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Health

Obama Budget Lays Groundwork For Reducing Health Care Costs

President Obama’s budget allocates $634 billion towards health care reform but only half of that amount will come from new sources of revenue (namely, reducing itemized deduction rates for families with incomes over $250,000). The other half is already in the health care system, but we’re wasting it.

Up to $700 billion a year is wasted on unnecessary or ineffective care and the Obama administration believes that it can re-orient some of those dollars to fund health care reform.

Part of that waste comes from unnecessary care. In fact, according to the most recent Dartmouth study which looked at “variations in spending growth and spending patterns among U.S. regions,” certain areas of the United States were spending more on care than others because physicians in higher spending regions “were much more likely than those in lower spending regions to recommend discretionary services.”

More care, however, does not always translate into better health outcomes. In fact, evidence suggests “that the quality of care and health outcomes are better in lower-spending regions.” Here is the Medicare data:

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Part of the problem is that current payment methods — which reimburse doctors for the number of treatments they prescribe — encourage “hospitals and doctors to try to expand their services”; doctors also often don’t know if certain treatments work better than others.

So to eliminate over-spending, Obama’s budget bundles payments for post-hospital providers and links a portion of Medicare payments for acute in-patient hospital services to hospital performance. The stimulus bill smartly invested in comparative effectiveness research.

The Dartmouth study argues that “to slow spending growth, we need policies that encourage high-growth (or high cost) regions to behave more like low-growth.” Some providers (like academic health centers or providers in high spending regions) may oppose restructuring the payment system, but insurance companies (who now reimburse for every procedure) and patients (who’ll be able to avoid unnecessary surgeries) would likely embrace the change. Overall it’s smart policy: it will reduce health spending and improve the qualify and efficiency of care.

Fortunately, the Obama budget adopts some of these cost-saving measures and reinvests the savings into health reform. But as the Dartmouth study suggests, there is more that can be done.

Update

Moderate Voice has more.

Politics

John Bolton jokes about nuking Chicago, entire CPAC audience erupts in laughter.

This morning, former U.N. ambassador John Bolton spoke to the Conservative Political Action Conference (CPAC). He tried to up the fear quotient in the room by raising the prospect of an Iranian-sent nuclear attack on an American city. “It’s [a] tiny [threat] compared to the Soviet Union,” Bolton said, “but is the loss of one American city — pick one at random: Chicago — is that a tiny threat?” The audience erupted in cheers and laughter at the idea of Obama’s home city being obliterated. Watch it:

Later during the conference, Joe Scarborough warned the audience that conservatives would have to work on their “tone.” “We’re not going to win votes, we’re not going to win elections by calling Obama a communist,” Scarborough said.

Update

The Wonk Room’s Matt Duss, who attended CPAC today, notes that Bolton also fearmongered on Obama’s dedication to Israel. He told an audience member that he “very much fear[s] it’s right” that Obama would not aid Israel were it attacked.

Climate Progress

Reid, Pelosi Call For End To Coal At U.S. Capitol Power Plant

Capitol Power PlantResponding pre-emptively to plans of a massive act of civil disobedience at the coal-fired U.S. Capitol Power Plant, the leaders of Congress today called for an end to its use of coal. In a letter to the Architect of the Capitol, Senate Majority Leader Harry Reid (D-NV) and House Speaker Nancy Pelosi (D-CA) describe the plant as “a shadow that hangs over the success” of the architect’s efforts to green the Capitol:

The Capitol Power Plant (CPP) continues to be the number one source of air pollution and carbon emissions in the District of Columbia and the focal point for criticism from local community and national environmental and public health groups.

Reid and Pelosi note that “there are not projected to be any economical or feasible technologies to reduce coal-burning emissions soon.” (In other words, coal is dirty.) They ask the architect to switch the plant fully to natural gas “by the end of the year”:

Therefore it is our desire that your approach focus on retrofitting at least one of the coal boilers as early as this summer, and the remaining boiler by the end of the year.

The switch will allow the plant “to dramatically reduce carbon and criteria pollutant emissions, eliminating more than 95 percent of sulfur oxides and at least 50 percent of carbon monoxide,” as well as the costs of “cleaning up the fly ash and waste.”

Gristmill’s Kate Sheppard reports “that doesn’t mean the big protest on Monday is off, according to organizers,” because “there are still hundreds of other power plants burning coal around the country.”

Yglesias

CAP Budget Reax

Everything you wanted to know about the Obama budget and more from the Center for American Progress policy teams:

obamabudget_onpage_1.jpg

  1. Dan Weiss on the climate and energy elements.
  2. Cindy Brown and Melissa Lazarín on education.
  3. Larry Korb on defense.
  4. Michael Ettlinger on the big picture.

It’s not Obama’s style to actually say this, but were this budget to be enacted it would be by far the most significant progressive step in over forty years.

Economy

Orszag Takes On Cavuto: ‘Folks Need To Actually Look At The Budget Document’

Today, Office of Management and Budget Director Peter Orszag appeared on Neil Cavuto’s show to discuss the budget released by the Obama administration, which “proposes significant tax increases for businesses and wealthy families worth nearly $2 trillion over the next 10 years.” Throughout the course of their conversation, Orszag debunked various conservative tax myths trumpeted by Cavuto including: the budget proposes to raise taxes during a recession, tax increases on the wealthy are a “job killer” that will ruin economic growth, and the increases will discourage investors from playing the stock market. Watch a compilation:

As Orszag said, “we’re returning to the tax rates that applied during the 1990′s. I think all Americans — including high income Americans — did quite well during that decade.”

Yglesias

Funded by the Funds

Part of Barack Obama’s budget is his plan to go after the special tax break enjoyed by hedge fund and private equity fund managers. This is an obvious idea, since there’s no good reason for this special treatment. But it didn’t manage to get done last year because Republicans love rich people and this particular class of rich people has given a lot of money to a few key Democrats. Indeed, Tom Edsall’s article on the subject includes these charts showing the Democrats are the main beneficiaries of the fund managers’ largess:

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and

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One noteworthy thing about this is that these guys weren’t just following the political winds and backing the majority party. It’s typical for Democrats to do well with certain industries when they’re in power, but not-so-well when they’re out of power. But these guys were Democrat-friendly even through the lean years. Thus:

When the hedge and private-equity fund industries faced a similar challenge to their capital gains tax break in 2007, most of them entered the ring expecting defeat, only to emerge victorious. In addition to campaign contributions, the individual companies and their trade associations sharply escalated their lobbying activities, pulling out the stops to beat back the tax reformers. [...] One of the factors working to the funds’ advantage is that the Senate Finance Committee works in mysterious ways, unexpected decisions abruptly emerging from private deal-making that can radically transform the impact of tax legislation. Anyone assuming that the special treatment of hedge and private-equity fund managers will be scrapped by a populist Democratic majority should hold the champagne until Obama signs the bill into law.

Of course the wild car here to some extent is the Republicans. I thought the quiet death of hedge fund loophole repeal during the last congress would have been a great opportunity for the GOP to steal a bit of the Democrats’ populist mojo while at the same time punishing a class of people who mostly finance the opposition. Certainly that political tactic would have seemed more likely to broaden the parties appeal than a lot of “Joe the Plumber” antics. And it would have been better for democracy, too. You need real competition between the parties.

Politics

EXCLUSIVE: Tancredo Says Jindal’s Speech Was The ‘Last Nail In The Coffin’ For His Presidential Ambitions

Gov. Bobby Jindal (R-LA) has been heralded as everything from the next Barack Obama to the next Ronald Reagan. As the GOP searches for a new leader, Jindal is seen by some conservatives as their best hope of capturing the White House in 2012. But Jindal’s abysmal response to Obama’s address to the nation on Tuesday has been ridiculed by commentators across the political spectrum, raising doubts about his 2012 ambitions.

Stepping up in Jindal’s defense yesterday, Rush Limbaugh warned his fellow conservatives yesterday not to say negative things about Jindal. “Those of you who think Jindal was horrible….I don’t ever want to hear from you ever again,” he said.

One Republican who isn’t heeding Limbaugh’s warnings is the anti-immigrant zealot and former congressman Tom Tancredo (R-CO). In an interview with ThinkProgress at the CPAC conference today, Tancredo declared that Jindal’s speech marks the end of his presidential ambitions:

TP: [Jindal] has gotten some flack for his performance on the response to Obama. I’m curious what your thoughts on it was.

TANCREDO: Great content. Lousy delivery. And I’m sorry to say this because I like him a lot. I served with him. Good guy. Solid guy. But I think that performance would very well have put the last nail in the coffin for him, for running for president. Mostly because what we are desperately looking for today in this party is a leader. Bobby Jindal is a great intellect, but his capacity to lead just is, his bearing, is not there. At least, it wasn’t there.

Watch it:

“I’m not saying he can’t overcome it, but I’m telling you it’s a major obstacle now. And I’m sorry about that,” Tancredo said. “In this business, often times you need more sizzle than steak.”

Update

RNC Chairman Michael Steele says Jindal is doing a “friggin awesome job” and offers up some “slum love“:

SLIWA: Because he is — when guys look at him and young women look at him — they say oh, that’s the slumdog millionaire, governor. So, give me some slum love.

STEELE: I love it. (inaudible) … some slum love out to my buddy. Gov. Bobby Jindal is doing a friggin’ awesome job in his state. He’s really turned around on some core principles — like hey, government ought not be corrupt. The good stuff … the easy stuff.

Politics

Obama’s budget includes family planning funding protested by Republicans during stimulus debate.

To congressional Republicans, one of the most objectionable parts of an early version of the House’s economic recovery package was funding for family planning services. Conservatives cried that spending “hundreds of millions on contraceptives” wouldn’t stimulate the economy. (Even though it would.) President Obama agreed to drop the provision from the recovery package. However, he has reinserted it into his FY 2010 budget. On p. 127, there is a provision to “[e]xpand availability of family planning services under Medicaid,” which is estimated to save the government $190 million over 10 years. Here are statements from Planned Parenthood and NFPRHA.

Yglesias

Sari Nusseibeh’s Big Idea for Peace in the Middle East

180px_sari_nusseibeh.jpg

Sari Nusseibeh, the Palestinian philosopher, academic, and moderate leader has a joint initiative with former Shin Bet chief Ami Ayalon called “The People’s Voice.” It’s basically a fleshed-out version of the Arab Peace Initiative from 2002 that gets more specific on the refugee front. It calls for:

  • A return to the 1967 borders.
  • 1:1 land swaps that deviate from the ’67 borders if those can be agreed to.
  • A connection between the West Bank and Gaza.
  • Removal of settlers from the new Palestine.
  • Establishment of Palestine as a demilitarized state.
  • Return of Palestinian refugees only to Palestine, with financial compensation and international community support for refugees who wish to permanently settle in their current country of residence.
  • Shared control of Jerusalem.

The Arab Initiative is very fuzzy on the refugees, but as an Arab League Initiative carries with it the significant sweetener that all the Arab League states are promising full normalization of relations with Israel. But the point is that the basic outline of this framework is not especially novel—this is basically what everyone agrees a mutually acceptable settlement would more-or-less have to look like. What’s provocative is this idea relayed by Jonathan Zasloff:

Nusseibeh noted that neither side’s leadership is prepared to make the compromises for peace at this stage, either because of weakness, ideological rigidity, extremist vetoes, or a combination of all of these. Thus, his proposal is to allow the Israeli and Palestinian publics to take the matter into their own hands. How could this be done?

George Mitchell, Nusseibeh suggested, should take an American peace plan (and he made it clear that it should be the People’s Voice framework) to both Netanyahu and Abbas.

He should then publicly challenge Netanyahu to place this plan on the Israeli ballot as a referendum. Netanyahu would not have to endorse the plan, but rather allow the voters to decide whether they would accept it as long as the other side does.

On the Palestinian side, he should publicly challenge Abbas to call for new elections (due in the PA thus year in any event) and run on that platform for his presidential campaign — accepting the plan as long as the Israeli electorate does.

Nusseibeh believes — and I agree with him — that such a public offer would be difficult for either side to refuse. It would not require Netanyahu to endorse the plan, but would undermine him politically if he refuses to allow the voters to decide. It would give Abbas a concrete platform and plan to rid the Palestinians of the occupation.

If the Obama Administration starts another round of negotiations, Nusseibeh argued, it will be drawn into an endless labyrinth. He’s right.

Both sides will have very strong incentives to vote yes — the side that votes no will very clearly be at fault for refusing an end to the conflict.

What Nusseibeh didn’t say is that the United States must send a strong signal about how important a yes vote is, and how difficult it will be to maintain strong political support for Israel in the US if it is seen as the obstacle. The Arab League must do the same for the Palestinians. The EU must do the same for both sides.

In the real world, it’s a bit hard for me to imagine an American president rolling the dice like this. Among other things, what do you do if one side votes yes and the other side votes no? Agree that this proves they’re the unreasonable ones and the other side now has license to deal with them through brute force? On the other hand, there are compelling elements to the logic. But I dunno . . . to really advocate putting all the chips on the table . . . it just sort of seems like too much. I dunno, I’ve got to think more.

Security

Bolton: I Fear That Obama Would Not Come To Israel’s Aid

Today at CPAC, after declaring that “for those who felt the Obama administration would be friendly to Israel, it’s wake up time,” former Ambassador John Bolton was asked if, “when the Arab nations attack Israel,” which the questioner expected to occur “within six months to a year,” Bolton thinks the Obama administration will act to defend Israel.

Bolton responded to this question as if it were reasonable, saying “I don’t know what the Obama administration will do in response” to an attack by the Arab nations against Israel:

BOLTON: I would certainly hope they would come to Israel’s assistance, but I think there’s no guarantee of it. I think the more likely response is to appoint a special envoy and try to negotiate an end the hostilities.

Q: Your short answer then would be “no”.

BOLTON: I very much fear that’s right.

Watch it:

As should be obvious, the scenario presented is ridiculous. There is no analyst on the right or the left who seriously thinks that the Arab states are preparing to attack Israel. (Right now these states are much more concerned about Iran, and the extent to which Iranian power and influence in the region was greatly increased as a result of the Iraq war, which Bolton still insists was awesome.) But, if this never-going-to-happen scenario did actually come to pass, I think there is little doubt that the United States would come to Israel’s aid. (Though, as it has in the past, this aid would probably come mainly in the form of replenishing the arsenal of Israel’s military, the conventional dominance of which is a main reason why the scenario is nonsensical.) But Bolton doesn’t allow any of this to get in the way of trashing the Obama administration with shameless fearmongering about Israel.

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