Penned

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By now you’ve heard that the controversial Mark Penn is no longer the chief strategist of the Clinton campaign. It’s not clear whether Penn has left the Clinton campaign entirely, however.

The breakup, if indeed it is a breakup, occurred because Penn was caught working with Colombia on a free trade deal that the Clinton campaign opposes.

Penn has been behind one blunder or embarrassment after another in the Clinton campaign, and there have been no end of calls from Clinton supporters to get rid of Penn. Yet the Clintons won’t let him go. Why is that? Michael Tomasky has some answers:

[T]here are two people who appear ready to stand by Penn, hell or high water, and they are the two who matter: Bill and Hillary Clinton. Penn joined Bill Clinton in the mid-90s, after the early woes (gays in the military, healthcare), and he kept the president on the ideological middle ground. He did the same for Hillary while overseeing her 2000 Senate campaign. In the course of these experiences, both Clintons came to swear by Penn’s advice. They saw his gift for numbers and demographic analysis, but they failed to grasp his obvious weak point.

Pennism is a kind of Democratic politics that one could argue was right for an era of conservative dominance: take few risks, and move as far to the centre and even right as possible so you couldn’t be labelled soft on defence or wobbly on support for the free market.

But George Bush and Karl Rove have seen to it that, after Iraq and Katrina and the US attorneys scandal and now a real-life recession, we are no longer in an era of conservative dominance. We’re not in an era of liberal dominance either, of course, but we are in a place where, for the first time in a very long time, conservatism has discredited itself, and more Americans are open to progressive alternatives. This was apparent to anyone paying attention in September 2005, after the tragedy of New Orleans.

But it wasn’t apparent to Penn. And by extension we can conclude it wasn’t apparent to the Clintons either (revealing, considering Bill’s alleged political genius). Hillary’s refusal to renounce her vote in support of the Iraq war – a refusal that I have no doubt was based on Penn’s advice, on the grounds that she had to continue to show she could be “tough” on foreign policy – was a disaster for her, as was the vote itself. If, in a few weeks’ time, we’re writing Clinton campaign post-mortems, her handling of Iraq will be deservedly high on the list of errata, and it was classic Pennism.

Tomasky’s column sums up my biggest concern about Senator Clinton. If Clinton becomes president, I fear she will continue the famous “triangulation” pattern that assumes the Right still controls public opinion, and progressivism will have missed a huge opportunity. What progressives need right now is someone who can communicate our values and ideals and inspire a disenchanted America to embrace them. That person is not Senator Clinton.

Yesterday while I was looking for something else I came across an old Mahablog post from January 2006 in which I said netroots progressives would not support Hillary Clinton. Clearly I was wrong about how much support she would get, although I still find it baffling that any progressive would support her. In this I quote a post by Chris Bowers, also from January 2006, titled “Why The Blogosphere and the Netroots Do Not Like Hillary Clinton,” and one by Stirling Newberry from November 2005, no longer online, in which he said “Hillary Clinton as a disaster for progressives and ultimately for the Democratic Party.”

The Clinton campaign hasn’t shown me any reason to change my mind.

Update: See also Jonathan Chait.

Why Wingnuts Are Idiots

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Yesterday I wrote a post about the way our health care system is no longer capable of providing basic, primary care and emergency services to everyone who needs it. There are several causes for this, but the primary cause is that the “system” has been skewed away from preventive and emergency care services (in which there is no profit) and toward the creation of treatments and health care products that do make a profit.

Yesterday’s post focused on a New York Times story about Massachusett, which initiated a “universal” health care program that currently is insuring 340,000 people who had no health insurance before. And now there are not enough primary care physicians to go around. One physician has a 13-month waiting list for basic physicals.

A few wingnuts commented on this same New York Times story. Their take? “See? Socialized medicine doesn’t work!”

Don Surber:

Question: Why isn’t universal health insurance working in Massachusetts?

Answer: Good intentions also lead to shortages in everything. What the New York Times calls “unintended consequences,” I call predictable.

If we didn’t have all these wimpy good intentions, there wouldn’t be a problem. Clearly, that millions of Americans have been cut off from basic health care services is not a problem.

Another rightie, Soccer Dad, concludes that the primary care physician shortage proves Mitt Romney (credited with the Massachusetts health care program) is incompetent. Romney may be incompetent, but the fact is whenever and however the U.S. finds a way to provide decent health care services to those currently uninsured, whether by public or private means, what’s happening in Massachusetts is going to be a nationwide phenomenon.

Put another way, the only reason the insured don’t have massive waiting lines for health care services (in most parts of the country) is that so many Americans have been kicked out of the line.

In other Right Wing news — Yes, Hugh, there were arm bands and book bags in 1968. I was there. Wearing arm bands in protest of the Vietnam War was pretty common, actually.

And why can’t we have civilized debates about important issues? Read this and be amazed — at the psychological projection.

Idiots.

Update: Another idiot speaks —

Why, it must be some kind of doctor shortage! … Could it be, oh I don’t know, lack of incentive?

No, brainless one, there is plenty of incentive. However, all the incentive tilts in the direction of what parts of medical practice that are very profitale (i.e., new technologies and drugs) and away from those parts that are much less profitable (i.e., preventive care) or tend to lose money (i.e., emergency rooms). Your market-driven health care system at work.

And, as Kevin Heyden says, Massachusetts has better health care resources than most other states. So “what will it be like in the Southern states that are mostly rural, or the vast wide open states that grow bigger, the wester you go?”

For years I’ve been hearing health-care experts saying that the nation’s ability to delivery basic medical services to its citizens has been deteriorating, even as we continue to excel at the development of new technologies and drugs for extremely serious illness.

The lack of basic services, however, is one of the factors that is driving up the cost of health care for everyone. It would be far more cost-effective if people got regular checkups and went to doctors at the first sign of illness. However, the millions of Americans who are uninsured or underinsured tend to wait until symptoms are more severe and the illness more difficult (and expensive) to treat.

Here’s just one example — the United States on the whole has world-class hospital neonatal care for infants born prematurely or unhealthy. However, we fall far behind most other industrialized nations in providing basic prenatal care for all pregnant women. Thus, a higher percentage of American babies are born prematurely or unhealthy and need intensive, and expensive, hospital care to survive.

This is what’s called “stupid.” Naturally, wingnuts are for it.

Someone asked in the comments if we have to choose between “unevenly distributed access to health care, and evenly distributed inaccess to health care?” No, we don’t have to choose that at all. Wingnut mythology aside, most industrialized nations provide access to perfectly good health care with no waiting lines to all its citizens. Some do a better job than others, but it can be done, and at a lower cost per capita than we’re paying now. But the longer we pretend that somehow “market forces” are going to solve our health care crisis the worse the inequality will grow, because “market forces” are causing the inequality.

When we do ever switch to universal health care, it will probably take several years to build the medical infrastructure needed to deliver good basic care.

Quick Comments

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The insanity among the Clintonistas continues.

See Benjamin Wallace-Wells for more on how the death of Martin Luther King devastated liberalism.

Tibetans are not the only minority group facing brutal oppression by the government of China. Charles Cummings writes on the treatment of the mostly Muslim Uighur people of Xinjiang:

Uighurs have been jailed for reading newspapers sympathetic to the cause of independence. Others have been detained merely for listening to Radio Free Asia, an English-language station funded by the US Congress. Even to discuss separatism in public is to risk a lengthy jail sentence, with no prospect of habeas corpus, effective legal representation or a fair trial. About 100 Uighurs were arrested in Khotan recently after several hundred demonstrated in the marketplace of the town, which lies on the Silk Road.

And what happens to these innocent Uighur men and women once they land up in one of Xinjiang’s notorious “black prisons”? Amnesty International has reported numerous incidents of torture, from cigarette burns on the skin to submersion in water or raw sewage. Prisoners have had toenails extracted by pliers, been attacked by dogs and burned with electric batons, even
cattle prods.

In Typhoon, I relate the terrifying true story of a prisoner in Xinjiang who had horse hair inserted into the tip of his penis. Throughout this diabolical torture, the victim was forced to wear a metal helmet on his head. Why? Because a previous inmate had been so traumatised by his treatment in the prison that he had beaten his own head against a radiator in an attempt to take his own life.

This is the reality of life in modern Xinjiang. Quite what the Chinese hope to gain from their inhumane behaviour remains unclear. According to Corinna-Barbara Francis, a researcher with Amnesty’s East Asia team, “the intensified repression of Uighurs by the Chinese authorities is in danger of contributing to the very outcome that China claims it is warding against – the radicalisation of the population and the adoption of violent responses to the repression.”

The government of China commits hideous atrocities on anyone it decides it doesn’t like. Of course, we’re hardly in a position to claim the moral high ground any more.

But ethnic minorities in China’s outlying areas, like the Uighurs and the Tibetans, are treated particularly harshly. As I said in “Rebellion in Tibet,” the Chinese are making every mistake every imperial power ever made.

That’s why it stuns me when some online publication that claims to be for “peace and social justice” publishes apologies for China such as this. Unbelievable.

Marketing Health Care

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Massachusetts instituted what’s called a universal health care program — about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage, — and now supply is no longer adequate to meet demand. Kevin Sack writes in today’s New York Times —

Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.

Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinson’s next opening for a physical is not until early May — of 2009.

A 13-month line for a physical? But the wingnuts tell us only Canadians have to wait in line!

In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.

This is something I’ve written about before. The fact is that “market forces” have skewed the way health care is delivered in this country away from basic services like preventive care and emergency rooms. That’s because the real money is in providing boutique medical care products and services for those with means to pay for it. About a year ago, I wrote,

Basically, our health care system is good at delivering difficult and expensive stuff but blows at simple, ordinary stuff, like preventive care, compared to other nations. This means we save some lives that might have been lost in Europe, but we also lose lives that would have been saved in Europe.

How did this come to pass? Certainly we Americans value creation and innovation. But it’s also the fact that our private, profit-based health care system is very good at creating new health care products that will make a lot of money. But where there’s no chance of profit, forget it.

This is what the “magic of the marketplace” has given us. You know how markets work; where there’s a demand, someone will hustle to provide a supply, and competition encourages the creation of better products at lower cost. Our system is very good at creating new drugs and new technologies and then marketing them to hospitals, physicians, and even potential patients. And I’m not saying this is a scam; many of us have benefited from the drugs and gizmos. The problem is that some parts of the health care process just don’t make any money. And where it isn’t profitable, our system is falling apart. …

… Here’s what the “free market” people never seem to wrap their heads around: Unprofitable demands do not generate supply, even when those demands are desperately needed.

Put another way, not everything that’s worth having can generate enough profit to pay for itself. …

… By now “market forces” have so skewed our health care delivery system that, even if we began to allocate our health care dollars according to need rather than profit, it would take years before the neglected parts of our system were built back up to where they should be.

Every now and then there will be a news story about our shameful infant mortality rates or our less-than-stellar life expectancy rates or that emergency rooms are closing or the number of hospital beds per capita is shrinking, and you can count on some wingnut to come out of the woodwork and declare that we are number one at delivering new drugs to colorectal cancer patients that increase their life expectancy by a whole 4.3 months, so take that.

One occasionally finds the claim that the U.S. has too many doctors, rather than a shortage of doctors. The problem is that the “oversupply” seems to fall short in primary care. Kevin Sack of the New York Times explains,

While fewer American-trained doctors are pursuing primary care, they are being replaced in droves by foreign medical school graduates and osteopathic doctors. There also has been rapid growth in the ranks of physician assistants and nurse practitioners.

A. Bruce Steinwald, the accountability office’s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.

My understanding is that there are adequate numbers of medical students who graduate as general practice doctors, but since they carry an average of $120,000 debt for student loans they can’t afford to go into primary care.

This is unfortunate, because comprehensive health care reform requires better primary care so that health problems are prevented or treated at earlier stages. But in the U.S. “market forces” are better at creating and marketing expensive drugs and gizmos to hospitals to treat seriously ill patents. Ain’t no money to be made in preventive care. Money to be saved, yes, but not to be made. So emergency rooms rot, and people in Massachusetts wait 13 bleeping months for a bleeping checkup.

The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs. [emphasis added]

Of course he has. You can count on Bush to do exactly the wrong thing.

Anyway, just because real-world experience proves beyond a shadow of a doubt that “market forces” will not provide anything approaching halfway decent health care for all Americans doesn’t mean the wingnuts will lose faith in market forces. There’s no point even arguing with them. And because wingnuts dominate media, few Americans hear all sides of this argument. All they ever hear about are waiting lines in Canada.

Of course, the only reason we haven’t had worse waiting lines here is that so many people have been kicked out of the health care system altogether.

Be sure to read Paul Krugman’s most recent column, “Voodoo Health Economics.” GOP presidential candidate John McCain’s health care plan is, essentially, to allow the “magic of the marketplace” to provide inexpensive health care for everyone. Krugman explains in no uncertain terms why this is nonsense. The Boston Globe has more about McCain’s not-even-half-assed heath care proposals.

I’m not enthusiastic about either Hillary Clinton’s or Barack Obama’s health care proposals. They both fall under the heading of “better than nothing” in my book, McCain’s proposals being “nothing.”

The two Dems may not be beyond hope on health care, however. From an editorial in today’s Toledo Blade:

At one time or another, both Senator Clinton and Senator Obama have said they could support a single-payer national health insurance system, a kind of “Medicare for all,” as a solution to the health care crisis, but they have apparently calculated that it is not politically feasible to advocate it today.

The new survey of the nation’s doctors suggests otherwise.

These findings dovetail with those of an AP/Yahoo public opinion poll last December showing 65 percent of Americans favor a similar approach.

National health insurance is not only necessary, but increasingly popular.

Winston Churchill is remembered to have said of Americans that we always do the right thing, after we have exhausted all the other possibilities.

It is time for our political leaders to stand up for the health of the American people and implement a nonprofit, single-payer national health insurance system.

In part I blame news media for not presenting anything approaching a balanced, fact-based debate on health care. We get only the Right’s POV and more of the Right’s POV. I think if the American people understood the facts, we’d have national health care already.

Forty Years

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Today is the 40th anniversary of the assassination of Dr. Martin Luther King, and the web is brimming over with retrospectives. See, for example, Eugene Robinson.

I want to point in particular to E.J. Dionne’s column, however, because he plays one of my own recurring themes — the way the Right exploited racism to take over America. The column begins:

Forty years ago, American liberalism suffered a blow from which it has still not recovered. On April 4, 1968, a relatively brief but extraordinary moment of progressive reform ended, and a long period of conservative ascendancy began.

The assassination of Martin Luther King Jr. and the ensuing riots that engulfed the nation’s capital and big cities across the country signaled the collapse of liberal hopes in a smoky haze of self-doubt and despair. Conservatives, on the run for much of the decade, found a broad new audience for their warnings against the disorders and disruptions bred by reform.

It wasn’t just the riots. Much of white America was still simmering with resentment over court-ordered school desegregation. Also, Lyndon Johnson had initiated New Deal-style programs aimed primarily at relieving poverty among African Americans. Suddenly, whites who had had no problem with “entitlements” before — when benefits went mostly to whites — discovered the virtues of “self-reliance.”

It is easy to forget that the core themes of contemporary conservatism were born in response to the events of 1968. The attacks on “big government,” the defense of states’ rights, and the scorn for “liberal judicial activism,” “liberal do-gooders,” “liberal elitists,” “liberal guilt” and “liberal permissiveness” were rooted in the reaction that gathered force as liberal optimism receded.

Richard Nixon did a masterful job of exploiting fear and prejudice to lure white working-class voters away from the Democrats. And, of course, whites in the Deep South switched their allegiance from the Dems to the Republicans en masse.

The Right-Wing Narrative says that Democrats lost power because George McGovern opposed the Vietnam War, and the Dem Party was overrun by “peaceniks.” But this view of history doesn’t square with what really happened. McGovern’s stand on the Vietnam War was the least of the reasons he lost to Nixon in 1972.

And check out the acceptance speech Nixon gave at the 1972 Republican convention. The first half of the speech was all about race. It was in code, of course, but no adult alive at the time could have mistaken his meaning when he spoke of quotas and tied paying high taxes to the costs of “welfare.” And Republicans are still running on those themes today.

Just the other day, someone argued in the comments that the next Dem president would be punished for “losing Iraq” the way the Democrats were punished for “losing Vietnam.” Except that I don’t see how the Dems were punished for losing Vietnam. Saigon fell to the Communists in 1975; in 1976, America elected Jimmy Carter as president and gave the Dems a small increase in Congress, expanding the large increase the Dems had enjoyed in the 1974 post-Watergate midterms.

The fact is, once combat troops were withdrawn from Vietnam and the POWs came home, America lost interest in Vietnam. The whole bleeping country developed amnesia over Vietnam (except for the extreme Right, a group of people who are never so happy as when they are nursing resentments). As I remember it, it wasn’t until the 1980s that the Narrative emerged about Dems losing elections because of Vietnam. But this was an important narrative for the Right, because it helped them paper over the real primary reason the Right gained and the Left lost in those years. And that primary reason was racism. There were other issues, too, but racism was the foundational issue upon which other right-wing issues would be built.

Right-wing politicians had employed Red-baiting with some success since the late 1940s. But the excesses of McCarthyism had turned off moderates, and the Kennedy Administration had ushered in a liberal resurgence. Eventually, racism would succeed where Red-baiting had faltered.

The success of the racism strategy in the 1960s and 1970s taught at least a couple of generations of right-wing politicians about the importance of wedge issues. As new issues came up — feminism, abortion, gay rights — right-wing politicians embraced them and followed the old racism scenario to exploit them. Meanwhile, the Left crumbled into confusion and single-issue activism.

And as right-wingers gained more and more power over the federal government, the federal government became less and less functional. Because wedge issues may win elections, but they don’t govern a nation.

E.J. Dionne continues,

Forty years later, is it possible to recapture the hope and energy of the days and years before that April 4? Has liberalism spent enough time in purgatory for the country to revisit how much was accomplished in its name and to acknowledge that the nation is better off for what the liberals did?

In “The Liberal Hour,” an important new history of the ’60s that will be published in July, Colby College scholars G. Calvin Mackenzie and Robert S. Weisbrot note that for all its deficiencies, the period of liberal sway “demonstrated what democratic politics can produce when public consensus crescendos, when coherent majorities prevail, and when skilled leaders provide direction, inspiration, and relentless energy.”

In the U.S., public consensus, coherent majorities, and skilled leaders providing direction in a positive, not a destructive, way are things only us geezers dimly remember and the young folks have never seen.

And after a few years of near-total dominance by right-wingers of the federal government, 81 percent of Americans say the U.S. is headed in the wrong direction.

It’s 40 years since 1968. Now a black man and a white woman are competing with each other for the Dem nomination. They both face nasty bigotry barriers, and it would be a breakthrough if either were elected. Yet only one of these candidates has shown a real talent for building public consensus. The other one is running an increasingly bitter, and angry, wedge-issue style campaign. I think 40 years of that crap is quite enough.

Update: Wingnut priorities.

What Counts

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News is that Senator Clinton’s lead in Pennsylvania is shrinking rapidly, and one poll actually shows Obama ahead. And I don’t think that’s an April Fool article. It’s an outlier, but stay tuned. If Obama can make it a close finish, expect the Clinton campaign to come up with creative reasons why Pennsylvania doesn’t count.

Simon Hoggart writes for The Guardian that, unlike Rocky, Senator Clinton punches below the belt.

Greg Sargent reports that the Clinton campaign is still pushing the Rev. Wright story to superdelegates, trying to persuade them that the Right will use it to destroy Obama in the fall, even though he seems to be recovering nicely from the hit he took on Wright a few days ago. And of course, the Republicans will be able to pin nothing on Senator Clinton. Right?

Tantrums

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David Usborne of The Independent reports that a record number of Americans are now on food stamps. Predictably, right-wing bloggers panned the article as an example of liberal media bias.

One can argue that the headline of the article — “The Great Depression” — is over-the-top, since we’re not in an economic depression and our situation is not nearly as dire as the real Great Depression. Yet. Also, the accompanying photo is more than two years old. You can count on righties to pick the headline and photo apart and ignore the article, which presents a sobering picture of economic life in America. If the data presented are true, we should be concerned.

BTW, David Jolly reports for the New York Times:

UBS, the largest Swiss bank, said on Tuesday that it would write down another $19 billion related to “U.S. real estate and related structured credit positions” and said Marcel Ospel, its chairman, would step down.

UBS said the write-down would result in a first-quarter loss of about 12 billion Swiss francs, or $12 billion, and that it would seek new capital of about $15 billion, in the second time it has announced plans to raise new funds since the credit crisis began. The bank’s board proposed that Peter Kurer, currently general counsel for the bank, take over as chairman, pending shareholders’ approval at a meeting on April 23.

The news came as Deutsche Bank, the biggest German lender, said Tuesday that it expected a first-quarter loss of about $3.9 billion on write-downs of United States real estate loans and assets. Global banks have now written down more than $200 billion of soured loans in the market debacle that began last summer with the implosion of the American subprime mortgage market.

On the plus side, Bush’s chief of Housing and Urban Development, Alphonso Jackson, resigned yesterday. Jackson is under investigation for allegedly giving lucrative housing contracts to friends.

Irrelevant in Iraq

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As usual, Juan Cole provides a succinct explanation of what’s going on in Iraq. Here’s the most critical bit about the fighting in Basra:

The southern parties have essentially defied al-Maliki and Bush to make a separate peace.

The entire episode underlines how powerful Iran has become in Iraq.

Way to go, Bushies.