The New Neo

Congress and health care reform: the hive and the worker bees

Posted on July 30, 2009 by neoJuly 30, 2009

As you probably know, the Democrat majority in Congress contains quite a few so-called “Blue Dog Democrats,” representatives of the party elected in districts that are relatively conservative. To a certain extent they are the mirror image of RINOs in the Seante such as Snowe and Collins of Maine—supportive of their party’s viewpoints on certain issues, but divergent on others (however, I get the impression the Blue Dogs are more true-blue Democrats on most issues than Snowe and Collins are true-red Republicans).

When we elect a representative, we tend to vote for whomever we think is the best person among those nominated for the job. Since most of us are not Washington cognescenti, we don’t usually think strategically about the way things work once those people go to DC and take their seats in Congress. But in that latter process, Party is King. And a party hierarchy determines the way the power flows.

I don’t pretend to be knowledgeable about all the details of the jockeying for position in the halls and dens and warrens of the House and Senate. But I do know that those who end up on top—Pelosi and Reid at this point—are hardly the ones with the most integrity or the deepest commitment to serving the people. They are the ones who know how to wield the power and crack the whip.

Exactly how they do so—what threats and what promises they offer, what methods they use to control their underlings—I’m not certain. Some of it must involve the awarding of perks such as committee placements and the like, as well as support in future elections vs. being hung out to dry, and the placement of local pork in bills of various sorts.

At any rate, we know that sometimes there is a huge disconnect between principle and pragmatism for members of Congress—that is, for those who still retain some smattering of principle. Sometimes they vote with the party and against their principles, in order to placate the Congressional powers that be. Sometimes—and this is perhaps true for at least some of the Blue Dogs right now—both their principles and their constituencies (and therefore their re-election chances) line up together to dictate a certain vote, such as one against Obama’s health care bill in its present form or anywhere near it.

But party unity has its own strong pull and a different sort of pragmatism, helped along by those behind-the-scenes threats and maneuvers. And yet, wouldn’t it seem to be counterproductive for party leaders to tell the Blue Dogs to vote with the party and yet in such a way that it would be likely to lead to those same Blue Dogs losing their bids for re-election in 2010, and their districts being represented by Republicans instead?

It would seem so, but I think it’s a case of priorities. And it defends how many votes the party has to spare on this bill. If it will pass handily without all the Blue Dogs, some of them will be allowed to defect. But if not, watch for the party to whip them into compliance (see this, for example).

The bottom line is that the party cares most about the party and its goals right now, not the fate of its individual members at some future date. Although the way the party gets its power is through the numbers, and of course this requires that many individuals from the party be elected, the identity of each of these people doesn’t tend to be especially important, nor would every single one of them ordinarily be required to be re-elected in order for the party itself to retain power (unless, of course, the party’s majority is very small, which is certainly not the case at present).

Pelosi and Reid know they are probably at their strongest point right now in terms of these numbers, and so its important for them to enact what they see as their agenda while they can. And this is the moment they think they can, so the individual principles and/or electoral fate of any one particular member of Congress is no concern of theirs.

Does the hive care about what happens to a worker bee or two (or three or four)? No, it’s the work itself that matters.

This is one of the reasons that, once a party has huge numbers in Congress, it tends to enact (or attempt to enact) an agenda the extremity of which causes it to lose popularity with the American people, which can lead to a backlash against the party in the next election. This overreach seems to be almost built into the system. The party is bargaining that the backlash won’t be great enough for it to lose control of Congress, and/or that the legislation they pass that is so important to their agenda now will be difficult to repeal once it has become law.

We got that swing

Posted on July 29, 2009 by neoJuly 29, 2009

Why do we swing our arms when we walk? It turns out that scientists find it has some advantages:

“Rather than a facultative relic of the locomotion needs of our quadrupedal ancestors, arm swinging is an integral part of the energy economy of human gait,” says the paper.

Or, rather:

Sowell on the “post-racial” Obama

Posted on July 29, 2009 by neoJuly 22, 2010

Thomas Sowell is a wonderful writer, one of those on the Right with whom I was unfamiliar until the last few years. His writing may lack flamboyance, but it is remarkably clear and concise, and this recent piece is one of his very best.

As a black man himself, Sowell compells extra respect in speaking on the subject of how Obama uses race. Here, for example, is one of the most succinct statements of what is so deeply wrong with Obama that I’ve ever seen:

[Obama] found it expedient to appeal to a wider electorate as a post-racial candidate, just as he has found it expedient to say a lot of other popular things ”” about campaign finance, about transparency in government, about not rushing legislation through Congress without having it first posted on the Internet long enough to be studied ”” all of which turned to be the direct opposite of what he has actually done after getting elected.

Those who were shocked at President Obama’s cheap shot at the Cambridge police for being “stupid” in arresting Henry Louis Gates must have been among those who let their wishes prevail over the obvious implications of Obama’s 20 years of association with the Reverend Jeremiah Wright. Anyone who can believe that Obama did not understand what the racist rants of Jeremiah Wright meant can believe anything.

Read. The. Whole. Thing.

Health care reform: Obama’s leadership skill set is lacking

Posted on July 29, 2009 by neoOctober 31, 2009

President Obama is not a leader.

By that I don’t just mean that I disagree with his agenda, or that I think he often lies to the American people, or that he’s not inspirational (although all of those statements do describe my position). I mean that, even from the point of view of a supporter on the Left, he seems to be an extreme disappointment at the moment in terms of getting his (and their) agenda passed.

One of the things that’s led me to this conclusion is that I’ve been doing a bit of reading on blogs on the Left and seeing the reactions there towards his strategy on health care reform. For the most part, commenters are angry at him because they feel he’s deserted the cause of single payer. To these people, single payer—despite Obama’s continuing to speak as though it’s important to him—is not being fought for sufficiently. They see single payer as not just one among many methods by which health care reform might be accomplished, but as the obligatory and necessary heart of the matter.

I’ve not seen their reasons for this primacy of single payer specifically articulated; it’s just assumed and implied. But one motivation seems to be hatred of private insurance and the profits therein; it’s a form of greedy capitalism, after all, and must be expunged from our national shame. Another seems to be idealization of the European and Canadian approaches, and a desire to emulate those countries. But whatever the reasons may be, there is a fair amount of rage at Obama, as well as at Congress and the Senate in particular, about the possible compromises being hammered out that eliminate the public option.

Some of that sentiment takes a form that would be familiar to anyone on the Right who has railed against the RINOs: throw the bums (in this case, the Blue Dogs in the House and various moderates Democrats in the Senate) out! Let’s elect us some real Progressives next time!

This plan is a bit shortsighted, since these people are from fairly conservative districts and would be likely to be replaced by Republicans if the Democratic Party mounted candidates sufficiently “progressive” to please its Left in the next election. But the point is that people on the Left are that angry, and a great many are saying the same about Obama as well: what’s the use of voting for him next time if he can’t get anything done?

I have a larger interest in another question, however: why can’t he get this done, considering what huge majorities he has in Congress? That question could be rendered moot of course (and my answers incorrect) if he ends up getting it done after all. But at the moment it looks as though a somewhat watered-down version of health care reform is all that will be passed.

The answer as to why it’s been so hard for Obama is one the Left don’t want to hear: America is not in favor of the solution they want, or the one Obama is offering. That may not matter to them—after all, they know better than stupid Americans, and we should be wanting what our intellectual and moral superiors on the Left think we should want. But it is certainly a fact that, despite the 2008 election results, America has still not turned sufficiently to the Left for most of these people.

And Obama has been foundering of late as a leader. This should be completely unsurprising—after all, if you look at his history, why would he be a leader? Obama is experienced in several things: campaigning, oratory, community organizing, and professorship. That is his skill set. You can see these elements all at work, big time, during his presidency. When in doubt, he falls back on one or several of them.

But presidents are required to do more. They need to get into specifics. They need to work with Congress. They need to persuade the reluctant. They need to reason, not spin. And they need to produce results. And Obama is bad at all of these, at least so far—thank goodness.

Some on the Left lament that Obama can’t pull an LBJ. Now there was a man who knew how to twist and manipulate and pressure and deal with Congress! LBJ had spent most of his life there, however, and had an acknowledged mastery of the game, legendary even before he became president. And although Obama did come from the Senate rather than a governorship, he was a freshman senator who spent almost no time there, and most of it campaigning. He is a neophyte compared to LBJ and other Washington insiders.

Obama lacks national legislative experience, but he also lacks executive experience, which is a huge part of a presidency. The perception is that he’s flailing around in that regard, unsure how to lead or manage or delegate properly. When in doubt, he falls back on propaganda and oratory.

But he’s having trouble controlling that message, too, as the adoring press becomes a little feistier and the public more demanding of results. Press conferences—as opposed to interviews by obsequious journalists—were never his forte, and as president he’s had to (or chosen to; take your pick) give quite a few so far. They’ve not gone well, especially the last one, which featured vague platitudes and generalities on health care, and the “stupidly” comment that led to Gatesgate.

I for one am glad Obama is turning out to lack leadership skills. Things are bad enough, and I shudder to think how much more of his agenda would have already been passed had he possessed them. Let’s hope he doesn’t learn on the job—unless he wants to lead us to policies that make more sense.

[ADDENDUM: Here’s an article that talks about the problem in different terms—that Obama is having trouble delivering his “message,” and is showing increasing frustration. For the Left, it seems to be mostly about competing narratives.

And here’s a quote on the topic of the Senate compromise vs. single payer, and the Left’s attitude:

Speaking of public option vs. co-op, the Finance Committee plan is either going to be the most brilliant piece of triangulation ever, or it’s going to open up a fight on the left that is U-G-L-Y. Clearly, the White House is VERY open to a co-op. It is trying hard NOT to bash the public option or show preference to a co-op. But Team Obama definitely has an open mind.]

[ADDENDUM II: Here’s an article I just found, with a pretty good summary of the fight on this issue between the hard Left and the liberals in the Democratic Party. And I just read this one by Michael Barone, who seems to pretty much agree with me.]

Talking back to cops

Posted on July 28, 2009 by neoJuly 28, 2009

Gatesgate has reminded us that one of the things that “everybody” knows is not to give cops a lot of lip.

This is information that most people learn by their late teens or early twenties, be they black or white, male or female, strong or weak, feisty or timid. A few “yessirs” and “nosirrs” (or the proper gender-adjusted terms of respect for a female police officer) sprinkled into the conversation doesn’t hurt at all, either.

Somehow, Professor Gates failed to learn this particular life lesson. And it’s not just all about cops wanting respect because of macho swaggering, either. A belligerent verbal attitude on the part of a civilian can be a warning sign of other belligerence to come, including the physical (and including the use of weapons), and the police can be the targets of the latter. That’s why they need to be alert to the possibilities of danger in every encounter they have with the public.

One of my early experiences with the police was during a cross-country drive with my then boyfriend (later to be husband). We were motoring along on a single-lane highway in Arizona, minding our own business and obeying the law, when we were pulled over by a cop. My boyfriend did the usual cautious thing—hands on the wheel, no sudden movements—as the trooper came over and explained that he’d seen him weaving, going back and forth erratically over the yellow line. Had he been drinking?

My boyfriend pointed to a large open bag of potato chips that was sitting on the console between our bucket seats. He’d been happily dipping into it and munching on them as we drove along.

“Officer, I was eating these,” he said.

The trooper frowned, and intoned in a serious voice, “You shouldn’t drive and eat potato chips like that. Next time, pull over if you want to eat potato chips.”

This struck me at the time as exceedingly funny. So very very funny that the laughter just bubbled up in me and spilled out. The trooper and my boyfriend both looked at me sternly and in unison, and I don’t know which one had the more annoyed expression (actually, I do; it was my boyfriend). The trooper was quite calm as he told me that this was no laughing matter.

And if you know anything about laughter, you probably know that it took every ounce of self-control I had to stop; after all, forbidden laughter is the most difficult to resist of all. But I did manage to stem my mirth and convince the trooper of the fact that I took the issue of driving while eating gobs of potato chips very seriously indeed.

He walked off after issuing a warning, and my boyfriend took a moment to impress on me the fact that you don’t mess with a trooper, and that includes joking. You just don’t.

And I never forgot it.

What’s an unnecessary medical test?

Posted on July 28, 2009 by neoOctober 31, 2009

Amidst all the wrangling on health care reform, one of the issues that often comes up is the elimination of unnecessary medical tests. Although everyone would probably agree that such a savings in cost and trouble would be a consummation devoutly to be wished, the question is: “unnecessary” according to whom, and how would this be determined?

“Unnecessary” is usually defined ex post factor, after all, as in: “A medical test that my idiot doctor ordered, which cost me a lot of money and no small amount of time and trouble and even perhaps pain, and turned up nothing in the end.” But at the time the test is ordered, many (perhaps even most) patients think it’s best to leave no stone unturned, and are pleased that their doctor is being so thorough.

Although we may want cost-effectiveness to be the criteria on which the “necessity” of such tests is judged for others, we tend to want no stone left unturned when it’s own or our loved ones’ health at stake. Cost-effectiveness evaluations tend to be very cold-blooded: “X” number of dollars per life saved or per life-quality improved, and those lives are not always measured the same, with the value of a young person differing from that of an old one. These calculations trouble a great many Americans, and are among the reasons most of us prefer to be allowed to choose among a variety of private health insurance plans, some of them more and some of them less restrictive than others.

And what about the medical reasons for these “unnecessary” tests? A certain test may be not be especially cost-effective, in the sense that there might be only a small probability that that particular procedure will turn up something in any one individual. But it might still be judged medically necessary to run that test if a doctor wants to practice good medicine in a difficult-to-diagnose case, to make sure to rule out a treatable condition that could be dangerous if left undiagnosed. Assuming that the insurance covers the test and it is not exorbitantly costly, such decisions are usually based on a balancing of the risk of side effects or damage to the patient as a result of the test vs. the probability of its uncovering something treatable. That’s a different sort of cost/benefit evaluation.

And then there’s another definition of “necessity,” one we patients often ignore but one that is quite important to the doctor: the need of the medical professional to cover him/herself against lawsuits. This is one of the dirty secrets of medicine that Obamacare refuses to address. Some portion of “unnecessary” medical tests are an attempt by doctors to stave off lawsuits by showing they exercised all possible diligence in diagnosis.

I can only conclude that anyone pretending that the elimination of unnecessary tests would be easy, is being neither serious nor honest about health care reform. And I’ve seen absolutely no evidence that would even begin to convince me that the task is the proper province of government, or that government would do a good job in making such judgments.

It’s Jello time again!

Posted on July 28, 2009 by neoJuly 28, 2009

Yes or no: is this the worst Jello dish ever?

And is it for real?

A video on Gatesgate that stands for itself

Posted on July 27, 2009 by neoJuly 27, 2009

[Hat tip: commenter “Darrell.”]

This woman, Kelly King, should run for President. She’s truly articulate, as opposed to the surface smoothness and careful word calibration of our President. And her affect matches her rhetoric; she burns with the slow fire of the knowledge that she’s telling the truth.

Let’s hear it for the olive race

Posted on July 27, 2009 by neoJuly 27, 2009

[Via Ann Althouse.]

It appears that Lucia Whalen, the woman who reported the two (race-unspecified) men breaking into Gates’s Cambridge house, would like to correct the record:

“Contrary to published reports that a ‘white woman’ called 911 and reported seeing ‘two black men’ trying to gain entry into Mr. Gates home, the woman, who has olive colored skin and is of Portuguese descent, told the 911 operator that she observed ‘two men’ at the home.”

Being of the olive persuasion myself, I’ve often bridled at being labeled “white.” And so I propose to that much-beleaguered good citizen Ms. Whalen (who has my sympathies for the unwanted and negative publicity her well-intentioned act has caused her) that we start a new racial classification hereafter to be known officially as olive.

How to sell health care reform, according to liberals

Posted on July 27, 2009 by neoOctober 31, 2009

I did a little reading yesterday about health care reform over at Matthew Yglesias blog. I was trying to learn the current liberal point of view on the subject.

Yglesias himself is frustrated at the American people, who don’t seem to understand (as he does) that what they really need is a fundamental change from a fee-for-service model for doctor reimbursement to one of salary-for-wellness. He cites seemingly contradictory data that says that Americans are satisfied with their own health care, and yet they feel that the system needs fundamental change and that rising medical costs are a threat to the economy.

Yglesias’s conclusion:

I just don’t really know what one is supposed to do in the face of public opinion data like that. Opting for the Barack Obama approach where you focus on reassuring people that the status quo won’t change too much seems like a smart play, even though the case for changing things a great deal is very strong.

I’m not sure whether Yglesias believes that Obamacare would in fact result in such a fundamental change and that, in order to sell it to the American people, Obama needs to dissemble; or whether Yglesias is chiding Obamacare for not going far enough to cause fundamental change, and therefore he believes Obama’s reassurances to be the truth.

At any rate, I don’t see anything in Yglesia’s piece (and only a single comment in the entire thread) that appears to understand the basic problem the American people have with Obamacare: they may want change in health care, but they want it to be for the better rather than for the worse. They want the freedom to make the important choices themselves, and they deeply distrust government’s ability to bring greater efficiency and cost-saving to the system (fearing that not only will the savings be illusory, but they will occur at the cost of Draconian and unwelcome rationing), as well as being mighty suspicious of the Democrats’ undue haste in trying to pass this enormous and life-changing bill so quickly. Those are the things that make the vast majority of Americans wary, not some sort of love of fee-for-service over salaries.

I haven’t done any other reading at Yglesia’s on the subject, so perhaps he does acknowledge these issues somewhere. But I found it remarkable that, in the thread I did read, issues of choice, liberty, distrust of government intrusion and government inefficiency, and distrust of the speed of the bill and its lack of transparency were difficult to find in either the post or the comments section (except for the inefficiency argument, which surfaces briefly in comment 6).

On the other hand, strongly present in both the article and in many of the comments was the idea of the American people’s stupidity and/or cluelessness, their ignorance about what’s best for themselves (something the blogger and most of the commenters profess to know). The entire thread reminded me of the way liberals often tend to talk about “the people” when amongst themselves—like Obama at the San Francisco fundraiser speaking of the bitter clingers.

The condescension is palpable:

The public at large doesn’t know the difference between fee-for-service and capitation, and probably wouldn’t care.

The trick is selling this change so it doesn’t frighten people. I would do it this way:
– tell people that you’re going to abolish co-pays and deductibles – “you’ll never have to pay anything but a premium.”
– tell them you’re going to pay doctors extra for improved outcomes – “we’re going to pay doctors more for making people better!”

Then turn round and trade the AMA non-profit Federal no-fault malpractice insurance in return for not causing a fuss.

Obama achieves bipartisanship at last

Posted on July 27, 2009 by neoOctober 31, 2009

Obama finally has achieved a certain measure of bipartisanship. The only thing is—it’s in opposition to his health care reform bill.

If a party with the huge majorities the Democrats enjoy right now in Congress is having trouble passing a bill, maybe that should be a clue that there’s something seriously and perhaps critically wrong with it. It seems that this particularly bitter pill that Obama and Pelosi are asking Congress to swallow comes in both red and blue.

[NOTE: James C. Capretta and Yuval Levin at the Weekly Standard point out some of the major drawbacks of Obamacare. In sum: “paying more for a worse health care system.”]

Required reading on Honduras

Posted on July 27, 2009 by neoAugust 28, 2009

Maybe President Obama can find a moment in his busy day to take a look at this WSJ piece, wherein new Honduran president Roberto Micheletti gives the former constitutional law lecturer a Con Law lesson.

Read the whole thing; it’s well worth it. But here’s a brief excerpt [emphasis mine]:

Like America, our constitutional democracy has three co-equal and independent branches of government””a fact that Mr. Zelaya ignored when he openly defied the positions of both the Supreme Court and Congress. But we are ready to continue discussions once the Supreme Court, the attorney general and Congress analyze President Arias’s proposal. That proposal has been turned over to them so that they can review provisions that impact their legal authority. Once we know their legal positions we will proceed accordingly.

The Honduran people must have confidence that their Congress is a co-equal branch of government. They must be assured that the rule of law in Honduras applies to everyone, even their president, and that their Supreme Court’s orders will not be dismissed and swept aside by other nations as inconvenient obstacles.

Prominent among those “other nations,” of course, is our own, to Obama’s unending shame. Perhaps lawyer and Con Law scholar Obama might some day be able to articulate the reasons why he felt the need to so flagrantly ignore the rule of law and distort the facts in Honduras. Till then, I suppose we’ll just have to guess.