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The critical views of your permanent rulers: Sally Quinn’s column in yesterday’s Post was deeply and sadly revealing. Quinn shrieked like Lady Dowd herself about the Bad Outsider Rogers:

QUINN (1/5/10): Many in Washington wondered why the director of the Secret Service, Mark Sullivan, did not resign over the state dinner security breach. At least Sullivan testified before Congress on the subject. White House social secretary Desiree Rogers came under fire after the Salahi scandal erupted. From the start, Rogers was an unlikely choice for social secretary. She was not of Washington, considered by many too high-powered for the job and more interested in being a public figure (and thus upstaging the first lady) than in doing the gritty, behind-the-scenes work inherent in that position. That Rogers stayed and that the White House refused to allow her to testify before Congress reflected badly on the president. He, not a member of his staff, ended up looking incompetent. Although it has emerged that a State Department protocol error is to blame for the presence of a third uninvited guest, both Rogers and Sullivan should step down.

In this passage, Quinn extends Dowd’s earlier, weird complaints about the deeply offensive Rogers. And she displays an unfortunate fact of life: Within the capital, a permanent, privileged gang of insiders believe they should get the final say about who gets to hold high positions.

Was Rogers a good choice for social secretary? We have no idea. But Quinn’s complaints are almost as weird as those presented by Dowd last month (see THE DAILY HOWLER, 12/7/09). Rogers “was not of Washington,” Quinn complains; she was “considered by many too high-powered for the job.” Almost surely, month of carping lie behind such remarks—the type of carping which popped to the surface in Lady Dowd’s weird column, delivered from JFK’s shag rug.

Read Quinn’s full column, and you’ll learn a sad fact: These people think they get a large say in how the White House operates. They start to get mad when their wishes aren’t met—when their firmly-held views about various procedures aren’t honored by the silly shlub who stooped to getting elected. In Quinn’s piece, we hear unmistakable echoes of the way these people turned on the Clintons when they somehow weren’t respectful enough. But then, Clinton and Clinton “were not of Washington” either!

This is a deeply foolish “elite.” They’ve done this damage before.

Don’t get mad, get stupid: Is the following claim about Sally Quinn true? We have no way of knowing. But Taylor Branch, a sober fellow, decided to include it in his book, The Clinton Tapes. David Corn told the tale in real time:

CORN (9/21/09): In 1996, when Washington author Sally Quinn was telling people that Hillary had not written her book, It Takes a Village, Branch suggested to the First Lady that she invite Quinn and her husband Ben Bradlee to the White House. "You know," Hillary shot back, "she has been hostile since the moment we got here. Why would we invite somebody like that into our home. How could she expect us to." Branch writes, Hillary "said Quinn and her friends simply invented gossip for their dinner circuit. They had launched one juicy affair between Hillary and a female veterinarian attending Socks, the Clinton family cat, with tales about how somebody discovered them in flagrante on a bedroom floor in the White House.”

Did “Quinn and her friends” really launch such a tale? We simply can’t say around here. We’d be curious about Branch’s decision to repeat that claim in his book.

Special report: After reform!

PART 2—TELL THE PEOPLE: T. R. Reid does many things well in his briefly-ballyhooed book, The Healing of America. Reid is a very good raconteur; he traveled the world to examine health systems, and he does a very good job describing the ways developed nations deliver health care. Over Christmas break, we reread Reid’s book, which got a grudging ten minutes of fame when it appeared this summer. We recommend The Healing of America as a way to review this important subject—a subject we pretended to discuss in this country this year.

That said, Reid does several things poorly. If progressives want to achieve more thorough health reform the next time around, we’d recommend a study of Reid’s shortcomings. A bit of background:

Over the past fifteen years, progressives, liberals and Democrats did a god-awful job in building a set of winning frameworks and understandings about American health care. In the meantime, the other side kept churning its pap—pap which gets lodged in voters’ brains, making it extremely hard to achieve thorough-going reform:

These claims are bogus, but voters believe them. In large part, the reason for that is obvious: In the past fifteen years, liberals have rarely risen off their duffs to counteract these poisonous claims. If we want stronger reform at some point in the future, we have to start developing winning frameworks and understandings.

Sadly, we have to start doing so now—and such a process will take many years. The areas where T. R. Reid is weak help show where the work should be done.

What does Reid do poorly in his book? In our view, he does a very poor job explaining the massive over-spending which characterizes American health care. Despite our “best health care in the world,” those Euro nations get health outcomes as good as our own (sometimes better). In the process, they spend only one-half to one-third as much as we spend, on a per-person basis!

Those are truly stunning facts; voters need to understand them. But during this year’s pseudo-discussion, the mainstream press and the liberal world made almost no attempt to examine this startling state of affairs. We think Reid did a poor job with this subject too. In our view, progressives can learn what not to do in examining this part of Reid’s (worthwhile) work.

Americans spend massively more on health care than other developed nations. For whatever reason, mainstream reporters have developed a maddening array of ways to fail to convey this important fact. So too for Reid, in his book.

First: Like many reporters, Reid displays a maddening tendency to discuss health care spending as a percentage of GDP. Presumably, this statistic is useful in various contexts, but it serves to block understanding in discussions aimed at general readers. On page 9, right at the start of his book, Reid presents a chart which should be very important—a chart comparing “health expenditures” in ten major countries. But uh-oh! This chart presents health expenditures “as a percentage of GDP,” and thus the chart becomes obscure and relatively useless. Indeed, Reid maintains this general type of preference all through his book, leading to absurdly opaque comparisons like this:

REID (page 104): The Brits do pay for health care, of course. They pay through a network of taxes which would make Americans cringe...But the [British] national system, with minimal paperwork and no billing, has proven to be an unusually cost-effective means of providing quality health care to everybody. It cares for roughly one-fifth the population of the United States but spends only one-fifteenth of the U.S. health care bill. And yet the results are good: Britain has lower child mortality, longer healthy life spans, and better recovery rates from most major diseases than does the United States.

In that passage, Reid says the British system is “unusually cost-effective”—then goes a hundred miles out of his way to make it hard for average readers to understand how cost-effective it is. “It cares for roughly one-fifth the population of the United States but spends only one-fifteenth of the U.S. health care bill?” It’s fine to say that, but how many readers will do the mental math which helps them see what this means—that the British system only spends roughly one-third as much per person as the U.S. system does? Throughout his book, Reid seems to be working with slightly-outdated OECD data—data from 2005. But these are the OECD’s remarkable data from 2007, presented in demystified form—expressed in the simple, per-person terms a reader can quickly ingest:

Total spending on health care, per person, 2007:
United States: $7290
United Kingdom: $2992

Those data are simply stunning—when they’re expressed in a way normal people can understand. But Reid, like many mainstream journalists (like many “career liberals”), seems unable to comprehend how astounding those data really are. What follows is one of the few places in The Healing of America (perhaps the only place) where Reid drops his high-fallutin’ “percentage of GDP” fixation and offers a simple, direct comparison of two nation’s per-person spending. In this passage, he compares the United States to France, which he describes throughout the book as perhaps the world’s most effective health system. The comparison is simply astounding:

REID (page 52): And France achieves all that [success] at a reasonable cost. Of course, the French don’t consider their system cheap; their planners and politicians see only that nearby countries like Britain, Sweden, Italy, Spain and the Netherlands all spend less on health care than France does...Compared to the amount of money the U.S. health system burns through each year, though, France’s system looks like a bargain. France spends about $3,165 per capita each year fore a health insurance system that covers everybody; the United States spends more than $7,000 per capita and leaves tens of millions without coverage.

Compulsively, Reid immediately starts explaining how much those two spending figures come to as percentages of GDP. As such, he obscures the stunning difference in simple, per-person health care spending between the U.S. and France. We don’t know where those per-person figures come from (Reid doesn’t say). But these are the relevant figures from the OECD for the year 2007:

Total spending on health care, per person, 2007:
United States: $7290
France: $3601

Data like those should stun the conscience—especially when we understand that France is a very highly-rated system in terms of overall effectiveness. But the mainstream press corps avoided such figures all year—as did the top “liberal journals.”

Reid also seems to avoid this type of statistic all through his book. (This one direct comparison occurs on page 52.) If we want to inform the public, this is a major error.

In fairness, Reid constantly notes that the U.S. spends “more”/“much more” than other nations; he just does a very poor job quantifying this difference. (How much is “much more?” Absent hard data, opinions will differ.) But we think he does a poor job at another task—at explaining the cause of this vast difference in per-person spending. Why do we spend so much more in this country? Where is all our money going? Reid addresses that question in a chunk of the book which runs from page 34 through page 45. And we’d have to say that, despite presumed good intentions, he fumbles this quite badly too.

Where does all our money go? How do we manage to spend so much extra money? In 2007, the French spent $3600 per person; we spent more than twice as much! (And we didn’t get better health outcomes!) Our advice: Read that section of Reid’s book, to see the way a very good writer can bumble and fumble his way through an important discussion. He starts by downplaying two possible explanations—overpayments to health care providers, and “Americans’ penchant for filing malpractice lawsuits.” In the following passage, he seems to cuff aside the notion that we’re getting looted by our health care “providers,” including the major drug companies:

REID (page 35): In any case, the big money providers earn is not the major cause of high medical spending in the United States. Most economists who study the question have concluded that lower fees and prices would save Americans something, but not much. If we cut the average American physician’s pay to European levels, and told the drug companies they can’t charge more for Lipitor in the United States than they do in the UK, there would be savings, but not nearly enough to bring our medical spending down to the levels in the rest of the developed world.

Those statements may all be technically accurate, but Reid makes no attempt to quantify the potential savings involved in these areas; he simply says that lower fees and prices would save us “something, but not much.” But what does “not much” mean to Reid? As we recently noted, progressive economist Dean Baker recently wrote this, concerning the size of prescription drug mark-ups:

BAKER (11/24/09): The U.S. pays more than twice as much per person than other countries because of government protection for the health care industry. For example, government patent monopolies for prescription drugs raise drugs prices by a factor of ten, adding close to $250 billion a year ($800 per person) to the country's health care bill.

Yikes! If Baker is right, then $800 of our per-person over-spending is explained just by those patent monopolies! That strikes us as a very large chunk of change; by way of contrast, Reid blows this whole area off as “not much.” We can’t imagine why Reid, in a 256-page book, would devote so little space to such important matters.

In the section of the book we’ve identified, Reid goes on to offer two explanations for where our extra spending does go. We’ll only say the second part of his explanation is notably vague, and that, in the first part of his explanation, his numbers don’t even begin to add up—don’t begin to explain how we manage to spend 103 percent more than the French, to cite just that one comparison.

Might we use an unpleasant word? Compared to citizens of other developed nations, American citizens seem to be getting looted in their health care spending. But so what? The mainstream press corps studiously ducked this topic all year—and we’d have to say that Reid did a very poor job exploring this remarkable matter too. But then, our “liberal journals” have made little attempt to develop this topic in the past fifteen years. Very few American voters understand the sweep of this problem—the depth of this apparent looting. The “liberal” and “progressive” worlds have largely agreed not to tell.

Pity the poor American voter! The other side tells them their health care is great—that European health care has everywhere failed. Our side keeps its big trap shut, refusing to challenge these fantasies. If we want stronger reform next time, we should start by telling the voters—Starting right now!—about how much they over-spend; about how mediocre their health outcomes actually are; about how well other nations do in these areas, as compared to ours.

And oh yes: As a bottom line, we have to tell the people where all their money is going! Most people don’t like being looted; they don’t like spending two to three times as much as something seems to be worth. But the “liberal” and Democratic worlds have been politely quiet about this problem for the past fifteen years. Isn’t it time we told the people about this massive, remarkable problem, in terms average people can understand? Or would this force us to dirty our hands, speaking to the Great Unwashed? (Even to tea-baggers!) Second question: Would this make our leaders behave in ways Serious People just won’t understand?

Tomorrow—part 3: “Welfare queens”—and that moral argument

Watching your side agree to fail: Last month, the Senate rejected Byron Dorgan’s proposal to allow re-importation of prescription drugs. Ed Schultz screamed and yelled, to his credit. Elsewhere in the liberal world, this action was met with silence. Elsewhere on MSNBC, the clowning, joking and fooling persisted, driven by tapes of Carrie Prejean and good solid fun about Tiger.

Why can’t your side win strong health reform? See THE DAILY HOWLER, 12/18/09. Basically, the “liberal world” is quite Potemkin—has been for a long time.