Needlenose

Barbara O’Brien of Mahablog fame asked to post on Needlenose.  Happy to post anything that bashes Confederates, particulary of the reactionary persuasion, so here goes:

Recently I wrote here that Mississippi has the worst health care in the nation. Now I want to tell the story about how desperate Mississippians, abandoned by their government, turned to Iran for help.

Bt first, I want to tell you about Mississippi’s infant mortality rate. The rate of infant mortality is the number of infants who are born alive but die before their first birthday, per 1,000 live births. In other words, if infant mortality is 5, that means that 5 of every 1,000 babies in that population will not survive the first year of life.

According to the CIA World Factbook, the estimated infant mortality rate in the United States for 2009 is 6.22, which is high for an industrialized democracy. But according to the U.S. Census Bureau, the infant mortality rate in Mississippi is 11.4. Only Florida is worse, at 14.1. By contrast, the infant mortality rate for Washington and Minnesota is 5.1.

Now, here’s where Iran comes in — according to the Times of London, last October “five top Iranian doctors, including a senior official at the health ministry in Tehran, were quietly brought to Mississippi” to advise Mississippians how to lower their infant mortality rate.

This exchange came about when James Miller, managing director of Oxford International Development Group, was consulting in a rural Mississippi hospital. “He was shocked to find that the state had the third highest medical expenditure per capita, but came last in terms of outcome,” the Times article said.

Miller remembered a conference presentation on how Iran radically lowered its infant mortality rates. Facing a shortage of doctors and hospitals, the government launched a program of “health houses” staffed by local people trained to be health workers. The health workers are authorized to provide basic medical services such as diabetes monitoring as well as prenatal and obstetric care. Infant and maternal mortality rates both fell dramatically as a result.

James Miller contacted Iranian doctors to find out if their program might be applied to Mississippi. So the Iranian doctors came to Mississippi to give advice. Although the idea of following an Iranian model was a hard sell in Mississippi, at least one community has begun work on an Iranian style “health house” to provide better care for pregnant women abandoned by Mississippi’s health care system.

Dr Aaron Shirley, who worked with James Miller on the Iranian project, admitted they were staying under the radar. Mississippi government officials, including Governor Haley Barbour, were not involved or informed.

This takes us back to the issue identified in the earlier post — Mississippi has the worst health care in the nation, but as far as Gov. Barbour is concerned, this is not a problem. The governor is perfectly clear, on his website and in public pronouncements, that Mississippi fixed its health care problems by passing a comprehensive tort reform bill in 2004. The 2004 law affected all kinds of personal injury lawsuits in Mississippi.

In the U.S., state after state has passed “tort reform” laws that make it harder for citizens to file personal injury suits and also limit the amount of damages they can receive. This is a critical issue for people with asbestos-related disease such as mesothelioma cancer, who so often need damage awards to care for themselves and their families. “Tort reform” also is being pushed by conservatives nationwide as the way to fix the nation’s health care crisis.

But Mississippi reformed tort in 2004, and it still has the worst health care in the nation. What did Governor Barbour “fix,” exactly?

-Barbara O’Brien

(Images via Witty Comics.)

Just assume a kayak and 2,756 miles' worth of stamina, and you're there!

Speaking of Fubar (as Green Boy was just below), about a month ago he passed along an off-site remark about Google Maps providing “driving directions” from San Francisco to Hawaii — including the awkwardly roundabout need to kayak from Washington state across the Pacific.  My reply, based on that week’s progressive disappointment in the White House, was that  President Obama must have used similar software in figuring out his escalate-in-order-to-withdraw strategy in Afghanistan.

Little did I know that despite my terminal procrastination in posting about that topic, the same half-hearted snark would be appropriate with regard to the state of healthcare reform… and even that requires a large quantity of optimism.

As you undoubtedly know by now (um, unless you’ve been depending on this blog to keep you informed of breaking news developments), separate reform proposals have passed in the House of Representatives and the Senate — with the latter bill’s benefits so thoroughly diminished that whether it’s any improvement at all over the present system is a matter of fierce debate in the progressive blogiverse.  In fact, Obama himself is under intense criticism for having exerted so little visible effort to avoid the legislative emasculation that occurred in the Senate.

In Obama’s defense, though, this is a situation that he apparently planned for early on in the year, as Brian Beutler reported for TPM back in August:

Dick Durbin (D-IL), the number two Democrat in the Senate, says President Obama wants to move forward with some form of health care bill quickly, and then fight the fight over particulars in negotiations with the House of Representatives. . . .

“… we are trying to walk this tightrope to get this bill through. The House [of Representatives] is likely to include it [a public option]. The Senate may not. Then we go into conference committee and President Obama has to roll up his sleeves and see if he can bring us all together. And when I’ve spoken to him about this a couple times, all he’s said is: ‘Get me to a conference committee. Let me bring these folks into a room, and let me work and get it done.‘”

Okay, so the Democrats in Congress have gotten healthcare reform to a conference committee, as Obama claims to have wanted.  Indeed, in his own comments on the subject, the president echoed Durbin’s language:

“… we hope to have a whole bunch of folks over here in the West Wing, and I’ll be rolling up my sleeves and spending some time before the full Congress even gets into session…. I intend to work as hard as I have to work, especially after coming this far over the course of the year, to make sure that we finally close the deal.”

The question is, rolling up his sleeves to do what?   Conventional wisdom has already hardened that whatever comes out of the House-Senate negotiations will be essentially identical to what passed the Senate (even if that bill is at least slightly improved over its worst incarnation) — lest it fall prey again to the unpredictable whims of Ben Nelson and Joe Lieberman as they threaten to join a Republican filibuster.

It seems like daydreaming at this point to imagine that Obama could move the bill in a more robust (and progressive) direction, then finally mount the bully pulpit, using the inherent popularity of a “public option” and similar features to pressure the centrist corporatist Dems into allowing a simple majority vote.  And yet, Obama’s speech to Congress in September showed that he could move the needle of popular opinion on healthcare reform, if only he cared enough to try.

Another possibility is the strategy that Nate Silver outlined a couple of weeks ago:

… the idea is to “surprise” the Senate by unexpectedly introducing additional provisions under reconciliation once you’ve already got the main portion of the bill passed. Does this sound attractive to you? Well then, the best thing to do would be topass the bill as is now, since that is the first step in the strategy. To repeat: the most promising application of the split-bill/reconciliation strategy involves passing what you can now — not killing it.

Silver sees this as also being unlikely, but it was also proposed by wonk-blogger Mark Schmitt back in July…

Use the 60-vote Senate to pass whatever they can pass now — we liberals will grumble but live with it — and then use reconciliation next year to fix it. With the exchange structure and subsidies established, it wouldn’t be hard to add an employer mandate, which would save money. With the rudiments of even a weak public plan in place, it wouldn’t be complicated to expand it and modify its eligibility rules, in ways that might save or cost money but in either event, involve budget changes to an existing program rather than creating something new. Aggregating small changes over the next few years (on the model of the steady expansion of Medicaid engineered by Henry Waxman and others over the 1980s and 1990s) could non-controversially build the kind of robust and equitable system we dream of.

… and Sen. Tom Harkin, a public option supporter, hinted at it two weeks ago (“We have to get this bill passed, and then we’ll come back and revisit the public option at some point.”)

Assuming the House and Senate finish making their legislative sausage by Obama’s “State of the Union” address to Congress, wouldn’t it be something of a political masterstroke for the president to announce a plan to strengthen and complete the watered-down bill by passing an expansion of Medicare using budget reconciliation rules?  That would be a classic example of doing the hard, unpleasant work during the off year, and delivering the most popular aspect of reform right before the 2010 elections.

If Obama lacks the chutzpah to even try that, instead settling for the cautious, least-resistance path of accepting whatever meager reforms the Congress will pass on its own, then he deserves whatever he gets — in terms of public opinion and a demotivated base going into the 2010 elections — for his failure to lead.  Just standing by and watching as others do all the rowing isn’t enough; at some point, the president has to grab an oar, too, or we’ll never get anywhere.

So, the Obama administration got a wake-up call suddenly concerned on Thursday about the health care reform drubbing it was taking in the progressive blogiverse, and held a conference call to try to stop the bleeding:

White House senior advisor David Axelrod and health care adviser Nancy-Ann DeParle held a conference call Thursday night with progressive bloggers — in what Axelrod described as a bid to clear the air after several tense days.

… In response to one blogger who chided the White House for failing to fight for the public option while taking “potshots” at the liberal activists, DeParle said: “The president is fighting for this. … You have no idea how many hours, how many hundreds of hours he has spent, how many phone calls he has made, how many meetings he has had. … We need your help and we don’t mean to be chiding you. But please appreciate how hard this is.”

… According to an account on DailyKos, DeParle said the provisions in the Senate bill need to be improved and moved closer to what the House bill includes, particularly on affordability.

Awww, I feel all warm and fuzzy now.  They like us, they really like us after all!  Except someone had to go and step on the (revised) message right away (via the Wall Street Journal):

Turn off MSNBC. Tune out Howard Dean and Keith Olbermann. The White House has its liberal wing in hand on health care, says White House Chief of Staff Rahm Emanuel….

… Emanuel pointed to a New York Times column by economist Paul Krugman and another coming from National Journal writer Ronald Brownstein pressing for passage of the Senate health bill. “What you’re seeing is the progressive backlash against the progressive backlash,” he said.

Nice going, Rahm.  Whatever small amount of goodwill the Axelrod-DeParle call created, you just undid it.  The boss must sure be glad he has you as his political mastermind.

(Cross-posted at Firedoglake.)

The Dems have rebranded themselves as the Spineless Whimp Party, or Whimps for short.

*Update 12/14/09* Senator Tom Harkin grows a spine – will he be expelled from the Whimps?

It’s becoming obvious now that the protracted drama of the Senate Finance Committee, long feared to be the beginning of the end for meaningful healthcare reform, really was just the end of the beginning.  Now that a version of the bill has been pried loose from Sen. “Max Tax” Baucus and his committee, the real negotiations — and posturing — have started.

That’s why Joe Lieberman and Evan Bayh are making noises about not ruling out a filibuster — but hey, they can be bribed persuaded not to join one, too!– and why Jay Rockefeller and Chuck Schumer (and Nancy Pelosi, on the House side) are applying pressure in the media for a robust public option.  Everyone’s jockeying for position.

Jon Walker’s post at FDL Action today sums up the state of play nicely with a quote from Tom Harkin:

There are 52 solid Democrats for a public option and only about five Democrats really kind of opposed to it…. One has to ask if the 52 should give into the five or if the five should come on board with the vast majority.

And you know what?  That’s how everyone knew (or should have known) this was going to wind up back in January — with a handful of faux-centrist Senators threatening to sabotage a Democratic president for at least the third straight time, and everyone else wondering how to get around that obstacle.

But this also means that of all people, Barack Obama should have a plan for how to deal with this situation.  I’ve been more naive optimistic than many progressive bloggers, holding out hope that Obama really does want a public option in the final healthcare bill — not out of his innate progressive nature or the goodness of his heart (always a bad bet when it comes to politicians), but due to his own stated recognition that whatever passes needs to work, or he’s going to pay the political price for the resulting fiasco just as surely as if the bill had been defeated.

That’s why I’m not surprised to read that Harry Reid is reportedly working behind the scenes “for the best possible public option coming out of conference” (though those last four words are worth noting, and perhaps being alarmed over), or to see Nancy Pelosi’s forthright defense of a public option yesterday just before appearing with President Obama at two events in San Francisco (where his praise of her would seem odd if she’d just thrown his alleged secret desire to kill the public option under the bus).

But now’s the time for Obama to stop forcing us to imagine what his real intentions are. We all know how solicitous he’s been of Max Baucus’s endless delays and whatever whim Olympia Snowe chooses to express on any given day, and not openly pressuring Democratic senators who have spoken against a public option.  I’ve tried to give Obama the benefit of the doubt, figuring that he’s worked directly with these bozos colleagues in the Senate and knows what preening, obnoxious assholes they are how sensitive they are to being pressured.

At the end of the day, though, he’s got to persuade them to do the right thing.  And the end of the day is rapidly approaching.

(Cross-posted at Firedoglake.)

Lindsay Beyerstein of the Media Consortium caught up with Howard Dean after an event in New York, capturing her brief, exclusive interview with him on video.

She asked Dean what it would mean if Democrats passed healthcare reform through the Senate using budget reconciliation rules, rather than relying on the whims of faux-centrists (Snowe, Lieberman, Nelson, et al.) to get a filibuster-proof 60 votes.

His response was that reconciliation would produce a better healthcare reform bill, and not just (as Lindsay notes) because of a lessened need to water the legislation down.

Saying that “the best way to do the public option is to have it be part of Medicare,” Dean points out that using reconciliation rules for a budget resolution would force the bill in this direction, because “there would be no question that an expansion of Medicare was germane and permitted in the budget resolution.”

Another benefit, Dean adds, is that “for political reasons, the Democrats need to get this done by 2010, so some people can sign up for it by 2010. And the only way to do that is to use an existing bureaucracy.”

The advantage isn’t just the typical desire of politicians to point at tangible results of their legislative work, either:

Implementing it [a public option] immediately for significant numbers of Americans is going to deflate all the lies that Republicans tell about this bill. Once people actually start to sign up, they’re going to find out that all those things weren’t true.

. . . Once health care reform actually goes into effect, the Republicans who are only selling fear and anger — that’s all they’re selling — that has to go away, because reality will always trump fear and anger.

Dean cites his experience with civil-unions legislation in Vermont as proof of this. All Democrats need to do is find the will to make the reality happen.

(Cross-posted at Firedoglake.)

Alec MacGillis of the Washington Post attended the AFL-CIO convention in Pittsburgh yesterday, and wrote this about President Obama’s speech there:

In a fiery speech to the nation’s largest labor federation, Obama urged members to get behind his proposal to overhaul the health-care system, which he vowed would pass in the next few months. To his audience’s satisfaction, he reiterated his support for including a government-run insurance plan, or public option, among the choices for consumers — a top priority for AFL-CIO leaders. And he dropped some of the language he used in last week’s health-care address to Congress in which he seemed to play down the importance of the public option.

But Jeff Zeleny of the New York Times was also there, apparently in the same convention hall but a different world:

A week after he asked Democrats in Congress to support the outlines of his health care plan, Mr. Obama made a similar but broader case to union audiences here and earlier Tuesday in Ohio. . . .

Yet despite the thunderous applause he received, his mentioning the term “public option” only once during a 35-minute speech at the convention did not go unnoticed. Many delegates carried signs and wore T-shirts declaring that a government-run insurance program was a nonnegotiable piece of health care legislation.

I suppose this is better than MacGillis and Zeleny getting together and deciding among themselves what the approved spin should be.  But still…

As you may know, there’s a psychiatric condition known as Münchausen syndrome by proxy, one of the manifestations of which can be loosely defined as putting someone or something else in jeopardy so that you can be a hero by “saving” it.

For obvious reasons, this came to mind as I watched a surprisingly reinvigorated Barack Obama give his speech to Congress on Wednesday night.  As columnist E.J. Dionne wrote for the Washington Post, “After a listless summer during which his opponents dominated the health-care debate… it seemed as if a politician who had been channeling the detached and cerebral Adlai Stevenson had discovered a new role model in the fighting Harry Truman.”

Then again (though I know I might be inviting sneering about “multi-dimensional chess” and the like), there may have been a method to the seeming madness of Obama’s lackadaisical summer attitude toward healthcare reform.  A New York Times story a few days ago navel-gazed about how Obama has attempted to learn lessons from the failure of Bill Clinton’s healthcare proposals in 1994:

That 15-year-old lesson underscores how much the Clinton debacle has defined Mr. Obama’s drive for his domestic priority from the beginning, providing a tip sheet for what not to do. Even Mr. Obama’s decision to address a joint session of Congress on Wednesday night to jumpstart his health initiative left some aides wary, given the inevitable parallels with Mr. Clinton’s September address 16 years ago to introduce his ill-fated plan.

I can point out a key difference just from the numbers in the quote above — Clinton’s speech was in September 1993; his reform bill died nearly a year later.

Obama quite likely concluded that the momentum from a single speech (particularly given the ever-shortening modern news cycle and attention spans) couldn’t possibly last an entire year.  It could, however, trigger a short legislative sprint of two months or so.

Thus the now-obsolete insistence earlier this year on a health bill by August wasn’t really intended to get a bill by August; rather, it was intended to provoke enough movement that a bill by Thanksgiving would be in striking distance.  (The declaration in the spring of an October 15 target date for invoking reconciliation is further evidence of this.)

All this, of course, leaves open the question — which, you might have noticed, is being pressed rather forcefully in many parts of the liberal blogiverse — of what kind of bill Obama hopes to pass with this last-minute rescue effort.  To go out really far on an optimistic limb, think about the president’s especially Munchausen-like treatment of the public option, which has been not merely thrown under the bus but tied to railroad tracks, hung over the edge of cliffs, and subjected to every other imaginable sort of peril in news reports.  And yet Obama continues to include it, at least nominally, in his proposed legislation.

Everyone who understands how important a public option is to successful healthcare reform feels terribly jerked around by now.  But then, the corporate-owned “centrist” types who have balked at a robust public option are probably feeling the same way about Obama’s refusal to officially kill it.  Like the old story of the carrot and the stick tied to the donkey’s back, the public option’s demise seems eternally just a few inches away, but never arrives.

Perhaps Obama is just waiting for the very last second to throw it away as a bargaining chip.  But if I were one of those hacks centrists, I’d be very nervous about the resilient popular support for a public option tempting Obama to champion it in fall rallies, daring them to vote against it.  As many other folks have observed, the momentum would be almost impossible for any politician, no matter how thoroughly bought off by the insurance companies, to resist.

Of course, that same possibility will make it all the more shameful if Obama really does surrender on the public option.  But I’ve waited 15 years just to have hope again, so I’ll cling to it for a few weeks longer.

(Cross-posted at Firedoglake.)

Highlights from the partial text released by the White House:

I am not the first President to take up this cause, but I am determined to be the last. . . .

Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point. . . . During that time, we have seen Washington at its best and its worst. . . .

Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week.  That has never happened before. . . . And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government.  Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise.  Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge.  And out of this blizzard of charges and counter-charges, confusion has reigned.

Well, the time for bickering is over.  The time for games has passed. Now is the season for action. . . .  Now is the time to deliver on health care.

The plan I’m announcing tonight would meet three basic goals: It will provide more security and stability to those who have health insurance.  It will provide insurance to those who don’t.  And it will slow the growth of health care costs for our families, our businesses, and our government. . . .

Here are the details that every American needs to know about this plan: First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have.  Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you.  Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most.  They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime.  We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick.  And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care. . . .

Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices.  If you lose your job or change your job, you will be able to get coverage.  If you strike out on your own and start a small business, you will be able to get coverage.  We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices.  Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage.  This is how large companies and government employees get affordable insurance.  It’s how everyone in this Congress gets affordable insurance. . . .

This is the plan I’m proposing.  It’s a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans.  And I will continue to seek common ground in the weeks ahead.  If you come to me with a serious set of proposals, I will be there to listen.  My door is always open.

But know this:  I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are.  If you misrepresent what’s in the plan, we will call you out.  And I will not accept the status quo as a solution.  Not this time.  Not now.

Obvious comment:  Who is this assertive, confident guy, and where has he been hiding the past several months?

Maybe it’s just, as someone once said, that you don’t roll out a new product before Labor Day….

Update: On the public option…

Now, I have no interest in putting insurance companies out of business.
They provide a legitimate service, and employ a lot of our friends and
neighbors. I just want to hold them accountable. The insurance reforms
that I’ve already mentioned would do just that. But an additional step we
can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

Despite all this, the insurance companies and their allies don’t like this
idea. They argue that these private companies can’t fairly compete with the
government. And they’d be right if taxpayers were subsidizing this public
insurance option. But they won’t be. I have insisted that like any private
insurance company, the public insurance option would have to be
self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only *one* part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect
only in those markets where insurance companies are not providing affordable
policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.