Republicans don’t much like to talk out loud about their party’s problems (unless they are talking about the increasingly rare species of “moderates”), so it was noteworthy when Ohio Sen. George Voinovich had this to say at an editorial board meeting of the Columbus Dispatch:

The GOP’s biggest problem? “We got too many Jim DeMints (R-S.C.) and Tom Coburns (R-Ok.). It’s the southerners. They get on TV and go ‘errrr, errrrr.’ People hear them and say, ‘These people, they’re southerners. The party’s being taken over by southerners. What [the] hell they got to do with Ohio?

I wish there was video or audio of the statement, to discover if “errrr, errrr” represents Voinovich’s impression of a southern accent, or was instead indicating that DeMint and Coburn have a tendency to growl like beasts, which might well be true.
What annoys me about Voinovich’s moment of candor isn’t so much the anti-southern animus it suggests, but the idea that Jim DeMint and Tom Coburn are giving the good people of Ohio the impression that they are typical southerners.
But that’s the price the South pays for some of the folks they elect to Congress. On a separate front, Poltico’s Anne Schroeder Mullins, looking for a mid-summer amusement, interviewed Georgia’s looniest House member, Paul Broun, Jr. Here’s an excerpt:

What do you miss most about your home state?
Fried chicken, fiscal and personal responsibility and the right to bear arms.
What’s the strangest thing a member has said to you?
That there is a scientific consensus that human-induced global warming is real.

How has your life changed?
Very little time now to do things I used to enjoy, like golf and hunting. But it’s all worth it in order to put America back on the right path and stop that steamroller of socialism.

Errrr, errrr.

This item is cross-posted from The New Republic.

Politico is reporting today that U.S. Sen. Jim Bunning (R-KY) is, by popular bipartisan demand, withdrawing his re-election candidacy, with a characteristic blast against the back-stabbers in his party who allegedly “undermined” his puny fundraising efforts.
Bunning nearly lost his first re-election in 2004 (to Daniel Mongiardo, subsequently elected Lt. Governor of Kentucky, and now a candidate for Bunning’s open seat) despite a Republican presidential landslide in the state. He hasn’t done a lot to improve his popularity at home or in the Senate since then. A substantial field of Republicans has lined up to succeed him, or, had he insisted on staying in the race, to beat him like a gong.
But what’s interesting is the sense of entitlement that Bunning appeared to possess, at the age of 77, about a third Senate term. To hear Bunning, the only obstacle to his desire to drift into his ninth decade on earth as a Senator was his reluctance to be concerned about attendance at “DC cocktail parties.”
The oldest of Republican Senators has, of course, has long had his problems with rumors of something less than laser-like mental agility, dating back to his 2004 attacks on Mongiardo as “limp-wristed” and looking “like a son of Saddam Hussein,” and then this interesting disclosure on the campaign trail:

Let me explain something: I don’t watch the national news, and I don’t read the paper. I haven’t done that for the last six weeks. I watch Fox News to get my information.

Bunning is the most senior member of what might be called (with props to Rick Perlstein) the Orthogonian Club, the band of pseudo-populist Republican politicians spawned by Richard Nixon who treat every setback as the product of a conspiracy of elitists. Sarah Palin is the most prominent junior member, and it’s fitting that Bunning’s trip to the showers followed so closely her unforced resignation as Governor of Alaska, accompanied by a similar claim of victimization.
Though I doubt we’ll hear much more about Bunning, once the baseball clichés about his retirement have subsided, Palin will mine the same mother lode of right-wing cultural resentment for quite some time. It will be interesting to see if the famous high school point guard Sarah Barracuda develops the same sense of blind invulnerability as the Hall of Fame hurler—and if she also learns when finally to take herself out of the game.

With so much of the fight over health care reform now coming down to issues of health care cost containment, it’s a pretty good time to take a look at the available evidence about where our system seems to “over-price” care as opposed to other countries.
TDS Co-Editor William Galston did a fascinating piece for The New Republic last week detailing the results of a McKinsey & Company study comparing health care spending patterns in the U.S. to those of other OECD (i.e., advanced) countries. Unsurprisingly, the U.S. has higher costs (about $2,000 per capita higher each year) and poorer health outcomes, and not because we are unhealthier to begin with.
One of the differential costs factors is pretty well known: Rx drug prices in the U.S. are on average 50 percent higher than in other OECD countries, and it’s attributable to marketing expenditures, not just R&D.
But two other factors are less well known:

* Much of the spending gap is attributable to the soaring use of out-patient services, which generate much higher profit margins than do hospital-based services. The ability of physicians to control the number of procedures patients receive drives up costs, and physicians’ ownership of testing facilities and ambulatory surgical clinics give them an incentive to drive up utilization….
* Generous physician compensation also contributes to higher costs. On average, U.S. general physicians earn 4.1 times per capita GDP, compared with the OECD average of 2.8 times. For specialists, the gap was even greater: 6.5 times per capita GDP, compared with 3.9 times elsewhere. McKinsey finds that higher than average physician incomes added $64 billion to total U.S. health care expenditures in 2006.

This has two big policy implications: the first is that there is indeed a tension between cost containment and the well-known desire of Americans to let physicians call most of the shots in terms of tests and treatments. The second is that the President is right in claiming that there are often less expensive ways of delivering quality health care, and that insisting on them is not, as conservatives so often argue, a form of “rationing.”
Still another important McKinsey finding is that cost-shifting from public to private insurance programs is in fact a significant problem in the growth of private health care costs. This is important in terms of proposed changes in Medicare and Medicaid reimbursement policies, and in the design of any “public option.”
Here’s Galston’s bottom line:

[W]e must look for ways of cutting the link between physicians’ earnings and the multiplication of high-cost procedures. Eliminating the loopholes in laws preventing physicians from owning test facilities would be a good start, as would reducing the compensation for high-tech tests to more reasonable levels. In the long run, fee-for-service is an unsustainable model of physician compensation, and health insurance reform should create incentives to move away from it.
We also need ways of exposing consumers more fully to the cost of the services they want without discouraging them from using the services they need. One strategy is to focus insurance coverage more on truly insurable events–the big-ticket medical events that can disrupt lives and bankrupt families–and less on routine medical expenditures and elective procedures. It should be possible to protect average families from spending an unaffordable share of their income on health care without entirely eliminating their awareness of trade-offs and costs.

Unfortunately, identifying unnecessary costs and then overcoming the institutional resistance to steps to reign them in, tough as that is, may not be enough in the current political climate. There’s also the problem of getting official recognition of costs savings–particularly by the Congressional Budget Office, which refuses to “score” some of the most fundamental structural changes as big cost-savers because, well, they haven’t been tried before.
And that’s why despite the understandable obsession with cost containment and the associated issue of covering the uninsured, we must continue paying attention to the third item on the health care reform agenda aside from cost and acces–health care quality. What we are buying for our dollars is as important as the price, and may well determine whether universal health coverage can achieve a more effective health care system both for individuals and for the country. And if we don’t pay attention to quality, then health care reform could be caught up in a destructive triage between cost and access factors that pit the insured against the uninsured with no common higher ground.

For all the ideological talk about divisions among Democrats on health care reform, there are some institutional issues that are equally important. Ezra Klein did a good job of analyzing the House-Senate dynamics over the weekend:

Some sources are speculating that the Blue Dogs are getting cold feet as they watch Max Baucus dither. Many of them felt burned by the hard and damaging vote on the cap-and-trade bill, as it looks like nothing will come of it in the Senate. Committing themselves to a health-care bill before the Senate shows its hand carries similar risks, and they’re no longer in a risk-taking mood. The worst outcome for conservative Democrats in the House is that they’re on record voting for a health-care reform bill that dies in the Senate and is judged a catastrophic example of liberal overreach.
The problem, of course, is that the more dissension there is among Democrats in the House, the less pressure there’ll be on the Senate Democrats to make a hard vote on health-care reform. This makes health-care reform something of a prisoner’s dilemma for conservative Democrats. If Blue Dogs in the House and centrists in the Senate both put it on the line to pass the bill, they’re both better off. But if one puts it on the line and the other whiffs, then the other pays the price.

Matt Yglesias notes the obvious way out of this “prisoner’s dilemma:”

[T]hey call it a “prisoner’s dilemma” because the idea is that the players are held incommunicado in separate cells. House and Senate Democrats can all get together in a room and talk this stuff out.

That’s all true, but from my own experience as a public-sector lobbyist and as a Senate staffer, I’m reasonably sure that getting House and Senate Members “together in a room” to “talk this stuff out” is really difficult, regardless of partisan or ideological issues. The institutional divisions between the two Houses are ridiculously, but obstinately, real. It goes beyond the problem of House members walking the plank on legislation that Senators may reject or significantly modify. Senators and House Members belong to very different clubs, with very different electoral cycles, committee systems, floor voting mechanisms, and constituencies. These institutional differences aren’t as large, at least lately, as partisan and ideological differences, but they can’t be discounted. And it’s yet another reason that the president must play a crucial role in leading, not following, congressional action on health care reform. The White House–the institutition, if not the actual physical location–is the only place you can get bicameral members from one party, much less from both, “together in a room” to “talk this stuff out.”

It’s hard to say that it’s over til it’s over, but it looks like the brouhaha over the President’s remarks about the arrest of Henry Louis Gates by the Cambridge Police Department mestastisized and then rapidly subsided in the course of just one day, with Obama playing the crucial role of peacekeeper.
In case you missed it, Boston-area police unions held a bristling press conference this morning that presented their own side of the Gates incident, and then basically demanded a presidential apology for his remarks on the subject earlier this week.
Then the President made a surprise appearance at a White House press briefing to announce that he had called James Crowley, the officer who arrested Gates, to apologize, and further, that he’d like to get Gates and Crowley together at the White House to talk and hoist a few beers.
What this accomplished, at least for the moment, was to humanize an issue that was rapidly in the process of being turned into a vast abstraction enlisting all sorts of primal emotions about race, crime, respect for authority, the “castle” of homeownership, and God knows what else. While Obama can definitely be faulted for making this a national news story the other night, he did strike the right chord in bringing it all back to earth, where sometimes misbehavior and misunderstanding can be resolved by conversation, with or without beer.

A close companion of the “Obama’s abandoned bipartisanship!” story-line among center-right gabbers is the “Obama’s shifted to the left!” argument. Two especially prominent journalists, the New York Times’ David Brooks and The Atlantic/FT‘s Clive Crook, have offered museum-piece-quality takes on the latter proposition this week. And they make little or no sense except as fine examples of how ideological definitions of “left,” “center” and “right” are constantly changed to comport with daily agitprop needs.
Brooks’ column, modestly entitled “Liberal Suicide March,” reflects one of David’s signature tactics: establishing moral and political equivalence between “the left” and “the right” without any reflection on, well, reality, or any sense of proportion. Because a majority of Democrats favor a course of action on, say, health reform, they are precisely as extreme and as worthy of dismissal as the looniest let’s-save-Terry-Schiavo conservatives of the Bush era. Good government is to be inherently identified with “the center,” as David Brooks happens to define it at any given moment.
At this given moment, Brooks defines “the center” as those Blue Dog Democrats who have heartburn over this or that feature of the House Democratic version of health reform, which in turn defines “the left,” which in turn defines Barack Obama because he hasn’t attacked said House version. The Blue Dogs are “brave moderates” because (like Barack Obama, but David can’t bring himself to admit that) they are concerned about health care cost containment. Many of them are also concerned, as it happens, about forcing higher reimbursement for rural doctors under Medicare, and many would just as soon boost costs even more by junking a “public option” that could force price competition among health plans. But apparently, Obama is participating in a “leftward surge” by failing to identify himself with the Blue Dogs on health care.
But Brooks is moving the goal-posts in a way that essentially means Obama can only stay in “the center” by moving “right.” Obama’s entire approach to health reform is a rejection of “the left’s” advocacy of a single-payer system–which isn’t even being debated–and a firm embrace of the “managed competition” model that used to define “the center”–and particularly the Blue Dog Democratic center–on health reform. More fundamentally, what Obama is advocating, far from representing a “leftward surge,” has been settled policy among mainstream Democrats since at least the 2004 campaign cycle, and is precisely what he promised to implement on the trail last year. His only notable “shift” has been to express an openness to an individual mandate, which has very much been a “centrist” idea within the Democratic Party.
Meanwhile, Clive Crook stipulates Brooks’ characterization of Obama’s positioning as obviously correct, and then plaintively asks why, why, why Obama doesn’t “pick fights” with “the left” and thereby get right with God and the American people.
I don’t know exactly how Crook has missed the many fights that Obama’s picked with “the left” since taking office, but to be helpful, I’d refer him to a fairly long list of progressive grievances with the administration that I made in a TNR article earlier this week about “the left’s” relative lack of leverage with Obama.
But let’s talk about “the center,” which is where Crook, like Brooks, thinks Obama should “move.” When it comes to health care policy, Clive Crook seems to define “the center” on health care as what Clive Crook thinks we should do:

I am for comprehensive health reform with a guarantee of universal coverage but favor broad-based taxes to pay for it, including limits to the tax deductibility of employer-provided insurance

Is “the left” the big obstacle to this approach? Yes, elements of the labor movement don’t like limits on tax deductibility of employer-provided insurance, but neither does much of anyone else outside the chattering classes (most emphatically a big majority of the American people). Crook very much wants Obama the President to emulate Obama the Candidate, but he is surely aware that the latter spent months attacking the idea of taxing employer-based benefits, and probably understands that Republicans, even though their presidential candidate embraced the idea (in the context of an amazingly reactionary health care proposal), would now violently oppose it as a forbidden “tax increase during a recession.” Indeed, Obama’s remarks at his press conference earlier this week opening the door to modest limitations on tax deductibility constituted something of a profile in courage, and probably displeased his political advisors.
So in the end, Barack Obama probably can’t satisfy Clive Crook on health reform, and probably can’t satisfy David Brooks by satisfying the self-contradictory desires of the Blue Dogs. For all the time that people like Crook and Brooks spend wringing their hands over Obama’s failure to ignore his own party and his own campaign platform to “lead” the country towards some ever-shifting concept of “the center,” he’d be better advised to forget about the labels and the positioning and get the closest thing possible to his original vision of health reform done.

This item is was originally published in The New Republic.
In recent news coverage of congressional action on health care reform, we’re back to one of Washington’s favorite games: the bipartisan trashing of the idea that Barack Obama cares about bipartisanship. Here’s a nice distillation of the CW from the New York Times’ Robert Pear and Michael Herszenhorn:

White House officials said they had a new standard for bipartisanship: the number of Republican ideas incorporated in the legislation, rather than the number of Republican votes for a Democratic bill. Mr. Obama said the health committee bill “includes 160 Republican amendments,” and he said that was “a hopeful sign of bipartisan support for the final product.”

Slate‘s John Dickerson sees this as the administration “replacing the traditional definition of bipartisanship with their version in the hopes that people don’t notice but still like the result.”
This bait-and-switch interpretation of the White House’s m.o., is, of course, political gold to Republicans, since it simultaneously absolves them of any responsibility the breakdown in bipartisanship while labeling the president as both partisan and deceitful. As has been the case throughout this year when Obama’s commitment to bipartisanship has been called into question, it is broadly assumed that the “traditional” definition of bipartisanship–pols getting together in Washington and cutting deals–is what candidate Obama was talking about on the campaign trail.
But there’s actually not much evidence of that. Obama eschewed Washington’s aisle-crossing metric in many of his campaign speeches, including his famous speech announcing his candidacy in February of 2007, his speech the night he clinched the Democratic nomination, and even on an occasion that screamed for the clubby bipartisanship of Washington, a bipartisan dinner on the eve of his nomination in which he shared the stage with his John McCain.
Obama made the same point over and over again in his rhetoric about bipartisanship: It’s about focusing on big national challenges without letting minor details get in the way of progress, and it’s about forcing the parties in Washington to deal with those challenges in the first place. It’s certainly not about the president of the United States going to Mitch McConnell and John Boener and saying: “Okay, boys, what do you want to do now?” In the past, I’ve called it “grassroots bipartisanship,” since it’s aimed more at disgruntled rank-and-file Republicans and Republican-leaning independents than at Republican elected officials. But whether that’s right or not, it’s clearly a conditional bipartisanship that depends on the willingness of the opposition to share the agenda on which Obama was elected.
Do congressional Republicans today share Obama’s goals, and simply disagree with Democrats on some details of implementation? With a very few exceptions, no, they don’t. On climate change, the range of opinion among congressional Republicans and conservative interest groups ranges from outright denial of global warming, to rejection of climate change as the top energy priority (viz. Sarah Palin’s recent op-ed refusing to acknowledge any issue other than “energy independence”), to rejection of any immediate action as impossible under current conditions. This refusal to cooperate is all the more remarkable since Democrats have themselves unilaterally compromised by embracing a market-oriented approach to regulating carbon emissions–the same approach once championed by the GOP’s 2008 presidential nominee–called “cap-and-trade,” which Republicans have now branded “cap-and-tax.”
And are congressional Republicans and conservative elites committed to universal health coverage? Maybe a few are, but the GOP’s opposition to Democratic health reform efforts has increasingly involved a defense of the status quo in health care (aside than their bizarre insistence that “frivolous lawsuits” are the main problem). Their violent rhetoric about the costs associated with universal health care is matched only by their violent opposition to any measures that would reduce those costs.
So you really can’t blame the White House for citing outreach to Republicans and adoption of Republican amendments as evidence of about the most bipartisanship they can reasonably achieve. If, like Dickerson, and many commentators from both ends of the political spectrum, you define bipartisanship in a way that excludes anything that doesn’t involve the sacrifice of basic principles or the abandonment of key policy goals, then to be sure, Barack Obama is not pursuing bipartisanship in that manner. But then he never was.