NYCweboy

On Healthcare... The Silence of the Blogs

One other observation about the healthcare reform moment we're in: yesterday's developments, which played out fairly fast and furious (by the time I finished my post, it was clear the Medicaid piece of expansion to 150% was actually DOA), reminded me of another problem we have, that there's precious little good blogging going on around healthcare, reform, and understanding more fully what is and isn't happening.

I've worked this observation from the reverse angle of saying we don't have a good, informative conversation about healthcare in this country... but it's important to understand why that is, and why it's hard to undo. I think a couple of things are in play: one is that, for a number of reasons, healthcare professionals, especially doctors but really a wide swath of the professions, are not online in quite the way others are (like writers, lawyers, educators, etc). This is part of the big hurdle to computerizing and standardizing medical records, in that even now, most doctors use paper for medical notes, and train their support personnel in similar methods. Ever notice that your doc's office has a huge collection of paper files? Ever notice that it's growing and not shrinking? That's the medical records problem... and it's enormous.

And it's indicative of how little daily interaction medical professionals have online; it's just not folded into the daily rhythm of many offices, care centers, or hospitals. Sure, there are exceptions... but many of them underscore that same divide: the medical professionals who do blog tend to be outside of practice (docs who write columns, do TV reporting, write books, and such). Some are working in nonprofits and other groups and are, indeed, working on reforms... but the point is, those people are outside of the practicing mainstream, and their views reflect, often, a narrow subset of the full professional insight on reform and its impact on actual care.

Feeding that narrow range of views is the fact, as I've pointed out before, that much of the energy around reform and thinking ceatively about changing healthcare is happening among liberlas and progressives. There is little activity on health reform on the right - a symptom and an illustration of the conservative malaise right now that there is so little interest in such a key issue - and the lack of knowledgeable opposing views hinders broad, thoughtful debate. Too often, you get panels and discussions among people who all agree, who share very similar backgrounds, exposure to similar data and ideas, and who see solutions in much the same way. It's hard, for many people in the think of things, to understand that there's things that they're missing, important, valuable things that might challenge worldviews and easy conclusions.

And finally, as healthcare reform has moved to the center of political discussions and gained media attention, what's become clear is how many people either don't understand or are only recently getting up to speed on the healthcare systems in this country, and tend to repeat the word of others when caught uninformed, or less than fully aware. I have little or no use for bloggers - many prominent ones - who blog about healthcare by repeating snips of coverage, usually from Ezra Klein and/or Jon Cohn. Both men are doing good (though not great) work covering the day-to-day twists and turns in Congress... but both have limitations and biases that tend to get lost in repetition. And few bloggers are doing, or seem to want to do, the hard work of questing further for more information, or looking deeper at prevailing views to ask if they make sense, or are supported by all the data. Hence, the need for a public option - which should have been a small piece of a number of other, much more significant changes to insurance - became by repetition and general agreement and lack of investigation... a be-all, end-all political chip that distorted the whole debate.

In the end, all of this reminds me that I ought to do more to write about these things, because I do have information to share, insights to challenge the status quo, and the ability to write persuasively. And I don;'t mean to leave anyone high and dry when it comes to looking for other, alternative places for insight. Myself, I'f recommend these in relative order of insight, usefulness and alternative ideas:

• The Healthcare blog - where you will find medical professionals with a variety of experiences sharing a broad range of ideas
• Karen Tumulty - who's been doing some of the best straight reporting I've seen that is both thorough and informative
• Talk Left - where Big Tent Democrat doesn't buy into all the hype of the progressives
• The Daily Dose at Washington Post - the Wa Po's more through (and more thoroughly reported) blog on healthcare, which makes you wonder why they need Ezra separately.
• Firedoglake - not my favorite site, but Jane Hamsher and company are very up to speed on both the politics and a number of the larger issues
• The Prescriptions blog at the New York Times, which occasionally breaks new news, and can be very insightful (but can also be very much the voice of The Establishment, as the Times likes to do)
• The healthcare blog at Change.org - a little likely to rehash the same Ezra Klein/Jon Cohn boilerplate, but with lively discussion threads. For that matter, if you do read Ezra, I highly recommend following his comment threads; a number of his commenters are very good for pointing out the weaknesses in his arguments, theories and political stances.

As I find more, I'll pass them along. I'm always on the lookout, and I appreciate any others you can share.

Still, the lack of anything but repetition of the same ideas, the same political thinking, and the same laundry list of expectations is tiring. As long as healthcare reform is a narrow conversation, among (fairly) informed people with similar poltical and worldviews who reach the same if not similar conclusions... we're not likely to have the good, healthy discussion we need... the one which, I think, would have made the current bill in Congress either a dead issue, or a significantly different, better piece of legislation than it is shaping up to be. The prmoise of blogs is that they offer the potential to challenge the status quo and offer fresh ideas; the challenge is that to do that requires the different thinking, different voices and fresh ideas of outsiders. And we don't have that... instead we have silence. And repetition.

The Soft Bigotry Of... Well, Soft Bigotry.

It's a rough end of year for The Gays.

When election day passed and we faced another loss on gay marriage, this one an especially cruel result in Maine, I debated what to say. And while I waited ("dithered" now belongs to Obama, apparently), there started a harangue from the right about intolerant gay activists.

And still I struggled. But this week, the icing arrived when the New York state Senate voted down a marriage equality bill that had already passed the Assembly.

When Prop 8 failed, I was one who noted the failure of gay marriage to find support in the black community; I take that back: the problem, apparently is finding enough of anyone - at least anyone's who not gay or one of our friends.

The failure of gay marriage in Maine and New York has many angles, but all come down to proving why "I'm not intolerant" types like Rod Dreher and Jeff Jacoby - who both accused gay advocates of negativity and namecalling - have it backwards. Those who accuse the gay marriage opponents of intolerance and bigotry have it right... the challenge is making such bigotry both socially less acceptable and to make clearer why that is. Until then... treating gay people badly... well, that's just what happens. And it's hard not to be angry about it.

Friday Evening Fireworks

jinb

The Case Against Bernanke

As I move - finally - to shake off the current doldrums, I've been tooling around the blogosphere, checking out the latest political thoughts (generally... not much new or especially enlightening). One that did catch my eye was over at My DD (still the "organized left" progressive political blog I prefer to Open Left or Daily Kos), where they posted Jim Bunning's harsh assessment of Ben Bernanke. If you want a concise, effective laying out of both the economic crisis and a case against Bernanke, this is it:

I have been kind of lukewarm on Bernanke's reappointment; like many Obama decisions, it doesn't seem to match his rep as especially bold in his thinking. Reappointing Bernanke is safe, establishment... and questionable on many levels. Bunning may not be right on everything... but his counterweight to prevailing economic talk is bracing, and welcome. Someone needs to say it.

Choosing and Choices and The Choice We're Stuck With

Of all the problematic aspects of the healthcare bill still (still!) not fully decided in Congress, none I think is as far reaching as the Stupak Amendment on coverage of abortion. And as much as it is revealing the complexities of applying the idea of "no federal funding of abortions" to health insurance, I think the bigger problem it's revealed is a deeper, more systemic question: is the left really as unified on abortion as we've been arguing for years?

One of the more popular lines people have been using in the new millenium is that abortion is "settled" - there's a left-right divide, easily labeled "pro-life and "pro-choice", never the twain shall meet, and almost all of the rest of anyone's politics can be determined by the simple test of picking a side on abortion.

It was never that simple, and it never quite will be... but I think up until about 2006, it was easy to mask internal tensions on the left while the Republicans were self destructing.

Blame it on the first President Bush and his "big tent" philosophizing, but for whatever reason, the drama around abortion for the past 15 years or so had been on the right. As much as religious conservatives were clearly anti-abortion absolutists and just as clearly had the power to dictate policy, the far right didn't have a lot to show for control of the Republican aganeda on abortion. For all the talk about "sanctity of life", the anti-abortion agenda of repealing Roe v. Wade, passing some sort of Human Life Amendment banning abortion, or even extensively altering laws at the state level never quite developed into much in the way of success. And many, myself included, would conclude that the problem, simply, was that anti-abortion forces were a vocal, but not powerful minority.

It's a real indication of the failure of Republicans in the northeast that "Country Club" Republican types - especially women - were never particularly interested in having government intrusion back into women's lives by excessively restricting or limiting abortions. Or, more pointedly, starting with abortions... and moving on to banning access to birth control. And the minute the Southern, religious conservatives made anti-abortion and other social issues central to whether or not you were a real Republican or a RINO... the exodus of northeastern Republicans began.

A big part of the Republican crack-up - the part that's keeping them from really figuring out how to reassert themselves into the majority - is just what the abortion tensions signify, a whittling down of the right to a smaller, more conservative core group much more homogenous in belief and approach to issues. "Prolife" is one of the easiest unifying points of the current Republican/conservative narrowing, pretty much a given among one and all, and virtually no candidate - even perceived "moderates" - can really voice any kind of support for women's reproductive freedom. That's one reason Stupak was so obviously going to pass - Republicans had no way to oppose it. And you can have unity around an unpopular doctrine... but you can't do it and be in the majority.

All of this means that, with Democrats in the majority, the question of who's got deep internal tensions on abortion suddenly switched, and in ways I think many people were unprepared to face. Yet the indications were always there - in the conservative and "Blue Dog" candidates being chosen, in the soft pedaling of "abortion rights" to rehtoric about "pro-choice" and "safe, legal and rare."  Liberals have operated under an illusion that we all supported women's reproductive rights... but never really determined just what everyone thought those rights should be.

One of the most problematic aspects of the "abortion debate" - a debate, as with other controversial topics, we talk more about having than ever actually have - is that much of the terms of debate are mush.  Neither "prochoice" nor "prolife" ever really meant anything, and both, really, served as fig leaf descriptions meant to protect people from the extremes of either side. You may not like abortions... but you'll support "choice."  You may not like clinic protesters... but surely, you support "life."

For years, feminists who believe in abortion - me included - have accepted that "choice" rhetoric was a necessary, if occasionally unhappy, compromise; you learned to live with the "I don't like the idea of abortions, myself, but I think a woman should be able to choose..." type logic even though, deep down, it meant that, at times, you couldn't count on that kind of support to keep abortion available. It's why we have the Hyde Amendment - you can be in favor of choice and believe, wholeheartedly, that it's just not "federal funding" of abortion... as opposed to keeping abortion services essentially unavailable to poor women on Medicaid.

I've argued - and still argue - privately that the real failure of progressive feminists is to stick to our terms: abortion is a medical procedure, and what we don't want, really, is government making decisions about which medical procedures we like and don't.  I want for women what I want for anyone - the right to determine, with a medical professional, the right care for a given situation. Sometimes, that choice is an abortion. And it's not about deciding what's a good abortion or a bad one, who's a woman who's suffering and who's a tramp. It's a medical procedure. And too often, the "choice" argument comes down to feelings over basic, medical facts.

We on the left have no one to blame but ourselves for where things stand, in the Democratic Party, with the Stupak Amendment still (still!) potentially standing as a possible element of healthcare reform. We have for years, blithely ignored that abortion is, for the left, hardly a settled issue, that women's reproductive rights are by no means solidly settled among liberals, and that the reason Stupak passed isn't about the hardline right, but about an inability on the left to use precise terms and come to internal agreement on a position. It may make us a (slightly) smaller party... but like many, I am convinced that most Americans believe in reproductive freedom, and believe, even in limited ways, that access to abortion is a reasonable part of that freedom.

As angry as many people are, as much as people are convinced that healthcare reform can happen without Stupak (I'd say 50-50, at best), the bigger fissure that's been blown open can't be dismissed or ignored. Until we do with abortion what needs to happen on so many issues right now - have a healthy, internal debate that is not about "right and left" but about finding common ground within our own party - we will have more Stupak moments. And we will not know how to solve them. And that, too, is a choice. A bad one.

The Sound Of One Hand, Patting It's Own Back

Part of the problem, too, over the weekend was the monumental sense of self-congratulation: as much as there's a significant milestone in having a close vote to pass such an enormous element of the ultimate reform package, too much of the lauding of Nancy Pelosi and Democrats celebrated what hasn't happened. And, to my chagrin, people who've held out admirably against the Obama-era vogue for celebrating in the future tense succumbed to it.

Missing from most laudatory comments was any sense of perspective, and almost any sense of balancing the problematic with the historic. As I said earlier, too many posts (usually men) did a "yes, but" with the Stupak Amendment... but that was simply one aspect. Just as often, few mentioned that the House vote suggested more bad news than good, given that Pelosi struggled, more than anyone expected, to find a bare majority of her members, losing 39 of the 40 votes she had to cushion victory. And not just, as many noted, losing "Blue Dog" conservatives: Dennis Kucinich voted against the bill, noting that if you are truly a progressive who favors single payer... there was nothing to like in the utimate compromise.

Kucinich made a good, sensible point that underlined how much liberals and progressives have given over to the politics of the process in DC and abandoned the very goals that "healthcare reform" was meant to accomplish. As I've said all along, fetishizing a "public plan" which was always a modest adjunct to other, far more crucial, aspects of change, made a hash of the whole bill. And as a result, people got swept up in the MSM presentation of  "historic moment" journalism over good sense, I'm convinced.

Since his election, there's been a sense of artificially set pressure by the Obama folks to accomplish major change in a short time frame. And that pressure has served, too often, as an easy out to make bad compromises and weak hash. Too few progressive activists have asked the questions that matter about how this process has unfolded - why was it being done in secret, behind closed doors? Why wasn't more effort expended, earlier, to better explain the need for certain reforms and lay out  responsible proposals for public debate? Why are we just accepting that every bad development is a necessary, if regrettable, watering down of a previously bad choice?

Nancy Pelosi and the - largely male - leadership team she's assembled did not, miraculously, go from the middling, not altogether effective legislators they've been all year to geniuses on Saturday; Pelosi has, all along, been able to deliver most of her majority to pass almost anything she wants. What she has been less good at, and always has been, is in rising above political gain to defend important principles. Everything, ultimately, is in service to winning and maintaining political control of the House. And if that means watering down a public option, or turning back years of progress on women's reproductive health... oh well. Maybe later, we can fix that. Look... it's history!

Sober reflection, I think, would have tried, harder, to put what happened over the weekend into perspective. Yes, it's exciting to see the potential for modestly positive developments in some reforms in healt insurance make some siginificant progress. But we are nowhere near the final result of an actual bill, agreed to by both houses, that makes sense and ought to be signed into law. And just as importantly, many of the bad compromises that have been made to achieve that result - including a cynical expansion of Medicaid eligibility without addressing the embarrasingly low reimbursement rates of the program, the failure to truly recognize or cover the costs of the reforms proposed, and the vague, poorly thought through notions of "improving" Medicare without making hard choices - all of these are reasons for serious, continued concern about just what it is "reform" is actually amounting to in the end.

Rather than get swept up in trying to write historical progress before it has actually happened, and to play the contorting game of patting one's own back too hard, I'd feel better if progressives didn't exhale and let up just when the pressure is needed most. Ask yourself... is this really the reform we said we favored? Are these the goals that progressives set for reform at any point in the process? Does this bill really offer the necessary pieces of progress to improve health care access, make it more affordable, and ultimately improve quality of care? Too much of what we're getting doesn't remotely meet these goals. And if that's case... why is that hand of yours still reaching over your shoulder?

Aw Hell No

Stunned into relative silence, it took a day or so to let the anger find its way to the surface. Now I'm just furious. The idea that Democrats in the House just eliminated access to reproductive health services for millions, and possibly all, women is just stupefying.

I think incomprehension has been the main force behind the slow rolling reaction - only late last evening did it seem clear that the full horror had begun to sink in widely - an incomprehension that itself seems cheerfully naive.   The signs that healthcare reform had become a political exercise fully ignorant of larger implications was clear months ago, the sense that women's heath concerns were being dismissed was clear weeks ago, and the national madness around abortion policy is just part of my entire lifetime. Yet, still... it's hard to imagine something quite this unbelievable taking place.  Even as I watched it unfold on Saturday afternoon... and then went to see Precious.

For years, I have tried to be one of those voices of "it's not their fault" when it comes to Democratic missteps. I've been one of those "gee I hope they get their act together one day" type of Dems who, since the seventies, has figured I just happen to be in the hapless party that can't quite pull it together. Sometimes we do... but usually, wecave, or we get scared, or we fold too soon.  If only we could get our act together... well, I have to admit, this one's got me realizing... this is their act. And it is together... and that's the scary part.

As others say so often, the Stupak amendment is "a feature, not a bug;" These things don't "just happen" and Nancy Pelosi doesn't just get to say some group or other made her do this, against her will. The woman who could claim to be prochoice and let this happen can't claim to be buffeted by circumstance. This is a choice that can be made, comfortably, by people who lead a party no longer attuned to the needs of poor people, working people, people in need. It's a cavalier, uncaring assessment that somehow, people can make do... or they'll just have to deal with it. Or the kind of bald political calculus that says, somehow, magically, this will all just go away.

There's plenty of reasons to be unhappy about the healthcare "reform" still going full steam ahead, racing pell mell to a foregone conclusion that looks less and less appealing each day. But there's unhappy... and then there's this, a situation which cannot be acceptable, cannot be excused, cannot just be called okay, if we just make a few changes. This is a "hell no... and what the hell were you thinking?" moment. Say it... shout it. And dammit, let's do something about it.

The Election Results: Yes, They Could... But It's Not Very Likely

In the end, it came down to expecting more: even Bob McDonnell couldn't deliver the expected 20 point rout of Creigh Deeds, just 19. We expected more drama, less certainty, more divisiveness, less muddle. We got none of it... and what we deserved. So now what?

If there's a thread to link a variety of mixed election results it seems, largely, like what I thought going in: this was anger, by and large that was taken out on the nearest and most incumbent... and beyond that, there's not much to tell, because Republicans have no idea how to capitalize on what actually worked.

Conservatives might have gotten their dream of a "right wing revival" storyline... but all those eggs in the NY 23 basket were a mistake - the results made clear that internal right side dissension mostly hurts their side, sweeping Bill Owens to a modest victory (no Democrat since before the Civil War in that region), and showing that national intervention in local elections is usually a bad idea. Conservatives had argued that a tight three way tie which Owens prevailed in would help their cause with Owens too weak to pull the seat in a two way future race; but Scozzafava managed to wreck that by dropping out, endorsing Owens... and remaining on the ballot to pull just enough votes to wreck Hoffman.

Conservatives may deny the obvious message in the loss, but that doesn't mean their ability to wreck the careers of moderates isn't suicidial: Voters who were angry enough to pick Scozzafava over Hoffman after she "dropped out" are Republicans who don't like the far right wing, and don't mind making it heard, and don't care that a Democrat would win as the result. That can't help the far right, and has little or nothing to do with anyone outside of the ever narrowing circle on their side. The failure to win NY 23 is huge, has enormous national implications (Marco Rubio, your clue phone is ringing) and will probably be the latest example in right wing denial over reality, a reality that clearly suggests that internal divisiveness and narrowing of the base is hurting, not helping Republicans. And it can't be stopped.

The Anger Is Real; The Right Wing Revival Is Not.

Off year election season is just kind of weird; in the "24 hour news" age, there's a whole political evaluation machine sitting around, little to do... and there's always a "trend report" needed for the next year.

And of course, there's the off chance that something real is actually happening.

Virginia and New Jersey's races for Governor always serve as the bellweather of their years, since they make easy commutes for northeastern reporters based in the NY-DC axis, and in both cases are the rather disrespected cousins of the neighboring metropolis. And usually, they don't necessarily tell us all that much, since both have fairly unique characters ("unique" is one of those adjectives a New Yorker can love when referring to the world across the Hudson, and that view is even stronger across the Potomac).

Still, with Jon Corzine struggling and Republicans poised to retake Virginia, something's clearly happening. The question is... is it proof of some sort of Republican, or right wing, revival, an indictment of failure so soon after Obama's election?

My own guess... kind of yes, kind of no. There's a lesson in this year's elections for the left... and for the right. But not what I suspect many people think it is.

Silence of the Dudebros

I was struck - but not surprised - by the relative silence over a Sunday front page NYT article about the White House's "DudeBro" problem: the reality that the President is surrounded by the lefty equivalent of the all male "boys club" mentality that can be found many places, including Washington politics.

The president, after all, is an unabashed First Guy’s Guy. Since being elected, he has demonstrated an encyclopedic knowledge of college hoops on ESPN, indulged a craving for weekend golf, expressed a preference for adopting a “big rambunctious dog” over a “girlie dog” and hoisted beer in a peacemaking effort.

He presides over a White House rife with fist-bumping young men who call each other “dude” and testosterone-brimming personalities like Rahm Emanuel, the often-profane chief of staff; Lawrence Summers, the brash economic adviser; and Robert Gibbs, the press secretary, who habitually speaks in sports metaphors.

The technical foul over the all-male game has become a nagging concern for a White House that has battled an impression dating to the presidential campaign that Mr. Obama’s closest advisers form a boys’ club and that he is too frequently in the company of only men — not just when playing sports, but also when making big decisions.

I think the relative silence was in part a shrug of obviousness: this is not new, and really has been dogging the Obama folks since the campaign with Hillary Clinton - who, wouldn't you know it, gets to be cited as the "we don't have a woman problem" example since she is now Secretary of State. I suspect that many feminists are wondering mostly why it took everyone this long to figure out the obvious.

Of course the "DudeBro" problem is a problem; and, of course, it goes a long way to explaining why the Administration has a variety of problems dealing with a number of women's issues and, by extension, the problems that have developed with gay and lesbian activists as well. When you surround yourself, comfortably, with mostly straight guys who share your straight guy interests... you get, well, comfortably DudeBro.

What's remarkabel, to me anyway, is watching the regression of progress I figured couldn't really be shaken; we're re-arguing issues that I feel like should have been settled long ago. The rise in anti-feminist stupidity, not just crassly sexist, but frankly disturbing anti-woman presentations in advertising and media, is deeply concerning. Or the stupefying conversations I've had - most recently at Red's wedding - suggesting that "gays have to be patient" when looking for progress on, say, Don't Ask, Don't Tell. Mustn't rock the boat. Must realize... this could be controversial, And difficult.

There's a sense that we're either moving forward on stuff like this... or slipping back. And, unfortunately, I think it's fairly obvious that the backsliding on progress for women and gays is systemic, and has everything to do with a comfortable, casual sexism that's taken hold, even as we mouth platitudes about progress and "change" since the election. Who cares if the President plays golf with only men? Or sets up basketball tournaments among the DudeBros? Hey... he's way better than that last guy! And his stay-at-home, no career of her own wife? That's her choice!

The point is... these are choices, in the most problematic sense. They are choices to accept the status quo, to not do the hard work - the teaspoon work as Melissa McEwan puts it - of challenging every prevailing notion of sexism and "traditional" expectations. As my female dinner companion - a well connected political woman in DC - told me about her thinking to finally change jobs after several years, she wouldn't contemplate working in the White House - "I like my family and my life too much" she said. That, of course, shouldn't be the choice. And when it is... it's not surprising that women, collectively, opt for alternative choices.

I suspect we're stuck with the DudeBro problem for some time to come; and like a number of entrenched, ignored, and often dismissed observations about a systemic problem with the supposed "progressiveness" of the Obama Administration that state obvious relaities... I also suspect that they're indicative of the growing political rumblings that the Democratic Establishment might consider owning up to, rather than denying. There's a reason that dissatisfaction seems to be growing, why surface notions that "everything is fine, and politics is hard and progress is slow" don't really suffice as defenses of the Obama Administration's weaknesses (and "we're way better than the last guy" is really... just getting old). If we can't admit and face that not everything is golden with this White House, we can't change it. And if we can't change it... then people will look elsewhere for the progress they seek. Bet on that, Dude.