Medicare for All is Civil Rights
Rule Number One
It's never Obama's fault.
"Someone needs to point out that elephants produce infinitely more shit than donkeys." Brad Mays
Poor widdle obama
It's all conniving, selfish staffers, undercutting the noble leader.
the blogosphere is full of all kinds of astroturf ... one of the reasons I see no upside in promoting anything as "a-list."
It goes hand-in-hand w/ the media reporting of violence/skinheads/wingers at townhalls ... danger for Obama! Same as the reporting on poll nrs for health care ... what does it mean for Obama? How will Obama be harmed?
You and yours are of little concern in this "debate."
Phew!
We almost got change there.
Actually, I think this is kind of funny.
This is going to get even the public option cheerleaders riled up and ready to kill the health care bill. Obama's obstinacy is going to be the wake-up call that none of us could ever hope to provide.
If this becomes what kills Obamacare, I'll have a hearty laugh.
Nothing is true; everything is permitted.
true dat
If this becomes what kills Obamacare, I'll have a hearty laugh.
What's REALLY funny is this idea about doubling down on
bipartisanship. That's precisely what Kossaks, at least, have grown utterly sick of. Hearing about this is going to throw them into a rage.
Me? I'm going to cackle maniacally.
Nothing is true; everything is permitted.
Did anyone really ever believe in bipartisanship?
or was it one more thing that they supported just because Obama did? A lot of Millennials seem to have been persuaded that partisanship was all Bill Clinton's fault, but did anyone else?
Check out that toxic "goody bag"
there at the end. Individual mandate for junk insurance.
Mass, told you last nite -- no way they were going for a "real" bill on their own.
People who are fighting over the public option are wasting their time. That's not where the fight is -- it's Medicare, and that's why Obama needs Baucus and Senate Finance so badly.
dblhelix: more please?
would you elaborate on this please? thanks.
+1000
I'd like to hear more on this too.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
IIRC, 500 of the 1000 plus pg HR3200 is on Medicare changes
-- (not sure about Medicaid), and that was before the Blue Dog amendments. Hipp knows all (well, lots about that bill).
Obama has made a big point of saying he will find $500 B worth of cuts to Medicare and Medicaid, which is one thing which has made seniors very nervous. Obama says it will be those subsidies to Big Insurers that Bush put in as part of the HMOing of Medicare and partially the prescription drug legislation gifts to Big Pharma.
However, as always, Obama tends toward the vaguely implied.
His discussion of the appointed "non-political" board to make changes to Medicare, on the other had, has been fairly specific. Not as to what the board will do precisely (so best practices, which can be used to deny care, btw), but at least we know it exists, which is more than can be said for most of his "goals" and "principles'" of reform. The board is how Obama wants to "rein in" (can we read denial of care actions?) Medicare costs.
Earlier this week lambert noted that Obama has not even named an appointee for administrator of Medicare/Medicaid. Paul Lukasiak pointed out the WH and Obama don't want someone in charge during the "reform" of Medicare/Medicaid--the better to let the board makes the cuts.... Can't blame Obama then.
I don't have this aspect down pat, so need some help fleshing this out.
People are going to get nasty surprises from anything other than Medicare for All (enhanced) single payer...with a robust private option.
BOHICA.
Obama may be the "Dem" president who goes to where Repubs have wanted to go for decades: Beginning to take down Medicare. He gets to satisfy that bipartisanship in his bones, his Inner Republican, and channel St. Ronnie (of the real change).
Aaarrrggghhhh!
My impression has always been
that Obama is much more committed to reforming Medicare and Social Security than he ever was to health care for everyone. I think cutting entitlements what he wants his legacy to be. Am I too cynical?
Obama campaigned on "entitlement reform" (puke)
and "entitlement reform" for the last 30 years has always meant cuts, and "why do these people think they are so entitled?" It's been a pejorative since Reagan.
Medicare for All is Civil Rights
larry summers sez:
Overhauling Social Security on the Agenda
most of hr3200 is medicare/medicaid 'reforms'
215 pages devoted to 'health insurance reforms' [the exchanges and stuff like no more recissions], but the remaining 800 pages are all changes in in medicare and medicaid, mostly medicare. the old people are right to worry about what 'health reform' is going to do
tofor them.i started in on looking at this here and here, but got distracted by all the other stuff that's going on. i want to get back to it, but it was much more important to push for support for wiener's work on single payer at the time. [plus, rl got in the way some too, and then there was to mention paul krugman selling us out, and ...]
Hell's bells! 800 out of the current 1000 plus pgs on Medicare?
So-called "reform"? Well, of both Medicare and Medicaid, the two programs which work for the general populace, altho' Medicaid, up for cuts per Obama, is deeply underfunded. And with the Baby Boomers coming of Medicare Age in a tad over a year, he wants to do big cuts to Medicare.
Oh, yeah, Inner Republican.... McCain would never have gotten away with even suggesting this. Hillary would be excoriatd had she even mentioned such a thing.
Damn, I just can't be skeptical, cynical enough about this guy.
Oh, and AARP is NOT afaik alerting seniors. Anyone know any different?
We wuz robbed!
aarp is an insurance company
and only incidentally an advocacy organization. aarp will do well with 'insurance reform' so they can't do too much to attack anything that's on the table right now.
but drs fees aren't going to get cut that pesky 21% that they've rallied the old folks around in the past, and the donut hole is going to close [but verrrrrry slowly], and medicare advantage subsidies will be cut [but there's some complicated bidding procedure to replace it, so this could be a boon after all for big insurance], medicare advantage policies will have to have a better medical loss ratio [but it's probably not going to be a huge change after all] ...
so many things that look good at first glance, and that aarp can point to, but probably aren't going to help seniors all that much after all.
sarah palin is sorta right on the death panels too. end-of-life spending is high, but convincing people to ask for less of it isn't going to save us as much as is being touted. even so, the parasites [in both the insurance and the hospital industries] do benefit if people decide they don't want lots of expensive hope-for-a-miracle care in the last few weeks of life, so they're for that controversial counseling bit [the counseling is good, the use to which it's likely to be put is less so].
the stuff with medicaid is weirder. we're going to expand it, and we're going to make the private insurers up their mlr from the present 80-ish% to 85% [which they won't like], but [and this part i haven't looked closely at yet, but i think i'm right] we're going to make it easier for private insurers to get into medicaid, or to expand their presence if they're already in [which they will like].
hard to say for sure, but i think the administration is sorta kinda not really lying about not cutting medicare benefits. they aren't going to make any actual cuts in benefits, but there are some nudges in there to discourage both patients and drs from utilizing those benefits 'unnecessarily'.
On nudges
See here.
I think if you reframe "nudge" as cynical manipulation and bamboozlement, people will be perfectly happy to accept that. Since it is. ("Nudge" is also nice because it's the sort of thing that creative class types are paid to do.)
I also think, that just as with the mandate, there'll be at least one thing that's big and forceful on the Medicare side. They will want some sort of guarantee on the money flow. IRS-enforced mandates are not nudges.
Oh, and Hentoff on the "death panels."
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
big and forceful
is those "30% variations" per Dartmouth, funded by BHIP.
You simply will not squeeze "better outcomes" out of impoverished areas w/ a high percentage of minority seniors.
it's the trigger on Medicare that's the biggie, the automatic cuts when it misses targets. The specific language on that will be very important.
Can you explain the 30% variations concept?
I'd like to hear it spelled out.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
See
http://www.nytimes.com/2009/06/09/us/pol...
The Senate Finance Committee recently suggested that one way to pay for health care overhaul would be to reduce geographic variations by cutting or capping Medicare payments in “areas where per-beneficiary spending is above a certain threshold, compared with the national average.”
Sounds like rescission
Let's take the money away from the people who need it!
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Hentoff
is dishonest about one thing. Emanuel's paper is about rationing during public health emergencies. It's fair to extrapolate on his thinking, but I think Hentoff should have been clear that the model is designated "for emergencies" and is not a health reform policy paper in general.
To not do so just makes one look paranoid.
whack-a-moles indeed
[thanks for the nudges link]
hentoff's fear is based on right-wing fud, he's reading the bills wrong.
the end-of-life counseling mandate is a mandate for medicare to pay your doctor to talk about end-of-life stuff if you want to. if you want to go over all your end-of-life issues every year with your doctor, you'll have to pay for it our of pocket 4 years, because medicare will only pay for it once every 5 years. they will, however, pay for it more often if you're terminally ill.
medicare/the guvmint isn't going to misuse this provision in order to kill you off early, but it could provide hospitals with a perverse incentive to talk you into getting this counseling if they think it might make you decide to go away and die sooner. hospitals [sort of] get paid a set fee for admitting you for a condition, and if they can send you home earlier and still get paid the same amount of $$... but they would never do that!
and if insurance companies more or less follow medicare in what they pay for and don't pay for, and if insurance companies start paying your doctor to talk you out of expensive treatments... but surely they would never do that! nor would they use proprietary analytic techniques [read: we're not going to tell you what our formulas are] to decide who's costing too much money.
it's worth noting that health dialog [proprietary analytic techniques] co-founder david wennberg is the son of jack wennberg, founder of the dartmouth atlas [old people, but only some of them, use too much health care] project.
it's not government that's running the death panels, though that little piece of the legislation would have been a nice-to-have for the parts of the medical-industrial complex that benefit if you just go away and die.
and no, i don't believe zeke emanuel is pushing obama to adopt the utilitarian view of life that everyone is afraid of from reading [or more likely, reading about] that paper. but with all of obama's talk about how much he loved his grandmother and would pay for her hip operation out of his own pocket but we've got to be adults and look at how much this is costing us as a country, of course people are going to worry about whether the govt wants to off them before they're ready to go.
specifically,
ut we've got to be adults and look at how much this is costing us as a country,
we're going to have "a very difficult" democratic conversation on these "very difficult moral issues."
I think progressives have been really dishonest on this issue. According to them, everyone else is paranoid or a birther.
I mean. there should be nothing that's so difficult about a little free counseling on a voluntary basis or those panels with nice people on them, right?
btw,
do you know anything about the "quality reporting" required by physicians on EOL counseling in 3200?
not specifically, no
do you have a link to something about it? i hadn't heard this one.
the pay-for-performance [or quality reporting] that has been tried for medicare so far [as a pilot project] has mostly consisted of checking off little boxes in a list of things [that are easy to measure] to do: give aspirin for heart attack, prescribe beta blocker after heart attack, tell someone to lose weight if their bmi is too high, tell someone to quit smoking if they're a smoker, etc.
there's a little bit of outcomes reporting too iirc, but mostly it's process/checklist stuff. my guess is that end of life counseling would be a checkbox that the dr would check off once every 5 years -- and possibly yes, the dr would be required to tell their patients that yes, medicare will pay for someone to sit down with them and explain living wills, power of attorney, medical power of attorney, etc.
i suspect there really are a lot of patients who would be grateful if the dr brought up the subject first, and while they're still in good shape, rather than waiting till they're on their deathbed to casually mention oh, btw, now that you're basically dead already...
but i'm mostly guessing on this one. haven't dug into the bill[s] on it yet.
This is dynamite, but we need detail
Clauses, numbers, analysis.
Anyone doing it? Surely somebody? Do we have to break this story?
Somehow, I'm just not picturing elders being real happy about taking health care cuts to guarantee the health insurance parasites continued profit -- especially when they have a single payer program that they know works.
Odd that this isn't mentioned anywhere. Or not.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
hard to analyze
so no, it's not odd that nobody's doing it. a couple two-three reasons it's hard to analyze, but part of it is just like the hex's -- the hhs sec, and the hoped-for imac, will make a lot of determinations/regulations, so there's not a lot of concrete actually in the bill [although if we could wrap it in concrete and throw it into a river....]
Well, checkmate there, too
Because with unelected and powerful boards, we're in lack of transparency and accountability mode.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Greenwald says the public option debate is the red herring to
take attention off of what the WH is really after and doing.
Or was it somewhere se I read that--oh well, too tired to look right now. But, indeed, we've been played.
Nite all.
greenwald on public option as red herring
here:
is that the one you meant?
Anybody up for this?
I just got an email from Andy Stern. [gah! I've got to get off that list - every time I get one of these, it raises my blood pressure dangerously.]
---------------
We can't afford not to have single-payer!
probably not
I won't give those ppl any of my info.
We have a real problem. Getting rid of Bush wasn't enough. We have a bipartisan corporatist govt ready to use the still-gullible to shove things down our throats we don't want and without any discussion.
"Goody bag"
I think that's going to be a gift that keeps on giving.
I haven't done a poll in a long time. I wonder what the goodies should be?
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Oh, I know!
An aspirin and a band aid.
Medicare for All is Civil Rights
Jane: it was all a sham to stop PhRMA $ --> GOP
I still don't understand why she and most of FDL didn't see the failure that was public option from the beginning, but she's right about the vast corruption. FDL:
I think she puts too much blame on Rahm, though. Yes, he's a batshit, fuck of a bastard, but Obama picked him for that very reason. If Obama had any problems with it, he would have fired Rahm.
Yeah, it's getting really irritating
Just got another email from nyceve at FDL, with the subject line "Rahm didn't count on you".
Really irritating that they keep forgetting who's Rahm's boss.
He who will not reason is a bigot; he who cannot is a fool; and he who dares not is a slave.
- Sir William Drummond
Know of any polls supporting the part about bipartisanship being
so favored by indies?
Really? Indie women in particular like his sucking up to Repubs?
The women over 40 in my building
that supported Obama during the campaign, now hate him. They see him as a big sell-out to corporate and they are angry. These are smart, educated women who have been active Democrats forever. And boy oh boy, are they made about healthcare reform and they think that is going after Medicare. Two of them have elderly parents and any talk about cuts to Medicare scares the bejesus out of them.
"Someone needs to point out that elephants produce infinitely more shit than donkeys." Brad Mays
Who would have thought Obama would have a problem....
... with woman voters?
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Poor guy
That's right; work when you're up, and hide when you're down. Heaven forbid that the president gets dirt under his nails! Oh, the horror!
Blah. Whatever. It's hardly the first time he's pulled a Marie Antoinette, and it won't be the last, which is why I largely wrote him off as any kind of serious ally long before he became president. He's always been flakey.
But, we've always been at war with Eastasia...