In the last post I discussed the inflated health care costs we have in the United States because health care providers here are largely immune :) from free market competition. In this post I'd like to examine the theory that consumer choice leads to higher quality and lower costs of health care. I think this "choice myth" is as bogus as the myth of a free market for health care. Here are my reasons.
First off, consumers make choices for personal benefit, not for group benefit. For things like health insurance, personal choice can drive up costs. As more companies drop health insurance coverage for their employees (in 2000 about 69% of companies provided health care benefits, by 2005 the portion of companies providing health care to their employees was down to 60%) politicians are creating personal health savings plans. The reasoning behind these is that if individual consumers pay for insurance out of their own pocket, they will buy the best care and negotiate for the best prices. The resulting consumer choice should drive insurance costs down. In practice it turns out to work in reverse. The healthiest consumers opt out of buying this insurance (why spend all that money on insurance, they're not likely to get sick), while those with poor health and chronic conditions opt in. Insurance works by spreading the costs of individual risk across a large risk pool. But by allowing healthy consumers to opt out, we end up with a smaller pool of insurees who have a higher proportion of health risks. This is a recipe for higher insurance prices. To end up with lower health insurance costs, we'd need to eliminate choice and mandate that everyone buy insurance. This would result in a large pool of insurees, and make sure that low-risk insurees are pooled with high risk insurees. This idea, of mandatory health insurance, is anathema to Americans (even though we've grown used to mandatory auto insurance). We will fight for our right to choose, even if that choice results in higher costs.
Secondly, consumers often make choices based on fear or fantasy, not science. There are many treatments that are performed routinely to provide a (false) sense of comfort, not because of medical need. These treatments add cost without improving overall health. One of these is mammography. Women over 40 have been told for years that they should have annual mammograms. The science shows that the vast majority of these mammograms are unhelpful. An article in the July, 2005 issue of the Journal of the National Cancer Institute found that regular mammogram screening did not actually decrease deaths from breast cancer. But many medical labs have bought expensive mammography equipment, and we're scared to death of cancer. We feel safer for having the procedure done. Lest you think I am picking on women, men are now buying the same bill of goods on annual prostate screenings. Most men have little need for a regular PSA test, according to the American Cancer Institute, but we often sign up for this procedure "just in case" (and in so doing, we inflate medical billings). We do the same with colonoscopies (out of fear of colon cancer), which the National Cancer Institute says are performed far more often than necessary. These are a few examples of the many medical procedures that we consumers have become convinced over the past twenty-five years that we should have as part of a regular check-up. It is often the case that we sign up for these procedures because they make us feel safer (and medical companies, doctors and labs can make money on them), not because performing them improves health care outcomes.
This is no less true for many medicines. We often turn to over-the-counter and prescription drugs when we are sick, whether or not they will actually help us. For example, many Americans with a cold will ask their doctor to prescribe an antibiotic. Colds are caused by viruses, antibiotics do not work on viruses. Doctors know this, but they will often provide the prescription anyway, because they want to please their patients. In June of 2005 the Journal of the American Medical Association published an article showing that doctors often prescribe antibiotics to make patients happy even though these drugs won't shorten the duration of cough, congestion or lower respiratory tract infections. In fact, this over-prescription of antibiotics has increased the threat to public health from drug resistant disease bacteria. We not only misuse antibiotics, we do the same with cough medicine (scientific studies show that cough medicine has little or no real health benefit), sinus medicines, even vitamins (scientific studies show that taking vitamin C does not prevent colds, nor does it reduce their length or severity). When we are sick, taking something (a magic potion) is "better" than doing nothing, but often the potion does nothing to improve health care. We love all the choices available on our pharmacy's shelves (and said pharmacies respond by growing ever larger), but the science shows that we could eliminate most of the vials and jars in our medicine cabinets and be just as healthy.
A third way in which increased choice has not led to improved health care is in the rise of the specialist. Over the past 25 years the proportion of doctors who choose to become general practitioners (GPs) has shrunk, and those who have become specialists has grown. I suspect that this is not because that's what we need as a population of patients but because that's where the money is for doctors (according to the Bureau of Labor Statistics specialists make 10-100% more than GPs). We'd expect that having more specialists, with deeper medical knowledge, would improve health care, but several studies (such as this one from Dartmouth - http://www.dartmouth.edu/~kbaicker/BaickerChandraSpecialists.pdf) show that an increased use of specialists results in a decrease in health care outcomes for a population. Studies show that the vast majority of office visits can and should be handled by GPs. Saying no to the "choice" of most specialist referrals would lead to both higher quality health care and lower costs. It turns out (as studies like this one from Colorado show - http://www.medscape.com/viewarticle/474281_4) that we'd be healthier if we had more GPs, not more specialists. Most of the time we don't need a dermatologist to treat our acne, or a podiatrist for those pesky bunions. But who's going to tell all those medical students that they shouldn't become podiatrists or dermatologists, but instead should take a salary cut and become family practitioners?
In sum, choice has not reduced health care costs or increased the quality of our health. Choice often leads to insurance inequalities, unnecessary specialist referrals, unnecessary diagnostic treatments and over-prescribed medicines - which do us little real good. We're looking for comfort and trying to alleviate our anxiety about our health, but we're not getting better health care for all the choices we have and the money we're spending. Americans are illogical when it comes to health care and we'll fight (to the death?) for the right to choose our "health" care, rather than let a system like England's or Canada's (or Universal Medicare) provide it for us.
Wednesday, February 27, 2008
Tuesday, February 19, 2008
Health Care Myth #1 - the free market works
Health care is a big, fuzzy ball of misery and mystery. In my next few blog posts I'm going to explore some of the contradictions of the American health care system. Such as the topic of today's post, the myth that the free market will provide us all with affordable, reliable health care. To start, I'd like to share two stories from my many years working in high tech and associating with biotech "entrepreneurs".
On the board of one of the start-ups I worked for was a very successful health care executive. He had made millions $$ as the CEO of a company that made blood test systems for use in clinics and hospitals. To motivate me to come up with creative ways to increase our software revenues, he told me a story about one of the secrets of his own success. His company made a very nice profit on the sale of each blood analyzer, but he felt they were not making enough revenue from clinics and labs after the analyzer was installed. He knew that every test on one of his machines used several gallons of distilled water, but his customers weren't buying this water from him (because his company charged $10.00 a gallon). Instead they bought distilled water from the local pharmacy, for $2.00 a gallon, keeping lab costs down for their patients. To put a stop to this economizing, he came up with a new "maintenance" plan which promised to void the warranty on his customers' machines unless they used "certified" distilled water, which only his company sold. This resulted in a brisk business in his $10/gallon water (the same exact water that CVS sold, since distilled water is distilled water). He was quite proud of this plan, it made his company millions $$ more in profits (and incidentally increased the cost of every lab test by $20-30).
Another company I knew at that time designed a surgical robot. This robot gives surgeons precision control during delicate coronary bypass procedures (the company had done extensive market research and chose the coronary bypass market because it was so large). One of the key business aspects of their robot's design is its "disposables". Disposables are all the tools, instruments and accessories that have to be discarded after they've been used once on a patient. This company went to great lengths to design expensive (and profitable) disposables. They not only ended up with a robot that performs coronary bypass procedures extremely well and which is sold today for about a million dollars, but they ensured a significant ongoing revenue stream for the expensive "disposable" end parts of the robot which have to be replaced after every surgery. As they explained to me, "the magic is in the disposables".
These companies can get away with this kind of profiteering because they are not operating in a free market. One cannot shop at Walmart or Target for the best deal on blood gas analyzers. There are no coronary bypass sale days at the local hospital ("Come in today for great deals at our Presidents' Day Bypass Extravaganza, and get a free set of snow tires!!!"). Both of the above businesses knew that once they had gone through the lengthy clinical trails needed to have their system certified for use on patients, they would be granted a virtual monopoly for their system and would have tremendous leeway in setting prices and guaranteeing profit margins.
In a true free market, suppliers can freely enter and bid down the price of inflated products, like the distilled water or the disposable surgical tips. In a true free market consumers are well-informed and have a number of options to obtain the best product or service for the best price. But it doesn't work this way in the health care market. The extensive and expensive clinical trial process, required by the FDA for every new medical device or pharmaceutical, makes it extremely difficult for a competitor to enter a market. This means the "first mover" supplier has tremendous clout. And consumers have very little power. To become well-informed about treatment options, laboratory equipment or surgical devices takes years of medical school. Consumers have few or no choices in hospitals, doctors, medical technologies or prescription drugs. In the shoe business, customers who don't like $120 Nikes might buy $70 New Balance sneakers. The typical medical care "shopping" experience is "here you go, take it or leave it". Try shopping around for the best deal the next time you're in need of a heart stent.
The consumer price index, which tracks the prices of day-to-day goods and services in what are primarily free markets, has risen about 250% since 1980. In that same time the costs of health care have grown 800%. This is what a monopoly market looks like. When consumers are weak and suppliers have all the power, prices can be hiked with little risk of competition. Medical companies who want to ensure the continued flow of their "healthy" revenue streams will lobby to the death to protect the "free market" for health care, but it's time we all admitted that the free market for health care does not exist, and it is unlikely it ever will.
On the board of one of the start-ups I worked for was a very successful health care executive. He had made millions $$ as the CEO of a company that made blood test systems for use in clinics and hospitals. To motivate me to come up with creative ways to increase our software revenues, he told me a story about one of the secrets of his own success. His company made a very nice profit on the sale of each blood analyzer, but he felt they were not making enough revenue from clinics and labs after the analyzer was installed. He knew that every test on one of his machines used several gallons of distilled water, but his customers weren't buying this water from him (because his company charged $10.00 a gallon). Instead they bought distilled water from the local pharmacy, for $2.00 a gallon, keeping lab costs down for their patients. To put a stop to this economizing, he came up with a new "maintenance" plan which promised to void the warranty on his customers' machines unless they used "certified" distilled water, which only his company sold. This resulted in a brisk business in his $10/gallon water (the same exact water that CVS sold, since distilled water is distilled water). He was quite proud of this plan, it made his company millions $$ more in profits (and incidentally increased the cost of every lab test by $20-30).
Another company I knew at that time designed a surgical robot. This robot gives surgeons precision control during delicate coronary bypass procedures (the company had done extensive market research and chose the coronary bypass market because it was so large). One of the key business aspects of their robot's design is its "disposables". Disposables are all the tools, instruments and accessories that have to be discarded after they've been used once on a patient. This company went to great lengths to design expensive (and profitable) disposables. They not only ended up with a robot that performs coronary bypass procedures extremely well and which is sold today for about a million dollars, but they ensured a significant ongoing revenue stream for the expensive "disposable" end parts of the robot which have to be replaced after every surgery. As they explained to me, "the magic is in the disposables".
These companies can get away with this kind of profiteering because they are not operating in a free market. One cannot shop at Walmart or Target for the best deal on blood gas analyzers. There are no coronary bypass sale days at the local hospital ("Come in today for great deals at our Presidents' Day Bypass Extravaganza, and get a free set of snow tires!!!"). Both of the above businesses knew that once they had gone through the lengthy clinical trails needed to have their system certified for use on patients, they would be granted a virtual monopoly for their system and would have tremendous leeway in setting prices and guaranteeing profit margins.
In a true free market, suppliers can freely enter and bid down the price of inflated products, like the distilled water or the disposable surgical tips. In a true free market consumers are well-informed and have a number of options to obtain the best product or service for the best price. But it doesn't work this way in the health care market. The extensive and expensive clinical trial process, required by the FDA for every new medical device or pharmaceutical, makes it extremely difficult for a competitor to enter a market. This means the "first mover" supplier has tremendous clout. And consumers have very little power. To become well-informed about treatment options, laboratory equipment or surgical devices takes years of medical school. Consumers have few or no choices in hospitals, doctors, medical technologies or prescription drugs. In the shoe business, customers who don't like $120 Nikes might buy $70 New Balance sneakers. The typical medical care "shopping" experience is "here you go, take it or leave it". Try shopping around for the best deal the next time you're in need of a heart stent.
The consumer price index, which tracks the prices of day-to-day goods and services in what are primarily free markets, has risen about 250% since 1980. In that same time the costs of health care have grown 800%. This is what a monopoly market looks like. When consumers are weak and suppliers have all the power, prices can be hiked with little risk of competition. Medical companies who want to ensure the continued flow of their "healthy" revenue streams will lobby to the death to protect the "free market" for health care, but it's time we all admitted that the free market for health care does not exist, and it is unlikely it ever will.
Wednesday, February 13, 2008
The tragedy of being Hillary
So many of my liberal friends really....really.....really....HATE Hillary. Can you blame them? She's a mean-spirited, ambitious politician. She's artificial. She practices dirty campaign tricks. I've got proof, just look at some of the things she's done in just the past couple of months:
* She had to return over $150,000 in donations that were raised by a businessman who is being investigated for fraud, and with whom she's had shady business dealings for 20 years.
* She turned her back and pretended not to see Barack Obama at a recent Senate gathering, because she's so vindictive she could not bring herself to shake his hand.
* She refused to apologize after one of her senior campaign staffers launched a personal attack against Obama, in which he claimed that Obama's personality would make it impossible for foreign leaders to work with him. When asked why she had not fired or reprimanded this staffer, Hillary disingenuously replied "It's not clear to me why I'd be apologizing for someone else's remark. I have said repeatedly I have the utmost respect for Obama and have considered Obama an ally in the Senate and will continue to consider it that way throughout this campaign."
You can see what a horrible person she is - we should all vote for Obama! He's so pure, so wonderful, so fresh, so different. So inspiring. He'd never do the things that Hillary does. Except there's a problem with this judgment. It's wrong. Hillary didn't say or do any of the above. Obama did.
Why are we so willing to give Obama a free pass, and to assume the worst about Hillary? Obama has been connected for twenty years to Tony Rezko, the Chicago real estate exec who's being investigated for fraud, who arranged in 2006 for Obama to make a huge profit on a shady land deal, and whose $150,000 in campaign donations Obama has had to donate to charity so as to clear them from his books (you can read all about that here - (http://www.suntimes.com/news/politics/obama/749138,obama20web.article ). It doesn't seem to matter, nobody (neither the media nor Obama's supporters) says "Boo" about Obama's shenanigans, while people are still going after Hillary for the phony White Water scandal. Obama turned his back on Hillary when she approached him with out-stretched hand a month ago at the State of the Union, and he's still admired by all for his warmth and charm, while we think her cold and aloof. Obama's chief of staff told the press that "no world leader could negotiate with Hillary because they can't trust her" and Obama (and the media) let it go, while Hillary fired one of her staffers for opining that Obama's admitted drug use may be a problem when campaigning against the GOP nominee in November. No matter what actually seems to happen in the campaign, Obama remains the "nice guy", and Hillary is the bitch.
Why do we hold this double standard?
This is what I call the tragedy of Hillary. She is the first woman to come down the pike with a real chance (not a Geraldine Ferraro chance) to become president. In fact she may be one of the most qualified and capable candidates we've seen in years. She's tough, she's experienced, she's wicked-pisser smart, she is one of the hardest working people in the Senate, she has compiled detailed policy positions on every domestic and foreign policy issue, she's very well-connected, she has tremendous name recognition, she is respected world-wide, she was re-elected to the Senate by a wide margin (doing well even in conservative upstate New York), and she has proven her ability to work with both Democrats and Republicans. What does this deep, rich and powerful resume get her? Not just the hatred of the Rush Limbaughs of the world, but the dislike and distrust of liberals and Democrats, even women! People accept and admire such a pedigree when it belongs to a man, but it's not enough for a woman. Hillary is smart, strong and experienced but she lacks a lovable side, she's not warm, she's not cuddly. It's okay for a man running for President to be intelligent, calculating, driven - but not a woman.
"It's not discrimination", my friends say, "I would love to see a woman in the White House, I just don't like Hillary." I beg to differ. It's not just Hillary, we'd be saying the same things about Maggie Thatcher, who served longer than any British Prime Minister. Maggie could not get elected here. We'd be saying the same things about Angela Merkel. I think that we hold a serious female candidate to a different standard than we do a man, and that is discrimination. There's even a name for it, it's called the Goldberg paradigm. Scientists have studied our gender bias, and demonstrated over and over that we judge the same work authored by "Joan McKay" to be much lower quality than when authored by "John McKay". It turns out that we judge a woman's work much more harshly, especially in a "man's world" such as science or politics.
I see the Goldberg paradigm being applied to our judgment of Hillary and of her campaign. My Obama-mama friends (and I should mention here that I voted for Obama, although I could happily support Hillary), tell me "I don't like Hillary, she's too ambitious". Of course she's ambitious, anyone who signs up for the grueling two-year gauntlet of a presidential campaign had damn well better be ambitious. I will guarantee you that Obama is ambitious, as was Bill, as was LBJ (LBJ dripped ambition). Is Hillary any more ambitious than JFK was? Why is it wrong for a woman to be ambitious? My friends say "Hillary's just like Karl Rove". All I can say is that anybody who thinks that Hillary's campaign tactics bear any similarities to Karl Rove's has a very short memory. Hillary has run a tough campaign, but she has been fair (does anyone remember Kerry's swift-boating? McCain's "illegitimate black child"?). Hillary immediately fired the staffer who mentioned Obama's drug use, Rove would have promoted him and then hired agents to plant crack vials in Obama's hotel room. Karl Rove would be insulted to know that people compare his Machiavellian dagger-in-the-dark campaign tactics with Hillary's.
I don't know if we'll get to the place in this country where we can vote for and even celebrate a tough, smart, experienced, ambitious woman, instead of demanding that she be warm and fuzzy and motherly. I don't see it happening any time soon. Meanwhile, there's really not much that Hillary can do (short of a sex change) to escape the tragedy of being Hillary. She's trapped in a solipsistic, self-fulfilling prophecy. We just don't like her. She's not electable, she has such strong "negatives". We're not ready to vote for a woman who has what it takes to be President.
* She had to return over $150,000 in donations that were raised by a businessman who is being investigated for fraud, and with whom she's had shady business dealings for 20 years.
* She turned her back and pretended not to see Barack Obama at a recent Senate gathering, because she's so vindictive she could not bring herself to shake his hand.
* She refused to apologize after one of her senior campaign staffers launched a personal attack against Obama, in which he claimed that Obama's personality would make it impossible for foreign leaders to work with him. When asked why she had not fired or reprimanded this staffer, Hillary disingenuously replied "It's not clear to me why I'd be apologizing for someone else's remark. I have said repeatedly I have the utmost respect for Obama and have considered Obama an ally in the Senate and will continue to consider it that way throughout this campaign."
You can see what a horrible person she is - we should all vote for Obama! He's so pure, so wonderful, so fresh, so different. So inspiring. He'd never do the things that Hillary does. Except there's a problem with this judgment. It's wrong. Hillary didn't say or do any of the above. Obama did.
Why are we so willing to give Obama a free pass, and to assume the worst about Hillary? Obama has been connected for twenty years to Tony Rezko, the Chicago real estate exec who's being investigated for fraud, who arranged in 2006 for Obama to make a huge profit on a shady land deal, and whose $150,000 in campaign donations Obama has had to donate to charity so as to clear them from his books (you can read all about that here - (http://www.suntimes.com/news/politics/obama/749138,obama20web.article ). It doesn't seem to matter, nobody (neither the media nor Obama's supporters) says "Boo" about Obama's shenanigans, while people are still going after Hillary for the phony White Water scandal. Obama turned his back on Hillary when she approached him with out-stretched hand a month ago at the State of the Union, and he's still admired by all for his warmth and charm, while we think her cold and aloof. Obama's chief of staff told the press that "no world leader could negotiate with Hillary because they can't trust her" and Obama (and the media) let it go, while Hillary fired one of her staffers for opining that Obama's admitted drug use may be a problem when campaigning against the GOP nominee in November. No matter what actually seems to happen in the campaign, Obama remains the "nice guy", and Hillary is the bitch.
Why do we hold this double standard?
This is what I call the tragedy of Hillary. She is the first woman to come down the pike with a real chance (not a Geraldine Ferraro chance) to become president. In fact she may be one of the most qualified and capable candidates we've seen in years. She's tough, she's experienced, she's wicked-pisser smart, she is one of the hardest working people in the Senate, she has compiled detailed policy positions on every domestic and foreign policy issue, she's very well-connected, she has tremendous name recognition, she is respected world-wide, she was re-elected to the Senate by a wide margin (doing well even in conservative upstate New York), and she has proven her ability to work with both Democrats and Republicans. What does this deep, rich and powerful resume get her? Not just the hatred of the Rush Limbaughs of the world, but the dislike and distrust of liberals and Democrats, even women! People accept and admire such a pedigree when it belongs to a man, but it's not enough for a woman. Hillary is smart, strong and experienced but she lacks a lovable side, she's not warm, she's not cuddly. It's okay for a man running for President to be intelligent, calculating, driven - but not a woman.
"It's not discrimination", my friends say, "I would love to see a woman in the White House, I just don't like Hillary." I beg to differ. It's not just Hillary, we'd be saying the same things about Maggie Thatcher, who served longer than any British Prime Minister. Maggie could not get elected here. We'd be saying the same things about Angela Merkel. I think that we hold a serious female candidate to a different standard than we do a man, and that is discrimination. There's even a name for it, it's called the Goldberg paradigm. Scientists have studied our gender bias, and demonstrated over and over that we judge the same work authored by "Joan McKay" to be much lower quality than when authored by "John McKay". It turns out that we judge a woman's work much more harshly, especially in a "man's world" such as science or politics.
I see the Goldberg paradigm being applied to our judgment of Hillary and of her campaign. My Obama-mama friends (and I should mention here that I voted for Obama, although I could happily support Hillary), tell me "I don't like Hillary, she's too ambitious". Of course she's ambitious, anyone who signs up for the grueling two-year gauntlet of a presidential campaign had damn well better be ambitious. I will guarantee you that Obama is ambitious, as was Bill, as was LBJ (LBJ dripped ambition). Is Hillary any more ambitious than JFK was? Why is it wrong for a woman to be ambitious? My friends say "Hillary's just like Karl Rove". All I can say is that anybody who thinks that Hillary's campaign tactics bear any similarities to Karl Rove's has a very short memory. Hillary has run a tough campaign, but she has been fair (does anyone remember Kerry's swift-boating? McCain's "illegitimate black child"?). Hillary immediately fired the staffer who mentioned Obama's drug use, Rove would have promoted him and then hired agents to plant crack vials in Obama's hotel room. Karl Rove would be insulted to know that people compare his Machiavellian dagger-in-the-dark campaign tactics with Hillary's.
I don't know if we'll get to the place in this country where we can vote for and even celebrate a tough, smart, experienced, ambitious woman, instead of demanding that she be warm and fuzzy and motherly. I don't see it happening any time soon. Meanwhile, there's really not much that Hillary can do (short of a sex change) to escape the tragedy of being Hillary. She's trapped in a solipsistic, self-fulfilling prophecy. We just don't like her. She's not electable, she has such strong "negatives". We're not ready to vote for a woman who has what it takes to be President.
Thursday, February 7, 2008
Poor, poor pitiful Rush...
I have to admit that while the Democratic primary is confusing the heck out of me (heart or head? inspiration or perspiration? beauty or brains? charm or churlishness?), I've been enjoying immensely what's going on over on the GOP side. Rudy the snarling nasty-meister, who ran for President of 9/11 (thank you John Stewart)? Gone. Fred Thompson, the couch potato candidate, who ran to fulfill conservative nostalgia for another second rate TV actor? Gone. Sam Brownback, the Bible-Gomer without the "aw shucks" or the bass guitar, who ran for the votes of the unborn? Gone. Duncan Hunter, the man with the interchangeable names, who was running for...(I have no idea what he was running for)? Gone. Ron Paul, "Did I pay for this mic? Really?", who would gladly be gone if his supporters would stop giving him money? Not gone (as far as I can tell), but forgotten. Mike Huckabee, the Bible-Gomer with the bass guitar, who ran to prove that wisdom and experience are not important to voters in Alabama and Arkansas? Nearly gone, but still running for something (Vice President Huckleberry? A heart beat away?). Mitt Romney, the patent-leather Stepford Guy with the tattered Karl Rove playbook, who's running to prove that brains, good looks and bucket-loads of money cannot overcome shallow, shifty phoniness of the highest order? Not gone, it seems, at least not until he's spent all the money, but fading fast. Their departures (sigh) leave John McCain standing alone.
Which really, really pisses off Rush Limbaugh, Sean Hannity, Ann Coulter, James Dobson, Tony Perkins, Grover Norquist et al. And when Rush Limbaugh, Sean Hannity, Ann Coulter, James Dobson, Tony Perkins and Grover Norquist are unhappy, well, I'm ecstatic. Mmmmm, schadenfreude.
Schadenfreude - : enjoyment obtained from the troubles of others, from the German Schaden damage + Freude joy.
Let's examine the damage and the joy of McCain's success, shall we? What is it about McCain that makes Rush and Ann and Grover quiver in their knickers? I suspect it's that he does not worship at the altar of Karl Rove, nor play by the Right Wing-Nut Rules like Dubya and Cheney. Limbaugh, Hannity, Coulter, et al. rose to prominence in the 1990s as the voices of conservative indignation, providing their audiences with daily offerings of righteous (and lucrative) umbrage over William Jefferson's shenanigans, and Hillary's Hillary-ness. Limbaugh proved that there's a lot of ad money to be made sputtering about besmirched "family" values and spewing femi-nazi bile. For the battalion of the bitter, the gravy train may be about to end. McCain is no fan of Karl Rove, not after Rove's South Carolina smear campaign aimed at McCain's adopted baby daughter in the 2000 primary (see http://www.boston.com/news/globe/editorial_opinion/oped/articles/2004/03/21/the_anatomy_of_a_smear_campaign/ if you have forgotten about this one). McCain, who helped bring down Jack Abramoff and the K Street irregulars won't be sending staffers to Grover Norquist's (Abramoff's best friend for life without parole) prayer breakfasts for fat cats the way Cheney and Dubyah have for the past 7 years (you can read more about Grover here http://slate.msn.com/id/2085277/). McCain won't be providing any softball one-on-one interviews with Limbaugh the way Dubya does (Dubya even calls Rush a "journalist").
Why are all the right-wing media whores - Coulter & Hannity & Limbaugh & Dobson (yes, the Family Research Council is really a media conglomerate) and all the rest - so afraid of McCain and promising to vote for Hillary if McCain gets the nomination? I think it's because they will lose access, lose influence, and hence lose money. These folks are entertainers (hard as it is to believe that anyone would find their bilious blather entertaining), after all. Limbaugh, for example, has 20 million listeners (can you believe that?) and brings in hundreds of $$ millions in annual ad revenues to Clear Channel, his master. Coulter's book sales, Limbaugh & Hannity's ad sales, Dobson's and Perkins' Christian tchotchke revenue streams, all have swelled over the past 8 years as Rove, Cheney and Dubya paid homage to their influence. The Bush team played along, never pulling back the curtain on the wing-nut horde's Wizard of Oz facade. McCain is not a frat-boy glad-hander like Bush, McCain won't play the Rush Limbaugh back-slap game. For this reason alone (although there are others to be sure) we should all be loving John McCain. For he may deliver us from Rush...
Which really, really pisses off Rush Limbaugh, Sean Hannity, Ann Coulter, James Dobson, Tony Perkins, Grover Norquist et al. And when Rush Limbaugh, Sean Hannity, Ann Coulter, James Dobson, Tony Perkins and Grover Norquist are unhappy, well, I'm ecstatic. Mmmmm, schadenfreude.
Schadenfreude - : enjoyment obtained from the troubles of others, from the German Schaden damage + Freude joy.
Let's examine the damage and the joy of McCain's success, shall we? What is it about McCain that makes Rush and Ann and Grover quiver in their knickers? I suspect it's that he does not worship at the altar of Karl Rove, nor play by the Right Wing-Nut Rules like Dubya and Cheney. Limbaugh, Hannity, Coulter, et al. rose to prominence in the 1990s as the voices of conservative indignation, providing their audiences with daily offerings of righteous (and lucrative) umbrage over William Jefferson's shenanigans, and Hillary's Hillary-ness. Limbaugh proved that there's a lot of ad money to be made sputtering about besmirched "family" values and spewing femi-nazi bile. For the battalion of the bitter, the gravy train may be about to end. McCain is no fan of Karl Rove, not after Rove's South Carolina smear campaign aimed at McCain's adopted baby daughter in the 2000 primary (see http://www.boston.com/news/globe/editorial_opinion/oped/articles/2004/03/21/the_anatomy_of_a_smear_campaign/ if you have forgotten about this one). McCain, who helped bring down Jack Abramoff and the K Street irregulars won't be sending staffers to Grover Norquist's (Abramoff's best friend for life without parole) prayer breakfasts for fat cats the way Cheney and Dubyah have for the past 7 years (you can read more about Grover here http://slate.msn.com/id/2085277/). McCain won't be providing any softball one-on-one interviews with Limbaugh the way Dubya does (Dubya even calls Rush a "journalist").
Why are all the right-wing media whores - Coulter & Hannity & Limbaugh & Dobson (yes, the Family Research Council is really a media conglomerate) and all the rest - so afraid of McCain and promising to vote for Hillary if McCain gets the nomination? I think it's because they will lose access, lose influence, and hence lose money. These folks are entertainers (hard as it is to believe that anyone would find their bilious blather entertaining), after all. Limbaugh, for example, has 20 million listeners (can you believe that?) and brings in hundreds of $$ millions in annual ad revenues to Clear Channel, his master. Coulter's book sales, Limbaugh & Hannity's ad sales, Dobson's and Perkins' Christian tchotchke revenue streams, all have swelled over the past 8 years as Rove, Cheney and Dubya paid homage to their influence. The Bush team played along, never pulling back the curtain on the wing-nut horde's Wizard of Oz facade. McCain is not a frat-boy glad-hander like Bush, McCain won't play the Rush Limbaugh back-slap game. For this reason alone (although there are others to be sure) we should all be loving John McCain. For he may deliver us from Rush...
Saturday, February 2, 2008
Impeach the bastards?
A few of the leftiest Democrats (led by Dennis Kucinich, the Keebler Elf of Cleveland) have been screaming for the heads of Cheney and Bush. Their impeachment demands are strong, and pure – “Cheney & Bush lied about intelligence, they pushed us into a disastrous war, they violated the Constitution with their wiretaps, they violated the Geneva conventions with their torture policies. Their abuse of signing statements is unprecedented. Their misdeeds are so much worse than Clinton’s “euphemism” stains on the Oval Office carpet! Impeach the bastards!!!”
I think that my lefty friends are mostly right about the failings and follies of Cheney (who pilots the Death Star) and Bush (who rides shotgun, but can't even fold the maps properly), but completely wrong on impeachment. I think that impeachment is an iffy proposition at best, and is likely to backfire on the Democrats, giving the GOP another 4 years in the White House. Here are my reasons:
First off, imagine the process itself. Kucinich has proposed that we start by impeaching Cheney, not Bush. I understand the reasoning - how can you hold Bush responsible for anything, the man can't get two sentences out without stumbling? And, if we first impeach Bush we end up with President Cheney (you know he's not going to resign). Try saying that again "President Cheney"!?!?
To bring impeachment proceedings requires a majority vote in the House of Representatives. It's improbable in the extreme that any Republicans would support an impeachment. It's possible, but unlikely, that 218 of the 233 Democrats would vote to impeach (only 28 Democrats have voiced support for Kucinich's proposal to date, after three months of the Keebler Elf’s arm-twisting). If the House votes to impeach, and a Cheney impeachment follows the path of the Clinton impeachment, the whole process of investigations, Senate hearings and impeachment vote might take several months (Ken Starr took 8 months). The Cheney impeachment might be over sometime in the summer.
If the Senate found Cheney guilty of high crimes & misdemeanors (liberals feel a delicious thrill at the sound of those words), and removed him from office, who would be picked to replace him? The most natural selection for interim Vice President is someone who has Washington experience, is well liked by Congress and has support from both parties. That would be John McCain (who else?).
With Cheney gone and Vice President McCain in place, Congress might continue on to impeach Bush, but I suspect that everyone (Congress and voters) would be tired of the whole mess by then. Bush might resign, or (more likely given his refusal to take any responsibility for the damage he's done to date), limp through his last few months in office. McCain, the increasingly popular caretaker Vice President-select would spend the summer and fall acting presidential - soothing the nation's partisan wounds (“I’m the Uniter!”), giving a lot of upbeat press conferences (McCain is the anti-Bush with the press - smart, glib and relaxed), spending a lot of time patching things up with Congress and (voila!) campaigning for election to President as the incumbent (with lots of free TV coverage!). In other words, impeaching Cheney would make McCain an even stronger candidate for President than he is now. And Pelosi and her Democratic Merry Men would have neutralized the strongest campaign plank that they had, which is “How do you like the job Bush and Cheney have done?” (if you impeach the bastards, you can't campaign against the bastards).
The second reason not to impeach is the "blow-back" (and no, this has nothing to do with euphemisms). It’s February 2nd, 2008. According to the 1/20/2009 digital Bush Countdown Calendar my sister gave me for Christmas (you can pick up yours here - http://www.bushslastday.com) we have 353 days and 4 hours until Bush and Cheney are gone (finally...). Americans are not so happy about things at the moment. The latest polls say that Americans want Congress to focus on the war, energy, the environment, immigration, social security, health care and the economy (especially the economy). Impeachment doesn’t make any list of top 10 American concerns. If the economy continues to worsen, or gas prices climb higher, or the wars in Iraq and Afghanistan are going badly, Americans will lose patience with a Congress spending all of its attention on impeachment.
And Americans actually want Congress to work together, they are tired of all the bitter partisan bickering (unlike Rush Limbaugh or the Daily Kos, who know that partisan bickering is great for their ratings). It's safe to say that impeachment would not result in increased bipartisan warmth and camaraderie. My lefty friends (like most liberals) talk only to liberals, and listen only to liberals. The echoes of their own voices sound to them like an overwhelming national call for impeachment. Liberals (their own chops-licking schadenfreude notwithstanding) have no idea how little support there is for impeachment among moderates, independents and conservatives (scroll down to the end of this post to see the actual numbers). They also have no idea how much they sound like outraged GOP conservatives did in 1998 (maybe this quote from the way back machine will give you an idea) - “Dan Quayle took the stage today to decry the ‘national embarrassment’ of illicit sex and perjury committed by President Clinton…”. There's little difference in tone or self-righteousness between Newt Gingrich's anti-Clinton rantings and Kucinich's anti-Bush screed. (Kucinich and Gingrich - look, their names both end in “ich”!).
If Congress votes for impeachment, how would the public likely respond? Bush’s approval rating is in the 35% range, but Congress’s approval ratings are much lower (24%). I suspect that many of the 65% of Americans who today disapprove of Bush/Cheney would rally to support them if Congress moves to impeach (liberals may not believe this, but it’s hard for them to be rational about Bush/Cheney). Everyone - liberal, moderate and conservative alike - agrees that the GOP hurt themselves immensely (and helped Clinton) by impeaching him in '98. In the 1998 midterm elections Democrats gained 5 seats, not the result you'd expect if voters wanted to reward the GOP for voting to impeach Clinton the month before. The odds are that the best way to raise Bush’s opinion poll numbers (and further lower Congress’s) would be for Congress to impeach Bush.
Impeachment, as delicious as it might be for liberals, is a lousy idea. The best thing for those of us who want to see a Democrat in the White House on January 21, 2009 to do is to bite our tongues and let Cheney and Bush serve out the last few months of our national sentence. Leave the bastards in office, where they will do our liberal cause the most good.
Here are the numbers from 1998 polls showing the (lack of) support for impeaching Clinton, followed by numbers from 2007 showing similar support for impeaching Bush:
Clinton:
ABC News Poll. August 17, 1998
"If he does not resign, do you think Congress should or should not impeach Clinton and remove him from office?"
Should impeach - 25%
Should not - 69%
No opinion - 6%
Pew Research Center Poll September 19-22, 1998
"If it turns out that President Clinton lied under oath about having a sexual relationship with Monica Lewinsky, do you think that he should be impeached and removed from office, or not?"
Should be - 40%
Should not - 57%
Don't know - 4%
Bush:
LA Times Poll fall 2007 "As you may know, impeachment is the first step in the constitutional process for removing a president from office, in which possible crimes are investigated and charges are made. Do you think there is or is not justification for Congress to begin impeachment proceedings against President Bush at this time?".
There Is Justification - 36%
There Is Not Justification - 62%
Unsure - 3%
CNN Poll spring 2007 - "Based on what you have read or heard, do you believe that President Bush should be impeached and removed from office, or don't you feel that way?"
Should Be - 30%
Should Not Be - 69%
Unsure - 1%
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