Congress Set To Make History Again, And Again In A Bad Way

Last year President Obama tried to push through his brand of health care reform before Congress recessed in August. The rush backfired and proved to be the straw that broke the camel's back for an already angry citizenry. Americans turned out in droves to congressional town hall meetings that August to express their displeasure. As Peggy Noonan writes in the Wall Street Journal, members of Congress were caught flat footed by the response and were revealed for the unprincipled, elitist and uninformed blow-hards they have always been.

But perhaps more amazing is the fact that they passed their reforms anyway. It took them a while, and it looked dead on more than one occasion, even costing them "Teddy Kennedy's Senate Seat". But they did it. And they did it despite almost 60% of the country opposed to it.

As elected representatives, voting against what your constituency clearly wants is not the best strategy for reelection. And now its time to pay the piper. Democrats are likely to lose a significant number of seats this fall, perhaps even losing control of the House.

And what is the Democratic response to clear voter disapproval of their policies?

Ram through as much of their crap policies as they possibly can before they're forced out.

there have been signs in recent weeks that party leaders are planning an ambitious, lame-duck session to muscle through bills in December they don't want to defend before November. Retiring or defeated members of Congress would then be able to vote for sweeping legislation without any fear of voter retaliation. "I've got lots of things I want to do" in a lame duck, Sen. Jay Rockefeller (D., W. Va.) told reporters in mid June.

This is truly despicable. And blatantly so. They started recess early this year because they don't want to face their constituents with more bad laws just before the election. But they clearly plan to pass every bad law in their play book when actually facing the voters isn't possible. What a horrible, political, tyrannical, disgusting thing to do.

Did Lies Change Health Care Reform Debate?

That's the question many are in a rush to answer in the wake of the Democrats losing their 60th seat in the US Senate. It's not that the public doesn't want this reform, the reasoning goes, it's that Republicans lied about reform and those lies are what turned the tide.

In light of this, let's review the history of the health care reform debate, and take a look at the lies it produced.

-There are 46 million uninsured Americans
-Democrats only want a public option, not a single payer. And the public option won't ever lead to a single payer system
-You will get to keep your current insurance if you want it even after the reform is passed
-We have a free market health care system in the US, and that is what is to blame for rising costs
-Preventive care drastically reduces total health care costs
-There are no sweetheart deals with the drug company lobbyists
-It will only cost a trillion dollars
-All the deal making would be shown on C-Span
-There would be no tax on so-called "Cadillac Plans"

Democrats lost the health care reform debate for two reasons: 1) Their ideas don't work 2) They lied about their ideas not working

Move On Tells Us the Magnitude of Scott Brown's Win

In the aftermath of Scott Brown beating Martha Coakley in the Massachusetts Senate race, pundits, both of the professional and the in-your-parent's-basement type, have been playing tug of war over what the election really means. Reading all these pundits simply shows that hindsight in this case seems to muddy rather than clear the waters. For that reason I went back to the archives and found this breathless email from Moveon.org, sent on January 8th, 11 days before the election, titled,

"Urgent: A Republican in Ted Kennedy's seat?"

Horror of all horrors! They said a Coakley loss would be "devastating", and that "health care could die, and the Republicans could block pretty much anything they want."

In order to avoid such a catastrophic outcome, Moveon invoked "progressive hero" Ted Kennedy's name seven times in the email. They quoted Kennedy's widow Vicki, who said, "My husband fought for healthcare reform for more than 40 years. Martha Coakley shares those critical beliefs."

Clearly Moveon saw this election as a referendum on health care. Clearly they thought that Massachusetts voters wouldn't dream of replacing a progressive health care reform icon with the very vote that could end the momentum of what is the closest the country has been to progressive reform in decades. Clearly, they were wrong.

Utah's Medicaid Doesn't Check for Fraud. On Unrelated Note, Medicare Losing $90 Billion A Year to Fraud

I recently discovered that our state Medicaid program is incredibly inept at catching fraud. Why is this important, you ask? Because 60 Minutes just did a piece about how Medicare is being defrauded out of $90 billion a year because they too are inept at catching it.

But yeah, a single payer system would be totally cool.


Watch CBS News Videos Online

Heather Graham Starring as Public Option - She Should Be Running By Herself

Because that's what the public option is all about.

More Absurd Lies in Health Care Discussion

I recently wrote about an interview NPR conducted with the author of a new book which shows that Lyndon Johnson lied to the American public in order to get Medicare passed. In the words of the author,

"One of the things he did was suppress the costs...if the true cost of Medicare had been known, if Johnson hadn't basically hidden them, the program would never have passed."

I tied this propensity for lying to the various lies and misrepresentations coming from Congress and the White House in the ongoing health care reform debate. This of course was dismissed as "full of logical absurdities".

In light of that discussion I was interested to read this editorial reprimanding the White House for using legislative tricks, in other words lying, to suppress the true cost of the latest health care reform bill being bandied about. It seems that in order to get under their self-imposed cost threshold, Congress has simply moved $247 billion in costs to a different bill which wouldn't go into effect for a year. It's the very definition of a shell game. This one designed to trick deficit conscious people into supporting this reform bill.

Utah's Medicaid Has Major Issues

In August Utah's Legislative Auditor General released the findings of its audit of the state's Medicaid program. What it found was a program which spends $1.7 billion a year, but has almost no oversight of where it's going.

Reading through the 100 page report, I was struck by the systemic failure exhibited by Medicaid. There is an appalling lack of oversight in basically every area the auditors looked at. From prior authorizations, to provider screening and enrollment, to fraud recovery, and internal policing - it all failed miserably. Each of these areas are critical points in keeping costs down and avoiding fraud and waste, yet the guidelines are either non-existent or so lazily enforced as to be worth less than the paper they're printed on.

For clarification, Medicaid is health insurance for low income people administered by the state of Utah, but funded with both state and federal money. Utah kicks in about $500 million of the total $1.7 billion spent.

There were a couple of things in the audit that stuck out at me. First is that 95% of that $1.7 billion is not reviewed for fraud at all. Organizationally, Medicaid is set up to ignore whether those payments to dentists, doctors, and hospitals are legit or not. There could be double billing, useless tests or exams, or out and out fraud, an no one will ever find out. Which in itself is concerning, but then it's coupled with the fact that Medicaid doesn't review its providers (the doctors, dentists, and hospitals) either. Anyone who wants to be a part of the Medicaid program is accepted, even if they have a history of fraud. So we accept any possible fraudster out there, and then we don't monitor their billings at all. Sounds like a recipe for disaster to me.

And disaster might be what we're getting. The auditors cite a national study which says that on average the low end of fraudulent cases is 3% of total billings. The auditors stress this is a conservative estimate. Well, Utah Medicaid finds and gets money back on about 1.7% of its total spending. But even that low number is misleading because most of that returned money comes not through our efforts, but because private insurance companies find out that Medicaid had paid for a service that was actually the private company's responsibility, and instead of pocketing the savings they fix the problem and pay for it themselves. So Medicaid on its own actually only finds and recovers a fraction of 1% of fraud. Again, this speaks to the total lack of oversight and due diligence by the program.

The most glaring deficiency in the audit is that, again because of poor guidelines and organization, Medicaid itself is never audited. There are no independent internal audits being conducted to ensure everything is on the up and up. So not only does Medicaid not audit providers or look for fraud, but no one is auditing Medicaid either.

The reason all of this is important really comes into focus through a specific, real life example written of in the audit. A provider bills medicaid for $370,000. Medicaid has to determine if the services were actually necessary before they pay for them, so they request medical history documentation. The requested documents never come, so Medicaid doesn't pay. The provider starts an appeal process so they can get their money, but even then they file the appeal late and still don't send the medical documents. Finally, they drop the appeal and go straight to the Medicaid director. Up to this point everything has been handled ok, despite the persistent lateness of the provider. Even going to the director is somewhat supported by written guidelines. At this point the director should have gotten the medical documents, reviewed them, and then made a decision. Instead, he unilaterally gave the provider $370,000 without even reviewing the case. Only after the auditors found this example two years later did Medicaid finally get the appropriate documentation. Medicaid's director's reason for handing over $370,000 without even reviewing the case? He said sometimes that's necessary in order to "maintain relationships with providers."

I can imagine the stress this audit must have created for everyone in the Medicaid office. As a controller of a large company, I get audited every year, and it's a stressful time. I have to justify every decision I've made over the course of the year, and provide documentation as part of the justification. If you're organized and prepared, audits can be relatively simple. If not, they can be a major source of heartburn.

This report is possibly the worst conceivable outcome of the audit. The only way it could have been worse is if the auditors caught Medicaid management stealing funds. The audit shows medicaid fits the stereotype of an inefficient, poorly managed, wasteful government program.

2009 Democrats Need to Learn Lessons of 1960s Democrats: Lie

NPR recently interviewed James Morone, who co-authored a book entitled, "The Heart of Power: Health and Politics in the Oval Office." The interview centered on how President Lyndon Johnson pushed Medicare through Congress until its ultimate passage. Mr. Morone and Renee Montagne, who interviewed him for NPR, both assume great current public support for Medicare, and this assumption is what allows them to reveal a remarkable fact about how Medicare was sold to the public all those years ago. Morone obtained tapes of phone conversations President Johnson had with members of Congress as he guided Medicare through the political process, including one such conversation with noted public health care advocate Ted Kennedy,

"Johnson maneuvered every step of the way, getting this bill through Congress. And one of the things he did - and this is a little dicey in today's climate. One of the things he did was suppress the costs. So this young kid gets elected from Massachusetts, Ted Kennedy, in 1962. And Johnson is explaining to him how you get a health bill through. And what he tells him is don't let them get the cost projected too far out, because it'll scare other people.

Pres. JOHNSON: A health program yesterday runs 300 million, but the fools had to go to projecting it down the road five or six years. And when you project the first year, it runs 900 million. Now I don't know whether I would approve 900 million the second year or not. I might approve 450 or 500. But the first thing Dick Russell comes running in, saying my God, you've got a billion dollar program for next year on health, therefore I'm against any of it now. Do you follow me?

Senator EDWARD KENNEDY (Democrat, Massachusetts): Yes, right.

Mr. MORONE: We believe after looking at the evidence - my co-author and I -that if the true cost of Medicare had been known, if Johnson hadn't basically hidden them, the program would never have passed. America's second-most beloved program would never have happened if we had had genuine cost estimates. "

Now, the title of this post is written somewhat in jest. Democrats don't really need to learn the lessons from their 60's counterparts. They're well on their way to upping the ante.

Putting aside for the moment many of the lies and misrepresentations regarding health care reform we've seen in the last couple of months (from a public option not leading to single payer, or that you'll get to keep your current insurance if you want to, to the President's fact-bending health care speech to Congress), we can focus on and find parallels to President Johnson's cost concealing Medicare push with what President Obama has done with the costs of the proposals we've seen so far.

The original bill making waves in Congress had a Congressional Budget Office price tag of over $1 trillion. Having learned the lessons of Medicare, Democrats couldn't allow that number to be taken seriously, so they went about trying to discredit the CBO's numbers,

Speaker Nancy Pelosi:

"it's always been a source, yes I will say frustration, for many of us in Congress that the CBO will always give you the worst case scenario"

Senator Tom Harkin:

"The way CBO scores some things sometimes doesn't make a whole lot of sense -- I mean, real-life sense,"

Senator Chris Dodd:

"One of the things that's disappointing about CBO -- and frustrating -- is all the work…done on prevention" that the CBO doesn’t factor in"

The President also voiced his "concern" over CBO numbers, saying the CBO doesn't give him credit for all the savings included in the bill which would offset many of the costs. What he neglects to mention is that the CBO did in fact account for those measures, and found they wouldn't save money at all. In fact, they likely will add to the costs. But no matter, these statements from Democratic stalwarts aren't meant to be used in factual debates; rather, their purpose is to cast enough doubt on the CBO numbers so that they can more readily ignore the independent group's cost projections.

Cost projections which could very well be on the low end. By law, CBO projections only go out ten years. So other groups have projected beyond that horizon and found significantly higher costs. Which is not surprising, considering recent studies showing government consistently underestimates the true costs of programs. So consistently, in fact, that it's apparent this underestimation is not done by accident. No, it would seem politicians have all learned President Johnson's lesson very well.

Cheneyed By A Guy Named Barack Obama

Those crazy right wing extremists are at it again, calling president Obama a fascist:

From the Huffington Post:

A memo obtained by the Huffington Post confirms that the White House and the pharmaceutical lobby secretly agreed to precisely the sort of wide-ranging deal that both parties have been denying over the past week.

The memo, which according to a knowledgeable health care lobbyist was prepared by a person directly involved in the negotiations, lists exactly what the White House gave up, and what it got in return.

Critics on Capitol Hill and online responded with outrage at the reports that Obama had gone behind their backs and sold the reform movement short. Furthermore, the deal seemed to be a betrayal of several promises made by then-Sen. Obama during the presidential campaign, among them that he would use the power of government to drive down the costs of drugs to Medicare and that negotiations would be conducted in the open.

I Love That 'Regular' People Are Getting Involved...Oh, And Larry O'Donnell Is Still A Shmuck

This video annoys me for a couple of reasons.

First, for Larry O'Donnell to cluck cluck about having a rational debate without yelling and screaming is incredibly ironic considering his meltdown about Mitt Romney's mormonism. You can watch it here. But really, that's indicative of pretty much everyone who has cluck clucked about the tone and tenor of the folks attending the town hall meetings across the country; it wasn't too long ago they were whining about their own free speech rights while burning US soldiers in effigy.

Second, O'Donnell is oozing fake niceness and understanding here. What a shmuck. He set up this woman and set out to make her look bad. This was not journalism, or debate. This was an orchestrated hit job. It's not often I watch these pundit shows, and this clip reminded me why. In fact, this clip typifies exactly why people like Katy Abram aren't involved in politics. No one's actually interested in solving things. It's all just a sick game to them.

Which brings me to my final point. I struggled watching this clip because I could see right away where it was headed. I wished I could have been in her place, as I'm fairly certain I have already heard and answered every inane question O'Donnell was prepared to ask. And that's the point. Too many people have left to others the task of being informed. Too many people shy away from political conversation. But now, many of these people are waking up, getting involved, going to town hall meetings. They know they don't like what's going on, but they don't know how to articulate it. Because these are their first baby steps into political conversation they've never heard someone like O'Donnell try to argue that Medicare is great so stop complaining about government health care.

This is the reason I enjoy blogging so much. I have come into contact with people all over this country from every political stripe. I have heard arguments for and against just about every issue, and I've had to defend my own positions time and again. I've become known as 'the political one' among my friends and family, and am always ready to join a political conversation wherever it arises. But those occur far too infrequently.

We need more of this. We need more political conversations - at home, at work, with friends and family. With more people sharing and hearing, the real issues will come into focus. People will be less able to be dismissed as a 'mob', less able to be sneered at in contempt like Larry O'Donnell did in this video. Oh, the O'Donnells of the world will still sneer, but if you answer from a place of knowledge and experience, they'll be revealed for the empty windbags they really are.

Health Care Lies That Are Deceiving the Public

I've read in a few places how the lies being spread in the media and elsewhere about Health Care reform are distorting the public's perception of the issue and making it difficult to have a rational debate. So I've put together a quick list of lies I've come across:

1. There are 46 million uninsured Americans.

See here and here for a serious debunking of this dubious statistic.

2. These plans are only for a "Public Option", not for single payer

President Obama has been quite eloquent in explaining away this myth.

3. You will get to keep your current insurance even if this reform bill is passed

This is one of those sorta, kinda technically true statements. Sure, there's nothing in the bill that I'm aware of that forces you to drop your current insurance plan. But in reality, millions of Americans who get their insurance through their work will find their employers dropping their plans. So it's not really truthful to say you'll get to keep your current plan if you so choose.

4. We need more government involvement because our current free market system is failing.

Hard to say we've got a free market system when government programs Medicare, Medicaid and SCHIP pay for 47% of health care in this country.

5. The reform bill includes measures for preventive care, which will drastically reduce overall health care costs.

Not according to the Congressional Budget Office, which quotes a study published in the New England Journal of Medicine which says,

"Sweeping statements about the cost-saving potential of prevention ... are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs. For example, screening costs will exceed the savings from avoided treatment in cases in which only a very small fraction of the population would have become ill in the absence of preventive measures. Preventive measures that do not save money may or may not represent cost-effective care (i.e., good value for the resources expended). Whether any preventive measure saves money or is a reasonable investment despite adding to costs depends entirely on the particular intervention and the specific population in question.

Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."

6. The initial cost projections are at $1 Trillion over the first ten years, but don't worry, the president assures us it will be paid for and won't add to the deficit.

Hmmmm...where have we heard that before?

"The Most Open Government Ever" Won't Answer A Simple Question

In response to the very vocal opposition to the health care reform plans being railroaded through Congress, the White House recently asked US citizens to send them any "fishy" (their word) information they may have gotten in emails and the like.

In an interview conducted on Fox News, White House spokesperson Bill Burton was asked what was being done with the email addresses and other information being sent to them per their request. Mr. Burton was extremely evasive, until finally the question was put this way:

"In an environment when you have the Speaker of the House referring to these people as swastika wearing, where you have another democrat calling them Nazis, where you have the president calling complaints about health care "smears" and saying he's going to fight them and then the White House comes out and says "send us the emails", those who are behind the emails may feel a little reluctant to engage in such speech in the future. And that is the complaint, not just cable news has about it, Bill Burton, but the ACLU has come out and said "we've got a serious problem with that."

Here's the entire interview:



This really is an example of when evading a question makes it an even bigger deal than if you had simply answered it. Perhaps the White House strategy is to not justify with a response what they feel are silly questions, but when you're directly asked a question four or five times and you flail around like Mr. Burton did, you're just raising more doubts.

We Will Find You, You Health Care Lying Liars

Dueling Health Care Videos

The first video shows clips of President Obama and others explaining how a public option is the first step to getting rid of private health care. The second is a quick follow up from the White House's youtube page showing President Obama promising that if you like your current doctor and insurance, his plan won't take that away from you. What it doesn't explain are his past statements as shown in the first video, other than to say they were taken out of context, nor does it explain that while the government technically won't "force" you to use the public option, it is making it so that your employer just won't offer it to you anymore.







UPDATE:

More Context

Jon Stewart Foretells the Future of Health Care

"If it [health care] is paid for by a surtax on the wealthy -- and I am wealthy -- can I then stop poor people from smoking and eating ice cream. 'Cause I see them on the subway and I want to say 'Hey! Dude. You're costing me money.'"

Jon Stewart

Visual Representation of Lies, Damned Lies, and 46 Million Uninsured

My post about the dishonest uninsured statistic from a couple of months ago got a revealing response. I thought this political cartoon further explains the point:

Lies, Damned Lies, and 46 Million Uninsured

From economist Keith Hennessey comes a really interesting breakdown of how many uninsured people there are in the United States, and how many of those people actually need/want insurance. Since the 46 million number appears prominently in the national health care debate, this information is very valuable.

First, nearly a quarter of the 46 million are already covered by Medicaid or SCHIP, and therefore should not be included. Another 20% are not citizens of the US, while a third are either significantly over the poverty level or are young, single, and childless. If you were to take out these groups from the number of uninsured, the new number becomes 10.6 million, or 2% of the population.

2% just doesn't generate much passion though.