Perhaps it’s a mistake to take seriously anything Bill Kristol says on a subject remotely connected with health reform, given his eagerness to reprise the partisan thug routine he played in 1993 and 1994, which pretty much created his later career. But his snarky reaction today to President Obama’s press conference last night, entitled “Obama Attacks Docs and Cops,” is hard to ignore, and will probably inspire other conservatives to equally ridiculous talking points.
Kristol expresses contemptuous credulity at Obama’s idea that doctors don’t always pursue the best diagnosis or treatment regimens, and suggests it’s all a ploy to justify “a government panel that will save money by restricting care.”
For a health care “expert,” Kristol sure isn’t paying much attention if he thinks docs today don’t have to tailor their every action to private health care plan rules, primary care “gatekeepers,” hospital managers, managed care organizations, and a host of other players. And given past GOP reliance on various strategies for “restricting care” to hold down costs (e.g., the Medicare Payment Advisory Committee, created by congressional Republicans, that Obama wants to beef up), it’s more than a bit disingenuous for Kristol to play the demagogue in defending the absolute sovereignty of physicians or suggesting they don’t make errors that risk lives and cost a lot of money.
(For a brief assessment of what Obama actually said on encouraging “good medicine,” and why it was important, see my post for the Progressive Policy Institute today).
As for Obama’s “attack on cops,” please give me a break. Obama explicitly conditioned his remarks about the Gates incident on his understanding of the facts. Anyone who isn’t sympathetic with someone who’s been arrested in his or her own house for “disturbing the peace” in the midst of a false allegation of breaking and entering said house must be one of those “elitists” that Obama’s always being accused of consorting with. No, the President shouldn’t have used the word “stupidly,” and if it turns out he’s wrong about the facts, he should say so and apologize. But I suspect Kristol’s solidarity with the Cambridge Police is about as genuine as his championship of doctors’ privileges.

As the debate over health reform becomes more and more focused on issues of “health care cost containment,” Mark Blumenthal at Pollster.com raises a crucial and much-ignored question: whose costs are we talking about here?

When Americans tell pollsters they want health care reform to focus on “costs” they usually mean their actual, out-of-pocket health care expenses: insurance premiums, deductibles, co-pays, the costs of prescription drugs and any other medical bills not covered by health insurance.

That’s not the same, of course, as what CBO or health policy wonks mean by “costs,” which is typically either the federal government’s outlays or the overall rate of inflation in the health care sector.
Blumenthal also notes that a rare poll focused on the kind of cost containment regular folks want shows some pretty amazing levels of support from Ds and Rs alike:

The survey…sponsored by the labor-business coalition known as America’s Agenda, included a test of measures to “reduce costs” that speaks directly to these kinds of out-of-pocket expenses:
Now I would like to read you a proposal that is being considered to reform health care. This proposal aims to reduce costs and improve quality of health care in the following ways: make health coverage more affordable and accessible for all Americans; eliminate co-pays and deductibles for recommended chronic disease treatment prescribed by your doctor; eliminate co- pays and deductibles for recommended preventive services and emphasize disease prevention including reducing obesity and smoking; ensure that doctors have accurate and updated information on the most effective treatments; and ensure that patients receive highly-coordinated, personalized treatment plans based on the latest medical evidence.
While the America’s Agenda poll did not test this proposal against alternatives, I would not be surprised to see Americans with health insurance react more positively to it than anything else we could dream up, especially if the alternative is framed in terms of providing “access” to those presently uninsured (in other words, to somebody else).

All these elements–particularly an emphasis on prevention, chronic disease management, electronic medical records, and research on effective treatments–have been part of what Barack Obama has meant by “cost containment” in the past, even if they haven’t much appeared in congressional plans. Looks like it would be a very good time for Obama to shift attention back to these highly popular forms of cost containment right now.

This item is cross-posted from The New Republic.
Only six months into the Obama presidency, the new administration has already experienced an unusually robust assortment of criticism from fellow Democrats, at least at the elite opinion-leading and activist level. The extended progressive “honeymoon” that John Judis warned against back in February has largely faded.
Obama has been faulted in large swaths of the blogosphere and op-ed pages for a wide array of missteps, if not downright heresies. Here are just a few:
*Undertaking expensive and questionably effective “bailouts” of the financial sector instead of simply regulating and/or nationalizing it.
*Using vast political capital to promote a fiscal stimulus package that was too small to work, and allowing Senate “centrists” to water it down even further.
*Refusing to reverse major elements of the Bush program for surveillance, detention, and interrogation of terrorism suspects, and obstructing efforts to hold Bush officials accountable for violations of civil liberties.
*Moving too slowly to end American military involvement in Iraq, and moving too fast to make new commitments for military action in Afghanistan.
*Deferring to “centrists” and even Republicans in Congress on crucial climate change and health reform legislation at the palpable risk of destroying the progressive nature of these initiatives.
*Failing to honor commitments for immediate action to promote GLBT equality, particularly with respect to the military.
Aside from these specific issues, there’s been a pervasive feeling in many progressive circles that Obama is too cautious, too “pragmatic,” too subservient to Democratic “centrists,” too worried about bipartisanship, too interested in outreach to people who will never support him, and too unwilling to utilize the bully pulpit to articulate and defend progressive principles.
But lefty unhappiness with Obama has another, and very poignant, dimension: a recognition that, despite helping to elect one of the most liberal presidents in recent memory, self-conscious progressives have less leverage with the administration than their “centrist” Democratic counterparts, and maybe no more than Republicans (or at least those few Republicans in the Senate willing to even consider cooperation with Obama’s agenda).
The reason is that efforts to create a “loyal opposition” to Obama from the left tend to be more “loyal” than “oppositional.” In a characteristically acerbic column about the Campaign for America’s Future annual meeting last month, the Washington Post’s Dana Milbank made these observations about the gap between progressive criticism of Obama and the willingness to take him on in meaningful (i.e., threatening) ways:

[S]peakers at the closing session exhorted the liberals to take back America–from Obama. “The president of the most powerful country in the world is doing all right, but there are a lot of people in this country who are not doing all right,” writer Naomi Klein told the crowd. “Obama is making us stupid,” she added. “Love can make you stupid.”
… But many in the audience had warmer feelings toward the Obama administration. A straw poll taken by pollster Stan Greenberg found that 90 percent of those in attendance approve of the job the president is doing, and that they have no consensus about whether to help Obama or fight him.

More interesting than Milbank’s mockery was the fact that influential progressive blogger Jane Hamsher agreed with it, saying that leading progressive groups are “little more than arms of the White House now playing a zero sum game with Republicans who really don’t matter.”
The same dynamic is evident with grassroots elements of the “Democratic base.” Even as Obama’s job approval rating has bounced around, with Republicans hardening their opposition and (according to a few polls) independents becoming skeptical, self-identified Democrats have remained solidly in his corner. And then there’s this stunning detail: According to Gallup’s weekly tracking poll, Obama’s job approval rating among self-identified “liberal Democrats” has risen from 90 percent on the week of his inauguration to 96 percent in the latest (the week ending July 12) survey. So while progressive criticism of Obama is hitting a fever pitch, it doesn’t seem to have affected their love affair with him.
The frustration of the progressive left was perfectly expressed last week by Chris Bowers, co-founder of OpenLeft, a web site specifically created to push the progressive blogosphere from a purely partisan to a more explicitly ideological posture. The post is a pretty remarkable admission of futility, arguing that progressives can’t credibly threaten to derail Obama’s agenda, since an Obama failure will be seen as their failure as well:

Whether or not the Democratic trifecta actually passes progressive legislation, the legislation that is passed and the policies that are followed will still be perceived as progressive. We simply can’t avoid that.
For example, right now the stimulus package pretty much equals left-wing economic philosophy in the eyes of the American people. If it doesn’t produce results, we are all going to see our ideas become discredited in the eyes of the American public, even if we thought policies of the Democratic trifecta did not go nearly far enough. The country is never going to say “well, that idea didn’t work, so let’s try a more extreme version of it.” People just don’t think that way in America.
Many conservatives felt the same way under the Republican trifecta, and are now roundly mocked for arguing that conservatism can’t fail, but people can fail conservatism. I imagine that if the economy doesn’t turn around, many progressives will sound quite similar in their critiques of the Obama administration. Problem is, we will sound just as silly as they will. Whether we like it or not, progressivism is on the hook for the success or failure of the policies passed under the Obama administration and the Democratic trifecta.

With this realization comes the equally frustrated feeling that Blue Dogs and other Democratic “centrists” have superior leverage over the administration and the Democratic congressional leadership, precisely because they (or at least those in their ranks from districts and states either carried by John McCain or narrowly carried by Obama) don’t view their political viability as inseparable from the president and the party. Thus they can make credible threats to take a dive on key elements of the Democratic agenda if their demands are not met.
Some liberal groups have been tentatively moving towards a more aggressive posture, most notably in the context of a campaign to push back against “centrist” Democratic and Republican demands for abandonment or significant modification of a strong “public option” in a competitive universal health care system. After being targeted by MoveOn for her opposition to the public option, Senator Kay Hagan came around promptly. And progressives are reasonably optimistic about similar efforts aimed at Dianne Feinstein, Mary Landrieu and Blanche Lincoln. Moreover, broader threats from Democratic senators to defect from support for the administration were credited by some with causing Harry Reid’s recent instruction to Max Baucus to stop screwing around with the public option in health care reform in order to pursue Republican support.
Still, it’s not clear how far any progressive Democrats will go in bucking the White House. Despite significant pressure to vote against the final House version of the Waxman-Markey climate change legislation, which had been significantly modified to gain the votes of rural (and often Blue Dog) members, a revolt from the left on the floor fizzled out (with Al Gore reportedly whipping the Progressive Caucus). A similar revolt on the vote to appropriate funds for Iraq and Afghanistan also failed to strike paydirt.
The left’s leverage with the White House and the congressional Democratic leadership is thus limited both by loyalty and by the possibility of being held accountable for the failure of Obama’s agenda. This “loyal opposition” to Obama is being forced to watch more-or-less helplessly as the game of chicken between Obama and the “centrists” plays out.
The abiding reality for all Democrats is that the power of the President of the United States to define his own party in this day and age may well be nearly limitless. This doesn’t mean intra-party criticism ought to end. But it does mean that this president’s success will largely define the success of the Democratic Party for years to come.

One of the odder political phenomena of 2009 has been the strength of the neo-Hooverite argument that the most appropriate response to the deepest recession since the 1930s is radical retrenchment of public spending policies to mitigate (or, at the state and local level, avoid) deficits. Most Republicans and some Democrats have embraced the rhetoric of hard-core fiscal hawkery, with particularly tough words for those state and local governments who have suddenly, through no particular fault of their own, watched revenues drop through the floor.
Well, the fiscal hawks ought to be enjoying the latest news from California, where Republican manipulation of a two-thirds-vote requirement for enactment of a state budget has led to a no-tax-increase deal to close an astounding $26 billion state shortfall.
The deal does have a revenue component that manages to take money out of California’s economy without actually increasing the state’s revenue base: it will increase and speed up tax withholding, and exploit an arcane provision related to Prop 13 that enables the state to borrow (to the tune of $1.9 billion) property tax dollars from local governments, who will in turn, of course, be forced to cut their own spending.
The spending side of the deal includes $1.2 billion in unspecified cuts to prison expenditures–virtually guaranteed to force early release of prisoners, a practice that earlier led to public demands, in California and elsewhere, for mandatory sentencing rules and restrictions on parole and probation.
But the crown jewel of the spending cuts in the California budget deal is the continuation and extension of furloughs for public employees that amount to a 14% pay cut. This isn’t exactly great news for California businesses that will feel the impact of reduced consumer spending by state employees.
Given the Golden State’s size, there’s no question the budget deal (if, indeed, it secures legislative approval) will represent a significant blow to national economic recovery. But it will undoubtedly please those for whom public spending is the villain, and “sacrifice” in every area other than taxes is the panacea.

Reader warning: I’m about to talk about a Rasmussen poll, and not only that, but a Rasmussen poll that shows Barack Obama and Mitt Romney running dead even among likely voters in a hypothetical 2012 matchup, with Obama running just six points ahead of Sarah Palin.
But here’s what’s interesting, even if, and particularly if, the sample for the poll skews Republican: it shows a robust 21% of likely voters supporting a third-party run for Palin if she is denied the GOP nomination.
You might object that lots of those supporters of a Palin third-party bid might be Democrats who love the idea of splitting the GOP vote to help Obama, right?
But a separate question about a three-way race with Romney as the GOP nominee and Palin running indie shows her pulling 16%, and giving Obama an eleven-pont lead.
I’ve always said that the hard-core supporters of St. Joan of the Tundra have a connection with her that won’t go away easily. That could be a problem for the Republican Party under various scenarios.

It’s becoming increasingly obvious that not only wholesale Republican opposition, but Democratic divisions, are risking the enactment of health reform legislation this year. Some of those divisions are rooted in relatively narrow objections this or that bill–e.g., jurisdictional squabbles between committees or between House and Senate approaches–or this or that provision–e.g., union opposition to taxation of high-end employer-sponsored health benefits. But the bigger division which falls roughly along ideological lines involves “moderate” Democrats (sometimes, as in last week’s Senate “gang of six,” working with like-minded Republicans) who seem to prefer delaying action on health reform to enactment of anything that vastly increases federal budget deficits, fails to reduce health care inflation, or exposes Democrats to conservative attacks on “big government.”
It’s fair to say that the prevalent attitude among other Democrats towards these “moderates” is one of anger and betrayal, on the theory that only political cowardice or total submission to the health care industry could possibly explain their point of view. And one talking point heard often in denunciations of Democratic foot-draggers on health care is that as “everyone knows,” the failure to enact health reform in Bill Clinton’s first two years caused the Democratic midterm debacle of 1994. Steve Benen, for example, stipulates this assumption about 1994 and quickly goes on to suggest that maybe “centrist” Democrats don’t really give a damn if their party loses seats or even control of Congress in 2010. This attribution of evil motives is also more-or-less incorporated by reference in an otherwise fine post today by TNR’s Jon Cohn on the Democratic politics of health reform.
As someone with still-vivid memories of 1994 and of the raging and inconclusive debate that ensued about the origins of that electoral debacle, I have to say that no, it’s not at all self-evident that the failure of a Democratic-controlled Congress to enact universal health coverage was the primary cause. For one thing, there was a lot going on in November of 1994–a vast number of Democratic retirements, the final stage of the ideological realignment of the South (exacerbated by racial gerrymandering in the House), and residual resentment of a Democratic majority in the House that had been in place since 1954. But even if you believe health care was the single largest factor in the 1994 results, it’s not entirely clear that the failure to enact health reform, as opposed to the unpopularity of the reforms being proposed (not to mention the timing of the health care debate, which in 1994 was on the very brink of the midterm elections), was the predominant factor.
And even if health care was the predominent factor, it’s not at all clear that the defeat of the Clinton health plan, as opposed to the composition and presentation (at least as perceived by the public) of the Clinton health plan, was the vote-killer. Yes, there has always been a point of view in the debate over 1994 that “disappointment” over the Clinton administration’s strikeout on health care, compounded by other White House strategic decisions (most notably the promotion of NAFTA and GATT and the prioritization of deficit reduction at the expense of “investments” in the budget), “discouraged” the Democratic “base” and led to conservative-skewed turnout patterns in 1994, and depressed Democratic performance among those who did turn out. But it’s just a point of view, not incontrovertible fact. A Kaiser Family Foundation election-night survey in 1994 that focused on health care reached a different conclusion:

The survey shows that the voters’ vision of health care reform has shifted toward that held by many moderate Republicans and Democrats. Thirty-one percent of those surveyed said they were less supportive of major health reform than six months ago, with half of those citing as their reason that they did not think the government would do it right. More voters now want Congress to make modest changes in the health care system (41%), rather than enacting a major reform bill (25%). In addition, one in four voters favor leaving the system as it is. [Tables 4 and 5] “These results say that voters want the new Congress to place health care high on their legislative agenda,” said Dr. Robert Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University. “But what the public means by health reform now comes closest to a more moderate vision: one which is more limited in scope, incremental, and that involves a much more limited role for government.”

My point here is not to argue that this or that theory about 1994 is the gospel truth (though I personally think there are elements of truth in the “discouragement” and the “rejection of big government” theories, along with non-issue explanations). It’s that I wouldn’t buy the idea that go-slow Democrats today know their position on health care will produce an electoral disaster, and just don’t care. For every good, loyal Democrat who has internalized the “discouragement” narrative about 1994, there’s another good, loyal Democrat who “remembers” 1994 as a tale of an “over-reaching” White House and an arrogant congressional Democratic leadership who relied on a secretive process to produce a highly complex health plan that was then marketed as a giant new government entitlement, repelling swing voters.
In the end, motives for the current behavior of Democrats on health care only matter so far. As it happens, I favor the argument that Senate Democrats ought to be pushed (with real consequences) to support a cloture vote on health care–and on climate change–no matter how they feel about the underlying legislation, which would make it a lot easier to get something done.
But the intraparty debate will become an unfortunate dialogue-of-the-deaf if the contending factions base their political assumptions about the consequences of various courses of action on health reform are based on different interpretations of an election held fifteen years ago.

A few weeks ago I wrote about the strange involvement of the highly secretive evangelical “leadership” group “The Family” in the adultery sagas of both John Ensign (who lived at The Family’s C Street townhouse on Capitol Hill and negotiated with the wife of his mistress there) and Mark Sanford (who apparently was counseled on his marital and extra-marital issues at the same place).
Today’s news brings the revelation of another adultery scandal involving a Republican pol who was very close to The Family: former U.S. Rep. Chip Pickering, once a big-time rising star on the Right, whose estranged wife is suing his alleged mistress for “alienation of affection.” Her complaint in court claims that the affair was in full bloom while Pickering was living at “the well-known C Street Complex.”
I don’t know what’s more notable here: the high prevalence of marital infidelity among the hard-core adherents of this quasi-theocratic group, or the fact that the publicity must be driving its leaders completely crazy. In any event, the “C Street Complex” is beginning to appear as something of a house of questionable repute.