Sunday, March 07, 2010

Emphasis Yours, Charles Krauthammer

Let's start with his title:

Onward with Obamacare, regardless

Of all the rhetorical gambits from our yearlong health care debate, none is more absurd than the phrase "Obamacare.” The president let Health Care Reform (HCR) sprout on Capital Hill; he didn’t torpedo it down Pennsylvania Avenue like Bill Clinton. Each committee in Congress got to shape the bill on its own while Obama announced deadlines, met with interest groups, mediated debates, held summits, and gave speeches of general advocacy. This makes him the foreman, not the architect, of the project.

By contrast, “Clintoncare” would have been a perfectly fair nickname for the disastrous 1993 HCR bill, but that doesn’t roll off the forked tongue as easily as the assonant iambs of “Obama.” Tactically, the phrase "Obamacare" accomplishes little because most people happen to like the man and most that don’t won’t go in for health care reform anyway. So “Obamacare” scares people already scared by Obama and tries to hide the history of HCR 2010 from the rest of us. Clever.

Syndicated sociopath and retired Dr. Seuss goblin Charles Krauthammer knows a good rhetorical trick when he smells one ...

... and he has a natural flair for compressing a sheaf of memes into one slick screed, so this post gives me a wonderful chance to hit a dozen lies in one shot.

His signature recipe is the Fact Casserole: he packs toxic ingredients under a slimy layer of cheese so the reader-eater never knows what caused the dysentery. If you complain that his argument tastes of cork, urine, haggis and lawn mulch, he will quickly reply, "What do you mean? It has fiber, protein, water, and leafy greens. Four essential nutrients in one dish! Shut the fuck up and eat your casserole.”

So let's plunge a rusty fork into his latest serving:

Among the few Republican suggestions President Obama pretended to incorporate was tort reform. What did he suggest to address the plague of defensive medicine that a Massachusetts Medical Society study showed leads to about 25 percent of doctor referrals, tests and procedures being done for no medical reason? A few ridiculously insignificant demonstration projects amounting to one-half of one-hundredth of 1 percent of the cost of his health-care bill.

Delicious! I love how those cascading clauses and nested prepositions work like a semantic laxative so his argument can glide swiftly down the page and achieve some force of persuasion through sheer inertia, if nothing else. Krauthammer does with speed what Rush Limbaugh does with volume (and VOLUME!). Both men hope you can't remember what was said or written three thoughts prior.

What did he suggest to address the plague of defensive medicine ...?

First, let's celebrate because the "plague” of defensive medicine happens to be one disease for which the 31 million uninsured possess a natural immunity. So this epidemic has been quarantined to the shrinking ranks of people who can afford to stay in the pool.

… a Massachusetts Medical Society study showed leads to about 25 percent of doctor referrals, tests, and medical procedures being done for no medical reason?

Let’s assume the Massachusetts Medical Society is really awesome. Let’s also assume you didn’t click through to read the actual study, which is not so much a study as it is a survey asking doctors to recall how often fear of litigation motivated them to order extra tests and procedures last year. An actual study would follow through to match specific "defensive" items with their final outcomes to see if there really was a valid medical reason after all.

about 25 percent of doctor referrals, tests, and medical procedures

Yes, that comma cluster bomb ("referrals, tests, and medical procedures") includes three of the categories explored in the MMS survey. But if you take the total snapshot, including hospital visits, you get an average of 13%. So Chuck doesn't need to consult a real study to make his case; he's content to fudge the figures of the one he happens to like.

"Defensive medicine" zooms in on one aspect of our massive health care economy, but it does not explain the exponential rise in the cost of the procedures themselves. Americans haven't become exponentially litigious over the years nor have malpractice settlements raised exponentially in cost. 100,000 people die each year from preventable medical errors in the US, of which 4% ever result in litigation. If anything, Americans are less litigious than they could be. Frivolous lawsuits comprise 10% of all malpractice cases and American juries have been consistently good at rejecting them.

Finally, the combined cost of malpractice insurance, litigation, and settlement comes to about 1% of the total health care economy, so capping settlements and restricting litigation will directly affect only a tiny slice of the pie. It bears repeating that this slice isn't getting proportionately bigger. And it simply does not follow that such hairsplitting reform would rein in defensive practices because doctors happen to have a positive incentive to be overcautious that has nothing to do with fear: they get paid for each extra pill and procedure they authorize.

But now that Chucky’s tapeworm of a question has been extracted, how does he answer it? What, exactly, did Obama suggest and what is in the current bill?

A few ridiculously insignificant demonstration projects amounting to one-half of one-hundredth of 1 percent of the cost of his health-care bill.

Again, let’s celebrate that the “ridiculously insignificant” comprises a ridiculously insignificant portion of the cost.

Man, this casserole is terrible. And such small portions.

So Chucky puts his cherry-picked 25 percent MMS figure side by side with the price of the stuff in the bill that would investigate tort reform (.005 percent) and he uses another mouthy sentence to highlight the contrast. The implication being: defensive medicine costs 25% so why does HCR devote only .005% of its budget to fixing that?

Well, you don't need Ezra Klein to tell you that tort reform is a matter of law, not resources. Which is why that reform has its place in the present legislation, just not the price tag. Comparing the two doesn't make any sense. It's like using a word count to prove that Cordelia isn't all that important to the plot of King Lear. "Well if she's so important, where are all her lines?! Clearly Oswald is the pivotal role, as evidenced by this chart." Something tells me George F. Will has already written that somewhere.

The preponderance of the bill is devoted to expanding coverage through subsidies to participate in the private market and other rules that simply outlaw inhuman health discrimination (e.g. pre-existing conditions). Funny enough, this bill resembles a roadmap to health reform outlined by Chuck last summer, but now that it’s actually here, his advocacy has vanished. Maybe it was all a brilliant trap. Or maybe Chuck is about as trustworthy on this issue as Joe Lieberman – the man who favored expanding Medicare until he found out other people were, too.

Chuck goes on to rebut an argument Obama has made several times: that people oppose the whole bill, but everyone likes the individual components, so what gives?

Allow me to demystify. Imagine a bill granting every American a free federally delivered ice cream every Sunday morning. Provision 2: steak on Monday, also home delivered. Provision 3: a dozen red roses every Tuesday. You get the idea. Would each individual provision be popular in the polls? Of course.

Well ... no. But this is just a cute analogy, right? He's not really comparing insulin shots to ice cream or cancer screening to steak, is he?

However (life is a vale of howevers) suppose these provisions were bundled into a bill that also spelled out how the goodies are to be paid for and managed -- say, half a trillion dollars in new taxes, half a trillion in Medicare cuts (cuts not to keep Medicare solvent but to pay for the ice cream, steak and flowers), 118 new boards and commissions to administer the bounty-giving, and government regulation dictating, for example, how your steak is to be cooked. How do you think this would poll?

Holy fuck, it's not an analogy. He’s serious. $500 billion for ice cream and steak? Cut Medicare to buy cut flowers? You're going to tell me how to cook my free steak that's not really free and that killed my grandma because she couldn't get Medicare so she ran out of Lipitor which she needs because of all the steak you gave her for free each Monday?

I don’t feel demystified at all; I feel like my brain is going to puke.

What is he really saying except that people want things but don’t want to pay for them? Does that make people stupid or Obama stupid for reminding people why they voted for him? Again, his sprint to create a glossy metaphor burns precious calories he desperately needs to form a coherent thought. He seems happy that people are opposed to HCR, but apparently people are too stupid to know why they oppose it? People like what the bill does, just not what the bill costs?

I'm not sure either is true. But I wouldn't know because Chuck doesn't even bother to follow his own metaphorical setup to a metaphorical conclusion. He just sorta lets it collapse, saying, in effect, "Want some free steak? PSYCH! Your grandma's dead!"

So let me try. Ahem:

Imagine a system where you get to choose someone to go to Washington. This special person will write laws and distribute money to provide for the general welfare so you don't have to. If you don't like how this person behaved on your behalf, you could fire them. Would this be popular? Of course.

Now imagine a system where every flippin' jackass in the country gets to do the same thing you just did above. Turns out your special person has to work with 534 other special people who all think they're special and want different special things. They never agree. And you rarely get what you want from them. Would this be popular?

Everyone hates Congress, but Congress has an 90% incumbency rate -- please explain that with a culinary metaphor, Chuck. You can’t call a national plebiscite just because the polls gave you a flattering snapshot yesterday. Oh, hell, let’s try it anyway! If for no other reason than to hear what revolting metaphor Chuck will serve up to explain why the persistently popular public option cannot be trusted to the public.

He ends with a swipe at reconciliation:

The man who vowed to undo Washington's devious and wicked ways has directed the Congress to ram Obamacare through, by one vote if necessary, under the parliamentary device of "budget reconciliation." The man who ran as a post-partisan is determined to remake a sixth of the U.S. economy despite the absence of support from a single Republican in either house, the first time anything of this size and scope has been enacted by pure party-line vote.

Hasn't someone told him HCR already passed both chambers of Congress? I'm pretty sure Fox and the National Review covered that. But heck, that was months ago. If he doesn't remember that, he probably doesn't remember that George W. Bush used budget reconciliation to give $1 trillion to rich people in 2001. President Obama wants to use reconciliation to give $1 trillion to the rest of us now. Wherever did he get the nerve? Did Obama win some sort of contest last year? Some contest that Bush didn't exactly have under his belt when he "rammed through" his first year spending spree?

Okay, so Chuck can't remember what happened nine years ago or three months ago. Does he at least remember what happened three weeks ago -- when he defended the filibuster because it was making things difficult for the president? “The system worked,” he wrote. “Barack Obama's two signature initiatives -- cap-and-trade and health-care reform -- lie in ruins.” But now that Obama has instructed Pelosi and Reid to wrap things up using the same system that worked so well three weeks ago (and three months ago, and nine years ago), Chuck accuses him of “ram[ming] through Obamacare” using a "device” that smacks of the “devious and wicked” ways of the past.

I give up. I know politicians have to pretend they're always right, but Krauthammer is a clever man, repeatedly cited as the lone intellectual voice in the American Right. If he doesn't do better, he should at least know better. His tantrums are embarrassing, transparent abuses of language and thought. His problem with Obama exceeds any political, intellectual, or emotional coordinates I can discern. His fixation on Obama borders on the pathological. And his prose disintegrates when you try to honor him by thinking about it. Speaking of ...

"Budget reconciliation" is exactly what it sounds like -- a process of balancing the budget differences between the Senate and the House. It limits what can be changed at this late stage, but that's the point. Chucky seems to think it entitles him to obliterate the whole thing and that anything less is an affront to civilization.

"Ram it through?" No, the bill has passed. It’s just time to take it out of the oven.