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ABOUT THOSE OVERPAYMENTS! David Leonhardt broke our hearts, describing big Medicare fraud: // link // print // previous // next //
FRIDAY, DECEMBER 18, 2009

We want our $800 back: On balance, as non-experts, we would tend to agree with Paul Krugman’s judgment about the developing health reform plan. (Headline: “Pass the Bill.” Click here. As non-experts, we tend to do what Krugman says.) That said, we would add several planks to Krugman’s “message to progressives,” with which his column opens.

But first, a note about what happened in the Senate on Tuesday night.

Last month, progressive economist Dean Baker provided some info about the looting which characterizes our health care spending. Trust us—few voters have any real knowledge of what follows, in large part thanks to the near-total absence of real “progressives” in our national discourse:

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. The protections that drive up prices are almost never discussed in policy debates because the beneficiaries are so powerful they can keep anyone from even considering challenging their government protection...

According to Baker, those patent monopolies, all by themselves, add $800 to our per-person spending. Each year.

(In the second comment to Baker’s post, comedian Jeff Caldwell relates that $800 to our massive overall over-spending, as compared with the spending of a nation like France. If Baker has accounted for $800, what accounts for the rest of our $3700 in annual over-spending? So the comedian asks.)

In short, Americans are getting massively looted through their prescription drug prices. But so what? On Tuesday evening, the Senate decided not to take action on this remarkable problem. On Wednesday evening, Ed Schultz did an excellent job examining this vote on The Ed Show. But so what? That same morning, the New York Times had devoted exactly one sentence to this remarkable action:

STOLBERG (12/16/09): Other issues flared Tuesday as well. The Senate rejected a bipartisan proposal to allow imports of prescription drugs from Canada and other countries where prices are often lower; the provision fell 9 votes short of the 60 needed.

That single sentence, deep in a long report, represents the New York Times’ only coverage (to date) of this remarkable vote. In the Washington Post, readers were allowed to understand a bit more of their world:

MONTGOMERY (12/16/09): The Senate also defeated a proposal by Sen. Byron L. Dorgan (D-N.D.) to allow Americans to import low-cost prescription drugs, a provision that could have upended a deal Obama made with drugmakers this year to support the health-care overhaul.

The Dorgan amendment garnered 51 votes, short of the 60 needed for passage. In one of the few bipartisan votes in the health-care debate, 23 Republicans joined 27 Democrats and one independent in supporting the proposal, while 17 Republicans joined 30 Democrats and one independent in opposing it.

Americans get massively looted on prescription drug prices. Dorgan offered a chance to address this problem. But 30 Democrats voted his amendment down, joining only 17 members of the other tribe.

Thirty Dems opposed the Dorgan amendment; only 27 supported it. The Times devoted exactly one sentence to this remarkable matter.

Why is it hard to pass progressive reform? In large part, because of matters like this. The vast bulk of voters have no idea of the ways they get looted in their health spending. Typically, successful efforts at social reform are driven along by righteous anger. It’s hard to get the voters angry when big news orgs like the New York Times so defiantly avoid informing them about the ways they get abused.

But then, the New York Times has refused, all year, to examine the looting in our health “system.” But so too with the Washington Post. In a nation whose “press corps” functions this way, the typical voter will lack the first clue about the real world.

You can’t do reform in this manner.

That said, it isn’t just the mainstream press which makes so little effort to tell voters about this looting. On that very same Wednesday evening, Rachel Maddow clowned her way through what may have the strangest hour we’ve ever seen on a cable “news” channel. (Dick Armey pronounced my last name as “Maddox!” Porn sites look really funny with the GOP’s URL-shortener!) But then, where in the “liberal/progressive” world has anyone ever made a real effort to inform the public about the ways they get looted in their health spending? Your “liberal journals” certainly haven’t. Mainstream “liberal” columnists haven’t. Has Bernie Sanders ever done it? We thought Sanders ended up looking slightly silly this week with his lengthy “amendment”—and he may be the most progressive member of the Senate.

Tell us: Who has ever told the public about the various ways they get looted through their health care? What “progressive” has ever done this in the dogged, systematic way which may eventually get results? Sanders has a salary; a staff; a platform; a budget. Has he ever done this? When? In what way? How loud? In fact, your country has virtually no progressive politics because its power structure includes so few active progressives.

Remember when Ross Perot had all those charts? When has our side produced any charts about the size of our health care looting?

Ed Schultz screamed and yelled about Tuesday’s vote; we say good for him! But what did most of us “progressives” do? We spent the week wailing about Joe Lieberman, treating ourselves to a good cleansing cry. For the most part, this was a silly, inane, futile act—a perfect example of the childish culture of American pseudo-progressives.

This brings us back to Krugman’s courteous “message to progressives.” In today’s column, Krugman urges a “yes” vote on the Senate bill, and he gives some actual reasons. But first, he offers this:

KRUGMAN (12/18/09): A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you're disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

On balance, we agree with Krugman’s views on the bill, although we do so as frustrated non-experts. But we’d offer a different “message to ‘progressives.’ ” Just get over your goddamned selves, our own helpful message would start.

We’d advise “progressives” to stop wasting time on caterwauling about Lieberman. After all, forty other senators stand behind him, supporting the very same filibuster, including relatively non-crazy people with names like Collins, Snowe, Voinovich, Lugar, Hutchison, Alexander. (Have you ever heard anyone criticize, challenge or question Lugar for his stance on these matters? Why not?) These people were elected with Republican votes, just the way Vile Lieberman was. And guess what, progressives? People elected with Republican votes may not be inclined to vote your way! They represent voters who don’t (yet) see the world the way you do.

The traditional remedy for such situations has always been this: Go work in the vineyards. Reformers go out and spread the word; within our system, reformers help voters develop frameworks of understanding which will produce loud demand for reform. This week, we pseudo-progressives have shrieked and wailed about the perfidious Lieberman’s conduct—embellishing a bit as we go. But when have we ever done the hard serious work required for better outcomes?

Below, we continue our series on David Leonhardt’s recent piece about “scary/scare stories,” the kinds of scare stories which tend to drive American politics. Those “scare stories” tend to work because they trade on fifty years of pseudo-conservative messaging—messaging the other side has worked quite hard to establish. (Big government never did anything right! European health care is a disaster!)

During that period, our side has tended to frolic and play. (We completely sat out the 1990s, the era which sent George Bush to the White House.) Can we talk? We’re ugly and stupid and nobody likes us. On balance, we’re silly, self-impressed, frivolous people. We don’t deserve to win.

If it weren’t for all those people who die young from lack of insurance, we wouldn’t deserve to win. That said, our heroes have completely stopped discussing those people this week. Their plights have disappeared from our screeds. We’re much too progressive for that!

(In this piece in the Washington Post, Howard Dean quite literally doesn’t mention the subsidies which would let many such people get insured. Some are mothers of teen-aged girls, mothers who might otherwise die; see THE DAILY HOWLER, 9/17/09. We like Howard Dean a lot. But why on earth is that missing?)

Krugman is being polite today—polite to the pseudo-progressive who likes to watch the Idiot Maddow laugh at the funny tea-baggers. The baggers have thoroughly kicked our keisters this year—and Maddow is still frowning darkly and rolling her eyes at their dumb stupid dumb ways.

She slips her cool million into her pocket. We’re so dumb—and so well entertained—that we admire these born-loser instincts!

We can burn Joe in effigy, Krugman allows, at the start of a serious column. And we can boo-hoo for ourselves as we do. Of course, we could spend our time in a different way. Why has no one heard about Dean Baker’s post? We could spend our time looking into a mirror, asking our loser selves that.

Special report: The culture of scary stories!

PART 3—ABOUT THOSE OVERPAYMENTS: Sometimes, the analysts give up and cry. That’s what happened when they read Ruth Marcus’ column on Wednesday.

Marcus seems like a good, decent person. But this made the analysts cry:

MARCUS (12/16/09): A recent analysis of the Senate proposal by Richard Foster, the chief actuary for the Medicare program, offers a sobering demonstration of this reality. If the Senate measure were to become law, Foster concludes, overall health-care spending would increase by 0.7 percent, or $234 billion, over 10 years. The House measure, according to Foster’s analysis, would drive up spending slightly more, by $289 billion.

It's possible to read the report in a more hopeful light. By 2019, Foster estimates, national health-care costs will be growing at an annual rate of 6.9 percent, compared with 7.2 percent in the absence of reform. A welcome degree of "curve" bending—if it persists. That's a big if. The trend line for spending growth under health reform at the end of the decade is rising, and the gap between spending increases with and without health reform is narrowing.

To the analysts, that “more hopeful” reading was hopeless. The baseline of our health care spending shows that we currently spend two to three times as much, per person, as other developed nations. Anyone with an ounce of sense would understand an obvious fact: That baseline is built on large doses of looting. But at the Post, Marcus finds her spirits soar when she imagines a world in which our overall health care spending rises at only 6.9 percent!

6.9 is less than 7.2. But we couldn’t blame the analysts when they started to sob.

Unfortunately, we had a slightly similar reaction to parts of David Leonhardt’s worthwhile “Economic Scene” piece in last week’s New York Times.

Like you, we aren’t health care experts; we fight our way through the personality blather, looking for the occasional piece which sheds a bit of light on the merits of proposed health reform. And Leonhardt, warning about scare stories, said he thinks there’s a lot of good stuff in the Senate bill. He started by stating an obvious fact about our current health “system:”

It is abundantly clear that our medical system wastes enormous amounts of money on health care that doesn't make people healthier.

Most voters simply don’t know that—though we’d agree it’s “abundantly clear.” But Leonhardt, warning about “scare stories,” said there’s actually a lot of good cost-cutting stuff in the existing health bills. And he said he’s been seeing good signs from the Congress:

LEONHARDT (12//9/09): I'm as skeptical as anyone of the ability of the United States Congress to formulate good policy, but the last few days have offered reason to hope that its members may be summoning the political courage to endure the scare stories.

That would be a big deal. Health costs, through Medicare, are the main source of the huge long-term budget deficit. In recent years, they have also caused insurance premiums to rise so quickly that employers haven't had the money to give workers a decent raise. David Cutler, a Harvard health economist, estimates that the measures already in the health bills will increase the typical family's income $2,500 a year by the end of the decade.

Is real cost-cutting built into these bills? We progressives prefer to spend our time wailing about the demon Lieberman and complaining—at least several months too late—that the public option is gone.

Leonhardt said the Congress is (to quote his headline) “Finding the Nerve To Cut Costs.” We’d love to think that’s true, in constructive ways, because our current health care “system” is plainly built around large gobs of corporate looting. But sometimes, it can be discouraging to puzzle out the way these bills work. Leonhardt tries much harder than most—has done so throughout the year. But this is how he explained the Senate’s attempt to address “perhaps the single clearest example of overpayment” in the Medicare program:

LEONHARDT: One piece of encouraging news came on Saturday, when the Senate finally began listening to its own health care advisers.

To help it oversee Medicare, Congress set up an outside board of doctors, economists and other experts in 1997, called the Medicare Payment Advisory Commission. Medpac, as it's known, tries to figure out which services Medicare may be paying too little for, thus creating shortages, and which ones it may be overpaying for.

Perhaps the single clearest example of overpayment is home health care. Home health agencies, which care for Medicare patients with specific health needs (as opposed to those receiving general long-term care), have been proliferating in recent years. Yet, according to the most recent data, they still had fat profit margins on Medicare, 16.6 percent. One reason, the Government Accountability Office found, was that fraud was rife.

So Medpac has recommended cutting home health payments, and the Senate bill would do so, by 13 percent over 10 years. On Saturday, the Senate rejected a Republican amendment, supported by a few Democrats, too, that would have blocked that cut.

Maddening! According to Leonhardt, “fraud is rife” at these home health agencies—corporate entities which would thus be looting the public through the public’s Medicare system. And yet, what triumph does Leonhardt report? Rather than hunt down the fraud and punish the fraudsters, the Senate bill would simply cut overall payments to these agencies! Apparently, the fraud will persist! The fraudsters will simply have to find ways to cut back on overall costs.

Leonhardt tries much harder than most. To us, he has seemed to do much more serious work than most other major scribes this year. We were a bit frustrated by this passage, in which he adopts an odd sort of logic. But we were most struck by his column’s framework, in which he directly addresses a key problem in our politics.

Congress will face “scare stories,” he said. In our politics, those scare stories tend to work—tend to do lots of harm. But why are those scare stories so darn effective? We’ve pondered that question a lot this year. We’ll ponder again in Part 4.

Coming Monday—part 4: Why do those scare stories work?