Mouse That Roared 3The Empire Strikes Canada: In this mornings New York Times, David Herszenhorn keeps breaking our hearts. Again, he explores the complexities of the Rube Goldberg Machine known as Americas health care system. For Herszenhorns previous heart-breaking work, see THE DAILY HOWLER, 9/14/09.
Friend, did you ever wonder how eligibility for Medicaid actually works? This morning, Herszenhorn explains part of the puzzlethe rules determining eligibility for adult parents of minor children. Warning! Due to some levers and pulleys in proposed health reform, this stuff now mattersbig-time:
HERSZENHORN (9/15/09): The proposed health care legislation would give additional federal money to help states pay for newly eligible Medicaid enrollees. And a higher percentage of those newly eligible would live in states that so far have made it hardest for people to qualify for Medicaid.
Alabama, for instance, sets its eligibility cutoff for parents at 11 percent of the federal poverty level. That means that a couple with two children qualify for Medicaid only if they earn less than $2,425.50 per year. A couple earning more would not be considered poor enough to qualify.
Compare that to the Medicaid cutoff in more generous states, most of them traditionally blue. Medicaid is offered to parents earning 100 percent of the poverty limit in California; 150 percent in New York; 185 percent in Illinois; 200 percent in Maine, New Jersey and Wisconsin; and 275 percent in Minnesota.
A crazy quilt of eligibility rules obtains around the nation. (In more grandiose moods, we describe this as the laboratory of the states. Its an example of American exceptionalism.) In Alabama, a two-child couple who earn $3000 per year are too rich to qualify for Medicaid. In Minnesota, a couple can qualify if they make upwards of 50 large.
In the current debate, this matters big-time because, under proposed reform, additional federal money would only go to cover newly eligible enrollees. The states which had already been more generous would therefore get the shaft.
But so it goes with our endless complexity. Indeed, this complexity defeated a New York Times editorthe editor who approved the map which accompanies Herszenhorns piece.
In the hard-copy Times, a United States map accompanies Herszenhorns report. It attempts to show, in graphic form, which states would receive an extra share of federal aid under the proposed reform plan. But the linguistic complexity of this matter defeated the person who constructed the map. Which states make it harder to qualify for Medicaid? Which states make it easier to qualify? The heading on the map reverses these categories. It looks like Minnesota makes it harder to qualify! Complexity defeats us again!
No, we cant show you the mapit doesnt seem to appear on-line. Heres the blog post from which Herszenhorns piece was takenbut the bungled map isnt present. By the way: Even without this reversal of categories, the map itself is so complex that no one likely gained from it.
In The Mouse That Roared 3: The Empire Strikes Canada, a no-nonsense, tough-talking Republican president finally reacts to all this confusion. Well describe the plotrather, the plotslater in the week.
Previous sequel: For the plot of Mouse 2: Pitiful Uninsured Giant, see THE DAILY HOWLER, 9/14/09.
Special report: Two days in the life!
PART 2HERBERT TRIED: Did Obama give a brilliant speech to last Wednesdays joint session of Congress? Was it his latest brilliant speech, as a fawning Frank Rich declared? (See THE DAILY HOWLER, 9/14/09.) In a rational world, you might encounter a range of intelligent views on that serious question as you read the New York Times op-ed page. The Times is our most famous newspaper. Its supposed to be the top of the heap in our journalistic discussions.
But that would be in a rational world. Lets discuss the world we live in. First, a few quick words about what was in the presidents speech last week:
Obama did several things which Democrats rarely do. At one point, he noted the fact that bogus claimshe even used the tricky word liehave been spread about his proposals. He didnt name the people who have done this. But he did mention some categories:
OBAMA (9/9/09): I believe a broad consensus exists for the aspects of the plan I just outlined...And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole.
Still, given all the misinformation that's been spread over the past few months, I realizeI realize that many Americans have grown nervous about reform. So tonight, I want to address some of the key controversies that are still out there.
Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but by prominent politicians that we plan to set up panels of bureaucrats with the power to kill off senior citizens.
Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie plain and simple.
Democrats need to explore this theme much more often, and much more fully. (They also need to do so more deftly.) It shouldnt fall to a sitting president to tell the public that theyre being deceived. Alas! Voters have been clownishly deceived for decades without Democrats or liberals deigning to tell them. Your side has simply refused to compete. Your side hasnt respected the public enough to tell them such basic things.
Second, Obama actually started to paint a picture of the need for progressive regulation of Big Corporate Interests. (Dare we say it? Of the need for big government!) Democrats and liberals have been too lazyand too indifferentto do this sort of scut-work in recent decades. The other side has pushed its Big Story relentlessly. But what, liberals worry? Not us!
Obama reviewed the creation of Social Security in 1935, and the creation of Medicare thirty years later. Then, he deigned to explain the real world to the public. Democrats and liberals rarely bother. Career liberals have been so store-bought and brain-dead for so many years that the thought wouldnt enter their heads:
OBAMA: You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom.
But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited.
And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matterthat at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.
That was true then. It remains true today.
When it comes to explaining the need for regulation of Interests, thats fairly weak tea. But in the longer passage from which that comes, Obama actually made an attempt to tell a progressive Big Story. And by the way, note the basic point: In the absence of regulation, the vulnerable can be exploited. (If we could just drop our sob-sister frames, we would state this point more accurately: Average people will be exploited. You know? As is happening now?)
Career liberals have been too lazyand too dumbto say such things in recent decades. Relentlessly, voters have heard about the perils of big governmentand theyve heard no countervailing Big Story.
Obama took several nice steps in this speech. If liberals and Democrats follow up on these moves (and they wont), it may make a differenceby the year 2020. But does this mean that Obama gave his latest brilliant speech, as a fawning courtier proclaimed? No, it actually doesnt. Early on, Obama also spoke about the stunning cost of American health care. In this passage, he introduced the part of his speech which was a stunning failure:
OBAMA: Then there's the problem of rising costs. We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages.
It's why so many employers, especially small businesses, are forcing their employersemployees to pay more for insurance, or are dropping their coverage entirely.
It's why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally, like our automakers, are at a huge disadvantage.
And it's why those of us with health insurance are also paying a hidden and growing tax for those without it, about $1000 per year that pays for somebody else's emergency room and charitable care.
Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid...
Now, these are the facts. Nobody disputes them.
These are the facts, Obama said. No one disputes them. Of course, he also left out a few basic facts. Because we spend so much on health care, the average person is getting looted in his insurance premiums, whether he or his employer is paying it. And her annual wage isnt going up! What should have been her pay increase is being sent to The Interests.
Obama left out those basic facts. But having listed his parade of horribles, the president did next to nothing, in this brilliant speech, to explain why our health care costs so much, or to explain how he plans to reverse the situation. And his proposed solution reads like a joke. What is his goal for reining in spending? See THE DAILY HOWLER, 9/10/09.
This major part of this speech was a joke. Unless you read the New York Times, our most famous newspaper. Indeed, pure piffle was being presented all weekend. Example: On Saturday, Charles Blow dispensed this familiar soap. Obama may not be a fighter!
But on that same day, one Times scribe made an actual effort. Bob Herbert made a decent attempt to explain the fears of average Americans at this very difficult time. Unfortunately, Herbert started by punching the crazies who have been disrupting health care forums, seeming to contrast them with the ordinary working men and women of America who are struggling with the worst economic downturn they have ever seen. (Only one big shot got named: Joe Wilson, in passing.) And even here, in the papers best effort, this was the best the Times could manage about two basic questions: Why are we spending so g*ddamned much? Who is looting our money?
HERBERT (9/12/09): Whats missing from all the talk about reform is how the runaway costs of health care, and all the dire consequences associated with them, can be reined in without a strong public insurance option and other big-time cost-saving initiatives.
If the government requires everyoneor nearly everyoneto have health insurance, the insurance companies and the pharmaceutical industry will reap a bonanza. What the Democrats still have to make clear to ordinary working men and women is how this latest incarnation of health care reform will be cost effective and broadly beneficial to them and to their government.
Whats missing is talk about how the runaway costs of health care...can be reined in? Thats like saying the Mets have a very good team this yearexcept for the lack of pitchers, catchers, shortstops, third basemen and all outfielders. By the way How can we rein in those massive costs with a public option? Has anyone ever really explained that?
We spend twice as much as France doesthree times as much as Japan! Obama made no attempt to explain why that situation obtains, or to say how he plans to fix it. He rattled off many devastations caused by this vast amount of spendingthen set an utterly clownish goal for reining this spending in. But Rich, fawning and preening as always, declared it his latest brilliant speech. At one point, the powdered wig flew right off his head, so energetically did the courtier cheer.
In a rational world, you would go to the Times op-ed page to see such basic matters assessed. But lets discuss the actual worldthe low-IQ world we live in. This weekend, we followed two days in the life. As always, the Gotham greats failed.
Tomorrow: Dowd the dumbnificent
Thursday: Kristof reads Reid