Pete Stark: "Medical Unicorns"

Why are co-ops a non-starter in the health care reform debate? Because they won't work. On Thursday Pete Stark blasted them:

there is no real example of either the regulation [of health co-ops], or how you would establish them, or where they would get enough people to have a purchasing base. So you might as well talk about unicorns.

From a paper released Thursday,

a public health insurance option could also lead to a more transparent market. As long as insurers conceal provider prices, price competition in provider markets is unlikely. As long as coverage protocols and utilization data are concealed, quality competition among plans is unlikely. The coverage protocols and provider payment rates of the public option, on the other hand, would be open to the public. And data on the utilization of health care services under the public plan would be available for expert analysis and reporting, just as Medicare data are now.

Finally, the public option is necessary as a backstop against risk selection. It takes more than simply prohibiting risk selection to stop it. Even with risk adjustment and strong non-discrimination rules, private insurers are likely to find a way to dodge people whose costs are expected to be high in order to protect profitability. The job of the public option, on the other hand, is to accept, not to avoid, risks and to be accountable to the public, not shareholders.

What mcjoan said:

That's what all the fuss is about, why this has become the key element of a proposal for so many people. We want the damned reform to actually work. Co-ops won't make it work, they just aren't going to be robust enough to do the job. Insurance reform is really good, and we very much need that, too, but it isn't going to be enough either. For one thing, does anybody seriously believe that our government could set up a strict regulatory scheme that insurance companies would actually follow? That'd be a first.

Barack Obama's Farewell To Ted Kennedy

From CBS here is the video from Senator Kennedy's funeral today and a truly magnificent farewell from the President.

Untold stories: thousands of American expats are medically exiled health care refugees

Moving testimonial about a little-known aspect of our current health-care system:

Cartoon Explains the Public Plan in under 5 Minutes

Great cartoon does an awesome job of explaining the proposed new federal health insurance plan:

There And Back Again: An Inaugural Adventure

An Oklahoma meteorology student, Greg Blumberg, had almost the exact same experience at Barack Obama's inauguration that my daughter and I had, including

We got stopped here. This was the end of our trip.

Go take a look. The photos at the site explain better than I could ever do in words what horrendous crowd management conditions existed that day.

What Health Care Overhaul Means For You

In this NPR article, What Health Care Overhaul Means For You, there is a good interactive visualization of what the healthcare public option proposal would mean for Americans with different levels and types of coverage.  One of the commenters there wrote:

It has been my experience that people who have a disdain for helping others have never really had the experience of bad luck or disaster. Though some people who experience difficulties become hardened or bitter against others, most don't. Once these people find themselves in a situation really beyond their control with their heads underwater and struggling to stay afloat, then they start to get the rest of us who have experienced some of the rougher waters of life and who have learned that many times those who suffer don't "deserve it". That’s why I believe in safety nets. …

I don't understand this reluctance of Americans to spend American money on our own people. People had no problem giving Bush/Cheney a trillion dollars for their "war" for a country on the other side of the planet, why aren't you willing to spend our money making sure our own are cared for? All Americans deserve universal health coverage. Every other country that provides health care to all (including people who get sick when visiting their country) provides this care and it costs them a LOT LESS than what Americans are paying right now - and we aren't getting universal care!

I could not agree more.

Hillary Clinton Redefining State Department

David Rothkopf, a visiting scholar at the Carnegie Endowment for International Peace, in the Washington Post writes

what is Clinton actually doing? Only overseeing what may be the most profound changes in U.S. foreign policy in two decades -- a transformation that may render the presidencies of Bill Clinton and George W. Bush mere side notes in a long transition to a meaningful post-Cold War worldview.

The secretary has quietly begun rethinking the very nature of diplomacy and translating that vision into a revitalized State Department, one that approaches U.S. allies and rivals in ways that challenge long-held traditions. And despite the pessimists who invoked the "team of rivals" cliche to predict that President Obama and Clinton would not get along, Hillary has defined a role for herself in the Obamaverse: often bad cop to his good cop, spine stiffener when it comes to tough adversaries and nurturer of new strategies. Recognizing that the 3 a.m. phone calls are going to the White House, she is instead tackling the tough questions that, since the end of the Cold War, have kept America's leaders awake all night.

and

Clinton's State Department can take on a bigger role in tackling the problems of the future -- in particular, how America will lead the world in the century ahead. This approach is both necessary and canny: It recognizes that U.S. policy must change to fulfill Obama's vision and that many high-profile issues such as those of the Middle East have often swamped the careers and aspirations of secretaries of state past.

Which nations will be our key partners? What do you do when many vital partners -- China, for example, and Russia -- are rivals as well? How must America's alliances change as NATO is stretched to the limit? How do we engage with rogue states and old enemies in ways that do not strengthen them and preserve our prerogative to challenge threats? How do we move beyond the diplomacy of men in striped pants speaking only for governments and embrace potent nonstate players and once-disenfranchised peoples?

In searching for answers, Clinton is leaving behind old doctrines and labels. She outlined her new thinking in a recent speech at the Council on Foreign Relations in New York, where she revealed stark differences between the new administration's worldview and those of its predecessors: The recurring themes include "partnership" and "engagement" and "common interests." Clearly, Madeleine Albright's "indispensable nation" has recognized the indispensability of collaborating with others.

Also,

by most accounts, the administration's national security team has come together successfully, with Clinton developing strong relationships with national security adviser Jones and Defense Secretary Gates. Her policy deputy, Jim Steinberg, has renewed an old collaboration with deputy national security adviser Tom Donilon; the two of them, working with Obama campaign foreign policy advisers Denis McDonough and Mark Lippert, have formed what one State Department seventh-floor dweller called "a powerful quartet at the heart of real interagency policymaking." ...
At the heart of things, though, is the relationship between Clinton and Obama. For all the administration's talk of international partnerships, that may be the most critical partnership of all.

So far, according to multiple high-level officials at State and the White House, the two seem aligned in their views. In addition, they are gradually defining complementary roles. Obama has assumed the role of principal spokesperson on foreign policy, as international audiences welcome his new and improved American brand. Clinton thus far has echoed his points but has also delivered tougher ones. Whether on a missile shield against Iran or North Korean saber-rattling, the continued imprisonment of Aung San Suu Kyi in Burma or rape and corruption in Congo, the secretary of state has spoken bluntly on the world stage

What a refreshing change from the last eight years of "I'll-kick-your-ass" belligerance!

"Take advantage of me and I will crush you"

Paraphrased: "You come straight at me and I'll come straight at you, but if you take advantage of me, I will crush you." Let's see some of this attitude against the Republicans in the health-care debate.

Paul Krugman on Obama’s Trust Problem

Paul Krugman a couple days ago wrote:

"it’s possible to have universal coverage without a public option — several European nations do it — and some who want a public option might be willing to forgo it if they had confidence in the overall health care strategy. Unfortunately, the president’s behavior in office has undermined that confidence.

On the issue of health care itself, the inspiring figure progressives thought they had elected comes across, far too often, as a dry technocrat who talks of “bending the curve” but has only recently begun to make the moral case for reform. Mr. Obama’s explanations of his plan have gotten clearer, but he still seems unable to settle on a simple, pithy formula; his speeches and op-eds still read as if they were written by a committee."

What we need most of all is for the President to cast this debate within the frame of the moral case for reform. It should have been so from the beginning.

The PolicySpeak Disaster

I have long admired George Lakoff's ability and teaching on framing and messaging. In a post at Huffpo and DailyKos, George Lakoff discusses the Obama Administration's "PolicySpeak Disaster."

PolicySpeak is the principle that: If you just tell people the policy facts, they will reason to the right conclusion and support the policy wholeheartedly.

PolicySpeak is the principle behind the President’s new Reality Check Website. To my knowledge, the Reality Check Website, has not had a reality check. ...
To many liberals, PolicySpeak sounds like the high road: a rational, public discussion in the best tradition of liberal democracy. Convince the populace rationally on the objective policy merits. Give the facts and figures. Assume self-interest as the motivator of rational choice. Convince people by the logic of the policymakers that the policy is in their interest.

But to a cognitive scientist or neuroscientist, this sounds nuts. The view of human reason and language behind PolicySpeak is just false. Certainly reason should be used. It’s just that you should use real reason, the way people really think. Certainly the truth should be told. It’s just that it should be told so it makes sense to people, resonates with them, and inspires them to act.

In this health-care debate, the President's advisors have fallen into the classic policyspeak framing disaster to which we on the left are so often prone. The White House would do well to get a cognitive scientist like George Lakoff on board, and fast.