HOW BIG IS ENORMOUS! Leonhardt described “enormous” waste. But how much waste is that? // link // print // previous // next //

Rashomon and Lieberman: This week, by happenstance, our state-of-the-art computer system hasn’t been playing video. For that reason, we haven’t been able to watch the tape of Joe Lieberman’s September visit with the editorial board of the Connecticut Post.

(You can watch the tape, thanks to Greg Sargent. Go ahead—just click here.)

What did Lieberman say to the Post? More specifically, what did he say about his views on a possible Medicare buy-in? Without access to the tape, it has really been quite an adventure trying to puzzle that out. For one example, this is what the New York Times says in today’s editorial:

NEW YORK TIMES EDITORIAL (12/16/09): [W]ay back in September, the senator was publicly championing a Medicare buy-in.

In an interview with The Connecticut Post, he said he had been refining his views on health care for many years and was ''very focused on a group post-50, or maybe more like post-55'' whose members should be able to buy Medicare if they lacked insurance.

According to the editors, Lieberman “was publicly championing a Medicare buy-in” when he spoke to the Post in September. In the short quote they pulled from the tape, they seem to have Lieberman describing his then-current views on a buy-in—views he’d maintained for “many years.”

But that isn’t what David Herszenhorn seemed to say in yesterday’s New York Times. In a front-page news report, Herszenhorn described Lieberman’s session with the Connecticut Post like this:

HERSZENHORN (12/15/09): Democratic leaders noted that Mr. Lieberman on numerous occasions had voiced support for the Medicare buy-in proposal that he now insists must be dropped. It was a core component of a health care proposal that he championed as Al Gore's running mate in the 2000 presidential race, and three months ago he voiced support for the same concept.

''What I was proposing was that they have an option to buy into Medicare early,'' Mr. Lieberman says on a video distributed by Democrats on Monday. In the interview, he did not dispute that he once supported the idea but said he had not recalled having done so, or the context, until Mr. Reid's office confronted him about it.

Herszenhorn said Lieberman “voiced support” for the buy-in when he met with the editors—but he offered no quote to that effect. Instead, he seemed to quote Lieberman discussing a similar proposal from the 2000 Gore campaign—while saying he hadn’t even remembered this matter until Reid’s office piped up. By the way: This Medicare buy-in was not a “core component” of Gore’s health proposals; it was very occasionally mentioned in passing. We note that the Times has dropped this formulation from the versions of this report which appear on-line. (We’ve transcribed our hard-copy Times.)

Might we note something about these two pieces? For whatever reason, in neither one is Lieberman quoted endorsing a Medicare buy-in.

On Monday evening’s Maddow show, Rachel Maddow played the following clip from Lieberman’s session with the Connecticut Post. This clip includes all the language which has been quoted by Herszenhorn and the Times editors. But Maddow offered a third account of Lieberman’s focus. According to Maddow, Lieberman was “talk[ing] favorably” about the stance he had taken in his 2006 Senate campaign:

LIEBERMAN (on videotape, from September 2009): When it came to Medicare, I was very focused on a group post-50, maybe post—more like post-55, people who have retired early or, unfortunately, have been laid off early, who lose their health insurance and they’re too young to qualify for Medicare. And what I was proposing is that they have an option to buy into Medicare early, and again, on the premise that that would be less expensive.

“The Medicare buy-in is, essentially, a trademarked Joe Lieberman policy idea,” Maddow said. “It’s an idea that he’s promoted and explained and campaigned on repeatedly.”

Is this some sort of Rashomon sequel? All three sources used the same tape. But Maddow said Lieberman was referring to his stance in his 2006 Senate race. Herszenhorn seemed to say he was talking about the 2000 White House campaign. Today, the Times editors give the impression that he was simply describing his current stance on this matter—rather, the stance he held as he spoke in September.

Repeat: We still haven’t seen the tape for ourselves. For ourselves, we’d have the most faith in Greg Sargent’s judgment. On Monday, when he posted the tape, Sargent also said that Lieberman was talking about the 2006 campaign. Meanwhile, this was his assessment of what the solon had said:

SARGENT (12/14/09): It’s not entirely clear that Lieberman was offering a full-throated current endorsement of the proposal, but his tone is clearly positive and approving. It’s yet another sign, as if you needed one, that Lieberman’s current opposition to the Senate proposal doesn’t appear to have any roots in a genuine policy disagreement.

We’re going to watch the tape today. What do you think he said?

Paraphrased under the Lash: This was reporter Devon Lash’s account, right there in the Connecticut Post, of what Lieberman said in that meeting. As Sargent notes, Lash was “only paraphrasing.” That doesn’t mean Lash was wrong:

LASH (9/2/09): Lieberman added that he supports mandating that no one can be denied coverage because of pre-existing conditions and that everyone be required to have health insurance.

As to how 47 million uninsured will afford coverage, Lieberman said only 12 million don't have insurance because they cannot afford it.

By allowing citizens who are not eligible for Medicare or Medicaid to buy in for a rate below the private market, the government can extend coverage to more of those who are currently uninsured, he said.

To arrive at his position, Lieberman said he reached out to "every conceivable group" in the state, including residents, providers, doctors and hospitals.

We’re going to watch the tape today to check out what Lieberman said.

Special report: The culture of scary stories!

PART 2—HOW BIG IS ENORMOUS: Scary stories have driven our politics for a good long time now. Last week, David Leonhardt discussed the way the culture of scary stories will likely affect the ongoing drive for significant health care reform.

“Over the next several weeks, members of Congress will be confronted with one scary story after another about what will happen if they try to cut health care costs,” Leonhardt predicted, with perfect justice. He said this would happen despite an obvious fact about our gruesome health system:

LEONHARDT (12/9/09): But here's the thing: It is abundantly clear that our medical system wastes enormous amounts of money on health care that doesn't make people healthier. Hospitals that practice more intensive medicine, to take one example, get no better results than more conservative hospitals, research shows. And while the insured receive better care and are healthier than the uninsured, the lavishly insured—those households with so-called Cadillac plans—are not better off than households with merely good insurance.

“Our medical system wastes enormous amounts of money,” Leonhardt said (our emphasis). The fact of this enormous waste is abundantly clear, he said. But the fact of this enormous waste may get wiped away by those scary stories, he said. As he continued, Leonhardt marveled at the irrationality of our political discourse:

LEONHARDT (continuing directly): Yet every time Congress comes up with an idea for cutting spending, the cry goes out: Patients will suffer! You're cutting bone, not fat!

How can this be? How can there be billions of dollars of general waste and no specific waste? There can't, of course.

The only way to cut health care costs is to cut health care costs and, in the process, invite politically potent scare stories.

In a more rational world, something would be wrong with this picture. According to Leonhardt, it’s abundantly clear that we’re wasting enormous sums in our health care system. Why then are those “scary/scare stories” so “politically potent?”

Why are those scary stories so potent? For our money, part of the answer can be found in Leonhardt’s (highly worthwhile) report.

Why are those scary stories so potent? Might it be because most voters don’t know the fact which is “abundantly clear?” It may be abundantly clear to Leonhardt that we waste enormous sums. But we’ll guess that very few voters know that.

How enormous is that waste? We’ll guess that few voters know.

In large part, these voters don’t know because they’ve never been told—not by their political leaders; not by our so-called “liberal journals;” not by the mainstream press corps. All year long, we’ve been stunned by this unfolding syndrome, a syndrome devoted to public incomprehension. In our view, Leonhardt’s very worthwhile piece provides the latest example.

Leonhardt says we waste “enormous” sums in our health care system. But how enormous is that waste? We’ll venture a wild crazy guess: Leonhardt’s readers don’t know. We’ll guess this is true despite a key fact: Leonhardt’s weekly “Economic Scene” column operates on the high end of mainstream journalism. Presumably, Leonhardt’s readers are much better informed than the average Joe.

But how “enormous” is our waste? Would Leonhardt’s readers be able to offer a reasonably well-informed answer?

Judging from Leonhardt’s work in this (worthwhile) column, we’ll guess that the answer is no.

Go ahead—read through the whole piece. See if Leonhardt gives his readers any sense of the scale on which that waste might be measured. He never mentions the foreign data, which give a sense of the mammoth scale on which that waste—that corporate looting—can be measured. Nor does he cite the handful of studies which have attempted to quantify the amount of waste in our system.

At least two such studies appeared this year, describing—and attempting to quantify—the ginormous amounts of waste in our system. We cited these studies here at THE HOWLER, but only as a way of noting the comically tiny amount of attention they received in the press.

But then, Leonhardt doesn’t cite these studies either. In all honesty, he gives his readers no way to know what “enormous” means in this column.

Do Leonhardt’s readers understand how “enormous” our waste really is? Go ahead—read through the whole piece. He doesn’t give readers any sense of the scale on which this waste may be measured. Indeed, let’s look again at the early passage in which Leonhardt does use a number:

LEONHARDT: How can this be? How can there be billions of dollars of general waste and no specific waste? There can't, of course.

The only way to cut health care costs is to cut health care costs and, in the process, invite politically potent scare stories.

Billions of dollars of waste? This is Leonhardt’s lone attempt to quantify the scale of the waste. And in his use of this highly general figure, Leonhardt vastly understates the apparent size of the problem.

Billions of dollars of waste? In this passage, Leonhardt uses that figure as a way to define the size of the problem. In fact, if reform could bring the figure down to that scale, it would be an enormous success. The studies which have defined this problem have talked about hundreds of billions in annual waste. Meanwhile, the foreign experience—expressed in dollars spent per person—brings measurement of our waste down to an understandable human scale.

In part, scary stories are political potent because they operate in the context of massive public ignorance. They employ demonistic imagery which is quite familiar to voters—for example, images of uncaring, incompetent bureaucrats who don’t give a fig about you or yours. These images are familiar to voters—and thereby potent—because Major Interests have spent massive amounts of time and energy promoting them in the past fifty years.

The mainstream press and the liberal world make little effort—indeed, almost none—to create countervailing frameworks. Dem pols wouldn’t tackle this task even on pain of death.

How enormous is that waste? Leonhardt made little attempt to say. He made little attempt to shock the conscience with the massive size of the problem. In future weeks, scary stories may well scare voters and, in the process, sway some pols. Their potency stems from the lax, lazy way other segments attempt to address them.

Tomorrow—Part 3: About those home health care overpayments.