Betsy McCaughey: Big Tobacco Flack

Last month I wrote this about critics of health care reform:

But thanks to lying liars like Krauthammer and McCaughey, progress on this front has probably been set back a good ten or twenty years, all because defeating health care reform justifies any lie, no matter how pernicious or no matter the effect it has on actual, real people. I'm not a Christian, and even if I was I doubt I'd believe in Hell. But if there is one, it is my most sincere and fondest wish that there is a special circle reserved for the likes of Krauthammer and McCaughey, and all those who lie without regard to the impact their lies have on the lives and deaths of real people.

But if this is at all true, one hack in particular is guilty of so much worset:

I have deliberately laid off the Betsy McCaughey theme for the past month-plus. I had my say; she continues to have hers; people can make up their minds.

But revelations late last week by Tim Dickinson, of Rolling Stone, are at face value so important that they deserve to be underscored. It's worth reading Dickinson's whole dispatch and studying the on-line scans of the documents he has found. But to me the real news is the evidence that tobacco lobbyists secretly worked with McCaughey to prepare her infamous 1994 New Republic article "No Exit."

In case that's blurry, here is what Dickinson says:

"What has not been reported until now is that McCaughey's writing was influenced by Philip Morris, the world's largest tobacco company, as part of a secret campaign to scuttle Clinton's health care reform. (The measure would have been funded by a huge increase in tobacco taxes.) In an internal company memo from March 1994, the tobacco giant detailed its strategy to derail Hillarycare through an alliance with conservative think tanks, front groups and media outlets. Integral to the company's strategy, the memo observed, was an effort to "work on the development of favorable pieces" with "friendly contacts in the media." The memo, prepared by a Philip Morris executive, mentions only one author by name:

' "Worked off-the-record with Manhattan and writer Betsy McCaughey as part of the input to the three-part exposé in The New Republic on what the Clinton plan means to you. The first part detailed specifics of the plan." '

"McCaughey did not respond to Rolling Stone's request for an interview."

Maybe there is another side to this story, but if unrebutted it is damning.

Oh, if only those words could become literally true. One would think that upon this revelation, Betsy McCaughey would be utterly disgraced, and too ashamed to show her face in the media. But that would imply that McCaughey has any decency or grace to be dispossessed of. Since it is not presently illegal to sell your soul to companies who profit off of the deaths of people, we shall have to merely wait and hope that divine justice is presented to her most directly upon her death.

Legislative Update XXIV

Congress is actually passing stuff again! Though still not health care.

The House of Representatives voted for the biggest overhaul of federal student loan programs since their creation; the measure ends subsidies for private lenders, boosts Pell Grants for needy students and creates grant programs to improve community colleges and college graduation rates. The House also passed a resolution of disapproval for Rep. Joe Wilson's "You lie!" outburst during President Obama's speech to Congress.

The Senate passed a big boost in spending for housing and transportation projects, and to allow guns on Amtrak.

And, yeah, both houses voted to defund ACORN to appease paranoid conservatives.

Lies and the Lying Liars Who Tell Them

I borrow the title of Al Franken's book for this post because, as is usually the case when dealing with right-wing pundits, it is apt. This is inspired by Daily Show host Jon Stewart's exchange with lying liar Betsy McCaughey, who would like to reprise her fifteen minutes of fame by playing a critical role in sinking not one, but two health care reform packages in her lifetime. First, watch some of the exchange, via James Fallows (it's thirteen minutes total between the two segments so I forgive you for not watching the whole thing; you don't need to for the purposes of this post anyway.) Now, observe this excerpt from Fallows' post:

That is: when McCaughey admits that there is no literal "death panel" provision in the new health care provision, she goes on to say something similar to what other conservatives, most recently Charles Krauthammer in the Washington Post today, contend: that the very act of reimbursing doctors for a discussion about "living wills" and end-of-life care will have a subtle bias in favor of an euthanasia-like outcome.

On the merits of this claim, I vehemently disagree. Having had, along with my siblings, first-hand, extended, and very painful experience with this process during my own father's decline and death last year, I would put reimbursement schemes for living-will discussions at the very bottom of the list of factors that make such decisions so wrenching for everyone involved.

This is the article by lying liar Krauthammer that Fallows is referring to, wherein Krauthammer concludes that it is "obvious" that it's better to rely upon the wishes of family and friends then some "form" somebody checked off "some fine summer's day years before being stricken." Really? Terri Schiavo might beg to differ.

It is simply a lie to say that mere discussions about late stage health care and end-of-life decisions will influence people (subtly or otherwise) to die early against their will (or be "euthanized", which isn't even legal in any state in the nation.) I'm not even going to assume for the purposes of argument, like Fallows does, that there might be such an effect because there isn't. And it is a pernicious and malicious lie at that, because this lie-whose primary goal is to scare idiots and the uninformed into being afraid of health care reform-will also have the incidental effect of encouraging people to avoid not only getting medical powers of attorney or advanced directives (also known as "living wills") but to avoid even talking about how much treatment they want before they die. It would not surprise me in the least to find out that there are literally thousands of people who, thanks to the casual but malicious lying of people like Krauthammer and McCaughey, will now delay or avoid having discussions about end of life care with their doctors or their family members, for fear that they might be giving somebody permission to stick a needle in them and send them off to the great beyond earlier than they might like. So what will they get instead? They will get family members arguing over how "grandma" wants to die (and sometimes going to court about it, a la Schiavo) or if they are alone, they will have anonymous doctors or hospital administrators or courts make the decision for them. Some of them will die in agony, when had someone spent fifteen minutes talking to them about it, they might have decided to die another way. Perhaps even some will be disconnected from life support because their family "knows" it's how they want to die (and anyway, best to get to probating grandma's estate so they can get her china) when in fact that person would have preferred to hang on until even machines couldn't keep them alive.

Before this health care reform "debate" you couldn't find anyone but the perhaps the most conservative, pro-life Catholics who would be against medical powers of attorney, or advance directives, or even mere discussions with family members or doctors about end of life care. That's because everyone with any amount of intelligence and compassion would rather let the individual make decisions about their own end of life care, whether they do it by advising family members they trust on what to do, or grant someone else the authority to make decisions for them, or advise doctors in advance what they want done. This is especially the case with the legal community, as both lawyers and judges have seen quite directly the effects of a failure to plan for the end of life, and are routinely advising people to get documents that will assure that their wishes are carried out both as and after they die.

But thanks to lying liars like Krauthammer and McCaughey, progress on this front has probably been set back a good ten or twenty years, all because defeating health care reform justifies any lie, no matter how pernicious or no matter the effect it has on actual, real people. I'm not a Christian, and even if I was I doubt I'd believe in Hell. But if there is one, it is my most sincere and fondest wish that there is a special circle reserved for the likes of Krauthammer and McCaughey, and all those who lie without regard to the impact their lies have on the lives and deaths of real people.

UPDATE: Kevin Drum beat me to the punch:

Up until two minutes ago, politicians and pundits across the political spectrum universally believed that advance care counseling was an entirely sane and uncontroversial practice, one that any compassionate society would encourage. Those same politicians and pundits knew perfectly well that it was never about guiding patients in any particular direction and has never been motivated by cost savings in any way. They knew that other countries reimburse for advance care planning — just like any other use of a doctor's time — and it hasn't led to any pressure, subtle or otherwise, to pull the plug on grandma.

They knew this. Until two minutes ago. But now they're pretending — subtly, temperately — that maybe it isn't true after all. And they're doing this not because they've changed their minds, but because they want to kill healthcare reform for political reasons and they don't care whether innocent bystanders get hurt in the process. Their "Yes, but" campaign might ensure that patients forevermore mistrust doctors who talk about advance care directives, but they also know that sober, serious, subtle op-eds endorsing this point of view are more likely to derail healthcare reform among the chattering classes than Sarah Palin's Facebook maunderings. It is intellectual venality of the first order.

Still, scholars of Dante, which circle of hell is reserved for intellectual venality?

Obama Retreating on Public Option

I guess a bunch of screaming nutballs at these "town hall" meetings are having the desired effect:

The White House, facing increasing skepticism over President Obama’s call for a public insurance plan to compete with the private sector, signaled Sunday that it was willing to compromise and would consider a proposal for a nonprofit health cooperative being developed in the Senate.

The “public option,” a new government insurance program akin to Medicare, has been a central component of Mr. Obama’s agenda for overhauling the health care system, but it has also emerged as a flashpoint for anger and opposition. Kathleen Sebelius, the health and human services secretary, said the public option was “not the essential element” for reform and raised the idea of the co-op during an interview on CNN.

[...]

Mr. Obama himself sought to play down the significance of the public option at a town-hall-style meeting on Saturday in Grand Junction, Colo., when a university student challenged him on how private insurers could compete with the government.

After strongly defending the public plan, the president suggested that he, too, viewed it as only a small piece of a broader initiative intended to control costs, expand coverage, protect consumers and make the delivery of health care more efficient.

“The public option, whether we have it or we don’t have it, is not the entirety of health care reform,” Mr. Obama said. “This is just one sliver of it, one aspect of it.”

Of course the administration would like to have its cake and eat it too:

An administration official said tonight that Health and Human Services Secretary Kathleen Sebelius "misspoke" when she told CNN this morning that a government run health insurance option "is not an essential part" of reform. This official asked not to be identified in exchange for providing clarity about the intentions of the President. The official said that the White House did not intend to change its messaging and that Sebelius simply meant to echo the president, who has acknowledged that the public option is a tough sell in the Senate and is, at the same time, a must-pass for House Democrats, and is not, in the president's view, the most important element of the reform package.

A second official, Linda Douglass, director of health reform communications for the administration, said that President Obama believed that a public option was the best way to reduce costs and promote competition among insurance companies, that he had not backed away from that belief, and that he still wanted to see a public option in the final bill.

"Nothing has changed," she said. "The President has always said that what is essential that health insurance reform lower costs, ensure that there are affordable options for all Americans and increase choice and competition in the health insurance market. He believes that the public option is the best way to achieve these goals."

A third White House official, via e-mail, said that Sebelius didn't misspeak. "The media misplayed it," the third official said.

Always the media with these folks. I'm trying to understand how Sibelius' "is not an essential part" is any different from "the public option is the best way", but not the only way, to achieve the goals of reducing health care costs and expanding coverage of the uninsured. Doesn't seem all that different from me.

Howard Dean at least isn't having any of it:

Former Democratic Party Chairman Howard Dean, a leading figure in the liberal wing of his party, said Monday he doubts there can be meaningful health care reform without a direct government role.

Dean urged the Obama administration to stand by statements made early on in the debate in which it steadfastly insisted that such a public option was indispensable to genuine change, saying that Medicare and the Veterans Administration are "two very good programs that have been around for a long time."

Dean, a physician, argued that a public option is fair and said there must be such a choice in any genuine shake up of the existing system.

"You can't really do health reform without it," he said. Dean maintained that the health insurance industry has "put enormous pressure on patients and doctors" in recent years.

He called a direct government role "the entirety of health care reform. It isn't the entirety of insurance reform ... We shouldn't spend $60 billion a year subsidizing the insurance industry."

Agreed. Health care reform without a public option is insufficient.

The Paranoid Style, Redux

The more things change, the more they...well, you know where I'm going with this:

It was the latest in a series of emotional public meetings on the health-care issue that have prompted Obama and Democratic leaders to complain of a campaign by opponents to drown out the debate with unruly disruptions.

At one point, Specter shouted into his microphone that demonstrators disrupting the proceedings would be thrown out.

"We're not going to tolerate any demonstrations or any booing," he said after one audience member shoved another making an unsolicited speech. "So it's up to you."

Many in the crowd identified themselves as conservative Republicans, with one man noting they had voted Specter to Congress before the senator changed parties earlier this year.

A woman prompted a standing ovation by telling Specter: "I don't believe this is just health care. This is about the systematic dismantling of this country. … I don't want this country turning into Russia, turning into a socialized country. What are you going to do to restore this country back to what our founders created, according to the Constitution?"

Cue Richard Hofstadter:

The paranoid spokesman sees the fate of conspiracy in apocalyptic terms—he traffics in the birth and death of whole worlds, whole political orders, whole systems of human values. He is always manning the barricades of civilization. He constantly lives at a turning point. Like religious millenialists he expresses the anxiety of those who are living through the last days and he is sometimes disposed to set a date for the apocalypse.

The date in this case being the day comprehensive health care reform passes both in the House and the Senate I suppose. It takes a smarter man than I to know why people cling to such apocalyptic and clearly lunatic beliefs (a man like Bob Altemeyer, for one.) What I do know, is that I'm tired of the fate of our nation being completely hijacked by the stupidest, most reactionary and paranoid among us. Marc Ambinder senses that the conservatives have already lost, but it's hard to tell when they're screaming so loud.

(h/t to Sadly, No! for general inspiration.)

Legislative Update XXII

Congress quickly adopted legislation that adds $7 billion to the highway trust fund, replenishes the federal unemployment insurance trust fund and gives new lending authority to Federal Housing Administration programs that play a large role in providing low-interest housing loans.

The House of Representatives passed $2 billion in emergency funds to keep the CARS or "cash for clunkers" program going and and unanticipated amount of people rushed to take advantage of it (the Senate will likely vote on it next week). The House also passed a bill restrict Wall Street pay and passed a far-reaching food safety bill requiring more government inspections and imposing new penalties on those who violate the law. Additionally, the House passed a defense appropriations bill, cutting the F-22 but not other programs the Obama administration and Pentagon want cut, but differences will need to be worked out with the Senate. Oh, and House members unanimously approved a resolution that in part recognizes President Barack Obama as being born in Hawaii which the Senate joined.

The Senate Judiciary Committee voted 13-6 to send Judge Sonia Sotomayor's nomination to the full Senate, which will take up confirmation on Tuesday (there's no firm date for a vote yet). Sen. Lindsey Graham was, sadly, the only Republican on the committee to vote in favor.

Unfortunately, a full House vote and a Senate Finance Committee vote on health care reform have both been put off until September.

Scorched Earth

I have to go link crazy for you to understand why I'm putting this up, but via Tim F at Balloon Juice, here's an amusing excerpt from Thomas Levenson's takedown of Megan McArdle's explanation of why she is opposed to a public option for health care:

There’s a lot more wrong in McArdle’s screed. She has very little understanding of the actual daily life of biomedical research — this next paragraph is so full of false statements it wearies the critic, which may be a deliberate feature rather than a bug of McArdle’s prose. Think of it as a form of rhetorical pesticide, an analogue to the tactics of plants that generate so much poison that those that would munch its leaves recoil in horror at its bitterness.

This is extraordinarily harsh, but I completely understand what he means. This is because I can remember that the hardest part of writing this blog post refuting Megan McArdle's claim that debtors have some moral obligation to pay was untangling McArdle's arguments in the first place, so that I could attempt to refute each of her points in turn. The only reason I've ever bothered to read McArdle is because I think she's a handy point of reference for what conservative-ish libertarians are thinking, but like Levenson, I finally had to give up because I was tired of reading arguments that are intellectually inconsistent and not well-thought-out just because the person making the arguments at least tries to sound reasonable about it all. And that's the case with the post that Levenson is busy dissecting; as with many who oppose a public option for health care, a lot of fantastical assumptions are made without any direct reference to how such programs work in other countries, that is, other than to (usually) highlight horror stories of people not getting certain kinds of experimental treatments (without mentioning the millions here who get no treatment at all) or apocryphal reports of waiting times (without mentioning the wait times many American with health insurance endure.) And why should I waste my time reading McArdle's 5,000 word dressing up of these arguments, when I can just get it at lesser (right-wing) blogs in 500 words or less?

Money

An article in today's New York Times highlights a single hospital in McAllen, Texas, that appears to be having a disproportionate impact on the health care debate in the form of the amount of money they're throwing at both Democrats and Republicans in an effort to soften the pending legislation:

One of the largest sources of campaign contributions to Senate Democrats during this year’s health care debate is a physician-owned hospital in one of the country’s poorest regions that has sought to soften measures that could choke its rapid growth.

The Democratic Senatorial Campaign Committee collected nearly $500,000 at a reception here on March 30, mostly from physicians and others affiliated with Doctors Hospital at Renaissance, financial disclosure records show.

The event was held at the home of a prominent McAllen developer, Alonzo Cantu, a hospital founder, investor and board member who has raised prodigious sums from the Rio Grande Valley for an array of Democrats.

Another event at Mr. Cantu’s home, in September 2007, brought in at least $800,000 for the committee’s House counterpart, the Democratic Congressional Campaign Committee, according to disclosure reports. The House speaker, Nancy Pelosi, was in attendance and cut a ribbon at the hospital’s new women’s center while in town.

The hospital, which is in Edinburg, adjacent to McAllen, is working both sides of the aisle. Its political action committee, Border Health PAC, split $120,000 last year among House and Senate candidates, including Republicans.

Although Congressional negotiations over health care legislation are continuing, Doctors Hospital seems to be getting much of what it wants. Thus far, physician-owned hospitals have been insulated from some of the most onerous potential restrictions in the health care legislation moving through Congress.

The reporters note the highly unflattering portrait of the hospital in this New Yorker column by Atul Gawande, a column I read just a few days ago (and that I highly recommend.) Gawande describes this meeting with the CEO of the aforementioned Doctors Hospital:

So I asked him why McAllen’s health-care costs were so high. What he gave me was a disquisition on the theory and history of American health-care financing going back to Lyndon Johnson and the creation of Medicare, the upshot of which was: (1) Government is the problem in health care. “The people in charge of the purse strings don’t know what they’re doing.” (2) If anything, government insurance programs like Medicare don’t pay enough. “I, as an anesthesiologist, know that they pay me ten per cent of what a private insurer pays.” (3) Government programs are full of waste. “Every person in this room could easily go through the expenditures of Medicare and Medicaid and see all kinds of waste.” (4) But not in McAllen. The clinicians here, at least at Doctors Hospital at Renaissance, “are providing necessary, essential health care,” Gelman said. “We don’t invent patients.”

Then why do hospitals in McAllen order so much more surgery and scans and tests than hospitals in El Paso and elsewhere?

In the end, the only explanation he and his colleagues could offer was this: The other doctors and hospitals in McAllen may be overspending, but, to the extent that his hospital provides costlier treatment than other places in the country, it is making people better in ways that data on quality and outcomes do not measure.
“Do we provide better health care than El Paso?” Gelman asked. “I would bet you two to one that we do.”

Or maybe not, says Gawande earlier in his piece:

...there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average.

Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.

Gawande highlights McAllen, and Doctors Hospital in particular, because they are an example of a system where doctors have every financial incentive to order as many tests and procedures as possible and so drive up the cost of health care per patient. He contrasts this with the "holistic" approach of the Mayo Clinic, which focuses on the particular outcome of each patient but-more importantly-structures the payment system so that doctors are not rewarded for the more tests they order or procedures they perform. Unfortunatley none of the current health care reform plans being mulled over by Congress tackle this problem directly, so we could be faced with massive reform that fails to drastically curtail medical expenses. Which is exactly what the physicians at Doctors Hospital want, of course.

No Purity Here

Why are the Blue Dog Democrats and Moderate Republicans who now constitute the "Gang of Six" busy holding up comprehensive health care reform? Paul Krugman is really trying to give them some credit for their alleged adherence to fiscal conservatism, though he points out that their plan would only drive up the cost of health care reform. Frank Pasquale grants them no such leniency however, pointing out that four of the Senators represent states whose respective health care industries are opposed to reform and who are busy making donations to those Senators as I type this. So please note: your chance at real, affordable health care, is beholden to the political aspirations of wealthy Senators whose families will never want for adequate medical care for the rest of their lives.

Legislative Update XXI

The House of Representatives passed funding for high-speed rail projects, lifted a stupid ban on using taxpayer dollars for needle exchange programs for intravenous drug users, and passed a measure to require PAYGO, or "pay-as-you-go" budget rules. House committees approved bills to Puerto Ricans decide their island's political status and to shift student loan lending from FFELP to the Department of Education's Direct Loan program instead per President Obama's request.

The Senate approved a defense spending bill that includes the F-22 and alternate F-35 engine cuts that President Obama and the Pentagon wanted. The Senate also rejected an amendment to would have let people carry hidden guns in 48 states if they have a concealed weapon permit in any one of them. Differences now need to be resolved with the House.

As for health care, Senate Majority Leader Harry Reid says the Senate will miss the August deadline for a vote on legislation and it will be postponed until September. The House may vote next week (or not), but work is still ongoing. The White House isn't happy, of course, but still hopeful.

Legislative Update XX

The House of Representatives to protect wild horses from slaughter and give them millions of more acres to roam.

The Senate confirmed retired astronaut Maj. Gen. Charles Bolden to be the next head of NASA. The Senate also added a hate crimes provision for sexual orientation and genders as part of the defense appropriations bill to be completed next week. The House had already passed a bill, but the defense bill this is attached to is under a veto threat for F-22 spending that the White House and Pentagon don't want. And it looks like the infamous "card check" provision will be dropped from the Employee Free Choice Act to win over enough support from conservative Dems.

The Senate Judiciary Committee conducted hearings for Sonia Sotomayor and her nomination to be an associate justice on the Supreme Court. Most observers think Sotomayor was cool and collected and impressed even her GOP questioners. Her confirmation by the August recess seems assured, as even some Republicans are going to vote for her.

The House Intelligence Committee will investigate whether the CIA broke the law by not telling Congress earlier about a secret program for terrorist assassination teams.

The House Ways and Means Committee and the Education and Labor Committee have approved a sweeping health care reform bill (which has been endorsed by the AMA), but it still needs to be approved by the Energy and Commerce Committee before going to the full House.

Health Care Update

Good news on the legislative and executive fronts on health care:

The three committees that have jurisdiction over health care in the House of Representatives have unveiled their bill to the full chamber. Details can be found here, with the major news being that it will be paid for with a surcharge on millionaires. Slate's Timothy Noah is calling it "real reform."

On the Senate side, the HELP committee also passed its version of the bill, but the Senate Finance Committee has "fallen behind schedule."

Over at the White House, advisers to President Obama are suggesting that they will rely only on Democratic votes if necessary to get this done, no doubt knowing the political consequences of failure that President Clinton saw in 1994. Meanwhile, President Obama has been pressing lawmakers to get bills finished by the August recess (with hopes for final passage by October 15th). Who knows if they will, but these are positive signs at least.

Encouraging

From the AP:

Democrats on a key Senate Committee outlined a revised and far less costly health care plan Wednesday night that includes a government-run insurance option and an annual fee on employers who do not offer coverage to their workers.

The plan carries a 10-year price tag of slightly over $600 billion, and would lead toward an estimated 97 percent of all Americans having coverage, according to the Congressional Budget Office, Sens. Edward M. Kennedy and Chris Dodd said in a letter to other members of the Senate Health, Education, Labor and Pensions Committee.

By contrast, an earlier, incomplete proposal carried a price tag of roughly $1 trillion and would have left millions uninsured, CBO analysts said in mid-June.

The letter indicated the cost and coverage improvements resulted from two changes. The first calls for a government-run health insurance option to compete with private coverage plans, an option that has drawn intense opposition from Republicans.

"We must not settle for legislation that merely gestures at reform," the two Democrats wrote. "We must deliver on the promise of true change."

This is much better than what Sen. Max Baucus and his Finance Committee currently seem to be working up. Let's hope the version that gets put to a vote looks more like this and not something significantly watered-down. The fact is that Democrats have 60 seats now. The Ben Nelsons and the Joe Liebermans don't have to vote for the final bill, but they at least should vote for cloture on any bill and not allow the Republicans to filibuster. To not do so will be simply disgraceful and their colleagues and constituents need to make that known sooner rather than later.

UPDATE: More encouraging - all thirteen Dems on the HELP committee will be voting for the plan.

Paying for it

Currently, figuring out how to pay for health care reform is one of the most contentious issues in the debate right now. President Obama favors limiting income-tax deductions for high-income earners, but Congress seems to be more interested in taxing employee health benefits because many economists argue it mainly goes to high-income earners and discourages cost-consciousness (at least according to this article). Both are looking at cutting Medicare costs, particularly by having insurance companies bid for government reimbursements for offering private plans (known as Medicare Advantage). But perhaps the most controversial idea is increasing what are termed "sin" taxes, or taxes on what are considered bad behaviors:

Congressional analyses show that more than $200 billion over 10 years could be collected from new or increased taxes on sugared soft drinks, tobacco products and alcoholic beverages implicated in common health problems like obesity and cancer. Yet while the options are on the lawmakers’ table, Senator Baucus has said they are on “life support.”

The Joint Committee on Taxation calculated that a 3-cent tax on each 12-ounce sugared soda would raise $51.6 billion over a decade. But opposition is not limited to the bottling industry. Major sources of sweeteners include Montana, which has a large sugar beet industry, and Iowa, which produces high-fructose corn syrup — the home states of Senators Baucus and Grassley.

The government could raise $61.5 billion with an additional alcoholic beverage tax that would mean about 40 cents more for a fifth of liquor, 48 cents for a six-pack of beer and 49 cents on a bottle of wine. Advocates point out that federal alcohol taxes were last raised in 1991; adjusted for inflation, they are 37 percent lower now. But local wineries and microbreweries now operate in nearly every state, suggesting that major distillers will not be the only opposition.

Each of these taxes is often criticized as regressive, meaning it would disproportionately affect lower-income people. But proponents counter that the poor have the most to gain from universal health coverage.

I'm usually not a fan, as I imagine most people aren't. These kinds of taxes are most often proposed when legislators are too afraid to ask voters for a progressive income tax but desperately need revenue, so they opt for something silly like a tax on strips clubs (as seen here in Texas, though admittedly that must be a pretty big revenue stream!).

But when it comes to paying for health care, I'm more open to the idea. One of the main reasons our health care costs are so high in this country is because people eat too much, smoke too much, and drink too much. I don't want to tell people how to live, but it makes some sense to tax those things to help cover the costs created by them. It should at least by considered, and perhaps could be used in tandem with some of the other proposals.

As always, Americans want big reforms but they don't want to see taxes go up or deficits increased either. Unfortunately, you do have to spend money or borrow it to pay for these things. Given the current shape of our health care system, it's not like it's a bad investment. And unlike the other proposed taxes, you could actually get out of paying them if you cut down on junk food, cigarettes, and alcohol that are pretty bad for you anyway when not taken in moderation.

And hey, as someone who gets a bag of Cheetos out of the vending machine almost every day for lunch, I'm not saying it wouldn't annoy me sometimes too to pay a little extra than what I do now. But that doesn't mean I won't think it's fair or a good trade if we actually get real health care reform. To me, that's the bigger and more important issue in this debate right now than the cost and how to pay for it.

Legislative Update XVII

After lots of arm-twisting on anti-war Democrats in the House of Representatives, Congress voted to approve funding for the wars in Iraq, Afghanistan in an emergency supplemental. This is supposed to be the last time such funds will be provided for outside of the normal budget. IMF funding and the "cash for clunkers" program made it into the final bill, but it does not include the $80 million the White House requested to start effort to close Gitmo. The bill also prohibits detainees from being released in the United States and allows the transfer of detainees for prosecution only after Congress receives a plan detailing the risks.

The Senate passed a separate bill to block the release of detainee abuse photos. President Obama had given his formal word to classify the photos to placate those who wanted to put the prohibition in the war funding bill, which would have further weakened its chances of passing. If and when it will come up for a vote in the House is unknown.

Senate Republicans blocked a resolution condemning violence against women's health-care providers. The Senate did pass a formal apology for slavery, and will be followed by the House next week. It's hard to believe this hasn't happened already. The House did pass a resolution knocking Tehran's crackdown on protesters, with Rep. Ron Paul being the only "nay" vote.

Lastly, on the health care front, House Dems presented a plan that does have a public option, but that was left out of the Senate version. What ultimate comes out of Congress is anyone's guess at this point, assuming that something does that is. The only thing we know for sure is that it appears it's a long road ahead...

UPDATE: For the first time in 20 years, the House unanimously approved four article of impeachment against U.S. District Judge Samuel Kent of Texas accusing him of sexually assaulting two female employees and lying to judicial investigators and Justice Department officials. This now sets up a trial in the Senate.

Wednesday Morning Reading

Some things for you to ponder this morning:

1. A senior cleric in Iran comes out against the election results. But were they rigged? Critics say yes.

2. Some analysis of Netanyahu's announcement that Israel would consider recognition of a Palestinian state. A step forward, but still balking on other important considerations like settlement expansion.

3. A Presidential election and some new laws, but the end result is the same; you can't trust the NSA not to spy on the American people.

4. Speaking of intelligence agencies, the CIA is fighting the release of it's own internal reports regarding interrogations of "high-value" detainees. Obviously, there's something in embarrassing in them.

5. Speaking of detainees, here are some people who don't wet their pants at the thought of being responsible for them.

6. Obama will announce that the federal government will extend benefits to the domestic partners, including same-sex partners and spouses, of federal employees.

7. The Obama administration is proposing regulatory changes that will broaden government oversight of banks and the financial markets.

8. And lastly, another great column of David Leonhardt at the New York Times. This time he takes on the scare word "rationing" and explains how health care is already rationed ineffeciently and unfairly everyday in America.

Is it really happening?

Looks like:

A broad consensus on the contours of legislation to remake the nation’s health care system appeared to be developing among Democratic leaders on Tuesday as three House committee chairmen outlined a bill generally similar to one being written in the Senate.

Of course, some of those pesky details need to be ironed out:

Democratic leaders in both houses said they would require individuals to carry insurance and employers to help pay for it. But they have yet to decide how to raise the necessary tax revenue.

Leaders in both chambers said they wanted to establish a new public health insurance program, which would compete with private insurers. But they have not settled on the details.

The House legislation looks likely to have the public option, whereas it's still not clear whether there's enough support in the Senate for more than a "trigger" or water-downed version.

Still, the progress is encouraging, as is the news that President Obama will soon take on a greater role in the push for reform (no doubt helped by things like this). It looks like he is ready to compromise on the idea of a mandate (which he fought with Hillary Clinton on during the primaries) and taxing at least some health benefits (which John McCain proposed during the general election), but he thankfully is coming out solidly behind a public option, which will be necessary to get the votes of conservative Dems in the Senate. Whatever comes out of Congress won't be perfect, but it will be a lot better than what we have now.

I don't know if we'll get this legislation by the August recess as the White House wants, but they are right to push for it. If it doesn't happen this year, it might not happen (same goes for the climate bill and immigration reform). Next year are the mid-terms and after that people start running for president. It's now or never. The good thing is there's reason to be cautiously optimistic that health care reform is - finally - going to happen.

Health care bill may be ready by August recess

Sen. Max Baucus and a returning-with-a-mission Sen. Ted Kennedy, whose respective committees both will be taking up health care reform soon, are promising to try to combine their legislation into one bill before the Senate's August recess. Sen. Kennedy has promised to deliver a bill with a public option, while Sen. Baucus has backed away from his noncommittal stance (conservative Sen. Ben Nelson also recently backed away from his outright opposition) that has lead to speculation of a watered down public option plan that wouldn't be allowed to be better than a private insurance company or a "trigger" plan that wouldn't come into play until years down the road if and when private insurance companies did not improve.

These are idiotic, insurance-industry appeasing ideas that are anathema to real reform, of course, but thankfully it appears that momentum is back on the side of a real public option as 28 Democratic Senators have come out in support and with the return of Sen. Kennedy to the Senate and the forefront of this issue.

You know, I was just reminded earlier that today was the "Nationwide Day of Action for Single-Payer" - a call for rallies across the U.S. in support of a single-payer system. I've detailed on this blog before the superiority of such a system before and I'd probably be preaching to the choir anyway if I rehashed it again. But I do find it very sad that single-payer advocates haven't even been seriously been brought the table in this health care reform effort (especially since Sen. Baucus is routinely throwing them out of his committee meetings). That said, I agree with President Obama that while such a system would be ideal if we were designing a health care policy from scratch, it's not politically do-able and it'd be too big of a transition for people, many of which see the need for reform but aren't quite ready to give up their current health care plans.

But for any other plan to be real reform in my estimation, it needs to a) achieve universality by covering the uninsured; b) regulate the insurance companies so they can't deny people coverage for "pre-existing conditions" and other non-sense, particularly if universality is achieved by mandating that everyone have insurance such as in Massachusetts; c) immediately offer an unrestrained public option ala Medicare that has all the advantages of being a government plan (lower administrative costs, ability to negotiate lower prices, etc.) that gives people another choice to what the private insurance companies currently offer (which, if successful, could eventually lead to single-payer anyway); and d) lower the ever-increasing costs of health care in this country.

Unless these conditions are met, I fear our health care system will remain broken. So I eagerly await to see what legislation comes out of the work of these two Senate committees. I hope it provides the fixes we've been waiting for.

UPDATE: Interesting article on how red states would benefit from universal health care the most with blue states picking up the tab.

Legislative Update XI

The White House and Congressional Democrats have come to a budget deal that includes reconciliation instructions for health-care legislation later this year. This would allow Democrats to pass a reform measure with a simple majority in the Senate, but the changes would have to renewed after 10 years. Republicans have cried afoul over this possibility, despite the fact that they used it to pass the Bush tax cuts, but Rep. Ryan admitted today it is within the Democrats rights to do so having won the election. My concern is that the changes expire and we could have a Republican president and/or Congress again in ten years, but the political calculation is probably that it is better to get it now and, if it's successful, it'll be too hard to let die.

The Senate voted 92-4 to create an independent bipartisan commission to investigate the causes of the financial crisis and the House of Representatives voted 342-78 to send billions of dollars to thousands of communities to help them hire and retain 50,000 police officers, reviving a Clinton-era "cops on the streets" program that withered under the Bush administration.

Senate Republicans blocked a confirmation vote on Kathleen Sebelius as HHS Secretary over her pro-choice views. A cloture vote could happen on Tuesday.

Lastly, former Vice President Al Gore has come out in support of the climate change bill that is being worked on in the House.

Early Afternoon Links

For your reading pleasure:

1. Obama's plan for Afghanistan: once again, the key appears to be figuring out what an administration means by "benchmarks."

2. Pakistan: suicide bomber kills upwards of fifty people in a mosque in Peshawar. Part of Baitullah Mehsud's campaign against the Pakistani government?

3. Iraq: U.S. forces are largely withdrawing from the cities as agreed upon, but may remain behind in areas where sectarian violence is still widespread, like Mosul.

4. Building nanobots...with DNA. Incredible.

5. How health care reform benefits small businesses.

6. Lawyer's should not be judged for who they represent...except when they worked for the tobacco companies, and were balls-deep in the tobacco companies' wrong-doing.