Politics

I used to be a fan of James Taranto's Best of the Web Today column from The Wall Street Journal.  He was witty and seemed take a no-nonsense, rational view of politics from a conservative's perspective.  He even occasionally defended Obama against his critics (e.g., regarding the birther conspiracy or his response to the Tiller shooting and the shootings outside the Little Rock Army recruiting center).  However, he has seemed to lose his even-handed-ness and rationality over Obamacare during the last few months.  It began to seem like I was reading the writings of just another political hack.

His two columns since the House passed the Senate's health insurance reform bill have continued this trend as he writes with the bias, lack of objectivity, and near delusion for which he usually castigates others.

From yesterday's column:

Expansions of the welfare state have always been controversial, but this is unprecedented: massive social legislation passed by a single party over the objections of a clear majority of voters.

Objections of a clear majority of voters?  Though conservatives had perhaps convinced themselves otherwise, about half of us either favored the bill or thought it didn't think it went far enough.  A new Gallup poll today indicates that, by a 49 to 40 margin, more Americans think the bill's passage was a good thing than think it was bad.  Nate Silver has more on why the talk of going against the people's will doesn't hold water.  Nate also highlighted a couple months ago something that I've observed in my personal interactions: people have generally lacked basic knowledge about what the House and Senate bills actually contained.  Furthermore, the Republican opposition wasn't really based on the content of the bill either (which is fairly characterized as a moderate Republican's bill), but rather was primarily a strategy for reversing the party's electoral fortunes.

Back to Taranto...from today's column:

So Republican unity was an accomplishment--but not much of one. The GOP, their numbers severely depleted by the 2006 and '08 elections, simply did not have the power to prevent a determined legislative majority from imposing its will on the nation.

Remind me again.  How did the GOP's numbers get severely depleted and the Democrats get a legislative majority?  Oh yeah, that's right, it was partly because the Democrats campaigned on health care reform (among other issues) and were elected by the nation.  Now, as that majority delivers on its election promise and passes legislation by majority rule...democracy has somehow now become an imposition of will?!?

Also, over and over again during the last few months Taranto has cited news stories from the U.K. and Canada in an attempt to discredit the proposed reforms.  However, among our peers (all of which have some form of universal health care), the U.K. and Canada are two examples that are among the least similar to our reforms (here's a tool for comparing us pre-reform to several of our peers; Obamacare is most similar to the Swiss system).  That's the kind of fallacious editorializing that normally gets Taranto's knickers in a twist.  Maybe, now that the reforms have been passed, he'll be more like himself.  I hope so.

One of the more interesting things to me about all this is that so many people are so sure that they absolutely hate this bill.  I don't expect everyone to be excited about it.  About half of us think government is more the problem than the solution.  I don't expect that half to be glad that the government is getting more involved in health care, but please be reasonable.

Let me say it again, this bill you're denouncing as Socialism is a moderate Republican's health insurance reform bill.  It's remarkably similar to one Chafee (R) proposed in 1993 and what Bob Dole (R), Howard Baker (R), and Tom Daschle (D) proposed last year.  It is the result of months of negotiations among the Gang of Six (R: Enzi, Grassley, Snowe; D: Baucus, Bingaman, Conrad). It contains a multitude of Republican amendments.  Yes, the government will be more involved than it is now, but that doesn't mean you get to redefine Socialism.  No, the vote wasn't bipartisan, but that was by design of the GOP's strategy for regaining power and not Obama's desire or the bill's actual merits.

If you, like the vast majority of us, get your health insurance via an employer-subsidized plan, then the government is already helping you out in big ways...ways that it isn't helping those who must get coverage on the individual market.  It is subsidizing employer-sponsored coverage to the tune of $250 billion per year by excluding that form of income from income tax.  Furthermore, pre-existing conditions are not an issue in the employer-based market because of government regulation (Health Insurance Portability and Accountability Act of 1996).  Why is it that you deserve these benefits but someone who is out of work or only able to get part-time work or is a freelancer does not?

It's not true that a majority opposes this bill because it is too liberal.  It is true that about half of us favor it or think it is not liberal enough.  Congress isn't ignoring the will of the people.  Obama and the Democrats ran on health reform and won the White House and large majorities in Congress.  Now they are delivering on a major campaign promise.  This is not an act tyranny.  This is democracy.

Also, there are no actual pro-abortion dimensions to the bill.  Claiming otherwise despite the facts diminishes our credibility as pro-lifers...and credibility is something we greatly need to be able to change hearts and minds about abortion.

I seem to have noticed a trend away from "Leave health care alone!  Our system is the best in the world!" to "Everyone agrees we need reform, but not this reform!"  OK, what do you want?  Tort reform?  Fine, but that's a drop in the bucket.  End discrimination against pre-existing conditions?  If you do that, then you need the individual mandate...otherwise only the sick will buy insurance.  If you have the individual mandate, then it's more important than ever to have adequate subsidies so that everyone can afford it.  Sounds like a decent plan you've got there, but it sounds suspiciously familiar.

In the end, I'm glad more of the minority will now have the access to affordable health care that the majority of us already have.  I hope you can understand that even if you think I'm misguided.

Tomorrow the House will vote on the Senate health reform bill and a set of amendments to it.  They will do it with explicit votes rather than the "deem and pass" strategy that had been floated.  Although the Senate will still have to pass the amendments itself via reconciliation, it is assumed that those votes are there.  That means tomorrow's votes will likely be decisive.

Much of today's drama surrounded whether or not Bart Stupak could be brought back on board by addressing his concerns about the Senate bill's abortion language.  Apparently that's not going to happen.  On the other hand, an executive order incorporating Stupak's language is apparently being considered.

The debate over whether or not the Senate bill subsidizes abortion is quite odd.  Folks like Stupak and the United States Conference of Catholic Bishops say it does.  Folks like Brad Ellsworth, The Catholic Health Association, and Catholics in Alliance for the Common Good say it doesn't.  The status quo (via the Hyde Amendment) is that the federal government doesn't pay for abortions, and President Obama has made it clear that he doesn't want the health insurance reform bill to change that status quo.

A look at the bill's abortion language makes if difficult to understand why so many people are apparently so sure that it funds abortions.  While not requiring or preventing insurance plans to include abortion coverage, it prevents public money from funding them. It requires that the state-based exchanges have at least one plan available that doesn't cover abortions and allows a state to rule out abortion coverage if it chooses.  Nevertheless, there seem to be two remaining threads to the pro-life opposition to the Senate bill.

First, the bill stipulates that anyone who wants to purchase a plan that includes abortion coverage in the state-based exchanges must make a separate payment for that coverage, and the insurer must keep that pool of money separate from any governmental subsidies so that they don't directly fund abortions.  This is not adequate to Stupak because there will be people who would not have insurance at all without the federal subsidies who then purchase abortion coverage for their subsidy-enabled health insurance.  Stupak seems to take the view that once you give someone aid you are effectively subsidizing any other way that they choose to spend money. By that logic I'm sure I have "paid for" all kinds of bad things (by giving money to a church that gives aid to people who also spend their money on bad things), but of course I haven't actually "paid for" those things.  Also, many employer-sponsored insurance plans cover elective abortions.  A Guttmacher Institute Study indicated 87 %, while a Kaiser Family Foundation said 46 % (LifeNews believes the KFF numbers).  I checked on mine (Aetna), and it does.  Famously, the Republican National Committee's plan covered elective abortion until it became a news story, and the argument could be made that even Focus on the Family indirectly pays for abortions.  By Stupak's logic, isn't everyone who pays premiums to those plans indirectly funding abortions?  Furthermore, the tax exclusion for employer sponsored health care is (by Stupak's logic) an enormous abortion subsidy that dwarfs the small, theoretical one that is his current focus.

Secondly, the bill includes funding for "community health centers" which some have claimed could provide abortions.  This may in fact be (theoretically) true since that funding would come via a route that might not be subject to the Hyde Amendment.  However, it's been argued that there are other long-standing regulations that would prevent programs administered by the Health Resources and Services Administration (programs such as the community health centers) providing abortion services and that the funds will end up in the same pot as other funds subject to the Hyde Amendment, effectively making it subject to the same restrictions.

Here is what National Association of Community Health Centers has to say about it:

Community health centers "have never performed abortions," said Dan Hawkins, senior vice president of policy and programs for the group. "They do not plan to or seek to become a provider of abortions. They don't do that."

Community health centers are focused on their mission of providing primary and preventive health care -- things like immunization and prenatal care -- to those typically underserved by the health care community, he said.

Community health centers were around for 11 years before the Hyde Amendment went into effect in 1976 and they never provided abortions, he said. And last year, they got $2 billion in federal stimulus funds. Of that, $500,000 was for operational funding. It has already been used to provide health care to more than 2 million additional people, he said. Like the Senate bill's proposal, the stimulus money came separate from the HHS appropriation funds (with its Hyde Amendment limits) and contained no specific abortion language. And again, none of it was used for abortions.

Hawkins makes one last point: the $7 billion over five years through the Senate health care bill would be combined by the secretary of HHS (currently Obama appointee Kathleen Sebelius) with the roughly $2.2 billion the centers receive through the annual appropriations bill.

"In our opinion, once this money is combined with the appropriated funds, the Hyde restrictions will apply to the whole thing," Hawkins said.

Together with repeated assurances from Sebelius that no federal funds will be used to pay for abortions, Hawkins said, "We feel confident the restriction (against abortions) will apply."

"And again," Hawkins said, "they haven't done abortions and they aren't looking to do them in the future."

To summarize, it's debatable (but very unlikely) that there is a theoretical risk that the bill could enable direct funding of abortions...but even if it is theoretically possible, it is still highly unlikely.  Even so, claims like "monstrously anti-life" and "the most anti-life piece of legislation in the history of our country" are common.  Such hyperbole is especially puzzling because there is good reason to think that the health insurance reforms will actually reduce the abortion rate.  As T.R. Reid recently argued:

There's a direct connection between greater health coverage and lower abortion rates. To oppose expanded coverage in the name of restricting abortion gets things exactly backward. It's like saying you won't fix the broken furnace in a schoolhouse because you're against pneumonia. Nonsense! Fixing the furnace will reduce the rate of pneumonia. In the same way, expanding health-care coverage will reduce the rate of abortion.

At least, that's the lesson from every other rich democracy.

The latest United Nations comparative statistics, available at http://data.un.org, demonstrate the point clearly. The U.N. data measure the number of abortions for women ages 15 to 44. They show that Canada, for example, has 15.2 abortions per 1,000 women; Denmark, 14.3; Germany, 7.8; Japan, 12.3; Britain, 17.0; and the United States, 20.8. When it comes to abortion rates in the developed world, we're No. 1.

No one could argue that Germans, Japanese, Brits or Canadians have more respect for life or deeper religious convictions than Americans do. So why do they have fewer abortions?

One key reason seems to be that all those countries provide health care for everybody at a reasonable cost. That has a profound effect on women contemplating what to do about an unwanted pregnancy.

Reid summarizes:

When I studied health-care systems overseas in research for a book, I asked health ministers, doctors, economists and others in all the rich countries why their nations decided to provide health care for everybody. The answers were medical (universal care saves lives), economic (universal care is cheaper), political (the voters like it), religious (it's what Christ commanded) and moral (it's the right thing to do). And in every country, people told me that universal health-care coverage is desirable because it reduces the rate of abortion.

It's only in the United States that opponents of abortion are fighting against expanded health-care coverage -- a policy step that has been proved around the world to limit abortions.

Michael New disputes Reid's thesis, claiming the figures Reid uses exaggerate the abortion rate in the U.S., ignores the impact of our racially-diverse population, and ignores the "experience of states that have offered more generous provision of public health benefits."  However, as David Gibson points out:

A study published in the latest New England Journal of Medicine shows that abortion rates declined during the first two years that Massachusetts implemented a near-universal health coverage program much like the nationwide plan currently before Congress.

As Ezra Klein put it:

...abortions were on a longer-term downward trend in Massachusetts, so it's possible (I might even say likely) that the reform didn't matter and abortion was dropping for other reasons. But it's hard to look at this data and say that the reforms led to a large increase in abortions.

Ron Sider, President of Evangelicals for Social Action, said the following about the bill:

It is a moral outrage for the richest nation in history to leave 47 million of its people without health insurance. This legislation substantially extends coverage and also retains the long-standing stance of the Hyde Amendment against federal funding of abortion. It will save thousands of lives, cover millions of people, and prevent federal funding of abortion."

It's disappointing to me that so many pro-life groups have opposed health reform so so vehemently and with so much hyperbole.  This is not the only way I've recently been disturbed by the tactics of the pro-life movement. 

Conspiracy theories seem to be flourishing these days: for example, 911 Truthers, birthers, and whatever nonsense Glenn Beck is pushing this week.  Here is one more: as reported in the New York Times:

Across the country, the anti-abortion movement, long viewed as almost exclusively white and Republican, is turning its attention to African-Americans and encouraging black abortion opponents across the country to become more active.

A new documentary, written and directed by Mark Crutcher, a white abortion opponent in Denton, Tex., meticulously traces what it says are connections among slavery, Nazi-style eugenics, birth control and abortion, and is being regularly screened by black organizations.

Black abortion opponents, who sometimes refer to abortions as “womb lynchings,” have mounted a sustained attack on the Planned Parenthood Federation of America, spurred by a sting operation by young white conservatives who taped Planned Parenthood employees welcoming donations specifically for aborting black children.

William Saletan has questioned the consistency of the messages of some of the conspiracy theorists.  Admittedly, the figures regarding abortion in the black community are certainly tragic:

Data from the federal Centers for Disease Control and Prevention show that black women get almost 40 percent of the country’s abortions, even though blacks make up only 13 percent of the population. Nearly 40 percent of black pregnancies end in induced abortion, a rate far higher than for white or Hispanic women.

...but I'm not glad to see pro-life groups encouraging conspiracy theories about racists specifically targeting blacks for elimination or to hear claims that blacks are worse off now than they were under slavery...

In response to my claim that the government isn't taking over health care, I was recently asked what's all the fuss about, then?

My answer: politics

(most of what follows is h/t Ezra Klein)

As Maggie Mertens recently pointed out (link) and summarized with the table at the end of this post, the current senate health care bill is remarkably similar to the bill proposed in 1993 by a moderate Republican senator (John Chafee), 19 other Republican senators, and 2 Democrats - considered the major GOP proposal at the time.  Naturally, therefore, the Republicans are celebrating that the Dems some 17 years later are pushing a GOP health care bill.  Not so much.

Instead, here's a sampling of what we get...

We get this from the Republican National Committee (link):

and we get commentary like this by conservative pundit Mark Steyn from the National Review (link):

I’ve been bandying comparisons with Britain and France but that hardly begins to convey the scale of it. Obamacare represents the government annexation of “one-sixth of the U.S. economy” — i.e., the equivalent of the entire British or French economy, or the entire Indian economy twice over. Nobody has ever attempted this level of centralized planning for an advanced society of 300 million people. Even the control freaks of the European Union have never tried to impose a unitary “comprehensive” health-care system from Galway to Greece. The Soviet Union did, of course, and we know how that worked out.

Annexation of 1/6 of the economy?  Ezra Klein rebuts (link):

Putting aside the question of whether government regulations are the same as "annexation" (in which case, the apple I'm eating is federally annexed, and I never knew socialism could be this crisp and delicious), the regulations in question are limited to insurance being offered on the exchanges.

Why does that matter? Because the exchanges, as you can see on Page 20 of this CBO analysis, are expected to serve 25 million people by 2019. That is to say, these regulations will be limited to less than 10 percent of the market. And that 10 percent of the market will be primarily composed of the uninsured.

Why would conservatives be freaking out so extravagantly about a health bill nearly identical to their own from 17 years ago?  Did the GOP propose a socialist health care bill in 1993?  Were they plotting an unprecedented expansion of government, an annexation of 1/6 of the economy?  No.  Then what is all the fuss about?

The fuss is all about politics (Waterloo).

From Kaiser Health News (link):

In Nature's January 7, 2010, issue (in an opinion section called 2020 Visions):

...Nature asked a selection of leading researchers and policy-makers where their fields will be ten years from now. [Nature] invited them to identify the key questions their disciplines face, the major roadblocks and the pressing next steps.

Several of the items caught my attention.  The first was the section on demographics by Joshua R. Goldstein.  Recently I'd already been thinking about how demographic changes are on track to create an explosion of debt via health care costs in the coming decades (link).  In Nature, Goldstein writes:

As population growth marked the twentieth century, population ageing will mark the twenty-first. By 2020, the average European will have fewer years of life expectancy remaining than years he or she has already lived. East Asians will soon follow. Humankind will spend much of the coming decade grappling with questions about how to organize and pay for the care of an increasing elderly population and about who will produce what the elderly consume.

In the longer term, a return to moderate fertility rates in those countries with very low fertility, and increases in immigration can do much to moderate population ageing. Sweden and Japan face quite different demographic futures, because fertility in Sweden is closer to replacement and a small but steady stream of immigrants will make up the difference. In Japan — the world's leader in longevity — fertility remains low, and immigration a major social challenge.

We need demographic research on four fronts addressing population ageing. Low birth rates can perhaps be increased by measures that reconcile work and family, enabling people to have the children they say they want. Fostering the social and economic integration of immigrants is another priority. Health research, helping people to stay younger longer, is already a priority of ageing societies; indeed, so far, the healthy period of life has been lengthening as fast or faster than life expectancy itself. But now — as the first 65-year-old baby-boomers prepare to blow out their birthday candles — we must address the larger question of rescheduling life's turning points, so that people can remain active and productive. The societies that respond to ageing successfully will be those that take advantage of longer life.

The last line of the first paragraph ("Humankind will spend much of the coming decade grappling with questions about how to organize and pay for the care of an increasing elderly population and about who will produce what the elderly consume.") reminded me of references to Atlas Shrugged.  Although I still haven't read it, in the wake of the US government's response to the current economic crisis I see it frequently invoked by pundits (link) and common-man political conservatives as a prophecy that the "producers" will eventually rebel against being taxed to support the "poor" and "lazy."  It's ironic that the big crisis that is coming is not whether or not the "producers" will be willing and able to support the poor and the immigrants (another common target of conservative scorn) but rather whether they will be willing and able to support the elderly (who, coincidentally, have recently been flocking to the Republican party: link)...and that our ability to successfully attract and integrate young immigrants will be crucial to facing this challenge.

Another item that caught my attention was soil.  David R. Montgomery writes:

To avoid the mistakes of past societies, as 2020 approaches, the world must address global soil degradation, one of this century's most insidious and under-acknowledged challenges. Humanity has already degraded or eroded the topsoil off more than a third of all arable land. We continue to lose farmland at about 0.5% a year — yet expect to feed more than 9 billion people later this century.

During the twentieth century, the Haber–Bosch process (allowing the mass production of nitrogen-based fertilizers) and the Green Revolution effectively divorced agriculture from soil stewardship. Increased yields were supported by intensive fertilizer inputs and mechanization that simplified and devastated soil life, reducing native soil fertility. For example, research in some conventional agricultural settings shows that other species such as bacteria have virtually replaced mycorrhizal fungi, which deliver soil nutrients to most plants. In a post-petroleum world, as the era of cheap fossil-fuel-produced fertilizers comes to an end, conventional, high-input agriculture is neither sustainable nor resilient. Ensuring future food security and environmental protection will require thoughtfully tailoring farming practices to the soils of individual landscapes and farms, rather than continuing to rely on erosive practices and fertilizer from a bag.

This sentence - "In a post-petroleum world, as the era of cheap fossil-fuel-produced fertilizers comes to an end, conventional, high-input agriculture is neither sustainable nor resilient." - really caught my attention.  It's not a question of if but when we will be operating in a "post-petroleum world"...and the arrival of that day will require a massive shift in our agricultural practices.

These two topics - demographics and agricultural practices - are examples of the huge problems we have before us.  There's no doubt that government will have to play a huge role in solving these problems.  However, there is little evidence that it's up to the task...our politics seem to be broken and incapable of producing bold and timely responses to our major problems.  The fact that half of us see government as being more of a  problem creator than a problem solver makes me wonder how we can possibly respond effectively to our changing world.

The third topic from the nature story that piqued my interest was lasers and their potential to be part of the solution to our energy problems.  Thomas M. Baer and Nicholas P. Bigelow write:

Next-generation lasers will allow the creation of new states of matter, compressing and heating materials to temperatures found only in the centres of massive stars, and at pressures that can squeeze hydrogen atoms together to a density 50 times greater than that of lead. The resulting fusion reactions may one day be harnessed to provide almost limitless carbon-free energy. Enough fusion fuel is present in the oceans to supply the current energy needs of the entire world for longer than the age of the Universe.

When so many of our pressing problems can be reduced to problems of energy supply, breakthroughs like this seem to be critical.  I realize that enormous sums of money are already devoted to research like this, but I wonder if we are making appropriately-large bets given the enormous payout of success...and if research funding can be sustained at appropriate levels in the coming decades.