An historic reminder: Chapter 3 has been posted at How He Got There. You know what to do: Just click here.
No sultans here/Every man a sultan: For one brief shining moment, there was Camelot over at TPM. Yesterday, briefly, the web site headlined Obamas sultan remark!
At the health summit, Wyoming senator John Barasso seemed to say that wed all be better off if we just restricted ourselves to catastrophic coverage. In reply, Obama alluded to the standard image, already pimped, in which Saudi sultans fly to the Mayo Clinic to take advantage of this countrys superlative health care:
OBAMA (2/25/10): Would you feel the same way if you were making $40,000 or you hadthat was your income? Because that's the reality for a lot of folks. I mean, it is very important, when you say to listen, to listen to that farmer that Tom mentioned in Iowa, to listen to the folks that we get letters from.
Because the truth of the matter, John, is they're not premiers of any place. They're not sultans from wherever. They don't fly in to Mayo and suddenly, you know, decide they're going to spend a couple million on the absolute best health care. They're folks who are left out.
And this notion somehow that for them the system was working and that if they just ate a little better and were better health care consumers they could manage is just not the case.
No sultans here, Obama said. Or perhaps, to borrow from Huey Long: Every man (and woman) a sultan!
Yesterday, for a few moments, TPM headlined this winning comment, right at the top of its front page. Today, its gone. We cant even find the sultan story in a search.
That said, we thought the most interesting presentation yesterday came from Senator Tom Coburn, Obamas Republican friend. Coburn spoke at some length about the gruesome problem all reigning elites have agreed to ignorethe massive levels of over-spending which make this nations health system a worldwide laughing-stock.
Coburn had his own point of view. But he spoke about a stunning situation, one which is always disappeared:
COBURN (2/25/10): Whether you go to Harvard or whether you go to Thomson Reuters, there are some facts we know about health care in America. And the facts we know is one out of every three dollars that gets spent doesn't help anybody get well and doesn't prevent anybody from getting sick.
The second thing we know is, from the Congressional Research Service, that most of the mal-drivers today in health care come from government rules and regulations. The government now directs over 60 percent of the health care in this country. And if throwing money at it and creating new government programs could solve it, we wouldn't be sitting here today because we've done all that. It hadn't worked.
So what I thought we ought to do is maybe talk about why does it cost so much, because the thing that keeps people from getting access to care in our country is cost.
You mentioned Malia and Sasha. The fact is, is with young kids going to the E.R., whether they have meningitis or asthma, they're going to get treated in this country. But they may get labeled with a preexisting illness after that. And that's another thing I'd be happy to talk about at a later time.
But the fact is, is we know how to treat acute asthma. What we don't do a good job of is preventing children from getting acute asthma. We don't do the good job of prevention.
So when you break down the costs, what we know is 33 percent of the costs in health care shouldn't be there.
And how do we go about doing that? And what are the components of that cost? And when you look at, when it's studied, if you look at what Malcolm Sparrow from Harvard says, he says 20 percent of the cost of federal government health care is fraud. That's his number.
If you look at Thomson Reuters, when they look at all of this, they say at least 15 percent of government-run health care is fraud.
Well, when you look at the total amount of health care that's government run, you know, you're talking $150 billion a year. So tomorrow, if we got together and fixed fraud, we could cut health care 7.5 percent tomorrow for people in this country.
So what we ought to do is do the Willie Sutton thing. We ought to go for where the money is.
What's the other area? What we do knowand I'm guilty of this, Dr. Barrasso's guilty of it, Dr. Boustany is guilty of it, is a large portion of the tests we order every day aren't for patients. They're for doctors. And the reason they're there is because we are risk-averse to the tort system and extortion system that's out there today in health care.
And there are a lot of ways to fix that. But I just went through last night, if you add up what Thomson Reuters, which looked at all the studies that have been done and combined them in, they say between $625 billion and $850 billion a year of health care dollars are wasted.
So it seems to me if cost is the number one thing that's keeping people from getting care, then the efforts of us, as we go after cost, ought to be to go to those areas where the cost is wasted.
Coburn spoke about fraud, and about defensive medicine. For the record, 60 Minutes did a large report about Medicare fraud a few months ago. It was completely ignored.
But then, the most clownish part of our year-long health care non-discussion concerns the massive over-spending to which Coburn alluded. On a per-person basis, we spend two to three times what comparable nations spendnations whose health care outcomes are as good as ours.
Where is all that money going? Put another way, who is looting the average American? All year long, our journalistic and our political elites have weirdly agreed not to ask.
Rachel Maddow hasnt asked; neither has Keith Olbermann. Rachel chased Republican sex tales. Keith just generally clowned.
Where is all that money going? Everyone has agreed not to ask. For the record, heres part of the way the buddies ended. Obama made a good point:
OBAMA: Tom, you made some powerful points. You want to just wrap up real quick?
COBURN: No, I'll just finish with that is $1 out of $3 not helping everybody, we ought to go for where it is.
OBAMA: Well, Tom, I appreciate what you said. I think we're going to have Steny Hoyer go next. I just want to make this quick point: Every good idea that we've heard about reducing fraud and abuse in the Medicare and Medicaid system, we've adopted in our legislation. So that's an example of where we agree. We want to eliminate fraud and abuse within the government systems.
Let's recognize, though, that those savings in the government systems, which will help taxpayers and allow us to do more, doesn't account for the rising costs in the private marketplace.
Fraud in Medicare cant explain the rising costs in the private marketplace. What does explain those astounding costs, then? Think back over the last year:
Have you really seen anyone ask?
Special report: Watching us clearly explain!
PART 4THIS JUST IN FROM THE SECRET GARDEN (permalink): Looking ahead to the health care summit, the New York Times gave advice to Obama. The president should clearly explain the stakes to the American people, an editorial somewhat comically said. (See THE DAILY HOWLER, 2/23/10.)
Obama should clearly explain? He had been clearly explaining all year! This morning, the Times reviews yesterdays summit, and the editors stick to their story:
NEW YORK TIMES EDITORIAL (2/26/10): Mr. Obama needs to keep explaining to Americans that this health care reform is criticalto give them security, to hold down costs and ease the strain on federal budgets. His main challenge, and his best chance, for passing it is to get his own party in line.
Keep explaining, the editors said. We wouldnt say that advice is wrong. We would say that something is missing..
As weve noted before, clear explanation plays little role in our devolving American culture. Very few things have been clearly explained in the course of the past years health care discussion. Big newspapers have rarely tried to explain even the basics in our pathetic debate.
And by the way: Clear explanation is hard! Consider todays column by Paul Krugman, the reigning MVP of clear explanation within the mainstream press corps. (At the top of the mainstream press, Columnist Krugman is MVP by a very wide margin.)
Republicans didnt bother making a case that could withstand even minimal fact-checking, Krugman says at the start of his column. What follows is the example he gives. Please remember: Clear explanation is hard:
KRUGMAN (2/26/10): It was obvious how things would go as soon as the first Republican speaker, Senator Lamar Alexander, delivered his remarks. He was presumably chosen because hes folksy and likable and could make his partys position sound reasonable. But right off the bat he delivered a whopper, asserting that under the Democratic plan, for millions of Americans, premiums will go up.
Wow. I guess you could say that he wasnt technically lying, since the Congressional Budget Office analysis of the Senate Democrats plan does say that average payments for insurance would go up. But it also makes it clear that this would happen only because people would buy more and better coverage. The price of a given amount of insurance coverage would fall, not rise and the actual cost to many Americans would fall sharply thanks to federal aid.
Under the Senate plan, the price of a given amount of insurance coverage would fall, Krugman said, quoting the CBO. But do you understand what that means? Well be honestwe pretty much dont. We dont know which of the following possibilities the CBO, and Krugman, meant:
First possibility: Under the Senate plan, the price of a given amount of coverage would be less than it is today.
Second possibility: Under the Senate plan, the price of a given amount of coverage would be less than it will otherwise be according to current projections.
Given the way the cost of insurance is rising, those are massively different possibilities. But which did the CBO say would occur? Wed guess at possibility 2the massively weaker possibility. But we simply dont know.
Repeat: By light years, Krugman is reigning MVP of clear explanation. The gentleman is an invaluable assethas been for many years. Its hard to imagine the past eleven years without his invaluable work.
But clear explanation is really quite hard. Beyond that, clear explanation plays almost no role in our national discourse, despite the tales we tell, within western culture, about being the rational animal. In our devolving press corps culture, we stopped explaining things long ago; at least by the mid-1990s, journalists had substituted gong-show narrative and novelized news for such tired traditions. (It makes my brains turn to mush, Ted Koppel pathetically said, when asked to explain the basic facts about Candidate Bushs tax cut proposal. See THE DAILY HOWLER, 10/24/02, to recall an illustrative moment.)
In our devolving press corps culture, we stopped explaining things long ago. Partial outcome: Within our political culture, you can pretty much parade around saying any damn thing you please, depending on your power quotient. Our mighty journalists will gaze away from even the most absurd statements, if they come from appropriate precincts of power. In his penultimate paragraph, Krugman makes this observationan observation which is actually soft:
KRUGMAN: So what did we learn from the summit? What I took away was the arrogance that the success of things like the death-panel smear has obviously engendered in Republican politicians. At this point they obviously believe that they can blandly make utterly misleading assertions, saying things that can be easily refuted, and pay no price. And they may well be right.
Republicans believe they can say the darnedest things! And they may well be right, Krugman says.
They may be right? Of course theyre right! Republican politicians and conservative talkers have been making utterly misleading assertions for years, secure in the knowledge that the mainstream press, and the career liberal world, will be too weak, too inept, too undisciplined, too compromised, to question, challenge or confront them.
(By the way: What did Sarah Palin actually mean by her famous death panel remark? What exactly was she claiming? Its hard to clearly refute a claim until its author has clearly explained it. That said: Did you ever see anyone ask Palin to explain the strange, influential thing she said? Many people have called her remark a smear. But did you ever see anyone ask her to explain her comment? Again: Clarity plays almost no role within our devolving culture)
Republicans can say any damn thing. The mainstream press is too weak, too frightened to complain, or to explain the things that are wrong with their totemic howlers. Example: Just gaze on this piece of porridge from todays Times editorial:
NEW YORK TIMES EDITORIAL: At the meeting, President Obama laid out his case for sweeping reform that would provide coverage to 30 million uninsured Americans and begin to wrestle down the rising cost of medical care and future deficits. The Republicans insisted that the country cannot afford thatand doesnt need it. The House Republican leader, John Boehner, trotted out the old chestnut that the United States has the best health care system in the world.
This isnt a question of boosterism or patriotism. If theres any doubt about whether to stick with the status quo, Americans just need to look at their relentlessly rising premiums or think about whereor even whetherthey can get coverage if they lose their jobs.
Actually, it was worse than that. At one point, Boehner said we have the best health care system in the world by far. But then, Republicans have repeated this ludicrous claim for the past many years, badly tilting our health care debates in the process.
But so what? Today, the editors can only bring themselves to call this ridiculous claim an old chestnut, denouncing it as boosterism. Question: Have you ever seen the New York Times explain how deeply absurd this claim is? In part, that would require the editors to explain how much extra we Americans spend on our health care, as compared with the rest of the developed world. And for whatever reason, it seems fairly clear that the New York Times, from its top on down, has chosen never to do that. Back to Krugman, slightly rewritten: At this point, Republican leaders obviously believe they can make this utterly bogus assertion, saying something that can be easily refuted, and pay no price.
Its just as Krugman said, a bit softly: Boehner can make this absurd misstatement! For decades, average voters have been misled by this deeply ridiculous claim. But it rarely occurs to any journalist to clearly explain the ludicrous problems lurking within this ludicrous statement. This very morning, the New York Times only dares call it a chestnuta piece of boosterism.
In the Times, you will never be told how absurd that misstatement is. (Except when Krugman does.)
Our discourse is built around ludicrous claimsludicrous claims about health care, for instance. Into this world walked Our Own Rachel Maddow, someone who is unprepared to run a national news hour.
American discourse is constantly driven by bogus pseudo-conservative assertions. In 2009, this pattern quickly obtained in our nations health care debate. For the most part, though, Maddow gamboled and played, coming to the health care discussion quite late (so too with Keith Olbermann) and rarely showing any real sign of knowing how to discuss it. What sorts of deceptions do voters hear when they listen to conservative talk radio programs? To programs on the Fox News Channel? Maddow rarely seemed to know or care. In profiles written about her, she has even said that she has never watched Sean Hannitys show. Heres a sad-but-true point:
People who never watch such shows are massively uninformed about the workings of our politics. You cant do politics in this country if you dont understand the sorts of claims by which the public is being disinformed and misled. But instead of addressing the various claims by which conservative-leaners get disinformed, Maddow spent some time last year insulting such voters with dick jokes, while pretending that this conduct made her embarrassed, of course.
Can we tell you a secret? When you rudely insult groups of voters, other voters will start assuming that youre insulting them as well, even if theyve never been to a tea party event. We can think of few better ways to consolidate conservative opposition. (In the profiles, Maddow constantly gushes about how polite and civil she is.)
Maddow clowned and played last year, telling her dick jokes and chasing Republican sex scandals all around town. (John Ensign gave an internship to his chief of staffs teenage son! Good God.) In the past few weeks, she has finally risen up on her horse, authoring long, embarrassing rants about what Republicans have allegedly said about the (year-old) stimulus program. The only problem: Instead of attacking real things Republican leaders have said, she has invented bogus statements, pretending that lesser players have made this foolish statements. This has been gonzo, embarrassing work. For the record, no one seems to enjoy making silly misstatements quite as much as Maddow does. At times, she makes Sean Hannity seem like an obsessive truth-telling self-flagellator.
In a universe driven by major false claims, American voters need clear explanations. Maddow prefers to make dick jokes at their expense, and now to invent misstatements. Sorry: Her broadcasts are aimed at we lucky duckies within The Tribe; her efforts send a thrill up our legs. And good God. When it comes to clear explanation, she is now clearly explaining things in the following manner, using our own private language. Weve begun inventing new names for problems, a language known only by us:
MADDOW (2/22/10): Thank you, Keith. And thanks to you at home for tuning in.
Republicans are still filibustering absolutely everything in Washington. But as Keith said, we do have a new name for that problem. And the Republicans did have some surprising defections from their usually unified front today.
But we begin with the Republican Partys failed effort to stop America from getting a jobs bill. While the country is mired in double-digit unemployment, Republicans voted today to filibuster the jobs bill. It was only able to advance when five Senate Republicans bucked their own party and voted with Democrats to allow the bill to move toward a final vote. Every other Republican who voted today, aside from these five, plus conservative Democratic Senator Ben Nelson voted to filibuster.
To be clear, they didnt just vote "no" on a jobs bill. They voted to not even allow it to pass if it got a majority vote. They filibustered itbecause they filibuster everything. This is the Tarantino in action. It kills bills.
Its the Republican effort from the minority to filibuster absolutely everything. So everything of any consequence in the Senate takes not a majority but a super-majority, 60 votes to pass. This has never been done before. But its being done now even on a jobs bill.
The Tarantino has become such a huge problem in Washington that even outgoing Democratic Senator Evan Bayhquite literally the least partisan person in the Senate, he`s the most conservative Democrat in the Senateeven Evan Bayh has made a huge splash on his post-retirement announcement tour by drawing attention to the Tarantino.
Senator Bayh wrote an editorial in the New York Times over the weekend in which he said this. "Historically, the filibuster was employed to ensure that momentous issues received a full and fair hearing. Instead, it has come to serve the exact opposite purposeto prevent the Senate from even conducting routine business. The minority has a right to voice legitimate concerns, but it must not employ this tactic to prevent progress on everything at a critical juncture for our country. We need to reduce the power of the minority to frustrate progress. The number of votes needed to overcome a filibuster should be reduced from 55to 55 from 60."
Senator Bayhs retirement tour even took him to the set of The View today where he again invoked the Tarantino:
BAYH (videotape): The filibusterits just got us stuck in the Senate. Its frustrating progress. Back in my fathers day, they reformed it. I think we need to reform it again.
MADDOW: Senator Bayh has pledged to use his remaining days in office to not just talk about the Tarantino but to do something about it. But even if Democrats launched a full frontal assault on the filibuster right now, starting tonight, theyin all likelihoodwould not be able to get it done in time to save the one thing that is critical to this country both policy-wise and critical to Democrats collective political future and that is health reform. The prospects of which, like everything else, are threatened by the Tarantino.
Lets be fair. A broadcaster gets to try some unusual things, even things that seem blatantly silly. That said, lets be a bit less fair: For Maddow, it isnt enough that we insult the publicthe very people we have to influence. Now, weve started inventing a private language, a hip language known just to us!
This is life in the secret garden, the garden to which the children repair. In this garden, our explanations will be clearto ourselves. The impulse to behave in this way is always strong within tribal culture. But if were dealing with national politics, this impulse leads on to disaster.
Krugman understated today. Our world is driven by flagrant misstatements. To know what they are, you have to listen to Fox. You then must rise up on your haunches and challenge the dissembling leaders who pimp these actual howlers, trying not to insult the voters who may have purchased their con.
Maddow represents what you can get when General Electric picks out your leaders. In our view, shes massively over her head at her postunless youre out in the secret garden, thrilling to the private talk, the private dick jokes, conducted among your own.
Additional logic from the garden: As Maddow has recently argued, average voters should have known what the term tea bag meant as a verb. After all, it was once explainedin a film by John Waters!