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LOOK AWAY! Whistling Dixie, Gawande’s team threw out the foreign experience: // link // print // previous // next //
TUESDAY, AUGUST 18, 2009

Ugh: Bob Herbert gets it right. Just click here.

We liberals get fed some thin gruel: We look forward to reading Matt Taibbi’s forthcoming report on the health care wars in Rolling Stone. That said, we were often massively underwhelmed by Taibbi’s discussion with Rachel Maddow last night. (If the transcript ever gets posted, it will get posted here. As of this morning, MSNBC still hadn’t posted last Friday’s programs!)

Maddow began with an overview about different types of health care systems—a discussion which was quite clear and concise. (The analysts cheered. To watch the full segment, click this.) We began to balk when she discussed Obama’s apparent retreat from a public option—and the earlier retreat by Max Baucus, who seems to have supported a public option back in November. Maddow gave this explanation for why the pair have flipped:

MADDOW (8/17/09): If Max Baucus was in favor of a public option, and President Obama was in favor of a public option, and a public option survived through three House committees and one Senate committee that passed bills on health care reform so far, why is the public option dying now?

It’s dying because of a collapse of political ambition. The Democrats are too scared of their own shadow to use the majority the American people elected them to in November to actually pass something they said they favored.

We wouldn’t say that explanation is “wrong”—but we’d call it ginormously underwhelming. But then, this was Taibbi’s response when asked why the Dems have flipped:

MADDOW: How do we get from Barack Obama saying there must be a public option, even Max Baucus saying there has to be a public option, to now, all of a sudden, no public option? What changed?

TAIBBI: You know, this is a complete and total mystery to me because it’s not like they’re going to get any Republican votes by dropping the public option.

MADDOW: Ding!

TAIBBI: You know, this is an auction where there’s only one person in the audience. You don’t have to keep bidding higher.

MADDOW: Right.

TAIBBI: You’re the only person there. You’re going to get the painting in the end, you know? It doesn’t make any sense what they’re doing and indicates to me that this is really what they want. They really wanted to pass something that doesn’t have any meaningful effect on the insurance industry.

Is this what Obama wanted all along? We have no idea. But it was sad to see this dual attempt to explain the Democrats’ flip.

“It doesn’t make any sense?” Jeez, we get fed some thin gruel!

It’s sad when liberals have to turn to Fox to get competent analysis. But on last night’s Special Report, one commentator had little trouble explaining why Obama has flipped. Charles Krauthammer’s analysis differed vastly from Taibbi’s. Sadly, it made much more sense:

KRAUTHAMMER (8/17/09): Look, Obama had wanted the public option a lot because it is the road to a government-run system, which is what, in his heart, he wants. And he wanted to have planted it in his presidency so it wouldn't become government-run until the very end. It wouldn't have had its major effect until perhaps after his presidency. But he would have been known as the father of national health care. But he's not going to get it and he knows it.

And he knew it early, but he hung on because it would be a bargaining chip when he goes for the minimal plan, which would be health insurance reform, where he slaps a lot of restrictions on the insurance companies when there are no preconditions, et cetera. And in return, he would offer to drop the public option. That's why he wanted to hang on until the end.

The reason he had to drop it now is because of the town halls and the public rebellion. It's because of the reaction, the angry, agitated, educated reaction of people against the public option, understanding that it's a way to national health care that it became a distraction and a liability.

And if you're going to drop it any way, he had to drop it now. But it takes away his leverage with negotiations in the end with insurance companies.

A quick note about Krauthammer’s statement that “the public option...is the road to a government-run system.” That remained an explicit Democratic appraisal at least through early 2008. (To see Krugman explaining this point in February 2008, see THE DAILY HOWLER, 6/23/09. Today, we liberals pretend this is tea-bagger lunacy.) Was this ever Obama’s thinking? We don’t know. But it was the explicit thinking behind John Edwards’ proposal of a public plan as part of a wider health package.

Was Krauthammer right about Obama’s current motives? Is Obama walking away from the public option because of all the town-hall commotion? Because the commotion has scared away too many Democratic votes? We can’t read Obama’s mind. (On Sunday, Kent Conrad said there were never enough Dem votes for a public plan.) But Krauthammer was stating an obvious possibility. It’s stunning to think that neither Maddow nor Taibbi could have imagined this explanation for Obama’s apparent retreat.

Are liberals forbidden from hearing an obvious possibility: This is your keister getting kicked by a bunch of tea-baggers?

A great deal more was underwhelming in the Maddow-Taibbi discussion. But liberals were fed some very thin gruel about this basic point. “This is a complete and total mystery to me?” Our analysts mouthed one word: Why?

Also underwhelming: Liberals were fed some very thin gruel in other parts of the confab. At one point, Maddow puzzled about the fact that single-payer was never part of Senator Baucus’ deliberations this spring:

MADDOW: If health care reform is ever going to be possible, it’s never going to be more possible than it is this year. But from the very, very beginning, single-payer health care and national health care were completely off the table.

As Matt Taibbi writes in his new gut-wrenching article on health care for Rolling Stone, when key Democratic senator Max Baucus convened the first roundtable discussions on health care reform last May, Senator Baucus invited 41 witnesses to Capitol Hill to share their perspective on what ought to happen with health care reform. Forty-one witnesses over three days. Not a single witness was scheduled to speak in favor of single-payer.

Because single-payer was inexplicably, totally beyond the realm of consideration, Democrats ended up instead proposing something called a public option—a Medicare-like plan that at least some Americans could choose to buy into instead of buying private insurance. Now, apparently, even that is off the table, too.

For the record, Maddow is talking about May 2009. Click here. (We luv Russell Mokhiber, who was once our biggest comedy fan.)

Why was single-payer “off the table” when these deliberations began? Sorry. Whatever your view of single-payer might be, that approach was hardly “inexplicable.” Presumably, single-payer was off the table for an obvious reason: Barack Obama got elected president while campaigning against single-payer! There were three major candidates in last year’s Democratic campaign: Obama, Hillary Clinton and Edwards. And none of the three proposed single-payer! We might want to ask why that was the case. But it was hardly “inexplicable” when single-payer was sidestepped by Baucus. In fact, it would have been fairly inexplicable if Baucus had pursued single-payer. His party’s newly-elected, popular president had run on a different approach!

For ourselves, we’d be inclined to support single-payer. We’d certainly like to see its merits widely discussed; our “liberal leaders” avoided that over the past fifteen years. (Most are Very Serious People. Mokhiber isn’t, and thus gets ignored.) But Obama didn’t run on single-payer! Despite that, Maddow found Baucus’ conduct “inexplicable”—and Taibbi seemed bollixed too:

TAIBBI: Well, one of the things important to remember is that they bargained away a single-payer from the very start. I mean, there was absolutely no discussion of it throughout the entire process.

Duh. Could that be because Obama didn’t run on single-payer?

Children of the poverty class sometimes get a bad deal at school. Sometimes, when we watch our shows, we libs get a weak deal too.

Special report: Pure madness!

PART 1—LOOK AWAY: Atul Gawande and three associates authored an informative column in last Wednesday’s New York Times.

Then too, there was the striking throw-away line which came at the start of the column.

Gawande directs the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston. His associates are health care policy experts. Their question: Can the U.S. figure out ways to deliver health care at lower cost?

Good news! “In studying communities all over America, not just a few unusual corners, we have found evidence that more effective, lower-cost care is possible,” Gawande and his team wrote.

Gawande’s team searched the country’s 306 Hospital Referral Regions, looking for regions which 1) had low or declining Medicare costs and 2) had above-average health care outcomes. They identified 74 such regions. Here is Gawande’s nugget:

GAWANDE (8/12/09): If the rest of America could achieve the performances of regions like these, our health care cost crisis would be over. Their quality scores are well above average. Yet they spend more than $1,500 (16 percent) less per Medicare patient than the national average and have a slower real annual growth rate (3 percent versus 3.5 percent nationwide).

When it comes to Medicare, these regions spend 16 percent less per patient than the national average. Gawande goes on to offer ten lessons from these high-performing, lower-cost regions. Would our cost crisis really be over if the rest of America performed like these regions? That could be true, but we feel unsure—in part because of that throw-away comment, right at the start of this column.

Do we want to learn how to curb health costs? If so, we’ve come to the right planet! All over the globe, other developed nations deliver health results comparable to ours at vastly lower cost. Below, we highlight the most striking line in yesterday’s Krugman column:

KRUGMAN (8/17/09): In Britain, the government itself runs the hospitals and employs the doctors. We've all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do.

Again, we meet that astounding statistic: The United Kingdom gets health outcomes much like ours—while spending 40 percent as much per person! (Interpreted baldly, that suggests that 60 percent of our health care spending is wasted.) Truly, that’s an astounding figure, but let’s present it a different way. According to the OECD, this was the per-person spending in these countries in 2007:

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

Those are astonishing figures. Meanwhile, if you don’t want to trust Krugman’s claim about the British system’s “overall good care,” go ahead and tackle this column from yesterday’s Washington Post.

Back to Gawande: The U.S. is looking for ways to provide health care at lower cost. At the same time, we’re confronted by that astonishing figure from Britain. (More figures, from other countries, as the week proceeds.) That brings us back to the throw-away comment at the start of Gawande’s report.

How might we produce less costly health care? We really do live in North Korea when frameworks like the one which follows are so standard—when a framework like Gawande’s can even seem to make sense:

GAWANDE: [We should try] to change how care is delivered so that it is both less expensive and more effective. But there is widespread skepticism about whether that is possible.

Yes, many European health systems have done it, but we are not Europe. And evidence that places like the Mayo Clinic in Minnesota or the Cleveland Clinic are doing it is likewise dismissed because their unique structures (for example, their physicians work on salary rather than being paid for each service) make them seem as far from Middle America as Sweden is.

Yet in studying communities all over America, not just a few unusual corners, we have found evidence that more effective, lower-cost care is possible.

With that throw-away line about “not being Europe,” Gawande sets his sites on health care regions in this country—regions which are saving 16 percent per patient. He stops considering a place like Great Britain—where the overall saving per person is instead 60 percent!
That approach would seem to define madness—yet it virtually defines our ongoing national discussion of health care. Again, we seem to be living in North Korea. When it comes to health care systems, you simply haven’t been allowed to know what happens in foreign lands.

We’re not suggesting that Gawande’s team is involved in some sort of plot. But truly, could it be more astounding? Great Britain is spending $2992 per person—compared to our own $7290! But again, we’re told by a team of experts: Look away! Look away, Dixie land!

We aren’t Europe, Gawande says. So true! With a long-term discussion built on such frameworks, we’re more like North Korea. But then, our health care discussion often seems like a tribute to mental illness. More tomorrow, as CNN throws away a stunning report.

Tomorrow—Part 2: CNN, in a throw-away comment: “All of these combined areas could add up to $1.2 trillion in waste [per year]—or, as the study notes, more than half of our health spending.”