Obligatory health care post

When I worked in the Clinton correspondence office, one of my issue areas was health reform. This was back in 1994, the really ugly year. I spent a lot of time trying to learn the details of the Clinton plan and to understand congressional committee procedures. I dealt with a lot of very critical letters. Some were from insurers and medical practitioners, worried that certain procedures wouldn't be covered or that their businesses were going to suffer. Some were from conservative ideologues who were convinced that, should Clinton's plan pass, visiting an American doctor was going to become like obtaining toilet paper under Brezhnev or living in a gulag under Stalin or playing dreidel under Hitler. Just about every day, of course, we had C-SPAN on in the office, and I heard congressional statements morph from "We will have health reform this year" to "The President's health care bill is deader than Elvis."

All this is to say that I've seen this movie before, and I didn't like the ending.

If you haven't read it, Ezra Klein's piece comparing the Obama and Clinton health reform efforts is really fascinating. He notes that Clinton was criticized for crafting the whole reform himself and not letting Congress figure it out, while Obama is being criticized for leaving it all up to Congress and not giving supporters something specific to rally around. He also notes that the Clinton plan was probably a lot more ambitious than anything Obama's pushing for today. It actually saw the way health care was going in this country and sought to create some workable rules:

The managed-care revolution of the mid-90s was, by the early years of that decade, clearly inevitable; the financing and delivery of health care could not remain separate forever. But this was a dangerous change. Insurers make money by denying claims. Money they spend on health care is money they lose (they even have a name for it: the "medical-loss ratio"). Private insurance is a bit like a fire department that turns a profit by letting buildings burn down.

So Clinton sought to cage managed care inside managed competition, which would regulate the behavior of insurers and force them to compete for patients. This would give consumers more power against their insurance companies, drive the bad actors from the market and generally protect against the excesses of managed care. Clinton's plan also included a handful of other safeguards, like out-of-pocket caps and an independent appeals process, designed to protect consumers from deficient insurance.

But Clinton's opponents sought to defeat the plan, raising fears that care would be rationed and costs would go up and that consumers would have less choice. This, of course, is exactly what happened, except that Clinton's plan didn't pass.

Now the same fears are being raised today. I have to say that the hostility makes me a bit sick. Of course, I have no problem with heated, polarized debate, but this is nothing of the sort. This is trying to whip people into a frenzy by scaring them to death without actually informing them of anything substantive. Here's the text of an e-mail I received from the Colorado GOP the other day:

Republican Call to Action – Help defeat Obamacare!

Four important things you can do to help:

1.) Call and email your member of Congress and let them know you oppose this legislation
2.) Write a letter to the editor
3.) Forward this email to your friends and family
4.) Participate in one of the “Hands off my Healthcare” rallies taking place throughout the state Thursday, August 6th – Friday, August 8th. Please see schedule below:

The Patients First bus “Hands off my Healthcare” tour will be coming to Colorado this Thursday, August 6th , Friday, August 7th and Saturday August 8th for a rally against a government takeover of your healthcare. Nearly 2,000 Coloradans have already rallied in Denver and Colorado Springs against Washington’s plans to dictate our health care choices. Now the rest of Colorado gets their chance for their voices to be heard.

What exactly are they protesting? There are several plans being considered by Congress right now. What does the Colorado GOP object to? Expanding health insurance? Creating more competition among insurers? We don't know.

At this point, only two factors give me any confidence that some version of health reform will pass this year:

1. The Democrats have (at least nominally) 60 votes in the Senate, which they did not have in 1993-94.
2. The Democrats remember how the failure of health care contributed to their loss of control of both chambers of Congress in 1994, and they do not want to repeat that.

Sorry for the rant.

On the state of Senate rhetoric

I've often wondered about the purpose of most congressional speeches. I mean, members go to the floor and speak every day about some topic of concern to them. But who's the audience? Almost no one is in the chamber most of the time. And your typical member could probably count on two hands the number of constituents who are watching on C-SPAN. It seems that very little good can come from it, except to brag to a constituent that you gave a speech on some issue of importance to him or her. Yay, a speech. But if you do something stupid, someone will catch it.

Which brings us to Sen. Chuck Grassley:

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The Republican nominee for Colorado's U.S. Senate seat will not be an Aurora city councilman

ColoradoPols is reporting that former U.S. Rep. Bob Beauprez will likely run for Senate next year. This makes sense to me. No offense to Ryan Frazier, but it's really hard to jump from a city council position to U.S. Senator in one year. Beauprez has long had the luxury of sitting back and waiting. Waiting to see how the GOP field is shaping up, how vulnerable Sen. Bennet looks, how weak the Democrats are nationally and statewide, etc. He can do this because he's got enormous name ID and great access to campaign funds and staff. It's not hard for him to assemble an organization relatively late.

Yeah, Beauprez ran a pretty crappy race for governor back in '06, but don't underestimate him. Bennet is definitely vulnerable and won't get much electoral help from the guy who appointed him. And if "The economy shrank by slightly less than expected" is 2010's version of good economic news, the Democrats are going to be in a world of hurt next year.

How are senators co-sponsoring legislation like cows licking each other?

Anyone out there familiar with social networks research? I'm trying to find a way to compare two different networks of different sizes. I need some way to control for size while seeing if there are significant differences in graph-level indices, such as density, degree centrality, etc. There's not a ton out there on this topic, although a few scholars made some suggestions, as Michael Heaney reports.

One of the few papers I've found that does this sort of technique is called “Comparing Networks Across Space and Time, Size and Species” by Katherine Faust and John Skvoretz (sorry, I can't find an ungated link), published in Sociological Methodology in 2002. They manage to compare a bunch of different networks, including Senate co-sponsorships, patterns of social licking among cows, and grooming among Patas monkeys. As near as I can tell, the co-sponsorship networks in the 1993 Senate were somewhat similar to aggressive/submissive relationships among vervet monkeys. Not sure what to make of that.

Anyway, I'll see if I can learn from this technique, but I'm open to other ideas.

Political reforms

All of a sudden the blogosphere is a-twitter with political reform ideas. Matt Yglesias started this by throwing a bunch of ideas out there, including a national popular vote and proportional representation. The only one of his ideas I feel particularly strongly about concerns the Senate: get rid of the filibuster or get rid of the upper chamber, I say. It's an antiquated, anti-majoritarian legislature. That made sense in the eighteenth century; it's a hard sell today. Plus, their staggered terms make it harder for political scientists to study.

Nicholas Beaudrot follows up on this by saying that we should triple the size of the House of Representatives. Jonathan Bernstein has some interesting critiques of Beaudrot's plan (here, here, here, and here), although he does claim that it would increase the percentage of women in the House. I'm not sure why that would be the result of shrinking districts -- it's not like our state legislatures are teeming with women.

One thing that would likely happen with a mega-House is that the tools that legislatures use to organize an unruly chamber -- notably parties, committee chairs, and the speaker -- would become stronger. I don't know that that's necessarily bad or good. I suppose the main advantage of the reform would be to improve representation. Members would have smaller, less diverse districts, and they could conceivably meet a high percentage of their voters. That's not nothing. But would it be worth the size of the reform? (Think of all the work that would have to be done to the chamber itself. Plus, if we still paid members at their current rate, we're talking about an increase of over $160 million in member salaries alone, not to mention staff.)

Oh, and nothing personal against Joe Biden, but we really don't need a vice presidency.

The Gangs of Boulder

Rep. Jared Polis (D-Boulder) continues to stray from the Democratic line on health care reform by complaining about costly tax increases. I've been wondering what the party's leaders are saying to him when they speak privately. Here's one scenario:

Cast:

-Jared Polis, played by John C. Reilly

-Nancy Pelosi, played by Daniel Day Lewis

Setting: Back room of butcher shop.

Script

Polis: My loyalty is to fiscal responsibility.

Pelosi: What the hell are you talking about?

Polis: [Looks sheepish.]

Pelosi: Here's the thing. I don't give a tupenny fuck about your moral conundrum, you meat-headed shit-sack. That's pretty much the thing.

Liberals vs. progressives

I recall seeing a study a few years ago about voting patterns in San Francisco, although I can't remember the author's name. The finding was that Republicans were essentially a negligible political force there -- the main political division was between liberals and progressives. Now, some folks use those words interchangeably, but this particular study differentiated between the two. Liberals were somewhat older and had resided in the city for multiple generations. They did nice things like raise money for the poor and donate to environmental causes. The progressives were younger and considerably further left. They tended to resort to activist politics -- attending rallies and so forth. Liberals drive Priuses while drinking fair trade coffee; progressive ride bikes and key SUVs while doing so.

If this is the proper distinction, then there's some sort of low-grade civil war of the Left occurring in Austin, Texas, where someone in a blue Prius has made a habit of shooting bicyclists with a pellet gun. Says one victim:

I mean, I guess it's nice they're concerned about the welfare of our planet [...] But it would be nice if they could stop shooting people that live on it.