Scott: Skip Krugman's analysis of the bill in question which is about as bad as he claims but not substantially different from the Democratic version as far as defects go. The abiding point of our debate on Medicare/prescription drugs/HMO's/health care has been a search for some magic 3rd party to pay the bills. No one will accept death and pain but no one will accept that 15% of the US economy cannot be paid for by finding deep pockets. You can ration by price [only the rich get the goodies]. You can ration by administrative fiat [the very old, the very sick,the unlucky get thrown off the sleigh to the wolves]. You can actually tax consumer spending and buy less at the mall. I have just described the triangle inside which reality occurs. No one deals in reality. Reality is about choices on who has pain, who dies, who pays. Our system is about demonology and Hollywood endings. So forget whether you get Newt's bill, teddy the girlfriend killer's or whoever's. Whoever wins will lose the next round as the public keeps searching for some magic way to avoid unpleasant choices.
What is big is AARP getting off the Democratic freight train. Krugman seems shocked to discover that behind the highminded front AARP is a major for profit business. Hint: it always was. However it served as a public front to help keep the FDR generation voting Democratic. Presume the Democrats manage to set up their own AARP clone aided by the national media who will pile on AARP in normal hunting pack style. A 10-20% swing of over 65 white votes to the GOP are a political revolution. The geezers actually vote. They are a core Democratic constituency.
So ask yourself what happened here. A major player in the Democratic tent has decided that the GOP House Majority may be generational instead of a set of flukes now in their 9th year. They have decided that half a loaf and being inside the conference room when Delay cuts the deals looks good. It is the problem every 'out' party faces. A lot of each coalition is in one camp or the other for essentially historic and chaotic reasons. There is no inherent reason why independent oil was a Democratic bastion for 3/4ths of a century and then switched totally to GOP except Occidental which is still a Gore fronted Democratic fief. Per se they belonged on the other side from the greens but it was originally a southern protestant thing and they had been historic yellow dog democrats.
If I were a major Democratic player - not one of the activist leaders but someone with a real interest in power - say Saint Hillary or Joe 'the Senator from Citibank' Lieberman or say Paul 'I was an advisor to Enron' Krugman - I would be sweating bullets. If AARP successfully makes the switch a lot of other interest groups [the industrial union part of the AFL-CIO, Silicon Valley, the Democratic part of Wall Street...] may start asking themselves why not get a deal while there are deals to be done. Unlike office holders they don't have to swear allegiance to the social and religious conservative agenda. They just have to direct they money to the right directions and their lobbyists will be allowed into the conference committee rooms for the final markups. They can be as personally pro-choice, new age, whatever as they want. In the end it is just different shit to swallow. Ideologically they have as many differences with the loony left activists as with the religious and social right.
You see, there is a potential synergy here. The more economic interest money leaves the Democratic camp, the more they are dependent on ideological money. This means running more Kennedy-Dean-Kuchinich-Cynthia McKinney types and fewer Gephardt-Bill Clinton-Lieberman-Clark types. This is turn will make the Democrats a bicoastal minority party for quite some time. That is why the hysteria. The first to break ranks must die lest there be a stampede. Interesting times.
Gone Astray
By PAUL KRUGMAN
Published: November 21, 2003
This is a good bill that will help every Medicare beneficiary," wrote Tom Scully, the Medicare administrator, in a letter to The New York Times defending the prescription drug bill. That's flatly untrue. (Are you surprised?) As the Center on Budget and Policy Priorities points out, the bill will force millions of beneficiaries to pay more for drugs, thanks to a provision that cuts off supplemental aid from Medicaid. Poorer recipients may find previously affordable drugs moving out of reach.
That's only one of a number of anti-retiree measures tucked away in the bill. It contains several Trojan horse provisions that are clearly intended to undermine Medicare over time — it will allow private insurers to cherry-pick healthy clients in selected cities, and it will heavily subsidize private plans competing with traditional Medicare. Meanwhile, the bill prohibits Medicare from using its bargaining power to cut drug prices; drug company stocks have soared since the bill's details became public.
Yet the bill has a good chance of passing, thanks to an endorsement from AARP, the retiree advocacy organization, which has already begun an expensive advertising campaign on the bill's behalf. What's going on?
Let's step back a minute. This is a bill with huge implications for the future of Medicare. It's also, at best, highly controversial. One might therefore have expected an advocacy group for retired Americans to take its time in responding — to make sure that major groups of retirees won't actually be hurt, and to poll its members to be sure that they are well informed about what the bill contains and don't object to it.
Instead, AARP has thrown its weight behind an effort to ram the bill through before Thanksgiving. And no, it's not urgent to get the bill passed so retirees can get immediate relief. The plan won't kick in until 2006 in any case, so no harm will be done if the nation takes some time to consider.
Many of AARP's members feel betrayed. The message boards at the organization's Web site have filled up with outraged posts. A number of those posts say something like this: "Now you're just an insurance company." Indeed, that may get to the heart of the matter.
Over the years AARP has become much more than an advocacy and service organization for older Americans. It receives more than $150 million each year in commissions on insurance, mutual funds and prescription drugs sold to its members.
And this Medicare bill is very friendly to insurance and drug companies. Senator John Breaux, one of only two Democrats who participated in negotiations over the bill, takes the controversy as a good sign: "No one got everything they wanted." But as Jonathan Cohn points out in The New Republic, drug and insurance companies got exactly what they wanted: no efforts to limit prices, generous subsidies and lots of additional business. For example, insurance companies that offer an alternative to Medicare will not only be able to pick and choose their customers, but will also get 30 percent more per client than the government spends on the average Medicare recipient.
So do AARP executives support this bill because they hope to share in the bounty? Maybe, but it probably runs deeper than that. Once an advocacy group becomes as much a business as a service organization, its executives are likely to start identifying more with industry interests than with the groups they are supposed to serve.
Thus it may seem odd on the surface that William Novelli, AARP's chief executive, wrote a glowing preface to Newt Gingrich's book on health care reform. After all, Mr. Gingrich has long advocated turning the administration of Medicare over to private companies — an unpopular idea, and also an expensive one (forget the clichés about inefficient government: private companies have much higher overhead than Medicare). But what looks like wasted money to taxpayers and retirees looks like opportunity to private providers. Enough said.
Am I being too cynical? How could I be? In case you haven't noticed, we live in a golden age of pork: the other big piece of legislation marching through Congress, the energy bill, makes the Smoot-Hawley tariff look like a classic of good government.
So it should come as no surprise that Medicare "reform" appears likely to be another triumph for the coalition of the bought-off — a coalition that, sadly, includes AARP.
posted by scott 10:13 PM