Politics

by hilzoy

It’s been a while since I last posted about Medicare Part D. Today’s topic: enrollment numbers. Kate Steadman at TPMCafe’s Drug Bill Debacle blog pointed me to a WSJ article (sorry, subscription) that claims that the administration has been cooking its figures:

“Despite the headline on a government press release — “30 million Medicare beneficiaries now receiving prescription drug coverage” — a smaller number is actually enrolled in the new program, and some of that group had coverage before. As of April 18, 19.7 million beneficiaries are getting drug insurance from Medicare. Of that group, 5.8 million already had coverage from Medicaid, the state-federal program for the poor. An additional 6.8 million people are getting drug coverage from former employers; the coverage is partially subsidized by Medicare. That means a total of 26.5 million people now are benefiting from the Medicare drug program.

To get to 30 million, government officials also counted 3.5 million people who have drug coverage from the military’s TRICARE program or federal-employee benefits, but aren’t signed up for the Medicare benefit. Christina Pearson, a spokeswoman for the Department of Health and Human Services, says the Medicare beneficiaries, regardless of source of coverage, “were able to make the choice that works best for them” because of the new drug-benefit program.”

Here’s the press release. In it, HHS Secretary Mike Leavitt is quoted as saying:

“With a month to go, we’ve passed our projections of 28 to 30 million enrollees in the first year, and we are intensifying our local outreach efforts to get more seniors signed up before the May 15th deadline,” HHS Secretary Mike Leavitt said. “These strong enrollment numbers are a tribute to everyone in the national network of caring — all of our partners, community leaders, the State Health Insurance Programs (SHIPS), and family members, who have provided counseling and assistance to the millions of beneficiaries who are now taking advantage of this new benefit and saving money.”

Let’s do a little fact-checking, shall we?

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by hilzoy

I have been thinking a lot about energy recently. For one thing, I made my monthly trip to the gas station the day before yesterday (aren’t Priuses wonderful? Everyone should own one), and got to pay nearly $3/gallon for gas. More importantly, however, there’s good news and bad news about my new house.

The bad news is that the boiler and the hot water heater need to be replaced. The boiler is an amazing object, which probably ought to be in a museum somewhere: it’s a converted coal burner whose front has cement smeared all over it in an attempt to seal it up, and which is literally held together with baling wire. — I really love it when I find something about which a cliché is literally true — the only thing that made getting lice at all worthwhile was the chance to become a literal nitpicker — and so part of me loves the baling wire. But not so much that I want to use this antiquated, delapidated relic to heat my home. The hot water heater is less urgent: it’s past the normal life for hot water heaters, and may or may not be leaking exhaust gasses, depending on who you believe. But that, it seems to me, makes this a good time to replace it: now, before I am stuck without a shower or dead of carbon monoxide poisoning.

The good news is that the boiler and the hot water heater need replacing. For one thing, the fact that my property inspector tagged these things now means that I have been able to extract a lot of the cost of replacing them from the seller. More importantly, however, it means that I will get to act on my basic theory of environmental responsibility which involves doing two things. First, periodically sitting down to think about what environmentally responsible things I could be doing, but am not. Second, always, always take advantage of the opportunities presented by the need to replace major appliances; and don’t bother to ask e.g. whether you can expect a new appliance to pay for itself in energy savings before you move; think of yourself instead as a sort of Johnny Appleseed, leaving a trail of efficient hot water heaters behind you.

I am not wholly consistent: if I were, I would not have been living in the country these last six years. Nor did I do well the last time I had to replace a hot water heater: that time, I really was stranded without the ability to take a shower, and the fact that the repair guy had a hot water heater in the back of his truck, while getting the really efficient kind I wanted would take days, made me falter. But I do try: hence the Prius, and so forth. Hence also the thought: yay, an excuse to replace the boiler and the hot water heater.

Still, it got me thinking, as did the recent run-up in oil prices. And I realized: I’ve never really written about this. I have no idea why not: it is, after all, something I care a lot about. Maybe it’s in part because I don’t know a lot of the details; I’ve never gotten into them, since on the one hand the broad outlines seem clear enough, and on the other we presently have an administration that flatly denies most of them; and so leaning the fine points doesn’t seem as important as it would if we were presently debating different strategies for energy independence. Still, for what it’s worth, I take the obvious outlines to be:

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by hilzoy

Every so often, you run into a program that combines doing good for people who need it with thrift and economy; and it’s always a mystery to me why policy makers don’t pounce on those programs and fully fund them. Normally, one reason for not fully funding a program is cost; but in the case of spending that actually saves money over the long term, that really shouldn’t be an issue. At one point in the 90s, prenatal care was like this: providing prenatal care for pregnant women who couldn’t afford it would have saved money not just over the long term, but in the same fiscal year, by preventing babies from being born prematurely or with costly health problems, problems that the government has to pay for enough of the time to produce the cost savings. So we could have saved money by sparing children serious health problems, some of which would mar their lives. But for some reason we didn’t. What that reason might possibly have been, I have absolutely no idea: to me, it is a mystery that passeth all understanding.

Well, it’s happening again.

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by hilzoy

Via TPM, yet another dubiously employed Congressional spouse:

“Acting as her husband’s campaign consultant, Julie Doolittle charged his campaign and his Superior California Political Action Committee a 15 percent commission on any contribution she helped bring in.

As a member of two key committees in the House – Appropriations and Administration – Doolittle is well-positioned to help contractors gain funding through congressional earmarks. Between 2002 and 2005, Wilkes and his associates and lobbyists gave Doolittle’s campaign and political action committee $118,000, more than they gave any other politician, including Cunningham.

Calculations based on federal and state campaign records suggest that Doolittle’s wife received at least $14,400 of that money in commissions. Meanwhile, Doolittle helped Wilkes get at least $37 million in government contracts. (…)

Julie Doolittle launched Sierra Dominion Financial Solutions in March 2001, two months after her husband was named to the Appropriations Committee.

The business, which is based at the couple’s home in Oakton, Va., has no phone listing or Web site. The firm has no known employees other than Julie Doolittle. The congressman’s office would not specify what previous fundraising experience she had.

Within months of its opening, the firm was receiving commissions from her husband’s campaign. Within the next two years, it was planning fundraising events for Abramoff and handling bookkeeping for the Korean lobbying group in Buckham’s office suite, where DeLay’s wife, Christine, also was working.

Federal and state campaign records show that Julie Doolittle has received nearly $180,000 in commissions from her husband’s political fundraising since late 2001.”

So, to summarize: Julie Doolittle has no known fundraising experience. Her business, which was started right after her husband landed a seat on the appropriations committee, has no office, phone listing, or other employees. Whenever someone gives money to her husband’s campaigns, however, if she claims a commission, 15% of that donation gets transferred from the campaign’s accounts to Julie Doolittle and her husband, for their own personal use. See how easy?

Moreover, John Doolittle’s seat is very safe, and his fundraising is going fine. Here are the FEC reports for his district in 2004 and 2002. In 2004, he raised $937,914. He had two challengers, an independent who seems to have raised no money, and run on a $50,000 loan, and a Democrat who raised the princely sum of $2,300, and still managed to have $237.00 left at the end of the campaign. Not exactly what you’d call a hotly contested seat, or one where a fundraiser would be needed.

Here’s an example of the sort of ‘work’ Ms. Doolittle got paid for. (Brent Wilkes, aka “Co-Conspirator No. 1”, who figures in the story that follows, is one of the contractors who bribed Duke Cunningham. More background on him here.)

“In November 2003, Wilkes held a fundraising dinner for Doolittle at ADCS’ headquarters in Poway that was catered by Wilkes’ wife, Regina, who ran a catering company based in the corporate cafeteria. The 15 guests on Wilkes’ invitation were all ADCS employees or partners on projects Wilkes was trying to get funded, together with their spouses.

Over the next four months, members of the group gave a total of $50,000 to Doolittle’s political action committee.

Federal and state election records show that Julie Doolittle claimed commissions on most of those contributions, even though there is no evidence that she planned the fundraising dinner or encouraged the contributors to donate to her husband.

No expenses related to the dinner are reflected on John Doolittle’s financial records.

Robinson, his chief of staff, refused to answer questions about that particular dinner. But in a prepared statement, he said Julie Doolittle had helped “initiate, plan and perform other administrative duties” for two dinners in the San Diego area, for which she claimed her standard fundraising commission.”

And here are all the clients the San Diego Union-Tribune was able to find:

“A search by The San Diego Union-Tribune yielded only three other clients of Julie Doolittle’s firm:

One was Greenberg Traurig, the lobbying firm that employed Jack Abramoff, who has pleaded guilty to conspiracy, mail fraud and tax-evasion charges. The second was Abramoff’s Washington restaurant, Signatures. The third was the Korea-U.S. Exchange Council, founded by Ed Buckham, one-time chief of staff for former House Majority Leader Tom DeLay.

The Korean group, which lobbied for improved U.S.-Korean relations, was based at the headquarters of Buckham’s Alexander Strategy Group, which dissolved in January because of negative publicity over its ties to Abramoff. Wilkes also was an Alexander Strategy client.”

So: Jack Abramoff’s lobbying firm, Abramoff’s restaurant, a group founded and run by Wilkes’ lobbyist, and of course her dear husband.

One last point. The people who bribed Duke Cunningham, Wilkes included, were defense contractors. They were paying bribes in order to get defense contracts, presumably contracts they would not have gotten in open competition. At a time when we have not managed to find enough body armor for our troops, or adequately armored vehicles for them to ride in, and when we are auditing everyone with PTSD and asking them to justify every cent of the money they get after having risked their lives for their country, these clowns thought it was appropriate to take bribes in order to induce the Defense Department to give money to contractors who would not have gotten contracts if they had had to play by the rules.

It’s shameful to bribe any government official in order to get contracts for substandard work. But it’s doubly shameful when your bribes take money away from things like body armor, and deliver substandard defense work at a time when our troops’ lives are on the line. After all, substandard defense work doesn’t just mean that (for instance) a highway will need repairs a bit sooner than it might have otherwise; it means that some kid who is only trying to do his or her duty might get killed or maimed. It was once thought that people who did this should be tarred and feathered, or strung up and hanged. I myself don’t believe in either of these punishments, for anyone. But I understand the sentiment.*

If you live in California’s 4th CD (east of Sacramento), do your best to get this guy out of office. We deserve better.

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by hilzoy

A list of co-sponsors of S.RES.398, “A resolution relating to the censure of George W. Bush”

None
[Updated: Tom Harkin]*.

Via Liberal Oasis, a list of Senators currently serving who co-sponsored S.RES.44 (106th Congress), “A resolution relating to the censure of William Jefferson Clinton”:

Democrats:

Daniel Akaka
Max Baucus
Byron Dorgan
Dick Durbin
Dianne Feinstein
Daniel Inouye
Jim Jeffords
Ted Kennedy
John Kerry*
Herb Kohl
Mary Landrieu
Carl Levin
Joe Lieberman
Blanche Lincoln
Barbara Mikulski
Patty Murray
Jack Reed
Harry Reid
Jay Rockefeller
Chuck Schumer
Ron Wyden

Republicans:

Pete Domenici
Mitch Mcconnell
Gordon Smith
Olympia Snowe

The text of the bill censuring Clinton appears below the fold, so that you can recall the gravity of his offenses, and the seriousness with which these senators regarded Presidential lawbreaking a few short years ago. If one of your Senators is among these modern Solons, it might be worth calling and asking him or her to explain the difference between Presidential law-breaking then and now.

[UPDATE: Thomas (the government’s official site for bills) still lists no cosponsors (as of 11:20pm, 3/15/06). On the other hand, firedoglake lists Harkin, Kerry, Boxer and Menendez as supporting Feingold’s censure motion. Make of this what you will.]

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by hilzoy

Bob Herbert had a horrifying editorial about children’s services in Mississippi in today’s NYT. It’s behind the firewall, alas. Excerpts below the fold.

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by Charles

If he didn’t learn it after the Harriet Miers mess, he should’ve learned it now.  After missteps in Iraq and Katrina, and after mediocre to substandard performance in areas not pertaining to national defense, George W. Bush lost an important presumption last year.  When the president said "trust me" after appointing Harriet Miers, the conservative wing of the party could not bring itself to.  Likewise this year, when Bush said "trust me" on the Dubai port deal, the Republican wing of the party didn’t.  This was something he could’ve had, if he worked at it, but the Occasional Communicator didn’t lobby Congress hard enough and he didn’t make the case strongly enough or frequently enough to the American people. 

For me, I would’ve been firmly in the "yes" column with the right assurances on security.  McCain is right when he said the president deserved better.  What made things worse is that when push came to shove, Bush got shoved, threatening to veto any legislation which would dump Dubai, but then backing down, making him look weak and ineffective.  The cost is that Bush lost face, both here and in the Middle East.  The United Oil Emirates–er, United Arab Emirates–also lost face.  For all of its problems, the UAE has been a good ally and a moderate Muslim nation whom we could do business with.  Alas, that relationship has now been unnecessarily taken back a few notches.

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by hilzoy

As you probably already know, Claude Allen, who was President Bush’s top domestic policy advisor until a couple of months ago, when he resigned ‘to spend more time with his family’, has been arrested:

“A former top White House aide was arrested on Thursday in the Maryland suburbs on charges that he stole merchandise from a number of retailers, the police in Montgomery County, Md., said Friday.

The former aide, Claude A. Allen, 45, was President Bush’s top domestic policy adviser until resigning last month. Known as a rising conservative star, he previously served as deputy secretary of the Health and Human Services Department, and in 2003 the White House announced its intention to nominate him to a seat on the federal appeals court based in Richmond, Va. Democrats raised questions about the nomination, and it never came to a vote.

The police said Mr. Allen was seen on Jan. 2 leaving a department store in Gaithersburg, Md., with merchandise for which he had not paid. He was apprehended by a store employee and issued a misdemeanor citation for theft, said Lt. Eric Burnett, a spokesman for the Montgomery County Police Department.

A statement issued on Friday by the police said store employees saw Mr. Allen fill a shopping bag with merchandise and put additional items into a shopping cart. He then sought, and received, a refund for some of the items and left the store without paying for others.

The Police Department said that as a result of an investigation it opened after the initial incident in January, it found that Mr. Allen had received refunds of more than $5,000 last year at stores like Target and Hecht’s. Mr. Allen was arrested on Thursday and charged in connection with a series of allegedly fraudulent returns. The police said he was charged with a theft scheme over $500 and theft over $500.

“He would buy items, take them out to his car and return to the store with the receipt,” the police said in the statement. “He would select the same items he had just purchased and then return them for a refund.””

This is a strange, strange story.

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by hilzoy

Regardless of where you stand on the NSA wiretap issue, it’s a matter that cries out for Congressional hearings. It concerns important constitutional principles — the rule of law, the separation of powers, and of course the fourth amendment. The best you can say about its legality is that it’s debatable. And a failure to inquire into it would leave unchallenged the idea that the President can do what he likes without bothering to tell anyone, except for a few members of Congress sworn to absolute secrecy.

One of the committees best suited to hold such hearings is the Intelligence Committee. Its members know a lot of classified information, and are therefore in a good position to assess the administration’s claims. Moreover, they have a reputation for discretion. And yet it’s still completely unclear whether or not Congress will hold any. This is largely due to its chairman, Pat Roberts, whose hometown newspaper, the Wichita Eagle, just wrote (h/t War and Piece):

“Roberts seems prepared to write the Bush team a series of blank checks to conduct the war on terror, even to the point of ignoring policy mistakes and possible violations of law.

That’s not oversight — it’s looking the other way.”

According to the Washington Post, last week Jay Rockefeller introduced a motion to hold hearings. The White House put pressure on committee members, but after a counterproductive call from Andy Card to Sen. Olympia Snowe,

“Snowe contacted fellow committee Republican Chuck Hagel (Neb.), who also had voiced concerns about the program. They arranged a three-way phone conversation with Chairman Pat Roberts (R-Kan.).

Until then, Roberts apparently thought he had the votes to defeat Rockefeller’s motion in the committee, which Republicans control nine to seven, the sources said. But Snowe and Hagel told the chairman that if he called up the motion, they would support it, assuring its passage, the sources said.

When the closed meeting began, Roberts averted a vote on Rockefeller’s motion by arranging for a party-line vote to adjourn until March 7. The move infuriated Rockefeller, who told reporters, “The White House has applied heavy pressure in recent weeks to prevent the committee from doing its job.””

Pressure indeed.

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by hilzoy

Kevin Drum notes this passage from the President’s health care speech yesterday, in which the President spells out some of the benefits of his new Health Savings Accounts:

“The traditional insurance today will cover your health care costs — most of your health care costs — in exchange for a high premium payment up front. The costs are generally shared by you and your employer. You may also pay a small deductible and co-payment at the time of treatment. What’s interesting about this system is that those payments cover only a fraction of the actual costs of health care, the rest of which are picked up by a third party, basically your insurance company.

It means most Americans have no idea what their actual cost of treatment is. You show up, you got a traditional plan, you got your down payment, you pay a little co-pay, but you have no idea what the cost is. Somebody else pays it for you. And so there’s no reason at all to kind of worry about price. If somebody else is paying the bill, you just kind of — hey, it seems like a pretty good deal. There’s no pressure for an industry to lower price. And so what you’re seeing is price going up. If you don’t care what you’re paying, and the provider doesn’t have any incentive to lower, the natural inclination is for the cost to go up and the insurance companies, sure enough, pass on the costs — the increase in cost to you and your employer. That’s what’s happening. (…)

For many routine medical needs, HSAs mean you can shop around until you get the best treatment for the best price. In other words, it’s your money; you’re responsible for routine medical expenses; the insurance pays for the catastrophic care. You’re responsible for paying for the portion of your health care costs up to your deductible. And so you — you talk to your doctor, you say, can’t we find this drug at a little cheaper cost? Or you go to a specialist, maybe we can do this a little better — old Joe does it for X, I’m going — why don’t you try it for Y? It allows you to choose treatment or tests that meet your needs in a way that you’re comfortable with when it comes to paying the bills. In other words, decisions about routine medical treatments are made by you and the doc, not by third-party people that you never know. And all of a sudden, when you inject this type of thinking in the system, price starts to matter. You’re aware of price. You begin to say, well, maybe there’s a better way to do this, and more cost-effective way.”

My sentiments exactly. Just the other day I was beset by a hollow, empty feeling, and I said to myself: Self, there’s a void in my life — a void that could only be filled by spending hours calling around, comparing prices for doctors’ visits and pharmaceuticals, preferably while sick. Oh, if only I could say to my doctor: Maybe we can do this a little better — old Joe does it for X, I’m going — why don’t you try it for Y?

You see, shopping for medical services isn’t like ordinary shopping. When you go to the grocery store, for instance, they make it easy for you. There are the boxes of cereal all lined up, awaiting your inspection, and all you need to do is compare the price, the percentage of your daily vitamin needs provided by one carefully measured serving, and so on, and then make your selection. Where’s the fun in that? Shopping for medical services is different: hours spent finding and tracking down the relevant physicians and getting through their daunting office staff; price discussions with hospital administrators who don’t want to tell you exactly how much anaesthesia you’ll need without an exam, and so forth. The thrill of the chase! The call of the wild! By comparison, ordinary shopping is a tame and pitiful facsimile, like shooting cage-raised quail when you could be hunting grizzlies.

You might be thinking: silly hilzoy! You can do this already! But that just shows how little you know about the thrills of shopping for medical services. It’s just no fun without a little skin in the game: the sort of skin that you only have if your medical insurance won’t cover your bills. And that’s what Bush is offering us: the chance to have the shopping experience of a lifetime, and to have it under the most deliciously grueling conditions: with our own dollars on the line, when we’re desperately ill. It’s a vision as bold and rugged as America herself; and that’s why we love our President.

***

Obviously, though, Bush wasn’t designing this solely for our enjoyment. He claims to be motivated by a desire to cut health care costs. There’s only one problem: HSAs would have a negligible impact on health care costs. To show you why, I’m going to reprint a graph I made up last time I wrote about HSAs. It’s based on 2002 data from this Kaiser Family Foundation report (see exhibit 1.11.) It shows what percentage of our health care spending is done by those who spend the most.

HSAs cover medical expenses above a certain limit, often around $5,000. Pretty much everyone in the top 50% of spenders on health care will have reached that limit. (My health care spending hit five figures in the first five days of this year, and I’m not even especially sick.) That means that any reduction in health care spending will come from that tiny little blip on the right hand side of the graph: the 50% of the public that spends least on health care. Since that part of the public accounts for only a tiny part of health care spending (3.4% in 2002), most health economists don’t think HSAs will actually save all that much.

They will, however, have other dreadful effects, which I wrote about here and here. The most important one is to gut the present system of health insurance. Moreover, a new study by Jonathan Gruber shows the following:

“I estimate that the President’s budget proposals will cost almost $12 billion dollars per year if fully phased in.  I estimate that these proposals will on net raise the number of uninsured (by 600,000 persons), as those left uninsured through firm dropping of insurance exceed those who gain insurance through taking up tax-subsidized high-deductible plans attached to HSAs.”

I can hear the nay-sayers among you grumbling that in a time of exploding budget deficits, twelve billion dollars seems like an awful lot of money to pay to strip health insurance away from six hundred thousand people, and leave many more underinsured, especially since anyone who wants to be uninsured can just cancel her insurance policy. But that just misses the point. In the immortal words of Rousseau, sometimes we must be “forced to be free” — in this case, free of health insurance, which enslaves the mind, degrades the spirit, and deprives us of the ennobling experience of shopping for medical services without a safety net.

This, then, is the inspiring vision to which our President calls us: to expand the liberties our forefathers gave us beyond freedom of speech, freedom of religion, freedom of assembly, and freedom of the press, to one of the noblest freedoms of all: the freedom to confront medical bills alone, in fear and trembling, without the false comfort of medical insurance, with only our own wits standing between us and personal bankruptcy.

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