Archive for November, 2013

Villain of Choice

Saturday, November 30th, 2013

Let no man deceive you by any means: II Thessalonians 2:3

This is the final installment in our attempt to answer how the biggest financial collapse since the Great Depression fueled by decades of financial deregulation turned into a full-throated defense by the Tea Party of the free market economy.

Capitalism

Capitalism can be a wonderful economic system. One of its weaknesses, however, is the boom and bust cycle. If you look at the economic history of this country, we have had boom and bust cycles since the beginning of our democracy. Some blame the cycles on the Fed, but the modern Federal Reserve Banking system was created in 1913 in response to the Financial Panic of 1907. Before the creation of the Fed, the country experienced 25 depressions. Since then, we’ve only had one. So the Fed must be doing something right. We DO continue to experience periods of expansion and contraction (recession) – 40 in all since 1940. Some recessions are mild and some, like the financial collapse of 2008, are catastrophic.

These cyclic economic periods are primarily triggered by private sector investment. As the economy grows there are natural pressures on prices, wages, and capital. Those inevitably lead to inflation and rising interest rates as demand exceeds supply. That increases the costs to expand as well as making it more expensive for consumers and businesses to purchase goods. As demand and expansion slow in reaction to increased prices, investor and consumer confidence wanes until expansion stops. Businesses cut back, individuals spend less and contraction begins. Businesses reduce their labor force. Prices, labor costs, and interest rates come down as supply exceeds demand. The contraction continues until costs become so low that new investment and a new cycle of growth starts. Recessions driven by contraction in the financial sector take longer to recover from because access to capital is a key factor in our investment driven economy.

Democracy and Capitalism

The problem that capitalism presents for a Democracy is that these cycles of expansion and contraction in an unregulated market can be extreme. Expansions can turn into economic bubbles. Economic bubbles are highly speculative periods where expansion is being driven by trading activity rather than production or consumption. When these bubbles inevitably burst, as was the case in the housing bubble, many innocent people can find themselves out of a job for no fault of their own. There is also an understandable outrage that the unregulated and sometimes illegal activities of a few greedy speculators end up hurting the much larger number of hard working people who WERE playing by the rules.

The normal reaction in a democracy is that the injured demand that the government do a better job preventing the sorts of excesses that lead to these severe economic downturns. The New Deal is a perfect example of this trade off. In return for preserving the basic tenants of capitalism after it ran amok in the 1920’s, FDR promised workers a social safety net. He also created a set of banking and investment regulations that until the 2000’s effectively prevented speculative bubbles to grow to a size that would threaten the economy.

The Great Recession

The financial collapse of 2008 was the result of a deregulated financial industry that created a bubble in the mortgage market. Financial deregulation started with Reagan, but continued in every subsequent administration through Bush II.

The 2008 financial collapse was broad, deep, and terrifying. The expected response from those who lost their jobs and their homes would have been a populist uprising against the free market economy in general and the deregulated financial industry in particular. Those individual traders whose irresponsible actions caused banks to stop lending would also have been in the line of fire. If it had followed the arc of the Great Depression, there would have been universal agreement that the free market was not able to regulate itself. People would have looked to government to step in and make sure something like this never happened again. Even Alan Greenspan who famously ignored all of the warning signs of the impending collapse because of his belief in the self-regulating forces of the free market, had to apologize to the American people.

“Those of us who have looked to the self-interest of lending institutions to protect shareholders’ equity, myself included, are in a state of shocked disbelief,” he told the House Committee on Oversight and Government Reform.

“You had the authority to prevent irresponsible lending practices that led to the subprime mortgage crisis. You were advised to do so by many others,” said Representative Henry A. Waxman of California, chairman of the committee. “Do you feel that your ideology pushed you to make decisions that you wish you had not made?”

Mr. Greenspan conceded: “Yes, I’ve found a flaw. I don’t know how significant or permanent it is. But I’ve been very distressed by that fact.”

The populist outrage did occur. It began with the election of Barack Obama, but it got hijacked by movement conservatism and became the Tea Party.

The Wrong Villain

In the 2008 Presidential election, the Republican Party and the whole politics of free markets and deregulation were rejected by the voting public. The Republicans were famously the party that drove the economy into the ditch and had the temerity to ask for another turn behind the wheel. There were many who said that it would take decades for the party to earn back the trust of the voters. It was so bad that even the reliable Southern Strategy and wedge politics failed to prevent an African American liberal from Illinois from winning.

In the aftermath, the Republicans had a choice. They could move more to the center and remake themselves as a more moderate party, or they could double down on the methods that had worked so well for them in the past and become even more conservative.

They chose to double down on their old strategies. Minority leader Mitch McConnell said that his goal was to make Barack Obama a one term President. This appealed to his base on both racial and political terms.

Republicans thought they could use the government’s recovery legislation to accomplish that goal but they also needed someone to blame. They found the villain in all of those victims who lost their homes.

The famous Rick Santelli rant from the floor of the Chicago Board and Trade was the spark that lit this particular fire. He didn’t mention the mega-billion dollar entities that had conspired with government to rig the system in their favor at the expense of ordinary Americans. Instead the Santelli rant was directed against a (quite modest) government program to help distressed mortgage holders and against the so-called “losers” who couldn’t pay their mortgages. In Santelli’s self-serving logic, the traders on the floor who helped create this mess were the real victims.

This was a triumph of the old Big Tobacco PR tactic and the tried and true “Willie Horton” strategy. When your side is unpopular seek to redirect public ire toward other villains. Reagan’s fictitious welfare queens reappeared as poor black people who were sold “liar” loans.

Even though the TARP and other financial recovery methods were originally crafted by the Bush White House, Obama was held responsible because he implemented these policies in the first few months following his election.

Even though it was unscrupulous predatory mortgage lenders like Morgan Stanley who broke the law, lied to their customers, and recruited people who clearly could not afford mortgages with the promise of home ownership – conservative ire was redirected. It was focused squarely on greedy neighbors, buying too much house; or on the liberal state, which according to myth forced banks to hand out bad loans to poor people; or on society generally for tolerating debt at every level.

As Thomas Franks summarized:

The (conservative) movement succeeded by capturing completely the one part of the story that was very clear: the bank bailouts, which instantly eclipsed the financial crisis proper when they happened and which immediately got people out of their armchairs sputtering with rage. The bailouts were not confusing. They were very clearly the deed of the federal government, apparently being operated by cronies of Wall Street. It was a spectacle of almost unbelievable corruption, the kind of thing that crushes the faith of a nation. What the public craved at that moment was a form of idealism that would allow us to scream a convincing “no” at the whole thing, and the free-market people—spotting the opportunity like any good entrepreneur—immediately stepped in and delivered exactly such an idealism. (Because, in a pure free-market system, they said, government would never rescue or bail out anyone. The market would decide who prospered and who failed.)

It didn’t matter that the bailout strategy actually worked. The global financial market melt-down did not become a depression. Trust WAS restored relatively quickly. The insolvent institutions were merged with the remaining stable institutions. The domestic auto industry was saved. The restructured companies led the country back out of recession. Five years later the stock market is hitting record highs. The government has fully divested itself of the remaining GM stock. The net cost to the taxpayers was a remarkably low $60B. In comparison, Reagan’s S&L crisis which was significantly less damaging to the economy cost six times as much to clean up.

But it didn’t matter. The Tea Party rage over the financial bailouts spilled over into deep opposition to the Affordable Care Act and the debt that the country was piling up as a result of high unemployment, low taxes, two wars, and an unfunded expansion of Medicare.

It also didn’t matter that the real financial risk was the 3x GDP growth rate in the cost of healthcare. The Affordable Care Act was the only option on the table to reduce this rate of growth and as a result reduce our potential long term unfunded liabilities. The Tea Party viewed it as another irresponsible expansion of government even though it actually saved $109B in its first decade.

It also didn’t matter that this administration committed to ending the wars that were putting a huge strain on our military and on the budget.

The Tea Party was focused on the poor and big government as the villains of the financial meltdown. The fantasy of a utopian free market promised equity, justice, and prosperity for those who played by the rules. The fact that we weren’t seeing this utopia emerge was the fault of government. Worse yet, our exploding debt was at least in part due to the burden that the poor and unemployed were placing on the social safety net.

Tea Party Irony

What should have started out as a populist backlash to the failure of our decades-long experiment in free market deregulation was transformed into a protest movement demanding MORE of the free market that caused the problem and even LESS of the government that is the only solution.

Rather than complain that the government failed to keep the FDR’s promise to workers, this protest movement rejected whole premise. It wasn’t that the social contract the FDR made with the prosperous to support a social safety net wasn’t working. It was that the prosperous were able to convince those who benefited most from the social safety net, that it wasn’t fair to continue to expect the “winners” in our economy to pay for it.

Movement conservatism was able to convince small business owners that they were the backbone of a sort of free market populism instead of in a life and death struggle with larger and better funded competitors. In this conservative scenario, it’s the heroic small business person pitted against the parasitic elites who acquire their power through education or unfair government influence. It was the elites that were making it difficult for all businesses, large and small, to enjoy the fruits of their labors. The practical effects of this free-market idealism, however, is to bolster the power of big business. Big business is the real beneficiary of small business’s long war on organized labor and government regulation. It is big business that regularly feeds at the trough of government contracts, subsidies, and tax breaks that the rest of us including small business pay for. It is also big business that seeks to create monopolies which make it impossible for small business to compete.

The ultimate irony is that the Tea Party’s drive for fiscal responsibility has hurt the very people who support that movement. The states with the greatest concentration of Tea Party participation are the states that get the most money from federal programs. These are the states that have the highest numbers of people receiving Social Security and Medicare. These are the states with the largest amounts of people dependent on defense spending. These are the states that send the least amount of federal taxes to Washington and get the most amount of money coming back into their economies. These are the states where according to Thomas Frank, voters to struck a blow against elitism and received in return a social order in which wealth is more concentrated than ever before in our lifetimes, in which workers have been stripped of power and CEOs are rewarded in a manner beyond imagining.

The ultimate irony is that in the Tea Party’s eyes, CEO’s are the heroes and government is the villain. The reality is that the majority of the unprecedented growth in wealth that has occurred over the last 25 years has been in CEO pay. That pay came from a direct transfer of wealth from working people into CEO salaries combined with historically low taxes on the wealthiest people in this country. Those statistics are not an accident. This is the direct result of government policy. Government has in fact done exactly what the Tea Party has requested. It allowed the free market to operate without limit. That free market methodically suppressed middle class wage growth even though productivity, working hours, and profits hit all time highs. Under free market rules, CEO’s decided to keep all of those gains for themselves because they could.

Summary

The Tea Party is the construct of the same political operatives and tactics that gave us decades of tobacco company products that both those companies and the government knew were addictive and deadly. It is the same political operatives who promised from Reagan to Bush that showering tax breaks on the rich would result in economic gains for everyone else.

The Tea Party professes a deeply flawed looking-glass ideology that is ultimately the product of big business self-interest. That agenda is a continuation of the same unregulated free market capitalism that caused the Great Recession, unprecedented growth in wealth, and the largest income inequality in our history.

This agenda includes policies which have lead to an economy where only the very rich prosper, yet those supporting the Tea Party continue to insist that government is the problem.

Government is not the problem

Government is the solution. It is the only power left in this economy to oppose the influence of corporations and the wealthy. You don’t get to vote for how a corporation operates. Yet the agenda of the Tea Party trusts these corporations more than the only organization that they CAN influence – our government.

They portray government as the big evil, when in fact, government is us. It is teachers, first responders, and any number of middle class people trying to do the best job that they can. None of those who make up our government even come close to the 100 million dollar salaries of our top CEO’s.

Instead the Tea Party has allowed themselves to be manipulated by the same forces which caused government to relax regulations and implement a policy of allowing the free market to govern itself.

The ultimate irony is that Karl Rove, who helped create the Tea Party, no longer has use for them. While libertarian Koch money continues to support Tea Party causes, Tea Party shutdown and default tactics have terrified business leaders. As a result, Rove’s Crossroads fundraising juggernaut has announced that they will support moderate Republican candidates to oppose Tea Party incumbents in the 2014 and 2016 elections. It appears that at least Republican business interests have found a new villain.

The uncomfortable truth is that, though Republicans had both the motive and the means to hijack the populist uprising caused by the 2008 financial meltdown, the Democrats deserve some credit for the birth of the Tea Party too. Next up, how the Democrats fumbled what should have been a golden moment to reassert the basic tenants of Democratic Populism. In other words, we have met the enemy and he is us.

John Birch, Big Tobacco, Young Republicans and the Birth of the Tea Party

Wednesday, November 27th, 2013

The John Birch Society

The John Birch Society was founded in 1958 in Indianapolis, IN. One of the founding members was Fred Koch, founder of Koch Industries and father of David and Charles Koch. The Birch Society was viewed as a radical right wing organization because it espoused fundamental changes in government, eliminating institutions that they felt threatened their values or economic interests, and prosecution of those people who disagreed with them.

They opposed civil rights movement and subsequent legislation calling it communist. They opposed the United Nations calling it “one world government”. They opposed immigration reform and all free trade agreements. They accused both Eisenhower and Kennedy of being communist agents. They espoused a particular form of “frontier mentality” which incubated a virulent strain of reactionary thought.

Now, fifty years later, the Koch brothers are still the major funders of conservative and libertarian political movements including the Tea Party. The difference is that these organizations, who continue to advocate for smaller government, elimination of civil rights legislation, opposition to the UN, opposition to immigration reform, elimination of free trade agreements, and support of an unregulated free market; are now regarded as part of the mainstream political fabric. When they call a democratically elected President a socialist, a fascist (not sure how you can be both), or an illegal alien; it’s now accepted as part of normal political discourse.

What happened?

Big Tobacco

One of the lobbying strategies of the Big Tobacco in the 70’s was to assert that big corporations should have more political power. This strategy is reflected in the “market fundamentalism” that is one of the major pillars of Tea Party philosophy – unfettered capitalism is the best economic philosophy. This libertarian philosophy was embraced by Big Tobacco in an effort to prevent the sort of regulations that eventually limited their right to promote an addictive drug that kills people. One of the groups supporting this position and the Tobacco industry was Citizens for a Sound Economy founded by the Koch brothers in 1984. The primary funders of the Tea Party include FreedomWorks which is a spin-off of Citizens for a Sound Economy and Americans for Prosperity founded by David Koch.

Young Republicans

Karl Rove rose to fame in the Republican Party because of his reputation as a master of dirty tricks. Among other things his campaign for chairman of the College Republicans is legendary. It was during this period of time that he because friends with both the Bush family and Lee Atwater. Lee Atwater was an expert in the Southern Strategy that was the bulwark of successful national Republican campaigns starting with Nixon. That strategy was in stark display in the 1988 Bush election when Atwater said he would defeat Dukakis by making “Willie Horton his running mate”. Late is life, Atwater apologized and asked forgiveness.

In 1991 Rove began to work for Big Tobacco. In that role, he spearheaded a tort reform movement to weaken the ability for states attorney generals to litigate against the Tobacco industry. It was these legal cases that eventually brought down Big Tobacco. Rove’s activities included setting up state chapters of a tobacco industry funded astroturfing organization called Citizens Against Lawsuit Abuse. The Texas chapter of this group under the direction of Tom Delay was particularly effective in getting conservative judges elected and ultimately pushing through the gerrymandering that supported the 2010 Republican Congressional landslide.

The CALA blueprint honed in Texas included running TV and radio ads warning that the legal system was out of control, affecting the economy and the pocketbooks of average people. This blue print included generous funding from the Texas Chamber of Commerce and corporations seeking protection from consumer law suits. The Chamber of Commerce was running ads supporting Big Tobacco as late as 2002. This followed classic Tobacco Industry public relations rules – When your side is unpopular, as the tobacco industry is, seek to redirect public ire toward other villains – in this case, trial lawyers, taxes and big government. When the words “trial lawyers” are spoken in a spot aired by the U.S. Chamber of Commerce, the screen shows a black stretch limousine passing by the Capitol.

Finally Rove was also credited as the architect of the wedge politics that propelled George W. Bush into the White House. Thomas Frank, author of What’s the Matter with Kansas, summarized those politics.

Vote to stop abortion; receive a rollback in capital gains taxes. Vote to make our country strong again; receive deindustrialization. Vote to screw those politically correct college professors; receive electricity deregulation. Vote to get government off our backs; receive conglomeration and monopoly everywhere from media to meatpacking. Vote to stand tall against terrorists; receive Social Security privatization. Vote to strike a blow against elitism; receive a social order in which wealth is more concentrated than ever before in our lifetimes, in which workers have been stripped of power and CEOs are rewarded in a manner beyond imagining.

It was this policy of “deceive, divide, and conquer” that also sowed the seeds which later grew into the Tea Party.

Summary

The Tea Party and to a large degree the dysfunctional politics that the Tea Party represents were a long time coming.

It started with Big Tobacco’s desperate attempt to save themselves from the inevitable outcome of selling an addictive drug that kills people. They developed many of the political techniques now in common use particularly by movement conservatism. Those include Partners in Crime, Astroturfing, Junk Science, and Lobbying.

Radical conservatism in the form of the John Birch Society eventually joined forces with the Tobacco Industry. The common interest here was a particularly twisted form of libertarianism called free market capitalism. This appealed to the Tobacco Industry because they wanted to be able to continue to sell their products even though they were addictive and deadly. The libertarian capitalists liked the money that the Big Tobacco brought with them. They and organizations like the Chamber of Commerce were happy to make a deal with Big Tobacco if it meant advancing their own cause of smaller government and fewer regulations.

The Koch family has been underwriting libertarian and conservative causes for two generations. They are really the invisible hand manipulating this whole political movement. Fred Koch was a founding member of the John Birch Society. David and Charles Koch have become the bankers of the Tea Party movement, major funders of the movement to oppose climate science, and promoters of libertarian free market philosophy. Their fortune is closely tied to the fossil fuel industry.

Karl Rove became the chief apparatchik of this new philosophy of politics. He refined the political use of the tools that Big Tobacco created. He added Lee Atwater’s racial politics and expanded it with social issues which appealed to the evangelical right. He wrapped it all up in the flag and the Bible (even though he himself is an admitted agnostic) and used it to win two national elections for George W. Bush. In response to Obama’s election in 2008, Rove went to work for Fox News and helped start the astroturfing opposition movement that later grew into the Tea Party.

Next up, we’ll try to connect the dots to show how these historical forces have twisted an otherwise completely predictable populist uprising into what has become radical conservatism and the Tea Party.

Big Lies and Big Tobacco

Saturday, November 23rd, 2013

I am a big believer in democracy. What often baffles me though, is why we go through periods of time when a large number of people believe things that aren’t true.

I can appreciate how people might have believed that the world was flat, because until people were able to sail around it, astronomers where the only people with personal experience to dispute what the senses told us. Very few people could actually read and fewer still had access to a telescope.

But science and the personal experiences of sailors soon convinced everyone else that the world was in fact round and orbited around the sun. Those who continued to dispute that fact were ridiculed.

That’s not the case today. Information is widely available. Most people, at least in this country can read. And most people in this country get a basic education that includes mathematics and science. Yet we seem to be living in age when facts are optional and science is relative.

What happened?

I believe that it has a lot to do with politics and in particular the strategy called the Big Lie.

John Boehner’s quote about the US health system being the best in the world is an example of the Big Lie. It works because those who already agree with his position that Obamacare is ruining the country will accept also accept this lie without question. It also works for those who inherently fear change, because Obamacare is all about change. Finally it works because those who stand to lose money or power as Obamacare rolls out are happy to support the claim that the current system is a better choice.

It didn’t use to be this way though. In the 50’s when the John Birch Society claimed that Eisenhower was a communist agent, the vast majority of the country just laughed. Now when the Tea Party (direct decedents of the Birchers) claimed that Barack Obama was born in Kenya – almost half the Republican Party agreed with them.

This is going to take a couple of posts to work through, but I think the train started to jump the track, in terms of these Big Lies, when tobacco companies realized two things – their products were killing people and if voters found out, they were out of business.

Background

Excerpts from a Stanford study by historian Robert Proctor

Cigarettes are “the deadliest artifact in the history of civilization” – more than bullets, more than atom bombs, more than traffic accidents or wars or heroin addiction combined. They are also among “the most carefully and most craftily devised small objects on the planet.”

“The industry has spent tens of billions designing cigarettes since the 1940s – that’s from the industry’s own documents,” he said.

The cigarette represents the perfect business model. “It costs a penny to make. Sell it for a dollar. It’s addictive,” says investment guru Warren Buffett. Proctor notes that “by artfully crafting its physical character and chemistry, industry scientists have managed to create an optimally addictive drug delivery device, one that virtually sells itself.”

Operation Berkshire

In 1977 the CEO’s of all of the major tobacco companies met in secret in the UK to “develop a defensive smoking and health strategy, to avoid our countries and/or companies being picked off one by one, with a resultant domino effect.” They created a front organization first called International Committee on Smoking Issues (ICOSI) (renamed the International Tobacco Information Centre, INFOTAB, in 1981), to prevent efforts to reduce smoking. That included not only identifying opposition, but promoting research supporting their position, and rebutting the claims of research opposing their position. This organization, code named Operation Berkshire, continued to operate in secret for twenty years. In 1998 as part of a Master Settlement Agreement between tobacco companies and states attorney generals the activities of this organization came to light.

The plan formed when major tobacco companies met together to form a unified defense against anti-smoking legislation. They agreed that they would not voluntarily make certain concessions about smoking and, if legislation was passed to force them, they would agree to sue. In particular, they decided that they would not concede the point that smoking has adverse health effects and would instead attempt to create controversy, lest they be held legally liable for the deaths of smokers. They also formulated coordinated activities to promote the social acceptability of smoking.

Similar behavior was demonstrated by the top seven biggest U.S. tobacco company CEOs, dubbed the “seven dwarfs”, testifying together before the U.S. Congress during a hearing on the regulation of tobacco products on April 14, 1994, in which they collectively denied, under oath, the addictive nature of nicotine, despite at least one published New York Times report at the time claiming that it has the ability to be more addictive than heroin, cocaine or amphetamines.

Here are some of the strategies described in the documents shared with the courts.

Partners in Crime

Co-operation between the manufacturers of tobacco and candy cigarettes to effectively promote smoking in children is described by Klein and St Clair. They show that some tobacco companies granted confectioners permission to use cigarette pack designs, tolerated trademark infringement and suppressed research showing the potentially harmful effects of candy cigarettes in promoting smoking to children.

Astroturfing

This is the process of creating fake grass roots organizations to suggest that a particular political position has strong support among the people.

As health advocates began winning legislation to raise taxes and increase regulation of smoking in the US, Philip Morris, Burson-Marsteller and other tobacco interests created the National Smokers Alliance (NSA) in 1993. The NSA and other tobacco interests initiated an aggressive public relations campaign from 1994 to 1999 in an effort to exaggerate the appearance of grassroots support for smoker’s rights. According to an article in the Journal of Health Communication, the NSA had mixed success at defeating bills that were damaging revenues of tobacco interests.

Junk Science

A small group of retired cold-war libertarian nuclear physicists pioneered the political use of junk science. They developed their techniques in defense Reagan’s seriously looney Strategic Defense Initiative. Their techniques included demanding equal air-time in the media every time a mainstream physicist or engineer criticized SDI. They also published fear mongering articles in conservative publications suggesting that within 5 years the US would suffer an ICBM nuclear attack. As a result of their success, several including Fredrick Seitz were hired by RJ Reynolds. They perfected their doubt-mongering strategy defending smoking. They insisted that the science was unsettled and therefore that it was always premature for the US government to act to control tobacco use.

As one tobacco company memo noted: “Doubt is our product since it is the best means of competing with the “body of fact” that exists in the mind of the general public. It is also the means of establishing a controversy.”

Lobbying

“My own view is that in many ways, the tobacco industry invented the kind of special-interest lobbying that has become so characteristic of the late 20th- and earlier 21st-century American politics,” said Allan Brandt, dean of Harvard’s Graduate School of Arts and Sciences.

Tobacco companies not only spent boatloads of money supporting politicians. They also sponsored game shows, cartoons, and sports. They hired celebrities, dentists, and doctors to endorse their products.

Altria (Phillip Morris) has spent more money since 1998 lobbying Congress than any other single business. In 1998 the Tobacco industry spent $125M lobbying for the defeat of the McCain Tobacco Control Bill.

Conclusion

The result of this campaign is that the rate of smoking in the US did not start to decline until 1985. It was as high as 45% in 1955. It is now at 19%. 2011 was the first time a majority of people supported banning smoking in public places.

In 2013, tobacco is still the leading cause of preventable death in this country. Tobacco kills more people than AIDS, Alcohol, car accidents, illegal drugs, murders and suicides combines. The 400,000 people who die and the 8.6M more who are ill cost the US $96B in healthcare costs and $97B in lost productivity.

But the tobacco industry was able to continue to produce and sell its products for decades AFTER the Surgeon General’s first report that smoking caused disease. Millions of people died. Several Trillion dollars were spent caring for those whom these companies killed. And they are still killing people today even though, at least in this country, their activities are severely limited.

That’s how effective their strategies have been.

These strategies are part of the reason why the Tea Party and movement conservatism exists today.

Next up, how some of those who learned these skills working for Big Tobacco, used them on behalf of the conservative political movement.

Big Republican Lie: The Best Health Care Delivery System in the World

Friday, November 15th, 2013

When the Son of man shall come in his glory, and all the holy angels with him, then shall he sit upon the throne of his glory: And before him shall be gathered all nations: and he shall separate them one from another, as a shepherd divideth his sheep from the goats: And he shall set the sheep on his right hand, but the goats on the left. Matt 25:31-33

Republicans have been trying to focus a lot of attention on President Obama’s promise to the American people. That promise was that under the Affordable Care Act, if you liked your current insurance you could keep it.

What has been lost in this conversation, however, are the bigger lies that Republicans have been telling since they decided to “bet the farm” on repealing this law.

It is true that healthcare.gov has problems.

It is also true that as many as 5M people who purchase their insurance on the open market may have received cancelation notices from their insurance provider because their plans were not compliant with the minimum requirements under the ACA.

Both of those things can be fixed. But Republicans don’t want to fix Obamacare. They want to repeal it. The reason they want to repeal it is because weakens their POLITICAL position. If it DOES ultimately deliver healthcare coverage to 20M people who can’t currently afford to purchase insurance on their own, those people will punish any future candidate or party who proposes to take it away.

Republicans also don’t want to offer an alternative BECAUSE they also know that it will NOT compare well to what already exists with Obamacare. The last time they tried in 2009, their alternative proposal covered 17M FEWER people and cost $36B more.

Instead, in order to leverage their political position that Obamacare should be repealed, they ALSO have to argue that the current healthcare system is just fine. That way they can also claim that Obamacare is making things worse, rather than making them better.

This argument has two added benefits. It appeals to those who fear change. They get to hear Republicans tell them that this particular change is unnecessary. And it appeals to those who make more money under the current system than they would under the new system. Their motivations are obvious.

So that’s why John Boehner, criticizing Obamacare, said yesterday, “This is going to destroy the best health care delivery system in the world,”

This is a BIG LIE. Easily on the same scale of “If you like your insurance you can keep it”.

Here’s why.

We DON’T have the best healthcare delivery system in world. Not even close.

What we DO have is the most EXPENSIVE and INEFFICIENT healthcare delivery system in the world.

Here is the proof with excerpts from NBC News.

Two studies out this week — and studies going back 15 years or longer — show quite the opposite. Americans pay more per capita for health care than people in any other industrialized country. In return, we are sicker, die younger and are unhappier with the system.

According to the Commonwealth Fund Study, healthcare costs $8,508 a head in the US, compared to $5,669 per person in Norway and $5,643 in Switzerland, the next-highest-spending countries. New Zealanders spend just $3,182 per person. If we were getting better outcomes than everyone else, perhaps you can justify it, but we aren’t. The U.S. has the eighth-lowest life expectancy in the Organization for Economic Co-operation and Development, which groups developed nations.

The reason is simple. Too few people have access to healthcare services, particularly the sorts of services that can prevent the onset of expensive chronic conditions like diabetes and heart disease.

Access

In the latest survey of more than 20,000 people from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, Britain and the U.S., Commonwealth researchers found that 37 percent of Americans went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared to as few as 4 percent to 6 percent in Britain and Sweden.

Cost

And 23 percent of U.S. adults either had serious problems paying medical bills or were unable to pay them, compared to fewer than 13 percent of adults in France and 6 percent or fewer in Britain, Sweden, and Norway, Commonwealth reported Wednesday in the journal Health Affairs.

The #1 cause of bankruptcies in this country (62%) is medical expenses. What’s worse, 78% of those filing for bankruptcy because of medical bills HAD some form of health insurance. In Europe the #1 cause of bankruptcy is living beyond your means or job loss.

Obamacare deals with the bankruptcy issue by putting annual and lifetime caps on medical expenses. This is one of several requirements that add cost to individual policies particularly for the young, healthy, and well off. But it also caps the premium cost to 8% of income, so those of more modest means can still afford to purchase insurance with some government help.

Satisfaction

75% of Americans polled said that our healthcare system needs fundamental changes or just rebuilt. Compare that to 50% or more of the Dutch, Swedes, and even Brits who are happy with their system.

Contrary to Republican claims, US patients wait longer to see a primary care physician than any other major industrialized country except Canada. That’s one of the reasons why we treat more people in our emergency rooms than any other country.

Waste

Even the U.S. Institute of Medicine says U.S. health care is a mess, with tens of thousands of Americans dying from medical errors and drug overdoses, and with the system wasting $750 billion in 2009.

Lifespan

While lifespans in all industrialized countries are increasing, US lifespans are not increasing as fast as European countries. Also there are huge regional differences in this country with poor Republican southern states lagging behind populous Democratic northern states.

Conclusion

This information is not new news to Republicans. They have described the growth in Medicare costs as a ticking time bomb. It’s ticking because until recently the cost of healthcare was growing at a rate 2-4 times GDP. Clearly that is unsustainable.

The Republican solution was to force seniors to pay more of the cost increase themselves. That is also unsustainable.

Obama’s solution is to restructure the way that healthcare is delivered in this country as a first step to bending the curve of healthcare cost. If we increase the number of people who can afford to visit their primary care physician where preventative care is practiced, we will reduce or at least delay the onset of chronic conditions like diabetes and heart disease which account for 80% of our costs. If we change the business model from transactions to outcomes, we have hope of physicians and their patients becoming aligned with the goal of better health rather than just treatment of disease. Finally, under Obamacare, the government is taking a more active role in regulating insurance companies. That has to expand to controlling costs particularly of pharmaceuticals.

And that’s the other basic problem. Restructuring 17% of the economy is going to create economic winners and losers. Those who feel that they are going to lose under the new system are pouring money into the campaign chests of Republicans. That money is being used to mount a cynical campaign of misinformation that easily rivals the worst of the tobacco industry.

Republicans know that the current system is unsustainable too. But they are more concerned with the precarious political position that they are in. They would prefer to preserve the current system that is bankrupting and ultimately killing innocent people, if that means that they can expand their political power.

There is a day of judgment coming though. Hopefully that day will come sooner rather than later. When it does, the goats will be separated from the sheep. The liars from the innocent. The punishment will be awesome, swift, and appropriate to the offense.

More Healthcare Myths

Thursday, November 14th, 2013

We already have a pretty good case for healthcare reform. Under our old employer-based insurance system, the cost to provide healthcare to those who need it was growing at two to three times the rate of GDP.

That’s clearly unsustainable.

So we are faced with a couple of choices.

Before we discuss those choices, let’s first look at what other countries around the world have chosen to do.

The vast majority provide some form of universal healthcare to whomever needs it whether they are citizens, immigrants, or tourists.

That clearly isn’t the only choice, but it is a choice that most of our global competitors have chosen and almost all of them have demonstrated that their versions of universal healthcare deliver better outcomes at lower costs than we do.

We are #1 in costs and % of GDP, but we are 35th or so in outcomes.

That’s because in part we have a lot of people who depend on care through the emergency room rather than primary or preventative care. Some have suggested that we just turn away those who can’t afford to pay for their own care. That opinion has deep ethical issues for a country so steeped in Christian values, but it isn’t a good economic or political solution either.

It’s not a good economic model because our growth depends on how effective we are at leveraging our basic assets which are capital, infrastructure, and people. If we commit to a path where only rich people are healthy, then we will have an economy where a significant portion of our consumers can only buy the bare necessities of life because they are too ill to either improve their skills or work at better paying jobs. We will, in effect, be trying to compete with other countries with one hand tied behind our back. That’s because their health systems allows a higher percentage of their population to be economically productive than we do.

It’s not a good model politically either. Building a permanent underclass that has a significantly compromised quality of life both in terms of income and health is going to have serious political repercussions in a country that calls itself a democracy. The ultimate political outcome of this model has been the grist for science fiction writers for decades.

Some have also suggested that our cost differential is because of an aging population, but that turns out not to be the case. The population across the world is aging, but our costs are growing much faster than any of our competitors. According to a recently released study most of the money in this country is being spent on people UNDER 65 with chronic conditions like diabetes and heart disease.

“In 2011, chronic illnesses account for 84 percent of costs overall among the entire population, not only of the elderly. Chronic illness among individuals younger than 65 years accounts for 67 percent of spending,” they found.

“Price of professional services, drugs and devices, and administrative costs, not demand for services or aging of the population, produced 91 percent of cost increases since 2000.”

When you dig into the numbers of what is really driving cost in the healthcare system today, another dramatic reality emerges.

The reason healthcare is so expensive in this country is because we are one of the few industrialized countries that treat it as a business rather than a service. The result is that our prices for comparable services are the highest here because there is no effective economic counter to the basic capitalistic drive to maximize profit.

“Other countries negotiate very aggressively with the providers and set rates that are much lower than we do,” Anderson says. They do this in one of two ways. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they’re set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.

In America, Medicare and Medicaid negotiate prices on behalf of their tens of millions of members and, not coincidentally, purchase care at a substantial markdown from the commercial average. But outside that, it’s a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured.

and

Moses points to a very big culprit – the standard fee-for-service system that encourages doctors and other caregivers to give lots of tests, individual treatments and to prescribe drugs, instead of keeping patients well. It’s not a new idea, but Moses says his team’s study shows it very clearly.

“This is a very myopic country,” he said. “There are lessons to be learned from other countries. Chronic illness is where the misery is, it is where the money is and it is where the greatest opportunity lies.”

Some have suggested that we are the innovation engine for the rest of the world and if our business model changes, that innovation will cease. Well that’s not exactly true either. Most of that money is just pure profit.

Many researchers are skeptical that this is an effective way to fund medical innovation. “We pay twice as much for brand-name drugs as most other industrialized countries,” Anderson says. “But the drug companies spend only 12 percent of their revenues on innovation. So yes, some of that money goes to innovation, but only 12 percent of it.”

What’s the solution?

Universal healthcare so that everyone has access to preventative care which can prevent the onset of the chronic conditions which drive most of the cost in this country.

A change in the business model where physicians are compensated for outcomes rather than transactions. That will provide significant financial incentives for both patients and physicians to make the sort of lifestyle changes required to prevent the onset of diabetes and heart disease.

Greater awareness of the real costs of care by those who are paying for them. It is possible that consumerism might help drive costs down, but it is likely going to be greater government involvement that will ultimately be required to bring our costs for comparable services in line with the rest of the world. That’s because the medical industry represents a huge lobby and they are not going to willingly live with lower profits. You don’t have to look any further than the Medicare Prescription Drug program where Congress expressly prohibited Medicare from negotiating lower prices.

As just one example, the health insurance lobby secretly funneled over $100M to the Chamber of Commerce to oppose the Affordable Care Act while they simultaneously were trying to cut the best deal they could with the White House on how the marketplace would be structured.

The consequences of inaction are not just felt by those who are sick. It affects everyone.

“There are opportunity costs,” says Reinhardt, an economist at Princeton. “The money we spend on health care is money we don’t spend educating our children, or investing in infrastructure, scientific research and defense spending. So if what this means is we ultimately have overmedicalized, poorly educated Americans competing with China, that’s not a very good investment.”

When Russia beat us to space with Sputnik, it was a wake-up call for the country. We invested in education, funding research, and promoting technology. The result was ultimately the growth of a whole new industry that revolutionized the world. We are facing a similar crisis today. The only difference is that we are talking about human capital rather than technology. Unfortunately we don’t appear to have to the same political will that we did 60 years ago to confront that issue and agree on a path forward. There is at least one reason that might not be obvious. I’ll cover that in a future post.

Obamacare Facts

Tuesday, November 5th, 2013

We need healthcare reform. Our employer-based system failed to manage costs or improve health. Cuba gets better results and spends far less than us.

Republicans proposed a healthcare marketplace in 1989. Romney successfully implemented it in 2006. Now 95% have coverage in Massachusetts.

Obamacare will REDUCE the deficit by $109B over the next decade. The best Republican alternative cost $36B more and covered 17M fewer people.

Most of us (149M) get employer-based health insurance. Because of Obmacare, your paperwork is simpler. Your policy now includes pre-existing conditions, kids up to age 26, free preventative care, smoking and alcohol cessation, birth control, and maternity care. There’s even an appeal process for denied claims.

70% of all health issues are preventable. More preventative services = better health

Employee payroll deductions are projected to go up 9.5% this year because of an improving economy – not Obamacare. As incomes improve, those who put off going to the doctor last year, ARE going this year. That drives up cost. The same dynamic that resulted in a 5% increase last year, is what is driving higher employee costs this year. Those costs will likely return to the 8% average next year. Any double-digit increases that individuals see are from employers shifting more cost to employees. As Obamacare cost containment and reductions in emergency room visits take hold, we should finally start to see the growth rate in healthcare costs come down. That should translate into slower growth in the rate of employee cost increases.

Seniors covered by Medicare will see no change. The 28% who purchase Medicare Advantage plans may see some changes as federal subsidies come in line with standard Medicare cost increases.

12M people buy their own insurance. These plans also must meet minimum coverage standards designed to reduce emergency room visits. Compliant plans may cost more, but subsidies will provide most people with better coverage at a lower cost.

The 20M uninsured will get subsidies to cover their costs. Access to primary preventative care will reduce the burdens on our hospitals and businesses and improve overall health.

96% of small businesses are exempt. 90% of all other businesses already provide insurance. The 3% who choose not to provide insurance will pay a penalty in 2015.

While healthcare.gov had rollout problems, it’s now fast and easy to browse prices. Try it yourself. Buying should be just as easy by December.

The CBO predicts 7M will sign up by the March deadline. Consumer subsidies, a reinsurance pool, and risk corridors built into the plan will prevent the death spiral Republicans hope for.

The first leg of the argument that Republicans are now making for a collapse of the healthcare exchanges is around rates. The claim is that insufficient participation of healthy people will drive the rates for everyone else up. That will drive more people out of the exchanges and ultimately they will collapse when no one can afford insurance. Consumer subsidies are going to protect those who buy through the exchanges from rate swings even if participation doesn’t follow the current predicted model. Those subsidies bring down the cost to purchase insurance to a particular percentage of income regardless of the actual costs for the insurance. While this could become a burden for tax payers, the government has built a structure to protect consumers from rate swings that would damage the marketplace.

The second part of the argument is that insurance companies will be saddled with a bunch of expensive customers that they otherwise wouldn’t insure. So they will drive the rates up or worse yet, just exit the marketplace reducing the competition that supposed to keep rates low. The government addresses this issue to with a reinsurance program. That program is funded by a tax on every insurance policy sold in the country. This tax provides the government funds that they can inject into the insurance markets to protect insurance companies from loss if the mix of sick and healthy people threatens to drive up rates.

The last part of the argument is that insurance companies will choose to sit out the first couple of years of the marketplace just because there is no track record that they can use to predict what their costs are going to be. The law addresses this too. The government has entered into a risk sharing agreement with all those companies that are participating in the marketplaces. In that risk sharing agreement, if the risks end up being less than government forecasts, insurance companies pay a portion of their gain into the pool. If in any particular year the risks are higher than forecast, the pool pays the insurance companies.

The whole purpose of these various parts of Obamacare is to minimize the risks and the volatility of the marketplaces as they get up to speed. Clearly the government has created sufficient incentives and protections to attract enough insurance companies to make it work. The same people who designed and implemented the Massachusetts marketplace, helped design and plan Obamacare.

By Election Day a year from now, voters will have an opportunity to hold Republicans accountable for their obsessive opposition to healthcare reform. That includes those who, in an attempt to defund Obamacare, voted twice to close the government and force the country into default. Cuccinelli’s defeat in Virginia and the victory of Chamber of Commerce based Bradley Byrne over the classic Tea Party birther Dean Young are harbingers of a national repudiation of Tea Party philosophy and tactics.

A new report by the Kaiser Family foundation supports this view. That study finds that almost 17M of the 29M people eligible to purchase insurance through the marketplaces will be eligible for tax credits. As a result, many people will discover that their net costs to purchase insurance will go down. Combine this with those covered by expansions in Medicare, and you have a lot of people whose personal experience will be at odds with the current Republican narrative.

That narrative, at its core, suggests that we scrap Obamacare and return to the current system of employer-based care. The problem is people like the current system even less than Obamacare. If Obamacare DOES deliver the projected individual savings, those who have been struggling to obtain or afford insurance under the old system are not going to vote for return to that system. If millions of people do discover that Obamacare DOES lower their net costs, Republicans will lose a lot of credibility and find it very difficult to run on this issue.

The question every Democrat is waiting to ask a Republican incumbent in the fall is, “Tell me again why you voted to close down the government and threatened to throw the country into default?”