John Podesta: Obama Has Lost Control of National Narrative and Needs to Regroup

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john podesta ft.jpgFinancial Times Washington Bureau Chief Edward Luce has posted a very good video interview and an analysis of his exchange with Center for American Progress President and former White House Chief of Staff John Podesta.
The robustness of Podesta’s critiques of the White House’s performance is growing. Podesta strongly encourages the Obama team to use his cabinet officials in a way that the White House is now not doing.
Podesta says that the White House has lost the narrative in the country and that this needs to be fixed. He said that this problem can’t be fixed “by one speech once in a while.” More needs to be done.
Podesta also says that politics in America today “sucks”.
Here is Luce’s intro and Podesta’s comment about serious trouble ahead:

Barack Obama, US president, has lost control of the political narrative and needs to make more use of his cabinet in order to regain it, says John Podesta, the man who headed the president’s transition team.
“My friends in the White House would agree with this, that they lost the narrative,” Mr Podesta said in an interview for View from DC, the Financial Times‘ video series from Washington. “Clearly that needs not one speech once in a while: it needs, I think, to be constantly reinforced. And not just by the president, but by his entire team?.?.?.?He’s got a terrific cabinet. Use it. Get out into the country and use it.”
Mr Podesta, who was also a chief of staff to Bill Clinton, drew parallels with the former president’s difficulties in his first two years, which culminated in the 1994 Republican takeover of Congress following the failure of healthcare reform.
When asked whether the failure of this latest attempt at healthcare reform would result in a similar electoral “massacre” for the Democratic party at the mid-term elections in November, he said: “I subscribe to that view.”

— Steve Clemons

Comments

71 comments on “John Podesta: Obama Has Lost Control of National Narrative and Needs to Regroup

  1. nadine says:

    “But the existing system is a runaway roller coaster. Isn’t it prudent to try brake pedals even if we’re not sure how well they’ll work?” (Kristof)
    Not if the “brake pedals” are actually accelerator pedals. What exactly, in the current bills is even designed to save money? When did a new government entitlement last cost anywhere near what it was projected to cost? Yes, spending on public programs is already ballooning; pass this, and it will explode.
    Just because we are spending a lot now does NOT mean that this bill is going to make things better. I don’t buy “just do something, anything!” arguments.
    Any head to head comparisons of mortality rates needs to be adjusted to count infant deaths the same way and not to penalize American doctors for America’s higher rates of murder and traffic fatalities, which are not the fault of the health care system.

    Reply

  2. Sweetness says:

    Kristof, always a sane voice…
    “Critics doubt that the Senate and House bills would succeed in
    containing health care costs very much, and they may be right.
    It’s hard to know. But the existing system is a runaway roller
    coaster. Isn’t it prudent to try brake pedals even if we’re not
    sure how well they’ll work?
    The United States Public Interest Research Group calculated last
    year that without reform, insurance premiums for those with
    employer-provided health care would nearly double by 2016.
    Also last month, the Urban Institute applied its computer model
    of health insurance costs to a scenario in which there is no
    reform, and this is what it found:
    “Over the next decade in every state, the percent of the
    population that is uninsured will increase, employer-sponsored
    coverage will continue to erode, spending on public programs
    will balloon, and individual and family out-of-pocket costs
    could increase by more than 35 percent,” it said. It added that
    the number of uninsured Americans could reach as many as 65
    million in another decade.
    As The New England Journal of Medicine noted last month, the
    United States ranks No. 1 only in terms of spending. We rank
    39th in infant mortality, 43rd in adult female mortality and 42nd
    in adult male mortality.
    Skeptics suggest that America’s poor health statistics are a
    result of social inequities and a large underclass. There’s
    something to that. But despite these problems, the population
    over age 65 manages to enjoy above-average health statistics —
    because it enjoyed health care reform back in 1965 with
    Medicare.
    The medical journal noted that “comparisons also reveal that the
    United States is falling farther behind” other countries each year.
    In 1974, for example, Australian men and boys aged 15 to 60
    died at about the same rate as American men and boys in that
    age group. Today, Australia’s rates for that group are about 40
    percent lower than America’s.
    “U.S. performance not only is poor at any given moment but also
    is improving much more slowly than that of other countries over
    time,” the medical journal reported.
    So don’t believe the canard that health reform is unaffordable.
    Last year, we spent 17.3 percent of gross domestic product on
    health care, about double what many other industrialized
    countries pay. The share is rising by more than one-quarter of a
    percentage point per year.
    At the present rate, by my calculations, in the year 2303 every
    penny of our G.D.P. will go to health care. At that time, we’ll
    probably get daily M.R.I.’s and CAT scans, even as we starve
    naked in caves.
    So the question isn’t: Can we afford to reform health care?
    Rather: Can we afford not to?”
    http://www.nytimes.com/2010/02/18/opinion/18kristof.html

    Reply

  3. Sweetness says:

    ‘Nuther side of Texas torts…
    http://www.citizen.org/documents/Texas_Liability_Limits.pdf
    And…
    http://mdcarroll.com/2010/02/05/reader-question-doesnt-
    texas-prove-you-wrong/
    And the Robert Wood Johnson Foundation, another socialist
    group…
    http://www.rwjf.org/pr/product.jsp?id=36768

    Reply

  4. karenk says:

    thats what Democrats do best-lose the narrative to the Rpublicans, who harp and harp on an issue or idea so much that be it true or false, people believe its true.(ie “death panels”)

    Reply

  5. Mr.Murder says:

    “So you think the VA is well run? Walter Reed is well run; but off in the sticks you are not likely to be so lucky”
    Dubya cut VA funding and rolled back hospitals, via consolidation.
    Compliments of the traitorous GOP.

    Reply

  6. Outraged American says:

    “Strong & energetic” govt. Dan? The kind of govt. that starts
    endless wars while destroying the Bill of Rights?
    What you need in your state, Dan, or even your city, is not what I
    need in my state, or my city, or even in my neighborhood.
    I do not believe in every tenant of the Libertarian idea of
    government, but I do believe that government should address the
    needs of the governed and that’s it. No big federal govt. means no
    empire. Local government responds to the needs of its people and
    doesn’t overstretch, because it is held responsible by the people.
    Government of the people, by the people and for the people, ring a
    bell, Dan? Like a Liberty Bell?

    Reply

  7. questions says:

    1. In August 2004, the Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state’s hospitals.
    ****But was there a reduction in the amount of harm to patients? Or is it just that lawyers wouldn’t take the cases?
    2. Medical liability insurance rates declined. Many doctors saw average rate reductions of over 21%, with some doctors seeing almost 50% decreases. (Recent information provided to The Perryman Group during the course of this study suggests that premiums are declining even further in 2008.)
    ***** Again, a limit on harm? Better returns in the stock market (which do seem to bear some relationship to premiums)? I’d be curious to see what happened to premiums around the big crashes in the market. (The Dow went up 25% in 2003 — a simplified view, but it might be meaningful since rate on return of investment is linked to premiums.)
    3. Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. Perryman has determined that at least 1,887 of those physicians are specifically the result of lawsuit reform.
    ****Could be that enough left that the market was ripe. Could be that many left for not a great reason. Lots of things could be issues here. An ideological lens oversimplifies the issues involved.
    ****Also some 3 million more people 2001-2007 or so. — approximate from a chart I found.
    4. In May 2006, the American Medical Association removed Texas from its list of states experiencing a liability crisis, marking the first time it has removed any state from the list. A recent survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures.
    **** Again, kind of murky on the proof. Doctors’ refusal to do certain things can be as much ideological as economic. I wouldn’t really assume that a doctor who blames tort issues really knows the economics behind tort issues.
    **** All of that said, I will say that it’s possible that mediation boards might be a good thing. It’s possible that lawsuits aren’t the fairest way to deal with tort compensation. It’s clear that the lawyers’ take is huge, but then running a liability case is a huge undertaking. We want deterrence in place. It’s a social good to deter gross negligent malpractice.
    **** At the same time, I think that insurance companies do not necessarily price liability insurance in a transparent way. So it’s harder to evaluate than your posting would suggest.
    *** I’m also not convinced that the limitations are really reasonable. Having the wrong kidney removed, the wrong leg amputated… these things are profoundly life altering, ruinous, and horrific, and the limits do not seem to be just. And it’s that pain and suffering part of things that pays the lawyers’ bills — w/o that, you get the drop in cases Texas saw. But, again, was there really a drop in negligent harm?
    ****Lost wages for a low or no wage person are small. Medical bills covered doesn’t fix the quality of life adjustments needed. 750k isn’t a lot to pay lawyers, experts at the trial, home modifications, care deemed non-medical but still seemingly necessary.

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  8. nadine says:

    Guys, tort reform does not mean that you can’t sue for malpractice or recover medical costs. It puts an cap on unlimited “pain and suffering” awards (with half going to the lawyer) and tries to weed out frivolous suits. Not only does it reduce the number of suits and cut defensive medicine, it reduces malpractice insurance premiums, a very high out-of-pocket cost to doctors, which of course has to be passed on to patients.
    As for studying it, how about showing actual results from states which have put in tort reform? Texas, for example. Here is a letter from Leo Linbeck:
    I’m pretty familiar with tort reform in Texas, as my dad was the founding Chairman of Texans for Lawsuit Reform. TLR started in the mid-1990s after forty years of steadily increasing tilting of the civil justice playing field in favor of plaintiffs. There were two major inflection points in this fight:
    The 1995 session (with George W. Bush was Governor)
    Limited punitive damages
    Reformed joint and several liability
    Restricted venue shopping
    Restored the Deceptive Trade Practices Act to its original purpose of protecting consumers in ordinary consumer transactions
    Enacted a half dozen other reforms to curtail specific lawsuit abuses
    The 2003 session (with George W. Bush was Governor)
    Enacted comprehensive reforms governing medical liability litigation, including a $750,000 limit on non-economic damages
    Initiated product liability reforms
    Made the burden of proving punitive damages similar to criminal law, requiring a unanimous jury verdict
    Comprehensively reformed the statutes governing joint and several liability and class action lawsuits
    Imposed limits on appeal bonds, enabling defendants to appeal their lawsuits and not be forced into settlements (this is what pushed Texaco into bankruptcy in its famous lawsuit against Pennzoil)
    Further limited the filing of lawsuits that should have been brought in other states or countries
    The changes to medical liability in 2003 were extraordinary, and had a very substantial impact, including:
    1. In August 2004, the Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state’s hospitals.
    2. Medical liability insurance rates declined. Many doctors saw average rate reductions of over 21%, with some doctors seeing almost 50% decreases. (Recent information provided to The Perryman Group during the course of this study suggests that premiums are declining even further in 2008.)
    3. Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. Perryman has determined that at least 1,887 of those physicians are specifically the result of lawsuit reform.
    4. In May 2006, the American Medical Association removed Texas from its list of states experiencing a liability crisis, marking the first time it has removed any state from the list. A recent survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures.
    Last year, TLR commissioned a study by The Perryman Group to figure out the impact of these reforms (the above are excerpted from that report). Here are the economic impact findings of that study:
    $112.5 billion increase in annual spending
    $51.2 billion increase in annual output – goods and services produced in Texas
    $2.6 billion increase in annual state tax revenue
    $468.9 million in annual benefits from safer products
    $15.2 billion in annual net benefits of enhanced innovation
    499,000 permanent jobs
    430,000 additional Texans have health insurance today as a result of the medical liability reforms
    The complete Perryman Group report is here: http://tlrfoundation.com/beta/files/Texas_Tort_Reform_Report_2008.pdf

    Reply

  9. MarkL says:

    Thanks to the person who posted links on defensive medicine costs.
    Even if those numbers are correct, they don’t show that bad medicine was practiced.
    Doctors’ self-policing is not great, which is another factor. Nurses are much more rigorous in getting rid of bad eggs.

    Reply

  10. Sweetness says:

    Questions: “My guess, though, is that every Repub who wants
    serious tort reform with fairly low caps set would sue the pants
    off a doctor who, say, removed the wrong kidney or leg because
    of negligence. And I’d guess that there are plenty of Repubs who
    have sued doctors. There is a real need for lawsuits,
    compensation for wrongs, and evening out of the power
    differentials between doctors and patients.”
    You bet! One of my conservative friends was the victim of
    malpractice when her child was born and now requires 5,000 of
    drug PER MONTH…and will for the rest of his life…and the
    generics don’t do the trick! It’s a twisted tale, but she is
    explicitly for socialized medicine–a conservative. Supported
    Bush, Iraq, bombing Iran, the whole 9 and a half yards.
    But the real irony here is that when you talk to libertarians, they
    frequently say that we don’t need government
    regulation/intervention BECAUSE people can SUE for damages
    when they are wronged or harmed by a corporation. And yet,
    out of the other corner of the ole mouth, they want to eliminate
    or severely cap damages (until, as you say, THEY are damaged).
    Of course, there’s the small matter of my winning a suit, as an
    individual, against even a beleaguered GM and its army of
    lawyers…but that’s for another day.

    Reply

  11. Sweetness says:

    Nadine writes: “Sweetness, proponents of Obamacare say tort
    reform would not save much money, but they deliberately look
    only at medical liability costs, i.e. the costs from actual suits,
    which are a small part of the puzzle.
    The much larger part of the puzzle is the cost of defensive
    medicine, where every doctor must CYA in case of a malpractice
    suit, and do extra tests that he knows are unnecessary just so he
    can say he checked this and checked that, just in the case if the
    outcome is bad and he is sued. This is a large chunk of the
    medical system, with all its attendant costs, being used for no
    medical purpose.”
    First of all, this issue has been STUDIED for a long time and a
    long time before there was any such thing as “Obamacare.” Long
    before there was this dispute. Long before Obama was
    president. Take a look at the links I provided; they cover the
    CYA angle. This is not a new point or argument; nor is it one
    that has been treated casually. In short, this isn’t just a talking
    point on the part of those who’ve studied it–and results, such
    as they are, don’t bear out your belief.
    You are perfectly free to hold to your position no matter what
    (and you will, clearly), as is everyone else. But speaking for
    myself at least, your arguments aren’t convincing.
    Those opposed to real change also have the current situation to
    defend. Like the 45,000 who die each year for lack of health
    insurance (Harvard study). It’s pretty clear that “competition” has
    not reduced costs, so it’s unclear how more competition among
    entities with the same profit goals is going to lower costs
    without the intervention of government, an entity whose goals is
    not to maximize a bottom line.
    A couple of points…
    • For competition to work, a competitor needs to find a
    competitive advantage–new technology, a better way of doing
    things, smarter marketing. Insurance companies, as far as I can
    see, can only squeeze out more competitive juice around the
    edges. They all confront the same set of rising costs. They
    can’t find a cheaper way of doing heart surgery, for example.
    • I think most of us can agree that the real need is to bring
    down the underlying costs–the cost of surgery, drugs, various
    treatments. But that will involve an even bigger overhaul of our
    system than what is proposed here. Paying doctors for results
    instead of the number of procedures they perform. Or paying
    them a flat fee for an entire treatment. Or a flat fee for a year’s
    worth of unlimited treatments.
    And doing THAT, regardless of the particulars, will involve
    “government intervention.” Here’s why: Government is the way,
    the vehicle by which, the people get to arrange their social and
    economic environment in a way that benefits them. Minus the
    government, there is no other way for “the people” or for “us” to
    reform any large system. The individual actors–doctors,
    hospitals–are all in it for themselves per force. They need to
    survive and are going to act in what they feel is THEIR best
    interests first and foremost. Because if they’re not for
    themselves, who will be? Government intervention is required.
    • For competition to work, the buyer needs to be able to walk
    away from the sale and walk down the street. But the buyer
    here is under tremendous pressure to buy “something.” So there
    is little incentive for the seller to undercut his competitors (by
    much) to get this guy’s money. And once the buyer gets sick,
    he’s stuck. Literally. He can’t go shopping for a policy that will
    insure his cancer treatments for less.
    • The big problems–people being turned away for pre-existing
    conditions, recision, caps, rising premiums–won’t be solved by
    more competition. You could imagine a company offering plans
    for people who are really sick, say with cancer. The premiums
    will have to be higher to make this plan work financially. But the
    people who are really sick are often the poorest and least able to
    pay for this expensive insurance. So the insurance company will
    need some sort of compensating infusion of cash to make this
    tenable–where does that come from? High risk pools strike me
    as putting all the ducks in a barrel so you can shoot at them,
    but I’m not an expert here, so maybe it would help.
    In short, people who support an entirely free market approach
    have to show why it WILL work any better than what we have
    now. Otherwise, it’s simply faith-based, as you say. Certain
    functions, like the military, are not amenable to profit-motivated
    organizations (see Blackwater/Xe). Making big money off of
    people’s health and life and death issues is one of them, IMO.

    Reply

  12. questions says:

    Nadine, a suggestion — since you have posted about the really great cheap insurance deals out there, get a new policy — say, low premium and high deductible, or maybe start using doxinabox or whatever. It’ll save your family 13 grand a year which you can then use for something else!
    But of course you know better than to do that. You have pretty pricey insurance if it’s only covering 2 adults and not a whole family, and you clearly know that, should you actually need insurance, it’s worth having a decent policy that doesn’t get canceled at the first sign of a health problem.
    The goal is to get this for everyone.
    As for tort reform, I’ve never seen good numbers on this issue. It’s way way polarized and partisan because of the trial lawyer/dem funding issue, because no doctor ever actually relishes being sued for negligence, because we have no good system for compensating bad medical outcomes beyond the deep pockets thing. My guess, though, is that every Repub who wants serious tort reform with fairly low caps set would sue the pants off a doctor who, say, removed the wrong kidney or leg because of negligence. And I’d guess that there are plenty of Repubs who have sued doctors. There is a real need for lawsuits, compensation for wrongs, and evening out of the power differentials between doctors and patients.
    And is it possible that all those tests, all that defensive medicine, all the checking just in case stuff might lead to somewhat better outcomes? I don’t think I’ve seen anything about this particular issue. But maybe there’s a little less waste in the system than people think, and maybe the threat of a lawsuit helps keep doctors awake and aware.
    Oh, and maybe, since I believe this is well-documented, it’s more a baby-and-bathwater thing. Lawsuits are good, broad compensation is good. Doctors can avoid most lawsuits by making eye contact with patients, having a good bedside manner, apologizing for mistakes, being open at the front about the range of expected complications. Patients treated well tend not to sue over bad outcomes. Then we save the tort system which is our only power as patients over doctors, and we cut down on lawsuits. So don’t throw away the chance for reasonable compensation and deterrence just cuz you heard it on Fox. There are proactive ways for doctors to cut down on lawsuits. And there may well be medical tort boards or the like to mediate disputes. But capping the value of a tort is not a great way to go. There are egregious wrongs. Really really egregious wrongs. And as with anything medical, it can happen to you. Always personalize medical things.
    What happens to you if your ins. co. drops you? Or jacks the premiums up 39% a year for the next 3 or 4 years…. What if it turns out you are a pre-existing condition and you didn’t even know it? What if there’s a crisis and you can’t make payments suddenly?
    Social back up, group awareness, personalizing disaster — useful thought experiments.
    The conservatives I know seem to operate in only one direction in their thinking – a kind of rigid “it can’t happen to me,” future discount, utter rejection of possibility. They focus instead on the wildly improbably fears of the government and lose sight of the very common individual disaster.
    What’s more likely? You lose your insurance and can’t get a new policy, or the fascistic US Government takes away your First Amendment rights with one hand while making you pay for health insurance with the other?
    The fantasies of disaster go the wrong direction, and nothing makes this clearer than yesterday’s NYT piece on the Tea Party. The mix of anxiety, fantasy, and non-fact that parades as truth is a thing to behold. I have talked to people sympathetic with this stuff. They get news from Fox, they don’t know what’s in the legislation, and they have these bizarre fantasy fears of losing things they don’t even have. It’s the weirdest psychic phenomenon. People think that if corporations do things, if they are left alone otherwise, nothing bad will happen. But if the government does something, it’s the end of the universe. (Until, that is, they make a Medicare claim or take out a mortgage or drive on a road, or eat in a restaurant that’s been inspected, or turn on a toaster oven that doesn’t explode, or see a doctor who has a license and a reasonable protocol for treatment, or take a prescription drug and have at least some chance of its being safe and effective…. They make use of the government even as they denounce the government. I think there’s a word for this?)
    The government helps us coordinate behavior that needs to be coordinated unless we are doomed to spend our lives in unwinnable game-theoretic messes. There are structures in place we actually need to deal with as a collective.

    Reply

  13. nadine says:

    Sweetness, proponents of Obamacare say tort reform would not save much money, but they deliberately look only at medical liability costs, i.e. the costs from actual suits, which are a small part of the puzzle.
    The much larger part of the puzzle is the cost of defensive medicine, where every doctor must CYA in case of a malpractice suit, and do extra tests that he knows are unnecessary just so he can say he checked this and checked that, just in the case if the outcome is bad and he is sued. This is a large chunk of the medical system, with all its attendant costs, being used for no medical purpose.

    Reply

  14. Sweetness says:

    Nadine: “Plus add in tort reform, a biggie. The costs of not
    having tort reform are not just settlement costs; but the
    enormous cost of forcing all physicians to practice defensive
    medicine.”
    Nadine: Factcheck.org and others have done research on this,
    and it is NOT a biggie. Try this; there are others:
    http://prescriptions.blogs.nytimes.com/2009/08/31/would-
    tort-reform-lower-health-care-costs/
    http://washingtonindependent.com/55535/tort-reform-
    unlikely-to-cut-health-care-costs
    http://wonkroom.thinkprogress.org/2009/09/11/tort-refom-
    costs/
    Carroll: If we start over, what makes you think we’ll end up with
    anything better?

    Reply

  15. Carroll says:

    We are wasting our time discussing the hokey HC bill. There’s nothing to it except giving the uninsured taxpayer subsidies to buy insurance.
    It does nothing to lower insurance premiums, nothing to lower health care cost, nothing to lower drug cost. It does nothing except pay Aetna or United for those who don’t’ have or haven’t bought insurance.
    It would be better to put all uninsured in Medicaid…make those with some money pay some kind of premium and be done with it.
    If DC is saying, and they are, that we can’t afford SS, can’t afford Medicare….think about it….how do they explain how we can afford the HC bill? Especially as cost will rise and rise and rise with every year.
    I just can’t believe everyone on earth doesn’t see thru this scam. And as for passing it and “fixing it later” good damn luck. Remember when ERIS was legislated to “protect retirement plans? And congress put in the provisions for protecting insurance companies by making sure hell would freeze over before anyone won a case in Fed District court against their insurer for denying care?
    Every year someone tires to “fix it”, take it out and it’s still there.
    Kill this plan, it’s crap. Start over. For Profit will not work, you must institute not for profit coverage. If it’s passed the insurers will suck everything they can out of it’s coffers until the whole thing goes bust.
    Congress voted against lowering drug cost by not allowing re importation and Obama cut a back room with big Pharm…Hello?…Wake up please. You are being had.

    Reply

  16. JohnH says:

    “Before you get to anti-trust actions…” You have to bust the monopolies first. Only then will providers even bother to reveal their prices. Today there are multiple sets of prices depending on which insurer the provider negotiated with. Those with no insurance get their prices jacked to the max. Busting the insurance monopolies would mean that providers would post prices and insurers would have to pay them or lose business to insurers who would. Their would be no multiple pricing structures based on sweetheart deals.
    Also, I did market research on exorbitant dental fees in the area. And guess what? Everybody charges the same. What good does it do to know the costs when the costs are all the same? Again, time to bring back competition, either government insurance like Canada or anti-trust suits.

    Reply

  17. nadine says:

    “However, I would not be opposed to bringing back the free market to health care–removing anti-trust exemptions from insurance markets, allowing importation of drugs from Canada, lifting the cap on the number of doctors attending medical school, bringing anti-trust action against price fixing providers in local markets, etc, etc.” (JohnH)
    This sort of thing would help, except the before you get to anti-trust actions you need to try to get the market to function in the first place. Right now third parties pay everything and most costs are hidden. When costs are hidden it’s a price-fixer’s paradise. When people pay their own money, even if via a voucher system, they suddenly want to know what things cost.
    Plus add in tort reform, a biggie. The costs of not having tort reform are not just settlement costs; but the enormous cost of forcing all physicians to practice defensive medicine.

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  18. nadine says:

    JohnH, nobody is paying my insurance. Sit up and listen. My husband and I run the same business and we pay for our insurance: $13,000 for TWO people, like I said before.
    “because government run insurance in the US (medicare) has extremely low administrative costs”
    It’s easy to have low administration costs (actually Medicare’s are not that low when you calculate them on a per-patient basis instead of a per-dollar basis) when you are content to have high fraud costs, which Medicare does.
    So you think the VA is well run? Walter Reed is well run; but off in the sticks you are not likely to be so lucky. And if you don’t like your local VA hospital, tough noogies, there is no choice. That is what creates these situations: a captive audience. You don’t have to keep standards of service up when you have a captive audience, and surprise, surprise, standards don’t stay up.
    “I get nervous with even the mention of the possibility of Medicare services being slashed. ” (DonS)
    Did you notice the $500 Billion dollar Medicare cuts in Obamacare? Which will be removed from Medicare to pay for Obamacare? During a period when the Medicare rolls will increase by 30% as the Baby Boomers age in?
    When it comes to government health care you guys have a faith-based policy.

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  19. DonS says:

    John, you are right on a, b and c. My brother in law has an option of three medical insurance plans, all subsidized, and he continues to choose the VA for services.
    My wife ran a small business(with a social conscience) for years, and provided limited health insurance options for key employees. She could not afford to do it now.
    We are now doing the high deductible policy thing until my wife turns 65, and keeping our fingers crossed. I get nervous with even the mention of the possibility of Medicare services being slashed. But you never know what the pols will find expedient since their own lifetime benefits will never be impacted.
    That’s the big story isn’t it. The pols have theirs, don’t they. Not an issue for them.

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  20. JohnH says:

    So Nadine’s husband must be footing her health insurance bill. And she’ll be exempt from buying insurance for any employees her budding small business might hire. Charming!
    And Nadine asks, “Why do you think adding the government in as a new bigfoot shared monopoly would do a single thing to fix the situation?” a) because government run insurance in the US (medicare) has extremely low administrative costs (vs. 30% for private industry), b) government run VA is very well run, and c) government run health care works quite well in the rest of the industrialized world.
    However, I would not be opposed to bringing back the free market to health care–removing anti-trust exemptions from insurance markets, allowing importation of drugs from Canada, lifting the cap on the number of doctors attending medical school, bringing anti-trust action against price fixing providers in local markets, etc, etc.

    Reply

  21. nadine says:

    “In fact, most doctors will take the PO,”
    We don’t know that. Depends what it pays. Congress was making noises about paying Medicare rates. Most doctors can’t live on Medicare rates alone; Medicare only works now because they cost-shift to the private patients who pay extra (one BIG reason for skyrocketing premiums). If the private patients all become PO patients, the doctors will go broke.
    This is what I mean by looking at the current system as an economic system. You can’t just order doctors and hospitals to join a system that will bankrupt them. They will refuse to join. Then people will REALLY lose access to their doctors.

    Reply

  22. susan says:

    From the New England Journal of Medicine:
    http://healthcarereform.nejm.org/?p=1790
    Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion
    Posted by NEJM • September 14th, 2009 • Printer-friendly
    Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H.
    “In the past few months, a key point of contention in the health care reform debate has been whether a public health insurance option should be included in the final legislation. Although polls have shown that 52 to 69% of Americans support such an option,1 the views of physicians are unclear. Physicians are critical stakeholders in health care reform and have been influential in shaping health policy throughout the history of organized medicine in the United States.2…”
    “Overall, a majority of physicians (62.9%) supported public and private options (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so.
    Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%)…”

    Reply

  23. questions says:

    But then, you ALREADY can’t keep your doctor except of course you can — but at a different reimbursement rate.
    You already can’t keep your insurance if your employer drops it and you can’t afford cobra.
    It’s a weak weak weak talking point and it’s designed to make people think they’re going to be assigned a doctor by the government and it makes people think they currently have more choice than they do. It’s a rhetorical point designed to make HCR scary.
    In fact, most doctors will take the PO, and if it’s fairly widespread, nearly all doctors will take the PO. If the reimbursement rates are fine and the rules for claim submission are rational, lots and lots of docs will take the PO and so someone going on to the PO will be fine. And those same docs will likely keep BCBS and the like.
    Docs want patients. They accept insurance.

    Reply

  24. Maw of America says:

    “if” not “is”
    D’oh!

    Reply

  25. Maw of America says:

    Government is (presumably) non-profit. I’d forsake the PO is all insurers had to be non-profit.

    Reply

  26. nadine says:

    “If there’s a gov’t PO, then doctors will either accept the plan or they won’t — just like now, and either there will be a different reimbursement rate (like a ppo — 50% out of plan as opposed to 80% in plan), or you’ll get a new doc. If you’re in an HMO and they drop someone, well, gee, you see a different doc.”
    questions, this is not being able to keep your doctor even if you like him. This is what Obama claimed all year would not happen under health care reform, to the detriment of his credibility.

    Reply

  27. nadine says:

    JohnH, we agree that there is a problem. But just because we agree there is a problem doesn’t mean I have to think the Obamacare bills would solve it. I think they would make it worse. A lot worse. But by the time you realized it it would be too late to take it back. But some of us can foresee the problems.
    BTW, you know nothing about my household income, which is quite low as I’m trying to build a business. The difference between us is not in income but in our mode of thinking.
    “Your “free market” is an illusion. It’s just a cluster of shared monopolies, each trying to maximize price and minimize service.”
    Why do you think adding the government in as a new bigfoot shared monopoly would do a single thing to fix the situation? What is amazing about the comments at TWN is that half of them bemoan the utter corruption of the government yet this never seems to touch the progressive faith that more government is always the answer to the problem.

    Reply

  28. questions says:

    What Sweetness said.

    Reply

  29. JohnH says:

    So Nadine, I’m so glad to hear that you’re very happy paying $13,000 for your insurance. Median household income in the US is $46000. Your market solution means that medical insurance costs about 30% of average family income. Your family’s income is obviously far, far above that, so you can’t relate to those making below the median.
    How many more double digit rate increases can your budget absorb? And what happens when you and you significant other lose your jobs?
    Meanwhile those dreaded “socialist” healthcare systems cost less than half of America’s. And everyone gets covered, even if they’ve just been fired.
    Your “free market” is an illusion. It’s just a cluster of shared monopolies, each trying to maximize price and minimize service. What don’t you understand about that?

    Reply

  30. questions says:

    NO NO NO no jail time. I looked that one up all by myself. No jail time. It was a bizarre and incorrect extrapolation from some IRS provision or other that would have nothing to do with HCR.
    What do you mean you can’t keep your doctor? There is not going to be any law about doctor switching. At this point, if your doc drops your insurance plan, or if your employer drops your insurance plan, or if you can’t pay your premiums, then either you pay full price, or you don’t see a doctor. If there’s a gov’t PO, then doctors will either accept the plan or they won’t — just like now, and either there will be a different reimbursement rate (like a ppo — 50% out of plan as opposed to 80% in plan), or you’ll get a new doc. If you’re in an HMO and they drop someone, well, gee, you see a different doc. And if they don’t have a specialist you need, well, then you pay.
    So what is the concern here? Be more specific.
    The fine for non-payment is 750 a year to start. the ins. cos don’t like a low fine because they want the premium bucks. So a public option with subsidies eases this concern.
    Remember, if you don’t have ins. and you do have cancer/car accident/stroke/appendicitis/broken limb — you get some treatment. You haven’t paid a penny.
    WE ALREADY PAY FOR UNINSURED CARE. We already pay for uninsured care. We already pay for uninsured care. We have extra dead people, too. That costs money. So, yeah, mandates. Subsidies. We already pay.
    Oh, and since you personally already have insurance, you don’t need to worry.

    Reply

  31. Sweetness says:

    “The mistake Obama made IMO was holding on to the dream of
    bipartisanship and a Republican party that was genuinely willing
    to negotiate in good faith rather than say no and demagogue.”
    (sweetness)
    Sweetness, the Republicans are never going to wake up one
    morning and proclaim, gee everything we’ve always believed
    about smaller government and free markets is wrong! we have
    seen the light! we want a massive government take-over of 1/6
    of the economy now!
    Sweetness: True, but it wasn’t a massive takeover by
    government. That was simply a lie. Moreover, when people
    understand what a government plan actually means, they are
    often for it. They LIKE Medicare, for example. They LIKE Social
    Security. “The people”–the most misused phrase in our
    lexicon–LIKE what government gives him. That’s why
    government has grown steadily since Reagan. They’ve just been
    fooled into thinking they’ll never have to pay for it.
    N: It is indeed a “dream” to think they will. Obama did not in fact
    have any such dream; he merely let Pelosi and Reid shut the GOP
    out of the discussions entirely and shoot for the most left-wing
    bill they thought they could get through the Democratic Caucus.
    Had they been able to hold the Democratic Caucus together, the
    bill would be law today. The Republicans were not strong
    enough to stop anything.
    Sweetness: This is nonsense. Obama is the most bipartisan
    president in his intentions that we have had in my lifetime. But
    you have to have a “partner for peace.” Otherwise, you don’t get
    anywhere. Bush got NCLB because Kennedy was right there with
    him. He got the drug bill because a bunch of Dems joined him.
    He got Pepfar because Dems were there. He got his ridiculous
    war in Iraq because the Dems went for it (much to their
    discredit). Right now, the Republicans are fighting off the teabag
    threat from the right, so they ain’t going to budge.
    Obama can’t even get the Republicans to vote for THEIR OWN
    ideas–it’s that bad. Howsa about that deficit reduction panel?
    Eight Republicans who had supported the panel voted against it.
    The idea that Reid in particular went for a “left-wing” bill is
    crazy. Reid, a left-winger? Baucus, a left-winger? I know these
    terms are relative, but still, you can’t really be serious. Either
    that or you must be very, very rightwing. After all, the Senate
    bill is close to a bill that Bob Dole and Howard Baker devised.
    And close to the MA system that Mitt Romney signed into law.
    You think Bob Dole, Howard Baker, and MItt Romney are left
    wingers who support left-wing approaches to health care?
    Also, the House Dems accepted something like 126 Republican
    amendments. Grassley negotiated for provisions that he agreed
    with and then voted against! Snowe wasted all of our time with
    dishonest “negotiations.” It is true that there were Democrats
    who gummed up the works. That’s what you get with a
    genuinely big tent party. And I wish they’d been able to keep
    the caucus together. On that, you and I agree.
    N: What you have to wrap your head around is this: to get a
    bipartisan bill passed, you need to put bipartisan contents into
    it. What was there in any of the proposed bills pleasing to
    Republicans? Nothing. No tort reform; no ability to sell insurance
    across state lines; no market-based coverage of the uninsured
    via high risk pools; nothing.
    Sweetness: This is silly. There is tort reform in the Senate bill.
    There is the ability to sell insurance across state lines. As I
    understand it, the exchanges do have a market element in them,
    though it is controlled. The market is controlled now fer
    crissakes! We have insurance commissioners!
    And as I say, this is the SAME approach, more or less, that Bob
    Dole, Howard Baker, and Mitt Romney supported. How much
    more bipartisan does a bill have to be before it satisfies your
    definition of “bipartisan”?
    The Republicans we’ve now seen–with close to TWICE the
    number of filibusters as in the last 10 or so Congresses–aren’t
    going to vote for ANYTHING.
    N: Obama also has to wrap his head around the idea. He hasn’t
    yet. He’s making a public show of bipartisanship while still trying
    to pass the Senate bill through reconciliation. That won’t work.
    Sweetness: What you fail to wrap your head around is the
    extreme demagoguery that was used to throw dust into the
    works. The lies, out and out, that were told–death panels
    being only the most egregious. Even Krauthammer agreed, in
    print, that there were no death panels in the House bill.
    Obama genuinely wants a bill–why else would he stake so
    much of his presidency on it–for kicks? He was willing to
    jettison one of the pet desires of the left, the PO.
    The Republicans, by contrast, don’t care if a bill is passed or
    not. Health care has never been one of their agenda items; they
    are happy with what we have. For them, tort reform–which has
    been shown over and over to have a negligible impact on price-
    -is simply a way of going after the Trial Lawyers, a Democratic
    source of funds.
    I guess the last point about what “the people” want is this:
    Obama campaigned on health care reform. A lot of the
    principles he’s for now, he was for then. In fact, he’s probably
    moved rightward since the election.
    Anyway, you’re obviously welcome to your opinion, but it doesn’t
    accord with the known facts.
    Late add:
    [Nadine] “questions, I question the polls about the PO. The ones
    I have seen had wording designed to be favorable, such as “do
    you favor the public option to increase competition with the
    insurance companies” which was the Democratic talking point.
    That’s a very different animal from “do you favor a public option
    designed to replace the insurance companies” which is what its
    supporters really wanted and hoped for the future.”
    So let me see if I have this right: A poll question should ask
    about what a provision’s supporters PRESUMABLY want rather
    than what the provision actually says? IOW, the question should
    ask about what’s inside a bunch of unidentified people’s heads
    rather than what is written down in black and white?
    And really and truly finally, if government “takeovers” drive costs
    up, why is it that we pay more for our health care per capita and
    get worse outcomes than all the other industrialized countries in
    the world? Why does the WHO list us as 37th in the world in
    terms of our health care system?
    And, to put a final point on it, how many competitors does there
    need to be to drive costs down? Right now, we have states
    where insurance companies compete (presumably), but the costs
    stay high and go higher? And what of those 100 million salaries
    for the CEOs? Doesn’t that suggest that competition isn’t really
    what’s at work here–but maybe greed?

    Reply

  32. nadine says:

    questions, I question the polls about the PO. The ones I have seen had wording designed to be favorable, such as “do you favor the public option to increase competition with the insurance companies” which was the Democratic talking point. That’s a very different animal from “do you favor a public option designed to replace the insurance companies” which is what its supporters really wanted and hoped for the future.
    “being jailed for not paying for insurance, not being allowed to keep your own doctor”
    These are not fantastic, questions. The bills both have a public mandate, which legally requires buying insurance, and which has fines if you don’t, and jail time if you don’t pay the fines. That comes with the territory.
    As for not keeping your doctor, if the bill has financial incentives that will lead to employers dumping their plans and putting their employees into the public option, which the House bill did, then the employees will have different coverage and might not be able to keep their doctors. Obama finally admitted this after a whole year of saying everybody could keep their doctor.
    “People are worried about premium cost. Subsidies will deal with this.”
    Because for the government, money grows on trees? Heaven help us. Don’t you understand that we have to pay, somehow, sometime, the unfunded liabilities of the Federal government? Medicare already has 38 Trillion in unfunded liabilities and your answer to add more.
    We have to get costs down. Government takeovers drive costs up. Way, way up.

    Reply

  33. questions says:

    P.O. polled in the 60s. What people seem to be reluctant about most are the following, near as I can tell:
    The end of Medicare, government involvement in Medicare, death panels, being jailed for not paying for insurance, not being allowed to keep your own doctor (I just had a long conversation with someone about this — I couldn’t even figure out what it meant)….
    On the less fantastic side, people are worried about the mandate but they want guaranteed issue. You can’t have one without the other.
    People are worried about the mandate and don’t want to pony up to corporations. The public option fixes this.
    People are worried about premium cost. Subsidies will deal with this.
    People are worried about having to pay for things they don’t use — while they’re not using them. But they will demand use should they need it, and so they should pay. We all have risk of health disasters. Cancer care is really expensive. Minor disasters are expensive. We need to pay for the disasters because we already do pay for them — in higher hospital costs, higher insurance premiums, bizarre pricing structures, unnecessary deaths and suffering.
    Repeat, we already pay for this stuff. Let’s open up the billing system and pay more honestly.
    Maybe that’s what we should call HCR — the Transparent Medical Billing Act of 2010, or Honesty in Medical Billing….

    Reply

  34. questions says:

    Nadine writes:
    “Sweetness, the Republicans are never going to wake up one morning and proclaim, gee everything we’ve always believed about smaller government and free markets is wrong! we have seen the light! we want a massive government take-over of 1/6 of the economy now!”
    I have some vague memory that Greenspan was, umm, at least beginning to wonder if the “free market” could do it all? I searched “Greenspan recants” and lots of things came up about his testimony.
    In fact, as has been pointed out by many at this point (incl. Jamie Galbraith), there’s no such thing as a FREE market. Markets need rules or no one will trade anything. People need contracts enforced, a stable currency, clear rules of conduct, full information, enforcement of all of this. Hobbes’s point about how little we’d do in the State of Nature is likely not far from wrong. We might try to establish local trading w/o government, but we’d soon need to establish some form of government to cut down on cheating.
    So, Nadine, if you’re going to insist on free markets, please define the phrase in some manner that is consistent, accurate and usable.
    I certainly don’t want just anyone to be able to open up a medical practice, to “promise” to help pay my bills should I need it, without some kind of heavy enforcement and licensing. I want to know that the medical school had reasonable teaching practices. I want to know that my contract with an insurance company will be enforced. None of this is “free”– but it’s necessary and prior to there being any kind of market.
    So what’s a “takeover?” What’s “choice?” What’s “free?” What’s a “market?” — all without talking points, all related to medical care to keep the topic limited and the posts finite.

    Reply

  35. nadine says:

    “Note, by the way, that not even shutting down Harry and Louise and pharma was enough to overcome the problems.” (questions)
    Yes, because your problem is not the lobbies but the people. The left of the American political spectrum wants the public option. The center and the right do not. Therefore you can’t pass it, even with supermajorities in Congress. It’s really just that simple.

    Reply

  36. nadine says:

    JohnH, I am well aware of the high costs of health care. I pay $13,000 a year for two people. Nobody pays for me or my husband. It’s just that I think about how the market as a whole is currently functioning, and how it is likely to function under any of the proposed laws. This kind of economic-based outlook makes me much more conservative than progressives who see the problem and think you can just pass a law to make it illegal. Then the unintended consequences take them by surprise.

    Reply

  37. nadine says:

    “And Nadine, it isn’t the inherent conservatism of the American people shining forth. It’s the inherent conservatism of the US Senate in all its non-representationalism. It’s the 60 votes. It’s the rural bias.”
    That’s not a bug, it’s a feature.

    Reply

  38. JohnH says:

    Once again Nadine shows her total ignorance, this time about health insurance. “It was the large section of the public that likes their current health insurance and/or pays for current health insurance that filled those halls.”
    Nadine has no clue as to what people pay for health insurance these days. Nobody paying these astronomical sums could be pleased with what they’re getting for the price. Hint: this year I will be forced to lay out $15,000 for insurance for two relatively healthy people, dental and vision not included. Our health care costs this year including dental and vision will top $20,000.
    Who could be happy with that?
    Nor does Nadine realize that rocketing insurance rates will soon put employer insurance coverage beyond the reach of anyone but those in executive suites. Our insurance went up 30% this year. At that rate, it will only be a few years before insurance premiums exceed average wages.
    It’s interesting that no one has bothered to poll the teabaggers. My guess is they included many with government insurance who were alarmed at the prospect of cuts to Medicare. Otherwise, the teabaggers must have been a delusional crowd, unaware of insurance costs or of the imminence of their being priced out of the market.
    Nadine, what sugar daddy is providing your insurance?

    Reply

  39. questions says:

    What Sweetness said.
    And Nadine, the public option is truly one of the most popular parts of HCR. Medicare is popular. The PO is basically a kind of expanded Medicare. It was limited only to those who had no other way to get insurance, and so couldn’t do a whole lot, but it was a start on things.
    There was no massive government takeover of anything anyway. The PO was to be premium-supported, supplemented with subsidies, competing with private health insurance. No takeover. Unless you define “takeover” very differently from how I do.
    When I get insurance statements, I see what the doctor charges and what the ins. co. allows. Talk about takeover. Massive corporate/monopolistic pricing practices.
    ****
    Once again, on the Obama as non-leader thing– The president isn’t supposed to dictate the legislative agenda. That’s what Congress is for. Around here, people castigate Obama for NOT-leading, and then cry “fascism” when any pres. actually DOES something. I smell contradiction?
    Further, there is nothing any leader could possibly do with repub solidarity and a group of super-conservative dems. There’s no pick off, no arm twisting, nothing that gets Lieberman and Nelson et al to vote for a robust public option. There’s no way to get a repub to betray the party. What in heaven’s name does anyone expect Obama to do about this structure?
    The repubs won’t give an inch. The most conservative dems won’t give an inch.
    And Nadine, it isn’t the inherent conservatism of the American people shining forth. It’s the inherent conservatism of the US Senate in all its non-representationalism. It’s the 60 votes. It’s the rural bias. It’s the distortions of what is in the bill. It’s House/Senate tension.
    Note, by the way, that not even shutting down Harry and Louise and pharma was enough to overcome the problems.

    Reply

  40. nadine says:

    “The mistake Obama made IMO was holding on to the dream of
    bipartisanship and a Republican party that was genuinely willing
    to negotiate in good faith rather than say no and demagogue.” (sweetness)
    Sweetness, the Republicans are never going to wake up one morning and proclaim, gee everything we’ve always believed about smaller government and free markets is wrong! we have seen the light! we want a massive government take-over of 1/6 of the economy now!
    It is indeed a “dream” to think they will. Obama did not in fact have any such dream; he merely let Pelosi and Reid shut the GOP out of the discussions entirely and shoot for the most left-wing bill they thought they could get through the Democratic Caucus. Had they been able to hold the Democratic Caucus together, the bill would be law today. The Republicans were not strong enough to stop anything.
    What you have to wrap your head around is this: to get a bipartisan bill passed, you need to put bipartisan contents into it. What was there in any of the proposed bills pleasing to Republicans? Nothing. No tort reform; no ability to sell insurance across state lines; no market-based coverage of the uninsured via high risk pools; nothing.
    Obama also has to wrap his head around the idea. He hasn’t yet. He’s making a public show of bipartisanship while still trying to pass the Senate bill through reconciliation. That won’t work.

    Reply

  41. nadine says:

    “With no plan to sell, the White House languished, deferred, and waited throughout the summer, while their opponents mobilized a massive, passionate, near-hysterical opposition movement that filled all of the dead air with their Cassandra warnings and threats.” (Dan Kervick)
    Interesting choice of metaphor. If you’ll remember the Greek myth, Cassandra was always correct, but never believed.
    The problem for the public option and the other pieces of the government take-over of health care that were floating around last summer is that most of the public doesn’t want it. The public, not the lobbies. Obama took care to buy off the Pharma and Insurance lobbies; AARP too. No Harry and Louise ads this time around! They had been promised 30 million new customers at high rates in exchange for turning into government-regulated utilities.
    It was the large section of the public that likes their current health insurance and/or pays for current health insurance (together that’s a majority) that filled those town halls. Costs are too high now, and they heard nothing believable about lowering them. They saw higher premiums AND higher taxes coming, together with some government bureaucrat controlling the interaction with their doctor. If you want to know what really fueled opposition, it was that.
    “Obama tried to convince the country that it didn’t even matter much whether there was a public option in the bill. That made no sense and damaged Obama’s credibility”
    Agreed. Also, when the time came for Obama to start ticking off the cost/benefits of the bill to really sell it, he stayed 30,000 feet up with hand-waving and anecdotes. Gave the definite impression that he didn’t know what he was talking about.
    The repulsive vote buying in both houses only added the idea that Congress had no earthly idea what it was doing, beyond short-term pork-rolling.

    Reply

  42. JohnH says:

    Given Obama’s failure to be pro-active on either the domestic front or the foreign front, you can only draw one of two conclusions:
    – As Sagacity suggests, Obama may have “gotten everything he truly wanted,” in which Obama’s candidacy was a con job exceeding even W’s.
    – Obama has no inclination to be a leader. He’ll just continue to go along with whatever the powers that be place before him.
    In either case, Obama is not acting on “the audacity of hope” or “yes, we can.” Instead, it’s simply whatever the Greedy Oligarchs and Plutocrats (GOP) want.

    Reply

  43. DonS says:

    “US finally admits that Yes, the US is trying for Regime Change in Iran.” (Carroll)
    See, this is a narrative that’s getting resonance. So Obama is going with what’s working for him. Everybody hates Iran — so — just look over there. Cranking up the “Iran is becoming a military dictatorship” narrative, like the US gives a damn about saving the Islamic Revolution. But maybe, you know, Israel keeps demanding ever greater belligerence towards Iran or they’ll threaten to pull some more Congressional strings and undercut Obama’s non-agenda. The Israelis must have a hard time keeping up with the demand for pretzels to watch the spectacle.

    Reply

  44. Win Monroe says:

    jonst, unfortunately we can’t vote much based on what will happen in an administration only what a candidate promises to pursue. My point, which I don’t think is mutually exclusive with yours, is to highlight the drift from what I believe was a strong progressive foreign policy platform, as articulated in that speech, to a more centrist, neo-liberal foreign policy since taking office.

    Reply

  45. Sagacity says:

    My fear is that Obama has gotten everything he truly wanted. An amped up war in Afghanistan, a Wall Street that is unchanged. The things he hasn’t won are the things he didn’t really care about–you know those things the people wanted like health care and jobs. When your narrative is a lie, you’re going to lose it.
    Now he wants a commission to cut spending of Social Security, Medicare (those annoying things the people want) but it has to exclude “security” spending, i.e., the military. He’s just a 1970s Republican; we wanted a Democrat. If he really was a Democrat, maybe his narrative would be selling.

    Reply

  46. Carroll says:

    Yep….”jaded and naive neo-liberals
    US finally admits that Yes, the US is trying for Regime Change in Iran.
    (AFP) – 2 days ago
    WASHINGTON — The United States is pressing for very tough new sanctions against Iran this month, a top US aide said Sunday, suggesting that the move could help bring about “regime change.”
    “We’re… going through the UN this month to present sanctions,” President Barack Obama’s national security advisor, retired general James Jones, told Fox News Sunday.
    While the US is not actively seeking to destabilize Iran, which has been rocked by months of anti-government protests since disputed elections last year, Jones said additional sanctions could nevertheless have that effect.
    “We know that internally there is a very serious problem. We’re about to add to that regime’s difficulties by engineering, participating in very tough sanctions, which we support,” he said.
    “Not mild sanctions. These are very tough sanctions. A combination of those things could well trigger a regime change — it’s possible.”

    Reply

  47. jonst says:

    Win Monroe wrote: ‘Part of Obama’s appeal for someone who cares about foreign policy was his promise to change the larger national security strategy rather than just tactics”.
    WM, do you anyone, at the Cabinet Level, and below, or on the National Security Agency/DOI that oppose the Authorization for Use of Military Force Against Iraq Resolution of 2002? Anyone?
    WM, do you know anyone in the Obama Admin that calls for defense cuts, on the grounds that defense spending is out of whack? Anyone?
    He brought in, as he did in his economic team as well, a bunch of jaded neo-liberals, who simultaneously, amazingly, also are naive. Jaded and naive…at the same time. One would have thought it an impossible combination….but it turned out to be a fact.

    Reply

  48. Carroll says:

    I don’t thnk Obama has “lost the narrative” so much as the narrative is now “lost on the people”.

    Reply

  49. Win Monroe says:

    Steve, the larger question (about the national security narrative, not Podesta) is really important. Part of Obama’s appeal for someone who cares about foreign policy was his promise to change the larger national security strategy rather than just tactics. I think Obama entered office executing this on all fronts (executive orders regarding gtmo; vocabulary change regarding characterization of our threats; diplomacy first and foremost) and began to loose course as the gtmo situation got more complicated, Israel pushed back hard and Iran refused any conciliation.
    The question I have that this post reminded me of is what is happening with the “Shared Strategic Security Partnership” program, promised in his keystone foreign policy speech (found here: http://www.realclearpolitics.com/articles/2008/07/a_new_strategy_for_a_new_world.html). While I cannot find details anywhere in particular, the context suggested that program would be something to the effect of an international police and intelligence cooperation effort, reshaping the war on terror into something more like a beefed up, US-led InterPol (one would hope of commandos and intelligence officers, not hamstrung European bureaucrats).
    It is mentioned in the first paragraph of the White House’s Homeland Security Agenda (found here: http://www.whitehouse.gov/issues/homeland-security), but I have not heard a word about it since that speech. Did it ever the the funding Obama requested? If so, what developments have there been or has it turned into a way to offer money to countries that help out, rather than an institution representing a major shift in the US’s strategy to protect itself from asymmetrical threats?
    I appreciate your thoughts and hope all is going well up in NAF.

    Reply

  50. Sweetness says:

    Dan, astute analysis.
    However…
    I do think Obama genuinely believed–maybe still–that there
    were a number of ways to achieve his goals for this legislation
    and didn’t want to close down options by insisting on certain
    specifics. In general, this strikes me as smart.
    As it turns out, the PO that almost made it was not a very good
    option. Wouldn’t have led to more competition. Would have
    been very expensive because it would have been open only to
    the sickest (probably).
    Now, maybe if Obama had hammered home the need for a good
    version of the PO, it would have made a difference. But it’s also
    possible that the whole enterprise would have been held
    hostage to a provision that wasn’t the whole enchilada. For
    example, the goal of getting a lot more people insured, doing
    away with the pre-existing condition problem, rescission, caps,
    and the like also count a great deal–and should to
    progressives. These provisions would do a world of good for
    millions of people.
    And many people claim, with some reason I think, that the
    exchanges would/will serve to keep premium costs down.
    Whether that’s true or not, whether more fixes would be
    necessary once experience was gained, is something we can’t
    know right now. But it’s not as if there are no financial brakes
    on the insurance companies in the Senate bill, as progressives
    sometimes seem to claim.
    The mistake Obama made IMO was holding on to the dream of
    bipartisanship and a Republican party that was genuinely willing
    to negotiate in good faith rather than say no and demagogue.
    The summer was disastrous in that it gave the Republicans
    several steps or put us back on our heels, however you want to
    characterize it.
    After a point, however, progressives did do damage to the cause
    with their vituperation over all the corporate giveaways (as if the
    current system isn’t making the health insurance companies
    filthy rich and giving them a monopoly right now and young
    people aren’t opting out and thus making everything even more
    expensive) and must be counted in those polls where a majority
    of people say they don’t like “the bill.” This allows Republicans
    and the MSM to claim, erroneously, that a majority of the people
    don’t like “Obama’s plan” and don’t want the government
    involved in health care–when that isn’t the case at all.
    (So, for example, Nadine can claim “Obama lost the narrative”
    because the American people listened carefully and said, “We
    don’t like the sound of this plan.” Which simply isn’t true in
    many ways. Some didn’t like the plan because they thought it
    was socialism, which was simply a lie. Or that there were death
    panels, another lie. Or that it would hurt Medicare, yet another
    lie, and a hypocritical one at that. Others didn’t like the plan
    because there wasn’t enough government intervention. Still
    others got scared because, despite what Nadine says, they didn’t
    know what the plan was.)
    I don’t say progressives were the principal problem; the
    Republicans and conservatives were and are. But when one’s
    own side breaks ranks, it becomes almost impossible to fend off
    the barbarians, let alone defeat them.

    Reply

  51. JohnH says:

    As Dan Kervick said, “A very popular president decided to hand off responsibility for developing, crafting, articulating and defending a piece of major social legislation.”
    No leadership. Unwillingness to use the powerful tools at Obama’s disposal.
    And in the Middle East, “A year of U.S. diplomatic efforts has so far failed to revive talks.”
    No leadership. Unwillingness to use the powerful tools at Obama’s disposal.
    A sham.

    Reply

  52. DonS says:

    For my part, I blame it on too much wine. Yet the yahoos* out there have about gotten me to give up and surrender. They win. Here, take my Constitution, Bill of Rights, habeas corpus,
    Geneva Convention, the whole nine yards. Oh, yeah, throw in what’s left of the Treasury; make a check payable to Bibi and friends.
    Don’t forget to turn out the lights. Leave the key in the lock box and turn over the worthless deed to Wall Street for the fire sale.
    * I didn’t really mean ‘yahoos’. I meant morally, ethically, and logically challenged little proto-people.

    Reply

  53. Dan Kervick says:

    “He urged passage of health care reform in over 30 speeches…”
    He urged health care reform, but didn’t sell it. And he didn’t sell it because he had no plan to sell. The White House made a strategic decision early in the game to offer the public only a broad outline of a reform plan, and to hand all of the details off to Congress. The details included major provisions: whether there would be a public option or not; whether there would be an individual mandate or not; who would pay for everything, etc.
    With no plan to sell, the White House languished, deferred, and waited throughout the summer, while their opponents mobilized a massive, passionate, near-hysterical opposition movement that filled all of the dead air with their Cassandra warnings and threats. Everything fell apart during the summer, and by the time the White House and Democrats regrouped after the recess, they had lost the public and were back on their heels on defense.
    So, finally, Obama gave the big speech, with more details. It was well-received and successful. But then there was weak follow-up and more Congressional wrangling with corporate power-brokers. And there was *still* no actual plan to sell, because Congress was still debating major provisions. Because he couldn’t predict what would be in the final bill, Obama tried to convince the country that it didn’t even matter much whether there was a public option in the bill. That made no sense an d damaged Obama’s credibility. Everyone in the United States understands that whether the US government will get its foot in the door as a major player in the health insurance business matters a very great deal. And for something that allegedly didn’t matter much, the insurance companies certainly fought incredibly hard to defeat it.
    A very popular president decided to hand off responsibility for developing, crafting, articulating and defending a piece of major social legislation the universally-reviled US Congress, with predictable results.
    And still, after all that, the US House passed a bill. Then the Senate passed a bill. Everything was almost done. But one little punch of electoral adversity and the sniveling Democratic Party falls down to the canvas like a bag of hammers, and then springs up and runs for the hills.

    Reply

  54. nadine says:

    “Instead of developing a marketing campaign for his top domestic priority (using the cabinet, using the bully pulpit, using the grass roots, reaching out to reform supporters), Obama simply shut the doors, turned out the lights, locked out potential supporters, and turned the mess over to Max Baucus” (JohnH)
    You make it sound like Obama adopted a Rose Garden strategy and didn’t talk to the public. That is scarcely the case. He urged passage of health care reform in over 30 speeches, including an address to a Joint Session of Congress. Granted, they proved ineffectual, so you can conclude he never developed a real “marketing campaign” but we all certainly heard Obama talk about health care. And talk. And talk.

    Reply

  55. PissedOffAmerican says:

    “Nadine, with respect, you are full of shit”
    Now thats a new one. How the hell do you tell someone they’re full of shit, “with respect”????
    Hmmmm, maybe it would sound something like….
    “I am constantly amazed that such a small mind can hold so much shit”

    Reply

  56. Carroll says:

    See…it’s just this kind of hypocritical corrupted crap that makes people realize DC thinks we are all stupid.
    See…we can ‘force Iraq” and we can “force Afghan and we can “force Iran and we can “force China”.
    But see….we can’t force a midget client welfare state and a wannbe state that doesn’t have a pot to piss in or a window to throw it out of to make nice.
    Beam me up Scotty.
    Clinton: U.S. can’t force Israel, Palestinians into peace talks
    By The Associated Press
    U.S. Secretary of State Hillary Clinton on Sunday acknowledged frustration in the Middle East over the delay in restarting Palestinian-Israeli peace talks, but said that the Obama administration could not “force” the sides into reaching a solution.
    “This is hard work,” Clinton said at the beginning of a three-day visit to the region. “I know people are disappointed that we have not yet achieved a breakthrough.”
    “But we must remember that neither the United States nor any country can force a solution. The parties must resolve their differences through negotiations,” she added.
    Advertisement
    A year of U.S. diplomatic efforts has so far failed to revive talks aimed at ending the six-decade conflict through a peace treaty that would create a Palestinian state in the West Bank and Gaza Strip.
    The U.S. recently offered to bring the Palestinians and Israelis into “proximity talks”, with a U.S. mediator shuttling between negotiating teams to restart the talks that broke down at the start of a war in Gaza in December 2008.
    President Barack Obama’s special Mideast envoy George Mitchell, came to the region last month for separate meetings with Prime Minister Benjamin Netanyahu and Palestinian President Mahmoud Abbas in another effort to see the talks re-launched.
    Clinton planned during her visit to discuss how Arab states might give
    Palestinian President Mahmoud Abbas political cover to help him resume peace talks despite his insistence that Israel first embark on a full freeze in West Bank settlements .

    Reply

  57. Mr.Murder says:

    Health Care = Job Creation
    Two problems dealt with.

    Reply

  58. JohnH says:

    Problem with Podesta’s analysis is not that he LOST the narrative on health care. Rather Obama NEVER DEVELOPED a narrative. He could have done a better job if he had just recycled clips from campaign speeches.
    Instead of developing a marketing campaign for his top domestic priority (using the cabinet, using the bully pulpit, using the grass roots, reaching out to reform supporters), Obama simply shut the doors, turned out the lights, locked out potential supporters, and turned the mess over to Max Baucus, who deserves to have his portrait hung in the Senate with the caption, “Sheer Incompetence.” Of course, Obama was the one who chose Baucus to shepherd his top domestic priority through the Senate, so ultimately the incompetence buck stops at Obama.
    Like I’ve said over and over again, Obama never tried to get health care reform enacted. He just articulated it as his top domestic priority, tossed it over the fence to Baucus, and proceeded to write pretty speeches for the Nobel Peace prize, etc.
    Quite simply, Obama is not a leader.

    Reply

  59. Steven Clemons says:

    folks — let’s drop the ad hominem attacks. You all can do better.
    Thanks, Steve

    Reply

  60. DonS says:

    Nadine, with respect, you are full of shit. These ‘centrist’ democrats who are blaming their dyspesia on ‘liberals’ are out of touch. It is the media, influenced by corporatist spending, that is driving the “liberal democrat” narrative, and that is driving the US back into the 19th century.
    Nadine, your talking points are getting tedious. In case you hadn’t noticed the US just dodged a huge economic bullet, and yet you and your ilk try to pull out republican talking points about “deficits” and “tax and spend” as if nothing had changed.
    When will you be satisfied? When the US is on it’s knees?
    Exactly what is the payoff for driving the US further into the hands of reactionaries? Is it orgasmic on some level? Inquiring minds want to know.

    Reply

  61. nadine says:

    Curious. Obama spent the first year passing or trying to pass an $800 billion Stimulus, a $400 billion Omnibus, a $3.5 Trillion budget, Cap and Trade, $2+ Trillon (realistically speaking) Health Care Reform, and I’m sure I’m forgetting something. Oh yeah, Afghanistan and Mideast Peace.
    Yet now you accuse Obama of being overcautious? Geeze, what would daring have looked like?
    Obama just bit off more than he could chew. A President gets only so many enormous initiatives, and even fewer if he and they are unpopular.
    Democrats should come out of denial. Obamacare didn’t fail because “Obama lost the narrative” but because the American people listened carefully and said, “We don’t like the sound of this plan.” What needs to be changed is not the narrative, but the plan.

    Reply

  62. Carroll says:

    Politics sucks? LOL.
    How about politicans are corrupted. And they have corrupted the entire system of government.
    Politicans are corrupted.
    Write that on the blackboard 100 times.

    Reply

  63. Dan Kervick says:

    “What the American people are seeing is a party that is afraid to lead, afraid to hurt someone’s feelings, afraid to lose their job. etc.”
    That’s the Democratic Party all over Chris.

    Reply

  64. Chris says:

    When the majority of the people (myself included) voted for Obama in ’08, we all expected the change which the Dems promised. They have not delivered I feel because of basically one reason- fear. They are all afraid to lead for fear they will make a wrong decision and then will lose in the next election. What the American people are seeing is a party that is afraid to lead, afraid to hurt someone’s feelings, afraid to lose their job. etc. They have the power and won’t use it. The Repugs very much in the MINORITY are sticking together and getting something done (obstructionism)– and the Dems are letting them get away with it. And by the way how did the Bush administration get everything they wanted pushed thru by barely having a majority? Frankly I’m just so fed up with hearing Dems make excuses. The time has come for them to “shit or get off the pot.

    Reply

  65. Alan K says:

    Mr. Podesta needs to recalibrate.
    We have a tax cheat in treasury. We have HC parked at State accomplishing nothing. We have Holder at Justice who is a complete embarrassment. And then there is Janet “the system worked” N. Steve Chu still thinks that CO2 is a problem. The cabinet members have been disastrous spokespersons for the administration and getting them out more will only make things worse for the administration.

    Reply

  66. Dan Kervick says:

    “He’s got a terrific cabinet. Use it. Get out into the country and use it.”
    Oh yeah. ‘Cuz every day I hear more Democrats say, “I want me some more Larry Summers!”

    Reply

  67. Dan Kervick says:

    Isn’t John Podesta the guy who helped handpick Obama’s fantastically popular team of uninspiring 90’s retreads, steady-as-she-goes conformists, dumpy and schlumpy media eyesores, and limpdick pseudo-progressives?
    I’m sure there is a rising generation of powerful, exciting, innovative, attractive and boat-rocking progressive thinkers out there. I think I have seen some desperately cruising the margins of our political culture. They’re just not in the bland and blah Podestacratic wing of the party that runs Washington.

    Reply

  68. sdemetri says:

    Jane Mayer’s New Yorker profile of AG Holder is a good case in
    point. There was a great deal of support of trying, for instance,
    KSM in New York. But the political background prep wasn’t
    done, and the narrative was lost in a series of blunders that
    amount to kowtowing to those who continue to preach a fear
    driven agenda. What I take away from the article, Emanuel is
    responsible for this lost momentum, fearful of losing republican
    support by influential senators. Strong leadership up front would
    have taken the wind out of the torture advocates and
    fearmonger’s sails had it been orchestrated properly. It wasn’t
    and even those that supported Holder’s choice of New York have
    backed off.
    We might have had torture investigations that resulted in
    convictions of the key architects. We might have had real health
    care and financial reform… now it looks like we will get little or
    nothing, and the possibility for a more rational reality-based
    legislative body will be lost as well.

    Reply

  69. Mr.Murder says:

    When President Obama took office, Dubya handed him lemons.
    Now everyone is complaining about the lemonade being served, resulting the function of our Chief Executive’s office.
    Empty suits are what got us to this point. Speak to powerment as an alternative to empty suit logic. Former President Clinton was someone who knew something about this, that as a leader talks to a higher level of discourse, Americans actually have understanding to agree with those words and even to aspire better outcomes.
    Maybe he needs to remind people about a little item known as “pay-go” and what it can accomplish. At a time when the credit crisis seems to have fractured some of the EU’s fiscal standing it really is a time to talk about revenue as it relates to dollar solvency. This is the second wave of the credit crisis coming to shore.
    Surf’s up….

    Reply

  70. DonS says:

    “Podesta also says that politics in America today “sucks”.”
    He must be a blogger. Write him off. Not serious. Not beltway approved.
    If Obama finds some way to tack, not just optics, and things stay the same, or get worse??? If politics sucks, it must mean politicians suck. Or that the process sucks. Or both. Get the money out of politics or this nation is doomed.

    Reply

  71. Paul Wicker (the tall vicar) says:

    Maybe a new policy of not seeing the people as stoopid would be a start. Another good move would be to get shot of Puddin’ Guts (aka Hilary Clinton) as she’s a disgrace to the human intellect.

    Reply

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