For some reason the MSM doesn’t do such a hot job of telling you what you really want to know about how the votes on the public option in health care reform are lining up in the Senate Finance Committee. For that you turn to Open Left‘s Chris Bowers, who usually has the most sober assessment. Here’s Bowers on a key vote, which may happen today:

All 10 Republicans on the Finance Committee, including Olympia Snowe, are expected to vote against both public option amendments. Eight Democrats are highly likely to be yes votes: Bingaman (NM), Cantwell (WA), Kerry (MA), Menendez (NJ), Schumer (NY), Stabenow (MI), Rockefeller (WV), and Wyden (OR). It took a lot of organizing to even get that far, given the reluctance of Bingaman, Cantwell, Kerry and Wyden at times.
The other five members of the committee are difficult to predict, given that they have been all over the map on the public option this year. To pass a public option through the committee, four of the following five will need to vote in favor:
1. Baucus (MT). Should be a yes given his stated and past support for the public option. However, he could be a no to defend the draft of the bill he released, and out of a continuing belief that the public option can’t pass the Senate.
2. Carper (DE): Has said that he opposes a non-trigger public option. I expect him to vote that way, even though he is from a pretty blue state.
3. Conrad (ND): Has assiduously avoided taking a position on the public option, instead stating over and over again that there are not 60 votes for it. Well, now we finally will learn if Conrad was just talking about himself all along. As chairman of the Budget committee that will merge the Senate Finance and HELP bills, how Conrad votes will be huge. I am suspicious Conrad might vote “yes” to save face and seem like a good-faith negotiator on the co-op.
4. Lincoln (AR): Blanche Lincoln appears to have recently flipped from supporting the public option to opposing it. She really has been all over the map during this entire debate. I think about the best we can hope for is that she votes yes on the public option in committee, and yes on the cloture vote, but then no on the floor vote.
5. Nelson (FL): Perhaps more silent on the public option than any member of the Senate. He has, however, called public option supporters idiots, and said that he believes a public option can’t pass. I am not confident on this vote.

Bowers sees a 3-2 toss-up among these five as the most likely outcome, so today is a really big deal for public option advocates. On MSNBC last night, Senator Shumer said that the Senate Finance Committee may be the crucial hurdle of the legislative battle to enact health care reform with a public option, because centrist Dems are stronger in this committee than on other committees or on a floor vote.
Here’s where an organized, disciplined network of progressive citizen lobbyists could really help. Press a button and activate progressives and other public option supporters to deluge the key Senators in MT, DE, ND, AR and FL with phone calls, faxes, emails and personal visits to district offices, urging them to step up and vote for the public option. There should also be a role for out-of-state progressives who want to get involved, such as a phone bank to mobilize supporters in the targeted states. Unions, MoveOn and other organizations do this on a smaller scale from time to time. But there ought to be a larger-scale effort, perhaps a coalition, funded appropriately.
To give the MSM it’s due, the WSJ has a handy chart depicting the differences between the health care reform proposals of: Sen. Baucus; the Senate HELP Committee; the House Democratic Bill; the House Republican Outline; and President Obama. Also recommended is Ezra Klein’s informative WaPo interview with Sen. Kent Conrad

Patrick Goldstein’s L.A. Times post “Is Ken Burns a Secret Propagandist for Socialism?” presages what will probably be an outrage du jour for the Beck-Limbaugh-Hannity-etc. neo-McCarthyites. Goldstein believes the loony right will seize on the new Burns documentary series, “The National Parks: America’s Best Idea” as the new exhibit ‘A; revealing the cultural left’s effort to sneak socialist values into American life. As Goldstein explains, refering to James Poniewozik’s Time magazine column on the topic:

The series is actually an ingenious refutation of the popular conservative belief that big government is evil, outmoded and unnecessarily involved in ruling our lives.
Noting that the original impetus for establishing national parks came from naturalists like John Muir who were horrified to see how Niagara Falls was nearly destroyed by the greed and hucksterism of free market- loving charlatans, Poniewozik writes: “With America frothing over the role of government — Should it save banks? Should it expand health coverage? — ‘The National Parks’ makes a simple case for an idea that is wildly controversial in the year of the tea party: That we need government to do things the private sector can’t or won’t.”
In other words, the entire origin of the national park system, whose most passionate backer was a Republican, Teddy Roosevelt, is based on a firm belief in — Glenn Beck, cover your ears, please — government intervention to regulate an out-of-control free-enterprise system. In fact, one of the more dramatic moments in Burns’ documentary involves the battle to create a park in the Great Smoky Mountains, while logging companies bankrolled anti-park ads and were “frantically cutting the old-growth forests to extract everything they could before the land was closed to them.”

Goldstein and Poniewozik make a good point. Burns’s documentary is right on time, because it serves up a potent, inarguable reminder that big business often does have rapacious and exploitative tendencies, which in this case would leave our wilderness areas denuded of hardwoods and clean rivers. It’s not such a huge leap from there to acknowledging that health care for profit often has a similar tendency, and maybe government could help contain it. Goldstein also posts a little preview clip of the series, and some interesting pro and con comments follow his post.

TDS contributor Alan I. Abramowitz has a new post up at Larry J. Sabato’s Crystal Ball which should dampen the spirits of GOP progosticators. Abramowitz spells out the reasons why Republican hopes for winning back control of congress next year are unmerited. Says Abramowitz:

…There are important differences between the makeup of the American electorate now and the makeup of the American electorate then, differences that make a repeat of the 1994 outcome highly unlikely…
The most important difference is that nonwhites make up about twice as large a share of the electorate now…First, whites generally make up a larger share of the electorate in midterm elections than in presidential elections–the presence of a presidential race appears to be a more important motivation for voting among African-Americans, Hispanics, and other nonwhites than among whites. This means that the nonwhite share of the electorate in 2010 is likely to be lower than the all-time record of 26 percent that was set in 2008. Second, however, the data show a clear upward trend in the nonwhite share of the electorate in both types of elections. This means that the nonwhite share of the electorate is almost certain to be higher in 2010 than it was in 2006.

More specifically, Abramowitz adds,

The weakness of the Republican Party among nonwhite voters is a much bigger problem for the GOP today than it was back in 1994. In that year, 86 percent of the voters were white while only 9 percent were African-American and only 5 percent were Hispanic or members of other racial minority groups…Based on the average rate of change in the racial composition of the electorate over the past two decades, by 2010 we can predict that no more than 76 percent of voters will be white while at least 11 percent will be African-American and at least 13 percent will be either Hispanic or members of other racial minority groups.

Moreover,

Based on the 2008 results and the projected racial make-up of the 2010 electorate, Republican candidates would have to win almost 60 percent of the white vote in order to win 50 percent of the overall national popular vote in 2010. That would be even more than the 58 percent of the white vote that Republican candidates received in 1994 and much more than the 54 percent of the white vote that Republican candidates received in the 2008 House elections.

Given recent polling and demographic trends, Abramowitz believes Dems could lose up tp 20 house seats in 2010 and perhaps 1 or 2 Senate seats, a far cry from any 1994 replay. And if the Democrats pass an impressive health care reform bill, all bets are off.

This item is cross-posted from The New Republic.
Naturally, the attention of health care reform observers (and who isn’t one these days?) is focused on the action in the Senate Finance Committee right now. But an equally important drama is playing out in the House Democratic Caucus.
As Ryan Grim explains at HuffPo today, the Caucus is due to meet tomorrow to assess the views of Members before the House formally acts on the “tri-committee” proposal that’s been cleared for the floor. And the big issue is the relative strength of those within the Congressional Progressive Caucus who have vowed to oppose any bill at any stage of the process that doesn’t include a “robust public option,” and those in the Blue Dog Coalition who don’t much like the public option. Both groups are whipping their members, reports Grim:

The fate of the public option in the House will be largely determined by the parallel whip efforts — and how aggressive each bloc is in pushing for its priorities. In other words, it comes down to which pack wants it more, the Blue Dogs or the progressives.

This isn’t, it’s important to understand, primarily about votes on the initial House legislation, particularly when it comes to the Progressive Caucus members. It’s about what happens after the Senate finally enacts its own version of health reform. If Progressive Caucus members continue to stand behind the pledge that 60 of them have made to torpedo any conference committee report that junks a strong (or possibly, any) public option, that will have an effect not just on House conferees, but on the Senate Democratic strategy (i.e., whether to pursue the risky budget reconciliation approach to produce a more “liberal” bill). At the same time, it’s clear that some Blue Dogs will vote for a House bill they don’t like in anticipation that the conference commitee report will produce a weaker version of the public option, or some different mechanism like co-ops or a public option “trigger.” If that’s no longer a lively prospect, more of them could be lost on the initial vote.
With House Republicans almost certain to oppose any legislation en masse, it’s all about what 218 House Democrats can be mustered to support now and later. So even among senators, what happens in the House tomorrow will be fateful.

Most accounts of what’s going on in the Senate Finance Committee on health care reform view the various amendments being offered as a buffet of Republican efforts to derail the legislation, and Democratic efforts to make the Baucus bill more like the versions already approved by the House committees and the Senate HELP Committee. And that’s generally the case.
But as TDS Co-Editor William Galston points out at The New Republic, there’s one big exception: Sen. Ron Wyden’s “Free Choice” amendment.
Under the previously approved reform blueprints, and in the Baucus bill, participation in the new “exchanges” that would establish a competitive system of health insurance plans offering federally-established minimum benefits is very limited: basically, they are for the uninsured who do not qualify for public programs, the self-employed, and small businesses. People already covered by employer-sponsored plans are barred from participating. That approach is designed to reassure those who fear the new system will discomfit people happy with their current insurance (other than, perhaps, rising premiums), and to avoid abandonment of employer-based insurance by younger and healthier folk who make coverage affordable for older and sicker employees.
But as Galston argues, the same logic greatly limits the ability of reform to hold down future costs, or for that matter, to satisfy consumer. Wyden’s amendment would require employers who do not offer a choice of affordable plans to offer employees vouchers that could be used on the exchange, and even converted to cash if low-cost alternatives were chosen. And that would have a powerful effect:

Wyden’s plan would offer more choice for both workers and employers, and it would encourage cost containment by encouraging consumers to select lower-cost options. CBO scores the plan as roughly deficit-neutral; the Lewin Group believes that it would actually lower the deficit by reducing the amount of revenue the federal government foregoes because of the tax exclusion for employer-provided health benefits.

So Wyden offers another way to reduce the revenues lost to the vast tax subsidy for employer-sponsored health coverage, while expanding individual choice. But at a time when Democrats are largely committed to a different approach, and Republicans are largely committed to the goal of killing reform altogether, it’s hard to see where Wyden will get any votes.
Perhaps a reformed system could move towards the Wyden approach in the near future, once the exchanges are set up and fears about costs gradually overcome fears about the disruptive effect of changing the employer-based system. But as Galston notes, the issues raised by Wyden can not be avoided perpetually.

Talk to a conservative about health care reform, and nine times out of ten he or she will quickly get around to a rap on medical malpractice insurance, tort reform, and the evil, evil trial lawyers that are responsible for high health care costs and that have bought political protection from the Democratic Party. Having heard this a million times, most progressives simply close their ears when the very subject comes up.
Via Ezra Klein, there’s a very good fact-based summary piece on this subject from David Leonhardt of the New York Times.
Here’s an excerpt:

The direct costs of malpractice lawsuits — jury awards, settlements and the like — are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn’t mean the malpractice system is working.
The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate. If a new policy could eliminate close to that much waste without causing other problems, it would be a no-brainer.
At the same time, though, the current system appears to treat actual malpractice too lightly. Trials may get a lot of attention, but they are the exception. Far more common are errors that never lead to any action.
After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim.

The usual GOP method for dealing with this issue is, of course, simply capping damage awards for malpractice suits, which might somewhat reduce “defensive medicine,” but at a hard-to-estimate cost in even greater medical errors. The other issue, of course, is that other elements of the health care system encourage unnecessary tests and procedures as much as fear of lawsuits. As Leonhardt notes:

The problem is that just about every incentive in our medical system is to do more. Most patients have no idea how much their care costs. Doctors are generally paid more when they do more. And, indeed, extra tests and procedures can help protect them from lawsuits.
So the most promising fixes are the ones that don’t treat the malpractice system as an isolated issue.
Imagine if the government paid for more research into which treatments really do make people healthier — a step many doctors don’t like. Such evidence-based medicine could then get the benefit of the doubt in court. The research would also make it easier to set up “health courts,” with expedited case schedules and expert judges, which many doctors advocate.

In other words, medical malpractice reform is not a substitute for health care reform, and in fact, the best way to deal with “defensive medicine” may be through health care reform.
That’s a better answer than the usual Kabuki Theater back and forth on this issue.

You often hear conservatives say that if alternative energy sources were feasible, they’d be cheaper. And many conservatives favor an approach of subsidizing every energy source through tax breaks, as opposed to making a conscious choice to limit or at least boost the price of the fossil fuels that contribute so much to climate change while perpetuating our dependence on unstable global oil markets.
That’s why it’s important to understand that producers of fossil fuels current benefit from a large variety of federal subsidies that are much more extensive than anything offered on behalf of clean and/or renewable energy sources. Via Grist’s David Roberts, there’s a new study by the Environmental Law Institute and the Woodrow Wilson International Center for Scholars that puts a price tag on U.S. subsidies for various energy sources during the years 2002-2008.
It’s a pretty bad picture. Over this period, fossil fuels received $79 billion in federal subsidies, while renewable fuels received $29 billion. And among the renewables, over half the subsidies actually went to just one politically connected source, corn ethanol, which is controversial because of its impact on agriculture, and because its production typically requires extensive use of fossil fuels.
As Roberts notes, the figures for fossil fuels subsidies are conservative:

It did not include any number of things that could be considered indirect or implicit subsidies. It didn’t include military spending to defend oil in the Middle East, spending on the electricity grid, or transportation spending. Those things don’t go exclusively to fossil fuels, but if there was a way of including the share that goes to fossil fuels, the fossil subsidy number would go way, way up. Infrastructure spending has more or less exclusively supported fossil fuels for decades now.

Just yesterday, President Obama told the United Nations that subsidies for fossil fuels around the world need to come to an end. That’s certainly a goal that needs to be embraced by the United States.

Mike Lux is a very pragmatic and unity-minded member of the self-conscious progressive wing of the Democratic Party. So it certainly got my attention when he published a post at OpenLeft today threatening that adoption by Senate Democrats of Sen. Olympia Snowe’s “public option trigger” would create a “Democratic Civil War.”
Mike’s primary substantive argument is that Snowe’s “trigger” involves a Catch-22 mechanism whereby the “affordability” of private health insurance that would avoid a public option in any given state is judged according to prices that include federal subsidies defined as making coverage “affordable.” Thus, he reasons, there will be no public option anywhere private insurance is offered. I doubt that’s right, but not having seen any actual legislative language for the Snowe “trigger,” I can’t say with certainty it’s wrong, either. This may be a case where perception matters as much as reality, particularly if progressives suspect they are being sold a pig in a poke.
The general “insider” view on the end-game for health care reform has been that in the end, public option advocates would unhappily accept a “trigger” as far preferable to the co-op structure embedded in the Baucus bill. Indeed, the main appeal of the “trigger” idea, as Ezra Klein has explained, is that it accomodates the wildly different empirical assumptions that supporters and opponents of a public option hold about what would happen to the price and availability of private health insurance in a competitive system. If progressives are right that effective competition would not occur–one of the main arguments for a public option in the first place–then a public option would arise, at least in theory.
Now Mike is saying that’s all a sham, and you’d have to expect that many public option opponents would say the same thing from the opposite perspective, arguing that the “trigger” will always be pulled. As Ezra Klein also noted in his piece on the “trigger,” there’s not much of a constituency for compromise on this issue. And that’s why offers of a legislative “fix” for the flaw that Mike is focusing on won’t be very warmly welcomed.
But here’s the realiity: As a practical matter, if Senate Democratic leaders reject both co-ops and a “triggered” public option, then they probably have to move health care reform legislation via the budget reconciliation route. It’s not just a matter of giving up the pursuit of Olympia Snowe (and perhaps the one or two Republicans she might be able to bring with her); enough “centrist” Democrats have heartburn over a “robust” public option, over a purely partisan bill, or over what will eventually emerge from a conference committee, to all but guarantee that Democrats will fall short of the 60 votes necessary to kill a filibuster, even now that Massachussets is supplying Democrats with a 60th senator.
As I noted earlier this week, there are legitimate concerns about how the use of reconciliation would play out. Maybe that really is the way to go, and maybe it will produce a 50-plus-one vote margin for a bill that not only has a strong public option, but that’s pretty close to what the House is likely to pass, which simplifies this whole process considerably.
But in cases like this, a Plan B would be advisable, and public option supporters might want to give some serious thought as to whether there is a version of the “trigger”–in which “affordability” is better defined, and a larger scale for competion is provided than the state-by-state approach Snowe is promoting–that might be acceptable if push comes to shove. This really isn’t a great time for a “Democratic civil war.”

DemFromCT has an informative Kos post on support for the President and health care reform, among other issues. He quotes from Jonathan Weisman’s Wall St. Journal report on On the latest WSJ/NBC News poll conducted 9/17-20 by Hart/McInturff:

…The president has shored up eroding support for his top domestic priority, with the survey showing he has arrested the slide in support for his health-care plan following this month’s speech to Congress.

On the same poll, from MSNBC’s First Read:

According to the poll, the president’s health-care numbers have slightly increased, although that increase remains within the margin of error. Thirty-nine percent believe Obama’s health-care plan is a good idea, which is up three points since August. Forty-one percent say it’s a bad idea.
In addition, 45% approve of Obama’s handling of health care, while 46% disapprove, which is up from his 41%-47% score last month. By comparison, just 21% approve of the Republican Party’s handling of the issue…And who will get blamed if health care doesn’t get passed this year? Per the poll, 10% say Obama, 16% say congressional Democrats, and 37% say congressional Republicans.

From the poll’s PDF:

Do you think it would be better to pass Barack Obama’s health care plan and make its changes to the health care system or to not pass this plan and keep the current health care system?
Better to pass this plan, make these changes 45
Better to not pass this plan, keep current system 39

The poll indicates 73 percent of respondents agree that it is “extremely important” or “quite important” to give people a choice of a public plan administered by the federal government and a private plan for health insurance.” When asked however, “Would you favor or oppose creating a health care plan adminsitered by the federal government that would compete directly with private health insurance companies?”, 46 percent favored the idea, with 48 percent opposed. DemFromCt notes that only 15 percent of respondents said they understood the legislative proposals being debated in congress “very well,” and he adds:

What they do understand is that they want something that requires that health insurance companies cover people with pre-existing medical conditions (63% say “absolutely must be included”, another 26% “would prefer” it be included), but people don’t want mandates to buy insurance (23% don’t want that included, and another 34% say it absolutely must not be in there).
…We’ve reached a stabilization of opposition and support of Obama’s health care policies for now, along with job approval. Obama continues with strong personal approval numbers.
The fate of the Congress rests with health reform and until that’s settled, the public is likely to take a dim view of Congress, especially on the R side. But that won’t stop voters from taking it out on Democrats… the generic D vs R congressional number in this poll is only +3 for Dems. If I were them, I’d take this as a strong signal to produce something on health reform. Failure is not an option.

As the Senate Finance Committee takes health care reform amendments and proposals, this poll indicates that there is a fair amount of ambivalence in public attitudes toward some of the particulars of health care reform, but not about the need for reform — and who is expected to lead the way forward.

In recent months not only Democrats but many other Americans as well have become increasingly dismayed by the growing irrationality and even downright delusional thinking that appears to be taking hold among many conservatives and Republicans.
The most recent evidence of this trend was a September poll of New Jersey voters that not only showed 33% of self-described conservatives accepting the notion that Obama was not born in the United States but 18% also agreeing with the statement that he is “the Anti-Christ.” The appearance of this view in a northern industrial state like New Jersey indicates that these kinds of beliefs can no longer be dismissed as geographic peculiarities of rural areas or the South rather than as a significant component of modern American conservatism.
Despite the concern, however, there has actually been little serious discussion of how opinion polls might be used to track the growth of genuinely delusional thinking in American politics. It is true that ever since many commentators began using the number of people who accept the “Birther” narrative – that Obama was not actually born in the U.S. – as a shorthand measure of conservative and Republican irrationality there have been similar attempts to demonstrate that an equal number of Democrats believe false “Truther” narratives about the 9/11 attacks. As we will see, however, these discussions have all been based on survey questions that do not accurately distinguish between genuinely delusional beliefs and non-delusional ones and, in the specific case of the “Truther” narratives, also ignore key polling data that does not support the “one extreme equals the other” point of view. As a result, these discussions are useful primarily as ammunition for partisan political debates and not as a basis for serious social analysis.
In contrast, in order to use public opinion polling to seriously attempt to track the growth of delusional thinking in American politics we need to first consider two questions.

1. Can peoples’ responses to survey questions be used to detect psychologically disordered thinking?
2. Can survey questions reliably distinguish between views that are so irrational as to be genuinely “delusional” in a clinical sense and those that are merely extreme or implausible?

The answer to the first question is actually not difficult to determine. In psychology there are a number of “self-report” questionnaires that use people’s response to written questions to gauge characteristics like paranoia, hypochondria and other psychological disorders. The Minnesota Multiphasic Personality Inventory (MMPI), for example, is widely used and – although far, far from perfect – has been found to be sufficiently predictive for use in a variety of screening and assessment settings.
The key to answering the second question, on the other hand, is to carefully focus attention on beliefs that are genuinely “delusional” — a term which is defined as “a rigid system of beliefs with which a person is preoccupied and to which the person firmly holds, despite the logical absurdity of the beliefs and a lack of supporting evidence”
The current version of the DSM-IV — the Diagnostic and Statistical Manual of Mental Disorders defines a Delusional Disorder as follows:

“A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.”

In diagnosing a delusional disorder there are three generally used criteria:

•certainty (held with absolute conviction)
•incorrigibility (not changeable by compelling counterargument or proof to the contrary)
•impossibility or falsity of content (implausible, bizarre or patently untrue)

Obviously there is often not 100% agreement among clinicians in diagnosing a particular delusional disorder, but there is generally a commanding consensus.
With this framework in mind, let’s examine both the “Birther” and the “Truther” narratives:

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