Healthcare

Healthcare Reform Politics

Date: August 6, 2009
Author: Bob Griendling
Categories: Healthcare

Matt Yglesias sums up a plausible healthcare strategy:

if I were a member of congress in addition to the polling I’d be thinking about how things will actually look to people when a bill passes. If you think Medicare recipients will continue to be happy with the quality of the health care services they receive, then you should assume that Medicare recipients will continue to be happy with the quality of the health care services they receive. Conversely, if you promise younger people that your bill will improve their health care, you’d better deliver something that actually improves their health care. Whether or not you sell them on it in advance seems less important than whether or not what you did looks good in retrospect. [emphasis added)

I suspect that the main reason Obama wants healthcare reform passed quickly is not so much that he felt he had momentum, but that he needs a little time after it passes for people to calm down, get familiar with the new environment and see that they won’t be hurt but may be helped by reform.  Seniors especially need time to realize that Medicare won’t be changed. 

I suspect it will be years before the impact of the bill becomes fully realized.  But if not much changes in a negative way come November 2010, the electoral prospects for Dems will not be as grim as they might be if no reform was passed.

Town Hall Meetings

Date: August 6, 2009
Author: Bob Griendling
Categories: Healthcare

The fuss over town hall meetings reminds me of the time more than 10 years ago when our local county supervisor held a meeting about a controversial subject: putting a cell phone tower on our neighborhood’s pool property.

After brief remarks, she began to take questions and listen to comments.  Most of them were skeptical if not down right hostile to the idea.  Those of us on the pool board had encouraged everyone, including people inclined to support the construction, to attend.  But it was clear from the questions she was getting the impression that this was not going to fly. 

I then suggested to her to ask for a show of hands for and against.  She was shocked to learn that a sizable majority supported the idea.  It was the turning point in our effort to get it built.  (Without the income from it, our community pool would have closed years ago.) 

After a 13-month battle, requiring approval from the planning commission and the board of supervisors, we received approval and got it built.

If supporters of health reform can get out to these town halls, they should ask for a show of hands.  They should ask that the question before the group be “How many of you support some kind of healthcare reform?”  If we don’t win that question, then we don’t deserve healthcare reform.

Stifling Free Speech, Part 2

Date: August 6, 2009
Author: Bob Griendling
Categories: GOP Dirty Work, Healthcare, Obama

ABC is reporting that Texas Republican Senator John Cronyn is sending a letter to the White House complaining that the Obama administration is stifling free speech by asking supporters to send the administration any “fishy” emails they receive about healthcare reform.  “Fishy” is a funny word to use in this case, as what they apparently were referring to emails that make claims about reform that the reader finds unusual given what s/he heard from reputable sources.

Seems Republicans want to make any outrageous claims they want to without being scrutinized.  What they want is to limit my free speech by prohibiting me from telling others that their claims are wrong.

But fishy was the wrong word.

Stifling Free Speech

Date: August 5, 2009
Author: Bob Griendling
Categories: Healthcare, Media Criticism

CNN is refusing to air an ad by supporters of healthcare reform.   

Here’s the reason:

“This ad does not comply with our clearance guidelines because it unnecessarily singles out an individual company and person.”

Gee, does that mean they will no longer run ads that single out individual politicians?  Or is that “necessary”?

Isn’t it ironic that an organization protected by free speech denies it to others.

This is happening frequently.  CNN also refused to air an ad by Media Matters about Lou Dobbs.

Taking a Chance on the American People

Date: August 5, 2009
Author: Bob Griendling
Categories: Healthcare, Message

President Obama has tacked a bit over the past few weeks and is trying to sell his healthcare reform as heath insurance reform.  He is doing so by employing a GOP strategy:  appeal solely to people’s selfish interest.

[W]hen President Barack Obama gave a nationally televised news conference to explain his health care policies, he focused on two narrow questions that are defining the health care debate in Washington: “What’s in this for me?” and “How does my family stand to benefit from health insurance reform?”

The U.S. Constitution calls on Americans to “promote the general welfare.”  There was a sense during the presidential campaign that Obama subscribed to that notion.  But he seems unwilling to make that argument, especially when promoting healthcare reform.  Why not ask for sacrifice?

For uninsured Americans, health care reform represents a bonanza. For millions of other Americans (many of whom like their health care coverage), reform will mean more in the long term but potentially less in the short term: fewer tests, a demand for changed lifestyles and, as Obama suggests, a more “discriminating” approach to the health care system.

For doctors, reform could mean less take-home pay; for small businesses, new mandates; and for insurance companies, more government regulation and greater competition.

In short, all members of the health care ecosystem will have to change their behavior so that, in the end, the overall system will be more efficient and more effective.

Sacrifice is a tough sell.  But if Obama asked for it in the name of our children, he might succeed.  People like to think they are leaving a better world to their children.  Asking people to make sacrifices so that the next generation will not be stuck with the healthcare tab for our generation, he might at the very least squelch the wackos yelling at town hall meetings.

We have been self-indulgent and careless with our health.  We baby-boomers will cost a lot to care for in our later years.  Under the current system, insurance premiums will continue to rise to pay for that care.  And our children will get stuck with that bill.

The president has sought to reassure Americans that nothing will change for them with reform. But if Obama’s goal is far-reaching and not incremental change, then inevitably he is going to have to ask Americans to give something of themselves for the greater good. It’s foolish to think that there can be serious policy changes that don’t involve someone’s ox getting gored, whether the issue is health care, climate change or any other policy shift that will have an effect on the way Americans live their lives. Obama clearly wants to be a change agent, but he’s not pushing Americans to do their part.

For a politician who rose to prominence by using the force of his words to inspire and energize millions of Americans, such a call for sacrifice and citizenry responsibility has been strikingly absent from his rhetoric. During his campaign for the White House — and even in his inaugural address — Obama showed little inclination to merge patriotic devotion with civic responsibility, à la John F. Kennedy or even Lyndon B. Johnson. The result is a debate on health care focused on making the system more efficient rather than more fair.

In his election night victory speech, Obama said, “Let us summon a new spirit of patriotism, of responsibility, where each of us resolves to pitch in and work harder and look after not only ourselves but each other.” The time has come for the president to demand of his fellow countrymen that they help make that pledge a reality.

Characterizing Poll Numbers

Date: July 20, 2009
Author: Bob Griendling
Categories: Economic Policy, Healthcare, Media Criticism, Washington Post

I’m thinking that if newspapers are to survive, they need a better way of delivering information.  It’s not only a paper vs. web dichotomy.  A lot of folks, me included, cannot envision a world without a paper to hold in one’s hands and the ability to have a story catch your eye while reading another.  That’s harder to do on the web.

One way to improve delivery is to re-think the need for every story to be a narrative.  But I’ll leave the larger question for a future post.

But certainly, a story that doesn’t lend itself to a narrative is reporting a poll.  Sure, some analysis is necessary for some readers.  But too often the interpretation inherent in a narrative is worthless.  Today’s poll story in The Washington Post is one example,  It would have been a better use of newsprint to simply present a chart with the key questions (if the entire poll results are too space consuming).

The problem comes with the headline and adjectives and adverbs that inevitably accompany poll stories.  The Post’s headline is “Poll Shows Obama Slipping on Key Issues.”  That’s the most many readers will see.  It’s accurate, but polls need to be taken in their entirety.  And the picture is more mixed.

At the same time, there is no slackening in public desire for Obama to keep pressing for action on the major issues of the economy, health care and the deficit. Majorities think he is either doing the right amount or should put greater emphasis on each of these issues.

So whatever his slackening of support about his specific policies, folks want him to continue fighting to change things.  And in many ways, politics is an either or proposition. 

Obama’s handling of the economy, the deficit and health care reform outpaces the Republicans by about 20 points.

So if his handling of things is 20 points better that GOPers, and folks want him to continue fighting, a stalemate is not what they’re looking for, much less the GOP solutions (if any).

And while, 49 percent approves of his handling of the healthcare issue,

On health care, the poll, conducted by telephone Wednesday through Saturday, found that a majority of Americans (54 percent) approve of the outlines of the legislation now heading toward floor action. The measure would institute new individual and employer insurance mandates and create a government-run plan to compete with private insurers. Its costs would be paid in part through new taxes on high-income earners.

What that “legislation” is, is questionable as there are several plans now working their way through Congress.

But the problem I have with many of the poll stories is that the reporters feel compelled to interpret them for us.  The tenor of this report is that Obama is slipping and people are losing confidence in him, despite the findings that most people still consider him a strong leader.

Obama’s leadership attributes remain highly rated, despite some slippage. Seven in 10 call him a strong leader, two in three say he cares about the problems of people like themselves, and just over six in 10 say he fulfilled a central campaign pledge and has brought needed change to Washington.

As an example of perhaps misplaced adverbs,

More than three-quarters of all Americans say they are worried about the direction of the economy over the next few years, down only marginally since Obama’s inauguration. Concerns about personal finances have also abated only moderately since January. [emphasis added]

That “moderate” abatement in concern about their personal finances is seven percent, from 70 percent in January who were worried to 63 percent today.

Yet the key figures that support the thrust of the story – he’s slipping significantly — are reflected in eight to nine point drops:

Approval of Obama’s handing the economy dropped from 60 percent in February, the earliest date available in the poll, to 52 percent, an eight point drop.

Approval of Obama’s handing the economy dropped from 57 percent in April, the earliest date available in the poll, to 49 percent, an eight point drop.

Approval of Obama’s handing the deficit dropped from 52 percent in March, the earliest date available in the poll, to 43 percent, a nine point drop.

So what makes an eight to nine point drop significant enough to support the thrust of the story but a seven percent drop is only “moderate.”

The answer is simply:  If the story was “Obama drop in support for policies is only moderate,” well, it might not make the front page.

The Post would have been better of simply printing a chart of the results, and let us interpret them.

Obama Grabs the News Cycle on Healthcare

Date: July 17, 2009
Author: Bob Griendling
Categories: Healthcare, Message, Message Delivery, Obama

The president just finished a rather unusual Friday 4 p.m. statement – without taking questions.  It was on healthcare, and it again demonstrated his ability to take the long view.  More important, it was a demonstration to the public of his ability to do just that.  It positions him as someone who cares about the future and not about political points. 

Obama has a knack for demonstrating to the public that he is thoughtful.  This statement was exactly that.  He took, in his words, “the long view” of the healthcare debate.  Just knowing someone is taking that view reassures the public.

He first focused on the idea that we have a consensus that something that needs to be done.

He then ticked off those who support him by listing the organizations that have either agreed to concessions or who have endorsed his plans – the pharmaceutical Industry, hospitals, nurses and the AMA.  What that does is reassure people that “your doctor is behind me.”

He also talked about the need to improve “preventive and wellness programs.”  Which is a way of saying, “Americans, you need to take responsibility for your health, without sounding like a fitness nut.

He used words like “stability and security,”  which can resonate in these uncertain times.

He then talked about keeping coverage even if you lose your job and not losing coverage for preexisting conditions.  Those are two key points.

He then addressed how we pay for it.  He discussed not adding to our deficit, paying for immediate changes and slowing long-term health costs.  He repeated that point, and sure enough, the news program I was watching, Bloomberg, emphasized that point. 

He made a plea for controlling costs by having independent doctors and others over seeing costs. Which means taking Medicare payments control away from Congress.

He finished by saying, “Now is not the time to slow down” on healthcare reform.  If we step back, we we assigning our children to crushing deficits and increased healthcare costs.”  It’s always a good idea to frame the debate with cherub faces.

He also said that “If we don’t get this down, no one insurance is secure.”  Which polls suggest the public understands.  Even if they like their current insurance, they know we have a problem.

Sure enough, the Bloomberg anchor, led with “Sounding confident, Obama…” and then mentioned the support he has among key players.

This guy is as good if not better than Reagan.

Myth of Small Business Job Creation

Date: July 8, 2009
Author: Bob Griendling
Categories: Economic Policy, Healthcare, Small Business

The Washington Post’s Steve Pearlstein argues that the meme that comes mostly from Repugnicans is patently false.

Suffice it to say that, in terms of new job creation, the data show that most of it happens in a small number of very fast-growing companies that are no longer what most of us would consider small. There are lots of reasons for the success of these fast-growing firms, among them the ingenuity and hard work of their founders, the availability of capital and a culture that celebrates risk-taking.

But the dirty little secret is that a lot of small-business job growth has also been driven by the decision of big businesses to outsource many tasks that they used to do in-house. In an economic sense, jobs haven’t been so much "destroyed" and "created" as they have been shifted from one company to another.

Pearlstein says the healthcare debate is colored by this myth. If we have universal coverage that requires all businesses offer healthcare and all employees must buy it, the impact on small business will be nil.  If all must offer it, none would get competitive advantage and thus be put out of business.

Pearlstein goes on to explain that many jobs created by small business is because big business has found that it is cheaper to outsource work to small businesses that are not saddled with healthcare costs.

What Pearlstein leaves out is that small businesses cited by GOPers are defined as companies with less than 500 employees.  I doubt most Americans think a business of 499 employees is a small mom-and-pop small business operation.